Sample records for canadian pediatric emergency

  1. Pediatric fractures – an educational needs assessment of Canadian pediatric emergency medicine residents

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    Dixon AC


    Full Text Available Andrew C Dixon Department of Pediatrics, University of Alberta, Edmonton, AB, Canada Objectives: To determine the gaps in knowledge of Canadian pediatric emergency medicine residents with regards to acute fracture identification and management. Due to their predominantly medical prior training, fractures may be an area of weakness requiring a specific curriculum to meet their needs. Methods: A questionnaire was developed examining comfort level and performance on knowledge based questions of trainees in the following areas: interpreting musculoskeletal X-rays; independently managing pediatric fractures, physical examination techniques, applied knowledge of fracture management, and normal development of the bony anatomy. Using modified Dillman technique the instrument was distributed to pediatric emergency medicine residents at seven Canadian sites. Results: Out of 43 potential respondents, 22 (51% responded. Of respondents, mean comfort with X-ray interpretation was 69 (62–76 95% confidence interval [CI] while mean comfort with fracture management was only 53 (45–63 95% CI; mean comfort with physical exam of shoulder 60 (53–68 95% CI and knee 69 (62–76 95% CI was low. Less than half of respondents (47%; 95% CI 26%–69% could accurately identify normal wrist development, correctly manage a supracondylar fracture (39%; 95% CI 20%–61%, or identify a medial epicondyle fracture (44%; 95% CI 24%–66%. Comfort with neurovascular status of the upper (mean 82; 95% CI 75–89 and lower limb (mean 81; 95% CI 74–87 was high. Interpretation: There are significant gaps in knowledge of physical exam techniques, fracture identification and management among pediatric emergency medicine trainees. A change in our current teaching methods is required to meet this need. Keywords: pediatric, fractures, education, radiologic interpretation

  2. Addressing the emergence of pediatric vaccination concerns: recommendations from a Canadian policy analysis. (United States)

    Wilson, Kumanan; Barakat, Meredith; Mills, Edward; Ritvo, Paul; Boon, Heather; Vohra, Sunita; Jadad, Alejandro R; McGeer, Allison


    Ever since the advent of pediatric vaccination, individuals have expressed concerns about both its risks and benefits. These concerns have once again resurfaced among some segments of the population and could potentially undermine national vaccination programs. The views of the public, however, must be considered and respected in the formulation of vaccination policy. We have conducted an analysis of the pediatric vaccination "debate" in the Canadian context. We believe that there is common ground between those who support pediatric vaccination and those who are concerned about these programs. Based on our findings, we believe that the goal of public health authorities should be to maintain trust in vaccines by continuing to meet certain reciprocal responsibilities. To do so, we recommend the following: 1) increased investment in adverse event reporting systems; 2) request for proposals for consideration of a no-fault compensation program; 3) developing pre-emptive strategies to deal with potential vaccine risks; 4) further examination of mechanisms to improve communication between physicians and parents concerned about vaccination. All of these approaches would require additional investment in pediatric vaccination. However, such an investment is easy to justify given the benefits offered by pediatric vaccination and the ramifications of failing to maintain confidence in vaccination programs or missing a vaccine-related adverse event.

  3. Barriers and supports to implementation of MDI/spacer use in nine Canadian pediatric emergency departments: a qualitative study

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    Graham Ian D


    Full Text Available Abstract Background Despite recent research supporting the use of metered dose inhalers with spacer devices (MDI/spacers in pediatric emergency departments (PEDs for acute exacerbations of asthma, uptake of this practice has been slow. The objectives of this study were to determine the barriers and supports to implementing MDI/spacer research and to identify factors associated with early and late adoption of MDI/spacers in Canadian PEDs. Methods Using a comparative case study design, we classified nine tertiary care pediatric hospital PEDs based on their stage of implementation. Data were collected using focus group interviews with physicians, registered nurses (RNs, and respiratory therapists (RTs, and individual interviews with both patient care and medical directors at each site. Initial coding was based on the Ottawa Model of Research Use (OMRU categories of elements known to influence the uptake of innovations. Results One hundred and fifty healthcare professionals from nine different healthcare institutions participated in this study. Lack of leadership in the form of a research champion, a lack of consensus about the benefits of MDI/spacers among staff, perceived resistance from patients/parents, and perceived increased cost and workload associated with MDI/spacer use were the most prevalent barriers to the adoption of the MDI/spacer. Common strategies used by early-adopting sites included the active participation of all professional groups in the adoption process in addition to a well-planned and executed educational component for staff, patients, and families. Early adopter sites were also more likely to have the MDI/spacer included in a clinical protocol/pathway. Conclusion Potential barriers and supports to implementation have been identified that will help EDs adopt MDI/spacer use. Future interventions intended to increase MDI/spacer use in PEDs will need to be sensitive to the barriers identified in this study.

  4. [Pediatric emergencies in the emergency medical service]. (United States)

    Silbereisen, C; Hoffmann, F


    Out-of-hospital pediatric emergencies occur rarely but are feared among medical personnel. The particular characteristics of pediatric cases, especially the unaccustomed anatomy of the child as well as the necessity to adapt the drug doses to the little patient's body weight, produce high cognitive and emotional pressure. In an emergency standardized algorithms can facilitate a structured diagnostic and therapeutic approach. The aim of this article is to provide standardized procedures for the most common pediatric emergencies. In Germany, respiratory problems, seizures and analgesia due to trauma represent the most common emergency responses. This article provides a practical approach concerning the diagnostics and therapy of emergencies involving children.

  5. Abdominal emergencies in pediatrics. (United States)

    Coca Robinot, D; Liébana de Rojas, C; Aguirre Pascual, E


    Abdominal symptoms are among the most common reasons for pediatric emergency department visits, and abdominal pain is the most frequently reported symptom. Thorough history taking and physical examination can often reach the correct diagnosis. Knowing the abdominal conditions that are most common in each age group can help radiologists narrow the differential diagnosis. When imaging tests are indicated, ultrasonography is usually the first-line technique, enabling the diagnosis or adding relevant information with the well-known advantages of this technique. Nowadays, plain-film X-ray studies are reserved for cases in which perforation, bowel obstruction, or foreign body ingestion is suspected. It is also important to remember that abdominal pain can also occur secondary to basal pneumonia. CT is reserved for specific indications and in individual cases, for example, in patients with high clinical suspicion of abdominal disease and inconclusive findings at ultrasonography. We review some of the most common conditions in pediatric emergencies, the different imaging tests indicated in each case, and the imaging signs in each condition.

  6. Pediatric Ingestions: Emergency Department Management. (United States)

    Tarango Md, Stacy M; Liu Md, Deborah R


    Pediatric ingestions present a common challenge for emergency clinicians. Each year, more than 50,000 children aged less than 5 years present to emergency departments with concern for unintentional medication exposure, and nearly half of all calls to poison centers are for children aged less than 6 years. Ingestion of magnetic objects and button batteries has also become an increasing source of morbidity and mortality. Although fatal pediatric ingestions are rare, the prescription medications most responsible for injury and fatality in children include opioids, sedative/hypnotics, and cardiovascular drugs. Evidence regarding the evaluation and management of common pediatric ingestions is comprised largely of case reports and retrospective studies. This issue provides a review of these studies as well as consensus guidelines addressing the initial resuscitation, diagnosis, and treatment of common pediatric ingestions. Also discussed are current recommendations for decontamination, administration of antidotes for specific toxins, and management of ingested foreign bodies.

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

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    Lee AYM


    Full Text Available Alison YM Lee,1 Paul Enarson,2 Ann E Clarke,3 Sébastien La Vieille,4 Harley Eisman,5,6 Edmond S Chan,7 Christopher Mill,7 Lawrence Joseph,8 Moshe Ben-Shoshan9 1Pediatric Residency Program, Department of Pediatrics, University of British Columbia, BC Children’s Hospital, 2Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, 3Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, 4Food Directorate, Health Canada, Ottawa, ON, 5Emergency Department, 6Department of Pediatrics, Montreal Children’s Hospital, Montreal, QC, 7Division of Allergy and Immunology, Department of Pediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, BC, 8Department of Epidemiology and Biostatistics, McGill University, 9Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, Montreal, QC, Canada 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

  8. Bedside ultrasound in pediatric emergency medicine. (United States)

    Levy, Jason A; Noble, Vicki E


    Bedside emergency ultrasound has been used by emergency physicians for >20 years for a variety of conditions. In adult centers, emergency ultrasound is routinely used in the management of victims of blunt abdominal trauma, in patients with abdominal aortic aneurysm and biliary disease, and in women with first-trimester pregnancy complications. Although its use has grown dramatically in the last decade in adult emergency departments, only recently has this tool been embraced by pediatric emergency physicians. As the modality advances and becomes more available, it will be important for primary care pediatricians to understand its uses and limitations and to ensure that pediatric emergency physicians have access to the proper training, equipment, and experience. This article is meant to review the current literature relating to emergency ultrasound in pediatric emergency medicine, as well as to describe potential pediatric applications.

  9. Anaphylaxis across two Canadian pediatric centers: evaluating management disparities (United States)

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


    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

  10. [Pediatric emergencies: Knowledge of basic measures for the emergency physician]. (United States)

    Meyer, S; Grundmann, U; Reinert, J; Gortner, L


    Life-threatening pediatric emergencies are relatively rare in the prehospital setting. Thus, the treating emergency physician may not always be familiar with and well trained in these situations. However, pediatric emergencies require early recognition and initiation of specific diagnostic and therapeutic interventions to prevent further damage. The treatment of pediatric emergencies follows current recommendations as detailed in published international guidelines. The aim of this review is to familiarize the emergency physician with general aspects pertinent to this topic-most importantly anatomical and physiological characteristics in this cohort. Also, specific information with regard to analgesia and sedation, which may be warranted in the prehospital setting, will be provided.

  11. Experience with Emergency Ultrasound Training by Canadian Emergency Medicine Residents

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    Daniel J. Kim


    Full Text Available Introduction: Starting in 2008, emergency ultrasound (EUS was introduced as a core competency to the Royal College of Physicians and Surgeons of Canada (Royal College emergency medicine (EM training standards. The Royal College accredits postgraduate EM specialty training in Canada through 5-year residency programs. The objective of this study is to describe both the current experience with and the perceptions of EUS by Canadian Royal College EM senior residents. Methods: This was a web-based survey conducted from January to March 2011 of all 39 Canadian Royal College postgraduate fifth-year (PGY-5 EM residents. Main outcome measures were characteristics of EUS training and perceptions of EUS. Results: Survey response rate was 95% (37/39. EUS was part of the formal residency curriculum for 86% of respondents (32/37. Residents most commonly received training in focused assessment with sonography for trauma, intrauterine pregnancy, abdominal aortic aneurysm, cardiac, and procedural guidance. Although the most commonly provided instructional material (86% [32/37] was an ultrasound course, 73% (27/37 of residents used educational resources outside of residency training to supplement their ultrasound knowledge. Most residents (95% [35/37] made clinical decisions and patient dispositions based on their EUS interpretation without a consultative study by radiology. Residents had very favorable perceptions and opinions of EUS. Conclusion: EUS training in Royal College EM programs was prevalent and perceived favorably by residents, but there was heterogeneity in resident training and practice of EUS. This suggests variability in both the level and quality of EUS training in Canadian Royal College EM residency programs.

  12. Pediatric training in emergency medicine residency programs. (United States)

    Ludwig, S; Fleisher, G; Henretig, F; Ruddy, R


    Endorsed emergency medicine (EM) residency programs were surveyed as to the nature and extent of training they provided in pediatric emergency care (PEC). In the surveys returned (82%) there were several important findings. The amount of time in PEC training was generally two months per year of training. This accounted for 16% of training time. However, the volume of pediatric patients was 25% of the overall patient population. There was wide variation in the sites of PEC training. Didactic sessions often did not cover even core topics. The training program directors were equally divided in their satisfaction with this aspect of their programs. Changes were recommended by 80% of the directors. Changes most often suggested were increasing pediatric patient exposure and obtaining PEC specialists as trainers.

  13. Pediatric imaging: Current and emerging techniques

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    Shenoy-Bhangle A


    Full Text Available Imaging has always been an important component of the clinical evaluation of pediatric patients. Rapid technological advances in imaging are making noninvasive evaluation of a wide range of pediatric diseases possible. Ultrasound and magnetic resonance imaging (MRI are two imaging modalities that do not involve ionizing radiation and are preferred imaging modalities in the pediatric population. Computed tomography (CT remains the imaging modality with the highest increase in utilization in children due to its widespread availability and rapid image acquisition. Emerging imaging applications to be discussed include MR urography, voiding urosonography with use of ultrasound contrast agents, CT dose reduction techniques, MR enterography for inflammatory bowel disease, and MR cine airway imaging.

  14. Implementation of a Pediatric Emergency Triage System in Xiamen, China (United States)

    Lin, Gang-Xi; Yang, Yin-Ling; Kudirka, Denise; Church, Colleen; Yong, Collin K K; Reilly, Fiona; Zeng, Qi-Yi


    Background: Pediatric emergency rooms (PERs) in Chinese hospitals are perpetually full of sick and injured children because of the lack of sufficiently developed community hospitals and low access to family physicians. The aim of this study was to evaluate the clinical value of a new five-level Chinese pediatric emergency triage system (CPETS), modeled after the Canadian Triage System and Acuity Scale. Methods: In this study, we compared CPETS outcomes in our PER relative to those of the prior two-level system. Patients who visited our PER before (January 2013–June 2013) and after (January 2014–June 2014) the CPETS was implemented served as the control and experimental group, respectively. Patient flow, triage rates, triage accuracy, wait times (overall and for severe patients), and patient/family satisfaction were compared between the two groups. Results: Relative to the performance of the former system experienced by the control group, the CPETS experienced by the experimental group was associated with a reduced patient flow through the PER (Cox-Stuart test, t = 0, P rate (93.40% vs. 90.75%; χ2 = 801.546, P rates (94.23% vs. 92.21%; χ2 = 321.528, P < 0.001). Conclusions: Implementing the CPETS improved nurses’ abilities to triage severe patients and, thus, to deliver the urgent treatments more quickly. The system shunted nonurgent patients to outpatient care effectively, resulting in improved efficiency of PER health-care delivery. PMID:27748332

  15. Pediatric Clinical Pharmacology and Child Health:A Canadian Perspective

    Institute of Scientific and Technical Information of China (English)

    Stuart Macleod


    @@ Introduction Canadian academic centres and children's hospitals have had a longstanding interest in the improvement of drug therapy for children through research conducted across the four pillars of activity identified as being of critical importance by the Canadian Institutes of Health Research(viz,basic research,clinical research,population health research,applied health and policy research)[1].

  16. [Pediatric emergencies in the Grenoble Medical Center]. (United States)

    Lebrun, E; Bost, M


    In the Grenoble Medical Centre, pediatric emergency admissions have been drastically influenced by the opening of an Emergency Unit in May 1983. Our work was carried out one year after the opening in order to study the characteristics of the admitted children. The enquiry was done over 4 months, one month for each season of that year. A total of 1,382 children were included in the study. Thirty-four percent were seen for a medical advice (66% hospitalized). Children seen for medical advice are younger and mostly migrants. They live close to the hospital and are brought most often for fever. Fifty one per cent directly brought to the hospital by their parents for a first pediatric advice (49% were sent by their personal physician). Children directly brought by their parents are in majority infants and migrants. They are mostly admitted at night and morning and during the week-end. They are more frequently followed within the public mother-child health protection system ("Service de Protection Maternelle et Infantile", PMI).

  17. Emerging uses for pediatric hematopoietic stem cells. (United States)

    Domen, Jos; Gandy, Kimberly; Dalal, Jignesh


    Many new therapies are emerging that use hematopoietic stem and progenitor cells. In this review, we focus on five promising emerging trends that are altering stem cell usage in pediatrics: (i) The use of hematopoietic stem cell (HSC) transplantation, autologous or allogeneic, in the treatment of autoimmune disorders is one. (ii) The use of cord blood transplantation in patients with inherited metabolic disorders such as Hurler syndrome shows great benefit, even more so than replacement enzyme therapy. (iii) Experience with the delivery of gene therapy through stem cells is increasing, redefining the potential and limitations of this therapy. (iv) It has recently been shown that human immunodeficiency virus (HIV) infection can be cured by the use of selected stem cells. (v) Finally, it has long been postulated that HSC-transplantation can be used to induce tolerance in solid-organ transplant recipients. A new approach to tolerance induction using myeloid progenitor cells will be described.

  18. Pediatric cardiac emergencies: Children are not small adults

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    Frazier Aisha


    Full Text Available Compared with adults, cardiac emergencies are infrequent in children and clinical presentation is often quite variable. In adults, cardiac emergencies are most commonly related to complications of coronary artery disease; however, in pediatric cases, the coronaries are only rarely the underlying problem. Pediatric cardiac emergencies comprise a range of pathology including but not limited to undiagnosed congenital heart disease in the infant; complications of palliated congenital heart disease in children; arrhythmias related to underlying cardiac pathology in the teenager and acquired heart disease. The emergency room physician and pediatric intensivist will usually be the first and second lines of care for pediatric cardiac emergencies and thus it is imperative that they have knowledge of the diverse presentations of cardiac disease in order to increase the likelihood of delivering early appropriate therapy and referral. The objective of this review is to outline cardiac emergencies in the pediatric population and contrast the presentation with adults.

  19. Diagnostic Emergency Ultrasound: Assessment Techniques In The Pediatric Patient. (United States)

    Guttman, Joshua; Nelson, Bret P


    Emergency ultrasound is performed at the point of care to answer focused clinical questions in a rapid manner. Over the last 20 years, the use of this technique has grown rapidly, and it has become a core requirement in many emergency medicine residencies and in some pediatric emergency medicine fellowships. The use of emergency ultrasound in the pediatric setting is increasing due to the lack of ionizing radiation with these studies, as compared to computed tomography. Utilizing diagnostic ultrasound in the emergency department can allow clinicians to arrive at a diagnosis at the bedside rather than sending the patient out of the department for another study. This issue focuses on common indications for diagnostic ultrasound, as found in the pediatric literature or extrapolated from adult literature where pediatric evidence is scarce. Limitations, current trends, controversies, and future directions of diagnostic ultrasound in the emergency department are also discussed.

  20. Pediatric emergency medical services and their drawbacks

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    Abdullah Foraih Al-Anazi


    Full Text Available Aim: To survey the literature on Pediatric Emergency Medical Services (PEMS with an aim to focus its drawbacks and emphasize the means of improvement. Materials and Methods: Published articles selected for inclusion were based on the significance and understanding of literature search on different aspects of PEMS. To meet this criterion, PubMed, PubMed Central, Science Direct, Uptodate, Med Line, comprehensive databases, Cochrane library and the Internet (Google, Yahoo were thoroughly searched. Results: PEMS provide out-of-hospital medical care and/or transport the patients to definitive care. The task force represents specialties of ambulance transport, first aid, emergency medical care, life saving, trauma, emergency medicine, water rescue, and extrication. Preliminary care is undertaken to save the patients from different medical exigencies. The techniques and procedures of basic and advanced life-support are employed. A large number of weaknesses are recorded in PEMS system, such as ambulance transport irregularities, deficit equipment, lack of expertise, and ignorance of the pre-hospital care providers. These are discussed with special reference to a few examples of medical exigencies. Conclusions: The appointments in PEMS should be regularized with specific qualifications, experience, and expertise in different areas. Responsibility of PEMS should not be left to pre-hospital care providers, who are non clinicians and lack proper education and training. Pediatricians should be adequately trained to play an active role in PEMS. Meetings should be convened to discuss the lapses and means of improvement. Networks of co-operation between pre-hospital providers and experts in the emergency department should be established.

  1. Blog and Podcast Watch: Pediatric Emergency Medicine (United States)

    Zaver, Fareen; Hansen, Michael; Leibner, Evan; Little, Andrew; Lin, Michelle


    Introduction By critically appraising open access, educational blogs and podcasts in emergency medicine (EM) using an objective scoring instrument, this installment of the ALiEM (Academic Life in Emergency Medicine) Blog and Podcast Watch series curated and scored relevant posts in the specific areas of pediatric EM. Methods The Approved Instructional Resources – Professional (AIR-Pro) series is a continuously building curriculum covering a new subject area every two months. For each area, six EM chief residents identify 3–5 advanced clinical questions. Using to search blogs and podcasts, relevant posts are scored by eight reviewers from the AIR-Pro Board, which is comprised of EM faculty and chief residents at various institutions. The scoring instrument contains five measurement outcomes based on 7-point Likert scales: recency, accuracy, educational utility, evidence based, and references. The AIR-Pro label is awarded to posts with a score of ≥26 (out of 35) points. An “Honorable Mention” label is awarded if Board members collectively felt that the posts were valuable and the scores were > 20. Results We included a total of 41 blog posts and podcasts. Key educational pearls from the 10 high quality AIR-Pro posts and four Honorable Mentions are summarized. Conclusion The WestJEM ALiEM Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high quality educational content on open-access blogs and podcasts. Until more objective quality indicators are developed for learners and educators, this series provides an expert-based, crowdsourced approach towards critically appraising educational social media content for EM clinicians. PMID:27625713

  2. Blog and Podcast Watch: Pediatric Emergency Medicine

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    Fareen Zaver


    Full Text Available Introduction: By critically appraising open access, educational blogs and podcasts in emergency medicine (EM using an objective scoring instrument, this installment of the ALiEM (Academic Life in Emergency Medicine Blog and Podcast Watch series curated and scored relevant posts in the specific areas of pediatric EM.    Methods: The Approved Instructional Resources – Professional (AIR-Pro series is a continuously building curriculum covering a new subject area every two months. For each area, six EM chief residents identify 3-5 advanced clinical questions. Using to search blogs and podcasts, relevant posts are scored by eight reviewers from the AIR-Pro Board, which is comprised of EM faculty and chief residents at various institutions. The scoring instrument contains five measurement outcomes based on 7-point Likert scales: recency, accuracy, educational utility, evidence based, and references. The AIR-Pro label is awarded to posts with a score of ≥26 (out of 35 points. An “Honorable Mention” label is awarded if Board members collectively felt that the posts were valuable and the scores were > 20. Results: We included a total of 41 blog posts and podcasts. Key educational pearls from the 10 high quality AIR-Pro posts and four Honorable Mentions are summarized. Conclusion: The WestJEM ALiEM Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high quality educational content on open-access blogs and podcasts. Until more objective quality indicators are developed for learners and educators, this series provides an expert-based, crowdsourced approach towards critically appraising educational social media content for EM clinicians.

  3. Implementation of a Pediatric Emergency Triage System in Xiamen, China

    Institute of Scientific and Technical Information of China (English)

    Gang-Xi Lin; Yin-Ling Yang; Denise Kudirka; Colleen Church; Collin K K Yong; Fiona Reilly; Qi-Yi Zeng


    Background:Pediatric emergency rooms (PERs) in Chinese hospitals are perpetually full of sick and injured children because of the lack of sufficiently developed community hospitals and low access to family physicians.The aim of this study was to evaluate the clinical value of a new five-level Chinese pediatric emergency triage system (CPETS),modeled after the Canadian Triage System and Acuity Scale.Methods:In this study,we compared CPETS outcomes in our PER relative to those of the prior two-level system.Patients who visited our PER before (January 2013-June 2013) and after (January 2014-June 2014) the CPETS was implemented served as the control and experimental group,respectively.Patient flow,triage rates,triage accuracy,wait times (overall and for severe patients),and patient/family satisfaction were compared between the two groups.Results:Relative to the performance of the former system experienced by the control group,the CPETS experienced by the experimental group was associated with a reduced patient flow through the PER (Cox-Stuart test,t =0,P < 0.05),a higher triage rate (93.40% vs.90.75%;x2 =801.546,P < 0.001),better triage accuracy (96.32% vs.85.09%;x2 =710.904,P < 0.001),shorter overall wait times (37.30 ± 13.80 min vs.41.60 ± 15.40 min;t =11.27,P < 0.001),markedly shorter wait times for severe patients (2.07 [0.65,4.11] min vs.3.23 [1.90,4.36] min;z =-2.057,P =0.040),and higher family satisfaction rates (94.23% vs.92.21%;x2 =321.528,P < 0.001).Conclusions:Implementing the CPETS improved nurses' abilities to triage severe patients and,thus,to deliver the urgent treatments more quickly.The system shunted nonurgent patients to outpatient care effectively,resulting in improved efficiency of PER health-care delivery.

  4. Emergency medicine physicians performed ultrasound for pediatric intussusceptions

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    Yi-Jung Chang


    Full Text Available Background: Intussusception is the common acute abdomen in children with difficult clinical diagnosis. The routine ultrasound has recently been proposed as the initial diagnostic modality with high accuracy, but is not available for 24 h by gastroenterologists. We aimed to evaluate the validation of bedside ultrasound for intussusceptions performed by pediatric emergency physicians with ultrasound training during the night or holiday. Methods: A retrospective study was conducted in children with suspected intussusceptions when routine ultrasounds by gastroenterologists were not available over the period from July 2004 to July 2008. Patients were divided into two groups: those diagnosed by emergency physicians with ultrasound training and without training. The clinical characteristics and course for all patients were reviewed and compared for seeking the difference. Results: A total of 186 children were included. One hundred and thirteen (61% children were diagnosed by pediatric emergency physician with ultrasound training. The clinical symptoms were not statistically different between the two groups. The diagnostic sensitivity of the ultrasound training group was significantly higher (90% vs. 79%, p = 0.034. Children of the training group also had significantly shorter hospital stay duration at emergency departments before reduction (2.41 ± 2.01 vs. 4.58 ± 4.80 h, p = 0.002. Conclusion: Bedside ultrasound performed by pediatric emergency physicians with ultrasound training is a sensitive test for detecting intussusceptions. Knowledge and use of bedside ultrasound can aid the emergency physician in the diagnosis of pediatric intussusceptions with less delay in treatment.

  5. Leading teams during simulated pediatric emergencies: a pilot study

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    Coolen EH


    Full Text Available Ester H Coolen,1 Jos M Draaisma,2 Sabien den Hamer,3 Jan L Loeffen2 1Department of Pediatric Surgery, Amalia Children’s Hospital, Radboud University Medical Center, 2Department of Pediatrics, Amalia Children’s Hospital, Radboud University Medical Center, 3Department of Communication Science, Radboud University, Nijmegen, the Netherlands Purpose: Leadership has been identified as a key variable for the functioning of teams and as one of the main reasons for success or failure of team-based work systems. Pediatricians often function as team leaders in the resuscitation of a critically ill child. However, pediatric residents often report having little opportunity to perform in the role of team leader during residency. In order to gain more insight into leadership skills and behaviors, we classified leadership styles of pediatric residents during simulated emergencies. Methods: We conducted a prospective quantitative study to investigate leadership styles used by pediatric residents during simulated emergencies with clinical deterioration of a child at a pediatric ward. Using videotaped scenarios of 48 simulated critical events among 12 residents, we were able to classify verbal and nonverbal communication into different leadership styles according to the situational leadership theory. Results: The coaching style (mean 54.5%, SD 7.8 is the most frequently applied by residents, followed by the directing style (mean 35.6%, SD 4.1. This pattern conforms to the task- and role-related requirements in our scenarios and it also conforms to the concept of situational leadership. We did not find any significant differences in leadership style according to the postgraduate year or scenario content. Conclusion: The model used in this pilot study helps us to gain a better understanding of the development of effective leadership behavior and supports the applicability of situational leadership theory in training leadership skills during residency. Keywords

  6. Characteristics of patients and families who make early return visits to the pediatric emergency department

    Directory of Open Access Journals (Sweden)

    Logue EP


    Full Text Available Erin Patricia Logue,1 Samina Ali,2,3 Judith Spiers,4 Amanda S Newton,2,3 Janice A Lander4 1 Alberta Health Services, 2Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 3Women and Children’s Health Research Institute, 4Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada Objectives: The primary objective of this study was to identify reasons why parents make early return visits, within 72 hours of discharge from a tertiary care pediatric emergency department (PED. A secondary objective was to investigate associated demographic and diagnostic variables. Methods: A survey was conducted with a convenience sample of parents of children returning to the PED within 72 hours of discharge. A chart review was also completed for consented survey participants. Recruitment occurred from September 2005 to August 2006 at the Stollery Children's Hospital, Edmonton, Alberta, Canada. Results: A total of 264 parents were approached to participate. Overall, 231 surveys were returned and 212 (92% charts were reviewed. The overall rate of early return during the study period was 5.4%. More than half of parents stated that they returned because their child's condition worsened and many parents (66.7% reported feeling stressed. Patients were typically under 6 years of age (67.4%, and most frequently diagnosed with infectious diseases (38.0%. Patients triaged with the Canadian Emergency Department Triage and Acuity Scale (CTAS as CTAS 2 (emergent for initial visits were more likely to be admitted on return, regardless of age (P < 0.001. Conclusion: Variables associated with early returns included young age, diagnosis, triage acuity, and parental stress. Future variable definition should include a deeper exploration of modifiable factors such as parental stress and patient education. These next steps may help direct interventions and resources to address needs in this group and possibly pre-empt the need to return

  7. Emergency medicine in pediatric dentistry: preparation and management. (United States)

    Malamed, Stanley F


    Medical emergencies can and do occur in the practice of dentistry. Although most emergencies take place in adults, serious problems can also develop in younger patients. The contemporary dentist must be prepared to manage expeditiously and effectively those few problems that do arise. Basic life support (as necessary) is all that is required to manage many emergency situations, with the addition of specific drug therapy in some others. Preparation of the office and staff includes basic life support (annually), pediatric advanced life support, development of an emergency team, consideration for emergency medical services, and the availability of emergency drugs and equipment with the ability to use these items effectively. As with the adult patient, effective management of pain (local anesthesia) and anxiety (behavioral management, conscious sedation) will minimize the development of medical emergencies.

  8. Bridging the gap between clinical research and knowledge translation in pediatric emergency medicine. (United States)

    Hartling, Lisa; Scott-Findlay, Shannon; Johnson, David; Osmond, Martin; Plint, Amy; Grimshaw, Jeremy; Klassen, Terry P


    In 2006, a multidisciplinary group of researchers from across Canada submitted a successful application to the Canadian Institutes for Health Research for a Canadian Institutes for Health Research Team in Pediatric Emergency Medicine. The conceptual foundation for the proposal was to bring together two areas deemed critical for optimizing health outcomes: clinical research and knowledge translation (KT). The framework for the proposed work is an iterative figure-eight model that provides logical steps for research and a seamless flow between the development and evaluation of therapeutic interventions (clinical research) and the implementation and uptake of those interventions that prove to be effective (KT). Under the team grant, we will conduct seven distinct projects relating to the two most common medical problems affecting children in the emergency department: respiratory illness and injury. The projects span the research continuum, with some projects targeting problems for which there is little evidence, while other projects involve problems with a strong evidence base but require further work in the KT realm. In this article, we describe the history of the research team, the research framework, the individual research projects, and the structure of the team, including coordination and administration. We also highlight some of the many advantages of bringing this research program together under the umbrella of a team grant, including opportunities for cross-fertilization of ideas, collaboration among multiple disciplines and centers, training of students and junior researchers, and advancing a methodological research agenda.

  9. Prevalence of otorhinolaryngologic diagnoses in the pediatric emergency room

    Directory of Open Access Journals (Sweden)

    Signorelli, Luiz Gabriel


    Full Text Available Introduction: Fever and pain, which are very common in ear, nose, and throat pathologies, are among the most frequent complaints recorded during emergency room pediatric patient treatment. Most of time, the pediatricians are called on to evaluate otorhinolaryngology disorders that requires specialist assessment. Aim: To determine the prevalence of otorhinolaryngologic diagnoses in a pediatric population in a reference hospital in the city of Itatiba, São Paulo. Methods: We evaluated 2,054 pediatric patients (age range, 0-12 years, 11 months in this descriptive, transversal observational (survey study. Data collection was performed by a single observer during 103 night shifts (07:00 p.m. to 07:00 a.m. between January and December 2011, and included documentation of the main diagnosis, and patient age and sex. The ethics committee and research institution approved study. Patients were divided into 2 groups based on diagnosis: Group A otorhinolaryngology disease and Group B included diagnoses not contained in Group A. Results: Of the total enrolled patients, 52.2% corresponded to Group A and 47.8% to Group B; 51.9% were male and 48.1% were female. The average age was 4.5 years (Group A, 3.93 years; Group B, 5.03 years. We compared the prevalence of the diagnostic hypotheses of the 2 groups. Conclusion: A large number of patients sought treatment at pediatric emergency rooms for otorhinolaryngologic diagnoses.

  10. [Ethics in pediatric emergencies: Care access, communication, and confidentiality]. (United States)

    Benoit, J; Berdah, L; Carlier-Gonod, A; Guillou, T; Kouche, C; Patte, M; Schneider, M; Talcone, S; Chappuy, H


    Children suffer most from today's increasing precariousness. In France, access to care is available for all children through various structures and existing measures. The support for foreign children is overseen by specific legislation often unfamiliar to caregivers. Pediatric emergencies, their location, organization, actors, and patient flow are a particular environment that is not always suitable to communication and may lead to situations of abuse. Communication should not be forgotten because of the urgency of the situation. The place of the child in the dialogue is often forgotten. Considering the triangular relationship, listening to the child and involving the parents in care are the basis for a good therapeutic alliance. Privacy and medical confidentiality in pediatric emergencies are governed by law. However, changes in treatments and medical practices along with the variety of actors involved imply both individual and collective limitations, to the detriment of medical confidentiality.

  11. Improving outcomes for ill and injured children in emergency departments: protocol for a program in pediatric emergency medicine and knowledge translation science

    Directory of Open Access Journals (Sweden)

    Shaw Nicola


    Full Text Available Abstract Approximately one-quarter of all Canadian children will seek emergency care in any given year, with the two most common medical problems affecting children in the emergency department (ED being acute respiratory illness and injury. Treatment for some medical conditions in the ED remains controversial due to a lack of strong supporting evidence. The purpose of this paper is to describe a multi-centre team grant in pediatric emergency medicine (PEM that has been recently funded by the Canadian Institutes of Health Research (CIHR. This program of research integrates clinical research (in the areas of acute respiratory illness and injury and knowledge translation (KT. This initiative includes seven distinct projects that address the objective to generate new evidence for clinical care and KT in the pediatric ED. Five of the seven research projects in this team grant make significant contributions to knowledge development in KT science, and these contributions are the focus of this paper. The research designs employed in this program include: cross-sectional surveys, randomized controlled trials (RCTs, quasi-experimental designs with interrupted time-series analysis and staggered implementation strategies, and qualitative designs. This team grant provides unique opportunities for making important KT methodological developments, with a particular focus on developing a better theoretical understanding of the causal mechanisms and effect modifiers of different KT interventions.

  12. Actinobaculum schaalii an emerging pediatric pathogen?

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    Zimmermann Petra


    Full Text Available Abstract Background Actinobaculum schaalii was first described as a causative agent for human infection in 1997. Since then it has mainly been reported causing urinary tract infections (UTI in elderly individuals with underlying urological diseases. Isolation and identification is challenging and often needs molecular techniques. A. schaalii is increasingly reported as a cause of infection in humans, however data in children is very limited. Case presentation We present the case of an 8-month-old Caucasian boy suffering from myelomeningocele and neurogenic bladder who presented with a UTI. An ultrasound of the urinary tract was unremarkable. Urinalysis and microscopy showed an elevated leukocyte esterase test, pyuria and a high number of bacteria. Empiric treatment with oral co-trimoxazole was started. Growth of small colonies of Gram-positive rods was observed after 48 h. Sequencing of the 16S rRNA gene confirmed an A. schaalii infection 9 days later. Treatment was changed to oral amoxicillin for 14 days. On follow-up urinalysis was normal and urine cultures were negative. Conclusions A.schaalii is an emerging pathogen in adults and children. Colonization and subsequent infection seem to be influenced by the age of the patient. In young children with high suspicion of UTI who use diapers or in children who have known abnormalities of their urogenital tract, infection with A. schaalii should be considered and empiric antimicrobial therapy chosen accordingly.

  13. Personal experience in pediatric emergency medicine training in Canada and China

    Institute of Scientific and Technical Information of China (English)

    LIN Gang-xi; LUO Yi-ming; Adam CHENG; YANG Shu-yu; WANG Jian-she; Ran-D Goldman


    Currently,pediatric emergency medicine (PEM) as practiced in many developed countries is different from ours in China.Chinese pediatric emergency medicine is just children's internal medicine and does not include general surgery,ear-nose-throat,etc.If children have an emergency condition that require specialized treatments they need to go to different departments.However in Canada,the pediatric emergency physicians will first treat the patients whatever the condition,then,if it is a complicated sub specialty problem,they will consult the specialist or let the patient see the specialist later.In addition,resuscitation is done in the pediatric intensive care unit (PICU) in China,but it is done in the emergency room in Canada.This article compares the differences in the pediatric emergency systems in Canada and China and also introduces the international standard system of pediatric triage.

  14. Intestinal ascariasis at pediatric emergency room in a developed country. (United States)

    Umetsu, Shuichiro; Sogo, Tsuyoshi; Iwasawa, Kentaro; Kondo, Takeo; Tsunoda, Tomoyuki; Oikawa-Kawamoto, Manari; Komatsu, Haruki; Inui, Ayano; Fujisawa, Tomoo


    Ascaris lumbricoides infection is rare among children in developed countries. Although large numbers of adult Ascaris in the small intestine can cause various abdominal symptoms, this infection remains asymptomatic until the number of worms in the intestine considerably increases in most cases. Ascaris causing bilious vomiting suggesting ileus is rare, especially in developed countries. A 6-year-old boy who lived in Japan, presented with abdominal colic, bilious vomiting at the pediatric emergency room. He appeared pale, and had no abdominal distention, tenderness, palpable abdominal mass, or findings of dehydration. He experienced bilious vomiting again during a physical examination. Laboratory tests showed mild elevation of white blood cells and C-reactive protein levels. Antigens of adenovirus, rotavirus, and norovirus were not detected from his stool, and stool culture showed normal flora. Ultrasonography showed multiple, round-shaped structures within the small intestine, and a tubular structure in a longitudinal scan of the small intestine. Capsule endoscopy showed a moving worm of Ascaris in the jejunum. Intestinal ascariasis should be considered as a cause of bilious vomiting in children, even at the emergency room in industrial countries. Ultrasound examination and capsule endoscopy are useful for diagnosis of pediatric intestinal ascariasis.

  15. Managing pediatric hepatitis C: current and emerging treatment options

    Directory of Open Access Journals (Sweden)

    Wikrom Karnsakul


    Full Text Available Wikrom Karnsakul, Mary Kay Alford, Kathleen B SchwarzPediatric Liver Center, Division of Pediatric Gastroenterology and Nutrition, Johns Hopkins School of Medicine, Baltimore, MD, USAAbstract: Since 1992, the maternal–fetal route of transmission has become the dominant route for acquisition of hepatitis C (HCV infection by children. With increasing knowledge of antiviral treatment for HCV infection, the main goal of therapy is to achieve a sustained virological response (SVR as defined by undetectable serum HCV RNA by polymerase chain reaction assay six months after cessation of therapy. In young children, interferon therapy is more effective than in adults with chronic HCV infection (CHC. Although children clearly have a milder degree of liver pathology, data have indicated that hepatic inflammation from HCV infection can progress to fibrosis or cirrhosis in children. Hepatocellular carcinoma has been reported in adolescents with CHC. In this article, recent improvements in therapy of children with CHC and in the clinical development of new emerging drugs with potential use in children will be reviewed.Keywords: chronic hepatitis C, children, current therapy, pegylated interferon

  16. Emerging role of autophagy in pediatric neurodegenerative and neurometabolic diseases. (United States)

    Ebrahimi-Fakhari, Darius; Wahlster, Lara; Hoffmann, Georg F; Kölker, Stefan


    Pediatric neurodegenerative diseases are a heterogeneous group of diseases that result from specific genetic and biochemical defects. In recent years, studies have revealed a wide spectrum of abnormal cellular functions that include impaired proteolysis, abnormal lipid trafficking, accumulation of lysosomal content, and mitochondrial dysfunction. Within neurons, elaborated degradation pathways such as the ubiquitin-proteasome system and the autophagy-lysosomal pathway are critical for maintaining homeostasis and normal cell function. Recent evidence suggests a pivotal role for autophagy in major adult and pediatric neurodegenerative diseases. We herein review genetic, pathological, and molecular evidence for the emerging link between autophagy dysfunction and lysosomal storage disorders such as Niemann-Pick type C, progressive myoclonic epilepsies such as Lafora disease, and leukodystrophies such as Alexander disease. We also discuss the recent discovery of genetically deranged autophagy in Vici syndrome, a multisystem disorder, and the implications for the role of autophagy in development and disease. Deciphering the exact mechanism by which autophagy contributes to disease pathology may open novel therapeutic avenues to treat neurodegeneration. To this end, an outlook on novel therapeutic approaches targeting autophagy concludes this review.

  17. Innis and the Emergence of Canadian Communication/Media Studies

    Directory of Open Access Journals (Sweden)

    Robert E. Babe


    Full Text Available The discussion in this paper examines the influence of Harold Innis’ medium theory on contemporary media and communication scholarship in Canada and abroad. The methodological construction of Innis’ medium theory comprises several dimensions including: media bias; the exercising of power through the use and control of media; the bias of communication media toward favouring control over space and control through time; the role of governance in overcoming the bias inherent in media; a materialist understanding of civilizations; space-media outpacing time-media; and dialectics. In this paper particular attention is given to two issues. The first is the connections between Innis’ political economy approach and the work of Marshall McLuhan on the one hand, and the ecological studies of David Suzuki on the other. Both McLuhan and Suzuki, it is argued, may be seen as filling in important gaps in Innis’ work. The second focuses on the reasons why Innis’ medium theory has struck a chord with the Canadian psyche. This stands in stark contrast to the apparent neglect of Innis’ work within American media and communication scholarship.

  18. First-attack pediatric hypertensive crisis presenting to the pediatric emergency department

    Directory of Open Access Journals (Sweden)

    Yang Wen-Chieh


    Full Text Available Background Hypertensive crisis in children is a relatively rare condition presenting with elevated blood pressure (BP and related symptoms, and it is potentially life-threatening. The aim of this study was to survey children with first attacks of hypertensive crisis arriving at the emergency department (ED, and to determine the related parameters that predicted the severity of hypertensive crisis in children by age group. Methods This was a retrospective study conducted from 2000 to 2007 in pediatric patients aged 18 years and younger with a diagnosis of hypertensive crisis at the ED. All patients were divided into four age groups (infants, preschool age, elementary school age, and adolescents, and two severity groups (hypertensive urgency and hypertensive emergency. BP levels, etiology, severity, and clinical manifestations were analyzed by age group and compared between the hypertensive emergency and hypertensive urgency groups. Results The mean systolic/diastolic BP in the hypertensive crisis patients was 161/102 mmHg. The major causes of hypertensive crisis were essential hypertension, renal disorders and endocrine/metabolic disorders. Half of all patients had a single underlying cause, and 8 had a combination of underlying causes. Headache was the most common symptom (54.5%, followed by dizziness (45.5%, nausea/vomiting (36.4% and chest pain (29.1%. A family history of hypertension was a significant predictive factor for the older patients with hypertensive crisis. Clinical manifestations and severity showed a positive correlation with age. In contrast to diastolic BP, systolic BP showed a significant trend in the older children. Conclusions Primary clinicians should pay attention to the pediatric patients who present with elevated blood pressure and related clinical hypertensive symptoms, especially headache, nausea/vomiting, and altered consciousness which may indicate that appropriate and immediate antihypertensive medications are

  19. Validity of different pediatric early warning scores in the emergency department

    NARCIS (Netherlands)

    N. Seiger (Nienke); I.K. MacOnochie (Ian); R. Oostenbrink (Rianne); H.A. Moll (Henriëtte)


    textabstractObjective: Pediatric early warning scores (PEWS) are being advocated for use in the emergency department (ED). The goal of this study was to compare the validity of different PEWS in a pediatric ED. Methods: Ten different PEWS were evaluated in a large prospective cohort. We included chi

  20. National Training Course. Emergency Medical Technician. Paramedic. Instructor's Lesson Plans. Module XII. Pediatrics and Neonatal. (United States)

    National Highway Traffic Safety Administration (DOT), Washington, DC.

    This instructor's lesson plan guide on pediatrics and neonatal transport is one of fifteen modules designed for use in the training of emergency medical technicians (paramedics). Five units of study are presented: (1) approach to the pediatric patient including patient assessment; (2) pathophysiology and management of problems unique to the…

  1. Intranasal Midazolam Sedation in a Pediatric Emergency Dental Clinic. (United States)

    Peerbhay, Fathima; Elsheikhomer, Ahmed Mahgoub


    The purpose of this study was to compare the effectiveness and recovery times of 0.3 and 0.5 mg/kg intranasal midazolam (INM) administered with a mucosal atomizer device (MAD) in a pediatric emergency dental hospital clinic. One hundred eighteen children aged from 4 to 6 years were randomly administered either 0.3 or 0.5 mg/kg INM via an MAD in a triple-blinded randomized controlled trial. Sedation was achieved to some degree in 100% of the sample. The pulse rate and oxygen saturation were within the normal range in 99% of the patients. A burning sensation was reported in 9% of children. The recovery time of the 0.5 mg/kg group was statistically longer than that of the 0.3 mg/kg group (16.5 vs 18.8 minutes) but the difference was not clinically significant. The findings of this study show that 0.3 or 0.5 mg/kg doses of INM resulted in safe and effective sedation. The 0.5 mg/kg dose was more effective than the 0.3 mg/kg dose in reducing anxiety.

  2. A workflow model to analyse pediatric emergency overcrowding. (United States)

    Zgaya, Hayfa; Ajmi, Ines; Gammoudi, Lotfi; Hammadi, Slim; Martinot, Alain; Beuscart, Régis; Renard, Jean-Marie


    The greatest source of delay in patient flow is the waiting time from the health care request, and especially the bed request to exit from the Pediatric Emergency Department (PED) for hospital admission. It represents 70% of the time that these patients occupied in the PED waiting rooms. Our objective in this study is to identify tension indicators and bottlenecks that contribute to overcrowding. Patient flow mapping through the PED was carried out in a continuous 2 years period from January 2011 to December 2012. Our method is to use the collected real data, basing on accurate visits made in the PED of the Regional University Hospital Center (CHRU) of Lille (France), in order to construct an accurate and complete representation of the PED processes. The result of this representation is a Workflow model of the patient journey in the PED representing most faithfully possible the reality of the PED of CHRU of Lille. This model allowed us to identify sources of delay in patient flow and aspects of the PED activity that could be improved. It must be enough retailed to produce an analysis allowing to identify the dysfunctions of the PED and also to propose and to estimate prevention indicators of tensions. Our survey is integrated into the French National Research Agency project, titled: "Hospital: optimization, simulation and avoidance of strain" (ANR HOST).

  3. Pediatric information seeking behaviour, information needs, and information preferences of health care professionals in general emergency departments: Results from the Translating Emergency Knowledge for Kids (TREKK) Needs Assessment. (United States)

    Scott, Shannon D; Albrecht, Lauren; Given, Lisa M; Hartling, Lisa; Johnson, David W; Jabbour, Mona; Klassen, Terry P


    The majority of children requiring emergency care are treated in general emergency departments (EDs) with variable levels of pediatric care expertise. The goal of the Translating Emergency Knowledge for Kids (TREKK) initiative is to implement the latest research in pediatric emergency medicine in general EDs to reduce clinical variation.

  4. Referral Criteria from Community Clinics to Pediatric Emergency Departments

    Directory of Open Access Journals (Sweden)

    Jacob Urkin


    Full Text Available Referral of patients to a pediatric emergency department (PED should be medically justified and the need for referral well communicated. The objectives of this paper were (1 to create a list of criteria for referral from the community to the PED, (2 to describe how community physicians categorize their need for referral, and (3 to determine agreement between the physician's referral letter and the selected criteria. We present a descriptive study of referrals to the PED of Soroka University Medical Center, Beer-Sheva, Israel, during February to April 2003. A list of 22 criteria for referral was created, using the Delphi method for reaching consensus. One or more criteria could be selected from this list for each referral, by the referring community physicians and, independently, based on the physicians' referral letters, by two consultants, and compared. There were 140 referrals included in the study. A total of 262 criteria for referral were selected by the referring community physicians. The criteria most frequently selected were: “Need for same-day consultation/laboratory/imaging result not available in the community” (32.1%, “Suspected life- or organ-threatening infection” (16.4%, and “Need for hospitalization” (15.7%. Rates of agreement regarding criteria for referral between the referring physicians and the two consultants, and a senior community pediatrician and a senior PED pediatrician, were 57.9 and 48.6%, respectively. We conclude that the standard referral letter does not convey in full the level of need for referral to the PED. A list of criteria for referral could augment efficient utilization of emergency department services and improve communication between community physicians and the PED.

  5. Adolescents' interhospital transfers from a pediatric emergency department

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    Cláudia Arriaga


    Full Text Available Introduction: The maternal-infant referral network, established in Portugal since 2001, allows a complementarity between all healthcare units, providing universal access to healthcare. Aim: To characterize adolescents interhospital transfers from the Pediatric Urgency (PU of a B1 hospital.. Methods: Retrospective analytic study. Data from clinical files of adolescents transferred from the PU in 2011 were collected. We defined and compared two age groups: 10 to 14 years old (G1 and 15 to 18 years old (G2 and characterized these about demographics, diagnosis, diagnostic procedures and reason for transfer. Statistical analysis was performed with PASW 18.0® software (p<0,05. Results: There were 43.409 admissions to the PU, 24,2%(n=10.498 from adolescents, with an average age of 14,5 (±2,1 years; 67% were males. Around 1,2% (n=131 of the adolescents were transferred, which counted for 46% of all transfers in pediatric age. When analyzing admissions by age group, 65,8% belonged to G1 from all transfers and 57,3% to G2 (p<0,001. The reason for transfer was trauma in 45%, medical in 37,4%, and surgical in 17,6%. The main diagnosis of the adolescents transferred were ear-nose-throat problems, urologic and psychiatric conditions. Diagnostic procedures were performed in 42,7% of the adolescents and 82,1% were imaging exams. The lack of specialities, in the emergency department, in the local hospital was the reason for the transfer in 90,8%, and the missing speciality was surgical in 72,2%. Psychiatric conditions were more frequently diagnosed in adolescents transferred from G2 (22,7% than G1 (9,1%, p=0,037. Of all the adolescents transferred to A1 hospital, 28,2% were admitted for hospitalization. Conclusions: Although adolescents comprised only a quarter of the admissions of the PU, they represented an important percentage of all transfers, mainly the older ones. The main reason for transfers was the lack of medical and surgical specialities in the PU

  6. Manchester Triage System: main flowcharts, discriminators and outcomes of a pediatric emergency care

    Directory of Open Access Journals (Sweden)

    Camila Amthauer

    Full Text Available ABSTRACT Objetive: to characterize the care services performed through risk rating by the Manchester Triage System, identifying demographics (age, gender, main flowcharts, discriminators and outcomes in pediatric emergency Method: cross-sectional quantitative study. Data on risk classification were obtained through a search of computerized registration data from medical records of patients treated in the pediatric emergency within one year. Descriptive statistics with absolute and relative frequencies was used for the analysis. Results: 10,921 visits were conducted in the pediatric emergency, mostly male (54.4%, aged between 29 days and two years (44.5%. There was a prevalence of the urgent risk category (43.6%. The main flowchart used in the care was worried parents (22.4% and the most prevalent discriminator was recent event (15.3%. The hospitalization outcome occurred in 10.4% of care performed in the pediatric emergency, however 61.8% of care needed to stay under observation and / or being under the health team care in the pediatric emergency. Conclusion: worried parents was the main flowchart used and recent events the most prevalent discriminator, comprising the hospitalization outcomes and permanency in observation in the pediatric emergency before discharge from the hospital.

  7. Why and when to use CT in children: perspective of a pediatric emergency medicine physician

    Energy Technology Data Exchange (ETDEWEB)

    Frush, Karen [Duke University School of Medicine, DUMC, Department of Pediatrics, Box 3701, Durham, NC (United States)


    The Emergency Department is a risk-laden environment for clinicians caring for children. A number of factors can increase the risk of medical errors and adverse events, including lack of standardized medication dosing because of size variation in the pediatric age range, unique physical and developmental characteristics of children that affect treatment strategies, and the inability of young or non-verbal children to provide a medical history or to clearly communicate pain and other symptoms. The Emergency Department (ED) setting is often hectic and chaotic, with lots of interruptions. Many EDs lack the pediatric-specific supplies deemed essential for managing pediatric emergencies, and long hours or overnight shifts, while necessary for maintaining 24-hour emergency services, can cause provider fatigue that can lead to increased medical errors. It is in this environment that ED physicians make decisions about the use of CT scans in children, often without evidence-based guidelines to help them weigh risks and benefits. Although recent efforts have raised the awareness of the risk of exposure to radiation, many pediatric providers and families lack adequate information to guide decisions about the use of CT. Pediatricians and emergency physicians need to collaborate with radiologists to maintain current knowledge of the risks and benefits of CT scans, to advocate for pediatric protocols and evidence-based guidelines, and to engage families in decisions regarding the evaluation and treatment of pediatric patients in the Emergency Department. (orig.)

  8. Policy and procedures for domestic violence patients in Canadian emergency departments: a national survey. (United States)

    Hotch, D; Grunfeld, A; Mackay, K; Ritch, L


    A cross-sectional research survey aimed to obtain information concerning 1) the proportion of Canadian emergency departments with domestic violence intervention policies and procedures; 2) how hospitals identify and provide service to patients who have been abused; and 3) measures that have been problematic/helpful in implementing domestic violence protocols in emergency departments. The study sample included 230 Canadian hospitals with emergency departments. Results showed that 198 hospitals returned the questionnaires, of which 39% indicated that there were policies and procedures concerning domestic violence for the emergency departments. Large, major hospitals were more likely than smaller community hospitals to have policies or protocols in place. About 26 hospitals reported screening all patients for domestic violence and 61 hospitals provided referral services and 46 hospitals provided on-site counseling. Physicians were principally involved in the physical examination, referral and identification. Follow-up, emotional support, and safety planning were provided by social workers. Findings of this survey encourage hospitals and individual health care providers to adopt guidelines concerning domestic violence to ensure a widespread adoption and implementation.

  9. Electroencephalography in the pediatric emergency department: when is it most useful? (United States)

    Fernández, Iván Sánchez; Loddenkemper, Tobias; Datta, Anita; Kothare, Sanjeev; Riviello, James J; Rotenberg, Alexander


    This study aimed to identify the indications in which electroencephalography in the pediatric emergency department is most useful. We retrospectively reviewed the influence that the results of the emergent electroencephalogram had on the eventual disposition of patients at our pediatric emergency department. Sixty-eight children (mean age, 7.3 years; 32 males) underwent 70 emergent electroencephalograms. Fifty-seven emergent electroencephalograms were performed for the suspicion of ongoing seizures or status epilepticus. Thirteen of the 22 children (59.1%) discharged from the emergency department were sent home mainly based on the results of the emergent electroencephalogram, which prevented an admission. In particular, 11 of 38 children with frequent and recurrent paroxysmal events concerning for seizures and 2 of 19 children with suspected ongoing status epilepticus were discharged after excluding an epileptic disturbance. The emergent electroencephalogram provided meaningful clinical information that influenced disposition, especially in patients with ongoing events in which the clinical picture was clarified by a rapidly acquired electroencephalogram.

  10. Pediatric AIDS/HIV Infection: An Emerging Challenge to Pediatric Psychology. (United States)

    Olson, Roberta A.; And Others


    The increasing number of cases of pediatric Acquired Immonodeficiency Syndrome (AIDS) presents unique issues for psychologists in the areas of prevention, clinical treatment, public education, research, neuropsychological effects, psychoneuroimmunology, and ethical concerns. (Author/DB)

  11. [An update of the diagnostic coding system by the Spanish Society of Pediatric Emergencies]. (United States)

    Benito Fernández, J; Luaces Cubells, C; Gelabert Colomé, G; Anso Borda, I


    The Quality Working Group of the Spanish Society of Pediatric Emergencies (SEUP) presents an update of the diagnostic coding list. The original list was prepared and published in Anales de Pediatría in 2000, being based on the International Coding system ICD-9-CM current at that time. Following the same methodology used at that time and based on the 2014 edition of the ICD-9-CM, 35 new codes have been added to the list, 15 have been updated, and a list of the most frequent references to trauma diagnoses in pediatrics have been provided. In the current list of diagnoses, SEUP reflects the significant changes that have taken place in Pediatric Emergency Services in the last decade.

  12. Epidemiology of Pediatric Bite/Sting Injuries. One-Year Study of a Pediatric Emergency Department in Israel

    Directory of Open Access Journals (Sweden)

    Michal Hemmo-Lotem


    Full Text Available Animal bite/sting injuries are a known source of morbidity with a significantly higher incidence among children who are most often bitten in the face, head, and neck. The objective of this study was to provide a better understanding of bite/sting injuries treated at the pediatric emergency department in order to guide preventive efforts.The sociodemographic, epidemiological, and clinical data on all bite/sting injuries treated in one representative pediatric emergency department in Israel over a 1-year period were retrieved and analyzed. Two hundred of the 9,309 pediatric trauma cases treated in the emergency department were bite/sting injuries (2.1%. Non-Jewish patients were under-represented in this subgroup. The majority of patients were males (61.5%. Age distribution from 0–12 years was fairly even, except for an unexplained peak at 8 years. Dogs inflicted 56%, cats 11%, and hornets 9.5% of the injuries. Limbs were affected in 64% and the head and neck in 27%. Specialists, mostly plastic surgeons, were consulted in 42 cases (21%. The incidence rate for hospitalization (7% was similar to that seen in other types of injuries. Children with scorpion or hornet stings and young age were more likely to be hospitalized. Preventive and educational aspects are discussed.

  13. Pediatric and adolescent mental health emergencies in the emergency medical services system. (United States)

    Dolan, Margaret A; Fein, Joel A


    Emergency department (ED) health care professionals often care for patients with previously diagnosed psychiatric illnesses who are ill, injured, or having a behavioral crisis. In addition, ED personnel encounter children with psychiatric illnesses who may not present to the ED with overt mental health symptoms. Staff education and training regarding identification and management of pediatric mental health illness can help EDs overcome the perceived limitations of the setting that influence timely and comprehensive evaluation. In addition, ED physicians can inform and advocate for policy changes at local, state, and national levels that are needed to ensure comprehensive care of children with mental health illnesses. This report addresses the roles that the ED and ED health care professionals play in emergency mental health care of children and adolescents in the United States, which includes the stabilization and management of patients in mental health crisis, the discovery of mental illnesses and suicidal ideation in ED patients, and approaches to advocating for improved recognition and treatment of mental illnesses in children. The report also addresses special issues related to mental illness in the ED, such as minority populations, children with special health care needs, and children's mental health during and after disasters and trauma.

  14. Leading teams during simulated pediatric emergencies: a pilot study

    NARCIS (Netherlands)

    Coolen, E.H.; Draaisma, J.M.T.; Hamer, S. den; Loeffen, J.L.C.M.


    PURPOSE: Leadership has been identified as a key variable for the functioning of teams and as one of the main reasons for success or failure of team-based work systems. Pediatricians often function as team leaders in the resuscitation of a critically ill child. However, pediatric residents often rep

  15. Accountability and pediatric physician-researchers: are theoretical models compatible with Canadian lived experience?

    Directory of Open Access Journals (Sweden)

    Czoli Christine


    Full Text Available Abstract Physician-researchers are bound by professional obligations stemming from both the role of the physician and the role of the researcher. Currently, the dominant models for understanding the relationship between physician-researchers' clinical duties and research duties fit into three categories: the similarity position, the difference position and the middle ground. The law may be said to offer a fourth "model" that is independent from these three categories. These models frame the expectations placed upon physician-researchers by colleagues, regulators, patients and research participants. This paper examines the extent to which the data from semi-structured interviews with 30 physician-researchers at three major pediatric hospitals in Canada reflect these traditional models. It seeks to determine the extent to which existing models align with the described lived experience of the pediatric physician-researchers interviewed. Ultimately, we find that although some physician-researchers make references to something like the weak version of the similarity position, the pediatric-researchers interviewed in this study did not describe their dual roles in a way that tightly mirrors any of the existing theoretical frameworks. We thus conclude that either physician-researchers are in need of better training regarding the nature of the accountability relationships that flow from their dual roles or that models setting out these roles and relationships must be altered to better reflect what we can reasonably expect of physician-researchers in a real-world environment.

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

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    Patel NH


    Full Text Available Nirali H Patel,1 Sarah K Romero,2 David C Kaelber31Division of Emergency Medicine, Akron Children's Hospital, Akron, OH, USA; 2Division of Emergency Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH, USA; 3Departments of Information Services, Internal Medicine, Pediatrics, and Epidemiology and Biostatistics, The Center for Clinical Informatics Research and Education, The MetroHealth System and School of Medicine, Case Western Reserve University, Cleveland OH, USAAbstract: 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

  17. Etiologies of septic shock in a pediatric emergency department population. (United States)

    Gaines, Nakia N; Patel, Binita; Williams, Eric A; Cruz, Andrea T


    Knowledge of pediatric sepsis etiologies is needed to optimize empiric therapy. A retrospective cross-sectional review of 428 children with clinically diagnosed sepsis found that 13% had lobar pneumonia, 12% bacteremia and 10% viral infections. No etiologies were found in 76%. Empiric antibiotic coverage of vancomycin/piperacillin-tazobactam/gentamicin for immunocompromised children and vancomycin/nafcillin/cefotaxime for previously healthy children would have covered all bacteremic children.

