WorldWideScience

Sample records for general pediatric clinic

  1. Population-Based Pediatric Reference Intervals in General Clinical Chemistry: A Swedish Survey.

    Science.gov (United States)

    Ridefelt, Peter

    2015-01-01

    Very few high quality studies on pediatric reference intervals for general clinical chemistry and hematology analytes have been performed. Three recent prospective community-based projects utilising blood samples from healthy children in Sweden, Denmark and Canada have substantially improved the situation. The Swedish survey included 701 healthy children. Reference intervals for general clinical chemistry and hematology were defined.

  2. A survey of dental treatment under general anesthesia in a Korean university hospital pediatric dental clinic.

    Science.gov (United States)

    Shin, Bisol; Yoo, Seunghoon; Kim, Jongsoo; Kim, Seungoh; Kim, Jongbin

    2016-09-01

    In South Korea, the number of cases of dental treatment for the disabled is gradually increasing, primarily at regional dental clinics for the disabled. This study investigated pediatric patients at a treatment clinic for the disabled within a university hospital who received dental treatment under general anesthesia. This data could assist those that provide dental treatment for the disabled and guide future treatment directions and new policies. This study was a retrospective analysis of 263 cases in which patients received dental treatment under general anesthesia from January 2011 to May 2016. The variables examined were gender, age, reason for anesthesia, type of disability, time under anesthesia, duration of treatment, type of procedure, treatment details, and annual trends in the use of general anesthesia. Among pediatric patients with disabilities who received dental treatment under general anesthesia, the most prevalent age group was 5-8 years old (124 patients, 47.1%), and the primary reason for administering anesthesia was dental anxiety or phobia. The mean time under anesthesia was 132.7 ± 77.6 min, and the mean duration of treatment was 101.9 ± 71.2 min. The most common type of treatment was restoration, accounting for 158 of the 380 treatments performed. Due to increasing demand, the number of cases of dental treatment performed under general anesthesia is expected to continue increasing, and it can be a useful method of treatment in patients with dental anxiety or phobia.

  3. Frequency of genetic diseases and health coverage of children requiring admission in a general pediatric clinic of northern Greece

    Directory of Open Access Journals (Sweden)

    Lialiaris Theodoros

    2010-01-01

    Full Text Available Abstract Background In order to estimate the causes of pediatric morbidity in our area, with particular emphasis on diseases with a genetic background, we retrospectively categorized the admissions of all children hospitalized in the Department of Pediatrics of the University General Hospital of Alexandroupolis, in the area of Evros, Thrace, Greece over the three year period 2005-2007. Finally, in order to guide health care administrators to improve the delivery of pediatric health care services, we estimated the percentage of hospitalized children who were uninsured and the type of health insurance of those who had medical coverage. Patients and Methods The causes of admission, as recorded in the medical records were categorized in terms of the major organ and/or system involved and/or the underlying pathology, with emphasis on diseases with a genetic background. Duplicate admissions, i.e., admissions of the same child for the same underlying disease were excluded. Additional information recorded was age, sex, and type of health insurance of all admitted children. Distribution of the causes of admission by study year was compared by chi-square. A p value Results Over the study period, there were 4,947 admissions in 2,818 boys and 2,129 girls. Respiratory diseases were the most common accounting for 30%, while infectious diseases followed with 26.4%. The frequency of chromosomal abnormalities among the hospitalized children was only 0.06%. However, if we consider diseases with an underlying genetic background, this percentage rises to 5%. Approximately 10.3% of the admitted children had no health insurance. Conclusions The percentage of children hospitalized in our area due to a disease with an underlying genetic background was 5%. This percentage pertains to a Department of Pediatrics that has no inpatient subspecialty units and which is located within a General hospital, because hospitalizations for genetic diseases are more frequent in

  4. Spectrum of digestive tract diseases 1985-1987 at the Pediatric Gastroenterology Outpatient Clinic of Dr. Pirngadi General Hospital, Medan.

    Science.gov (United States)

    Siregar, C D; Sinuhaji, A B; Sutanto, A H

    1990-01-01

    A retrospective study has been done on infants and children attending to the Pediatric Gastroenterology Outpatient Clinic of Dr. Pirngadi General Hospital in Medan, from 1985 through 1987. During the study there were 874 patients, 477 (54.58%) suffered from diarrhea, 209 (23.91%) had bloody stool, 20 (2.99%) jaundice, 57 (6.52%) abdominal pain, 48 (5.49%) abdominal distention, 30 (3.43%) vomiting, 13 (1.49%) constipation, and 20 (2.29%) others. Of all cases with diarrhoea, watery diarrhoea were found in only 319 (66.88%), diarrhoea with vomiting 84 (17.61%), and bloody diarrhoea 74 (15.51%). Stool examination in patients with diarrhoea revealed 144 (30.19%) cases with Candida albicans, while 16 (3.35%) of them with steatorrhoea. Of 63 patients with diarrhoea on which the clinitest had been performed, sugar intolerance were found in 30 (47.62%) cases.

  5. [Clinical and epidemiological characteristics of humeral supracondylar fractures in pediatric patients in a Regional General Hospital].

    Science.gov (United States)

    Barrón-Torres, Erika Alejandrina; Sánchez-Cruz, Juan Francisco; Cruz-Meléndez, José Ramses

    2015-01-01

    Supracondylar humerus fractures are common in children between 5-7 years of age and more frequent in the males, 90-95% of these fractures are in extension mechanism, the urgency of immediate attention is to prevent complications and sequelae. To establish the clinical and epidemiological profile of supracondylar humerus fractures, in a General Regional Hospital from the Instituto Mexicano del Seguro Social in Yucatan Mexico, during 2011-2013. A cross-sectional study. Strength association was measured by odds ratios and statistical significance with chi(2) test, p value was considered in < 0.05 RESULTS: 56 cases were analyzed, the mean age was 2.6 ± 5.33 years, the mechanism of injury was falling over at home, male gender is associated with extent injure mechanism (OR 5.6, 95% CI 1.0-30.1, p = 0.03), we observed that at most time elapsed between injury and medical means more hospital days (r = 0.40; p = 0.002), surgical treatment was established in 44 cases (78.6%), 18 (40.9%) with closed technique and placement of cloves and 26 (59.1%) with open reduction, in 100% cross configuration was used, ten complications were reported. Supracondylar humerus fractures are a common injury in children, males are more likely to be injured by extension, and the speed in medical treatment is an important issue. Copyright © 2015. Published by Masson Doyma México S.A.

  6. Integration of pediatric mental health in general pediatrics in eritrea ...

    African Journals Online (AJOL)

    Integration of pediatric mental health in general pediatrics in eritrea: improving ... where integration of such services within the primary health care framework has not ... and 10% had behaviour disorders predominantly attention deficit disorder.

  7. Information Resources in Clinical Medicine: Family Practice, Pediatrics, Obstetrics and Gynecology, General Surgery, Internal Medicine.

    Science.gov (United States)

    Schwank, Jean; Allen, Joyce

    Designed for beginning health science librarians, this continuing education course syllabus presents a guide to information resources for answering physicians' questions about patient care. Sources from standard core lists, such as the Alfred Brandon list, are highlighted and described, along with additional titles. General resources covered…

  8. 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)

    2007-07-15

    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.)

  9. Complications in common general pediatric surgery procedures.

    Science.gov (United States)

    Linnaus, Maria E; Ostlie, Daniel J

    2016-12-01

    Complications related to general pediatric surgery procedures are a major concern for pediatric surgeons and their patients. Although infrequent, when they occur the consequences can lead to significant morbidity and psychosocial stress. The purpose of this article is to discuss the common complications encountered during several common pediatric general surgery procedures including inguinal hernia repair (open and laparoscopic), umbilical hernia repair, laparoscopic pyloromyotomy, and laparoscopic appendectomy. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Comparison of Pediatric and General Orthopedic Surgeons? Approaches in Management of Developmental Dysplasia of the Hip and Flexible Flatfoot: the Road to Clinical Consensus

    OpenAIRE

    Ramin Haj Zargarbashi; Hirbod Nasiri Bonaki; Shayan Zadegan; Taghi Baghdadi; Mohammad Hossein Nabian; Mehdi Ramezan Shirazi

    2017-01-01

    Developmental dysplasia of the hip (DDH) and flatfoot are common pediatric orthopedic disorders, being referred to and managed by both general and pediatric orthopedic surgeons, through various modalities. Our study aimed to evaluate their consensus and perspective disagreements in terms of diagnostic and therapeutic approaches of the mentioned deformities. Forty participants in two groups of general orthopedic surgeons (GOS) (n=20) and pediatric orthopedic surgeons (POS) (n=20), were asked t...

  11. NIH Pediatric Rheumatology Clinic

    Science.gov (United States)

    ... to diagnose and treat children with arthritis, periodic fever syndromes, and rheumatic diseases. This clinic will also help doctors and ... are juvenile arthritis including spondyloarthritis, lupus, and periodic ... how juvenile rheumatic diseases affect them and what treatments work best. ...

  12. Efficacy and utility of phone call follow-up after pediatric general surgery versus traditional clinic follow-up.

    Science.gov (United States)

    Fischer, Kevin; Hogan, Virginia; Jager, Alesha; von Allmen, Daniel

    2015-01-01

    Typical follow-up for surgical procedures consists of an interim history and brief focused physical examination. These appointments occupy clinic resources, require a time investment by the family, and rarely identify problems. Previous studies have demonstrated the safety of a postoperative phone call. Compare a traditional in-person clinic postoperative visit with postoperative phone call follow-up regarding patient satisfaction, rate of successful follow-up, and clinic resource utilization in a large academic practice. A retrospective review of charts of patients who underwent select surgical procedures, along with a review of the clinic schedule for the same time period. Efficacy, patient/family satisfaction, and impact on the clinic. Families were contacted by telephone two weeks after select surgical procedures to assess for complications and questions. Cohorts of patients six months before and six months after implementation were assessed for main outcome measures. Before implementation, 55.5% of patients (427/769) who had one of the select surgical procedures were seen in the clinic postoperatively, and 62.6% (435/695) had a successful postoperative phone call follow-up. There were also 1090 overall scheduled postoperative appointments. Six months after implementation, overall postoperative appointments decreased 35.5% to 703. Overall, postoperative-scheduled visits decreased by 6% compared with new visits and other general follow-up visits, which each increased by 3%. A satisfaction survey revealed that 93% of patients (n = 231) were highly satisfied with the process. A hospital cost analysis suggested an 89% cost savings ($101.75 per patient for clinic visit vs $12.50 per patient for phone call follow-up). Postoperative phone call follow-up is an effective tool that improves patient and physician efficiency and satisfaction.

  13. Pediatric anthrax clinical management.

    Science.gov (United States)

    Bradley, John S; Peacock, Georgina; Krug, Steven E; Bower, William A; Cohn, Amanda C; Meaney-Delman, Dana; Pavia, Andrew T

    2014-05-01

    Anthrax is a zoonotic disease caused by Bacillus anthracis, which has multiple routes of infection in humans, manifesting in different initial presentations of disease. Because B anthracis has the potential to be used as a biological weapon and can rapidly progress to systemic anthrax with high mortality in those who are exposed and untreated, clinical guidance that can be quickly implemented must be in place before any intentional release of the agent. This document provides clinical guidance for the prophylaxis and treatment of neonates, infants, children, adolescents, and young adults up to the age of 21 (referred to as "children") in the event of a deliberate B anthracis release and offers guidance in areas where the unique characteristics of children dictate a different clinical recommendation from adults.

  14. [Clinical and hematologic features of pediatric leukemias].

    Science.gov (United States)

    Hasanbegović, Edo

    2006-01-01

    to present main clinical and hematologic features of pediatric leukemias treated at Hematooncologic department of Pediatric Clinic in Sarajevo during last 7 years. In retrospective study we followed up children with leukemia aged 0-15 who were treated during period of 01.01.1997-31.12.2003. at Hematooncologic department on Pediatric Clinic in Sarajevo. A total number of patient with leukemia was 130 of them 112 (83.2%) had acute lymphoblastic leukemia (ALL), 16 (12.3%) of them had acute myeloid leukemia (AML) and 2 (1.5%) patients had chronic myeloid leukemia (CML). There were 84 (64.6%) boys and 46 (35.4%) girls. Median age of newly diagnosed patients was 6 years and 4 months. Dominant clinical signs were: high temperature-72.9%, fatigue and paleness-74.8% and bone pain-87.9%. Most of the children had leucocitosis (51.5%), anemia (56.1%) and trombocitopenia (57.5%). Most frequent signs at the beginning of the illness are general symptoms like fatigue, unclear febrile state and accented bone pains. Those united signs with complete blood picture finding should be enough reason for suspicion under possible leukemia.

  15. Clinical recommendation: pediatric lichen sclerosus.

    Science.gov (United States)

    Bercaw-Pratt, Jennifer L; Boardman, Lori A; Simms-Cendan, Judith S

    2014-04-01

    Lichen sclerosus is a chronic inflammatory condition affecting the anogenital region that may present in the prepubertal or adolescent patient. Clinical presentations include significant pruritus, labial adhesions, and loss of pigmentation. Treatment includes topical anti-inflammatory agents and long-term follow-up as there is a high risk of recurrence and an increased risk of vulvar cancer in adult women with history of lichen sclerosus. These recommendations are intended for pediatricians, gynecologists, nurse practitioners and others who care for pediatric/adolescent girls in order to facilitate diagnosis and treatment.

  16. Pediatric insomnia: clinical, diagnosis, and treatment.

    Science.gov (United States)

    Miano, Silvia; Peraita-Adrados, Rosa

    2014-01-01

    Pediatric insomnia is an extrinsic sleep disorder subdivided into two categories: behavioral insomnia and insomnia related to medical, neurological, and psychiatric diseases. This review will cover several types of insomnia, comorbidities and specific pediatric therapies according to clinical characteristics and age. Behavioral insomnia should be differentiated from pediatric insomnia due to medical conditions, mostly occurring during the first year of life. Multiple night awakenings and diurnal hypersomnolence are strong indicators of insomnia due to medical conditions. Insomnia during adolescence and pediatric insomnia associated with psychiatric comorbidity, cognitive disabilities and epilepsy, will be discussed in terms of diagnosis, clinical features and implications for treatment.

  17. Psychometric Properties of the Physical Activity Questionnaire for Older Children in Italy: Testing the Validity among a General and Clinical Pediatric Population.

    Directory of Open Access Journals (Sweden)

    Erica Gobbi

    Full Text Available The purpose of this research was to assess an Italian version of the Physical Activity Questionnaire for Older Children (PAQ-C-It. Three separate studies were conducted, whereby testing general psychometric properties, construct validity, concurrent validity and the factor structure of the PAQ-C-It among general and clinical pediatric population. Study 1 (n = 1170 examined the psychometric properties, internal consistency, factor structure (exploratory factor analysis, EFA and construct validity with enjoyment perception during physical activity. Study 2 (n = 59 reported on reliability, construct validity with enjoyment and BMI, and on cross-sectional concurrent validity with objectively measured MVPA (tri-axial accelerometry over the span of seven consecutive days. Study 3 (n = 58 examined the PAQ-C-It reliability, construct validity with BMI and VO2max as the objective measurement among a population of children with congenital heart defects (CHD. In study 2 and 3, the factor structure of the PAQ-C-It was then re-examined with an EFA. The PAQ-C-It showed acceptable to good reliability (alpha .70 to .83. Results on construct validity showed moderate but significant association with enjoyment perception (r = .30 and .36, with BMI (r = -.30 and -.79 for CHD simple form, and with the VO2max (r = .55 for CHD simple form. Significant concurrent validity with the objectively measured MVPA was reported (rho = .30, p < .05. Findings of the EFA suggested a two-factor structure for the PAQ-C-It, with items 2, 3, and 4 contributing little to the total score. This study supports the PAQ-C-It as an appropriate instrument to assess the MVPA levels of Italian children, including children with simple forms of CHD. Support is given to the possible instrument effectiveness on a large international perspective in order to level out data gathering across the globe.

  18. Psychometric Properties of the Physical Activity Questionnaire for Older Children in Italy: Testing the Validity among a General and Clinical Pediatric Population.

    Science.gov (United States)

    Gobbi, Erica; Elliot, Catherine; Varnier, Maurizio; Carraro, Attilio

    2016-01-01

    The purpose of this research was to assess an Italian version of the Physical Activity Questionnaire for Older Children (PAQ-C-It). Three separate studies were conducted, whereby testing general psychometric properties, construct validity, concurrent validity and the factor structure of the PAQ-C-It among general and clinical pediatric population. Study 1 (n = 1170) examined the psychometric properties, internal consistency, factor structure (exploratory factor analysis, EFA) and construct validity with enjoyment perception during physical activity. Study 2 (n = 59) reported on reliability, construct validity with enjoyment and BMI, and on cross-sectional concurrent validity with objectively measured MVPA (tri-axial accelerometry) over the span of seven consecutive days. Study 3 (n = 58) examined the PAQ-C-It reliability, construct validity with BMI and VO2max as the objective measurement among a population of children with congenital heart defects (CHD). In study 2 and 3, the factor structure of the PAQ-C-It was then re-examined with an EFA. The PAQ-C-It showed acceptable to good reliability (alpha .70 to .83). Results on construct validity showed moderate but significant association with enjoyment perception (r = .30 and .36), with BMI (r = -.30 and -.79 for CHD simple form), and with the VO2max (r = .55 for CHD simple form). Significant concurrent validity with the objectively measured MVPA was reported (rho = .30, p PAQ-C-It, with items 2, 3, and 4 contributing little to the total score. This study supports the PAQ-C-It as an appropriate instrument to assess the MVPA levels of Italian children, including children with simple forms of CHD. Support is given to the possible instrument effectiveness on a large international perspective in order to level out data gathering across the globe.

  19. General anesthesia time for pediatric dental cases.

    Science.gov (United States)

    Forsyth, Anna R; Seminario, Ana Lucia; Scott, Joanna; Berg, Joel; Ivanova, Iskra; Lee, Helen

    2012-01-01

    The purpose of this study was to describe the use of operating room (OR) time for pediatric dental procedures performed under general anesthesia (GA) at a regional children's hospital over a 2-year period. A cross-sectional review of a pediatric dental GA records was performed at Seattle Children's Hospital. Data were collected for 709 0- to 21-year-old patients from January 2008 to December 2009. Demographic data, dental and anesthesia operator types, and procedures were recorded. Utilization of OR time was analyzed. The mean age of patients was 7.1 years (±4.2 SD), and 58% were male. Distribution by American Society of Anesthesiology (ASA) classifications were: ASA I 226 (32%); ASA II 316 (45%); ASA III 167 (24%). Cases finished earlier than the scheduled time by an average of 14 minutes (±28). Overrun time was significantly associated with: patient age (P=.01); ASA classification (P=.006); treatment type (Ppediatric dental procedures.

  20. Educational practices and exploration of the clinical teaching of general Pediatrics%普通儿科临床实习教学实践

    Institute of Scientific and Technical Information of China (English)

    胡晓红; 孙婧; 李乔俊

    2016-01-01

    After years of general Pediatrics medicine clinical practice teaching, we have dis-covered that there exist some problems such as teachers’ job burnout, teachers’ low professional knowledge level of clinical teaching and lack of teaching ability, medical students fear, low self-esteem, psychological fear and emotional weariness breeding as well as the children patients and their parents refusal of practice because of their worrying about being a test and so on. To solve these problems, we have put forward some proposals such as to implement the management system, recognizing and rewarding teachers to affirm their teaching levels, organizing teachers to participate in academic con-ferences, seminars, and to expand their professional knowledge in order to improve their overall quality. Meanwhile, we have adopted some new teaching ways to instead of traditional ways, such as applied multimedia technology and network platforms, put emphasis on basic skills training, the im-provement of departmental rotation assessment, and other ways to improve clinical teaching quality and develop interns’ clinical thinking ability to help them transit to clinicians.%综合医院普通儿科实习教学中长期存在医生教学时间有限、意识有限和能力有限,患儿哭闹不配合,家长不信任,实习生陌生、惶恐、厌学问题。针对这3方面问题,解放军总医院第一附属医院儿科通过健全管理制度,培训带教医生理论知识和教学技巧,加强学生操作技能训练、完善出科考核等探索和实践,提高带教医生的教学能力,激发学生学习热情,提高学生临床思维、操作和解决临床问题的能力,取得了良好的教学效果。

  1. Comparison of Pediatric and General Orthopedic Surgeons’ Approaches in Management of Developmental Dysplasia of the Hip and Flexible Flatfoot: the Road to Clinical Consensus

    Directory of Open Access Journals (Sweden)

    Ramin Haj Zargarbashi

    2017-01-01

    Full Text Available Developmental dysplasia of the hip (DDH and flatfoot are common pediatric orthopedic disorders, being referred to and managed by both general and pediatric orthopedic surgeons, through various modalities. Our study aimed to evaluate their consensus and perspective disagreements in terms of diagnostic and therapeutic approaches of the mentioned deformities. Forty participants in two groups of general orthopedic surgeons (GOS (n=20 and pediatric orthopedic surgeons (POS (n=20, were asked to answer an 8-item questionnaire on DDH and flexible flatfoot. The questions were provided with two- or multiple choices and a single choice was accepted for each one. Chi-square and Fisher’s exact tests was performed to compare the responses. For a neonate with limited hip abduction, hip ultrasonography was the agreed-upon approach in both groups (100% POS vs 71% GOS, and for its interpretation 79% of POS relied on their own whereas 73% of GOS relied on radiologist’s report (P=0.002. In failure of a 3-week application of the Pavlik harness, ending it and closed reduction (57% POS vs. 41% GOS followed by surgery quality assessment with CT scan (64% POS vs. 47% GOS and without the necessity for avascular necrosis evaluation (79% POS vs. 73% GOS were the choice measures. In case of closed reduction failure, open reduction via medial approach was the favorite next step in both groups (62% POS and 80% GOS. For the patient with flexible flat foot, reassurance was the choice plan of 79% of pediatric orthopedists. Our findings demonstrated significant disagreements among the orthopedic surgeons. This proposes insufficiency of high-level evidence.

  2. Comparison of Pediatric and General Orthopedic Surgeons' Approaches in Management of Developmental Dysplasia of the Hip and Flexible Flatfoot: the Road to Clinical Consensus.

    Science.gov (United States)

    Zargarbashi, Ramin Haj; Bonaki, Hirbod Nasiri; Zadegan, Shayan Abdollah; Baghdadi, Taghi; Nabian, Mohammad Hossein; Shirazi, Mehdi Ramezan

    2017-01-01

    Developmental dysplasia of the hip (DDH) and flatfoot are common pediatric orthopedic disorders, being referred to and managed by both general and pediatric orthopedic surgeons, through various modalities. Our study aimed to evaluate their consensus and perspective disagreements in terms of diagnostic and therapeutic approaches of the mentioned deformities. Forty participants in two groups of general orthopedic surgeons (GOS) (n=20) and pediatric orthopedic surgeons (POS) (n=20), were asked to answer an 8-item questionnaire on DDH and flexible flatfoot. The questions were provided with two- or multiple choices and a single choice was accepted for each one. Chi-square and Fisher's exact tests was performed to compare the responses. For a neonate with limited hip abduction, hip ultrasonography was the agreed-upon approach in both groups (100% POS vs 71% GOS), and for its interpretation 79% of POS relied on their own whereas 73% of GOS relied on radiologist's report (P=0.002). In failure of a 3-week application of the Pavlik harness, ending it and closed reduction (57% POS vs. 41% GOS) followed by surgery quality assessment with CT scan (64% POS vs. 47% GOS) and without the necessity for avascular necrosis evaluation (79% POS vs. 73% GOS) were the choice measures. In case of closed reduction failure, open reduction via medial approach was the favorite next step in both groups (62% POS and 80% GOS). For the patient with flexible flat foot, reassurance was the choice plan of 79% of pediatric orthopedists. Our findings demonstrated significant disagreements among the orthopedic surgeons. This proposes insufficiency of high-level evidence.

  3. [Induction of general anesthesia in pediatric patients].

    Science.gov (United States)

    Ota, Chiharu; Taniguchi, Akihiro

    2007-05-01

    The induction of general anesthesia is one of the most stressful procedures during the perioperative period for pediatric patients. Postoperative negative behavioral changes, such as nightmares or separation anxiety are reported in the children undergoing general anesthesia. To avoid these problems, the anesthesiologists have to pay more attention to the psychological needs of young patients as well as the technical aspects. Preoperative interview is important to identify the child who has extreme fear and anxiety. Premedication with sedatives and psychological preparation are effective for the smooth induction. In this article, preparation for the induction and practical skills of the induction in children, newborns, as well as patients with difficult airway and with full stomach are summarized.

  4. A Comparative Analysis of Health-Related Quality of Life and Family Impact between Children with ADHD Treated in a General Pediatric Clinic and a Psychiatric Clinic Utilizing the PedsQL

    Science.gov (United States)

    Limbers, Christine A.; Ripperger-Suhler, Jane; Boutton, Kelly; Ransom, Daniel; Varni, James W.

    2011-01-01

    Objective: To evaluate health-related quality of life (HRQOL) from the perspective of children with ADHD and their parents being seen in a Pediatric Clinic in comparison to healthy children and children with ADHD being seen in a Psychiatric Clinic. Method: Participants were children with a physician diagnosis of ADHD ages 5-18 years and their…

  5. Clinical Effectiveness of Family Therapeutic Interventions Embedded in General Pediatric Primary Care Settings for Parental Mental Health: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Cluxton-Keller, Fallon; Riley, Anne W; Noazin, Sassan; Umoren, Mfon Valencia

    2015-12-01

    The aim of this systematic review and meta-analysis was to synthesize the available evidence on embedded family therapy interventions in pediatrics and impacts on parental mental health and family functioning outcomes. The Cochrane Collaboration guidelines for systematic reviews and meta-analysis were used for this study. Six electronic databases were searched for randomized controlled trials and cluster randomized trials. The Cochrane Collaboration's Risk of Bias Tool and GRADE system were used to rate the quality of evidence of the included studies. The primary outcomes included parental distress, parental depressive symptoms, and dysfunctional parent-child interaction. Fixed effects models showed statistically significant reductions in parental distress at 6-month and 12-month post-intervention in favor of the intervention group. Family therapy model, intervention level, delivery modality, and dosage moderated intervention impacts on parental distress. Fixed effects models showed statistically significant reductions in parental depressive symptoms and in dysfunctional parent-child interaction in favor of the intervention group. Family therapy interventions can be successfully embedded in general pediatric primary care, and intended outcomes are achieved in this setting. Recommendations for future research and implications for policy development are discussed.

  6. A prospective study on the attitude of post graduates in general pediatrics toward pediatric oncology subspeciality as a career.

    Science.gov (United States)

    Thirugnanasambandam, Ram Prakash; Latha, Magatha Sneha; Moorthy, Aravind; Kannan, Lakshminarayanan; Paramasivam, Venkataraman; Scott, Julius Xavier

    2014-01-01

    The health care scenario in India is experiencing an increase in the number of children affected with cancer and the number of pediatric oncologists available to treat these children are few and the awareness of childhood cancer is decimally low. Hence, the purpose of this study was to determine the attitude of post-graduate students of general pediatrics towards childhood cancer and to assess their interest in pursuing pediatric oncology as a specialty in their carrier. The study was conducted among 188 post-graduates hailing from various Medical colleges all over South India who were attending a 2 day workshop at Chennai. The survey was a 10 point questionnaire pertaining to their previous training, competence, interest toward the field of hematooncology. The data were analyzed by SPSS 18.V software. Among the post-graduates, 74.7% of them reported that they did not have a pediatric oncology unit in their institution. 63.3% reported that they never been posted in pediatric oncology clinical postings before. 62% were not interested in pursuing pediatric oncology as a sub-specialty at all. 45.3% felt that pediatric oncology was too depressing to take as a specialty. 46.7% felt that late diagnosis and referral was the main factor which contributed to the failure of effective treatment of childhood cancers. 52.7% had never attended a class on pediatric oncology. 61.3% felt that they did not have sufficient knowledge to suspect and refer a child with cancer. 92% felt that there was a need to improve pediatric oncology teaching in their curriculum. 56.7% felt that the best way to imprint awareness on childhood malignancies was to improve pediatric oncology teaching in their medical curriculum. The results show that majority of post-graduates in pediatrics were not interested in pursuing pediatric oncology as a sub-specialty. The main reasons may be lack of specialized Pediatric oncology units in the majority of the medical institutions, lack of opportunity of these

  7. Pediatric echocardiography laboratory organization and clinical productivity.

    Science.gov (United States)

    Lai, Wyman W; Srivastava, Shubhika; Cohen, Meryl S; Frommelt, Peter C; Allada, Vivek

    2013-10-01

    The American Society of Echocardiography's Committee on Pediatric Echocardiography Laboratory Productivity (C-PELP) was formed to study the organizational and productivity issues particular to academic pediatric echocardiography laboratories. After much deliberation, the committee chose studies per physician full-time equivalent per day --the average number of studies interpreted per day by a full-time echocardiography physician dedicated to the laboratory -as the primary measure of physician productivity. A survey was sent to 74 North American pediatric echocardiography laboratory directors. The aims of the survey were to (1) determine the annual laboratory volume and types of echocardiographic studies performed, (2) define the average number of studies performed by a pediatric cardiac sonographer in a year, (3) assess the productivity of echocardiography physicians, and (4) identify factors (programmatic or laboratory related) that affect clinical productivity. There were 54 responses to the C-PELP 2011 survey. The average number of studies per physician full-time equivalent per day was 15.0 + 4.5 (median, 13.8; range, 6.2 -27.1), and the average number of studies performed per year by a sonographer was 1,297 + 326 (median, 1,279; range 717 -2,475). These figures were not adjusted for case complexity, time requirement for transesophageal echocardiography, level of expertise, or availability of sonographer assistance. Moreover, the issues of study quality and accuracy were not addressed. The C-PELP 2011 survey gathered important information on the current organization and staffing of academic pediatric echocardiography laboratories, but the committee did not attempt to craft guidelines or recommendations on staffing requirements. The results of the survey, however, should provide a framework for additional investigation into the optimal structure and staffing of pediatric echocardiography laboratories. Copyright © 2013 American Society of Echocardiography

  8. Clinical Pearls in pediatric infections.

    Science.gov (United States)

    Singhi, Sunit; Mathew, Joseph; Jindal, Atul; Verma, Sanjay

    2011-12-01

    This series of Clinical Pearls presents four cases presenting with infection. Each of these cases had clinical clues to the correct diagnosis, which could be picked up on meticulous history, clinical examination, or basic laboratory investigations. The authors highlight the important lessons to be learnt from each case. The first is a 7 year old boy with recurrent respiratory tract infections since early life. Clinical examination revealed the presence of dextrocardia and situs inversus and bronchiectasis leading to a diagnosis of Primary Ciliary Dyskinesia. The second case is a 1.5-month-old infant who presented with meningitis and increasing head size since birth. CSF examination and CT scanning led to the correct diagnosis of congenital Toxoplasmosis. The next case is an infant with high grade fever and neck swelling. He had the rare Lemierre's syndrome comprising of oro-pharyngeal infection, suppurative thrompbophlebitis of the internal jugular vein and systemic dissemination of septic emboli. The fourth case is a 2-year-old infant with recurrent respiratory tract infections and discharging neck swellings from early life. Repeated testing for tuberculosis was negative. The diagnosis was Chronic granulomatous disease. The authors describe the clinical approach and investigations in these cases; along with an outline of the management.

  9. Clinical characterization of pediatric pulmonary hypertension : complex presentation and diagnosis

    NARCIS (Netherlands)

    van Loon, Rosa Laura E.; Roofthooft, Marcus T. R.; van Osch-Gevers, Magdalena; Delhaas, Tammo; Strengers, Jan; Blom, Nico A.; Backx, Ad; Berger, Rolf M. F.

    OBJECTIVES: To describe the clinical presentation of pediatric pulmonary arterial hypertension (PAH) and the intricacies of how to classify pediatric PAH according to the Venice classification. STUDY DESIGN: Children (n = 63) seen at a national referral center for pediatric PAH underwent a

  10. Manifestations and clinical impact of pediatric inherited thrombophilia.

    Science.gov (United States)

    Klaassen, Irene L M; van Ommen, C Heleen; Middeldorp, Saskia

    2015-02-12

    The etiology of pediatric venous thromboembolic disease (VTE) is multifactorial, and in most children, 1 or more clinical risk factors are present. In addition, inherited thrombophilic disorders contribute to the development of pediatric VTE. In this review, the role of inherited thrombophilic disorders in the development of pediatric VTE, as well as the benefits and limitations of thrombophilia testing, will be discussed.

  11. CARACTERISTICS OF PNEUMONIA HOSPITALIZATIONS AT PEDIATRIC CLINIC TUZLA

    Directory of Open Access Journals (Sweden)

    Hadžić Devleta

    2015-03-01

    Full Text Available Introduction: Pneumonia is the most serious inflammatory disease of the lower respiratory system caused by various microorganisms. It occurs in all age groups, more often in children aged 5 years and below, in children with chronic diseases and impairments of the immune status. The aim of this study was to present the epidemiological, etiological and clinical characteristics of pneumonia in hospitalized children. Patients and methods:Â We analyzed the epidemiological, etiological and clinical characteristics of pneumonia in 224 children hospitalized at the Pediatric hospital Tuzla during one year period with radiologically proven pneumonia. Results: Almost half of children with pneumonia (46.4% were infants, and 82.1% of patients were under five years of age. The boys were leading in all age groups. A significant number of children had one or more predisposing risk factors. Clinical signs, gas analyses and pulse oximetry well correlated with hypoxemic type of respiratory failure. The most frequently isolated pathogens were Staphylococcus aureus, Klebsiella sp. and Pseudomonas aeruginosa. The average length of intensive treatment was 2.8 days and the average total length of treatment was 9.5 days. Conclusion: Pneumonia hospitalizations of children at the Pediatric Clinic Tuzla, showed the usual age and gender distribution. A significant number of children had underlying chronic diseases. Etiological characteristics emphasizing severity of disease and immune status of children. The management of pneumonia in children has to follow general pediatric principles, and special attention should be given to risk categories.

  12. Pediatric generalized joint hypermobility with and without musculoskeletal complaints : A localized or systemic disorder?

    NARCIS (Netherlands)

    Engelbert, RHH; Bank, RA; Sakkers, RJB; Helders, PJM; Beemer, FA; Uiterwaal, CSPM

    2003-01-01

    Objectives. Children with generalized hypermobility of the joints and musculoskeletal complaints frequently visit pediatric clinics, but many show no currently known collagen or other possibly related diseases. Whether the symptoms are confined to the musculoskeletal system is unknown. We assessed w

  13. Demand in pediatric dentistry for sedation and general anesthesia by dentist anesthesiologists: a survey of directors of dentist anesthesiologist and pediatric dentistry residencies.

    Science.gov (United States)

    Hicks, C Gray; Jones, James E; Saxen, Mark A; Maupome, Gerardo; Sanders, Brian J; Walker, Laquia A; Weddell, James A; Tomlin, Angela

    2012-01-01

    This study describes what training programs in pediatric dentistry and dental anesthesiology are doing to meet future needs for deep sedation/general anesthesia services required for pediatric dentistry. Residency directors from 10 dental anesthesiology training programs in North America and 79 directors from pediatric dentistry training programs in North America were asked to answer an 18-item and 22-item online survey, respectively, through an online survey tool. The response rate for the 10 anesthesiology training program directors was 9 of 10 or 90%. The response rate for the 79 pediatric dentistry training program directors was 46 of 79 or 58%. Thirty-seven percent of pediatric dentistry programs use clinic-based deep sedation/general anesthesia for dental treatment in addition to hospital-based deep sedation/general anesthesia. Eighty-eight percent of those programs use dentist anesthesiologists for administration of deep sedation/general anesthesia in a clinic-based setting. Pediatric dentistry residency directors perceive a future change in the need for deep sedation/general anesthesia services provided by dentist anesthesiologists to pediatric dentists: 64% anticipate an increase in need for dentist anesthesiologist services, while 36% anticipate no change. Dental anesthesiology directors compared to 2, 5, and 10 years ago have seen an increase in the requests for dentist anesthesiologist services by pediatric dentists reported by 56% of respondents (past 2 years), 63% of respondents (past 5 years), and 88% of respondents (past 10 years), respectively. Predicting the future need of dentist anesthesiologists is an uncertain task, but these results show pediatric dentistry directors and dental anesthesiology directors are considering the need, and they recognize a trend of increased need for dentist anesthesiologist services over the past decade.

  14. Different Aspects of General Anesthesia in Pediatric Dentistry: A Review.

    Science.gov (United States)

    Ramazani, Nahid

    2016-04-01

    Most child population is able to undergo dental treatment in the conventional setting. However, some children fail to cope with in-office conscious state and cannot respond to usual management modalities. This review aims to discuss the topic further. A computerized search in databases PubMed, MEDLINE, EMBASE, Google Scholar and Google were performed using dental general anesthesia related keywords. Original and review English-written articles that were limited to child population were retrieved without any limitation of publication date. The suitable papers were selected and carefully studied. A data form designed by author was used to write relevant findings. Preoperative oral examination and comprehensive evaluation of treatment needs is only possible after clinical and radiographic oral examination. Effective collaboration in dental GA team should be made to minimize psychological trauma of children who undergo dental GA. Before conducting comprehensive dental treatment under GA, the general health of the child and the success rate of procedures provided needs to be accurately evaluated. It is noteworthy that determination of the optimal timing for GA dental operation is of great importance. Providing safety with pediatric dental rehabilitation under GA is critical. Besides criteria for case selection of dental GA, some degree of dental practitioner's judgment is required to make decision. Pre- and post-operative instructions to parents or caregiver decrease the risk of complications. However, trained resuscitation providers, careful monitoring and advanced equipment minimize adverse outcomes.

  15. Clinical Effects of Prebiotics in Pediatric Population.

    Science.gov (United States)

    Orel, Rok; Reberšak, Lea Vodušek

    2016-12-15

    Prebiotics are non-digestible components of food that in a selective manner trigger the expansion of microbes in the gut with valuable effects for the health of the host. In our document, current literature pertaining to the clinical effects of the use of prebiotics for the treatment and prevention of some common pediatric pathology such as infantile colic, constipation, absorption of minerals, weight gain, diarrhea, respiratory infections, and eczema is reviewed. Data was collected through search of the MEDLINE, PubMed, UpToDate, Cochrane Database of Systemic Reviews, and the Cochrane Controlled Trials Register database as well as through references from relevant articles, all until September 2015. However, only the results of publications with adequate methodological quality were included. Prebiotics seem to be very appealing in treatment of many clinical conditions, explicitly in the fight against constipation, poor weight gain in preterm infants, and eczema in atopic children. In contrast to probiotics, the evidence of true clinical efficacy of prebiotics, supported with exact type and dose information are rather sparse, and there are a limited number of randomized controlled trials concerning prebiotics in children, especially beyond the age of infancy. Large well-designed, controlled, confirmatory clinical trials are required, using commercially available products, to help healthcare providers in making an appropriate decision concerning the appropriate use of prebiotics in different conditions.

  16. Incorporating Hypnosis into Pediatric Clinical Encounters.

    Science.gov (United States)

    Pendergrast, Robert A

    2017-03-16

    Increasing numbers of licensed health professionals who care for children have been trained in clinical hypnosis. The evidence base for the safety and efficacy of this therapeutic approach in a wide variety of conditions is also growing. Pediatricians and other health professionals who have received training may wish to apply these skills in appropriate clinical scenarios but still may be unsure of the practical matters of how to incorporate this skill-set into day to day practice. Moreover, the practical application of such skills will take very different forms depending on the practice setting, types of acute or chronic conditions, patient and family preferences, and the developmental stages of the child or teen. This article reviews the application of pediatric clinical hypnosis skills by describing the use of hypnotic language outside of formal trance induction, by describing natural trance states that occur in children and teens in healthcare settings, and by describing the process of planning a clinical hypnosis encounter. It is assumed that this article does not constitute training in hypnosis or qualify its readers for the application of such skills; rather, it may serve as a practical guide for those professionals who have been so trained, and may serve to inform other professionals what to expect when referring a patient for hypnotherapy. The reader is referred to specific training opportunities and organizations.

  17. Incorporating Hypnosis into Pediatric Clinical Encounters

    Directory of Open Access Journals (Sweden)

    Robert A. Pendergrast

    2017-03-01

    Full Text Available Increasing numbers of licensed health professionals who care for children have been trained in clinical hypnosis. The evidence base for the safety and efficacy of this therapeutic approach in a wide variety of conditions is also growing. Pediatricians and other health professionals who have received training may wish to apply these skills in appropriate clinical scenarios but still may be unsure of the practical matters of how to incorporate this skill-set into day to day practice. Moreover, the practical application of such skills will take very different forms depending on the practice setting, types of acute or chronic conditions, patient and family preferences, and the developmental stages of the child or teen. This article reviews the application of pediatric clinical hypnosis skills by describing the use of hypnotic language outside of formal trance induction, by describing natural trance states that occur in children and teens in healthcare settings, and by describing the process of planning a clinical hypnosis encounter. It is assumed that this article does not constitute training in hypnosis or qualify its readers for the application of such skills; rather, it may serve as a practical guide for those professionals who have been so trained, and may serve to inform other professionals what to expect when referring a patient for hypnotherapy. The reader is referred to specific training opportunities and organizations.

  18. Pediatric bariatric surgery: the clinical pathway.

    Science.gov (United States)

    Alqahtani, Aayed R; Elahmedi, Mohamed O

    2015-05-01

    Despite the rising interest in bariatric surgery (BS) for children and adolescents, algorithms that incorporate BS in weight management (WM) programs are lacking. This study presents the results of the pediatric bariatric surgery clinical pathway employed in our institution. Starting March 2008, we enrolled obese children and adolescents in a standardized multidisciplinary obesity management program. Weight loss, complications, comorbidities, and growth results of those who eventually underwent BS were compared with a matched (age, gender, and height z-score) group of patients on non-surgical WM only. Up to July 2014, a total of 659 patients received care through the pathway, of whom 291 patients underwent laparoscopic sleeve gastrectomy (LSG). Mean age and pre-LSG body mass index (BMI) were 14.4 ± 4.0 years (range; 5 to 21 years) and 48.3 ± 10.0 (range; 31.8-109.6). Mean BMI change (% excess weight loss) at 1, 2, 3, and 4 postoperative years was -16.9 ± 4.9 (56.6 ± 22.6), -17.5 ± 5.2 (69.8 ± 22.5), -18.9 ± 4.3 (75.1 ± 26.8), and -19.6 ± 6.4 (73.6 ± 24.3), respectively. Postoperatively, complications occurred in 12 patients (4.1%), with no leaks or mortality, and more than 90% of comorbidities were resolved or improved without recurrence. Additionally, LSG patients exhibited significantly higher postoperative growth velocity compared to WM patients. Applying this standardized clinical pathway with its BS component results in safe and successful weight loss for pediatric patients, with low complication rates, maximum comorbidity resolution, and minimum morbidity.

  19. Management of a pediatric patient with epidermolysis bullosa receiving comprehensive dental treatment under general anesthesia.

    Science.gov (United States)

    Yoon, Richard K; Ohkawa, Susumu

    2012-01-01

    The purpose of this report was to detail clinical considerations and a general anesthetic approach for a 3-year-old pediatric dental patient with epidermolysis bullosa, a group of rare genetic disorders characterized by blister development following minor trauma or traction to the skin or mucosal surfaces. Challenges in providing comprehensive dental treatment and care under general anesthesia are discussed. Early evaluation is vital to preventing the consequences of severe early childhood caries.

  20. Educating Parents About Pediatric Research: Children and Clinical Studies Website Qualitative Evaluation.

    Science.gov (United States)

    Marceau, Lisa D; Welch, Lisa C; Pemberton, Victoria L; Pearson, Gail D

    2016-07-01

    A gap in information about pediatric clinical trials exists, and parents remain uncertain about what is involved in research studies involving children. We aimed to understand parent perspectives about pediatric clinical research after viewing the online Children and Clinical Studies (CaCS) program. Using a qualitative descriptive study design, we conducted focus groups with parents and phone interviews with physicians. Three themes emerged providing approaches to improve parent's understanding of clinical research by including strategies where parents (a) hear from parents like themselves to learn about pediatric research, (b) receive general clinical research information to complement study-specific details, and (c) are provided more information about the role of healthy child volunteers. Parents found the website a valuable tool that would help them make a decision about what it means to participate in research. This tool can assist parents, providers, and researchers by connecting general information with study-specific information.

  1. Clinical management guidelines of pediatric septic shock

    Directory of Open Access Journals (Sweden)

    Khilnani Praveen

    2005-01-01

    Full Text Available Septic shock in children is the prototype combination of hypovolemia,cardiogenic and distributive shock. Recently published American college of critical care medinie(ACCM recommendations for hemodynamic support of neonatal and pediatric patients with sepsis,Surviving sepsis campaign and its pediatric considerations and subsequent revision of definitions for pediatric sepsis has led to compilation of this review article. Practical application of this information in Indian set up in a child with septic shock will be discussed based on available evidence.Though guidelines mainly apply to pediatric age group,however a reference has been made to neonatal age group wherever applicable.

  2. Global general pediatric surgery partnership: The UCLA-Mozambique experience.

    Science.gov (United States)

    Amado, Vanda; Martins, Deborah B; Karan, Abraar; Johnson, Brittni; Shekherdimian, Shant; Miller, Lee T; Taela, Atanasio; DeUgarte, Daniel A

    2017-09-01

    There has been increasing recognition of the disparities in surgical care throughout the world. Increasingly, efforts are being made to improve local infrastructure and training of surgeons in low-income settings. The purpose of this study was to review the first 5-years of a global academic pediatric general surgery partnership between UCLA and the Eduardo Mondlane University in Maputo, Mozambique. A mixed-methods approach was utilized to perform an ongoing needs assessment. A retrospective review of admission and operative logbooks was performed. Partnership activities were summarized. The needs assessment identified several challenges including limited operative time, personnel, equipment, and resources. Review of logbooks identified a high frequency of burn admissions and colorectal procedures. Partnership activities focused on providing educational resources, on-site proctoring, training opportunities, and research collaboration. This study highlights the spectrum of disease and operative case volume of a referral center for general pediatric surgery in sub-Saharan Africa, and it provides a context for academic partnership activities to facilitate training and improve the quality of pediatric general surgical care in limited-resource settings. Level IV. Copyright © 2017 Elsevier Inc. All rights reserved.

  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.

    Science.gov (United States)

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

    2017-01-09

    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. Conscious sedation vs general anesthesia in pediatric dentistry – a review

    OpenAIRE

    Silva,Cátia Carvalho; Lavado, Carla; Areias, Cristina; Mourão, Joana; Andrade, David

    2015-01-01

    INTRODUCTION: Performing dental treatments on pediatric patients who present behavioral problems is usually a great clinical challenge. Depending on the patients’ emotional maturity and their physical, psychological and mental skills, the usual behavior control techniques may not offer adequate efficacy and safety when dental procedures are being carried out. In these circumstances, alternative and more invasive methods such as conscious sedation and general anesthesia may become necess...

  5. Practice patterns and outcomes of pediatric partial nephrectomy in the United States: Comparison between pediatric urology and general pediatric surgery.

    Science.gov (United States)

    Suson, Kristina D; Wolfe-Christensen, Cortney; Elder, Jack S; Lakshmanan, Yegappan

    2015-08-01

    In the United States, both pediatric urologists (PUROs) and general pediatric surgeons (GPSs) perform nephrectomies in children, with PUROs performing more nephrectomies overall, most commonly for benign causes. GPSs perform more nephrectomies for malignant causes. We questioned whether the same trends persisted for partial nephrectomy. We hypothesized that PUROs performed more partial nephrectomies for all causes, including malignancy. Our primary aim was to characterize the number of partial nephrectomies performed by PUROs and GPSs. We also compared short-term outcomes between subspecialties. We analyzed the Pediatric Health Information System (PHIS), a database encompassing data from 44 children's hospitals. Patients were ≤18 years old and had a partial nephrectomy (ICD-9 procedure code 554) carried out by PUROs or GPSs between 1 January, 2004 and June 30, 2013. Queried data points included surgeon subspecialty, age, gender, 3M™ All Patient Refined Diagnosis Related Groups (3M™ APR DRG) code, severity level, mortality risk, length of stay (LOS), and medical/surgical complication flags. Data points were compared in patients on whom PUROs and GPSs had operated. Statistical analysis included the Student t test, chi-square test, analysis of covariance, and logistic regression. Results are presented in the table. While PUROs performed the majority of partial nephrectomies, GPSs operated more commonly for malignancy. For surgeries performed for non-malignant indications, PURO patients had a shorter LOS and lower complication rate after controlling for statistically identified covariates. There was no difference in LOS or complication rate for patients with malignancy. A Pediatric Health Information System study of pediatric nephrectomy demonstrated PUROs performed more nephrectomies overall, but GPSs performed more surgeries for malignancy. The difference was less dramatic for partial nephrectomies (63% GPS, 37% PURO) than for radical nephrectomies (90% GPS, 10

  6. Electronic resources preferred by pediatric hospitalists for clinical care.

    Science.gov (United States)

    Beck, Jimmy B; Tieder, Joel S

    2015-10-01

    There is little research on pediatric hospitalists' use of evidence-based resources. The aim of this study was to determine the electronic resources that pediatric hospitalists prefer. Using a web-based survey, the authors determined hospitalists' preferred electronic resources, as well as their attitudes toward lifelong learning, practice, and experience characteristics. One hundred sixteen hospitalists completed the survey. The most preferred resource for general information, patient handouts, and treatment was UpToDate. Online search engines were ranked second for general information and patient handouts. Pediatric hospitalists tend to utilize less rigorous electronic resources such as UpToDate and Google. These results can set a platform for discussing the quality of resources that pediatric hospitalists use.

  7. Management of Pediatric Skin Abscesses in Pediatric, General Academic and Community Emergency Departments

    Directory of Open Access Journals (Sweden)

    Baumann, Brigitte M

    2011-05-01

    Full Text Available Objectives: To compare the evaluation and management of pediatric cutaneous abscess patients at three different emergency department (ED settings.Method: We conducted a retrospective cohort study at two academic pediatric hospital EDs, a general academic ED and a community ED in 2007, with random sampling of 100 patients at the three academic EDs and inclusion of 92 patients from the community ED. Eligible patients were ≤18 years who had a cutaneous abscess. We recorded demographics, predisposing conditions, physical exam findings, incision and drainage procedures, therapeutics and final disposition. Laboratory data were reviewed for culture results and antimicrobial sensitivities. For subjects managed as outpatients from the ED, we determined where patients were instructed to follow up and, using electronic medical records, ascertained the proportion of patients who returned to the ED for further management.Result: Of 392 subjects, 59% were female and the median age was 7.7 years. Children at academic sites had larger abscesses compared to community patients, (3.5 versus 2.5 cm, p=0.02. Abscess incision and drainage occurred in 225 (57% children, with the lowest rate at the academic pediatric hospital EDs (51% despite the relatively larger abscess size. Procedural sedation and the collection of wound cultures were more frequent at the academic pediatric hospital and the general academic EDs. Methicillin-resistant Staphylococcus aureus (MRSA prevalence did not differ among sites; however, practitioners at the academic pediatric hospital EDs (92% and the general academic ED (86% were more likely to initiate empiric MRSA antibiotic therapy than the community site (71%, (p<0.0001. At discharge, children who received care at the community ED were more likely to be given a prescription for a narcotic (23% and told to return to the ED for ongoing wound care (65%. Of all sites, the community ED also had the highest percentage of follow-up visits (37

  8. National practice patterns and outcomes of pediatric nephrectomy: comparison between urology and general surgery.

    Science.gov (United States)

    Suson, Kristina D; Wolfe-Christensen, Cortney; Elder, Jack S; Lakshmanan, Yegappan

    2015-05-01

    In adults nephrectomy is under the purview of urologists, but pediatric urologists and pediatric general surgeons perform extirpative renal surgery in children. We compared the contemporary performance and outcome of all-cause nephrectomy at pediatric hospitals as performed by pediatric urologists and pediatric general surgeons. We queried the Pediatric Health Information System to identify patients 0 to 18 years old who were treated with nephrectomy between 2004 and 2013 by pediatric urologists and pediatric general surgeons. Data points included age, gender, severity level, mortality risk, complications and length of stay. Patients were compared by APR DRG codes 442 (kidney and urinary tract procedures for malignancy) and 443 (kidney and urinary tract procedures for nonmalignancy). Pediatric urologists performed more all-cause nephrectomies. While pediatric urologists were more likely to operate on patients with benign renal disease, pediatric general surgeons were more likely to operate on children with malignancy. Patients on whom pediatric general surgeons operated had a higher average severity level and were at greater risk for mortality. After controlling for differences patients without malignancy operated on by pediatric urologists had a shorter length of stay, and fewer medical and surgical complications. There was no difference in length of stay, or medical or surgical complications in patients with malignancy. Overall compared to pediatric general surgeons more nephrectomies are performed by pediatric urologists. Short-term outcomes, including length of stay and complication rates, appear better in this data set in patients without malignancy who undergo nephrectomy by pediatric urologists but there is no difference in outcomes when nephrectomy is performed for malignancy. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  9. Pediatric Flexible Flatfoot; Clinical Aspects and Algorithmic Approach

    OpenAIRE

    2013-01-01

    Flatfoot constitutes the major cause of clinic visits for pediatric foot problems. The reported prevalence of flatfoot varies widely due to numerous factors. It can be divided into flexible and rigid flatfoot. Diagnosis and management of pediatric flatfoot has long been the matter of controversy. Common assessment tools include visual inspection, anthropometric values, footprint parameters and radiographic evaluation. Most flexible flatfeet are physiologic, asymptomatic, and require no treatm...

  10. The role of psychology in a pediatric outpatient cardiology setting: preliminary results from a new clinical program.

    Science.gov (United States)

    Brosig, Cheryl; Yang, Kai; Hoffmann, Raymond G; Dasgupta, Mahua; Mussatto, Kathleen

    2014-12-01

    The aim of this study was to provide a descriptive analysis of a new clinical program integrating psychology services within a pediatric outpatient cardiology clinic. Patients with congenital heart disease (CHD) (n = 79) were referred for psychological services by their pediatric cardiologist. Parents completed the child behavior checklist, and the pediatric quality of life inventory generic core scales (PedsQL parent report). Teachers completed the teacher report form. Reasons for referral included: emotional problems (29%); attention problems (25%); learning problems (22%); behavior problems (16%); and developmental delay (8%). Parents and teachers reported higher rates of behavior problems and lower quality of life scores than the general population. Psychological evaluation suggested that incorporating a psychologist within a pediatric cardiology clinic may be beneficial for children with CHD in order to optimize their psychosocial functioning. Practice implications for implementing psychology services within a pediatric outpatient cardiology program are discussed.

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

    Science.gov (United States)

    Bimstein, E; Mayes, A; Mittal, Hc

    2014-01-01

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

  12. Unit-based clinical pharmacists' prevention of serious medication errors in pediatric inpatients.

    Science.gov (United States)

    Kaushal, Rainu; Bates, David W; Abramson, Erika L; Soukup, Jane R; Goldmann, Donald A

    2008-07-01

    Rates of serious medication errors in three pediatric inpatient units (intensive care, general medical, and general surgical) were measured before and after introduction of unit-based clinical pharmacists. Error rates on the study units and similar patient care units in the same hospital that served as controls were determined during six- to eight-week baseline periods and three-month periods after the introduction of unit-based clinical pharmacists (full-time in the intensive care unit [ICU] and mornings only on the general units). Nurses trained by the investigators reviewed medication orders, medication administration records, and patient charts daily to detect errors, near misses, and adverse drug events (ADEs) and determine whether near misses were intercepted. Two physicians independently reviewed and rated all data collected by the nurses. Serious medication errors were defined as preventable ADEs and nonintercepted near misses. The baseline rates of serious medication errors per 1000 patient days were 29 for the ICU, 8 for the general medical unit, and 7 for the general surgical unit. With unit-based clinical pharmacists, the ICU rate dropped to 6 per 1000 patient days. In the general care units, there was no reduction from baseline in the rates of serious medication errors. A full-time unit-based clinical pharmacist substantially decreased the rate of serious medication errors in a pediatric ICU, but a part-time pharmacist was not as effective in decreasing errors in pediatric general care units.

  13. Comparing Pediatric Rotations at Two University of Queensland Clinical Schools

    Science.gov (United States)

    Park, Julie; Kantrow, Charles M.; Coulthard, Mark G.

    2016-01-01

    Background: The University of Queensland (UQ), Ochsner Clinical School (OCS) is a partnership between Ochsner Health System in New Orleans, LA, and UQ in Brisbane, Australia. OCS medical students are trained on both continents, receiving their didactic education in Australia and their clinical education in the United States. Methods: We review the OCS experience and compare the pediatric rotations at OCS and UQ. Results: Students in the pediatric rotations in Australia and in the United States receive their clinical instruction in the real-world learning environment of hospitals and clinics. In addition, lectures, online learning modules, case-based tutorials, and rigorous assessment at the end of the rotation help prepare medical students for future contact with pediatric patients. Sixty-nine third-year OCS students and 499 fourth-year UQ students completed the pediatric rotation in 2014. In 2015, 105 third-year OCS students and approximately 400 fourth-year UQ students completed the pediatric rotation. Conclusion: In a unique educational collaboration, OCS has used e-learning and face-to-face tutorials to produce a well-rounded curriculum that assimilates global healthcare and international medicine. This article demonstrates the feasibility of delivering a standardized curriculum across two continents using modern e-learning tools. PMID:27046407

  14. Shared care and implementation of a pediatric clinical pathway

    DEFF Research Database (Denmark)

    Langfrits, Mette Sørensen; Thomsen, RW; Rubak, Jens Mørck

    with uncontrolled asthma should be followed at the pediatrics department. Study 2) An increased overall proportion of children with well-controlled asthma. Study 3) Favorable changes in the use of asthma medication. Study 4) Self-reported higher quality of life among children with asthma Material and methods...... specialist out-patient clinic at the pediatrics department at Viborg hospital or at one of 100 GPs in the Viborg area. At baseline the involved health care professionals participated in an introduction to the clinical pathway and treatment guide. Furthermore the clinical pathway and treatment guide...... Midten. We sincerely thank Lars G. Hansen (Head of Department of Pediatrics, Viborg Hospital) for his help and participation....

  15. Nonattendance in pediatric pulmonary clinics: an ambulatory survey

    Directory of Open Access Journals (Sweden)

    Dreiher Jacob

    2009-04-01

    Full Text Available Abstract Background Nonattendance for scheduled appointments disturbs the effective management of pediatric pulmonary clinics. We hypothesized that the reasons for non-attendance and the necessary solutions might be different in pediatric pulmonary medicine than in other pediatric fields. We therefore investigated the factors associated with nonattendance this field in order to devise a corrective strategy. Methods The effect of age, gender, ethnic origin, waiting time for an appointment and the timing of appointments during the day on nonattendance proportion were assessed. Chi-square tests were used to analyze statistically significant differences of categorical variables. Logistic regression models were used for multivariate analysis. Results A total of 1190 pediatric pulmonology clinic visits in a 21 month period were included in the study. The overall proportion of nonattendance was 30.6%. Nonattendance was 23.8% when there was a short waiting time for an appointment (1–7 days and 36.3% when there was a long waiting time (8 days and above (p-value Conclusion The factors associated with nonattendance in pediatric pulmonary clinics include the length of waiting time for an appointment, the hour of the appointment within the day and the origin of the patient.

  16. [Clinical studies of pediatric malabsorption syndromes].

    Science.gov (United States)

    Hosoyamada, Takashi

    2006-11-01

    Multiple cases with various types of pediatric malabsorption syndromes were evaluated. The clinical manifestations, laboratory findings, pathophysiology, and histopathological descriptions of each patient were analyzed in an effort to clear the pathogenesis of the malabsorption syndromes and the treatments were undertaken. The cases studied, included one patient with cystic fibrosis, two with lactose intolerance with lactosuria (Durand type), one with primary intestinal lymphangiectasia, two with familial hypobetalipoproteinemia, one with Hartnup disease, one with congenital chroride diarrhea, one with acrodermatitis enteropathica, one with intestinal nodular lymphoid hyperplasia (NLH), five with intractable diarrhea of early infancy and four with glycogenosis type Ia. Each case description and outcome is described below: 1. A 15-year-old Japanese boy with cystic fibrosis presented with severe symptoms, including pancreatic insufficiency, bronchiectasis, pneumothorax and hemoptysis. His prognosis was poor. Analysis of the CFTR genes of this patient revealed a homozygous large deletion from intron 16 to 17b. 2. In the sibling case of Durand type lactose intolerance, the subjects'disaccaridase activity of the small bowel, including lactase, were within normal limits. The results of per oral and per intraduodenal lactose tolerance tests confirmed lactosuria in both. These observations suggested, not only an abnormal gastric condition, but also duodenal and intestinal mucosal abnormal permeability of lactose. 3. In the case of primary intestinal lymphangiectasia, the subject had a lymphedematous right arm and hand, a grossly coarsened mucosal pattern of the upper gastrointestinal tract (identified via radiologic examination) and the presence of lymphangiectasia (confirmed via duodenal mucosal biopsy). The major laboratory findings were hypoalbuminemia, decreased immunoglobulin levels and lymphopenia resulting from loss of lymph fluid and protein into the gastro

  17. Pediatric flexible flatfoot; clinical aspects and algorithmic approach.

    Science.gov (United States)

    Halabchi, Farzin; Mazaheri, Reza; Mirshahi, Maryam; Abbasian, Ladan

    2013-06-01

    Flatfoot constitutes the major cause of clinic visits for pediatric foot problems. The reported prevalence of flatfoot varies widely due to numerous factors. It can be divided into flexible and rigid flatfoot. Diagnosis and management of pediatric flatfoot has long been the matter of controversy. Common assessment tools include visual inspection, anthropometric values, footprint parameters and radiographic evaluation. Most flexible flatfeet are physiologic, asymptomatic, and require no treatment. Otherwise, the physician should treat symptomatic flexible flatfeet. Initial treatment options include activity modification, proper shoe and orthoses, exercises and medication. Furthermore, comorbidities such as obesity and ligamenous laxity should be identified and managed, if applicable. When all nonsurgical treatment options faile, surgery can be considered. Our purpose in this article is to present a clinical algorithmic approach to pediatric flatfoot.

  18. Clinical and molecular insights into primary pediatric liver cancer

    NARCIS (Netherlands)

    V.B. Weeda

    2016-01-01

    This thesis aims to give insight into the clinical status quo of primary pediatric liver tumors and investigate signaling pathways that may be of importance for liver tumorigenesis. The most recent series of the International Childhood Liver Tumors Strategy Group (SIOPEL) of hepatocellular carcinoma

  19. A quality assessment of randomized clinical trials in pediatric orthopaedics.

    Science.gov (United States)

    Dulai, Sukhdeep K; Slobogean, Bronwyn L T; Beauchamp, Richard D; Mulpuri, Kishore

    2007-01-01

    The promotion and practice of evidence-based medicine necessitates a critical evaluation of medical literature, including the criterion standard of randomized clinical trials (RCTs). Recent studies have examined the quality of RCTs in various surgical specialties, but no study has focused on pediatric orthopaedics. The purpose of this study was to assess and describe the quality of RCTs published in the last 10 years in journals with high clinical impact in pediatric orthopaedics. All of the RCTs in pediatric orthopaedics published in 5 well-recognized journals between 1995 and 2005 were reviewed using the Detsky Quality Assessment Scale. The mean percentage score on the Detsky scale was 53% (95% confidence interval, 46%-60%). Only 7 (19%) of the articles satisfied the threshold for a satisfactory level of methodological quality (Detsky >75%). Most RCTs in pediatric orthopaedics that are published in well-recognized peer-reviewed journals demonstrate substantial deficiencies in methodological quality. Particular areas of weakness include inadequate rigor and reporting of randomization methods, use of inappropriate or poorly described outcome measures, inadequate description of inclusion and exclusion criteria, and inappropriate statistical analysis. Further efforts are necessary to improve the conduct and reporting of clinical trials in this field to avoid inadvertent misinformation of the clinical community.

  20. Screening for Harsh Punishment in a Pediatric Primary Care Clinic

    Science.gov (United States)

    Feigelman, Susan; Dubowitz, Howard; Lane, Wendy; Prescott, Leslie; Meyer, Walter; Tracy, J. Kathleen; Kim, Jeongeun

    2009-01-01

    Objectives: To determine: (1) the prevalence of harsh punishment among parents in a pediatric clinic, and (2) the sensitivity, specificity, predictive values, and stability of a brief screening measure. Methods: A subset of families involved in a study of child maltreatment prevention were recruited for this study. Two items in a parent screening…

  1. Clinical Uses of Melatonin in Pediatrics

    Directory of Open Access Journals (Sweden)

    Emilio J. Sánchez-Barceló

    2011-01-01

    Full Text Available This study analyzes the results of clinical trials of treatments with melatonin conducted in children, mostly focused on sleep disorders of different origin. Melatonin is beneficial not only in the treatment of dyssomnias, especially delayed sleep phase syndrome, but also on sleep disorders present in children with attention-deficit hyperactivity, autism spectrum disorders, and, in general, in all sleep disturbances associated with mental, neurologic, or other medical disorders. Sedative properties of melatonin have been used in diagnostic situations requiring sedation or as a premedicant in children undergoing anesthetic procedures. Epilepsy and febrile seizures are also susceptible to treatment with melatonin, alone or associated with conventional antiepileptic drugs. Melatonin has been also used to prevent the progression in some cases of adolescent idiopathic scoliosis. In newborns, and particularly those delivered preterm, melatonin has been used to reduce oxidative stress associated with sepsis, asphyxia, respiratory distress, or surgical stress. Finally, the administration of melatonin, melatonin analogues, or melatonin precursors to the infants through the breast-feeding, or by milk formula adapted for day and night, improves their nocturnal sleep. Side effects of melatonin treatments in children have not been reported. Although the above-described results are promising, specific studies to resolve the problem of dosage, formulations, and length of treatment are necessary.

  2. Demand in pediatric dentistry for sedation and general anesthesia by dentist anesthesiologists: a survey of directors of dentist anesthesiologist and pediatric dentistry residencies

    National Research Council Canada - National Science Library

    Hicks, C Gray; Jones, James E; Saxen, Mark A; Maupome, Gerardo; Sanders, Brian J; Walker, Laquia A; Weddell, James A; Tomlin, Angela

    2012-01-01

    This study describes what training programs in pediatric dentistry and dental anesthesiology are doing to meet future needs for deep sedation/general anesthesia services required for pediatric dentistry...

  3. Pediatric dual-energy X-ray absorptiometry: interpretation and clinical and research application

    Directory of Open Access Journals (Sweden)

    Jung Sub Lim

    2010-03-01

    Full Text Available Peak bone mass is established predominately during childhood and adolescence. It is an important determinant of future resistance to osteoporosis and fractures to gain bone mass during growth. The issue of low bone density in children and adolescents has recently attracted much attention and the use of pediatric dual-energy X-ray absorptiometry (DXA is increasing. The process of interpretation of pediatric DXA results is different from that of adults because normal bone mineral density (BMD of children varies by age, body size, pubertal stage, skeletal maturation, sex, and ethnicity. Thus, an appropriate normal BMD Z-score reference value with Z-score should be used to detect and manage low BMD. Z-scores below -2.0 are generally considered a low BMD to pediatrician even though diagnoses of osteoporosis in children and adolescents are usually only made in the presence of at least one fragility fracture. This article will review the basic knowledge and practical guidelines on pediatric DXA based on the International Society for Clinical Densitometry (ISCD Pediatric Official Positions. Also discussed are the characteristics of normal Korean children and adolescents with respect to BMD development. The objective of this review is to help pediatricians to understand when DXA will be useful and how to interpret pediatric DXA reports in the clinical practice for management of children with the potential to develop osteoporosis in adulthood.