  18. A Canadian Study toward Changing Local Practice in the Diagnosis of Pediatric Celiac Disease

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    Seema Rajani


    Full Text Available Background. The European Society for Pediatric Gastroenterology, Hepatology and Nutrition endorses serological diagnosis (SD for pediatric celiac disease (CD. The objective of this study was to pilot SD and to prospectively evaluate gastrointestinal permeability and mucosal inflammation at diagnosis and after one year on the gluten-free diet (GFD. We hypothesized that SD would be associated with similar short term outcomes as ED. Method. Children, 3–17 years of age, referred for possible CD were eligible for SD given aTTG level ≥200 U/mL, confirmed by repeat aTTG and HLA haplotypes. Gastrointestinal permeability, assessed using sugar probes, and inflammation, assessed using fecal calprotectin (FC, at baseline and after one year on a GFD were compared to patients who had ED. Results. Enrolled SD (n=40 and ED (n=48 patients had similar demographics. ED and SD groups were not different in baseline lactulose: mannitol ratio (L : M (0.049 versus 0.034; p=0.07, fractional excretion of sucrose (%FES; 0.086 versus 0.092; p=0.44, or fecal calprotectin (FC; 89.6 versus 51.4; p=0.05. At follow-up, urine permeability improved and was similar between groups, L : M (0.022 versus 0.025; p=0.55 and %FES (0.040 versus 0.047; p=0.87 (p>0.05. FC improved but remained higher in the SD group (37.1 versus 15.9; p=0.04. Conclusion. Patients on the GFD showed improved intestinal permeability and mucosal inflammation regardless of diagnostic strategy. This prospective study supports that children diagnosed by SD have resolving mucosal disease early after commencing a GFD.

  19. From cradle to adolescence: the development of Research in European Pediatric Emergency Medicine. (United States)

    Mintegi, Santiago; Lyttle, Mark D; Maconochie, Ian K; Benito, Javier; Gervaix, Alain; Moll, Henriette; Shavit, Itai; Da Dalt, Liviana; Waisman, Yehezkel


    Pediatric emergency medicine (PEM) has been developing rapidly but heterogeneously in many European countries in recent years, and many national PEM societies have been founded to improve the quality of care of ill and injured children and adolescents. Key facets of any such improvement are the development, delivery and translation of high-quality research. Research in European Pediatric Emergency Medicine (REPEM) has developed a robust international structure involving clinicians, academics and national PEM research networks. This structure facilitates research collaboration within Europe and with PEM research networks from other continents. Multicentre research carried out in this way will bring about improvements in the quality of emergency care for children in European emergency departments, and result in a better quality of life for children and adolescents. This paper outlines the background and achievements of REPEM to date and describes the current structure and next steps.

  20. Challenges and Emerging Technologies within the Field of Pediatric Actigraphy. (United States)

    Galland, Barbara; Meredith-Jones, Kim; Terrill, Philip; Taylor, Rachael


    Actigraphy as an objective measure of sleep and wakefulness in infants and children has gained popularity over the last 20 years. However, the field lacks published guidelines for sleep-wake identification within pediatric age groups. The scoring rules vary greatly and although sensitivity (sleep agreement with polysomnography) is usually high, a significant limitation remains in relation to specificity (wake agreement). Furthermore, accurate algorithm output and sleep-wake summaries usually require prior entry from daily logs of sleep-wake periods and artifact-related information (e.g., non-wear time), involving significant parent co-operation. Scoring criteria for daytime naps remains an unexplored area. Many of the problems facing accuracy of measurement are inherent within the field of actigraphy itself, particularly where sleep periods containing significant movements are erroneously classified as wake, and within quiet wakefulness when no movements are detected, erroneously classified as sleep. We discuss the challenges of actigraphy for pediatric sleep, briefly describe the technical basis and consider a number of technological approaches that may facilitate improved classification of errors in sleep-wake discrimination.

  1. Challenges and emerging technologies within the field of pediatric actigraphy

    Directory of Open Access Journals (Sweden)

    Barbara eGalland


    Full Text Available Actigraphy as an objective measure of sleep and wakefulness in infants and children has gained popularity over the last 20 years. However, the field lacks published guidelines for sleep-wake identification within pediatric age groups. The scoring rules vary greatly and although sensitivity (sleep agreement with polysomnography is usually high, a significant limitation remains in relation to specificity (wake agreement. Furthermore, accurate algorithm output and sleep-wake summaries usually require prior entry from daily logs of sleep–wake periods and artefact-related information (e.g. non-wear time, involving significant parent co-operation. Scoring criteria for daytime naps remains an unexplored area. Many of the problems facing accuracy of measurement are inherent within the field of actigraphy itself, particularly where sleep periods containing significant movements are erroneously classified as wake, and within quiet wakefulness when no movements are detected, erroneously classified as sleep. We discuss the challenges of actigraphy for pediatric sleep, briefly describe the technical basis and consider a number of technological approaches that may facilitate improved classification of errors in sleep-wake discrimination.

  2. Advanced training in pediatric emergency medicine in the United States, Canada, United Kingdom, and Australia : An international comparison and resources guide

    NARCIS (Netherlands)

    Babl, FE; Weiner, DL; Bhanji, F; Davies, F; Berry, K; Barnett, P


    Pediatric emergency medicine is an important subspecialty of pediatrics and emergency medicine. It is a well-established subspecialty in some countries and less well developed or evolving in others. We set out to develop a resource guide and document the current status of pediatric emergency medicin

  3. Use of Placebo in Pediatric Inflammatory Bowel Diseases: A Position Paper From ESPGHAN, ECCO, PIBDnet, and the Canadian Children IBD Network. (United States)

    Turner, Dan; Koletzko, Sibylle; Griffiths, Anne M; Hyams, Jeffrey; Dubinsky, Marla; de Ridder, Lissy; Escher, Johanna; Lionetti, Paolo; Cucchiara, Salvatore; Lentze, Michael J; Koletzko, Berthold; van Rheenen, Patrick; Russell, Richard K; Mack, David; Veereman, Gigi; Vermeire, Séverine; Ruemmele, Frank


    Performing well-designed and ethical trials in pediatric inflammatory bowel diseases (IBD) is a priority to support optimal therapy and reduce the unacceptable long lag between adult and pediatric drug approval. Recently, clinical trials in children have been incorporating placebo arms into their protocols under conditions that created controversy. Therefore, 4 organizations (the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition; European Crohn's and Colitis Organization; the Canadian Children IBD Network; and the Global Pediatric IBD Network) jointly provide a statement on the role of placebo in pediatric IBD trials. Consensus was achieved by 94 of 100 (94%) voting committees' members that placebo should only be used if there is genuine equipoise between the active treatment and placebo; for example, this may be considered in trials of drugs with new mechanisms of action without existing adult data, especially when proven effective alternatives do not exist outside the trial. Placebo may also be used in situations where it is an "add-on" to an effective therapy or to evaluate exit-strategies of maintenance therapy after long-term deep remission. It has been, however, agreed that no child enrolled in a trial should receive a known inferior treatment both within and outside the trial. This also includes withholding therapy in children who show clinical response after a short induction therapy. Given the similarity between pediatric and adult IBD regarding pathophysiology and response to treatments, drugs generally cannot be considered being in genuine equipoise with placebo if it has proven efficacy in adults. Continued collaboration of all stakeholders is needed to facilitate drug development and evaluation in pediatric IBD.

  4. Does Academic Blogging Enhance Promotion and Tenure? A Survey of US and Canadian Medicine and Pediatric Department Chairs (United States)

    Varma, Manu; Adams, Martha; Jhaveri, Kenar D


    Background Electronic educational (e-learning) technology usage continues to grow. Many medical journals operate companion blogs (an application of e-learning technology) that enable rapid dissemination of scientific knowledge and discourse. Faculty members participating in promotion and tenure academic tracks spend valuable time and effort contributing, editing, and directing these medical journal blogs. Objective We sought to understand whether chairs of medicine and pediatric departments acknowledge blog authorship as academic achievement. Methods The authors surveyed 267 chairs of US and Canadian medicine and pediatric departments regarding their attitudes toward the role of faculty participation in e-learning and blogging in the promotion and tenure process. The survey completion rate was 22.8% (61/267). Results A majority of respondents (87%, 53/61) viewed educational scholarship as either important or very important for promotion. However, only 23% (14/61) perceived importance to faculty effort in producing content for journal-based blogs. If faculty were to participate in blog authorship, 72% (44/61) of surveyed chairs favored involvement in a journal-based versus a society-based or a personal (nonaffiliated) blog. We identified a “favorable group” of chairs (19/59, 32%), who rated leadership roles in e-learning tools as important or very important, and an “unfavorable group” of chairs (40/59, 68%), who rated leadership roles in e-learning tools as somewhat important or not important. The favorable group were more likely to be aware of faculty bloggers within their departments (58%, 11/19 vs 25%, 10/40), viewed serving on editorial boards of e-learning tools more favorably (79%, 15/19 vs 31%, 12/39), and were more likely to value effort spent contributing to journal-based blogs (53%, 10/19 vs 10%, 4/40). Conclusions Our findings demonstrate that although the majority of department chairs value educational scholarship, only a minority perceive value

  5. The case of the missing testicle: blunt scrotal trauma in the pediatric emergency department. (United States)

    Pesch, Megan H; Bradin, Stuart


    Serious blunt scrotal trauma in the pediatric population is rare and can pose significant danger to the viability of the testes. The following case describes an adolescent boy who presented with a single testis in his scrotum after low-impact perineal trauma, consistent with testicular dislocation. The literature regarding scrotal trauma includes few cases of testicular dislocation from low-impact perineal trauma. Included is a brief review of the most recent data including epidemiology, differential diagnosis, acute management, and complications pertinent to the pediatric emergency clinician.

  6. [Guidelines: state of the art and peculiar aspects in pediatric emergency]. (United States)

    Tubino, B; Ciccone, M O; Di Pietro, P


    In recent years pediatric guidelines have increasingly become part of clinical practice, in Italy too. Aim of the present work is, on the basis of a review of national and international literature, to focus on the Italian situation about the use of guidelines in pediatric emergency, with particular respect to methodology, correct use, and related risks and benefits. The developing of efficient guidelines is achieved in different steps: 1) identifying and refining the topic for guidelines, in order to obtain an improvement of healthcare; 2) correct developing strategies, based on scientific evidence, leading to production of recommendations validated by external review; 3) adequate implementation and diffusion in local settings; 4) application with sensible and appropriate clinical discretion. Benefits obtained with the correct use of efficient pediatric guidelines, can be identified at different levels: patients' care (outcome improvement, increased patients' consciousness, influence on public healthcare policy); healthcare professionals (improving quality of clinical decisions, agreement on clinical and therapeutic strategies; medicolegal protection, representing a reference for prospective and retrospective audits); healthcare systems (standardising care, improving efficacy of care; optimising costs). Personal experience in systematic development of emergency pediatric guidelines, applied in a second level Emergency Department is also presented.

  7. The culture of patient safety from the perspective of the pediatric emergency nursing team

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    Taise Rocha Macedo

    Full Text Available Abstract OBJECTIVE To identify the patient safety culture in pediatric emergencies from the perspective of the nursing team. METHOD A quantitative, cross-sectional survey research study with a sample composed of 75 professionals of the nursing team. Data was collected between September and November 2014 in three Pediatric Emergency units by applying the Hospital Survey on Patient Safety Culture instrument. Data were submitted to descriptive analysis. RESULTS Strong areas for patient safety were not found, with areas identified having potential being: Expectations and actions from supervisors/management to promote patient safety and teamwork. Areas identified as critical were: Non-punitive response to error and support from hospital management for patient safety. The study found a gap between the safety culture and pediatric emergencies, but it found possibilities of transformation that will contribute to the safety of pediatric patients. CONCLUSION Nursing professionals need to become protagonists in the process of replacing the current paradigm for a culture focused on safety. The replication of this study in other institutions is suggested in order to improve the current health care scenario.

  8. Clinical analysis of pediatric patients who visited Masan Samsung Emergency Center

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    Jae Wook Yoo


    Full Text Available Purpose : Through a clinical and retrospective analysis of pediatric patients who visited the Regional Emergency Medical Center of Masan Samsung Hospital from January 2007 to December 2008, we characterized pediatric and adolescent emergency patients to improve emergency care in future. Methods : We reviewed the medical records of 14,065 pediatric patients below 19 years of age. Results : The male to female ratio was 1.5:1, and the most common age group was less than 3 years (49.6%. The peak month was May (10.0%, the peak day of the week was Sunday (24.7%, and the peak time of day was 20:00&#8211;20:59 (8.5%. There was no difference in the number of visits per day based on weather (sunny, rain [below 10 mm per day], snow, and fog or daily temperature difference; however, visits increased on sandy, dusty days and decreased on rainy days with more than 10 mm of rain per day. Based on the international classification of disease (ICD-10 system, the most common disease code was code R (symptoms, sign, and abnormal clinical laboratory finding (31.5%, and the most common symptom was fever (13.1%. Final outcomes were discharged (73.8%, admitted (25.7%, transferred (0.4%, and expired (0.1%. In adolescent patients aged 15&#8211;19 years, the most common disease code was Injury & Poisoning (code S&T, 36.9%; the most common symptom was abdominal pain (9.6%. Conclusion : Pediatric patients visiting the emergency center were most likely to be male and under 3 years of age and to visit between 20:00 and 21:00 on Sundays and in May, and the most common symptom was fever. Differences between adolescents and pediatric patients showed that adolescents had a higher visiting rate with abdominal pain and a larger temperature difference.

  9. 儿童牙科急症的分析%Emergency analysis in pediatric dentistry

    Institute of Scientific and Technical Information of China (English)

    黄群; 钱虹; 东耀峻


    Objective To assess emergency in pediatric dentistry. Methods Toinvestigate the incidence and classification of pediatric dental emergencies. Results The nature of emergency was different in patients'sex and age groups.But there was no significant relationship between seasonal change and the nature.The most usual position of trauma lies on lips. Conclusion The nature of pediatric emergency shows significant difference in age and sex.%目的 对儿童牙科急症的发生率、发生类型等进行分析。方法 对970例儿童牙科急症患儿记录年龄、性别、急症发生部位、时间、类型,并对调查结果进行统计分析。结果 儿童急症性质存在性别、年龄方面的差异,与季节无显著关系。暴露部位最易受创伤,非创伤急症以根尖周病为多。结论 儿童牙科急症的性质存在明显的年龄和性别差异。

  10. Development and assessment of a pediatric emergency medicine simulation and skills rotation: meeting the demands of a large pediatric clerkship

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    Elaine K. Fielder


    Full Text Available Objective: To implement a curriculum using simulation and skills training to augment a Pediatric Emergency Medicine (PEM rotation within a pediatric clerkship. Background: PEM faculty are often challenged with a high learner to teacher ratio in a chaotic clinical setting. This challenge was heightened when our pediatric clerkship's traditional 1-week PEM rotation (consisting of 4 students completing four 8-hour ED shifts/week expanded to 8 students every 2 weeks. We sought to meet this challenge by integrating simulation-based education into the rotation. Methods: Clerkship students from March to June 2012 completed our traditional rotation. Students between July and October 2012 completed the new PEM-SIM curriculum with 19 hours ED shifts/week and 16 hours/week of simulation/skills training. Pre/post-tests evaluated 1 medical management/procedural comfort (five-point Likert scale; and 2 PEM knowledge (15 multiple-choice questions. Results: One hundred and nine students completed the study (48 traditional, 61 PEM-SIM. Improvement in comfort was significantly higher for the PEM-SIM group than the traditional group for 6 of 8 (75% medical management items (p<0.05 and 3 of 7 (43% procedures, including fracture splinting, lumbar puncture, and abscess incision/drainage (p<0.05. PEM-SIM students had significantly more improvement in mean knowledge compared to the traditional group (p<0.001. Conclusions: We have successfully integrated 16 hours/week of faculty-facilitated simulation-based education into a PEM rotation within our clerkship. This curriculum is beneficial in clinical settings with high learner to teacher ratios and when patient care experiences alone are insufficient for all students to meet rotation objectives.

  11. Syncope In Pediatric Patients: A Practical Approach To Differential Diagnosis And Management In The Emergency Department. (United States)

    Fant, Collen; Cohen, Arl


    Syncope is a condition that is often seen in the emergency department. Most syncope is benign, but it can be a symptom of a life-threatening condition. While syncope often requires an extensive workup in adults, in the pediatric population, critical questioning and simple, noninvasive testing is usually sufficient to exclude significant or life-threatening causes. For low-risk patients, resource-intensive workups are rarely diagnostic, and add significant cost to medical care. This issue will highlight critical diseases that cause syncope, identify high-risk "red flags," and enable the emergency clinician to develop a cost-effective, minimally invasive algorithm for the diagnosis and treatment of pediatric syncope.

  12. Pain management policies and practices in pediatric emergency care: a nationwide survey of Italian hospitals


    Ferrante, Pierpaolo; Cuttini, Marina; Zangardi, Tiziana; Tomasello, Caterina; Messi, Gianni; Pirozzi, Nicola; Losacco, Valentina; Piga, Simone; Benini, Franca


    Background Pain experienced by children in emergency departments (EDs) is often poorly assessed and treated. Although local protocols and strategies are important to ensure appropriate staff behaviours, few studies have focussed on pain management policies at hospital or department level. This study aimed at describing the policies and reported practices of pain assessment and treatment in a national sample of Italian pediatric EDs, and identifying the assocoated structural and organisational...

  13. Residents need focused teaching during pediatric emergency medicine rotation to optimize their educational objectives

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    Mohammed Alomar


    Full Text Available Pediatric Emergency Medicine (PEM rotation provides a unique training environment for rotating residents. We aim to assess the impact of PEM rotation on the scientific knowledge of residents from different specialties and training centers by comparing the pre- and post-rotation knowledge. PEM Departments of three major tertiary care training centers were selected. Rotating pediatric and emergency medicine residents were given pre-test with twenty multiple-choice type questions related to the scientific knowledge of PEM and then re-tested with the same questions towards the end of their rotation. The t-test was used to compare mean scores. Further comparison based on specialty and training center was also done. Seventy-three residents were approached and enrolled, 48 from Pediatrics and 25 from Emergency Medicine. The mean pre- and post-scores for all residents were 15.9/20 and 15.5/20, respectively. All residents’ score was less on the post-rotation compared to the pre-rotation in all centers. Pediatric residents at one center scored higher, but they were not statistically significant. There were no statistically significant differences in resident specialty. We found a statistical difference between the residents of two centers compared to the third with P=0.04 and 0.02 respectively. After one month of rotation in PEM, we observed a decrease in the post-rotation test scores as compared to the pre-rotation scores. Since the reasons for the lower scores could not be identified by this study, educational deficiencies should be identified and perhaps a focused teaching and allotted study time to optimize the residents educational objective could be advised.

  14. Caudal block and emergence delirium in pediatric patients: Is it analgesia or sedation?

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    Aparna Sinha


    Full Text Available Background: Emergence delirium (ED although a short-lived and self-limiting phenomenon, makes a child prone to injury in the immediate postoperative period and hence is a cause of concern not only to the pediatric anesthesiologist, surgeons, and post anesthesia care unit staff but also amongst parents. Additional medication to quieten the child offsets the potential benefits of rapid emergence and delays recovery in day care settings. There is conflicting evidence of influence of analgesia and sedation following anesthesia on emergence agitation. We hypothesized that an anesthetic technique which improves analgesia and prolongs emergence time will reduce the incidence of ED. We selected ketamine as adjuvant to caudal block for this purpose. Methods: This randomized, double blind prospective study was performed in 150 premedicated children ASA I, II, aged 2 to 8 years who were randomly assigned to either group B (caudal with bupivacaine, BK (bupivacaine and ketamine, or NC (no caudal, soon after LMA placement. Recovery characteristics and complications were recorded. Results: Emergence time, duration of pain relief, and Pediatric Anesthesia Emergence Delirium (PAED scores were significantly higher in the NC group (P<0.05. Duration of analgesia and emergence time were significantly more in group BK than groups B and NC. However, the discharge readiness was comparable between all groups. No patient in BK group required to be given any medication to treat ED. Conclusion: Emergence time as well as duration of analgesia have significant influence on incidence of emergence delirium. Ketamine, as caudal adjuvant is a promising agent to protect against ED in children, following sevoflurane anesthesia.

  15. Pediatric head trauma: the evidence regarding indications for emergent neuroimaging

    Energy Technology Data Exchange (ETDEWEB)

    Kuppermann, Nathan [UC Davis Medical Center, Department of Emergency Medicine, Sacramento, CA (United States); University of California, Davis School of Medicine, Departments of Emergency Medicine and Pediatrics, Davis, CA (United States)


    Traumatic brain injury (TBI) is a leading cause of childhood death and disability worldwide. In the United States, childhood head trauma results in approximately 3,000 deaths, 50,000 hospitalizations, and 650,000 emergency department (ED) visits annually. Children presenting to the ED with seemingly minor head trauma account for approximately one-half of children with documented TBIs. Despite the frequency and importance of childhood minor head trauma, there exists no highly accurate, reliable and validated clinical scoring system or prediction rule for assessing risk of TBI among those with minor head trauma. At the same time, use of CT scanning in these children in recent years has increased substantially. The major benefit of CT scanning is early identification (and treatment) of TBIs that might otherwise be missed and result in increased risk of morbidity and mortality. Unnecessary CT imaging, however, exposes the child needlessly to the risk of radiation-induced malignancies. What constitutes appropriate criteria for obtaining CT scans in children after minor blunt head trauma remains controversial. Current evidence to guide clinicians in this regard is limited; however, large studies performed in multi-center research networks have recently been conducted. These studies should provide the foundation of evidence to guide CT decisions by clinicians, help identify TBIs in a timely fashion, and reduce unnecessary radiation exposure. (orig.)

  16. Triage in pediatric emergency department%规范儿科急诊预检与分诊

    Institute of Scientific and Technical Information of China (English)

    李璧如; 王莹


    分析儿科急诊预检分诊的国内外现状,阐述急诊预检分诊的目的及正确实施预检分诊在急诊医疗服务中的重要性,提出对儿科急诊预检分诊的建议和设想.%In the review,we analyzed the status of triage in pediatric emergency both at home and abroad,stated the importance of the correct implementation of emergency triage in the emergency medical services,and maked recommendations for pediatric emergency triage.

  17. Pediatric cervical spine in emergency: radiographic features of normal anatomy, variants and pitfalls

    Energy Technology Data Exchange (ETDEWEB)

    Adib, Omar; Berthier, Emeline; Loisel, Didier; Aube, Christophe [University Hospital of Angers, Department of Radiology, Angers (France)


    Injuries of the cervical spine are uncommon in children. The distribution of injuries, when they do occur, differs according to age. Young children aged less than 8 years usually have upper cervical injuries because of the anatomic and biomechanical properties of their immature spine, whereas older children, whose biomechanics more closely resemble those of adults, are prone to lower cervical injuries. In all cases, the pediatric cervical spine has distinct radiographic features, making the emergency radiological analysis of it difficult. Such features as hypermobility between C2 and C3, pseudospread of the atlas on the axis, pseudosubluxation, the absence of lordosis, anterior wedging of vertebral bodies, pseudowidening of prevertebral soft tissue and incomplete ossification of synchondrosis can be mistaken for traumatic injuries. The interpretation of a plain radiograph of the pediatric cervical spine following trauma must take into account the age of the child, the location of the injury and the mechanism of trauma. Comprehensive knowledge of the specific anatomy and biomechanics of the childhood spine is essential for the diagnosis of suspected cervical spine injury. With it, the physician can, on one hand, differentiate normal physes or synchondroses from pathological fractures or ligamentous disruptions and, on the other, identify any possible congenital anomalies that may also be mistaken for injury. Thus, in the present work, we discuss normal radiological features of the pediatric cervical spine, variants that may be encountered and pitfalls that must be avoided when interpreting plain radiographs taken in an emergency setting following trauma. (orig.)

  18. How Much are Emergency Medicine Specialists’ Decisions Reliable in the Diagnosis and Treatment of Pediatric Fractures?

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    Mohsen Mardani-Kivi


    Full Text Available Background: Considering the importance of an early diagnosis and proper decision-making in regards to the treatment of pediatric distal radius and elbow fractures, this study examines emergency medicine specialists’ accuracy in the diagnosis and treatment of these patients. Methods: From 2012 and 2013, children less than 14 years old who were referred to an academic hospital emergency department with elbow or distal radius fractures were enrolled. Initially, patients were examined by an emergency medicine specialist and then they were referred to an orthopedic surgeon. Type of fracture and the proposed treatment of two specialists were compared. Results: In total, there were 108 patients (54 patients in each group with a mean age of 8.1+3.3 years. Identical diagnosis in 48 cases (88.9% of distal radius and 36 cases (66.7% of elbow trauma were observed. We found a difference between diagnosis of the two specialists in diagnosing lateral condyle of the humerus fracture in the elbow group and growth plate fracture in the distal radius fracture group, but the differences were not significant. Among 108 patients, 70 patients (64.8% received identical treatment. Conclusion: Although the emergency medicine specialists responded similarly to the orthopedic specialists in the diagnosis of pediatric distal radius and elbow fractures, diagnosis of more complicated fractures such as lateral condylar humoral fractures, distal radius growth plate and for choosing the proper treatment option, merits further education.

  19. Trends in CT Request and Related Outcomes in a Pediatric Emergency Department (United States)

    Islam, S.M. Saiful; Abru, Amir Fattah; Al Obaidani, Saeed; Shabibi, Saud Al; Al Farsi, Sami


    Objectives To study and to establish the overall trends of computed tomography (CT) use and associated outcomes in the pediatric emergency department (PED) at Royal Hospital, Oman, from 2010 to 2014. Methods The hospital electronic medical record was retrospectively searched to find children (from birth to 12 years old) who had visited the PED and the number of CT requests between 1 January 2010 and 31 December 2014. The types of CT examinations ordered were analyzed according to anatomical location and were as follows; head, abdomen/pelvis, chest, cervical spine/neck, and others. Results There were a total of 67 244 PED visits during the study period, 569 of which received 642 CT scans. There was a remarkable rise in CT uses per 1000 visits from 7 in 2010 to 12 in 2014. There was a 56% hike in CT requests from 87 in 2010 to 175 in 2014 while the number of pediatric emergency visits rose by about 28% from 11 721 to 15 052. Although head CT scans were the most common, cervical spine CT scans had the highest rate of increase (600%) followed by the chest (112%), head (54%) and abdomen (13%). There were no significant changes in other CT scan requests. The cost of CT scans increased from $18 096 to $36 400 during the study period, which increased the average PED cost by about $2 per visit. The average time between a CT being requested and then performed was 1.24 hours. Conclusions CT use in the pediatric emergency department has risen significantly at a rate that markedly exceeds the growth of emergency visits. This is associated with an increase in PED costs and longer waiting times. PMID:27602191

  20. Trends in CT Request and Related Outcomes in a Pediatric Emergency Department

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    S.M. Saiful Islam


    Full Text Available Objectives: To study and to establish the overall trends of computed tomography (CT use and associated outcomes in the pediatric emergency department (PED at Royal Hospital, Oman, from 2010 to 2014. Methods: The hospital electronic medical record was retrospectively searched to find children (from birth to 12 years old who had visited the PED and the number of CT requests between 1 January 2010 and 31 December 2014. The types of CT examinations ordered were analyzed according to anatomical location and were as follows; head, abdomen/pelvis, chest, cervical spine/neck, and others. Results: There were a total of 67 244 PED visits during the study period, 569 of which received 642 CT scans. There was a remarkable rise in CT uses per 1000 visits from 7 in 2010 to 12 in 2014. There was a 56% hike in CT requests from 87 in 2010 to 175 in 2014 while the number of pediatric emergency visits rose by about 28% from 11 721 to 15 052. Although head CT scans were the most common, cervical spine CT scans had the highest rate of increase (600% followed by the chest (112%, head (54% and abdomen (13%. There were no significant changes in other CT scan requests. The cost of CT scans increased from $18 096 to $36 400 during the study period, which increased the average PED cost by about $2 per visit. The average time between a CT being requested and then performed was 1.24 hours. Conclusions: CT use in the pediatric emergency department has risen significantly at a rate that markedly exceeds the growth of emergency visits. This is associated with an increase in PED costs and longer waiting times.

  1. Point-of-care sonographic detection of intestinal ascaris lumbricoides in the pediatric emergency department. (United States)

    Kessler, David O; Gurwitz, Avrahom; Tsung, James W


    Point-of-care ultrasound use is rapidly growing in acute-care settings such as pediatric emergency departments, and new applications are continually being explored. This is especially true in the developing world where the World Health Organization estimates that 75% of people have no access to any imaging or availability of more costly imaging technology may be limited (Essential Health Technologies Strategy 2004-2007). We report a case of intestinal roundworm infection in a 3-year-old boy and describe the ultrasound findings of Ascaris lumbricoides.

  2. Trends of CT Use in the Pediatric Emergency Department in a Tertiary Academic Hospital of Korea during 2001-2010



    Objective We wanted to assess the trends of computed tomography (CT) examinations in a pediatric emergency department (ED). Materials and Methods We searched the medical database to identify the pediatric patients who had visited the ED, and the number of CTs conducted from January 2001 to December 2010. We analyzed the types of CTs, according to the anatomic region, and the patients who underwent CT examinations for multiple regions. Data were stratified, according to the patient age (< 13 y...

  3. English Language Learners in Canadian Schools: Emerging Directions for School-Based Policies (United States)

    Cummins, Jim; Mirza, Rania; Stille, Saskia


    This article attempts to provide ESL teachers, school administrators, and policymakers with a concise overview of what matters in promoting academic success among learners of English in Canadian schools. We review research focused on bilingual and biliteracy development, the nature of academic language, and the roles of societal power relations…

  4. Process Mapping in a Pediatric Emergency Department to Minimize Missed Urinary Tract Infections (United States)

    Singh, Valene; Belostotsky, Vladimir; Roy, Madan; Yamamura, Deborah; Gambarotto, Kathryn; Lau, Keith


    Urinary tract infections (UTIs) are common in young children and are seen in emergency departments (EDs) frequently. Left untreated, UTIs can lead to more severe conditions. Our goal was to undertake a quality improvement (QI) initiative to help minimize the number of children with missed UTIs in a newly established tertiary care pediatric emergency department (PED). A retrospective chart review was undertaken to identify missed UTIs in children < 3 years old who presented to a children's hospital's ED with positive urine cultures. It was found that there was no treatment or follow-up in 12% of positive urine cultures, indicating a missed or possible missed UTI in a significant number of children. Key stakeholders were then gathered and process mapping (PM) was completed, where gaps and barriers were identified and interventions were subsequently implemented. A follow-up chart review was completed to assess the impact of PM in reducing the number of missed UTIs. Following PM and its implementation within the ED, there was no treatment or follow-up in only 1% of cases. Based on our results, the number of potentially missed UTIs in the ED decreased dramatically, indicating that PM can be a successful QI tool in an acute care pediatric setting. PMID:27974897

  5. Multi-agent Architecture for the Multi-Skill Tasks Modeling at the Pediatric Emergency Department. (United States)

    Ajmi, Ines; Zgaya, Hayfa; Hammadi, Slim; Gammoudi, Lotfi; Martinot, Alain; Beuscart, Régis; Renard, Jean-Marie


    Patient journey in the Pediatric Emergency Department is a highly complex process. Current approaches for modeling are insufficient because they either focus only on the single ancillary units, or therefore do not consider the entire treatment process of the patients, or they do not account for the dynamics of the patient journey modeling. Therefore, we propose an agent based approach in which patients and emergency department human resources are represented as autonomous agents who are able to react flexible to changes and disturbances through pro-activeness and reactiveness. The main aim of this paper is to present the overall design of the proposed multi-agent system, emphasizing its architecture and the behavior of each agent of the model. Besides, we describe inter-agent communication based on the agent interaction protocol to ensure cooperation between agents when they perform the coordination of tasks for the users. This work is integrated into the ANR HOST project (ANR-11-TecSan-010).

  6. Dental emergencies in a university-based pediatric dentistry postgraduate outpatient clinic: a retrospective study. (United States)

    Agostini, F G; Flaitz, C M; Hicks, M J


    The purpose of this retrospective study was to determine the prevalence and types of dental emergencies occurring in a university-based, pediatric dentistry postgraduate outpatient clinic. All patients presenting for emergency dental care during scheduled clinic hours over a three year were identified, and their charts were retrieved. Each record was reviewed for demographic information, chief complaint and clinical diagnosis. Only those charts with both chief complaints and clinical diagnoses recorded were included in this study. A total of 816 patients received emergency care, representing 15.3 percent of all patient treated during the study period. The patient population had a slight female predilection (53 percent female, 47 percent male) and a mean age of 5.1 years (range 10 days to 15 years). Ethnicity (39 percent African-American, 36 percent Hispanic, 24 percent Caucasian emergency visit was their first dental visit. Reasons for seeking emergency included 1) pain or discomfort due to caries [30.1 percent] with 27 percent due to early childhood caries; 2) dental trauma [23 percent];3) eruption difficulties [18 percent] with 27 percent due to early childhood caries; 2) dental trauma [23 percent];3 eruption difficulties [18 percent];4) soft tissue pathoses [16 percent]; 5) problems with orthodontic appliances or space maintainers [10 percent]; and 6) lost restorations [2 percent]. Pain and bleeding were the most common reasons for seeking emergency dental care. Most causes for seeking outpatient emergency dental care are disease processes which may be avoided by infant oral health and preventive dentistry programs and early treatment intervention.

  7. Improvements in Pain Outcomes in a Canadian Pediatric Teaching Hospital Following Implementation of a Multifaceted, Knowledge Translation Initiative

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    Lisa M Zhu


    Full Text Available BACKGROUND: A previous audit performed at a tertiary/quaternary pediatric hospital in Toronto, Ontario, demonstrated suboptimal assessment and treatment of children’s pain. Knowledge translation (KT initiatives (education, reminders, audit and feedback were implemented to address identified care gaps; however, the impact is unknown.

  8. Pediatric martial arts injuries presenting to Emergency Departments, United States 1990-2003. (United States)

    Yard, Ellen E; Knox, Christy L; Smith, Gary A; Comstock, R Dawn


    Although an estimated 6.5 million United States (US) children aged 6-17 practiced a martial art in 2004, there have been no nationally representative studies comparing pediatric injuries among the three most popular disciplines, karate, taekwondo, and judo. Describe pediatric martial arts injuries presenting to a representative sample of US Emergency Departments (EDs) from 1990 to 2003. We reviewed all martial arts injuries captured by the US Consumer Product Safety Commission's (CPSC), National Electronic Injury Surveillance System (NEISS). An estimated 128,400 children martial arts-related injuries from 1990 to 2003. Injured tended to be male (73.0%) and had a mean age of 12.1 years. Most injuries were attributed to karate (79.5%). The most common mechanism of injury was being kicked (25.6%), followed by falling (20.6%) and kicking (18.0%). The majority of injuries occurred to the lower leg/foot/ankle (30.1%) and hand/wrist (24.5%). The most common injury diagnoses were sprains/strains (29.3%), contusions/abrasions (27.8%), and fractures (24.6%). Participants in judo sustained significantly higher proportions of shoulder/upper arm injuries than karate (IPR=4.31, 95% CI: 2.84-6.55) or taekwondo (IPR=9.75, 95% CI: 3.53-26.91) participants. There were also higher proportions of neck injuries sustained by judo participants compared to karate (IPR=4.73, 95% CI: 1.91-11.70) or taekwondo (IPR=4.17, 95% CI: 1.02-17.06) participants. Pediatric martial arts injuries differ by discipline. Understanding these injury patterns can assist with the development of discipline-specific preventive interventions.

  9. Pediatric volleyball-related injuries treated in US emergency departments, 1990-2009. (United States)

    Pollard, Katherine A; Shields, Brenda J; Smith, Gary A


    This study describes the epidemiology of pediatric volleyball-related injuries treated in US hospital emergency departments. Data for children younger than 18 years obtained from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission from 1990 through 2009 were analyzed. An estimated 692 024 volleyball-related injuries to children younger than 18 years occurred during the study period. The annual number of injuries declined significantly by 23% during the study period; however, the annual injury rate remained unchanged, and the number of volleyball-related concussions/closed head injuries increased significantly. Upper (48%) and lower (39%) extremity injuries occurred most frequently, as did strains/sprains (54%). Contact with the net/pole was associated with concussions/closed head injury our findings indicate opportunities for making volleyball an even safer sport for children. Protective padding, complying with US volleyball standards, should cover all volleyball poles and protruding hardware to prevent impact-related injuries.

  10. Comparison of two analgesia protocols for the treatment of pediatric orthopedic emergencies

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    Andrea Barcelos


    Full Text Available SummaryObjective:to compare the efficacy of two analgesia protocols (ketamine versus morphine associated with midazolam for the reduction of dislocations or closed fractures in children.Methods:randomized clinical trial comparing morphine (0.1mg/kg; max 5mg and ketamine (2.0mg/kg, max 70mg associated with midazolam (0.2mg/kg; max 10mg in the reduction of dislocations or closed fractures in children treated at the pediatrics emergency room (October 2010 and September 2011. The groups were compared in terms of the times to perform the procedures, analgesia, parent satisfaction and orthopedic team.Results:13 patients were allocated to ketamine and 12 to morphine, without differences in relation to age, weight, gender, type of injury, and pain scale before the intervention. There was no failure in any of the groups, no differences in time to start the intervention and overall procedure time. The average hospital stay time was similar (ketamine = 10.8+5.1h versus morphine = 12.3+4.4hs; p=0.447. The median pain (faces pain scale scores after the procedure was 2 in both groups. Amnesia was noted in 92.3% (ketamine and 83.3% (morphine (p=0.904. Parents said they were very satisfied in relation to the analgesic intervention (84.6% in the ketamine group and 66.6% in the morphine group; p=0.296. The satisfaction of the orthopedist regarding the intervention was 92.3% in the ketamine group and 75% in the morphine group (p=0.222.Conclusion:by producing results similar to morphine, ketamine can be considered as an excellent option in pain management and helps in the reduction of dislocations and closed fractures in pediatric emergency rooms.

  11. Efficacy of patient discharge instructions: A pointer toward caregiver friendly communication methods from pediatric emergency personnel

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    Nesrin Al-Harthy


    Full Text Available Background: Discharge instructions are vital in postemergency patient care to help the caregiver understand the diagnosis and identify symptoms which require prompt readmission. In general, oral or written instructions are provided on discharge. However, there is a dearth of information on the efficacy of discharge instructions provided by physicians in KSA. Objectives: To evaluate the efficacy of discharge instructions for postpediatrics emergency visit. Materials and Methods: This observational cross-sectional survey conducted in the Department of Paediatric Emergency at King Abdul Aziz Medical City, Riyadh, KSA, included 173 literate adult caregivers who had given their consent. Those who had been on admission earlier and been discharged from the emergency department were excluded. Demographic data and variables like knowledge of medicine and treatment follow-up were collected using a structured questionnaire and analyzed using SPSS version 16. Results: Verbal only, written only, or both verbal and written discharge instructions were provided. Written and verbal instructions, when provided together, were the most effective modes of communication with caregivers. The majority of the respondents were unaware of the follow-up plan (64.16%, unable to identify problems that would necessitate a follow-up (58.96%, and unable to identify the signs and symptoms that would require a revisit (62.43% irrespective of the mode of instruction. However, more attention is necessary because of the 34.68% of the subjects who left the hospital without discharge instructions. Conclusions: Instructions given both verbally and in writing were observed to be more effective than verbal only or written only. The effectiveness of discharge instructions was highly influenced by the level of education of the caregivers. Improved caregiver friendly methods of communication from the pediatric emergency health-care team are necessary for the delivery of discharge

  12. Creation and Assessment of a Bad News Delivery Simulation Curriculum for Pediatric Emergency Medicine Fellows. (United States)

    Chumpitazi, Corrie E; Rees, Chris A; Chumpitazi, Bruno P; Hsu, Deborah C; Doughty, Cara B; Lorin, Martin I


    Background  Bad news in the context of health care has been broadly defined as significant information that negatively alters people's perceptions of the present or future. Effectively delivering bad news (DBN) in the setting of the emergency department requires excellent communication skills. Evidence shows that bad news is frequently given inadequately. Studies show that trainees need to devote more time to developing this skill through formalized training. This program's objectives were to utilize trained standardized patients in a simulation setting to assist pediatric emergency medicine (PEM) fellows in the development of effective, sensitive, and compassionate communication with patients and family members when conveying bad news, and to recognize and respond to the patient/parent's reaction to such news. Methods PEM fellows participated in a novel curriculum utilizing simulated patients (SPs) acting as the patient's parent and immersive techniques in a realistic and supportive environment. A baseline survey was conducted to ascertain participant demographics and previous experience with simulation and DBN. Experienced, multi-disciplinary faculty participated in a training workshop with the SPs one week prior to course delivery. Three scenarios were developed for bad news delivery. Instructors watched via remote video feed while the fellows individually interacted with the SPs and then participated in a confidential debriefing. Fellows later joined for group debriefing. Fellow characteristics, experience, and self-perceived comfort pre/post-course were collected.   Results Baseline data demonstrated that 78% of fellows reported DBN two or more times per month. Ninety-three percent of fellows in this study were present during the delivery of news about the death of a child to a parent or family member in the six-month period preceding this course. Fellows' self-reported comfort level in DBN to a patient/family and dealing with patient and parent emotions

  13. Suicidality and hospitalization as cause and outcome of pediatric psychiatric emergency room visits. (United States)

    Grudnikoff, Eugene; Soto, Erin Callahan; Frederickson, Anne; Birnbaum, Michael L; Saito, Ema; Dicker, Robert; Kane, John M; Correll, Christoph U


    The aim of this study was to identify predictors of suicidality in youth presenting to a pediatric psychiatric emergency room service (PPERS). To this end, we conducted a retrospective cohort study of youth aged PPERS 01.01.2002-12.31.2002, using a 12-page semi-structured institutional evaluation form and the Columbia Classification Algorithm for Suicide Assessment. Multivariate regression analyses were conducted to identify correlates of suicidal thoughts and attempts/preparation and their relationship to outpatient/inpatient disposition. Of 1,062 youth, 265 (25.0%) presented with suicidal ideation (16.2%) or attempt/preparation (8.8%). Suicidal ideation was associated with female sex, depression, adjustment disorder, absent referral by family/friend/self, school referral, precipitant of peer conflict, and no antipsychotic treatment (p PPERS evaluations. Higher GAF score and school referral distinguished suicidal ideation from suicidal attempt/preparation and was associated with outpatient disposition in both presentations. Increased education of referral sources and establishment of different non-PPERS evaluation systems may improve identification of non-emergent suicidal presentations and encourage more appropriate outpatient referrals.

  14. Parental preference for short- versus long-course corticosteroid therapy in children with asthma presenting to the pediatric emergency department. (United States)

    Williams, Kelli W; Andrews, Annie L; Heine, Daniel; Russell, W Scott; Titus, M Olivia


    Asthma is the most common chronic condition affecting children and a prominent chief complaint in pediatric emergency departments (ED). We aimed to determine parental preference between short- and long-term courses of oral corticosteroids for use in children with mild to moderate asthma presenting to our pediatric ED with acute asthma exacerbations. We surveyed parents of asthmatic children who presented to our pediatric ED from August 2011 to April 2012. Questions characterized each patient's asthma severity, assessed parental preference among systemic steroid and inhaled medication delivery options for acute asthma management, and inquired about compliance, medication costs, and intention to follow up. The majority of our parents prefer the use of 1 to 2 days of steroids to 5 days for acute asthma exacerbations in the ED. Thus, dexamethasone is an attractive alternative to prednisone/prednisolone and should be considered in the management of acute asthma exacerbations in the ED.

  15. Hospital-based inter-professional strategy to reduce in-patient admissions and emergency department visits for pediatric asthma. (United States)

    Fleming, Karen; Kuzik, Brian; Chen, Chee


    Pediatric asthma is a common reason for emergency department (ED) visits and in-patient hospital admissions. Evidence demonstrates that asthma management initiated in the ED has limited benefit unless followed by ongoing coordinated inter-professional care (IPC). The Royal Victoria Hospital (RVH) of Barrie, Ontario, has developed a best practice model of care for pediatric asthma. Primary care providers and ED physicians are actively encouraged to refer children with any recurrent respiratory problems consistent with asthma to the Paediatric Asthma Clinic (PAC). Quarterly PAC visits with a certified asthma educator and a pediatrician include lung function measurement, written action plans and primary care provider communication. Ongoing outcome monitoring of patients receiving IPC has revealed that, compared with 12 months prior to enrolment in the PAC, patients show a two-thirds decrease in asthma-related ED visits and an 85% decrease in admissions. The PAC has contributed to an ongoing decline in the rates of pediatric asthma-related ED visits and admissions at RVH, which are currently less than half the rates seen at our peer hospitals. IPC for chronic diseases is best practice, and our model of care for pediatric asthma continues to provide critical data demonstrating and supporting the advantages of IPC in chronic disease management. RVH modifies practice and policy to meet best practices, optimizing the care provided to children with pediatric asthma.

  16. Nonurgent Use of the Emergency Department by Pediatric Patients: A Theory-Guided Approach for Primary and Acute Care Pediatric Nurse Practitioners. (United States)

    Ohns, Mary Jean; Oliver-McNeil, Sandra; Nantais-Smith, Leanne M; George, Nancy M


    Providing quality, cost-effective care to children and their families in the appropriate setting is the goal of nurse practitioners in primary and acute care. However, increased utilization of the emergency department (ED) for nonurgent care threatens cost-effective quality care, interrupts continuity of care, and contributes to ED overcrowding. To date, descriptive research has identified demographics of those using the ED for nonurgent care, the chief complaints of children seeking nonurgent care, the cost to the health care system of pediatric nonurgent care, and characteristics of associated primary care settings. Using Donabedian's Model of Quality of Healthcare and a Theory of Dependent Care by Taylor and colleagues, acute and primary care pediatric nurse practitioners can incorporate interventions that will channel care to the appropriate setting and educate caregivers regarding common childhood illnesses and the value of continuity of care. By using a theoretical framework as a guide, this article will help both acute and primary care pediatric nurse practitioners understand why parents seek nonurgent care for their children in the ED and actions they can take to ensure that care is provided in an optimal setting.

  17. Are Pediatric Emergency Care Applied Research Network Rules (PECARN Sufficient for Computed Cranial Tomography Decision in Pediatric Patients with Mild Head Trauma?

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    Hasan Mansur Durgun


    Full Text Available Objective: In this study we aimed to investigate the ap­plicability of Pediatric Emergency Care Applied Research Network (PECARN rules for decision to perform computed cranial tomography (CCT in pediatric patients with minor head trauma (MHT. Methods: 317 pediatric patients who underwent CCT for mild head trauma were evaluated retrospectively. The pa­tients were classified in two groups according to PECARN rules: below 2 years old, above 2 years old and then, these patient groups were classified into two subgroups accord­ing to the compatibility with PECARN rules. The patients re­quiring CCT according to PECARN rules were classified as PECARN compatible (PECARN +, the patients who under­went CCT without the need of CCT according to PECARN were classified as PECARN incompatible (PECARN -. Results: Approximately 20% patients in PECARN (+ group had abnormalities leading to prolonged hospitalization and only 3.8% patients of PECARN (- group had abnormali­ties. However, none of PECARN (- group patients required follow-up longer than 48 hours in the hospital. The most common symptoms necessitate CCT in PECARN (+ group were scalp swelling, scalp hematoma and vomiting. In PE­CARN (- group the most common signs were cuts in the scalp and dermal abrasions. The incidence of fracture in CCT was significantly higher in PECARN (+ group. Conclusion: Because CCT poses serious radiation expo­sure, neurological examination and clinical follow-up should be preferred in the evaluation of children with MHT. In con­clusion, PECARN rules were sufficient for CCT decision in pediatric patients with MHT. J Clin Exp Invest 2016; 7 (1: 35-40

  18. A matched-pair cluster design study protocol to evaluate implementation of the Canadian C-spine rule in hospital emergency departments: Phase III

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    Rowe Brian H


    Full Text Available Abstract Background Physicians in Canadian emergency departments (EDs annually treat 185,000 alert and stable trauma victims who are at risk for cervical spine (C-spine injury. However, only 0.9% of these patients have suffered a cervical spine fracture. Current use of radiography is not efficient. The Canadian C-Spine Rule is designed to allow physicians to be more selective and accurate in ordering C-spine radiography, and to rapidly clear the C-spine without the need for radiography in many patients. The goal of this phase III study is to evaluate the effectiveness of an active strategy to implement the Canadian C-Spine Rule into physician practice. Specific objectives are to: 1 determine clinical impact, 2 determine sustainability, 3 evaluate performance, and 4 conduct an economic evaluation. Methods We propose a matched-pair cluster design study that compares outcomes during three consecutive 12-months "before," "after," and "decay" periods at six pairs of "intervention" and "control" sites. These 12 hospital ED sites will be stratified as "teaching" or "community" hospitals, matched according to baseline C-spine radiography ordering rates, and then allocated within each pair to either intervention or control groups. During the "after" period at the intervention sites, simple and inexpensive strategies will be employed to actively implement the Canadian C-Spine Rule. The following outcomes will be assessed: 1 measures of clinical impact, 2 performance of the Canadian C-Spine Rule, and 3 economic measures. During the 12-month "decay" period, implementation strategies will continue, allowing us to evaluate the sustainability of the effect. We estimate a sample size of 4,800 patients in each period in order to have adequate power to evaluate the main outcomes. Discussion Phase I successfully derived the Canadian C-Spine Rule and phase II confirmed the accuracy and safety of the rule, hence, the potential for physicians to improve care. What

  19. Discharge against medical advice in a pediatric emergency center in the State of Qatar

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    Hala Abdulateef


    Full Text Available Objective: The objective of this study was to analyze cases that had left the Pediatric Emergency Center Al Sadd, Doha (PEC against medical advice, with the aim of developing policies to help reduce this occurrence. Methodology: All patients that were admitted to the main PEC observation room for treatment and/or investigation and subsequently left against medical advice from February 18, 2007 to June 18, 2007, were followed by a phone call, and a questionnaire, which was completed by the departmental patient representative. Results: 99,133 patients attended the facility during the study period. Of those, 106 left the facility against medical advice. Ninety-four guardians were successfully contacted. 90% of the cases were in children below 2 years of age. In 87% of the cases the mother was the main decision maker for leaving against medical advice. Domestic obligations were the leading cause of DAMA (discharge against medical advice, reported in 45% of the cases. Respondents reported that the consequences of DAMA were well explained by medical staff before they left the facility however, they had not met with the departmental patient representative during their stay. Conclusion:As the majority of DAMA cases occurred in infants, medical staff should address the concerns of this group early on in the course of treatment. Maintaining communication and providing support, in particular for mothers of higher risk groups may help to reduce the rate of DAMA cases.

  20. The Burden of Inappropriate Emergency Department Pediatric Visits: Why Italy Needs an Urgent Reform (United States)

    Vedovetto, Alessio; Soriani, Nicola; Merlo, Emanuela; Gregori, Dario


    Objective To better understand the issue of inappropriate pediatric Emergency Department (ED) visits in Italy, including the impact of the last National Health System reform. Study Design A retrospective cohort study was conducted with five health care providers in the Veneto region (Italy) in a 2-year period (2010–2011). ED visits were considered “inappropriate” by evaluating both nursing triage and resource utilization, as addressed by the Italian Ministry of Health in 2007. Factors associated with inappropriate ED visits were identified. The cost of each visit was calculated. Principal Findings In total, 134,358 ED visits with 455,650 performed procedures were recorded in the 2-year period; of these, 76,680 (57.1 percent) were considered inappropriate ED visits. Patients likely to make inappropriate ED visits were younger, female, visiting the ED during night or holiday, when the primary care provider (PCP) is not available. Conclusion The National Health System reform aims to improve efficiency, effectiveness, and costs by opening PCP offices 24 hours a day and 7 days a week. This study highlights the need for a deep reorganization of the Italian Primary Care System not only providing a larger time availability but also treating the parents' lack of education on children's health. PMID:24495258

  1. Metabolic risk factors in pediatric stone formers: a report from an emerging economy. (United States)

    Imran, Kiran; Zafar, Mirza Naqi; Ozair, Uzma; Khan, Sadia; Rizvi, Syed Adibul Hasan


    The goal of this study was to investigate metabolic risk factors in pediatric stone formers in an emerging economy. A prospective, data collection enrolled 250 children age family history of urolithiasis was found in 41 (16.4 %), urinary tract infection in 18 (7 %) and chronic diarrhea in 75 (30 %). Hypercalcemia was seen in 37 (14.8 %), hyperuricemia in 23 (9.2 %) and hyperphosphatemia in 6 (2.4 %). Urinary metabolic abnormalities were identified in 248 (98 %) of the cases. Hypocitraturia was found in 207 (82.8 %), hyperoxaluria in 62 (26.4 %), hyperuricosuria in 82 (32.8 %), hypercalciuria in 51 (20.4 %), hyperphosphaturia in 46 (18.4 %), hyperammonuria in 10 (4 %), hypocalciuria in 82 (32.8 %), and hypovolemia in 73 (29.2 %). Risk factors were similar between genders except higher rates of hyponatriuria, hypophosphaturia, and hypocalciuria in females. Hyperuricosuria, hyponatriuria, and hypovolemia were highest in 1-5 years (52, 49, 49 %) as compared to (18, 21, 12 %) those in 11-15 years (p < 0.001), respectively. This study shows that careful metabolic analysis can identify risk factors in 98 % of the children where appropriate metaphylaxis can be undertaken both for treatment and prevention of recurrence.

  2. Alternative management of diabetic ketoacidosis in a Brazilian pediatric emergency department

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    Savoldelli Roberta D


    Full Text Available Abstract DKA is a severe metabolic derangement characterized by dehydration, loss of electrolytes, hyperglycemia, hyperketonemia, acidosis and progressive loss of consciousness that results from severe insulin deficiency combined with the effects of increased levels of counterregulatory hormones (catecholamines, glucagon, cortisol, growth hormone. The biochemical criteria for diagnosis are: blood glucose > 200 mg/dl, venous pH 3 mmol/L and presence of ketonuria. A patient with DKA must be managed in an emergency ward by an experienced staff or in an intensive care unit (ICU, in order to provide an intensive monitoring of the vital and neurological signs, and of the patient's clinical and biochemical response to treatment. DKA treatment guidelines include: restoration of circulating volume and electrolyte replacement; correction of insulin deficiency aiming at the resolution of metabolic acidosis and ketosis; reduction of risk of cerebral edema; avoidance of other complications of therapy (hypoglycemia, hypokalemia, hyperkalemia, hyperchloremic acidosis; identification and treatment of precipitating events. In Brazil, there are few pediatric ICU beds in public hospitals, so an alternative protocol was designed to abbreviate the time on intravenous infusion lines in order to facilitate DKA management in general emergency wards. The main differences between this protocol and the international guidelines are: intravenous fluid will be stopped when oral fluids are well tolerated and total deficit will be replaced orally; if potassium analysis still indicate need for replacement, it will be given orally; subcutaneous rapid-acting insulin analog is administered at 0.15 U/kg dose every 2-3 hours until resolution of metabolic acidosis; approximately 12 hours after treatment initiation, intermediate-acting (NPH insulin is initiated at the dose of 0.6-1 U/kg/day, and it will be lowered to 0.4-0.7 U/kg/day at discharge from hospital.

  3. The incidence of emergence delirium and risk factors following sevoflurane use in pediatric patients for day case surgery, Kingston, Jamaica

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    Rachel Gooden


    Full Text Available Background and objectives: Emergence delirium is a distressing complication of the use of sevoflurane for general anesthesia. This study sought to determine the incidence of emergence delirium and risk factors in patients at a specialist pediatric hospital in Kingston, Jamaica. Methods: This was a cross-sectional, observational study including pediatric patients aged 3-10 years, ASA I and II, undergoing general anesthesia with sevoflurane for elective day-case procedures. Data collected included patients' level of anxiety pre-operatively using the modified Yale Preoperative Anxiety Scale, surgery performed, anesthetic duration and analgesics administered. Postoperatively, patients were assessed for emergence delirium, defined as agitation with non-purposeful movement, restlessness or thrashing; inconsolability and unresponsiveness to nursing and/or parental presence. The need for pharmacological treatment and post-operative complications related to emergence delirium episodes were also noted. Results: One hundred and forty-five (145 children were included, with emergence delirium occurring in 28 (19.3%. Emergence delirium episodes had a mean duration of 6.9±7.8 min, required pharmacologic intervention in 19 (67.8% children and were associated with a prolonged recovery time (49.4±11.9 versus 29.7± 10.8 min for non-agitated children; p<0.001. Factors positively associated with emergence delirium included younger age (p = 0.01, OR 3.3, 95% CI 1.2-8.6 and moderate and severe anxiety prior to induction (p <0.001, OR 5.6, 95% CI 2.3-13.0. Complications of emergence delirium included intravenous line removal (n = 1, and surgical site bleeding (n = 3. Conclusion: Children of younger age with greater preoperative anxiety are at increased risk of developing emergence delirium following general anesthesia with sevoflurane. The overall incidence of emergence delirium was 19%.

  4. Prevalence and predictors of hypoxemia in acute respiratory infections presenting to pediatric emergency department

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    Singhi S


    Full Text Available Rational & Objective: Early detection of hypoxemia and oxygen therapy improves the outcome of children with acute respiratory illnesses (ARI. However, facility to measure oxygen saturation (SpO2 is not available in many health facilities of resource poor countries. We have studied prevalence of hypoxemia in children with ARI and examined value of various clinical signs to predict hypoxemia. Subjects & Methods: Consecutive children, aged 2 months - 59 months, with respiratory symptom(s attending the pediatric emergency service between Oct 2001 to December 2002 were studied. Presence or absence of cough, nasal flaring, ability to feed/drink, cyanosis, chestwall indrawing, wheeze, tachypnoea (respiratory rate >50/min in children up to 11 months and >40/min up to 59 months, crepitations on auscultation and oxygen saturation (SpO2, by Nellcore™pulse oximeter and clinical diagnosis were recorded. Results: Of 2216 children studied 266 (11.9% had hypoxemia (SpO2 £90%. It was seen in 73.8% of 126 patients with WHO defined very severe pneumonia, 25.8% of 331 patients with severe pneumonia, 11% of 146 patients with bronochiolitis and 6.5% of 338 patients with acute asthma. Most sensitive indicators of hypoxemia were chestwall indrawing (sensitivity-90%, negative predictive value -98% and crepitations (sensitivity-75%, negative predictive value 95.7% while the best positive predictive value was seen with cyanosis (71.4% and inability to feed (47.6%. Nasal flaring had the good balance of sensitivity (64%, specificity (82% and positive predictive value (33% among the signs studied. Conclusion: None of the clinical signs of respiratory distress had all the attributes of a good predictors of hypoxemia. Chest wall indrawing was the most sensitive and 'inability to feed/ drink' was the most specific indicator.

  5. The Impact of High-Profile Sexual Abuse Cases in the Media on a Pediatric Emergency Department. (United States)

    Flannery, Dustin D; Stephens, Clare L; Thompson, Amy D


    High-profile media cases of sexual abuse may encourage disclosures of abuse from victims of unrelated assaults and also influence parental concerns, leading to increased emergency department visits. In the region of the study authors' institution, there are two recent high-profile sexual abuse cases with media coverage: Earl Bradley, a Delaware pediatrician, and Jerry Sandusky, a Pennsylvania college football coach. This is a retrospective cohort study of children evaluated for sexual abuse at a pediatric emergency department. Patients were classified as either presenting during a media period or non-media period. The media periods were one-month periods immediately following breaking news reports, when the cases were highly publicized in the media. The non-media periods were the 12-month periods directly preceding the first reports. The median number of emergency department visits per month during a non-media period was 9 visits (interquartile range 6-10). There were 11 visits in the month following the Sandusky case and 13 visits following the Bradley case. There was no statistical difference in number of emergency department visits for sexual abuse between the periods (p = .09). These finding have implications regarding use of resources in pediatric EDs after high-profile sexual abuse cases.

  6. Availability of mobile phones for discharge follow-up of pediatric Emergency Department patients in western Kenya

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    Darlene R. House


    Full Text Available Objective. Mobile phones have been successfully used for Emergency Department (ED patient follow-up in developed countries. Mobile phones are widely available in developing countries and may offer a similar potential for follow-up and continued care of ED patients in low and middle-income countries. The goal of this study was to determine the percentage of families with mobile phones presenting to a pediatric ED in western Kenya and rate of response to a follow-up phone call after discharge.Methods. A prospective, cross-sectional observational study of children presenting to the emergency department of a government referral hospital in Eldoret, Kenya was performed. Documentation of mobile phone access, including phone number, was recorded. If families had access, consent was obtained and families were contacted 7 days after discharge for follow-up.Results. Of 788 families, 704 (89.3% had mobile phone access. Of those families discharged from the ED, successful follow-up was made in 83.6% of cases.Conclusions. Mobile phones are an available technology for follow-up of patients discharged from a pediatric emergency department in resource-limited western Kenya.