  4. The Globalization of Pediatric Research: An Analysis of Clinical Trials Completed for Pediatric Exclusivity

    Science.gov (United States)

    Pasquali, Sara K.; Burstein, Danielle S.; Benjamin, Daniel K.; Smith, P. Brian; Li, Jennifer S.

    2010-01-01

    Background Recent studies have examined the globalization of clinical research. These studies focused on adult trials, and the globalization of pediatric research has not been examined to date. We evaluated the setting of published studies conducted under the US Pediatric Exclusivity Program, which provides economic incentives to pharmaceutical companies to conduct drug studies in children. Methods Published studies containing the main results of trials conducted from 1998–2007 under the Pediatric Exclusivity Provision were included. Data were extracted from each study and described, including the therapeutic area of drug studied, number of patients enrolled, number of sites, and location where the study was conducted, if reported. Results Overall, 174 trials were included (sample size 8–27,065 patients); 9% did not report any information regarding the location or number of sites where the study was conducted. Of those that did report this information, 65% were conducted in at least one country outside the US, and 11% did not have any sites in the US. Fifty-four different countries were represented and 38% of trials enrolled patients in at least one site located in a developing/transition country, including more than one third of infectious disease, cardiovascular, and allergy/immunology trials. Conclusions The majority of published pediatric trials conducted under the Pediatric Exclusivity Provision included sites outside of the US, and over a third of trials enrolled patients in developing/transition countries. While there are many potential benefits to the globalization of pediatric research, this trend also raises certain scientific and ethical concerns which require further evaluation. PMID:20732941

  5. Clinical value of ambulatory blood pressure in pediatric patients after renal transplantation.

    Science.gov (United States)

    Krmar, Rafael T; Ferraris, Jorge R

    2017-08-25

    Hypertension is a highly prevalent co-morbidity in pediatric kidney transplant recipients. Undertreated hypertension is associated with cardiovascular complications and negatively impacts renal graft survival. Thus, the accurate measurement of blood pressure is of the utmost importance for the correct diagnosis and subsequent management of post-renal transplant hypertension. Data derived from the general population, and to a lesser extent from the pediatric population, indicates that ambulatory blood pressure monitoring (ABPM) is superior to blood pressure measurements taken in the clinical setting for the evaluation of true mean blood pressure, identification of patients requiring antihypertensive treatment, and in the prediction of cardiovascular outcome. This Educational Review will discuss the clinical value of ABPM in the identification of individual blood pressure phenotypes, i.e., normotension, new-onset hypertension, white-coat hypertension, masked hypertension, controlled blood pressure, and undertreated/uncontrolled hypertension in pediatric kidney transplant recipients. Finally, we examine the utility of performing repeated ABPM for treatment monitoring of post-renal transplant hypertension and on surrogate markers related to relevant clinical cardiovascular outcomes. Taken together, our review highlights the clinical value of the routine use of ABPM as a tool for identifying and monitoring hypertension in pediatric kidney transplant recipients.

  6. Pediatric Clinical Trials: Current Scenario in the Asia Pacific Region

    Directory of Open Access Journals (Sweden)

    Saldanha LM

    2013-07-01

    Full Text Available Lisa Marie Saldanha,1 Saumya Nayak,1 Adeline Sng,1 Mei-Ling Long,1 Elisabeth Schrader,2 Amanur Rahman,3 Elvira Zenaida Lansang,1 Karen Wai,1 Ken Lee41Feasibility and Site Identification Asia, Quintiles East Asia Private Limited, Singapore; 2Quintiles Pediatric Center of Excellence, Durham, NC, USA; 3Faculty of Engineering, National University of Singapore, Singapore; 4Asia Site Services, Quintiles East Asia Private Limited, SingaporeObjective: This site survey was conducted to understand the current pediatric clinical trial landscape across countries in the Asia Pacific region, specifically in terms of interest, experience, capabilities, requirements of the ethics committee, patient availability, and overall challenges involved in conducting pediatric trials.Methods and materials: Between May and June 2012, an English language survey form was sent to sites (identified through Quintiles’ internal database with pediatric capability and referrals from doctors during a preliminary outreach. In July 2012, the responses from the completed survey forms were entered into SurveyMethods, a web-based central repository. Data analysis was performed in August–September 2012 using SurveyMethods.Results: Seventy-seven sites were contacted for this survey across the Asia Pacific region. Sixty-four percent (49 sites completed 63 surveys and confirmed interest to participate in clinical trials in the pediatric population. Seventy-one percent of the sites had prior experience. Eighty percent confirmed needing an assent from pediatric patients; 81%–95% confirmed acceptance of placebo-controlled and pharmacokinetic studies by ethics committees; and 37% cited challenges in conducting studies in this population.Conclusion: This survey indicates that there is a high level of interest among sites in the Asia Pacific region in conducting pediatric trials across various therapeutic indications. No major insurmountable challenges were identified in conducting

  7. General anesthesia: as a challenge and treatment need option in pediatric dentistry

    OpenAIRE

    2005-01-01

    Objetive. The purpose of this study was to determine the type and characteristics of the interventions, indications of dental treatment and procedures performed to patients treated under general anesthesia (GA) by pediatric dentistry residents, during the 1997-1999 period. Method. a sample of 57 hospital records of patientes treated as part of the Special Pediatric course at the Puerto rico Pediatric hostpial were reviewed. statistical analysis was done using the chi-square test for infere...

  8. Training general surgery residents in pediatric surgery: educational value vs time and cost.

    Science.gov (United States)

    Lee, Steven L; Sydorak, Roman M; Applebaum, Harry

    2009-01-01

    This study evaluated the educational value of pediatric surgery rotations, the likelihood of performing pediatric operations upon completing general surgery (GS) residency, and time and cost of training GS residents in pediatric surgery. A survey was administered to GS residents that evaluated the pediatric surgery rotation and anticipated practice intentions. A retrospective analysis (2005-2006) of operative times for unilateral inguinal hernia repair, bilateral inguinal hernia repair, and umbilical hernia repair was also performed. Procedure times were compared for operations performed by a pediatric surgeon with and without GS residents. Cost analysis was based on time differences. General surgery residents (n = 19) considered the pediatric surgery rotation to have high educational value (4.7 +/- 0.6 of 5) with extensive teaching (4.6 +/- 0.7) and operative experience (4.4 +/- 0.8). Residents listed pediatric surgery exposure, operative technique, and observed work ethic as most valuable. Upon graduation, residents expect to perform pediatric operations 2 to 3 times annually. Thirty-seven percent of residents felt competent to perform appendectomy (patients >5 years), 32% appendectomy (3-5 years), 21% gastrostomy (>1 year), and 11% inguinal herniorrhaphy (>1 year). Operative times and costs were significantly higher in operative procedures performed with a GS resident. General surgery residents considered pediatric surgery as a valuable educational experience. Residents anticipate performing pediatric operations a few times annually. Training GS residents in pediatric surgery increased operative time and cost. This information may be useful in determining the appropriate setting for resident education as well as budget planning for pediatric surgical practices.

  9. Variables Affecting General Anesthesia Time for Pediatric Dental Cases.

    Science.gov (United States)

    Yi, Young; Lee, Joseph; Yi, Han; Asher, Sheetal; Feldman, Lauren; Rivas-Morello, Chiara; Haque, Mehedia; Ross, Elizabeth

    2015-01-01

    The purpose of this study was to identify variables affecting procedural times for dental treatments performed in the operating room (OR) under general anesthesia. A total of 2,264 OR cases at Boston Children's Hospital were included in the study. A series of patient, provider, and operational variables were studied, including: patient age, gender, American Society of Anesthesiologists (ASA) class, need for intraoperative radiographs, intubation type, provider type, referring provider type, referral date, waiting time between referral and OR, and symmetry of caries pattern. Analysis of variance, z test, t test, Pearson correlations, and regression modeling were used. Provider inexperience, need for obtaining radiographs, older age, higher ASA class, and oral intubation significantly increased surgical case times. Using the current OR case estimation resulted in an overestimation of 14.6 hours per month. Application of our regression model improved the accuracy of case time estimation by 7.9 hours per month. Overestimation of pediatric dental operating room cases exists, and identification of variables associated with these inaccuracies can aid providers in recapturing underutilized operating room times.

  10. Case Study: Caregiver Perception of Pediatric Multidisciplinary Feeding Outpatient Clinic

    Directory of Open Access Journals (Sweden)

    Thomas F. Fisher PhD, OT, FAOTA

    2014-01-01

    Full Text Available This study explores the perception of satisfaction of caregivers who attended a feeding clinic at a large pediatric hospital in the midwest. The clinic is designed for a multidisciplinary team to meet with the child and the caregiver. Thirty-five participants were involved in the study. Results indicated that most participants were satisfied with the clinic experience. However, there were areas of care not covered by the members of the feeding team, which indicates a need. It is suggested that this need could be filled by occupational therapists.

  11. Complementary and alternative medicine use in a pediatric neurology clinic.

    Science.gov (United States)

    Aburahma, Samah K; Khader, Yousef S; Alzoubi, Karem; Sawalha, Noor

    2010-08-01

    To evaluate the frequency and determinants of complementary and alternative medicine (CAM) use in children attending a pediatric neurology clinic in North Jordan, a parent completed questionnaire survey of children attending the pediatric neurology clinic at King Abdullah University Hospital from March to July 2008 was conducted. A review of 176 completed questionnaires showed that 99 parents (56%) had used CAM for their child's specific neurological illness. The most common modalities were prayer/reciting the Quran (77%), religious healers (30%), massage with olive oil (32%), and consumption of honey products (29%). The most common reason was religious beliefs in 68%. None reported lack of trust in conventional medicine as the reason behind seeking CAM. Factors significantly associated with CAM use were speech delay, belief in its usefulness, father's age more than 30 years, and mothers with education less than high school. CAM had a supplementary role in relation to traditional western medicine use.

  12. Clinical and diagnostic pathways in pediatric fungal infections

    Directory of Open Access Journals (Sweden)

    Elio Castagnola

    2013-07-01

    Full Text Available Generally speaking, in pediatrics the patients mostly affected by fungal infections are hematological patients, followed by those with solid tumors, and transplant recipients. Candida infections generally occur just after birth, whereas Aspergillus infections are age-related, and increase their incidence with age. However, among infections, the incidence of bacteremias are still greater than that of mycoses. In pediatrics, in Italy the immunocompromised patients – thus particularly susceptible to fungal infections – are mainly those with severe combined immunodeficiency, chronic mucocutaneous candidiasis, and chronic granulomatous disease. Particular Aspergillus or Scedosporium infections should be considered in peculiar kinds of patients, such as those affected by cystic fibrosis. Finally, different kinds of fungi should be considered in those who come from or spend a lot time in specific areas, such as South America (e.g. coccidioidomycoses, for which differential diagnosis is with tuberculosis.http://dx.doi.org/10.7175/rhc.v4i1S.859

  13. Impact of implementation of a pediatric surgery fellowship on general surgery resident operative volume.

    Science.gov (United States)

    Snyder, Rebecca A; Phillips, Sharon E; Terhune, Kyla P

    2012-01-01

    The purpose of this study was to determine the impact of the initiation of a pediatric surgery fellowship on general surgery resident operative volume at 1 major academic institution. Retrospective review of operative records obtained from the Accreditation Council for Graduate Medical Education (ACGME) general surgery resident and pediatric surgery fellow case logs. Data collected included number and type of pediatric index cases per year, number of total pediatric surgery cases per year, and number of total cases logged as primary surgeon to date. Vanderbilt University School of Medicine Department of Surgery, which has an accredited general surgery program, finishes 7 chief residents per year during the study period, and instituted a new pediatric surgery fellowship in 2007. Case logs submitted by third and fourth year general surgery residents and first and second year pediatric surgery fellows were studied. The number of pediatric attending surgeons, relative value units (RVUs), and hospital admissions increased from 2003 to 2011. The median number of pediatric index cases performed by a resident decreased after the onset of fellowship from 34 cases to 23.5 cases per year (p pediatric surgery rotation also decreased from 74 to 53 cases per year after onset of the fellowship (p surgery resident index and overall case volume in pediatric surgery. Although operative volume is only 1 measure of surgical educational value, these findings suggest that the addition of surgical fellowships affects the educational experience of general surgery residents. We recommend that residency programs establish goals and calculate any potential impact on general surgery resident case volume before initiating a new surgical fellowship. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  14. The Hispanic Clinic for Pediatric Surgery: A model to improve parent-provider communication for Hispanic pediatric surgery patients.

    Science.gov (United States)

    Jaramillo, Joshua; Snyder, Elizabeth; Dunlap, Jonathan L; Wright, Robert; Mendoza, Fernando; Bruzoni, Matias

    2016-04-01

    26 million Americans have limited English proficiency (LEP). It is well established that language barriers adversely affect health and health care. Despite growing awareness of language barriers, there is essentially a void in the medical literature regarding the influence of language disparity on pediatric surgery patients. This study was designed to assess the impact of patient-provider language concordance on question-asking behavior and patient satisfaction for pediatric surgery patients. Participants included families of patients in a General Pediatric Surgery Clinic categorized into 3 groups by patient-provider language concordance: concordant English-speaking, LEP concordant Spanish-speaking, and LEP discordant Spanish-speaking using an interpreter. Clinical visits were audio recorded and the number of patient-initiated questions and the length of clinical encounter were measured. Families were administered a surgery-specific, 5-point Likert scale questionnaire modeled after validated surveys concerning communication, trust, perceived discrimination and patient-provider language concordance. Regression models were performed to analyze associations between language concordance and patient's question-asking behavior and between language concordance and survey results. A total of 156 participants were enrolled including 57 concordant-English, 52 LEP concordant-Spanish and 47 LEP-discordant-Spanish. There was significant variation in the mean number of patient-initiated questions among the groups (p=0.002). Both the English and Spanish concordant groups asked a similar number of questions (p=0.9), and they both asked more questions compared to the Spanish-discordant participants (p=0.002 and p=0.001). Language discordance was associated with fewer questions asked after adjustment for socioeconomic status. Language concordant participants rated higher scores of communication. Both Spanish-concordant and Spanish-discordant patients reported significantly increased

  15. Different clinical applications of bondable reinforcement ribbond in pediatric dentistry.

    Science.gov (United States)

    Tuloglu, Nuray; Bayrak, Sule; Tunc, Emine Sen

    2009-10-01

    Ribbond is a bondable, biocompatible, esthetic, translucent and easy-to-use reinforced ribbon. By virtue of its wide spectrum of intended properties, it enjoys various applications in clinical dentistry. This case report demonstrates usage of Ribbond as a space maintainer, a fixed partial denture with a natural tooth pontic, an endodontic post and cores and a splint material in children. Ribbond can be used as an alternative to conventional treatment in pediatric dentistry.

  16. Different Clinical Applications of Bondable Reinforcement Ribbond in Pediatric Dentistry

    Science.gov (United States)

    Tuloglu, Nuray; Bayrak, Sule; Tunc, Emine Sen

    2009-01-01

    Ribbond is a bondable, biocompatible, esthetic, translucent and easy-to-use reinforced ribbon. By virtue of its wide spectrum of intended properties, it enjoys various applications in clinical dentistry. This case report demonstrates usage of Ribbond as a space maintainer, a fixed partial denture with a natural tooth pontic, an endodontic post and cores and a splint material in children. Ribbond can be used as an alternative to conventional treatment in pediatric dentistry. PMID:19826607

  17. MRI for clinically suspected pediatric appendicitis: case interpretation

    Energy Technology Data Exchange (ETDEWEB)

    Moore, Michael M.; Brian, James M.; Methratta, Sosamma T.; Hulse, Michael A.; Choudhary, Arabinda K.; Eggli, Kathleen D.; Boal, Danielle K.B. [Penn State Milton S. Hershey Medical Center, Division of Pediatric Radiology, Department of Radiology, Hershey, PA (United States)

    2014-05-15

    As utilization of MRI for clinically suspected pediatric appendicitis becomes more common, there will be increased focus on case interpretation. The purpose of this pictorial essay is to share our institution's case interpretation experience. MRI findings of appendicitis include appendicoliths, tip appendicitis, intraluminal fluid-debris level, pitfalls of size measurements, and complications including abscesses. The normal appendix and inguinal appendix are also discussed. (orig.)

  18. Profile of special needs patients at a pediatric dentistry clinic

    OpenAIRE

    Sílvio Augusto Fernandes de Menezes; Helder Henrique Costa Pinheiro; Luciana Teixeira Passos; Camila de Almeida Smith; Tatiany Oliveira de Alencar Menezes

    2011-01-01

    Objective: To assess the characteristics of special needs patients assisted at the Clinic of Pediatric Dentistry, Faculty of Dentistry, Federal University of Pará. Methods: A descriptive observational study conducted from March 2007 to December 2009, assessing 137 records of which were extracted the following data: gender, age, origin, current and past medical history, type of special needs and major oral diseases. We applied descriptive statistics, one-dimensional frequency table and prepare...

  19. Educating residents in behavioral health care and collaboration: integrated clinical training of pediatric residents and psychology fellows.

    Science.gov (United States)

    Pisani, Anthony R; leRoux, Pieter; Siegel, David M

    2011-02-01

    Pediatric residency practices face the challenge of providing both behavioral health (BH) training for pediatricians and psychosocial care for children. The University of Rochester School of Medicine and Dentistry and Rochester General Hospital developed a joint training program and continuity clinic infrastructure in which pediatric residents and postdoctoral psychology fellows train and practice together. The integrated program provides children access to BH care in a primary care setting and gives trainees the opportunity to integrate collaborative BH care into their regular practice routines. During 1998-2008, 48 pediatric residents and 8 psychology fellows trained in this integrated clinical environment. The program's accomplishments include longevity, faculty and fiscal stability, sustained support from pediatric leadership and community payers, the development in residents and faculty of greater comfort in addressing BH problems and collaborating with BH specialists, and replication of the model in two other primary care settings. In addition to quantitative program outcomes data, the authors present a case example that illustrates how the integrated program works and achieves its goals. They propose that educating residents and psychology trainees side by side in collaborative BH care is clinically and educationally valuable and potentially applicable to other settings. A companion report published in this issue provides results from a study comparing the perceptions of pediatric residents whose primary care continuity clinic took place in this integrated setting with those of residents from the same pediatric residency who had their continuity clinic training in a nonintegrated setting.

  20. Clinical Decision Support in Pediatric Care

    NARCIS (Netherlands)

    J. Roukema (Jolt)

    2006-01-01

    textabstractThe overall aim of the studies described in this thesis was to investigate and optimize the diagnostic process of (febrile) children presenting to the hospital emergency department (ed), and to study aspects of this process as a base for clinical decision support systems. We discussed

  1. The hypothesis-oriented pediatric focused algorithm: a framework for clinical reasoning in pediatric physical therapist practice.

    Science.gov (United States)

    Kenyon, Lisa K

    2013-03-01

    Pediatric physical therapist practice presents unique challenges to the clinical reasoning processes of novice clinicians and physical therapist students. The purpose of this article is to present the Hypothesis-Oriented Pediatric Focused Algorithm (HOP-FA), a clinical framework designed to guide the clinical reasoning process in pediatric physical therapist practice. The HOP-FA provides a systematic, stepwise guide to the patient/client management process wherein the therapist is asked to consider various factors and issues that may affect the clinical reasoning process for a particular child and family. The framework provided by the HOP-FA is not built upon a specific therapeutic philosophy and may be useful as a tool in clinical education, in the classroom, and for clinicians who are new to or re-entering pediatric practice.

  2. Pre-clinical medical student experience in a pediatric pulmonary clinic

    Directory of Open Access Journals (Sweden)

    Thomas G. Saba

    2015-11-01

    Full Text Available Objective: Our objective was to evaluate the educational value of introducing pre-clinical medical students to pediatric patients and their families in a subspecialty clinic setting. Methods: First- and second-year medical students at the University of Michigan seeking clinical experience outside of the classroom attended an outpatient pediatric pulmonary clinic. Evaluation of the experience consisted of pre- and post-clinic student surveys and post-clinic parent surveys with statements employing a four-point Likert scale as well as open-ended questions. Results: Twenty-eight first-year students, 6 second-year students, and 33 parents participated in the study. Post-clinic statement scores significantly increased for statements addressing empathic attitudes, confidence communicating with children and families, comfort in the clinical environment, and social awareness. Scores did not change for statements addressing motivation, a sense of team membership, or confidence with career goals. Students achieved their goals of gaining experience interacting with patients, learning about pulmonary diseases, and observing clinic workflow. Parents felt that they contributed to student education and were not inconvenienced. Conclusions: Students identified several educational benefits of exposure to a single pediatric pulmonary clinic. Patients and families were not inconvenienced by the participation of a student. Additional studies are warranted to further investigate the value of this model of pre-clinical medical student exposure to subspecialty pediatrics.

  3. Analysis of clinical interventions and the impact of pediatric pharmacists on medication error prevention in a teaching hospital.

    Science.gov (United States)

    Cunningham, Kelli J

    2012-10-01

    Research has shown that the potential risk for medication errors within the pediatric inpatient population is about 3 times as high as for adults; however, there is limited information regarding the impact of a pediatric pharmacist's contribution to decreasing medication errors and adverse drug events (ADEs). The purpose of this study was to record and analyze all interventions during a 2-month time span in a pediatric teaching hospital to determine the benefit of having a pediatrics-trained clinical pharmacist on the floor. Pediatric pharmacists prospectively collected data for all interventions and medication errors made between July 1 and August 31, 2010. The pediatric hospital comprises 87 beds, and data were collected during the influx of new pediatric resident interns on the general pediatric ward and pediatric and neonatal intensive care units. During the study period, 1315 interventions were recorded, which is an average of 21 interventions per day. Most interventions were made through order entry. Errors made up 24.5% of all interventions, with the most common cause of error being prescribing. Physicians with the least amount of training made the most errors. Of order pages scanned, 5.9% contained an error in the order; however, only 0.2% of all errors reached the patient. This study highlighted the impact a pediatric pharmacist can make on prevention of ADEs and medication errors. Only 0.2% of all errors made during the study period reached the patient owing to interventions made by the pediatric pharmacists, which shows a vast improvement in patient safety.

  4. How many referrals to a pediatric orthopaedic hospital specialty clinic are primary care problems?

    Science.gov (United States)

    Hsu, Eric Y; Schwend, Richard M; Julia, Leamon

    2012-01-01

    Many primary care physicians believe that there are too few pediatric orthopaedic specialists available to meet their patients' needs. However, a recent survey by the Practice Management Committee of the Pediatric Orthopaedic Society of North America found that new referrals were often for cases that could have been managed by primary care practitioners. We wished to determine how many new referral cases seen by pediatric orthopaedic surgeons are in fact conditions that can be readily managed by a primary care physician should he/she chose to do so. We prospectively studied all new referrals to our hospital-based orthopaedic clinic during August 2010. Each new referral was evaluated for whether it met the American Board of Pediatrics criteria for being a condition that could be managed by a primary care pediatrician. Each referral was also evaluated for whether it met the American Academy of Pediatrics Surgery Advisory Panel guidelines recommending referral to an orthopaedic specialist, regardless of whether it is for general orthopaedics or pediatric orthopaedics. On the basis of these criteria, we classified conditions as either a condition manageable by primary care physicians or a condition that should be referred to an orthopaedic surgeon or a pediatric orthopaedic surgeon. We used these guidelines not to identify diagnosis that primary care physicians should treat but, rather, to compare the guideline-delineated referrals with the actual referrals our specialty pediatric orthopaedic clinic received over a period of 1 month. A total of 529 new patient referrals were seen during August 2010. A total of 246 (47%) were considered primary care conditions and 283 (53%) orthopaedic specialty conditions. The most common primary care condition was a nondisplaced phalanx fracture (25/246, 10.1%) and the most common specialty condition was a displaced single-bone upper extremity fracture needing reduction (36/283, 13%). Only 77 (14.6%) of the total cases met the strict

  5. Clinical Boot Camp: An Innovative Simulation Experience to Prepare Nursing Students for Obstetric and Pediatric Clinicals.

    Science.gov (United States)

    Hogewood, Connie; Smith, Tedra; Etheridge, Sherita; Britt, Sylvia

    2015-01-01

    Obstetric and pediatric patients require unique specialized care not included in traditional adult health education. To prepare nursing students for clinical rotations beginning the second week of class, faculty developed an innovative one-day simulation seminar, the OB/PEDS Boot Camp, in which groups of students rotated through six stations of obstetric and pediatric simulation exercises. This article provides insight on the development and implementation of the OB/PEDS Boot Camp.

  6. [Clinical studies with cefmenoxime in the field of pediatrics].

    Science.gov (United States)

    Takimoto, M; Yoshioka, H; Maruyama, S; Sanae, N; Nagamatsu, I

    1982-10-01

    The present study was performed to evaluate the clinical effectiveness and safety of cefmenoxime (CMX), a new cephalosporin antibiotic for injection in the field of pediatrics. Thirty-one cases, including 2 cases with sepsis, 18 cases with respiratory tract infections and 7 cases with urinary tract infections, were given CMX at daily doses of 30 mg/kg to 125 mg/kg divided into 3 or 4 for 3 days to 13 days. Clinical responses were excellent in 16 cases, good in 9 cases and poor in 6 cases, the satisfactory response being 80.6%. No side effects and no abnormal laboratory findings relating to the drug were observed.

  7. NMO in pediatric patients: brain involvement and clinical expression

    Directory of Open Access Journals (Sweden)

    Joaquín A. Peña

    2011-02-01

    Full Text Available OBJECTIVE: To analyze the clinical, neuroimaging characteristics and positivity of the acquaporin water channel (NMO-IgG in pediatric patients with neuromyelitis optica (NMO. This disorder could have a variable clinical expression. To address such variability, the term NMO spectrum has been suggested. METHOD: We evaluated six pediatric patients, with a median age of 11 years at the time of the study, with the diagnosis of NMO by the Wingerchuck criteria. RESULTS: All the cases exhibited bilateral optic neuritis (ON. Four patients had abnormalities on brain MRI from the onset,although only three of them developed symptoms correlated to those lesions during the course of their disorder. NMO-IgG was positive in 80%. CONCLUSION: Optic neuropathy is the most impaired feature in NMO patients. Brain MRI lesions are not compatible with multiple sclerosis and positivity of the NMO-IgG are also present in NMO pediatric patients, confirming the heterogeneity in the expression of this disorder.

  8. Clinically profiling pediatric patients with dengue

    Directory of Open Access Journals (Sweden)

    Sriram Pothapregada

    2016-01-01

    Full Text Available Objective: To study the clinical profile and outcome of dengue fever in children at a tertiary care hospital in Puducherry. Materials and Methods: All children (0-12 years of age diagnosed and confirmed as dengue fever from August 2012 to January 2015 were reviewed retrospectively from hospital case records as per the revised World Health Organization guidelines for dengue fever. The diagnosis was confirmed by NS1 antigen-based ELISA test or dengue serology for IgM and IgG antibodies, and the data were analyzed using SPSS 16.0 statistical software. After collecting the data, all the variables were summarized by descriptive statistics. Results: Among the 261 confirmed cases of dengue fever non-severe and severe dengue infection was seen in 60.9% and 39.1%, respectively. The mean age (standard deviation of the presentation was 6.9 + 3.3 years and male: female ratio was 1.2:1. The most common clinical manifestations were fever (94.6%, conjunctival congestion (89.6%, myalgia (81.9%, coryza (79.7%, headache (75.1%, palmar erythema (62.8%, and retro-orbital pain (51.3%. The common early warning signs at the time of admission were persistent vomiting (75.1%, liver enlargement (59.8%, cold and clammy extremities (45.2%, pain abdomen (31.0%, hypotension (29.5%, restlessness (26.4%, giddiness (23.0%, bleeding (19.9%, and oliguria (18.4%. The common manifestation of severe dengue infection was shock (39.1%, bleeding (19.9%, and multi-organ dysfunction (2.3%. The most common complications were liver dysfunction, acute respiratory distress syndrome, encephalopathy, pleural effusion, ascites, myocarditis, myositis, acute kidney injury, and disseminated intravascular coagulopathy. Platelet count did not always correlate well with the severity of bleeding. There were six deaths (2.3% and out of them four presented with impaired consciousness (66.6%. The common causes for poor outcome were multiorgan failure, encephalopathy, and fluid refractory shock

  9. Parental Vaccine Hesitancy: Clinical Implications for Pediatric Providers.

    Science.gov (United States)

    Barrows, Meagan A; Coddington, Jennifer A; Richards, Elizabeth A; Aaltonen, Pamela M

    2015-01-01

    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.

  10. Pediatric ocular trauma--a clinical presentation.

    Directory of Open Access Journals (Sweden)

    Dasgupta S

    1990-01-01

    Full Text Available A year long study of ocular injuries in children below the age of 15 years was conducted in the Ophthalmology Department of a general hospital. Fortyfour cases were studied. Of these 45.45% were in the age group of 6-10 years. The male to female ratio was 5.28 : 1. Pointed objects viz. sticks, wires etc. were found to be the common causative agents; the recent trend being of bow and arrow injuries. Ocular perforation was observed in 28 cases. On follow up of all the cases with ocular trauma, only 12 patients were found to have a visual acuity better than 6/18; perception of light was absent in 7 patients. A need for increased parental awareness and supervision of children is stressed upon.

  11. Longitudinal analysis of a pediatric rheumatology clinic population.

    Science.gov (United States)

    Rosenberg, Alan M

    2005-10-01

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

  12. [Technology of nitrous oxide/oxygen inhalation sedation and its clinical application in pediatric dentistry].

    Science.gov (United States)

    Zhong, Tian; Hu, Daoyong

    2014-02-01

    Dental fear is a common problem in pediatric dentistry. Therefore, sedation for pediatric patients is an essential tool for anxiety management. Nitrous oxide/oxygen inhalation sedation is a safe, convenient, effective way to calm children. The review is about the technology of nitrous oxide/oxygen inhalation sedation and its clinical application in pediatric dentistry.

  13. Computerized axial tomography in clinical pediatrics.

    Science.gov (United States)

    McCullough, D C; Kufta, C; Axelbaum, S P; Schellinger, D

    1977-02-01

    Computerized axial tomography (CAT), a noninvasive radiologie method, provides a new dimension in screening and diagnosis of intracranial pathology. Evaluation of 725 scans in infants and children demonstrates that CAT may be performed with negligible risk, although sedation and restraint are essential to the successful performance of studies in children under 6 years of age. CAT is the preferred initial diagnostic method in suspected hydrocephalls and is accurate in the detection and precise localization of brain tumors. The management of hydrocephalus and brain tumors has been significantly altered by the availability of CAT. Few invasive neuroradiologic procedures are required and pneumography is especially curtailed. Serial scanning is the best available method of monitoring ventricular alterations in hydrocephalus, tumor size during radiotherapy or chemotherapy, and postoperative recurrence of benign neoplasms. Complex intracranial anomalies are detectable with computerized tomography, but complete definition of pathology often requires angiography and air studies. Limited clinical experience in detecting neonatal intraventricular hemorrhage suggests that CAT will be a valuable tool for futlre investigations of that problem.

  14. Pediatric dyslipidemia: recommendations for clinical management.

    Science.gov (United States)

    Wilson, Don P; McNeal, Catherine; Blackett, Piers

    2015-01-01

    During the last 50 years, it has become evident that atherosclerosis originates in childhood. Although cardiovascular disease (CVD) events are rare in children, autopsy data and imaging studies have documented subclinical disease in association with measurable risk factors during childhood. When present at a young age, risk factors track into adulthood and have been associated with a moderate to high risk of future CVD. As such, the ability to identify this vulnerable population creates the opportunity to prevent the development of risk factors and future CVD events with effective management of genetic and acquired risk factors. In 2011, the National Heart, Lung, and Blood Institute Expert Panel published comprehensive guidelines summarizing the current evidence and providing developmentally appropriate recommendations for screening, treatment, and follow-up of children and adults younger than 21 years at risk for premature CVDs such as myocardial infarction and stroke. In addition to screening individuals with a family history of hypercholesterolemia and/or premature CVD, the Expert Panel recommended universal screening of all children between 9 and 11 years of age and then again between 17 and 21 years of age. Although the recommendation for universal screening, regardless of general health or the presence/absence of risk factors of CVD, is not without controversy, this review serves to create awareness among healthcare providers, elected officials, and the lay public about the burden of CVD, the opportunity for prevention, and the benefits of early and effective therapeutic intervention with lifestyle changes and lipid-lowering medications.

  15. Comparison of pediatric appendectomy outcomes between pediatric surgeons and general surgery residents.

    Science.gov (United States)

    Mizrahi, Ido; Mazeh, Haggi; Levy, Yair; Karavani, Gilad; Ghanem, Muhammad; Armon, Yaron; Vromen, Amos; Eid, Ahmed; Udassin, Raphael

    2013-04-01

    Appendectomy is the most common urgent procedure in children, and surgical outcomes may be affected by the surgeon's experience. This study's aim is to compare appendectomy outcomes performed by pediatric surgeons (PSs) and general surgery residents (GSRs). A retrospective review of all patients younger than 16y treated for appendicitis at two different campuses of the same institution during the years 2008-2009 was performed. Appendectomies were performed by PS in one campus and GSR in the other. Primary end points included postoperative morbidity and hospital length of stay. During the study period, 246 (61%) patients were operated by senior GSR (postgraduate year 5-7) versus 157 (39%) patients by PS. There was no significant difference in patients' characteristics at presentation to the emergency room and the rate of appendeceal perforation (11% versus 15%, P=0.32), and noninfectious appendicitis (5% versus 5% P=0.78) also was similar. Laparoscopic surgery was performed more commonly by GSR (16% versus 9%, P=0.02) with shorter operating time (54±1.5 versus 60±2.1, P=0.01). Interestingly, the emergency room to operating room time was shorter for GSR group (419±14 versus 529±24min, P<0.001). The hospital length of stay was shorter for the GSR group (4.0±0.2 versus 4.5±0.2, P=0.03), and broad-spectrum antibiotics were used less commonly (20% versus 53%, P<0.0001) and so was home antibiotics continuation (13% versus 30%, P<0.0001). Nevertheless, postoperative complication rate was similar (5% versus 7%, P=0.29) and so was the rate of readmissions (2% versus 5%, P=0.52). The results of this study suggest that the presence of a PS does not affect the outcomes of appendectomies. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. The clinical features and treatment of pediatric intracranial aneurysm.

    Science.gov (United States)

    Liang, Jiantao; Bao, Yuhai; Zhang, Hongqi; Wrede, Karsten Henning; Zhi, Xinglong; Li, Meng; Ling, Feng

    2009-03-01

    Intracranial aneurysms are relatively rare in the pediatric population. The objective of this study was to highlight the clinical and radiological features and the therapeutic outcome and clarify the choice of therapeutic strategies for pediatric intracranial aneurysms. Twenty-four consecutive children (age aneurysms in our institute in the last 23 years were included in this study. There were nine (36%) patients with posterior circulation aneurysms and eight (32%) with giant aneurysms. Eleven (46%) patients presented with subarachnoid hemorrhage. Fifteen patients underwent endovascular treatment, and four received microsurgical therapy. Five patients were treated conservatively. Ninety-two percent (n=22) of the patients showed favorable outcomes. Pediatric intracranial aneurysms differ in many ways from those in adults: male predominance; high incidence of giant, dissecting, and fusiform aneurysms; high incidence of aneurysms in the posterior circulation; high incidence of spontaneous thrombosis; better Hunt-Hess grades at presentation; and better therapeutic outcome. For children with intracranial aneurysms, both microsurgical approaches and endovascular treatment were effective. For many complex aneurysms, endovascular therapy was the best choice.

  17. Innovation in Pediatric Surgical Education for General Surgery Residents: A Mobile Web Resource.

    Science.gov (United States)

    Rouch, Joshua D; Wagner, Justin P; Scott, Andrew; Sullins, Veronica F; Chen, David C; DeUgarte, Daniel A; Shew, Stephen B; Tillou, Areti; Dunn, James C Y; Lee, Steven L

    2015-01-01

    General surgery residents lack a standardized educational experience in pediatric surgery. We hypothesized that the development of a mobile educational interface would provide general surgery residents broader access to pediatric surgical education materials. We created an educational mobile website for general surgery residents rotating on pediatric surgery, which included a curriculum, multimedia resources, the Operative Performance Rating Scale (OPRS), and Twitter functionality. Residents were instructed to consult the curriculum. Residents and faculty posted media using the Twitter hashtag, #UCLAPedSurg, and following each surgical procedure reviewed performance via the OPRS. Site visits, Twitter posts, and OPRS submissions were quantified from September 2013 to July 2014. The pediatric surgery mobile website received 257 hits; 108 to the homepage, 107 to multimedia, 28 to the syllabus, and 19 to the OPRS. All eligible residents accessed the content. The Twitter hashtag, #UCLAPedSurg, was assigned to 20 posts; the overall audience reach was 85 individuals. Participants in the mobile OPRS included 11 general surgery residents and 4 pediatric surgery faculty. Pediatric surgical education resources and operative performance evaluations are effectively administered to general surgery residents via a structured mobile platform. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  18. Urgency in Pediatric Dentistry: Care Profile of the Integrated Pediatric Clinic of FOUFAL

    Directory of Open Access Journals (Sweden)

    Noelle Albuquerque AMORIM

    2007-09-01

    Full Text Available Objective: To analyze the profile of the urgency care provided atthe Integrated Pediatric Clinic of the School of Dentistry of theFederal University of Alagoas (FOUFAL.Method: 221 patient files were analyzed between April toNovember 2006 and the following data were analyzed by descriptivestatistics: patient identification, type of urgency, involved tooth(teeth, diagnosis and proposed treatment. Only complete files wereincluded.Results: Urgency care was most frequently sought by femalechildren (55.7%; the age ranged between 2 and 14 years (meanage =7.6 years; toothache was the most common cause of urgencycare (53.84%; most cases of dental urgencies involved primarymandibular second molars (34.7%; the maxillary central incisorswere the most affected by traumatic injuries in both the primary(78.5% and permanent (76.2% dentitions; extraction (44% wasthe most common dental procedure followed by root canal therapy(34.5% and restorative treatment (24.5%; dental caries (48.3%was the diagnosis most frequently associated with toothachefollowed by irreversible pulpitis (22.8% and reversible pulpitis(16.1%.Conclusions: Most patients that sought treatment at the UrgencyService of the Pediatric Dentistry Clinic at FOUFAL were femalechildren with a low socioeconomic level. Toothache was the mostfrequent reason for the urgency appointments, extraction was themost common procedure, affecting mainly the primary dentition andthe mandibular second molars.

  19. 75 FR 54351 - Cell and Gene Therapy Clinical Trials in Pediatric Populations; Public Workshop

    Science.gov (United States)

    2010-09-07

    ... HUMAN SERVICES Food and Drug Administration Cell and Gene Therapy Clinical Trials in Pediatric... public workshop entitled ``Cell and Gene Therapy Clinical Trials in Pediatric Populations.'' The purpose... therapy clinical researchers, and other stakeholders regarding best practices related to cell and...

  20. Muscle MRI in pediatrics: clinical, pathological and genetic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Cejas, Claudia P.; Serra, Maria M.; Galvez, David F.G. [Foundation for Neurological Research Dr. Raul Carrea (FLENI), Radiology Department, Buenos Aires (Argentina); Cavassa, Eliana A.; Vazquez, Gabriel A.; Massaro, Mario E.L.; Schteinschneider, Angeles V. [Foundation for Neurological Research Dr. Raul Carrea (FLENI), Department of Neuropediatrics, Buenos Aires (Argentina); Taratuto, Ana L. [Foundation for Neurological Research Dr. Raul Carrea (FLENI), Neuropathology Consultant, Buenos Aires (Argentina)

    2017-05-15

    Pediatric myopathies comprise a very heterogeneous group of disorders that may develop at different ages and affect different muscle groups. Its diagnosis is sometimes difficult and must be confirmed by muscle biopsy and/or genetic analysis. In recent years, muscle involvement patterns observed on MRI have become a valuable tool, aiding clinical diagnosis and enriching pathological and genetic assessments. We selected eight myopathy cases from our institutional database in which the pattern of muscle involvement observed on MRI was almost pathognomonic and could therefore contribute to establishing diagnosis. Muscle biopsy, genetic diagnosis or both confirmed all cases. (orig.)

  1. Optimal normative pediatric cardiac structure dimensions for clinical use.

    Science.gov (United States)

    Awori, Mark N; Finucane, Kirsten; Gentles, Thomas L

    2011-01-01

    Cardiac structure size influences surgical decision making in pediatric cardiac surgery. Lack of universally adopted normative cardiac structure dimensions may confound decision making. A review of the relevant literature contained in 2 large databases was performed with a view to determine the optimal normative cardiac structure dimensions for clinical use. The current article initially discusses technical issues related to cardiac structure measurement and measurement normalization. It then describes the literature search strategy and examines the quality of published data in subjects below 19 years of age. The optimal normative dimension data set is then recommended.

  2. Tablet Computing in Clinical Training of Pediatric Residents.

    Science.gov (United States)

    Howard, David J; Coovert, Sally A; Coovert, Michael D; Nelson, Robert M

    2015-07-01

    Medical residents receive both medical education and clinical skills training. New technologies and pedagogies are being developed to address each of these phases. Our research focuses on the efficacy of an iPad(®) (Apple, Cupertino, CA) for clinical skills training. For a period of 3 years, the University of South Florida provided incoming pediatric residents (n=94) with an iPad. At the end of the 3-year program, we surveyed the residents, measuring perceptions and satisfaction of iPad use in clinical training. Sixty percent of the residents responded to the survey. Ninety-three percent reported at least some iPad usage per day on clinical activities. We classified 13 facets of clinical training into three conceptual areas and provided figures detailing iPad use for each facet relative to other facets in the same cluster. The obtaining, management, and display of information are primary uses of iPad applications in clinical training. Finally, we provide information relative to perceived obstacles in clinical training, with weight of the device being the most frequently cited. The role of graduate medical education is changing with the introduction of new technologies. These technologies can differentially impact the various aspects of residency education and training. Residents reported using an iPad extensively in their clinical training. We argue that in addition to impacting traditional educational strategies, iPads can successfully facilitate aspects of clinical training in medical education.

  3. Prevalence, clinical presentation and differential diagnosis of pediatric bipolar disorder.

    Science.gov (United States)

    Goldstein, Benjamin I; Birmaher, Boris

    2012-01-01

    Over the past 20 years, the evidence regarding pediatric bipolar disorder (BP) has increased substantially. As a result, recent concerns have focused primarily on prevalence and differential diagnosis. Selective review of the literature. BP as defined by rigorously applying diagnostic criteria has been observed among children and especially adolescents in numerous countries. In contrast to increasing diagnoses in clinical settings, prevalence in epidemiologic studies has not recently changed. BPspectrum conditions among youth are highly impairing and confer high risk for conversion to BP-I and BP-II. Compared to adults, youth with BP have more mixed symptoms, more changes in mood polarity, are more often symptomatic and seem to have worse prognosis. The course, clinical characteristics, and comorbidities of BP among children and adolescents are in many ways otherwise similar to those of adults with BP. Nonetheless, many youth with BP receive no treatment and most do not receive BP-specific treatment. Despite increased evidence supporting the validity of pediatric BP, discrepancies between clinical and epidemiologic findings suggest that diagnostic misapplication may be common. Simultaneously, low rates of treatment of youth with BP suggest that withholding of BP diagnoses may also be common. Clinicians should apply diagnostic criteria rigorously in order to optimize diagnostic accuracy and ensure appropriate treatment.

  4. Prevalence, Clinical Presentation, and Differential Diagnosis of Pediatric Bipolar Disorder

    Science.gov (United States)

    Goldstein, Benjamin I.; Birmaher, Boris

    2016-01-01

    Background Over the past 20 years, the evidence regarding pediatric bipolar disorder (BP) has increased substantially. As a result, recent concerns have focused primarily on prevalence and differential diagnosis. Method Selective review of the literature. Results BP as defined by rigorously applying diagnostic criteria has been observed among children and especially adolescents in numerous countries. In contrast to increasing diagnoses in clinical settings, prevalence in epidemiologic studies has not recently changed. BP-spectrum conditions among youth are highly impairing and confer high risk for conversion to BP-I and BP-II. Compared to adults, youth with BP have more mixed symptoms, more changes in mood polarity, are more often symptomatic and seem to have worse prognosis. The course, clinical characteristics, and comorbidities of BP among children and adolescents are in many ways otherwise similar to those of adults with BP. Nonetheless, many youth with BP receive no treatment and most do not receive BP-specific treatment. Conclusion Despite increased evidence supporting the validity of pediatric BP, discrepancies between clinical and epidemiologic findings suggest that diagnostic misapplication may be common. Simultaneously, low rates of treatment of youth with BP suggest that withholding of BP diagnoses may also be common. Clinicians should apply diagnostic criteria rigorously in order to optimize diagnostic accuracy and ensure appropriate treatment. PMID:22652925

  5. Evidence-based guidelines for pediatric clinical trials: focus on StaR Child Health.

    Science.gov (United States)

    Sampson, Mario R; Benjamin, Daniel K; Cohen-Wolkowiez, Michael

    2012-09-01

    Clinical trials in children are challenging and filled with important ethical considerations that differ from adults. Given difficulties associated with pediatric clinical trials, off-label prescribing is a common practice in pediatrics, which can lead to adverse safety events and efficacy failures. To overcome these consequences, in the past 15 years, legislation in the USA and Europe has provided incentives to industry and increased government funding to conduct pediatric trials. Pediatric trial networks have also been formed to decrease the knowledge gap. However, challenges to performing pediatric trials and lack of standardization and guidelines regarding studies in children still exist. Standards for Research (StaR) in Child Health, begun in 2009, aims to improve the design, conduct and reporting of pediatric trials. This organization uses a consensus guideline approach involving academic, government and industry stakeholders to identify and disseminate best practices for pediatric trials. Six out of 11 planned standards are currently published.

  6. Pediatric dentistry for the general practitioner: satisfying the need for additional education and training opportunities.

    Science.gov (United States)

    Stewart, Ray E; Sanger, Roger G

    2014-11-01

    The Pediatric Oral Health Access Program is a joint project of the California Dental Association and the California Society of Pediatric Dentistry. The results have been remarkable in terms of the number of underserved children who have received oral health services. What is less certain is the number of general dentists who, as a result of the training, have been able and willing to provide comprehensive care to more and younger children.

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

    Directory of Open Access Journals (Sweden)

    Christine Edwards

    2013-01-01

    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.

  8. MRI for clinically suspected pediatric appendicitis: an implemented program

    Energy Technology Data Exchange (ETDEWEB)

    Moore, Michael M.; Gustas, Cristy N.; Choudhary, Arabinda K.; Methratta, Sosamma T.; Hulse, Michael A.; Eggli, Kathleen D.; Boal, Danielle K.B. [Penn State Milton S. Hershey Medical Center, Department of Radiology, Mail Code H066, 500 University Drive, P.O. Box 850, Hershey, PA (United States); Geeting, Glenn [Penn State Milton S. Hershey Medical Center, Department of Emergency Medicine, Hershey, PA (United States)

    2012-09-15

    Emergent MRI is now a viable alternative to CT for evaluating appendicitis while avoiding the detrimental effects of ionizing radiation. However, primary employment of MRI in the setting of clinically suspected pediatric appendicitis has remained significantly underutilized. To describe our institution's development and the results of a fully implemented clinical program using MRI as the primary imaging evaluation for children with suspected appendicitis. A four-sequence MRI protocol consisting of coronal and axial single-shot turbo spin-echo (SS-TSE) T2, coronal spectral adiabatic inversion recovery (SPAIR), and axial SS-TSE T2 with fat saturation was performed on 208 children, ages 3 to 17 years, with clinically suspected appendicitis. No intravenous or oral contrast material was administered. No sedation was administered. Data collection includes two separate areas: time parameter analysis and MRI diagnostic results. Diagnostic accuracy of MRI for pediatric appendicitis indicated a sensitivity of 97.6% (CI: 87.1-99.9%), specificity 97.0% (CI: 93.2-99.0%), positive predictive value 88.9% (CI: 76.0-96.3%), and negative predictive value 99.4% (CI: 96.6-99.9%). Time parameter analysis indicated clinical feasibility, with time requested to first sequence obtained mean of 78.7 +/- 52.5 min, median 65 min; first-to-last sequence time stamp mean 14.2 +/- 8.8 min, median 12 min; last sequence to report mean 57.4 +/- 35.2 min, median 46 min. Mean age was 11.2 +/- 3.6 years old. Girls represented 57% of patients. MRI is an effective and efficient method of imaging children with clinically suspected appendicitis. Using an expedited four-sequence protocol, sensitivity and specificity are comparable to CT while avoiding the detrimental effects of ionizing radiation. (orig.)

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

    Science.gov (United States)

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

    2016-01-01

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

  10. Demand in Pediatric Dentistry for Sedation and General Anesthesia by Dentist Anesthesiologists: A Survey of Directors of Dentist Anesthesiologist and Pediatric Dentistry Residencies

    OpenAIRE

    Hicks, C. Gray; Jones, James E.; Saxen, Mark A.; Maupome,Gerardo; Sanders, Brian J.; Walker, LaQuia A.; James A. Weddell; Tomlin, Angela

    2012-01-01

    This study describes what training programs in pediatric dentistry and dental anesthesiology are doing to meet future needs for deep sedation/general anesthesia services required for pediatric dentistry. Residency directors from 10 dental anesthesiology training programs in North America and 79 directors from pediatric dentistry training programs in North America were asked to answer an 18-item and 22-item online survey, respectively, through an online survey tool. The response rate for the 1...

  11. Family patterns of decision-making in pediatric clinical trials.

    Science.gov (United States)

    Snethen, Julia A; Broome, Marion E; Knafl, Kathleen; Deatrick, Janet A; Angst, Denise B

    2006-06-01

    The decision-making process related to a child's participation in clinical trials often involves multiple family members. The aim of this study was to compare family patterns of decision-making within and across family units in pediatric clinical trials. Participants for this secondary analysis included 14 families from a larger study of informed consent. Four distinct patterns of decision-making were identified: Exclusionary, informative, collaborative, and delegated. These patterns varied with regard to three dimensions of parents' decision-making goals, child level of involvement, and the parental role. These patterns of decision-making affect how parents and children communicate with health professionals and influence the effectiveness of health care providers interactions with the family related to the decision-making process.

  12. Socio-demographic, Clinical and Laboratory Features of Rotavirus Gastroenteritis in Children Treated in Pediatric Clinic

    OpenAIRE

    Azemi, Mehmedali; Berisha, Majlinda; Ismaili-Jaha, Vlora; Kolgeci, Selim; Avdiu, Muharrem; Jakupi, Xhevat; Hoxha, Rina; Hoxha-Kamberi, Teuta

    2013-01-01

    Aim: The aim of work was presentation of several socio-demographic, clinical and laboratory characteristics of gastroenteritis caused by rotavirus. The examinees and methods: The examinees were children under the age of five years treated at the Pediatric Clinic due to acute gastroenteritis caused by rotavirus. Rotavirus is isolated by method chromatographic immunoassay by Cer Test Biotec. Results: From the total number of patients (850) suffering from acute gastroenteritis, feces test on bac...

  13. Clinical forms of shoulder instability in pediatric patients

    Directory of Open Access Journals (Sweden)

    Yaroslav N. Proshchenko

    2016-12-01

    Full Text Available Background. The recurrence rate of adolescent chronic shoulder instability is approximately 56%–68%. However, this pathology is often missed in childhood and adolescence. Aim. To identify the clinical forms of shoulder joint instability in pediatric patients. Materials and methods. The authors present the data from 57 pediatric patients aged 3−17 years with a total of 61 unstable shoulder joints. All patients were divided into groups according to the form of instability. Traumatic chronic shoulder instability was identified in 40 patients (Bankart and Hill–Sachs injuries. Of these, non-traumatic shoulder instability was diagnose in 17, including five with recurrent dislocation, and spontaneous shoulder dislocation due to dysplasia of glenoid and labrum was diagnosed in 12. Of the 57 patients in the study cohort, 53 underwent surgery. Postoperatively, two patients developed recurrent shoulder dislocation (Andreev–Boichev technique due type III shoulder dysplasia in the first patient and multidirectional injury in the second. Conclusions. Shoulder joint instability should be considered as the traumatic or non-traumatic form. Treatment decisions should be based on anatomical characteristics that predispose to recurrent dislocation.

  14. Osteopathic Manipulative Treatment in Pediatric and Neonatal Patients and Disorders: Clinical Considerations and Updated Review of the Existing Literature.

    Science.gov (United States)

    Bagagiolo, Donatella; Didio, Alessia; Sbarbaro, Marco; Priolo, Claudio Giuseppe; Borro, Tiziana; Farina, Daniele

    2016-09-01

    Osteopathic medicine is a form of complementary and alternative medicine. Osteopathic practitioners treat patients of all ages: according to the Osteopathic International Alliance's 2012 survey, about one-third of all treated patients are aged between 31 and 50 years and nearly a quarter (23.4%) are pediatric patients, with 8.7% of them being younger than 2 years. In 2013 a systematic review evaluated the effectiveness of osteopathic manipulative treatment (OMT) in pediatric patients with different underlying disorders, but due to the paucity and low methodological quality of the primary studies the results were inconclusive. The aim of this review is therefore to update the evidence concerning OMT in perinatal and pediatric disorders and to assess its clinical impact. Most published studies favor OMT, but the generally small sample sizes in these studies cannot support ultimate conclusions about the efficacy of osteopathic therapy in pediatric age. In turn, clinical trials of OMT in premature infants might represent an important step in the osteopathic research because they can address both cost-effectiveness issues, and an innovative, multidisciplinary approach to the management of specific pediatric diseases cared for by the same, common health care system. The available studies in neonatal settings provide evidence that OMT is effective in reducing the hospital length of stay of the treated infants, therefore, suggesting that robust cost-effectiveness analyses should be included in the future clinical trials' design to establish new possible OMT-shared strategies within the health care services provided to newborns.

  15. The promise of service learning in a pediatric audiology course on clinical training with the pediatric population.

    Science.gov (United States)

    Kaf, Wafaa A; Strong, Elizabeth C

    2011-12-01

    This study investigated the effectiveness of service learning (SL) and its impact on students' clinical competency, interest in pediatric audiology as a career, and levels of community engagement, as well as its impact on the community. Forty-eight students enrolled in an SL pediatric audiology course providing hearing and middle ear testing to 292 children, ages 6 months to 5 years. Another 10 non-SL students served as a control group. SL surveys were administered to students before and after the SL experience and post hoc to the non-SL group to assess their perceived readiness for evaluating children and their interest in pediatric audiology. Parents and community partner staff members completed another survey to provide feedback about their experience with the SL activity. The students' ratings were higher post-SL than pre-SL, and their learning gain was positively ranked post-SL compared with the non-SL group. Also, 71% of the SL students expressed positive interest in pediatric audiology post-SL compared with 37% of the non-SL group. Responses from community partners were also positive. Embedding SL into a pediatric audiology course increased student interest in pediatric audiology as a career and enhanced readiness to evaluate young children.

  16. Diagnosis and clinical genetics of Cushing syndrome in pediatrics

    Science.gov (United States)

    Stratakis, Constantine A.

    2016-01-01

    SYNOPSIS Endogenous Cushing syndrome (CS) in pediatrics is rare; it may be caused by tumors that produce corticotropin (ACTH) in the pituitary gland (this form of CS is called Cushing disease) or elsewhere (ectopic CS), tumors that produce corticotropin-releasing hormone (CRH) anywhere (mostly neuroendocrine tissues), and finally adrenocortical masses that produce cortisol, such as adrenocortical cancer (ACC) or adenomas, and bilateral adrenocortical hypeprlasia (BAHs). ACC is a very rare cause of CS in children but should be excluded first, especially among younger patients. CS in children is often caused by germline or somatic mutations in an expanding list of genes with implications for the prognosis of the patients and for their families. CS should be early recognized in children; otherwise, it can lead to significant morbidity and mortality. All patients with suspected CS should be referred to specialized clinical centers for work-up; these centers should have access to experienced endocrine and neurological surgeons. PMID:27241967

  17. Pediatric insomnia: new insights in clinical assessment and treatment options.

    Science.gov (United States)

    Bruni, Oliviero; Angriman, Marco

    2015-01-01

    Sleep disorders in children can compromise quality of life of both children and families and chronic sleep deprivations is associated with poorer developmental outcome, overweight and behavioral disturbances. Clinicians should incorporate questions about sleep into their routine health assessment, and the assessment of insomnia should follow a medical approach primary and secondary contributing factors should be assessed, as well as maladaptive behaviors related to sleep. A careful examination of sleep/wake schedule, abnormal movements or behavior during sleep, and daytime consequences of sleep disruption or deprivation is mandatory. Sleeping environment, and bedtime routines should be examined to identify behavioral issues related to sleep. Polysomnography is not routinely indicated for children with insomnia, but actigraphy can give an objective estimation of sleep parameters. The Authors propose a new classification of pediatric insomnia, based on both genetic and clinical aspects, and suggest specific treatment options, including sleep hygiene, behavioral strategies and pharmacological treatment.

  18. Usage and Attitudes Towards Natural Remedies and Homeopathy in General Pediatrics: A Cross-Country Overview.

    Science.gov (United States)

    Beer, André-Michael; Burlaka, Ievgeniia; Buskin, Stephen; Kamenov, Borislav; Pettenazzo, Andrea; Popova, Diana; Riveros Huckstadt, María Pilar; Sakalinskas, Virgilijus; Oberbaum, Menachem

    2016-01-01

    In order to better understand the global approach and country differences in physicians' usage, knowledge, and attitudes towards natural remedies and homeopathy in pediatric practice, an online survey involving 582 general pediatricians and general practitioners treating pediatric diseases was conducted in 6 countries. Overall, 17% of the pediatric prescriptions refer to phytotherapy and 15% refer to homeopathic preparations. Natural remedies and homeopathic preparations are more frequently used in upper respiratory tract infections, infant colic, sleep disturbances, and recurrent infections. In the majority of cases, they are used together with chemical drugs. Both treatment options are typically used if parents are concerned about side effects of conventional drugs or prefer natural remedies for themselves. Physicians express high interest in natural remedies and homeopathy; however, their knowledge is variable. Lack of proven efficacy, knowledge on mechanism of action, and information on indications are main factors that limit their usage.

  19. Usage and Attitudes Towards Natural Remedies and Homeopathy in General Pediatrics

    Directory of Open Access Journals (Sweden)

    André-Michael Beer MD, PhD

    2016-07-01

    Full Text Available In order to better understand the global approach and country differences in physicians’ usage, knowledge, and attitudes towards natural remedies and homeopathy in pediatric practice, an online survey involving 582 general pediatricians and general practitioners treating pediatric diseases was conducted in 6 countries. Overall, 17% of the pediatric prescriptions refer to phytotherapy and 15% refer to homeopathic preparations. Natural remedies and homeopathic preparations are more frequently used in upper respiratory tract infections, infant colic, sleep disturbances, and recurrent infections. In the majority of cases, they are used together with chemical drugs. Both treatment options are typically used if parents are concerned about side effects of conventional drugs or prefer natural remedies for themselves. Physicians express high interest in natural remedies and homeopathy; however, their knowledge is variable. Lack of proven efficacy, knowledge on mechanism of action, and information on indications are main factors that limit their usage.

  20. Kidney Stones as an Under-Recognized Clinical Sign in Pediatric Cushing Disease

    Science.gov (United States)

    Rahman, Sara H.; Papadakis, Georgios Z.; Keil, Margaret F.; Faucz, Fabio R.; Lodish, Maya B.; Stratakis, Constantine A.

    2015-01-01

    Objective To investigate the prevalence of kidney stones in a population of children with Cushing disease (CD) and to compare this prevalence with that of healthy children. Study design Clinical and biochemical data from 139 pediatric patients with CD (68 female, 71 male) were retrospectively analyzed. Computed tomography (CT) scans were reviewed for kidney stones. Results Of 139 patients, 27 children with CD (19.4%) had either radiographic evidence and/or a history of kidney stones. Those with kidney stones had higher urine free cortisol (p-value = 0.008) and a transsphenoidal surgery at an older age (p-value = 0.007). Average urinary calcium creatinine ratio was elevated in patients with CD (0.22 ± 0.11). The prevalence of kidney stones in children with CD was higher than in normal children (19.42% vs 1.0%, p-value <0.001). Conclusion Our results illustrate that kidney stones are an under-estimated complication of pediatric CD, especially when compared with the prevalence of nephrolithiasis in the general pediatric population. Long term consequences for kidney function are not known and need to be studied. PMID:26703870

  1. Wound classification in pediatric general surgery: significant variation exists among providers.

    Science.gov (United States)

    Snyder, Rebecca A; Johnson, Lisa; Tice, Jamie; Wingo, Tammy; Williams, Dana; Wang, Li; Blakely, Martin L

    2013-11-01

    Risk-adjusted rates of surgical site infections (SSI) are used as a quality metric to facilitate improvement within a hospital system and allow comparison across institutions. The NSQIP-Pediatric, among others, uses surgical wound classification as a variable in models designed to predict risk-adjusted postoperative morbidity, including SSI rates. The purpose of this study was to measure the level of agreement in wound classification assignment among 3 providers: surgeons, operating room (OR) nurses, and NSQIP surgical clinical reviewers (SCR). An analysis was performed of pediatric general surgery operations from 2010 to 2011. Wound classification was assigned at the time of operation by the OR nurse and surgeon, and by the NSQIP SCR postoperatively, according to NSQIP methodology. Disagreement was defined as any discrepancy in classification among the 3 providers, and the level of agreement was determined using the kappa statistic. For the 374 procedures reviewed, there was an overall disagreement of 48% among all providers, kappa 0.48 (95% CI 0.43 to 0.53). When comparing wound classification by surgeon and NSQIP SCR, 23% of cases were in disagreement, kappa 0.74 (95% CI 0.68 to 0.78). Disagreement between OR nurse and either surgeon or NSQIP SCR was higher: 38%, kappa 0.45 (95% CI 0.38 to 0.53) and 40%, kappa 0.44 (95% CI 0.37 to 0.51). Fundoplication, appendectomy, and cholecystectomy demonstrated the highest overall disagreement (73%, 71%, and 60%, respectively). There is significant variation in assigning surgical wound classification among health care providers. For future SSI comparative analyses, it will be critical to improve uniformity and understanding of wound class assignment among providers and institutions. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Systematic psychosocial screening in a paediatric cardiology clinic: clinical utility of the Pediatric Symptom Checklist 17.

    Science.gov (United States)

    Struemph, Kari L; Barhight, Lydia R; Thacker, Deepika; Sood, Erica

    2016-08-01

    To examine the clinical utility of the Pediatric Symptom Checklist 17 for identifying psychosocial concerns and improving access to psychology services within a paediatric cardiology clinic. Parents of 561 children (aged 4-17 years) presenting for follow-up of CHD, acquired heart disease, or arrhythmia completed the Pediatric Symptom Checklist 17 as part of routine care; three items assessing parental (1) concern for learning/development, (2) questions about adjustment to cardiac diagnosis, and (3) interest in discussing concerns with a behavioural healthcare specialist were added to the questionnaire. A psychologist contacted the parents by phone if they indicated interest in speaking with a behavioural healthcare specialist. Percentages of children scoring above clinical cut-offs for externalising (10.5%), attention (8.7%), and total (9.3%) problems were similar to a "normative" primary-care sample, whereas fewer children in this study scored above the cut-off for internalising problems (7.8%; pclinical, characteristics were associated with Pediatric Symptom Checklist 17 scores. 17% of the parents endorsed concerns about learning/development, and 20% endorsed questions about adjustment to diagnosis. History of cardiac surgery was associated with increased concern about learning/development (pdiagnosis may yield improved utility. Psychology integration in clinics serving high-risk cardiac patients may decrease barriers to behavioural healthcare services.

  3. [Abdominal masses in pediatric age; clinical aspects and diagnostic approach in 52 cases (author's transl)].

    Science.gov (United States)

    Perrelli, L; Calisti, A; Molle, P

    1981-01-01

    A large series of malignant and benign conditions are generally collected under the term of abdominal masses. Their common aspect is the lack, in most of the cases, of peculiar clinical features which may help early differential diagnosis. In many cases the mass is detected late after a long period of vague, aspecific symptoms. 40% of these space occupying lesions of the abdomen are of malignant origin and delayed detection and investigation affect clinical course. Preoperative study of abdominal masses is a problem of primary importance in pediatric surgical practice. A changing attitude is registered towards many diagnostic procedures and the role of largely diffused techniques like angiography is controversial. The introduction of ultrasonography makes in many cases intensive radiologic investigation unwarranted and academic. The Authors discuss the real role and targets of preoperative investigations of abdominal masses and refer on their experience based on 52 cases, to underline some clinical aspects and analyse their diagnostic approach to this pathology.

  4. The epidemiology of epilepsy in children: a report from a Turkish pediatric neurology clinic.

    Science.gov (United States)

    Ünver, Olcay; Keskin, Sabiha Paktuna; Uysal, Serap; Ünver, Afşin

    2015-05-01

    This retrospective cohort study aims to assess the distribution of seizure types and epileptic syndromes in children with epilepsy who were followed up in a tertiary outpatient pediatric neurology clinic between January 2004 and December 2009. The findings of 533 children aged between 2 months and 16 years were evaluated. The International League Against Epilepsy criteria (of 1981 and 1989) were used for diagnosis and classification. The rate of partial seizures (56.5%) was higher than that of generalized seizures (43.5%). Partial seizures were more common during late childhood (P epilepsies (53.3%) were more frequent than generalized epilepsies (37.1%). Generalized epilepsies were more frequent during the first year of life, whereas localization-related epilepsies were more common at later ages (P epilepsies during childhood represent an important health issue for developing countries. © The Author(s) 2014.

  5. Clinical Stratification of Pediatric Patients with Idiopathic Thoracic Aortic Aneurysm.

    Science.gov (United States)

    Landis, Benjamin J; Ware, Stephanie M; James, Jeanne; Shikany, Amy R; Martin, Lisa J; Hinton, Robert B

    2015-07-01

    To describe the global phenotypes of pediatric patients with thoracic aortic aneurysm (TAA) who do not have a clinical diagnosis of Marfan syndrome (MFS) or related connective tissue disorders. We hypothesized that the presence of noncardiovascular abnormalities correlate with TAA severity and that medical therapy reduces TAA progression. This is a retrospective case series of patients with TAA age ≤ 21 years evaluated in a cardiovascular genetics clinic. Patients meeting clinical criteria for MFS or related disorders were excluded. Repeated measures analyses of longitudinal echocardiographic measurements of the aorta were used to test associations between TAA severity and noncardiovascular phenotype and to assess the impact of medical therapy. Sixty-nine patients with TAA at mean age 12.5 ± 5.3 years were included. Noncardiovascular abnormalities, including skeletal (65%) or craniofacial (54%) findings, were frequently observed. Increased rate of aortic root enlargement was associated with ocular (P = .002) and cutaneous (P = .003) abnormalities, and increased rate of ascending aorta enlargement was associated with craniofacial (P < .001) abnormalities. Beta blocker or angiotensin receptor blocker therapy (n = 41) was associated with reduction in the rate of aortic root growth (P = .018). Children with TAA not satisfying diagnostic criteria for MFS or related disorders frequently have noncardiovascular findings, some of which are associated with TAA progression. Because therapy initiation may reduce risk of progression and long-term complications, comprehensive assessment of noncardiovascular findings may facilitate early risk stratification and improve outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Pediatrics

    Science.gov (United States)

    Spackman, T. J.

    1978-01-01

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

  7. Electronic medical records (EMRs), epidemiology, and epistemology: reflections on EMRs and future pediatric clinical research.

    Science.gov (United States)

    Wasserman, Richard C

    2011-01-01

    Electronic medical records (EMRs) are increasingly common in pediatric patient care. EMR data represent a relatively novel and rich resource for clinical research. The fact, however, that pediatric EMR data are collected for the purposes of clinical documentation and billing rather than research creates obstacles to their use in scientific investigation. Particular issues include accuracy, completeness, comparability between settings, ease of extraction, and context of recording. Although these problems can be addressed through standard strategies for dealing with partially accurate and incomplete data, a longer-term solution will involve work with pediatric clinicians to improve data quality. As research becomes one of the explicit purposes for which pediatricians collect EMR data, the pediatric clinician will play a central role in future pediatric clinical research.

  8. Clinical Features and Outcome of Ebola Virus Disease in Pediatric Patients

    DEFF Research Database (Denmark)

    Damkjær, Mads; Rudolf, Frauke; Mishra, Sharmistha

    2017-01-01

    Clinical and outcome data on pediatric Ebola virus disease are limited. We report a case-series of 33 pediatric patients with Ebola virus disease in a single Ebola Treatment Center in 2014-2015. The case-fatality rate was 42%, with the majority of deaths occurring within 10 days of admission....

  9. Intranasal Midazolam Sedation in a Pediatric Emergency Dental Clinic.

    Science.gov (United States)

    Peerbhay, Fathima; Elsheikhomer, Ahmed Mahgoub

    2016-01-01

    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.

  10. Different Aspects of General Anesthesia in Pediatric Dentistry: A Review

    National Research Council Canada - National Science Library

    Ramazani, Nahid

    2016-01-01

    .... This review aims to discuss the topic further. A computerized search in databases PubMed, MEDLINE, EMBASE, Google Scholar and Google were performed using dental general anesthesia related keyword...

  11. Management of pediatric central nervous system emergencies: a review for general radiologists.

    Science.gov (United States)

    Rebollo Polo, M

    2016-05-01

    To review the most common and most important diseases and disorders of the central nervous system (CNS) in pediatric emergencies, discussing the indications for different imaging tests in each context. In pediatric patients, acute neurologic symptoms (seizures, deteriorating level of consciousness, focal neurologic deficits, etc.) can appear in diverse clinical situations (trauma, child abuse, meningoencephalitis, ischemia…). It is important to decide on the most appropriate neuroimaging diagnostic algorithm for each situation and age group, as well as to know the signs of the most typical lesions that help us in the etiological differential diagnosis. Pediatric patients' increased vulnerability to ionizing radiation and the possible need for sedation in studies that require more time are factors that should be taken into account when indicating an imaging test. It is essential to weigh the risks and benefits for the patient and to avoid unnecessary studies. Copyright © 2016 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  12. Virtual Pediatric Hospital

    Science.gov (United States)

    ... Assistant™ Last revised on February 22, 2017 Related Digital Libraries Pediatric GeneralPediatrics.com - the general pediatrician's view of the Internet PediatricEducation.org - a pediatric digital library and learning collaboratory intended to serve as a ...

  13. Different Aspects of General Anesthesia in Pediatric Dentistry: A Review

    OpenAIRE

    Nahid Ramazani

    2016-01-01

    Context Most child population is able to undergo dental treatment in the conventional setting. However, some children fail to cope with in-office conscious state and cannot respond to usual management modalities. This review aims to discuss the topic further. Evidence Acquisition A computerized search in databases PubMed, MEDLINE, EMBASE, Google Scholar and Google were performed using dental general anesthesia related keywords. Or...

  14. Clinical Practice of Steroid Avoidance in Pediatric Kidney Transplantation.

    Science.gov (United States)

    Nehus, E; Liu, C; Hooper, D K; Macaluso, M; Kim, M-O

    2015-08-01

    Steroid-avoidance protocols have recently gained popularity in pediatric kidney transplantation. We investigated the clinical practice of steroid avoidance among 9494 kidney transplant recipients at 124 transplant centers between 2000 and 2012 in the Organ Procurement and Transplantation Network database. The practice of steroid avoidance increased during the study period and demonstrated significant variability among transplant centers. From 2008 to 2012, 39% of transplant centers used steroid avoidance in avoidance in 10-40% of transplant recipients, and 40% of transplant centers used steroid avoidance in >40% of discharged patients. Children receiving steroid avoidance more frequently received induction with lymphocyte-depleting agents. Repeat kidney transplants were the least likely to receive steroid avoidance. Children who received a deceased donor kidney, underwent pretransplant dialysis, were highly sensitized, or had glomerular kidney disease or delayed graft function were also less likely to receive steroid avoidance. The variation in practice between centers remained highly significant (p avoidance among transplant centers remain unexplained and may reflect uncertainty about the safety and efficacy of steroid-avoidance protocols.

  15. Virologic and clinical characteristics of HBV genotypes/subgenotypes in 487 Chinese pediatric patients with CHB

    OpenAIRE

    Gu Mei-Lei; Li Xiao-Dong; Xing Xiao-Yan; Dong Yi; Duan Zhong-Ping; Song Hong-Bin; Li Jin; Zhong Yan-Wei; Han Yu-Kun; Zhu Shi-Shu; Zhang Hong-Fei

    2011-01-01

    Abstract Background The association of hepatitis B virus (HBV) genotypes/subgenotypes with clinical characteristics is increasingly recognized. However, the virologic and clinical features of HBV genotypes/subgenotypes in pediatric patients remain largely unknown. Methods Four hundred and eighty-seven pediatric inpatients with CHB were investigated, including 217 nucleos(t)ide analog-experienced patients. HBV genotypes/subgenotypes and reverse transcriptase (RT) mutations were determined by d...

  16. Advance MRI for pediatric brain tumors with emphasis on clinical benefits

    Energy Technology Data Exchange (ETDEWEB)

    Goo, Hyun Woo; Ra, Young Shin [Asan Medical Center, University of Ulsan College of Medicine, Seoul(Korea, Republic of)

    2017-01-15

    Conventional anatomic brain MRI is often limited in evaluating pediatric brain tumors, the most common solid tumors and a leading cause of death in children. Advanced brain MRI techniques have great potential to improve diagnostic performance in children with brain tumors and overcome diagnostic pitfalls resulting from diverse tumor pathologies as well as nonspecific or overlapped imaging findings. Advanced MRI techniques used for evaluating pediatric brain tumors include diffusion-weighted imaging, diffusion tensor imaging, functional MRI, perfusion imaging, spectroscopy, susceptibility-weighted imaging, and chemical exchange saturation transfer imaging. Because pediatric brain tumors differ from adult counterparts in various aspects, MRI protocols should be designed to achieve maximal clinical benefits in pediatric brain tumors. In this study, we review advanced MRI techniques and interpretation algorithms for pediatric brain tumors.

  17. Rates and risk factors of unplanned 30-day readmission following general and thoracic pediatric surgical procedures.

    Science.gov (United States)

    Polites, Stephanie F; Potter, Donald D; Glasgow, Amy E; Klinkner, Denise B; Moir, Christopher R; Ishitani, Michael B; Habermann, Elizabeth B

    2017-08-01

    Postoperative unplanned readmissions are costly and decrease patient satisfaction; however, little is known about this complication in pediatric surgery. The purpose of this study was to determine rates and predictors of unplanned readmission in a multi-institutional cohort of pediatric surgical patients. Unplanned 30-day readmissions following general and thoracic surgical procedures in children Pediatric. Time-dependent rates of readmission per 30 person-days were determined to account for varied postoperative length of stay (pLOS). Patients were randomly divided into 70% derivation and 30% validation cohorts which were used for creation and validation of a risk model for readmission. Readmission occurred in 1948 (3.6%) of 54,870 children for a rate of 4.3% per 30 person-days. Adjusted predictors of readmission included hepatobiliary procedures, increased wound class, operative duration, complications, and pLOS. The predictive model discriminated well in the derivation and validation cohorts (AUROC 0.710 and 0.701) with good calibration between observed and expected readmission events in both cohorts (p>.05). Unplanned readmission occurs less frequently in pediatric surgery than what is described in adults, calling into question its use as a quality indicator in this population. Factors that predict readmission including type of procedure, complications, and pLOS can be used to identify at-risk children and develop prevention strategies. III. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Receiving Providers' Perceptions on Information Transmission During Interfacility Transfers to General Pediatric Floors.

    Science.gov (United States)

    Rosenthal, Jennifer L; Romano, Patrick S; Kokroko, Jolene; Gu, Wendi; Okumura, Megumi J

    2017-06-01

    Pediatric patients can present to a medical facility and subsequently be transferred to a different hospital for definitive care. Interfacility transfers require a provider handoff across facilities, posing risks that may affect patient outcomes. The goal of this study was to describe the thoroughness of information transmission between providers during interfacility transfers, to describe perceived errors in care at the posttransfer facility, and to identify potential associations between thoroughness of information transmission and perceived errors in care. We performed an exploratory prospective cohort study on communication practices and patient outcomes during interfacility transfers to general pediatric floors. Data were collected from provider surveys and chart review. Descriptive statistics were used to summarize survey responses. Logistic regression was used to analyze the association of communication deficits with odds of having a perceived error in care. A total of 633 patient transfers were reviewed; 218 transport command physician surveys and 217 frontline provider surveys were completed. Transport command physicians reported higher proportions of key elements being included in the verbal handoff compared with frontline providers. The written key element transmitted with the lowest frequency was a summary document (65.2%), and 13% of transfers had at least 1 perceived error in care. Transfers with many deficits were associated with higher odds of having a perceived error in care. Information transmission during pediatric transfers is perceived to be inconsistently complete. Deficits in the verbal and written information transmission are associated with odds of having a perceived error in care. Copyright © 2017 by the American Academy of Pediatrics.

  19. Clinical presentation and audiologic findings in pediatric auditory neuropathy

    Directory of Open Access Journals (Sweden)

    Navneet Gupta

    2014-01-01

    Full Text Available Aim: of the study was to rule out audiologic findings, related etiologies and its effect in pediatric patients having hearing deficits that are most likely due to a neuropathy of the eighth nerve. Study Design: Retrospective neo-natal hearing screening programme based. Subject and Methods: Subjects include 30 children aged from 0 yrs to 12 yrs, were tested with pure tone audiometry, behavioral observation audiometry, free-filed audiometry, speech audiometry, auditory brainstem response, and click evoked otoacoustic emissions. Results: Pure tone and free-field testing revealed 40 ears (66.67%, n = 60 with sloping type, sensorineural hearing loss, 20 ears (33.3%, n = 60 had flat configuration. Out of this 18 (6%, n = 30 subject showed bilateral similar configuration (either bilateral sloping type/ flat type of audiogram. Rest 12 (40%, n = 30 subject showed bilateral different pattern. 10 (33.3%, n = 30 children demonstrated fair to poor word discrimination scores and the other 2 (6.67%, n = 30 had fair to good word discrimination. For other rest of 18 (60%, n = 30 children speech test couldn′t be performed because of age limit and poor speech and language development. Out of 30 subjects 28 (93.3%, n = 30 showed normal distortion product Otoacoustic emissions and 2(6.67%, n = 30 subjects showed absent emissions. Conclusions: All thirty children demonstrated absent or marked abnormalities of brainstem auditory evoked potentials which suggest cochlear outer hair cell function is normal; mostly lesion is located at the eighth nerve or beyond. Generally auditory neuropathy is associated with different etiologies and it is difficult to diagnose auditory neuropathy with single audiological test; sufficient test of battery is required for complete assessment and diagnosis of auditory neuropathy

  20. Pediatric Brain Tumors: Innovative Genomic Information Is Transforming the Diagnostic and Clinical Landscape.

    Science.gov (United States)

    Gajjar, Amar; Bowers, Daniel C; Karajannis, Matthias A; Leary, Sarah; Witt, Hendrik; Gottardo, Nicholas G

    2015-09-20

    Pediatric neuro-oncology has undergone an exciting and dramatic transformation during the past 5 years. This article summarizes data from collaborative group and institutional trials that have advanced the science of pediatric brain tumors and survival of patients with these tumors. Advanced genomic analysis of the entire spectrum of pediatric brain tumors has heralded an era in which stakeholders in the pediatric neuro-oncology community are being challenged to reconsider their current research and diagnostic and treatment strategies. The incorporation of this new information into the next-generation treatment protocols will unleash new challenges. This review succinctly summarizes the key advances in our understanding of the common pediatric brain tumors (ie, medulloblastoma, low- and high-grade gliomas, diffuse intrinsic pontine glioma, and ependymoma) and some selected rare tumors (ie, atypical teratoid/rhabdoid tumor and CNS primitive neuroectodermal tumor). The potential impact of this new information on future clinical protocols also is discussed. Cutting-edge genomics technologies and the information gained from such studies are facilitating the identification of molecularly defined subgroups within patients with particular pediatric brain tumors. The number of evaluable patients in each subgroup is small, particularly in the subgroups of rare diseases. Therefore, international collaboration will be crucial to draw meaningful conclusions about novel approaches to treating pediatric brain tumors. © 2015 by American Society of Clinical Oncology.

  1. Generalized periodic discharges: Pathophysiology and clinical considerations

    NARCIS (Netherlands)

    van Putten, Michel Johannes Antonius Maria; Hofmeijer, Jeannette

    2015-01-01

    Generalized periodic discharges (GPDs) are commonly encountered in metabolic encephalopathy and cerebral hypoxia/ischemia. The clinical significance of this EEG pattern is indistinct, and it is unclear whether treatment with antiepileptic drugs is beneficial. In this study, we discuss potential

  2. Ethical principles and legal requirements for pediatric research in the EU: an analysis of the European normative and legal framework surrounding pediatric clinical trials.

    Science.gov (United States)

    Pinxten, Wim; Dierickx, Kris; Nys, Herman

    2009-10-01

    The involvement of minors in clinical research is inevitable to catch up with the lack of drugs labeled for pediatric use. To encourage the responsible conduct of pediatric clinical trials in the EU, an extensive legal framework has been developed over the past decade in which the practical, ethical, legal, social, and commercial issues in pediatric research are addressed. In this article, the European legal framework surrounding pediatric clinical trials is analyzed from the perspective of the major ethical concerns in pediatric research. The four principles of biomedical ethics will be used as a conceptual framework (1) to map the ethical issues addressed in the European legal framework, (2) to study how these issues are commonly handled in competent adults, (3) to detect workability problems of these paradigmatic approaches in the specific setting of pediatric research, and (4) to illustrate the strong urge to differentiate, specify, or adjust these paradigmatic approaches to guarantee their successful operation in pediatric research. In addition, a concise comparative analysis of the European regulation will be made. To conclude our analysis, we integrate our findings in the existing ethical discussions on issues specific to pediatric clinical research.

  3. Estimated clinical benefit of protecting neurogenesis in the developing brain during radiation therapy for pediatric medulloblastoma

    DEFF Research Database (Denmark)

    Blomstrand, M.; Berthelsen, Anne Kiil; Munck af Rosenschöld, Per Martin

    2012-01-01

    We sought to assess the feasibility and estimate the benefit of sparing the neurogenic niches when irradiating the brain of pediatric patients with medulloblastoma (MB) based on clinical outcome data. Pediatric MB survivors experience a high risk of neurocognitive adverse effects, often attributed......%-60%), and 33% (95% CI, 23%-44%) with opposing fields, IMAT, IMRT, and IMPT, respectively. Neurogenic niche sparing during cranial irradiation of pediatric patients with MB is feasible and is estimated to lower the risks of long-term neurocognitive sequelae. Greatest sparing is achieved with intensity...

  4. Medical diagnoses of pediatric dental patients treated under general anesthesia: a 19 year review.

    Science.gov (United States)

    Roberts, Michael W; Milano, Michael; Lee, Jessica Y

    2009-01-01

    The objective of this study was to examine the records of pediatric dental patients treated under general anesthesia to determine if there had been any significant change in preoperative diagnoses between 1990-99 and 2000-08. The records of 3298 pediatric dental patients treated in the operating room under general anesthesia at the University of North Carolina (UNC) Children's Hospital were examined and medical diagnoses recorded. The number of cases treated by calendar year was obtained. The results of this study did not find any significant differences in percentage frequency of medical diagnoses between the years of 1990-99 and 2000-08. There has been a steady increase in the number of cases treated under general anesthesia over the period of the study. 1. Dental care under general anesthesia remains an important treatment option. 2. The medical diagnoses of children provided dental treatment under general anesthesia has not changed significantly over the past nineteen years at the UNC Children's Hospital. 3. The demand to provide dental care for children under general anesthesia has continued to increase.

  5. [Use of hypnosis in radiotherapy as an alternative to general anesthesia in pediatric radiation oncology].

    Science.gov (United States)

    Claude, Line; Morelle, Magali; Mancini, Sandrine; Duncan, Anita; Sebban, Henri; Carrie, Christian; Marec-Berard, Perrine

    2016-11-01

    General anesthesia (GA) is often needed for radiotherapy (RT) in young children. This study aimed to evaluate the place of the rituals and/or hypnosis in pediatric in a reference center in pediatric radiation oncology in Rhône-Alpes Auvergne. This observational study retrospectively collected data on AG in childrenhypnosis systematically. Explanatory analyses of AG were performed using logistic regression. One hundred and thirty-two children benefited from RT in that period and were included (70 patients until 2008, 62 after 2008). Fifty-three percent were irradiated under GA. There was significant reduction (Phypnosis can be used instead of GA in about half of patients under 5 years, even also with high-technicity RT requiring optimal immobilization. Copyright © 2016 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

  6. The U.N. Convention on the Rights of the Child: Relevance and Application to Pediatric Clinical Bioethics.

    Science.gov (United States)

    Lansdown, Gerison; Lundy, Laura; Goldhagen, Jeffrey

    2016-01-01

    This article provides an overview of the relevance and import of the U.N. Convention on the Rights of the Child (CRC) to child health practice and pediatric bioethics. We discuss the four general principles of the CRC that apply to the implementation of all rights contained in the document, the right to health articulated in Article 24, and the important position ascribed to parents in fulfilling the rights of their children. We then examine how the CRC is implemented and monitored in law and practice. The CRC and associated principles of child rights provide strategies for rights-based approaches to clinical practice and health systems, as well as to policy design, professional training, and health services research. In light of the relevance of the CRC and principles of child rights to children's health and child health practice, it follows that there is an intersection between child rights and pediatric bioethics. Pediatric bioethicists and child rights advocates should work together to define this intersection in all domains of pediatric practice.

  7. [Minimally invasive surgery in pediatric patients within a general urology department].

    Science.gov (United States)

    Ríos, Jorge Subirá; Zalabardo, José Manuel Sánchez; Gil, Joaquín Navarro; Conejos, José Ignacio Hijazo; Alonso, Jesús García-Magariño; Calero, David García; López, José Antonio López; Uría, José Gabriel Valdivia

    2008-01-01

    The advances of minimally invasive surgery in urology over the last years have enabled a progressive and constant implementation of endourology and laparoscopy in pediatric patients. We perform a review of our experience, as a general hospital, with minimally invasive surgery performed in pediatric patients over the last ten years. We retrospectively analyzed the endourological and laparoscopic operations performed between 1997 and 2007 in children up to the age of 16 years, collecting data about patient's age and gender, type of disease, techniques, anesthesia, and perioperative events. seventy-two surgical operations were performed in patients with an age range between 28 days and 16 years, with a mean age of 6.8 years. 56% of the patients were boys and 44% girls. Indications for surgery was vesicoureteral reflux (VUR) in 28 cases (38.8%); lithiasis 17 cases (23.6%) which were distributed in 4 cystolithotripsies, 9 ureterorenoscopy with lithotripsy, one pure percutaneous nephrolithotomy and three mixed; ureterocele 9 cases (12.5%); urethral obstruction 7 cases (9.7%); 3 diagnostic laparoscopies for cryptorchidism (4. 1%), 2 laparoscopic procedures for cystic pathology (2.7%), another 2 laparoscopic renal biopsies (2.7%), and one laparoscopic repair of a ureteropyelic junction syndrome; 1 case of emergency percutaneous nephrostomy in the supine position after open pyeloplasty with subsequent reoperation with percutaneous resection of a granuloma; and 1 case of botulin toxin injection into the detrusor muscle. The consolidation of pediatric endourology in our department, and more recently laparoscopy, has contributed to improve the quality of care in pediatric patients; it has been achieved thanks to our previous know-how in general endourological techniques and the existence of adequate technical and human resources.

  8. Anaphylaxis in referred pediatric patients: demographic and clinical features, triggers, and therapeutic approach.

    Science.gov (United States)

    De Swert, Liliane F A; Bullens, Dominique; Raes, Marc; Dermaux, Anna-Maria

    2008-11-01

    Anaphylaxis remains under-diagnosed and under-treated. A better knowledge of patterns and triggers of anaphylaxis might contribute to a better management. In this study we evaluated the demographic and clinical features of anaphylaxis in pediatric patients, as well as its triggers and therapeutic approach. From May 1st 2004 until April 30th 2006 we prospectively collected data on all patients referred for investigation of anaphylaxis to the pediatric department of the University Hospital Gasthuisberg Leuven and to two private pediatric practices. Data were stored in a MYSQL database by use of an online encrypted web form. Sixty-four cases of anaphylaxis occurred in 48 children, aged 6 months to 14.8 years. Twenty-seven episodes (42.2%) occurred at home. The symptoms were dermatologic in 62 (96.9%) episodes, respiratory in 57 (89.1%), gastrointestinal in 19 (29.7%), cardiovascular in 14 (21.8%), and neurological or behavioural in 19 (29.7%). Antihistamines were administered in 41/57 (71.9%) cases, corticosteroids in 26/57 (45.6%), beta-2-mimetics in 14/57 (24.6%), and adrenaline in 11/57 (19.3%). Out of nine cases where Epipen was available at the moment of anaphylaxis, it was administered in one case only. Food was the cause of anaphylaxis in 42/55 (76.4%) cases with identified trigger, while medication, insect stings, latex, and birch pollen triggered 5 (9.1%), 4 (7.3%), 3 (5.5%), and 1 (1.8%) case(s), respectively. Allergy to the trigger was known prior to anaphylaxis in 19/55 (34.5%) cases. In conclusion, anaphylaxis in pediatric patients generally presents with dermatologic and respiratory symptoms, while in 1/5 episodes cardiovascular symptoms occur. Food is by far the most frequent trigger. Allergy to the trigger is known in 1/3 cases only. Anaphylaxis is under-treated, even when appropriate medication is available.

  9. Utilization of stainless steel crowns by general dentists and pediatric dental specialists in Indiana.

    Science.gov (United States)

    Kowolik, Joan; Kozlowski, Diana; Jones, James E

    2007-01-01

    The purpose of this study was to evaluate utilization of the stainless steel crown by both the general and pediatric dentists in Indiana. Although reports indicate that there has been a dramatic reduction in dental caries in the US, almost 20 percent of children have dental decay by age four, with almost 80 percent having a cavity by 17 years of age. After reviewing the literature, Seale has recommended that the stainless steel crown is the most successful restoration for children with a rate of high caries. All dental schools in North America teach the value of using stainless steel crowns and the method of tooth preparation. We hypothesized that greater use of the stainless steel crowns would be made by specialists than by general dentists. In this study, of the 200 questionnaires distributed, 62.5 percent were returned and analyzed. The results imply that stainless steel crowns are being significantly underutilized in general dental practice. It is interesting, and perhaps of concern, that the general dentists are not interested in continuing education courses about this subject. Over the next few years, with the aging of the pediatric dental community in Indiana, general (not specialty) dentists will treat most of the children. Because of this, pre-doctoral education needs to place more emphasis on preparation and utilization of the stainless steel crown.

  10. Pediatric Gastrointestinal Motility Disorders: Challenges and a Clinical Update

    OpenAIRE

    Chumpitazi, Bruno; Nurko, Samuel

    2008-01-01

    Pediatric gastrointestinal motility disorders are common and can range from relatively benign conditions such as functional constipation to more serious disorders such as achalasia, Hirschsprung disease, and intestinal pseudoobstruction. Performing and interpreting motility evaluations in children presents unique challenges and is complicated by a dearth of control information, underlying gastrointestinal developmental maturation, technical challenges (eg, catheter size limitations), and pati...

  11. Recent clinical and translational advances in pediatric hypertension.

    Science.gov (United States)

    Falkner, Bonita

    2015-05-01

    Epidemiological reports describe a child population increase in BP level and an increase in prevalence of hypertension, that is largely, but not entirely, driven by a concurrent increase in childhood obesity. Given current estimates, ≈10% of adolescents have hypertension or prehypertension. In addition to obesity, dietary salt intake and waist circumference, a marker of visceral obesity, are found to be independently associated with the rise in BP among children and adolescents. Dietary salt intake in urban children is well above recommended levels largely because of consumption of processed and fast foods. Childhood exposures, such as stress,52 salt, and fructose, as well as lifestyles, including food sources, sleep patterns, and reductions in physical activity may have a role in obesity-high BP associations. In addition, clinical and translational evidence is mounting that intrauterine exposures alter can effect changes in fetal development that have an enduring effect on cardiovascular and metabolic function later in life. These effects can be detected even in children who are products of a term otherwise normal pregnancy. Hypertension in childhood has been defined statistically (BP ≥ 95th percentile) because of lack of outcome data that links a BP level with heightened risk for future cardiovascular events. Therefore, primary hypertension had been considered a risk factor for later hypertension in adulthood. Intermediate markers of TOD, including cardiac hypertrophy, vascular stiffness, and increases in cIMT, are detectable in adolescents with primary hypertension. Evidence that vascular injury is present in the early phase of hypertension and even in prehypertension warrants consideration on the current definition of pediatric hypertension. With further studies on TOD and other risk factors in addition to high BP, it may be possible to shift from a statistical definition to a definition of childhood hypertension that is evidence based. Preventing or

  12. Computer Decision Support to Improve Autism Screening and Care in Community Pediatric Clinics

    Science.gov (United States)

    Bauer, Nerissa S.; Sturm, Lynne A.; Carroll, Aaron E.; Downs, Stephen M.

    2013-01-01

    An autism module was added to an existing computer decision support system (CDSS) to facilitate adherence to recommended guidelines for screening for autism spectrum disorders in primary care pediatric clinics. User satisfaction was assessed by survey and informal feedback at monthly meetings between clinical staff and the software team. To assess…

  13. Pediatric Clinical Pharmacology of Voriconazole: Role of Pharmacokinetic/Pharmacodynamic Modeling in Pharmacotherapy.

    Science.gov (United States)

    Kadam, Rajendra S; Van Den Anker, Johannes N

    2016-09-01

    Voriconazole is a potent antifungal agent used for the treatment of invasive fungal infections caused by Aspergillus and Candida species in adult and pediatric patients. Voriconazole has a narrow therapeutic index and a large intra- and inter-individual pharmacokinetics (PK) variability. Several factors including non-linear PK, age, body weight, cytochrome P450 2C19 genotype, concomitant drugs, liver function, and food are responsible for the large variability in voriconazole PK. A combination of a narrow therapeutic index with a large PK variability results in treatment failure in many patients at clinically recommended doses. There is an urgent need to establish an optimal dosing regimen for pediatric patients 60 %) treatment failure rates. Therapeutic drug monitoring is commonly used in clinical practice to optimize the voriconazole dosing regimens in pediatric patients, but it is associated with several practical limitations. Implementation of a PK model-guided individualized dose selection will help in reducing the PK variability and will improve therapeutic outcomes. In this review, we have summarized the covariates influencing the PK of voriconazole in adult and pediatric patients, emphasizing that the clearance of voriconazole is significantly different between adult and pediatric patients owing to developmental changes in the major clearance pathways. Moreover, we have provided the limitations of the current dosing regimens and have proposed a new dosing method using a PK model-guided dose individualization of voriconazole in pediatric patients.

  14. Time and Cost Analysis: Pediatric Dental Rehabilitation with General Anesthesia in the Office and the Hospital Settings

    Science.gov (United States)

    Rashewsky, Stephanie; Parameswaran, Ashish; Sloane, Carole; Ferguson, Fred; Epstein, Ralph

    2012-01-01

    Pediatric dental patients who cannot receive dental care in the clinic due to uncooperative behavior are often referred to receive dental care under general anesthesia (GA). At Stony Brook Medicine, dental patients requiring treatment with GA receive dental care in our outpatient facility at the Stony Brook School of Dental Medicine (SDM) or in the Stony Brook University Hospital ambulatory setting (SBUH). This study investigates the time and cost for ambulatory American Society of Anesthesiologists (ASA) Class I pediatric patients receiving full-mouth dental rehabilitation using GA in these 2 locations, along with a descriptive analysis of the patients and dental services provided. In this institutional review board–approved cross-sectional retrospective study, ICD-9 codes for dental caries (521.00) were used to collect patient records between July 2009 and May 2011. Participants were limited to ASA I patients aged 36–60 months. Complete records from 96 patients were reviewed. There were significant differences in cost, total anesthesia time, and recovery room time (P anesthesia end time minus anesthesia start time) to treat a child at SBUH under GA was 222 ± 62.7 minutes, and recovery time (time of discharge minus anesthesia end time) was 157 ± 97.2 minutes; the average total cost was $7,303. At the SDM, the average total time was 175 ± 36.8 minutes, and recovery time was 25 ± 12.7 minutes; the average total cost was $414. After controlling for anesthesia time and procedures, we found that SBUH cost 13.2 times more than SDM. This study provides evidence that ASA I pediatric patients can receive full-mouth dental rehabilitation utilizing GA under the direction of dentist anesthesiologists in an office-based dental setting more quickly and at a lower cost. This is very promising for patients with the least access to care, including patients with special needs and lack of insurance. PMID:23241037

  15. The ACGME case log: general surgery resident experience in pediatric surgery.

    Science.gov (United States)

    Gow, Kenneth W; Drake, F Thurston; Aarabi, Shahram; Waldhausen, John H

    2013-08-01

    General surgery (GS) residents in ACGME programs log cases performed during their residency. We reviewed designated pediatric surgery (PS) cases to assess for changes in performed cases over time. The ACGME case logs for graduating GS residents were reviewed from academic year (AY) 1989-1990 to 2010-2011 for designated pediatric cases. Overall and designated PS cases were analyzed. Data were combined into five blocks: Period I (AY1989-90 to AY1993-94), Period II (AY1994-95 to AY1998-99), Period III (AY1999-00 to AY2002-03), Period IV (AY2003-04 to AY2006-07), and Period V (AY2007-08 to AY2010-11). Periods IV and V were delineated by implementation of duty hour restrictions. Student t-tests compared averages among the time periods with significance at P pediatric cases declined for each period from an average of 47.7 in Period I to 33.8 in Period V. These changes are due to a decline in hernia repairs, which account for half of cases. All other cases contributed only minimally to the pediatric cases. The only laparoscopic cases in the database were anti-reflux procedures, which increased over time. GS residents perform a diminishing number of designated PS cases. This decline occurred before the onset of work-hour restrictions. These changes have implications on the capabilities of the current graduating workforce. However, the case log does not reflect all cases trainees may be exposed to, so revision of this list is recommended. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. General anesthesia: as a challenge and treatment need option in pediatric dentistry.

    Science.gov (United States)

    Del Machuca Portillo, María Carmen; Hanke Herrero, Rosana; del López Valle, Lydia; Machuca Portillo, Guillermo; Bullón Fernández, Pedro

    2005-12-01

    The purpose of this study was to determine the type and characteristics of the interventions, indications of dental treatment and procedures performed to patients treated under general anesthesia (GA) by pediatric dentistry residents, during the 1997-1999 period. A sample of 57 hospital records of patients treated as part of the Special Pediatric Course at the Puerto Rico Pediatric Hospital were reviewed. Statistical analysis was done using the chi-square test for inferences on proportions. MR patients made up 59.7% and NMR patients made up 40.3% of the sample studied. Ages ranged from 2 to 35 years with a mean age of 11 years (SD=8.54). MR patients were classified into 7 categories: mental retardation (38.2%), cerebral palsy (14.7%), epileptic (5.9%), mental syndromes (26.9%), hydrocephalic (5.9%), autism (5.9%) and others (2.9%). The NMR were classified into 5 categories: early childhood caries (65.2%), cardiac patients (8.7%), maxillofacial anomalies (4.3%), organic syndromes (13.1%) and others (8.7%). The dental procedures performed were: dental extractions 84%(MR) and 68% (NMR), restorative procedures 87.3%(MR) and 12.7%(NMR). Oral prophylaxis was performed in 76.8%, fissure sealants in 10.7% and topical fluoride applications in 21.8%. Dental extraction was a frequently performed procedure in both groups. The prevalence of exodontia and restorative procedures indicates the need to design and implement prevention programs for special pediatric patients.

  17. The ACGME case log: General surgery resident experience in pediatric surgery

    Science.gov (United States)

    Gow, Kenneth W.; Drake, F. Thurston; Aarabi, Shahram; Waldhausen, John H.

    2014-01-01

    Background General surgery (GS) residents in ACGME programs log cases performed during their residency. We reviewed designated pediatric surgery (PS) cases to assess for changes in performed cases over time. Methods The ACGME case logs for graduating GS residents were reviewed from academic year (AY) 1989–1990 to 2010–2011 for designated pediatric cases. Overall and designated PS cases were analyzed. Data were combined into five blocks: Period I (AY1989–90 to AY1993–94), Period II (AY1994–95 to AY1998–99), Period III (AY1999–00 to AY2002–03), Period IV (AY2003–04 to AY2006–07), and Period V (AY2007–08 to AY2010–11). Periods IV and V were delineated by implementation of duty hour restrictions. Student t-tests compared averages among the time periods with significance at P < .05. Results Overall GS case load remained relatively stable. Of total cases, PS cases accounted for 5.4% in Period I and 3.7% in Period V. Designated pediatric cases declined for each period from an average of 47.7 in Period I to 33.8 in Period V. These changes are due to a decline in hernia repairs, which account for half of cases. All other cases contributed only minimally to the pediatric cases. The only laparoscopic cases in the database were anti-reflux procedures, which increased over time. Conclusions GS residents perform a diminishing number of designated PS cases. This decline occurred before the onset of work-hour restrictions. These changes have implications on the capabilities of the current graduating workforce. However, the case log does not reflect all cases trainees may be exposed to, so revision of this list is recommended. PMID:23932601

  18. Clinical Profile, Co-Morbidities and Health Related Quality of Life in Pediatric Patients with Allergic Rhinitis and Asthma

    OpenAIRE

    Keya R. Lahiri, Milind S. Tullu* and Rachna Kalra

    2010-01-01

    Background: Co-existence of allergic rhinitis (AR) and bronchial asthma (BA) is well known. We planned to study the clinical profile of patients with AR & BA, the associated co-morbidities and the effect of AR &/ or BA on health related quality of life (HRQOL) in Pediatric patients. Methods: Patients attending the Pediatric out-patients department and Pediatric Chest Clinic of tertiary care center were enrolled. The sample size included 100 subjects with BA & AR (Group 1) with control groups ...

  19. Pediatric patients on ketogenic diet undergoing general anesthesia-a medical record review.

    Science.gov (United States)

    Soysal, Elif; Gries, Heike; Wray, Carter

    2016-12-01

    To identify guidelines for anesthesia management and determine whether general anesthesia is safe for pediatric patients on ketogenic diet (KD). Retrospective medical record review. Postoperative recovery area. All pediatric patients who underwent general anesthesia while on KD between 2009 and 2014 were reviewed. We identified 24 patients who underwent a total of 33 procedures. All children were on KD due to intractable epilepsy. The age of patients ranged from 1 to 15 years. General anesthesia for the scheduled procedures. Patients' demographics, seizure history, type of procedure; perioperative blood chemistry, medications including the anesthesia administered, and postoperative complications. Twenty-four patients underwent a total of 33 procedures. The duration of KD treatment at the time of general anesthesia ranged from 4 days to 8 years. Among the 33 procedures, 3 patients had complications that could be attributable to KD and general anesthesia. A 9-year-old patient experienced increased seizures on postoperative day 0. An 8-year-old patient with hydropcephalus developed metabolic acidosis on postoperative day 1, and a 7-year-old patient's procedure was complicated by respiratory distress and increased seizure activity in the postanesthesia care unit. This study showed that it is relatively safe for children on KD to undergo general anesthesia. The 3 complications attributable to general anesthesia were mild, and the increased seizure frequencies in 2 patients returned back to baseline in 24 hours. Although normal saline is considered more beneficial than lactated Ringer's solution in patients on KD, normal saline should also be administered carefully because of the risk of exacerbating patients' metabolic acidosis. One should be aware of the potential change of the ketogenic status due to drugs given intraoperatively. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Impact of pharmacist integration in a pediatric primary care clinic on vaccination errors: a retrospective review.

    Science.gov (United States)

    Haas-Gehres, Anna; Sebastian, Sonya; Lamberjack, Kristen

    2014-01-01

    To measure the impact of ambulatory clinical pharmacist integration in a pediatric primary care clinic on vaccination error rates and to evaluate missed opportunities. A retrospective, quasi-experimental review of electronic medical records of visit encounters during a 3-month period compared vaccine error rates and missed opportunities between two pediatric residency primary care clinics. The intervention clinic has a full-time ambulatory clinical pharmacist integrated into the health care team. Pharmacy services were not provided at the comparison clinic. A vaccine error was defined as follows: doses administered before minimum recommended age, doses administered before minimum recommended spacing from a previous dose, doses administered unnecessarily, live virus vaccination administered too close to a previous live vaccine, and doses invalid for combinations of these reasons. 900 encounters were randomly selected and reviewed. The error rate was found to be 0.28% in the intervention clinic and 2.7% in the comparison clinic. The difference in error rates was found to be significant (P = 0.0021). The number of encounters with greater than or equal to one missed opportunity was significantly higher in the comparison clinic compared with the intervention clinic (29.3% vs. 10.2%; P clinic with a pharmacist had reductions in vaccination errors as well as missed opportunities. Pharmacists play a key role in the pediatric primary care team to improve the appropriate use of vaccines.

  1. A 10-year review of pediatric uveitis at a Hispanic-dominated tertiary pediatric ophthalmic clinic

    Science.gov (United States)

    Dajee, Kruti P; Rossen, Jennifer Landau; Bratton, Monica L; Whitson, Jess T; He, Yu-Guang

    2016-01-01

    Purpose The aim of this study was to evaluate the characteristics and outcomes of pediatric uveitis cases at a large tertiary referral center in Dallas, TX, USA. Materials and methods The authors performed a retrospective chart review between 2001 and 2011 to identify children with uveitis. Results A total of 46 children (68 eyes) with uveitis were identified. Sixty-seven percent were Hispanic, and the mean age was 9.2 years. The majority of cases were idiopathic (74%). Anterior uveitis accounted for 42% of cases followed by intermediate uveitis/pars planitis (33%), posterior uveitis/retinitis (7%), and panuveitis (20%). Most patients were treated with corticosteroids (98% topical), 52% with systemic immunosuppression therapy, and 30% with surgery. Complications occurred in 74% of patients, with the most common complication being cataract development (26%), followed by posterior synechiae (24%). Twenty-four percent of patients had recurrences. Hispanic patients had worse visual acuities at presentation (P-value =0.073) and follow-up (P-value =0.057), compared to non-Hispanic patients. Conclusion Pediatric uveitis cases seen in a large center in Dallas were largely idiopathic, had commonly developed complications, and were associated with worse visual outcomes in Hispanic patients. PMID:27601874

  2. The effects of language concordant care on patient satisfaction and clinical understanding for Hispanic pediatric surgery patients.

    Science.gov (United States)

    Dunlap, Jonathan L; Jaramillo, Joshua D; Koppolu, Raji; Wright, Robert; Mendoza, Fernando; Bruzoni, Matias

    2015-09-01

    Hispanics account for over 60% of the U.S. population growth and 25% speak little-to-no English. This language barrier adversely affects both access to and quality of care. Surgical specialties trail other medical fields in assessing the effects of language barriers to surgical clinical care and patient satisfaction. This study was designed to assess the effects of patient-provider language concordance on a pediatric surgery practice. A surgery-specific, 7-point Likert scale questionnaire was designed with 14 questions modeled after validated patient satisfaction surveys from the literature. Questions concerning provider-patient language concordance, quality of understanding, and general satisfaction were included. Surveys were administered to families of patients in the General Pediatric Surgery Clinic at our institution. Families were categorized into three groups: English-speaking, regardless of race/ethnicity; Spanish-speaking using interpreter services with an English-speaking medical team; and Spanish-speaking communicating directly with a Spanish-speaking medical team (Hispanic Center for Pediatric Surgery, HCPS). One-way analysis of variance was used to test for group differences. We administered 226 surveys; 49 were removed due to lack literacy proficiency. Families in the HCPS group reported a higher level of satisfaction than the interpreter and English groups (ppediatric surgery clinic, language concordant care improves patient satisfaction and understanding for Hispanic families in comparison to language discordant care. Other clinics in other surgery sub-specialties may consider using this model to eliminate language barriers and improve patient satisfaction and understanding of surgical care. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Is There Value in Having Radiology Provide a Second Reading in Pediatric Orthopaedic Clinic?

    Science.gov (United States)

    Natarajan, Vivek; Bosch, Patrick; Dede, Ozgur; Deeney, Vincent; Mendelson, Stephen; Ward, Timothy; Brooks, Maria; Kenkre, Tanya; Roach, James

    2017-06-01

    The Joint Commission on Accreditation of Healthcare Organizations specifically mandates the dual interpretation of musculoskeletal radiographs by a radiologist in addition to the orthopaedist in all hospital-based orthopaedic clinics. Previous studies have questioned the utility of this practice. The purpose of this study was to further investigate the clinical significance of having the radiologist provide a second interpretation in a hospital-based pediatric orthopaedic clinic. A retrospective review was performed of all patients who had plain radiographs obtained in the pediatric orthopaedic clinic at an academic children's hospital over a 4-month period. For each radiographic series, the orthopaedist's note and the radiology interpretation were reviewed and a determination was made of whether the radiology read provided new clinically useful information and/or a new diagnosis, whether it recommended further imaging, or if it missed a diagnosis that was reflected in the orthopaedist's note. The hospital charges associated with the radiology read for each study were also quantified. The charts of 1570 consecutive clinic patients who were seen in the pediatric orthopaedic clinic from January to April, 2012 were reviewed. There were 2509 radiographic studies performed, of which 2264 had both a documented orthopaedist's note and radiologist's read. The radiologist's interpretation added new, clinically important information in 1.0% (23/2264) of these studies. In 1.7% (38/2264) of the studies, it was determined that the radiologist missed the diagnosis or clinically important information that could affect treatment. The total amount of the professional fees charged for the radiologists' interpretations was $87,362. On average, the hospital charges for each occurrence in which the radiologist's read provided an additional diagnosis or clinically important information beyond the orthopaedist's note were $3798. The results of this study suggest that eliminating the

  4. Mechanical thrombectomy in pediatric acute ischemic stroke: Clinical outcomes and literature review.

    Science.gov (United States)

    Madaelil, Thomas P; Kansagra, Akash P; Cross, DeWitte T; Moran, Christopher J; Derdeyn, Colin P

    2016-08-01

    There are limited data on outcomes of mechanical thrombectomy for pediatric stroke using modern devices. In this study, we report two cases of pediatric acute ischemic stroke treated with mechanical thrombectomy, both with good angiographic result (TICI 3) and clinical outcome (no neurological deficits at 90 days). In addition, we conducted a literature review of all previously reported cases describing the use of modern thrombectomy devices. Including our two cases, the aggregate rate of partial or complete vessel recanalization was 100% (22/22), and the aggregate rate of favorable clinical outcome was 91% (20/22). This preliminary evidence suggests that mechanical thrombectomy with modern devices may be a safe and effective treatment option in pediatric patients with acute ischemic stroke. © The Author(s) 2016.

  5. Characteristics of pediatric pulmonary hypertension trials registered on ClinicalTrials.gov.

    Science.gov (United States)

    Awerbach, Jordan D; Krasuski, Richard A; Hill, Kevin D

    2017-01-01

    The investigation of pediatric pulmonary hypertension (PH) drugs has been identified as a high priority by the United States National Institutes of Health (NIH). Studying pediatric PH is challenging due to the rare and heterogeneous nature of the disease. We sought to define the pediatric PH clinical trials landscape, to evaluate areas of trial success or failure, and to identify potential obstacles to the study of pediatric PH drugs. Interventional pediatric (ages 0-17 years) PH trials registered on ClinicalTrials.gov from June 2005 through December 2014 were analyzed. There were 45 pediatric PH trials registered during the study period. Median (IQR) projected trial enrollment was 40 (24-63), with seven trials (16%) targeting > 100 participants. Industry was the most common trial sponsor (n = 23, 50%), with only two (4.4%) NIH-sponsored trials. Phosphodiesterase inhibitors were the most frequently studied drug (n = 18, 39%). Single group study designs were used in 44% (n = 20) with an active comparator (parallel, factorial, or cross-over designs) in 25 trials, including 22 with randomization and ten that were double-blinded. Study outcomes varied markedly with inconsistent use of known surrogate and composite endpoints. One-third of trials (n = 15, 33%) were terminated, predominantly due to poor participant enrollment. Of the 17 completed trials, 11 had published results and only three efficacy trials met their primary endpoint. There are unique challenges to drug development in pediatric PH, including enrolling patients, identifying appropriate study endpoints, and conducting randomized, controlled, double-blind trials where the likelihood of meeting the study endpoint is optimized.

  6. The clinical and financial impact of a pediatric surgical neuro-oncology clinical trial.

    Science.gov (United States)

    Thompson, Eric M; Gururangan, Sridharan; Grant, Gerald; Mitchell, Duane; Sampson, John H

    2017-03-01

    Pediatric surgical trials are rare and the impact of such trials on the institutions in which they are conducted is unknown. The purpose of this study was to analyze the clinical and financial impact of The Re-MATCH trial, a Phase I clinical trial requiring the biopsy or resection of recurrent medulloblastoma or PNET for enrollment. Inpatient financial and clinical volume information was collected during the 3 years of trial enrollment and the years preceding and following it. The primary endpoints were the difference in direct contribution margin (DCM), or net gain, of study and non-study patients and the difference in surgical volume during the study and non-study periods. The trial enrolled 18 patients; 15 had surgery at the sponsor institution and three had surgery at their home institution, then transferred tumor material to the sponsor institution. There were no differences between the two groups for potentially confounding variables such as neurosurgical procedure work relative value units (P = 0.13) or insurance provider (P = 0.26). There was no difference between the inpatient DCM per case for the institution for non-study patients (mean ± SD, $9039 ± $28,549) and study patients ($14,332 ± $20,231) (P = 0.4819). During the non-study period, there were a mean of 2.78 ± 1.65 pediatric brain tumor resections per month compared to 3.34 ± 1.66 cases per month during the study period, a 17% increase. When the 15 study patients were excluded, there were 2.97 ± 1.64 cases per month, a 7% increase. However, this increase in total case volume including study and non-study patients was not significant (P = 0.121). Phase I investigator-initiated surgically-based clinical trials may increase institutional surgical volume without imposing a financial burden. Finances are unlikely to be a barrier for researchers negotiating for resources to conduct such trials.

  7. Comparison between a pediatric health promotion center and a pediatric obesity clinic in detecting metabolic syndrome and non-alcoholic fatty liver disease in children.

    Science.gov (United States)

    Yang, Hye Ran; Yi, Dae Yong; Choi, Hyoung Soo

    2014-12-01

    This study was done to evaluate the efficacy of health check-ups in children in detecting metabolic syndrome and non-alcoholic fatty liver disease (NAFLD) by comparing the pediatric health promotion center with the pediatric obesity clinic. Children who visited a pediatric health promotion center (n=218) or a pediatric obesity clinic (n=178) were included. Anthropometric data, blood pressure, laboratory tests, and abdominal ultrasonography were evaluated. Two different criteria were applied to diagnose metabolic syndrome. The prevalence of metabolic syndrome in the 2 units was 3.2%-3.7% in a pediatric health promotion center and 23%-33.2% in a pediatric obesity clinic. Significant differences were observed in the prevalence of each component of metabolic syndrome between the 2 units including abdominal adiposity, blood pressure, serum triglycerides, and fasting blood glucose (Pobesity clinic targeting obese children than that among patients visiting the health promotion center offering routine check-ups. An obesity-oriented approach is required to prevent obesity-related health problems in children.

  8. First Clinical Consensus and National Recommendations on Tracheostomized Children of the Brazilian Academy of Pediatric Otorhinolaryngology (ABOPe) and Brazilian Society of Pediatrics (SBP).

    Science.gov (United States)

    Avelino, Melissa A G; Maunsell, Rebecca; Valera, Fabiana Cardoso Pereira; Lubianca Neto, José Faibes; Schweiger, Cláudia; Miura, Carolina Sponchiado; Chen, Vitor Guo; Manrique, Dayse; Oliveira, Raquel; Gavazzoni, Fabiano; Picinin, Isabela Furtado de Mendonça; Bittencourt, Paulo; Camargos, Paulo; Peixoto, Fernanda; Brandão, Marcelo Barciela; Sih, Tania Maria; Anselmo-Lima, Wilma Terezinha

    Tracheostomy is a procedure that can be performed in any age group, including children under 1year of age. Unfortunately health professionals in Brazil have great difficulty dealing with this condition due to the lack of standard care orientation. This clinical consensus by Academia Brasileira de Otorrinolaringologia Pediátrica (ABOPe) and Sociedade Brasileira de Pediatria (SBP) aims to generate national recommendations on the care concerning tracheostomized children. A group of experts experienced in pediatric tracheostomy (otorhinolaryngologists, intensive care pediatricians, endoscopists, and pediatric pulmonologists) were selected, taking into account the different regions of Brazil and following inclusion and exclusion criteria. The results generated from this document were based on the agreement of the majority of participants regarding the indications, type of cannula, surgical techniques, care, and general guidelines and decannulation. These guidelines can be used as directives for a wide range of health professionals across the country that deal with tracheostomized children. Copyright © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  9. Improving Clinical Remission Rates in Pediatric Inflammatory Bowel Disease with Previsit Planning

    Science.gov (United States)

    Savarino, Jeffrey R.; Kaplan, Jess L.; Winter, Harland S.; Moran, Christopher J.; Israel, Esther J.

    2016-01-01

    Inflammatory Bowel Disease (IBD) is a chronic autoimmune inflammatory disease of the intestine which can lead to malnutrition, poor quality of life, and colon cancer.1–4 Although there is no cure for the disease, clinical remission is the primary goal.5 The Center for Inflammatory Bowel Disease at MassGeneral Hospital for Children (MGHfC) adopted a Previsit Planning (PVP) model to identify and discuss symptomatic patients prior to their appointments to identify specific issues that impact disease management.6–8 The Registry from ImproveCareNow (ICN), the international Quality Improvement Collaborative for the management of Crohn's Disease and Ulcerative Colitis in pediatric and adolescent patients, was used to capture information from each ambulatory visit and hospitalization. Using the Model for Improvement framework, the team began a weekly review and made care recommendations of patients with active disease who were cared for by one physician. Interventions were modified over multiple Plan-Do-Study-Act (PDSA) improvement cycles to increase the number of providers and to include patients with mild or moderate disease activity.9 Feedback from the providers regarding this process was elicited via a REDCap survey and the clinical remission rate was tracked using the ICN Registry. The clinical remission rate for the Center's patients increased from 77% (n=597) in September 2014 to 83% (n=585) in August 2015 and has been maintained. 78% of responding providers indicated that they found the PVP recommendations helpful “all of the time”. One hundred percent who responded to the survey said that they have used at least one recommendation provided to them. PVP for management of a chronic disease in pediatrics is feasible, even in a high volume practice. This process at MGHfC has resulted in the improvement of clinical remission rate. PDSA cycles were used to document successes and failures to help guide the work. Ongoing expansion of this PVP practice to all

  10. Pediatric anxiety disorders: from neuroscience to evidence-based clinical practice

    Directory of Open Access Journals (Sweden)

    Giovanni Abrahao Salum

    2013-01-01

    Full Text Available The objective of this narrative review of the literature is to describe the epidemiology, etiology, pathophysiology, diagnosis, and treatment of pediatric anxiety disorders. We aim to guide clinicians in understanding the biology of anxiety disorders and to provide general guidelines for the proper diagnoses and treatment of these conditions early in life. Anxiety disorders are prevalent, associated with a number of negative life outcomes, and currently under-recognized and under-treated. The etiology involves both genes and environmental influences modifying the neural substrate in a complex interplay. Research on pathophysiology is still in its infancy, but some brain regions, such as the amygdala and the prefrontal cortex, have been implicated in fear and anxiety. Current practice is to establish diagnosis based purely on clinical features, derived from clinical interviews with the child, parents, and teachers. Treatment is effective using medication, cognitive behavioral therapy, or a combination of both. An introduction to the neuroscience behind anxiety disorders combined with an evidence-based approach may help clinicians to understand these disorders and treat them properly in childhood.

  11. Extemporaneous Compounding of Oral Acitretin Suspension for Pediatric Patient with Generalized Pustular Psoriasis.

    Science.gov (United States)

    Choo, Winnie

    2016-01-01

    Generalized pustular psoriasis is rare in children, but it can occur and affect an extensive body surface area of a child. Treatment regimens can include medications that are not available in pediatric dosage form. Acitretin is considered one of the treatment options for acute generalized pustular psoriasis in children, but, in Singapore, it is only available as Neotigason capsules. Extemporaneous compounding of the powder content in the capsules was developed for formulating the oral acitretin suspension with a standardized formulation table and compounding process at National Skin Centre. An appropriate beyond-use date of the extemporaneous preparation was assigned after reviewing the photostability data of acitretin, compatibility of the active ingredient and excipients, and United States Pharmacopeia guidelines. It is deemed appropriate to assign a beyond-use date of 14 days when the extemporaneous preparation is stored in amber glass bottles at 2 degrees C to 8 degrees C.

  12. Clinical profile and follow-up of 51 pediatric neurocysticercosis cases: A study from Eastern India

    Directory of Open Access Journals (Sweden)

    Shakya Bhattacharjee

    2013-01-01

    Full Text Available Introduction: Our present observational study attempted to evaluate the clinical profiles, diagnosis, treatment and follow-up results of 51 pediatric neurocysticercosis patients over a mean duration of five years (from January 2006 to December 2010. Materials and Methods: Diagnosis was mainly based on clinical features, computed tomography (CT/magnetic resonance imaging scan and exclusion of other causes. Patients with active, transitional cysts and seizure were treated with albendazole for 28 days, steroids and anticonvulsants. Results: A total of 38 patients completed this study. Mean age of the presentation was 8.47 ± 3.19 years 52.6% of the patients were female. Overall patients presented with generalized seizure in 55.3%, focal in 31.6%, headache ± vomiting in 63.2%, focal neurodeficit in 10.5% and combination of symptoms in 60.5% cases. Contrast CT brain showed a solitary lesion in 27 (71.1% and multiple in the rest. At presentation lesions were transitional in 58.2%, inactive in 20% and mixed in 14.6%. After a mean of 2 years, seizure persisted in 9 (23.7% and headache in 8 (21.1% of whom six had normal electroencephalography (EEG while one each showed focal slowing, generalized slowing and epileptiform discharges. During the follow-up, CT scan brain 44.7% lesions calcified, 31.6% disappeared, 10.5% regressed and the rest persisted. Conclusion: Solitary ring enhancing lesions (transitional stage involving the parietal lobe was the commonest CT picture at presentation. Generalized tonic-clonic seizure was the most common type of seizure. Number of lesions, persistence of lesion, number of seizures, EEG abnormality at presentation were not found to be prognostically significant (P > 0.05.

  13. Phenomenology and clinical correlates of family accommodation in pediatric anxiety disorders.

    Science.gov (United States)

    Storch, Eric A; Salloum, Alison; Johnco, Carly; Dane, Brittney F; Crawford, Erika A; King, Morgan A; McBride, Nicole M; Lewin, Adam B

    2015-10-01

    Despite evidence documenting high prevalence of family accommodation in pediatric obsessive-compulsive disorder, examination in other pediatric anxiety disorders is limited. Preliminary evidence suggests that family accommodation is common amongst children with anxiety disorders; however, the impact on clinical presentation and functional impairment has not been addressed. This study assessed the nature and clinical correlates of family accommodation in pediatric anxiety, as well as validating a mechanistic model. Participants included 112 anxious youth and their parents who were administered a diagnostic clinical interview and measure of anxiety severity, as well as questionnaires assessing internalizing and externalizing symptoms, family accommodation and functional impairment. Some form of accommodation was present in all families. Family accommodation was associated with increased anxiety severity and externalizing behaviors, having a diagnosis of separation anxiety, and increased functional impairment. Family accommodation partially mediated the relationship between anxiety severity and functional impairment, as well as externalizing behaviors and functional impairment. Family accommodation is common in pediatric anxiety disorders, and is associated with more severe clinical presentations and functional impairment. These findings highlight the importance of parental involvement in treatment and the need to specifically target accommodation practices during interventions to mitigate negative outcomes in anxious youth. Further studies utilizing longitudinal data are needed to validate mechanistic models.

  14. Pediatric Obesity Management in Rural Clinics in California and the Role of Telehealth in Distance Education

    Science.gov (United States)

    Shaikh, Ulfat; Nettiksimmons, Jasmine; Romano, Patrick

    2011-01-01

    Objective: To determine health care provider needs related to pediatric obesity management in rural California and to explore strategies to improve care through telehealth. Methods: Cross-sectional survey of health care providers who treated children and adolescents at 41 rural clinics with existing telehealth connectivity. Results: Most of the…

  15. Preterm piglets are a clinically relevant model of pediatric GI disease

    Science.gov (United States)

    The goal of our research is to establish how nutritional support, enteral versus parenteral, affects gut function and susceptibility to disease in early development. We and others have used the neonatal pig to establish unique models of clinically relevant problems in pediatric gastroenterology, esp...

  16. Clinical and laboratory findings of 97 pediatric brucellosis patients in central Turkey.

    Science.gov (United States)

    Yoldas, Tamer; Tezer, Hasan; Ozkaya-Parlakay, Aslinur; Sayli, Tulin Revide

    2015-08-01

    Brucellosis is a disease transmitted to humans by consumption of unpasteurized animal milk, or through direct contact with infected animals. The aim of this study was to evaluate clinical, laboratory findings of pediatric patients with brucellosis. Data of 97 patients diagnosed with brucellosis between January 2000 and December 2010 were evaluated retrospectively.

  17. Ways of Improving the Training of Interns Pediatricians and General Practitioners — Family Physicians in «Pediatrics» Discipline

    Directory of Open Access Journals (Sweden)

    S.A. Mokiia-Serbina

    2015-10-01

    Full Text Available Graduates of medical schools having sufficient theoretical and practical skills often have difficulty in communicating with patients — children and their parents, as well as with colleagues. Objective: improving the efficiency of the educational process in the training of interns pediatricians and general practitioners — family physicians in «Pediatrics» course. Methods of the study: theoretical analysis of gathered experience. Results and discussion. During internship at the department, there are used seminars-discussions, seminars — training conferences, seminars — round tables that allows you to work out the tactics of speech, methods of discussion, reasoning of judgments, review, assessment, analysis. Interns most of the time must participate in the examination of a sick child, discussions of the results, conversations with parents. Clinical analysis of patients should be carried out using the method of structured group discussion when each intern can express his views. Interns are involved in scientific work, speak at scientific conferences. The department created a series of ambulatory pediatrics, -during which the intern talks to a child, his parents and he must to conciliate them, to inspire confidence and to prove himself as a specialist. During this course, special attention is paid to the psychological component of medical trai-ning. Clas-ses are conducted by assistant pediatrician, a graduate majoring in «Practical Psychology». Conclusions. The use of interactive teaching methods at different stages of the educational process contributes not only to improvement of theoretical activity, but also the formation in interns of professional qualities of clinical and scientific thinking, competence in the construction and development of interpersonal relations, humanism.

  18. Best clinical and research practice in pediatric neurology.

    Science.gov (United States)

    Martland, Timothy; Helen Cross, J

    2009-06-01

    Many children with epilepsy experience it as part of a broader disability. The cause is often a developmental, genetic, or early acquired abnormality associated with learning difficulties and impairments in other systems. In addition, it has become increasingly recognized in recent years that even children with so-called idiopathic generalized epilepsies may have specific language or cognitive impairments. The combination of seizures and these factors can form a significant barrier to the child and family in social and emotional terms as well. A child's brain must mature and learn new skills; and a large proportion of childhood epilepsies directly impact on this. The degree of control of the epilepsy can affect cognitive progress; but for many children the underlying cause of the impairment is the significant factor. For all children, access to appropriate clinical, educational, and social services for assessment and therapy is paramount. Specific initiatives in the North West of the United Kingdom are attempting to address service and organizational issues. Current research projects are investigating the impairments children with epilepsy have in addition to having seizures.

  19. Musculoskeletal imaging in pediatric emergencies: the basics through three clinical scenarios.

    Science.gov (United States)

    Garcés Iñigo, E F; Guasp Vizcaíno, M; Gómez Fernández-Montes, J

    2016-05-01

    A high percentage of the pediatric imaging studies requested during calls are related to musculoskeletal disease. Since bones and joints in children are immature, constantly growing and remodeling, they have physiological and anatomical peculiarities that make it necessary to use an approach specific for pediatric patients. In this article, we use three clinical scenarios (limping, fractures, and musculoskeletal infections) to summarize and transmit the concepts that are essential in emergency musculoskeletal imaging in children. Copyright © 2016 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  20. Pediatric MR elastography of hepatic fibrosis: principles, technique and early clinical experience

    Energy Technology Data Exchange (ETDEWEB)

    Binkovitz, Larry A.; Glaser, Kevin J.; Yin, Meng; Ehman, Richard L. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); El-Youssef, Mounif [Mayo Clinic, Pediatric Gastroenterology, Rochester, MN (United States); Binkovitz, Anna K. [Macalaster College, St. Paul, MN (United States)

    2012-04-15

    Numerous pediatric conditions result in hepatic fibrosis. As treatments develop for the underlying disorders, a non-invasive assessment of liver fibrosis would be beneficial as an adjunct or possible replacement for the traditional gold standard, liver biopsy. Magnetic resonance elastography is a noninvasive imaging technique that has been used successfully in adults for identification and assessment of liver fibrosis. This review describes the basic principles of MR elastography as well as the technical aspects specific to children. Clinical pediatric applications, limitations and areas for future research are described. (orig.)

  1. The relationships between clinical variables and renal parenchymal disease in pediatric clinically suspected urinary tract infection

    Directory of Open Access Journals (Sweden)

    Jung Lim Byun

    2010-02-01

    Full Text Available Purpose : To evaluate the significance of clinical signs and laboratory findings as predictors of renal parenchymal lesions and vesicoureteral reflux (VUR in childhood urinary tract infection (UTI. Methods : From July 2005 to July 2008, 180 patients admitted with a first febrile UTI at the Pediatric Department of Konkuk University Hospital were included in this study. The following were the clinical variables: leukocytosis, elevated C-reactive protein (CRP, positive urine nitrite, positive urine culture, and fever duration both before and after treatment. We evaluated the relationships between clinical variables and dimercaptosuccinic acid (DMSA scan and voiding cystourethrography (VCUG results. Results : VCUG was performed in 148 patients; of them, 37 (25.0% had VUR: 18 (12.2% had low-grade (I-II VUR, and 19 (10.5% had high-grade (III-V VUR. Of the 95 patients who underwent DMSA scanning, 29 (30.5% had cortical defects, of which 21 (63.6% had VUR: 10 (30.3%, low-grade (I-II VUR; and 11 (33.3%, high-grade VUR. Of the 57 patients who were normal on DMSA scan, 8 (14.0% had low-grade VUR and 6 (10.5% had high-grade VUR. The sensitivity, specificity, and positive and negative predictive values of the DMSA scan in predicting high-grade VUR were 64.7%, 69.9%, 33.3%, and 89.5%, respectively. Leukocytosis, elevated CRP, and prolonged fever (?#243;6 hours after treatment were significantly correlated with the cortical defects on DMSA scans and high-grade VUR. Conclusion : Clinical signs, including prolonged fever after treatment, elevated CRP, and leukocytosis, are positive predictors of acute pyelonephritis and high-grade VUR.

  2. Experience of clinical pharmaceutical care carried out in pediatric respiratory department

    Institute of Scientific and Technical Information of China (English)

    DU Xiao-ming; JIAN Ling-yan; ZHAO Li-mei

    2008-01-01

    Objective To discuss the role of clinical pharmacists in providing pharmaceutical care in pediatric respiratory department. Methods Supply pharmaceutical information, participate in clinical rounds, provide the rationalization proposal, help doctors to formulate correctly dose regimen, enhance medication efficiency; establish medicine record for the patient, record the drugs which were used, provide pharmaceutical care for the patient such as disease propaganda, medicine-use education, medicine consultation and so on. Results Promote rational administration, enhance the security of medical practice, the clinical pharmacists' work obtains the doctors' approval; improve the medication compliance, reduce patients' economy and spiritual burden, and obtain the patients' trust. Conclusions The pharmaeeutical care carried out in pediatric respiratory department can help reduce the incidence of medication errors, cut down the medication cost, shorten the time of patients to be hospitalized, raise the medication efficieney, and promote the doctor-patient relationship harmoniously. In a word the clinical pharmacists are indispensable.

  3. Stress system dysregulation in pediatric generalized anxiety disorder associated with comorbid depression.

    Science.gov (United States)

    Funke, R; Eichler, A; Distler, J; Golub, Y; Kratz, O; Moll, G H

    2016-12-16

    Because chronic stress is an important risk factor for anxiety states and depressive disorders, we studied hypothalamus-pituitary-adrenal (HPA) axis and sympathetic system activity via changes in cortisol and alpha amylase activity levels in pediatric generalized anxiety disorder (GAD) patients (n = 26) with comorbid depression and a healthy comparison group (n = 26). Morning plasma cortisol and diurnal profiles of salivary cortisol and salivary alpha amylase (sAA) activity were assessed, also reactivity of HPA-axis, sAA activity, and heart rate following a psychosocial stressor (Trier Social Stress Test for children). GAD patients with comorbid depression showed increased morning plasma and salivary cortisol levels, ameliorating throughout in-patient treatment, and higher sAA activity in their diurnal profile. Both HPA and sympathetic activity positively correlated with the severity of anxiety and depression. We also demonstrated a blunted HPA and sympathetic response to acute stress in patients. This pattern of neuroendocrine and sympathetic changes seems to be distinct from the one previously reported in pediatric patients with only social anxiety or depressive disorders. We propose morning plasma and saliva cortisol levels as potential physiological indicators for supporting the evaluation of symptoms' severity and treatment progress in children with GAD and comorbid depressive disorder.

  4. Levels of Stress among General Practitioners, Students and Specialists In Pediatric Dentistry during Dental Treatment.

    Science.gov (United States)

    Davidovich, E; Pessov, Y; Baniel, A; Ram, D

    2015-01-01

    To assess self-reported stress during the performance of different procedures in pediatric dentistry, according to the professional experience of the dentists. During the years 2010 to 2011, an anonymous survey was administered by means of an internet link, and by distribution at professional meetings of dentists . No statistically significant differences in stress were reported for maxilla and mandibular procedures. Placement of a rubber dam was rated as the most stressful procedure among dental students. For general practitioners and specialists, injection of local anesthesia to an anxious child was the most stressful procedure, regardless of age, sex, or years of professional experience. A negative correlation was found between years of experience and level of stress for all the procedures surveyed, but not for the use of nitrous oxide. No differences were found between male and female dentists in stress scores for any of the procedures. Higher rates of stress during operative procedures were reported among dental students than among experienced dentists. Anxiety of the pediatric patients, but not the location of the procedure: maxillary or mandibular, affected the dentists' reported level of stress.

  5. Expression of Survivin, CDK4, Ki-67 and Clinical Significance in Pediatric Acute Leukemia

    Institute of Scientific and Technical Information of China (English)

    ZHANG Liuqing; LIU Jing; LIN Hanhua; HU Qun; LIU Aiguo; HU Ying

    2006-01-01

    The expression of Survivin, CDK4 and Ki-67 and the clinical significance in pediatric acute leukemia (AL) were investigated. The expression of Survivin, CDK4 and Ki-67 proteins was detected by using immunohistochemical assay in 37 children with AL and 10 children with normal bone marrow as controls. The positive expression rate of Survivin, CDK4 and Ki-67 was 45.9 %,56.8 %, and 40.5 % respectively in 37 AL children, which was significantly higher than in control group accordingly (P<0.05). The expression of Survivin was positively correlated with CDK4(P=0.007) and Ki-67 (P=0.008). In conclusion, all Survivin, CDK4 and Ki-67 proteins are over-expressed in pediatric AL and involved in the modulation of apoptosis and proliferation in pediatric AL.