  7. Availability of mobile phones for discharge follow-up of pediatric Emergency Department patients in western Kenya. (United States)

    House, Darlene R; Cheptinga, Philip; Rusyniak, Daniel E


    Objective. Mobile phones have been successfully used for Emergency Department (ED) patient follow-up in developed countries. Mobile phones are widely available in developing countries and may offer a similar potential for follow-up and continued care of ED patients in low and middle-income countries. The goal of this study was to determine the percentage of families with mobile phones presenting to a pediatric ED in western Kenya and rate of response to a follow-up phone call after discharge. Methods. A prospective, cross-sectional observational study of children presenting to the emergency department of a government referral hospital in Eldoret, Kenya was performed. Documentation of mobile phone access, including phone number, was recorded. If families had access, consent was obtained and families were contacted 7 days after discharge for follow-up. Results. Of 788 families, 704 (89.3%) had mobile phone access. Of those families discharged from the ED, successful follow-up was made in 83.6% of cases. Conclusions. Mobile phones are an available technology for follow-up of patients discharged from a pediatric emergency department in resource-limited western Kenya.

  8. Availability of mobile phones for discharge follow-up of pediatric Emergency Department patients in western Kenya


    Darlene R. House; Philip Cheptinga; Rusyniak, Daniel E.


    Objective. Mobile phones have been successfully used for Emergency Department (ED) patient follow-up in developed countries. Mobile phones are widely available in developing countries and may offer a similar potential for follow-up and continued care of ED patients in low and middle-income countries. The goal of this study was to determine the percentage of families with mobile phones presenting to a pediatric ED in western Kenya and rate of response to a follow-up phone call after discharge....

  9. Pediatric emergency care capacity in a low-resource setting: An assessment of district hospitals in Rwanda (United States)

    Shoveller, Jean; Tuyisenge, Lisine; Kenyon, Cynthia; Cechetto, David F.; Lynd, Larry D.


    Background Health system strengthening is crucial to improving infant and child health outcomes in low-resource countries. While the knowledge related to improving newborn and child survival has advanced remarkably over the past few decades, many healthcare systems in such settings remain unable to effectively deliver pediatric advance life support management. With the introduction of the Emergency Triage, Assessment and Treatment plus Admission care (ETAT+)–a locally adapted pediatric advanced life support management program–in Rwandan district hospitals, we undertook this study to assess the extent to which these hospitals are prepared to provide this pediatric advanced life support management. The results of the study will shed light on the resources and support that are currently available to implement ETAT+, which aims to improve care for severely ill infants and children. Methods A cross-sectional survey was undertaken in eight district hospitals across Rwanda focusing on the availability of physical and human resources, as well as hospital services organizations to provide emergency triage, assessment and treatment plus admission care for severely ill infants and children. Results Many of essential resources deemed necessary for the provision of emergency care for severely ill infants and children were readily available (e.g. drugs and laboratory services). However, only 4/8 hospitals had BVM for newborns; while nebulizer and MDI were not available in 2/8 hospitals. Only 3/8 hospitals had F-75 and ReSoMal. Moreover, there was no adequate triage system across any of the hospitals evaluated. Further, guidelines for neonatal resuscitation and management of malaria were available in 5/8 and in 7/8 hospitals, respectively; while those for child resuscitation and management of sepsis, pneumonia, dehydration and severe malnutrition were available in less than half of the hospitals evaluated. Conclusions Our assessment provides evidence to inform new strategies

  10. Additive, Multi-Component Treatment of Emerging Refusal Topographies in a Pediatric Feeding Disorder (United States)

    Sharp, William G.; Jaquess, David L.; Bogard, Jennifer D.; Morton, Jane F.


    This case study describes inter-disciplinary treatment of chronic food refusal and tube dependency in a 2-year-old female with a pediatric feeding disorder. Evidence-based behavioral components--including escape extinction (EE), differential reinforcement of alterative mealtime behavior (DRA), and stimulus fading--were introduced sequentially as…

  11. Egypt emerges : with help from some Canadian companies, Alexandria is striving to grab a spot on the global LNG stage

    Energy Technology Data Exchange (ETDEWEB)

    Lorenz, A.


    Two new liquefied natural gas (LNG) plants recently built in Egypt are a testimony to the country's renewed natural gas industry. This article presented details of Canadian companies who are now operating in Egypt as a result of the Egyptian government's decision to include gas as a commodity from which foreign companies could earn a profit in the late 1980s. Apache negotiated a lease on a 2.2 million acre block southwest of Giza called the Qarun Block along with a partner called Phoenix Resources Companies Inc. in 1992, and has since made significant gas discoveries. In March 2006, the company posted record gross oil and gas production of 119,500 barrels per day and 501 million cubic feet per day. Egypt currently produces 3.5 billion cubic feet of natural gas per day. Approximately half is consumed locally and the balance is liquefied for export to Europe and Asian markets. The 2 LNG plants in Egypt currently process 700 million cubic feet and 1 billion cubic feet per day respectively. Egypt's Nile Delta is emerging as a world-class hydrocarbon basin, where companies such as BP have been exploring and producing since 1992. BP is confident that Egypt's potential reserves exceed 100 trillion cubic feet and that its aggressive exploration strategy is expected to form the foundation of a significant LNG business. Calgary-based company Centurion has established a presence in Egypt and has formed a partnership with Royal Dutch/Shell Group. The company has granted Shell 2 concessions in exchange for the construction of a gas train worth $1.5 billion capable of handling 500 million cubic feet per day of gas. It was concluded that while current global prices for natural gas are still too low to make it economical to ship Egyptian LNG to North America, higher prices may mean that LNG currently being transported to Europe may eventually end up in North American LNG terminals. 9 figs.

  12. Canadian/US update: The emerging visibility and role of agroforestry in national and international climate change strategies (United States)

    U.S. and Canadian agricultural lands are being targeted to provide more environmental and economic services while at the same time their continued capability to provide these services under potential climate change (CC) is being questioned. Addressing both concerns requires a broader approach of des...

  13. 儿科急诊现状和规范化建设%Current situation and standardization of pediatric emergency system

    Institute of Scientific and Technical Information of China (English)

    李璧如; 王莹


    分析儿科急诊发展现状及儿科急诊医疗服务体系;阐述儿科急诊配置和人员、急诊医护人员应该掌握的技术、预检分诊系统、急性疾病和创伤儿童的服务流程及急症与危重症疾病诊治流程;提出对儿科急诊建设发展模式的建议和思考.%The current situation of pediatric emergency medicine and the pediatric emergency medical service systems were analyzed.The equipment configuration,personnel allocation and the requirement of professional knowledge and technology in pediatric emergency setting,the triage system,the process of medical services for patients with acute illness or trauma,and the optimizing process of diagnosis and treatment for emergency cases and critical cases were discussed.The nationwide development model of pediatric emergency service systems were reviewed.

  14. Emergence of Non-Serotype b Encapsulated Haemophilus influenzae as a Cause of Pediatric Meningitis in Northwestern Ontario

    Directory of Open Access Journals (Sweden)

    Pouya Sadeghi-Aval


    Full Text Available Before the introduction of the conjugate vaccine, Haemophilus influenzae serotype b (Hib was the leading cause of bacterial meningitis in children. Although successful in reducing Hib cases, the vaccine confers no protection against other serotypes of H influenzae, such as a (Hia, or f (Hif. The emergence of invasive disease caused by non-Hib in northwestern Ontario (38 cases between 2002 and 2008 with predominance of Hia was previously reported by the authors. At that time, no cases of pediatric meningitis caused by H influenzae were recorded in the region. Continued surveillance identified 12 new cases of invasive non-Hib between January 2009 and July 2011. Among these cases, three young children developed meningitis with severe complications caused by Hia or Hif. The present article describes these cases along with the characteristics of recent H influenzae isolates from the region, (ie, their genetic background and antibiotic sensitivity. The findings point to the clonal nature of circulating Hia strains as well as to an increase in frequency and severity of pediatric invasive H influenzae infections in northwestern Ontario.

  15. Pediatric cardiac surgery in low- and middle-income countries or emerging economies: a continuing challenge. (United States)

    Nguyen, Nguyenvu; Pezzella, A Thomas


    A number of recent publications, addresses, seminars, and conferences have addressed the global backlog and increasing incidence of both congenital and acquired cardiac diseases in children, with reference to early and delayed recognition, late referral, availability of and access to services, costs, risks, databases, and early and long-term results and follow-up. A variety of proposals, recommendations, and projects have been outlined and documented. The ultimate goal of these endeavors is to increase the quality and quantity of pediatric cardiac care and surgery worldwide and particularly in underserved areas. A contemporary review of past and present initiatives is presented with a subsequent focus on the more challenging areas.

  16. Childhood Emergencies (United States)

    ... emergency physicians. They receive comprehensive training in treating childhood emergencies and have more training in pediatric emergencies than other physicians, including pediatricians. Does Your Child's School Know About Food Allergies? - 8/10/2015 The nation's emergency physician ...

  17. Reasons behind non-adherence of healthcare practitioners to pediatric asthma guidelines in an emergency department in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Wahabi Hayfaa A


    Full Text Available Abstract Background The prevalence of childhood bronchial asthma in Saudi Arabia has increased in less than a decade from 8% to 23%. Innovations in the management of asthma led to the development of evidence based clinical practice guidelines and protocols to improve the patients’ outcomes. The objectives of this study are to examine the compliance of the healthcare providers in the Pediatrics Emergency Department, in King Khalid University Hospital, with the recommendations of the Pediatrics Asthma Management Protocol (PAMP, and to explore the reasons behind non-adherence. Methods This study is designed in 2 parts, a patients’ chart review and a focus group interview. The medical records of all the children who presented to the Pediatric Emergency Department (PED and were diagnosed as asthmatic, during the period from the 1st of January 2009 to the 31st of March 2009, were reviewed to investigate the compliance of healthcare providers (physicians and nurses with 8 recommendations of the PAMP which are considered to be frequently encountered evidence-practice gaps, and these are 1 documentation of asthma severity grading by the treating physician and nurse 2 limiting the prescription of Ipratropium for children with severe asthma 3 administration of Salbutamol through an inhaler and a spacer 4 documentation of parental education 5 prescription of systemic corticosteroids to all cases of acute asthma 6 limiting chest x-ray requisition for children with suspected chest infection 7 management of all cases of asthma as outpatients, unless diagnosed as severe or life threatening asthma 8 limiting prescription of antibiotics to children with chest infection. The second part of this study is a focus group interview designed to elicit the reasons behind non- adherence to the recommendations detected by the chart review. Two separate focus group interviews were conducted for 10 physicians and 10 nurses. The focus group interviews were tape

  18. Improving Emergency Department Triage Classification with Computerized Clinical Decision Support at a Pediatric Hospital (United States)

    Kunisch, Joseph Martin


    Background: The Emergency Severity Index (ESI) is an emergency department (ED) triage classification system based on estimated patient-specific resource utilization. Rules for a computerized clinical decision support (CDS) system based on a patient's chief complaint were developed and tested using a stochastic model for predicting ESI scores.…

  19. Successful emergency department interventions that reduce time to antibiotics in febrile pediatric cancer patients (United States)

    Spencer, Sandra; Nypaver, MIchele; Hebert, Katherine; Benner, Christopher; Stanley, Rachel; Cohen, Daniel; Rogers, Alexander; Goldstick, Jason; Mahajan, Prashant


    Children with cancer and fever are at high risk for sepsis related death. Rapid antibiotic delivery ( 38.0 C). A secondary objective was to identify interventions amenable to translation to other centers. We conducted a post project analysis of prospectively collected observational data from children practice guideline establishment 7) Family pre-ED education for fever and 8) Staff project updates. This core set of eight low cost, high yield QI interventions were developed independently by the three ED's which led to substantial reduction in time to antibiotic delivery in children with cancer presenting with fever. These interventions may inform future QI initiatives in other settings caring for febrile pediatric oncology patients. PMID:28321299

  20. Dental emergencies in a university pediatric dentistry clinic: a retrospective study

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    Ayah Qassem Shqair


    Full Text Available A significant number of children visit a dentist for the first time due to emergency situations. However, little is known regarding the prevalence, etiology, and treatment provided for children at emergency dental visits. This study aimed to evaluate the profile of children attending a dental school emergency clinic, the reasons for seeking dental care, and the treatment provided. Records of 270 patients who attended an emergency clinic during 2010 were analyzed, and 253 were selected. Demographic, diagnostic, and procedural information was collected. The mean child age was 7.8 years. For 208 children (82%, pain was the main reason for the emergency visit. Nearly 79% of the visits were due to caries, and the most frequently required treatment was endodontic intervention (31.22%. Of the decayed teeth, 61.70% were primary posterior teeth and 31.9% permanent posterior teeth. Pain caused by dental decay was the most frequent chief complaint. A large number of children were brought to the dentist with complaints that had started long before, for which over-the-counter medications had been used.

  1. Pulmonary Function Tests in Emergency Department Pediatric Patients with Acute Wheezing/Asthma Exacerbation

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    Kathryn Giordano


    Full Text Available Background. Pulmonary function tests (PFT have been developed to analyze tidal breathing in patients who are minimally cooperative due to age and respiratory status. This study used tidal breathing tests in the ED to measure asthma severity. Design/Method. A prospective pilot study in pediatric patients (3 to 18 yrs with asthma/wheezing was conducted in an ED setting using respiratory inductance plethysmography and pneumotachography. The main outcome measures were testing feasibility, compliance, and predictive value for admission versus discharge. Results. Forty patients were studied, of which, 14 (35% were admitted. Fifty-five percent of the patients were classified as a mild-intermittent asthmatic, 30% were mild-persistent asthmatics, 12.5% were moderate-persistent asthmatics, and 2.5% were severe-persistent. Heart rate was higher in admitted patients as was labored breathing index, phase angle, and asthma score. Conclusions. Tidal breathing tests provide feasible, objective assessment of patient status in the enrolled age group and may assist in the evaluation of acute asthma exacerbation in the ED. Our results demonstrate that PFT measurements, in addition to asthma scores, may be useful in indicating the severity of wheezing/asthma and the need for admission.

  2. Twitter and Canadian Educators (United States)

    Cooke, Max


    An emerging group of leaders in Canadian education has attracted thousands of followers. They've made Twitter an extension of their lives, delivering twenty or more tweets a day that can include, for example, links to media articles, research, new ideas from education bloggers, or to their own, or simply a personal thought. At their best,…

  3. Calibrating Urgency: Triage Decision-Making in a Pediatric Emergency Department (United States)

    Patel, Vimla L.; Gutnik, Lily A.; Karlin, Daniel R.; Pusic, Martin


    Triage, the first step in the assessment of emergency department patients, occurs in a highly dynamic environment that functions under constraints of time, physical space, and patient needs that may exceed available resources. Through triage, patients are placed into one of a limited number of categories using a subset of diagnostic information.…

  4. Effects of a Web-based Educational Module on Pediatric Emergency Medicine Physicians’ Knowledge, Attitudes, and Behaviors Regarding Youth Violence

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    Tracy E. Madsen


    Full Text Available Introduction: Youth seen in the emergency department (ED with injuries from youth violence (YV have increased risk for future violent injury and death. Pediatric emergency medicine (PEM physicians rarely receive training in, or perform, YV screening and intervention. Our objective was to examine effects of a web-based educational module on PEM physicians’ knowledge, attitudes, and behaviors regarding YV screening and interventions in the ED. Methods: We invited all PEM fellows and attendings at an urban Level I pediatric trauma center to complete an interactive web-based education module (and 1-month booster with information on YV’s public health impact and how to screen, counsel and refer YV-involved patients. Consenting subjects completed electronic assessments of YV prevention knowledge and attitudes (using validated measures when possible before and after the initial module and after the booster. To measure behavior change, chart review identified use of YV-specific discharge instructions in visits by YV-injured PEM patients (age 12–17; identified by E codes 6 months before and after the intervention. We analyzed survey data were analyzed with Fisher’s exact for binary outcomes and Kruskal-Wallis for Likert responses. Proportion of patients given YV discharge instructions before and after the intervention was compared using chi-square. Results: Eighteen (67% of 27 PEM physicians participated; 1 was lost at post-module assessment and 5 at 1 month. Module completion time ranged from 15–30 minutes. At baseline, 50% of subjects could identify victims’ re-injury rate; 28% were aware of ED YV discharge instructions. After the initial module and at 1 month, there were significant increases in knowledge (p,0.001 and level of confidence speaking with patients about avoiding YV (p¼0.01, df¼2. Almost all (94% said the module would change future management. In pre-intervention visits, 1.6% of patients with YV injuries were discharged with

  5. Pediatric oncologists' coping strategies for dealing with patient death. (United States)

    Granek, Leeat; Barrera, Maru; Scheinemann, Katrin; Bartels, Ute


    This research examined pediatric oncologists coping strategies when their patients died of cancer. Twenty-one pediatric oncologists at 2 Canadian pediatric academic hospitals were interviewed about their coping strategies when patients died or were in the process of dying. The grounded theory method of data collection and data analysis were used. Line-by-line coding was used to establish codes and themes and constant comparison was used to establish relations among emerging codes and themes. Pediatric oncologists used engagement coping strategies with primary and secondary responses including emotional regulation (social support and religion), problem solving (supporting families at end of life), cognitive restructuring (making a difference and research), and distraction (breaks, physical activity, hobbies and entertainment, spending time with own children). They also used disengagement coping strategies that included voluntary avoidance (compartmentalization and withdrawing from families at end of life). Given the chronic nature of patient death in pediatric oncology and the emotionally difficult nature of this work, medical institutions such as hospitals have a responsibility to assist pediatric oncologists in coping with this challenging aspect of their work. Future research is needed to evaluate how best to implement these changes on the institutional level to help oncologists cope with patient death and the effect of using these strategies on their quality of life.

  6. The therapeutic itinerary in urgent/emergency pediatric situations in a Maroon community. (United States)

    Siqueira, Samylla Maira Costa; Jesus, Viviane Silva de; Camargo, Climene Laura de


    The goal was to understand the therapeutic itinerary of Maroon children in urgent/emergency situation. Is a descriptive research with a qualitative approach that uses the Health Care System model of Arthur Kleinman as its theoretical support. Participants included 12 mothers of children who had experienced any urgent or emergency medical situation. Data collection took place from December 2013 to June 2014 through semi-structured interviews with a thematic analysis of the data. The care of the child started in the "informal" subsystem, and access to a "formal" subsystem was characterized as a pilgrimage for health services. A development of specific strategies is needed to ensure and facilitate full access to the services of the professional subsystem for Maroon communities.

  7. Anesthetic management of a pediatric patient with hypohidrotic ectodermal dysplasia undergoing emergency surgery

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    Elif Oral Ahiskalioglu


    Full Text Available ABSTRACT Ectodermal dysplasias are rare conditions with a triad of hypotrichosis, anodontia and anhidrosis. In literature review there have been only a few reports of anesthetic management of patients with ectodermal dysplasias. Hyperthermia is a very serious risk which may occur due to the defect of sweat glands. The present case involves a 10-year-old child with ectodermal dysplasia who presented with an acute abdomen and was considered for an emergency surgery. Our aim was to demonstrate the successful management of this case using a combination of general and epidural anesthesia. It is important for anesthesiologist to have information about this syndrome in case of emergency operations, since it can prevent serious complications and even save lives.

  8. Bicycle-related injuries: a survey in a pediatric emergency department.


    Cushman, R; Down, J; MacMillan, N; Waclawik, H


    The number of bicycle-related injuries has risen significantly with the increased popularity of bicycle riding in Canada. The risk of injury is highest among children. To assess the magnitude of the problem and to identify the contributing factors we used a questionnaire, injury reports and patient charts to survey bicycle-related injuries among children brought to the emergency department of the Children's Hospital of Eastern Ontario, Ottawa, between May 1 and Sept. 30, 1988. The questionnai...

  9. Pediatric tea tree oil aspiration treated with surfactant in the emergency department. (United States)

    Richards, David B; Wang, George S; Buchanan, Jennie A


    Tea tree oil is an essential oil containing a mixture of aromatic hydrocarbons. We describe an 18-month-old male patient who ingested tea tree oil, developed central nervous system depression, respiratory distress, and received early emergency department treatment with surfactant. Early treatment of hydrocarbon pneumonitis with surfactant has not been previously described. Early administration of surfactant should be further evaluated for treatment of hydrocarbon aspiration.

  10. Shift from Snowfall to Rainfall in the Canadian Rockies: Consequences for Snowpacks, Glacier Mass Balance and Streamflow in an Emerging Drought (United States)

    Pomeroy, J. W.; Fang, X.; Pradhananga, D.; Schirmer, M.; Conway, J. P.; Helgason, W.; Whitfield, P. H.


    The winter and spring of 2014-15 brought abnormal warmth to much of Western Canada and a transition from snowfall to rainfall for many winter and spring precipitation events in the Canadian Rocky Mountains where snowfall normally dominates precipitation volumes in these seasons. Spring and summer remained abnormally warm and exceptionally dry. The impact of a warm winter and dry spring and summer resulted in substantial reduction in snowfall and a shift to earlier rainfall in the Canadian Rockies. As a result peak snow accumulation was from 1/3 to 1/2 of long term averages at upper middle elevations and low elevation valley snowpacks ablated shortly after forming in early December. Snowmelt occurred 2 to 6 weeks earlier than average, resulting in earlier than normal spring freshets and exposure of glacier firn and ice. June 1st snow accumulation was completely ablated or at record low values for most observation stations. The shift from winter and spring snowfall to rainfall and subsequent low summer rainfall resulted in the emergence of exceptionally wide-spread forest fires, rapid glacier melt, low streamflow and severe agricultural drought in Western Canada. By mid-July the seasonal snowpack had largely ablated, discharge rates in the Bow River at Calgary were 40% of average, many mountain streams had dried up and the Athabasca Glacier had experienced 3 m of ice melt. The Cold Regions Hydrological Model was used to simulate the impacts of the snowfall to rainfall transition on the snow redistribution, sublimation and melt processes, runoff and evapotranspiration that control the water balance of selected mountain environments in this period, employing Harder and Pomeroy's Psychrometric Energy Balance Method to estimate precipitation phase. The results help to diagnose how a "warm drought" impacts the hydrology and glaciology of cold regions environments and suggest the possible impacts of future warmer climates and increased rainfall fraction on this region.

  11. Optimizing Simulated Multidisciplinary Team Training of Pediatric Emergencies: An Evaluation of Prerequisites for Transfer of Skills to Clinical Practice

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    E. H. A. J. Coolen


    Full Text Available Introduction. Multidisciplinary simulation-based team training (STT provides a powerful training method to train technical and team skills during emergencies. Effectiveness of STT depends on transfer of learned skills to clinical practice. In this study we examined three important prerequisites to enhance transfer from STT into clinical practice, intervention readiness, realism, and performance self-efficacy. Methods. For the quantitative part of the study, 131 participants (pediatric nurses and physicians were asked to fill out an online questionnaire before and after training. For the qualitative part of the study we organized three one-hour focus group sessions in which participants were interviewed on attitude, realism, and self-efficacy. Results. Providing adequate preparation material and extensive debriefing of scenarios is important in creating this positive learning experience. The perspective of realism depends strongly on setting and learning goals. During STT team assembly and role playing can become more important to participants, while physical aspects become less important. Performance self-efficacy for all participants increases significantly (P<0.05 regarding team skills. Conclusions. STT can be a very positive multidisciplinary learning experience, which creates the possibility of enhancing confidence, skills, and team performance within the clinical context. STT combines three important prerequisites for transfer of training to take place.

  12. Diagnóstico pouco frequente de dor abdominal em unidade de emergência infantil Unusual diagnosis of abdominal pain in pediatric emergency unit

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    Suelen Bianca S. Martins


    Full Text Available OBJETIVO: Relatar um caso de doença péptica na infância em escolar, com queixa inicial de dor abdominal aguda e palidez. DESCRIÇÃO DO CASO: Escolar de nove anos procurou pronto-socorro infantil com queixa de dor abdominal súbita e palidez. Não apresentava outros sintomas ou sinais ao exame físico além de mucosas descoradas e hemograma com nível baixo de hemoglobina. Durante a observação intra-hospitalar, apresentou episódio de melena. Foi realizada endoscopia digestiva alta, sendo observadas gastrite erosiva de antro e úlcera duodenal, com Helicobacter pylori positivo. O paciente foi tratado com esquema tríplice (inibidor de bomba de prótons e dois antimicrobianos por uma semana e, posteriormente, acompanhado ambulatorialmente. COMENTÁRIOS: O caso em questão descreve uma doença rara em unidade de emergência pediátrica. O paciente referia dor abdominal e observou-se palidez confirmada por baixo nível de hemoglobina, que se manteve nos exames subsequentes durante a observação no pronto-socorro infantil, dificultando o diagnóstico de sangramento ativo. Porém, a presença de melena na evolução facilitou e propiciou a condução do caso para se chegar à hipótese de sangramento digestivo alto. Realizada endoscopia digestiva alta, que confirmou o diagnóstico de gastrite erosiva de antro e úlcera duodenal H. pylori positiva, sendo, então, necessário tratamento específico, inclusive para erradicação da bactéria.OBJECTIVE: To report a case of peptic disease in a school child whose first symptoms were acute abdominal pain and paleness. CASE DESCRIPTION: A nine-year-old school child presented to a pediatric emergency unit with acute abdominal pain and sudden pallor. There were no other symptoms or signs on physical examination, except for discolored mucous and a low hemoglobin level. During hospital observation he presented one episode of melena. The esophagogastroduodenoscopy showed erosive antrum gastritis and

  13. Acesso vascular por via intraóssea em emergências pediátricas Vascular access through the intraosseous route in pediatric emergencies

    Directory of Open Access Journals (Sweden)

    Ricardo Américo Ribeiro de Sá


    Full Text Available A obtenção do acesso venoso em crianças gravemente enfermas é um procedimento essencial para o restabelecimento da volemia e a administração de fármacos nas emergências pediátricas. A primeira opção para obtenção de acesso vascular é pela punção de uma veia periférica. Quando essa via não pode ser utilizada ou sua obtenção se torna demorada, a via intraóssea consiste em efetiva opção para obtenção de um acesso venoso rápido e seguro. O presente estudo possui caráter descritivo e exploratório, realizado por meio de pesquisa bibliográfica, com o objetivo de descrever os princípios técnicos, as atribuições profissionais e os cuidados relacionados à obtenção do acesso venoso pela via intraóssea em emergências pediátricas. Foram selecionados 22 artigos disponibilizados nas bases de dados LILACS e MEDLINE e na biblioteca eletrônica SciELO, publicados entre o período de 2000 a 2011, além do protocolo vigente de ressuscitação cardiopulmonar da American Heart Association, de 2010. Após a leitura das publicações, os dados foram agrupados, possibilitando a construção de cinco categorias de análise: aspectos históricos e princípios fisiológicos; indicações, vantagens e contraindicações; atribuições dos profissionais; princípios técnicos; cuidados com o acesso; e possíveis complicações. Os resultados desse estudo mostraram que a via intraóssea consolida-se, hoje, como uma segunda opção de acesso vascular no atendimento a emergências, por ser uma técnica de fácil e rápida execução, apresentar vários sítios de punção não colapsáveis e permitir que a administração de fármacos e a reposição volêmica sejam rápidas e eficazes.Obtaining venous access in critically ill children is an essential procedure to restore blood volume and administer drugs during pediatric emergencies. The first option for vascular access is through a peripheral vein puncture. If this route cannot be used

  14. Seeing Oneself in a Book: The Changing Face of Canadian Children's Literature. (United States)

    Bainbridge, Joyce; Fayjean, Janet


    Takes a look at children's literature over time, and its recent emergence as a respected body of literary work. Discusses what is Canadian about Canadian children's literature. Annotates six picture books. Notes that Canadian literature reflects the diversity of the Canadian population, the vast differences in the Canadian landscape, and the…

  15. Emergency in pediatric and adolescent psychiatry. Note taking for the primary health assistance.

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    Zenaida María Sáez


    Full Text Available The psyquiatric emergences in children and adolescents are usually manifested as alterations of the feelings, behavior or in the school efficiency and its origin is found in the physical tensions, contradictions in the breeding, marital conflicts, bad interpersonal relationships, negligence, loss of the significant model at home, etc. It is important to address that there is no direct relationship between the causal factor and the onset of the symptoms. This largely depends on variables such as temperament, levels of development, nature and duration of the stress, past experience and family capacity/ability of the family to get adapted to new situations.Parents frequently come to visit General Comprehensive doctor because they are worried about their children´s behaviors, i.e.; if they are normal or require certain intervention.In the current review we make reference to the psychosocial issues that may bring about psychopathological manifestations which need a timely intervention. Otherwise, there is a risk for the physical integrity of the kid, adolescent or another people which may result into a remarkable complications and suffering for the patients or their relatives. We are going to make reference to the abuse of some substances, adoption, nervous anorexia, suicide attempt, infant abuse, fire provocation and mourning reaction.We are making emphasis on the clinical assessment of the risk factors which contribute to the appearance of these issues and the management in the primary level of assistance to prevent further complications.

  16. Rapid emergence of free-riding behavior in new pediatric immunization programs.

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    Chris T Bauch

    Full Text Available BACKGROUND: Mathematical models have formalized how free-rider effects can threaten the stability of high vaccine coverage levels under established voluntary vaccination programs. However, little research has addressed the question of when free-riding begins to develop when a new vaccine is first introduced in a population. METHODOLOGY/PRINCIPAL FINDINGS: Here, we combine a game theoretical model of vaccinating behavior with an age-structured compartmental model to analyze rational vaccinating behavior in the first years of a universal immunization program, where a new vaccine is free to all children of a specified age. The model captures how successive birth cohorts face different epidemiological landscapes that have been shaped by the vaccinating decisions of previous birth cohorts, resulting in a strategic interaction between individuals in different birth cohorts. The model predicts a Nash equilibrium coverage level of for the first few birth cohorts under the new program. However, free-riding behavior emerges very quickly, with the Nash equilibrium vaccine coverage dropping significantly within 2-5 years after program initiation. Subsequently, a rich set of coupled dynamics between infection prevalence and vaccinating behaviors is possible, ranging from relatively stable (but reduced coverage in later birth cohorts to wide fluctuations in vaccine coverage from one birth cohort to the next. Individual tolerance for vaccine risk also starts out at relatively high levels before dropping significantly within a few years. CONCLUSIONS/SIGNIFICANCE: These results suggest that even relatively new immunization programs can be vulnerable to drops in vaccine coverage caused by vaccine scares and exacerbated by herd immunity effects, necessitating vigilance from the start.

  17. Modification of the effect of ambient air pollution on pediatric asthma emergency visits: susceptible subpopulations (United States)

    Strickland, Matthew J; Klein, Mitchel; Flanders, W Dana; Chang, Howard H; Mulholland, James A; Tolbert, Paige E; Darrow, Lyndsey A


    Background Children may have differing susceptibility to ambient air pollution concentrations depending on various background characteristics of the children. Methods Using emergency department (ED) data linked with birth records from Atlanta, Georgia, we identified ED visits for asthma or wheeze among children aged 2–16 years from 1 January 2002 through 30 June 2010 (n=109,758). We stratified by preterm delivery, term low birth weight, maternal race, Medicaid status, maternal education, maternal smoking, delivery method, and history of a bronchiolitis ED visit. Population-weighted daily average concentrations were calculated for 1-hour maximum carbon monoxide and nitrogen dioxide; 8-hour maximum ozone; and 24-hour average particulate matter less than 10 microns in diameter, particulate matter less than 2.5 microns in diameter (PM2.5), and the PM2.5 components sulfate, nitrate, ammonium, elemental carbon, and organic carbon, using measurements from stationary monitors. Poisson time-series models were used to estimate rate ratios for associations between three-day moving average pollutant concentrations and daily ED visit counts and to investigate effect-measure modification by the stratification factors. Results Associations between pollutant concentrations and asthma exacerbations were larger among children born preterm and among children born to African American mothers. Stratification by race and preterm status together suggested that both factors affected susceptibility. The largest estimated effect size (for an interquartile-range increase in pollution) was observed for ozone among preterm births to African American mothers: rate ratio=1.138 (95% confidence interval=1.077–1.203). In contrast, the rate ration for the ozone association among full-term births to mothers of other races was 1.025 (0.970–1.083). Conclusions Results support the hypothesis that children vary in their susceptibility to ambient air pollutants. PMID:25192402

  18. The respiratory presentation of severe combined immunodeficiency in two Mennonite children at a tertiary centre highlighting the importance of recognizing this pediatric emergency (United States)

    Lam, Simon; Kavadas, Fotini D; Haider, Seemab; Noseworthy, Mary E


    Severe combined immunodeficiency (SCID) is considered to be a pediatric emergency, with respiratory distress being the most common presenting symptom. The authors present two cases of SCID in children <4 months of age with respiratory distress at a tertiary care centre due to a recently described homozygous CD3 delta mutation found only in the Mexican Mennonite population. Failure to respond to broad-spectrum antibiotics prompted investigation for possible SCID. Bronchial alveolar lavage fluid from both patients grew Pneumocystis jiroveci, and flow cytometry revealed absent T cells. The CD3 delta gene is believed to be important in T cell differentiation and maturation. The present article reminds pediatricians and pediatric respirologists that the key to diagnosing SCID is to have a high index of suspicion if there is poor response to conventional therapies. PMID:24288697

  19. Laughing Gas in a Pediatric Emergency Department-Fun for All Participants: Vitamin B12 Status Among Medical Staff Working With Nitrous Oxide. (United States)

    Staubli, Georg; Baumgartner, Matthias; Sass, Jörn Oliver; Hersberger, Martin


    The efficiency of nitrous oxide in an equimolar mixture with oxygen or in concentrations up to 70% is approved for short painful procedures. Evaluation of the vitamin B12 levels in anesthetic staff applying nitrous oxide showed reduced vitamin B12 plasma levels. This study examines the vitamin B12 status of medical staff working with nitrous oxide in a pediatric emergency department (ED). Medical staff of the ED at the University Children's Hospital Zurich participated. The vitamin B12 status was evaluated by measuring homocysteine, methylmalonic acid, vitamin B12, blood count, and the MTHFR C677T genotype. As a control group, medical personnel working in the "nitrous oxide-free" pediatric intensive care unit were recruited.

  20. The Respiratory Presentation of Severe Combined Immunodeficiency in Two Mennonite Children at a Tertiary Centre Highlighting the Importance of Recognizing This Pediatric Emergency

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    Simon Lam


    Full Text Available Severe combined immunodeficiency (SCID is considered to be a pediatric emergency, with respiratory distress being the most common presenting symptom. The authors present two cases of SCID in children <4 months of age with respiratory distress at a tertiary care centre due to a recently described homozygous CD3 delta mutation found only in the Mexican Mennonite population. Failure to respond to broad-spectrum antibiotics prompted investigation for possible SCID. Bronchial alveolar lavage fluid from both patients grew Pneumocystis jiroveci, and flow cytometry revealed absent T cells. The CD3 delta gene is believed to be important in T cell differentiation and maturation. The present article reminds pediatricians and pediatric respirologists that the key to diagnosing SCID is to have a high index of suspicion if there is poor response to conventional therapies.

  1. The respiratory presentation of severe combined immunodeficiency in two Mennonite children at a tertiary centre highlighting the importance of recognizing this pediatric emergency. (United States)

    Lam, Simon; Kavadas, Fotini Dimitriou; Haider, Seemab; Noseworthy, Mary Elizabeth


    Severe combined immunodeficiency (SCID) is considered to be a pediatric emergency, with respiratory distress being the most common presenting symptom. The authors present two cases of SCID in children <4 months of age with respiratory distress at a tertiary care centre due to a recently described homozygous CD3 delta mutation found only in the Mexican Mennonite population. Failure to respond to broad-spectrum antibiotics prompted investigation for possible SCID. Bronchial alveolar lavage fluid from both patients grew Pneumocystis jiroveci, and flow cytometry revealed absent T cells. The CD3 delta gene is believed to be important in T cell differentiation and maturation. The present article reminds pediatricians and pediatric respirologists that the key to diagnosing SCID is to have a high index of suspicion if there is poor response to conventional therapies.

  2. The 2015 Academic College of Emergency Experts in India's INDO-US Joint Working Group White Paper on Establishing an Academic Department and Training Pediatric Emergency Medicine Specialists in India. (United States)

    Mahajan, Prashant; Batra, Prerna; Shah, Binita R; Saha, Abhijeet; Galwankar, Sagar; Aggrawal, Praveen; Hassoun, Ameer; Batra, Bipin; Bhoi, Sanjeev; Kalra, Om Prakash; Shah, Dheeraj


    The concept of pediatric emergency medicine (PEM) is virtually nonexistent in India. Suboptimally, organized prehospital services substantially hinder the evaluation, management, and subsequent transport of the acutely ill and/or injured child to an appropriate facility. Furthermore, the management of the ill child at the hospital level is often provided by overburdened providers who, by virtue of their training, lack experience in the skills required to effectively manage pediatric emergencies. Finally, the care of the traumatized child often requires the involvement of providers trained in different specialities, which further impedes timely access to appropriate care. The recent recognition of Doctor of Medicine (MD) in Emergency Medicine (EM) as an approved discipline of study as per the Indian Medical Council Act provides an unprecedented opportunity to introduce PEM as a formal academic program in India. PEM has to be developed as a 3-year superspeciality course (in PEM) after completion of MD/Diplomate of National Board (DNB) Pediatrics or MD/DNB in EM. The National Board of Examinations (NBE) that accredits and administers postgraduate and postdoctoral programs in India also needs to develop an academic program - DNB in PEM. The goals of such a program would be to impart theoretical knowledge, training in the appropriate skills and procedures, development of communication and counseling techniques, and research. In this paper, the Joint Working Group of the Academic College of Emergency Experts in India (JWG-ACEE-India) gives its recommendations for starting 3-year DM/DNB in PEM, including the curriculum, infrastructure, staffing, and training in India. This is an attempt to provide an uniform framework and a set of guiding principles to start PEM as a structured superspeciality to enhance emergency care for Indian children.

  3. The 2015 Academic College of Emergency Experts in Indias INDO-US Joint Working Group White Paper on Establishing an Academic Department and Training Pediatric Emergency Medicine Specialists in India. (United States)

    Mahajan, Prashant; Batra, Prerna; Shah, Binita R; Saha, Abhijeet; Galwankar, Sagar; Aggrawal, Praveen; Hassoun, Ameer; Batra, Bipin; Bhoi, Sanjeev; Kalra, Om Prakash; Shah, Dheeraj


    The concept of pediatric emergency medicine (PEM) is virtually nonexistent in India. Suboptimally organized prehospital services substantially hinder the evaluation, management, and subsequent transport of the acutely ill and/or injured child to an appropriate facility. Furthermore, the management of the ill child at the hospital level is often provided by overburdened providers who, by virtue of their training, lack experience in the skills required to effectively manage pediatric emergencies. Finally, the care of the traumatized child often requires the involvement of providers trained in different specialities, which further impedes timely access to appropriate care. The recent recognition of Doctor of Medicine in Emergency Medicine as an approved discipline of study as per the Indian Medical Council Act provides an unprecedented opportunity to introduce PEM as a formal academic program in India. PEM has to be developed as a 3 year superspeciality course after completion of MD Diplomate of National Board (DNB) Pediatrics or MD DNB in EM. The National Board of Examinations that accredits and administers postgraduate and postdoctoral programs in India also needs to develop an academic program DNB in PEM. The goals of such a program would be to impart theoretical knowledge, training in the appropriate skills and procedures, development of communication and counseling techniques, and research. In this paper, the Joint Working Group of the Academic College of Emergency Experts in India (JWG ACEE India) gives its recommendations for starting 3 year DM DNB in PEM, including the curriculum, infrastructure, staffing, and training in India. This is an attempt to provide an uniform framework and a set of guiding principles to start PEM as a structured superspeciality to enhance emergency care for Indian children.

  4. Emergency wounds treated with cyanoacrylate and long-term results in pediatrics: a series of cases; what are the advantages and boards?

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    Gursoy Sonnur


    Full Text Available Abstract Background Ethyl-2-cyanoacrylate (ECA is a tissue adhesive material applied to close superficial wounds. The aim of this study was to explore the benefits of cyanoacrylates in the emergency department in children with current application with regard to cost-effectiveness, satisfaction and long follow up. Findings Patients were treated after assignment of the consent with an explanation by the relatives in a tertiary emergency department (ED, 2007. The evaluation was based on different superficial wound repairs due to blunt trauma within a 2-hour time period ( A total of 9 patients were evaluated and followed for 6 months. Except for one, all children were treated without any serious complications. ECA was cost-effective, time-saving, and provided successful repair satisfaction by a blinded plastic surgeon and patient/parents. Conclusion This report displayed the pediatric effective use of cyanoacrylates, even in non- traditional repairs in the emergency departments.

  5. Pediatric intensive care. (United States)

    Macintire, D K


    To provide optimal care, a veterinarian in a pediatric intensive care situation for a puppy or kitten should be familiar with normal and abnormal vital signs, nursing care and monitoring considerations, and probable diseases. This article is a brief discussion of the pediatric intensive care commonly required to treat puppies or kittens in emergency situations and for canine parvovirus type 2 enteritis.

  6. Prophylactic Use of Oral Acetaminophen or IV Dexamethasone and Combination of them on Prevention Emergence Agitation in Pediatric after Adenotonsillectomy

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    Parvin Sajedi


    Full Text Available Background: The present study was aimed to evaluate the efficacy of acetaminophen plus dexamethasone on post-operative emergence agitation in pediatric adenotonsillectomy. Methods: A total of 128 patients were randomized and assigned among four groups as: Intravenous (IV dexamethasone, oral acetaminophen, IV dexamethasone plus oral acetaminophen, placebo. Group 1 received 0.2 mg/kg dexamethasone plus 0.25 mg/kg strawberry syrup 2 h before surgery. Group 2 received 20 mg/kg oral acetaminophen (0.25 ml/kg with 0.05 ml/kg IV normal saline. Group 3 received 20 mg/kg acetaminophen and 0.2 mg/kg dexamethasone intravenously. Group 4 received 0.25 ml/kg strawberry syrup and 0.05 ml/kg normal saline. Agitation was measured according to Richmond agitation sedation score in the post anesthetic care unit (PACU after admission, 10, 20 and 30 min after extubation. Pain score was measured with FACE scale. Nurse satisfaction was measured with verbal analog scale. If agitation scale was 3 ≥ or pain scale was 4 ≥ meperidine was prescribed. If symptoms did not control wit in 15 min midazolam was prescribed. Patients were discharged from PACU according Modified Alderet Score. Data were analyzed with ANOVA, Chi-square, and Kruskal-Wallis among four groups. P < 0.05 was considered statistically significant. Results: A total of 140 patients were recruited in the study, which 12 of them were excluded. Thus, 128 patients were randomized and assigned among four groups. The four treatment groups were generally matched at baseline data. Median of pain score in 0, 10, 20 and 30 min after extubation were different between each study group with the control group (<0.001, 0.003 respectively. Also median of agitation score in 0, 10, 20 and 30 min after extubation were different between each study group with the control group (<0.001. Incidence of pain and incidence of agitation after extubation were not statistically identical among groups (P < 0.001 and P = 0

  7. Pediatric emergency department visits and ambient Air pollution in the U.S. State of Georgia: a case-crossover study


    Xiao, Qingyang; Liu, Yang; Mulholland, James A.; Russell, Armistead G.; Darrow, Lyndsey A.; Tolbert, Paige E.; Strickland, Matthew J.


    Background Estimating the health effects of ambient air pollutant mixtures is necessary to understand the risk of real-life air pollution exposures. Methods Pediatric Emergency Department (ED) visit records for asthma or wheeze (n = 148,256), bronchitis (n = 84,597), pneumonia (n = 90,063), otitis media (n = 422,268) and upper respiratory tract infection (URI) (n = 744,942) were obtained from Georgia hospitals during 2002–2008. Spatially-contiguous daily concentrations of 11 ambient air pollu...

  8. Exploring Canadian Identity through Canadian Children's Literature. (United States)

    Pantaleo, Sylvia


    Considers what commonplaces of culture and identity are being, could be, transmitted through the use of children's literature in classrooms. Explores what is Canadian about Canadian children's literature. Describes a study which involved Canadian elementary school children who read Canadian children's books. Concludes that literature plays a…

  9. Development and Testing of a Computerized Decision Support System to Facilitate Brief Tobacco Cessation Treatment in the Pediatric Emergency Department: Proposal and Protocol (United States)

    Dexheimer, Judith W; Khoury, Jane C; Miller, Julie A; Gordon, Judith S


    Background Tobacco smoke exposure (TSE) is unequivocally harmful to children's health, yet up to 48% of children who visit the pediatric emergency department (PED) and urgent care setting are exposed to tobacco smoke. The incorporation of clinical decision support systems (CDSS) into the electronic health records (EHR) of PED patients may improve the rates of screening and brief TSE intervention of caregivers and result in decreased TSE in children. Objective We propose a study that will be the first to develop and evaluate the integration of a CDSS for Registered Nurses (RNs) into the EHR of pediatric patients to facilitate the identification of caregivers who smoke and the delivery of TSE interventions to caregivers in the urgent care setting. Methods We will conduct a two-phase project to develop, refine, and integrate an evidence-based CDSS into the pediatric urgent care setting. RNs will provide input on program content, function, and design. In Phase I, we will develop a CDSS with prompts to: (1) ASK about child TSE and caregiver smoking, (2) use a software program, Research Electronic Data Capture (REDCap), to ADVISE caregivers to reduce their child's TSE via total smoking home and car bans and quitting smoking, and (3) ASSESS their interest in quitting and ASSIST caregivers to quit by directly connecting them to their choice of free cessation resources (eg, Quitline, SmokefreeTXT, or SmokefreeGOV) during the urgent care visit. We will create reports to provide feedback to RNs on their TSE counseling behaviors. In Phase II, we will conduct a 3-month feasibility trial to test the results of implementing our CDSS on changes in RNs’ TSE-related behaviors, and child and caregiver outcomes. Results This trial is currently underway with funding support from the National Institutes of Health/National Cancer Institute. We have completed Phase I. The CDSS has been developed with input from our advisory panel and RNs, and pilot tested. We are nearing completion of

  10. I Am Canadian

    DEFF Research Database (Denmark)

    Goddard, Joe


    "I Am Canadian: Immigration and Multiculturalism in the True North" looks at Canadian immigration history from a contemporary point of view. The article scrutinizes recent discussions on dual nationality and what this may mean for Canadianness......."I Am Canadian: Immigration and Multiculturalism in the True North" looks at Canadian immigration history from a contemporary point of view. The article scrutinizes recent discussions on dual nationality and what this may mean for Canadianness....

  11. [Management of children with headache in a Pediatric Emergency Department before and after the introduction of the Second International Classification of Headache Disorders (ICHD-II)]. (United States)

    Gioachin, Anna; Fiumana, Elisa; Tarocco, Anna; Verzola, Adriano; Forini, Elena; Guerra, Valentina; Salani, Manuela; Faggioli, Raffaella


    The aim of this study was to evaluate how the management of children admitted with headache to a Pediatric Emergency Department, was modified by the introduction of the Second International Classification of Headache Disorders ( ICHD-II) published in 2004. The complexity and average costs of the services provided to patients in 2002 and 2011 were compared. The results revealed a decrease in the number of tests performed and in-hospital admissions. However, tests were more complex, and an increase in requests of specialist advice was observed. We hypothesized that this change may be related to the introduction of ICHD-II, which suggests a more rational approach to the child with headache and a better use of hospital resources.

  12. Adapting protocols of CT imaging in a pediatric emergency department. Evaluation of image quality and dose; Adaptacion de los protocolos de adquisicion de imagenes de TC pediatricos en un servicio de urgencia. Valoracion de la calidad de imagen y dosis

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    Batista Arce, A.; Gonzalez Lopez, S.; Catalan Acosta, A.; Casares Magaz, O.; Hernandez Armas, O.; Hernandez Armas, J.


    The purpose of this study was to assess qualitatively the picture quality in relation to the radiation dose delivered in CT studies of computer tomograph Pediatric Emergency Department of Hospital Universitario de Canarias (HUC) in order to optimize the technical parameters used these radiological examinations so as to obtain optimal image quality at the lowest possible dose.

  13. A randomized controlled trial of sucrose and/or pacifier as analgesia for infants receiving venipuncture in a pediatric emergency department

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    Vandermeer Ben


    Full Text Available Abstract Background Although sucrose has been accepted as an effective analgesic agent for procedural pain in neonates, previous studies are largely in the NICU population using the procedure of heel lance. This is the first report of the effect of sucrose, pacifier or the combination thereof for the procedural pain of venipuncture in infants in the pediatric emergency department population. Methods The study design was a double (sucrose and single blind (pacifier, placebo-controlled randomized trial – factorial design carried out in a pediatric emergency department. The study population was infants, aged 0 – 6 months. Eighty-four patients were randomly assigned to one of four groups: a sucrose b sucrose & pacifier c control d control & pacifier. Each child received 2 ml of either 44% sucrose or sterile water, by mouth. The primary outcome measure: FLACC pain scale score change from baseline. Secondary outcome measures: crying time and heart rate change from baseline. Results Sucrose did not significantly reduce the FLACC score, crying time or heart rate. However sub-group analysis revealed that sucrose had a much greater effect in the younger groups. Pacifier use reduced FLACC score (not statistically significant, crying times (statistically significant but not heart rate. Subgroup analysis revealed a mean crying time difference of 76.52 seconds (p 3 months pacifier did not have any significant effect on crying time. Age adjusted regression analysis revealed that both sucrose and pacifier had significant effects on crying time. Crying time increased with both increasing age and increasing gestational age. Conclusion Pacifiers are inexpensive, effective analgesics and are easy to use in the PED for venipuncture in infants aged 0–3 months. The benefits of sucrose alone as an analgesic require further investigation in the older infant, but sucrose does appear to provide additional benefit when used with a pacifier in this age group. Trial

  14. Trends of CT Use in the Pediatric Emergency Department in a Tertiary Academic Hospital of Korea during 2001-2010

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    Oh, Hye Yeon; Kim, Eunb Young; Kim, Jee Eun; Kim, Yoo Jin; Choi, Hye Young; Cho, Jin Seong; Yang, Hyuk Jun; Ryoo, Eell [Gachon University Gil Hospital, Incheon (Korea, Republic of)


    We searched the medical database to identify the pediatric patients who had visited the ED, and the number of CTs conducted from January 2001 to December 2010. We analyzed the types of CTs, according to the anatomic region, and the patients who underwent CT examinations for multiple regions. Data were stratified, according to the patient age (< 13 years and 13 {<=} ages < 18 years). The number of CTs performed per 1000 patients increased by 92% during the 10-year period (per 1000 patients, increased from 50.1 CTs in 2001 to 156.5 CTs in 2006, and then decreased to 96.0 CTs in 2010). Although head CTs were performed most often (74.6% of all CTs), facial bone CTs showed the largest rate of increase (3188%) per 1000 patients, followed by cervical CTs (642%), abdominal CTs (474%), miscellaneous CTs (236%), chest CTs (89%) and head CTs (39%). The number of patients who had CT examinations for multiple regions in the same day showed a similar pattern of increase, to that of overall CT examinations. Increase of CT utilization was more pronounced in adolescents than in pediatric patients younger than 13 years (189% vs. 59%). The utilization of CTs increases from 2001 to 2006, and has declined since 2006. The increase of CTs is more pronounced in adolescents, and facial bone CTs prevail in increased number of examination followed by cervical CTs, abdominal CTs, miscellaneous CTs, chest CTs, and head CTs.

  15. Severe versus Moderate Criteria for the New Pediatric Case Definition for ME/CFS (United States)

    Jason, Leonard; Porter, Nicole; Shelleby, Elizabeth; Till, Lindsay; Bell, David S.; Lapp, Charles W.; Rowe, Kathy; De Meirleir, Kenny


    The new diagnostic criteria for pediatric ME/CFS are structurally based on the Canadian Clinical Adult case definition, and have more required specific symptoms than the (Fukuda et al. Ann Intern Med 121:953-959, 1994) adult case definition. Physicians specializing in pediatric ME/CFS referred thirty-three pediatric patients with ME/CFS and 21…

  16. Prevalence of hypoxemia in under-five children with pneumonia in an emergency pediatrics hospital in Sudan

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    Elmuntasir Taha Salah


    Full Text Available Context: Hypoxemia is a common and potentially lethal complication of acute respiratory infection in children under-five, particularly among those with severe disease. Aims: The aim of this study was to determine the prevalence of hypoxemia in under-five Sudanese children with pneumonia. Settings and Design: A cross-sectional study conducted in a pediatrics hospital in a developing country. Subjects and Methods: Data were collected using structured questionnaire and oxygen saturation was measured using a pulse oximeter. Hypoxemia was defined as arterial blood oxygen saturation <90%. Results: Of 150 studied patients, 86 (57.3% were males and 46 (32% were in the age group 2 to ≤12 months. Of the total number, 42.7% had hypoxemia (with pulse oximeter oxygen saturation <90%, out of them 36 (56.25% were in the age group <2 months. Of the hypoxic patients, 30 (46.88% had severe pneumonia, and 7 (10.94 had very severe pneumonia (P < 0.001. Conclusions: The prevalence of hypoxemia was 42.7% among the studied population. There was a significant association between the hypoxemia and small age group and very severe pneumonia. In limited resource settings pulse oximeter can be used to correctly identify hypoxemia in under-five children particularly among those diagnosed clinically as very severe pneumonia.

  17. Immunochromatographic test for detection of adenovirus from respiratory samples: is it a real solution for pediatric emergency department? (United States)

    Romero-Gómez, María Pilar; López López, Rosario; González Montes, Remedios; Ots Ruiz, Cristina; Hierro Cuesta, Sara; Martín Crespo, María Antonia; García García, Santos


    Rapid diagnosis of adenoviral respiratory infections is required in order to decide optimal treatment strategies. The adenovirus antigen immunochromatography Adeno Respiratory Card Letitest (Leti diagnostics, Barcelona, Spain), was evaluated versus the shell-vial culture and multiplex PCR (Clart Pneumovir Version 3.0, Genomica, Madrid, Spain), in nasopharyngeal washes and oropharyngeal swabs specimens from subjects with respiratory tract infections. Between April 2011 and November 2012, 224 patients were included. The IC Adeno Respiratory Card Letitest was positive for 77.9% (74 of 95) of patients diagnosed at bedside. Using multiplex-PCR as the reference standard, the overall sensitivity was 77.9% and the specificity was 73.6%. Taking shell-viral culture as the reference method, the Adeno Respiratory Card Letitest (Leti diagnostics, Barcelona, Spain) sensitivity and specificity values were 80.0% and 60.9%, respectively. Using RT-PCR (Clart Pneumovir Version 3.0, Genomica, Madrid, Spain) as the reference standard, the viral culture sensitivity was 53.2% and the specificity was 100%. The Adeno Respiratory Card Letitest (Leti diagnostics, Barcelona, Spain) assay could be a simple and rapid method for antigenic detection of adenovirus in pediatric respiratory samples although it would be necessary to improve the specificity and sensitivity of the test.

  18. Psychosocial Issues in Pediatric Oncology


    Marcus, Joel


    Psychosocial oncology, a relatively new discipline, is a multidisciplinary application of the behavioral and social sciences, and pediatric psychosocial oncology is an emerging subspecialty within the domain of psychosocial oncology. This review presents a brief overview of some of the major clinical issues surrounding pediatric psychosocial oncology.

  19. Effect of Low Dose Dexmedetomidine on Emergence Delirium and Recovery Profile following Sevoflurane Induction in Pediatric Cataract Surgeries

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    Babita Ghai


    Full Text Available This randomized trial was conducted to assess the efficacy and recovery profile of low dose intravenous dexmedetomidine in prevention of post-sevoflurane emergence delirium in children undergoing cataract surgery. Sixty-three children aged 1–6 years were included. Anesthesia was induced with sevoflurane and airway was maintained with LMA. They were randomized to group D 0.15 (received intravenous dexmedetomidine 0.15 μg/kg, group D 0.3 (received dexmedetomidine 0.3 μg/kg, or group NS (received normal saline. The incidence of emergence delirium, intraoperative haemodynamic variables, Aldrete scoring, pain scoring, rescue medication, and discharge time were recorded. Emergence delirium was significantly reduced in dexmedetomidine treated groups with incidence being 10% in group D 0.15, none in group D 0.3, and 35% in the NS group (p=0.002. Significantly lower PAED scores were observed in D 0.15 and D 0.3 group compared to the NS group (p=0.004. Discharge time was significantly prolonged in the NS group compared to D 0.15 and D 0.3 (45.1 min ± 4.4 versus 36.8 min ± 3.8 versus 34.4 min ± 4.6, p<0.02. Intravenous dexmedetomidine in low doses (0.3 and 0.15 μg/kg was found to be effective in reducing emergence delirium in children undergoing unilateral cataract surgery.


    Directory of Open Access Journals (Sweden)

    Santosh K


    Full Text Available AIM: This study was conducted to compare the speed of induction, intubation, and speed of emergence with sevoflurane and halothane in pediatric patients. METHODOLOGY: All the patients had full preanesthetic check-up and the routine investigation (complete blood count, urine albumin was done. Patients were kept fasting for 6 hrs. for solid food, 4hours for semisolid and 2 hours for liquid. They were randomly divided into Gr S and Gr H each comprising of 30 patients each to receive sevoflurane and halothane with 60% nitrous and 40% oxygen respectively by inhalation. On arrival in the operation theatre, the standard monitors were applied including an electrocardiogram, pulse oximeter, non-invasive blood pressure and precordial stethoscope and the baseline readings of respective parameters were taken. Anesthetic induction was done with face mask application using incremental dosing of 0.5% for halothane and 1% for sevoflurane every three to five breath to deliver maximum inspired concentration of upto 5% halothane(maximum inspired concentration or 8% sevoflurane (maximum inspired concentration. Spontaneous ventilation was maintained till loss of eye lash reflex. Following the loss of the eyelash reflex, the vaporizer concentration was decreased to 4% for sevoflurane and 0.86 % for halothane (approximately 2 MAC. Intravenous catheter was inserted. Inhalational agent at the same concentration was given until the loss of corneal reflex. After the intravenous line was secured, inj pentazocine 0.3 mg/kg was given. The patients were intubated with appropriate size endotracheal tube only after the loss of corneal reflex. After successful intubation, intravenous vecuronium 0.1 mg/kg was administered for muscle paralysis and the anesthetic concentrations was adjusted at 1.3 MAC with N2O (0.56% halothane and 2.6% sevoflurane. Time intervals measured: (induction time, intubation time, emergence time were measured. Vitals recorded: Heart rate, systolic

  1. The "Canadian" in Canadian Children's Literature. (United States)

    Bainbridge, Joyce; Wolodko, Brenda


    Notes that a rich body of Canadian children's literature exists that reflects the country's literary and socio-cultural values, beliefs, themes and images, including those of geography, history, language and identity. Discusses how Canadians tend to identify themselves first by region or province and then by nation. (SG)

  2. Canadian Children's Literature. (United States)

    School Libraries in Canada, 2001


    Includes 15 articles that relate to Canadian children's literature, including the power of literature; using Canadian literature in Canada; the principal's role in promoting literacy; Canadian Children's Book Centre; the National Library of Canada's children's literature collection; book promotion; selection guide; publisher's perspective; and…

  3. Pediatric airway nightmares. (United States)

    D'Agostino, James


    Pediatric disorders that involve actual or potential airway compromise are among the most challenging cases that emergency department providers face. This article discusses the diagnosis and management of common and uncommon conditions in infants and children who may present with airway obstruction.