  6. Sexuality in early childhood: pediatric nurses' attitudes, knowledge, and clinical practice.

    Science.gov (United States)

    Popovich, D M

    2000-01-01

    This exploratory study assessed pediatric nurses' attitudes, knowledge, and patient care practices related to the sexuality of hospitalized preschool and early school-age children. Sexuality was defined as the sum of the physical, emotional, and psychologic attributes that are expressed in gender identity and behavior. For this study, a questionnaire containing 24 attitude, 20 knowledge, and 29 nursing practice Likert-scale items was used to survey 45 pediatric nurses in a southeastern tertiary care teaching hospital. Results indicated that, in general, the nurses surveyed had positive attitudes, sound knowledge, and appropriate practice with regard to the sexuality-related needs of their patients. However, there appeared to be some attitudinal biases and knowledge gaps that could adversely affect nursing practice. These findings were used to alter the content in pediatric nursing education at the study institution.

  7. [Clinical characteristics of pediatric victims in the Lushan and Wenchuan earthquakes and experience of medical rescue].

    Science.gov (United States)

    Jiang, Xin; Xiang, Bo; Liu, Li-Jun; Liu, Min; Tang, Xue-Yang; Huang, Lu-Gang; Li, Yuan; Peng, Ming-Xing; Xin, Wen-Qiong

    2013-06-01

    To get a more comprehensive understanding of the clinical characteristics of pediatric victims in earthquake and to summarize the experience of medical rescue. The clinical information was collected from the pediatric victims who were admitted to West China Hospital, Sichuan University following the Lushan earthquake in 2013 and Wenchuan earthquake in 2008. The clinical data were compared between the pediatric victims in the two earthquakes. Thirty-four children under 14 years of age, who were injured in the Lushan earthquake, were admitted to the West China Hospital before April 30, 2013. Compared with the data in the Wenchuan earthquake, the mean age of the pediatric victims in the Lushan earthquake was significantly lower (Pearthquake to hospitalization was significantly shorter (Pearthquake, 67.6% of the injured children had variable limb fractures; traumatic brain injury was found in 29.4% of hospitalized children, versus 9.5% in the Wenchuan earthquake (Pearthquake than in the Wenchuan earthquake. But these cases recovered well, which was possibly due to timely on-site rescue and transfer and multi-sector, multi-institution, and multidisciplinary cooperation.

  8. The Spectrum of General Surgery Interventions in Pediatric Patients with Ventricular Assist Devices.

    Science.gov (United States)

    Kamel, Fady; Buchholz, Holger; Dicken, Bryan; Conway, Jennifer

    2017-06-13

    Ventricular assist devices (VADs) have positively impacted the management of heart failure. However, they come with a range of complications. Although general surgical complications have been assessed in adults with VADs, there is no study to date that has assessed general surgery intervention in the pediatric population. Fifty-two patients who received VADs from 2005 to 2015 at the Stollery Children's Hospital were assessed for general surgery intervention and anticoagulation status at the time of intervention. Eighteen patients (35%) had general surgery intervention; there were 21 nonemergency procedures and six emergency procedures performed. For nonemergency procedures, 89% of patients had anticoagulation held within 24 hours of surgery and 84% had anticoagulation resumed within 4 hours postoperatively. Antiplatelet therapy was not held perioperatively. In both emergency and nonemergency procedures, anticoagulation status was not a factor in the success of the procedure. This study shows that it is safe to have general surgery intervention on the same admission as a VAD implant provided an appropriate interdisciplinary healthcare team is involved with the perioperative management of the patient.

  9. Clinical and Para clinical Manifestations of Tuberous Sclerosis: A Cross Sectional Study on 81 Pediatric Patients

    Directory of Open Access Journals (Sweden)

    Seyyed Hassan TONEKABONI

    2012-09-01

    Full Text Available How to Cite this Article: Tonekaboni SH, Tousi P, Ebrahimi A, Ahmadabadi F, keyhanidoust Z, Zamani Gh, Rezvani M, Amirsalari S, Tavassoli A, Rounagh A, Rezayi A. Clinical and Para clinical Manifestations of Tuberous Sclerosis: A Cross Sectional Study on 81 Pediatric Patients. Iran J Child Neurol 2012; 6(3: 25-31.ObjectiveMigraine is a disabling illness that causes absence from school andaffects the quality of life. It has been stated that headache may representan epileptic event. EEG abnormality is a prominent finding in childrenwith migraine. The aim of this study was to evaluate EEG abnormalitiesin children with migraine.Materials & MethodsTwo-hundred twenty-eight children were enrolled into the study.Evaluation and following of cases was performed by one physician,paraclinical tests were used to increase the accuracy. The study wasconducted under the supervision of pediatric neurology masters and theselected cases were from different parts of the country.ResultsComparing EEG abnormalities in different types of migraine revealedthat there is an association between them. There was also a significantdifference between EEG abnormalities in different types of aura. Migrainetype was associated with the patient’s age. Sleep disorders were morecommon in patients with a positive family history of seizure.ConclusionOur study dosclosed migraine as a common problem in children withabnormalities present in approximately 20% of the patients. Migraineand abnormal EEG findings are significantly associated.RefrencesBundey S, Evans K. Tuberous sclerosis: a genetic study. J Neurol Neurosurg. Psychiatry 1969 Dec;32(6:591-603.Staley BA, Vail EA, Thiele EA. Tuberous sclerosis complex: diagnostic challenges, presenting symptoms,and commonly missed signs. Pediatrics 2011 Jan;127(1:e117-25.Thiele EA, Korf BR. Phakomatoses and allied conditions.In: Swaiman KF, Ashwal S, Ferriero DM. Swaimans pediatric neurology. 5th ed. China: Elsevier Saunders;2012. p. 504

  10. Clinical Characteristics of Pediatric-Onset and Adult-Onset Multiple Sclerosis in Hispanic Americans.

    Science.gov (United States)

    Langille, Megan M; Islam, Talat; Burnett, Margaret; Amezcua, Lilyana

    2016-07-01

    Multiple sclerosis can affect pediatric patients. Our aim was to compare characteristics between pediatric-onset multiple sclerosis and adult-onset multiple sclerosis in Hispanic Americans. This was a cross-sectional analysis of 363 Hispanic American multiple scleroses cases; demographic and clinical characteristics were analyzed. A total of 110 Hispanic patients presented with multiple sclerosis before age 18 and 253 as adult multiple sclerosis. The most common presenting symptoms for both was optic neuritis. Polyfocal symptoms, seizures, and cognitive symptoms at presentation were more prevalent in pediatric-onset multiple sclerosis (P ≤ .001). Transverse myelitis was more frequent in adult-onset multiple sclerosis (P ≤ .001). Using multivariable analysis, pediatric-onset multiple sclerosis (adjusted odds ratio, 0.3OR 95% confidence interval 0.16-0.71, P = .004) and being US born (adjusted odds ratio, 0.553, 95% confidence interval 0.3-1.03, P = .006) were less likely to have severe ambulatory disability. Results suggest that pediatric-onset multiple sclerosis and adult-onset multiple sclerosis in Hispanics have differences that could be important for treatment and prognosis.

  11. Innovations for phase I dose-finding designs in pediatric oncology clinical trials.

    Science.gov (United States)

    Doussau, Adelaide; Geoerger, Birgit; Jiménez, Irene; Paoletti, Xavier

    2016-03-01

    Phase I oncology clinical trials are designed to identify the optimal dose that will be recommended for phase II trials. In pediatric oncology, the conduct of those trials raises specific challenges, as the disease is rare with limited therapeutic options. In addition, the tolerance profile is known from adult trials. This paper provides a review of the major recent developments in the design of these trials, inspired by the need to cope with the specific challenges of dose finding in cancer pediatric oncology. We reviewed simulation studies comparing designs dedicated to address these challenges. We also reviewed the design used in published dose-finding trials in pediatric oncology over the period 2009-2014. Three main fields of innovation were identified. First, designs that were developed in order to relax the rules for more flexible inclusions. Second, methods to incorporate data emerging from adult studies. Third, designs accounting for toxicity evaluation at repeated cycles in pediatric oncology. In addition to this overview, we propose some further directions for designing pediatric dose-finding trials.

  12. Stress Reduction through Audio Distraction in Anxious Pediatric Dental Patients: An Adjunctive Clinical Study

    Science.gov (United States)

    Samadi, Firoza; Jaiswal, JN; Tripathi, Abhay Mani

    2014-01-01

    ABSTRACT Aim: The purpose of the present study was to evaluate the eff-cacy of ‘audio distraction’ in anxious pediatric dental patients. Materials and methods: Sixty children were randomly selected and equally divided into two groups of thirty each. The first group was control group (group A) and the second group was music group (group B). The dental procedure employed was extraction for both the groups. The children included in music group were allowed to hear audio presentation throughout the treatment procedure. Anxiety was measured by using Venham's picture test, pulse rate, blood pressure and oxygen saturation. Results: ‘Audio distraction’ was found efficacious in alleviating anxiety of pediatric dental patients. Conclusion: ‘Audio distraction’ did decrease the anxiety in pediatric patients to a significant extent. How to cite this article: Singh D, Samadi F, Jaiswal JN, Tripathi AM. Stress Reduction through Audio Distraction in Anxious Pediatric Dental Patients: An Adjunctive Clinical Study. Int J Clin Pediatr Dent 2014;7(3):149-152. PMID:25709291

  13. Knowledge and attitude of pediatric dentists, general dentists, postgraduates of pediatric dentistry, and dentists of other specialties toward the endodontic treatment of primary teeth

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    P Devendra Patil

    2016-01-01

    Full Text Available Background: Pediatric dentists (PDs play an important role in treating primary teeth and oral health care needs for children. Pulp therapy is widely used in the treatment of primary teeth. The choice of endodontic treatment modality changes among general dentist (GD and PD. Aim and Objectives: The aim of this study is to determine the attitudes of PDs, GDs, postgraduates (PGs of pediatric dentistry and dentists of other specialties toward endodontic treatment of primary teeth. Materials and Methods: A structured 20-item questionnaire was formulated in English and distributed to PD, GD's, PGs of pediatric dentistry, and dentist of other specialties. The filled questionnaire survey was statistically analyzed using simple descriptive analysis and inferential analysis was performed using Chi-square t- test. Results: Out of the 237 survey respondents, 27.43% were BDS (GD's, 16.88% were MDS (PD, 12.66% were PG's (pediatric dentistry, and 43.04% were MDS (other than PD. About 91.6% of the total respondents preferred endodontic procedures in primary teeth. Conclusion: The study concluded that the GD's, PD's, and dentist of other specialty differ in their treatment recommendations for primary teeth. The GDs and dentist of other specialty were regularly performing pulp therapy in primary teeth and should frequently update their knowledge about endodontic procedures in primary teeth.

  14. Clinical and radiological profiles and outcomes in pediatric patients with intracranial aneurysms.

    Science.gov (United States)

    Mehrotra, Anant; Nair, Anup P; Das, Kuntal Kanti; Srivastava, Arun; Sahu, Rabi Narayan; Kumar, Raj

    2012-10-01

    Intracranial aneurysms are extremely uncommon in the pediatric population, their characteristics are not well studied, and certain features make them unique. The authors analyzed pediatric patients with aneurysms to try to understand their clinical, radiological, and outcome profile. Sixty-three pediatric patients (≤ 18 years of age) with ages ranging from 4 to 18 years and features (clinical and radiological) suggestive of aneurysm presented to, and were treated at, the authors' center in the past 20 years (1991-2011). Included in the present study were only those patients who underwent surgical intervention, and thus data for 57 patients were analyzed. Seventy-three aneurysms in 57 patients were surgically treated. There was a slight female predominance (M/F 1:1.2), and the mean age among all patients was 12.69 ± 3.75 years. Fifty patients (87.72%) presented with subarachnoid hemorrhage, 4 (7.02%) with mass effect, and 3 (5.26%) with seizure. On presentation the majority of patients (45 [78.95%]) had a good clinical grade. Eleven patients had multiple aneurysms. The internal carotid artery (ICA) bifurcation was the most common aneurysm site (18 cases [24.66%]), followed by the middle cerebral artery (MCA) bifurcation (11 cases [15.07%]). At a mean follow-up of 18.58 ± 10.71 months (range 1.5-44 months), 44 patients (77.19%) had a favorable outcome, and 5 patients had died. Pediatric patients with intracranial aneurysms most commonly presented with subarachnoid hemorrhage, and there was a slight female predominance. The ICA bifurcation followed by the MCA bifurcation was the most common aneurysm site. The incidence of posterior circulation and giant aneurysms is higher in pediatric patients than in the adult population. Children tend to present with better clinical grades and have better overall survival results and good functional outcomes.

  15. International Conference on Harmonisation; guidance on E11 clinical investigation of medicinal products in the pediatric population; availability. Notice.

    Science.gov (United States)

    2000-12-15

    The Food and Drug Administration (FDA) is announcing the availability of a guidance entitled "E11 Clinical Investigation of Medicinal Products in the Pediatric Population." The guidance was prepared under the auspices of the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH). The guidance sets forth critical issues in pediatric drug development and approaches to the safe, efficient, and ethical study of medicinal products in the pediatric population. The guidance is intended to encourage and facilitate the timely development of pediatric medicinal products internationally.

  16. [Clinical applications of the use of probiotics in pediatrics].

    Science.gov (United States)

    Álvarez-Calatayud, Guillermo; Pérez-Moreno, Jimena; Tolín, Mar; Sánchez, César

    2013-01-01

    Introducción: El empleo de probióticos supone un novedoso avance en el campo de la Pediatría puesto que pueden ser útiles en la prevención y tratamiento de múltiples patologías gastrointestinales, constituyendo un elemento más en nuestro arsenal terapéutico. Objetivo: En este artículo se presenta una revisión actualizada de la literatura científica sobre el uso de los probióticos en Pediatría, principalmente en problemas gastrointestinales con alteración en la microbiota intestinal describiéndose las principales aplicaciones del empleo de los probióticos y prebióticos en la infancia y repasando las líneas de investigación futuras. Resultados y conclusiones: A pesar de existir suficiente evidencia científica en varias patologías, la utilización de probióticos no está del todo incorporado a la práctica clínica habitual de los pediatras. Se emplea en el contexto de las enfermedades gastrointestinales (diarrea aguda infecciosa, la diarrea asociada a antibióticos, sobredesarrollo bacteriano) y, más recientemente, en procesos inflamatorios crónicos como la enfermedad inflamatoria intestinal o en trastornos funcionales como el cólico del lactante o el estreñimiento. También se ha valorado su efecto beneficioso en alteraciones extraintestinales, tales como la alergia (dermatitis atópica) o los efectos sobre las mucosas respiratorias o urogenitales y, en los últimos años, en la prevención de patología del recién nacido pretérmino y en la infección por H. pylori. Además existen varias líneas de investigación abiertas en la suplementación alimentaria con probióticos y prebióticos. Cada cepa prebiótica debe ser estudiada individualmente y extensamente para determinar su eficacia y seguridad en todas aquellas situaciones en que su empleo puede ser aconsejable.

  17. Clinical and Molecular Characteristics in 100 Chinese Pediatric Patients with m.3243A>G Mutation in Mitochondrial DNA

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    Chang-Yu Xia

    2016-01-01

    Conclusions: Our study showed that half of Chinese pediatric patients with m.3243A>G mutation presented seizures, short stature, abnormal MRI/CT changes, elevated plasma lactate, vomiting, and headache. Pediatric patients with these recurrent symptoms should be considered for screening m.3243A>G mutation. Clinical manifestations and laboratory abnormalities should be carefully monitored in patients with this point mutation.

  18. Learning curve evaluation using cumulative summation analysis-a clinical example of pediatric robot-assisted laparoscopic pyeloplasty.

    Science.gov (United States)

    Cundy, Thomas P; Gattas, Nicholas E; White, Alan D; Najmaldin, Azad S

    2015-08-01

    The cumulative summation (CUSUM) method for learning curve analysis remains under-utilized in the surgical literature in general, and is described in only a small number of publications within the field of pediatric surgery. This study introduces the CUSUM analysis technique and applies it to evaluate the learning curve for pediatric robot-assisted laparoscopic pyeloplasty (RP). Clinical data were prospectively recorded for consecutive pediatric RP cases performed by a single-surgeon. CUSUM charts and tests were generated for set-up time, docking time, console time, operating time, total operating room time, and postoperative complications. Conversions and avoidable operating room delay were separately evaluated with respect to case experience. Comparisons between case experience and time-based outcomes were assessed using the Student's t-test and ANOVA for bi-phasic and multi-phasic learning curves respectively. Comparison between case experience and complication frequency was assessed using the Kruskal-Wallis test. A total of 90 RP cases were evaluated. The learning curve transitioned beyond the learning phase at cases 10, 15, 42, 57, and 58 for set-up time, docking time, console time, operating time, and total operating room time respectively. All comparisons of mean operating times between the learning phase and subsequent phases were statistically significant (P=learning curve evaluation and outcome quality monitoring. In applying this statistical technique to the largest reported single surgeon series of pediatric RP, we demonstrate numerous distinctly shaped learning curves and well-defined learning phase transition points. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Pediatric Sepsis.

    Science.gov (United States)

    Prusakowski, Melanie K; Chen, Audrey P

    2017-02-01

    Pediatric sepsis is distinct from adult sepsis in its definitions, clinical presentations, and management. Recognition of pediatric sepsis is complicated by the various pediatric-specific comorbidities that contribute to its mortality and the age- and development-specific vital sign and clinical parameters that obscure its recognition. This article outlines the clinical presentation and management of sepsis in neonates, infants, and children, and highlights some key populations who require specialized care. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Demographic and Clinical Findings in Pediatric Patients Affected by Organic Acidemia

    Science.gov (United States)

    NAJAFI, Reza; HASHEMIPOUR, Mahin; MOSTOFIZADEH, Neda; GHAZAVI, Mohammadreza; NASIRI, Jafar; SHAHSANAI, Armindokht; FAMORI, Fatemeh; NAJAFI, Fatemeh; MOAFI, Mohammad

    2016-01-01

    Objective Metabolic disorders, which involve many different organs, can be ascribed to enzyme deficiency or dysfunction and manifest with a wide range of clinical symptoms. This study evaluated some of the demographic and clinical findings in pediatric patients affected by organic acidemia. Materials & Methods This cross-sectional study was part of a larger study conducted in patients with metabolic disorders during a period of 7 years from 2007 to 2014 in Isfahan Province, Iran. Our study covered a wide range of cases from newborn infants (one-week old) to adolescents (children up to the age of 17 years). This study evaluated patients’ demographic information, history of disease, developmental and educational status, clinical and general conditions. Phone and in-person interviews were used to gather information. Results Out of 5100 patients screened in this study, 392 patients were affected by one of the different metabolic disorders and 167 individuals were diagnosed as organic acidemia. Propionic acidemia/methyl malonic acidemia (PA/MMA) was the most prevalent form of this metabolic disorder. The frequency of consanguinity was 84.7% in the group of patients. The mortality rate was 18.8% in patients with organic academia. Conclusion Each of the metabolic diseases, as a separate entity, is rare; nevertheless, in aggregate they have a somewhat high overall prevalence. These diseases result in mental and developmental disorders in the absence of quick diagnosis and initiation of treatment. Furthermore, more mutations should be identified in societies affected by consanguinity. Further research should also be conducted to determine worthwhile and more-efficient screening methods as well as long term neurological prognosis. PMID:27247587

  1. [Results of 30 children treated under dental general anesthesia in pediatric dentistry].

    Science.gov (United States)

    Chen, Xu; Liu, Yao; Jin, Shi-fu; Zhang, Qian; Jin, Xuan-yu

    2008-12-01

    To determine the age and sex characteristics of the children and type of dental procedures performed under dental general anesthesia (DGA) and to assess the results after six months to one year's follow-up. A sample of 30 patients treated under dental general anesthesia (DGA) during 2006-2007 in the Department of Pediatric Dentistry of China Medical University was reviewed. All the teeth were treated one time. The dental procedures performed included caries restoration, indirect pulp capping, pulpotomy, root canal therapy (RCT) and dental extraction. Oral prophylaxis and topical fluoride applications were performed on all teeth. Pit and fissure sealing was performed on all healthy premolars and molars. SPSS10.0 software package was used for statistical analysis. Chi-square test was used to analyze the difference of the sex distribution in different age group and the difference of dental procedures performed between the primary teeth and the permanent teeth. The age of the patients ranged from 19 months to 14 years. The mental retardation patients accounted for 10% and mental healthy patients accounted for 90% of the sample studied. Males were more than females with the ratio about 2 to 1 in each age group. The dental procedures performed were caries restoration (18.67%), indirect pulp capping (23.26%), pulpotomy (0.77%), RCT (29.16%), dental extractions (2.05%) and fissure sealants (26.09%). The percentage of RCT was higher than that of caries restoration in the primary teeth, whereas the result was opposite as for the permanent teeth as indicated by Chi-square test (X(2)=11.630, P=0.001). New dental caries was not found except 2 patients who suffered from dysnoesia and were not cooperative to have regular examination. Fillings were lost in 3 cases, with 3 anterior teeth and 2 posterior teeth after RCT. All the children could cooperate except two mental retardation patients during the follow-up visit. Caries restoration and RCT are the most frequently performed

  2. Functional Gastrointestinal Disorders in a Primary Care Pediatric Clinic

    Directory of Open Access Journals (Sweden)

    Ronen Stein MD

    2015-01-01

    Full Text Available Functional gastrointestinal disorders (FGIDs are a common problem in pediatric patients and can affect quality of life. However, the extent of these disorders may vary in different subpopulations of children. This study investigated the prevalence of FGIDs in an inner-city primary care practice. Healthy patients between the ages of 9 and 17 were administered a validated questionnaire that assessed for FGIDs and other somatic complaints. Eleven of 145 patients (7.5% met criteria for FGIDs based on Rome III Diagnostic Criteria. Raynaud-like symptoms tended to occur more often in patients meeting criteria for FGIDs, although this association was not statistically significant (P = .07. The lower prevalence of FGIDs in this population compared with earlier studies may suggest a link between socioeconomic status and the prevalence of FGIDs. Larger population-based studies consisting of a heterogeneous cohort from a variety of socioeconomic backgrounds are necessary to further elucidate the true connection between FGIDs and socioeconomic status.

  3. [A paradigm shift in pediatric surgery created by the National Clinical Database].

    Science.gov (United States)

    Maeda, Kosaku

    2014-01-01

    The use of data from the National Clinical Database (NCD) is becoming more important in pediatric surgery. First, it is possible to review all surgical data in the NCD. Although pediatric surgeons treat a wide variety of conditions, with the exceptions of common ones such as appendicitis or inguinal hernia, rare anomalies with an incidence of only one in 1,000 births account for most cases. Therefore the number of surgeries for each type of rare anomaly performed in institutions specializing in pediatric surgery annually is very few. If many institutions do not accumulate large numbers of cases over the short-term, it will be impossible to analyze useful surgical data. The use of NCD data can therefore contribute to safe, clear medical care. Second, the Japanese neonate/infant mortality rate is the world's lowest, but on the other hand, the mortality rate of 1-3-year-olds is around the 20th lowest. The leading cause of death in this age-group is accident, and therefore the development of a childhood emergency medical system is important to improve this situation. Pediatric surgeons have an important role to play in emergency care and only they can prevent complications from surgery. However, until the creation of the NCD it was not clear which types of medical care were given at which institutions. Analysis of the reasonable placement of specialists or the ideal system of pediatric surgical emergency care can now be conducted based on scientific grounds by analyzing data from the NCD provided by all surgeons. For those performing pediatric surgery, the true value of the NCD will be determined in the future based on how they cope with this paradigm shift.

  4. Referral Criteria from Community Clinics to Pediatric Emergency Departments

    Directory of Open Access Journals (Sweden)

    Jacob Urkin

    2008-01-01

    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. A review of repeat general anesthesia for pediatric dental surgery in Alberta, Canada.

    Science.gov (United States)

    Schroth, Robert J; Smith, W F

    2007-01-01

    The purpose of this study was to review data from the province of Alberta, Canada for First Nations children who required more than 1 general anesthesia (GA) procedure for dental surgery from 1996 to 2005. This study was limited to First Nations and Inuit children younger than 18 years old in Alberta who received 2 or more GA procedures to facilitate dental treatment Data spanning 1996 to 2005 were provided from the Alberta Regional Office of First Nations & Inuit Health Branch, Health Canada. The entire database contained claims for 339 children who received repeat GA procedures for rehabilitative dental core. Seventy-six percent received 2 procedures, while the remainder underwent 3 or more surgeries. Twenty-four percent of First Nations children in this cohort were subjected to >2 GA procedures. Retreatment of previously restored teeth was a common observation. The majority of children were treated by general practitioners instead of pediatric dentists. Seventy-four percent who had 2 or more surgeries were treated by general dentists at the time of the first GA procedure. The mean age of children at the time of the first GA procedure was not associated with whether children received 2 or more GA procedures for dental care (P=.07). These data suggest that there may be on over-reliance on GA to treat dental caries for First Notions children in Alberta.

  6. Characteristics and Associated Comorbidities of Pediatric Dental Patients Treated under General Anesthesia.

    Science.gov (United States)

    Delfiner, Alexandra; Myers, Aaron; Lumsden, Christie; Chussid, Steve; Yoon, Richard

    2017-09-22

    To describe characteristics and identify common comorbidities of children receiving dental treatment under general anesthesia at Children's Hospital of New York-Presbyterian. Electronic medical records of all children that received dental treatment under general anesthesia through the Division of Pediatric Dentistry from 2012-2014 were reviewed. Data describing patient characteristics (age, sex, race/ethnicity, insurance carrier, and American Society of Anesthesiologists physical status classification system), medical history, and justification for treatment were collected. Descriptive statistics, including frequencies, percentages and t-tests, were calculated. A total of 298 electronic medical records were reviewed, of which 50 records were excluded due to missing information. Of the 248 electronic medical records included, the average age was 5-years-old and 58% were male. The most common reason for dental treatment under general anesthesia was extent and severity of dental disease (53%), followed by significant medical history (47%) and behavior/pre-cooperative age (39%). Those who were ASA III or IV were older (6.6-years) (ppediatric specialty services at Children's Hospital of NewYork-Presbyterian.

  7. Evaluation of pulmonary embolism in a pediatric population with high clinical suspicion

    Energy Technology Data Exchange (ETDEWEB)

    Victoria, Teresa; Mong, Andrew; Altes, Talissa; Hernandez, Andrea; Gonzalez, Leonardo; Kramer, Sandra S. [Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Jawad, Abbas F. [Children' s Hospital of Philadelphia, Department of Biostatistics and Epidemiology, Philadelphia, PA (United States); Raffini, Leslie [Children' s Hospital of Philadelphia, Department of Pediatrics, Division of Hematology, Philadelphia, PA (United States)

    2009-01-15

    Pulmonary embolism (PE) is an underdiagnosed entity in the pediatric population in part because of the low level of suspicion and awareness in the clinical world. To examine its relative prevalence, associated risk factors and imaging features in our pediatric population. A total of 92 patients age 21 years and younger with a high clinical suspicion of PE and who had available radiographic studies were identified from January 2003 to September 2006. Patients with a positive CT scan or a high probability ventilation/perfusion scan formed the case group; patients with a high clinical suspicion of PE and no radiographic evidence of PE or deep venous thrombosis (DVT), randomly matched in age and sex, became the matched control group. We reviewed the charts of both groups and analyzed the imaging studies. In our hospital, the prevalence of PE in patients with a strong suspicion of PE was 14%. The overall prevalence of thromboembolic disease (PE and/or DVT) was 25%. Recent surgery or orthopedic procedure, blood dyscrasias and contraceptive use were more common in patients with PE. No child died of PE in our study. The youngest child with PE in our study was 13 years. Girls were twice as likely to develop PE as boys. PE is a relatively common diagnosis in our tertiary care pediatric population when the clinical suspicion is high. We suggest increased awareness and index of suspicion in order to initiate prompt diagnostic imaging and treatment. (orig.)

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

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    Jae Wook Yoo

    2010-03-01

    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. Postoperative complications of pediatric dental general anesthesia procedure provided in Jeddah hospitals, Saudi Arabia

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    Almushayt Abdullah

    2009-02-01

    Full Text Available Abstract Background Review of post-operative morbidity reports for pediatric dental care under general anesthesia (GA show great variations. Until now, no morbidity data has been available to estimate the safety of pediatric patients under GA for dental rehabilitation in Saudi Arabia. The purposes of this study were to (1 investigate post-operative complications associated with dental care under GA and (2 correlate morbidity reports with patient's characteristics, dental procedures, and hospital protocol. Methods Study sample included 90 children attending GA for dental treatment at major governmental hospitals in Jeddah. Data were collected from every patient on three occasions, intra-operatively at the operating room, and post-operatively via phone calls in the first and third days after operation. Results Results showed that 99% of the children had one or more complaints in the first day in contrast to only 33% in the third day. Inability to eat (86%, sleepiness (71%, and pain (48% were the most common complaints in the first day, followed by bleeding (40%, drowsiness (39%, sore throat (34%, vomiting (26%, psychological changes (24%, fever (21%, cough (12%, and nausea (8%. A great significant complaints reduction was reported by the third post-operative day. Age, gender, admission type of the patients and GA duration were the factors that showed a significant relationship with post-operative complaints. Conclusion Post-operative morbidity was common, but mostly of mild severity and limited to the first day. Hospital staff efforts should be directed to control commonly reported postoperative complaints.

  10. Clinical and imaging features of intracranial arterial aneurysms in the pediatric population; Klinische und radiologische Merkmale des intrakraniellen arteriellen Aneurysmas bei Kindern und Jugendlichen

    Energy Technology Data Exchange (ETDEWEB)

    Abruzzo, Todd A. [Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States). Dept. of Radiology; Aeron, Gunjan; Jones, Blaise V.

    2013-07-15

    Intracranial arterial aneurysms (IAAs) are rare in children. Nevertheless, IAAs account for at least 10 % - 15 % of hemorrhagic strokes during the first two decades of life. Traditional vascular risk factors, which are common in the adult population, are generally absent in the pediatric population, engendering distinct modes of IAA pathogenesis. Classification of pediatric IAAs according to the pathogenetic mechanism shows eight distinct categories: idiopathic, traumatic, those due to excessive hemodynamic stress, vasculopathic, infectious, noninfectious inflammatory, oncotic, and familial. Pathogenetic mechanism is the best predictor of the clinical course of the disease, response to treatment, and long-term prognosis. The pathogenetic subtypes of pediatric IAA show characteristic and variably overlapping features. In most cases, IAAs manifesting during the first two decades of life are idiopathic. IAAs that are idiopathic, traumatic (second most common type), or due to excessive hemodynamic stresses (third most common type) account for more than 80 % of IAAs in the pediatric age group. Most of the remaining pediatric IAAs are the result of congenital cerebral aneurysmal arteriopathies or infection. Multiple IAAs are unusual in young children except in those with acquired (secondary to immune deficiency states) or congenital cerebral aneurysmal arteriopathies or infectious IAAs. (orig.)

  11. Comparison of maternal anxiety scores in pediatric intensive care unit and general ward parents

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    Lie Affendi Kartikahadi

    2012-02-01

    Full Text Available Background Hospitalization of a child is known to be a dreadful and stressful situation for parents. One study reported that admitting a child to a general ward caused mild anxiety to mothers, while admitting a child to the pediatric intensive care unit (PICU caused moderate anxiety to mothers. Objective To compare Hamilton anxiety scores of mothers whose children were admitted to the PICU to those of mothers whose children were admitted to the general ward. Methods A cross-sectional study was done on mothers of children aged 1 month-12 years. Children were admitted to either the intensive care unit or the general ward from October 2010-January 2011. All subjects were assessed by Hamilton anxiety scores and questioned for risk factors and other causes of maternal anxiety. Consecutive sampling was used to allocate the subjects. Differences were considered statistically significant for P < 0.05. Results Of the 72 subjects, the median Hamilton anxiety score in mothers of children admitted to the PICU was 20.5 (interquartile range 14-29.75, higher than that of mothers of children admitted to the general ward (14, interquartile range 9-16.75. Mann-Whitney U test revealed a statistically significant difference in scores between the two groups (P = 0.001. Ancova multivariate analysis showed the admission location to be the only significant relationship to Hamilton anxiety score (P = 0.0001. Conclusion Hamilton anxiety scores were higher for mothers of children admitted to the PICU than that of mothers with children admitted to the general ward. [Paediatr Indones.2012;52:95-8].

  12. Treatment trends during a thirteen-year period in a student pediatric dentistry clinic.

    Science.gov (United States)

    Bimstein, E; Eidelman, E

    1997-01-01

    This manuscript reports the treatment trends in a pediatric dentistry clinic from 1980 to 1992 and discusses their implication in clinical teaching. Analysis of the records of the senior year pediatric dentistry students indicated: no significant change with time in the patients/student ratio, the number of preformed crowns, pulpotomies, and pulpectomies by student or by patient; a significant decrease in the number of one-surface and > or = 2-surface restorations by student and by patient; a significant increase in the number of pit-and-fissure sealants and preventive resin restorations by student and by patient. During the thirteen-year period, the students performed an average of 7.3 one-surface; 12.9 > or = 2-surface restorations; 5.5 preformed crowns; 6.4 pit-and-fissure sealants; 2.4 pulpotomies. There was a significant increase with time in the number of students who performed pit-and-fissure sealants.

  13. The clinical method in pediatrics El método clínico en pediatría

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    Sonia Pérez García

    2010-12-01

    Full Text Available Pediatrics deals with the health care of newborn, children and adolescents and their growing up and development. In order to achieve this purpose it is necessary to make an evaluation of their health condition. The application of the clinical method in children health care is a fundamental tool because it is a system of thoughts implemented to solve problems that may appear when implementing clinical medicine. Nevertheless, it has some particularities, scientific foundations and some art. Children are not young adults, so our medical activities should be oriented according to the age of the patient. The interview, the physical examination and the appropriate parents-patient-doctor relationship are part of the main strategy but it is always related to the age of the child. The objective of all medical interviews is to obtain as much data as possible in order to make a final evaluation of the patient’s health condition. In children, there are some differences about the application of the medical interviews’ structure, that is why some characteristics of the use of the clinical method in paediatrics are discussed in this article.La pediatría trata de la salud de los lactantes, niños y adolescentes, de su crecimiento y desarrollo y para ello es necesaria la evaluación de su estado de salud. La aplicación del Método Clínico en la atención de los niños es la herramienta fundamental, pues constituye un sistema de pensamiento para la resolución de los problemas que surgen en la medicina clínica, pero tiene sus particularidades, tiene su fundamento científico y parte de arte. Los niños no son adultos pequeños, por lo que debemos condicionar nuestro actuar en dependencia de la edad del infante, el interrogatorio, el examen físico, la adecuada relación médico-paciente-padres, es la estrategia fundamental, pero condicionada al periodo de la vida en que se encuentre el niño. El objetivo de toda entrevista médica es obtener la mayor

  14. Socio-demographic, Clinical and Laboratory Features of Rotavirus Gastroenteritis in Children Treated in Pediatric Clinic

    Science.gov (United States)

    Azemi, Mehmedali; Berisha, Majlinda; Ismaili-Jaha, Vlora; Kolgeci, Selim; Avdiu, Muharrem; Jakupi, Xhevat; Hoxha, Rina; Hoxha-Kamberi, Teuta

    2013-01-01

    Aim: The aim of work was presentation of several socio-demographic, clinical and laboratory characteristics of gastroenteritis caused by rotavirus. The examinees and methods: The examinees were children under the age of five years treated at the Pediatric Clinic due to acute gastroenteritis caused by rotavirus. Rotavirus is isolated by method chromatographic immunoassay by Cer Test Biotec. Results: From the total number of patients (850) suffering from acute gastroenteritis, feces test on bacteria, viruses. protozoa and fungi was positive in 425 (49.76%) cases. From this number the test on bacteria was positive in 248 (58.62%) cases, on viruses it was positive in 165 (39.0%), on protozoa in 9 (2.12%) cases and on fungi only one case. Rotavirus was the most frequent one in viral test, it was isolated in 142 (86.06%) cases, adenoviruses were found in 9 (5.45%) cases and noroviruses in only one case. The same feces sample that contained rotavirus and adenoviruses were isolated in five cases, whereas rotavirus with bacteria was isolated in the same feces sample in five cases. The biggest number of cases 62 (43.66%) were of the age 6-12 months, whereas the smallest number 10 (7.04%) cases were of the age 37-60 months. There were 76 (53.52%) of cases of male gender, from rural areas there were 81 (57.04%) cases and there were 58 (40.80%) cases during the summer period. Among the clinical symptoms the most prominent were diarrhea, vomiting, high temperature, whereas the different degree of dehydration were present in all cases (the most common one was moderate dehydration). The most frequent one was isonatremic dehydration in 91 (64.08%) cases, less frequent one was hypernatremic dehydration in 14 (9.85%) cases. The majority of cases (97.89%) had lower blood pH values, whereas 67 (47.17%) cases had pH values that varied from 7.16 -7.20 (curve peak), normal values were registered in only 3 (2.11%) cases. Urea values were increased in 45 (31.07%) cases (the maximum value

  15. Relationships Between Clinical Decision-Making Patterns and Self-Efficacy and Nursing Professionalism in Korean Pediatric Nurses.

    Science.gov (United States)

    Choi, Miyoung; Kim, Jisoo

    2015-01-01

    As pediatric nurses must make decisions on a regular basis when caring for hospitalized children, clinical decision-making abilities are necessary in this profession. In the present study, we explored clinical decision-making patterns and their association with self-efficacy and nursing professionalism in pediatric nurses. We surveyed 173 pediatric nurses and analyzed the relationships between their clinical decision-making patterns and self-efficacy and nursing professionalism. Factor analysis identified 5 clinical decision-making patterns: patient-family-nurse collaborative (PNC), individual patient-oriented (IP), nurse model-oriented (NM), pattern-oriented intuitive (PI), and nursing knowledge-oriented (NK). The most frequently observed clinical decision-making pattern was the PNC. The self-efficacy and nursing professionalism were found to be higher in pediatric nurses using the IP and NM, and were lower for those using the PNC. Thus, the present results suggest that pediatric nurses' clinical decision-making patterns are influenced by nursing professionalism and self-efficacy. Therefore, intervention programs focusing on these variables might improve clinical decision-making in pediatric nurses. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Development and clinical application of a color pediatric visual acuity chart

    Directory of Open Access Journals (Sweden)

    Shu-Guo Yin

    2014-12-01

    Full Text Available AIM: To introduce a new color pediatric visual acuity chart and its clinical application.METHODS:The color pediatric visual acuity chart was designed based on principle of visual angle. The optotype on the color chart had graphics. The progression rate of optotype size between 2 lines was 10(101/2 and 1.2589. A regular geometric progression of optotype sizes and distribution was employed to arrange 8 lines with 11 optotype on the color chart. The testing distance was 3m. The visual acuity score could be recorded as logarithm of the minimum angle of resolution notation or decimal notation. The reliability of naked distant measurements with this new chart was tested in one eye of 100 children(4 ~6 years oldtaking the Chinese national standard logarithm visual acuity chart standard. RESULTS: The color pediatric visual acuity chart and logarithmic chart controls, visual acuity test results that in the two groups had no significant difference(t=1.2671, P>0.05. Two sets of vision data existed positive correlation(r=0.924, PCONCLUSION:Children are easier to accept used new color pediatric visual acuity chart to inspect vision. New chart is reliability and apply to children's vision screening.

  17. Lidocaine versus mepivacaine in sedated pediatric dental patients: randomized, prospective clinical study.

    Science.gov (United States)

    Çalış, Aylin Sipahi; Cagiran, Esra; Efeoglu, Candan; Ak, Aslı Topaloglu; Koca, Huseyın

    2014-01-01

    Dental anxiety is usually seen in the pediatric patients. specially in the case of minor oral surgical procedures and exodontia, cooperation of the patients and their families with the dentist will lead to superior treatment outcomes. Pain control is important in dentistry. The aim of this randomized prospective clinical study is to compare the local anaesthetic and haemodynamic effects of 2% lidocaine (Group 1) and 3% mepivacaine (Group 2) in sedated pediatric patients undergoing primary tooth extraction. 60 pediatric patients undergoing sedation for elective primary tooth extraction was prospectively included in the study in a randomized fashion. Inclusion and exclusion criteria were assigned. Patients were given premedication via oral route. Local anesthesia was achieved before extraction(s). There were no significant differences between the groups in patient demographics, number of teeth extracted, duration of the operation and time from the end of the procedure to discharge (p ≥ 0.05). FLACC pain scale scores were not statistically significant between the groups, except at 20 minutes post-operatively when the score is significantly lower in Group 2 (p=0.029). Prevention of pain during dental procedures can nurture the relationship of the patient and dentist. Tooth extraction under sedation in pediatric patients could be safe with both local anesthetics.

  18. Relationship between the clinical characteristics of osteomyelitis and the finding of extraosseous fat on MRI in pediatric patients

    Energy Technology Data Exchange (ETDEWEB)

    Mattis, Tod A. [Spectrum Health Helen Devos Children' s Hospital, Grand Rapids, MI (United States); Michigan State University, College of Human Medicine, Radiology, Grand Rapids, MI (United States); Grand Rapids Medical Education Partners, Grand Rapids, MI (United States); Borders, Heather L.; Ellinger, Doug M.; Junewick, Joseph J. [Spectrum Health Helen Devos Children' s Hospital, Grand Rapids, MI (United States); Michigan State University, College of Human Medicine, Radiology, Grand Rapids, MI (United States); Advanced Radiology Services, Grand Rapids, MI (United States)

    2011-10-15

    MRI is frequently utilized to evaluate patients for osteomyelitis. The findings of intramedullary and extramedullary fat globules as well as extramedullary fat-fluid levels can help improve the specificity of MRI for this diagnosis. To correlate these MRI findings with the clinical characteristics in children with osteomyelitis. A retrospective electronic medical record search for pediatric patient charts from March 2004 to November 2009 that contained the word ''osteomyelitis'' in the ''principal diagnosis'' portion of the international classification of disease (ICD) billing code. Each electronic chart was reviewed. MRI examinations of selected children were reviewed by a pediatric radiologist, a general radiologist and a transitional year resident. A total of 10 patients/11 MRI studies were included. Five of the 11 had the MRI finding of extramedullary globular fat signal. There was a significantly increased likelihood of seeing this finding in children of pubertal or postpubertal age compared to those of prepubertal age (p < 0.05). This study provides evidence that the MRI finding of extramedullary fat globules in children with acute osteomyelitis is associated with the clinical characteristic of being within or above the age range for puberty. (orig.)

  19. Evaluating Success of Pediatric Dentistry Department at Mashhad Dental School (Iran in Clinical Skills Education from Students’ Perspectives

    Directory of Open Access Journals (Sweden)

    Hosein Nematollahi

    Full Text Available Introduction: Periodic evaluation of educational programs provides insight into the course and teaching effectiveness. Effective evaluation provides valuable information, which contributes to both student’s and course success. The purpose of this study was to evaluate the success of pediatric dentistry department at Mashhad dental school in clinical education from students’ perspectives.Materials & Methods: This cross-sectional study was conducted on 116 fifth and sixth grade undergraduate dental students in pediatric dentistry at Mashhad dental school. A questionnaire including 21 multiple choice questions about 7 parts of clinical skills in pediatric dentistry was given to each student. Data were analyzed by Mann-Whitney in SPSS software. Results: According to the study results, among 7 different clinical skills in pediatric dentistry including: examination, behavior management, prevention, injection, restoration, pulp treatment and space management, the highest success rate of pediatric dentistry department was in prevention and injection and the lowest success rate in space management and behavior control. Furthermore, from the students’ perspective, male students compared to female students mentioned a higher rate of success in choosing the type of restoration material for pediatric dentistry department (P=0. 041. Conclusion: This study showed that the students’ self-reported clinical skills in different parts of pediatric dentistry has been adequate. Students reported a lack of confidence in “behavior management” and “space management” which warrants greater emphasis in the undergraduate curriculum.

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

    Institute of Scientific and Technical Information of China (English)

    Stuart Macleod

    2011-01-01

    @@ 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].

  1. Pediatric Headache and Epilepsy Comorbidity in the Pragmatic Clinical Setting.

    Science.gov (United States)

    Papavasiliou, Antigone S; Bregianni, Marianna; Nikaina, Irene; Kotsalis, Charalambos; Paraskevoulakos, Evangelos; Bazigou, Helen

    2016-04-01

    Demographic and clinical data were collected from three cross-sectional samples, from the headache and epilepsy clinics according to respective protocols. During structured interviews, we examined the co-occurrence of headaches and epilepsy in children and their families: (1) 172 children from the headache clinic, were questioned for the number and type of epileptic seizures and epilepsy diagnosis. (2) Around 70 children from the epilepsy clinic for the frequency and type of headaches and headache syndrome diagnosis. (3) A total of 149 parents of children with benign childhood epilepsy with centro-temporal spikes (BCECTS) and childhood absence epilepsy (CAE), for the relative frequency of headaches in first- and second-degree relatives. Out of 172, 84 (48.8%) children with headache had a migraine and 60 (34.9%) had tension headaches; 3 children (1.7%) had epilepsy or unprovoked seizures. Migraine and epilepsy, co-occurred in 2/84 (2.3%). Eight out of 70 patients with epilepsy had headaches (11.4%); none had migraine. Around 43% of patients with BCECTS or CAE had a family history of headache, more prevalent in first-degree relatives of children with BCECTS than CAE. Contrary to existing literature, migraine and epilepsy, co-occurred infrequently in these highly selected samples. Family history of headache was frequent in patients with BCECTS and CAE, without any significant difference between the two. Georg Thieme Verlag KG Stuttgart · New York.

  2. Clinical outcomes in pediatric hemodialysis patients in the USA: lessons from CMS' ESRD CPM Project.

    Science.gov (United States)

    Neu, Alicia M; Frankenfield, Diane L

    2009-07-01

    Although prospective randomized trials have provided important information and allowed the development of evidence-based guidelines in adult hemodialysis (HD) patients, with approximately 800 prevalent pediatric HD patients in the United States, such studies are difficult to perform in this population. Observational data obtained through the Center for Medicare & Medicaid Services' (CMS') End Stage Renal Disease (ESRD) Clinical Performance Measures (CPM) Project have allowed description of the clinical care provided to pediatric HD patients as well as identification of risk factors for failure to reach adult targets for clinical parameters such as hemoglobin, single-pool Kt/V (spKt/V) and serum albumin. In addition, studies linking data from the ESRD CPM Project and the United States Renal Data System have allowed evaluation of associations between achievement of those targets and the outcomes of hospitalization and death. The results of those studies, while unable to prove cause and effect, suggest that the adult ESRD CPM targets may assist in identifying pediatric HD patients at risk for poor outcomes.

  3. Pharmacotherapy for Pediatric Generalized Anxiety Disorder: A Systematic Evaluation of Efficacy, Safety and Tolerability

    Science.gov (United States)

    Dobson, Eric T.; Strawn, Jeffrey R.

    2016-01-01

    Background Randomized controlled trials consistently support the efficacy of antidepressants in treating youth with generalized anxiety disorder (GAD), although integrated examinations of efficacy, safety, and tolerability of psychotropic medications in GAD specifically are rare. With this in mind, we sought to describe the efficacy, safety and tolerability of psychopharmacologic interventions in youth with GAD. Methods Randomized, double-blind, placebo-controlled, prospective trials of psychopharmacologic interventions in youth with GAD were identified through a PubMed/Medline (1966–2015) search. Both authors manually reviewed trials and, to evaluate comparative efficacy and tolerability across medications, numbers needed to treat (NNT) (based on Pediatric Anxiety Rating Scale (PARS) remission criteria (PARS ≤8 [1]), and number needed to harm (NNH) for selected treatment-emergent adverse events (TEAEs) were calculated. Finally, treatment-emergent suicidality and taper-emergent/post-study adverse events are reported descriptively. Results Five trials that involved 1,186 patients and evaluated four medications were reviewed and efficacy data were extracted with regard to dimensional measures of anxiety. SSRI/SNRIs demonstrated efficacy in the reduction of anxiety symptoms with NNTs ranging from 2.8 to 9.3. TEAEs varied considerably between studies but tended to be mild and generally did not lead to discontinuation. Conclusions Data from five trials of SSRI/SNRI in youth with GAD, many of whom had co-occurring separation and social anxiety disorders, suggest superiority to placebo and favorable tolerability profiles. PMID:26660158

  4. Clinical guidelines: their implementation in general practice.

    OpenAIRE

    M Conroy; Shannon, W

    1995-01-01

    In recent years the development of clinical guidelines has received increasing attention from medical educators and those involved in standard setting, and has been initiated at both central and local levels. This review article outlines the current state of knowledge with regard to clinical guideline implementation in medical practice. It deals with the main aspects of the current guideline debate, such as, clinical freedom and doctor autonomy, the importance of ownership in guideline implem...

  5. Moebius syndrome: clinical manifestations in a pediatric patient.

    Science.gov (United States)

    Lima, Luciana Monti; Diniz, Michele Baffi; dos Santos-Pinto, Lourdes

    2009-01-01

    Moebius syndrome is a congenital, nonprogressive disorder clinically characterized by loss of facial expression, impaired stomatognathic system functions, incapacity to close the eyelids, and several oral impairments. The purpose of this paper was to present the clinical manifestations and the dental treatment in a 5-year, 2-month-old male Moebius syndrome patient. The child presented with facial asymmetry, difficulty performing facial mimic movements and pronouncing some letters, and compromised suction, mastication, breathing, and deglutition. An intraoral examination revealed hypofunction of the perioral muscles, cheeks and tongue, ankyloglossia, anterior open bite, and absence of carious lesions and dental anomalies. The dental treatment consisted of frenectomy and further placement of a removable orthodontic appliance with a palatal crib for correction of the anterior open bite. After 12 months of follow-up, anterior open bite decreased and speech, deglutition, and mastication improved.

  6. [Urticaria pigmentosa: two different clinical presentations in pediatric patients].

    Science.gov (United States)

    Spada, Julieta; Lequio, Mariana; Pyke, María de los Ángeles; Hernández, Marisa; Chouela, Edgardo

    2011-08-01

    Urticaria pigmentosa (UP) is the most frequent clinical feature of cutaneous mastocytosis. It usually begins in a bimodal way: a peak of incidence from birth to the age of 3 and the other one between 2(nd) and 6(th) decades of life. Darier's sign is constant over the affected skin without affecting the surrounding skin. When UP starts early, it has a good prognosis disappearing into adolescence, while late onset is often associated with persistent or systemic involvement. This article reports two cases of UP, one with the classic description of the disease and the other with an unusual clinical presentation, prompting the pediatrician to incorporate both forms as different manifestations of the same entity.

  7. Demographics, clinical features and treatment of pediatric celiac disease

    OpenAIRE

    Tapsas, Dimitrios

    2015-01-01

    Celiac disease (CD) is a chronic small intestinal immune-mediated enteropathy triggered by ingestion of gluten-containing food in genetically predisposed subjects. The enteropathy is presented with a wide variety of clinical manifestations, which can occur even outside the gastrointestinal tract. In the majority of cases, the diagnosis of CD is based on a small intestinal biopsy showing mucosal alterations, i.e. intraepithelial lymphocytosis, crypt hyperplasia, and villous atrophy. The treatm...

  8. Computerized clinical documentation system in the pediatric intensive care unit

    Directory of Open Access Journals (Sweden)

    Campbell Deborah Y

    2001-09-01

    Full Text Available Abstract Background To determine whether a computerized clinical documentation system (CDS: 1 decreased time spent charting and increased time spent in patient care; 2 decreased medication errors; 3 improved clinical decision making; 4 improved quality of documentation; and/or 5 improved shift to shift nursing continuity. Methods Before and after implementation of CDS, a time study involving nursing care, medication delivery, and normalization of serum calcium and potassium values was performed. In addition, an evaluation of completeness of documentation and a clinician survey of shift to shift reporting were also completed. This was a modified one group, pretest-posttest design. Results With the CDS there was: improved legibility and completeness of documentation, data with better accessibility and accuracy, no change in time spent in direct patient care or charting by nursing staff. Incidental observations from the study included improved management functions of our nurse manager; improved JCAHO documentation compliance; timely access to clinical data (labs, vitals, etc; a decrease in time and resource use for audits; improved reimbursement because of the ability to reconstruct lost charts; limited human data entry by automatic data logging; eliminated costs of printing forms. CDS cost was reasonable. Conclusions When compared to a paper chart, the CDS provided a more legible, compete, and accessible patient record without affecting time spent in direct patient care. The availability of the CDS improved shift to shift reporting. Other observations showed that the CDS improved management capabilities; helped physicians deliver care; improved reimbursement; limited data entry errors; and reduced costs.

  9. Body temperature increases during pediatric full mouth rehabilitation surgery under general anesthesia

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    Yi-Shan Chuang

    2015-12-01

    Conclusion: Body temperature transiently increased during pediatric full mouth rehabilitation surgery. The increase in body temperature was associated with operation duration. The etiology is uncertain. Continuous body temperature monitoring and the application of both heating and cooling devices during pediatric full mouth rehabilitation surgery should be mandatory.

  10. Influence of sub-specialty surgical care on outcomes for pediatric emergency general surgery patients in a low-middle income country.

    Science.gov (United States)

    Shah, Adil A; Shakoor, Amarah; Zogg, Cheryl K; Oyetunji, Tolulope; Ashfaq, Awais; Garvey, Erin M; Latif, Asad; Riviello, Robert; Qureshi, Faisal G; Mateen, Arif; Haider, Adil H; Zafar, Hasnain

    2016-05-01

    Whether adult general surgeons should handle pediatric emergencies is controversial. In many resource-limited settings, pediatric surgeons are not available. The study examined differences in surgical outcomes among children/adolescents managed by pediatric and adult general surgery teams for emergency general surgical (EGS) conditions at a university-hospital in South Asia. Pediatric patients (pediatric surgical management team. Outcome measures included: length of stay (LOS), mortality, and occurrence of ≥1 complication(s). Descriptive statistics and multivariable regression analyses with propensity scores to account for potential confounding were used to compare outcomes between the two groups. Quasi-experimental counterfactual models further examined hypothetical outcomes, assuming that all patients had been treated by pediatric surgeons. A total of 2323 patients were included. Average age was 7.1y (±5.5 SD); most patients were male (77.7%). 1958 (84.3%) were managed by pediatric surgery. The overall probability of developing a complication was 1.8%; 0.9% died (all adult general surgery). Patients managed by adult general surgery had higher risk-adjusted odds of developing complications (OR [95%CI]: 5.42 [2.10-14.00]) and longer average LOS (7.98 vs. 5.61 days, p pediatric surgery. Pediatric patients had better post-operative outcomes under pediatric surgical supervision, suggesting that, where possible in resource-constrained settings, resources should be allocated to promote development and staffing of pediatric surgical specialties parallel to adult general surgical teams. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  11. Clinical and Laboratory Characteristics of Pediatric Scorpion Stings: A Report From Southern Iran.

    Science.gov (United States)

    Dehghankhalili, Maryam; Mobaraki, Hossein; Akbarzadeh, Armin; Yazdani, Reza; Nazemi, Abdolmajid; Ghaffarpasand, Fariborz; Mohammadi, Zahra; Shahrzad, Mohammad Esmaeil; Mohmudi, Forugh; Taghavi, Mohsen; Dehghankhalili, Saeed

    2017-06-01

    Scorpion stings are a major public health problem in many countries, particularly in pediatrics. Children are more susceptible to severe clinical manifestations of envenomation. The aim of this study is to determine the epidemiological and clinical characteristics of pediatric scorpionism in Hormozgan province of Iran during 2012. This was a cross-sectional study being conducted during 2010 in Hormozgan, the southern province of Iran. We included 350 patients admitted to emergency unit of the hospitals of 8 cities of Hormozgan with impression of scorpion envenomation. The clinical and epidemiological characteristics as well as the treatment and outcome were recorded. The prevalence rate of pediatric scorpion stings in the province was 1.8 in 1000 children. The mean age of the patients was 5.75 ± 4.54 (range, 1-18) years. There were 208 (59.5%) boys and 142 (40.5%) girls among the patients. The most common site of sting was sole to knee in 94 (26.8%) followed by hand in 61 (17.4%) and fingers in 47 (13.4%). The most common presenting symptom was vomiting in 236 (67.4%) followed by localized pain in 131 (37.3%), erythema in 120 (34.2%), and edema in 119 (33.9%). The highest and lowest frequency occurred in July (17.7%) and January (3.2%), respectively. Nocturnal envenomations (53.7%) were more common than diurnal (46.3%). Most of scorpionism were mild (83.4%) that all evolved to cure, without any deaths. The results demonstrate the pediatric scorpionism is a public health problem in Hormozgan province of Iran, and special attention should be paid to prevention and treatment.

  12. Clinical practice guidelines in pediatric and newborn medicine: implications for their use in practice.

    Science.gov (United States)

    Merritt, T A; Palmer, D; Bergman, D A; Shiono, P H

    1997-01-01

    or guidelines. Furthermore, there are many medicolegal implications of guideline implementation that may not favor physicians and leave to hospitals, insurers, and ultimately the courts decisions regarding evidence-based practice. In this review article, we pay special attention to the guidelines developed in newborn medicine. We discuss why and how guidelines are developed and critically evaluate the available evidence describing potential benefits and drawbacks of guidelines in general. There are legal implications to the implementation of guidelines, and guidelines may increase provider susceptibility to malpractice allegations. Neonatologists and pediatricians should critically analyze the following questions when guidelines are being developed: Are clinical practice parameters the most effective means to reduce the costs of health care, or improve the quality of health care services while reducing the need for and protecting physicians from malpractice suits? Or do clinical practice guidelines more closely resemble an audit system developed by health care organizations, insurers, and others including government-sponsored health care to appease powerful interests-with limited evidence for promise and perhaps potential negative cost, quality, and malpractice liability implications? In pediatric and newborn medicine there is limited evidence that guidelines have achieved the desired goals and further analysis of their process of care and the costs of implementation is warranted.

  13. Nosocomial bloodstream infections in Brazilian pediatric patients: microbiology, epidemiology, and clinical features.

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Pires Pereira

    Full Text Available BACKGROUND: Nosocomial bloodstream infections (nBSIs are an important cause of morbidity and mortality and are the most frequent type of nosocomial infection in pediatric patients. METHODS: We identified the predominant pathogens and antimicrobial susceptibilities of nosocomial bloodstream isolates in pediatric patients (≤16 years of age in the Brazilian Prospective Surveillance for nBSIs at 16 hospitals from 12 June 2007 to 31 March 2010 (Br SCOPE project. RESULTS: In our study a total of 2,563 cases of nBSI were reported by hospitals participating in the Br SCOPE project. Among these, 342 clinically significant episodes of BSI were identified in pediatric patients (≤16 years of age. Ninety-six percent of BSIs were monomicrobial. Gram-negative organisms caused 49.0% of these BSIs, Gram-positive organisms caused 42.6%, and fungi caused 8.4%. The most common pathogens were Coagulase-negative staphylococci (CoNS (21.3%, Klebsiella spp. (15.7%, Staphylococcus aureus (10.6%, and Acinetobacter spp. (9.2%. The crude mortality was 21.6% (74 of 342. Forty-five percent of nBSIs occurred in a pediatric or neonatal intensive-care unit (ICU. The most frequent underlying conditions were malignancy, in 95 patients (27.8%. Among the potential factors predisposing patients to BSI, central venous catheters were the most frequent (66.4%. Methicillin resistance was detected in 37 S. aureus isolates (27.1%. Of the Klebsiella spp. isolates, 43.2% were resistant to ceftriaxone. Of the Acinetobacter spp. and Pseudomonas aeruginosa isolates, 42.9% and 21.4%, respectively, were resistant to imipenem. CONCLUSIONS: In our multicenter study, we found a high mortality and a large proportion of gram-negative bacilli with elevated levels of resistance in pediatric patients.

  14. Comparative study of postoperative morbidity in dental treatment under general anesthesia in pediatric patients with and without an underlying disease.

    Science.gov (United States)

    Escanilla-Casal, Alejandro; Ausucua-Ibáñez, Martina; Aznar-Gómez, Mireia; Viaño-García, José M; Sentís-Vilalta, Joan; Rivera-Baró, Alejandro

    2016-03-01

    To identify and quantify the variables and their influence on postoperative morbidity in dental treatment under general anesthesia (GA) in pediatric patients with and without an underlying disease. A prospective, descriptive, and comparative analysis was conducted of healthy (n = 49) and disabled/medically compromised (n = 81) children treated under GA. Intra-/post-surgical, clinical epidemiology, technical, care-related, and pharmacologic data were gathered, as were postoperative complications. The average age of ASA I patients (6.7 ± 4.4 years) was younger than that of ASA II-III patients (9.0 ± 4.5 years). Average hospitalization time was 4.27 ± 6.5 h in ASA I and 7.41 ± 6.8 h in ASA II-III. Significant differences were found between the two groups in fillings, pulpotomies, oral surgery, and scaling. Postoperative morbidity in ASA I and ASA II-III was similar both in frequency and severity and decreased during the first 72 h. The most common complication in both groups was toothache. Postoperative morbidity is high after dental treatment under GA, but it is not higher in disabled/medically compromised patients. © 2015 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. General dentists', pediatric dentists', and endodontists' diagnostic assessment and treatment strategies for deep carious lesions: A comparative analysis.

    Science.gov (United States)

    Koopaeei, Mahshid Majlessi; Inglehart, Marita R; McDonald, Neville; Fontana, Margherita

    2017-02-01

    There is a large variation among clinicians when managing deep carious lesions (DCLs). The purpose of this study was to assess general dentists' (GDs), pediatric dentists' (PDs), and endodontists' (EDs) diagnostic methods, clinical decision-making considerations, treatment strategies, and knowledge, behavior, and attitudes related to the diagnosis and treatment of DCLs. A total of 175 GDs, 511 PDs, and 377 EDs responded to a nationwide Web-based survey. Most EDs (68%) and GDs (47%) practiced complete caries removal. PDs (31%) were more likely than GDs (12%) and EDs (4%) to remove carious tissues partially. Dentin hardness was the most important diagnostic criterion used during caries excavation (GDs, 90%; PDs, 72%; EDs, 88%). Only 30% of GDs, 17% of PDs, and 90% of EDs used diagnostic tests (for example, a cold test) when assessing pupal health. A substantial percentage of respondents considered endodontic treatment as a choice for treating DCLs in asymptomatic teeth in young patients (GDs, 40%; PDs, 30%; EDs, 40%). GDs rarely used a rubber dam when treating these lesions. Most respondents practiced complete caries removal until hard dentin was felt, using hardness as the primary excavation criterion, and did not use pulp diagnostic tests routinely before making decisions about treatment of teeth with DCLs. Efforts should be made to translate the growing body of evidence supporting the use of conservative caries removal criteria to preserve pulpal health and tooth structure integrity when managing DCLs. Copyright © 2017 American Dental Association. Published by Elsevier Inc. All rights reserved.

  16. A wellness framework for pediatric nursing clinical practice.

    Science.gov (United States)

    Spurr, Shelley; Bally, Jill; Ogenchuk, Marcella; Peternelj-Taylor, Cindy

    2011-01-01

    This article presents a proposed holistic Framework for Exploring Adolescent Wellness specific to the discipline of nursing. Conceptualized as a practical adolescent wellness assessment tool, the framework attends to the physical, spiritual, psychological and social dimensions of adolescent health. Through the discussion of a reconstructed case study the framework's application to nursing practice is illustrated. Nurses are distinctly positioned to promote adolescent wellness. This approach facilitates the exploration of the multiple influences on the health of adolescents, across a variety of clinical practice specialties and settings, by nurses of varying experiences.

  17. Clinical and Neurobiological Perspectives of Empowering Pediatric Cancer Patients Using Videogames.

    Science.gov (United States)

    Govender, Meveshni; Bowen, Randy C; German, Massiell L; Bulaj, Grzegorz; Bruggers, Carol S

    2015-10-01

    Pediatric oncology patients often experience fatigue and physical and mental deconditioning during and following chemotherapy treatments, contributing to diminished quality of life. Patient empowerment is a core principle of patient-centered care and reflects one's ability to positively affect his or her own health behavior and health status. Empowerment interventions may enhance patients' internal locus of control, resilience, coping skills, and self-management of symptoms related to disease and therapy. Clinical and technological advancements in therapeutic videogames and mobile medical applications (mobile health) can facilitate delivery of the empowerment interventions for medical purposes. This review summarizes clinical strategies for empowering pediatric cancer patients, as well as their relationship with developing a "fighting spirit" in physical and mental health. To better understand physiological aspects of empowerment and to elucidate videogame-based intervention strategies, brain neuronal circuits and neurotransmitters during stress, fear, and resilience are also discussed. Neuroimaging studies point to the role of the reward system pathways in resilience and empowerment in patients. Taken together, videogames and mobile health applications open translational research opportunities to develop and deliver empowerment interventions to pediatric cancer patients and also to those with other chronic diseases.

  18. Stratification, Hypothesis Testing, and Clinical Trial Simulation in Pediatric Drug Development

    Science.gov (United States)

    McMahon, Ann W.; Watt, Kevin; Wang, Jian; Green, Dionna; Tiwari, Ram; Burckart, Gilbert J.

    2016-01-01

    Background Pediatric drug development is plagued by small sample sizes, unvalidated clinical endpoints, and limited studies. Objectives The objective of this study was to determine whether age stratification within the pediatric population could be used to (1) assess response to a pharmacologic intervention and to (2) design future trials based upon published stratified disease data using clinical trial simulation (CTS). Methods Data available from the literature for Kawasaki disease (KD) was used in the model. Age-stratified CTS for a theoretical new drug was conducted. Results Population-specific differences due to age might affect trial success if not taken into account. CTS predicted inflammatory indices, and inclusion cutoff significantly altered the trial outcome. Finally, altered pharmacokinetics/pharmacodynamics in varying age groups of KD patients may alter drug exposure and response. Conclusions If assumptions regarding a pediatric disease process, such as KD, do not include age stratification with inclusion or response, then the wrong decision could result with regard to age-appropriateness or approval of a drug.

  19. Development of a multi-institutional clinical research consortium for pediatric surgery.

    Science.gov (United States)

    Hirschl, Ronald B; Minneci, Peter; Gadepalli, Samir; Saito, Jacqueline M; Askegard-Giesmann, Johanna; Deans, Katherine; Downard, Cynthia; Fallat, Mary; Finnell, Maria; Helmrath, Michael; Kabre, Rashmi; Lal, David; Leys, Charles; Mak, Grace; Ostlie, Daniel; Rescorla, Fred; Sato, Thomas; St Peter, Shawn; von Allmen, Daniel; Warner, Brad

    2017-07-01

    Multicenter clinical research studies in pediatric surgery have been largely limited to relatively small case-series and retrospective reviews because of the rarity of many of the diseases we treat and difficulty coordinating and executing multi-institutional studies. Creation of a collaborative research network can provide the needed patient population and infrastructure to perform high quality multi-institutional studies. In 2013, eleven academic pediatric surgery centers within the United States formed a research consortium to develop and conduct multicenter clinical research projects to advance the practice of pediatric surgery. We present our process for creating, developing, and maintaining this consortium including initial regional geographic limitation, charter development with by-laws and procedures for adopting studies, and research infrastructure including a central website for study monitoring and central reliance institutional review board process. Our model could be reproduced or adapted by other institutions to develop or strengthen other research collaboratives. Type of study: retrospective, IV. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Clinical Applications of Transcranial Magnetic Stimulation in Pediatric Neurology.

    Science.gov (United States)

    Narayana, Shalini; Papanicolaou, Andrew C; McGregor, Amy; Boop, Frederick A; Wheless, James W

    2015-08-01

    Noninvasive brain stimulation is now an accepted technique that is used as a diagnostic aid and in the treatment of neuropsychiatric disorders in adults, and is being increasingly used in children. In this review, we will discuss the basic principles and safety of one noninvasive brain stimulation method, transcranial magnetic stimulation. Improvements in the spatial accuracy of transcranial magnetic stimulation are described in the context of image-guided transcranial magnetic stimulation. The article describes and provides examples of the current clinical applications of transcranial magnetic stimulation in children as an aid in the diagnosis and treatment of neuropsychiatric disorders and discusses future potential applications. Transcranial magnetic stimulation is a noninvasive tool that is safe for use in children and adolescents for functional mapping and treatment, and for many children it aids in the preoperative evaluation and the risk-benefit decision making.