  4. Les fonds communs de placement canadiens et l’émergence d’une finance de masse Canadian Mutual Funds and the Emergence of Mass Finance

    Directory of Open Access Journals (Sweden)

    Maxime Lefrançois


    Full Text Available Cet article cherche à rendre compte de deux transformations de nature socio-économique qu’implique la montée fulgurante du secteur des fonds communs de placement (FCP canadiens, tout en contribuant à leur conceptualisation du point de vue de la sociologie de l’économique. La première de ces transformations renvoie à l’affectation de l’épargne des ménages. Dans la perspective d’une analyse de la financiarisation, un portrait du secteur des FCP indique comment il favorise un déplacement de l’épargne depuis les dépôts bancaires et les obligations vers des formes de placements plus actifs, notamment sur les marchés d’actions. Dans un deuxième temps, l’analyse se tourne vers la généralisation des rapports sociaux de placement et l’entrée de nouvelles catégories d’investisseurs sur les marchés financiers découlant de la marchandisation des FCP. Tandis que les observateurs y voient généralement soit une démocratisation de la finance, soit un redéploiement de l’antagonisme capital/travail, il est ici indiqué en quoi il pourrait plutôt d’abord s’agir d’un processus de massification.The rapid growth of Canadian mutual funds entails socio-economic transformations related to 1 the allocation of savings, and 2 the social diffusion of investment. This paper discusses the nature of these two changes, and contributes to their economical and sociological conceptualisation from a “financialisation analysis” perspective. First, mutual funds provoke a shift in savings, from bonds and bank deposits to more active investments - namely in stocks. Second, due to the commodification of mutual funds, new categories of investors enter financial markets; these new actors therefore modify the social diffusion of investment at a more general level. Observers generally understand such changes as either a step in the democratization of finance, or as a reformulation of the capital/labour antagonism. In this paper, we

  5. Qualitative analysis of emergency department reports applied to a pilot project for the prevention of pediatric burns. (United States)

    Longo, E; Masellis, M; Fondi, G; Cedri, C; Debbia, C; Pitidis, A


    Accidents and burns are a major problem in Italy and in industrialized countries, due to the consequences they have on health, especially in children aged 0-4 years. In Italy, about 400 people die each year from burns, with over 70% of these occurring in the home. In the European Union, burns are one of the top five causes of death from accidents, accounting for 3% of all deaths from accidents and violence in those age groups. One percent of all deaths in children are due to burns. In this paper, we illustrate the results of qualitative analysis, conducted according to the methodology of content analysis, on narratives included in the anamnesis of clinical papers at the ED in 738 cases of burns in children (0-14 years) observed in a sample of Emergency Departments in the years 2005-2009. The results of content analysis show that the most frequent mechanism that leads to burns is contact with hot liquids and heating surfaces. Much of preventive action should be directed at controlling the child. The accidental event descriptions for the younger age group (0-4 years) reveal an unequivocal responsibility of the parents. The qualitative analysis of narratives was carried out to produce scientific evidence to identify the more frequent and severe burn accidents for specific target/age groups and to establish specific preventive measures. The study of qualitative analysis of burns observed at the ED was introductory to the pilot project PRIUS (Preventing burns among school-aged children). The objective of PRIUS is to increase awareness of the risks of burns in children and adults through a learning path tailored towards their prevention, and the promotion of appropriate standards of personal safe behaviour and first aid actions.

  6. Unintentional Childhood Injury Patterns, Odds, and Outcomes in Kampala City: an analysis of surveillance data from the National Pediatric Emergency Unit

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    Emilio Ovuga


    Full Text Available BACKGROUND: Unintentional Childhood Injuries pose a major public health challenge in Africa and Uganda. Previous estimates of the problem may have underestimated the childhood problem. We set to determine unintentional childhood injury pattern, odds, and outcomes at the National Paediatric Emergency unit in Kampala city using surveillance data. METHODS: Incident proportions, odds and proportional rates were calculated and used to determine unintentional injury patterns across childhood (1-12 years. RESULTS: A total of 556 cases recorded between January and May 2008 were analyzed: majority had been transported to hospital by mothers using mini-buses, private cars, and motorcycles. Median distance from injury location to hospital was 5 km. Homes, roads, and schools were leading injury locations. Males constituted 60% of the cases. Play and daily living activities were commonest injury time activities. Falls, burns and traffic accounted for 70.5% of unintentional childhood injuries. Burns, open wounds, fractures were commonest injury types. Motorcycles, buses and passenger-cars caused most crashes. Play grounds, furniture, stairs and trees were commonest source of falls. Most burn injuries were caused by liquids, fires and hot objects. 43.8% of cases were admitted. 30% were discharged without disability; 10%, were disabled; 1%, died. Injury odds and proportional incidence rates varied with age, place and cause. Poisoning and drowning were rare. Local pediatric injury priorities should include home, road and school safety. CONCLUSIONS: Unintentional injuries are common causes of hospital visit by children under 13 years especially boys. Homes, roads and educational facilities are commonest unintentional injury sites. Significant age and gender differences exist in intentional injury causation, characteristics and outcomes. In its current form, our surveillance system seems inefficient in capturing poisoning and drowning. The local prevention

  7. Unintentional childhood injury patterns, odds, and outcomes in Kampala City: an analysis of surveillance data from the National Pediatric Emergency Unit (United States)

    Mutto, Milton; Lawoko, Stephen; Nansamba, Catherine; Ovuga, Emilio; Svanstrom, Leif


    Abstract: Background: Unintentional Childhood Injuries pose a major public health challenge in Africa and Uganda. Previous estimates of the problem may have underestimated the childhood problem. We set to determine unintentional childhood injury pattern, odds, and outcomes at the National Paediatric Emergency unit in Kampala city using surveillance data. Methods: Incident proportions, odds and proportional rates were calculated and used to determine unintentional injury patterns across childhood (1-12 years). Results: A total of 556 cases recorded between January and May 2008 were analyzed: majority had been transported to hospital by mothers using mini-buses, private cars, and motorcycles. Median distance from injury location to hospital was 5 km. Homes, roads, and schools were leading injury locations. Males constituted 60% of the cases. Play and daily living activities were commonest injury time activities. Falls, burns and traffic accounted for 70.5% of unintentional childhood injuries. Burns, open wounds, fractures were commonest injury types. Motorcycles, buses and passenger-cars caused most crashes. Play grounds, furniture, stairs and trees were commonest source of falls. Most burn injuries were caused by liquids, fires and hot objects. 43.8% of cases were admitted. 30% were discharged without disability; 10%, were disabled; 1%, died. Injury odds and proportional incidence rates varied with age, place and cause. Poisoning and drowning were rare. Local pediatric injury priorities should include home, road and school safety. Conclusions: Unintentional injuries are common causes of hospital visit by children under 13 years especially boys. Homes, roads and educational facilities are commonest unintentional injury sites. Significant age and gender differences exist in intentional injury causation, characteristics and outcomes. In its current form, our surveillance system seems inefficient in capturing poisoning and drowning. The local prevention priorities could

  8. Pediatric Dentistese

    Directory of Open Access Journals (Sweden)

    Sharath Asokan


    Full Text Available Successful practice of pediatric dentistry depends on the establishment of a good relationship between the dentist and the child. Such a relationship is possible only through effective communication. Pediatric dentistry includes both an art and a science component. The focus has been mostly on the technical aspects of our science, and the soft skills we need to develop are often forgotten or neglected. This paper throws light on the communication skills we need to imbibe to be a successful pediatric dentist. A new terminology “Pediatric Dentistese” has been coined similar to motherese, parentese, or baby talk. Since baby talk cannot be applied to all age groups of children, pediatric dentistese has been defined as “the proactive development-based individualized communication between the pediatric dentist and the child which helps to build trust, allay fear, and treat the child effectively and efficiently.”

  9. Integrative Pediatrics: Looking Forward

    Directory of Open Access Journals (Sweden)

    Hilary McClafferty


    Full Text Available Increase in the prevalence of disease and illness has dramatically altered the landscape of pediatrics. As a result, there is a demand for pediatricians with new skills and a sharper focus on preventative health. Patient demand and shifting pediatric illness patterns have accelerated research in the field of pediatric integrative medicine. This emerging field can be defined as healing-oriented medicine that considers the whole child, including all elements of lifestyle and family health. It is informed by evidence and carefully weighs all appropriate treatment options. This Special Issue of Children, containing a collection of articles written by expert clinicians, represents an important educational contribution to the field. The goal of the edition is to raise awareness about integrative topics with robust supporting evidence, and to identify areas where more research is needed.

  10. 210例小儿急诊惊厥病因分析%Pathogeny analysis of 210 pediatric convulsions cases in emergency treatment

    Institute of Scientific and Technical Information of China (English)

    赵永强; 苏艳琦


    目的 探讨小儿急诊惊厥的病因,为急诊儿科提供诊断思路.方法 采用回顾性分析法,收集210例惊厥患儿的临床资料,并根据病史、性别、初发年龄、脑脊液、脑电图、体温、影像学检查等进行分析.结果 210例患儿中,不伴发热48例(22.86%),伴发热162例(77.14%);伴咳嗽、流涕137例(65.24%),伴腹泻、呕吐26例(12.38%),意识障碍或昏迷12例(5.71%),反复惊厥发作并智力发育迟缓7例(3.33%),惊厥持续状态4例(1.90%),既往已确诊癫痫3例(1.43%).体格检查神经系统阳性体征51例(24.29%).对27例伴有意识障碍疑似颅内感染的患儿进行脑脊液检查,发现其中有8例出现异常;对55例白细胞明显增加的患儿进行血培养检查,发现其中有9例出现细菌生长;对113例患儿进行脑电图检查,发现有61例患儿出现异常.64例患儿行头颅CT检查,9例异常,分别为颅内出血6例、脑干多发低密度灶1例、脑室增宽1例、颅内占位病变1例.210例患儿中最常见症状为热性惊厥、癫痫和颅内感染.其中,1~28 d新生儿惊厥多为颅内出血所致;28 d~3岁婴幼儿期惊厥病因主要为热性惊厥,其次为癫痫和颅内感染;3~6岁学龄前儿童的惊厥仍以热性惊厥为主;>6岁后,病因则以癫痫为主.结论 因儿童发生惊厥的病因呈多样化、复杂化,在对患儿的惊厥病因进行确诊时,不仅需根据患儿的过往病史、年龄段等进行辅助分析,更需要应用诸如头颅CT、脑电图等辅助检查工具,以达到快速确诊、及早治疗、预防复发和减轻患儿脑损伤、杜绝患儿后遗症发生的效果.%Objective To investigate pathogeny of pediatric convulsions in emergency treatment, and to provide diagnosis basis for pediatric emergency treatment.Methods A retrospective analysis was made on clinical data of 210 children with convulsions, along with their medical history, gender, onset age, cerebrospinal fluid, electroencephalogram, body

  11. Exogenic poisoning in children assisted in a pediatric emergency unit Intoxicaciones exógenas en niños atendidos en una unidad de emergencia pediátrica Intoxicações exógenas em crianças atendidas em uma unidade de emergência pediátrica


    Juliana Lourenço; Betise Mery Alencar Furtado; Cristine Bonfim


    OBJECTIVE: To describe the epidemiological characteristics of all exogenic poisoning cases in children assisted in a pediatric emergency unit in Recife, State of Pernambuco, Brazil, from April to September 2006. METHODS: This is a descriptive study of exogenic poisoning in 0-12 aged children treated at Centro de Assistência Toxicológica de Pernambuco (Pernambuco Toxicological Assistance Center). The data were collected through interviews and by consulting patients' records. RESULTS: 26 cases ...

  12. A Method for Reviewing the Accuracy and Reliability of a Five-Level Triage Process (Canadian Triage and Acuity Scale in a Community Emergency Department Setting: Building the Crowding Measurement Infrastructure

    Directory of Open Access Journals (Sweden)

    Michael K. Howlett


    Full Text Available Objectives. Triage data are widely used to evaluate patient flow, disease severity, and emergency department (ED workload, factors used in ED crowding evaluation and management. We defined an indicator-based methodology that can be easily used to review the accuracy of Canadian Triage and Acuity Scale (CTAS performance. Methods. A trained nurse reviewer (NR retrospectively triaged two separate month’s ED charts relative to a set of clinical indicators based on CTAS Chief Complaints. Interobserver reliability and accuracy were compared using Kappa and comparative statistics. Results. There were 2838 patients in Trial 1 and 3091 in Trial 2. The rate of inconsistent triage was 14% and 16% (Kappa 0.596 and 0.604. Clinical Indicators “pain scale, chest pain, musculoskeletal injury, respiratory illness, and headache” captured 68% and 62% of visits. Conclusions. We have demonstrated a system to measure the levels of process accuracy and reliability for triage over time. We identified five key clinical indicators which captured over 60% of visits. A simple method for quality review uses a small set of indicators, capturing a majority of cases. Performance consistency and data collection using indicators may be important areas to direct training efforts.

  13. Pediatric neuropsychology: toward subspecialty designation. (United States)

    Baron, Ida Sue; Wills, Karen; Rey-Casserly, Celiane; Armstrong, Kira; Westerveld, Michael


    Clinical neuropsychology is a rapidly expanding field of study in the psychological sciences whose practitioners are expert in the assessment, treatment, and research of individuals with known or suspected central nervous system disease or disorder. Pediatric neuropsychology has emerged as a distinct subspecialty area with related education, training, and clinical expertise for a growing number of neuropsychologists. This paper details the numerous steps taken by two affiliated organizations, the American Board of Clinical Neuropsychology and its membership organization, the American Academy of Clinical Neuropsychology, in the interest of the larger pediatric neuropsychology community and in pediatric neuropsychology subspecialty development.

  14. Virtual Pediatric Hospital (United States)

    ... Digital Storytelling System for Teaching Common Pediatric Problems Virtual Pediatric Hospital is the Apprentice's Assistant™ Last revised ... pediatric resources: | | Virtual Pediatric Hospital is curated by Donna M. D' ...

  15. Pediatric trauma BIG score: Predicting mortality in polytraumatized pediatric patients

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    Mohamed Abd El-Aziz El-Gamasy


    Full Text Available Background: Trauma is a worldwide health problem and the major cause of death and disability, particularly affecting the young population. It is important to remember that pediatric trauma care has made a significant improvement in the outcomes of these injured children. Aim of the Work: This study aimed at evaluation of pediatric trauma BIG score in comparison with New Injury Severity Score (NISS and Pediatric Trauma Score (PTS in Tanta University Emergency Hospital. Materials and Methods: The study was conducted in Tanta University Emergency Hospital to all multiple trauma pediatric patients attended to the Emergency Department for 1 year. Pediatric trauma BIG score, PTS, and NISS scores were calculated and results compared to each other and to observed mortality. Results: BIG score ≥12.7 has sensitivity 86.7% and specificity 71.4%, whereas PTS at value ≤3.5 has sensitivity 63.3% and specificity 68.6% and NISS at value ≥39.5 has sensitivity 53.3% and specificity 54.3%. There was a significant positive correlation between BIG score value and mortality rate. Conclusion: The pediatric BIG score is a reliable mortality-prediction score for children with traumatic injuries; it uses international normalization ratio (INR, Base Excess (BE, and Glasgow Coma Scale (GCS values that can be measured within a few minutes of sampling, so it can be readily applied in the Pediatric Emergency Department, but it cannot be applied on patients with chronic diseases that affect INR, BE, or GCS.

  16. Pediatric MRI (United States)

    U.S. Department of Health & Human Services — The NIH Study of Normal Brain Development is a longitudinal study using anatomical MRI, diffusion tensor imaging (DTI), and MR spectroscopy (MRS) to map pediatric...

  17. Pediatric Terminology (United States)

    The National Institute of Child Health and Human Development (NICHD) is working with NCI Enterprise Vocabulary Services (EVS) to provide standardized terminology for coding pediatric clinical trials and other resea

  18. Pediatric Anthropometry (United States)

    Klinich, Kathleen D.; Reed, Matthew P.

    Anthropometry is the measurement of human size, shape, and physical capabilities. Most pediatric anthropometry data are gathered to describe child growth patterns, but data on body size, mass distribution, range of motion, and posture are used to develop crash test dummies and computational models of child occupants. Pediatric anthropometry data are also used to determine child restraint dimensions, so they will accommodate the applicable population of child occupants.

  19. Pediatric Dentistese


    Sharath Asokan; Sivakumar Nuvvula


    Successful practice of pediatric dentistry depends on the establishment of a good relationship between the dentist and the child. Such a relationship is possible only through effective communication. Pediatric dentistry includes both an art and a science component. The focus has been mostly on the technical aspects of our science, and the soft skills we need to develop are often forgotten or neglected. This paper throws light on the communication skills we need to imbibe to be a successful pe...

  20. Pediatric integrative medicine: pediatrics' newest subspecialty?

    Directory of Open Access Journals (Sweden)

    Vohra Sunita


    Full Text Available Abstract Background Integrative medicine is defined as relationship-centered care that focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing, including evidence-based complementary and alternative medicine. Pediatric integrative medicine (PIM develops and promotes this approach within the field of pediatrics. We conducted a survey to identify and describe PIM programs within academic children’s hospitals across North America. Key barriers and opportunities were identified for the growth and development of academic PIM initiatives in the US and Canada. Methods Academic PIM programs were identified by email and eligible for inclusion if they had each of educational, clinical, and research activities. Program directors were interviewed by telephone regarding their clinical, research, educational, and operational aspects. Results Sixteen programs were included. Most (75% programs provided both inpatient and outpatient services. Seven programs operated with less than 1 FTE clinical personnel. Credentialing of complementary and alternative medicine (CAM providers varied substantially across the programs and between inpatient and outpatient services. Almost all (94% programs offered educational opportunities for residents in pediatrics and/or family medicine. One fifth (20% of the educational programs were mandatory for medical students. Research was conducted in a range of topics, but half of the programs reported lack of research funding and/or time. Thirty-one percent of the programs relied on fee-for-service income. Conclusions Pediatric integrative medicine is emerging as a new subspecialty to better help address 21st century patient concerns.

  1. Pediatric cyanide poisoning by fire smoke inhalation: a European expert consensus. Toxicology Surveillance System of the Intoxications Working Group of the Spanish Society of Paediatric Emergencies. (United States)

    Mintegi, Santiago; Clerigue, Nuria; Tipo, Vincenzo; Ponticiello, Eduardo; Lonati, Davide; Burillo-Putze, Guillermo; Delvau, Nicolas; Anseeuw, Kurt


    Most fire-related deaths are attributable to smoke inhalation rather than burns. The inhalation of fire smoke, which contains not only carbon monoxide but also a complex mixture of gases, seems to be the major cause of morbidity and mortality in fire victims, mainly in enclosed spaces. Cyanide gas exposure is quite common during smoke inhalation, and cyanide is present in the blood of fire victims in most cases and may play an important role in death by smoke inhalation. Cyanide poisoning may, however, be difficult to diagnose and treat. In these children, hydrogen cyanide seems to be a major source of concern, and the rapid administration of the antidote, hydroxocobalamin, may be critical for these children.European experts recently met to formulate an algorithm for prehospital and hospital management of adult patients with acute cyanide poisoning. Subsequently, a group of European pediatric experts met to evaluate and adopt that algorithm for use in the pediatric population.

  2. Indigenous populations health protection: A Canadian perspective

    Directory of Open Access Journals (Sweden)

    Richardson Katya L


    Full Text Available Abstract The disproportionate effects of the 2009 H1N1 pandemic on many Canadian Aboriginal communities have drawn attention to the vulnerability of these communities in terms of health outcomes in the face of emerging and reemerging infectious diseases. Exploring the particular challenges facing these communities is essential to improving public health planning. In alignment with the objectives of the Pandemic Influenza Outbreak Research Modelling (Pan-InfORM team, a Canadian public health workshop was held at the Centre for Disease Modelling (CDM to: (i evaluate post-pandemic research findings; (ii identify existing gaps in knowledge that have yet to be addressed through ongoing research and collaborative activities; and (iii build upon existing partnerships within the research community to forge new collaborative links with Aboriginal health organizations. The workshop achieved its objectives in identifying main research findings and emerging information post pandemic, and highlighting key challenges that pose significant impediments to the health protection and promotion of Canadian Aboriginal populations. The health challenges faced by Canadian indigenous populations are unique and complex, and can only be addressed through active engagement with affected communities. The academic research community will need to develop a new interdisciplinary framework, building upon concepts from ‘Communities of Practice’, to ensure that the research priorities are identified and targeted, and the outcomes are translated into the context of community health to improve policy and practice.

  3. Pediatric intensive care in Argentina. (United States)

    Schnitzler, E J


    8.2% of the gross domestic product is spent annually on health care in Argentina, a country of 32 million people. There is 1 medical doctor of every 147,000 beds in a total 3180 hospitals. The infant mortality rate in Argentina is 24.5/1000 live births which is high compared to developed countries. Perinatal causes and congenital anomalies are the main cause of death after the neonatal period, and accidents, cardiac disease, and respiratory tract infections are the main causes of death among children over age 1 year. Argentina has approximately 35 pediatric intensive care units (ICU), but 154 of 244 beds are within or near the capital. Only 2 hospitals have pediatric intensive care fellowship programs, so full time dedicated staff is rare. 250 registered pediatricians dedicated to intensive care are in the Argentine Pediatric Society and the nurse/bed ratio is 1:2-1:3. Moreover, the country has neither postanesthesia recuperation units, burn units, chronic ventilation units, nor approved home assistance programs, and intermediate care is not clearly standardized. These inadequacies have led to a shortage of beds and the caring for of critically ill children in general pediatric or emergency wards in hospitals which lack adequate equipment; patients are often discharged inappropriately to clear bed space. Even so, prehospital and emergency room care tends to be provided without the necessary coordination with the pediatric ICU, and structural conditions regarding electrical self-sufficiency, air conditioning, and circulation are met in only few units. Despite the existence of these adverse conditions for the care of critically ill children, a pediatric organ transplant program developed since 1987 has demonstrated 70% to 100% survival rates for 16l orthotopic liver and 9 heart transplants, respectively. Alternatives to improving intensive care in Argentina include optimizing the response of emergency and critical care delivery systems, categorizing hospitals and

  4. 儿科急诊分级分诊模式的实践与效果%Practice and effect of triage mode according to illness in pediatric emergency

    Institute of Scientific and Technical Information of China (English)

    丁金花; 苗歌


    目的:探讨儿科分级分诊模式的实施效果。方法选取2012年1~6月就诊的60例患儿为对照组,选取2012年7~12月就诊的60例患儿为实验组,对照组患者自行选择医生,实验组实行分级分诊模式后由患者选择医生。结果实验组患者满意度和护理质量均好于对照组。结论按照急诊分级分诊模式开展分诊工作,能够优化急诊护理服务流程,提高患者满意度,改善医患与护患关系,降低医疗风险。%Objective To study the effects of triage mode according to illness in pediatric emergency .Method 60 children in our hospital during January to June in 2012 were selected as control group ,who chose doctors by themselves .60 children in our hospital during July to December in 2012 were selected as experimental group ,who chose doctors by given guide in accordance with triage mode according to illness . Results The patients'satisfaction and nursing quality in the experimental group were better than those in the control group .Conclusion Triage mode according to illness in pediatric emergency can optimize the emergency nursing service process ,improve the satisfaction of patients , improve the relationship of doctor-patient and nurse-patient , reduce the m edical risk .

  5. 儿科急诊分诊标准实施效果的调查研究%Survey study on implementation effect of triage standard in pediatric emergency

    Institute of Scientific and Technical Information of China (English)

    苗歌; 丁金花


    Objective To investigate the effect of implementing the triage standard in pediatric emergency to provide a basis for the nursing triage system.Methods The self-designed questionnaire was adopted to investigate the satisfaction degree on the triage nursing work from patients,emergency nurses,triage nurses and doctors.Results The satisfaction degrees of the patients,doctors and nurses on the triage nursing work after implementation of the triage system were significantly increased compared with before implementation(P<0.05).Conclusion Implementing the pediatric emergency triage system can effectively identify critical chil-dren,make them to obtain timely treatment and conduce to increase the triage quality.%目的:探讨儿科急诊分诊标准的实施效果,为护理分诊制度提供参考依据。方法采用自行设计的问卷调查患者、急诊护士、分诊护士和急诊医师对分诊护理工作的满意度。结果儿科急诊分诊标准实施后,患者对分诊护理工作满意度、医师对分诊护理工作满意度、护士对分诊护理满意度较实施前组均有显著提高(P<0.05)。结论儿科急诊分诊标准的实施,能有效识别危重患儿,使急危重症患儿得到及时救治,有利于提高分诊质量。

  6. 2003 Canadian Asthma Consensus Guidelines Executive Summary

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    Becker Allan


    Full Text Available Abstract Background Guidelines for the diagnosis and management of asthma have been published over the last 15 years; however, there has been little focus on issues relating to asthma in childhood. Since the last revision of the 1999 Canadian Asthma Consensus Report, important new studies, particularly in children, have highlighted the need to incorporate new information into the asthma guidelines. The objectives of this article are to review the literature on asthma published between January 2000 and June 2003 and to evaluate the influence of new evidence on the recommendations made in the 1999 Canadian Asthma Consensus Report and its 2001 update, with a major focus on pediatric issues. Methods The diagnosis of asthma in young children and prevention strategies, pharmacotherapy, inhalation devices, immunotherapy, and asthma education were selected for review by small expert resource groups. The reviews were discussed in June 2003 at a meeting under the auspices of the Canadian Network For Asthma Care and the Canadian Thoracic Society. Data published through December 2004 were subsequently reviewed by the individual expert resource groups. Results This report evaluates early-life prevention strategies and focuses on treatment of asthma in children, emphasizing the importance of early diagnosis and preventive therapy, the benefits of additional therapy, and the essential role of asthma education. Conclusion We generally support previous recommendations and focus on new issues, particularly those relevant to children and their families. This document is a guide for asthma management based on the best available published data and the opinion of health care professionals, including asthma experts and educators.

  7. [Pediatric advanced life support]. (United States)

    Muguruma, Takashi


    Important changes or points of emphasis in the recommendations for pediatric advanced life support are as follows. In infants and children with no signs of life, healthcare providers should begin CPR unless they can definitely palpate a pulse within 10 seconds. New evidence documents the important role of ventilations in CPR for infants and children. Rescuers should provide conventional CPR for in-hospital and out-of-hospital pediatric cardiac arrests. The initial defibrillation energy dose of 2 to 4J/kg of either monophasic or biphasic waveform. Both cuffed and uncuffed tracheal tubes are acceptable for infants and children undergoing emergency intubation. Monitoring capnography/capnometry is recommended to confirm proper endotracheal tube position.

  8. Application of Process Management and Patient Stratification in Pediatric Emergency Nursing Service%流程管理与患者分层在急诊儿科护理服务中的应用

    Institute of Scientific and Technical Information of China (English)

    石小毛; 胡余明; 阳秀春


    目的 探讨流程管理与对患者进行分层在优化急诊儿科护理服务的有效性.方法 运用流程管理的理论和方法,调查分析急诊儿科护理服务中存在的问题并进行流程改进,结合在急诊儿科已建立门急诊静脉药物输液中心的基础上重新制定出更加规范、科学的工作流程,同时引导护理人员根据患者病情轻重缓急进行分层次管理并不断改进;统计新的管理方式执行前后护理不良事件发生率、病人满意度、护士工作效率、护士满意度.结果 新的管理方式执行后:(1)护理不良事件发生率明显降低;(2)病人满意度明显增加、投诉发生率明显降低;(3)护士工作效率明显提高;(4)护士满意度明显提高;差异均有统计学意义.结论 运用流程管理的科学理论和方法对患者进行分层可以优化急诊儿科护理服务.%Objective To explore the validity of process management and patient stratification in optimizing pediatric emergency nursing service. Methods The theory and method of process management were used to investigate and analyze the existing problems in pediatric emergency nursing service so as to improve the process. We reformulated a more normative and scientific working process based on the existing infusion center for intravenous medications in pediatric emergency nursing service; meanwhile, the nurses were guided to stratify the patients in terms of the status of the disease and to improve the management continuously. Before and after executing the new management method, the incidence rate of nursing mistakes, the satisfaction rate of the patients, the working efficiency of the nurses, and the satisfaction rate of the nurses were statistically analyzed. Results After executing the new management method, the incidence rate of nursing mistakes and the incidence rate of patients' complaints were both decreased significantly, but the satisfaction rate of the patienis, the working

  9. The effects of dexmedetomidine on emergence delirium in pediatric under total intravenous anesthesia%右美托咪定对小儿全凭静脉麻醉苏醒期躁动的影响

    Institute of Scientific and Technical Information of China (English)

    石念军; 张维霞; 张昊; 于海涛; 张宁; 王绪彩


    目的 观察右美托咪定预防小儿扁桃体腺样体切除术全凭静脉麻醉苏醒期躁动的作用.方法 将60例全凭静脉麻醉下行择期扁桃体腺样体切除术患儿,随机分为实验组(A组)与对照组(B组),诱导后分别持续静脉泵入右美托咪定每小时0.2 μg/kg和等容量的生理盐水至手术结束.记录患儿手术时间、停药至清醒时间、恢复室滞留时间、到达恢复室即刻改良Aldrete评分、进入恢复室后30 min内根据儿童麻醉后躁动评分(PAED)和改良加拿大东安大略儿童医院疼痛评分量表(m-CHEOPS),每5 min对患儿进行躁动和疼痛评分,所得最高值作为监测有效值.结果 实验组与对照组比较,停药至清醒时间、Aldrete评分及恢复室滞留时间的差异无统计学意义(P>0.05),PAED评分E组[(9.4±1.8)分]显著低于C组[(13.8±2.2)分,P<0.05],疼痛评分E组[(3.8±0.6)分]显著低于C组[(4.8±0.8)分,P<0.05].结论 右美托咪定可在一定程度上预防小儿扁桃体腺样体切除术全凭静脉麻醉苏醒期躁动的发生.%Objective To observe the effects of dexmedetomidine on emergence delirium in pediatric adenotonsillectomy under total intravenous anesthesia (TIVA).Methods 60 children undergoing adenotonsillectomy under TIVA were randomly divided into experimental group (group A) and control group (group B).Anesthesia was induced than dexmedetomidine was infused at the rate of 0.2 μg/kg.h in group E and sodium chloride was infused at the same volume in group C after induction.Record the time of operation,drug withdrawal to conscious,retention time of recovery room,and the modified Aldrete score of reaching recovery room,according to the Pediatric Anesthesia Emergence Delirium to mark the delirium of the patient in the future 30 minutes per 5 minutes,the highest score is used to effective value.and at the same time,mark the degree of pain according to the modified Children' s Hospital of Eastern Ontario Pain Scale

  10. Renal replacement therapy in adult and pediatric intensive care : Recommendations by an expert panel from the French Intensive Care Society (SRLF) with the French Society of Anesthesia Intensive Care (SFAR) French Group for Pediatric Intensive Care Emergencies (GFRUP) the French Dialysis Society (SFD). (United States)

    Vinsonneau, Christophe; Allain-Launay, Emma; Blayau, Clarisse; Darmon, Michael; Ducheyron, Damien; Gaillot, Theophile; Honore, Patrick M; Javouhey, Etienne; Krummel, Thierry; Lahoche, Annie; Letacon, Serge; Legrand, Matthieu; Monchi, Mehran; Ridel, Christophe; Robert, René; Schortgen, Frederique; Souweine, Bertrand; Vaillant, Patrick; Velly, Lionel; Osman, David; Van Vong, Ly


    Acute renal failure (ARF) in critically ill patients is currently very frequent and requires renal replacement therapy (RRT) in many patients. During the last 15 years, several studies have considered important issues regarding the use of RRT in ARF, like the time to initiate the therapy, the dialysis dose, the types of catheter, the choice of technique, and anticoagulation. However, despite an abundant literature, conflicting results do not provide evidence on RRT implementation. We present herein recommendations for the use of RRT in adult and pediatric intensive care developed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system by an expert group of French Intensive Care Society (SRLF), with the participation of the French Society of Anesthesia and Intensive Care (SFAR), the French Group for Pediatric Intensive Care and Emergencies (GFRUP), and the French Dialysis Society (SFD). The recommendations cover 4 fields: criteria for RRT initiation, technical aspects (access routes, membranes, anticoagulation, reverse osmosis water), practical aspects (choice of the method, peritoneal dialysis, dialysis dose, adjustments), and safety (procedures and training, dialysis catheter management, extracorporeal circuit set-up). These recommendations have been designed on a practical point of view to provide guidance for intensivists in their daily practice.

  11. The Study of Canadian Culture (United States)

    Mandel, Eli


    Discussed are Canadian novels, short stories, poems and a film which revolve around man's confrontation with nature, the depression, the problem of isolation, realism in Canadian literature. (Author/AF)

  12. 儿科急诊现状及急救技术规范化建设思考%The current situation and standardization construction of pediatric emergency system and technique

    Institute of Scientific and Technical Information of China (English)



    As a new branch of subject,pediatric emergency medicine developed rapidly but imbalanced.In this article,we reviewed the current situation of pediatric emergency medicine,analyzed the existed main problems and put forward some proposals about its development.Because we lacked professional and standardized medical team and systems,personnel configuration distributed unreasonably,pre-hospital transport developed relatively backward and scientific researches in this field do not have big progress,we are now still in lack of unified documents which are suitable for our national conditions as a guideline.So it is highly important to organize specialized talent training,introduce some new technologies and strengthen multidisciplinary cooperation for further constitute and promote guideline.%儿科急诊医学作为一门新兴学科,发展迅速但不平衡.本文通过回顾我国儿科急诊医学发展的历程与现状,分析了存在的主要问题,包括专业医师队伍缺乏、体系不规范、标准少、患者多、院前转运滞后、科学研究薄弱等.提出未来完善儿科急诊医疗体系过程中加强符合我国国情的儿科急诊技术规范化的设想,如专业人才培养、新技术准入和多学科合作,强调制定和推广指南的重要性.

  13. Application progress of intraosseous infusion in pediatric emergency and critical care%骨髓输液在儿科急危重症中的应用进展

    Institute of Scientific and Technical Information of China (English)

    贺晓春; 罗晓菊


    骨髓输液在对急危重症患儿抢救中可迅速、有效地建立液体通路而赢得宝贵的抢救时机,作为一种急救手段,逐渐受到重视.该文总结近年来国内、外骨髓输液在儿科急危重症中的应用进展,以推进对该项技术的认识,并促进其在医疗机构救治急危重患儿时的应用.%Intraosseous infusion can establish the liquid access in emergency and critical care rapidly and effectively so that it helps winning rescue chance for children. Attention is paid to it gradually as a means of first aid. This article intends to deepen the understanding of intraosseous infusion technique and promote application of it in emergency or critical disease in medical institution by summarizing the domestic and foreign application progress of this technique in pediatric emergency and critical care in recent years.

  14. Teaching Canadian Literature: An Evaluation. (United States)

    Harker, W. John


    Suggests granting greater recognition to the artistic integrity of Canadian literature by removing it from the broader context of Canadian studies. Indicates that understanding and appreciation of Canadian literature as a representation of reality filtered through the perception of an author should be focus of literature in schools. (NEC)

  15. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... Resources Professions Site Index A-Z Children's (Pediatric) Nuclear Medicine Children’s (pediatric) nuclear medicine imaging uses small ... of Children's Nuclear Medicine? What is Children's (Pediatric) Nuclear Medicine? Nuclear medicine is a branch of medical ...

  16. Pediatric sleep apnea (United States)

    Sleep apnea - pediatric; Apnea - pediatric sleep apnea syndrome; Sleep-disordered breathing - pediatric ... During sleep, all of the muscles in the body become more relaxed. This includes the muscles that help keep ...

  17. Children's (Pediatric) Nuclear Medicine (United States)

    ... Professions Site Index A-Z Children's (Pediatric) Nuclear Medicine Children’s (pediatric) nuclear medicine imaging uses small amounts ... Children's Nuclear Medicine? What is Children's (Pediatric) Nuclear Medicine? Nuclear medicine is a branch of medical imaging ...

  18. Canadian Adult Basic Education. (United States)

    Brooke, W. Michael, Comp.

    "Trends," a publication of the Canadian Association for Adult Education, is a collection of abstracts on selected subjects affecting adult education; this issue is on adult basic education (ABE). It covers teachers and teacher training, psychological factors relating to the ABE teacher and students, manuals for teachers, instructional…

  19. Pediatric parasomnias. (United States)

    Mason, Thornton B A; Pack, Allan I


    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.

  20. Pediatric fibromyalgia

    Directory of Open Access Journals (Sweden)

    J. Ablin


    Full Text Available Fibromyalgia (FM is currently defined as chronic widespread pain (CWP with allodynia or hyperalgesia to pressure pain. It is classified as one of the large group of soft-tissue pain syndromes. Pain is the cardinal symptom of FM; however, most patients also experience additional symptoms such as debilitating fatigue, disrupted or non-restorative sleep, functional bowel disturbances, and a variety of neuropsychiatric problems, including cognitive dysfunction, anxiety and depressive symptoms. Its pathogenesis is not entirely understood, although it is currently believed to be the result of a central nervous system (CNS malfunction that increases pain transmission and perception. FMS usually involves females, and in these patients it often makes its first appearance during menopause. But it is often diagnosed both in young as well as elderly individuals. Pediatric FMS is a frustrating condition affecting children and adolescents at a crucial stage of their physical and emotional development. Pediatric FMS is an important differential diagnosis to be considered in the evaluation of children suffering from widespread musculoskeletal pain, and must be differentiated from a spectrum of inflammatory joint disorders such as juvenile idiopathic arthritis (JIA, juvenile ankylosing spondylitis, etc. The management of pediatric FMS is centered on the issues of education, behavioral and cognitive change (with a strong emphasis on physical exercise, and a relatively minor role for pharmacological treatment with medications such as muscle relaxants, analgesics and tricyclic agents.

  1. Canadian Asthma Consensus Conference Summary of Recommendations

    Directory of Open Access Journals (Sweden)

    Pierre Ernst


    Full Text Available The Asthma Committee of the Canadian Thoracic Society invited a group of Canadian physicians with a particular interest in asthma to meet in Montebello, Quebec, March 9-12, 1995 to arrive at a consensus statement on the optimal approach to the management of asthma in the pediatric and adult ambulatory care settings. The societies and associations represented are listed in the appendix with the names of the contributors to this document. The objectives of the Montebello conference were: 1. To review the current ambulatory care management of asthma in Canada; 2. To develop guidelines with the participation of family physicians and specialists; 3. To develop guidelines which are evidence-based; 4. In creating evidence-based guidelines to focus attention on aspects of asthma management that are currently not supported by randomized controlled trials; 5. To develop strategies that allow for the implementation of rational guidelines at a local level. Recommendations were based on a critical review of the scientific literature by small groups prior to the meeting and are categorized according to the strength of the scientific evidence supporting each recommendation (Table 1.

  2. Kano模式对提升儿科门急诊护理服务满意度的影响%Effect of Kano model on improving satisfaction of nursing service in outpatient and emergency department of pediatrics

    Institute of Scientific and Technical Information of China (English)

    苏颖; 李素芳; 郑群; 秦尚够; 李绍焕


    Objective To discuss the effect of Kano model on improving satisfaction of nursing service in outpatient and emergency department of pediatrics.Methods Questionnaires about Kano model on the needs of nursing service in outpatient and emergency department were designed,and the attributes of needs were determined.Children' s needs were included in the nursing service process.And the satisfaction of nursing was investigated and compared before and after by a third party.Results There were ten must-be items (M),nine one-dimensional items (O) and six attractive itmes (A) in Kano model analysis of nursing service.After improving nursing process,the satisfaction rate increased from 78.23% to 86.30%,with statistically significant difference (x2 =6.536,P < 0.05).Conclusions Kano model can exactly screen the quality attributes of children's and parents' needs of nursing service,and significantly improve satisfaction in outpatient and emergency department of pediatrics.%目的 探讨Kano模式在提升儿科门急诊护理服务满意度中的作用.方法 自行设计Kano模式门急诊护理服务需求调查问卷,确定儿科门急诊护理服务需求的属性;将患儿需求转化到改进护理服务流程的设计中;委托第三方对流程改进前后的门急诊护理服务满意度进行调查并比较.结果 Kano模式分析中,儿科门急诊护理服务项目必备属性(M)10项、期望属性(0)9项、魅力属性(A)6项;改进护理服务流程后,护理满意度由78.23%提高到86.30%,差异有统计学意义(x2=6.536,P<0.05).结论 Kano模式能准确筛选出患儿及家长对门急诊护理服务需求的质量属性,可以显著提高儿科门急诊护理服务的满意度.

  3. CANLIT (Canadian Literature) Teachers' Crash Course. (United States)

    CANLIT, Toronto (Ontario).

    As a result of a study of the situation of Canadian literature in Canadian high schools and universities, this course was developed to provide teachers with useful information about Canadian literature. Included in this kit are sections on Canadian literature (the great debate about the importance of Canadian content), history and sources…

  4. 儿科急诊分诊护理应答措施的改进效果%To improve the effect of pediatric emergency triage nursing response measures

    Institute of Scientific and Technical Information of China (English)

    安博; 梁婉琪; 姜国莹


    Objective To explore and study the pediatric emergency triage nursing response measures to improve the effect,provides the basis for improving the nursing triage system.Methods The study subjects selected for the full year of 2012(prior to the implementation of 18 976 patients) and full year 2013 pediatric emergency treated(after the implementation of 20 131 cases were children),starting in 2013,improved triage nursing measures of response,before and after the implementation of risk event rate and satisfaction survey contrast.Results After the implementation of risk occurrence rate of 0.05 per thousand(1/20 131),significantly lower than before the implementation of the 0.37 per thousand(7/18 976),with significant difference(P<0.05);after the implementation of the child's family,the satisfaction degree of doctors and nurses were significantly increased(P<0.05).Conclusion The improved pediatric emergency triage nursing response measures can improve medical staff effective risk prevention awareness,reduce the risk of incident,and comprehensively improve the quality of nursing,worthy of clinical popularization and application.%目的:探讨和研究儿科急诊分诊护理应答措施改进的效果,为护理分诊制度的改进提供依据。方法:选择2012年全年(实施前)儿科急诊收治的18976例患儿及2013年全年(实施后)收治的20131例患儿,于2013年起改进分诊护理应答措施,对实施前后的风险事件发生率及满意度进行调查对比。结果:实施后风险事件发生率为0.05‰(1/20131),显著低于实施前的0.32‰(6/18976),差异有统计学意义(P<0.05);实施后患儿家属、医护人员的满意度均显著提高(P<0.05)。结论:儿科急诊分诊护理应答措施的改进能够有效的提高医护人员的风险防范意识,减少风险事件的发生,全面提高了护理质量,值得在临床上推广和应用。

  5. Canadian Mathematical Congress

    CERN Document Server


    For two weeks in August, 1975 more than 140 mathematicians and other scientists gathered at the Universite de Sherbrooke. The occasion was the 15th Biennial Seminar of the Canadian Mathematical Congress, entitled Mathematics and the Life Sciences. Participants in this inter­ disciplinary gathering included researchers and graduate students in mathematics, seven different areas of biological science, physics, chemistry and medical science. Geographically, those present came from the United States and the United Kingdom as well as from academic departments and government agencies scattered across Canada. In choosing this particular interdisciplinary topic the programme committee had two chief objectives. These were to promote Canadian research in mathematical problems of the life sciences, and to encourage co-operation and exchanges between mathematical scientists" biologists and medical re­ searchers. To accomplish these objective the committee assembled a stim­ ulating programme of lectures and talks. Six ...

  6. Canadian identity: Implications for international social work by Canadians

    DEFF Research Database (Denmark)

    Hiranandani, Vanmala Sunder


    This paper is in response to recent calls to conceptualize and articulate Canadian perspectives and experiences in international social work, given that the Canadian standpoint has been lacking in international social work literature. This paper contends that it is imperative, first of all......, to critically examine and unpack our ‘Canadian’ identity in order to practice international work that is socially just and anti-imperialist. Drawing on the work of post-colonial authors, critical race theorists, and those who study national myth-making, this essay revisits Canadian identity because...... it is this identity that Canadian social workers often carry into their international work....

  7. Pediatric vitiligo. (United States)

    Silverberg, Nanette B


    Vitiligo is a disease of pigment loss. Most investigators currently consider vitiligo to be a disorder that occurs as a result of autoimmune destruction of melanocytes, supported by identification of antimelanocyte antibodies in many patients, and the presence of comorbid autoimmune disease in patients with and family members of individuals with vitiligo. One-half of vitiligo cases are of childhood onset. This article presents a current overview of pediatric vitiligo including comorbidities of general health, psychological factors, therapeutic options, and long-term health considerations.

  8. Pediatric urticaria. (United States)

    Tsakok, Teresa; Du Toit, George; Flohr, Carsten


    Although urticaria is not a life-threatening disease, its impact on quality of life in children should not be overlooked. A systematic search of online databases, including Medline, was performed to inform a review aiming to equip clinicians with an evidence-based approach to all aspects of pediatric urticaria. This review hinges on an illustrative case and includes a summary table of studies pertaining to disease management in children. The multiple issues faced by patients, their families, and treating clinicians are highlighted, and the current literature on the presentation, natural history, investigation, and management of this poorly understood condition is assessed.

  9. Tuberculosis in Aboriginal Canadians

    Directory of Open Access Journals (Sweden)

    Vernon H Hoeppner


    Full Text Available Endemic tuberculosis (TB was almost certainly present in Canadian aboriginal people (aboriginal Canadians denotes status Indians, Inuit, nonstatus Indians and metis as reported by Statistics Canada before the Old World traders arrived. However, the social changes that resulted from contact with these traders created the conditions that converted endemic TB into epidemic TB. The incidence of TB varied inversely with the time interval from this cultural collision, which began on the east coast in the 16th century and ended in the Northern Territories in the 20th century. This relatively recent epidemic explains why the disease is more frequent in aboriginal children than in Canadian-born nonaboriginal people. Treatment plans must account for the socioeconomic conditions and cultural characteristics of the aboriginal people, especially healing models and language. Prevention includes bacillus Calmette-Guerin vaccination and chemoprophylaxis, and must account for community conditions, such as rates of suicide, which have exceeded the rate of TB. The control of TB requires a centralized program with specifically directed funding. It must include a program that works in partnership with aboriginal communities.

  10. Analysisn ursing workload in pediatric emergency to uidancenurse rostering%新疆医科大学第一附属医院儿科门急诊护理工作量分析

    Institute of Scientific and Technical Information of China (English)

    董菊; 赵琦; 林素兰


    目的:分析儿科门急诊护理工作量变化及规律,为合理分配人力资源、指导护理排班提供依据。方法回顾性统计2010-2012年每月日平均输液人次变化,2013年9、10、11月3个月日不同时间段平均接收输液病人人次,3个月日上下午平均采血量,3个月日夜间门诊量分布。结果1、2、7、8、9月每月日平均输液人次量少;每日12∶00~14∶00为接收输液病人的高峰时段;上午采血量明显高于下午;夜间门诊量上半夜多于下半夜。结论根据儿科门急诊护理工作量存在的规律指导排班,可节省人力资源,保证护理工作质量。%Objective To statistics the nursing workload changes in pediatric emergency,Analysis of law.To pro-vide the basis for the rational allocation of human resources and nursing instruction scheduling.Methods Collecting monthly average daily amount of transfusion changes retrospectively from 2010 to 2012.Daily average received transfusion patient attendances at different time,the average blood volume in the morning or afternoon and the outpatient amount distribution during the day or nigh In 2013,September,October and November.Results The monthly average daily amount of transfusion less in January,February,July,August and September.The peak hours daily receiving transfusion patients from twelve to fourteen o′clock.Morning blood volume was signifi-cantly higher than that in the afternoon;The midnight night outpatient amount more than the night.Conclusion Nursing workload in law in Pediatric emergency.According to these rules to guide the scheduling.Can save human resource and guarantee the quality of nursing work.

  11. General Anesthetic Versus Light Sedation: Effect on Pediatric Endoscopy Wait Times

    Directory of Open Access Journals (Sweden)

    Christine Edwards


    Full Text Available BACKGROUND: Wait times are an important measure of health care system effectiveness. There are no studies describing wait times in pediatric gastroenterology for either outpatient visits or endoscopy. Pediatric endoscopy is performed under light sedation or general anesthesia. The latter is hypothesized to be associated with a longer wait time due to practical limits on access to anesthesia in the Canadian health care system.

  12. Principles of disaster planning for the pediatric population. (United States)

    Allen, Gwenn M; Parrillo, Steven J; Will, Jean; Mohr, Johnathon A


    Unique physiological, developmental, and psychological attributes of children make them one of the more vulnerable populations during mass-casualty incidents. Because of their distinctive vulnerabilities, it is crucial that pediatric needs are incorporated into every stage of disaster planning. Individuals, families, and communities can help mitigate the effects of disasters on pediatric populations through ongoing awareness and preventive practices. Mitigation efforts also can be achieved through education and training of the healthcare workforce. Preparedness activities include gaining Emergency Medical Services for Children Pediatric Facility Recognition, conducting pediatric disaster drills, improving pediatric surge capacity, and ensuring that the needs of children are incorporated into all levels of disaster plans. Pediatric response can be improved in a number of ways, including: (1) enhanced pediatric disaster expertise; (2) altered decontamination protocols that reflect pediatric needs; and (3) minimized parent-child separation. Recovery efforts at the pediatric level include promoting specific mental health therapies for children and incorporating children into disaster relief and recovery efforts. Improving pediatric emergency care needs should be at the forefront of every disaster planner's agenda.

  13. Canadian advanced life support capacities and future directions (United States)

    Bamsey, M.; Graham, T.; Stasiak, M.; Berinstain, A.; Scott, A.; Vuk, T. Rondeau; Dixon, M.


    Canada began research on space-relevant biological life support systems in the early 1990s. Since that time Canadian capabilities have grown tremendously, placing Canada among the emerging leaders in biological life support systems. The rapid growth of Canadian expertise has been the result of several factors including a large and technically sophisticated greenhouse sector which successfully operates under challenging climatic conditions, well planned technology transfer strategies between the academic and industrial sectors, and a strong emphasis on international research collaborations. Recent activities such as Canada's contribution of the Higher Plant Compartment of the European Space Agency's MELiSSA Pilot Plant and the remote operation of the Arthur Clarke Mars Greenhouse in the Canadian High Arctic continue to demonstrate Canadian capabilities with direct applicability to advanced life support systems. There is also a significant latent potential within Canadian institutions and organizations with respect to directly applicable advanced life support technologies. These directly applicable research interests include such areas as horticultural management strategies (for candidate crops), growth media, food processing, water management, atmosphere management, energy management, waste management, imaging, environment sensors, thermal control, lighting systems, robotics, command and data handling, communications systems, structures, in-situ resource utilization, space analogues and mission operations. With this background and in collaboration with the Canadian aerospace industry sector, a roadmap for future life support contributions is presented here. This roadmap targets an objective of at least 50% food closure by 2050 (providing greater closure in oxygen, water recycling and carbon dioxide uptake). The Canadian advanced life support community has chosen to focus on lunar surface infrastructure and not low Earth orbit or transit systems (i.e. microgravity

  14. Clinical application of emergency bedside-echocardiography in pediatric intensive care unit%急诊床旁超声心动图在儿童重症监护室的应用价值

    Institute of Scientific and Technical Information of China (English)

    陶子瑜; 张育才; 谢利剑; 沈捷; 肖婷婷; 张永为; 张儒舫; 许云峰


    目的 探讨急诊床旁超声心动图(EB-Echo)在儿童重症监护室检查中的临床应用价值.方法 应用便携式超声诊断仪和超声心动图诊断仪对1028例患儿进行EB-Echo探查.结果 1028例患儿检查发现异常者624例,占60.7%,经EB-Echo及时诊断治疗后好转出院511例,有效率达81.9%.结论 EB-Echo能迅速评价和监测危重症患儿心脏结构和功能,检测药物疗效和判断预后.%Objective To evaluate the clinical value of emergency bedside- echocardiography ( EB - Echo ) in the examination of pediatric intensive care unit (PICU). Methods SonoSite Micromax and Philips iE 33 ultrasonic systems were employed for EB-Echo in 1028 children. Results The positive rate of EB-Echo examination was 60.7% (624/1028). Five hundred and eleven children were correctly diagnosed and received treatment. The diagnostic accordance rate was 81.9%. Conclusion EB-Echo echocardiography can be used to evaluate and monitor cardiac structure and function, test the therapeutic effect of drugs and judge the prognosis.

  15. Developing competencies for pediatric hospice and palliative medicine. (United States)

    Klick, Jeffrey C; Friebert, Sarah; Hutton, Nancy; Osenga, Kaci; Pituch, Kenneth J; Vesel, Tamara; Weidner, Norbert; Block, Susan D; Morrison, Laura J


    In 2006, hospice and palliative medicine (HPM) became an officially recognized subspecialty. This designation helped initiate the Accreditation Council of Graduate Medical Education Outcomes Project in HPM. As part of this process, a group of expert clinician-educators in HPM defined the initial competency-based outcomes for HPM fellows (General HPM Competencies). Concurrently, these experts recognized and acknowledged that additional expertise in pediatric HPM would ensure that the competencies for pediatric HPM were optimally represented. To fill this gap, a group of pediatric HPM experts used a product development method to define specific Pediatric HPM Competencies. This article describes the development process. With the ongoing evolution of HPM, these competencies will evolve. As part of the Next Accreditation System, the Accreditation Council of Graduate Medical Education uses milestones as a framework to better define competency-based, measurable outcomes for trainees. Currently, there are no milestones specific to HPM, although the field is designing curricular milestones with multispecialty involvement, including pediatrics. These competencies are the conceptual framework for the pediatric content in the HPM milestones. They are specific to the pediatric HPM subspecialist and should be integrated into the training of pediatric HPM subspecialists. They will serve a foundational role in HPM and should inform a wide range of emerging innovations, including the next evolution of HPM Competencies, development of HPM curricular milestones, and training of adult HPM and other pediatric subspecialists. They may also inform pediatric HPM outcome measures, as well as standards of practice and performance for pediatric HPM interdisciplinary teams.

  16. A Review of Tuberculous Meningitis in a Canadian Pediatric Hospital

    Directory of Open Access Journals (Sweden)

    Lissette Navas


    Full Text Available Tuberculous meningitis is a disease associated with high morbidity and mortality. Experience with this disease at the Hospital for Sick Children in Toronto was reviewed to determine whether changes in prognosis have occurred in the past decade. All patients from whom the organism was recovered from the cerebrospinal fluid, or who had a positive Mantoux test in association with a compatible history, were included. Thirteen patients were identified from 1978 to 1989. The median age was six years (range 11 months to 17.5 years. Nine patients were born in Canada, but all except one were members of recently immigrant families. History of close contact with an adult with tuberculosis, or travel to an endemic area in the preceding six months, was present in seven cases. All patients had clinical manifestations and mild pleocytosis with elevated protein content in the cerebrospinal fluid. Patients were all diagnosed within 20 days after admission (median one day. Computed tomography scan of the head was abnormal in all patients within three weeks of admission. No patient died, although long term sequelae developed in five. The prognosis of tuberculous meningitis has improved in the past decade. Although a specific reason for this improvement cannot be definitively stated, earlier diagnosis and better chemotherapy may contribute.

  17. The reliability of the Canadian triage and acuity scale: Meta-analysis

    Directory of Open Access Journals (Sweden)

    Amir Mirhaghi


    Full Text Available Background: Although the Canadian Triage and Acuity Scale (CTAS have been developed since two decades ago, the reliability of the CTAS has not been questioned comparing to moderating variable. Aims: The study was to provide a meta-analytic review of the reliability of the CTAS in order to reveal to what extent the CTAS is reliable. Materials and Methods: Electronic databases were searched to March 2014. Only studies were included that had reported samples size, reliability coefficients, adequate description of the CTAS reliability assessment. The guidelines for reporting reliability and agreement studies (GRRAS were used. Two reviewers independently examined abstracts and extracted data. The effect size was obtained by the z-transformation of reliability coefficients. Data were pooled with random-effects models and meta-regression was done based on method of moments estimator. Results: Fourteen studies were included. Pooled coefficient for the CTAS was substantial 0.672 (CI 95%: 0.599-0.735. Mistriage is less than 50%. Agreement upon the adult version, among nurse-physician and near countries is higher than pediatrics version, other raters and farther countries, respectively. Conclusion: The CTAS showed acceptable level of overall reliability in the emergency department but need more development to reach almost perfect agreement.

  18. Pediatric tracheomalacia. (United States)

    Fraga, Jose Carlos; Jennings, Russell W; Kim, Peter C W


    Tracheomalacia (TM) is defined as an increased collapsibility of the trachea due to structural anomalies of the tracheal cartilage and/or posterior membrane. Tracheomalacia has a wide range of etiologies but is most commonly present in children born with esophageal atresia and tracheal esophageal fistula. Clinical symptoms can range from minor expiratory stridor with typical barking cough to severe respiratory distress episodes to acute life-threatening events (ALTE). Although the majority of children have mild-to-moderate symptoms and will not need surgical intervention, some will need life-changing surgical treatment. This article examines the published pediatric literature on TM, discusses the details of clinical presentation, evaluation, diagnosis, and a variety of treatments.

  19. Pediatric biobanking

    DEFF Research Database (Denmark)

    Salvaterra, Elena; Giorda, Roberto; Bassi, Maria T


    such as decision making, privacy protection, minor recontact, and research withdrawal by focusing on theoretical or empirical perspectives. Our research attempted to analyze such issues in a comprehensive manner by exploring practices, rules, and researcher opinions regarding proxy consent, minor assent, specimens...... was subjected to national or local regulations covering adult biobanks (n=26). Informed consent was generally given by parents or legal representatives (n=17). Children's opinions were frequently sought and taken into account (n=16). However, minors were usually not recontacted at the age of maturity to express......Ethical, legal, and social issues related to the collection, storage, and use of biospecimens and data derived from children raise critical concerns in the international debate. So far, a number of studies have considered a variety of the individual issues crucial to pediatric biobanking...

  20. Midazolam versus diazepam para tratamento de estado de mal epiléptico em emergência pediátrica = Midazolam versus diazepam for the treatment of status epilepticus in pediatric emergency

    Directory of Open Access Journals (Sweden)

    Portela, Janete de Lourdes


    Conclusões: se o acesso intravenoso não estiver disponível, há evidências de que o midazolam por via intramuscular, bucal ou nasal pode ser a alternativa ao diazepam endovenoso ou retal, para tratamento de convulsão em emergência pediátrica

  1. On Realities of Canadian Multiculturalism

    Institute of Scientific and Technical Information of China (English)



    Canada is a multicultural country which was mainly established by immigrants. Just because of that, Canadian govern⁃ment has carried out the policy of multiculturalism since1970s. However, it has encountered many problems such as policy con⁃flicts, national identity, democracy-inquiry and racial discrimination, etc. Hence the Canadian multiculturalism has been in a di⁃lemma.

  2. Medical cannabis - the Canadian perspective. (United States)

    Ko, Gordon D; Bober, Sara L; Mindra, Sean; Moreau, Jason M


    Cannabis has been widely used as a medicinal agent in Eastern medicine with earliest evidence in ancient Chinese practice dating back to 2700 BC. Over time, the use of medical cannabis has been increasingly adopted by Western medicine and is thus a rapidly emerging field that all pain physicians need to be aware of. Several randomized controlled trials have shown a significant and dose-dependent relationship between neuropathic pain relief and tetrahydrocannabinol - the principal psychoactive component of cannabis. Despite this, barriers exist to use from both the patient perspective (cost, addiction, social stigma, lack of understanding regarding safe administration) and the physician perspective (credibility, criminality, clinical evidence, patient addiction, and policy from the governing medical colleges). This review addresses these barriers and draws attention to key concerns in the Canadian medical system, providing updated treatment approaches to help clinicians work with their patients in achieving adequate pain control, reduced narcotic medication use, and enhanced quality of life. This review also includes case studies demonstrating the use of medical marijuana by patients with neuropathic low-back pain, neuropathic pain in fibromyalgia, and neuropathic pain in multiple sclerosis. While significant preclinical data have demonstrated the potential therapeutic benefits of cannabis for treating pain in osteoarthritis, rheumatoid arthritis, fibromyalgia, and cancer, further studies are needed with randomized controlled trials and larger study populations to identify the specific strains and concentrations that will work best with selected cohorts.

  3. News on pediatric urology

    Directory of Open Access Journals (Sweden)

    Giuseppe Masnata


    Full Text Available Pediatric urology is a pediatric speciality dedicated to the diagnosis and treatment of congenital and acquired genitourinary tract diseases. It is a speciality that is rapidly changing, thanks to the technological development that has been emerging in recent years. There have been important diagnostic and therapeutic news.Congenital anomalies of the kidneys and urinary tract (CAKUT include various entities of structural malformations that result from defects in their morphogenesis. Clinical research and genetic studies on the origins of CAKUT are quickly evolving, with significant growth of high-quality research.Management goals of CAKUT include prevention of febrile urinary tract infections (UTIs in newborns and toddles and renal injury, while minimizing the morbidity of treatment and follow-up. Treatment options include observation with or without continuous antibiotic prophylaxis (CAP and surgical correction. Now, randomized controlled studies show that children with normal urinary tracts or low-grade vesicoureteral reflux (VUR do not benefit from prophylaxis.All children with known mechanical or functional obstructions of the urinary tract are considered to have UTI. Functional obstruction often results from lower urinary tract dysfunction (LUTD of either neurogenic or non-neurogenic origin and dilating VUR.The role of bladder and bowel dysfunction (BBD in children with UTI and the long-term risk of renal scarring have shed new light on treatment strategies. Often it is BBD, rather than reflux, that causes UTI in children older than 2 years.Pediatric urology has evolved in recent years, with a greater focus on bladder and renal function, minimally invasive treatment, evidence-based interventions, and guideline adherence. Other topics in pediatric urology include urinary incontinence in children with special needs and the use of robot-assisted laparoscopic surgery (RALS in children, with advantages over conventional laparoscopic surgery

  4. Canadian construction industry

    Energy Technology Data Exchange (ETDEWEB)

    Rich, M.