  1. Adapting a tertiary-care pediatric weight management clinic to better reach Spanish-speaking families.

    Science.gov (United States)

    Guzman, Angelica; Irby, Megan B; Pulgar, Camila; Skelton, Joseph A

    2012-06-01

    Pediatric obesity continues to be an epidemic, affecting Hispanic children disproportionately. Recent recommendations outline a step-wise approach to the treatment of overweight and obese children, culminating in tertiary-care, multidisciplinary programs. We detail here how our tertiary-care, family-based, pediatric weight management clinic addressed the problem of few Spanish-speaking families enrolling in treatment after referral by adding a Bilingual Case Manager. Utilizing a family-centered, high-contact, personal approach, our program increased the number of Hispanic families enrolling over ten-fold. Further, outcomes in Hispanic families were equal to or better than other racial/ethnic groups. Lessons learned from this experience may benefit other obesity treatment programs trying to improve care of Spanish-speaking families.

  2. Pharmacogenomics in Pediatric Oncology: Review of Gene—Drug Associations for Clinical Use †

    Science.gov (United States)

    Mlakar, Vid; Huezo-Diaz Curtis, Patricia; Satyanarayana Uppugunduri, Chakradhara Rao; Krajinovic, Maja; Ansari, Marc

    2016-01-01

    During the 3rd congress of the European Society of Pharmacogenomics and Personalised Therapy (ESPT) in Budapest in 2015, a preliminary meeting was held aimed at establishing a pediatric individualized treatment in oncology and hematology committees. The main purpose was to facilitate the transfer and harmonization of pharmacogenetic testing from research into clinics, to bring together basic and translational research and to educate health professionals throughout Europe. The objective of this review was to provide the attendees of the meeting as well as the larger scientific community an insight into the compiled evidence regarding current pharmacogenomics knowledge in pediatric oncology. This preliminary evaluation will help steer the committee’s work and should give the reader an idea at which stage researchers and clinicians are, in terms of personalizing medicine for children with cancer. From the evidence presented here, future recommendations to achieve this goal will also be suggested. PMID:27618021

  3. Clinical application of exhaled nitric oxide measurement in pediatric lung diseases

    Directory of Open Access Journals (Sweden)

    Manna Angelo

    2012-12-01

    Full Text Available Summary Fractional exhaled nitric oxide (FeNO is a non invasive method for assessing the inflammatory status of children with airway disease. Different ways to measure FeNO levels are currently available. The possibility of measuring FeNO levels in an office setting even in young children, and the commercial availability of portable devices, support the routine use of FeNO determination in the daily pediatric practice. Although many confounding factors may affect its measurement, FeNO is now widely used in the management of children with asthma, and seems to provide significantly higher diagnostic accuracy than lung function or bronchial challenge tests. The role of FeNO in airway infection (e.g. viral bronchiolitis and common acquired pneumonia, in bronchiectasis, or in cases with diffuse lung disease is less clear. This review focuses on the most recent advances and the current clinical applications of FeNO measurement in pediatric lung disease.

  4. Outcome of pediatric inpatient asthma clinical pathway implementation in a military medical center.

    Science.gov (United States)

    Hsu, Daniel P; Lee, Thomas J; Barker, James A

    2013-04-01

    A performance improvement project was instituted at our facility to standardize pediatric inpatient asthma care by instituting an asthma clinical pathway (ACP). Formal asthma education and standardized postdischarge follow-up plans for all asthma inpatients were initiated. Patients treated by following the ACP were compared against historically similar patients from the previous 4 years. Differences in hospital length-of-stay (LOS) for patients treated on the ACP were compared to historical LOS. Adherence to The Joint Commission's home management plan of care metric, CAC-3, was also compared. There was a 25% lower hospital LOS in the ACP group compared to historical control group, 45.8 hours versus 60.9 hours (p asthma education. The implementation of a pediatric asthma inpatient performance improvement project was associated with a significant decrease in hospital LOS, when compared to historic controls. It also led to a significant improvement in adherence with The Joint Commission's CAC-3 measures.

  5. Pharmacogenomics in Pediatric Oncology: Review of Gene—Drug Associations for Clinical Use

    Directory of Open Access Journals (Sweden)

    Vid Mlakar

    2016-09-01

    Full Text Available During the 3rd congress of the European Society of Pharmacogenomics and Personalised Therapy (ESPT in Budapest in 2015, a preliminary meeting was held aimed at establishing a pediatric individualized treatment in oncology and hematology committees. The main purpose was to facilitate the transfer and harmonization of pharmacogenetic testing from research into clinics, to bring together basic and translational research and to educate health professionals throughout Europe. The objective of this review was to provide the attendees of the meeting as well as the larger scientific community an insight into the compiled evidence regarding current pharmacogenomics knowledge in pediatric oncology. This preliminary evaluation will help steer the committee’s work and should give the reader an idea at which stage researchers and clinicians are, in terms of personalizing medicine for children with cancer. From the evidence presented here, future recommendations to achieve this goal will also be suggested.

  6. Why Computerized Adaptive Testing In Pediatric Brain Tumor Clinics.

    Science.gov (United States)

    Lai, Jin-Shei; Beaumont, Jennifer L; Nowinski, Cindy J; Cella, David; Hartsell, William F; Han-Chih Chang, John; Manley, Peter E; Goldman, Stewart

    2017-08-07

    Monitoring of health-related quality of life (HRQOL) and symptoms of patients with brain tumors is needed yet not always feasible. This is partially due to lack of brief-yet-precise assessments with minimal administration burden that are easily incorporated into clinics. Dynamic computerized adaptive testing (CAT) or static fixed-length short-forms, derived from psychometrically-sound item banks, are designed to fill this void. This study evaluated the comparability of scores obtained from CATs and short-forms. Patients (ages 7-22) were recruited from brain tumor clinics and completed PROMIS CATs and short-forms (Fatigue, Mobility, Upper Extremity, Depressive Symptoms, Anxiety, and Peer Relationships). Pearson correlations, paired t-tests, and Cohen's d were used to evaluate the relationship, significant differences and the magnitude of the difference between these two scores, respectively. Data from 161 patients with brain tumors were analyzed. Patients completed each CAT within 2 minutes. Scores obtained from CATs and short-forms were highly correlated (r=0.95 - 0.98). Significantly different CAT versus short-form scores were found on 4 (of 6) domains yet with negligible effect sizes (|d| < 0.09). These relationships varied across patients with different levels of reported symptoms, with the strongest association at the worst or best symptom scores. This study demonstrated the comparability of scores from CATs and short-forms. Yet the agreement between these two varied across degrees of symptom severity which was a result of the ceiling effects of static short-forms. We recommend CATs to enable individualized assessment for longitudinal monitoring. Copyright © 2017. Published by Elsevier Inc.

  7. Physical Activity in Clinical Pediatric Weight Management Programs: Current Practices and Recommendations.

    Science.gov (United States)

    Kist, Christopher; Gier, Amanda; Tucker, Jared; Barbieri, Teresa F; Johnson-Branch, Sonya; Moore, Lindy; Picard, Sarah; Lukasiewicz, Gloria; Coleman, Nailah

    2016-11-01

    Physical activity (PA) is essential for youth weight management. FOCUS on a Fitter Future (FFF), a group of health care professionals from 25 children's hospitals, sponsored by the Children's Hospital Association, examined current care practices for overweight and obese youth with the goal of building consensus on outcome measurements and quality improvement for pediatric weight management programs (WMPs). WMPs completed a survey regarding PA practices, including testing, assessment and intervention. Consistency in general treatment practices was noted with variability in implementation. All programs included PA assessment and counseling. A majority of programs measured aerobic fitness, and more than half evaluated muscular fitness. Most offered group exercise sessions. Programs differed in availability of resources, assessment tools, interventions and outcome measures. Based on current practice and research, the FFF PA subgroup recommends key components for inclusion in a pediatric WMP: exercise testing, body composition assessment, PA and sedentary behaviors measures, individual exercise counseling, and group exercise programming. © The Author(s) 2015.

  8. Oral health-related quality of life in pediatric patients under general anesthesia

    Science.gov (United States)

    Li, Lanlan; Wang, Hongwei; Han, Xueping

    2017-01-01

    Abstract Our goal was to evaluate how dental treatments under general anesthesia (GA) affect the quality of life by a prospective pair-matched design. Pediatric patients, who had received dental treatments under GA, were enrolled and were asked to complete the Early Childhood Oral Health Impact Scale (ECOHIS) before the treatment and 1 month after the treatment. To shield the observed impacts, a pair-matched control group was performed. Patients in the control group were also required to complete the ECOHIS at these different points in time. In both groups, the items of troubled sleep and oral/dental pain scored highest, whereas avoiding smiling or laughing and avoiding talking scored lowest before the treatment. The total mean score in the 2 groups was 13.1 and 13.7, respectively, and there was no significant statistical difference (P > 0.05). However, the total mean score was 1.9 in the experimental group after the treatment and smaller compared with the control group (1.9 vs. 4.7, P < 0.001). The majority of the items in both groups had an apparent effect size and the total mean effect in the experimental group was greater than that in the control group (85.5% vs. 65.7%, P < 0.001). Therefore, dental treatment under GA could provide better quality of life restoration compared with treatment over multiple visits. PMID:28079793

  9. Differences in pediatric dental services under general anesthesia for Medicaid and military dependent children.

    Science.gov (United States)

    Johnson, M B; Cappelli, D P; Bradshaw, B S; Mabry, J C

    2010-01-01

    This study's purpose was to compare pediatric dental services provided for Medicaid and military dependent children to determine if differences in dental treatment choices exist based on site and payment method. Subjects included 120 Medicaid patients at the University of Texas Health Science Center at San Antonio and 120 military dependents at Lackland Air Force Base, Texas. Demographic data and treatment information were abstracted for children younger than 6 years old receiving dental treatment under general anesthesia between 2002 and 2006. Data was analyzed using Wilcoxon rank sum, Kruskal-Wallis, and Fisher's exact tests. The Medicaid recipients were younger (40.2 vs 49.8 months, P<.001) and more likely to be Hispanic (78% vs 30%, P<.001). The means of decayed teeth, fillings, and stainless steel crowns did not differ between sites. Medicaid children received more composite fillings (P<.001), fewer amalgam fillings (P<.001), fewer pulp therapies (P<.001), more extractions (P=.01), and fewer sealants (P<.001). Age and gender did not affect decay rates, but those of Hispanic ethnicity did experience more decay than non-Hispanics (9.5 vs 8.6, P=.02). This study found no difference in the number of less conservative, albeit more costly, procedures performed with Medicaid children at a university compared to military dependents at a military base.

  10. A Clinical Pharmacist's Role in Screening for Metabolic Syndrome in a Rural Pediatric Ambulatory Clinic

    Science.gov (United States)

    Benavides, Sandra; Kohler, Lisa A.; Souffrant, Garry

    2011-01-01

    Purpose: The prevalence of metabolic syndrome in the pediatric population is increasing. Barriers, including the lack of consensus of a definition for metabolic syndrome and time constraints for the pediatrician, may limit the identification and diagnosis of metabolic syndrome in children. The objective of this pilot study was to evaluate the role…

  11. Identification and Management of Obese Patients in a Pediatric Orthopaedic Clinic.

    Science.gov (United States)

    Davila, Natalia; Vess, Joy; Johnson, Emily E

    Childhood obesity is a complex healthcare problem that affects all aspects of a child's health. The American Academy of Pediatrics and the Expert Committee recommends that all children be evaluated for current medical conditions including the risk for obesity by identifying elevated body mass index (BMI), physical activity habits, and diet. Childhood obesity is defined as a BMI of 95th percentile or greater on standardized age-based growth charts. Abdominal and visceral fat mass has a negative effect on bone formation during childhood and adolescence. Effective interventions are aimed at prevention and treatment and include collection and assessment of obesity, eating habits, physical activity, and family history. At a local outpatient pediatric orthopaedic practice, few patients had a diagnosis of childhood obesity and weight management varied by providers. The purpose of this quality improvement project was to improve identification of obese children and increase referrals to a weight management program. Setting: A hospital-affiliated pediatric orthopaedic clinic staffed with 3 orthopaedic surgeons and 2 nurse practitioners. 6- to 18-year-olds with a BMI of greater than 95th percentile (N = 239). Electronic medical record chart review for documented obesity and referral to weight management program: Intervention: Provider educational in-service reviewing management guidelines and referral process. Average percentages of documented obesity diagnosis increased from 11% to 53%. The number of referrals to Heart Healthy weight management program increased by 400%. An educational-based intervention in a pediatric orthopaedic clinic was effective in increasing the number of patients with a diagnosis of obesity and referred to a weight management program.

  12. Novel phenotypes and loci identified through clinical genomics approaches to pediatric cataract.

    Science.gov (United States)

    Patel, Nisha; Anand, Deepti; Monies, Dorota; Maddirevula, Sateesh; Khan, Arif O; Algoufi, Talal; Alowain, Mohammed; Faqeih, Eissa; Alshammari, Muneera; Qudair, Ahmed; Alsharif, Hadeel; Aljubran, Fatimah; Alsaif, Hessa S; Ibrahim, Niema; Abdulwahab, Firdous M; Hashem, Mais; Alsedairy, Haifa; Aldahmesh, Mohammed A; Lachke, Salil A; Alkuraya, Fowzan S

    2017-02-01

    Pediatric cataract is highly heterogeneous clinically and etiologically. While mostly isolated, cataract can be part of many multisystem disorders, further complicating the diagnostic process. In this study, we applied genomic tools in the form of a multi-gene panel as well as whole-exome sequencing on unselected cohort of pediatric cataract (166 patients from 74 families). Mutations in previously reported cataract genes were identified in 58% for a total of 43 mutations, including 15 that are novel. GEMIN4 was independently mutated in families with a syndrome of cataract, global developmental delay with or without renal involvement. We also highlight a recognizable syndrome that resembles galactosemia (a fulminant infantile liver disease with cataract) caused by biallelic mutations in CYP51A1. A founder mutation in RIC1 (KIAA1432) was identified in patients with cataract, brain atrophy, microcephaly with or without cleft lip and palate. For non-syndromic pediatric cataract, we map a novel locus in a multiplex consanguineous family on 4p15.32 where exome sequencing revealed a homozygous truncating mutation in TAPT1. We report two further candidates that are biallelically inactivated each in a single cataract family: TAF1A (cataract with global developmental delay) and WDR87 (non-syndromic cataract). In addition to positional mapping data, we use iSyTE developmental lens expression and gene-network analysis to corroborate the proposed link between the novel candidate genes and cataract. Our study expands the phenotypic, allelic and locus heterogeneity of pediatric cataract. The high diagnostic yield of clinical genomics supports the adoption of this approach in this patient group.

  13. Pharmacotherapy of Pediatric Insomnia

    Science.gov (United States)

    Owens, Judith A.

    2009-01-01

    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…

  14. Clinical Trial Simulations and Pharmacometric Analysis in Pediatrics: Application to Inhaled Loxapine in Children and Adolescents.

    Science.gov (United States)

    Dong, Min; Fukuda, Tsuyoshi; Selim, Sally; Smith, Mark A; Rabinovich-Guilatt, Laura; Cassella, James V; Vinks, Alexander A

    2017-02-15

    Loxapine for inhalation is a drug-device combination product approved in adults for the acute treatment of agitation associated with schizophrenia or bipolar I disorder. The primary objective of this study was to develop a clinical trial protocol to support a phase I pharmacokinetic study in children aged 10 years and older. In addition, this report details the results of the clinical study in relation to the predicted likelihood of achieving the target exposure associated with therapeutic effect in adults. A nonlinear mixed-effects population pharmacokinetic model was developed using adult data and was adjusted for the targeted pediatric age groups by applying allometric scaling to account for body size effects. Based on this pediatric model, age-appropriate regimens to achieve loxapine exposures similar to the ones associated with therapeutic effect in the adult studies were identified via trial simulation. D-optimal design and power analysis were conducted to identify optimal pharmacokinetic sampling times and sample size, respectively. The developed clinical trial design formed the basis of a phase I study to assess the safety and pharmacokinetics of loxapine for inhalation in children aged 10 years and older (ClinicalTrials.gov ID: NCT02184767). The results of the study indicated that overall loxapine exposures were consistent with what had been predicted by the trial simulations. The presented approach illustrates how modeling and simulation can assist in the design of informative clinical trials to identify safe and effective doses and dose ranges in children and adolescents.

  15. HRV biofeedback for pediatric irritable bowel syndrome and functional abdominal pain: a clinical replication series.

    Science.gov (United States)

    Stern, Mark J; Guiles, Robert A F; Gevirtz, Richard

    2014-12-01

    Irritable bowel syndrome (IBS) and Functional Abdominal Pain (FAP) are among the most commonly reported Functional Gastrointestinal Disorders. Both have been associated with varying autonomic dysregulation. Heart Rate Variability Biofeedback (HRVB) has recently begun to show efficacy in the treatment of both IBS and FAP. The purpose of this multiple clinical replication series was to analyze the clinical outcomes of utilizing HRVB in a clinical setting. Archival data of twenty-seven consecutive pediatric outpatients diagnosed with IBS or FAP who received HRVB were analyzed. Clinical outcomes were self-report and categorized as full or remission with patient satisfaction, or no improvement. Qualitative reports of patient experiences were also noted. Full remission was achieved by 69.2 % and partial remission was achieved by 30.8 % of IBS patients. Full remission was achieved by 63.6 % and partial remission was achieved by 36.4 % of FAP patients. No patients in either group did not improve to a level of patient satisfaction or >50 %. Patient's commonly reported feeling validated in their discomfort as a result of psychophysiological education. Results suggest that HRVB is a promising intervention for pediatric outpatients with IBS or FAP. Randomized controlled trials are necessary to accurately determine clinical efficacy of HRVB in the treatment of IBS and FAP.

  16. Methemoglobin levels in generally anesthetized pediatric dental patients receiving prilocaine versus lidocaine.

    Science.gov (United States)

    Gutenberg, Lauren L; Chen, Jung-Wei; Trapp, Larry

    2013-01-01

    The purpose of this study was to measure and compare peak methemoglobin levels and times to peak methemoglobin levels following the use of prilocaine and lidocaine in precooperative children undergoing comprehensive dental rehabilitation under general anesthesia. Ninety children, 3-6 years of age, undergoing dental rehabilitation under general anesthesia were enrolled and randomly assigned into 3 equal groups: group 1, 4% prilocaine plain, 5 mg/kg; group 2, 2% lidocaine with 1:100,000 epinephrine, 2.5 mg/kg; and group 3, no local anesthetic. Subjects in groups 1 and 2 were administered local anesthetic prior to restorative dental treatment. Methemoglobin levels (SpMET) were measured and recorded throughout the procedure using a Masimo Radical-7 Pulse Co-Oximeter (Masimo Corporation, Irvine, Calif, RDS-1 with SET software with methemoglobin interface). Data were analyzed using chi-square, one-way analysis of variance (ANOVA), and Pearson correlation (significance of P < .05). Group 1 had a significantly higher mean peak SpMET level at 3.55% than groups 2 and 3 at 1.63 and 1.60%, respectively. The mean time to peak SpMET was significantly shorter for group 3 at 29.50 minutes than that of group 1 at 62.73 and group 2 at 57.50 minutes. Prilocaine, at 5 mg/kg in pediatric dental patients, resulted in significantly higher peak SpMET levels than lidocaine and no local anesthetic. In comparison to no local anesthetic, the administration of prilocaine and lidocaine caused peak SpMET levels to occur significantly later in the procedure.

  17. Comparison of surgical outcomes among infants in neonatal intensive care units treated by pediatric surgeons versus general surgeons: The need for pediatric surgery specialists.

    Science.gov (United States)

    Boo, Yoon Jung; Lee, Eun Hee; Lee, Ji Sung

    2017-01-31

    This study compared the outcomes of infants who underwent surgery in neonatal intensive care units by pediatric surgeons and by general surgeons. This was a retrospective study of infants who underwent surgery in neonatal intensive care units between 2010 and 2014. A total of 227 patients were included. Of these patients, 116 were operated on by pediatric surgeons (PS) and 111 were operated on by general surgeons (GS). The outcome measures were the overall rate of operative complications, unplanned reoperation, mortality rate, length of stay, operative time, and number of total number of operative procedures. The overall operative complication rate was higher in the GS group compared with the PS group (18.7% vs. 7.0%, p=0.0091). The rate of unplanned reoperations was also higher in the GS group (10.8% vs. 3.5%, p=0.0331). The median operation time (90min vs. 75min, p=0.0474) and median length of stay (24days vs. 18days, p=0.0075) were significantly longer in the GS group. The adjusted odd ratios of postoperative complications for GS were 2.9 times higher than that of PS (OR 2.90, p=0.0352). The operative quality and patient outcomes of the PS group were superior to those of the GS group. III. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Time series analysis as input for clinical predictive modeling: Modeling cardiac arrest in a pediatric ICU

    Directory of Open Access Journals (Sweden)

    Kennedy Curtis E

    2011-10-01

    Full Text Available Abstract Background Thousands of children experience cardiac arrest events every year in pediatric intensive care units. Most of these children die. Cardiac arrest prediction tools are used as part of medical emergency team evaluations to identify patients in standard hospital beds that are at high risk for cardiac arrest. There are no models to predict cardiac arrest in pediatric intensive care units though, where the risk of an arrest is 10 times higher than for standard hospital beds. Current tools are based on a multivariable approach that does not characterize deterioration, which often precedes cardiac arrests. Characterizing deterioration requires a time series approach. The purpose of this study is to propose a method that will allow for time series data to be used in clinical prediction models. Successful implementation of these methods has the potential to bring arrest prediction to the pediatric intensive care environment, possibly allowing for interventions that can save lives and prevent disabilities. Methods We reviewed prediction models from nonclinical domains that employ time series data, and identified the steps that are necessary for building predictive models using time series clinical data. We illustrate the method by applying it to the specific case of building a predictive model for cardiac arrest in a pediatric intensive care unit. Results Time course analysis studies from genomic analysis provided a modeling template that was compatible with the steps required to develop a model from clinical time series data. The steps include: 1 selecting candidate variables; 2 specifying measurement parameters; 3 defining data format; 4 defining time window duration and resolution; 5 calculating latent variables for candidate variables not directly measured; 6 calculating time series features as latent variables; 7 creating data subsets to measure model performance effects attributable to various classes of candidate variables; 8

  19. Analysis on clinical characteristics of intracranial Arachnoid Cysts in 488 pediatric cases.

    Science.gov (United States)

    Huang, Jian-Huang; Mei, Wen-Zhong; Chen, Yao; Chen, Jian-Wu; Lin, Zhi-Xiong

    2015-01-01

    To summarize the clinical characteristics of intracranial arachnoid cysts (IACs) in pediatric cases. A retrospective analysis was carried out on clinical characteristics of IACs in 488 pediatric cases who were treated at our hospital from January 2003 to September 2013. There were 342 males and 146 females (male-to-female ratio, 2.34:1), aged 5.61±3.25 years on average. 221 cases (45.29%) were diagnosed accidentally, 267 cases had clinical complaints (54.71%), among which relationships between clinical complaints and IACs were identified in 123 (46.07%). Simple IACs occurred in 364 cases (4.59%), and concurrent congenital abnormalities occurred in 124 cases (4.59%). In terms of location, 355 had IACs in middle cranial fossa (72.75%), 82 cases in posterior cranial fossa (16.80%), 20 cases in anterior cranial fossa (4.10%), 12 cases in dorsolateral surface (2.46%), 7 cases in suprasellar cistern (1.43%), 5 cases in cerebral ventricle (1.02%), 5 cases in quadrigeminal cistern (1.02%), and 2 cases in interhemispheric region (0.41%). There were 449 cases with single IAC (92.01%) and 39 cases with multiple IACs (7.99%). On MRI, the cysts produced tension in 127 cases (26.02%), but not in the remaining 361 cases (73.98%). Surgery was performed on 76 of 488 cases (15.57%), while conservative observation was accepted in 412 cases (84.43%). For the former, the symptoms and the cyst volume were improved to varying extent; for the latter, the follow-up lasting for 3-72 months (average 32.43±8.92 months) showed that the cyst volume remained stable in 407 cases (98.78%), enlarged with aggravated symptoms in 3 cases (0.73%), and shrank in 2 cases (0.49%). Clinical complaints of IACs varied in pediatric cases, and the relationships between clinical complaints and IACs were established only partially. Some pediatric cases were combined with other congenital abnormalities. The cyst volume largely remained stable during the disease course, and surgery was required for only a few

  20. Clinical Activity in General Practice and Cancer

    DEFF Research Database (Denmark)

    Hjertholm, Peter

    2015-01-01

    BACKGROUND AND AIMS Cancer is a common, serious disease and early diagnosis is a cornerstone in the effort to improve the outcome from cancer disease. The general practitioner (GP) plays a crucial role in achieving this goal. Little is known about GPs’ suspicion of cancer and the activities the GPs...... institute in relation to such suspicion. Knowledge is also sparse on any effects of different diagnostic activities in general practice. The overall aims of this thesis were therefore: -to describe how often Danish GPs suspected cancer or other serious diseases and how they acted on the suspicion......, and to analyse how a suspicion influenced the demand for health care services and predicted a future diagnosis of serious disease - to investigate whether variation in GPs’ diagnostic activity influences cancer patients’ prognosis in relation to prostate-specific antigen (PSA) testing and prostate cancer...

  1. Integrating research into clinical internship training bridging the science/practice gap in pediatric psychology.

    Science.gov (United States)

    McQuaid, Elizabeth L; Spirito, Anthony

    2012-03-01

    Existing literature highlights a critical gap between science and practice in clinical psychology. The internship year is a "capstone experience"; training in methods of scientific evaluation should be integrated with the development of advanced clinical competencies. We provide a rationale for continued exposure to research during the clinical internship year, including, (a) critical examination and integration of the literature regarding evidence-based treatment and assessment, (b) participation in faculty-based and independent research, and (c) orientation to the science and strategy of grantsmanship. Participation in research provides exposure to new empirical models and can foster the development of applied research questions. Orientation to grantsmanship can yield an initial sense of the "business of science." Internship provides an important opportunity to examine the challenges to integrating the clinical evidence base into professional practice; for that reason, providing research exposure on internship is an important strategy in training the next generation of pediatric psychologists.

  2. Junk food seen at pediatric clinic visits: is it a problem?

    Science.gov (United States)

    Frazier, Johnnie P; Land, Megan; Hsieh, Pei-Hsuan; Barratt, Michelle S

    2014-04-01

    To document the prevalence of junk foods seen at clinic visits. A cross-sectional 23-item survey of observed food items were completed by medical staff using a convenience sample of families from June 2, 2011 to March 2, 2012. The study was conducted in pediatric clinics affiliated with the University of Texas Medical School at Houston. A convenience sample consisting of 738 families with children from 4 months to 16 years old presenting for visits were included in the study. Children exclusively breast and formula fed was excluded. Junk food was observed 20.9% at the clinic visits. Junk food was often seen at clinic visits. There was a trend toward higher body mass index in patients whose families had junk food at the visit.

  3. Integrating Research Into Clinical Internship Training Bridging the Science/Practice Gap in Pediatric Psychology

    Science.gov (United States)

    Spirito, Anthony

    2012-01-01

    Existing literature highlights a critical gap between science and practice in clinical psychology. The internship year is a “capstone experience”; training in methods of scientific evaluation should be integrated with the development of advanced clinical competencies. We provide a rationale for continued exposure to research during the clinical internship year, including, (a) critical examination and integration of the literature regarding evidence-based treatment and assessment, (b) participation in faculty-based and independent research, and (c) orientation to the science and strategy of grantsmanship. Participation in research provides exposure to new empirical models and can foster the development of applied research questions. Orientation to grantsmanship can yield an initial sense of the “business of science.” Internship provides an important opportunity to examine the challenges to integrating the clinical evidence base into professional practice; for that reason, providing research exposure on internship is an important strategy in training the next generation of pediatric psychologists. PMID:22286345

  4. Clinical analysis and follow-up study of chronic active Epstein-Barr virus infection in 53 pediatric cases

    Institute of Scientific and Technical Information of China (English)

    LU Gen; XIE Zheng-de; ZHAO Shun-ying; YE Ling-jun; WU Run-hui; LIU Chun-yan; YANG Shuang; JIN Ying-kang; SHEN Kun-ling

    2009-01-01

    Background Chronic active Epstein-Barr virus infection (CAEBV) has been previously reported to be sometimes associated with an aggressive clinical course. The characteristics of CAEBV in Mainland Chinese pediatric patients are largely unreported. The main aims of this survey were to recognize the clinical features of CAEBV in children and to explore its diagnostic criteria and risk factors.Methods A retrospective study was performed on 53 pediatric patients (36 boys and 17 girls) with CAEBV who were admitted to Beijing Children's Hospital between 2003 and 2007. All their medical records were reviewed and analyzed. For each patient, demographic, clinical, laboratory data and outcome were collected. Independent-samples t test was used for statistical analysis.Results The age at onset of CAEBV was from 2 months to 14.6 years (mean (5.3±3.3) years). At the time of onset, 43.4% patients had an infectious mononucleosis-like symptom. Most patients exhibited intermittent fever (92.5%, 49/53), hepatomegaly (81.1%, 43/53) and splenomegaly (77.4%, 41/53). Life-threatening complications including hemophagocytic syndrome (24.5%,13/53), interstitial pneumonia (24.5%, 13/53), hepatic failure (15.1%, 8/53) and malignant lymphoma (11.3%, 6/53) were also observed. The serum EBV DNA level in 23 patients with CAEBV was in the range of 5.05×102-4.60×106 copies/ml with a mean value of 103.7 copies/ml. Many patients with CAEBV generally had continuous symptoms during the observational period. Eleven out of 42 patients (26.2%) died 7 months to 3 years after onset. Deceased patients were more likely to have had lower platelet counts and albumin levels than the living patients (P<0.05 for all comparisons).Conclusions The study reveals that CAEBV in Chinese pediatric patients has a severe clinical course and prognosis is poor. Thrombocytopenia and decreases in albumin might potentially be risk factors for a poor prognosis. EBV loads should be measured and tissue should be stained on

  5. Evaluation of efficacy of restorative dental treatment provided under general anesthesia at hospitalized pediatric dental patients of Isfahan

    OpenAIRE

    Eshghi, Alireza; Samani, Mahdi Jafarzadeh; Najafi, Naghme Feyzi; Hajiahmadi, Maryam

    2012-01-01

    Background: General anesthesia (GA) allows dental treatment to be rendered under optimal conditions, theoretically ensuring ideal outcomes. The aim of this study was to determine the efficacy of restorative dental procedures performed under GA. Materials and Methods: In this cross-sectional retrospective study, 305 pediatric patients who had been treated under GA 6 to 24 months before our survey at Isfahan's hospitalized dentistry center were examined. The examination was performed on dental ...

  6. Knowledge, Attitude and Practices of General Surgeons Regarding Pediatric Inguinal Hernia at Liaquat University Hospital Jamshoro Sindh

    OpenAIRE

    Pushpa Goswami; Samreen Memon; Nand Lal Kella

    2014-01-01

    Inguinal hernia is a most common surgical condition worldwide during infancy. In spite of significant improvements in pediatric surgery it still carries mortality and morbidity due to delay between diagnosis and surgical intervention. A delay in the treatment of inguinal hernia may lead to incarceration and strangulation. In developing countries like us the risk of incarceration and complications is much higher due to delay in seeking treatment due to lack of awareness among parents, general ...

  7. Knowledge, Attitude and Practices of General Surgeons Regarding Pediatric Inguinal Hernia at Liaquat University Hospital Jamshoro Sindh

    OpenAIRE

    Pushpa Goswami; Samreen Memon; Nand Lal Kella

    2014-01-01

    Inguinal hernia is a most common surgical condition worldwide during infancy. In spite of significant improvements in pediatric surgery it still carries mortality and morbidity due to delay between diagnosis and surgical intervention. A delay in the treatment of inguinal hernia may lead to incarceration and strangulation. In developing countries like us the risk of incarceration and complications is much higher due to delay in seeking treatment due to lack of awareness among parents, general ...

  8. Failure to Validate a Multivariable Clinical Prediction Model to Identify Pediatric Intensive Care Unit Patients at High Risk for Candidemia.

    Science.gov (United States)

    Fisher, Brian T; Ross, Rachael K; Roilides, Emmanuel; Palazzi, Debra L; Abzug, Mark J; Hoffman, Jill A; Berman, David M; Prasad, Priya A; Localio, A Russell; Steinbach, William J; Vogiatzi, Lambrini; Dutta, Ankhi; Zaoutis, Theoklis E

    2016-12-01

    We attempted to validate a previously derived clinical prediction rule for candidemia in the pediatric intensive care unit. This multicenter case control study did not identify significant association of candidemia with most of the previously identified predictors. Additional study in larger cohorts with other predictor variables is needed. © The Author 2015. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  9. Evaluation of undergraduate clinical learning experiences in the subject of pediatric dentistry using critical incident technique

    Directory of Open Access Journals (Sweden)

    S Vyawahare

    2013-01-01

    Full Text Available Introduction: In pediatric dentistry, the experiences of dental students may help dental educators better prepare graduates to treat the children. Research suggests that student′s perceptions should be considered in any discussion of their education, but there has been no systematic examination of India′s undergraduate dental students learning experiences. Aim: This qualitative investigation aimed to gather and analyze information about experiences in pediatric dentistry from the students′ viewpoint using critical incident technique (CIT. Study Design: The sample group for this investigation came from all 240 3 rd and 4 th year dental students from all the four dental colleges in Indore. Using CIT, participants were asked to describe at least one positive and one negative experience in detail. Results: They described 308 positive and 359 negative experiences related to the pediatric dentistry clinic. Analysis of the data resulted in the identification of four key factors related to their experiences: 1 The instructor; 2 the patient; 3 the learning process; and 4 the learning environment. Conclusion: The CIT is a useful data collection and analysis technique that provides rich, useful data and has many potential uses in dental education.

  10. pediatric patient with acute myeloid leukemia | EU Clinical Trials Register [EU Clinical Trials Register

    Lifescience Database Archive (English)

    Full Text Available emia in children and adolescent protocollo per la leucemia acuta mieloide in età pediatrica A.3.2Name or abb...pediatric patient with acute myeloid leukemia pazienti in età pediatrica affetti da leucemia acuta mieloide ...te myeloid leukemia pazienti in età pediatrica affetti da leucemia acuta mieloide E.1.1.2Therapeutic area Di

  11. Pediatric chest CT after trauma: impact on surgical and clinical management

    Energy Technology Data Exchange (ETDEWEB)

    Patel, Rina P. [Vanderbilt University School of Medicine, Nashville, TN (United States); Hernanz-Schulman, Marta; Hilmes, Melissa A.; Kan, J.H. [Vanderbilt University, Department of Radiology and Radiological Sciences, Vanderbilt Children' s Hospital, Nashville, TN (United States); Yu, Chang [Vanderbilt University, Department of Biostatistics, Nashville, TN (United States); Ray, Jackie [Vanderbilt University, Department of Pediatric Surgery, Vanderbilt Children' s Hospital, Nashville, TN (United States)

    2010-07-15

    Chest CT after pediatric trauma is frequently performed but its clinical impact, particularly with respect to surgical intervention, has not been adequately evaluated. To assess the impact of chest CT compared with chest radiography on pediatric trauma management. Two hundred thirty-five consecutive pediatric trauma patients who had both chest CT and radiography were identified. Images were reviewed and findings were categorized and correlated with subsequent chest interventions, blinded to final outcome and management. Of the 235 children, 38.3% (90/235) had an abnormal chest radiograph and 63.8% (150/235) had an abnormal chest CT (P < 0.0001). Chest interventions followed in 4.7% (11/235); of these, the findings could be made 1 cm above the dome of the liver in 91% (10/11). Findings requiring chest intervention included pneumothorax (PTX) and vertebral fractures. PTX was found on 2.1% (5/235) of chest radiographs and 20.0% (47/235) of chest CTs (P < 0.0001); 1.7% (4/235) of the children received a chest tube for PTX, 0.85% (2/235) seen on chest CT only. Vertebral fractures were present in 3.8% of the children (9/235) and 66.7% (6/9) of those cases were treated with spinal fusion or brace. There were no instances of mediastinal vascular injury. Most intrathoracic findings requiring surgical management in our population were identified in the lower chest and would be included in routine abdominopelvic CT exams; this information needs to be taken into consideration in the diagnostic algorithm of pediatric trauma patients. (orig.)

  12. Acute poisoning in children; changes over the years, data of pediatric clinic department of toxicology

    Institute of Scientific and Technical Information of China (English)

    Keka Alije; Ramosaj A; Toro H; Azemi M; Baloku A; Sylaj B; Lenjani B; Kyseni K

    2014-01-01

    Objective:To present the frequency, etiology, changes over the years of acute poisoning in children admitted toPediatricClinic ofPristina and to determine the extent and characteristics of the problem, according to which related preventive measures can be taken.Methods:Retrospectively we have analyzed the epidemiology of accidental and suicidal poisonings in children hospitalization inPediatricClinicDepartment ofToxicology during the year2012. Our data we compared with data from previous studies on acute poisoning in children in the PediatricClinic conducted during the years1976-1985 and2001.Results:During the year2012, inPediatricClinic ofPristina5723 children were hospitalized,136 of them or2.3% were treated due to acute poisoning inDepartment ofToxicology,82 of them was boys and54 was girls, rate boys girls was1.5:1.The majority of cases101 or74.2% were under five years with peak age three and35% or25.7% were over five years.The most of the cases was accidentally97% and only 2.9% was suicidal and all of them were over the age of ten.Drugs were the most common agent causing the poisoning71(52.2%) followed by house cleaning products38(27.9%), food10(5.8%), pesticides7(5.14%), rare agent that caused poisoning were: narcotic substances, plant, heavy metals, alcohol, carbon monoxide, carburant.Poisoning occurred mostly in spring and the peak was observed inMay,(1.17% of all patients).January was the month of lowest rate of poisoning. During the years1976-1985, inPediatricClinic ofPristina900 children were hospitalized due to acute poisoning,44.11% were from drugs,15.88% from pesticides,65(7.2%), while during2001 in the unit care intensive were hospitalized66 children due to acute poisoning, among them51.5% were poisoning from drugs,30.03 from pesticides,12.2% from cleaning products.Conclusion:In our study drugs and house cleaning products are the most frequent agents causing accidental poisoning in children less than5 years-old, this age of children is the most

  13. Etiology, extended-spectrum β-lactamase rates and antimicrobial susceptibility of gram-negative bacilli causing intra-abdominal infections in patients in general pediatric and pediatric intensive care units--global data from the Study for Monitoring Antimicrobial Resistance Trends 2008 to 2010.

    Science.gov (United States)

    Badal, Robert E; Bouchillon, Samuel K; Lob, Sibylle H; Hackel, Meredith A; Hawser, Stephen P; Hoban, Daryl J

    2013-06-01

    Antimicrobial resistance has been increasing for several years and is often higher in intensive care units (ICUs) than in other facilities. The spread of extended-spectrum β-lactamases (ESBLs) in particular has profoundly impacted antimicrobial efficacy and usage. The Study for Monitoring Antimicrobial Resistance Trends has monitored the in vitro activity of ertapenem and several comparators against aerobic gram-negative bacteria from intra-abdominal infections (IAIs) for many years. This report summarizes susceptibility levels and epidemiology for key IAI pathogens cultured from general pediatric medical wards and pediatric ICUs globally. 1248 gram-negative bacteria were collected from pediatric IAIs by 113 labs in 40 countries from 2008 to 2010. Susceptibility was determined by Clinical and Laboratory Standards Institute broth microdilution. Susceptibility rates (%S) were determined for species with ≥10 isolates. Sixty-two percent of isolates came from general pediatric wards and 38% from pediatric ICUs. The overall ESBL-positive rate was 11.0% for Escherichia coli and 38.9% for Klebsiella pneumoniae; the ESBL-positive rate for E. coli was twice as high in ICU as non-ICU. Most study drugs inhibited >90% of ESBL-negative isolates, but only the carbapenems inhibited >90% of ESBL-positive E. coli and only imipenem inhibited >90% of ESBL-positive K. pneumoniae. Amikacin, imipenem and ertapenem were the most active against gram-negative bacteria from pediatric IAIs, followed closely by the fluoroquinolones and cefepime. Other cephalosporins were often <90% active. ESBL rates were 38.9% for K. pneumoniae and 11.0% for E. coli. Therapy for pediatric IAIs should take into consideration local ESBL rates because only carbapenems inhibited most of these pathogens.

  14. Clinical significance of pretreatment FDG PET/CT IN MOBG-avid pediatric neuroblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Seo Young; Kim, Yong Il; Cheon, Gi Jeong; Kang, Keon Wook; Chung, June Key; Lee, Dong Soo; Kang, Hyoung Jin; Shin, Hee Young [Seoul National University Hospital, Seoul (Korea, Republic of); Kim, E. Edmund [Seoul National University, Seoul (Korea, Republic of); Rahim, Muhammad Kashif [Nishtar Medical College and Hospital, Multan (Pakistan)

    2017-06-15

    {sup 18}F-fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging is well known to have clinical significance in the initial staging and response evaluation of the many kinds of neoplasms. However, its role in the pediatric neuroblastoma is not clearly defined. In the present study, the clinical significance of FDG-PET/computed tomography (CT) in 123I- or 131I-metaiodobenzylguanidine (MIBG)-avid pediatric neuroblastoma was investigated. Twenty patients with neuroblastoma who undertook pretreatment FDG PET/CT at our institute between 2008 and 2015 and showed MIBG avidity were retrospectively enrolled in the present study. Clinical information—including histopathology, and serum markers—and several PET parameters—including SUVmax of the primary lesion (Psuv), target-to-background ratio (TBR), metabolic tumor volume (MTV), and coefficient of variation (CV)—were analyzed. The prognostic effect of PET parameters was evaluated in terms of progression-free survival (PFS). Total 20 patients (4.5 ± 3.5 years) were divided as two groups by disease progression. Six patients (30.0 %) experienced disease progression and one patient (5.0 %) died during follow-up period. There were not statistically significant in age, stage, MYCN status, primary tumor size, serum lactate dehydrogenase (LDH), neuron-specific enolase (NSE), and ferritin level between two groups with progression or no progression. However, Psuv (p = 0.017), TBR (p = 0.09), MTV (p = 0.02), and CV (p = 0.036) showed significant differences between two groups. In univariate analysis, PFS was significantly associated with Psuv (p = 0.021) and TBR (p = 0.023). FDG-PET parameters were significantly related with progression of neuroblastoma. FDG-PET/CT may have the potential as a valuable modality for evaluating prognosis in the patients with MIBG-avid pediatric neuroblastoma.

  15. [The clinic and the general physician].

    Science.gov (United States)

    Jinich, Horacio

    2004-01-01

    The clinician's activity consists of in the simple words of Dr. Gonzalo Castañeda "knowledge, good deeds and bread winning ". The respective value that clinicians grant to each of these, is variable, but even those whose priority is the latter of the three are obliged to accomplish the other two. Knowledge requires continuous medical education. Effective education requires the ability to separate the "wheat from the chaff". It is important to know how to study. Knowing the patient requires careful collection of symptoms, signs, and paraclinical data, as well as awareness of the sensitivity, specificity, and positive and negative predictive value of the data, but acknowledgment of the important discrepancies that occur among different observers as well as in the same observer at different times should not be disregarded. Clinical medicine is a scientific art that challenges the reasoning and decision-making abilities of the practitioner, who must apply various diagnostic strategies, the hypothetic-deductive strategy usually being the most important of all. Knowing the disease that the patient bears is not enough: it is equally important to know the patient who bears the disease. In clinical medicine there are no diseases, only diseased people. The biological approach to the patient must be substituted by a biopsycho-social one. The clinician's main objective--to heal, has become enormously fiacilitated by the dramatic progress of modern scientific medicine, which has provided the physician with powerful but dangerous tools. The old Hippocratic aphorism, primum non nocere, should never beforgotten. Equally essential for the clinician is application of evidence-based knowledge applied to diagnostic and therapeutic measures; there should be no room for past attitudes that were supported by empires and the advice of "authorities". A solid and warm patient-physician relationship is a tremendously important aspect of the healer's behavior.

  16. Blended Learning Educational Format for Third-Year Pediatrics Clinical Rotation.

    Science.gov (United States)

    Langenau, Erik E; Lee, Robert; Fults, Marci

    2017-04-01

    Traditional medical education is shifting to incorporate learning technologies and online educational activities with traditional face-to-face clinical instruction to engage students, especially at remote clinical training sites. To describe and evaluate the effectiveness of the blended learning format (combining online and face-to-face instruction) for third-year osteopathic medical students during their pediatric rotation. Third-year medical students who completed the 4-week clerkship in pediatrics during the 2014-2015 academic year were divided into a standard learning group and a blended learning group with online activities (discussion boards, blogs, virtual patient encounters, narrated video presentations, and online training modules). Comprehensive Osteopathic Medical Achievement Test scores and final course grades were compared between the standard learning and blended learning groups. Students in the blended learning group completed a postsurvey regarding their experiences. Of 264 third-year students who completed the 4-week clerkship in pediatrics during the 2014-2015 academic year, 78 (29.5%) participated in the blended learning supplement with online activities. Of 53 students who completed the postsurvey in the blended learning group, 44 (83.0%) agreed or strongly agreed that "The integration of e-learning and face-to-face learning helped me learn pediatrics." Open-ended comments supported this overall satisfaction with the course format; however, 26 of 100 comments reflected a desire to increase the amount of clinical exposure and face-to-face time with patients. No statistical differences were seen between the standard learning (n=186) and blended learning (n=78) groups with regard to Comprehensive Osteopathic Medical Achievement Test scores (P=.321). Compared with the standard learning group, more students in the blended learning group received a final course grade of honors (P=.015). Results of this study support the use of blended learning in a

  17. Acute poisoning in children; changes over the years, data of pediatric clinic department of toxicology

    Directory of Open Access Journals (Sweden)

    Alije Keka

    2014-01-01

    Conclusion: In our study drugs and house cleaning products are the most frequent agents causing accidental poisoning in children less than 5 years-old, this age of children is the most susceptible in terms of morbidity. Compared with the previous studies in Pediatric Clinic of Pristina, drugs are still the most frequent cause of acute poisoning in children; the number of poisoning with pesticides has fallen but has increased the number of poisoning with cleaning products. All preventive measures against poisoning should be taken including preventive strategies of education at national level especially in drug and household product storage.

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

    Science.gov (United States)

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

    2015-09-30

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

  19. A New Ethical Challenge for Institutional Review Boards (IRBs)/Ethics Committees (ECs) in the Assessment of Pediatric Clinical Trials.

    Science.gov (United States)

    Rose, Klaus; Kummer, Hans

    2015-01-01

    Both the US and EU have introduced pediatric pharmaceutical legislation to facilitate clinical trials in children and development of better medicines for children. The first concerns were published in 2014 that the European Medicines Agency (EMA)'s Pediatric Committee (PDCO) may be over-enthusiastic and has compelled questionable pediatric clinical trials from pharmaceutical companies. Numerous clinical trials are mandated in rare conditions for which not enough patients exist for even one trial. Furthermore, where these trials are mandated in adolescent patients, the legal age limit of the 18th birthday is confused with a medical age limit and can result in separate clinical trials in adolescent patients that neither make medical nor scientific sense nor will ever recruit enough patients for a meaningful outcome. To confirm our concerns we searched the registry clinicaltrials.gov and found examples for PDCO-triggered unethical trials. We conclude that such trials should not be accepted by institutional review boards (IRBs)/ethics committees (ECs) and that clinical trials resulting from negotiations with EMA's PDCO need extra careful scrutiny by IRBs/ECs in order to prevent unethical studies and damage to pediatric research and unnecessary risks to pediatric patients.

  20. A New Ethical Challenge for Institutional Review Boards (IRBs/Ethics Committees (ECs in the Assessment of Pediatric Clinical Trials

    Directory of Open Access Journals (Sweden)

    Klaus Rose

    2015-05-01

    Full Text Available Both the US and EU have introduced pediatric pharmaceutical legislation to facilitate clinical trials in children and development of better medicines for children. The first concerns were published in 2014 that the European Medicines Agency (EMA’s Pediatric Committee (PDCO may be over-enthusiastic and has compelled questionable pediatric clinical trials from pharmaceutical companies. Numerous clinical trials are mandated in rare conditions for which not enough patients exist for even one trial. Furthermore, where these trials are mandated in adolescent patients, the legal age limit of the 18th birthday is confused with a medical age limit and can result in separate clinical trials in adolescent patients that neither make medical nor scientific sense nor will ever recruit enough patients for a meaningful outcome. To confirm our concerns we searched the registry clinicaltrials.gov and found examples for PDCO-triggered unethical trials. We conclude that such trials should not be accepted by institutional review boards (IRBs/ethics committees (ECs and that clinical trials resulting from negotiations with EMA’s PDCO need extra careful scrutiny by IRBs/ECs in order to prevent unethical studies and damage to pediatric research and unnecessary risks to pediatric patients.

  1. Impact of Clinical Pharmacist on the Pediatric Intensive Care Practice: An 11-Year Tertiary Center Experience.

    Science.gov (United States)

    Tripathi, Sandeep; Crabtree, Heidi M; Fryer, Karen R; Graner, Kevin K; Arteaga, Grace M

    2015-01-01

    With increasing complexity of critical care medicine comes an increasing need for multidisciplinary involvement in care. In many institutions, pharmacists are an integral part of this team, but long-term data on the interventions performed by pharmacists and their effects on patient care and outcomes are limited. We aimed to describe the role of pediatric clinical pharmacists in pediatric intensive care unit (PICU) practice. We retrospectively reviewed the records of pharmacy interventions in the PICU at the Mayo Clinic in Rochester, Minnesota, from 2003-2013, with a distinct period of increased pharmacist presence in the PICU from 2008 onward. We compared demographic and outcome data on patients who did and who did not have pharmacy interventions during 2 periods (2003-2007 and 2008-2013). We identified 27,773 total interventions by pharmacists during the 11-year period, of which 79.8% were accepted by the clinical team. These interventions were made on 10,963 unique PICU admissions and prevented 5867 order entry errors. Pharmacists' interventions increased year over year, including a significant change in 2008. Patients who required pharmacy involvement were younger, sicker, and had longer intensive care unit, hospital, and ventilator duration. Average central line infections and central line entry rates decreased significantly over the study period. Increased pharmacist presence in the PICU is associated with increased interventions and prevention of adverse drug events. Pharmacist participation during rounds and order entry substantially improved the care of critically sick children and should be encouraged.

  2. Teaching clinical decision-making to pediatric residents in an era of managed care.

    Science.gov (United States)

    Chessare, J B

    1998-04-01

    The growth of managed care has brought a new focus on physician competency in the appropriate use of resources to help patients. The community of pediatric educators must improve residency curricula and teaching methodologies to ensure that graduates of their programs can effectively and efficiently meet the needs of children and their families. The educational approach in many pediatric residency programs is an implicit apprenticeship model, with which the residents follow the actions of attending physicians with little attention to scrutiny of the clinical evidence for and against diagnostic and treatment strategies. Evidence-based medicine stresses to the trainee the importance of the evaluation of evidence from clinical research and cautions against the use of intuition, unsystematic clinical experience, and untested pathophysiologic reasoning as sufficient for medical decision-making. Managed care also has helped to create a heightened awareness of the need to educate residents to incorporate the preferences of patients and families into diagnostic and treatment decisions. Trainees must know how to balance their duty to maximize the health of populations at the lowest resource use with their duty to each individual patient and family. Changes in the residency curriculum will bring change in educational settings and the structure of rotations. Potential barriers to implementation will include the need for faculty development and financial resources for information technology.

  3. Pediatric clinical trials in Latin America and Guyana: present views of local practitioners and ways to embrace the future.

    Science.gov (United States)

    Arenas-López, Sara; Fajardo, Carlos; Valls i Soler, Adolf; García-Corzo, Jorge Raúl; Lima-Rogel, Ma Victoria; Calle, Graciela; Leite, Roberio; Lobos, Edgard; Hume-Wright, Querida; MacLeod, Stuart

    2011-08-01

    Global pediatric research has recently received increased attention by health professionals, and research and government institutions. Since the approval of the FDA Pediatric Exclusivity Provision and the EU Paediatric Regulation, pharmaceutical companies have begun to look to developing/transitional countries for international pediatric research collaboration as a way of facilitating the recruitment of patients to clinical trials. Among countries identified as being 'developing/transitional' some were in the North, Central, and South American regions. The aim of this study was to ascertain views from local practitioners on awareness and understanding of pediatric clinical research and to clarify resources and training required by pediatricians engaging in such research in the North, Central, and South American regions. A brief survey was disseminated via Sociedad Iberoamericana de Neonatología (SIBEN) and several other randomly selected pediatric institutions. This survey provided information for a Paediatric Global Research meeting at WorldPharma 2010 (Copenhagen, Denmark). Pediatricians (n = 55) from seven countries in Latin America and Guyana replied to the survey. They appeared to be enthusiastic about embracing the opportunity to participate in meaningful research to improve treatment of children worldwide. However, some challenges remain to be addressed around good clinical practice in the conduct of trials, education, and training of professionals, and the availability and use of resources. The survey indicated a considerable depth of interest in the improvement of the pediatric clinical research environment in Latin America. There is some momentum toward the development of a Latin American network for the facilitation and supervision of pediatric clinical research.

  4. Perceptual discrimination in fear generalization: Mechanistic and clinical implications.

    Science.gov (United States)

    Struyf, Dieter; Zaman, Jonas; Vervliet, Bram; Van Diest, Ilse

    2015-12-01

    For almost a century, Pavlovian conditioning is the imperative experimental paradigm to investigate the development and generalization of fear. However, despite the rich research tradition, the conceptualization of fear generalization has remained somewhat ambiguous. In this selective review, we focus explicitly on some challenges with the current operationalization of fear generalization and their impact on the ability to make inferences on its clinical potential and underlying processes. The main conclusion is that, despite the strong evidence that learning influences perception, current research has largely neglected the role of perceptual discriminability and its plasticity in fear generalization. We propose an alternative operationalization of generalization, where the essence is that Pavlovian conditioning itself influences the breadth of fear generalization via learning-related changes in perceptual discriminability. Hence a conceptualization of fear generalization is incomplete without an in-depth analysis of processes of perceptual discriminability. Furthermore, this highlights perceptual learning and discriminability as important future targets for pre-clinical and clinical research.

  5. Drinking motives in clinical and general populations.

    Science.gov (United States)

    Mezquita, Laura; Stewart, Sherry H; Ibáñez, Manuel I; Ruipérez, María A; Villa, Helena; Moya, Jorge; Ortet, Generós

    2011-01-01

    This paper had three aims: (1) to validate a Spanish adaptation of the Modified Drinking Motives Questionnaire-Revised (M DMQ-R), (2) to explore the relationship of each drinking motive with different patterns of alcohol use, and (3) to compare the drinking motives of moderate drinkers, heavy drinkers, and alcohol abusing/dependent individuals. Two studies were carried out. In Study 1, a sample of 488 participants completed the M DMQ-R and a self-report scale of alcohol consumption in order to study the factor structure and different indices of reliability and validity of the Spanish M DMQ-R. In Study 2, we compared the drinking motives of moderate and heavy drinkers from Study 1 and an additional sample of 59 clinical drinkers. The M DMQ-R demonstrated sound reliability and validity indices. Coping-with-anxiety, social, and enhancement motives predicted higher alcohol use on weekends, but only coping-with-anxiety and social motives were related to consumption on weekdays. Furthermore, moderate drinkers had the lowest scores for all motives, whereas alcohol-dependent participants obtained the highest scores for negative reinforcement drinking motives. The Spanish M DMQ-R is a reliable and valid measure of drinking motives and has potential for assisting with treatment planning for problem drinkers. Copyright © 2011 S. Karger AG, Basel.

  6. Psychosocial Issues in Pediatric Inflammatory Bowel Disease: A Clinical Report of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

    Science.gov (United States)

    Mackner, Laura M.; Greenley, Rachel Neff; Szigethy, Eva; Herzer, Michele; Deer, Kate; Hommel, Kevin A.

    2013-01-01

    Pediatric inflammatory bowel disease (IBD) can affect many areas of psychosocial functioning, and comprehensive medical care includes consideration of psychosocial issues as well as disease factors. The purpose of this clinical report is to review research on psychosocial functioning in pediatric IBD and to provide recommendations for care providers in the areas of psychopathology, health related quality of life and social, family and school functioning. Youth with IBD are at increased risk for difficulty in all areas reviewed, and many psychosocial factors are associated with disease activity, which highlights the importance of monitoring psychosocial functioning as part of clinical care. Several interventions have empirical support or show promise for addressing psychosocial difficulty, and recommendations for monitoring and treating these issues are provided. PMID:23287808

  7. 国际儿科临床期刊PEDIATRICS文献计量学分析%Bibliometric analysis of international pediatric clinical journal PEDIATRICS

    Institute of Scientific and Technical Information of China (English)

    许文婕

    2013-01-01

    目的 介绍国际儿科临床期刊PEDIATRICS,供儿科学临床医务工作者参考.方法 检索Web of Science数据库2008年1月至2012年10月PEDIATRICS的全部文献,对文献年代、国别、语种、作者及主题词词频分布等进行分析.结果 近5年PEDIATRICS刊载的论文共涉及96个国家、地区,发表论文数量最多的是美国,共2687篇,占全部文献量的64.89%;其次为加拿大,共295篇,占7.12%.中国排在第9位,共发表论文73篇,占1.76%.以论著类文献为主,主要语种为英语.结论 流行病学、护理、管理、影响因素、诊断、病死率统计、治疗、哮喘、肥胖等为PEDIATRICS近5年来的报道热点内容.%Objective To introduce the international pediatric clinical journal PEDIATRICS for pediatrics clinical medical researchers.Methods Articles of PEDIATRICS from Jan.2008 to Oct.2012 were searched through Web of Science database.Analysis in country,language,authors and frequency of subject headings based on bibliomettics methodologies was performed.Results In recent 5 years,articles of PEDIATRICS involved a total of 96 countries or regions.The United States published the most papers,2687 of the total amount of literatures,accounted for 64.89% ;followed by Canada,295 of the literatures,accounted for 7.12%.China ranked ninth,a total of 73 papers of literature,accounted for 1.76%.Article was the most frequent type of the papers and English was the dominating language.Conclusions Currently,the researches of PEDIATRICS focus in the fields of epidemiology,care,management,influence factors,diagnosis,treatment,mortality statistics,asthma,obesity.

  8. Pediatric Clinical Trials Conducted in South Korea from 2006 to 2015: An Analysis of the South Korean Clinical Research Information Service, US ClinicalTrials.gov and European Clinical Trials Registries.

    Science.gov (United States)

    Choi, Sheung-Nyoung; Lee, Ji-Hyun; Song, In-Kyung; Kim, Eun-Hee; Kim, Jin-Tae; Kim, Hee-Soo

    2017-08-02

    The status of pediatric clinical trials performed in South Korea in the last decade, including clinical trials of drugs with unapproved indications for children, has not been previously examined. The aim was to provide information regarding the current state of pediatric clinical trials and create a basis for future trials performed in South Korea by reviewing three databases of clinical trials registrations. We searched for pediatric clinical studies (participants gov, and the European Clinical Trials Registry (EuCTR). Additionally, we reviewed whether unapproved indications were involved in each trial by comparing the trials with a list of authorized trials provided by the Ministry of Food and Drug Safety (MFDS). The primary and secondary outcomes were to determine the change in number of pediatric clinical trials with unapproved indications over time and to assess the status of unauthorized pediatric clinical trials from the MFDS and the publication of articles after these clinical trials, respectively. We identified 342 clinical studies registered in the CRIS (n = 81), ClinicalTrials.gov (n = 225), and EuCTR (n = 36), of which 306 were reviewed after excluding duplicate registrations. Among them, 181 studies were interventional trials dealing with drugs and biological agents, of which 129 (71.3%) involved unapproved drugs. Of these 129 trials, 107 (82.9%) were authorized by the MFDS. Pediatric clinical trials in South Korea aiming to establish the safety and efficacy of drugs in children are increasing; however, non-MFDS-authorized studies remain an issue.

  9. Conformity of pediatric/adolescent HIV clinics to the patient-centered medical home care model.

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    Yehia, Baligh R; Agwu, Allison L; Schranz, Asher; Korthuis, P Todd; Gaur, Aditya H; Rutstein, Richard; Sharp, Victoria; Spector, Stephen A; Berry, Stephen A; Gebo, Kelly A

    2013-05-01

    The patient-centered medical home (PCMH) has been introduced as a model for providing high-quality, comprehensive, patient-centered care that is both accessible and coordinated, and may provide a framework for optimizing the care of youth living with HIV (YLH). We surveyed six pediatric/adolescent HIV clinics caring for 578 patients (median age 19 years, 51% male, and 82% black) in July 2011 to assess conformity to the PCMH. Clinics completed a 50-item survey covering the six domains of the PCMH: (1) comprehensive care, (2) patient-centered care, (3) coordinated care, (4) accessible services, (5) quality and safety, and (6) health information technology. To determine conformity to the PCMH, a novel point-based scoring system was devised. Points were tabulated across clinics by domain to obtain an aggregate assessment of PCMH conformity. All six clinics responded. Overall, clinics attained a mean 75.8% [95% CI, 63.3-88.3%] on PCMH measures-scoring highest on patient-centered care (94.7%), coordinated care (83.3%), and quality and safety measures (76.7%), and lowest on health information technology (70.0%), accessible services (69.1%), and comprehensive care (61.1%). Clinics moderately conformed to the PCMH model. Areas for improvement include access to care, comprehensive care, and health information technology. Future studies are warranted to determine whether greater clinic PCMH conformity improves clinical outcomes and cost savings for YLH.

  10. CLINICAL PROFILE OF PEDIATRIC SCRUB TYPHUS PATIENTS : A HOSPITAL BASED STUDY

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    Sunil Dutt

    2015-07-01

    Full Text Available BACKGROUND : Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. The organism is transmitted during the bite of trombiculid mites. Field rodents are the reservoir hosts. The disease is endemic in many parts of India including the stat e of Jammu and Kashmir but is often under reported due to lack of diagnostic facilities. AIM: The aim was to study the clinical and epidemiological profile of pediatric scrub typhus patients reporting to the Department of Pediatrics, Government Medical College Jammu, a referral hospital for whole of Jammu region. METHODS : Prospective study conducted in the Department of Pediatrics Govt . Medical College Jammu from January 2011 to December 2011. A total of 90 children who reported with fever and rash or ly mphadenopathy or both were tested using qualitative ELISA for IgM antibodies against Orientia tsutsugamushi . The clinical and epidemiological profile of 74 pediatric scrub typhus patients who tested positive for IgM ELISA for Scrub typhus was studied. OBSE RVATION: Most ( 71.6% patients were in the age group of 6 - 15 years. 83% of them reported in the months of September and October. One third of the patients belonged to Rajouri district. Common physical signs were fever ( 100%, rash ( 86.4% and generalised l ymphadenopathy ( 83.7%. Others included conjuctival congestion ( 44.59%, hepatosplenomegaly ( 36.48%, jaundice ( 22.97%, edema ( 18.91%, eschar ( 17.56%, meningeal signs ( 10.81%, and myocarditis ( 5.4%.Most of the children presented late with complication s like hepatic dysfunction ( 55.4% , renal dysfunction ( 24.32 %, shock ( 4% meningoencephalitis ( 9.4%, gastrointestinal haemorrhage ( 8.1% and myocarditis ( 4.05 % , bronchopneumonia ( 4.05% and multiorgan involvement ( 2.7%. Children were treated with chloramphenicol or doxycycline. There was no mortality in the study group. CONCLUSION: Scrub typhus is endemic in the Jammu region especially Nowshera - Sunderbani - Rajouri belt

  11. Clinical predictors of vestibulo-ocular dysfunction in pediatric sports-related concussion.

    Science.gov (United States)

    Ellis, Michael J; Cordingley, Dean M; Vis, Sara; Reimer, Karen M; Leiter, Jeff; Russell, Kelly

    2017-01-01

    OBJECTIVE There were 2 objectives of this study. The first objective was to identify clinical variables associated with vestibulo-ocular dysfunction (VOD) detected at initial consultation among pediatric patients with acute sports-related concussion (SRC) and postconcussion syndrome (PCS). The second objective was to reexamine the prevalence of VOD in this clinical cohort and evaluate the effect of VOD on length of recovery and the development of PCS. METHODS A retrospective review was conducted for all patients with acute SRC and PCS who were evaluated at a pediatric multidisciplinary concussion program from September 2013 to May 2015. Acute SRS was defined as presenting vision, etc.) and more than 1 objective physical examination finding (abnormal near point of convergence, smooth pursuits, saccades, or vestibulo-ocular reflex testing). Poisson regression analysis was used to identify factors that increased the risk of VOD at initial presentation and the development of PCS. RESULTS Three hundred ninety-nine children, including 306 patients with acute SRC and 93 with PCS, were included. Of these patients, 30.1% of those with acute SRC (65.0% male, mean age 13.9 years) and 43.0% of those with PCS (41.9% male, mean age 15.4 years) met the criteria for VOD at initial consultation. Independent predictors of VOD at initial consultation included female sex, preinjury history of depression, posttraumatic amnesia, and presence of dizziness, blurred vision, or difficulty focusing at the time of injury. Independent predictors of PCS among patients with acute SRC included the presence of VOD at initial consultation, preinjury history of depression, and posttraumatic amnesia at the time of injury. CONCLUSIONS This study identified important potential risk factors for the development of VOD following pediatric SRC. These results provide confirmatory evidence that VOD at initial consultation is associated with prolonged recovery and is an independent predictor for the

  12. The Clinical and Demographic Characteristics of Pediatric Behçet’s Patients

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    Hayriye Sarıcaoğlu

    2008-01-01

    Full Text Available Aim: In this study, we aimed to compare the clinical and demographic features of pediatric Behçet’s patients with those of adult age.Materials and Method: We examined the clinical and demographic features of the 18 and under 18-year-old children who were followed-up in the Behçet's Center of Uludağ University Medical Faculty between 1992 and 2007, retrospectively. The information of age, sex, presence of oral aphthous ulcers, genital ulcers, erythema nodosum, papulopustular eruption, pathergy test positivity, ocular, articular, neurological, gastrointestinal, renal involvements and HLA-B5 positivity were obtained from the medical charts of the patients.Results: There were 30 pediatric Behçet diagnosed according to the diagnostic criteria of International Study Group for Behçet's Disease. The mean age of the patients was 15.9. At the time of the diagnosis, most of the patients were aged between 17-18 (43.3%. There was only one patient under 10. Oral aphthae was observed in all, and genital ulceration or the scar of the ulcer was observed in 23 patients; 15 females, 8 males (76.6%. Ocular involvement was present in 18 patients; 8 females, 10 males (60%; erythema nodosum in 13 patients; 8 females, 5 males (43.3%, papulopustular eruption in 16 patients; 10 females, 6 males and pathergy test positivity in 12 patients; 7 females, 5 males (36.6%. Vascular symptoms were observed in 2 patients, arthralgia-arthritis in 15 patients and neurological involvement in 4 patients.Conclusion: In this study, it was concluded that ocular involvement was more frequent in Behçet’s patients aged between 0-18 than adult Behçet’s patients, but mucocutaneous findings had similar frequency. (Journal of Current Pediatrics 2008; 6: 89-93

  13. Clinical Characteristics of Pediatric Esophagitis in Southern Iran; A Single-Center Experience

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    Mozhgan Zahmatkeshan

    2013-06-01

    Full Text Available Background: We sought to determine the clinical characteristics of pediatric esophagitis in southern Iran. Methods: This cross-sectional study was conducted over a 4-year period, from 2005 to 2009, in Nemazee Hospital, a tertiary healthcare center in Shiraz, southern Iran. We consecutively included all pediatric patients (<18 years who underwent endoscopy in our center and had pathology-confirmed diagnosis of esophagitis. Data regarding the patients’ demographic characteristics, comorbidities, and clinical findings were recorded using a questionnaire. All the patients underwent upper gastrointestinal endoscopy and biopsy of the esophagus, and the findings were recorded in the questionnaire. Results: We studied 125 children, comprising 61 (48.8% girls and 64 (51.2% boys at a mean age of 6.6±5.5 years. Repeated vomiting was the prominent symptom in our series, with it being reported by 75 (60% patients, followed by fever in 35 (28%. Erythema (33.6%, esophageal ulcer (11.2%, and whitish patch (8.0% were the most common endoscopic findings, while reflux esophagitis (32.8%, chronic (6.4% and acute esophagitis (5.6%, and candida esophagitis (5.6% were the most common histological diagnoses. Only one (0.8% patient was diagnosed as having eosinophilic esophagitis, aspergillosis, and graft-versus-host disease. Conclusion: Reflux was the most common cause of esophagitis in the pediatric population of southern Iran. Contrary to previous reports, the prevalence of eosinophilic esophagitis was far less than that estimated, while the prevalence of opportunistic infections was higher secondary to post-liver transplantation immunosuppression.

  14. Clinical profile and neuroimaging in pediatric optic neuritis in Indian population: A case series

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    Rutika Khadse

    2017-01-01

    Full Text Available Purpose of the study: The purpose of this study was to report clinical features, neuroimaging, and visual outcome in pediatric optic neuritis (ON in Indian population. Materials and Methods: This is a retrospective study of children up to the age of 16 years, diagnosed with ON, that presented at pediatric and neuroophthalmology clinic of a tertiary eye care center, in South India, within the period of 2010–2015. Results: We identified 62 eyes of 40 children diagnosed as ON within the study period. The mean age was 11.15 ± 3.24 years (1–15 years with mean follow-up of 13 months. In this series, there was female preponderance (67%. Mean logarithm of the minimum angle of resolution visual acuity at presentation was 1.14 ± 0.93, which after treatment recovered to 0.10 ± 0.26 at final visit (P < 0.001. Involvement was bilateral in 22 children (55% and recurrent in 3 eyes of 3 children. Preceding febrile illness was reported in seven cases (18%. Four (10% cases were diagnosed as multiple sclerosis (MS, one with neuromyelitis optica , and one with acute disseminated encephalomyelitis. One case was associated with tuberculous meningitis, 1 with septicemia, and 1 with bilateral maxillary sinusitis. Neuroimaging studies of optic nerve in 14 children demonstrated isolated optic nerve enhancement. Magnetic resonance imaging brain revealed white matter T2 hyperintense lesions separate from optic nerve in ten cases, of which four cases were diagnosed as MS. Conclusions: Bilateral presentation was common, association with MS was low. Papillitis was more frequent than retrobulbar neuritis and prognosis was good in pediatric ON in Indian population.

  15. Paroxysmal Sympathetic Hyperactivity in Pediatric Rehabilitation: Clinical Factors and Acute Pharmacological Management.

    Science.gov (United States)

    Pozzi, Marco; Conti, Valentino; Locatelli, Federica; Galbiati, Sara; Radice, Sonia; Citerio, Giuseppe; Clementi, Emilio; Strazzer, Sandra

    2015-01-01

    Paroxysmal sympathetic hyperactivity (PSH) is widely described as occurring during intensive care, but in a number of patients it may last longer into the rehabilitation phase. Furthermore, drug therapy has been based on isolated observations. In this study, our aims are to describe a group of 26 pediatric rehabilitation patients with PSH and to quantify the effect of several drugs used to suppress PSH episodes. Neurorehabilitation unit of IRCCS Eugenio Medea, Bosisio Parini (LC), Italy. A total of 407 pediatric patients with postacute acquired brain injury, 26 of which had PSH. Retrospective cohort study. Descriptive demographic and clinical data. Odds ratios quantification of the efficacy of drug therapies administered acutely to suppress PSH episodes. PSH was associated with a longer duration of coma and a greater incidence of death. When administered acutely to suppress PSH episodes, the best drugs were clonazepam, hydroxyzine, and delorazepam, while analgesic drugs showed little efficacy. PSH, whether causative or not, is associated with a worse long-term course in rehabilitation. Clinical management of PSH may be helped by a number of acutely administered drug therapies.

  16. Advanced Pre-clinical Research Approaches and Models to Studying Pediatric Anesthetic Neurotoxicity

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    Cheng eWang

    2012-10-01

    Full Text Available Advances in pediatric and obstetric surgery have resulted in an increase in the duration and complexity of anesthetic procedures. A great deal of concern has recently arisen regarding the safety of anesthesia in infants and children. Because of obvious limitations, it is not possible to thoroughly explore the effects of anesthetic agents on neurons in vivo in human infants or children. However, the availability of some advanced pre-clinical research approaches and models, such as imaging technology both in vitro and in vivo, stem cell and nonhuman primate experimental models, have provided potentially invaluable tools for examining the developmental effects of anesthetic agents. This review discusses the potential application of some sophisticaled research approaches, e.g., calcium imaging, in stem cell-derived in vitro models, especially human embryonic neural stem cells, along with their capacity for proliferation and their potential for differentiation, to dissect relevant mechanisms underlying the etiology of the neurotoxicity associated with developmental exposures to anesthetic agents. Also, this review attempts to discuss several advantages for using the developing rhesus monkey models (in vivo, when combined with dynamic molecular imaging approaches, in addressing critical issues related to the topic of pediatric sedation/anesthesia. These include the relationships between anesthetic-induced neurotoxicity, dose response, time-course and developmental stage at time of exposure (in vivo studies, serving to provide the most expeditious platform toward decreasing the uncertainty in extrapolating pre-clinical data to the human condition.

  17. FDDI information management system for centralizing interactive, computerized multimedia clinical experiences in pediatric rheumatology/Immunology.

    Science.gov (United States)

    Rouhani, R; Cronenberger, H; Stein, L; Hannum, W; Reed, A M; Wilhelm, C; Hsiao, H

    1995-01-01

    This paper describes the design, authoring, and development of interactive, computerized, multimedia clinical simulations in pediatric rheumatology/immunology and related musculoskeletal diseases, the development and implementation of a high speed information management system for their centralized storage and distribution, and analytical methods for evaluating the total system's educational impact on medical students and pediatric residents. An FDDI fiber optic network with client/server/host architecture is the core. The server houses digitized audio, still-image video clips and text files. A host station houses the DB2/2 database containing case-associated labels and information. Cases can be accessed from any workstation via a customized interface in AVA/2 written specifically for this application. OS/2 Presentation Manager controls, written in C, are incorporated into the interface. This interface allows SQL searches and retrievals of cases and case materials. In addition to providing user-directed clinical experiences, this centralized information management system provides designated faculty with the ability to add audio notes and visual pointers to image files. Users may browse through case materials, mark selected ones and download them for utilization in lectures or for editing and converting into 35mm slides.

  18. Relation between safe use of medicines and Clinical Pharmacy Services at Pediatric Intensive Care Units

    Science.gov (United States)

    Okumura, Lucas Miyake; da Silva, Daniella Matsubara; Comarella, Larissa

    2016-01-01

    Abstract Objective: Clinical Pharmacy Services (CPS) are considered standard of care and is endorsed by the Joint Commission International, the American Academy of Pediatrics, and the American College of Clinical Pharmacy. In Brazil, single experiences have been discreetly arising and the importance of these services to children and adolescents care has led to interesting results, but certainly are under reported. This short report aims to discuss the effect of implementing a bedside CPS at a Brazilian Pediatric Intensive Care Unit (PICU). Methods: This is a cross-sectional study conducted in a 12 bed PICU community hospital, from Campo Largo/Brazil. Subjects with<18 years old admitted to PICU were included for descriptive analysis if received a CPS intervention. Results: Of 53 patients accompanied, we detected 141 preventable drug-related problems (DRPs) which were solved within clinicians (89% acceptance of all interventions). The most common interventions performed to improve drug therapy included: preventing incompatible intravenous solutions (21%) and a composite of inadequate doses (17% due to low, high and non-optimized doses). Among the top ten medications associated with DRPs, five were antimicrobials. By analyzing the correlation between DRPs and PICU length of stay, we found that 74% of all variations on length of stay were associated with the number of DRPs. Conclusions: Adverse drug reactions due to avoidable DRPs can be prevented by CPS in a multifaceted collaboration with other health care professionals, who should attempt to use active and evidence-based strategies to reduce morbidity related to medications. PMID:27578187

  19. Associations between clinical and sociodemographic data and patterns of communication in pediatric oncology

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    Marina Kohlsdorf

    2016-01-01

    Full Text Available Abstract Pediatric communication directly contributes to treatment adherence, fewer symptoms, better clinical responses, healthier treatment adaptation and management of psychosocial issues. This study aimed to evaluate associations between the clinical and sociodemographic data of caregivers and children and the communicative patterns of pediatricians. Three oncohematology physicians and 44 child-caregiver dyads took part, with audio recording of 146 medical consultations. The physicians interacted more often with older children, offering more guidance, clarifying doubts, and asking for information. The number of questions from children and caregivers was positively correlated with the physician’s communicative behaviors. However, there was no association between the age of the children and the number of doubts of the patients. The diagnosis, treatment time, family income, marital status and caregiver’s level of education were associated with the amount of interaction provided by physicians to the children and caregivers. This study offers subsides relevant to psychosocial interventions that may improve communication in pediatric oncohematology settings.

  20. Pediatric acute respiratory distress syndrome: Host factors in Down syndrome and the general population

    NARCIS (Netherlands)

    M. Bruijn

    2013-01-01

    We find that Down syndrome is an important risk factor for developing acute respiratory distress syndrome (ARDS) in children, but the reason why remains to be elucidated. In addition, we find several differences between adult and pediatric ARDS. The association between C-reactive protein (CRP) level

  1. [Pediatric traumatic brain injury due to civil gunshot wounds at a General Hospital in Cali, Colombia].

    Science.gov (United States)

    Parrado Sánchez, L; Gómez, C; Valderrama Chaparro, J A; Beltrán Osorio, L D; Sierra Ruiz, M; Enríquez Marulanda, A; Lobato Polo, J

    2017-01-25

    Traumatic brain injury (TBI) due to gunshot-wounds (GSW) is a critical situation in the pediatric population. The aim of this study is to characterize TBI in this population since there are few reports that describe it especially in Colombia where its incidence is high, also to determine which were the main mortality predictor within our population. We conducted a retrospective cross-sectional study in which we reviewed pediatric medical records of patients that had consulted at the Fundacion Valle del Lili pediatric Emergency Room between January of 2011 and December of 2015 because of TBI due to GSW. A descriptive statistical analysis was performed. In our sample of 32 patients the average age was of 13.3 (SD ± 5.4) and with 75% male patients. In our sample the Glasgow Coma Scale (GCS) at entry was less than 8 in 59.38%, a 15.6% needed craniotomy and 81.2% were admitted to the Intensive Care Unit (ICU). Death occurred in 43.75% of cases. The following mortality predictors were obtained: GCS at entry, pupillary exam and light reflexes, ISS, Marshal Score, absence of basal cisterns and presence of subarachnoid hemorrhage in CT scan, and APACHE II. TBI due to GSW is a devastating entity, especially in the pediatric population, they are responsible of high mortality and disability rates. There were no significant findings regarding infection rates and the use of surgery as a preventive method, therefore there's a chance it might not be indicated.

  2. Innovative Training in Pediatrics, General Psychiatry, and Child Psychiatry: Background, Outcomes, and Experiences

    Science.gov (United States)

    Gleason, Mary Margaret; Fritz, Gregory K.

    2009-01-01

    Objectives: The authors describe the history, rationale, and outcomes of combined training programs in pediatrics, psychiatry, and child psychiatry ("triple board"), including narrative feedback from graduates and reflections upon the important components of the program. Methods: This article reviews the background and experiences of triple board…

  3. Pain and placebo in pediatrics: a comprehensive review of laboratory and clinical findings.

    Science.gov (United States)

    Simmons, Kanesha; Ortiz, Robin; Kossowsky, Joe; Krummenacher, Peter; Grillon, Christian; Pine, Daniel; Colloca, Luana

    2014-11-01

    Pain modulation by placebo mechanisms is one of the most robust and best-studied phenomena, yet almost all research investigating the mechanisms and implications of the placebo analgesia are based on adult research. After highlighting crucial aspects that need to be considered in studying pain modulation in children, this comprehensive review examines studies related to pain modulation with an emphasis on factors such as age, neural development and pain measures. We critically discuss psychological mechanisms underlying placebo effects, including (1) verbally induced expectations, (2) conditioning and learning mechanisms, and (3) child-parent-physician interactions. Taken together, research suggests that placebo mechanisms can affect therapeutic outcomes and potentially be exploited clinically to improve clinical outcomes in pediatric population. Recommendations for further investigating the mechanistic bases and harnessing placebo effects for supportive therapeutic applications are given.

  4. Senior dental students' experience with Cariogram in a pediatric dentistry clinic.

    Science.gov (United States)

    Gonzalez, Cesar D; Okunseri, Christopher

    2010-02-01

    The study objective was to assess predoctoral dental students' experience with a caries risk assessment computer program in the pediatric dentistry clinic at Marquette University School of Dentistry. In 2005, spring semester sophomore dental students (class of 2008) were introduced to the caries risk assessment computer program "Cariogram." The students received a fifty-minute lecture on caries risk assessment and a demonstration on how to use Cariogram in the clinic. After two years of clinical exposure to Cariogram, sixty-six out of eighty senior dental students completed an anonymous eleven-item questionnaire on their experience with the tool. Each item on the questionnaire was scored on a five-point Likert scale with the exception of two questions. Full- and part-time faculty members in the pediatric dentistry clinic were involved in teaching and supervising students in the use of Cariogram for caries risk assessment after their training and calibration. Forty-five percent of the students who participated in the study agreed that Cariogram was easy to understand, and 18 percent disagreed. Thirty-six percent felt that it was easy to apply, and 25 percent reported that it was useful in determining caries preventive procedures. The students reported that 60 percent of full-time and 33 percent of part-time faculty were knowledgeable about Cariogram use. A majority of the students felt that Cariogram was not easy to understand, and eighty-two percent of them reported that they would not be using Cariogram in their private offices. Future studies should explore reasons why students do not feel inclined to use Cariogram as a caries risk assessment tool in their private practices even after being exposed to the tool in dental school.

  5. Pediatric intracranial dural arteriovenous fistulas: age-related differences in clinical features, angioarchitecture, and treatment outcomes.

    Science.gov (United States)

    Hetts, Steven W; Moftakhar, Parham; Maluste, Neil; Fullerton, Heather J; Cooke, Daniel L; Amans, Matthew R; Dowd, Christopher F; Higashida, Randall T; Halbach, Van V

    2016-11-01

    OBJECTIVE Intracranial dural arteriovenous fistulas (DAVFs) are rare in children. This study sought to better characterize DAVF presentation, angioarchitecture, and treatment outcomes. METHODS Children with intracranial DAVFs between 1986 and 2013 were retrospectively identified from the neurointerventional database at the authors' institution. Demographics, clinical presentation, lesion angioarchitecture, treatment approaches, angiographic outcomes, and clinical outcomes were assessed. RESULTS DAVFs constituted 5.7% (22/423) of pediatric intracranial arteriovenous shunting lesions. Twelve boys and 10 girls presented between 1 day and 18 years of age; boys presented at a median of 1.3 years and girls presented at a median of 4.9 years. Four of 8 patients ≤ 1 year of age presented with congestive heart failure compared with 0/14 patients > 1 year of age (p = 0.01). Five of 8 patients ≤ 1 year old presented with respiratory distress compared with 0/14 patients > 1 year old (p = 0.0021). Ten of 14 patients > 1 year old presented with focal neurological deficits compared with 0/8 patients ≤ 1 year old (p = 0.0017). At initial angiography, 16 patients harbored a single intracranial DAVF and 6 patients had 2-6 DAVFs. Eight patients (38%) experienced DAVF obliteration by the end of treatment. Good clinical outcome (modified Rankin Scale score 0-2) was documented in 77% of patients > 1 year old at presentation compared with 57% of patients ≤ 1 year old at presentation. Six patients (27%) died. CONCLUSIONS Young children with DAVFs presented predominantly with cardiopulmonary symptoms, while older children presented with focal neurological deficits. Compared with other pediatric vascular shunts, DAVFs had lower rates of angiographic obliteration and poorer clinical outcomes.

  6. Impact of registration on clinical trials on infection risk in pediatric acute myeloid leukemia.

    Science.gov (United States)

    Dix, David; Aplenc, Richard; Bowes, Lynette; Cellot, Sonia; Ethier, Marie-Chantal; Feusner, Jim; Gillmeister, Biljana; Johnston, Donna L; Lewis, Victor; Michon, Bruno; Mitchell, David; Portwine, Carol; Price, Victoria; Silva, Mariana; Stobart, Kent; Yanofsky, Rochelle; Zelcer, Shayna; Beyene, Joseph; Sung, Lillian

    2016-04-01

    Little is known about the impact of enrollment on therapeutic clinical trials on adverse event rates. Primary objective was to describe the impact of clinical trial registration on sterile site microbiologically documented infection for children with newly diagnosed acute myeloid leukemia (AML). We conducted a multicenter cohort study that included children aged ≤18 years with de novo AML. Primary outcome was microbiologically documented sterile site infection. Infection rates were compared between those registered and not registered on clinical trials. Five hundred seventy-four children with AML were included of which 198 (34.5%) were registered on a therapeutic clinical trial. Overall, 400 (69.7%) had at least one sterile site microbiologically documented infection. In multiple regression, registration on clinical trials was independently associated with a higher risk of microbiologically documented sterile site infection [adjusted odds ratio (OR) 1.24, 95% confidence interval (CI) 1.01-1.53; p = 0.040] and viridans group streptococcal infection (OR 1.46, 95% CI 1.08-1.98; p = 0.015). Registration on trials was not associated with Gram-negative or invasive fungal infections. Children with newly diagnosed AML enrolled on clinical trials have a higher risk of microbiologically documented sterile site infection. This information may impact on supportive care practices in pediatric AML.

  7. Characterization of the age-dependent shape of the pediatric thoracic spine and vertebrae using generalized procrustes analysis.

    Science.gov (United States)

    Peters, James R; Campbell, Robert M; Balasubramanian, Sriram

    2017-08-11

    Generalized Procrustes Analysis (GPA) is a superimposition method used to generate size-invariant distributions of homologous landmark points. Several studies have used GPA to assess the three-dimensional (3D) shapes of or to evaluate sex-related differences in the human brain, skull, rib cage, pelvis and lower limbs. Previous studies of the pediatric thoracic vertebrae suggest that they may undergo changes in shape asa result of normative growth. This study uses GPA and second order polynomial equations to model growth and age- and sex-related changes in shape of the pediatric thoracic spine. We present a thorough analysis of the normative 3D shape, size, and orientation of the pediatric thoracic spine and vertebrae as well as equations which can be used to generate models of the thoracic spine and vertebrae for any age between 1 and 19years. Such models could be used to create more accurate 3D reconstructions of the thoracic spine, generate improved age-specific geometries for finite element models (FEMs) and used to assist clinicians with patient-specific planning and surgical interventions for spine deformity. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Screening for Food Insecurity in Pediatric Clinical Settings: Opportunities and Barriers.

    Science.gov (United States)

    Barnidge, Ellen; LaBarge, Gene; Krupsky, Kathryn; Arthur, Joshua

    2017-02-01

    Food insecurity is a serious health concern among children in the United States with 15.3 million children living in food insecure households. The American Academy of Pediatrics recommends that pediatricians screen for food insecurity at health maintenance visits as identifying children at risk is a crucial step in the amelioration of food insecurity. Two surveys were administered in a Midwest pediatric clinic. A cross-sectional survey was electronically distributed to pediatric providers to assess perceptions of food insecurity among patients, provider readiness to conduct food security screenings, and barriers to conducting those screenings. A cross-sectional caregiver survey was administered to assess demographics, household food security status, participation in nutrition assistance programs, and barriers to getting enough food to eat. Descriptive statistics and odds ratios were calculated. Eighty-eight percent of physicians believe that food insecurity is a challenge for some of their patients. Only 15 % of providers reported screening for food insecurity, while 80 % were willing to screen. Physicians were most concerned with knowing how to handle a positive screen. Among caregivers, 57 % screened positive for food insecurity. Those experiencing food insecurity were more likely to be non-white, participate in SNAP and to feel discomfort towards the idea of talking to a doctor or nurse about food needs. Caregivers reporting food insecurity were significantly less likely to have a personal vehicle. Effective food insecurity screening requires addressing caregiver and health provider barriers in order to increase the likelihood of identifying households most at risk.

  9. Access to digital technology among families coming to urban pediatric primary care clinics.

    Science.gov (United States)

    Demartini, Tori L; Beck, Andrew F; Klein, Melissa D; Kahn, Robert S

    2013-07-01

    Digital technologies offer new platforms for health promotion and disease management. Few studies have evaluated the use of digital technology among families receiving care in an urban pediatric primary care setting. A self-administered survey was given to a convenience sample of caregivers bringing their children to 2 urban pediatric primary care centers in spring 2012. The survey assessed access to home Internet, e-mail, smartphone, and social media (Facebook and Twitter). A "digital technology" scale (0-4) quantified the number of available digital technologies and connections. Frequency of daily use and interest in receiving medical information digitally were also assessed. The survey was completed by 257 caregivers. The sample was drawn from a clinical population that was 73% African American and 92% Medicaid insured with a median patient age of 2.9 years (interquartile range 0.8-7.4). Eighty percent of respondents reported having Internet at home, and 71% had a smartphone. Ninety-one percent reported using e-mail, 78% Facebook, and 27% Twitter. Ninety-seven percent scored ≥1 on the digital technology scale; 49% had a digital technology score of 4. The digital technology score was associated with daily use of digital media in a graded fashion (P < .0001). More than 70% of respondents reported that they would use health care information supplied digitally if approved by their child's medical provider. Caregivers in an urban pediatric primary care setting have access to and frequently use digital technologies. Digital connections may help reach a traditionally hard-to-reach population.

  10. Pediatric Terminology

    Science.gov (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

  11. Improved Clinical Performance and Teamwork of Pediatric Interprofessional Resuscitation Teams With a Simulation-Based Educational Intervention.

    Science.gov (United States)

    Gilfoyle, Elaine; Koot, Deanna A; Annear, John C; Bhanji, Farhan; Cheng, Adam; Duff, Jonathan P; Grant, Vincent J; St George-Hyslop, Cecilia E; Delaloye, Nicole J; Kotsakis, Afrothite; McCoy, Carolyn D; Ramsay, Christa E; Weiss, Matthew J; Gottesman, Ronald D

    2017-02-01

    To measure the effect of a 1-day team training course for pediatric interprofessional resuscitation team members on adherence to Pediatric Advanced Life Support guidelines, team efficiency, and teamwork in a simulated clinical environment. Multicenter prospective interventional study. Four tertiary-care children's hospitals in Canada from June 2011 to January 2015. Interprofessional pediatric resuscitation teams including resident physicians, ICU nurse practitioners, registered nurses, and registered respiratory therapists (n = 300; 51 teams). A 1-day simulation-based team training course was delivered, involving an interactive lecture, group discussions, and four simulated resuscitation scenarios, each followed by a debriefing. The first scenario of the day (PRE) was conducted prior to any team training. The final scenario of the day (POST) was the same scenario, with a slightly modified patient history. All scenarios included standardized distractors designed to elicit and challenge specific teamwork behaviors. Primary outcome measure was change (before and after training) in adherence to Pediatric Advanced Life Support guidelines, as measured by the Clinical Performance Tool. Secondary outcome measures were as follows: 1) change in times to initiation of chest compressions and defibrillation and 2) teamwork performance, as measured by the Clinical Teamwork Scale. Correlation between Clinical Performance Tool and Clinical Teamwork Scale scores was also analyzed. Teams significantly improved Clinical Performance Tool scores (67.3-79.6%; p Teamwork Scale scores (56.0-71.8%; p Teamwork Scale (R = 0.281; p teamwork during simulated pediatric resuscitation. A positive correlation between clinical and teamwork performance suggests that effective teamwork improves clinical performance of resuscitation teams.

  12. Aptitud clínica ante el paciente pediátrico con asma grave en residentes de pediatría y urgencias Clinical skills at the pediatric patient with severe asthma of Pediatrics and Emergency residents

    Directory of Open Access Journals (Sweden)

    J. Loría-Castellanos

    2010-12-01

    Full Text Available Objetivo. Construir, validar y aplicar un instrumento para evaluar la aptitud clínica de los residentes de pediatría y urgencia ante los pacientes pediátricos con asma grave. Sujetos y métodos. Estudio observacional autorizado por el comité de investigación. El instrumento se construyó a través de cinco casos clínicos reales, validado por consenso de expertos en pediatría, urgencias e investigación educativa, obteniéndose una versión final de 150 ítems con una consistencia de 0,89. Se evaluaron 10 residentes de pediatría y 21 de urgencias. Se realizó un análisis estadístico no paramétrico. Resultados. La mayoría de los residentes (79,73% se ubicaron en los niveles bajos-muy bajos de aptitud clínica, ninguno alcanzó niveles superiores. Las pruebas estadísticas no encontraron diferencias entre los grados académicos o la especialidad. Conclusiones. El instrumento construido tiene una adecuada consistencia. El proceso educativo al que se han sometido estos residentes parece no favorecer el desarrollo de reflexión, lo que podría limitar su práctica profesional real.Aim. To develop, validate and implement a tool to assess the clinical competence of pediatric residents and medical emergencies to pediatric patients with severe asthma. Subjects and methods. An observational study approved by the research committee. The instrument was built through five problematized clinical cases, validated by consensus by experts in pediatrics, emergency and educational research, obtaining a final version of 150 items with a consistency of 0.89. It evaluated 10 pediatric residents and 21 of emergency. We performed a nonparametric statistical analysis. Results. Most residents (79.73% were located in low-very low levels of clinical competence, none reached higher levels. Statistical tests found no differences between academic degrees or specialty. Conclusions. The educational process that these students have had seems to favor the development

  13. Clinical Competence: General Ability or Case-Specific?

    Science.gov (United States)

    Wimmers, Paul F.; Splinter, Ted A. W.; Hancock, Gregory R.; Schmidt, Henk G.

    2007-01-01

    Background: Before the 1970s, research into the development of clinical competence was mainly focused on general problem-solving abilities. The scope of research changed when Elstein and colleagues discovered that individual ability to solve clinical problems varies considerably across cases. It was concluded that problem solving abilities are…

  14. Clinical competence : General ability or case-specific?

    NARCIS (Netherlands)

    Wimmers, Paul F.; Splinter, Ted A. W.; Hancock, Gregory R.; Schmidt, Henk G.

    2007-01-01

    Background: Before the 1970s, research into the development of clinical competence was mainly focused on general problem-solving abilities. The scope of research changed when Elstein and colleagues discovered that individual ability to solve clinical problems varies considerably across cases. It was

  15. MRI of pediatric growth plate injury: correlation with plain film radiographs and clinical outcome

    Energy Technology Data Exchange (ETDEWEB)

    Carey, J.; Spence, L.; Blickman, H.; Eustace, S. [Medical Center, Boston, MA (United States). Dept. of Radiol.

    1998-05-01

    Purpose. To evaluate pediatric growth plate injuries with conventional radiographs and magnetic resonance imaging (MRI). To review potential clinical impact of MRI on subsequent patient management and outcome. Methods. Fourteen patients with known or suspected growth plate injury were studied. Each patient underwent imaging by conventional radiography and MRI within 2 weeks of injury. Findings on conventional radiographs and on MR images were compared and then correlated with subsequent management and outcome at a mean of 12 months. Results. Direct visualization of cartilage afforded by MRI improved evaluation of growth plate injury in each case. MRI changed Salter Harris classification or staging in 2 of 9 patients with fractures visualized on conventional radiographs, allowed the detection of radiographically occult fractures in 5 of 14 cases, and resulted in a physical change in management in 5 of the 14 patients studied. Conclusion. MRI has an important role in the evaluation of acute pediatric growth plate injury, particularly when diagnostic uncertainty persists following the evaluation of conventional radiographs. MRI allows detection of occult fractures, may alter Salter Harris staging, and in the reported study it frequently resulted in a change in patient management. (orig.) With 4 figs., 1 tab., 20 refs.

  16. Clinical metabolomics and nutrition: the new frontier in neonatology and pediatrics.

    Science.gov (United States)

    Dessì, Angelica; Cesare Marincola, Flaminia; Masili, Alice; Gazzolo, Diego; Fanos, Vassilios

    2014-01-01

    In the pediatric clinic, nutritional research is focusing more and more on preventing the development of long-term diseases as well as supporting the repair processes important in the therapy of already fully developed diseases. Most children who are hospitalized or affected by chronic diseases could benefit from specific and careful attention to nutrition. Indeed, the state of nutrition modulates all body functions, including the different metabolic processes which, all together, have a profound effect on the development of the health and future of all individuals. Inappropriate food, even in the first periods of life, can accelerate the development of chronic metabolic diseases, especially in the pediatric age. To gain further insights into metabolic cycles and how they are connected with diet and health, nutrition and metabolomics interact to develop and apply modern technologies for metabolic assessment. In particular, nutritionists are evaluating the metabolomic approach to establish the single nutritional phenotypes, that is, the way in which diet interacts with individuals' metabolisms. This strategy offers the possibility of providing a complete definition of the individual's nutritional and health status, predict the risk of disease, and create metabolomic databases supporting the development of "personalized nutrition," in which diet is attuned to the nutritional needs of individual patients.

  17. Clinical effectiveness in the diagnosis and acute management of pediatric nephrolithiasis.

    Science.gov (United States)

    Van Batavia, Jason P; Tasian, Gregory E

    2016-12-01

    The incidence of pediatric nephrolithiasis has risen over the past few decades leading to a growing public health burden. Children and adolescents represent a unique patient population secondary to their higher risks from radiation exposure as compared to adults, high risk of recurrence, and longer follow up time given their longer life expectancies. Ultrasound imaging is the first-line modality for diagnosing suspected nephrolithiasis in children. Although data is limited, the best evidence based medicine supports the use of alpha-blockers as first-line MET in children, especially when stones are small and in a more distal ureteral location. Surgical management of pediatric nephrolithiasis is similar to that in adults with ESWL and URS first-line for smaller stones and PCNL reserved for larger renal stone burden. Clinical effectiveness in minimizing risks in children and adolescents with nephrolithiasis centers around ED pathways that limit CT imaging, strict guidance to ALARA principles or use of US during surgical procedures, and education of both patients and families on the risks of repeat ionizing radiation exposures during follow up and acute colic events.

  18. Clinical Metabolomics and Nutrition: The New Frontier in Neonatology and Pediatrics

    Science.gov (United States)

    Dessì, Angelica; Cesare Marincola, Flaminia; Masili, Alice; Gazzolo, Diego; Fanos, Vassilios

    2014-01-01

    In the pediatric clinic, nutritional research is focusing more and more on preventing the development of long-term diseases as well as supporting the repair processes important in the therapy of already fully developed diseases. Most children who are hospitalized or affected by chronic diseases could benefit from specific and careful attention to nutrition. Indeed, the state of nutrition modulates all body functions, including the different metabolic processes which, all together, have a profound effect on the development of the health and future of all individuals. Inappropriate food, even in the first periods of life, can accelerate the development of chronic metabolic diseases, especially in the pediatric age. To gain further insights into metabolic cycles and how they are connected with diet and health, nutrition and metabolomics interact to develop and apply modern technologies for metabolic assessment. In particular, nutritionists are evaluating the metabolomic approach to establish the single nutritional phenotypes, that is, the way in which diet interacts with individuals' metabolisms. This strategy offers the possibility of providing a complete definition of the individual's nutritional and health status, predict the risk of disease, and create metabolomic databases supporting the development of “personalized nutrition,” in which diet is attuned to the nutritional needs of individual patients. PMID:25247199

  19. Compliance with a pediatric clinical practice guideline for intravenous fluid and electrolyte administration.

    Science.gov (United States)

    Hurdowar, Amanda; Urmson, Lynn; Bohn, Desmond; Geary, Denis; Laxer, Ronald; Stevens, Polly

    2009-01-01

    The occurrence of acute hyponatremia associated with cerebral edema in hospitalized children has been increasingly recognized, with over 50 cases of neurological morbidity and mortality reported in the past decade. This condition most commonly occurs in previously healthy children where maintenance intravenous (IV) fluids have been prescribed in the form of hypotonic saline (e.g., 0.2 or 0.3 NaCl). In response to similar problems at The Hospital for Sick Children (six identified through hospital morbidity and mortality reviews and safety reports prior to fall 2007), an interdisciplinary clinician group from our institution developed a clinical practice guideline (CPG) to guide fluid and electrolyte administration for pediatric patients. This article reviews the evaluation of one patient safety improvement to change the prescribing practice for IV fluids in an acute care pediatric hospital, including the removal of the ability to prescribe hypotonic IV solutions with a sodium concentration of team engagement and support from the hospital leadership. A key learning was that a project leader with considerable dedicated time is required during the implementation to develop change concepts, organize and liaise with stakeholders and measure changes in practice. This project highlights the importance of active implementation for policy and guideline documents.

  20. Clinical Metabolomics and Nutrition: The New Frontier in Neonatology and Pediatrics

    Directory of Open Access Journals (Sweden)

    Angelica Dessì

    2014-01-01

    Full Text Available In the pediatric clinic, nutritional research is focusing more and more on preventing the development of long-term diseases as well as supporting the repair processes important in the therapy of already fully developed diseases. Most children who are hospitalized or affected by chronic diseases could benefit from specific and careful attention to nutrition. Indeed, the state of nutrition modulates all body functions, including the different metabolic processes which, all together, have a profound effect on the development of the health and future of all individuals. Inappropriate food, even in the first periods of life, can accelerate the development of chronic metabolic diseases, especially in the pediatric age. To gain further insights into metabolic cycles and how they are connected with diet and health, nutrition and metabolomics interact to develop and apply modern technologies for metabolic assessment. In particular, nutritionists are evaluating the metabolomic approach to establish the single nutritional phenotypes, that is, the way in which diet interacts with individuals’ metabolisms. This strategy offers the possibility of providing a complete definition of the individual’s nutritional and health status, predict the risk of disease, and create metabolomic databases supporting the development of “personalized nutrition,” in which diet is attuned to the nutritional needs of individual patients.

  1. Clinical and Histopathological Profiles of Pediatric and Adolescent Oral and Maxillofacial Biopsies in a Persian Population

    Directory of Open Access Journals (Sweden)

    Shirin Saravani

    2015-01-01

    Full Text Available Introduction The frequency of pediatric and adolescent oral and maxillofacial lesions is various in different societies. The present study aimed at investigating the frequency of oral and maxillofacial pediatric and adolescent biopsies in Zahedan (southeast Iran, and compare the results with other epidemiologic studies.Methods and Materials This retrospective study reviewed oral and maxillofacial lesions in patients with 0-18 years old referring to the treatment centers of Zahedan University of Medical Sciences during 12-years period. Patients’ demographic information including age, gender and location of the lesion were collected and statistically analyzed.ResultsIn general, among 1112 oral and maxillofacial lesions, 154 (13.9% cases were related to children and adolescents younger than 18 years old. The average age of patients was 11.4 ± 4.9, 53.2% and 46.8% of them were boys and girls, respectively. The most frequent sites of lesions were the gingiva and lip. The most prevalent lesions included inflammatory/reactive, cystic and neoplastic lesions, respectively. Benign and malignant tumors comprised 12.3% and 4.5% of cases. Moreover, pyogenic granuloma and peripheral giant cell granuloma (PGCG were the most frequent lesions.ConclusionThe most prevalent oral and maxillofacial lesions in patients under 18 years old were inflammatory/reactive lesions in gingiva and in the 13-18 age range. Determining the characteristics of these lesions in the children and adolescents population provides a firm groundwork for proper diagnosis and treatment.

  2. General Hospital and Personal Use Devices: Renaming of Pediatric Hospital Bed Classification and Designation of Special Controls for Pediatric Medical Crib; Classification of Medical Bassinet. Final rule.

    Science.gov (United States)

    2016-12-19

    The Food and Drug Administration (FDA) is issuing a final rule to rename pediatric hospital beds as pediatric medical cribs and establish special controls for these devices. FDA is also establishing a separate classification regulation for medical bassinets, previously under the pediatric hospital bed classification regulation, as a class II (special controls) device. In addition, this rule continues to allow both devices to be exempt from premarket notification and use of the device in traditional health care settings and permits prescription use of pediatric medical cribs and bassinets outside of traditional health care settings.

  3. Patient Use of Complementary and Alternative Medicines in an Outpatient Pediatric Neurology Clinic.

    Science.gov (United States)

    Kenney, Daniel; Jenkins, Sarah; Youssef, Paul; Kotagal, Suresh

    2016-05-01

    This article describes the use of complementary and alternative medicines in an outpatient pediatric neurology clinic, and assesses family attitudes toward the efficacy of complementary and alternative medicines versus prescription medications. Complementary and alternative medicine is an important element of the modern health care landscape. There is limited information about whether, and to what extent, families perceive its utility in childhood neurological disorders. Surveys were distributed to 500 consecutive patients at a child neurology clinic in Rochester, Minnesota. Questions pertained to the child's diagnoses, use of complementary and alternative medicines, and the specific complementary and alternative medicine modalities that were used. Opinions were also gathered on the perceived efficacy of complementary and alternative medicines and prescription medications. Data were compared using χ(2) or Fisher exact tests as indicated. A total of 484 surveys were returned, of which 327 were usable. Only 17.4% admitted to use of complementary and alternative medicine to treat neurological problems. However, in follow-up questioning, actually 41.6% of patients recognized that they were using one or more types of complementary and alternative medicines. Disorders associated with a statistically significant increased prevalence of complementary and alternative medicine use were headache (50.8% with headache used complementary and alternative medicine versus 35.7% without headache; P = 0.008, Fisher exact test), chronic fatigue (63.2% vs 38.8%; P = 0.005, Fisher exact test), and sleep disorders (77.1% vs 37.3%; P pediatric neurology patients in our clinic are also using complementary and alternative medicine. Only 38.5% of these recognize themselves as using complementary and alternative medicine, underlining the need to inquire in-depth about its use. Patients who are less satisfied with their prescription medications are more likely to use complementary and

  4. Sleep Problems as Consequence, Contributor, and Comorbidity: Introduction to the Special Issue on Sleep, Published in Coordination With Special Issues in Clinical Practice in Pediatric Psychology and Journal of Developmental and Behavioral Pediatrics.

    Science.gov (United States)

    Beebe, Dean W

    2016-07-01

    Despite long-standing public and scientific interest in the phenomenon of sleep, the current decade has shown tremendous growth in our understanding of the sleep of children who have medical or developmental conditions. To accommodate, promote, and guide that growth, Journal of Pediatric Psychology, Clinical Practice in Pediatric Psychology, and Journal of Developmental and Behavioral Pediatrics have published coordinated special issues, encompassing >30 relevant articles. This article introduces the special issue in Journal of Pediatric Psychology, highlighting papers that illustrate how sleep problems are not only commonly comorbid with childhood medical and developmental conditions; they are also likely caused by and contribute to these conditions. In doing so, these coordinated special issues guide clinical care and reveal opportunities for future research. © The Author 2016. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  5. Effect of Oral Midazolam Premedication on Children's Co-operation Before General Anesthesia in Pediatric Dentistry.

    Science.gov (United States)

    Kaviani, Nasser; Shahtusi, Mina; Haj Norousali Tehrani, Maryam; Nazari, Sara

    2014-09-01

    Premedication is expedient in reducing the psychological trauma from recalling the unpleasant pre-anesthetic phases, hence, inducing a trouble-free anesthesia. This study aimed to determine the effectiveness of oral midazolam in co-operation of the subjects before general anesthesia and in recalling the pre-anesthetic phases, performed on children candidate for dental treatment under general anesthesia. In this prospective clinical trial study, 62 healthy non-cooperative children, candidate for dental treatment under general anesthesia, were randomly divided into study and control groups. The children received 20ml orange juice, 20 minutes before starting the anesthesia. The juice of the test group contained 0.5mg/kg of midazolam and that of the control group included no medication. The induction and the maintenance process of anesthesia were similar in both groups. The manner of subjects when separated from parents, their cooperation during intravenous catheterization, and recalling the pre-anesthetic events were recorded. Data were analyzed by adopting chi-square and Mann-Whitney tests. Most of the children in the test group had a comfortable separation from parents, restful IV catheterization and 90% of the subjects did not recall the pre-anesthetic events. Under the circumstances of this study, it could be concluded that 0.5mg/kg oral midazolam premedication is effective for comfortable separation of children from parents and restful IV catheterization and also forgetting the pre-anesthetic events.

  6. 75 FR 47819 - Workshop on Optimizing Clinical Trial Design for the Development of Pediatric Cardiovascular Devices

    Science.gov (United States)

    2010-08-09

    ... support from the American Academy of Pediatrics (AAP), the American College of Cardiology (ACC), and the... developing devices for the pediatric cardiology market. The information gathered in this and future workshops will help to develop future guidance on optimal designs for pediatric cardiology device trials....

  7. Protein and calorie intakes in adult and pediatric subjects with urea cycle disorders participating in clinical trials of glycerol phenylbutyrate☆

    Science.gov (United States)

    Hook, Debra; Diaz, George A.; Lee, Brendan; Bartley, James; Longo, Nicola; Berquist, William; Le Mons, Cynthia; Rudolph-Angelich, Ingrid; Porter, Marty; Scharschmidt, Bruce F.; Mokhtarani, Masoud

    2016-01-01

    Background Little prospectively collected data are available comparing the dietary intake of urea cycle disorder (UCD) patients to UCD treatment guidelines or to healthy individuals. Objective To examine the protein and calorie intakes of UCD subjects who participated in clinical trials of glycerol phenylbutyrate (GPB) and compare these data to published UCD dietary guidelines and nutritional surveys. Design Dietary data were recorded for 45 adult and 49 pediatric UCD subjects in metabolic control during participation in clinical trials of GPB. Protein and calorie intakes were compared to UCD treatment guidelines, average nutrient intakes of a healthy US population based on the National Health and Nutrition Examination Survey (NHANES) and Recommended Daily Allowances (RDA). Results In adults, mean protein intake was higher than UCD recommendations but lower than RDA and NHANES values, while calorie intake was lower than UCD recommendations, RDA and NHANES. In pediatric subjects, prescribed protein intake was higher than UCD guidelines, similar to RDA, and lower than NHANES data for all age groups, while calorie intake was at the lower end of the recommended UCD range and close to RDA and NHANES data. In pediatric subjects height, weight, and body mass index (BMI) Z-scores were within normal range (− 2 to 2). Conclusions Pediatric patients treated with phenylbutyrate derivatives exhibited normal height and weight. Protein and calorie intakes in adult and pediatric UCD subjects differed from UCD dietary guidelines, suggesting that these guidelines may need to be reconsidered. PMID:27014577

  8. Resources for pediatric drug information.

    Science.gov (United States)

    Zenk, K E

    1990-10-01

    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.

  9. Pediatric referrals to psychiatry in a Tertiary Care General Hospital: A descriptive study

    Directory of Open Access Journals (Sweden)

    Bheemsain Tekkalaki

    2017-01-01

    Full Text Available Background: Children with chronic physical illnesses frequently have psychiatric comorbidities, which often go un-noticed and may lead to more resource utilization and morbidity. Pediatric liaison services can be effectively used to bridge this gap. Literature on pediatric liaison services is sparse. Aims: To study the referral patterns, reasons for referrals, psychiatric diagnoses and interventions in children and adolescents referred to psychiatry department in a tertiary care hospital. Materials and Methods: A retrospective chart analysis of all children and adolescents below 19 years of age, referred to psychiatry department from 2010 to 2015, was done. Data was collected and statistical analysis was done. Results: Two hundred and nine subjects were included in the study. Mean age of sample was 12.15 (±4.20 years, with about 66.02% being males. About 54.06% of the participants were referred from pediatricians. Almost three fourth (72.25% of children had no diagnosable physical illness. Intellectual disability (19.62% was the most common psychiatric diagnosis, followed by depressive disorders (14.35%, and dissociative disorders (12.92%. Conclusions: In our study, majority of the referrals were the adolescent males from pediatric department. Intellectual disability, depressive disorder, and stress-related disorders were the common diagnoses. The fact that three-fourth of the referred children had no physical illness implies lack of awareness, stigma toward mental illness, and pathway of care.

  10. Distinct Clinical Characteristics of Pediatric Guillain-Barre Syndrome: A Comparative Study between Children and Adults in Northeast China.

    Directory of Open Access Journals (Sweden)

    Xiujuan Wu

    Full Text Available Clinical characteristics of pediatric Guillain-Barré syndrome (GBS have been extensively studied whereas scarcely been compared with those of adult GBS. Herein we compared the clinical features of GBS between pediatric and adult patients.We retrospectively collected the clinical data of 750 patients with GBS (541 adults and 209 children, and compared the clinical characteristics between children and adults.Pain was a more frequent complaint in children (17.2% vs 9.6%, p 0.05. The clinical features of acute motor axonal neuropathy (AMAN and acute inflammatory demyelinating polyneuropathy (AIDP in children were overall comparable with adult ones (p > 0.05. Similar to adults, bulbar dysfunction (odds ratio [OR]: 4.621, 95% confidence interval [CI]: 1.240-17.218, p < 0.05 and lower nadir Medical Research Council (MRC sum score (OR: 0.897, 95% CI: 0.855-0.941, p < 0.01 were also risk factors for mechanical ventilation in children. However, distinct from adult ones, autonomic dysfunction was significantly higher in mechanically ventilated childhood GBS (39.1% vs 8.8%, p < 0.01, which also served as a predictor for mechanical ventilation in pediatric GBS (OR: 70.415, 95% CI: 9.265-535.158, p < 0.01. As to the efficacy of intravenous immunoglobulin, insignificant difference was identified between children and adults.The clinical features of pediatric GBS differ from those of adults. Autonomic dysfunction is an independent risk factor for mechanical ventilation in pediatric patients.

  11. Clinical research participation among adolescent and young adults at an NCI-designated Comprehensive Cancer Center and affiliated pediatric hospital.

    Science.gov (United States)

    Sanford, Stacy D; Beaumont, Jennifer L; Snyder, Mallory A; Reichek, Jennifer; Salsman, John M

    2017-05-01

    Minimal clinical trial participation among adolescents and young adults (AYAs) with cancer limits scientific progress and ultimately their clinical care and outcomes. These analyses examine the current state of AYA clinical research participation at a Midwestern comprehensive cancer center and affiliated pediatric hospital to advise program development and increase availability of trials and AYA participation. Enrollment is examined across all diagnoses, the entire AYA age spectrum (15-39), and both cancer therapeutic and supportive care protocols. his study was a retrospective review of electronic medical records via existing databases and registries for all AYAs. Data were collected for AYAs seen by an oncologist at the adult outpatient cancer center or at the pediatric hospital between the years 2010 and 2014. Descriptive statistics and logistic regression analyses were conducted to characterize this sample. In the pediatric setting, 42.3% of AYAs were enrolled in a study compared to 11.2% in the adult setting. Regression analyses in the pediatric setting revealed that AYAs with private insurance or Caucasian race were more likely to participate. Within the adult setting, ethnicity, race, insurance, and diagnosis were associated with study participation; 54.8% of study enrollments were for cancer therapeutic and 43.4% for supportive care studies. These results are comparable to previously published data and support the need for new local and national AYA initiatives to increase the availability of and enrollment in therapeutic clinical trials. The same is true for supportive care studies which play a crucial role in improving quality of life.

  12. Influenza B Virus-associated Pneumonia in Pediatric Patients: Clinical Features, Laboratory Data, and Chest X-ray Findings

    Directory of Open Access Journals (Sweden)

    Chi-Yu Liu

    2014-02-01

    Conclusion: Pneumonia should be considered in pediatric patients with influenza B virus infection presenting with younger age, higher white blood cell count, lower hemoglobin, and higher C-reactive protein level. The CXR findings were varied. Patients with pleural effusion and positive bacterial culture may have more severity of clinical outcome.

  13. Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy in the Pediatric Population Clinical Characterization and Comparison with Adult-Onset Disease

    NARCIS (Netherlands)

    Te Riele, Anneline S J M; James, Cynthia A.; Sawant, Abhishek C.; Bhonsale, Aditya; Groeneweg, Judith A.; Mast, Thomas P.; Murray, Brittney; Tichnell, Crystal; Dooijes, Dennis; Van Tintelen, J. Peter; Judge, Daniel P.; van der Heijden, Jeroen F.; Crosson, Jane; Hauer, Richard N W; Calkins, Hugh; Tandri, Harikrishna

    2015-01-01

    Objectives The aims of this study were to determine the clinical characteristics and outcomes of pediatric-onset arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) and to compare these with those of adult-onset ARVD/C. Background Improved early detection and increased awareness of AR

  14. Developing authentic clinical simulations for effective listening and communication in pediatric rehabilitation service delivery.

    Science.gov (United States)

    King, Gillian; Shepherd, Tracy A; Servais, Michelle; Willoughby, Colleen; Bolack, Linda; Strachan, Deborah; Moodie, Sheila; Baldwin, Patricia; Knickle, Kerry; Parker, Kathryn; Savage, Diane; McNaughton, Nancy

    2016-10-01

    To describe the creation and validation of six simulations concerned with effective listening and interpersonal communication in pediatric rehabilitation. The simulations involved clinicians from various disciplines, were based on clinical scenarios related to client issues, and reflected core aspects of listening/communication. Each simulation had a key learning objective, thus focusing clinicians on specific listening skills. The article outlines the process used to turn written scenarios into digital video simulations, including steps taken to establish content validity and authenticity, and to establish a series of videos based on the complexity of their learning objectives, given contextual factors and associated macrocognitive processes that influence the ability to listen. A complexity rating scale was developed and used to establish a gradient of easy/simple, intermediate, and hard/complex simulations. The development process exemplifies an evidence-based, integrated knowledge translation approach to the teaching and learning of listening and communication skills.

  15. An Official American Thoracic Society Clinical Practice Guideline: Pediatric Chronic Home Invasive Ventilation.

    Science.gov (United States)

    Sterni, Laura M; Collaco, Joseph M; Baker, Christopher D; Carroll, John L; Sharma, Girish D; Brozek, Jan L; Finder, Jonathan D; Ackerman, Veda L; Arens, Raanan; Boroughs, Deborah S; Carter, Jodi; Daigle, Karen L; Dougherty, Joan; Gozal, David; Kevill, Katharine; Kravitz, Richard M; Kriseman, Tony; MacLusky, Ian; Rivera-Spoljaric, Katherine; Tori, Alvaro J; Ferkol, Thomas; Halbower, Ann C

    2016-04-15

    Children with chronic invasive ventilator dependence living at home are a diverse group of children with special health care needs. Medical oversight, equipment management, and community resources vary widely. There are no clinical practice guidelines available to health care professionals for the safe hospital discharge and home management of these complex children. To develop evidence-based clinical practice guidelines for the hospital discharge and home/community management of children requiring chronic invasive ventilation. The Pediatric Assembly of the American Thoracic Society assembled an interdisciplinary workgroup with expertise in the care of children requiring chronic invasive ventilation. The experts developed four questions of clinical importance and used an evidence-based strategy to identify relevant medical evidence. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to formulate and grade recommendations. Clinical practice recommendations for the management of children with chronic ventilator dependence at home are provided, and the evidence supporting each recommendation is discussed. Collaborative generalist and subspecialist comanagement is the Medical Home model most likely to be successful for the care of children requiring chronic invasive ventilation. Standardized hospital discharge criteria are suggested. An awake, trained caregiver should be present at all times, and at least two family caregivers should be trained specifically for the child's care. Standardized equipment for monitoring, emergency preparedness, and airway clearance are outlined. The recommendations presented are based on the current evidence and expert opinion and will require an update as new evidence and/or technologies become available.

  16. Assessing barriers to adherence in routine clinical care for pediatric kidney transplant patients.

    Science.gov (United States)

    Varnell, Charles D; Rich, Kristin L; Nichols, Melissa; Dahale, Devesh; Goebel, Jens W; Pai, Ahna L H; Hooper, David K; Modi, Avani C

    2017-08-01

    Patient-identified barriers to immunosuppressive medications are associated with poor adherence and negative clinical outcomes in transplant patients. Assessment of adherence barriers is not part of routine post-transplant care, and studies regarding implementing such a process in a reliable way are lacking. Using the Model for Improvement and PDSA cycles, we implemented a system to identify adherence barriers, including patient-centered design of a barriers assessment tool, identification of eligible patients, clear roles for clinic staff, and creating a culture of non-judgmental discussion around adherence. We performed time-series analysis of our process measure. Secondary analyses examined the endorsement and concordance of adherence barriers between patient-caregiver dyads. After three methods of testing, the most reliable delivery system was an EHR-integrated tablet that alerted staff of patient eligibility for assessment. Barriers were endorsed by 35% of caregivers (n=85) and 43% of patients (n=60). The most frequently patient-endorsed barriers were forgetting, poor taste, and side effects. Caregivers endorsed forgetting and side effects. Concordance between patient-caregiver dyads was fair (k=0.299). Standardized adherence barriers assessment is feasible in the clinical care of pediatric kidney transplant patients. Features necessary for success included automation, redundant systems with designated staff to identify and mitigate failures, aligned reporting structures, and reliable measurement approaches. Future studies will examine whether barriers predict clinical outcomes (eg, organ rejection, graft loss). © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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

    Science.gov (United States)

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

    2016-01-01

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

  18. Accuracy of a pediatric early warning score in the recognition of clinical deterioration.

    Science.gov (United States)

    Miranda, Juliana de Oliveira Freitas; Camargo, Climene Laura de; Nascimento, Carlito Lopes; Portela, Daniel Sales; Monaghan, Alan

    2017-07-10

    to evaluate the accuracy of the version of the Brighton Pediatric Early Warning Score translated and adapted for the Brazilian context, in the recognition of clinical deterioration. a diagnostic test study to measure the accuracy of the Brighton Pediatric Early Warning Score for the Brazilian context, in relation to a reference standard. The sample consisted of 271 children, aged 0 to 10 years, blindly evaluated by a nurse and a physician, specialists in pediatrics, with interval of 5 to 10 minutes between the evaluations, for the application of the Brighton Pediatric Early Warning Score for the Brazilian context and of the reference standard. The data were processed and analyzed using the Statistical Package for the Social Sciences and VassarStats.net programs. The performance of the Brighton Pediatric Early Warning Score for the Brazilian context was evaluated through the indicators of sensitivity, specificity, predictive values, area under the ROC curve, likelihood ratios and post-test probability. the Brighton Pediatric Early Warning Score for the Brazilian context showed sensitivity of 73.9%, specificity of 95.5%, positive predictive value of 73.3%, negative predictive value of 94.7%, area under Receiver Operating Characteristic Curve of 91.9% and the positive post-test probability was 80%. the Brighton Pediatric Early Warning Score for the Brazilian context, presented good performance, considered valid for the recognition of clinical deterioration warning signs of the children studied. avaliar a acurácia da versão traduzida e adaptada do Brighton Paediatric Early Warning Score para o contexto brasileiro, no reconhecimento da deterioração clínica. estudo de teste diagnóstico para medir a acurácia do Brighton Paediatric Early Warning Score, para o contexto brasileiro, em relação a um padrão de referência. A amostra foi composta por 271 crianças de 0 a 10 anos, avaliadas de forma cega por uma enfermeira e um médico, especialistas em pediatria, com

  19. Improving patient experience in a pediatric ambulatory clinic: a mixed method appraisal of service delivery

    Directory of Open Access Journals (Sweden)

    Soeteman M

    2015-03-01

    Full Text Available Marijn Soeteman,1 Vera Peters,2 Jamiu O Busari1,3 1Department of Pediatrics, Atrium Medical Center, Heerlen, 2Faculty of Health, Medicine and Life Sciences, 3Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, the Netherlands Objective: In 2013, customer satisfaction surveys showed that patients were unhappy with the services provided at our ambulatory clinic. In response, we performed an appraisal of our services, which resulted in the development of a strategy to reduce waiting time and improve quality of service. Infrastructural changes to our clinic’s waiting room, consultation rooms, and back offices were performed, and schedules were redesigned to reduce wait time to 10 minutes and increase consultation time to 20 minutes. Our objective was to identify if this would improve 1 accessibility to caregivers and 2 quality of service and available amenities. Design: We conducted a multi-method survey using 1 a patient flow analysis to analyze the flow of service and understand the impact of our interventions on patient flow and 2 specially designed questionnaires to investigate patients’ perceptions of our wait time and how to improve our services. Results: The results showed that 79% of our respondents were called in to see a doctor within 20 minutes upon arrival. More patients (55% felt that 10–20 minutes was an acceptable wait time. We also observed a perceived increase in satisfaction with wait time (94%. Finally, a large number of patients (97% were satisfied with the quality of service and with the accessibility to caregivers (94%. Conclusion: The majority of our patients were satisfied with the accessibility to our ambulatory clinics and with the quality of services provided. The appraisal of our operational processes using a patient flow analysis also demonstrated how this strategy could effectively be applied to investigate and improve quality of

  20. Relation between safe use of medicines and Clinical Pharmacy Services at Pediatric Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Lucas Miyake Okumura

    Full Text Available Abstract Objective: Clinical Pharmacy Services (CPS are considered standard of care and is endorsed by the Joint Commission International, the American Academy of Pediatrics, and the American College of Clinical Pharmacy. In Brazil, single experiences have been discreetly arising and the importance of these services to children and adolescents care has led to interesting results, but certainly are under reported. This short report aims to discuss the effect of implementing a bedside CPS at a Brazilian Pediatric Intensive Care Unit (PICU. Methods: This is a cross-sectional study conducted in a 12 bed PICU community hospital, from Campo Largo/Brazil. Subjects with<18 years old admitted to PICU were included for descriptive analysis if received a CPS intervention. Results: Of 53 patients accompanied, we detected 141 preventable drug-related problems (DRPs which were solved within clinicians (89% acceptance of all interventions. The most common interventions performed to improve drug therapy included: preventing incompatible intravenous solutions (21% and a composite of inadequate doses (17% due to low, high and non-optimized doses. Among the top ten medications associated with DRPs, five were antimicrobials. By analyzing the correlation between DRPs and PICU length of stay, we found that 74% of all variations on length of stay were associated with the number of DRPs. Conclusions: Adverse drug reactions due to avoidable DRPs can be prevented by CPS in a multifaceted collaboration with other health care professionals, who should attempt to use active and evidence-based strategies to reduce morbidity related to medications.

  1. Unilateral renal agenesis: case review of ambulatory pediatric nephrology clinics in Cali

    Directory of Open Access Journals (Sweden)

    Consuelo Restrepo de Rovetto

    2010-09-01

    Full Text Available Introduction: Unilateral renal agenesis is a frequent renal malformation with incidence of 1 per 1000 live born children. There are no statistics nor protocols to manage and follow-up these patients. Usually asymptomatic, it can be early detected by prenatal ultrasound, allowing opportune detection and adequate follow up. The goal is to describe main features found in children with renal agenesis at four ambulatory pediatric nephrology clinics in Cali, Colombia: Hospital Universitario del Valle (HUV, Club Noel Children’s hospital and the private practice of two pediatric nephrologists. Methods: This is a retrospective descriptive study in a series of cases with congenital renal agenesis diagnosed between January, 1995 and December 2007, of patients under 18 years of age and based on a review of clinical records. Results: 43 patients were found, 51.2% males, 88% from the department of Valle del Cauca. Prenatal diagnoses were conducted in only 21% of these patients; agenesis was right in 48.8% and left in 51.2%. In 46.5%, association with other pathologies was found: occult spinal bifida, congenital scoliosis, and Klippel-Feil sequence. Compensatory renal hypertrophy was reported in 39.5% of the patients, 42% had episodes of urinary tract infection, 31% vesicoureteral reflux and 10% proteinuria. Four male patients (9.3% developed renal failure. The average follow-up was 6.6 years. Conclusions: Prenatal diagnose was not very frequent in our set of cases. Urinary tract infection and vesicoureteral reflux were common, increasing the risk of renal deterioration. Prolonged follow up is suggested, with unified protocols to prevent renal failure.

  2. Unilateral renal agenesis: case review of ambulatory pediatric nephrology clinics in Cali

    Directory of Open Access Journals (Sweden)

    Consuelo Restrepo de Rovetto

    2010-03-01

    Full Text Available Introduction: Unilateral renal agenesis is a frequent renal malformation with incidence of 1 per 1000 live born children. There are no statistics nor protocols to manage and follow-up these patients. Usually asymptomatic, it can be early detected by prenatal ultrasound, allowing opportune detection and adequate follow up. The goal is to describe main features found in children with renal agenesis at four ambulatory pediatric nephrology clinics in Cali, Colombia: Hospital Universitario del Valle (HUV, Club Noel Children’s hospital and the private practice of two pediatric nephrologists.Methods: This is a retrospective descriptive study in a series of cases with congenital renal agenesis diagnosed between January, 1995 and December 2007, of patients under 18 years of age and based on a review of clinical records.Results: 43 patients were found, 51.2% males, 88% from the department of Valle del Cauca. Prenatal diagnoses were conducted in only 21% of these patients; agenesis was right in 48.8% and left in 51.2%. In 46.5%, association with other pathologies was found: occult spinal bifida, congenital scoliosis, and Klippel-Feil sequence. Compensatory renal hypertrophy was reported in 39.5% of the patients, 42% had episodes of urinary tract infection, 31% vesicoureteral reflux and 10% proteinuria. Four male patients (9.3% developed renal failure. The average follow-up was 6.6 years.Conclusions: Prenatal diagnose was not very frequent in our set of cases. Urinary tract infection and vesicoureteral reflux were common, increasing the risk of renal deterioration. Prolonged follow up is suggested, with unified protocols to prevent renal failure.

  3. Quantitative CT characterization of pediatric lung development using routine clinical imaging

    Energy Technology Data Exchange (ETDEWEB)

    Stein, Jill M.; Brody, Alan S.; Fleck, Robert J. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Walkup, Laura L. [Cincinnati Children' s Hospital Medical Center, Center for Pulmonary Imaging Research, Pulmonary Medicine and Radiology, Cincinnati, OH (United States); Woods, Jason C. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Cincinnati Children' s Hospital Medical Center, Center for Pulmonary Imaging Research, Pulmonary Medicine and Radiology, Cincinnati, OH (United States)

    2016-12-15

    The use of quantitative CT analysis in children is limited by lack of normal values of lung parenchymal attenuation. These characteristics are important because normal lung development yields significant parenchymal attenuation changes as children age. To perform quantitative characterization of normal pediatric lung parenchymal X-ray CT attenuation under routine clinical conditions in order to establish a baseline comparison to that seen in pathological lung conditions. We conducted a retrospective query of normal CT chest examinations in children ages 0-7 years from 2004 to 2014 using standard clinical protocol. During these examinations semi-automated lung parenchymal segmentation was performed to measure lung volume and mean lung attenuation. We analyzed 42 CT examinations in 39 children, ages 3 days to 83 months (mean ± standard deviation [SD] = 42 ± 27 months). Lung volume ranged 0.10-1.72 liters (L). Mean lung attenuation was much higher in children younger than 12 months, with values as high as -380 Hounsfield units (HU) in neonates (lung volume 0.10 L). Lung volume decreased to approximately -650 HU by age 2 years (lung volume 0.47 L), with subsequently slower exponential decrease toward a relatively constant value of -860 HU as age and lung volume increased. Normal lung parenchymal X-ray CT attenuation decreases with increasing lung volume and age; lung attenuation decreases rapidly in the first 2 years of age and more slowly thereafter. This change in normal lung attenuation should be taken into account as quantitative CT methods are translated to pediatric pulmonary imaging. (orig.)

  4. Ethical issues at the interface of clinical care and research practice in pediatric oncology: a narrative review of parents' and physicians' experiences

    OpenAIRE

    de Vries Martine C; Houtlosser Mirjam; Wit Jan M; Engberts Dirk P; Bresters Dorine; Kaspers Gertjan JL; van Leeuwen Evert

    2011-01-01

    Abstract Background Pediatric oncology has a strong research culture. Most pediatric oncologists are investigators, involved in clinical care as well as research. As a result, a remarkable proportion of children with cancer enrolls in a trial during treatment. This paper discusses the ethical consequences of the unprecedented integration of research and care in pediatric oncology from the perspective of parents and physicians. Methodology An empirical ethical approach, combining (1) a narrati...

  5. Whole-body MRI in generalized cystic lymphangiomatosis in the pediatric population: diagnosis, differential diagnoses, and follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Herruela-Suffee, Cecile; Warin, Mathilde; Castier-Amouyel, Melody; Dallery, Florine; Bonnaire, Bruno; Constans, Jean-Marc [CHU Amiens-Picardie, Service de Radiologie, Amiens Cedex 1 (France)

    2016-02-15

    Generalized cystic lymphangiomatosis is a particularly rare disease with variable involvement of skeletal and extraskeletal sites. The key role of imaging in the diagnosis of this disease is no longer in doubt. The aim of our study was to demonstrate the contribution of whole-body magnetic resonance imaging (WB-MRI) at the diagnostic stage and during the follow-up in the pediatric population. Three children were included from 2008. The inclusion criteria were radiological images (conventional radiographs, computed tomography, and MRI) compatible with histological confirmation. Each child included received WB-MRI at the diagnosis stage and during follow-up. WB-MRI detected multiple hypointense T1 and hyperintense T2-STIR cystic bony lesions. One unnoticed mass in the retroperitoneum on computed tomography was easily detected by MRI. Mediastinal involvement was observed in one asymptomatic case. Histology was contributory in all cases. Preventive intramedullary nailings was done in one case. Follow-up WB-MRI detected new asymptomatic lesions in all cases. One child presented a third episode of lymphangitis of the right thigh during follow-up. Due to its high sensitivity to diagnose, ability to eliminate differential diagnoses and make exhaustive lesions assessment, and its non-radiating character for long-term follow-up, WB-MRI is highly recommended for generalized cystic lymphangiomatosis in the pediatric population. (orig.)

  6. Self-management in pediatric inflammatory bowel disease: A clinical report of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

    Science.gov (United States)

    Hommel, Kevin A; Greenley, Rachel N; Maddux, Michele Herzer; Gray, Wendy N; Mackner, Laura M

    2013-08-01

    This clinical report aims to review key self-management and adherence issues in pediatric inflammatory bowel disease (IBD) and to provide recommendations for health care providers regarding evidence-based assessment and treatment approaches to promote optimal self-management. Self-management difficulties in the form of nonadherence to treatment regimens are common in pediatric IBD and are influenced by various disease-related, individual, family, and health professional relationship factors. To promote adaptive self-management, health care providers are encouraged to adopt a long-term preventive orientation, which includes routine screening of barriers to self-management and nonadherence in the context of routine clinic appointments. The use of a multimethod approach to assessment that incorporates objective measures (eg, pill counts or bioassays) may be particularly advantageous. Individualized treatment approaches that incorporate evidence-based practices, such as providing written treatment plans and offering opportunities to practice and receive feedback on skills, may help to ameliorate minor self-management concerns; however, more severe or chronic self-management problems may require a referral for behavioral health intervention. Additional research to broaden our understanding of self-management in domains beyond medication adherence and to evaluate the effect of clinic-based interventions is imperative.