    The principal sectors of the Canadian construction industry - commercial, industrial, institutional and residential - are examined with regard to their technical considerations concerning the subject of sustainability. Apart from the different needs of each of the sectors of the industry there are also regional differences caused by population distribution, and differences in climate, that have to be identified and accommodated in considering attitudes to recycling and sustainable development. Some indications that there is growing awareness of recycling and reuse are: the increasing frequency of life cycle costing in the commercial and institutional sectors, the use of recycled or otherwise waste materials in concrete, examples of using steel supporting structures and roof joists salvaged from previous uncompleted projects in the industrial sector, improved building envelope and indoor air quality concerns, collective ground source heating, and new basement and framing technologies and construction materials in the residential sector. These improvements notwithstanding, there remains much to be done. The new objective-based National Building Code, for which comments are now being solicited across the country, is expected to identify new and innovative solutions and to kick-start serious efforts to come up with solutions towards increasing overall sustainability in all sectors of the Canadian construction industry.

  5. Grade 3 Students Explore the Question, "What's Canadian about Canadian Children's Literature?" (United States)

    Pantaleo, Sylvia


    Explores third graders' responses to the question "What's Canadian about Canadian Children's Literature?" Describes 6 picture books and summarizes students' responses to each. Finds students mentioned geographical aspects as characteristic of Canadian literature, and they felt Canadian children's literature should reflect Canadian "experiences."…

  6. Problems in the Study of Canadian Literature. (United States)

    Cameron, Barry


    Considers reasons for studying Canadian literature. Notes the relative infancy of Canadian literature and the need for maintaining objectivity in the study of Canadian literature. Proposes that teachers of Canadian literature focus on individual, contemporary works, examining language, form, and craftsmanship. (RL)

  7. [Canadian Literature. "Featuring: CanLit." (United States)

    Haycock, Ken, Ed.; Haycock, Carol-Ann, Ed.


    The feature articles in this journal issue deal with various aspects of Canadian literature. The articles include: (1) a discussion of who's who and what's what in Canadian literature; (2) reviews of worthwhile but overlooked Canadian children's literature; (3) a list of resource guides to Canadian literature and a short quiz over famous first…

  8. Pediatric Thyroid Cancer (United States)

    ... Marketplace Find an ENT Doctor Near You Pediatric Thyroid Cancer Pediatric Thyroid Cancer Patient Health Information News media ... and neck issues, should be consulted. Types of thyroid cancer in children: Papillary : This form of thyroid cancer ...

  9. Pediatric Celiac Disease (United States)

    ... of Pediatric Gastroenterology and Nutrition Nurses Print Share Celiac Disease Many kids have sensitivities to certain foods, ... protein found in wheat, rye, and barley. Pediatric Celiac Disease If your child has celiac disease, consuming ...

  10. Pediatric Endocrinology Nurses Society (United States)

    ... International Welcome to PENS The Pediatric Endocrinology Nursing Society (PENS) is committed to the development and advancement ... • Copyright © 2016 Pediatric Endocrinology Nursing Society • ALL RIGHTS RESERVED • Privacy Policy • Admin

  11. The APA and the rise of pediatric generalist network research. (United States)

    Wasserman, Richard; Serwint, Janet R; Kuppermann, Nathan; Srivastava, Rajendu; Dreyer, Benard


    The Academic Pediatric Association (APA, formerly the Ambulatory Pediatric Association) first encouraged multi-institutional collaborative research among its members over 30 years ago. Individual APA members subsequently went on to figure prominently in establishing formal research networks. These enduring collaborations have been established to conduct investigations in a variety of generalist contexts. At present, 4 generalist networks--Pediatric Research in Office Settings (PROS), the Pediatric Emergency Care Applied Research Network (PECARN), the COntinuity Research NETwork (CORNET), and Pediatric Research in Inpatient Settings (PRIS)--have a track record of extensive achievement in generating new knowledge aimed at improving the health and health care of children. This review details the history, accomplishments, and future directions of these networks and summarizes the common themes, strengths, challenges, and opportunities inherent in pediatric generalist network research.

  12. The Role of Japanese as a Heritage Language in Constructing Ethnic Identity among Hapa Japanese Canadian Children (United States)

    Noro, Hiroko


    Today, Japanese Canadians are marrying outside of their ethnic community at an unprecedented rate, resulting in the creation of a newly identifiable group of "Japanese Canadians" borne from these interracial unions. Members of this emergent group are increasingly being referred to both by social scientists and self-referentially as…

  13. Proton Radiotherapy for Pediatric Sarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Ladra, Matthew M.; Yock, Torunn I., E-mail: [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114 (United States)


    Pediatric sarcomas represent a distinct group of pathologies, with approximately 900 new cases per year in the United States alone. Radiotherapy plays an integral role in the local control of these tumors, which often arise adjacent to critical structures and growing organs. The physical properties of proton beam radiotherapy provide a distinct advantage over standard photon radiation by eliminating excess dose deposited beyond the target volume, thereby reducing both the dose of radiation delivered to non-target structures as well as the total radiation dose delivered to a patient. Dosimetric studies comparing proton plans to IMRT and 3D conformal radiation have demonstrated the superiority of protons in numerous pediatric malignancies and data on long-term clinical outcomes and toxicity is emerging. In this article, we review the existing clinical and dosimetric data regarding the use of proton beam radiation in malignant bone and soft tissue sarcomas.

  14. Canadian National Vegetation Classification (CNVC) (United States)

    US Fish and Wildlife Service, Department of the Interior — The mandate of the CNVC is to comprehensively classify and describe natural and semi-natural Canadian vegetation in an ecologically meaningful manner. The...

  15. Canadian Literature Is Comparative Literature. (United States)

    Blodgett, E. D.


    Argues that the way out of worn out analogies of Canadian literature is found not only by acquiring knowledge of other cultures, but also by abandoning the deceptive parallelisms that overcome differences only by hiding them. (RAE)

  16. Resources for pediatric drug information. (United States)

    Zenk, K E


    Finding information on the use of drugs fro infants and children is becoming easier with the publication of excellent resources for pediatric and neonatal drug information. Useful pediatric texts and journals are listed. Texts are graded A and B. Category A books would be useful to include in a basic pharmacy library; Category B books are more comprehensive but expensive, or texts that are not as highly recommended as those in Category A. Some of the resources listed include: (1) Pediatrics--Nelson Textbook of Pediatrics, Rudolph's Pediatrics, Current Pediatric Diagnosis and Treatment, Manual of Pediatric Therapeutics; (2) Dosage Guides--The Pediatric Drug Handbook, Harriet Lane Handbook, Problems in Pediatric Drug THerapy; (3) Intensive Care--Textbook of Pediatric Intensive Care; (4) Infectious Disease--Report of the Committee on Infectious Diseases, Pocketbook of Pediatric Antimicrobial Therapy; (5) Poisoning--Handbook of Poisoning, Medical Toxicology; (6) Parenteral Nutrition--Manual of Pediatric Parenteral Nutrition; (7) Pregnancy and Lactation--Drugs in Pregnancy and Lactation; (8) Compounding--Handbook on Extemporaneous Formulation; (9) IV Administration--Guidelines for Administration of Intravenous Medications to Pediatric Patients; (1) Neonatology--Schaffers Diseases of the Newborn, Neonatology, Basic Management, On-Call Problems, Diseases, Drugs, Drug Therapy in Infants; (11) Pediatric Journals--Pediatrics, Journal of Pediatrics, American Journal of Diseases of Children, Pediatric Infectious Disease Journal, Pediatric Alert, Clinics in Perinatology, Pediatric Clinics of North America, Pediatric Clinical Oncology Journal, and Pediatric Surgery.


    Institute of Scientific and Technical Information of China (English)

    石念军; 张昊


    目的:探讨右美托咪定用于儿童扁桃体合并腺样体切除术后苏醒期躁动的预防作用。方法选择择期扁桃体腺样体切除术患儿80例,A S A分级I级或Ⅱ级,年龄3~6岁,性别不限。采用随机数字表法,分为实验组(E组)与对照组(C组)。诱导后E组静脉泵入右美托咪定0.2 u g/kg/h ,C组泵入等容量的生理盐水,直至手术结束。观察内容包括:手术持续时间、术毕至拔管时间、复苏室观察时间、进入复苏室后的改良Aldrete评分、儿童麻醉后躁动评分(PAED )和疼痛评分(根据改良加拿大东安大略儿童医院疼痛评分量表),于右美托咪啶给药前(T1)、切皮时(T2)及拔管时(T 3)采集外周静脉血样,测定血糖水平及血清皮质醇浓度。结果实验组与对照组比较, PAED评分及疼痛评分显著降低,T3时血糖水平及血清皮质醇浓度降低,差异均有统计学意义( P<0.05)。结论右美托咪定可明显降低儿童扁桃体腺样体切除术后苏醒期躁动的发生率,可安全的用于儿科手术患者。%Objective To explore the preventive effect of dexmedetomidine on emergence delirium in pediatric adenotonsillectomy . Methods 80 children aged 3‐6 at ASA physical status I or Ⅱ of both sexes underwent adenotonsillectomy ,and were randomly divided into the experimental group (Group E)and the control group (Group C) .The children in Group E received 0 .2 ug/kg .h of dexmedetomidine and the same volume of sodium chloride infusion in Group C after induction .Re‐corded in the data were the time of operation and extubation ,the observation time in recovery room ,the modified Aldrete score of reaching recovery room ,the score of PAED to mark the delirium of the patient , the score of pain according to the modified Children’s Hospital of Eastern Ontario Pain Scaele ,the deter‐mination of the blood glucose level and serum cortisol

  18. Children’s Mental Health Visits to the Emergency Department: Factors Affecting Wait Times and Length of Stay

    Directory of Open Access Journals (Sweden)

    Amanda S. Newton


    Full Text Available Objective. This study explores the association of patient and emergency department (ED mental health visit characteristics with wait time and length of stay (LOS. Methods. We examined data from 580 ED mental health visits made to two urban EDs by children aged ≤18 years from April 1, 2004, to March 31, 2006. Logistic regressions identified characteristics associated with wait time and LOS using hazard ratios (HR with 95% confidence intervals (CIs. Results. Sex (male: HR=1.48, 95% CI=1.20–1.84, ED type (pediatric ED: HR=5.91, 95% CI=4.16–8.39, and triage level (Canadian Triage and Acuity Scale (CTAS 2: HR=3.62, 95% CI=2.24–5.85 were statistically significant predictors of wait time. ED type (pediatric ED: HR=1.71, 95% CI=1.18–2.46, triage level (CTAS 5: HR=2.00, 95% CI=1.15–3.48, number of consultations (HR=0.46, 95% CI=0.31–0.69, and number of laboratory investigations (HR=0.75, 95% CI=0.66–0.85 predicted LOS. Conclusions. Based on our results, quality improvement initiatives to reduce ED waits and LOS for pediatric mental health visits may consider monitoring triage processes and the availability, access, and/or time to receipt of specialty consultations.

  19. [Pediatric emergency: adrenal insufficiency and adrenal crisis]. (United States)

    Martínez, Alicia; Pasqualini, Titania; Stivel, Mirta; Heinrich, Juan Jorge


    Adrenal insufficiency is defined by impaired secretion of adrenocortical hormones. It is classified upon the etiology in primary and secondary. Rapid recognition and therapy of adrenocortical crisis are critical to survival. Patients often have nonspecific symptoms: anorexia, vomiting, weakness, fatigue and lethargy. They are followed by hypotension, shock, hypoglicemia, hyponatremia and hyperkalemia. All patients with adrenal insufficiency require urgent fluid reposition, correction of hypoglycemia and glucocorticoid replacement, in order to avoid serious consequences of adrenal crisis. After initial crisis treatment, maintenance dose of corticoids should be indicated. Mineralocorticoids replacement, if necessary, should also be initiated.

  20. Selected pediatric emergencies in community practice. (United States)

    Mangione, R A


    In children, the signs and symptoms of serious infection often mimic those observed with minor, self-limiting diseases. One of the most important steps in making a diagnosis of an infection of the central nervous system is to suspect that an infection may be present. Acute epiglotitis predominantly affects children 2 to 7 years of age; delays in its diagnosis or treatment may result in death within a matter of hours. Pharmacists should be aware of the signs and symptoms of child abuse and neglect and understand the reporting procedures and requirements.

  1. Initial Pediatric Assessment in the Emergency Room

    Directory of Open Access Journals (Sweden)

    Eduardo Cázares-Ramírez


    In this phase, examining room and laboratory studies are not decisive components. General, or specific, treatment focuses on restoring bodily and physiological homeostasis, in other words to prevent evolution to respiratory failure, shock, or cardiopulmonary insufficiency. It is not the time to make a specific diagnosis.

  2. Laser gingivectomy for pediatrics. (United States)

    Kelman, Michelle M; Poiman, David J; Jacobson, Barry L


    Traditional gingivectomy procedures have been a challenge for pediatric dentists who confront issues of patient cooperation and discomfort. Treatment of pediatric patients must involve minimal operative and postoperative discomfort. Laser soft-tissue surgery has been shown to be well accepted by children. For the pediatric patient, the greatest advantage of the laser is the lack of local anesthesia injection and the associated pre- and postoperative discomfort. The following case report describes a gingivectomy procedure performed on a 14-year-old female.

  3. Pediatric facial nerve rehabilitation. (United States)

    Banks, Caroline A; Hadlock, Tessa A


    Facial paralysis is a rare but severe condition in the pediatric population. Impaired facial movement has multiple causes and varied presentations, therefore individualized treatment plans are essential for optimal results. Advances in facial reanimation over the past 4 decades have given rise to new treatments designed to restore balance and function in pediatric patients with facial paralysis. This article provides a comprehensive review of pediatric facial rehabilitation and describes a zone-based approach to assessment and treatment of impaired facial movement.

  4. Harvey Cushing's Canadian connections. (United States)

    Feindel, William


    During his surgical career between 1896 and 1934, Harvey Cushing made eight visits to Canada. He had a broad impact on Canadian medicine and neurosurgery. Cushing's students Wilder Penfield and Kenneth McKenzie became outstanding leaders of the two major centers in Canada for neurosurgical treatment and training. On his first trip to Canada, shortly after completing his surgical internship in August 1896, Cushing traveled with members of his family through the Maritime Provinces and visited hospitals in Quebec and Montreal. Eight years later, in February 1904, as a successful young neurosurgeon at the Johns Hopkins Hospital, he reported to the Montreal Medico-Chirurgical Society on his surgical experience in 20 cases of removal of the trigeminal ganglion for neuralgia. In 1922, as the Charles Mickle Lecturer at the University of Toronto, Cushing assigned his honorarium of $1000 to support a neurosurgical fellowship at Harvard. This was awarded to McKenzie, then a general practitioner, for a year's training with Cushing in 1922-1923. McKenzie returned to initiate the neurosurgical services at the Toronto General Hospital, where he developed into a master surgeon and teacher. On Cushing's second visit to McGill University in October 1922, he and Sir Charles Sherrington inaugurated the new Biology Building of McGill's Medical School, marking the first stage of a Rockefeller-McGill program of modernization. In May 1929, Cushing attended the dedication of the Osler Library at McGill. In September 1934, responding to the invitation of Penfield, Cushing presented a Foundation Lecture-one of his finest addresses on the philosophy of neurosurgery-at the opening of the Montreal Neurological Institute. On that same trip, Cushing's revisit to McGill's Osler Library convinced him to turn over his own treasure of historical books to Yale University.

  5. How Should Canadian Literature Be Taught? (United States)

    Colborne, Garnet


    Discusses the rationale for and several approaches to teaching Canadian literature, including a cultural and regional approach to Canadian literature, a comparative approach, and a language study approach. (HTH)

  6. Sedation for pediatric endoscopy. (United States)

    Lee, Myung Chul


    It is more difficult to achieve cooperation when conducting endoscopy in pediatric patients than adults. As a result, the sedation for a comfortable procedure is more important in pediatric patients. The sedation, however, often involves risks and side effects, and their prediction and prevention should be sought in advance. Physicians should familiarize themselves to the relevant guidelines in order to make appropriate decisions and actions regarding the preparation of the sedation, patient monitoring during endoscopy, patient recovery, and hospital discharge. Furthermore, they have to understand the characteristics of the pediatric patients and different types of endoscopy. The purpose of this article is to discuss the details of sedation in pediatric endoscopy.

  7. Find a Pediatric Dentist (United States)

    ... New Dentist Resources Volunteering in AAPD AAPD Publications Advertising Brochures Journals & Publications Full Journal Archives Access Pediatric ... Us Site Map Privacy Policy Terms of Use facebook twitter instagram

  8. Responsible Canadian energy progress report

    Energy Technology Data Exchange (ETDEWEB)



    The Canadian Association of Petroleum Producers (CAPP) represents oil and gas companies throughout Canada; its members produce over 90% of Canada's natural gas and crude oil output. The aim of the Association is to improve the economics of the Canadian upstream petroleum sector in an environmentally and socially responsible way. The aim of this Responsible Canadian Energy report is to present the performance data of CAPP's members for the year 2009. Data, trends, and performance analyses are provided throughout the document. This analysis makes it possible to determine where progress has been made and where performance improvement is necessary. It also presents success stories and best practices so that other companies can learn from them how to improve their own performance. This paper provides useful information on the performance of the upstream petroleum industry in Canada and highlights where the focus should be for further improvement in its performance.

  9. Birth of the Canadian Digestive Health Foundation


    Beck, Ivan T.


    The Canadian Digestive Disease Foundation, renamed the Canadian Digestive Health Foundation -- Fondation canadienne pour la promotion de la santé digestive -- in December 2001, is the culmination of ongoing efforts by the Canadian Association of Gastroenterology to establish an independent charitable organization. In February 2001, it was officially endorsed as the Foundation for the Canadian Association of Gastroenterology. The initial efforts to establish this Foundation, led by Dr Richa...

  10. Assessment of terrorist threats to the Canadian energy sector

    Energy Technology Data Exchange (ETDEWEB)

    Shull, A. [Carleton Univ., Ottawa, ON (Canada). Norman Paterson School of International Affairs]|[Ottawa Univ., ON (Canada). Faculty of Law


    A critical terrorist threat assessment of Canadian energy systems was presented, as well as an analysis of integrated continental systems. Recent responses to heightened threat levels on the part of the Canadian government have ranged from information sharing to emergency preparedness and disaster mitigation strategies. This paper examined threats that the energy sector has traditionally encountered and argued that response capabilities do not match current threats posed by terrorism. The potential of a terrorist attack on the Canadian energy infrastructure is significant and has been referred to as a possible target by terrorist organizations. Actions taken by the Canadian government in response to heightened threat levels were examined. A review of energy industry security measures included outlines of: the natural gas industry, the electric sector, and nuclear reactors and waste. It was noted that not all elements of the critical energy infrastructure share the same level of risk. Recommendations included increased information sharing between government agencies and the private sector; resiliency standards in densely populated areas; and insulating the energy grid against a cascading blackout through the use of DC rather than AC lines. 59 refs.

  11. A Topography for Canadian Curriculum Theory. (United States)

    Chambers, Cynthia


    Presents challenges to Canadian curriculum theorists: (1) to create curriculum languages and genres that represent all of Canada; (2) to use Canadian scholars and indigenous languages to find these curriculum languages and genres; (3) to seek interpretive tools to understand what it means to be Canadian; and (4) to create curriculum theory that…

  12. Canadian Children's Literature: An Alberta Survey (United States)

    Bainbridge, Joyce; Carbonaro, Mike; Green, Nicole


    This article presents the findings of an online survey administered to Alberta elementary school teachers in 2000-2001. The survey explored the teachers' knowledge and use of Canadian children's literature and their thoughts about the role of Canadian literature in elementary school classrooms. Canadian children's trade books espouse particular…

  13. The Ideological Orientations of Canadian University Professors (United States)

    Nakhaie, M. Reza; Brym, Robert J.


    This paper analyzes the ideological orientations of Canadian university professors based on a unique 2000 study of a representative sample of Canadian academics (n=3,318). After summarizing methodological problems with extant research on this subject, and tentatively comparing the political views of Canadian and American academics, the paper…

  14. Transnational archives: the Canadian case

    Directory of Open Access Journals (Sweden)

    Julia Creet


    Full Text Available This paper is a brief overview of the concept of the transnational archive as a counterpoint to the idea that a national archive is necessarily a locus of a static idea of nation. The Canadian national archives is used as a case study of an archives that was transnational in its inception, and one that has continued to change in its mandate and materials as a response to patterns in migration and changing notions of multiculturalism as a Canadian federal policy. It introduces the most recent formation of the transnational archive and its denizens: the genealogical archive inhabited by family historians.

  15. Determinação das concentrações plasmáticas de salbutamol pós-nebulização em serviço de emergência pediátrica Determination of plasma salbutamol concentrations after nebulization in a pediatric emergency department

    Directory of Open Access Journals (Sweden)

    Eloni T. Rotta


    Full Text Available OBJETIVOS: Validar parcialmente a metodologia para determinação do salbutamol em plasma humano por cromatografia líquida de alta eficiência (detecção por fluorescência. Analisar as concentrações plasmáticas de salbutamol em um grupo de pacientes pediátricos com indicação de nebulizações em sala de emergência. MÉTODO: Estudo transversal, analítico, prospectivo, do tipo série de casos. Foram selecionados consecutivamente 15 pacientes com idade entre 12 e 37meses, com diagnóstico de crise aguda de asma, atendidos no Serviço de Emergência Pediátrica do Hospital da Criança Santo Antônio - Complexo Hospitalar Santa Casa, Porto Alegre, Brasil. Os pacientes foram tratados conforme a rotina da unidade para manejo de crise aguda de asma: nebulização (fluxo 6-8 L/min com salbutamol (0,15 mg/kg diluídosem4mL de NaCL 0,9%. A nebulização era administrada seqüencialmente, em intervalos de 20 minutos, por três vezes. Concomitantemente às nebulizações, todos os pacientes recebiam prednisolona via oral (1 mg/kg. RESULTADOS: As concentrações plasmáticas evidenciaram grande variabilidade em portadores de crise aguda de asma que receberam três nebulizações com salbutamol (0,15 mg/kg. Níveis plasmáticos médios foram de 12,09±10,8 ng/mL, com mediana de 8,9 (IQ25-75% 2,75-17,65 e coeficiente de variação da amostra de 92,4%. CONCLUSÕES: As concentrações plasmáticas após inalação de salbutamol apresentam grande dispersão na população pediátrica, a exemplo de outros estudos. As possíveis causas e implicações relacionadas ao achado permanecem alvo de controvérsias e avaliações complementares.OBJECTIVES: To partially validate the methodology for determining salbutamol in human plasma through high-efficiency liquid chromatography and fluorescence detection. To analyze plasma salbutamol concentrations in a group of pediatric patients with indication for nebulization in the emergency room. METHOD: Analytical

  16. Pediatric neurosurgery--a golden decade. (United States)

    Ciurea, A V; Vasilescu, G; Nuteanu, L


    Pediatric neurosurgery, once an annex of general neurosurgery, has evolved into a well-defined and complex medical specialty. The last 10 years have witnessed major advances in documentation of the minute details of CNS diseases of childhood, refinement of the specific means of action and better adaptation of therapeutic efforts to the requirements of a developing organism. Pediatric neurosurgeons are now increasingly involved in beneficial cooperation within complex medical teams. This fact has by no means diminished the importance of pediatric neurosurgery; rather, in such settings it has proved to have better effects in the struggle for stable long-lasting good results of multi-modal treatments covering all pathological entities. Progress in neurological surgery for patients in the pediatric age group has emerged from the development of supranational scientific structures and from that of specific concepts exchanging channels, so that today pediatric neurosurgeons belong to an extremely specialized medical corps, working in harmony across geographical and socio-economic national features in the interests of humankind's young generation's health.

  17. Pediatric brain death: updated guidelines. (United States)

    Mullen, Jodi E


    Logan, a 5-year-old boy, was riding his bike with his 7-year-old brother when he was struck from behind by a car traveling at approximately 40 mph. The driver indicated that she did not see the riders until she hit Logan, who was not wearing a helmet at the time of the accident. Logan was thrown from his bike and was found at the side of the road, unresponsive and posturing. Although he was uninjured, Logan's brother witnessed the incident.Emergency medical services arrived and placed Logan on a backboard with a c-collar. Because he was not protecting his airway, he was intubated and then given sodium chloride fluids and brought to the pediatric emergency department. Upon arrival, his Glasgow Coma Scale score was 5, and his right pupil was 6 mm and not reactive.Logan's initial head computed tomographic scan showed diffuse brain edema, with early downward transtentorial brain herniation. The pediatric neurosurgeon determined that no operative management was appropriate for Logan. Besides a small laceration on his forehead, Logan had no other injuries. At this time, he was taking a few spontaneous respirations and had occasional posturing of his extremities.

  18. [Research in pediatrics]. (United States)

    Herrera-Márquez, Julia Rocío; González-Cabello, Héctor Jaime


    In the interest of encouraging the promotion of research done by physicians of the Instituto Mexicano del Seguro Social, in this supplement we publish articles written by residents of different specialties related to critical themes on pediatrics. These residents are guided by affiliated physicians from the Hospital de Pediatría del Centro Médico Nacional Siglo XXI.

  19. Canadian contributions studies for the WFIRST instruments (United States)

    Lavigne, J.-F.; Rowlands, N.; Grandmont, F. J.; Lafrenière, D.; Marois, C.; Daigle, O.; Thibault, S.; Schade, D.; Artigau, É.; Brousseau, D.; Maire, J.; Cretot-Richert, G.; Ducharme, M.-È.; Levesque, L. E.; Laurin, D.; Dupuis, J.


    WFIRST-AFTA is the NASA's highest ranked astrophysics mission for the next decade that was identified in the New World, New Horizon survey. The mission scientific drivers correspond to some of the deep questions identified in the Canadian LRP2010, and are also of great interest for the Canadian scientists. Given that there is also a great interest in having an international collaboration in this mission, the Canadian Space Agency awarded two contracts to study a Canadian participation in the mission, one related to each instrument. This paper presents a summary of the technical contributions that were considered for a Canadian contribution to the coronagraph and wide field instruments.

  20. Why do Chinese Canadians not consult mental health services: health status, language or culture? (United States)

    Chen, Alice W; Kazanjian, Arminée; Wong, Hubert


    Data from the Canadian Community Health Survey Cycle 1.1 showed that Chinese immigrants to Canada and Chinese individuals born in Canada were less likely than other Canadians to have contacted a health professional for mental health reasons in the previous year in the province of British Columbia. The difference persisted among individuals at moderate to high risk for depressive episode. Both immigrant and Canadian-born Chinese showed similar characteristics of mental health service use. The demographic and health factors that significantly affected their likelihood to consult mental health services included Chinese language ability, restriction in daily activities, frequency of medical consultations, and depression score. Notwithstanding lower levels of mental illness in ethnic Chinese communities, culture emerged as a major factor explaining differences in mental health consultation between Chinese and non-Chinese Canadians.

  1. The 1998 Canadian Contraception Study. (United States)

    Fisher, William A.; Boroditsky, Richard; Bridges, Martha L.


    Describes the 1998 Canadian Contraception Study, a mailed survey which asked women about contraceptive practices past, present, and future (including use of oral contraceptives, condoms, and sterilization); familiarity with and opinion about different contraception methods; and general sexual and reproductive health. The paper also examines…

  2. Universal values of Canadian astronauts (United States)

    Brcic, Jelena; Della-Rossa, Irina


    Values are desirable, trans-situational goals, varying in importance, that guide behavior. Research has demonstrated that universal values may alter in importance as a result of major life events. The present study examines the effect of spaceflight and the demands of astronauts' job position as life circumstances that affect value priorities. We employed thematic content analysis for references to Schwartz's well-established value markers in narratives (media interviews, journals, and pre-flight interviews) of seven Canadian astronauts and compared the results to the values of National Aeronautics and Space Administration (NASA) and Russian Space Agency (RKA) astronauts. Space flight did alter the level of importance of Canadian astronauts' values. We found a U-shaped pattern for the values of Achievement and Tradition before, during, and after flight, and a linear decrease in the value of Stimulation. The most frequently mentioned values were Achievement, Universalism, Security, and Self-Direction. Achievement and Self Direction are also within the top 4 values of all other astronauts; however, Universalism was significantly higher among the Canadian astronauts. Within the value hierarchy of Canadian astronauts, Security was the third most frequently mentioned value, while it is in seventh place for all other astronauts. Interestingly, the most often mentioned value marker (sub-category) in this category was Patriotism. The findings have important implications in understanding multi-national crew relations during training, flight, and reintegration into society.

  3. Canadian Government Electronic Information Policy. (United States)

    Nilsen, Kirsti


    Examines development and evolution of Canadian government information policy in response to issues of preservation of data, information industry involvement in government data development and marketing, role of Crown copyright, and public access to government information in electronic formats. Six key information policy instruments are also…

  4. Canadian Literature in American Libraries (United States)

    Rogers, A. Robert


    Acquisition of Canadian literature by American libraries was investigated in three ways: questionnaires were sent to selected large libraries, titles were checked against the National Union Catalog'' and published literature describing major collections was examined. With the exception of the Library of Congress, American libraries purchase…

  5. 儿科门急诊患儿静脉输液疼痛相关因素的研究%Related factors research of intravenous infusion-related pain access in out-patient and emergency departments of pediatrics

    Institute of Scientific and Technical Information of China (English)



    目的:通过研究儿科门急诊患儿静脉输液疼痛相关因素,分析影响静脉输液时患儿疼痛的原因以及改进工作的最佳方法,提高患儿及家长的满意度.方法:通过应用疼痛量表Wong-Baker面部表情评估法和改良面部表情评分法评估327例儿科门急诊患儿静脉输液疼痛程度,收集与儿科门急诊患儿静脉输液疼痛相关的因素并详细记录,运用统计学的方法分析其对疼痛结果的影响程度.结果:Logistic回归分析显示:转移患儿注意力和血管清晰度为静脉输液相关疼痛的保护因素;家长陪伴人数>2人是其危险因素.强制固定患儿、近期重复输液对静脉输液相关疼痛没有统计学意义上的影响.结论:采取有效的安抚和诱导患儿转移注意力,提高操作技能,限制家长陪伴人数使患儿配合护士操作,能减轻患儿疼痛,保证静脉输液成功实施.%Objective : Through the related factors research of intravenous infusion - related pain access in out - patient and emergency departments of pediatrics, to search the main cause of intravenous infusion - related pain and the best method of improving the work in order to heighten the contentment rate of the sick children and parents. Methods : Apply the modified Wong - Baker faces scale and the modified faces , legs , activity , cry and console ahility scale , dato collections list to completely record every related factor about intravenous infusion and the influence degree to the result, adopt statistics means to get a conclusion. Results:A total of 327 patients were included in the study. By multivariate logistic regression analysis, to transfer the children' s attention and blood vessel appearance degree were found as protected ( or beneficial ) factors of intravenous infusion - related pain, more than 2 people of households accompanying was risk factor. Whether mandatory fixed children and recent repeated infusion have no statistics meanings influence

  6. Hot spots analysis of Chinese Pediatric Emergency Medicine based on co-words cluster analysis%采用共词聚类法分析近6年《中国小儿急救医学》杂志研究热点

    Institute of Scientific and Technical Information of China (English)

    李巍; 张薇; 王晓茵


    目的 研究《中国小儿急救医学》近年发表文献的研究热点.方法 选取万方数据库收录的《中国小儿急救医学》2006年至2011年发表的论文为基本数据来源,挑选有关键词的1194篇文献,从中逐一抽出4054个关键词.采用书目共现分析系统对关键词进行词频统计和共现分析,利用SPSS 11.5软件对共词矩阵进行聚类分析.结果 新生儿、早产儿、手足口病、机械通气、脓毒症、先天性心脏病是排在前10位的高频关键词.聚类分析关系图显示,《中国小儿急救医学》近6年发表文章的研究热点主要集中在以下8个方面:手足口病、脓毒性休克的预后影响因素、急性肺损伤和急性呼吸窘迫综合征、新生儿窒息导致的缺氧缺血性脑病、早产儿疾病、婴幼儿先天性心脏病合并重症肺炎及心力衰竭的治疗、儿童重症监护病房内获得性感染的病原菌及耐药性分析、脓毒症.结论 通过关键词共词聚类分析法,探明了我刊近6年发表论文的主体研究规律和方向.%Objective To investigate the literature research focus of Chinese Pediatric Emergency Medicine.Methods The papers published in Chinese Pediatric Emergency Medicine from 2006 to 2011 and indexed by wanfang database served as the basic data sources.Four thousands and fifty-four keywords were collected from 1194 literature.Keyword frequency statistics and the co-occurrence analysis were made by using bibliographic item co-occurrence matrix builder,and cluster analysis was made using SPSS 11.5 software.Results Newborns,premature,hand,foot and mouth disease,mechanical ventilation,sepsis,congenital heart disease was the top 10 high-frequency keywords.Cluster analysis diagram showed the research focus from articles published in Chinese Pediatric Emergency Medicine for the past six years,which included:(1) hand,foot and mouth disease; (2) prognostic factors for septic shock; (3) acute lung injury and acute

  7. Evaluation of the medication process in pediatric patients: a meta-analysis



    OBJECTIVE: to meta-analyze studies that have assessed the medication errors rate in pediatric patients during prescribing, dispensing, and drug administration. SOURCES: searches were performed in the PubMed, Cochrane Library, and Trip databases, selecting articles published in English from 2001 to 2010. SUMMARY OF THE FINDINGS: a total of 25 original studies that met inclusion criteria were selected, which referred to pediatric inpatients or pediatric patients in emergency department...

  8. Toward Enteral Nutrition in the Treatment of Pediatric Crohn Disease in Canada: A Workshop to Identify Barriers and Enablers

    Directory of Open Access Journals (Sweden)

    Johan Van Limbergen


    Full Text Available The treatment armamentarium in pediatric Crohn disease (CD is very similar to adult-onset CD with the notable exception of the use of exclusive enteral nutrition (EEN [the administration of a liquid formula diet while excluding normal diet], which is used more frequently by pediatric gastroenterologists to induce remission. In pediatric CD, EEN is now recommended by the pediatric committee of the European Crohn’s and Colitis Organisation and the European Society for Paediatric Gastroenterology Hepatology and Nutrition as a first-choice agent to induce remission, with remission rates in pediatric studies consistently >75%. To chart and address enablers and barriers of use of EEN in Canada, a workshop was held in September 2014 in Toronto (Ontario, inviting pediatric gastroenterologists, nurses and dietitians from most Canadian pediatric IBD centres as well as international faculty from the United States and Europe with particular research and clinical expertise in the dietary management of pediatric CD. Workshop participants ranked the exclusivity of enteral nutrition; the health care resources; and cost implications as the top three barriers to its use. Conversely, key enablers mentioned included: standardization and sharing of protocols for use of enteral nutrition; ensuring sufficient dietetic resources; and reducing the cost of EEN to the family (including advocacy for reimbursement by provincial ministries of health and private insurance companies. Herein, the authors report on the discussions during this workshop and list strategies to enhance the use of EEN as a treatment option in the treatment of pediatric CD in Canada.

  9. [Robotics in pediatric surgery]. (United States)

    Camps, J I


    Despite the extensive use of robotics in the adult population, the use of robotics in pediatrics has not been well accepted. There is still a lack of awareness from pediatric surgeons on how to use the robotic equipment, its advantages and indications. Benefit is still controversial. Dexterity and better visualization of the surgical field are one of the strong values. Conversely, cost and a lack of small instruments prevent the use of robotics in the smaller patients. The aim of this manuscript is to present the controversies about the use of robotics in pediatric surgery.

  10. Canadian Content in Video Games


    Paul, Leonard


    THEME: Internationalism: Worlds at Play Topics: Internationalism, Identity in Gaming and Learning to Play Abstract: How does Canada fit into the global cultural context of video games? This paper investigates the culture being reflected in video games being produced in Canada as Canada is one of the world's leading producers of video games. It examines the how Canadian culture is represented in current new media artistic output against the culture, or lack of culture, being represented in vid...

  11. Establishing a pediatric robotic surgery program in Canada. (United States)

    Bütter, Andreana; Merritt, Neil; Dave, Sumit


    Despite the introduction of robotic surgery in 2000, few pediatric surgeons outside the United States have embraced this technology. We discuss our experience with establishing the first Canadian pediatric robotic surgery program. After simulator training, live animal surgery and observation of robotically assisted cases at an outside institution, we performed our first pediatric da Vinci(®) surgery in July 2013. A prospective database was established to assess outcomes. Forty one children have undergone robotically assisted surgery for the following 42 procedures: (a) pyeloplasty (17), (b) ureteral reimplantations (12), (c) uretero-uretostomy (1), (d) cholecystectomies (10), (e) interval appendectomy (1) and (f) distal pancreatectomy (1). The average age was 9.7 years (range 1.6-17.9) and 66% of patients were female. Average operative time was 174 min (range 47-301). Length of stay was 3 days (range 0-20). All procedures were completed without conversion to open or laparoscopy. There were no technical failures. Two post re-implantation patients had urine leaks which required conservative treatment. Despite the lack of haptic feedback, we have noted that the markedly enhanced three-dimensional visualization and instrument dexterity offer significant advantages for complex reconstructive pediatric surgery. This platform may also enable trainees to perform more advanced minimally invasive pediatric surgery. We have successfully established the first pediatric robotic surgery program in Canada. Our da Vinci(®) system is shared with our adult colleagues, which enables more frequent use as well as some cost sharing. A dedicated group of operative nurses and surgeons are required to allow adoption of this new technology.

  12. Pediatric liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Marco Spada; Silvia Riva; Giuseppe Maggiore; Davide Cintorino; Bruno Gridelli


    In previous decades, pediatric liver transplantation has become a state-of-the-art operation with excellent success and limited mortality. Graft and patient survival have continued to improve as a result of improvements in medical, surgical and anesthetic management, organ availability, immunosuppression, and identification and treatment of postoperative complications. The utilization of split-liver grafts and living-related donors has provided more organs for pediatric patients. Newer immunosuppression regimens, including induction therapy, have had a significant impact on graft and patient survival. Future developments of pediatric liver transplantation will deal with long-term followup, with prevention of immunosuppression-related complications and promotion of as normal growth as possible. This review describes the state-of-the-art in pediatric liver transplantation.

  13. Pediatric heart surgery (United States)

    Heart surgery - pediatric; Heart surgery for children; Acquired heart disease; Heart valve surgery - children ... outside the heart. Some heart defects may need surgery right after the baby is born. For others, ...

  14. Pediatric inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Karen A Diefenbach; Christopher K Breuer


    Inflammatory bowel disease is an important cause of gastrointestinal pathology in children and adolescents.The incidence of pediatric inflammatory bowel disease is increasing; therefore, it is important for the clinician to be aware of the presentation of this disease in the pediatric population. Laboratory tests, radiology studies,and endoscopic procedures are helpful in diagnosing inflammatory bowel disease and differentiating between Crohn's disease and ulcerative colitis. Once diagnosed,the goal of medical management is to induce remission of disease while minimizing the side effects of the medication. Specific attention needs to be paid to achieving normal growth in this susceptible population.Surgical management is usually indicated for failure of medical management, complication, or malignancy.Algorithms for diagnostic evaluation and treatment of pediatric inflammatory bowel disease are presented.The specific psychosocial issues facing these patients are also discussed in this review as are the future goals of research in the complex problem of pediatric inflammatory bowel disease.

  15. Pediatric Brain Tumor Foundation (United States)

    ... you insights into your child's treatment. LEARN MORE Brain tumors and their treatment can be deadly so ... Cancer Foundation joins the PBTF Read more >> Pediatric Brain Tumor Foundation 302 Ridgefield Court, Asheville, NC 28806 ...

  16. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... of page What are some common uses of the procedure? Children's (pediatric) nuclear medicine imaging is performed ... the thyroid gland. top of page How does the procedure work? With ordinary x-ray examinations, an ...

  17. Art Therapy with Pediatric Cancer Patients: Helping Normal Children Cope with Abnormal Circumstances. (United States)

    Councill, Tracy


    Notes that art therapy with pediatric cancer patients addresses emotional and developmental needs of normal population under extreme stress. Reviews literature on the problems likely to be encountered by pediatric cancer patient and presents case examples to illustrate the emergence of these issues and their management in art therapy. (Author/NB)

  18. Cerebral imaging in pediatrics

    Energy Technology Data Exchange (ETDEWEB)

    Gordon, I. [London, Great Ormond Street Hospital for Children (United Kingdom)


    Radioisotope brain imaging has focused mainly on regional cerebral blood flow (rCBF). However the use of ligand which go to specific receptor sites is being introduced in pediatrics, mainly psychiatry. rCBF is potentially available in many institutions, especially with the availability of multi-headed gamma cameras. The use of this technique in pediatrics requires special attention to detail in the manner of data acquisition and handling the child. The interpretation of the rCBF study in a child requires knowledge of normal brain maturation. The major clinical use in pediatrics is epilepsy because of the advances in surgery and the frequency of complex partial seizures. Other indications in pediatric neurology include brain death, acute neurological loss including stroke, language disorders, cerebral palsy, hypertension due to renovascular disease, traumatic brain injury and migraine. There are pediatric physiological conditions in which rCBF has been undertaken, these include anorexia nervosa, autism, Gilles de la Tourette syndrome (GTS) and attention deficit disorder-hyperactivity (ADHD). Research using different ligands to specific receptor sites will also be reviewed in pediatrics.

  19. Pediatric enteral nutrition. (United States)

    Axelrod, David; Kazmerski, Kimberly; Iyer, Kishore


    Common to all pediatric patients receiving enteral nutrition is the inability to consume calories orally. This is often secondary to issues of inadequate weight gain, inadequate growth, prolonged feeding times, weight loss, a decrease in weight/age or weight/height ratios, or a persistent triceps skinfold thickness <5% for age. Enteral nutrition requires enteral access. In the neonatal period the nasoenteric route is usually used. In pediatric patients requiring long-term enteral access, surgically, endoscopically, or radiologically placed percutaneous feeding tubes are common. Jejunal feeding tubes are used in pediatric patients with gastric feeding intolerance or persistent gastroesophageal reflux. Low-profile enteral access devices are preferred by most pediatric patients because of their cosmetic appearance. For most children, a standard pediatric polypeptide enteral formula is well tolerated. There are specialized pediatric enteral formulas available for patients with decreased intestinal length, altered intestinal absorptive capacity, or altered pancreatic function. Weaning patients from tube feeding to oral nutrition is the ultimate nutrition goal. A multidisciplinary approach to patients with short bowel syndrome will maximize the use of enteral nutrition while preserving parenteral nutrition for patients with true enteral nutrition therapy failure.

  20. Contexts for Ethnic Identity of Japanese Canadians


    浦田, 葉子; Yoko, URATA


    In this paper I reviewed the literature in order to gain a broad understanding of the contexts for ethnic identity of Japanese Canadians guided by the premise that ethnic identity is a situational as well as a primordial phenomenon. Two main areas were reviewed - the pattern of distribution of resources in Canadian society and the particular situation in which Japanese Canadians are placed. In the distribution of material resources, individual meritocracy for mass and social closure for elite...

  1. [Kingella kingae pediatric septic arthritis]. (United States)

    Vásquez, María Alejandra; Palacián, María Pilar; Cruz Villuendas, María; Marne, Carmen; Paz Ruiz-Echarri, María; Revillo, María José


    Kingella kingae is a bacterium that colonizes the upper respiratory tract. Despite its low pathogenicity in this location, previous respiratory pathological processes may favor its systemic spread causing bone and joint infections, mainly in children under five years. It can be considered an emerging pathogen in osteoarticular infection in pediatric patients. We report the case of a two-year-old girl with hips pain and limitation of both abduction and extension, and fever. Radiography and ultrasonography were compatible with transitory synovitis; showed scintigraphy inflammatory pathology of the right hip. Articular puncture was performed. The material showed altered biochemical parameters. Microbiological culture yielded isolation of a strain of K. kingae susceptible to beta-lactam antibiotics, azithromycin and trimethoprim-sulfamethoxazole. Blood cultures were negative. The patient was treated empirically with cloxacillin and cefotaxime iv. and continued with amoxicillin-clavulanate orally with osteoarticular improvement.

  2. Pediatric Sedation: A Global Challenge

    Directory of Open Access Journals (Sweden)

    David Gozal


    Full Text Available Pediatric sedation is a challenge which spans all continents and has grown to encompass specialties outside of anesthesia, radiology and emergency medicine. All sedatives are not universally available and local and national regulations often limit the sedation practice to specific agents and those with specific credentials. Some specialties have established certification and credentials for sedation delivery whereas most have not. Some of the relevant sedation guidelines and recommendations of specialty organizations worldwide will be explored. The challenge facing sedation care providers moving forward in the 21st century will be to determine how to apply the local, regional and national guidelines to the individual sedation practices. A greater challenge, perhaps impossible, will be to determine whether the sedation community can come together worldwide to develop standards, guidelines and recommendations for safe sedation practice.

  3. Burden of anxiety disorders in pediatric medical settings: prevalence, phenomenology, and a research agenda. (United States)

    Ramsawh, Holly J; Chavira, Denise A; Stein, Murray B


    The current review describes the phenomenology of several common anxiety disorders in children and adolescents as they present in medical settings. Anxiety disorders and associated features in children are described, along with epidemiology, functional impairment, common somatic complaints, medical comorbidity, health care utilization, and presentation in general and in specialty pediatric medical settings. Recommendations for clinical management in pediatric settings are presented, and evidence-based interventions and emerging treatments for pediatric anxiety disorders are described. The review concludes with a discussion of future research directions that may lead to increased recognition and improved management of anxiety disorders in pediatric medical settings.

  4. Literary Research and Canadian Literature: Strategies and Sources. Literary Research--Strategies and Sources #10 (United States)

    Reznowski, Gabriella


    Canada's rich literary heritage, dominated by a multicultural and multilingual presence, reflects the country's unique history and experience. In addition, an emerging body of new writers is redefining both the geographic and metaphorical boundaries of Canadian literature. Coupled with the propagation of digital technologies, Canada's burgeoning…

  5. Financial Barriers for Students with Non-Apparent Disabilities within Canadian Postsecondary Education (United States)

    Chambers, Tony; Bolton, Melissa; Sukhai, Mahadeo A.


    This study examined the education-related debt, sources of debt, and the process of acquiring accommodations for students with non-apparent (such as learning disabilities and mental health disabilities) and apparent disabilities in Canadian postsecondary education. A third group emerged during analyses, students with medical disabilities, which…

  6. Tele-Epidemiology and Public Health in the Canadian Context (United States)

    Brazeau, Stephanie; Kotchi, Serge Olivier; Ludwig, Antoinette; Turgeon, Patricia; Pelcat, Yann; Aube, Guy; Ogden, Nicholas H.


    The management of key public health issues requires solid evidence-based knowledge for the prevention and control of various emerging or re-emerging vector borne diseases (e.g. Lyme disease, West Nile virus, etc.) and environmentally-linked diseases (e.g. enteric infections from recreational water contamination). Earth observation (EO) images enhance knowledge and capacity to characterize risk of illness across the vast Canadian territory by deriving new and up-to-date data from population, climatic and environmental determinants of health relevant to public health actions such as risk mapping, risk communication and identification of vulnerable populations.Modeling of infectious disease transmission has made possible the identification of risk areas and the underlying factors (human activities, ecology, environment and climate) that may explain this emergence. New data products derived from Earth observation satellites pertaining to climate, land cover and land use, and distribution and density of animal and human populations have greatly improved the resolution and the specificity of explanatory and predictive models.This article focuses on the scope of tele-epidemiology activities of the Canadian public health community as well as current and potential future fields of application for Earth observation data. It will demonstrate the strength, sustainability and innovative character of these approaches to improve scale-dependent decision- making at different levels of government in Canada (federal, provincial/territorial and regional) and increase the efficiency of many preventive, preparedness and response actions.Examples of tele-epidemiology applications will be presented such as the risk assessment of microbial contamination of recreational waters and modelling the risk of vector borne diseases in the Canadian context.

  7. Exogenic poisoning in children assisted in a pediatric emergency unit Intoxicaciones exógenas en niños atendidos en una unidad de emergencia pediátrica Intoxicações exógenas em crianças atendidas em uma unidade de emergência pediátrica

    Directory of Open Access Journals (Sweden)

    Juliana Lourenço


    Full Text Available OBJECTIVE: To describe the epidemiological characteristics of all exogenic poisoning cases in children assisted in a pediatric emergency unit in Recife, State of Pernambuco, Brazil, from April to September 2006. METHODS: This is a descriptive study of exogenic poisoning in 0-12 aged children treated at Centro de Assistência Toxicológica de Pernambuco (Pernambuco Toxicological Assistance Center. The data were collected through interviews and by consulting patients' records. RESULTS: 26 cases of accidental exogenic poisoning were registered, mainly males (65.4%. Regarding age, children under five years old were the most affected (65.4%. Medication was involved in 50.0% of the cases. CONCLUSION: Accidental exogenic poisoning affecting children younger than five years of age stands out as a significant public health problem. As a member of a multiprofessional health team, the nurse plays an important role in health education and in the measures to prevent child poisoning.OBJETIVO: Describir las características epidemiológicas de los casos de intoxicaciones exógenas en niños atendidos en una unidad de emergencia pediátrica de Recife (PE, en el período de abril a setiembre del 2006. MÉTODOS: Se trata de un estudio descriptivo de los casos de intoxicaciones exógenas ocurridos en niños del grupo etáreo de 0 a 12 años de edad notificados en el Centro de Asistencia Toxicológica de Pernambuco. Los datos fueron recolectados a través de entrevistas y consultas a las fichas de atención hospitalaria. RESULTADOS: Fueron registrados 26 casos de intoxicación exógena accidental. Predominó el sexo masculino (65,4% siendo el grupo etáreo de menores de cinco años de edad el más afectado (65,4%. Los medicamentos estaban involucrados en el 50,0% de los casos. CONCLUSIÓN: La intoxicación exógena accidental de niños, sobre todo en menores de cinco años es un problema de salud pública que requiere medidas preventivas para evitar que ocurra en

  8. A Cross-Sectional Study to Compare Caregiver Distress Among Korean Canadian, Chinese Canadian, and Other Canadian Home Care Clients

    Directory of Open Access Journals (Sweden)

    Byung Wook Chang


    Full Text Available This study examines the health of elderly Korean Canadians in home care and investigates the risk factors for caregiver distress of families caring for their elderly relatives. Korean Canadians, Chinese Canadians, and other Canadian home care clients were compared using the Resident Assessment Instrument–Home Care (RAI-HC. The assessments were done as a part of normal clinical practice between January 2002 and December 2010 within Ontario. A sample of 58,557 home care clients was analyzed using descriptive statistics and chi-square analysis at the bivariate level and multiple logistic regression models. The major finding of the present study is that Korean clients had higher physical impairments and higher prevalence of major chronic diseases, but they were less likely to receive personal support or nursing services. Moreover, the results provide clear evidence of the importance of language barriers for all linguistic minorities, including Korean Canadians.

  9. Pediatric psoriasis: an update

    Directory of Open Access Journals (Sweden)

    Nanette B Silverberg


    Full Text Available Nanette B SilverbergPediatric and Adolescent Dermatology, St. Luke’s-Roosevelt Hospital Center, New York, NY, USAAbstract: Pediatric psoriasis consists broadly of 3 age groups of psoriatic patients: infantile psoriasis, a self-limited disease of infancy, psoriasis with early onset, and pediatric psoriasis with psoriatic arthritis. About one-quarter of psoriasis cases begin before the age of 18 years. A variety of clinical psoriasis types are seen in childhood, including plaque-type, guttate, erythrodermic, napkin, and nail-based disease. Like all forms of auto-immunity, susceptibility is likely genetic, but environmental triggers are required to initiate disease activity. The most common trigger of childhood is an upper respiratory tract infection. Once disease has occurred, treatment is determined based on severity and presence of joint involvement. Topical therapies, including corticosteroids and calcipotriene, are the therapies of choice in the initial care of pediatric patients. Ultraviolet light, acitretin and cyclosporine can clear skin symptoms, while methotrexate and etanercept can clear both cutaneous and joint disease. Concern for psychological development is required when choosing psoriatic therapies. This article reviews current concepts in pediatric psoriasis and a rational approach to therapeutics. Keywords: psoriasis, autoimmunity, Streptococcus, etanercept, calcipotriene, topical corticosteroids

  10. Medication use among Canadian seniors. (United States)

    McPherson, Mark; Ji, Hong; Hunt, Jordan; Ranger, Rob; Gula, Cheryl


    As they age, many seniors develop a progressively more complex mix of health conditions. Multiple prescription medications are often required to help manage these conditions and control symptoms, with the goal of maintaining seniors' health for as long as possible. This article explores trends in the number and types of medications used by seniors on public drug programs in Canada. Our findings suggest that a high proportion of Canadian seniors are taking several medications, highlighting the need for medication management systems focusing on this population.


    Institute of Scientific and Technical Information of China (English)


    Modern English is an international language inthe world.Besides Great Britain,English is spokenas first language in 39 countries.These countries arelocated in different regions with different naturalfeatures,history development and cultural character-istics.Thus,English used in these different regionscarries its own regional character—forming Englishregional varieties.The main English regional varieties are:BritishEnglish,American English,Canadian English andSouth African English.Canada is a rich country inNorth America with its own characteristics,which of

  12. Accidental Children Poisoning With Methadone: An Iranian Pediatric Sectional Study

    Directory of Open Access Journals (Sweden)



    phosphine. In: Haddad LM, Shannon MW, Winchester J, eds. Clinical Management of Poisoning and Drug Overdose. 3rd ed. Philadelphia: WB Saunders; 2007. p. 640-7.Jennifer C, Gibson A. Accidental methadone poisoning in children: A call for Canadian research action. Child Abuse Negl;2010;34(8:553-4.Binchy JM, Molyneux E, Manning J. Accidental ingestion of methadone by children in Merseyside. BMJ 1994;308(6940:1335-6.Zamani N, Sanaei-Zadeh H, Mostafazadeh B. Hallmarks of opium poisoning in infants and toddlers. Trop Doct 2010;40(4:220-2.LoVecchio F, Pizon A, Riley B, Sami A, D’Incognito C. Onset of symptoms after methadone overdose. Am J Emerg Med 2007;25(1:57-9.Thanavaro KL, Thanavaro JL. Methadone-induced torsades de pointes: a twist of fate. Heart Lung 2011;40(5:448-53.Gaalen FA, Compier EA, Fogteloo AJ. Sudden hearing loss after a methadone overdose. Eur Arch Otorhinolaryngol 2009;266(5:773-4.Lynch RE, Hack RA. Methadone-induced rigid-chest syndrome after substantial overdose.Pediatrics. 2010; 126(1:232-4.Sidlo J, Valuch J, Ocko P, Bauerová J. Fatal methadone intoxication in a 11-month-old male infant. Soud Lek 2009;54(2:23-5. 

  13. Rural Canadian Youth Exposed to Physical Violence (United States)

    Laye, Adele M.; Mykota, David B.


    Exposure to physical violence is an unfortunate reality for many Canadian youth as it is associated with numerous negative psychosocial effects. The study aims to assist in understanding resilience in rural Canadian youth exposed to physical violence. This is accomplished by identifying the importance of protective factors, as measured by the…


    Directory of Open Access Journals (Sweden)



    Full Text Available This paper sums up the applications of Statistical model such as ARIMA family timeseries models in Canadian lynx data time series analysis and introduces the method of datamining combined with Statistical knowledge to analysis Canadian lynx data series.

  15. A Boost for Sino-Canadian Ties

    Institute of Scientific and Technical Information of China (English)



    @@ If Canadian Prime Minister Stephen Harper's visit to China last December led to a thaw in the frozen Sino-Canadian relations in recent years, Chinese President Hu Jintao's latest trip to Ottawa appeared to usher in yet another warm period for these deep-rooted relations.

  16. Canadian Library Integrated Systems: Second Annual Survey. (United States)

    Merilees, Bobbie


    Reports the results of a survey of the Canadian integrated library systems market. The analysis includes comparisons of large versus microcomputer-based installations by type of library and across all libraries, foreign sales by Canadian vendors, and trends in the library systems market. (CLB)

  17. Children's (Pediatric) Magnetic Resonance Imaging

    Medline Plus

    Full Text Available ... Resources Professions Site Index A-Z Children’s (Pediatric) Magnetic Resonance Imaging Children’s magnetic resonance imaging (MRI) uses a powerful ... of Children’s (Pediatric) MRI? What is Children’s (Pediatric) MRI? Magnetic resonance imaging (MRI) is a noninvasive medical ...

  18. Designing a Pediatric Severe Sepsis Screening Tool

    Directory of Open Access Journals (Sweden)

    Robert eSepanski


    Full Text Available We sought to create a screening tool with improved predictive value for pediatric severe sepsis and septic shock that can be incorporated into the electronic medical record and actively screen all patients arriving at a pediatric Emergency Department (ED. Gold standard severe sepsis cases were identified using a combination of coded discharge diagnosis and physician chart review from 7,402 children who visited a pediatric ED over two months. The tool’s identification of severe sepsis was initially based on International Consensus Conference on Pediatric Sepsis (ICCPS parameters that were refined by an iterative, virtual process that allowed us to propose successive changes in sepsis detection parameters in order to optimize the tool’s predictive value based on receiver operating curve (ROC characteristics. Age-specific normal and abnormal values for heart rate (HR and respiratory rate (RR were empirically derived from 143,603 children seen in a second pediatric ED over three years. Univariate analyses were performed for each measure in the tool to assess its association with severe sepsis and to characterize it as an early or late indicator of severe sepsis. A split-sample was used to validate the final, optimized tool. The final tool incorporated age-specific thresholds for abnormal HR and RR and employed a linear temperature correction for each category. The final tool’s positive predictive value was 48.7%, a significant, nearly three-fold improvement over the original ICCPS tool. False positive Systemic Inflammatory Response Syndrome (SIRS identifications were nearly six-fold lower.

  19. Medical cannabis – the Canadian perspective (United States)

    Ko, Gordon D; Bober, Sara L; Mindra, Sean; Moreau, Jason M


    Cannabis has been widely used as a medicinal agent in Eastern medicine with earliest evidence in ancient Chinese practice dating back to 2700 BC. Over time, the use of medical cannabis has been increasingly adopted by Western medicine and is thus a rapidly emerging field that all pain physicians need to be aware of. Several randomized controlled trials have shown a significant and dose-dependent relationship between neuropathic pain relief and tetrahydrocannabinol – the principal psychoactive component of cannabis. Despite this, barriers exist to use from both the patient perspective (cost, addiction, social stigma, lack of understanding regarding safe administration) and the physician perspective (credibility, criminality, clinical evidence, patient addiction, and policy from the governing medical colleges). This review addresses these barriers and draws attention to key concerns in the Canadian medical system, providing updated treatment approaches to help clinicians work with their patients in achieving adequate pain control, reduced narcotic medication use, and enhanced quality of life. This review also includes case studies demonstrating the use of medical marijuana by patients with neuropathic low-back pain, neuropathic pain in fibromyalgia, and neuropathic pain in multiple sclerosis. While significant preclinical data have demonstrated the potential therapeutic benefits of cannabis for treating pain in osteoarthritis, rheumatoid arthritis, fibromyalgia, and cancer, further studies are needed with randomized controlled trials and larger study populations to identify the specific strains and concentrations that will work best with selected cohorts. PMID:27757048

  20. Canadian biodosimetry capacity for response to radiation emergencies

    Energy Technology Data Exchange (ETDEWEB)

    Wilkinson, D. [Defense Research and Development Canada-Ottawa, 3701 Carling Avenue, Ottawa, Ont., K1A 0Z4 (Canada)], E-mail:; Segura, T.; Prud' homme-Lalonde, L.; Mullins, D.; Lachapelle, S. [Defense Research and Development Canada-Ottawa, 3701 Carling Avenue, Ottawa, Ont., K1A 0Z4 (Canada); Qutob, S.; Thorleifson, E.; Wilkins, R. [Consumer and Clinical Radiation Protection Bureau, 775 Brookfield Road, PL6303B Health Canada, Ottawa, Ont., K1A 1C1 (Canada); Morrison, D. [Atomic Energy of Canada Limited, Chalk River, Ont. (Canada); Dolling, J.-A. [Genetics Department, Credit Valley Hospital, 2200 Eglinton Avenue West, Mississauga, Ont., L8S 4L8 (Canada); Boreham, D. [McMaster Institute of Applied Radiation Sciences, McMaster University, 1280 Main Street West, Hamilton, Ont., L5M 2N1 (Canada)


    In December 2001, Canada's response to the international political climate was launched by the creation of the Chemical, Biological, Radiological/Nuclear Research and Technology Initiative (CRTI). The National Biological Dosimetry Response Plan (NBDRP), established through partnering the expertise of three federal departments and one university, was created in response to this initiative. The NBDRP objectives were to develop a network of laboratories with expertise to perform biological dosimetry by cytogenetics and to investigate new technologies that may be applicable in the development of the new biodosimetry program. Since the creation of the NBDRP, Canada has made significant progress in enhancing expertise and resources to be better prepared for radiological/nuclear events. Through participation in exercises, the existing capacities were tested and recommendations for improvements were made. This paper describes the results from two exercises. The first exercise was designed to test the culturing, analysis, and reporting procedures within a single laboratory, and the second exercise was intended to test the capacity of the NBDRP. Future exercises will further challenge the network resulting in an improved national response capability.