  7. Pediatric Cardiomyopathies.

    Science.gov (United States)

    Lee, Teresa M; Hsu, Daphne T; Kantor, Paul; Towbin, Jeffrey A; Ware, Stephanie M; Colan, Steven D; Chung, Wendy K; Jefferies, John L; Rossano, Joseph W; Castleberry, Chesney D; Addonizio, Linda J; Lal, Ashwin K; Lamour, Jacqueline M; Miller, Erin M; Thrush, Philip T; Czachor, Jason D; Razoky, Hiedy; Hill, Ashley; Lipshultz, Steven E

    2017-09-15

    Pediatric cardiomyopathies are rare diseases with an annual incidence of 1.1 to 1.5 per 100 000. Dilated and hypertrophic cardiomyopathies are the most common; restrictive, noncompaction, and mixed cardiomyopathies occur infrequently; and arrhythmogenic right ventricular cardiomyopathy is rare. Pediatric cardiomyopathies can result from coronary artery abnormalities, tachyarrhythmias, exposure to infection or toxins, or secondary to other underlying disorders. Increasingly, the importance of genetic mutations in the pathogenesis of isolated or syndromic pediatric cardiomyopathies is becoming apparent. Pediatric cardiomyopathies often occur in the absence of comorbidities, such as atherosclerosis, hypertension, renal dysfunction, and diabetes mellitus; as a result, they offer insights into the primary pathogenesis of myocardial dysfunction. Large international registries have characterized the epidemiology, cause, and outcomes of pediatric cardiomyopathies. Although adult and pediatric cardiomyopathies have similar morphological and clinical manifestations, their outcomes differ significantly. Within 2 years of presentation, normalization of function occurs in 20% of children with dilated cardiomyopathy, and 40% die or undergo transplantation. Infants with hypertrophic cardiomyopathy have a 2-year mortality of 30%, whereas death is rare in older children. Sudden death is rare. Molecular evidence indicates that gene expression differs between adult and pediatric cardiomyopathies, suggesting that treatment response may differ as well. Clinical trials to support evidence-based treatments and the development of disease-specific therapies for pediatric cardiomyopathies are in their infancy. This compendium summarizes current knowledge of the genetic and molecular origins, clinical course, and outcomes of the most common phenotypic presentations of pediatric cardiomyopathies and highlights key areas where additional research is required. URL: http

  8. Clinical Impact and Cost-Effectiveness of Whole Exome Sequencing as a Diagnostic Tool: A Pediatric Center’s Experience

    OpenAIRE

    C Alexander Valencia; Ammar eHusami; Jennifer eHolle; Johnson, Judith A; Yaping eQian; Abhinav eMathur; Chao eWei; Subba Rao Indugula; Fanggeng eZou; Haiying eMeng; Lijun eWang; Xia eLi; Rachel eFisher; Tony eTan; Amber eHogart Begtrup

    2015-01-01

    Background There are limited reports of the use of whole exome sequencing (WES) as a clinical diagnostic tool. Moreover, there are no reports addressing the cost burden associated with genetic tests performed prior to WES. Objective We demonstrate the performance characteristics of WES in a pediatric setting by describing our patient cohort, calculating the diagnostic yield, and detailing the patients for whom clinical management was altered. Moreover, we examined the potential cos...

  9. Clinical Characteristics and Pharmacological Treatment of Psychotic Patients Attending the Mental Health Services of the Pediatric Hospital of Cienfuegos

    OpenAIRE

    Beatriz Sabina Roméu; Daimí Sarmiento González; Mario Isaías Alzuri Falcato; Anais Leyva Madrigales

    2016-01-01

    Background: the mental health services of the Pediatric Hospital of Cienfuegos receive all patients in the province that need to be hospitalized. Among them, children and adolescents functioning at the psychotic level are of great clinical and social importance. Objective: to describe the clinical characteristics and pharmacological treatment of psychotic patients treated in the mental health services. Methods: a case series study of 35 psychotic patients admitted to the mental health unit of...

  10. A multifaceted approach to decrease inappropriate antibiotic use in a pediatric outpatient clinic

    Science.gov (United States)

    Al-Tawfiq, Jaffar A.; Alawami, Amel H.

    2017-01-01

    BACKGROUND: Inappropriate use of antimicrobial agents is the major cause for the development of resistance. Thus, it is important to include outpatient clinics in the development of antibiotic stewardship program. METHODS: We report a multifaceted approach to decrease inappropriate antibiotic use in upper respiratory tract infections (URTIs) in an outpatient pediatric clinic. The interventions included educational grand round, academic detailing, and prospective audit and feedback and peer comparison. RESULTS: During the study period, a total of 3677 outpatient clinic visits for URTIs were evaluated. Of all the included patients, 12% were 5 years of age. Of the total patients, 684 (17.6%) received appropriate antibiotics, 2812 (76.4%) appropriately did not receive antibiotics, and 217 (6%) inappropriately received antibiotics. The monthly rate of prescription of inappropriate antibiotics significantly decreased from 12.3% at the beginning of the study to 3.8% at the end of the study (P < 0.0001). Antibiotic prescription among those who had rapid streptococcal antigen test (RSAT) was 40% compared with 78% among those who did not have RSAT (P < 0.0001). CONCLUSIONS: The combination of education and academic detailing is important to improve antibiotic use. PMID:28197223

  11. [Immunophenotypes in 207 pediatric patients with ALL and theirs correlation with cytogenetics and clinical features].

    Science.gov (United States)

    Tong, Hai-Xia; Wang, Qiu-Shi; Lu, Chun-Wei; Wang, Hong; Liu, Zhuo-Gang

    2011-06-01

    The objective of this study was to investigate the immunophenotypic subtype profiles of 207 pediatric patients with acute lymphoblastic leukemia (ALL) and its correlation with cytogenetics and clinical features. 207 children with ALL were immunophenotyped by four color flow cytometry using a panel of monoclonal antibodies. 207 patients were enrolled in this study, out of which 146 cases were subjected to karyotype analysis by R-banding technology. The results showed that 11.6% out of 207 children with ALL were identified as T-ALL, 88.4% as B-ALL. Myeloid antigen (MyAg) expression was documented in 42.5% out of 207 cases analyzed and CD13 was the most commonly expressed MyAg (31.4%). No difference was observed in the expression of MyAg between the groups of patients with T-ALL (41.7%) and B-ALL (42.6%). Abnormal karyotypes were detected in 84 out of 146 (57.5%) children. The clinical and biological characteristics of ALL patients between MyAg(+) and MyAg(-) groups showed that higher percentage of patients with high WBC count (> 50 × 10(9)/L) and higher CD34 positivity were found to be correlated with MyAg(+) ALL. It is concluded that immunophenotype analysis is useful for ALL diagnosis and classification, and the immunophenotypes are in relevance to the abnormal cytogenetic changes as well as clinical features in childhood ALL.

  12. The need for clinical quantification of combined PET/MRI data in pediatric epilepsy

    Energy Technology Data Exchange (ETDEWEB)

    Muzik, Otto, E-mail: otto@pet.wayne.edu [Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI (United States); Department of Radiology, Wayne State University School of Medicine, Detroit, MI (United States); Pai, Darshan [Department of Computer Science, Wayne State University School of Medicine, Detroit, MI (United States); Juhasz, Csaba [Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI (United States); Hua, Jing [Department of Computer Science, Wayne State University School of Medicine, Detroit, MI (United States)

    2013-02-21

    In the past, multimodality integrative analysis of image data has been used to obtain a better understanding of underlying mechanisms of seizure generation and propagation in children with extratemporal lobe epilepsy. However, despite important advances in the combined analysis of PET, MRI, DTI and EEG data, successful surgical outcome is only achieved in about 2/3 of patients undergoing resective surgery. The advent of simultaneous PET/MR data acquisition promises an important advance in neuroimaging through clinical quantification, which will finally translate the strength of PET (which is the ability to absolutely quantify physiological parameters such as metabolic rates and receptor densities) into clinical work. Taking advantage of recently developed integrated PET/MR devices, absolute physiological values will be available in clinical routine, replacing currently used visual assessment of relative tissue tracer uptake. This will allow assessment of global increases/decreases of brain function during critical phases of development and is likely to have a significant impact on patient management in pediatric epilepsy.

  13. Impact of an audiology clinic in one general practice.

    Science.gov (United States)

    Khunti, K; Carr, M

    1997-01-01

    There is a large demand for the provision of hearing aids. However, there are lengthy delays involved between referral and fitment of National Health Service (NHS) hearing aids. This report shows that a general practice based audiology clinic can lead to an increase in the number of patients referred and fitted with a hearing aid. The introduction of the clinic also led to reduced waiting times for patients to be fitted with hearing aids. PMID:9474829

  14. A Mobile Clinical Decision Support Tool for Pediatric Cardiovascular Risk-Reduction Clinical Practice Guidelines: Development and Description

    Science.gov (United States)

    2017-01-01

    Background Widespread application of research findings to improve patient outcomes remains inadequate, and failure to routinely translate research findings into daily clinical practice is a major barrier for the implementation of any evidence-based guideline. Strategies to increase guideline uptake in primary care pediatric practices and to facilitate adherence to recommendations are required. Objective Our objective was to operationalize the US National Heart, Lung, and Blood Institute’s Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents into a mobile clinical decision support (CDS) system for healthcare providers, and to describe the process development and outcomes. Methods To overcome the difficulty of translating clinical practice guidelines into a computable form that can be used by a CDS system, we used a multilayer framework to convert the evidence synthesis into executable knowledge. We used an iterative process of design, testing, and revision through each step in the translation of the guidelines for use in a CDS tool to support the development of 4 validated modules: an integrated risk assessment; a blood pressure calculator; a body mass index calculator; and a lipid management instrument. Results The iterative revision process identified several opportunities to improve the CDS tool. Operationalizing the integrated guideline identified numerous areas in which the guideline was vague or incorrect and required more explicit operationalization. Iterative revisions led to workable solutions to problems and understanding of the limitations of the tool. Conclusions The process and experiences described provide a model for other mobile CDS systems that translate written clinical practice guidelines into actionable, real-time clinical recommendations. PMID:28270384

  15. Pediatric MATCH Infographic

    Science.gov (United States)

    Infographic explaining NCI-COG Pediatric MATCH, a cancer treatment clinical trial for children and adolescents, from 1 to 21 years of age, that is testing the use of precision medicine for pediatric cancers.

  16. Clinical significance of pulmonary nodules detected on abdominal CT in pediatric patients

    Energy Technology Data Exchange (ETDEWEB)

    Breen, Micheal; Lee, Edward Y. [Boston Children' s Hospital and Harvard Medical School, Department of Radiology, Boston, MA (United States); Zurakowski, David [Boston Children' s Hospital and Harvard Medical School, Departments of Anesthesiology and Surgery, Boston, MA (United States)

    2015-11-15

    The clinical significance of a pulmonary nodule that is detected incidentally on CT studies in children is unknown. In addition, there is limited information regarding the management of incidentally detected pulmonary nodules discovered on abdominal CT studies in children. The purpose of this study was to investigate the clinical significance of incidental pulmonary nodules detected on abdominal CT studies in children. This was a retrospective study performed following institutional review board approval. Abdominal CT reports in patients younger than 18 years of age from July 2004 to June 2011 were reviewed for the terms ''nodule,'' ''nodular'' or ''mass'' in reference to the lung bases. The study population included those pediatric patients in whom pulmonary nodules were initially detected on abdominal CT studies. The largest pulmonary nodules detected on CT studies were evaluated for their features (size, shape, margin, attenuation, location, and presence of calcification and cavitation). Follow-up CT studies and clinical records were reviewed for demographic information, history of underlying malignancies and the clinical outcome of the incidental pulmonary nodules. Comparison of malignant versus benign pulmonary nodules was performed with respect to the size of the nodule, imaging features on CT, and patient history of malignancy using the Student's t-test and Fisher exact test. Youden J-index in receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off size for suggesting a high risk of malignancy of incidentally detected pulmonary nodules. Pulmonary nodules meeting inclusion criteria were detected in 62 (1.2%) of 5,234 patients. The mean age of patients with nodules was 11.2 years (range: 5 months-18 years). Thirty-one patients (50%) had follow-up CT studies and two of these patients (6%) were subsequently found to have malignant pulmonary nodules. Both of these

  17. Clinical significance of pulmonary nodules detected on abdominal CT in pediatric patients.

    Science.gov (United States)

    Breen, Micheál; Zurakowski, David; Lee, Edward Y

    2015-11-01

    The clinical significance of a pulmonary nodule that is detected incidentally on CT studies in children is unknown. In addition, there is limited information regarding the management of incidentally detected pulmonary nodules discovered on abdominal CT studies in children. The purpose of this study was to investigate the clinical significance of incidental pulmonary nodules detected on abdominal CT studies in children. This was a retrospective study performed following institutional review board approval. Abdominal CT reports in patients younger than 18 years of age from July 2004 to June 2011 were reviewed for the terms "nodule," "nodular" or "mass" in reference to the lung bases. The study population included those pediatric patients in whom pulmonary nodules were initially detected on abdominal CT studies. The largest pulmonary nodules detected on CT studies were evaluated for their features (size, shape, margin, attenuation, location, and presence of calcification and cavitation). Follow-up CT studies and clinical records were reviewed for demographic information, history of underlying malignancies and the clinical outcome of the incidental pulmonary nodules. Comparison of malignant versus benign pulmonary nodules was performed with respect to the size of the nodule, imaging features on CT, and patient history of malignancy using the Student's t-test and Fisher exact test. Youden J-index in receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off size for suggesting a high risk of malignancy of incidentally detected pulmonary nodules. Pulmonary nodules meeting inclusion criteria were detected in 62 (1.2%) of 5,234 patients. The mean age of patients with nodules was 11.2 years (range: 5 months-18 years). Thirty-one patients (50%) had follow-up CT studies and two of these patients (6%) were subsequently found to have malignant pulmonary nodules. Both of these patients had a history of malignancy. Of the remaining 31 patients

  18. Characteristics of Patients Referred to a Pediatric Infectious Diseases Clinic With Unexplained Fever.

    Science.gov (United States)

    Statler, Victoria A; Marshall, Gary S

    2016-09-01

    Older case series established diagnostic considerations for children meeting a priori definitions of fever of unknown origin (FUO). No recent study has examined the final diagnoses of children referred for unexplained fever. This study was conducted with a retrospective chart review of patients referred to a pediatric infectious diseases clinic from 2008 to 2012 for unexplained fever. Sixty-nine of 221 patients were referred for "prolonged" unexplained fever. Ten of these were not actually having fever, and 11 had diagnoses that were readily apparent at the initial visit. The remaining 48 were classified as having FUO. The median duration of reported fever for these patients was 30 days; 15 had a diagnosis made, 5 of which were serious. None of the serious FUO diagnoses were infections. Of 152 patients with "recurrent" unexplained fever, 92 had an "intermittent" fever pattern, and most of these had sequential, self-limited viral illnesses or no definitive diagnosis made. Twenty of the 60 patients with a "periodic" fever pattern were diagnosed with periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome. Overall, 166 patients either were not having fever, had self-limited illnesses, or ultimately had no cause of fever discovered. Only 12 had a serious illness, 2 of which were infections (malaria and typhoid fever). Most children referred with unexplained fever had either self-limited illnesses or no specific diagnosis established. Serious diagnoses were unusual, suggesting that these diagnoses rarely present with unexplained fever alone, or that, when they do, the diagnoses are made by primary care providers or other subspecialists. © The Author 2015. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  19. Childhood developmental disorders: an academic and clinical convergence point for psychiatry, neurology, psychology and pediatrics.

    Science.gov (United States)

    Reiss, Allan L

    2009-01-01

    Significant advances in understanding brain development and behavior have not been accompanied by revisions of traditional academic structure. Disciplinary isolation and a lack of meaningful interdisciplinary opportunities are persistent barriers in academic medicine. To enhance clinical practice, research, and training for the next generation, academic centers will need to take bold steps that challenge traditional departmental boundaries. Such change is not only desirable but, in fact, necessary to bring about a truly innovative and more effective approach to treating disorders of the developing brain. I focus on developmental disorders as a convergence point for transcending traditional academic boundaries. First, the current taxonomy of developmental disorders is described with emphasis on how current diagnostic systems inadvertently hinder research progress. Second, I describe the clinical features of autism, a phenomenologically defined condition, and Rett and fragile X syndromes, neurogenetic diseases that are risk factors for autism. Finally, I describe how the fields of psychiatry, psychology, neurology, and pediatrics now have an unprecedented opportunity to promote an interdisciplinary approach to training, research, and clinical practice and, thus, advance a deeper understanding of developmental disorders. Research focused on autism is increasingly demonstrating the heterogeneity of individuals diagnosed by DSM criteria. This heterogeneity hinders the ability of investigators to replicate research results as well as progress towards more effective, etiology-specific interventions. In contrast, fragile X and Rett syndromes are 'real' diseases for which advances in research are rapidly accelerating towards more disease-specific human treatment trials. A major paradigm shift is required to improve our ability to diagnose and treat individuals with developmental disorders. This paradigm shift must take place at all levels - training, research and clinical

  20. Pediatric melanoma.

    Science.gov (United States)

    Tracy, Elisabeth T; Aldrink, Jennifer H

    2016-10-01

    Childhood melanoma is a rare pediatric malignancy, with fewer than 500 new diagnoses annually. The incidence is increasing, particularly in the adolescent population. This review highlights the epidemiology, clinical presentation, and histopathologic challenges of pediatric melanoma. Surgical resection remains the cornerstone for localized and regionally advanced disease. Adjuvant therapies, including current options and potential novel therapeutics for this unique population will be discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Ethical issues at the interface of clinical care and research practice in pediatric oncology: a narrative review of parents' and physicians' experiences.

    NARCIS (Netherlands)

    Vries, M.C. de; Houtlosser, M.; Wit, J.M.; Engberts, D.P.; Bresters, D.; Kaspers, G.J.L.; Leeuwen, E. van

    2011-01-01

    BACKGROUND: Pediatric oncology has a strong research culture. Most pediatric oncologists are investigators, involved in clinical care as well as research. As a result, a remarkable proportion of children with cancer enrolls in a trial during treatment. This paper discusses the ethical consequences o

  2. Ethical issues at the interface of clinical care and research practice in pediatric oncology: a narrative review of parents' and physicians' experiences.

    NARCIS (Netherlands)

    Vries, M.C. de; Houtlosser, M.; Wit, J.M.; Engberts, D.P.; Bresters, D.; Kaspers, G.J.L.; Leeuwen, E. van

    2011-01-01

    BACKGROUND: Pediatric oncology has a strong research culture. Most pediatric oncologists are investigators, involved in clinical care as well as research. As a result, a remarkable proportion of children with cancer enrolls in a trial during treatment. This paper discusses the ethical consequences

  3. Ethical issues at the interface of clinical care and research practice in pediatric oncology: a narrative review of parents' and physicians' experiences.

    NARCIS (Netherlands)

    Vries, M.C. de; Houtlosser, M.; Wit, J.M.; Engberts, D.P.; Bresters, D.; Kaspers, G.J.L.; Leeuwen, E. van

    2011-01-01

    BACKGROUND: Pediatric oncology has a strong research culture. Most pediatric oncologists are investigators, involved in clinical care as well as research. As a result, a remarkable proportion of children with cancer enrolls in a trial during treatment. This paper discusses the ethical consequences o

  4. A systematic review of pediatric clinical trials of high dose vitamin D

    Directory of Open Access Journals (Sweden)

    Nassr Nama

    2016-02-01

    Full Text Available Background. Due to inadequate UV exposure, intake of small quantities of vitamin D is recommended to prevent musculoskeletal disease. Both basic science and observational literature strongly suggest that higher doses may benefit specific populations and have non-musculoskeletal roles. Evaluating the evidence surrounding high dose supplementation can be challenging given a relatively large and growing body of clinical trial evidence spanning time, geography, populations and dosing regimens. Study objectives were to identify and summarize the clinical trial literature, recognize areas with high quality evidence, and develop a resource database that makes the literature more immediately accessible to end users. Methods. Medline (1946 to January 2015, Embase (1974 to January 2015, and Cochrane databases (January 2015, were searched for trials. All pediatric (0–18 years trials administering doses higher than 400 IU (<1 year or 600 IU (≥1 year were included. Data was extracted independently by two of the authors. An online searchable database of trials was developed containing relevant extracted information (http://www.cheori.org/en/pedvitaminddatabaseOverview. Sensitivity and utility were assessed by comparing the trials in the database with those from systematic reviews of vitamin D supplementation including children. Results. A total of 2,579 candidate papers were identified, yielding 169 trials having one or more arms meeting eligibility criteria. The publication rate has increased significantly from 1 per year (1970–1979 to 14 per year (2010–2015. Although 84% of the total trials focused on healthy children or known high risk populations (e.g., renal, prematurity, this proportion has declined in recent years due to the rise in trials evaluating populations and outcomes not directly related to the musculoskeletal actions of vitamin D (27% in 2010s. Beyond healthy children, the only pediatric populations with more than 50 participants from

  5. Detection of crossing vessels in pediatric ureteropelvic junction obstruction: Clinical patterns and imaging findings.

    Science.gov (United States)

    Weiss, Dana A; Kadakia, Sagar; Kurzweil, Rebecca; Srinivasan, Arun K; Darge, Kassa; Shukla, Aseem R

    2015-08-01

    Pediatric ureteropelvic junction obstruction (UPJO) is caused by congenital intrinsic narrowing and/or a lower pole-crossing renal artery. When a crossing renal vessel (CRV) is missed at the time of pyeloplasty, a redo-pyeloplasty is often required. The aims were to analyze clinical predictors for the presence of a CRV in UPJO and the utility of functional magnetic resonance urography (fMRU) in preoperative identification of a crossing vessel. Using an Institutional Review Board approved registry database, we identified 166 patients from July of 2007 until January of 2014 who had undergone open, laparoscopic, or robotic assisted laparoscopic pyeloplasty at our institution. We abstracted data including age at surgery, preoperative symptoms, preoperative imaging findings, and whether or not a CRV was identified intraoperatively. Statistical analysis was performed on SPSS using the Mann-Whitney U test. Of the 166 patients identified, 78 were found to have a CRV at the time of surgery and 88 did not. The surgical approach was distributed as 104 robotic assisted laparoscopic, 51 open, and 11 pure laparoscopic. On univariate analysis, older age at presentation and pain at presentation predicted the presence of a CRV; antenatal hydronephrosis was a negative predictor, though 20 of 68 (25.6%) infants diagnosed with UPJO antenatally did have a CRV. Subgroup analysis of patients undergoing preoperative MRU showed a sensitivity of 88.2% and specificity of 91.7% for the detection of CRVs. This study confirmed the importance of looking for a crossing vessel in all cases, with the knowledge that increased age and pain at presentation were more likely to be associated with a crossing vessel. In addition, fMRU is a valuable source of information in the preoperative identification of the presence of a crossing vessel. The study has limitations including being retrospective in nature, and that the sensitivity of fMRU to identify CRVs was based on the read of an experienced

  6. Implementing a clinical practice guideline for the treatment of bronchiolitis in a high-risk Hispanic pediatric population.

    Science.gov (United States)

    Zamora-Flores, Dora; Busen, Nancy H; Smout, Randall; Velasquez, Otto

    2015-01-01

    Bronchiolitis is the leading cause of hospitalization among infants and young children. Because of its frequency, a clinical practice guideline for bronchiolitis was implemented in this population in an effort to decrease costs and the number of diagnostic evaluations performed and medications used without increasing length of stay or transfers to the pediatric intensive care unit. A retrospective chart review of 322 pediatric admissions to a rural community hospital was conducted (169 before guideline implementation and 153 after guideline implementation), and data were categorically stratified into three groups for comparison purposes. Descriptive statistics were used to analyze the data, with a p value bronchiolitis. Statistically significant decreases in cost per day and decreases in use of antibiotics and chest radiographs were achieved without increasing length of stay or pediatric intensive care unit transfers. This project demonstrated feasibility in implementing an evidence-based clinical practice guideline in a rural hospital to improve patient outcomes. Copyright © 2015 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  7. Inter-radiologist agreement for CT scoring of pediatric splenic injuries and effect on an established clinical practice guideline

    Energy Technology Data Exchange (ETDEWEB)

    Leschied, Jessica R.; Smith, Ethan A.; Ladino-Torres, Maria F.; Dillman, Jonathan R. [University of Michigan Health System, Department of Radiology, Section of Pediatric Radiology, C.S. Mott Children' s Hospital, Ann Arbor, MI (United States); Mazza, Michael B.; Chong, Suzanne T.; Hoff, Carrie N. [University of Michigan Health System, Department of Radiology, Division of Emergency Radiology, C.S. Mott Children' s Hospital, Ann Arbor, MI (United States); Davenport, Matthew S. [University of Michigan Health System, Department of Radiology, Division of Abdominal Imaging, C.S. Mott Children' s Hospital, Ann Arbor, MI (United States); Khalatbari, Shokoufeh [University of Michigan, Michigan Institute for Clinical and Health Research, Ann Arbor, MI (United States); Ehrlich, Peter F. [University of Michigan Health System, Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children' s Hospital, Ann Arbor, MI (United States)

    2016-02-15

    The American Pediatric Surgical Association (APSA) advocates for the use of a clinical practice guideline to direct management of hemodynamically stable pediatric spleen injuries. The clinical practice guideline is based on the CT score of the spleen injury according to the American Association for the Surgery of Trauma (AAST) CT scoring system. To determine the potential effect of radiologist agreement for CT scoring of pediatric spleen injuries on an established APSA clinical practice guideline. We retrospectively analyzed blunt splenic injuries occurring in children from January 2007 to January 2012 at a single level 1 trauma center (n = 90). Abdominal CT exams performed at clinical presentation were reviewed by four radiologists who documented the following: (1) splenic injury grade (AAST system), (2) arterial extravasation and (3) pseudoaneurysm. Inter-rater agreement for AAST injury grade was assessed using the multi-rater Fleiss kappa and Kendall coefficient of concordance. Inter-rater agreement was assessed using weighted (AAST injury grade) or prevalence-adjusted bias-adjusted (binary measures) kappa statistics; 95% confidence intervals were calculated. We evaluated the hypothetical effect of radiologist disagreement on an established APSA clinical practice guideline. Inter-rater agreement was good for absolute AAST injury grade (kappa: 0.64 [0.59-0.69]) and excellent for relative AAST injury grade (Kendall w: 0.90). All radiologists agreed on the AAST grade in 52% of cases. Based on an established clinical practice guideline, radiologist disagreement could have changed the decision for intensive care management in 11% (10/90) of children, changed the length of hospital stay in 44% (40/90), and changed the time to return to normal activity in 44% (40/90). Radiologist agreement when assigning splenic AAST injury grades is less than perfect, and disagreements have the potential to change management in a substantial number of pediatric patients. (orig.)

  8. Cognitive-behavioral therapy for pediatric obsessive-compulsive disorder: Empirical review and clinical recommendations.

    Science.gov (United States)

    Franklin, Martin E; Kratz, Hilary E; Freeman, Jennifer B; Ivarsson, Tord; Heyman, Isobel; Sookman, Debbie; McKay, Dean; Storch, Eric A; March, John

    2015-05-30

    The efficacy of cognitive-behavioral therapy (CBT) for pediatric obsessive-compulsive disorder (OCD) has been the subject of much study over the past fifteen years. Building on a foundation of case studies and open clinical trials, the literature now contains many methodologically sound studies that have compared full CBT protocols to waitlist controls, pill placebo, psychosocial comparison conditions, active medication, combined treatments, and brief CBT. This review is part of a series commissioned by The Canadian Institute for Obsessive Compulsive Disorders (CIOCD) in an effort to publish in one place what is known about the efficacy of treatments for OCD. A total of fourteen studies were identified; collectively their findings support the efficacy of CBT for youth with OCD. CBT protocols that emphasized either strictly behavioral or cognitive conceptualizations have each been found efficacious relative to waitlist controls. Efforts to enhance CBT׳s efficacy and reach have been undertaken. These trials provide guidance regarding next steps to be taken to maximize efficacy and treatment availability. Findings from studies in community clinics suggest that significant treatment benefits can be realized and are not reported only from within academic contexts. These findings bode well for broader dissemination efforts. Recommendations for future research directions are provided.

  9. Flexion type supracondylar humerus fractures: 12 year experience of a pediatric orthopedics clinic.

    Science.gov (United States)

    Turgut, Ali; Kalenderer, Önder; Bozoğlan, Muhammet; Bacaksız, Tayfun; Ağuş, Haluk

    2015-01-01

    This study aims to review flexion type supracondylar humerus fractures in children and treatment options. Forty-seven patients (26 males, 21 females; mean age 8.6±3.2 years; range 4 to 15 years) who admitted to and were hospitalized in a pediatric orthopedics clinic between January 2002 and January 2014 due to flexion type supracondylar humerus fracture were included in this retrospective study. Fractures were classified according to Wilkins modification of Gartland system. Closed reduction and percutaneous pinning (CRPP) were administered in all patients with type 2 and 3 fractures. An overhead traction or open reduction was applied when closed reduction could not be achieved with three manipulations. Patients were evaluated clinically and radiologically. The results were graded according to Flynn criteria. Four patients with type 1 fracture were treated conservatively. Of the remaining patients, we were able to perform CRPP successfully in 36 (83.7%). While six patients (14%) were treated with open reduction and internal fixation, one patient (2.1%) was treated with overhead traction. The results were excellent or good in 44 patients (93.7%). Compared with extension type fractures, these fractures are seen in older children and are rarer. One should be prepared to perform open reduction especially for type 3 fractures. In our study, results of patients with type 3 fractures treated with CRPP were superior.

  10. Multiple Treatments of Pediatric Constraint-Induced Movement Therapy (pCIMT): A Clinical Cohort Study.

    Science.gov (United States)

    DeLuca, Stephanie C; Ramey, Sharon Landesman; Trucks, Mary Rebekah; Wallace, Dorian Ainsworth

    2015-01-01

    Pediatric constraint-induced movement therapy (pCIMT) is one of the most efficacious treatments for children with cerebral palsy (CP). Distinctive components of pCIMT include constraint of the less impaired upper extremity (UE), high-intensity therapy for the more impaired UE (≥ 3 hr/day, many days per week, for multiple weeks), use of shaping techniques combined with repetitive task practice, and bimanual transfer. A critical issue is whether multiple treatments of pCIMT produce additional benefit. In a clinical cohort (mean age = 31 mo) of 28 children with asymmetrical CP whose parents sought multiple pCIMT treatments, the children gained a mean of 13.2 (standard deviation [SD] = 4.2) new functional skills after Treatment 1; Treatment 2 produced a mean of 7.3 (SD = 4.7) new skills; and Treatment 3, 6.5 (SD = 4.2). These findings support the conclusion that multiple pCIMT treatments can produce clinically important functional gains for children with hemiparetic CP.

  11. Bridging the gap between clinical research and knowledge translation in pediatric emergency medicine.

    Science.gov (United States)

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

    2007-11-01

    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.

  12. Cognitive Predictors of Verbal Memory in a Mixed Clinical Pediatric Sample

    Directory of Open Access Journals (Sweden)

    Shelley C. Heaton

    2013-08-01

    Full Text Available Verbal memory problems, along with other cognitive difficulties, are common in children diagnosed with neurological and/or psychological disorders. Historically, these “memory problems” have been poorly characterized and often present with a heterogeneous pattern of performance across memory processes, even within a specific diagnostic group. The current study examined archival neuropsychological data from a large mixed clinical pediatric sample in order to understand whether functioning in other cognitive areas (i.e., verbal knowledge, attention, working memory, executive functioning may explain some of the performance variability seen across verbal memory tasks of the Children’s Memory Scale (CMS. Multivariate analyses revealed that among the cognitive functions examined, only verbal knowledge explained a significant amount of variance in overall verbal memory performance. Further univariate analyses examining the component processes of verbal memory indicated that verbal knowledge is specifically related to encoding, but not the retention or retrieval stages. Future research is needed to replicate these findings in other clinical samples, to examine whether verbal knowledge predicts performance on other verbal memory tasks and to explore whether these findings also hold true for visual memory tasks. Successful replication of the current study findings would indicate that interventions targeting verbal encoding deficits should include efforts to improve verbal knowledge.

  13. Intravenous midazolam sedation in pediatric diagnostic upper digestive endoscopy. A prospective study in a general hospital.

    Science.gov (United States)

    Verhage, Jan; Mulder, Chris J J; Willekens, Frans L A

    2003-12-01

    The positive role of benzodiazepines (Midazolam) in conscious sedation in pediatric patients is widely known. However, problems concerning the role of sedation in diagnostic upper endoscopy are a matter for debate as little is known about dosage and timing. We prospectively evaluated the efficacy, safety and optimal intravenous sedation dosage of midazolam in 257 consecutive patients, aged 2 months to 18 years old, who underwent upper endoscopy of the gastrointestinal tract. The initial midazolam dosage was 0.2 mg/kg Bw (Body weight) i.v. for 1 minute and, if necessary, another 0.1 mg/kg Bw was administered 5 minutes later. If sedation was sufficient, the procedure would be started 4-5 minutes later; if not, another 0.1 - 0.2 mg/kg Bw would be administered. All procedures were performed by a pediatrician together with a gastroenterologist. No serious complications occurred in any of the procedures. Oxygen saturation (OS) was maintained at over 90%, if necessary with blowby oxygen. Flumazenil was administered to 7 children (OS < 90%). Endoscopy could not be completed in 1 child. All endoscopies were completed within 10 minutes. No unexpected hospital admissions were necessary. The mean midazolam dosage was 0.4 mg/kg Bw in patients up to 6 years, for the over 6 years-olds the mean dosage was decreased to 0,2 mg/kg Bw. Particular attention was paid to the importance of informing patients before the procedure. Endoscopic diagnostic procedures can be performed safely and effectively in children with intravenous sedation in a well equipped pediatric endoscopy unit.

  14. Rectal Thiopental versus Intramuscular Ketamine in Pediatric Procedural Sedation and Analgesia; a Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Reza Azizkhani

    2015-01-01

    Full Text Available Introduction: Physicians frequently deal with procedures which require sedation of pediatric patients. Laceration repair is one of them. No study has been performed regarding the comparison between induction of sedation with sodium thiopental and ketamine in laceration repair. Therefore, the present study was aimed to comparison of induced sedation by rectal sodium thiopental and muscular injection of hydrochloride ketamine in pediatric patients need laceration repair. Methods: The presented study is a single-blinded clinical trial performed through 2013 to 2014 in Ayatollah Kashani and Alzahra Hospitals, Isfahan, Iran. Patients from 3 months to 14 years, needed sedation for laceration repair, were entered. Patients were sequentially evaluated and randomly categorized in two groups of hydrochloride ketamine with dose of 2-4 milligram per kilogram and sodium thiopental with dose of 25 milligram per kilogram. Demographic data and vital signs before drug administration and after induction of sedation, Ramsey score, time to onset of action, and sedation recovery time were evaluated. Chi-squared, Mann-Whitney, and Non-parametric analysis of covariance tests were used. P<0.05 was considered as a significant level. Results: In this study 60 pediatric patients were entered. 30 patients with mean age of 42.8±18.82 months were received sodium thiopental and the rest with mean age of 30.08±16.88 months given ketamine. Mann-Whitney test was showed that time to onset of action in sodium thiopental group (28.23±5.18 minutes was significantly higher than ketamine (7.77±4.13 minutes, (p<0.001. The sedation recovery time in ketamine group (29.83±7.70 was higher than sodium thiopental. Depth of sedation had no significant difference between two groups based on Ramsey score (p=0.87. No significant difference was seen between two groups in the respiratory rate (df=1, 58; F=0.002; P=0.96 and heart rate (df=1, 58; F=0.98; P=0.33. However, arterial oxygen

  15. Dental emergencies in a university-based pediatric dentistry postgraduate outpatient clinic: a retrospective study.

    Science.gov (United States)

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

    2001-01-01

    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.

  16. Clinical outcome of pediatric collagenous gastritis: case series and review of literature.

    Science.gov (United States)

    Hijaz, Nadia Mazen; Septer, Seth Steven; Degaetano, James; Attard, Thomas Mario

    2013-03-07

    Collagenous gastritis (CG) is characterized by patchy subepithelial collagen bands. Effective treatment and the clinical and histological outcome of CG in children are poorly defined. The aim of this study is to summarize the published literature on the clinical outcome and response to therapy of pediatric CG including two new cases. We performed a search in Pubmed, OVID for related terms; articles including management and clinical and/or endo-histologic follow up information were included and abstracted. Reported findings were pooled in a dedicated database including the corresponding data extracted from chart review in our patients with CG. Twenty-four patients were included (17 females) with a mean age of 11.7 years. The clinical presentation included iron deficiency anemia and dyspepsia. The reported duration of follow up (in 18 patients) ranged between 0.2-14 years. Despite most subjects presenting with anemia including one requiring blood transfusion, oral iron therapy was only documented in 12 patients. Other treatment modalities were antisecretory measures in 13 patients; proton pump inhibitors (12), or histamine-2 blockers (3), sucralfate (5), prednisolone (6), oral budesonide in 3 patients where one received it in fish oil and triple therapy (3). Three (13%) patients showed no clinical improvement despite therapy; conversely 19 out of 22 were reported with improved symptoms including 8 with complete symptom resolution. Spontaneous clinical resolution without antisecretory, anti-inflammatory or gastroprotective agents was noted in 5 patients (4 received only supplemental iron). Follow up endo-histopathologic data (17 patients) included persistent collagen band and stable Mononuclear cell infiltrate in 12 patients with histopathologic improvement in 5 patients. Neither collagen band thickness nor mononuclear cell infiltrate correlated with clinical course. Intestinal metaplasia and endocrine cell hyperplasia were reported (1) raising the concern of long

  17. Clinical classification in pediatric pulmonary arterial hypertension associated with congenital heart disease

    NARCIS (Netherlands)

    Zijlstra, Willemijn M H; Douwes, Johannes M; Ploegstra, Mark-Jan; Krishnan, Usha; Roofthooft, Marcel; Hillege, Hans L; Ivy, D Dunbar; Rosenzweig, Erika B; Berger, Rolf M F

    2016-01-01

    Congenital heart disease (CHD) is a frequent cause of pediatric pulmonary arterial hypertension (PAH), with diverse etiology and outcome. We aimed to describe phenotypic heterogeneity in pediatric PAH associated with CHD (PAH-CHD), assess the applicability of the Nice CHD classification, and explore

  18. Integrating Interactive Web-Based Technology to Assess Adherence and Clinical Outcomes in Pediatric Sickle Cell Disease

    Directory of Open Access Journals (Sweden)

    Lori E. Crosby

    2012-01-01

    Full Text Available Research indicates that the quality of the adherence assessment is one of the best predictors for improving clinical outcomes. Newer technologies represent an opportunity for developing high quality standardized assessments to assess clinical outcomes such as patient experience of care but have not been tested systematically in pediatric sickle cell disease (SCD. The goal of the current study was to pilot an interactive web-based tool, the Take-Charge Program, to assess adherence to clinic visits and hydroxyurea (HU, barriers to adherence, solutions to overcome these barriers, and clinical outcomes in 43 patients with SCD age 6–21 years. Results indicate that the web-based tool was successfully integrated into the clinical setting while maintaining high patient satisfaction (>90%. The tool provided data consistent with the medical record, staff report, and/or clinical lab data. Participants reported that forgetting and transportation were major barriers for adherence to both clinic attendance and HU. A greater number of self-reported barriers (P<.01 and older age (P<.05 were associated with poorer clinic attendance and HU adherence. In summary, the tool represents an innovative approach to integrate newer technology to assess adherence and clinical outcomes for pediatric patients with SCD.

  19. Adoption of the children's obesity clinic's treatment (TCOCT) protocol into another Danish pediatric obesity treatment clinic

    DEFF Research Database (Denmark)

    Most, Sebastian W; Højgaard, Birgitte; Teilmann, Grete Katrine;

    2015-01-01

    was developed in collaboration with the patient and the family. Patients' height and weight were measured at subsequent visits. There were no exclusion criteria. RESULTS: Three-hundred-thirteen (141 boys) were seen in the clinic in the period of February 2010 to March 2013. At inclusion, the median age......, the mean BMI SDS difference was -0.40 (95% CI: -0.56; -0.25, p intervention 120 patients stopped treatment. Retention rates were 0.76 (95% CI: 0.71; 0.81) after one year and 0.57 (95% CI: 0.51; 0.63) after two years...

  20. Comparative effectiveness of childhood obesity interventions in pediatric primary care: a cluster-randomized clinical trial.

    Science.gov (United States)

    Taveras, Elsie M; Marshall, Richard; Kleinman, Ken P; Gillman, Matthew W; Hacker, Karen; Horan, Christine M; Smith, Renata L; Price, Sarah; Sharifi, Mona; Rifas-Shiman, Sheryl L; Simon, Steven R

    2015-06-01

    Evidence of effective treatment of childhood obesity in primary care settings is limited. To examine the extent to which computerized clinical decision support (CDS) delivered to pediatric clinicians at the point of care of obese children, with or without individualized family coaching, improved body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) and quality of care. We conducted a cluster-randomized, 3-arm clinical trial. We enrolled 549 children aged 6 to 12 years with a BMI at the 95% percentile or higher from 14 primary care practices in Massachusetts from October 1, 2011, through June 30, 2012. Patients were followed up for 1 year (last follow-up, August 30, 2013). In intent-to-treat analyses, we used linear mixed-effects models to account for clustering by practice and within each person. In 5 practices randomized to CDS, pediatric clinicians received decision support on obesity management, and patients and their families received an intervention for self-guided behavior change. In 5 practices randomized to CDS + coaching, decision support was augmented by individualized family coaching. The remaining 4 practices were randomized to usual care. Smaller age-associated change in BMI and the Healthcare Effectiveness Data and Information Set (HEDIS) performance measures for obesity during the 1-year follow-up. At baseline, mean (SD) patient age and BMI were 9.8 (1.9) years and 25.8 (4.3), respectively. At 1 year, we obtained BMI from 518 children (94.4%) and HEDIS measures from 491 visits (89.4%). The 3 randomization arms had different effects on BMI over time (P = .04). Compared with the usual care arm, BMI increased less in children in the CDS arm during 1 year (-0.51 [95% CI, -0.91 to -0.11]). The CDS + coaching arm had a smaller magnitude of effect (-0.34 [95% CI, -0.75 to 0.07]). We found substantially greater achievement of childhood obesity HEDIS measures in the CDS arm (adjusted odds ratio, 2.28 [95% CI, 1

  1. Clinical analysis and prognostic judgment of artificial extracorporeal liver support therapy for pediatric acute liver failure

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    ZHANG Zhen

    2015-08-01

    Full Text Available Objective To observe the clinical efficacy of artificial extracorporeal liver support therapy in the treatment of pediatric acute liver failure (PALF and to analyze the associated prognostic factors. Methods The clinical records of 23 patients with PALF treated from January 2012 to February 2015 in the Pediatric Intensive Care Unit of the First Hospital of Jilin University were analyzed retrospectively. After three-month follow-up, 15 patients survived (survival group, n=15, while 8 patients died (death group, n=8. The changes in biomarkers of liver function and coagulation function after treatment were evaluated within groups. At the same time, the above parameters and Model for End-Stage Liver Disease (MELD score before treatment were compared between the two groups. The efficacy of artificial extracorporeal liver support therapy was analyzed, and the prognostic factors were reviewed. The t test was applied in the comparison of continuous data. Results In the survival group, the levels of serum alanine aminotransferase (ALT, total bilirubin (TBil, ammonia, and lactic acid were significantly reduced after treatment (t=8.812, 6.243, 8.431, and 6.721, respectively; all P<0.01. However, in the death group, only ALT level was significantly reduced after treatment (t=2.532, P<0.05. Compared with the levels before treatment, the levels of prothrombin time (PT, prothrombin time activity (PTA, and international normalized ratio (INR were significantly improved after treatment (t=6.256, -2.738, and 6.711, respectively; all P<0.05. Before treatment, compared with the survival group, patients in the death group presented significantly lower level of ALT (t=6.283,P<0.01, significantly higher level of TBil (t=-3.938, P=0.001, significantly longer PT (t=-2.394, P=0.026, and significantly higher MELD score (t=-6.239, P<0.01. Conclusion Artificial extracorporeal liver support therapy is an effective way of treating PALF. Once patients with high ALT level

  2. Learning Experience of Student Nurses through Reflection on Clinical Practice: A Case Study in Pediatric Nursing, Southern Thailand

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    Charuai SUWANBAMRUNG

    2015-07-01

    Full Text Available This article aims to describe student nurse experiences of clinical practice through their reflections. Forty reflections on clinical practice in a pediatric department were conducted at a tertiary hospital. Student nurses wrote reflections which were then thematically analyzed. Analysis was founded on the following: First, situations of nursing care in medical and surgical pediatrics; Second, clinical practice with nursing care as procedurals; Third, results after student’s activities; and Fourth, reflections of students presented as “what?”, “now what?”, and “new actions?” Particularly, reflections of student nurses were classed into 7 themes; 1 “Significant knowledge for nursing practice”, 2“Better self-confidence for nursing practices”, 3“Patient and family centers”, 4 “Concentration/attention must come first”, 5 “Practice carefully”, 6 “Make students have accountability, honesty, and ethics” and 7 “Mirror for improving intervention in the future as professional nurses”. Overall, student nurses had an improved learning experience in pediatric nursing care through reflection on clinical practice.

  3. Is expertise in pediatric surgery necessary to perform laparoscopic splenectomy in children? An experience from a department of general surgery.

    Science.gov (United States)

    Guaglio, Marcello; Romano, Fabrizio; Garancini, Mattia; Degrate, Luca; Luperto, Margherita; Uggeri, Fabio; Scotti, Mauro; Uggeri, Franco

    2012-06-01

    Splenectomy is frequently required in children for various hematologic pathologic findings. Because of progress in minimally invasive techniques, laparoscopic splenectomy (LS) has become feasible. The objective of this report is to present a monocentric experience and to evaluate the efficacy of and complications observed after laparoscopic splenic procedures in a department of general surgery. 57 consecutive LSs have been performed in a pediatric population between January 2000 and October 2010. There were 33 females and 24 males with a median age of 12 years (range 4-17). Indications were: hereditary spherocytosis 38 cases, idiopathic thrombocytopenic purpura 10, sickle cell disease (SCD) 6, thrombocytopenic thrombotic purpura 2 and non-hodgkin lymphoma 1 case. Patients were operated on using right semilateral position, employing Atlas Ligasure vessel sealing system in 49 cases (86%) and Harmonic Scalpel + EndoGIA in 8. In 24 patients (42.1%), a cholecystectomy was associated. Two patients required conversion to open splenectomy (3.5%). In three cases, a minilaparotomy was performed for spleen removal (5.2%). Accessory spleens were identified in three patients (5.2%). Complications (8.8%) included bleeding (two), abdominal collection (one) and pleural effusion (two). There was no mortality. Average operative time was 128 min (range 80-220). Average length of stay was 3 days (range 2-7). Mean blood loss was 80 ml (range 30-500) with a transfusion rate of 1.7% (one patient). Laparoscopic spleen surgery is safe, reliable and effective in the pediatric population with hematologic disorders and is associated with minimal morbidity, zero mortality, and a short length of stay. Ligasure vessel sealing system shortened operative time and blood loss. On the basis of the results, we consider laparoscopic approach the gold standard for the treatment of these patients even in a department of general surgery.

  4. Clinical Profile, Co-Morbidities and Health Related Quality of Life in Pediatric Patients with Allergic Rhinitis and Asthma

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    Keya R. Lahiri, Milind S. Tullu* and Rachna Kalra

    2010-10-01

    Full Text Available Background: Co-existence of allergic rhinitis (AR and bronchial asthma (BA is well known. We planned to study the clinical profile of patients with AR & BA, the associated co-morbidities and the effect of AR &/ or BA on health related quality of life (HRQOL in Pediatric patients. Methods: Patients attending the Pediatric out-patients department and Pediatric Chest Clinic of tertiary care center were enrolled. The sample size included 100 subjects with BA & AR (Group 1 with control groups of 60 asthmatic children (Group 2 & 40 children suffering from AR (Group 3. The patients were subjected to a questionnaire & a through physical examination and the details were recorded in a pre-designed proforma. General medical, environmental, occupational, personal & family history was procured along with examination of respiratory system. The standard heath related quality of life (HRQOL parameters were studied. Findings: The study was conducted over a period of 13 months (February 2004 to March 2005. 200 patients between ages of 3 to 15 years (mean 7.95 years were enrolled (100 patients with BA and AR- group 1, 60 patients with asthma alone- group 2 and 40 patients with AR alone- group 3. Dust, smoke, outdoor dust, holi festival, winter season, exercise, and smoking by father were important exacerbating factors in all the three groups. Additionally, diwali festival and family history of asthma were important in Group 2 (BA; while pollen, weeds, diwali festival and family history of allergic rhinitis were important causes of exacerbation in group 3 (AR. Cough was commonly seen in all three groups. Wheezing, sneezing, itching throat, rhinorrhea, watering, altered taste, and nasal block was common in patients in group 1 while wheezing was important symptom in patients in group 2 (BA. Sneezing, itching throat, rhinorrhea, watering, altered taste, and nasal block were common symptoms in patients in group 3 (AR. Conjunctivitis, pharyngitis, and post-nasal drip

  5. The clinical features of ankle syndesmosis injuries: a general review.

    Science.gov (United States)

    Kellett, John J

    2011-11-01

    To review the research conclusions relating to clinical aspects of syndesmosis, the incidence and prognosis of syndesmosis injuries, and the effectiveness of the history and clinical examination to reliably diagnose ankle syndesmosis injury. Google Scholar search: Syndesmosis paired with incidence, prognosis, history, and examination in turn. There was no time limit for the search. Articles were selected by reading titles, abstracts, and the full article, if indicated, seeking original articles determining these clinical aspects of syndesmosis injuries. Further articles were derived from the references of the primary articles. The prognosis for isolated syndesmosis injuries, including the time to functional recovery, is unknown. The incidence of acute syndesmosis injury in moderate to severe ankle injuries requiring imaging is of the order of 5%. Historical features and special clinical tests of syndesmosis injury have not been proven reliable by clinical studies using evidence-based diagnostic criteria. Acute local tenderness of the anterior inferior tibiofibular ligament will indicate significant syndesmosis injury in only approximately half of nonspecific ankle injuries. There is limited, evidence-based, standard, published literature from which to draw conclusions regarding the validity or reliability of various clinical special tests for syndesmosis injury. Literature assessing the incidence, prognosis, and clinical features is generally not based on definitively confirmed syndesmosis injuries, which is a critical aspect of evidence-based medicine before valid conclusions can be drawn.

  6. Clinical efficacy and safety of lamotrigine monotherapy in newly diagnosed pediatric patients with epilepsy

    Directory of Open Access Journals (Sweden)

    Ji Hye Han

    2010-04-01

    Full Text Available Purpose : To verify the efficacy and safety of lamotrigine (LTG monotherapy in newly diagnosed children with epilepsy. Methods : We prospectively enrolled 148 children who had undergone LTG monotherapy at our institution between September 2002 and June 2009. Twenty-nine patients were excluded: 19 due to incomplete data and 10 were lost to follow up. The data of the remaining 119 patients was analyzed. Results : We enrolled 119 pediatric epilepsy patients (aged 2.8-19.3 years; 66 males and 53 females in this study. Out of 119 patients, 29 (25.2% had generalized epilepsy and 90 (74.8% had partial epilepsy. The responses of seizure reduction were as follows: Seizure freedom (no seizure attack for at least 6 months in 87/111 (78.4%, n=111 patients; partial response (reduced seizure frequency compared to baseline in 13 (11.7% patients; and persistent seizure in 11 (9.9% patients. The seizure freedom rate was in 81.6% in patients with partial seizure (75.9% for complex partial seizure and 90.9% for benign rolandic epilepsy and 44.8% in patients with generalized epilepsy (30.0% for absence seizure, 35.7% for juvenile myoclonic epilepsy patients, and 100.0% for idiopathic generalized epilepsy patients. Adverse reactions were reported in 17 (14.3% patients, and 8 patients (6.7% discontinued LTG because of rash and tic. No patient experienced severe adverse reaction such as Stevens-Johnson syndrome. Conclusion : LTG showed excellent therapeutic response and had few significant adverse effects. Our findings report may contribute in promoting the use of LTG monotherapy in epileptic children.

  7. Fully liquid DTaP-IPV-Hib pediatric combination vaccine (Pediacel): a review of 18 years of clinical experience.

    Science.gov (United States)

    Reynolds, Donna L; Vidor, Emmanuel

    2014-08-01

    Safe and effective combination pediatric vaccines are necessary to simplify complex immunization schedules and to improve coverage and protection for children worldwide. We provide an overview of the 18 years of clinical and worldwide experience with DTaP-IPV-Hib (Pediacel(®)), a unique fully liquid pentavalent vaccine (diphtheria [D], tetanus [T], acellular pertussis, inactivated poliovirus [IPV], Haemophilus influenzae type b [Hib]). Pediacel has demonstrated good and lasting immunogenicity in many populations, with differing primary series and booster schedules, and with a variety of coadministered vaccines. The acellular pertussis antigens have proven efficacy and real-world effectiveness. Clinical and post-marketing studies confirm the safety of Pediacel. Pediacel can be used for primary series and toddler booster doses, as well as in mixed pediatric vaccine schedules.

  8. Training pediatric clinical pharmacology and therapeutics specialists of the future: the needs, the reality, and opportunities for international networking.

    Science.gov (United States)

    Gazarian, Madlen

    2009-01-01

    In recent years there has been a rapid and marked increase in global recognition of the need for better medicines for children, with various initiatives being implemented at global and regional levels. These exciting developments are matched by recognition of the need to build greater capacity in the field of pediatric clinical pharmacology and therapeutics to help deliver on the promise of better medicines for children. A range of pediatric medicines researchers, educators, clinical therapeutics practitioners, and experts in drug evaluation, regulation, and broader medicines policy are needed on a larger scale, in both developed and developing world settings. The current and likely future training needs to meet these diverse challenges, the current realities of trying to meet such needs, and the opportunities for international networking to help meet future training needs are discussed from a global perspective.

  9. [Clinical-metabolic data base on chronic generalized parodontitis].

    Science.gov (United States)

    Gil'miiarov, E M; Berezhnoĭ, V P; Gil'miiarova, I E; Tlustenko, V P

    2008-01-01

    As the result of clinical-lab study of 40 oral fluid parameters in 176 patients new block of data was received disclosing key pathogenetic links of chronic generalized parodontitis (CGP) to which could be attributed endocrine dysfunction with cortisol level reduction and free thyroid hormones increase, enforcing prooxidant processes with multiple iron content increase. As the result of it molecules of medium mass were accumulated; protein spectrum, protein coupling capacity, content of collagenous C-peptide, osteocalcine, Ca, P and Mg were changing. In comprehensive CGP treatment due to Natursyl (lipophilic fraction of holy thistle) applications the disease clinical signs disappeared quicker and biochemical markers normalized.

  10. Pediatric allergy and immunology in Israel.

    Science.gov (United States)

    Geller-Bernstein, Carmi; Etzioni, Amos

    2013-03-01

    After the geographic and sociodemographic settings as well as the health care in Israel are briefly described, the scope of pediatric allergy and immunology in Israel is presented. This includes specific disorders commonly encountered, the environment that induces symptoms, the specialists who treat them, and the common challenges of patients, parents, doctors, and allied health personnel who collaborate to manage the maladies and patient care. Allergies usually affect some overall 15-20% of the pediatric population. The main allergens are inhaled, ingested, or injected (insects stings). Generally, the incidence of the various allergens affecting children in Israel, is similar to other parts of the Western world. Owing to the high consanguinity rate in the Israeli population, the prevalence of the various immunodeficiency conditions (in the adaptive as well as the innate system) is higher than that reported worldwide. Pediatric allergists/immunologists also treat autoimmune disorders affecting the pediatric group. Pediatric allergy and clinical immunology are not separate specialties. The 25 specialists who treat children with allergic/immunologic diseases have undergone a basic training in Pediatrics. They also received an additional 2-yr training in allergy and clinical immunology and then have to pass the board examinations. They work mainly in pediatric allergy units, in several hospitals that are affiliated to the five medical schools in the country. Aside from clinical work, most of the centers are also heavily involved in clinical and basic research in allergy and immunology.

  11. Profile of special needs patients at a pediatric dentistry clinic - doi:10.5020/18061230.2011.p136

    OpenAIRE

    Tatiany Oliveira de Alencar Menezes; Camila de Almeida Smith; Luciana Teixeira Passos; Helder Henrique Costa Pinheiro; Sílvio Augusto Fernandes de Menezes

    2012-01-01

    Objective: To assess the characteristics of special needs patients assisted at the Clinic of Pediatric Dentistry, Faculty of Dentistry, Federal University of Pará. Methods: A descriptive observational study conducted from March 2007 to December 2009, assessing 137 records of which were extracted the following data: gender, age, origin, current and past medical history, type of special needs and major oral diseases. We applied descriptive statistics, one-dimensional frequency table and p...

  12. CLINICAL PROFILE AND OUTCOME OF ACUTE PEDIATRIC POISONING IN URBAN TERTIARY CARE HOSPITAL

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    Basavaraj

    2015-01-01

    Full Text Available Childhood poisoning is a significant public health problem. Poisoning though an important cause of morbidity and mortality in children, has received little attention over the years. Objective: To determine the clinical profile and outcome of acute poisoning in children admitted to tertiary care hospital in South In dia. MATERIALS AND METHODS: We retrospectively reviewed the hospital records of all children aged 1 month to 18 years with definite history of poisoning during the 2 - years period from January 2013 to December 2014. We took the profile of all cases and note d their outcome. RESULTS: 50 patients presented with acute poisoning during the study period. Majority of children were in the age group between 12 to 18 years (30 cases, 60%. Median age of our patients was 10 years. The majority of our patients resided i n urban areas. Drugs (40%, Kerosene oil (24% and Insecticides (20% were the agents most frequently implicated. 52% cases were suicidal in nature and the above children belonged to age group of 12 to 18 years. Almost all cases in 1 - 6 years age group were accidental in nature. One case of kerosene oil consumption died whereas outcome in other cases was good. CONCLUSION: Poisoning in pediatric age group is a common problem. Incidence of poisoning with suicidal intension is increasing with accidental poisoni ng due to kerosene oil consumption is still common in younger age group

  13. Intestinal parasitic infestation in pediatric gastroenterology outpatient clinic Dr. Pirngadi Hospital Medan.

    Science.gov (United States)

    Yusuf, R; Siregar, C D; Sinuhaji, A B; Sutanto, A H

    1991-01-01

    A retrospective study had been done at the outpatient clinic sub division of Pediatric Gastroenterology, Dr. Pirngcdi Hospital Medan, comprising patients from 1 January 1985-31 December 1987. There were 874 patients. Three hundred seventy eight (43.25%) patients consisting of 210 (55.56%) males and 168 (44.44%) females had intestinal parasitic infestations. The youngest patient was 5 months and the oldest was 14 years and 3 months. Ascaris lumbricoides was found in 215 patients (24.60%) while Trichuris trichiura, hookworm, Oxyuris vermicularis, Hymenolepis nana, and Taenia were in 152 (17.39%), 13 (1.49%), 4 (0.46%), 15 (1.72%) and 4 (0.46%) cases respectively. Entamoeba histolytica was found in 121 (13.84%) and Giardia lamblia in 16 (1.83%) patients. The highest age specific attack rate was found in the age group of 5-10 years (65.67%). Ascaris lumbricoides was most frequently found namely in 100 children (26.46%), followed by Entameba histolytica in 73 (19.31%) and mixed infestation of Ascaris lumbricoides and Trichuris trichiura in 68 (17.99%) patients. One hundred seventy three (66.28%) under five patients with intestinal parasitic infestation had malnutrition while of the 433 under fives without intestinal parasitic infestation only 201 (46.42%) suffered from malnutrition (P less than 0.001).

  14. Household computer and Internet access: The digital divide in a pediatric clinic population.

    Science.gov (United States)

    Carroll, Aaron E; Rivara, Frederick P; Ebel, Beth; Zimmerman, Frederick J; Christakis, Dimitri A

    2005-01-01

    Past studies have noted a digital divide, or inequality in computer and Internet access related to socio-economic class. This study sought to measure how many households in a pediatric primary care outpatient clinic had household access to computers and the Internet, and whether this access differed by socio-economic status or other demographic information. We conducted a phone survey of a population-based sample of parents with children ages 0 to 11 years old. Analyses assessed predictors of having home access to a computer, the Internet, and high-speed Internet service. Overall, 88.9% of all households owned a personal computer, and 81.4% of all households had Internet access. Among households with Internet access, 48.3% had high speed Internet at home. There were significant associations between home computer ownership or Internet access and parental income or education. There was no relationship these factors and high speed Internet access. Over 60% of families with annual household income of $10,000-$25,000, and nearly 70% of families with only a high-school education had Internet access at home. While income and education remain significant predictors of household computer and internet access, many patients and families at all economic levels have access, and might benefit from health promotion interventions using these modalities.

  15. Respiratory viruses in the pediatric intensive care unit: prevalence and clinical aspects

    Directory of Open Access Journals (Sweden)

    Selir M Straliotto

    2004-12-01

    Full Text Available A survey was conducted in two pediatric intensive care units in hospitals in Porto Alegre, Brazil, in order to monitor the main respiratory viruses present in bronchiolitis and/or pneumonia and their involvement in the severity of viral respiratory infections. Viral respiratory infection prevalence was 38.7%. In bronchiolitis, respiratory syncytial virus (RSV was detected in 36% of the cases. In pneumonia, the prevalence rates were similar for adenovirus (10.3% and RSV (7.7%. There was a difference among the viruses detected in terms of frequency of clinical findings indicating greater severity. Frequency of crackles in patients with RSV (47.3% showed a borderline significance (p = 0.055, Fisher's exact test as compared to those with adenovirus (87.5%. The overall case fatality rate in this study was 2.7%, and adenovirus showed a significantly higher case fatality rate (25% than RSV (2.8% (p = 0.005. Injected antibiotics were used in 49% of the children with RSV and 60% of those with adenovirus. Adenovirus was not detected in any of the 33 children submitted to oxygen therapy.

  16. [Pharmaceutical analysis and clinical efficacy of Kampo medicine, maoto, extract suppository against pediatric febrile symptoms].

    Science.gov (United States)

    Nishimura, Nobuhiro; Doi, Norio; Uemura, Tomochika; Taketani, Takeshi; Hayashi, George; Kasai, Takeshi; Kanai, Rie; Yamaguchi, Seiji; Iwamoto, Kikuo; Naora, Kohji

    2009-06-01

    A traditional Chinese herbal medicine, Kampo medicine, maoto, has been widely used in the treatment of febrile symptoms caused by viral infection. This herbal extract granule for oral use, however, is not well accepted by infants or young children due to its unpleasant taste and odor. Therefore, we prepared Kampo medicine, maoto, suppository and investigated the pharmaceutical and clinical efficacy of the suppository. Kampo medicine, maoto, granules were micro-pulverized and homogeneously dispersed into Hosco-H15 to prepare suppositories containing 0.25 to 1.0 g herbal extract by the conventional fusion method. Content of l-ephedrine, an index compound of Kampo medicine, maoto, in the extract granules and suppositories was determined by using a high performance liquid chromatographic method. Physicochemical experiments revealed that the suppository containing 0.5 g herbal extract had the most suitable melting point of 34 degrees C. Contents of l-ephedrine in the suppository were constant, 93-96% of those in the same amount of the extract granules in different three lots. Upper and lower portions of the suppository had the same content of l-ephedrine. The suppository maintained more than 95% of l-ephedrine content through 6 months at 4 degrees C, room temperature and 40 degrees C, although maldistribution of the extract constituent was observed after storage at 40 degrees C. The suppository was administered to 21 pediatric febrile patients at a dose of 1/3 to 2 full pieces depending on their body weight and physical status. Significant reduction (psuppository was found to satisfy the physicochemical quality and quantity standards as well as to be clinically applicable to neonates, infants and children with viral febrile symptoms without any adverse effects.

  17. Frequency of Metabolic Risk Factors in Children with Urinary Tract Stones Referred to Hamadan Pediatric Nephrology Clinic

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    H.E. Momtaz

    2012-07-01

    Full Text Available Introduction & Objective: Urinary stones are among the most common complaints referred to nephrologist and urologists. Although incidence of urolithiasis is low in children compared to adults and only 7% of all urinary stones are diagnosed before the age of 16 but stones are detected more frequently in pediatric age group in recent years. Metabolic derangements, infection, neurogenic bladder and urinary obstruction are major risk factors of urolithiasis. Common metabolic risk factors of urolithiasis in children are hypercalciuria, uricosuria, hypocitraturia, hyperoxaluria, metabolic acidosis and cystinuria. There are many clinical studies about the frequency of these metabolic risk factors with different results reflecting difference in diet, geographic area and genetics in study populations. In this study we tried to evaluate the frequency of metabolic causes of urinary stones in children referred to Hamadan pediatric nephrology clinic.Materials & Methods: In this cross sectional-descriptive study 156 patients referred due to urinary stones to pediatric nephrology clinic underwent thorough metabolic evaluations including: serum calcium,phosphorus, uric acid, creatinine and non fasting random urine sample for calcium, creatinine , uric acid , oxalate, citrate and cystine . urine solute: creatinine ratios were calculated and compared with normative data.Results: Of 156 patients 136(87.2% had metabolic derangements including: hyperuricosuria in 71 (45.5%, hypercalciuria in 41(26.3%, hypocitraturia in 26 (16.7%, hyperoxaluria in 16(10.3%,cystinuria in 1(0.6% and metabolic acidosis in 39 (25%.Conclusion: High rate of metabolic derangement in pediatric urinary stone patients mandates proper metabolic evaluation in all of them. hyperuricosuria was the most common metbolic finding instead of hypercalciuria in this study. This could be due to differences in diet, geographic area and genetic background in various populations.(Sci J Hamadan Univ Med Sci

  18. Advanced general dentistry program directors' attitudes on physician involvement in pediatric oral health care.

    Science.gov (United States)

    Raybould, Ted P; Wrightson, A Stevens; Massey, Christi Sporl; Smith, Tim A; Skelton, Judith

    2009-01-01

    Childhood oral disease is a significant health problem, particularly for vulnerable populations. Since a major focus of General Dentistry Program directors is the management of vulnerable populations, we wanted to assess their attitudes regarding the inclusion of physicians in the prevention, assessment, and treatment of childhood oral disease. A survey was mailed to all General Practice Residency and Advanced Education in General Dentistry program directors (accessed through the ADA website) to gather data. Spearman's rho was used to determine correlation among variables due to nonnormal distributions. Overall, Advanced General Dentistry directors were supportive of physicians' involvement in basic aspects of oral health care for children, with the exception of applying fluoride varnish. The large majority of directors agreed with physicians' assessing children's oral health and counseling patients on the prevention of dental problems. Directors who treated larger numbers of children from vulnerable populations tended to strongly support physician assistance with early assessment and preventive counseling.