  1. Pediatric nuclear medicine

    Energy Technology Data Exchange (ETDEWEB)


    This symposium presented the latest techniques and approaches to the proper medical application of radionuclides in pediatrics. An expert faculty, comprised of specialists in the field of pediatric nuclear medicine, discussed the major indications as well as the advantages and potential hazards of nuclear medicine procedures compared to other diagnostic modalities. In recent years, newer radiopharmaceuticals labeled with technetium-99m and other short-lived radionuclides with relatively favorable radiation characteristics have permitted a variety of diagnostic studies that are very useful clinically and carry a substantially lower radiation burden then many comparable X-ray studies. This new battery of nuclear medicine procedures is now widely available for diagnosis and management of pediatric patients. Many recent research studies in children have yielded data concerning the effacacy of these procedures, and current recommendations will be presented by those involved in conducting such studies. Individual papers are processed separately for the Energy Data Base.

  2. Nelson Textbook of Pediatrics. (United States)

    Pomerance, Herbert H


    The dedication of this volume states:To the physicians and nurses who care for children in many different circumstances throughout the world and who, by their efforts and commitment, make the world a better place for children.I have used the Nelson Textbook of Pediatrics since its third edition. It remains a source of amazement to me, as I witness the evolution of the book and of the knowledge that dictates its scope. From the days when a textbook was written by 1 or 2 authors, we have progressed to the point where this would be impossible. Three editors preside over this volume; they are also counted among the 212 contributors that lend special expertise to the work, continuing the volume as one of the traditions of pediatrics.The tremendous and rapid explosion in the amount of knowledge in pediatrics made a revision of the total material and even of.

  3. Radiology illustrated. Pediatric radiology

    Energy Technology Data Exchange (ETDEWEB)

    Kim, In-One (ed.) [Seoul National Univ. College of Medicine (Korea, Republic of). Dept. of Radiology


    Depicts characteristic imaging findings of common and uncommon diseases in the pediatric age group. Will serve as an ideal diagnostic reference in daily practice. Offers an excellent teaching aid, with numerous high-quality illustrations. This case-based atlas presents images depicting the findings typically observed when imaging a variety of common and uncommon diseases in the pediatric age group. The cases are organized according to anatomic region, covering disorders of the brain, spinal cord, head and neck, chest, cardiovascular system, gastrointestinal system, genitourinary system, and musculoskeletal system. Cases are presented in a form resembling teaching files, and the images are accompanied by concise informative text. The goal is to provide a diagnostic reference suitable for use in daily routine by both practicing radiologists and radiology residents or fellows. The atlas will also serve as a teaching aide and a study resource, and will offer pediatricians and surgeons guidance on the clinical applications of pediatric imaging.

  4. Pediatric perspective on pharmacogenomics. (United States)

    Stevens, Adam; De Leonibus, Chiara; Hanson, Daniel; Whatmore, Andrew; Murray, Philip; Donn, Rachelle; Meyer, Stefan; Chatelain, Pierre; Clayton, Peter


    The advances in high-throughput genomic technologies have improved the understanding of disease pathophysiology and have allowed a better characterization of drug response and toxicity based on individual genetic make up. Pharmacogenomics is being recognized as a valid approach used to identify patients who are more likely to respond to medication, or those in whom there is a high probability of developing severe adverse drug reactions. An increasing number of pharmacogenomic studies are being published, most include only adults. A few studies have shown the impact of pharmacogenomics in pediatrics, highlighting a key difference between children and adults, which is the contribution of developmental changes to therapeutic responses across different age groups. This review focuses on pharmacogenomic research in pediatrics, providing examples from common pediatric conditions and emphasizing their developmental context.

  5. [Treatment of pediatric epilepsy]. (United States)

    Ito, Susumu; Oguni, Hirokazu


    Recently, the treatment strategy for pediatric epilepsy has been dramatically changed in Japan, because of the approval of new-generation antiepileptic drugs. Since 2006, a total of 6 new antiepileptic drugs, including gabapentin (GBP; adults/pediatric patients: 2006/2011 [year of approval]), topiramate (TPM; 2007/2013), lamotrigine (LTG; 2008/2008), levetiracetam (LEV; 2010/2013), stiripentol (STP; 2012/2012), and rufinamide (RUF; 2013/2013), have been introduced. Thus far, valproate (VPA) and carbamazepine (CBZ) have been first indicated for "generalized" epilepsy and "focal" epilepsy syndromes/types, respectively, in Japan. However, the approval of these new drugs could allow us to choose more effective and less toxic ones at an early stage of treatment. In this chapter, we describe the latest domestic and foreign guidelines for the treatment of pediatric epilepsy.

  6. The transition process of spina bifida patients to adult-centred care: An assessment of the Canadian urology landscape (United States)

    Wajchendler, Amy; Anderson, Peter; Koyle, Martin A.


    Introduction: Due to medical advances over the past three decades, the vast majority of children with spina bifida (SB) now survive into adulthood. As a result, there is a need to implement a well-defined urological transition process for these patients from the pediatric to adult environment. The objective of this study was to identify and analyze the current medical practices employed and the attitudes regarding transition by Canadian pediatric urologists caring for the SB population. Methods: A survey consisting of 14 questions pertaining to physician demographics, current practice, and attitudes towards the transition process of SB patients was distributed at the 2015 annual Pediatric Urologists of Canada (PUC) conference. The survey respondents remained anonymous, and the data were collected and analyzed. Results: A total of 28 surveys were collected from urologists across Canada (25 full-time pediatric, three also providing adult care), representing a >75% response rate. The transition process was suggested to begin at the age of 18 or older by 43% (12/28) of pediatric urologists. The majority, 86% (24/28), do not currently use a questionnaire or a checklist to determine transition readiness of patients. Forty-six percent (13/28) of pediatric urologists do not provide ongoing urological care to their patients after referral has been made to adult-centred care. In the province of Ontario, in which 39% (11/28) of the pediatric urologists practice, 82% (9/11) are full-time pediatric urologists and 78% (7/9) do not provide ongoing care to SB patients after the age of 18. Conclusions: A significant minority of Canadian pediatric urologists perceive that the transition process should begin at the age of 18 or older. As such, it can be inferred that transfer of care and transition are synonymous, not independent. Simplistically, this suggests that transition represents an event rather than a longitudinal process. The fact there is no defined ongoing urological care

  7. The Relationship Between Nursing Experience and Education and the Occurrence of Reported Pediatric Medication Administration Errors. (United States)

    Sears, Kim; O'Brien-Pallas, Linda; Stevens, Bonnie; Murphy, Gail Tomblin


    Medication errors are one of the most common incidents in the hospitals. They can be harmful, and they are even more detrimental for pediatric patients. This study explored the relationship between nursing experience, education, the frequency and severity of reported pediatric medication administration errors (PMAEs). The data for this study were collected from a larger pan Canadian study. A survey tool was developed to collect self-reported data from nurses. In addition to descriptive statistics, a Poisson regression or a multiple linear regression was completed to address the research questions, and a Boneferrai correction was conducted to adjust for the small sample size. Results demonstrated that on units with more nurses with a higher level of current experience, more PMAEs were reported (p=.001), however; the PMAEs reported by these nurses were not as severe (p=.003). Implications to advance both safe medication delivery in the pediatric setting and safe culture of reporting for both actual and potential errors are identified.

  8. Contact Dermatitis in Pediatrics. (United States)

    Pelletier, Janice L; Perez, Caroline; Jacob, Sharon E


    Contact dermatitis is an umbrella term that describes the skin's reaction to contacted noxious or allergenic substances. The two main categories of contact dermatitis are irritant type and allergic type. This review discusses the signs, symptoms, causes, and complications of contact dermatitis. It addresses the testing, treatment, and prevention of contact dermatitis. Proper management of contact dermatitis includes avoidance measures for susceptible children. Implementation of a nickel directive (regulating the use of nickel in jewelry and other products that come into contact with the skin) could further reduce exposure to the most common allergens in the pediatric population. [Pediatr Ann. 2016;45(8):e287-e292.].

  9. Geospatial Analysis of Pediatric EMS Run Density and Endotracheal Intubation

    Directory of Open Access Journals (Sweden)

    Matthew Hansen


    Full Text Available Introduction: The association between geographic factors, including transport distance, and pediatric emergency medical services (EMS run clustering on out-of-hospital pediatric endotracheal intubation is unclear. The objective of this study was to determine if endotracheal intubation procedures are more likely to occur at greater distances from the hospital and near clusters of pediatric calls. Methods: This was a retrospective observational study including all EMS runs for patients less than 18 years of age from 2008 to 2014 in a geographically large and diverse Oregon county that includes densely populated urban areas near Portland and remote rural areas. We geocoded scene addresses using the automated address locator created in the cloud-based mapping platform ArcGIS, supplemented with manual address geocoding for remaining cases. We then use the Getis-Ord Gi spatial statistic feature in ArcGIS to map statistically significant spatial clusters (hot spots of pediatric EMS runs throughout the county. We then superimposed all intubation procedures performed during the study period on maps of pediatric EMS-run hot spots, pediatric population density, fire stations, and hospitals. We also performed multivariable logistic regression to determine if distance traveled to the hospital was associated with intubation after controlling for several confounding variables. Results: We identified a total of 7,797 pediatric EMS runs during the study period and 38 endotracheal intubations. In univariate analysis we found that patients who were intubated were similar to those who were not in gender and whether or not they were transported to a children’s hospital. Intubated patients tended to be transported shorter distances and were older than non-intubated patients. Increased distance from the hospital was associated with reduced odds of intubation after controlling for age, sex, scene location, and trauma system entry status in a multivariate logistic

  10. Psychological issues in pediatric obesity

    Directory of Open Access Journals (Sweden)

    Gurvinder Kalra


    Full Text Available Pediatric obesity is a major health problem and has reached epidemiological proportions today. The present paper reviews major psychological issues in pediatric obesity from a developmental perspective. Research and literature has shown that a number of developmental, family, maternal and child factors are responsible in the genesis of pediatric obesity. Family food habits, early developmental lifestyle of the child, parenting, early family relationships and harmony all contribute towards the growth and development of a child. The present review focuses on the role of developmental psychological factors in the pathogenesis of pediatric obesity and highlights the developmental factors that must be kept in mind when evaluating a case of pediatric obesity.

  11. [On the rehabilitation of pediatric burn patients in China]. (United States)

    Jia, Chi-yu


    Rehabilitation medicine is an emerging discipline. At present, there are many problems in rehabilitation of pediatric burn patients in China, including idea lag, weak technical force, lack of standardized technology, disunity in evaluation indexes, etc. The new era of reformation of health system and development and flourish of medical insurance business bring good opportunity for the development of rehabilitation medicine.

  12. Development of a Pediatric Fall Risk And Injury Reduction Program. (United States)

    Kramlich, Debra L; Dende, Denise


    Fall prevention programs that include reliable, valid, and clinically tested screening tools have demonstrated more positive effects for adult and geriatric populations than those not including such assessment. In contrast, because falling is a natural part of growth and development for pediatric patients, progression toward effective prevention programs for this population has proven to be a challenge; a significant impediment is the lack of definition regarding what constitutes a reportable fall. This project explored pediatric health care providers' perceptions of patient falls in order to define a reportable pediatric fall and inform development of a prevention program. A concept analysis of defining attributes, antecedents, and consequences of pediatric falls from literature formed the basis for a set of questions; a convenience sample of 28 pediatric health care providers in an acute care hospital in New England participated in six moderated focus groups. Constant comparison method was used to code the qualitative data and develop themes. Participants unanimously agreed on several points; as expected, their years of experience in pediatric practice provided valuable insight. Three major themes emerged: patient characteristics, caregiver characteristics, and environmental characteristics. Based on factors identified by staff, a screening tool was adopted and integrated into the electronic medical record. Staff were actively engaged in developing definitions, selecting tools, and identifying next steps toward a comprehensive fall reduction program for their patients. As a result, they have embraced changes and advocated successfully for endorsement by the organization.

  13. Pediatric tooth extractions under sedoanalgesia (United States)

    Arpaci, Ayse Hande; Isik, Berrin


    Objective: The present study aims to evaluate intravenous ketamine and inhalation sedation in children, their unwanted side-effects and surgeon satisfaction. Methods: In this study, data of 922 children aged between 1-18 who underwent tooth extraction under sedoanalgesia in our department between September 2015-January 2016 were gathered and anesthesia approaches, unwanted side effects and surgical satisfaction was investigated. Postoperative recovery emergence agitation or delirium was evaluated with Watcha Behavior Scale (WBS). Results: Patients were grouped and compared according to acceptance of intravenous line placement (Group-1) or not (Group- 2). Group 1 received intravenous ketamine anesthesia (n=822), Group 2 received inhalation anesthesia with sevoflurane (n=100). Number of patients, age, weight and gender was significantly different in two groups. When side effects were investigated nausea was observed in 30 patients (3.6%), skin rashes were observed in 26 patients (3.2%) in Group-1 while skin rashes were observed in one patient (1%) in Group 2. 95% of surgeons reported intravenous anesthesia, 18% of surgeons reported inhalation anesthesia to be the anesthesia of choice. Emergence of postoperative recovery agitation (WBS≥3) was observed more frequent in Group 2 (p<0.05) than Group 1. Conclusion: Ketamine, which has analgesic, hypnotic and amnestic effects and which does not alter pharyngeal and laryngeal reflexes thus minimizes aspiration possibility, is a safe and effective anesthetic agent for tooth extractions of the pediatric population under sedoanalgesia. PMID:27882039

  14. Colonial Fantasies, Narrative Borders, and the Canadian North in the Works of Germany's Colin Ross(1885-1945

    Directory of Open Access Journals (Sweden)

    Nicole Pissowotzki


    Full Text Available This paper argues that the Canadian North is a discursive construction, within which German colonial fantasies emerge. In particular, I argue that it is through bordering that colonial fantasies of German Lebensraum ("living space" in the Canadian North are brought into being. I further argue that the German biologist and geographer Friedrich Ratzel (1844-1904, with his view of the "organic state," provides the ideological framework for colonial fantasies in the travel writings of Colin Ross.I focus on the writer's colonial imagination and his perception of borders, and on how both relate to the Canadian North. I show that seemingly bare geographical information and demographical data, provided in Ross' travelogues, carry colonial fantasies of German spaces in the Canadian North. Those spaces are bordered by "shared histories" and "narrative boundaries," thus constructing a collective German colonial identity (cf. Eder 2006, 255-257.

  15. Social Workers' Role in the Canadian Mental Health Care System (United States)

    Towns, Ashley M.; Schwartz, Karen


    Objective: Using Canadian survey data this research provides social workers in Canada with a better understanding of their role in the Canadian mental health care system. Methods: By analyzing data from the Canadian Community Health Survey, Cycle 1.2 Mental Health and Well-being, the role of social workers in the Canadian mental health system was…

  16. Introduction to special issue: moving forward in pediatric neuropsychology. (United States)

    Daly, Brian P; Giovannetti, Tania; Zabel, T Andrew; Chute, Douglas L


    This special issue of The Clinical Neuropsychologist focuses on advances in the emerging subspecialty of pediatric neuropsychology. The national and international contributions in this issue cover a range of key clinical, research, training, and professional issues specific to pediatric neuropsychology. The genesis for this project developed out of a series of talks at the Philadelphia Pediatric Neuropsychology Symposium in 2010, hosted by the Stein Family Fellow, the Department of Psychology of the College of Arts and Sciences at Drexel University, and the Philadelphia Neuropsychology Society. Articles that explore clinical practice issue focus on the assessment of special medical populations with congenital and/or acquired central nervous system insults. Research articles investigate the core features of developmental conditions, the use of technology in neuropsychological research studies, and large sample size genomic, neuropsychological, and imaging studies of under-represented populations. The final series of articles examine new considerations in training, advocacy, and subspecialty board certification that have emerged in pediatric neuropsychology. This introductory article provides an overview of the articles in this special issue and concluding thoughts about the future of pediatric neuropsychology.

  17. Pitfalls in pediatric radiology

    Energy Technology Data Exchange (ETDEWEB)

    Engelkemier, Dawn R. [Boston Children' s Hospital, Harvard Medical School, Department of Radiology, Boston, MA (United States); Kern Radiology, Bakersfield, CA (United States); Taylor, George A. [Boston Children' s Hospital, Harvard Medical School, Department of Radiology, Boston, MA (United States)


    This essay depicts some of the diagnostic errors identified in a large academic pediatric imaging department during a 13-year period. Our aim is to illustrate potential situations in which errors are more likely to occur and more likely to cause harm, and to share our difficult cases so other radiologists might learn without having to experience those situations themselves. (orig.)

  18. Pharmacotherapy of Pediatric Insomnia (United States)

    Owens, Judith A.


    General guidelines for the use of medication to treat pediatric insomnia are presented. It should be noted that medication is not the first treatment choice and should be viewed within the context of a more comprehensive treatment plan. The pharmacological and clinical properties of over the counter medications and FDA-approved insomnia drugs are…

  19. Pediatric brainstem oligodendroglioma

    Directory of Open Access Journals (Sweden)

    Sandeep Mohindra


    Full Text Available The authors present the first report of pediatric brainstem oligodendroglioma, infiltrating midbrain, and medulla oblongata. The report details clinical features, radiological findings, and surgical steps. As this entity is exceedingly uncommon, the overall epidemiology, prognosis, and long-term outcome remain far from established.

  20. Pediatric Urinary Tract Infection (United States)

    SBA National Resource Center: 800-621-3141 Pediatric Urinary Tract Infections and Catheterization in Children with Neurogenic Bladder and ... To protect the kidneys from damage – By preventing urinary tract infections (UTI) – By identifying and treating vesicoureteral remux (VUR). ...

  1. Modelling pediatric kinematics

    NARCIS (Netherlands)

    Ratingen, M.R. van; Wismans, J.S.H.M.


    In the field of pediatric biomechanics, crash dumy and numerical model development suffers from to limited human subject data to directly establish response and injury values. In order to create child crash dummies and numerical models, it is necessary to combine the results from real world accident

  2. Pediatric Cervicofacial Necrotizing Fasciitis (United States)

    King, Ericka; Chun, Robert; Sulman, Cecille


    Objective To present a case of a pediatric cervicofacial necrotizing fasciitis (NF), a rapidly progressive infection, and a review of a 10-year pediatric inpatient database. Design Case report and review. Setting Pediatric intensive care unit. Patients A healthy 5-year-old male who developed NF of the lower lip 36 hours following minor trauma. International Classification of Diseases, Ninth Revision, code 728.86 (NF), was the inclusion criteria for the Kids’ Inpatient Database (KID) in 1997 and 2006. Results A pediatric case is presented with a thorough photographic record demonstrating the need for rapid diagnosis and treatment. In a review of the KID from 1997 and 2006, the relative risk of being discharged with NF in 2006 vs 1997 was 1.4 (95% CI, 9.95-2.28). Age at diagnosis of NF was older in 2006 compared with 1997 (11.5 years vs 8.05 years; Ppediatric discharges with a diagnosis of NF compared with discharges without a diagnosis of NF (Pnecrotizing fasciitis with aggressive medical and surgical treatment are still the foundation in disease survival. PMID:22508620

  3. Pediatric Low Vision (United States)

    ... Asked Questions Español Condiciones Chinese Conditions Pediatric Low Vision What is Low Vision? Partial vision loss that cannot be corrected causes ... and play. What are the signs of Low Vision? Some signs of low vision include difficulty recognizing ...

  4. Update on pediatric hyperhidrosis. (United States)

    Gordon, Jennifer R S; Hill, Samantha E


    Hyperhidrosis is a common and under-recognized disease in the pediatric population that has a significant impact on quality of life. Focal and generalized forms of hyperhidrosis exist, which can be idiopathic or secondary to underlying medical conditions or medications. Treatment is tailored to the specific patient needs, characteristics and goals. These include topical preparations, iontophoresis, botulinum toxin and anticholinergic medications.

  5. Pediatric Glaucoma: Pharmacotherapeutic Options. (United States)

    Samant, Monica; Medsinge, Anagha; Nischal, Ken K


    Childhood glaucoma is a major therapeutic challenge for pediatric ophthalmologists and glaucoma specialists worldwide. Management depends on the etiology and age at presentation. A variety of drugs are available for the control of intraocular pressure in children; however, none of these drugs have been licensed by the regulatory agencies for use in children. Furthermore, evidence gained from randomized controlled trials in the pediatric population is sparse, and little is known regarding the use of newer anti-glaucoma preparations. This evidence-based review aims to discuss the available pharmacotherapeutic options for glaucoma in children. Topical adrenoceptor blockers, topical and systemic carbonic anhydrase inhibitors, prostaglandin (PG) analogs, adrenoceptor agonists, parasympathomimetics, and combined preparations are available for use in children, but usually as an off-label indication. Therefore, it is important to recognize that serious side effects have been reported, even with topical drops, and measures to reduce systemic absorption should be taken. Most drugs have been shown to have comparable ocular hypotensive effects, with the lowest occurrence of systemic side effects with PG analogs. Whereas a newly introduced prostaglandin analog, tafluprost, and some other preservative-free preparations have shown promising results in adult glaucoma patients, no pediatric reports are available as yet. Future studies may describe their role in treating pediatric glaucoma. This review also shares some suggested treatment pathways for primary congenital glaucoma (PCG), juvenile open angle glaucoma (JOAG), developmental glaucoma, aphakic/pseudophakic glaucoma, and uveitic glaucoma.

  6. [Notes for a history of pediatrics]. (United States)

    Maggioni, G


    The origins, major events and the Italian and foreign literature on the history of pediatrics are summarized. The origins of the word ''pediatrics'', the history of pediatric incunables and the first textbooks of pediatrics in Italian language are reviewed. Moreover, the foundation of the first pediatric hospital in Italy, the Italian history of academic schools in pediatrics, the first national congress and the formation of the national society of pediatrics are outlined. In 1998, on the occasion of the 100 years anniversary of the foundation of the national society of pediatrics, a special group on the history of pediatrics was formed. Finally, other topics for further studies are suggested.

  7. Terrorism threats and preparedness in Canada: the perspective of the Canadian public. (United States)

    Gibson, Stacey; Lemyre, Louise; Clément, Mélanie; Markon, Marie-Pierre L; Lee, Jennifer E C


    Although Canada has not experienced a major terrorist attack, an increased global pending threat has put preparedness at the top of the Canadian government's agenda. Given its strong multicultural community and close proximity to the recently targeted United States, the Canadian experience is unique. However, minimal research exists on the public's reactions to terrorism threats and related preparedness strategies. In order for response initiatives to be optimally effective, it is important that the public's opinions regarding terrorism and preparedness be considered. This qualitative study examined perceptions of terrorism threats among Canadians living in Central and Eastern Canada (N = 75) in the fall of 2004. Conceptualizations of terrorism threat, psychosocial impacts, and sense of preparedness were explored in a series of qualitative interviews. Findings revealed that the majority of Canadians did not feel overly threatened by terrorist attacks, due in part to a perception of terrorist threats as related to global sociopolitical events and a positive Canadian identity. In addition, while most respondents did not feel they were individually affected by the threat of terrorism, there was some concern regarding larger societal impacts, such as increased paranoia, discrimination, and threats to civil liberties. Participants' views on preparedness focused largely on the utility of emergency preparedness strategies and the factors that could mitigate or inhibit preparedness at the individual and institutional levels, with a specific focus on education. Finally, the significant relevance of these findings in shaping terrorism preparedness, both in Canada and generally, is discussed.

  8. A perspective on Canadian shale gas

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, Mike; Davidson, Jim; Mortensen, Paul


    In a relatively new development over just the past few years, shale formations are being targeted for natural gas production. Based on initial results, there may be significant potential for shale gas in various regions of Canada, not only in traditional areas of conventional production but also non-traditional areas. However, there is much uncertainty because most Canadian shale gas production is currently in experimental or early developmental stages. Thus, its full potential will not be known for some time. If exploitation proves to be successful, Canadian shale gas may partially offset projected long-term declines in Canadian conventional natural gas production.

  9. Chinese Feelings Cherished By Canadians

    Institute of Scientific and Technical Information of China (English)


    <正>On March 30, "The Chinese Feelings Across the Pacific-The Century Exhibition of the Old Photos Treasured by the Canadians" was open in the Lu Xun Museum in Beijing. The exhibition lasted for one week. At the exhibition some old photos taken in the early 20th century were on display, showing James G. Endicott, envoy of world peace, together with Mao Zedong and Zhou Enlai; the family of O. L. Kilborn, one of the founders of West China Union University, together with Chinese women with bound feet: O. L. Kilborn treating the wounded soldiers during the Revolution of 1911; Leslie Earl Willmott in Chinese tunic suit and his wife reluctant to bid farewell to China, as well as photos of Ashley Woodward Lindesay, founder of China’s modern


    Directory of Open Access Journals (Sweden)

    Barbara Libby


    Full Text Available This paper will discuss the existence of a Canadian Political Business Cycle (PBC during the period 1946-1989. Logit analysis was used to determine if changes in the unemployment rate, growth of real GNE and the rate of inflation are significantly different in the period before an election than during the rest of the electoral term. It was found that the rate of growth in the unemployment rate declines and the rate of growth of real GNP increases in the four quarters before an election. The behavior of these variables reverses in the period after an election. These findings are consistent with a political business cycle. Policy variables, under a majority government, also behave in a manner associated with a PBC, with the government stimulating the economy approximately two years into its term so that good economic news will occur before it has to call an election. Minority governments tend to simulate the economy immediately after taking office.

  11. Current use of intraosseous infusion in Danish emergency departments: a cross-sectional study

    DEFF Research Database (Denmark)

    Molin, Rune; Hallas, Peter; Brabrand, Mikkel;


    Intraosseous infusion (IOI) is recommended when intravenous access cannot be readily established in both pediatric and adult resuscitation. We evaluated the current use of IOI in Danish emergency departments (EDs).......Intraosseous infusion (IOI) is recommended when intravenous access cannot be readily established in both pediatric and adult resuscitation. We evaluated the current use of IOI in Danish emergency departments (EDs)....

  12. Pediatric neurocysticercosis: current challenges and future prospects

    Directory of Open Access Journals (Sweden)

    Singhi P


    Full Text Available Pratibha Singhi, Arushi Gahlot SainiDepartment of Pediatrics, Pediatric Neurology and Neurodevelopment Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaAbstract: Neurocysticercosis (NCC is an acquired infection of the nervous system caused by encysted larvae of Taenia solium. It is a major cause of epilepsy in the tropics and the commonest cause of focal seizures in North Indian children. T. solium teniasis-cysticercosis is considered a parasitic “Neglected Tropical Diseases” endemic throughout Southeast Asia. NCC in children has pleomorphic manifestations depending on the location, number and viability of the cysts, and host response. Even with advancing knowledge of the disease manifestations, many aspects related to diagnosis and treatment, particularly in children, still remain controversial and pose challenges to clinical practice. There is no gold standard test to diagnose NCC and the management recommendations are still emerging. This review provides an overview of diagnosis of NCC in children and its management with special focus on current challenges and future prospects.Keywords: neurocysticercosis, children, epilepsy, ring enhancing lesions, pigs

  13. Initial Assessment of the Pediatric Patient: How to Perform?



    In the pediatric emergency department, it is essential to recognize early clinical signs that indicate threat to the patient’s life and should be handled quickly, becoming a challenge for the medical team assisting. It requires a quick initial assessment of the critically ill patient, approaching it from a physiological point of view by analyzing the hemodynamic and respiratory compromise, preventing cardiac arrest. This first approach is called the Pediatric Assessment Triangle based on gene...

  14. Canadian national nuclear forensics capability project

    Energy Technology Data Exchange (ETDEWEB)

    Ball, J.; Dimayuga, I., E-mail: [Canadian Nuclear Laboratories, Chalk River, Ontario (Canada); Summerell, I. [Royal Canadian Mounted Police, Ottawa, Ontario (Canada); Totland, M. [Canadian Nuclear Laboratories, Chalk River, Ontario (Canada); Jonkmans, G. [Defence Research and Development Canada, Ottawa, Ontario (Canada); Whitlock, J. [Canadian Nuclear Laboratories, Chalk River, Ontario (Canada); El-jaby, A. [Canadian Nuclear Safety Commission, Ottawa, Ontario (Canada); Inrig, E. [Defence Research and Development Canada, Ottawa, Ontario (Canada)


    Following the 2010 Nuclear Security Summit, Canada expanded its existing capability for nuclear forensics by establishing a national nuclear forensics laboratory network, which would include a capability to perform forensic analysis on nuclear and other radioactive material, as well as on traditional evidence contaminated with radioactive material. At the same time, the need for a national nuclear forensics library of signatures of nuclear and radioactive materials under Canadian regulatory control was recognized. The Canadian Safety and Security Program, administered by Defence Research and Development Canada's Centre for Security Science (DRDC CSS), funds science and technology initiatives to enhance Canada's preparedness for prevention of and response to potential threats. DRDC CSS, with assistance from Canadian Nuclear Laboratories, formerly Atomic Energy of Canada Limited, is leading the Canadian National Nuclear Forensics Capability Project to develop a coordinated, comprehensive, and timely national nuclear forensics capability. (author)

  15. Canadian Law Schools: In Search of Excellence. (United States)

    Trakman, Leon E.


    Academically, Canadian education is at the crossroads between formalism and functionalism, with the latter prevailing in recent years. There now arises a demand for a more integrated approach, linking legal theory with legal practice. (MSE)

  16. Facts about Canadian musk-oxen (United States)

    US Fish and Wildlife Service, Department of the Interior — This paper discusses the historical and current status of the Canadian musk-oxen. The musk-oxen's distribution, social structure, food and range, and breeding...

  17. Canadian Business Schools: Going out of Business? (United States)

    Dobni, Dawn; Dobni, Brooke


    Using Porter's five-forces model (potential entrants, suppliers, buyers, rivalry, substitutes) to analyze competition in Canadian university business schools, the authors conclude that schools are becoming increasingly vulnerable to competitive pressures and that strategic reorientation is necessary. (SK)

  18. Southeastern Regional Pediatric Disaster Surge Network: a public health partnership. (United States)

    Ginter, Peter M; Rucks, Andrew C; Duncan, W Jack; Wingate, Martha S; Beeman, S Kenn; Reeves, Jane; West, Maury A


    In the event of a natural or man-made disaster involving large numbers of children, resources in the Southeastern U.S. are extremely limited. This article chronicles the efforts of the Alabama Department of Public Health, the Mississippi State Department of Health, and the South Central Center for Public Health Preparedness in conjunction with more than 40 organizations to develop a voluntary network of health-care providers, public health departments, volunteers, and emergency responders from Alabama, Florida, Louisiana, Mississippi, and Tennessee. The purpose of the Southeastern Regional Pediatric Disaster Surge Network (the Network) is to improve the pediatric preparedness response strategies of public health, emergency response, and pediatric providers in the event of large-scale emergencies or disasters that overwhelm local or state pediatric resources. The planning and development of the Network is proceeding through three general phases--information sharing, mutual goal setting and collective action, and long-term formal linkages. In Phase 1, critical planning tasks to be undertaken in the development of the Network were identified. In Phase 2, the agencies developed a draft operational handbook that served as the basis for a formal memorandum of understanding. In Phase 3, participants will engage in exercises and evaluations that will further identify and work out logistical and operational details.

  19. Canadian National Identity and Anti-Americanism

    Institute of Scientific and Technical Information of China (English)



    Canadian national identity is closely related to antiAmericanism and for Canadians,comparing with America has become the main way to identify themselves.So some scholars argue that Canada lacks a real national identity and this is the main reason of its anti-American tradition.However,the author remarks Canada has its national identity.In this paper,the author will present three reasons to support her view.

  20. Canadian National Identity and Anti-Americanism

    Institute of Scientific and Technical Information of China (English)



    Canadian national identity is closely related to anti-Americanism and for Canadians,comparing with America has become the main way to identify themselves.So some scholars argue that Canada lacks a real national identity and this is the main reason of its anti-American tradition.However,the author remarks Canada has its national identity.In this paper,the author will present three reasons to support her view.

  1. Pediatrics in 21(st) Century and Beyond. (United States)

    Singh, Meharban


    Pediatrics is a dynamic discipline and there is awareness and hope for actualizing outstanding achievements in the field of child health in 21(st) century and beyond. Improved lifestyle and quality of children's health is likely to reduce the burden of adult diseases and enhance longevity because seeds of most adult diseases are sown in childhood. Identification and decoding of human genome is expected to revolutionize the practice of pediatrics. The day is not far off when a patient will walk into doctor's chamber with an electronic or digital health history on a CD or palmtop and a decoded genomic constitution. There will be reduced burden of genetic diseases because of selective abortions of "defective" fetuses and replacement of "bad" genes with "good" ones by genetic engineering. Availability of totipotent stem cells and developments in transplant technology are likely to revolutionize the management of a variety of hematologic cancers and life-threatening genetic disorders. The possibility of producing flawless designer babies by advances in assisted reproductive technologies (ARTs) is likely to be mired by several ethical and legal issues.The availability of newer vaccines by recombinant technology for emerging infective and for non-infective lifestyle diseases is likely to improve survival and quality of life. There is going to be a greater focus on the "patient" having the disease rather than "disease" per se by practicing holistic pediatrics by effective utilization of alternative or complementary strategies for health care. Due to advances in technology, pediatrics may get further dehumanized. A true healer cannot simply rely on technology; there must be a spiritual bond between the patient and the physician by exploiting the concept of psycho-neuro-immunology and body-mind interactions. In the years to come, physicians are likely to play "god" but medicine can't achieve immortality because anything born must die in accordance with nature's recycling

  2. Pediatric imaging. Rapid fire questions and answers

    Energy Technology Data Exchange (ETDEWEB)

    Quattromani, F.; Lampe, R. (eds.) [Texas Tech Univ. Health Sciences Center, School of Medicine, Lubbock, TX (United States); Handal, G.A. [Texas Tech Univ. Health Sciences Center, School of Medicine, El Paso, TX (United States)


    The book contains the following contributions: Airway, head, neck; allergy, immunology rheumatology; pediatric cardiac imaging; child abuse; chromosomal abnormalities; conscious sedation; contrast agents and radiation protection; pediatric gastrointestinal imaging; genetic disorders in infants and children; pediatric genitourinary imaging; pediatric hematology, oncology imaging; pediatric intenrventional radiology; metabolic and vitamin disorders; muscoskeletal disorders (osteoradiology); neonatology imaging; pediatric neuroimaging; imaging of the respiratory tract in infants and children; vascular anomalies.

  3. Pediatric head injury. (United States)

    Tulipan, N


    Pediatric head injury is a public health problem that exacts a high price from patients, their families and society alike. While much of the brain damage in head-injured patients occurs at the moment of impact, secondary injuries can be prevented by aggressive medical and surgical intervention. Modern imaging devices have simplified the task of diagnosing intracranial injuries. Recent advances in monitoring technology have made it easier to assess the effectiveness of medical therapy. These include intracranial pressure monitoring devices that are accurate and safe, and jugular bulb monitoring which provides a continuous, qualitative measure of cerebral blood flow. The cornerstones of treatment remain hyperventilation and osmotherapy. Despite maximal treatment, however, the mortality and morbidity associated with pediatric head injury remains high. Reduction of this mortality and morbidity will likely depend upon prevention rather than treatment.

  4. Hippocrates on Pediatric Dermatology. (United States)

    Sgantzos, Markos; Tsoucalas, Gregory; Karamanou, Marianna; Giatsiou, Styliani; Tsoukalas, Ioannis; Androutsos, George


    Hippocrates of Kos is well known in medicine, but his contributions to pediatric dermatology have not previously been examined. A systematic study of Corpus Hippocraticum was undertaken to document references of clinical and historical importance of pediatric dermatology. In Corpus Hippocraticum, a variety of skin diseases are described, along with proposed treatments. Hippocrates rejected the theory of the punishment of the Greek gods and supported the concept that dermatologic diseases resulted from a loss of balance in the body humors. Many of the terms that Hippocrates and his pupils used are still being used today. Moreover, he probably provided one of the first descriptions of skin findings in smallpox, Henoch-Schönlein purpura (also known as anaphylactoid purpura, purpura rheumatica, allergic purpura), and meningococcal septicemia.

  5. Acupuncture for Pediatric Pain

    Directory of Open Access Journals (Sweden)

    Brenda Golianu


    Full Text Available Chronic pain is a growing problem in children, with prevalence as high as 30.8%. Acupuncture has been found to be useful in many chronic pain conditions, and may be of clinical value in a multidisciplinary treatment program. The basic principles of acupuncture are reviewed, as well as studies exploring basic mechanisms of acupuncture and clinical efficacy. Conditions commonly treated in the pediatric pain clinic, including headache, abdominal pain, fibromyalgia, juvenile arthritis, complex regional pain syndrome, cancer pain, as well as perioperative pain studies are reviewed and discussed. Areas in need of further research are identified, and procedural aspects of acupuncture practice and safety studies are reviewed. Acupuncture can be an effective adjuvant in the care of pediatric patients with painful conditions, both in a chronic and an acute setting. Further studies, including randomized controlled trials, as well as trials of comparative effectiveness are needed.

  6. Helicobacter pylori in pediatrics. (United States)

    Homan, Matjaž; Hojsak, Iva; Kolaček, Sanja


    This review summarizes important pediatric studies published from April 2011 up to March 2012. Proteomics profile of ulcerogenic Helicobacter pylori strains was defined in the most interesting study of the last year. The antigen stool test is becoming the "gold standard" in prevalence studies, and according to the last epidemiologic studies, the prevalence of H. pylori infection in childhood is not decreasing any more in the developed world. The resistance rate of H. pylori strains is high in children. Therefore, among other important issues concerning H. pylori in pediatrics, guidelines published by ESPGHAN and NASPGHAN last year also recommended culture and susceptibility testing before first-line treatment in areas with high or unknown antibiotic resistance rates.

  7. Pediatric brain tumors

    Energy Technology Data Exchange (ETDEWEB)

    Poussaint, Tina Y. [Department of Radiology, Boston, MA (United States); Panigrahy, Ashok [Children' s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA (United States); Huisman, Thierry A.G.M. [Charlotte R. Bloomberg Children' s Center, Johns Hopkins Hospital, Division of Pediatric Radiology and Pediatric Neuroradiology, Baltimore, MD (United States)


    Among all causes of death in children from solid tumors, pediatric brain tumors are the most common. This article includes an overview of a subset of infratentorial and supratentorial tumors with a focus on tumor imaging features and molecular advances and treatments of these tumors. Key to understanding the imaging features of brain tumors is a firm grasp of other disease processes that can mimic tumor on imaging. We also review imaging features of a common subset of tumor mimics. (orig.)

  8. Pediatric contact dermatitis


    Sharma Vinod; Asati Dinesh


    Allergic contact dermatitis (ACD) in children, until recently, was considered rare. ACD was considered as a disorder of the adult population and children were thought to be spared due to a lack of exposure to potential allergens and an immature immune system. Prevalence of ACD to even the most common allergens in children, like poison ivy and parthenium, is relatively rare as compared to adults. However, there is now growing evidence of contact sensitization of the pediatric population, and i...

  9. Pediatric palliative care

    Directory of Open Access Journals (Sweden)

    Trapanotto Manuela


    Full Text Available Abstract The WHO defines pediatric palliative care as the active total care of the child's body, mind and spirit, which also involves giving support to the family. Its purpose is to improve the quality of life of young patients and their families, and in the vast majority of cases the home is the best place to provide such care, but for cultural, affective, educational and organizational reasons, pediatric patients rarely benefit from such an approach. In daily practice, it is clear that pediatric patients experience all the clinical, psychological, ethical and spiritual problems that severe, irreversible disease and death entail. The international literature indicates a prevalence of incurable disease annually affecting 10/10,000 young people from 0 to 19 years old, with an annual mortality rate of 1/10,000 young people from birth to 17 years old. The needs of this category of patients, recorded in investigations conducted in various parts of the world, reveal much the same picture despite geographical, cultural, organizational and social differences, particularly as concerns their wish to be treated at home and the demand for better communications between the professionals involved in their care and a greater availability of support services. Different patient care models have been tested in Italy and abroad, two of institutional type (with children staying in hospitals for treating acute disease or in pediatric hospices and two based at home (the so-called home-based hospitalization and integrated home-based care programs. Professional expertise, training, research and organization provide the essential foundations for coping with a situation that is all too often underestimated and neglected.

  10. Evaluation of pediatric nephrolithiasis


    Kokorowski, Paul J.; Katherine Hubert; Nelson, Caleb P.


    Nephrolithiasis in the pediatric population is an important cause of morbidity worldwide. Presenting signs and symptoms are often considerably different from those in adults. Vague abdominal pain, hematuria, and urinary tract infection are more common in children than the classic colicky flank pain. Imaging of suspected cases should be undertaken with careful consideration of diagnostic accuracy and the potentially harmful effects of ionizing radiation. Because children with nephrolithiasis h...

  11. Pediatric salivary gland imaging

    Energy Technology Data Exchange (ETDEWEB)

    Boyd, Zachary T. [University of Missouri-Kansas City School of Medicine, Kansas City, MO (United States); Goud, Asha R. [University of California Irvine Medical Center, Department of Radiology, Orange, CA (United States); Lowe, Lisa H. [Children' s Mercy Hospitals and Clinics and the University of Missouri-Kansas City, Department of Radiology, Kansas City, MO (United States); Shao, Lei [Children' s Mercy Hospitals and Clinics and the University of Missouri-Kansas City, Department of Pathology, Kansas City, MO (United States)


    A variety of lesions occur in the pediatric salivary glands. With modern imaging techniques such as Doppler sonography, helical CT, and MRI, identification of a specific etiology is often possible. Knowledge of clinical information, normal anatomy, and imaging characteristics of salivary gland pathology are essential for appropriate radiologic evaluation. This review illustrates the various congenital, neoplastic, and inflammatory entities that can occur within the parotid, submandibular, and sublingual spaces. (orig.)

  12. Moral Dilemmas in Pediatric Orthopedics. (United States)

    Mercuri, John J; Vigdorchik, Jonathan M; Otsuka, Norman Y


    All orthopedic surgeons face moral dilemmas on a regular basis; however, little has been written about the moral dilemmas that are encountered when providing orthopedic care to pediatric patients and their families. This article aims to provide surgeons with a better understanding of how bioethics and professionalism apply to the care of their pediatric patients. First, several foundational concepts of both bioethics and professionalism are summarized, and definitions are offered for 16 important terms within the disciplines. Next, some of the unique aspects of pediatric orthopedics as a subspecialty are reviewed before engaging in a discussion of 5 common moral dilemmas within the field. Those dilemmas include the following: (1) obtaining informed consent and assent for either surgery or research from pediatric patients and their families; (2) performing cosmetic surgery on pediatric patients; (3) caring for pediatric patients with cognitive or physical impairments; (4) caring for injured pediatric athletes; and (5) meeting the demand for pediatric orthopedic care in the United States. Pertinent considerations are reviewed for each of these 5 moral dilemmas, thereby better preparing surgeons for principled moral decision making in their own practices. Each of these dilemmas is inherently complex with few straightforward answers; however, orthopedic surgeons have an obligation to take the lead and better define these kinds of difficult issues within their field. The lives of pediatric patients and their families will be immeasurably improved as a result.

  13. Preventable Pediatric Stroke via Vaccination?


    Press, Craig A.; Wainwright, Mark S


    Investigators from the Vascular Effects of Infection in Pediatric Stroke (VIPS) group studied the risk of arterial ischemic stroke (AIS) associated with minor infection and routine childhood vaccinations.

  14. American Academy of Pediatric Dentistry (United States)

    ... New Dentist Resources Volunteering in AAPD AAPD Publications Advertising Brochures Journals & Publications Full Journal Archives Access Pediatric ... Us Site Map Privacy Policy Terms of Use facebook twitter instagram

  15. Canadian Society of Nephrology Commentary on the 2012 KDIGO clinical practice guideline for glomerulonephritis: management of nephrotic syndrome in children. (United States)

    Samuel, Susan; Bitzan, Martin; Zappitelli, Michael; Dart, Allison; Mammen, Cherry; Pinsk, Maury; Cybulsky, Andrey V; Walsh, Michael; Knoll, Greg; Hladunewich, Michelle; Bargman, Joanne; Reich, Heather; Humar, Atul; Muirhead, Norman


    The KDIGO (Kidney Disease: Improving Global Outcomes) clinical practice guideline for management of glomerulonephritis was recently released. The Canadian Society of Nephrology convened a working group to review the recommendations and comment on their relevancy and applicability to the Canadian context. A subgroup of pediatric nephrologists reviewed the guideline statements for management of childhood nephrotic syndrome and agreed with most of the guideline statements developed by KDIGO. This commentary highlights areas in which there is lack of evidence and areas in need of translation of evidence into clinical practice. Areas of controversy or uncertainty, including the length of corticosteroid therapy for the initial presentation and relapses, definitions of steroid resistance, and choice of second-line agents, are discussed in more detail. Existing practice variation is also addressed.

  16. Environmental contaminants and human health in the Canadian Arctic. (United States)

    Donaldson, S G; Van Oostdam, J; Tikhonov, C; Feeley, M; Armstrong, B; Ayotte, P; Boucher, O; Bowers, W; Chan, L; Dallaire, F; Dallaire, R; Dewailly, E; Edwards, J; Egeland, G M; Fontaine, J; Furgal, C; Leech, T; Loring, E; Muckle, G; Nancarrow, T; Pereg, D; Plusquellec, P; Potyrala, M; Receveur, O; Shearer, R G


    The third Canadian Arctic Human Health Assessment conducted under the Canadian Northern Contaminants Program (NCP), in association with the circumpolar Arctic Monitoring and Assessment Programme (AMAP), addresses concerns about possible adverse health effects in individuals exposed to environmental contaminants through a diet containing country foods. The objectives here are to: 1) provide data on changes in human contaminant concentrations and exposure among Canadian Arctic peoples; 2) identify new contaminants of concern; 3) discuss possible health effects; 4) outline risk communication about contaminants in country food; and 5) identify knowledge gaps for future contaminant research and monitoring. The nutritional and cultural benefits of country foods are substantial; however, some dietary studies suggest declines in the amount of country foods being consumed. Significant declines were found for most contaminants in maternal blood over the last 10 years within all three Arctic regions studied. Inuit continue to have the highest levels of almost all persistent organic pollutants (POPs) and metals among the ethnic groups studied. A greater proportion of people in the East exceed Health Canada's guidelines for PCBs and mercury, although the proportion of mothers exceeding these guidelines has decreased since the previous assessment. Further monitoring and research are required to assess trends and health effects of emerging contaminants. Infant development studies have shown possible subtle effects of prenatal exposure to heavy metals and some POPs on immune system function and neurodevelopment. New data suggest important beneficial effects on brain development for Inuit infants from some country food nutrients. The most successful risk communication processes balance the risks and benefits of a diet of country food through input from a variety of regional experts and the community, to incorporate the many socio-cultural and economic factors to arrive at a risk

  17. Pediatric Neck Mass

    Directory of Open Access Journals (Sweden)

    Guilherme Machado de Carvalho


    Full Text Available Introduction  Neck masses include a wide variety of diagnostic possibilities, with more than 60 etiologies that depend on clinical aspects such as age, location and time of disease progression. The interview and physical examination guide research that cross the neck masses in pediatric patients in 3 groups: infectious / inflammatory, and neoplastic embryonic remnants. The aim of this study was to present a protocol for evaluation of neck masses in the pediatric age group, based on a review of literature on the subject and experience of this service. Materials and Methods Survey of literature data from PubMed / Medline, Google Scholar and Scopus Database without language restriction, since 1980 sources, with the MeSH term "Pediatric neck mass".  Results Prepared flowchart guidelines to be followed according with diagnostic suspicions. Patients were divided into 3 groups according to the initial clinical manifestations and according to etiological hypotheses formulated recommend evaluations protocols.  Conclusion The standardization of the evaluation of neck masses in children proves valuable and can help in the differential diagnosis of different etiologies involved.

  18. [Pediatric neurology in rehabilitation]. (United States)

    Kurihara, Mana


    There are some criteria for administering pediatric rehabilitation, such as (1) plasticity of the child's brain sometimes plays an enormous roles in recovery, (2) on the other hand, break-down of the child's brain is sometimes worse than expected, (3) rehabilitation should be continued with the prospect that child grows and develops everyday, (4) family members should join their child's rehabilitation. The team approach is very effective for pediatric rehabilitation. The pediatric neurologist will be one of the best members of the team because he/she can manage a disabled child and his/her family members well, and is familiar with a normal child's development. Rehabilitation should be performed appropriates, which means that the child is evaluated first, a rehabilitation program is developed and rehabilitation is implemented. The World Health Organization published the International Classification of Functioning, Disability and Health (ICF), which moves away from being a "consequence of disease" classification to "components of health". The concept of disability is changing.

  19. Functional foods in pediatrics. (United States)

    Van den Driessche, M; Veereman-Wauters, G


    The philosophy that food can be health promoting beyond its nutritional value is gaining acceptance. Known disease preventive aspects of nutrition have led to a new science, the 'functional food science'. Functional foods, first introduced in Japan, have no universally accepted definition but can be described as foods or food ingredients that may provide health benefits and prevent diseases. Currently, there is a growing interest in these products. However, not all regulatory issues have been settled yet. Five categories of foods can be classified as functional foods: dietary fibers, vitamins and minerals, bioactive substances, fatty acids and pro-, pre- and symbiotics. The latter are currently the main focus of research. Functional foods can be applied in pediatrics: during pregnancy, nutrition is 'functional' since it has prenatal influences on the intra-uterine development of the baby, after birth, 'functional' human milk supports adequate growth of infants and pro- and prebiotics can modulate the flora composition and as such confer certain health advantages. Functional foods have also been studied in pediatric diseases. The severity of necrotising enterocolitis (NEC), diarrhea, irritable bowel syndrome, intestinal allergy and lactose intolerance may be reduced by using functional foods. Functional foods have proven to be valuable contributors to the improvement of health and the prevention of diseases in pediatric populations.

  20. Primary pediatric gastrointestinal lymphoma

    Directory of Open Access Journals (Sweden)

    Ranjana Bandyopadhyay


    Full Text Available Background: Primary non-Hodgkin′s lymphoma (NHL of the gastrointestinal (GI tract is the most common extranodal lymphoma in pediatric age group. Yet, the overall incidence is very low. The rarity of the disease as well as variable clinical presentation prevents early detection when the possibility of cure exists. Materials and Methods: We studied six cases of primary GI NHL in pediatric age group with reference to their clinical presentation, anatomic distribution and histopathologic characteristics. Results: All were males except one. Intestinal obstruction was the presenting feature in 50%. Half the cases showed ileocaecal involvement, while large bowel was involved in 16%. Histology showed four cases of diffuse large B-cell lymphoma (DLBCL, one case of Burkitt lymphoma, and one Burkitt-like lymphoma. Immunohistochemistry for Tdt, CD20, CD3, CD30, bcl2, bcl6 confirmed the morphological diagnosis. Conclusion: Pediatric GI lymphoma commonly involves the ileocaecal region and presents with intestinal obstruction. A higher prevalence of DLBCL is found compared to other series. A high proliferative index is useful in differentiating Burkitt-like lymphoma from DLBCL.

  1. Pediatric Nutrition Assessment. (United States)

    Green Corkins, Kelly; Teague, Erin E


    Pediatric patients with chronic illnesses or diseases or who require long-term nutrition support are most vulnerable to nutrition-related issues. Malnutrition in a pediatric patient may negatively affect long-term growth and development. Children also become malnourished much more quickly than adults. A comprehensive nutrition assessment that includes food and nutrition-related history, anthropometric measurements, biochemical data, medical tests and procedures, nutrition-focused physical findings, and patient history should be completed on these patients as no one parameter is a comprehensive indicator of nutrition status. Anthropometric measurements provide important information on the growth and nutrition status of a child, yet many times it is difficult to get accurate and valid measurements due to physical limitations of the child or improper technique. Inaccurate measurements may result in a missed diagnosis of malnutrition or may lead to an incorrect diagnosis of a healthy child. Knowledge of appropriate anthropometric measurements and alternatives is crucial when assessing growth in all children and essential for those who are physically handicapped or critically ill. The purpose of this review is to present key components of a pediatric nutrition assessment so proper nutrition-related diagnosis, including malnutrition, can be accomplished, a nutrition care plan established, and expected outcomes documented.

  2. Canadian suppliers of mining goods and services: Links between Canadian mining companies and selected sectors of the Canadian economy

    Energy Technology Data Exchange (ETDEWEB)

    Lemieux, A. [Natural Resources Canada, Ottawa, ON (Canada)


    Economic links between Canada's minerals and metals industry and Canadian suppliers of mining goods and services are examined to provide an insight into the interdependencies of these two key resource-related components of Canada's economy. The impact of globalization of the mining industry, estimates of its economic potential and the potential for exporting goods and services in conjunction with Canadian mining projects abroad are also assessed. The study concludes that the links between Canadian mining companies and the rest of the economy are difficult to quantify, due to the absence of statistical data that would differentiate supplier transactions with mining companies from those with other areas of the economy. At best, the approaches used in this study give but an imperfect understanding of the complex relationships between mining companies and their suppliers. It is clear, however, that as much of the demand for mining products is global, so is the supply, therefore, globalization of the mining industry, while creating unprecedented opportunities for Canadian suppliers to provide expertise, goods and services to Canadian and other customers offshore, the fact remains that mining multinationals buy a lot of their supplies locally. As a result, only some of the opportunities created by mining companies based in Canada and elsewhere will translate into sales for Canadian suppliers. Nevertheless, Canadian suppliers appear to have considerable depth in products related to underground mining, environment protection, exploration, feasibility studies, mineral processing, and mine automation. There appear to be considerable opportunities to derive further benefits from these areas of expertise. Appendices contain information about methodological aspects of the survey. 8 tabs., 32 figs., 6 appendices.

  3. Effectiveness of high-fidelity simulation for pediatric staff nurse education. (United States)

    Bultas, Margaret W; Hassler, Margaret; Ercole, Patrick M; Rea, Gail


    A pre-test post-test control group design was used to compare the effectiveness of high-fidelity simulation (HFS) with traditional static mannequins as a teaching strategy for pediatric staff nurse education. Thirty-three nurses from a metropolitan pediatric Magnet hospital completed the study that evaluated knowledge retention, skill performance, and team confidence during the American Heart Association's (AHA) Pediatric Emergency Assessment, Recognition and Stabilization (PEARS) course. Written exams, competency and skill performance measures, and the Mayo High Performance Teamwork Scale (MHPTS) were used to compare the outcomes between the two groups. Results indicated that knowledge retention was maintained, skill performance improved, and teamwork performance scores increased in the experimental group. This study provides a foundation supporting the use of HFS as an effective teaching modality when educating pediatric staff nurses in the identification and intervention of the deteriorating pediatric patient.

  4. A nurse practitioner patient care team: implications for pediatric oncology. (United States)

    Golden, Julia Rose


    The role of the pediatric advanced practice registered nurse continues to evolve within the ever-changing field of health care. In response to increased demand for health care services and because of a variety of changes in the health care delivery system, nurse practitioner patient care teams are an emerging trend in acute care settings. Care provided by nurse practitioner teams has been shown to be effective, efficient, and comprehensive. In addition to shorter hospital stays and reduced costs, nurse practitioner teams offer increased quality and continuity of care, and improved patient satisfaction. Nurse practitioner patient care teams are well suited to the field of pediatric oncology, as patients would benefit from care provided by specialized clinicians with a holistic focus. This article provides health care professionals with information about the use of nurse practitioner patient care teams and implications for use in pediatric oncology.

  5. Performance of Bedside Lung Ultrasound by a Pediatric Resident

    DEFF Research Database (Denmark)

    Zhan, Chen; Grundtvig, Natalia; Klug, Bent Helmuth


    : This was a prospective study comparing bedside lung ultrasound to chest radiography as the reference standard. Children aged 0 to 15 years with suspected pneumonia at a pediatric emergency department were included and underwent chest radiography and lung ultrasound. A pediatric resident with minimal practical ultrasound......OBJECTIVES: Recent studies suggest that lung ultrasound is a good, radiation-free alternative to chest radiography in children with pneumonia. We investigated how bedside lung ultrasound performed by a pediatric resident compared with chest radiography in children with suspected pneumonia. METHODS...... took 7 to 20 minutes to perform, and 10% were of suboptimal quality due to an uneasy child. The prevalence of consolidations by chest radiography was 50%. Lung ultrasound had a sensitivity of 40% (95% confidence interval [CI], 30%-51%), specificity of 91% (95% CI, 83%-96%), positive likelihood ratio...

  6. Ablative fractional laser resurfacing helps treat restrictive pediatric scar contractures. (United States)

    Krakowski, Andrew C; Goldenberg, Alina; Eichenfield, Lawrence F; Murray, Jill-Peck; Shumaker, Peter R


    Conventional management of debilitating pediatric scar contractures, including hand therapy and surgery, may often be beset by delayed treatment, suboptimal results, and additional surgical morbidity. Ablative fractional laser resurfacing is an emerging adjunctive procedural option for scar contractures because of its promising efficacy and safety profile. However, its use to improve function has not been studied in the pediatric population. Herein we report 2 pediatric patients with recalcitrant scar contractures, causing persistent functional deficits, treated with an ablative fractional laser protocol. Both patients experienced rapid and cumulative subjective and objective improvements in range of motion and function as measured by an independent occupational therapist without reported complications. We highlight ablative fractional laser resurfacing as a novel and promising tool in the management of function-limiting scar contractures in children and propose that the technique be incorporated into existing scar treatment paradigms, guided by future research.

  7. Pediatric cervical spine: normal anatomy, variants, and trauma. (United States)

    Lustrin, Elizabeth Susan; Karakas, Sabiha Pinar; Ortiz, A Orlando; Cinnamon, Jay; Castillo, Mauricio; Vaheesan, Kirubahara; Brown, James H; Diamond, Alan S; Black, Karen; Singh, Sudha


    Emergency radiologic evaluation of the pediatric cervical spine can be challenging because of the confusing appearance of synchondroses, normal anatomic variants, and injuries that are unique to children. Cervical spine injuries in children are usually seen in the upper cervical region owing to the unique biomechanics and anatomy of the pediatric cervical spine. Knowledge of the normal embryologic development and anatomy of the cervical spine is important to avoid mistaking synchondroses for fractures in the setting of trauma. Familiarity with anatomic variants is also important for correct image interpretation. These variants include pseudosubluxation, absence of cervical lordosis, wedging of the C3 vertebra, widening of the predental space, prevertebral soft-tissue widening, intervertebral widening, and "pseudo-Jefferson fracture." In addition, familiarity with mechanisms of injury and appropriate imaging modalities will aid in the correct interpretation of radiologic images of the pediatric cervical spine.

  8. Tissue Engineering for the Neonatal and Pediatric Patients

    Directory of Open Access Journals (Sweden)

    Amulya K. Saxena


    Full Text Available Of all the surgical specialties, the remit of the pediatric surgeon encompasses the widest range of organ systems and includes disorders from the fetus to the adolescent. As such, the recent emergence of tissue engineering is of particular interest to the pediatric surgical community. The individual challenges of tissue engineering depend largely on the nature and function of the target tissue. In general, the main issues currently under investigation include the sourcing of an appropriate cell source, design of biomaterials for guided tissue growth, provision of a biomolecular stimulus to enhance cellular functions and the development of bioreactors to allow for prolonged periods of cell culture under specific physiological conditions. This review aims to provide a general overview of tissue engineering in the major organ systems, including the cardiovascular, digestive, urinary, respiratory, musculoskeletal, nervous, integumentary and lymphatic systems. Special attention is paid to pediatrics as well as recent clinical applications.

  9. Therapies for multiple sclerosis: considerations in the pediatric patient. (United States)

    Banwell, Brenda; Bar-Or, Amit; Giovannoni, Gavin; Dale, Russell C; Tardieu, Marc


    Current and emerging therapies for multiple sclerosis (MS) offer promise for improved disease control and long-term clinical outcome. To date, these therapies have been evaluated solely in the context of adult MS. However, onset of MS in children is being increasingly recognized, and recent studies have identified a significant impact of MS onset during childhood on cognitive and physical functioning. Optimization of pediatric MS care requires that promising new therapies be made available to children and adolescents, but also that safety and tolerability and potential influence of therapies on the developing immune and neural networks of pediatric patients be closely considered. We propose care algorithms illustrating models for therapy that detail careful monitoring of pediatric patients with MS, provide definitions for inadequate treatment response and treatment escalation, and foster multinational collaboration in future therapeutic trials.

  10. Chemokines as Potential Markers in Pediatric Renal Diseases

    Directory of Open Access Journals (Sweden)

    Ana Cristina Simões e Silva


    Full Text Available Glomerular diseases and obstructive uropathies are the two most frequent causes of chronic kidney disease (CKD in children. Recently, biomarkers have become a focus of clinical research as potentially useful diagnostic tools in pediatric renal diseases. Among several putative biomarkers, chemokines emerge as promising molecules since they play relevant roles in the pathophysiology of pediatric renal diseases. The evaluation of these inflammatory mediators might help in the management of diverse renal diseases in children and the detection of patients at high risk to develop CKD. The aim of this paper is to revise general aspects of chemokines and the potential link between chemokines and the most common pediatric renal diseases by including experimental and clinical evidence.

  11. Theorizing Gender in Contemporary Canadian Citizenship: Lessons Learned from the CBC's "Greatest Canadian" Contest (United States)

    Jubas, Kaela


    In this article, I have used the 2004 Greatest Canadian contest as an example of media's educational function. Contrary to mainstream discourse of gender-neutral citizenship, this contest reiterates a notion of Canadian citizenship as masculinized, classed, and raced. Gramsci's concepts of "hegemony," "ideology", and…

  12. Clinical study on dexmedetomidine applied in the prevention of emergence agitation in pedi-atric laparoscopic surgery%右美托咪啶预防小儿腹腔镜手术苏醒期躁动的临床研究

    Institute of Scientific and Technical Information of China (English)

    王潇; 赵斌江


    Objective To study the effect of dexmedetomidine on the prevention of emergence agitation in pediatric laparoscopic surgery. Method This study takes 64 cases of pediatric laparoscopic surgery as the object of study. Be-fore the surgeries,children are divided with random number table into two groups,group of dexmedetomidine and group of ketamine,with each group having 32 cases. Dexmedetomidine group children are injected with 10ml dilution conventional trachea cannula with 1μg/kg dexmedetomidine with pump;ketamine group children are intravenously injected with 10ml dilution conventional trachea cannula with 0. 3mg/kg ketamine,during which the children main-tain anesthesia. The study observes the heart rate agitation occurrence rate and agitation scale of the two groups at different time post operation;it also observes the indicators of Ramsay sedation scale and awakening time at different time after tube removal. Result the heart rates of dexmedetomidine group children before,during and after the tube removal are lower than ketamine group(P<0. 05);the agitation proportion and agitation scale of dexmedetomidine group are both lower than ketamine group(P<0. 05);the Ramsay sedation scale at 60 min,120 min,180 min and 240 min after the tube removal of dexmedetomidine group are better than ketamine group(P<0. 05);the awakening time of dexmedetomidine group is shorter significantly than ketamine group ketamine group(P<0. 05). Conclusion The application of dexmedetomidine in the prevention of emergence agitation of pediatric laparoscopic surgery has better effect and safer than small-dose ketamine.%目的:观察右美托咪啶对预防小儿腹腔镜手术苏醒期躁动的效果。方法选择64例腹腔镜手术小儿,按照随机数字表法分为右美托咪啶组与氯胺酮组各32例。两组小儿常规气管插管,右美托咪啶组泵注稀释为10ml的右美托咪啶1μg/kg,氯胺酮组静脉注射稀释为10ml的氯胺酮0.3mg/kg,术中维持麻醉,观察

  13. Pediatric nurses' attitudes toward hospice and pediatric palliative care. (United States)

    Knapp, Caprice A; Madden, Vanessa; Wang, Hua; Kassing, Kristin; Curtis, Charlotte; Sloyer, Phyllis; Shenkman, Elizabeth A


    Several studies have investigated nurses' attitudes toward hospice and palliative care for adults, yet little information exists about pediatrics. Assessing pediatric nurses' attitudes is especially important in Florida, where a publicly funded pediatric palliative care program operates in eight cities across the State. The aims of this study were 1) to assess the attitudes toward hospice and palliative care, and 2) to examine the associations between sociodemographic and nursing care factors and nurses' attitudes toward hospice and palliative care. A cross-sectional research design using online and mail-in survey data was used to address the study aims. Surveys were conducted with 279 pediatric nurses across Florida. Bivariate results showed there were significant differences between the attitudes of pediatric nurses employed in a city with a pediatric palliative care program versus those not employed in a program site (p = 0.05). Multivariate analyses also showed that being employed in a program site increased attitudinal scores toward hospice and pediatric palliative care by 0.6 points. Beyond being employed in an area city where a pediatric palliative care program operates, results also suggest that having prior training in palliative care could alter nurses' attitudes, which might subsequently lead to increased referrals and improved outcomes for children and families.

  14. Challenging issues in pediatric oncology (United States)

    Pui, Ching-Hon; Gajjar, Amar J.; Kane, Javier R.; Qaddoumi, Ibrahim A.; Pappo, Alberto S.


    Improvements in protocol-driven clinical trials and supportive care for children and adolescents with cancer have reduced mortality rates by more than 50% over the past three decades. Overall, the 5-year survival rate for pediatric cancer patients has increased to approximately 80%. Recognition of the biological heterogeneity within specific subtypes of cancer, the discovery of genetic lesions that drive malignant transformation and cancer progression, and improved understanding of the basis of drug resistance will undoubtedly catalyze further advances in risk-directed treatments and the development of targeted therapies, boosting the cure rates further. Emerging new treatments include novel formulations of existing chemotherapeutic agents, monoclonal antibodies against cancer-associated antigens, and molecular therapies that target genetic lesions and their associated signaling pathways. Recent findings that link pharmacogenomic variations with drug exposure, adverse effects, and efficacy should accelerate efforts to develop personalized therapy for individual patients. Finally, palliative care should be included as an essential part of cancer management to prevent and relieve the suffering and to improve the quality of life of patients and their families. PMID:21709698

  15. A survey of program evaluation practices in family-centered pediatric rehabilitation settings. (United States)

    Moreau, Katherine A; Cousins, J Bradley


    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.

  16. Hypertensive emergencies in children: identification and management of dangerously high blood pressure. (United States)

    Constantine, E; Merritt, C


    The prevalence of hypertension in the pediatric population is rising, coincident with the rise in childhood obesity worldwide. While most hypertensive children do not require emergent care, hypertensive urgencies and emergencies may be encountered in the outpatient clinic, the emergency department or the inpatient ward. To avoid the life-threatening complications associated with both hypertension and its treatment, the treating physician should be familiar with the presentation and management of pediatric hypertension. This review will serve to examine some of the important aspects of pediatric hypertensive urgencies and emergencies, including common causes, important features of diagnosis and options for medical management.

  17. Drug repurposing in pediatrics and pediatric hematology oncology. (United States)

    Blatt, Julie; Corey, Seth J


    Drug 'repurposing', that is, using old drugs for new indications, has been proposed as a more efficient strategy for drug development than the current standard of beginning with novel agents. In this review, we explore the scope of drug repurposing in pediatric hematology oncology and in pediatrics in general. Drugs commonly used in children were identified using the Harriet Lane Handbook (HLH) and searched in PubMed for different uses. Additional drugs were identified by searching PubMed and for 'drug repurposing' or 'drug repositioning'. Almost 10% of drugs with primary uses in pediatrics have been repurposed in pediatric hematology oncology or pediatrics. The observant clinician, pharmacologist and translational bioinformatician, as well as structural targeting, will have a role in discovering new repurposing opportunities.

  18. Management of neutropenic patients in the intensive care unit (NEWBORNS EXCLUDED) recommendations from an expert panel from the French Intensive Care Society (SRLF) with the French Group for Pediatric Intensive Care Emergencies (GFRUP), the French Society of Anesthesia and Intensive Care (SFAR), the French Society of Hematology (SFH), the French Society for Hospital Hygiene (SF2H), and the French Infectious Diseases Society (SPILF). (United States)

    Schnell, David; Azoulay, Elie; Benoit, Dominique; Clouzeau, Benjamin; Demaret, Pierre; Ducassou, Stéphane; Frange, Pierre; Lafaurie, Matthieu; Legrand, Matthieu; Meert, Anne-Pascale; Mokart, Djamel; Naudin, Jérôme; Pene, Frédéric; Rabbat, Antoine; Raffoux, Emmanuel; Ribaud, Patricia; Richard, Jean-Christophe; Vincent, François; Zahar, Jean-Ralph; Darmon, Michael


    Neutropenia is defined by either an absolute or functional defect (acute myeloid leukemia or myelodysplastic syndrome) of polymorphonuclear neutrophils and is associated with high risk of specific complications that may require intensive care unit (ICU) admission. Specificities in the management of critically ill neutropenic patients prompted the establishment of guidelines dedicated to intensivists. These recommendations were drawn up by a panel of experts brought together by the French Intensive Care Society in collaboration with the French Group for Pediatric Intensive Care Emergencies, the French Society of Anesthesia and Intensive Care, the French Society of Hematology, the French Society for Hospital Hygiene, and the French Infectious Diseases Society. Literature review and formulation of recommendations were performed using the Grading of Recommendations Assessment, Development and Evaluation system. Each recommendation was then evaluated and rated by each expert using a methodology derived from the RAND/UCLA Appropriateness Method. Six fields are covered by the provided recommendations: (1) ICU admission and prognosis, (2) protective isolation and prophylaxis, (3) management of acute respiratory failure, (4) organ failure and organ support, (5) antibiotic management and source control, and (6) hematological management. Most of the provided recommendations are obtained from low levels of evidence, however, suggesting a need for additional studies. Seven recommendations were, however, associated with high level of evidences and are related to protective isolation, diagnostic workup of acute respiratory failure, medical management, and timing surgery in patients with typhlitis.

  19. Factors Associated with Chronic Noncancer Pain in the Canadian Population

    Directory of Open Access Journals (Sweden)

    Saifudin Rashiq


    Full Text Available Chronic noncancer pain (CNCP is a prevalent health problem with pervasive negative effects on the individual’s quality of life. Previous epidemiological studies of CNCP have suggested a number of individual biological, psychological and societal correlates of CNCP, but it has rarely been possible to simultaneously compare the relative strengths of many such correlates in a Canadian population sample. With data provided by the 1996/1997 Canadian National Population Health Survey, ordinal logistic regression was used to examine the extent to which a number of population variables are associated with CNCP in a large (n=69,365 dataset. The analysis revealed cross-sectional correlations of varying strengths between CNCP and 27 factors. Increasing age, low income, low educational achievement, daily cigarette smoking, physical inactivity and abstention from alcohol were among the factors found to increase CNCP risk. The considerable impact of distress and depression on CNCP are also highlighted. A number of comorbid medical illnesses increased CNCP risk, including some (such as chronic obstructive pulmonary disease, epilepsy and thyroid disease that have not hitherto been associated with pain. White race and the affirmation of an important role for spirituality or faith reduced CNCP risk. In contrast to some previous studies, female sex did not emerge as an independent CNCP risk. The present exploratory analysis describes associations between CNCP and a number of characteristics from several domains, thus suggesting many areas for further research.

  20. Pediatric Inpatient Headache Therapy: What is Available. (United States)

    Kabbouche, Marielle


    Status migrainosus is defined by the international classification of headache disorders (ICHD) criteria as a debilitating migraine lasting more then 72 hours. The epidemiology of status migrainosus is still unknown in adult and children, and frequently underdiagnosed. Children and adolescents often end up in the emergency room with an intractable headache that failed outpatient therapy. Six to seven percent of these children do not respond to acute infusion therapy and require hospitalization. It is imperative that more aggressive therapy is considered when patients are affected by a severe intractable headache to prevent further disability and returning the child to baseline activity. Multiple therapies are available for adults and children. Studies for acute therapy in the emergency room are available in adults and pediatric groups. Small studies are available for inpatient therapy in children and, along with available therapies for children and adolescents, are described in this review. A review of the literature shows growing evidence regarding the use of dihydroergotamine intravenously once patients are hospitalized. Effectiveness and safety have been proven in the last decades in adults and small studies in the pediatric populations.

  1. Pediatric Idiopathic Intracranial Hypertension: A Case Report

    Directory of Open Access Journals (Sweden)

    Divya Nandwani, OD


    Full Text Available Background: Idiopathic intracranial hypertension (IIH presents differently in prepubertal children as compared to postpubertal children and adults. In adults, IIH is most common in obese women of child-bearing age. However, when occurring in prepubertal children, IIH has been shown to have no predilection for gender and does not correlate with obesity. This case report exemplifies the rare occurrence of IIH in a pediatric patient. Case Report: A five-year-old Hispanic female patient was seen at the University Eye Center for a longstanding hypotropia secondary to a likely congenital fourth nerve palsy with an exotropia component. After a strabismus surgery and a series of follow-up visits, bilateral swollen optic nerves were observed, and a prompt referral to the emergency room was made. Consequently, she was diagnosed with IIH. A treatment regimen of acetazolamide was initiated with subsequent improvement of the clinical presentation of increased intracranial pressure, confirmed by the reduction of swelling of her optic nerves. Conclusions: Bilateral swelling of the optic nerves can be an emergency, especially in children. It is important urgently to rule out causes for increased intracranial pressure. If treatment is significantly delayed, or if no treatment is given to a patient with this condition, loss of visual function may occur. In addition to reporting a rare circumstance of pediatric idiopathic intracranial hypertension, this case report serves to remind eye care practitioners of the importance of monitoring the ocular health of patients closely, even in young, healthy children.

  2. Emergency use of extracorporeal membrane oxygenation in pediatric critically ill patients%体外膜肺氧合在儿科危重病急救中的应用

    Institute of Scientific and Technical Information of China (English)

    林茹; 张晨美; 谈林华; 施丽萍; 熊启星; 张泽伟; 舒强; 杜立中


    目的 总结体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)在儿科危重病急救中应用的管理经验.方法 回顾性分析2007年7月至2011年5月,浙江大学医学院附属儿童医院应用ECMO抢救12例多种原因所致严重心肺功能衰竭患儿的临床情况.结果 12例,男7例,女5例;年龄6d~11岁;体重2.8~35(17.21 ±11.64)kg,其中4例小于60 d.肺部感染并发急性呼吸窘迫(Acute Respiratory Distress Syndrome,ARDS)致呼吸衰竭2例,心脏术后低心排不能脱离体外循环直接转ECM0 4例,暴发性心肌炎3例,右心室心肌病反复心跳骤停4次1例,完全性大动脉转位术前严重低氧血症1例,过敏性休克并发大量肺出血,严重低氧血症1例.12例中有3例为心肺复苏胸外按压(cardiopulmonary resuscitation,CPR)同时建立ECMO (E-CPR).平均ECMO支持时间为151.75(15 ~572)h,12例中7例脱离ECMO,脱机率58.33%,存活出院6例,存活率50.00%,死亡6例.机械并发症:膜肺渗漏更换有2例,溶血更换系统3例,膜肺氧合不佳更换2例,膜肺血栓形成1例;机体并发症:伤口出血6例、二次开胸止血2例、急性肾衰2例、感染3例,高胆红素血症2例、下肢缺血1例、高血糖3例、弥漫性血管内凝血 1例.随访半年至4年半,1例因下肢缺血运动障碍,出院后1年行肢体矫形术,功能得到基本恢复;其余5例生活质量、社会功能良好,无任何智力、神经系统障碍.结论 ECMO可以有效地为可逆性严重心肺衰竭患儿提供呼吸循环支持治疗.%Objective The history of clinical application of extracorporeal membrane oxygenation (ECMO) has been more than 30 years. But in China,there were only a few ECMO centers with limited successful cases reported by the end of twentieth century. The high morbidities and mortalities in current pediatric ECMO practice are noted in China. Therefore,it is necessary to review the experience on rescue use of ECMO in critically ill pediatric

  3. Evaluation of an initiative to reduce radiation exposure from CT to children in a non-pediatric-focused facility. (United States)

    Blumfield, Einat; Zember, Jonathan; Guelfguat, Mark; Blumfield, Amit; Goldman, Harold


    We would like to share our experience of reducing pediatric radiation exposure. Much of the recent literature regarding successes of reducing radiation exposure has come from dedicated children's hospitals. Nonetheless, over the past two decades, there has been a considerable increase in CT imaging of children in the USA, predominantly in non-pediatric-focused facilities where the majority of children are treated. In our institution, two general hospitals with limited pediatric services, a dedicated initiative intended to reduce children's exposure to CT radiation was started by pediatric radiologists in 2005. The initiative addressed multiple issues including eliminating multiphase studies, decreasing inappropriate scans, educating referring providers, training residents and technologists, replacing CT with ultrasound or MRI, and ensuring availability of pediatric radiologists for consultation. During the study period, the total number of CT scans decreased by 24 %. When accounting for the number of scans per visit to the emergency department (ED), the numbers of abdominal and head CT scans decreased by 37.2 and 35.2 %, respectively. For abdominal scans, the average number of phases per scan decreased from 1.70 to 1.04. Upon surveying the pediatric ED staff, it was revealed that the most influential factors on ordering of scans were daily communication with pediatric radiologists, followed by journal articles and lectures by pediatric radiologists. We concluded that a non-pediatric-focused facility can achieve dramatic reduction in CT radiation exposure to children; however, this is most effectively achieved through a dedicated, multidisciplinary process led by pediatric radiologists.

  4. Human resources needs in the Canadian wind energy industry

    Energy Technology Data Exchange (ETDEWEB)

    Wittholz, H. [Synova International Business Development, London, ON (Canada)


    This paper reviewed human resources issues related to wind energy expansion. As the fastest growing energy source in the world, wind energy has the potential to provide thousands of jobs. With the signing of the Kyoto Protocol, the Canadian government and industry will take measures to increase the use of renewable energy. As such, forecasters predict that Canada's total installed capacity will increase from 444 MW in 2004 to 5,600 MW by 2012. Initially, employment opportunities will be in the service industry, followed by an increased demand for scientists, engineers, technicians and other personnel with specialized knowledge in the wind industry. This paper described the assumptions on which the forecasted demand for skilled labour is based. Approximately 2,230 technicians will be required by 2012 to develop and manufacture wind turbines and to establish an infrastructure that would maximize the benefits of the emerging industry for Canadians. Wind energy initiatives include the establishment of a competitive manufacturing and service base; the provision of specialized training and education to meet the human resources demands of the industry; and, support from research and development to reduce the knowledge gap between Canada and Europe. Canada also holds the potential to establish a niche market for hybrid wind-diesel-storage systems. Insurance companies and investors will require high standards to safeguard their investments. A breakdown of various jobs in the wind power industry was presented along with forecasts of revenues and employment in Canada's wind energy industry. This paper also outlined the wind energy research programs available at Canadian universities, colleges and institutes. It was recommended that education and training programs in this field of study should be developed based on proven programs with a governing body to ensure industry requirements are met. It was also suggested that partnerships should be formed with successful

  5. Diabetic Emergencies (United States)

    ... Emergencies A-Z Share this! Home » Emergency 101 Diabetic Emergencies It is estimated that more than 20 ... they have it. The best way to prevent diabetic emergencies is to effectively manage the disease through ...

  6. Group Intervention in Pediatric Rehabilitation (United States)

    LaForme Fiss, Alyssa


    Group intervention in pediatric physical and occupational therapy is an alternative to individual intervention allowing the therapist to meet the needs of multiple children at one time. Survey research indicates that approximately 40% to 60% of pediatric physical and occupational therapists use group intervention at least occasionally in practice,…

  7. 700MHz Spectrum Requirements for Canadian Public Safety Interoperable Mobile Broadband Data Communications (United States)


    time frame. The data demand for recurring emergency situations was modeled through an interactive process with active participation from Canadian...bande qui permettra aux divers organismes de sécurité publique de mieux planifier , coordonner et exécuter leurs mandats, tant dans le cadre de leurs...plan for 700MHz spectrum 2 Figure 2.1: Process to develop the Data Demand Model 4 Figure

  8. Canadians with Health Problems: Their Use of Specialized Services and Their Waiting Experiences



    Improving access to healthcare has been a consistent priority for Canadians. In particular, reducing patient waiting times for health services has been a prominent policy issue. Across the country, governments are using a range of strategies to reduce patient waiting times for care, with a particular focus on reducing waits for specialized services. Although information is emerging on waits for selected procedures, there is limited information on whether the utilization of services or waiting...

  9. Education scholarship in emergency medicine part 1: innovating and improving teaching and learning. (United States)

    Sherbino, Jonathan; Van Melle, Elaine; Bandiera, Glen; McEwen, Jill; Leblanc, Constance; Bhanji, Farhan; Frank, Jason R; Regehr, Glenn; Snell, Linda


    As emergency medicine (EM) education evolves, a more advanced understanding of education scholarship is required. This article is the first in a series of three articles that reports the recommendations of the 2013 education scholarship consensus conference of the Academic Section of the Canadian Association of Emergency Physicians. Adopting the Canadian Association for Medical Education's definition, education scholarship (including both research and innovation) is defined. A rationale for why education scholarship should be a priority for EM is discussed.

  10. Assessment of Financial Burden as a Standard of Care in Pediatric Oncology. (United States)

    Pelletier, Wendy; Bona, Kira


    Family financial hardship has emerged as a burden of pediatric cancer treatment with negative implications for family well-being. As part of an extensive project to create evidence-based standards for the psychosocial care of children with cancer, we performed a literature review of pediatric cancer-associated financial hardship utilizing six databases, and identified 24 publications for incorporation into this review. Financial hardship during childhood cancer was found to affect a significant proportion of the population and to negatively impact family well-being. Existing literature supports a strong recommendation for assessment of financial hardship as a component of comprehensive psychosocial care in pediatric oncology.

  11. Community pediatrics: the Rochester story. (United States)

    Haggerty, Robert J; Aligne, C Andrew


    There are so many problems facing children today (eg, violence, poor nutrition, substance abuse, teen pregnancy) that conventional medical care can only address a small portion of these concerns. Thus, to be optimally effective, pediatrics needs to be linked to other disciplines and programs that address these issues by using different paradigms. Robert Haggerty, the originator of the term "community pediatrics," reflects on how one can successfully practice community pediatrics in an academic setting and model it for young physicians while also improving the health of children at the community level. Here we tell the story of the years that Haggerty was chief of pediatrics at the University of Rochester and took on the challenge of fulfilling the department's responsibility to all children in the county. Because of his pioneering work, his tenure was heralded as a critical period in the development of the field of community pediatrics.

  12. 78 FR 48438 - Pediatric Ethics Subcommittee of the Pediatric Advisory Committee; Notice of Meeting (United States)


    ... HUMAN SERVICES Food and Drug Administration Pediatric Ethics Subcommittee of the Pediatric Advisory... Administration (FDA). The meeting will be open to the public. Name of Subcommittee: Pediatric Ethics Subcommittee... recommendations to the Pediatric Advisory Committee on pediatric ethical issues. Date and Time: The meeting...

  13. Some tropical viral diseases that can mimic swine flu in pediatrics


    Wiwanitkit, Viroj


    Abstract Swine flu is an important emerging infection that is presently pandemic around the world. The pediatric population is an important group that can be infected with swine flu. Generally, common presentations of swine flu include fever and respiratory presentations. However, there are several infections that can have similar presentations to swine flu. In this specific article, the author will briefly discuss on some tropical viral diseases that can mimic swine flu in pediatrics. ...

  14. Some tropical viral diseases that can mimic swine flu in pediatrics

    Directory of Open Access Journals (Sweden)



    Full Text Available Swine flu is an important emerging infection that is presently pandemic around the world. The pediatric population is an important group that can be infected with swine flu. Generally, common presentations of swine flu include fever and respiratory presentations. However, there are several infections that can have similar presentations to swine flu. In this specific article, the author will briefly discuss on some tropical viral diseases that can mimic swine flu in pediatrics.

  15. The Role of Focused Echocardiography in Pediatric Intensive Care: A Critical Appraisal

    Directory of Open Access Journals (Sweden)

    Heloisa Amaral Gaspar


    Full Text Available Echocardiography is a key tool for hemodynamic assessment in Intensive Care Units (ICU. Focused echocardiography performed by nonspecialist physicians has a limited scope, and the most relevant parameters assessed by focused echocardiography in Pediatric ICU are left ventricular systolic function, fluid responsiveness, cardiac tamponade and pulmonary hypertension. Proper ability building of pediatric emergency care physicians and intensivists to perform focused echocardiography is feasible and provides improved care of severely ill children and thus should be encouraged.


    Directory of Open Access Journals (Sweden)

    Peter McCormick


    Full Text Available Since the 1970s, the appointment of trial judges in Canada has generally involved an arms-length committee of professionals, although the structure of these committees and their role in the process has varied from province to province, as well as evolving over time. Yet these “new” structures and “new” processes did not prevent a major judicial appointment scandal in the province of Quebec in 2010, culminating in the formation of the Bastarache Committee to recommend changes. This paper summarizes the forty-year history of Canadian judicial appointment committees, identifies the major challenges that face those committees, and suggests the basic values toward which reforms to the appointment process might be directed. Depuis les années 1970, la nomination des juges de première instance au Canada a généralement mis à contribution un comité de professionnels indépendants, bien que la structure de ce comité et son rôle dans le processus de nomination aient varié d’une province à l’autre et évolué avec le temps. Ces « nouvelles » structures et « nouveaux » processus n’ont certes pas empêché l’éclatement du scandale sur la nomination des juges au Québec en 2010. Ce scandale a donné lieu à la formation de la Commission Bastarache qui avait notamment le mandat de recommander des changements. La présent document résume les quarante ans d’histoire des comités canadiens de nomination des juges, recense les principaux défis que ces comités doivent relever, et propose les valeurs fondamentales qui devraient inspirer les réformes du processus de nomination.

  17. Pediatric lymphomas in Brazil

    Directory of Open Access Journals (Sweden)

    Gabriela Gualco


    Full Text Available OBJECTIVE: This study provides the clinical pathological characteristics of 1301 cases of pediatric/adolescent lymphomas in patients from different geographic regions of Brazil. METHODS: A retrospective analyses of diagnosed pediatric lymphoma cases in a 10-year period was performed. We believe that it represents the largest series of pediatric lymphomas presented from Brazil. RESULTS: Non-Hodgkin lymphomas represented 68% of the cases, including those of precursor (36% and mature (64% cell origin. Mature cell lymphomas comprised 81% of the B-cell phenotype and 19% of the T-cell phenotype. Hodgkin lymphomas represented 32% of all cases, including 87% of the classical type and 13% of nodular lymphocyte predominant type. The geographic distribution showed 38.4% of the cases in the Southeast region, 28.7% in the Northeast, 16.1% in the South, 8.8% in the North, and 8% in the Central-west region. The distribution by age groups was 15-18 years old, 33%; 11-14 years old, 26%; 6-10 years old, 24%; and 6 years old or younger, 17%. Among mature B-cell lymphomas, most of the cases were Burkitt lymphomas (65%, followed by diffuse large B-cell lymphomas (24%. In the mature T-cell group, anaplastic large cell lymphoma, ALK-positive was the most prevalent (57%, followed by peripheral T-cell lymphoma, then not otherwise specified (25%. In the group of classic Hodgkin lymphomas, the main histological subtype was nodular sclerosis (76%. Nodular lymphocyte predominance occurred more frequently than in other series. CONCLUSION: Some of the results found in this study may reflect the heterogeneous socioeconomical status and environmental factors of the Brazilian population in different regions.

  18. Pediatric cerebral aneurysms. (United States)

    Gemmete, Joseph J; Toma, Ahmed K; Davagnanam, Indran; Robertson, Fergus; Brew, Stefan


    Childhood intracranial aneurysms differ from those in the adult population in incidence and gender prevalence, cause, location, and clinical presentation. Endovascular treatment of pediatric aneurysms is the suggested approach because it offers both reconstructive and deconstructive techniques and a better clinical outcome compared with surgery; however, the long-term durability of endovascular treatment is still questionable, therefore long-term clinical and imaging follow-up is necessary. The clinical presentation, diagnosis, and treatment of intracranial aneurysms in children are discussed, and data from endovascular treatments are presented.

  19. Pediatric transplantation: preventing thrombosis. (United States)

    Robertson, J D


    Due to progressive advances in surgical techniques, immunosuppressive therapies, and supportive care, outcomes from both solid organ transplantation and hematopoietic stem cell transplantation continue to improve. Thrombosis remains a challenging management issue in this context, with implications for both graft survival and long-term quality of life. Unfortunately, there remains a general paucity of pediatric-specific data regarding thrombosis incidence, risk stratification, and the safety or efficacy of preventative strategies with which to guide treatment algorithms. This review summarizes the available evidence and rationale underlying the spectrum of current practices aimed at preventing thrombosis in the transplant recipient, with a particular focus on risk factors, pathophysiology, and described antithrombotic regimens.

  20. Pediatric asthma disease management. (United States)

    Myers, T R; Chatburn, R L


    The prevalence of asthma in children in the United States is estimated at more than 5% of the population, and it has risen more than 40% in the previous decade. Several guidelines for the management of acute and chronic asthma exist, and they all emphasize several basic components including state-of-the-art pharmacologic treatment, trigger avoidance, and patient self-management skills. This Article highlights the necessary components for pediatric asthma disease management to insure a smooth continuum of care across all disciplines and settings.

  1. Pediatric asthma controller therapy. (United States)

    Anselmo, Mark


    The treatment of children with asthma has historically relied upon expert opinion using data extrapolated from adult studies. Over the past few years, landmark studies have been completed providing healthcare professionals with evidence on which a reasonable approach can be made for children suffering from this common and serious disease. Asthmatic phenotype in children, unlike adults, tends to differ according to age, which must be taken into account as well as triggers, severity, and level of control. The care of the child with asthma is complex, but accumulating data have demonstrated that we are on the right path for optimizing control while reducing the burden of side effects. The newest Global Initiative for Asthma (GINA) guidelines, as well as recent updates from the landmark CAMP (Childhood Asthma Management Program) study and information from the PACT (Pediatric Asthma Control Trial) and budesonide/formoterol controller and reliever studies, along with recent comparisons of higher dose inhaled corticosteroids (ICS), and ICS/long-acting β(2)-adrenoceptor agonist (LABA) combination and leukotriene receptor antagonist (LTRA) therapies in children have clarified a few of the big questions in pediatric asthma. For children with asthma aged 5 years and older, the CAMP trial demonstrated that regular use of ICS reduces the frequency of symptoms; however, height was adversely affected and there is no evidence for altering the natural history of asthma. In patients aged 6 years and over whose asthma is uncontrolled on ICS alone, combination therapy with ICS and a LABA has been recently compared with the use of higher dose ICS and the addition of an LTRA in pediatric patients. The addition of a LABA statistically will be of most benefit; however, some children will have optimal control with doubling the baseline dose of ICS or addition of an LTRA. Use of budesonide/formoterol as a controller and reliever therapy extends the time to first exacerbation versus

  2. Chair in Pediatric Surgery


    Graña, Francisco; Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú


    Inaugural lecture of the course of 1922, Department of Paediatric Surgery, by Dr. Francisco Grana, Professor of Pediatric Surgery and Orthopedics at the Faculty of Medicine of Lima, the National Academy of Medicine, of the Peruvian Society of Surgery. Lección inaugural del curso de 1922, Cátedra de Cirugía Infantil, por el Dr. Francisco Graña, Catedrático de Cirugía Infantil y Ortopedia en la Facultad de Medicina de Lima, de la Academia Nacional de Medicina, de la Sociedad Peruana de Cirug...

  3. A Roadmap for Canadian Submillimetre Astronomy

    CERN Document Server

    Webb, Tracy; Di Francesco, James; Matthews, Brenda; Murray, Norm; Scott, Douglas; Wilson, Christine


    We survey the present landscape in submillimetre astronomy for Canada and describe a plan for continued engagement in observational facilities to ~2020. Building on Canada's decadal Long Range Plan process, we emphasize that continued involvement in a large, single-dish facility is crucial given Canada's substantial investment in ALMA and numerous PI-led submillimetre experiments. In particular, we recommend: i) an extension of Canadian participation in the JCMT until at least the unique JCMT Legacy Survey program is able to realize the full scientific potential provided by the world-leading SCUBA-2 instrument; and ii) involvement of the entire Canadian community in CCAT, with a large enough share in the partnership for Canadian astronomers to participate at all levels of the facility. We further recommend continued participation in ALMA development, involvement in many focused PI-led submillimetre experiments, and partnership in SPICA.

  4. Birth of the Canadian Digestive Health Foundation. (United States)

    Beck, Ivan T


    The Canadian Digestive Disease Foundation, renamed the Canadian Digestive Health Foundation--Fondation canadienne pour la promotion de la santé digestive--in December 2001, is the culmination of ongoing efforts by the Canadian Association of Gastroenterology to establish an independent charitable organization. In February 2001, it was officially endorsed as the Foundation for the Canadian Association of Gastroenterology. The initial efforts to establish this Foundation, led by Dr Richard McKenna in 1963, were unsuccessful. In 1991, Glaxo Canada (now GlaxoSmithKline) became a founding donor, and with the four founding physicians--Drs Ivan T Beck, Richard H Hunt, Suzanne E Lemire and Alan BR Thomson--the expenses to establish the Foundation were met. A charitable number was obtained in 1995 (0997427-11). The second founding donor was Janssen Canada (now Janssen-Ortho), and public education support came from Astra Canada (now AstraZeneca Canada). The Foundation initially relied on corporate donors, but now approaches physicians, patients and the general public. The objectives of the Foundation are to advance the science of gastroenterology and to provide knowledge of digestive diseases and nutrition to the general public, to enhance the quality of life of persons who are afflicted with these disorders. The major achievements of the Foundation are the provision of one-year operating grants to new investigators, which have allowed them to accumulate early data and subsequently obtain support from other major granting organizations. It also provides Fellowships and studentship support grants, in conjunction with the Canadian Institutes of Health Research and the pharmaceutical industry. The education committee found that there was little research support in this field, considering the large economic burden of digestive disease and the amount of outstanding work done by Canadian researchers. A bilingual Web site, a web-based specialist's discussion program and bilingual

  5. A Course in Canadian Film for U.S. Students (United States)

    Gutenko, Gregory


    Canadian Film will be a new course in the Communications Studies department at the University of Missouri at Kansas City particularly designed for non-Canadian Midwestern US students. It will not only introduce students to the richness and significance of Canadian film as both art and entertainment (which is virtually unrecognized around here),…

  6. 47 CFR 101.1423 - Canadian and Mexican coordination. (United States)


    ... 47 Telecommunication 5 2010-10-01 2010-10-01 false Canadian and Mexican coordination. 101.1423... GHz Band § 101.1423 Canadian and Mexican coordination. Pursuant to § 2.301 of this chapter, MVDDS systems in the United States within 56 km (35 miles) of the Canadian and Mexican border will be...

  7. Management of hereditary angioedema: 2010 Canadian approach

    Directory of Open Access Journals (Sweden)

    Bowen Tom


    Full Text Available Abstract C1-inhibitor (C1-INH deficiency is a rare blood disorder resulting in angioedema attacks that are debilitating and may be life-threatening. Prophylaxis and therapy of events has changed since our first Canadian Consensus Conference on the diagnosis, therapy and management of HAE. We have formed the Canadian Hereditary Angioedema Network (CHAEN/Réseau Canadien d'Angioédème Héréditaire (RCAH - to advance care of patients with this disorder in Canada. We here present a review of management of HAE in Canada.

  8. Statistics in action a Canadian outlook

    CERN Document Server

    Lawless, Jerald F


    Commissioned by the Statistical Society of Canada (SSC), Statistics in Action: A Canadian Outlook helps both general readers and users of statistics better appreciate the scope and importance of statistics. It presents the ways in which statistics is used while highlighting key contributions that Canadian statisticians are making to science, technology, business, government, and other areas. The book emphasizes the role and impact of computing in statistical modeling and analysis, including the issues involved with the huge amounts of data being generated by automated processes.The first two c

  9. Pediatric contact dermatitis

    Directory of Open Access Journals (Sweden)

    Sharma Vinod


    Full Text Available Allergic contact dermatitis (ACD in children, until recently, was considered rare. ACD was considered as a disorder of the adult population and children were thought to be spared due to a lack of exposure to potential allergens and an immature immune system. Prevalence of ACD to even the most common allergens in children, like poison ivy and parthenium, is relatively rare as compared to adults. However, there is now growing evidence of contact sensitization of the pediatric population, and it begins right from early childhood, including 1-week-old neonates. Vaccinations, piercing, topical medicaments and cosmetics in younger patients are potential exposures for sensitization. Nickel is the most common sensitizer in almost all studies pertaining to pediatric contact dermatitis. Other common allergens reported are cobalt, fragrance mix, rubber, lanolin, thiomersol, neomycin, gold, mercapto mix, balsum of Peru and colophony. Different factors like age, sex, atopy, social and cultural practices, habit of parents and caregivers and geographic changes affect the patterns of ACD and their variable clinical presentation. Patch testing should be considered not only in children with lesions of a morphology suggestive of ACD, but in any child with dermatitis that is difficult to control.

  10. Pediatric DXA: clinical applications

    Energy Technology Data Exchange (ETDEWEB)

    Binkovitz, Larry A. [Columbus Children' s Hospital, Department of Radiology, Columbus, OH (United States); Sparke, Paul [Capital University, Department of Chemistry, Columbus, OH (United States); Henwood, Maria J. [Columbus Children' s Hospital, Department of Endocrinology, Columbus, OH (United States)


    Normal bone mineral accrual requires adequate dietary intake of calcium, vitamin D and other nutrients; hepatic and renal activation of vitamin D; normal hormone levels (thyroid, parathyroid, reproductive and growth hormones); and neuromuscular functioning with sufficient stress upon the skeleton to induce bone deposition. The presence of genetic or acquired diseases and the therapies that are used to treat them can also impact bone health. Since the introduction of clinical DXA in pediatrics in the early 1990s, there has been considerable investigation into the causes of low bone mineral density (BMD) in children. Pediatricians have also become aware of the role adequate bone mass accrual in childhood has in preventing osteoporotic fractures in late adulthood. Additionally, the availability of medications to improve BMD has increased with the development of bisphosphonates. These factors have led to the increased utilization of DXA in pediatrics. This review summarizes much of the previous research regarding BMD in children and is meant to assist radiologists and clinicians with DXA utilization and interpretation. (orig.)

  11. Pediatric Hypovitaminosis D

    Directory of Open Access Journals (Sweden)

    Rafiu Ariganjoye MD, MBA, FAAP, FAIHQ, CPE, CHCQM


    Full Text Available Vitamin D, a secosteroid, is essential for the development and maintenance of healthy bone in both the adult and pediatric populations. Low level of 25-hydroxy vitamin D (25-(OH-D is highly prevalent in children worldwide and has been linked to various adverse health outcomes including rickets, osteomalacia, osteomalacic myopathy, sarcopenia, and weakness, growth retardation, hypocalcemia, seizure and tetany, autism, cardiovascular diseases, diabetes mellitus, cancers (prostate, colon, breast, infectious diseases (viral, tuberculosis, and autoimmune diseases, such as multiple sclerosis and Hashimoto’s thyroiditis. Risk factors for hypovitaminosis D are people with darker skin pigmentation, use of sunscreen, insufficient ultraviolet B exposure, prematurity, living in northern latitudes, malnutrition, obesity, exclusive breastfeeding, low maternal vitamin D level, certain medications, drinking unfortified cow’s milk, liver failure, chronic renal insufficiency, cystic fibrosis, asthma, and sickle cell hemoglobinopathy. This review highlights and summarizes the molecular perspectives of vitamin D deficiency and its potential adverse health outcomes in pediatric age groups. The recommended treatment regimen is beyond the scope of this review.

  12. Pediatric Hypovitaminosis D (United States)

    Ariganjoye, Rafiu


    Vitamin D, a secosteroid, is essential for the development and maintenance of healthy bone in both the adult and pediatric populations. Low level of 25-hydroxy vitamin D (25-(OH)-D) is highly prevalent in children worldwide and has been linked to various adverse health outcomes including rickets, osteomalacia, osteomalacic myopathy, sarcopenia, and weakness, growth retardation, hypocalcemia, seizure and tetany, autism, cardiovascular diseases, diabetes mellitus, cancers (prostate, colon, breast), infectious diseases (viral, tuberculosis), and autoimmune diseases, such as multiple sclerosis and Hashimoto’s thyroiditis. Risk factors for hypovitaminosis D are people with darker skin pigmentation, use of sunscreen, insufficient ultraviolet B exposure, prematurity, living in northern latitudes, malnutrition, obesity, exclusive breastfeeding, low maternal vitamin D level, certain medications, drinking unfortified cow’s milk, liver failure, chronic renal insufficiency, cystic fibrosis, asthma, and sickle cell hemoglobinopathy. This review highlights and summarizes the molecular perspectives of vitamin D deficiency and its potential adverse health outcomes in pediatric age groups. The recommended treatment regimen is beyond the scope of this review. PMID:28229097

  13. Pediatric contact dermatitis. (United States)

    Sharma, Vinod K; Asati, Dinesh P


    Allergic contact dermatitis (ACD) in children, until recently, was considered rare. ACD was considered as a disorder of the adult population and children were thought to be spared due to a lack of exposure to potential allergens and an immature immune system. Prevalence of ACD to even the most common allergens in children, like poison ivy and parthenium, is relatively rare as compared to adults. However, there is now growing evidence of contact sensitization of the pediatric population, and it begins right from early childhood, including 1-week-old neonates. Vaccinations, piercing, topical medicaments and cosmetics in younger patients are potential exposures for sensitization. Nickel is the most common sensitizer in almost all studies pertaining to pediatric contact dermatitis. Other common allergens reported are cobalt, fragrance mix, rubber, lanolin, thiomersol, neomycin, gold, mercapto mix, balsum of Peru and colophony. Different factors like age, sex, atopy, social and cultural practices, habit of parents and caregivers and geographic changes affect the patterns of ACD and their variable clinical presentation. Patch testing should be considered not only in children with lesions of a morphology suggestive of ACD, but in any child with dermatitis that is difficult to control.

  14. Blunt adrenal gland trauma in the pediatric population. (United States)

    Roupakias, Stylianos; Papoutsakis, Marinos; Mitsakou, Paraskevi


    A retrospective review of the literature was performed to determine the natural history, prevalence, prognosis and management of adrenal injury associated with blunt abdominal trauma in pediatric population. Blunt adrenal injury in children is uncommon, rarely isolated, and typically present as part of a multi organ trauma. Adrenal hemorrhage is being diagnosed more frequently since the emergence of computed tomography in modern emergency rooms. Obstetric birth trauma during vaginal delivery of a macrosomic fetus may result in neonatal adrenal hemorrhage. In children appear to be an incidental finding that resolves on follow-up imaging. Most of these injuries are self-limited and do not require intervention. The differential diagnosis of an adrenal neoplasm, especially in children with an isolated adrenal hemorrhage, must be considered. The presence of adrenal hemorrhage in the absence of a trauma history should alert to the possibility of pediatric inflicted injury.

  15. Mentoring practices benefiting pediatric nurses. (United States)

    Weese, Meghan M; Jakubik, Louise D; Eliades, Aris B; Huth, Jennifer J


    Previous studies examining predictors of pediatric nurse protégé mentoring benefits demonstrated that protégé perception of quality was the single best predictor of mentoring benefits. The ability to identify the mentoring practices that predict specific benefits for individual nurses provides a better understanding of how mentoring relationships can be leveraged within health care organizations promoting mutual mentoring benefits. This descriptive correlational, non-experimental study of nurses at a northeast Ohio, Magnet® recognized, free-standing pediatric hospital advances nursing science by demonstrating how mentoring practices benefit pediatric nurse protégés.

  16. Pediatrics pharmacovigilance: need of a new sub-unit


    Rakesh C. Chaurasia


    Pharmacovigilance is a new discipline of pharmacology concerned with adverse drug reaction (ADR) monitoring. Being an emerging section, it gains widespread global popularity within a short span of time. Pediatrics is very special branch of medical science deals with innocent aspect of growing life. As most of their body physiology are varies in accordance to age, therefore ADRs detection needs special attention. [Int J Basic Clin Pharmacol 2012; 1(2.000): 116-117

  17. Epidemiology of acute otitis in pediatric patients

    Directory of Open Access Journals (Sweden)

    Maddalena Perotti


    Full Text Available Introduction. Acute otitis is one of the most common pediatric infectious diseases that requires an accurate diagnosis in order to direct appropriate therapy to reduce the risk of complications. In this study pathogens collected from pediatric patients and their antibiotic susceptibility patterns were evaluated. Methods. Between May 2009 and May 2010, 739 samples (swabs taken from nasopharynx in case of acute otitis media and/or from ears in case of acute external otitis, collected from 680 patients, suffering of otalgia, admitted to the emergency department of our Hospital were studied.The specimens were submitted for routine bacterial cultures and the susceptibility tests were performed according to Clinical Laboratory Standards. Nitrocefin was used to detect ß-lactamase activity. Results. 316 samples (42.8% of 739 were negative, 102 (13.8% were positive for Streptococcus pneumoniae, 97 (13.1% for Moraxella catarrhalis, 68 (9.2% for Haemophilus influenzae, 62 (8.4% for Pseudomonas aeruginosa, 49 (6.6% for Staphylococcus aureus, 36 (4.9% for Streptococcus pyogenes, 5 (0.7% for Gram negative and 4 (0.5% for Candida spp. Antibiotic susceptibility tests showed that amikacin, ceftazidime, ciprofloxacin, imipenem, meropenem and piperacillin/tazobactam were active against all Gram negative strains isolated.We found one strain of MRSA. Of 102 Streptococcus pneumoniae, 5 (4.9% were penicillin resistant and 25 (24.5% were erythromycin resistant, showing the prevalence of constitutive phenotype (80%. All M. catarrhalis strains were ß-lactamase producers while all H. influenzae were ß-lactamase negatives. Conclusions. The prevalent etiological agents in pediatric acute otitis are S. pneumoniae, M. catharralis, and H. influenzae, as reported in literature. In external acute otitis P. aeruginosa prevails in particular in summer.

  18. Canadian Association of Gastroenterology and the Canadian Digestive Health Foundation: Guidelines on Colon Cancer Screening

    Directory of Open Access Journals (Sweden)

    Desmond Leddin


    Full Text Available Colorectal cancer is the third most prevalent cancer affecting both men and women in Canada. Many of these cancers are preventable, and the Canadian Association of Gastroenterology (CAG and the Canadian Digestive Health Foundation (CDHF strongly support the establishment of screening programs for colorectal cancer. These guidelines discuss a number of screening options, listing the advantages and disadvantages of each. Ultimately, the test that is used for screening should be determined by patient preference, current evidence and local resources.

  19. The Canadian Hypertension Education Program – a unique Canadian knowledge translation program


    Tobe, Sheldon W; Touyz, Rhian M.; Campbell, Norm RC


    The Canadian Hypertension Education Program annually appraises data from hypertension research and updates clinical practice recommendation for the diagnosis and management of hypertension. Enormous effort is devoted to disseminating these recommendations to target groups throughout the country and, through the use of institutional databases, to evaluating their effectiveness in improving the health of Canadians by lowering blood pressure in people with hypertension. The mission of the Canadi...

  20. Nutrition: A Primary Therapy in Pediatric Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    Bryan Wilson


    Full Text Available Appropriate nutrition is an essential component of intensive care management of children with Acute Respiratory Distress Syndrome (ARDS and is linked to patient outcomes. One out of every two children in the PICU will develop malnutrition or have worsening of baseline malnutrition, and present with specific micronutrient deficiencies. Early and adequate enteral nutrition (EN is associated with improved 60-day survival after pediatric critical illness and yet, despite early EN guidelines, critically ill children receive on average only 55% of goal calories by PICU day 10. Inadequate delivery of EN is due to perceived feeding intolerance, reluctance to enterally feed children with hemodynamic instability, and fluid restriction. Underlying each of these factors is large practice variation between providers and across institutions for initiation, advancement and maintenance of EN. Strategies to improve early initiation, advancement, and to maintain delivery of EN are needed to improve morbidity and mortality from pediatric ARDS. Both over and underfeeding prolongs duration of mechanical ventilation in children and worsens other organ function such that precise calorie goals are needed. The gut is thought to act as a ‘motor’ of organ dysfunction and emerging data regarding the role of intestinal barrier functions and the intestinal microbiome on organ dysfunction and outcomes of critical illness present exciting opportunities to improve patient outcomes. Nutrition should be considered a primary rather than supportive therapy for pediatric ARDS. Precise nutritional therapies, which are titrated and targeted to preservation of intestinal barrier function, prevention of intestinal dysbiosis, preservation of lean body mass, and blunting of the systemic inflammatory response, offer great potential for improving outcomes of pediatric ARDS. In this review we examine the current evidence regarding dose, route, and timing of nutrition, current

  1. Canadian Ethnohistory: A Source for Social Studies? (United States)

    Wickwire, Wendy


    Presents an overview of ethnohistory, a relatively new area of historical investigation that draws on anthropology, geography, and linguistics, as well as history, to document the pasts of predominantly indigenous peoples. Encourages social studies teachers to take notice of a major body of work being produced by Canadian ethnohistorians. (DSK)

  2. Who Are the Players in Canadian Curriculum? (United States)

    Milburn, Geoffrey


    Labels range of persons advocating different theoretical positions of Canadian curriculum as "players." Describes players as "managers,""predictors,""transformers,""sleuths,""analysts." Values varied viewpoints for attention to language regarding curriculum, critical review of ideas/concepts, examination of current policies, awareness of history…

  3. Canadian Art Partnership Program in Finland (United States)

    Ketovuori, Mikko


    This article is about a multidisciplinary R&D project in which a Canadian Learning Through The Arts (LTTA) program was imported to Finland in 2003-2004. Cultural differences in arts education in Finland and Canada are discussed. While Finland has a national school curriculum with all the arts included. Canada relies more on partnerships to…

  4. International surgery: definition, principles and Canadian practice. (United States)

    Lett, Ronald


    This article is dedicated to the Canadian international surgeon, Norman Bethune (1890-1939). International surgery is defined as a humanitarian branch of medicine concerned with the treatment of bodily injuries or disorders by incision or manipulations, emphasizing cooperation and understanding among nations and involving education, research, development and advocacy. In this article I review the colonial past, the dark ages following the Declaration of Alma-Ata, the progress made and the present challenges in international surgery. I present a definition of international surgery that recognizes the current era of surgical humanitarianism, validates a global understanding of surgical issues and promotes cooperation among nations. Included are the principles of international surgery: education, research, infrastructure development and advocacy. International surgical projects are classified according to type (clinical, relief, developmental) and integration strategy (vertical or horizontal). Also reviewed are the Canadian practice of international surgery by nongovernmental, professional and academic organizations and the requirements of international and Canadian funding agencies, the development concepts basic to all projects, including results-based management and the cross-cutting themes of gender equity, environmental protection and human safety. I recommend formalizing international surgery into a discipline as a means of promoting surgical care in low-income countries. If international surgery is to be sustained in Canada, infrastructure and support from Canadian surgeons is particularly important. An understanding of the history, definition and classification of international surgery should promote surgical care in low-income countries.

  5. Canadian Adult Education: Still a Movement (United States)

    Nesbit, Tom


    Writing recently in this journal, two of Canada's veteran adult educators contemplated the "death" of the Canadian adult education movement. I disagree and argue that adult education in Canada is as vital an activity as ever and one that still fully justifies being called a movement. Specifically, Selman and Selman (2009) list five…

  6. Canadian Adult Education: Still a Movement? (United States)

    Selman, Mark


    In this journal's Fall 2009 issue, the Forum section included an article by Gordon Selman and Mark Selman arguing that although Canadian adult education had existed as a social movement in the middle part of the 20th century, it is no longer a social movement. They also speculated about the causes of this change. In the Spring 2011 issue, Tom…

  7. Canadian Children's Perceptions of Spirituality: Diverse Voices (United States)

    Moore, Kelsey; Talwar, Victoria; Bosacki, Sandra


    Few researchers have explored children's understandings of spirituality. Thus, Canadian children from different religious, spiritual and cultural backgrounds were asked open-ended questions concerning their spiritual thoughts, beliefs and experiences. Parents of participants completed a demographic questionnaire and reported children's religious…

  8. Canadian Perspectives on Equity in the Classroom. (United States)

    Bowlby, Brenda; Komlen, Mile


    Canadian school board administrators are increasingly expected to meet the needs of disabled or other students requiring specific types of accommodation. The duty to accommodate arises when otherwise legitimate school rules or policies affect the customs and observances of nonmajoritarian religions. (Contains 12 references.) (MLH)

  9. Asian and Pacific Migration: The Canadian Experience. (United States)

    Samuel, T. John


    Examines the characteristics of landed immigrants (permanent settlers) from Asia, and explores their settlement, adaptation, and integration experience in Canada. It suggests that access to Canadian land does not always translate into equal opportunity in the economy and society, but notes that Canada may be more successful at assimilating Asian…

  10. Heat exposure in the Canadian workplace. (United States)

    Jay, Ollie; Kenny, Glen P


    Exposure to excessive heat is a physical hazard that threatens Canadian workers. As patterns of global climate change suggest an increased frequency of heat waves, the potential impact of these extreme climate events on the health and well-being of the Canadian workforce is a new and growing challenge. Increasingly, industries rely on available technology and information to ensure the safety of their workers. Current Canadian labor codes in all provinces employ the guidelines recommended by the American Conference of Governmental Industrial Hygienists (ACGIH) that are Threshold Limit Values (TLVs) based upon Wet Bulb Globe Temperature (WBGT). The TLVs are set so that core body temperature of the workers supposedly does not exceed 38.0 degrees C. Legislation in most Canadian provinces also requires employers to install engineering and administrative controls to reduce the heat stress risk of their working environment should it exceed the levels permissible under the WBGT system. There are however severe limitations using the WGBT system because it only directly evaluates the environmental parameters and merely incorporates personal factors such as clothing insulation and metabolic heat production through simple correction factors for broadly generalized groups. An improved awareness of the strengths and limitations of TLVs and the WGBT index can minimize preventable measurement errors and improve their utilization in workplaces. Work is on-going, particularly in the European Union to develop an improved individualized heat stress risk assessment tool. More work is required to improve the predictive capacity of these indices.

  11. Family Business Training: A Canadian Perspective (United States)

    Ibrahim, A. B.; Soufani, K.; Lam, Jose


    Family firms play an important role in the working of the Canadian economy; despite their importance to the economic activities and job creation it is observed that family businesses have lower survival rates than non-family firms, some argue that this can possibly be attributed (amongst other factors) to the lack of training. Most of the training…

  12. Canadian suicide mortality rates: first-generation immigrants versus Canadian-born. (United States)

    Strachan, J; Johansen, H; Nair, C; Nargundkar, M


    This article examines suicide mortality rates and trends in Canada for first-generation immigrants and the Canadian-born population. Data are analyzed by age, sex and country of birth. Since 1950, suicide rates worldwide for both men and women have been increasing. In North America and most of Europe, suicide has been one of the major causes of death for many years. In Canada, suicide rates are also rising. However, this increase is due entirely to a rise in the rate for men; the rate for women has remained relatively stable. Several differences are apparent between the rates for the Canadian-born population and those for first-generation immigrants. For example, three times as many Canadian-born men as women commit suicide. For first-generation immigrants, the ratio is two to one. Suicide mortality rates for the Canadian-born are higher than those for first-generation immigrants in every age group except for the 65 and over groups. Canadian born males have higher ASMR than first generation immigrant males. The rates for women show that first-generation immigrant women have higher suicide mortality rates than their Canadian-born counterparts, and that the highest rate for all women is for immigrants born in Asia.

  13. Pediatric Suprasellar Tumors. (United States)

    McCrea, Heather J; George, Emilie; Settler, Allison; Schwartz, Theodore H; Greenfield, Jeffrey P


    The various childhood suprasellar tumors, while pathologically distinct, present similar clinical and surgical challenges as a result of their common anatomic location. These lesions are in close proximity to or may invade the optic nerve and chiasm, pituitary gland and infundibulum, hypothalamus, and third ventricle, leading to presenting features including visual field loss, impairment in visual acuity, endocrine dysfunction, and hydrocephalus. Though many suprasellar lesions are relatively benign in pathology, treatment may be complicated by high surgical morbidity resulting from damage to the hypothalamic-pituitary axis. Here we review the most frequent pediatric lesions occurring in the suprasellar region: craniopharyngioma, chiasmatic glioma, germ cell tumor, Rathke cleft and arachnoid cysts, pituitary adenoma, and histiocytosis. This review outlines both common presenting features and differentiating aspects of these lesions. It also includes classic radiographic presentations and treatment considerations for each lesion.

  14. What Is a Pediatric Endocrinologist? (United States)

    ... Article Body If your child has problems with growth, puberty, diabetes, or other disorders related to the hormones and the glands that produce them, a pediatric endocrinologist may treat your child. ...

  15. Nutrition for the pediatric athlete. (United States)

    Unnithan, Viswanath B; Goulopoulou, Styliani


    A paucity of literature exists with regard to research on nutrition for the pediatric athlete. This lack of research makes the development of specific nutritional recommendations for young athletes problematic. This issue is made difficult by the macro- and micronutrient intake required for growth and development in conjunction with that required for sports. Exogenous carbohydrate drinks could be considered for the young athlete engaged in both endurance exercise and high-intensity exercise. Monitoring of the energy intake during resistance training in the pediatric athlete needs to be considered, as there is evidence to suggest that energy deficits may occur. If decrements in exercise performance are noted, then serum ferritin and hemoglobin concentrations should be monitored, as nonanemic iron deficiency is prevalent in the pediatric athlete. The pediatric athlete exercising in the heat is susceptible to voluntary dehydration and evidence exists to suggest that a carbohydrate-electrolyte drink will abolish this phenomenon.

  16. Targeted therapy for pediatric glioma

    NARCIS (Netherlands)

    A.K. Olow


    This thesis assesses molecular underpinnings of responses to promising targeted agents for pediatric tumors of Central Nervous System (CNS), incorporating preclinical testing of novel and translatable combination therapies to define the best therapy for each tumor cell specific molecular aberration.

  17. Children's (Pediatric) CT (Computed Tomography)

    Medline Plus

    Full Text Available ... Computed Tomography) Pediatric computed tomography (CT) is a fast, painless exam that uses special x-ray equipment ... period of time. Modern CT scanners are so fast that they can scan through large sections of ...

  18. Childhood Obesity for Pediatric Gastroenterologists (United States)

    Huang, Jeannie S.; Barlow, Sarah E.; Quiros-Tejeira, Ruben E.; Scheimann, Ann; Skelton, Joseph; Suskind, David; Tsai, Patrika; Uko, Victor; Warolin, Joshua P.; Xanthakos, Stavra A.


    Obesity in childhood is one of the major health issues in pediatric health care today. As expected, the prevalence of obesity-related comorbidities has risen in parallel with that of obesity. Consultation regarding these concomitant diseases and subsequent management by subspecialists, including pediatric gastroenterologists, is now common and has resulted in obesity being recognized as a chronic disease requiring coordination of care. Although medications and even surgery may provide effective, though often temporary, treatments for obesity and its comorbidities, behavioral interventions addressing healthy dietary and physical activity habits remain a mainstay in the obesity treatment paradigm. Therefore, the issue of weight management must be addressed by both general practitioner and subspecialist alike. In this report, we review select aspects of pediatric obesity and obesity-related management issues because it relates in particular to the field of pediatric gastroenterology and hepatology. PMID:23282941

  19. Emergency transport of pediatric critical care in primary hospital 128 cases reports%基层医院小儿危重症的急救转运128例报道

    Institute of Scientific and Technical Information of China (English)

    饶袖珍; 杨海红; 谢云菲


    目的 探讨基层医院急救转运模式及方法,提高本地区危重患儿的抢救成功率,降低危重患儿死亡率及致残率.方法对丰顺县人民医院近3年来转运的危重患儿128例进行回顾性分析.结果全部危重病患儿均安全转运至上级医院相应专科病房,在转运患儿的原发病以新生儿疾病、重症肺炎和各种感染为主,无1例在途中发生意外或死亡.结论加强转运前、转运途中质量控制,充分估计病情变化,密切监测病情是安全转运的前提条件,快捷安全的转运,提高了本地区危重患儿的抢救成功率,降低危重患儿死亡率及致残率是非常有效的.%Objective To explore the transport mode and hospital emergency methods to improve the survival rate in critically ill children, reducing mortality and morbidity in critically ill children. Methods Totally 128 cases from the past three years of transport critically ill children were analyzed retrospectively. Results All children were safety in critically ill patients transported to the appropriate specialist hospital ward higher, the disease neonatal illness, severe pneumonia and various infections primarily were the primary disease in transport children, no case of accident or death on the way. Conclusions Strengthening the transit quality control, estimates of changes in condition adequately, close monitoring of the disease is a premise for safe transport, fast and safety transport can improve the survival rate of critically ill children in the region, reducing mortality in critically ill children and disability.

  20. A review of pediatric dentistry program websites: what are applicants learning about our programs? (United States)

    Lin, Jenn-Yih; Lee, Jung; Davidson, Bo; Farquharson, Kara; Shaul, Cheryl; Kim, Sara


    The purpose of this study was twofold: 1) to examine website content provided by U.S. and Canadian pediatric dentistry residency programs, and 2) to understand aspects of program websites that dental students report to be related to their interests. Sixty-eight program websites were reviewed by five interprofessional evaluators. A thirty-six-item evaluation form was organized into 1) program descriptive items listed on the American Academy of Pediatric Dentistry (AAPD) website (n=21); 2) additional program descriptive items not listed on the AAPD website but of interest (n=9); and 3) items related to website interface design (n=5). We also surveyed fifty-four dental students regarding their interest in various aspects of program descriptions. The results of this study suggest that pediatric dentistry residency programs in general tend to provide identical or less information than what is listed on the AAPD website. The majority of respondents (76 percent) reported that residency program websites would be their first source of information about advanced programs. The greatest gap between the available website information and students' interests exists in these areas: stipend and tuition information, state licensure, and program strengths. Pediatric dentistry residency programs underutilize websites as a marketing and recruitment tool and should incorporate more information in areas of students' priority interests.

  1. Entrepreneurship, Emerging Technologies, Emerging Markets

    NARCIS (Netherlands)

    Thukral, Inderpreet S.; Von Ehr, James; Groen, Aard J.; Sijde, van der Peter; Adham, Khairul Akmaliah


    Academics and practitioners alike have long understood the benefits, if not the risks, of both emerging markets and emerging technologies.Yet it is only recently that foresighted firms have embraced emerging technologies and emerging markets through entrepreneurial activity. Emerging technologies an

  2. Prognosis of pediatric epilepsy

    Directory of Open Access Journals (Sweden)

    Girish C Nair


    Full Text Available Epilepsy is a significant and commonplace neurological disability in the pediatric population. Data from increasingly larger and more representative studies have brought about noteworthy changes in our understanding of the prognosis of epilepsy in the pediatric age-group. Prevalence rates for epilepsy in both the developing and the developed world are surprisingly similar despite distinct differences in incidence and large treatment gaps in the developing world; this strongly points towards the possibility of spontaneous remission, at least in some patients. Prognosis after an isolated first seizure is generally quite favorable, but worsens with recurring seizures, remote symptomatic etiology, and the presence of abnormalities on EEG. Presently available antiepileptic drugs (AEDs are at best seizure suppressant in their action and have not been shown to be antiepileptic in the sense that they alter the long-term prognosis of the epilepsy for the better. Epilepsy syndromes can be considered to belong to distinct groups on the basis of their prognosis. Some have an excellent outcome in terms of seizure freedom and neurological development; yet others have a grim prognosis with respect to these variables. Factors that impact on the prognosis of treated epilepsy are being understood and include the specific etiology, age of onset of epilepsy, and EEG findings. Epileptics, especially those with remote symptomatic seizures and refractory epilepsy, suffer higher mortality as compared to the general population. While the outcomes in terms of seizure freedom in patients with epilepsy appear favorable, disturbing data on psychosocial morbidity are coming to light and are reflected in the lower rates of higher education, employment, marriage, and fertility among epileptics.

  3. Evaluation of a Pilot Project to Introduce Simulation-Based Team Training to Pediatric Surgery Trauma Room Care

    Directory of Open Access Journals (Sweden)

    Markus Lehner


    Full Text Available Introduction. Several studies in pediatric trauma care have demonstrated substantial deficits in both prehospital and emergency department management. Methods. In February 2015 the PAEDSIM collaborative conducted a one and a half day interdisciplinary, simulation based team-training course in a simulated pediatric emergency department. 14 physicians from the medical fields of pediatric surgery, pediatric intensive care and emergency medicine, and anesthesia participated, as well as four pediatric nurses. After a theoretical introduction and familiarization with the simulator, course attendees alternately participated in six simulation scenarios and debriefings. Each scenario incorporated elements of pediatric trauma management as well as Crew Resource Management (CRM educational objectives. Participants completed anonymous pre- and postcourse questionnaires and rated the course itself as well as their own medical qualification and knowledge of CRM. Results. Participants found the course very realistic and selected scenarios highly relevant to their daily work. They reported a feeling of improved medical and nontechnical skills as well as no uncomfortable feeling during scenarios or debriefings. Conclusion. To our knowledge this pilot-project represents the first successful implementation of a simulation-based team-training course focused on pediatric trauma care in German-speaking countries with good acceptance.

  4. An industry perspective on Canadian patients' involvement in Medical Tourism: implications for public health

    Directory of Open Access Journals (Sweden)

    Snyder Jeremy


    Full Text Available Abstract Background The medical tourism industry, which assists patients with accessing non-emergency medical care abroad, has grown rapidly in recent years. A lack of reliable data about medical tourism makes it difficult to create policy, health system, and public health responses to address the associated risks and shortcomings, such as spread of infectious diseases, associated with this industry. This article addresses this knowledge gap by analyzing interviews conducted with Canadian medical tourism facilitators in order to understand Canadian patients' involvement in medical tourism and the implications of this involvement for public health. Methods Semi-structured phone interviews were conducted with 12 medical facilitators from 10 companies in 2010. An exhaustive recruitment strategy was used to identify interviewees. Questions focused on business dimensions, information exchange, medical tourists' decision-making, and facilitators' roles in medical tourism. Thematic analysis was undertaken following data collection. Results Facilitators helped their Canadian clients travel to 11 different countries. Estimates of the number of clients sent abroad annually varied due to demand factors. Facilitators commonly worked with medical tourists aged between 40 and 60 from a variety of socio-economic backgrounds who faced a number of potential barriers including affordability, fear of the unfamiliar, and lack of confidence. Medical tourists who chose not to use facilitators' services were thought to be interested in saving money or have cultural/familial connections to the destination country. Canadian doctors were commonly identified as barriers to securing clients. Conclusions No effective Canadian public health response to medical tourism can treat medical tourists as a unified group with similar motivations for engaging in medical tourism and choosing similar mechanisms for doing so. This situation may be echoed in other countries with patients

  5. Innovation in pediatric surgical education. (United States)

    Clifton, Matthew S; Wulkan, Mark L


    Pediatric surgical training in the United States remained basically unchanged from the model developed by Ladd and Gross in the 1930s until recently. Standardized curriculum and novel evaluation methods are now being implemented. Pediatric Surgical education is currently undergoing a transition to competency-based evaluation and promotion. Unfortunately, there is little data on the efficacy of these changes. This presents an opportunity for further study of how we conduct training, and how we evaluate and promote our trainees.

  6. Pediatric oral and maxillofacial surgery. (United States)

    Kutcipal, Elizabeth


    Pediatric oral and maxillofacial surgery is rarely seen as a separate entity from adult oral and maxillofacial surgery. Many procedures are similar on adults and children; however, children have unique behavioral, anatomic, and physiologic considerations. Children also have a propensity for certain injuries and pathologic lesions. Children born with congenital anomalies may also have a special subset of needs. This article is a brief review of oral and maxillofacial surgery on the pediatric population.

  7. Pediatric Obesity: Etiology and Treatment^


    Crocker, Melissa K.; Yanovski, Jack A.


    This paper reviews factors that contribute to excessive weight gain in children and outlines current knowledge regarding approaches for treating pediatric obesity. Virtually all of the known genetic causes of obesity primarily increase energy intake. Genes regulating the leptin signaling pathway are particularly important for human energy homeostasis. Obesity is a chronic disorder that requires long-term strategies for management. The foundation for all treatments for pediatric obesity remain...

  8. What is a pediatric tumor?

    Directory of Open Access Journals (Sweden)

    Mora J


    Full Text Available Jaume Mora1,21Department of Oncology, 2Developmental Tumor Biology Laboratory, Hospital Sant Joan de Deu, Fundacio Sant Joan de Deu, Barcelona, SpainAbstract: Working together with medical oncologists, the question of whether a Ewing sarcoma in a 25-year-old is a pediatric tumor comes up repeatedly. Like Ewing's, some tumors present characteristically at ages that cross over what has been set as the definition of pediatrics (15 years, 18 years, or 21 years?. Pediatric oncology textbooks, surprisingly, do not address the subject of defining a pediatric tumor. They all begin with an epidemiology chapter defining the types of tumors appearing at distinct stages of childhood, adolescence, and young adulthood. Describing the epidemiology of tumors in relation to age, it becomes clear that the disease is related to the phenomenon of aging. The question, however, remains: is there a biological definition of what pediatric age is? And if so, will tumors occurring during this period of life have anything to do with such biological definition? With the aim of finding an objective definition, the fundamental concepts of what defines "pediatrics" was reviewed and then the major features of tumors arising during development were analyzed. The tumors were explored from the perspective of a host immersed in the normal process of growth and development. This physiological process, from pluripotential and undifferentiated cells, makes possible the differentiation, maturation, organization, and function of tissues, organs, and apparatus. A biological definition of pediatric tumors and the infancy–childhood–puberty classification of developmental tumors according to the infancy–childhood–puberty model of normal human development are proposed.Keywords: growth and development, pediatric tumor, infant, childhood and adolescence, pubertal tumors

  9. Pediatric robotic urologic surgery-2014

    Directory of Open Access Journals (Sweden)

    James T Kearns


    Full Text Available We seek to provide a background of the current state of pediatric urologic surgery including a brief history, procedural outcomes, cost considerations, future directions, and the state of robotic surgery in India. Pediatric robotic urology has been shown to be safe and effective in cases ranging from pyeloplasty to bladder augmentation with continent urinary diversion. Complication rates are in line with other methods of performing the same procedures. The cost of robotic surgery continues to decrease, but setting up pediatric robotic urology programs can be costly in terms of both monetary investment and the training of robotic surgeons. The future directions of robot surgery include instrument and system refinements, augmented reality and haptics, and telesurgery. Given the large number of children in India, there is huge potential for growth of pediatric robotic urology in India. Pediatric robotic urologic surgery has been established as safe and effective, and it will be an important tool in the future of pediatric urologic surgery worldwide.

  10. Specialist training in pediatric anesthesia

    DEFF Research Database (Denmark)

    Hansen, Tom G


    There has been a great deal of focus on specialist training in pediatric anesthesia in the last decade or so. Internationally, however, there is still no uniform agreement as to how such a training program should be arranged and organized. Since September 2003, the Scandinavian Society of Anaesth......There has been a great deal of focus on specialist training in pediatric anesthesia in the last decade or so. Internationally, however, there is still no uniform agreement as to how such a training program should be arranged and organized. Since September 2003, the Scandinavian Society...... of Anaesthesiology and Intensive Care Medicine has coordinated an advanced Inter-Nordic educational program in pediatric anesthesia and intensive care. The training program is managed by a Steering Committee. This program is intended for physicians who recently have received their specialist degree in anesthesiology...... and intensive care. The training period is 12 months of which 9 months are dedicated to pediatric anesthesia and 3 months to pediatric intensive care. During the 1-year training period, the candidates are designated a Scandinavian host clinic (at a tertiary pediatric center in Scandinavia approved...

  11. The potential for bio-mediators and biomarkers in pediatric traumatic brain injury and neurocritical care

    Directory of Open Access Journals (Sweden)

    Patrick M. Kochanek


    Full Text Available The use of biomarkers of brain injury in pediatric neurocritical care has been explored for at least 15 years. Two general lines of research on biomarkers in pediatric brain injury have been pursued, 1 studies of bio-mediators in cerebrospinal fluid (CSF of children after traumatic brain injury (TBI to explore the components of the secondary injury cascades in an attempt to identify potential therapeutic targets and 2 studies of the release of structural proteins into the CSF, serum, or urine in order to diagnose, monitor, and/or prognosticate in patients with TBI or other pediatric neurocritical care conditions. Unique age-related differences in brain biology, disease processes, and clinical applications mandate the development and testing of brain injury bio-mediators and biomarkers specifically in pediatric neurocritical care applications. Finally, although much of the early work on biomarkers of brain injury in pediatrics has focused on TBI, new applications are emerging across a wide range of applications specifically for pediatric neurocritical care including abusive head trauma, cardiopulmonary arrest, septic shock, extracorporeal membrane oxygenation, hydrocephalus, and cardiopulmonary bypass. The potential scope of the utility of biomarkers in pediatric neurocritical care is thus also discussed.

  12. Emergency in pediatric and adolescent psychiatry. Note taking for the primary health assistance. Urgencias en psiquiatría infantil y adolescente. Apuntes para el nivel primario de atención.

    Directory of Open Access Journals (Sweden)

    Zenaida María Sáez

    Full Text Available The psyquiatric emergences in children and adolescents are usually manifested as alterations of the feelings, behavior or in the school efficiency and its origin is found in the physical tensions, contradictions in the breeding, marital conflicts, bad interpersonal relationships, negligence, loss of the significant model at home, etc. It is important to address that there is no direct relationship between the causal factor and the onset of the symptoms. This largely depends on variables such as temperament, levels of development, nature and duration of the stress, past experience and family capacity/ability of the family to get adapted to new situations.

    Parents frequently come to visit General Comprehensive doctor because they are worried about their children´s behaviors, i.e.; if they are normal or require certain intervention.

    In the current review we make reference to the psychosocial issues that may bring about psychopathological manifestations which need a timely intervention. Otherwise, there is a risk for the physical integrity of the kid, adolescent or another people which may result into a remarkable complications and suffering for the patients or their relatives. We are going to make reference to the abuse of some substances, adoption, nervous anorexia, suicide attempt, infant abuse, fire provocation and mourning reaction.

    We are making emphasis on the clinical assessment of the risk factors which contribute to the appearance of these issues and the management in the primary level of assistance to prevent further complications.

    Las urgencias psiquiátricas en el niño y el adolescente se manifiestan usualmente como alteraciones de los sentimientos, de la conducta o del rendimiento escolar y tienen su origen en tensiones físicas, contradicciones en la crianza, conflictos maritales, malos tratos, negligencia, pérdida de figuras significativas, etc. Es importante señalar que no existe una relación directa entre

  13. Acolhimento de usuários em um pronto-socorro infantil na perspectiva dos enfermeiros Acogida de usuarios en un servicio de emergencia Infantil en la perspectiva de los enfermeros Reception of pediatric emergency room users from the perspective of nurses

    Directory of Open Access Journals (Sweden)

    Ellen Maria Reimberg da Silva


    Full Text Available OBJETIVO: Compreender o significado e a experiência do enfermeiro a respeito da qualidade envolvida no acolhimento de usuários/acompanhantes em um Pronto-Socorro Infantil de um hospital universitário do Município de São Paulo. MÉTODOS: Estudo qualitativo do tipo exploratório descritivo, com participação de oito enfermeiros. A coleta de dados foi realizada por intermédio de entrevistas semiestruturadas e as falas foram submetidas à análise de conteúdo. RESULTADOS: Emergiram as categorias: significado do acolhimento: concepções e atitudes profissionais; acolhimento: do real ao ideal; vivência na implantação das mudanças; processo de acolher: fatores intervenientes. CONCLUSÃO: O processo de acolher foi modificado ao longo do trabalho, caracterizado pelo relacionamento interpessoal, postura profissional, comunicação e questões relativas à infraestrutura.OBJETIVO: Comprender el significado y la experiencia del enfermero respecto a la calidad involucrada en la acogida de usuarios/acompañantes en un servicio de emergecia Infantil de un hospital universitario del Municipio de Sao Paulo. MÉTODOS: Estudio cualitativo de tipo exploratorio descriptivo, con la participación de ocho enfermeros. La recolección de datos fue realizada por medio de entrevistas semi estructuradas y los discursos fueron sometidos al análisis de contenido. RESULTADOS: Emergieron las categorías: significado de la acogida: concepciones y actitudes profesionales; acogida: de lo real a lo ideal; vivencia en la implantación de los cambios; proceso de acoger: factores intervinientes. CONCLUSIÓN: El proceso de acoger fue modificado a lo largo del trabajo, caracterizado por la relación interpersonal, postura profesional, comunicación y cuestiones relativas a la infraestructura.OBJECTIVE: To understand the meaning and experience of the nurse in respect to the quality of the reception of users / attendants in a Pediatric Emergency Room of a university

  14. Canadian Cardiovascular Society 2009 Consensus Conference on the management of adults with congenital heart disease: executive summary. (United States)

    Silversides, Candice K; Marelli, Ariane; Beauchesne, Luc; Dore, Annie; Kiess, Marla; Salehian, Omid; Bradley, Timothy; Colman, Jack; Connelly, Michael; Harris, Louise; Khairy, Paul; Mital, Seema; Niwa, Koichiro; Oechslin, Erwin; Poirier, Nancy; Schwerzmann, Markus; Taylor, Dylan; Vonder Muhll, Isabelle; Baumgartner, Helmut; Benson, Lee; Celermajer, David; Greutmann, Matthias; Horlick, Eric; Landzberg, Mike; Meijboom, Folkert; Mulder, Barbara; Warnes, Carole; Webb, Gary; Therrien, Judith


    With advances in pediatric cardiology and cardiac surgery, the population of adults with congenital heart disease (CHD) has increased. In the current era, there are more adults with CHD than children. This population has many unique issues and needs. They have distinctive forms of heart failure, and their cardiac disease can be associated with pulmonary hypertension, thromboemboli, complex arrhythmias and sudden death.Medical aspects that need to be considered relate to the long-term and multisystemic effects of single-ventricle physiology, cyanosis, systemic right ventricles, complex intracardiac baffles and failing subpulmonary right ventricles. Since the 2001 Canadian Cardiovascular Society Consensus Conference report on the management of adults with CHD, there have been significant advances in the understanding of the late outcomes, genetics, medical therapy and interventional approaches in the field of adult CHD. Therefore, new clinical guidelines have been written by Canadian adult CHD physicians in collaboration with an international panel of experts in the field. The present executive summary is a brief overview of the new guidelines and includes the recommendations for interventions. The complete document consists of four manuscripts that are published online in the present issue of The Canadian Journal of Cardiology, including sections on genetics, clinical outcomes, recommended diagnostic workup, surgical and interventional options, treatment of arrhythmias, assessment of pregnancy and contraception risks, and follow-up requirements. The complete document and references can also be found at or

  15. Canadian Cardiovascular Society 2009 Consensus Conference on the management of adults with congenital heart disease: complex congenital cardiac lesions. (United States)

    Silversides, Candice K; Salehian, Omid; Oechslin, Erwin; Schwerzmann, Markus; Vonder Muhll, Isabelle; Khairy, Paul; Horlick, Eric; Landzberg, Mike; Meijboom, Folkert; Warnes, Carole; Therrien, Judith


    With advances in pediatric cardiology and cardiac surgery, the population of adults with congenital heart disease (CHD) has increased. In the current era, there are more adults with CHD than children. This population has many unique issues and needs. They have distinctive forms of heart failure and their cardiac disease can be associated with pulmonary hypertension, thromboemboli, complex arrhythmias and sudden death. Medical aspects that need to be considered relate to the long-term and multisystemic effects of single ventricle physiology, cyanosis, systemic right ventricles, complex intracardiac baffles and failing subpulmonary right ventricles. Since the 2001 Canadian Cardiovascular Society Consensus Conference report on the management of adults with CHD, there have been significant advances in the field of adult CHD. Therefore, new clinical guidelines have been written by Canadian adult CHD physicians in collaboration with an international panel of experts in the field. Part III of the guidelines includes recommendations for the care of patients with complete transposition of the great arteries, congenitally corrected transposition of the great arteries, Fontan operations and single ventricles, Eisenmenger's syndrome, and cyanotic heart disease. Topics addressed include genetics, clinical outcomes, recommended diagnostic workup, surgical and interventional options, treatment of arrhythmias, assessment of pregnancy risk and follow-up requirements. The complete document consists of four manuscripts, which are published online in the present issue of The Canadian Journal of Cardiology. The complete document and references can also be found at or

  16. Relationship between optimum preoperative fasting time and intervals between eating and trauma in pediatric patients undergoing emergency orthopedic surgery%急诊骨科患儿术前禁食的适宜时间与进食-创伤间期的关系

    Institute of Scientific and Technical Information of China (English)

    孙可; 金梅; 杨庆国


    目的 通过超声测量胃窦部横截面积(CSA),探讨急诊骨科患儿术前禁食的适宜时间与进食-创伤间期的关系.方法 择期骨科手术患儿50例,年龄2~7岁,ASA分级Ⅰ或Ⅱ级,体重10 ~ 25 kg,采用随机数字表法,将其分为2组(n=25):禁食6h组(CA组)和禁食8h组(CB组);急诊骨科手术患儿75例,年龄2~7岁,ASA分级Ⅰ或Ⅱ级,体重10~ 25 kg,根据进食-创伤间期分3组:进食-创伤间期≤1h组(TA组,n=22)、进食-创伤间期>1h且≤4h(TB组,n=26),进食-创伤间期>4h(TC组,n=27).CA组于距末次进食6 h(T1)时、CB组于距末次进食8 h(T2)时测量CSA,TA、TB、TC组于T1、T2时测量CSA.结果 CA组与CB组CSA比较差异无统计学意义(P>0.05).与CA组比较,TA组和TB组CSA增大(P<0.05),TC组差异无统计学意义(P>0.05);与CB组比较,TA组CSA增大(P<0.05),TB组和TC组差异无统计学意义(P>0.05);与TA组比较,TC组T1时、TB组和TC组T2时CSA减小(P<0.05),TB组T1时差异无统计学意义(P>0.05);与TB组比较,L时TC组CSA减小(P<0.05),T2时差异无统计学意义(P>0.05);与T1时比较,T2时TB组CSA减小(P<0.05),TA组和TC组差异无统计学意义(P>0.05).结论 对于急诊骨科患儿,进食-创伤间期1~4h之间建议术前禁食时间达到8h;进食-创伤间期<1h时,即使禁食8h仍不能达到禁食目的,应做好应对返流误吸的措施;进食-创伤间期>4h时者可适当缩短术前禁食时间至6h.%Objective To evaluate the relationship between the optimum preoperative fasting time and in tervals between eating and trauma in pediatric patients undergoing emergency orthopedic surgery by measuring the gastric antral cross-sectional area (CSA) using ultrasound.Methods Fifty ASA physical status Ⅰ or Ⅱ pediatric patients,aged 2-7 yr,weighing 10-25 kg,undergoing elective orthopedic surgery,were randomly divided into 2 groups (n =25 each) using a random number table:6-h fast group (group CA) and 8-h fast group

  17. Chemotherapy drug shortages in pediatric oncology: a consensus statement. (United States)

    Decamp, Matthew; Joffe, Steven; Fernandez, Conrad V; Faden, Ruth R; Unguru, Yoram


    Shortages of essential drugs, including critical chemotherapy drugs, have become commonplace. Drug shortages cost significant time and financial resources, lead to adverse patient outcomes, delay clinical trials, and pose significant ethical challenges. Pediatric oncology is particularly susceptible to drug shortages, presenting an opportunity to examine these ethical issues and provide recommendations for preventing and alleviating shortages. We convened the Working Group on Chemotherapy Drug Shortages in Pediatric Oncology (WG) and developed consensus on the core ethical values and practical actions necessary for a coordinated response to the problem of shortages by institutions, agencies, and other stakeholders. The interdisciplinary and multiinstitutional WG included practicing pediatric hematologist-oncologists, nurses, hospital pharmacists, bioethicists, experts in emergency management and public policy, legal scholars, patient/family advocates, and leaders of relevant professional societies and organizations. The WG endorsed 2 core ethical values: maximizing the potential benefits of effective drugs and ensuring equitable access. From these, we developed 6 recommendations: (1) supporting national polices to prevent shortages, (2) optimizing use of drug supplies, (3) giving equal priority to evidence-based uses of drugs whether they occur within or outside clinical trials, (4) developing an improved clearinghouse for sharing drug shortage information, (5) exploring the sharing of drug supplies among institutions, and (6) developing proactive stakeholder engagement strategies to facilitate prevention and management of shortages. Each recommendation includes an ethical rationale, action items, and barriers that must be overcome. Implemented together, they provide a blueprint for effective and ethical management of drug shortages in pediatric oncology and beyond.

  18. Grade Management in Establishing Pediatric Peripheral Venous Access

    Directory of Open Access Journals (Sweden)

    Ya-Min Yan


    Full Text Available Background Establishing venous access is a challenging job for pediatric nurses, especially in the emergency department. Measures to ensure higher success rates on the first attempt are important to provide quality nursing care. Objectives To explore the effect of grade management on the success of establishing peripheral venous access in the child population of China and to analyze the factors influencing failed IV access on the first attempt. Methods This is an observational study on children aged 0 - 16 years old undergoing peripheral venous catheterization in a children’s hospital. Patient information was collected before attempting each puncture. Logistic regression was used to identify independent factors for success prediction. Results A total of 1,016 subjects enrolled. The success rate of intravenous puncture on the first attempt was 86.02%. This can be influenced by several factors, such as patient age, department, venous condition, and nurse experience. The success rate within two attempts was 96.85%; the number of catheters used per IV attempt was 1.21. Conclusions To date, only a few studies have explored the success rate of peripheral IV catheterization in the pediatric population of China. Grade management of peripheral veins and pediatric nurses facilitated higher first-attempt success than in previously published reports. Failures of catheterization were multifactorial. The success rate of peripheral intravenous insertion in children can be improved through applying assistance devices or enhancing the venipuncture skills of pediatric nurses.

  19. Health behaviour changes after diagnosis of chronic illness among Canadians aged 50 or older. (United States)

    Newson, Jason T; Huguet, Nathalie; Ramage-Morin, Pamela L; McCarthy, Michael J; Bernier, Julie; Kaplan, Mark S; McFarland, Bentson H


    Changes in health behaviours (smoking, physical activity, alcohol consumption, and fruit and vegetable consumption) after diagnosis of chronic health conditions (heart disease, cancer, stroke, respiratory disease, and diabetes) were examined among Canadians aged 50 or older. Results from 12 years of longitudinal data from the Canadian National Population Health Survey indicated relatively modest changes in behaviour. Although significant decreases in smoking were observed among all groups except those with respiratory disease, at least 75% of smokers did not quit. No significant changes emerged in the percentage meeting physical activity recommendations, except those with diabetes, or in excessive alcohol consumption, except those with diabetes and respiratory disease. The percentage reporting the recommended minimum fruit and vegetable intake did not increase significantly among any group.

  20. Novel treatment options for pediatric HIV infection. (United States)

    Day, Eleanor; Buckberry, Karen; Sharland, Michael R; Chakraborty, Rana


    The development of effective antiretroviral therapy for HIV has led to significant virological suppression and immune reconstitution, and resulted in dramatic reductions in HIV-related morbidity and mortality. However, in children initial regimens were unpalatable and inconvenient due to a high pill burden. Management was further compromised by a paucity of pharmacokinetic data and the late development of associated toxicities. These factors have resulted in the emergence of drug-resistant virus in many treated children and adolescents. In this review, therapeutic options that may be available for treatment-experienced pediatric individuals are summarized on the basis of data from adult clinical trials evaluating protease, non-nucleoside reverse transcriptase, fusion, integrase and CCR5 inhibitors.

  1. Extracorporeal life support in pediatric cardiac patients

    Directory of Open Access Journals (Sweden)

    Matteo Di NARDO


    Full Text Available Extracorporeal Life Support (ECLS is a valuable tool in the management of neonates and older children with severe cardiac or respiratory failure. In this review, we focus on ECLS when used for neonatal and pediatric cardiac disease. Strict selection of patients and timely deployment are necessary to optimize outcomes. Although every attempt should be made to deploy ECLS urgently rather than emergently, extracorporeal cardiopulmonary resuscitation (ECPR is being increasingly used and reasonable survival rates have been achieved after initiation of ECLS during active compressions of the chest following in-hospital cardiac arrest. Contraindications to ECLS are falling over time, although lethal chromosomal abnormalities, severe irreversible brain injury, and extremely low gestational age and weight (<32 weeks gestation or <1.5 kg remain firm contraindications.

  2. Committing Canadian sociology: developing a Canadian sociology and a sociology of Canada. (United States)

    Matthews, Ralph


    This paper is a slightly revised version of the author's "Outstanding Career Award Lecture" presented at the Annual Meeting of the Canadian Sociological Association in Victoria, British Columbia on June 6, 2013. The paper distinguishes between Canadian Sociology and the Sociology of Canada. The former involves the explanatory stance that one takes to understanding Canada. The latter addresses the significant social dimensions that underlie Canadian social organization, culture, and behavior. I make a case for a Canadian Sociology that focuses on the unique features of Canadian society rather than adopting a comparative perspective. I also argue that there is a continuing need within the Sociology of Canada to address the issues of staples development. However, I argue that "new" staples analysis must have a directional change from that of the past, in that social processes now largely determine the pattern of staples development. Moreover, new staples analysis must include issues that were never part of earlier staples analysis, such as issues of environmental impacts and of staples depletion under conditions, such as climate change. The paper concludes by analyzing four factors that provide the dominant social contexts for analyzing modern staples development: (1) the rise of neoliberal government, (2) the implementation of globalization and its social consequences, (3) the assumption of aboriginal rights and entitlement, and (4) the rise of environmentalism. These factors were generally not considered in earlier staples approaches. They are critical to understanding the role of staples development and its impact on Canada in the present time.

  3. Kerala Pioneering Pediatric Surgery in India

    Directory of Open Access Journals (Sweden)

    TP Joseph


    Full Text Available Pediatric surgeons of Kerala are very proud to have led the development of superspeciality in any branch of medicine in Kerala and also superspeciality of Pediatric surgery in whole of India. Late Prof. Raman Nair returned in 1954 after training under Dr. Everett Koop in US. Same year, in his far-sighted vision for future development of the speciality, he moved to SATH, Medical College, Trivandrum and started Pediatric surgery as a speciality attached to Paediatrics department; this was the beginning of Pediatric surgery in India. He opted for Pediatric surgery as a full time job and did not do any general surgery work in adults. He was the first full time Pediatric surgeon of India; during the next few years, 2 surgeons, one in Calcutta, Prof. UC Chakraboty and Prof. D Anjaneyulu in Hyderabad started working as full time Pediatric surgeons. In Mumbai, Delhi and Chennai, Pediatric surgery developed much later and then all over the country.

  4. Atypical disease phenotypes in pediatric ulcerative colitis

    DEFF Research Database (Denmark)

    Levine, Arie; de Bie, Charlotte I; Turner, Dan


    Definitive diagnosis of pediatric ulcerative colitis (UC) may be particularly challenging since isolated colitis with overlapping features is common in pediatric Crohn's disease (CD), while atypical phenotypes of UC are not uncommon. The Paris classification allows more accurate phenotyping...

  5. Canadian petroleum history bibliography. Release update

    Energy Technology Data Exchange (ETDEWEB)

    Cass, D.


    The petroleum history bibliography was created over several years as a record dedicated to preserving the history of the Canadian petroleum industry. It comprises a list of more than 5000 publications, including books, theses, films, audio tapes, published articles and stories of the many companies that have come and gone. It aims to include all publications and audio visual products from the Social Sciences and Humanities on company histories, biographies, autobiographies, fiction, poetry and humour. An author index is included. Most government documents are excluded as they are accessible through Library and Archives Canada. This bibliography is an ongoing piece of work, and welcomes any additions relating to the study and preservation of Canadian petroleum industry history.

  6. Webpages on copyright in Canadian academic libraries

    Directory of Open Access Journals (Sweden)

    Tony G Horava


    Full Text Available Academic libraries value the web as being a vital channel for communicating information and policies to their user community. Designing a webpage on copyright is a challenging task that requires a consideration of the medium and the message. This article proposes a conceptual model and proactive approach for integrating policy objective and goals into the development of a copyright webpage, based on key elements of the library’s involvement in academia. To complement this theoretical approach, an analysis of Canadian academic library websites was conducted in order to gage the effectiveness of copyright webpages, in the Canadian legal context, according to the model as well as related design issues of visibility and access.

  7. Common pediatric epilepsy syndromes. (United States)

    Park, Jun T; Shahid, Asim M; Jammoul, Adham


    Benign rolandic epilepsy (BRE), childhood idiopathic occipital epilepsy (CIOE), childhood absence epilepsy (CAE), and juvenile myoclonic epilepsy (JME) are some of the common epilepsy syndromes in the pediatric age group. Among the four, BRE is the most commonly encountered. BRE remits by age 16 years with many children requiring no treatment. Seizures in CAE also remit at the rate of approximately 80%; whereas, JME is considered a lifelong condition even with the use of antiepileptic drugs (AEDs). Neonates and infants may also present with seizures that are self-limited with no associated psychomotor disturbances. Benign familial neonatal convulsions caused by a channelopathy, and inherited in an autosomal dominant manner, have a favorable outcome with spontaneous resolution. Benign idiopathic neonatal seizures, also referred to as "fifth-day fits," are an example of another epilepsy syndrome in infants that carries a good prognosis. BRE, CIOE, benign familial neonatal convulsions, benign idiopathic neonatal seizures, and benign myoclonic epilepsy in infancy are characterized as "benign" idiopathic age-related epilepsies as they have favorable implications, no structural brain abnormality, are sensitive to AEDs, have a high remission rate, and have no associated psychomotor disturbances. However, sometimes selected patients may have associated comorbidities such as cognitive and language delay for which the term "benign" may not be appropriate.

  8. Pediatric brain death determination. (United States)

    Mathur, Mudit; Ashwal, Stephen


    Clinical guidelines for the determination of brain death in children were first published in 1987. These guidelines were revised in 2011 under the auspices of the Society of Critical Care Medicine, the American Academy of Pediatrics, and the Child Neurology Society, and provide the minimum standards that must be satisfied before brain death can be declared in infants and children. After achieving physiologic stability and exclusion of confounders, two examinations including apnea testing separated by an observation period (24 hours for term newborns up to 30 days of age, and 12 hours for infants and children from 31 days up to 18 years) are required to establish brain death. Apnea testing should demonstrate a final arterial PaCO2 20 mm Hg above the baseline and ≥ 60 mm Hg with no respiratory effort during the testing period. Ancillary studies (electroencephalogram and radionuclide cerebral blood flow) are not required to establish brain death and are not a substitute for the neurologic examination. The committee concluded that ancillary studies may be used (1) when components of the examination or apnea testing cannot be completed, (2) if uncertainty about components of the neurologic examination exists, (3) if a medication effect may be present, or (4) to reduce the interexamination observation period. When ancillary studies are used, a second clinical examination and apnea test should still be performed and components that can be completed must remain consistent with brain death.

  9. Morbidity Experiences and Disability Among Canadian Women (United States)

    DesMeules, Marie; Turner, Linda; Cho, Robert


    Health Issue Women are more frequently affected by chronic conditions and disability than men. Although some of these sex differences have been in part attributed to biological susceptibility, social determinants of health and other factors, these gaps have not been fully explained in the current literature. This chapter presents comparisons of hospitalization rates, and the prevalence of chronic conditions and physical disability between Canadian women and men and between various subgroups of women, adjusting for selected risk factors. The Canadian Hospital Morbidity Database (2000–2001) and Canadian Community Health Survey (2000–2001) were used to examine inpatient hospital morbidity, prevalence of chronic conditions and disability. Key Findings Hospitalization rates were 20% higher among women than men. This was due to the large number of hospitalizations for pregnancies and childbirth. When "normal" deliveries were excluded, hospitalization rates remained higher among women. Women had slightly lower rates of hospitalizations for ambulatory-care sensitive conditions than men. Prevalence of activity limitation (mild and severe) was higher among women than men, and differences remained after adjusting for age, chronic conditions, socio-economic status, and smoking. Women who reported a disability were less likely than men to be in a partnered relationship, have less tangible social support, and have lower income and employment rates. Data Gaps and Recommendations The impact of morbidity and disability on Canadian women is substantial. These results identify areas for interventions among more vulnerable subgroups, and point to the need for further research in the area of risk factors for the prevention of morbidity and disability in the population. PMID:15345073

  10. Canadian mercury inventories: the missing pieces

    Energy Technology Data Exchange (ETDEWEB)

    Hagreen, L.A.; Lourie, B.A. [Summerhill Group, Toronto, ON (Canada)


    Research was conducted to determine the significance of the deliberate use of mercury in products in Canada and the associated releases from these sources. Through a combination of literature review and new calculations, the reservoir, flux, and releases of mercury from eight product sources were calculated, and these results compared to historical Canadian inventories. Mercury contributions from the waste sector were also assessed and compared to total Canadian mercury releases and to mercury releases from coal-fired generating stations. Results suggest the use and release of mercury associated with its use in products is 4.5 times what previous inventories indicate. Including dental amalgam and sewage sludge, the total releases of mercury to all environmental compartments in Canada totals 20 tonnes per year. This accounts for less than one-half of the 44 tonnes per year of mercury released from mercury waste disposal each year in Canada. Waste mercury contributions from hazardous waste imports, unknown product sources, and incomplete information on the use of mercury in known products may account for this discrepancy. Waste-related mercury releases and transfers for disposal and recycling are 11 times greater than that of electricity generation in Canada. Results indicate that Canadian inventories have underestimated the significance of mercury use and release associated with products, calling into question the current priorities for mercury management. This paper was developed as part of a panel session at the International Joint Commission 'Mercury in the Ecosystem' workshop, February 26-27, 2003, Windsor, ON, Canada, as a complement to the information on Canadian Inventories presented by Luke Trip (Senes Consulting, Ottawa, ON, Canada).

  11. Canadian Multiculturalism, Same as it ever Was?

    Directory of Open Access Journals (Sweden)

    Kathleen Hoyos


    Full Text Available After the Second World War ended, Canada was no longer mainly composed of its two dominant ethnocultural groups, French and English, but rather constituted by polyethnicity; meaning, Canadian culture was made up of many different ethnic groups. Since then, Canada has actively embraced multiculturalism and on 12 July 1988, the House of Commons passed Bill C-93, ‘An Act for the preservation and enhancement of multiculturalism in Canada’. The Canadian multicultural experience has been much portrayed as a celebration of ethnicity where different cultural groups share their customs and learn from each other. However, it is recently being rumoured that the multiculturalism hype is not all it is cut out to be and segregates communities rather than integrate. According to Canadian authors Keith Banting and Will Kymlicka, “in much of the world and particularly in Europe, there is a widespread perception that multiculturalism has failed” (44. In this paper, I examine some recent common issues of concern, especially, racism and discrimination, through the literary expression of Canadian playwrights and writers such as George F. Walker, Cecil Foster, and Mordecai Richler. These writers are not meant to represent any ethnic group as a whole, but rather try to project a general feeling about the nation in individual ways. I will finally explore the idea of how perhaps multiculturalism in Canada is evolving into another state since migratory patterns and the social circumstances that Canada is facing in the 21st century have changed. Today, the idea of celebrating different ethnicities and customs is no longer as important as celebrating the transcultural or “transnational” aspects of relations between individuals and groups of immigrants.

  12. The Canadian Assessment of Physical literacy

    DEFF Research Database (Denmark)

    Francis, Claire E; Longmuir, Patricia E; Boyer, Charles


    Background: The Canadian Assessment of Physical Literacy (CAPL) was conceptualized as a tool to monitor children's physical literacy. The original model (fitness, activity behavior, knowledge, motor skill) required revision and relative weights for calculating/interpreting scores were required....... Methods: Nineteen childhood physical activity/fitness experts completed a 3-round Delphi process. Round 1 was open-ended questions. Subsequent rounds rated statements using a 5-point Likert scale. Recommendations were sought regarding protocol inclusion, relative importance within composite scores...

  13. Canadian Light Infantry in Adaptive Dispersed Operations (United States)


    Sources Bercuson, David . Significant Incident: Canada’s Army, the Airborne and the murder in Somalia. Toronto: McClelland and Stewart, 1996. Bernier...36 David Bercuson, Significant Incident: Canada’s Army, the Airborne and the Murder in Somalia...Toronto: McClelland and Stewart, 1996), 54-58. 37 Bernd Horn and M. Wyczynski, Hook-up! The Canadian Airborne Compendium (St.Catharines: Vanwell

  14. Pediatric neurosurgery: pride and prejudice. (United States)

    Winston, K R


    Pediatric neurosurgery now exists as a member of the family of neurosurgery with its own training programs, process of accreditation, national and international conferences and scientific journals. The relentless expansion of science relevant to the practice of neurosurgery and the changing patterns of neurosurgical practice have driven and continue to drive the juggernaut of evolutionary process which sometimes necessitates the birth of new specialties of practice. The history and the development of neurosurgery as they relate to children are presented. There is no more reason to think that the established specialty of pediatric neurosurgery or the patients under the care of pediatric neurosurgeons would benefit from the collapsing of pediatric neurosurgery back into the general neurosurgical fold than to think that all of neurosurgery, and hence all patients cared for by neurosurgeons, would benefit from the return of organized neurosurgery to its general surgical parent. Just as mankind benefits from the steady advancement of all aspects of neurosurgery, children benefit from the existence and steady advancement of pediatric neurosurgery.

  15. Personalized assent for pediatric biobanks. (United States)

    Giesbertz, Noor A A; Melham, Karen; Kaye, Jane; van Delden, Johannes J M; Bredenoord, Annelien L


    Pediatric biobanking is considered important for generating biomedical knowledge and improving (pediatric) health care. However, the inclusion of children's samples in biobanks involves specific ethical issues. One of the main concerns is how to appropriately engage children in the consent procedure. We suggest that children should be involved through a personalized assent procedure, which means that both the content and the process of assent are adjusted to the individual child. In this paper we provide guidance on how to put personalized assent into pediatric biobanking practice and consider both the content and process of personalized assent. In the discussion we argue that the assent procedure itself is formative. Investing in the procedure should be a requirement for pediatric biobank research. Although personalized assent will require certain efforts, the pediatric (biobank) community must be aware of its importance. The investment and trust earned can result in ongoing engagement, important longitudinal information, and stability in/for the research infrastructure, as well as increased knowledge among its participants about research activity. Implementing personalized assent will both respect the child and support biobank research.

  16. Science Traverses in the Canadian High Arctic (United States)

    Williamson, Marie-Claude


    The presentation is divided into three parts. Part I is an overview of early expeditions to the High Arctic, and their political consequences at the time. The focus then shifts to the Geological Survey of Canada s mapping program in the North (Operation Franklin), and to the Polar Continental Shelf Project (PCSP), a unique organization that resides within the Government of Canada s Department of Natural Resources, and supports mapping projects and science investigations. PCSP is highlighted throughout the presentation so a description of mandate, budgets, and support infrastructure is warranted. In Part II, the presenter describes the planning required in advance of scientific deployments carried out in the Canadian High Arctic from the perspective of government and university investigators. Field operations and challenges encountered while leading arctic field teams in fly camps are also described in this part of the presentation, with particular emphasis on the 2008 field season. Part III is a summary of preliminary results obtained from a Polar Survey questionnaire sent out to members of the Arctic research community in anticipation of the workshop. The last part of the talk is an update on the analog program at the Canadian Space Agency, specifically, the Canadian Analog Research Network (CARN) and current activities related to Analog missions, 2009-2010.

  17. Canadian oil and gas survey 1998

    Energy Technology Data Exchange (ETDEWEB)

    Roberge, R.B. [ed.


    The year 1997 brought record levels of financing for the Canadian oil and gas industry which led to record levels of capital spending and unprecedented merger and acquisition activity. Production records were achieved, but soft commodity prices in the fourth quarter resulted in a significant downturn in the equity markets. El Nino reduced demand for natural gas and heating oil, resulting in increased storage levels for both commodities. Record drilling and capital spending fueled the Canadian oilfield service industry as total market capitalization rose to $10 billion. As for the 1998 outlook, the industry has turned to natural gas as the favoured commodity, as indicated by the conclusion of the Alliance pipeline hearings and the Nova/TCPL merger. This survey presents a review of crude oil and natural gas production, prices, and capital spending for development and exploratory wells, and the financial and operating results for fiscal year 1997 of selected oil and gas companies and income trusts. All listed companies are Canadian public companies, or publicly traded income trusts, traded on one of the country`s four major stock exchanges. They are ranked according to gross oil and gas production revenue only (before royalties). Syncrude and oil sands production is also included. The remaining data in the financial statistics tables includes all business segments of each company included. The survey excluded companies that were wholly-owned subsidiaries, divisions or U.S. subsidiaries and private companies. tabs., figs.

  18. Create an Emergency Kit (United States)

    ... Rights to Education: IEPs and 504s Teacher Perspectives Homeschooling Camps Pediatric Transplant PPHN (persistent pulmonary hypertension of ... Rights to Education: IEPs and 504s Teacher Perspectives Homeschooling Camps Pediatric Transplant PPHN (persistent pulmonary hypertension of ...

  19. 2009 Pediatric Academic Societies Annual Meeting

    Institute of Scientific and Technical Information of China (English)


    @@ Pediatric experts from Children's National Medical Center are being featured in 85 presentations, workshops, and posters at the 2009 Pediatric Academic Societies Annual Meeting-the largest meeting for pediatric clinical research in the country, May 2-5, Baltimore, Maryland.

  20. Japanese consensus guidelines for pediatric nuclear medicine. Part 1: Pediatric radiopharmaceutical administered doses (JSNM pediatric dosage card). Part 2: Technical considerations for pediatric nuclear medicine imaging procedures. (United States)

    Koizumi, Kiyoshi; Masaki, Hidekazu; Matsuda, Hiroshi; Uchiyama, Mayuki; Okuno, Mitsuo; Oguma, Eiji; Onuma, Hiroshi; Kanegawa, Kimio; Kanaya, Shinichi; Kamiyama, Hiroshi; Karasawa, Kensuke; Kitamura, Masayuki; Kida, Tetsuo; Kono, Tatsuo; Kondo, Chisato; Sasaki, Masayuki; Terada, Hitoshi; Nakanishi, Atsushi; Hashimoto, Teisuke; Hataya, Hiroshi; Hamano, Shin-ichiro; Hirono, Keishi; Fujita, Yukihiko; Hoshino, Ken; Yano, Masayuki; Watanabe, Seiichi


    The Japanese Society of Nuclear Medicine has recently published the consensus guidelines for pediatric nuclear medicine. This article is the English version of the guidelines. Part 1 proposes the dose optimization in pediatric nuclear medicine studies. Part 2 comprehensively discusses imaging techniques for the appropriate conduct of pediatric nuclear medicine procedures, considering the characteristics of imaging in children.

  1. Installation of the Canadian Muon Cargo Inspection System at CRL (United States)


    Installation of the Canadian Muon Cargo Inspection System at CRL Prepared by: Guy Jonkmans Atomic Energy of Canada Limited Chalk River ON...INSTALLATION OF THE CANADIAN MUON CARGO INSPECTION SYSTEM AT CRL 153-30100-REPT-001 Revision 0 2013/02/19 UNRESTRICTED 2013/02/19 ILLIMITÉ 153...30100-REPT-001 2013/02/19 Report, General Installation of the Canadian Muon Cargo Inspection System at CRL Research and Development 153-30100

  2. Should investors prefer Canadian hedge funds or stocks?


    Ma, Xiao Yan; Zhou, Weihui


    This paper updates Brulhart and Klein (2006) by comparing the magnitude of extreme returns from Tremont, HFRI hedge fund indices with stock indices. It also compares the magnitude of extreme returns from Canadian hedge fund indices with stock indices. We found that the results from Brulhart and Klein hold for the updated US data. However, the results do not hold for the Canadian hedge fund indices. The magnitude of extreme returns from Canadian hedge fund indices is lower than the magnitude o...

  3. Predictors of Outcome of Convulsive Status Epilepticus Among an Egyptian Pediatric Tertiary Hospital. (United States)

    Halawa, Eman F; Draz, Iman; Ahmed, Dalia; Shaheen, Hala A


    Convulsive status epilepticus is a common neurologic emergency in pediatrics. We aimed to study the etiology, clinical features, and prognostic factors among pediatric patients with convulsive status epilepticus. Seventy patients were included in this cohort study from pediatric emergency department of the specialized Children Hospital of Cairo University. The outcome was evaluated using the Glasgow Outcome Score. Acute symptomatic etiology was the most common cause of convulsive status epilepticus. Refractory convulsive status epilepticus was observed more significantly in cases caused by acute symptomatic etiologies. The outcome was mortality in 26 (37.1%) patients, severe disability in 15 (21.4%), moderate disability in 17 (24.3%), and good recovery in 12 (17.1%) patients. The significant predictor of mortality was lower modified Glasgow Coma Scale score on admission, whereas lower modified Glasgow Coma Scale score on admission and refractory convulsive status epilepticus were the significant predictors for disability and mortality.

  4. Pediatric lateral atlantodental interval: how much asymmetry is normal? (United States)

    Borders, Heather L; Junewick, Joseph J; Sherwood, John M; Macke, Michael R


    Imaging of the cervical spine is commonly performed in the pediatric patient population, typically after trauma, as well as for a variety of nontraumatic reasons. There are many challenges in the interpretation of these studies, particularly at the level of the atlantoaxial joint. We recognized a particular problem with assessing the lateral atlantodental interval in our emergency radiology department. Mild lateral atlantodental interval asymmetry in relatively asymptomatic patients was being interpreted as indicative of atlantoaxial rotatory fixation, which leads to the recommendation for dynamic computed tomographic examinations. The goal of this study was to define the reference range of the lateral atlantodental interval in pediatric patients to help avoid misinterpretation of radiographic findings and resultant excessive imaging.

  5. Parental Vaccine Hesitancy: Clinical Implications for Pediatric Providers. (United States)

    Barrows, Meagan A; Coddington, Jennifer A; Richards, Elizabeth A; Aaltonen, Pamela M


    Despite being recognized as one of the greatest public health achievements, vaccines are increasingly under scrutiny for a multitude of reasons. "Parental vaccine hesitancy," an emerging term in today's literature, encompasses a wide range of concerns regarding vaccines and is believed to be responsible for decreasing coverage of many childhood vaccines. The threat to herd immunity posed by poor vaccine uptake increases the risk for resurgence of vaccine-preventable diseases. Pediatric primary health care providers have an obligation to respond to the increasing prevalence of vaccine hesitancy by providing education related to vaccines to ensure the safety and health of the population. The purpose of this article is to examine the most common concerns surrounding vaccine hesitancy and outline strategies for pediatric providers to address concerns with parents in the clinical setting.

  6. Nanomedicine as an innovative therapeutic strategy for pediatric lung diseases. (United States)

    Tian, Ye; Chen, Jian; Zahtabi, Fatemeh; Keijzer, Richard; Xing, Malcolm


    Nanomedicine is a rapidly emerging technology and represents an innovative field for therapy. Nanomaterials have intrinsically defined features for biomedical applications due to the high specific surface area, the amazing diversity, versatility in structure and function and the possibility of surface charge. In particular, the functionalization of targeting or stimuli-responsive unit on the surface of these materials gives them specific targeted therapeutic properties. There are many pediatric lung diseases that could potentially benefit from nanomedicine. Herein, we aim to review various drug carrier systems and release systems specifically targeting pediatric lung diseases. The injection of nanomedicine into in vivo models and their elimination will also be discussed. Finally, the potential toxicity of nanomaterials will be addressed.

  7. MicroRNAs and Recent Insights into Pediatric Ovarian Cancers

    Directory of Open Access Journals (Sweden)

    Jessica Anne Crawford


    Full Text Available Ovarian cancer is the most common pediatric gynecologic malignancy. When diag-nosed in children, ovarian cancers present unique challenges that differ dramatically from those faced by adults. Here, we review the spectrum of ovarian cancers found in young women and girls and discuss the biology of these diseases. A number of advances have re-cently shed significant new understanding on the potential causes of ovarian cancer in this unique population. Particular emphasis is placed on understanding how altered expression of non-coding RNA transcripts known as microRNAs play a key role in the etiology of ovarian germ cell and sex cord-stromal tumors. Emerging transgenic models for these diseases are also reviewed. Lastly, future challenges and opportunities for understanding pediatric ovarian cancers, delineating clinically useful biomarkers and developing targeted therapies are discussed.

  8. Tropical pediatrics: 2002 to 2015. (United States)

    Santos Ocampo, Perla D; Santos Ocampo-Padilla, Cynthia


    It also presents the challenges that confront children in the tropics and their effects on the health of these children. These challenges include the technology divide, economic disparity, ecological changes, urbanization and industrialization, globalization, political instability, population explosion, and gender inequality. The paper paints a scenario of tropical pediatrics into the year 2015. Problems brought about by both underdevelopment and modernization, with urbanization and industrialization, will persist. Infectious diseases will continue to be the leading causes of deaths. The paper presents some significant achievements in the fight against tropical diseases and tries to predict what future progress will contribute to the alleviation of such diseases. The paper also outlines the commitment of the International Society of Tropical Pediatrics (ISTP) to improve the state of tropical pediatrics in the next 15 years.

  9. Patterns of Pediatric Maxillofacial Injuries. (United States)

    Bede, Salwan Yousif Hanna; Ismael, Waleed Khaleel; Al-Assaf, Dhuha


    Facial trauma in children and adolescents is reported to range from 1% to 30%. Because of many anatomical, physiological, and psychological characteristics of the pediatric population, maxillofacial injuries in children should be treated with special consideration that is attributable to certain features inherent in facial growth patterns of children. This study evaluated maxillofacial injuries in 726 children in terms of incidence, patterns of injury, causes, and treatment modalities and compared these parameters among 3 pediatric age groups. Intergroup differences were analyzed using Z test for 2 populations' proportion. The results showed that the incidence of pediatric maxillofacial injuries and fractures is higher than that reported elsewhere with male predominance. Soft tissue injuries are more frequently encountered in younger individuals, whereas the incidence of skeletal injuries increases with age. This study also revealed that certain etiologies, namely road traffic accidents, violence, bicycle, missiles, and industrial injures, increase with age; on the other hand, falls and puncture wounds are more common in younger children.

  10. Emerging Hopes

    Institute of Scientific and Technical Information of China (English)


    China looks to strategically important emerging industries for innovation-driven economic growthc hina will soon announce a decision to rev up seven strategically impor- tant emerging industries,said the National

  11. Emergency contraception (United States)

    Morning-after pill; Postcoital contraception; Birth control - emergency; Plan B; Family planning - emergency contraception ... prevents pregnancy in the same way as regular birth control pills: By preventing or delaying the release of an ...

  12. [Perception of medical emergencies in a private pediatric hospital]. (United States)

    González-López, Ramón Antonio; Iglesias-Leboreiro, José; Bernárdez-Zapata, Maria Isabel; Testas-Hermo, Manuel; Rendón-Macías, Mario Enrique


    Introducción: el objetivo de este trabajo es conocer si la atención de los niños enfermos a su ingreso, coincide con percepción de urgencia real de parte de los padres con la del médico y no por la inquietud percibida en los familiares (urgencias sentidas). Métodos: se analizaron todas las atenciones otorgadas en el servicio de urgencias, del 1 enero del 2009 al 31 diciembre del 2010. Se determinó una urgencia real por consenso según las condiciones del menor. Se compararon las condiciones sociodemográficas de la urgencias reales contra las sentidas. Resultados: se otorgaron 8888 consultas, de las cuales 2024 (22.7 %) cumplieron criterios de urgencias reales. Las principales causas de urgencias reales fueron los procesos infecciosos seguidos de accidentes e intoxicaciones. De las urgencias reales 17 (1 %) requirieron finalmente manejo intensivo. Los factores asociados con una urgencia real fueron: la edad, enfermedades no infecciosas, ocurrencia entre el lunes a viernes, en el turno matutino y en los meses de invierno. Conclusiones: La frecuencia de atención de urgencias reales fue baja para lo informado en otros centros pediátricos. La restructuración de los servicios de preconsulta para la aplicación de una clasificación óptima de pacientes antes de pasar a urgencias ayudaría en gran medida al aprovechamiento máximo del servicio de urgencias, derivando desde antes la entrada de pacientes que realmente lo ameritan.

  13. Recognizing victims of human trafficking in the pediatric emergency department. (United States)

    Becker, Heather J; Bechtel, Kirsten


    Human trafficking is a form of modern-day slavery that is rapidly expanding in the United States and throughout the world. It is a crime under both the United States and international law. The child and adult victims of human trafficking are denied their basic human rights and subjected to unspeakable physical and emotional harm. Traffickers exert complete control over their victims and are proficient at hiding their condition from authorities. Healthcare practitioners may be the only professionals who come into contact with victims if they present for medical care. This article will describe human trafficking and its potential victims, as well as guide medical management and access to services that will ensure their safety and restore their freedom.

  14. Methylisothiazolinone: An Emergent Allergen in Common Pediatric Skin Care Products

    Directory of Open Access Journals (Sweden)

    Megan J. Schlichte


    Full Text Available Recalcitrant dermatitis, such as that of the hands, face, or genitals, may be due to allergic contact dermatitis (ACD from ingredients in seemingly innocuous personal care products. Rising rates of allergy have been noted due to the preservative methylisothiazolinone (MI. This preservative is commonly found in skin and hair care products, especially wipes. This study evaluated the use of MI in products specifically marketed for babies and children and examined the associated marketing terms of such products. Ingredients of skin care products specifically marketed for babies and children were surveyed at two major retailers. Of 152 products surveyed, 30 products contained MI. Categories of products surveyed included facial or body wipes, antibacterial hand wipes, hair products, soaps, bubble baths, moisturizers, and sunscreens. Facial or body wipes and hair products were the categories with the greatest number of MI-containing products. MI-containing products were manufactured by a number of popular brands. Of note, products marketed as “gentle,” “sensitive,” “organic,” or “hypoallergenic” often contained MI, thus emphasizing the importance of consumer scrutiny of product choices. These findings reinforce the importance of educating parents and providing consumer decision-making advice regarding common skin care products, in order to help prevent ACD in children.

  15. Cross-language acoustic similarity predicts perceptual assimilation of Canadian English and Canadian French vowels. (United States)

    Escudero, Paola; Vasiliev, Polina


    Monolingual Peruvian Spanish listeners identified natural tokens of the Canadian French (CF) and Canadian English (CE) /ɛ/ and /æ/, produced in five consonantal contexts. The results demonstrate that while the CF vowels were mapped to two different native vowels, /e/ and /a/, in all consonantal contexts, the CE contrast was mapped to the single native vowel /a/ in four out of five contexts. Linear discriminant analysis revealed that acoustic similarity between native and target language vowels was a very good predictor of context-specific perceptual mappings. Predictions are made for Spanish learners of the /ɛ/-/æ/ contrast in CF and CE.

  16. Obstructive Sleep Apnea and Driving: A Canadian Thoracic Society and Canadian Sleep Society Position Paper

    Directory of Open Access Journals (Sweden)

    Najib Ayas


    Full Text Available Individuals with obstructive sleep apnea (OSA experience sleep fragmentation and poor sleep quality that results in daytime sleepiness, which impairs performance during driving and leads to an increased risk for collisions. Not surprisingly, observational studies have shown that patients with OSA experience a two- to 10-fold higher risk for collision compared with healthy controls. Although treatment would clearly mitigate these risks, there is no current Canadian position on driving and OSA. This article, the first Canadian position statement addressing the issue, provides an overview of provincial regulations and proposes recommendations with regard to driving in patients with OSA.

  17. Pediatric health, medicine, and therapeutics

    Directory of Open Access Journals (Sweden)

    Claire E Wainwright


    Full Text Available Claire E Wainwright1,21Royal Children’s Hospital, Brisbane and Queensland, Queensland, Australia; 2Queensland Children’s Medical Research Institute, The University of Queensland, Brisbane, AustraliaThe idea of children as small adults with health care needs that can be managed by extrapolation from adult studies has now largely been abandoned. We now recognize that adult health and disease are closely linked to childhood factors and the critical and ethical importance of clinical research in pediatrics is increasingly being recognized.  While funding and output from pediatric clinical research continues to lag behind health research in adults, particularly in the area of therapeutics, the last decade has thankfully seen a dramatic increase in the number of pediatric studies and particularly randomized controlled clinical trials (RCTs. Since the 1997 Food and Drug Administration (FDA Modernization Act in the United States (US and the subsequent changes in drug registration regulatory systems in the US and Europe, there has been a huge increase in the number of pediatric studies sponsored by pharmaceutical companies. In the United Kingdom, the Medicine for Children’s Research Network was established in 2005 to address the lack of clinical studies in pediatrics. Over the first five years they reported an exciting increase in the number of high quality clinical studies and on their website they have a current portfolio of over 200 pediatric studies, half of which are RCTs and half are sponsored by pharmaceutical companies. Other countries particularly across Europe are also establishing similar programs. 

  18. Emergent Expertise? (United States)

    McGivern, Patrick


    The concept of emergence appears in various places within the literature on expertise and expert practice. Here, I examine some of these applications of emergence in the light of two prominent accounts of emergence from the philosophy of science and philosophy of mind. I evaluate these accounts with respect to several specific contexts in which…

  19. Advances in Pediatric Gastrostomy Placement. (United States)

    McSweeney, Maireade E; Smithers, C Jason


    Placement of gastrostomy tubes in infants and children has become increasingly commonplace. A historical emphasis on use of open gastrostomy has been replaced by less invasive methods of placement, including percutaneous endoscopic gastrostomy and laparoscopically assisted gastrostomy procedures. Various complications, ranging from minor to the more severe, have been reported with all methods of placement. Many pediatric patients who undergo gastrostomy tube placement will require long-term enteral therapy. Given the prolonged time pediatric patients may remain enterally dependent, further quality improvement and education initiatives are needed to improve long-term care and outcomes of these patients.

  20. Pharmacologic Treatment of Pediatric Hypertension. (United States)

    Dhull, Rachita S; Baracco, Rossana; Jain, Amrish; Mattoo, Tej K


    Prevalence of hypertension is increasing in children and adolescents. Uncontrolled hypertension in children not only causes end organ damage but also increases the risk of adult hypertension and cardiovascular disease. Clinical trials have proven efficacy of antihypertensive medications in children. These medications are well tolerated by children with acceptable safety profile. The choice of agent is usually driven by underlying etiology of hypertension, profile of its side effects, and clinician's preference. This article will review currently available pediatric data on mechanism of action, common adverse effects, pediatric indication, recent clinical trial, and newer drugs in the common classes of antihypertensive medications.