  19. Dual-energy compared to single-energy CT in pediatric imaging: a phantom study for DECT clinical guidance

    Energy Technology Data Exchange (ETDEWEB)

    Zhu, Xiaowei; Servaes, Sabah; Darge, Kassa [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); University of Pennsylvania, The Perelman School of Medicine, Philadelphia, PA (United States); McCullough, William P. [University of Virginia Health System, Department of Radiology and Medical Imaging, Charlottesville, VA (United States); Mecca, Patricia [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States)

    2016-11-15

    Dual-energy CT technology is available on scanners from several vendors and offers significant advantages over classic single-energy CT technology in multiple clinical applications. Many studies have detailed dual-energy CT applications in adults and several have evaluated the relative radiation dose performance of dual-energy CT in adult imaging. However, little has been published on dual-energy CT imaging in the pediatric population, and the relative dose performance of dual-energy CT imaging in the pediatric population is not well described. When evaluating dual-energy CT technology for implementation into a routine clinical pediatric imaging practice, the radiation dose implications must be considered, and when comparing relative CT dose performance, image quality must also be evaluated. Therefore the purpose of this study is to develop dual-energy CT scan protocols based on our optimized single-energy scan protocols and compare the dose. We scanned the head, chest and abdomen regions of pediatric-size anthropomorphic phantoms with contrast inserts, using our optimized single-energy clinical imaging protocols on a Siemens Flash {sup registered} CT scanner. We then scanned the phantoms in dual-energy mode using matching image-quality reference settings. The effective CT dose index volume (CTDI{sub vol}) of the scans was used as a surrogate for relative dose in comparing the single- and dual-energy scans. Additionally, we evaluated image quality using visual assessment and contrast-to-noise ratio. Dual-energy CT scans of the head and abdomen were dose-neutral for all three phantoms. Dual-energy CT scans of the chest showed a relative dose increase over the single-energy scan for 1- and 5-year-old child-based age-equivalent phantoms, ranging 11-20%. Quantitative analysis of image quality showed no statistically significant difference in image quality between the single-energy and dual-energy scans. There was no clinically significant difference in image quality by

  20. Experimenting clinical pathways in general practice: a focus group investigation with Italian general practitioners

    Directory of Open Access Journals (Sweden)

    Lucia Zannini

    2012-07-01

    Full Text Available Background. Clinical governance is considered crucial in primary care. Since 2005, clinical pathways have been experimentally implemented at the Local Health Authority of Monza Brianza (ASLMB, Italy, to develop general practitioners’ (GPs care of patients affected by some chronic diseases. The experimentation was aimed at introducing clinical governance in primary care, increasing GPs’ involvement in the care of their patients, and improving both patients’ and professionals’ satisfaction. In the period 2005-2006, 12% of the 763 employed GPs in the ASLMB were involved in the experiment, while this percentage increased to 15-20% in 2007-2008. Design and Methods. Twenty-four GPs were purposively sampled, randomly divided into two groups and asked to participate in focus groups (FGs held in 2008, aimed at evaluating their perception of the experiment. The FGs were audio-recorded, dialogues were typed out and undergone to a thematic analysis, according to the Interpretative Phenomenological Approach. Results. Four major themes emerged: i clinical pathways can result in GPs working in a more efficient and effective fashion; ii they can assure higher levels of both patient and professional satisfaction, since they sustain a caring approach and strengthen the GPs’ role; iii nevertheless, clinical pathways increase the bureaucratic workload and problems can arise in relationships among GPs and the LHA; iv the implementation of clinical pathways can be improved, especially by reducing bureaucracy and by assuring their continuity. Conclusions. Managerial aspects should be considered with care in order to experimentally introduce clinical pathways in general practice, and continuity of the experimentation should be guaranteed to improve GPs’ adherence and commitment.

  1. Tumor angiogenesis and its clinical significance in pediatric malignant liver tumor

    Institute of Scientific and Technical Information of China (English)

    Xiao-Yi Sun; Zai-De Wu; Xiao-Feng Liao; Ji-Yan Yuan

    2005-01-01

    AIM: To investigate the expression of vascular endothelial growth factor (VEGF) and microvascular density (MVD) count in pediatric malignant liver tumor and their dinical significances.METHODS: Fourteen children with malignant liver tumors including seven hepatocellular carcinomas (HCCs), five hepatoblastomas, one malignant mesenchymoma and one rhabdomyosarcoma were studied. Twelve adult HCC samples served as control group. All samples were examined with streptavidin-biotin peroxidase (SP) immunohistochemical staining for VEGF expression and MVD count.RESULTS: VEGF positive expression in all pediatric malignant liver tumors was significantly higher than that in adult HCC(0.4971±0.14 vs 0.4027±0.03, P<0.05). VEGF expression in pediatric HCC group was also markedly higher than that in adult HCC group (0.5665±0.10 vs 0.4027±0.03,P<0.01) and pediatric non-HCC group (0.5665±0.10 vs0.4276±0.15, P<0.05). The mean value of MVD in pediatric malignant liver tumors was significantly higher than that in adult HCC (33.66±12.24 vs 26.52±4.38, P<0.05).Furthermore, MVD in pediatric HCC group was significantly higher compared to that in adult HCC group (36.94±9.28 vs26.52±4.38, P<0.05), but there was no significant difference compared to the pediatric non-HCC group (36.94±9.28 vs30.37±14.61, P>0.05). All 7 children in HCC group died within2 years, whereas the prognosis in pediatric non-HCC group was better, in which two patients survived more than 5 years.CONCLUSION: Children with malignant liver tumors,especially with HCC, may have extensive angiogenesis that induces a rapid tumor growth and leads to a poor prognosis.

  2. [A case of a pediatric patient with tuberous sclerosis (Bourneville-Pringle disease) and frequent epileptic seizure for intensive dental treatment under general anesthesia].

    Science.gov (United States)

    Mimura, Shinichiro; Kikura, Mutsuhito; Itagaki, Taiga; Inokuma, Mie; Iwamoto, Tatsuaki; Kawakubo, Atsushi; Hirano, Kazuhiro; Sato, Shigehito

    2006-04-01

    Tuberous sclerosis (Bourneville-Pringle disease) is a rare disease with a triad of mental retardation, epilepsy, and facial spot. Management of the patients with tuberous sclerosis under general anesthesia has been previously reported. However, there are few case reports about management under general anesthesia of a pediatric patient with tuberous sclerosis with frequent epileptic seizure. Here, we report a case of a pediatric patient with tuberous sclerosis and frequent epileptic seizure who underwent intensive dental treatment under general anesthesia with careful management of epilepsy. The patient was discharged on the day of surgery without any complications. In this case report, we discussed the appropriate assessment of the complications of tuberous sclerosis; such as, of central nervous, circulatory, respiratory, endocrine, and urinary systems including the management of general anesthesia.

  3. Cardiomyopathy in congenital and acquired generalized lipodystrophy: a clinical assessment.

    Science.gov (United States)

    Lupsa, Beatrice C; Sachdev, Vandana; Lungu, Andreea O; Rosing, Douglas R; Gorden, Phillip

    2010-07-01

    Lipodystrophy is a rare disorder characterized by loss of adipose tissue and low leptin levels. This condition is characterized by severe dyslipidemia, insulin resistance, diabetes mellitus, and steatohepatitis. Another phenotypic feature that occurs with considerable frequency in generalized lipodystrophy is cardiomyopathy. We report here the cardiac findings in a cohort of patients with generalized congenital and acquired lipodystrophy, and present a literature review of the cardiac findings in patients with generalized lipodystrophy. We studied 44 patients with generalized congenital and acquired lipodystrophy, most of them enrolled in a clinical trial of leptin therapy. Patients underwent electrocardiograms and transthoracic echocardiograms to evaluate their cardiac status. We followed these patients for an extended time period, some of them up to 8 years. Evaluation of our cohort of patients with generalized lipodystrophy shows that cardiomyopathy is a frequent finding in this population. Most of our patients had hypertrophic cardiomyopathy, and only a small number had features of dilated cardiomyopathy. Hypertrophic cardiomyopathy was more frequent in patients with seipin mutation, a finding consistent with the literature. The underlying mechanism for cardiomyopathy in lipodystrophy is not clear. Extreme insulin resistance and the possibility of a "lipotoxic cardiomyopathy" should be entertained as possible explanations.

  4. Sudden benzodiazepine-induced resolution of post-operative pediatric cerebellar mutism syndrome: a clinical-SPECT study.

    Science.gov (United States)

    Nicita, Francesco; Paiano, Milena; Liberatore, Mauro; Spalice, Alberto; Papoff, Paola; Ullo, Mariacristina; Piccirilli, Manolo; Clerico, Anna; Schiavetti, Amalia

    2017-03-01

    Post-operative pediatric cerebellar mutism syndrome (PPCMS) is a clinical syndrome arising from cerebellar injury and characterized by absence of speech and other possible symptoms and signs. Rare reports described some benefit after administration of dopamine agonist therapy, but no treatment has proven efficacy. In this paper, we report on the dramatic, sudden resolution of PPCMS induced by midazolam administration in a boy who underwent posterior fossa surgery for choroid plexus papilloma of the fourth ventricle. In addition to clinical improvement, post-midazolam single-photon emission computed tomography also demonstrated amelioration of brain perfusion.

  5. Quality of Life in Childhood Epilepsy in pediatric patients enrolled in a prospective, open-label clinical study with cannabidiol.

    Science.gov (United States)

    Rosenberg, Evan C; Louik, Jay; Conway, Erin; Devinsky, Orrin; Friedman, Daniel

    2017-08-01

    Recent clinical trials indicate that cannabidiol (CBD) may reduce seizure frequency in pediatric patients with certain forms of treatment-resistant epilepsy. Many of these patients experience significant impairments in quality of life (QOL) in physical, mental, and social dimensions of health. In this study, we measured the caregiver-reported Quality of Life in Childhood Epilepsy (QOLCE) in a subset of patients enrolled in a prospective, open-label clinical study of CBD. Results from caregivers of 48 patients indicated an 8.2 ± 9.9-point improvement in overall patient QOLCE (p Epilepsy.

  6. Clinical characteristics of pediatric hospitalizations associated with 2009 pandemic influenza A (H1N1 in Northern Bavaria, Germany

    Directory of Open Access Journals (Sweden)

    Wieching Anna

    2012-06-01

    Full Text Available Abstract Background The 2009 pandemic influenza A (H1N1 (PIA virus infected large parts of the pediatric population with a wide clinical spectrum and an initially unknown complication rate. The aims of our study were to define clinical characteristics and outcome of pandemic influenza A (H1N1 2009-associated hospitalizations (PIAH in children Results Between July 2009 and March 2010, 94 PIAH (62% males occurred in children Conclusions Most PIAH demonstrated a benign course of disease. However, six children (6% needed treatment at an intensive care unit for severe complications.

  7. Analysis of Potential Drug-Drug Interactions and Its Clinical Manifestation of Pediatric Prescription on 2 Pharmacies in Bandung

    Directory of Open Access Journals (Sweden)

    Melisa I. Barliana

    2013-09-01

    Full Text Available The potential of Drug-Drug Interactions (DDI in prescription have high incidence around the world, including Indonesia. However, scientific evidence regarding DDI in Indonesia is not available. Therefore, in this study we have conducted survey in 2 pharmacies in Bandung against pediatric prescription given by pediatrician. These prescriptions then analyzed the potential for DDI contained in the prescription and clinical manifestation. The analysis showed that in pharmacy A, there are 33 prescriptions (from a total of 155 prescriptions that have potential DDI, or approximately 21.19% (2 prescriptions have the potential DDI major categories, 23 prescriptions categorized as moderate, and 8 prescriptions as minor. In Pharmacy B, there are 6 prescriptions (from a total of 40 prescriptions or 15% of potential DDI (4 prescriptions categorized as moderate and 2 prescriptions as minor. This result showed that potential DDI happened less than 50% in pediatric prescription from both pharmacies. However, this should get attention because DDI should not happen in a prescription considering its clinical manifestations caused by DDI. Moreover, current pharmaceutical care refers to patient oriented than product oriented. In addition, further study for the pediatric prescription on DDI incidence in large scale need to be investigated.

  8. Optimizing resources for the surgical care of children: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee consensus statement.

    Science.gov (United States)

    Goldin, Adam B; Dasgupta, Roshni; Chen, Li Ern; Blakely, Martin L; Islam, Saleem; Downard, Cynthia D; Rangel, Shawn J; St Peter, Shawn D; Calkins, Casey M; Arca, Marjorie J; Barnhart, Douglas C; Saito, Jacqueline M; Oldham, Keith T; Abdullah, Fizan

    2014-05-01

    The United States' healthcare system is facing unprecedented pressures: the healthcare cost curve is not sustainable while the bar of standards and expectations for the quality of care continues to rise. Systems committed to the surgical treatment of children will likely require changes and reorganization. Regardless of these mounting pressures, hospitals must remain focused on providing the best possible care to each child at every encounter. Available clinical expertise and hospital resources should be optimized to match the complexity of the treated condition. Although precise criteria are lacking, there is a growing consensus that the optimal combination of clinical experience and hospital resources must be defined, and efforts toward this goal have been supported by the Regents of the American College of Surgeons, the members of the American Pediatric Surgical Association, and the Society for Pediatric Anesthesia (SPA) Board of Directors. The topic of optimizing outcomes and the discussion of the concepts involved have unfortunately become divisive. Our goals, therefore, are 1) to provide a review of the literature that can provide context for the discussion of regionalization, volume, and optimal resources and promote mutual understanding of these important terms, 2) to review the evidence that has been published to date in pediatric surgery associated with regionalization, volume, and resource, 3) to focus on a specific resource (anesthesia), and the association that this may have with outcomes, and 4) to provide a framework for future research and policy efforts.

  9. Pediatric cancer gone viral. Part II: potential clinical application of oncolytic herpes simplex virus-1 in children

    Directory of Open Access Journals (Sweden)

    Gregory K Friedman

    2015-01-01

    Full Text Available Oncolytic engineered herpes simplex viruses (HSVs possess many biologic and functional attributes that support their use in clinical trials in children with solid tumors. Tumor cells, in an effort to escape regulatory mechanisms that would impair their growth and progression, have removed many mechanisms that would have protected them from virus infection and eventual virus-mediated destruction. Viruses engineered to exploit this weakness, like mutant HSV, can be safely employed as tumor cell killers, since normal cells retain these antiviral strategies. Many preclinical studies and early phase trials in adults demonstrated that oncolytic HSV can be safely used and are highly effective in killing tumor cells that comprise pediatric malignancies, without generating the toxic side effects of nondiscriminatory chemotherapy or radiation therapy. A variety of engineered viruses have been developed and tested in numerous preclinical models of pediatric cancers and initial trials in patients are underway. In Part II of this review series, we examine the preclinical evidence to support the further advancement of oncolytic HSV in the pediatric population. We discuss clinical advances made to date in this emerging era of oncolytic virotherapy.

  10. Clinical Signs, Causes, and Risk Factors of Pediatric Chronic Kidney Diseases: a Hospital-based Case-control Study

    Directory of Open Access Journals (Sweden)

    Parsa Yousefichaijan

    2016-06-01

    Full Text Available Background This retrospective study aimed to determine the epidemiologic characteristics and risk factors of chronic kidney diseases (CKD in patients < 18 years old at a single referral center. Materials and Methods In a hospital-based case control study, 66 CKD patients less than 18 years old were compared to 81 control patients (also under 18 without CKD. A patient was defined as a CKD case with renal injury and/or had a glomerular filtration rate (GFR of Results Fever, chills, and urinary tract infections were the most common clinical signs in the referred patients. Urinary tract infection (39.5% and growth failure (12.9% were the most important causes in referred pediatric CKD. After controlling the effect of confounding variables, household income, using packed water for drinking, percentile of body mass index (BMI, and gestational age were the significant predictors of pediatric CKD (P

  11. Palpable pediatric thyroid abnormalities – diagnostic pitfalls necessitate a high index of clinical suspicion: a case report

    Directory of Open Access Journals (Sweden)

    Klopper Joshua P

    2007-06-01

    Full Text Available Abstract A 12-year-old girl presented with a 4 year history of an enlarged, firm thyroid gland. On exam, her thyroid was firm and fixed and an enlarged cervical lymph node was palpable as well. Though a thyroid ultrasound prior to referral was read as thyroiditis, clinical suspicion for thyroid carcinoma mandated continued investigation. The diagnosis of papillary thyroid cancer was established and her workup revealed lymph node metastases as well as a tremendous burden of pulmonary metastases. Pediatric thyroid cancer is extremely rare, but often presents with aggressive disease. Palpable thyroid abnormalities in an individual under 20-years-old should be viewed with suspicion and should be thoroughly investigated to rule out malignancy even in the face of negative diagnostic procedures. Though pediatric papillary thyroid cancer often presents with loco-regional and even distant metastatic disease, mortality rates in follow-up for as long as 20 years are very favorable.

  12. Effect of pre-cooling injection site on pain perception in pediatric dentistry: “A randomized clinical trial”

    Science.gov (United States)

    Ghaderi, Faezeh; Banakar, Shahin; Rostami, Shima

    2013-01-01

    Background: Injection of local anesthesia is one of the most important reasons for development of avoidance behavior in children. Efforts have been performed to decrease pain perception of injection. The present research evaluated the effect of cooling the injection site on pain perception before infiltration of local anesthetics. Materials and Methods: A prospective single-blind crossover clinical trial was used to investigate pain perception in 50 healthy pediatric patients who needed bilateral buccal infiltration of local anesthetics for dental treatment. They received a topical anesthetic agent (Benzocaine) on one side (control) for 1 min and topical anesthetic agent plus one minute of ice pack on the other side (trial) prior to the injection. A dentist blind to the study assessed the patients’ reaction during injection. Wilcoxon and Mann-Whitney U tests were used for statistical analysis. Statistical significance was defined at P pediatric patients. PMID:24379869

  13. ASSOCIATION BETWEEN BINGE EATING AND ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) IN TWO PEDIATRIC COMMUNITY MENTAL HEALTH CLINICS

    Science.gov (United States)

    Reinblatt, Shauna P.; Leoutsakos, Jeannie-Marie S.; Mahone, E. Mark; Forrester, Sarah; Wilcox, Holly C.; Riddle, Mark A.

    2014-01-01

    Objective Attention-Deficit/ Hyperactivity Disorder (ADHD) has been linked with obesity; however its relationship with binge eating (BE) is less clear. We aimed to explore the associations among ADHD, weight and BE in pediatric mental health clinics. Method We retrospectively reviewed consecutive intakes in two pediatric mental health clinics (N=252). BE was assessed using the C-BEDS scale. Associations between ADHD, BE, and BMI-z score were assessed via regression. Results Mean age was 10.8 (3.7 SD) years. Twelve percent (n= 31) had BE. The association between ADHD and BE was statistically significant (OR 16.1, p < 0.001), and persisted after adjusting for comorbid diagnoses, medications, demographic variables and clinic. There was a statistically significant association between ADHD and BMI z-scores (β=0.54, p < 0.001). After adjusting for BE, the relationship between ADHD and BMI z-scores was attenuated (β=0.35, p=0.025), and the coefficient for BE was decreased (β=0.75, p=0.001). Although stimulant use was associated with a three-fold increase in odds of BE (OR 3.16, p=0.006), stimulants were not associated with greater BMI-z scores (β=0.18, p=0.32). Discussion There was a significant association between ADHD and BE in two pediatric mental health clinics. Although these data are cross-sectional, and cannot be used to make causal inferences, these findings are compatible with the hypothesis that BE partially mediates the association between ADHD and BMI z-scores. In mental health clinics, children with ADHD may present as overweight or obese. Further, children with ADHD may exhibit BE. Future prospective studies should elucidate the complex relationships among ADHD, weight, stimulants and BE. PMID:25130278

  14. General and Maladaptive Personality Dimensions in Pediatric Obsessive-Compulsive Symptoms

    Science.gov (United States)

    Aelterman, Nathalie; De Clercq, Barbara; De Bolle, Marleen; De Fruyt, Filip

    2011-01-01

    Obsessive-compulsive disorder (OCD) is a chronic and impairing clinical disorder in childhood, often characterized by a heterogeneous symptomatic profile and high co-occurrence with other disorders. The present study introduces a new perspective on the description of OCD symptoms in youth, and empirically examines the value of a personality…

  15. Pediatric Oncology Clinic Care Model: Achieving Better Continuity of Care for Patients in a Medium-sized Program.

    Science.gov (United States)

    Johnston, Donna L; Halton, Jacqueline; Bassal, Mylène; Klaassen, Robert J; Mandel, Karen; Ramphal, Raveena; Simpson, Ewurabena; Peckan, Li

    2016-10-25

    Providing the best care in both the inpatient and outpatient settings to pediatric oncology patients is all programs goal. Using continuous improvement methodologies, we changed from a solely team-based physician care model to a hybrid model. All patients were assigned a dedicated oncologist. There would then be 2 types of weeks of outpatient clinical service. A "Doc of the Day" week where each oncologist would have a specific day in clinic when their assigned patients would be scheduled, and then a "Doc of the Week" week where one physician would cover clinic for the week. Patient satisfaction surveys done before and 14 months after changing the model of care showed that patients were very satisfied with the care they received in both models. A questionnaire to staff 14 months after changing showed that the biggest effect was increased continuity of care, followed by more efficient clinic workflow and increased consistency of care. Staff felt it provided better planning and delivery of care. A hybrid model of care with a primary physician for each patient and assigned clinic days, alternating with weeks of single physician coverage is a feasible model of care for a medium-sized pediatric oncology program.

  16. Clinical features of severe malnutrition at the pediatric ward of Dr. Pirngadi Hospital Medan.

    Science.gov (United States)

    Barus, S T; Rani, R; Lubis, N U; Hamid, E D; Tarigan, S

    1990-01-01

    A retrospective study on severe malnutrition concerning children hospitalized at the Pediatric ward of Dr. Pirngadi Hospital, Medan from January 1 to December 31, 1988 was conducted. Patients less than five years old were included in this study. The purpose of this study was to know the incidence of severe malnutrition, its symptoms and signs, the immunization status, feeding pattern and socio-economic factors. Out of the 3370 hospitalized patients, 2453 (72.78%) were children under five years old. Of these, 312 (12%) suffered from severe malnutrition. It consisted of marasmus 131 (41.9%), marasmic kwashiorkor 94 (30.1%) and kwashiorkor 87 (27.8%). The highest incidence was found in the age group of 0-2 years (58%). Clinical manifestation of marasmus were old man face (131 or 100%), muscular hypotrophy (118 or 71.9%) and decreased subcutaneous fat (116 or 71.1%) in marasmic kwashiorkor children 46 or 50% had their hair easily picked out, 45 or 46.3% showed hyperpigmentation and 48 or 52% had pretibial edema in the kwashiorkor group 29 or 63% had moon face, 52 or 60.4% showed crazy pavement dermatosis, 77 or 51.3% had hepatomegaly and 87 or 48% pretebial edema. Moon face was seen in 29 (63%), crazy Pavement Dermatosis in 52 (60.4%), hepatomegaly in 77 (51.3%), and pretebial edema in 87 (48%) of kwashiorkor cases. The accompanying diseases were mostly diarrhea (95%) and bronchopneumonia (22%). Immunization status showed that BCG comprised 50.6%, while DPT III and OPV III in 13.7% and 10.5% respectively and measles only 0.64%. More than half (59.6%) of them were breast-fed up to 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. Scandinavian clinical practice guidelines on general anaesthesia for emergency situations

    DEFF Research Database (Denmark)

    Gadegaard Jensen, Anders; Callesen, T; Hagemo, J S;

    2010-01-01

    Emergency patients need special considerations and the number and severity of complications from general anaesthesia can be higher than during scheduled procedures. Guidelines are therefore needed. The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care...... Medicine appointed a working group to develop guidelines based on literature searches to assess evidence, and a consensus meeting was held. Consensus opinion was used in the many topics where high-grade evidence was unavailable. The recommendations include the following: anaesthesia for emergency patients...

  18. Effects of parental gender and level of education on the quality of life and general health of pediatric patients with epilepsy: An outpatient cross-sectional survey.

    Science.gov (United States)

    Iqbal, Meisam; Amirsalari, Susan; Radfar, Shokofeh; Haidari, Mohsen Reza

    2016-07-01

    The quality of life (QOL) of children with epilepsy has been widely studied, and several problems related to cognition, behavior, social lives, and physical activity among these children have been reported. Family life and parental care are important aspects of the lives of these patients. The impact of parental education on the QOL of pediatric patients with epilepsy is an understudied topic, especially in developing countries. In this study, we investigated the QOL and general health (GH) of patients with epilepsy presenting at the pediatric neurology clinic at Baqiyatallah Hospital and a private clinic. The Quality of Life in Childhood Epilepsy (QOLCE) questionnaire, which is a 92-item epilepsy-specific questionnaire covering physical activity, well-being, cognition, behavior, social activity, overall QOL, and GH, was used for interviewing parents. A total of 106 patients (m=61, 57.5% and f=45, 42.5%) aged 5-17years (mean: 10.31±2.91) participated in the study. Overall, there was no significant difference between the QOL and GH results of male and female patients. However, the maternal education level had a significant impact on the overall QOL (high school: 3.02±0.85 vs. B.Sc.: 3.67±0.61, peducation had no significant effect. A multiple linear regression showed that the maternal education level had an independently significant association with the physical activity of the patients (p=0.02, CI: 1.4-6.25), and the paternal education level had an independently significant association with the well-being of the patients (p=0.02, CI: 0.43-5.36). In addition, the maternal education level (high school vs. B.Sc.) had a significant effect on physical activity, well-being, cognition, and behavior for all of the patients (peducation level (high school vs. B.Sc.) had no significant impact. However, in a comparison of high school vs. higher education, paternal education had a significant effect on patients' physical activity and well-being (peducation play a significant

  19. [Using Objective Structured Clinical Examination (OSCE) across different levels of pediatric training].

    Science.gov (United States)

    Di Lalla, Sandra; Manjarin, Mercedes; Torres, Fernando; Ossorio, María Fabiana; Wainsztein, Raquel; Ferrero, Fernando

    2014-01-01

    Antecedentes:Evaluar competencias profesionales es objetivo principal de todo programa de capacitación; el examen clínico objetivo estructurado (ECOE) es una herramienta útil para explorarlas. Objetivo:Describimos la implementación del ECOE en tres instancias de enseñanza de la pediatría (carrera de especialista, módulo pediatría del internado anual rotatorio, materia pediatría en el grado). Métodos: En relación con situaciones y patologías frecuentes en pediatría, se evaluaron conocimiento aplicado, juicio clínico y habilidad comunicacional. Resultados: En el posgrado el ECOE se aplica desde hace 8 años, examinando 330 alumnos, con 60%-82% de aprobación. En el Internado Anual Rotatorio el ECOE se emplea desde hace 2 años, examinando 12 alumnos, con 84% de aprobación. En el grado el ECOE se empleó sólo en una oportunidad, examinando 15 alumnos, con 93,4% de aprobación. Conclusión:En nuestra experiencia, a pesar de desafíos logísticos, la implementación del ECOE fue factible en distintas instancias de enseñanza de la pediatría.

  20. The use of general anesthesia in pediatric dental care of children at multi-dental centers in Saudi Arabia.

    Science.gov (United States)

    Ba'akdah, Rania; Farsi, Najat; Boker, Abdulaziz; Al Mushayt, Abdullah

    2008-01-01

    High caries reports in young Saudi children strongly suggest the need occasionally for general anesthesia to provide quality dental work. The purpose of this study was to investigate the characteristics of patients, dental procedures and hospital protocols for Pediatric Dental General Anesthesia (PDGA) procedure at multi-dental centers in Jeddah, Saudi Arabia. Study sample included 90 children attending PDGA treatment at three governmental hospitals in Jeddah. Collected data included patient's demographics, medical condition, admission type, intra-operative protocols, and dental procedures. Results showed the mean age of treated children was 5 +/- 2 years and the majority of them (93%) were treated for the first time under general anesthesia (GA). Long waiting duration for PDGA procedure was reported regardless of the patient age and medical status. Being very young with extensive caries was the major indication for GA (58%). Children mean preoperative fasting times were 10 +/- 2 hours. Hospitals were significantly different in some protocols for PDGA procedures. Child behavior during GA induction was significantly related to child's age, premedication use, and hospital admission type. The mean number of treated teeth per child was 14 +/- 3.8 and the treatment mostly included restorations. Age was found to significantly affect the type of dental treatment, while gender and medical status did not. PDGA procedure is used mostly for young children with extensive dental caries. Children treated under GA received a comprehensive dental care in Saudi hospitals. Efforts should be directed to improve some of the existing hospitals protocols with PDGA procedure. The long waiting period for PDGA operation indicated the need to improve available facilities in the three hospitals.

  1. Generalized anxiety disorder: clinical presentation, diagnostic features, and guidelines for clinical practice.

    Science.gov (United States)

    van der Heiden, Colin; Methorst, Gerda; Muris, Peter; van der Molen, Henk T

    2011-01-01

    Generalized anxiety disorder (GAD) is a prevalent and disabling disorder characterised by persistent worrying, anxiety symptoms, and tension. General practitioners and mental healthcare professionals frequently misdiagnose the presenting symptoms. This article addresses the clinical presentation of GAD and provides guidelines for discriminating GAD from other disorders, based on theoretical considerations and clinical experience. Debate relating to the validity of the definition of GAD is discussed, and suggestions are made for improving the criteria for GAD, which may guide future versions of classification systems such as the Diagnostic and Statistical Manual.

  2. Clinical Determinants of HIV-1B Between-Host Evolution and their Association with Drug Resistance in Pediatric Patients

    Science.gov (United States)

    Rojas, Patricia; Ramos, José Tomás; Holguín, África

    2016-01-01

    Understanding the factors that modulate the evolution of virus populations is essential to design efficient control strategies. Mathematical models predict that factors affecting viral within-host evolution may also determine that at the between-host level. Although HIV-1 within-host evolution has been associated with clinical factors used to monitor AIDS progression, such as patient age, CD4 cells count, viral load, and antiretroviral experience, little is known about the role of these clinical factors in determining between-host HIV-1 evolution. Moreover, whether the relative importance of such factors in HIV-1 evolution vary in adult and children patients, in which the course of infection is different, has seldom been analysed. To address these questions, HIV-1 subtype B (HIV-1B) pol sequences of 163 infected children and 450 adults of Madrid, Spain, were used to estimate genetic diversity, rates of synonymous and non-synonymous mutations, selection pressures and frequency of drug-resistance mutations (DRMs). The role and relative importance of patient age, %CD4, CD4/mm3, viral load, and antiretroviral experience in HIV-1B evolution was analysed. In the pediatric HIV-1B population, three clinical factors were primary predictors of virus evolution: Higher HIV-1B genetic diversity was observed with increasing children age, decreasing CD4/mm3 and upon antiretroviral experience. This was mostly due to higher rates of non-synonymous mutations, which were associated with higher frequency of DRMs. Using this data, we have also constructed a simple multivariate model explaining between 55% and 66% of the variance in HIV-1B evolutionary parameters in pediatric populations. On the other hand, the analysed clinical factors had little effect in adult-infecting HIV-1B evolution. These findings highlight the different evolutionary dynamics of HIV-1B in children and adults, and contribute to understand the factors shaping HIV-1B evolution and the appearance of drug

  3. Music to reduce pain and distress in the pediatric emergency department: a randomized clinical trial.

    Science.gov (United States)

    Hartling, Lisa; Newton, Amanda S; Liang, Yuanyuan; Jou, Hsing; Hewson, Krista; Klassen, Terry P; Curtis, Sarah

    2013-09-01

    Many medical procedures aimed at helping children cause them pain and distress, which can have long-lasting negative effects. Music is a form of distraction that may alleviate some of the pain and distress experienced by children while undergoing medical procedures. To compare music with standard care to manage pain and distress. Randomized clinical trial conducted in a pediatric emergency department with appropriate sequence generation and adequate allocation concealment from January 1, 2009, to March 31, 2010. Individuals assessing the primary outcome were blind to treatment allocation. A total of 42 children aged 3 to 11 years undergoing intravenous placement were included. Music (recordings selected by a music therapist via ambient speakers) vs standard care. The primary outcome was behavioral distress assessed blinded using the Observational Scale of Behavioral Distress-Revised. The secondary outcomes included child-reported pain, heart rate, parent and health care provider satisfaction, ease of performing the procedure, and parental anxiety. With or without controlling for potential confounders, we found no significant difference in the change in behavioral distress from before the procedure to immediately after the procedure. When children who had no distress during the procedure were removed from the analysis, there was a significantly less increase in distress for the music group (standard care group = 2.2 vs music group = 1.1, P Pain scores among children in the standard care group increased by 2 points, while they remained the same in the music group (P = .04); the difference was considered clinically important. The pattern of parent satisfaction with the management of children's pain was different between groups, although not statistically significant (P = .07). Health care providers reported that it was easier to perform the procedure for children in the music group (76% very easy) vs the standard care group (38% very easy) (P

  4. The Liver Biopsy in Modern Clinical Practice: A Pediatric Point-of-View

    Science.gov (United States)

    Ovchinsky, Nadia; Moreira, Roger K.; Lefkowitch, Jay H.; Lavine, Joel E.

    2012-01-01

    Liver biopsy remains the foundation of evaluation and management of liver disease in children, although the role of the liver biopsy is changing with development of alternative methods of diagnosis and advancement of hepatic imaging techniques. The indications for liver biopsy are evolving as current knowledge of etiologies, noninvasive biomarker alternatives and treatment options in pediatric liver disease are expanding. The procedure can often be complicated in children by technical difficulties, cost and smaller specimen size. Communication and partnership of clinicians with pathologists experienced in pediatric liver diseases are essential. DNA sequencing, novel imaging modalities, non-invasive biomarkers of fibrosis and apoptosis, proteomics, and genome-wide association studies offer potential alternative methods for evaluation of liver disease in children. This review presents specific indications, considerations, methods, complications, contraindications, and alternatives for pediatric liver biopsy. PMID:22692288

  5. Clinical Characteristics of Pediatric Trichotillomania: Comparisons with Obsessive-Compulsive and Tic Disorders.

    Science.gov (United States)

    Rozenman, Michelle; Peris, Tara S; Gonzalez, Araceli; Piacentini, John

    2016-02-01

    This study compared youth ages 5-17 years with a primary diagnosis of trichotillomania (TTM, n = 30) to those with primary OCD (n = 30) and tic disorder (n = 29) on demographic characteristics, internalizing, and externalizing symptoms. Findings suggest that youth with primary TTM score more comparably to youth with tics than those with OCD on internalizing and externalizing symptom measures. Compared to the OCD group, youth in the TTM group reported lower levels of anxiety and depression. Parents of youth in the TTM group also reported fewer internalizing, externalizing, attention, and thought problems than those in the OCD group. Youth with TTM did not significantly differ from those with primary Tic disorders on any measure. Findings suggest that pediatric TTM may be more similar to pediatric tic disorders than pediatric OCD on anxiety, depression, and global internalizing and externalizing problems.

  6. Liver biopsy in modern clinical practice: a pediatric point-of-view.

    Science.gov (United States)

    Ovchinsky, Nadia; Moreira, Roger K; Lefkowitch, Jay H; Lavine, Joel E

    2012-07-01

    Liver biopsy remains the foundation of evaluation and management of liver disease in children, although the role of the liver biopsy is changing with development of alternative methods of diagnosis and advancement of hepatic imaging techniques. The indications for liver biopsy are evolving as current knowledge of etiologies, noninvasive biomarker alternatives, and treatment options in pediatric liver disease are expanding. The procedure can often be complicated in children by technical difficulties, cost, and smaller specimen size. Communication and partnership of clinicians with pathologists experienced in pediatric liver diseases are essential. DNA sequencing, novel imaging modalities, noninvasive biomarkers of fibrosis and apoptosis, proteomics, and genome-wide association studies offer potential alternative methods for evaluation of liver disease in children. This review presents specific indications, considerations, methods, complications, contraindications, and alternatives for pediatric liver biopsy.

  7. The experiences of undergraduate nursing students and self-reflective accounts of first clinical rotation in pediatric oncology.

    Science.gov (United States)

    Mirlashari, Jila; Warnock, Fay; Jahanbani, Jahanfar

    2017-07-01

    The clinical practicum is one of the most anticipated components of the nursing program for nursing students. However, the practicum can be anxiety producing for students, especially when it is their first placement in an emotional demanding setting like pediatric oncology unit. Taking care of children with cancer and who are facing the death trajectory is complex and demanding not only for students but also for the experienced nurse. In this qualitative research, the purpose was to explore senior student perceptions and self-reflective accounts of what it was like to care for children with cancer and their family throughout the course of their first practicum on a pediatric oncology unit that also provided children palliative care as needed. Data from the self-reflective journals and interviews were analyzed together using conventional content analysis. The three resultant categories that emerged: state of shock and getting lost, walking in to a mind shaking world and finding the way provided in-depth novel insight on the perceptions of senior undergraduate nursing students as they journey through their first time practicum on a pediatric oncology unit. The findings also confirmed the importance and benefit of reflective journaling to student integrated learning and adjustment in nursing practice. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. The effects of the addition of a pediatric surgery fellow on the operative experience of the general surgery resident.

    Science.gov (United States)

    Raines, Alexander; Garwe, Tabitha; Adeseye, Ademola; Ruiz-Elizalde, Alejandro; Churchill, Warren; Tuggle, David; Mantor, Cameron; Lees, Jason

    2015-06-01

    Adding fellows to surgical departments with residency programs can affect resident education. Our specific aim was to evaluate the effect of adding a pediatric surgery (PS) fellow on the number of index PS cases logged by the general surgery (GS) residents. At a single institution with both PS and GS programs, we examined the number of logged cases for the fellows and residents over 10 years [5 years before (Time 1) and 5 years after (Time 2) the addition of a PS fellow]. Additionally, the procedure related relative value units (RVUs) recorded by the faculty were evaluated. The fellows averaged 752 and 703 cases during Times 1 and 2, respectively, decreasing by 49 (P = 0.2303). The residents averaged 172 and 161 cases annually during Time 1 and Time 2, respectively, decreasing by 11 (P = 0.7340). The total number of procedure related RVUs was 4627 and 6000 during Times 1 and 2, respectively. The number of cases logged by the PS fellows and GS residents decreased after the addition of a PS fellow; however, the decrease was not significant. Programs can reasonably add an additional PS fellow, but care should be taken especially in programs that are otherwise static in size.

  9. Screening for developmental delay in the setting of a community pediatric clinic: a prospective assessment of parent-report questionnaires.

    Science.gov (United States)

    Rydz, David; Srour, Myriam; Oskoui, Maryam; Marget, Nancy; Shiller, Mitchell; Birnbaum, Rena; Majnemer, Annette; Shevell, Michael I

    2006-10-01

    Our goal for this study was to prospectively test whether parent-completed questionnaires can be effectively used in the setting of a busy ambulatory pediatric clinic to accurately screen for developmental impairments. Specific objectives included (1) assessing the feasibility of using parent-report instruments in the setting of a community pediatric clinic, (2) evaluating the accuracy of 2 available screening tests (the Ages and Stages Questionnaire and Child Development Inventory), and (3) ascertaining if the pediatrician's clinical judgment could be used as a potential modifier. Subjects were recruited from the patient population of a community clinic providing primary ambulatory pediatric care. Subjects without previous developmental delay or concerns noted were contacted at the time of their routine 18-month-old visit. Those subjects who agreed to participate were randomly assigned to 1 of 2 groups and completed either the Ages and Stages Questionnaire or Child Development Inventory. The child's pediatrician also completed a brief questionnaire regarding his or her opinion of the child's development. Those children for whom concerns were identified by either questionnaire underwent additional detailed testing by the Battelle Development Inventory, the "gold standard" for the purposes of this study. An equal number of children scoring within the norms of the screening measures also underwent testing with the Battelle Development Inventory. Of the 356 parents contacted, 317 parents (90%) agreed to participate. Most parents correctly completed the Ages and Stages Questionnaire (81%) and the Child Development Inventory (75%). Predictive values were calculated for the Ages and Stages Questionnaire and the Child Development Inventory (sensitivity: 0.67 and 0.50; specificity: 0.39 and 0.86; positive predictive value: 34% and 50%; negative predictive value: 71% and 86%, respectively). Incorporating the physician's opinion regarding the developmental status of the

  10. Clinical-Homeopathic Profile in the Pediatric Ward at the University Hospital – Brazil

    Directory of Open Access Journals (Sweden)

    Debora Alves dos Santos Fernandes

    2011-09-01

    Full Text Available Background: In 2004, the deployment of Homeopathy in the pediatric ward at the University Hospital of Gaffrée Guinle – UNIRIO (HUGG at the Federal University of the State of Rio de Janeiro was initiated in conjunction with both the Pediatric and Homeopathy Service. A research project approved by the HUGG Ethics and Research Committee was prepared to survey the most prevalent diseases. A team composed of medical students and doctors participating in the homeopathy course was formed and underwent training, enabling them to use the established protocols of action. A partnership was established with the Fluminense Federal University(Universidade Federal Fluminense – UFF, for the supply of drugs. In early 2009, the research project started, followed by homeopathic treatment in the pediatric ward. Aim: To demonstrate the diseases and treatment using homeopathic therapy on patients in the pediatric ward at the HUGG-UNIRIO-Brazil. Methodology: A sectional clinical study was carried out on patients participating in a research approved and registered by the Brazilian Research Ethics Committee, named,"The study of the effect of Homeopathic Treatment as an Adjunct Therapy on patients Hospitalized in the Pediatric Ward of HUGG". Criteria of Inclusion: Newborns up to the age of 16 of both sexes were admitted to the pediatric ward of HUGG, from May to October 2009. The diagnosis for admission being: respiratory, gastrointestinal and/or dermatologic diseases. A consent form had to be accepted and signed by the person responsible. Inclusion depended on the availability of having the appropriate homeopathic medicine in stock. Criteria of Exclusion: Cases of discontinuation of the homeopathic treatment or medical records not completed correctly. The medical records were analyzed individually. Microsoft Office Excel 2007 was used for data collection and analysis. Results: 32 patients admitted: 80% treated with

  11. Two Oral Midazolam Preparations in Pediatric Dental Patients: A Prospective Randomised Clinical Trial

    OpenAIRE

    Katayoun Salem; Shaqayegh Kamranzadeh; Maryam Kousha; Shahnaz Shaeghi; Fatemeh AbdollahGorgi

    2015-01-01

    Pharmacological sedation is an alternative behavior management strategy in pediatric dentistry. The aim of this study was to compare the behavioral and physiologic effects of “commercially midazolam syrup” versus “orally administered IV midazolam dosage form (extemporaneous midazolam (EF))” in uncooperative pediatric dental patients. Eighty-eight children between 4 to 7 years of age received 0.2–0.5 mg/kg midazolam in this parallel trial. Physiologic parameters were recorded at baseline and e...

  12. [Clinical course and prognosis of patients with urolithiasis in a pediatric hospital].

    Science.gov (United States)

    Ubillo-Sánchez, José Manuel; Bonilla-Rojas, Jesús; Peña, Luis Alberto; Zurita-Cruz, Jessie Nallely; Cárdenas-Navarrete, Rocío; Serret-Montoya, Juana; Villasís-Keever, Miguel Angel

    2014-01-01

    INTRODUCCIÓN: la litiasis renal se considera poco frecuente en pediatría. La información disponible no es suficiente para determinar con certeza su pronóstico. El objetivo de esta investigación fue describir los signos, síntomas, complicaciones y recurrencia que presentaron los pacientes pediátricos con urolitiasis. MÉTODOS: se identificaron los expedientes de pacientes pediátricos con urolitiasis atendidos en el Hospital de Pediatría del Centro Médico Nacional Siglo XXI, en el periodo de 2003 a 2009.

  13. Pediatric clinical drug trials in low-income countries: key ethical issues.

    Science.gov (United States)

    MacLeod, S M; Knoppert, D C; Stanton-Jean, M; Avard, D

    2015-02-01

    Potential child participants in clinical research trials in low-income countries are often vulnerable because of poverty, high morbidity and mortality, inadequate education, and varied local cultural norms. However, vulnerability by itself must not be accepted as an obstacle blocking children from the health benefits that may accrue as an outcome of sound clinical research. As greater emphasis is placed on evidence-based treatment of children, it should be anticipated that there will be a growing call for agreement on principles to guide clinical investigations in low-income countries. There is now general acceptance of the view that children must be protected from non-evidence-based interventions and from substandard treatments. The questions remaining relate to how best to stimulate clinical research activity that will serve the needs of infants, children, and youth in developing countries and how best to assign priority to ethically sound research that will meet their clinical requirements. In low-income countries, 39 % of citizens are 13 years of age or younger, and consequently it is certain that clinical investigations of some new therapeutic products will be conducted there more frequently. This review offers some suggestions for approaches that will help to achieve more effective ethical consideration, including (1) improving the quality of research ethics boards; (2) fostering collaborative partnerships among important stakeholders; (3) making concerted efforts to build capacity; (4) improving the quality of the consent and waiver process; and (5) developing improved governance for harmonized ethics platforms. Continuing support by international organizations is required to sustain the establishment and maintenance of stronger research ethics boards to protect children enrolled in clinical trials. This review underscores the importance of developing a culture of solidarity and true partnership between developed and low-income country organizations, which

  14. The epidemiological profile of pediatric patients admitted to the general intensive care unit in an Ethiopian university hospital

    Directory of Open Access Journals (Sweden)

    Abebe T

    2015-01-01

    Full Text Available Teshome Abebe, Mullu Girmay, Girma G/Michael, Million Tesfaye Department of Anesthesia, Jimma University, Jimma, Ethiopia Background: In least developing countries, there are few data on children's critical care. This makes the provision of aid and improvement of outcome difficult. Objectives: To describe admission and outcome patterns of children managed in a general intensive care unit at Jimma University Specialized Hospital (JUSH, Ethiopia, over a 5-year period. Methods: A retrospective cross-sectional study design was used. All children from birth to 14 years of age who were admitted to the general ICU of the hospital from 2009–2013 were included. Patient charts and ICU documentation log were reviewed. Results: A total of 170 children were admitted to the ICU of JUSH over the study period. The greater share was taken by males (54.7%, with a male-to-female ratio of 1.2:1. The overall mortality rate was 40%. The majority of the children were in the age range of 10–14 years (38.8%. Of the total number of patients admitted, 34.7% were trauma cases, 45.8% of whom died. The highest percentage, 69.5%, of trauma patients were admitted for head injuries. Among the trauma cases, burn and polytrauma were the second and third leading causes (15.3% of admission. Postoperative patients and medical patients accounted for the rest of the admitted cases (28.2% and 27.6% of the cases respectively. Conclusion: The leading cause of admission and death was trauma. Postoperative and medical causes of admission were also significant. The mortality rate in the ICU was very high, and this could be due to various factors. Further research benchmarking and interventions are highly recommended. Keywords: trauma, critical care, pediatric, ICU, ventilation, oxygenation

  15. The Presenting Feature and Role of General Practitioners and Non-neurosurgeon Physicians in Recognizing Pediatric Brain Tumors

    Directory of Open Access Journals (Sweden)

    Wihasto Suryaningtyas

    2010-04-01

    Full Text Available AIM: To determine the presenting features and role of non-neurosurgeon physician in recognizing the signs and symptoms of brain tumours in children. METHOD: Medical records of 31 pediatric brain tumor patients treated in Department of Neurosurgery, Soetomo General Hospital, Airlangga University Faculty of Medicine, Surabaya from August 2005 to September 2006 were reviewed. RESULTS: Thirty five percents f parents went to pediatrician as their first contact physician, 25% to general practitioner, 20% neurologist, 20% to neurosurgeon. Neurosurgeon was the second and third contact physician receiving refferal from non-neurosurgeon physician. The most common symptoms were headache (71%, vomiting (61%, motor weakness (48%, visual disturbance (45%, decrease level of consciousness (45% and seizures (38%, unsteadiness (35%. The most common symptoms that led the parents to find medical help at any time were motor disturbance (48%, vomiting (48%, visual disturbance (45%, unsteadiness (35%, decrease level of consciousness (32%, seizures (32%, headache (32%. All patients had neurological signs at diagnosis; 58% had papilloedema, 48% cranial nerve abnormalities, 35% cerebellar signs, 32% motor disturbance, 29% a reduced level of consciousness, 12% cranial enlargement. Duration of symptoms at admission was 1 months (32%, 2 months (42%, 3-6 months (19%, more than 6 months (7%. A short symptom interval was significantly associated with high grade tumours and patient age 3 years or younger. CONCLUSION: The symptoms and signs are often nonspecific, mimicking more common diseases. Therefore, the possibility of a brain neoplasm should always be considered, it materializes very rarely. Benign neurologic symptoms such as headache, which last for 2 months or more, should indicate the need of additional studies. Our results higlighted the neurologic impairments which might facilitate early recognition of a brain neoplasm. Neurologic problems as the only symptom of brain

  16. Clinical impact and cost-effectiveness of whole exome sequencing as a diagnostic tool: a pediatric center’s experience

    Directory of Open Access Journals (Sweden)

    C. Alexander Valencia

    2015-08-01

    Full Text Available Background: There are limited reports of the use of whole exome sequencing as a clinical diagnostic tool. Moreover, there are no reports addressing the cost burden associated with genetic tests performed prior to WES.Objective: We demonstrate the performance characteristics of WES in a pediatric setting by describing our patient cohort, calculating the diagnostic yield, and detailing the patients for whom clinical management was altered. Moreover, we examined the potential cost-effectiveness of WES by examining the cost burden of diagnostic workups.Methods: To determine the clinical utility of our hospital’s clinical WES, we performed a retrospective review of the first 40 cases. We utilized dual bioinformatics analyses pipelines based on commercially available software and in-house tools. Results: Of the first 40 clinical cases, we identified genetic defects in twelve (30% patients, of which, 47% of the mutations were previously unreported in the literature. Among the 12 patients with positive findings, 7 have autosomal dominant disease and 5 have autosomal recessive disease. Ninety percent of the cohort opted to receive secondary findings, and of those, secondary medical actionable results were returned in three cases. Among these positive cases there are a number of novel mutations that are being reported here. The diagnostic workup included a significant number of genetic tests with microarray and single gene sequencing being the most popular tests. Significantly, genetic diagnosis from WES led to altered patient medical management in positive cases. Conclusions: We demonstrate the clinical utility of WES by establishing the clinical diagnostic rate and its impact on medical management in a large pediatric center. The cost-effectiveness of WES was demonstrated by ending the diagnostic odyssey in positive cases. Also, in some cases it may be most cost-effective to directly perform WES. WES provides a unique glimpse into the complexity of

  17. Clinical Impact and Cost-Effectiveness of Whole Exome Sequencing as a Diagnostic Tool: A Pediatric Center's Experience.

    Science.gov (United States)

    Valencia, C Alexander; Husami, Ammar; Holle, Jennifer; Johnson, Judith A; Qian, Yaping; Mathur, Abhinav; Wei, Chao; Indugula, Subba Rao; Zou, Fanggeng; Meng, Haiying; Wang, Lijun; Li, Xia; Fisher, Rachel; Tan, Tony; Hogart Begtrup, Amber; Collins, Kathleen; Wusik, Katie A; Neilson, Derek; Burrow, Thomas; Schorry, Elizabeth; Hopkin, Robert; Keddache, Mehdi; Harley, John Barker; Kaufman, Kenneth M; Zhang, Kejian

    2015-01-01

    There are limited reports of the use of whole exome sequencing (WES) as a clinical diagnostic tool. Moreover, there are no reports addressing the cost burden associated with genetic tests performed prior to WES. We demonstrate the performance characteristics of WES in a pediatric setting by describing our patient cohort, calculating the diagnostic yield, and detailing the patients for whom clinical management was altered. Moreover, we examined the potential cost-effectiveness of WES by examining the cost burden of diagnostic workups. To determine the clinical utility of our hospital's clinical WES, we performed a retrospective review of the first 40 cases. We utilized dual bioinformatics analyses pipelines based on commercially available software and in-house tools. Of the first 40 clinical cases, we identified genetic defects in 12 (30%) patients, of which 47% of the mutations were previously unreported in the literature. Among the 12 patients with positive findings, seven have autosomal dominant disease and five have autosomal recessive disease. Ninety percent of the cohort opted to receive secondary findings and of those, secondary medical actionable results were returned in three cases. Among these positive cases, there are a number of novel mutations that are being reported here. The diagnostic workup included a significant number of genetic tests with microarray and single-gene sequencing being the most popular tests. Significantly, genetic diagnosis from WES led to altered patient medical management in positive cases. We demonstrate the clinical utility of WES by establishing the clinical diagnostic rate and its impact on medical management in a large pediatric center. The cost-effectiveness of WES was demonstrated by ending the diagnostic odyssey in positive cases. Also, in some cases it may be most cost-effective to directly perform WES. WES provides a unique glimpse into the complexity of genetic disorders.

  18. CLINICAL EVALUATION OF EFFICACY AND SAFETY OF DEXMEDETOMEDINE AS AN ADJUNCT TO CAUDAL ROPIVACAINE IN PEDIATRIC INFRAUMBILICAL SURGERIES

    Directory of Open Access Journals (Sweden)

    Urmila

    2014-05-01

    Full Text Available BACKGROUND: Caudal epidural is one of the most popular reliable & safe technique mainly used for intra and post-op analgesia in pediatric patients undergoing infra umbilical surgeries. To prolong the duration of analgesia various adjuvants like epinephrine, opioids, ketamine, midazolam, tramadol, clonidine, were added to local anesthetic. The aim of this study was to evaluate the clinical efficacy and safety of CAUDAL administration of plain Ropivacaine 0.2% (1miligram/kilogram body weight with and without dexmedetomedine (2 microgram/kilogram body weight in children undergoing infraumbilical surgeries; in terms of quality of surgical anesthesia and the duration of post-operative analgesia.

  19. Practitioner Review: Bridging the Gap between Research and Clinical Practice in Pediatric Obesity

    Science.gov (United States)

    Jelalian, Elissa; Wember, Yana Markov; Bungeroth, Heidi; Birmaher, Vered

    2007-01-01

    Background: Pediatric obesity is a significant public health concern, with rising prevalence rates in both developed and developing countries. This is of particular significance given that overweight children and adolescents are at increased risk for multiple medical comorbidities, as well as psychosocial and behavioral difficulties. The current…

  20. PERSPECTIVES OF THERAPY WITH CEREBROLYSIN IN NEUROLOGY AND ITS PLACE IN CLINICAL PRACTICE OF PEDIATRIC NEUROLOGY

    Directory of Open Access Journals (Sweden)

    A. S. Petrukhin

    2012-01-01

    Full Text Available A detailed review of the literature, reflecting many aspects of сerebrolysin in a wide range of nervous system disorders, including various diseases in children is described. In addition to high efficacy, the therapy was well tolerated, which further enhances the perspectives of using сerebrolysin in pediatric neurology

  1. Systematic review of the clinical course, natural history, and prognosis for pediatric mild traumatic brain injury

    DEFF Research Database (Denmark)

    Hung, Ryan; Carroll, Linda J; Cancelliere, Carol;

    2014-01-01

    OBJECTIVE: To synthesize the best available evidence on prognosis after pediatric mild traumatic brain injury (MTBI). DATA SOURCES: We searched MEDLINE, Embase, PsycINFO, CINAHL, and SPORTDiscus (2001-2012), as well as reference lists of eligible articles, and relevant systematic reviews and meta...

  2. Clinical Characteristics and Pharmacological Treatment of Psychotic Patients Attending the Mental Health Services of the Pediatric Hospital of Cienfuegos

    Directory of Open Access Journals (Sweden)

    Beatriz Sabina Roméu

    2016-06-01

    Full Text Available Background: the mental health services of the Pediatric Hospital of Cienfuegos receive all patients in the province that need to be hospitalized. Among them, children and adolescents functioning at the psychotic level are of great clinical and social importance. Objective: to describe the clinical characteristics and pharmacological treatment of psychotic patients treated in the mental health services. Methods: a case series study of 35 psychotic patients admitted to the mental health unit of the Pediatric Hospital of Cienfuegos was conducted between 2008 and 2012. Demographic variables, in addition to variables related to clinical data and pharmacotherapeutic aspects were analyzed. Results: sixty five point seven percent of patients were adolescents and 77.1% were of urban origin. The most common diagnoses were acute and transient psychotic disorder and schizophrenia. Sixty three percent had a family history of psychiatric disorder. Forty percent were treated with trifluoperazine and an equal percent took haloperidol. Psychotic symptoms were controlled in 58% of patients during the first weeks. Conclusion: white adolescent patients from urban areas with a family history of psychiatric illness predominated. They received regular psychiatric attention and experienced the symptoms for a short time before being treated. The most frequently prescribed medications were typical antipsychotic drugs, which caused adverse reactions in a third of the patients. In the first few weeks, psychotic symptoms were controlled in most patients, although half of them experienced a recurrence of symptoms, which evolved into conditions with worse prognosis.

  3. Relationships Between Alanine Aminotransferase, Serum Triglycerides, Body Mass Index and Nonalcoholic Fatty Liver Disease in an Outpatient Pediatric Clinic Population.

    Science.gov (United States)

    Cohen, Deborah; Gonzales-Pacheco, Diana; Myers, Orrin

    2016-01-01

    Nonalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease in children and adolescents. The goal of this study was to describe the demographic, anthropometric and biochemical data of children and adolescents diagnosed with NAFLD during a seven-year period in an outpatient pediatric clinic in the Southwest region of the US and to evaluate relationships between race, BMI, ALT, triglyceride levels, age and gender with a diagnosis of NAFLD. A retrospective medical record review of patients who attended an outpatient pediatric clinic with a billing diagnosis ICD-9 code of 571.8 was conducted. Forty-one patients met these criteria. The majority was male (74%) Hispanic (32%), Hispanic/Latino (68%) and obese. The small number of patients diagnosed with NAFLD in our study is consistent with previously reported results. Our results indicate that the population of this culturally diverse, high-risk population has significant clinical markers that are indicative of NAFLD. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. High-dose infliximab for treatment of pediatric ulcerative colitis: A survey of clinical practice

    Institute of Scientific and Technical Information of China (English)

    Roy Nattiv; Janet M Wojcicki; Elizabeth A Garnett; Neera Gupta; Melvin B Heyman

    2012-01-01

    AIM:TO assess attitudes and trends regarding the use of high-dose infliximab among pediatric gastroenterologists for treatment of pediatric ulcerative colitis (UC).METHODS:A 19-item survey was distributed to subscribers of the pediatric gastroenterology (PEDSGI)listserv.Responses were submitted anonymously and results compiled in a secure website.RESULTS:A total of 113 subscribers (88% based in the United States) responded (101 pediatric gastroenterology attendings and 12 pediatric gastroenterology fellows).There were 46% in academic medical institutions and 39% in hospital-based practices.The majority (91%) were treating >10 patients with UC; 13% were treating >100 patients with UC; 91% had prescribed infliximab (IFX) 5 mg/kg for UC; 72% had prescribed IFX 10 mg/kg for UC.Using a 5-point Likert scale,factors that influenced the decision not to increase IFX dosing in patients with UC included:"improvement on initial dose of IFX" (mean:3.88) and "decision to move to colectomy" (3.69).Lowest mean Likert scores were:"lack of guidelines or literature regarding increased IFX dosing" (1.96) and "insurance authorization or other insurance issues" (2.34)."Insurance authorization or other insurance issues" was identified by 39% as at least somewhat of a factor (Likert score ≥ 3) in their decision not to increase the IFX dose.IFX 10 mg/kg was more commonly used for the treatment of pediatric UC among responders based in the United States (75/100) compared to non-United States responders (6/13,P =0.047).Induction of remission was reported by 78% of all responders and 81% reported maintenance of remission with IFX 10 mg/kg.One responder reported one death with IFX 10 mg/kg.CONCLUSION:IFX 10 mg/kg is more commonly used in the United States to treat pediatric UC.Efficacy and safety data are required to avoid insurance barriers for its use.

  5. Ten Years after the International Committee of Medical Journal Editors' Clinical Trial Registration Initiative, One Quarter of Phase 3 Pediatric Epilepsy Clinical Trials Still Remain Unpublished: A Cross Sectional Analysis.

    Directory of Open Access Journals (Sweden)

    Anette Lampert

    Full Text Available Although selective reporting of clinical trial results introduces bias into evidence based clinical decision making, publication bias in pediatric epilepsy is unknown today. Since there is a considerable ambiguity in the treatment of an important and common clinical problem, pediatric seizures, we assessed the public availability of results of phase 3 clinical trials that evaluated treatments of seizures in children and adolescents as a surrogate for the extent of publication bias in pediatric epilepsy.We determined the proportion of published and unpublished study results of phase 3 clinical trials that were registered as completed on ClinicalTrials.gov. We searched ClinicalTrials.gov, PubMed, and Google Scholar for publications and contacted principal investigators or sponsors. The analysis was performed according to STROBE criteria.Considering studies that were completed before 2014 (N = 99, 75 (76% pediatric phase 3 clinical trials were published but 24 (24% remained unpublished. The unpublished studies concealed evidence from 4,437 patients. Mean time-to-publication was 25 SD ± 15.6 months, more than twice as long as mandated.Ten years after the ICMJE's clinical trials registration initiative there is still a considerable amount of selective reporting and delay of publication that potentially distorts the body of evidence in the treatment of pediatric seizures.

  6. Clinical TVA-based studies: a general review

    Science.gov (United States)

    Habekost, Thomas

    2015-01-01

    In combination with whole report and partial report tasks, the theory of visual attention (TVA) can be used to estimate individual differences in five basic attentional parameters: the visual processing speed, the storage capacity of visual short-term memory, the perceptual threshold, the efficiency of top–down selectivity, and the spatial bias of attentional weighting. TVA-based assessment has been used in about 30 studies to investigate attentional deficits in a range of neurological and psychiatric conditions: (a) neglect and simultanagnosia, (b) reading disturbances, (c) aging and neurodegenerative diseases, and most recently (d) neurodevelopmental disorders. The article introduces TVA based assessment, discusses its methodology and psychometric properties, and reviews the progress made in each of the four research fields. The empirical results demonstrate the general usefulness of TVA-based assessment for many types of clinical neuropsychological research. The method’s most important qualities are cognitive specificity and theoretical grounding, but it is also characterized by good reliability and sensitivity to minor deficits. The review concludes by pointing to promising new areas for clinical TVA-based research. PMID:25852607

  7. Clinical TVA-based studies: a general review.

    Science.gov (United States)

    Habekost, Thomas

    2015-01-01

    In combination with whole report and partial report tasks, the theory of visual attention (TVA) can be used to estimate individual differences in five basic attentional parameters: the visual processing speed, the storage capacity of visual short-term memory, the perceptual threshold, the efficiency of top-down selectivity, and the spatial bias of attentional weighting. TVA-based assessment has been used in about 30 studies to investigate attentional deficits in a range of neurological and psychiatric conditions: (a) neglect and simultanagnosia, (b) reading disturbances, (c) aging and neurodegenerative diseases, and most recently (d) neurodevelopmental disorders. The article introduces TVA based assessment, discusses its methodology and psychometric properties, and reviews the progress made in each of the four research fields. The empirical results demonstrate the general usefulness of TVA-based assessment for many types of clinical neuropsychological research. The method's most important qualities are cognitive specificity and theoretical grounding, but it is also characterized by good reliability and sensitivity to minor deficits. The review concludes by pointing to promising new areas for clinical TVA-based research.

  8. Clinical TVA-based studies: a general review

    Directory of Open Access Journals (Sweden)

    Thomas eHabekost

    2015-03-01

    Full Text Available In combination with whole report and partial report tasks, the Theory of Visual Attention (TVA can be used to estimate individual differences in five basic attentional parameters: The visual processing speed, the storage capacity of visual short-term memory, the perceptual threshold, the efficiency of top-down selectivity, and the spatial bias of attentional weighting. TVA-based assessment has been used in about 30 studies to investigate attentional deficits in a range of neurological and psychiatric conditions: (a neglect and simultanagnosia, (b reading disturbances, (c aging and neurodegenerative diseases, and most recently (d neurodevelopmental disorders. The article introduces TVA based assessment, discusses its methodology and psychometric properties, and reviews the progress made in each of the four research fields. The empirical results demonstrate the general usefulness of TVA-based assessment for many types of clinical neuropsychological research. The method’s most important qualities are cognitive specificity and theoretical grounding, but it is also characterized by good reliability and sensitivity to minor deficits. The review concludes by pointing to promising new areas for clinical TVA-based research.

  9. Pediatric Specialists

    Science.gov (United States)

    ... Healthy Children > Family Life > Medical Home > Pediatric Specialists Pediatric Specialists Article Body ​Your pediatrician may refer your child to a pediatric specialist for further evaluation and treatment. Pediatric specialists ...

  10. 178名儿童口腔医生对笑气镇静及全麻的认知调查%Investigation of the cognition of 178 pediatric dentists about nitrous oxide sedation and general anesthesia

    Institute of Scientific and Technical Information of China (English)

    陈静涛; 周志斐; 邬礼政; 王小竞

    2013-01-01

    provinces or cities only 12 out of 86(13.9% ) had carried out the technology. 85 pediatric dentists (47. 8% ) thought that the main advantage of NO sedation and general anesthesia was to avoid the possible psychological impact to the children while the disadvantage was high cost to patients (33.7% ) , difficulty in carrying out the procedure (29. 2% ) and possible risks (27.5% ). And 175 (98. 3% ) peadiatrician would recommend NO sedation and general anesthesia in future clinical work. CONCLUSION: Nitrous oxide sedation and general anesthesia are not popular in clinical pediatric dentistry in China.

  11. Clinical factors associated with intracranial complications after pediatric traumatic head injury: an observational study of children submitted to a neurosurgical referral unit

    DEFF Research Database (Denmark)

    Åstrand, Ramona Alice; Undén, Johan; Hesselgard, Karin;

    2010-01-01

    Clinically validated guidelines for the management of head injury in children do not exist, and the treatment is often based upon adult management routines. In order to examine the safety of this procedure, an analysis of clinical factors associated with complications after pediatric head injury ...

  12. Clinical factors associated with intracranial complications after pediatric traumatic head injury: an observational study of children submitted to a neurosurgical referral unit

    DEFF Research Database (Denmark)

    Åstrand, Ramona Alice; Undén, Johan; Hesselgard, Karin

    2010-01-01

    Clinically validated guidelines for the management of head injury in children do not exist, and the treatment is often based upon adult management routines. In order to examine the safety of this procedure, an analysis of clinical factors associated with complications after pediatric head injury ...

  13. Clinical analysis of 70 pediatric anemia cases%小儿贫血70例临床分析

    Institute of Scientific and Technical Information of China (English)

    黄丽丽

    2015-01-01

    Objective To analyze and research the clinical characteristics and curative effect of pediatric anemia. Methods A total of 70 children with anemia were taken as study subjects, and their clinical characteristics and curative effect were analyzed. Results Among the 70 cases, there were 54 cured cases (77.14%) and 16 improved cases (22.86%). The clinical total effective rate was 100.00%. Morbidity of pediatric anemia decreased along with their age, and there was almost no difference between male and female cases. Conclusion Treatment of pediatric anemia is easy, while the prevention is the emphasis. Pregnant women should take a certain amount of iron, and 4-month-old infants should be given easily absorbable food with rich iron. That can obviously reduce incidence of pediatric anemia, and improve healthy life quality of children.%目的:分析研究小儿贫血的发病特点和疗效。方法70例贫血患儿作为研究对象,对其发病特点以及临床临床分析研究。结果70例患儿中治愈54例(77.14%),好转16例(22.86%),临床总有效率为100.00%。根据年龄段分析,小儿贫血几率随着年龄增长,其发病率呈现下降趋势,男女在发病率上几乎相近。结论对小儿贫血的治疗并不十分困难,重点在于预防,要求孕产妇在妊娠期间补充一定的铁,并且在出生4个月的婴幼儿食物当中添加富含铁和容易吸收的食物,进而可以将小儿贫血的发病率明显降低,使患儿健康生活质量明显提高。

  14. Oral Chloral Hydrate Compare with Rectal Thiopental in Pediatric Procedural Sedation and Analgesia; a Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Reza Azizkhani

    2014-03-01

    Full Text Available Introduction: The increasing use of diagnostic imaging in pediatric medicine has resulted in growing need for procedural sedation and analgesia (PSA to minimize motion artifacts during procedures. The drug of choice in pediatric PSA was not introduced till now. The aim of the present study was comparison of oral chloral hydrate (OCH and rectal sodium thiopental (RST in pediatric PSA.Methods: In the present randomized clinical trial, 2-6 years old pediatrics who referred for performing brain computed tomography scan was enrolled and were randomly divided in to two groups. OCH (50mg/kg and RST (25mg/kg were prescribed and a trained nurse recorded the time from drug prescription to receiving the conscious sedation (onset of action, the total time period which the patient has the Ramsay score≥4 (duration of action, and adverse effect of agents. Mann-Whitney U test and chi-squared test, and Non-parametric analysis of covariance (ANCOVA were used for comparisons. Results: One hundred and forty children were entered to two groups of OCH and RST, randomly. The patients of two groups had similar age, sex, weight, and baseline vital signs except for diastolic blood pressure (p<0.001. The onset of action in OCH and RST groups were 24.5±6.1and 28.7±5.2 minutes, respectively (p<0.001. Duration of action in OCH and RST groups were 12.9±2.8 minutes and 13.7±2.6 minutes, respectively (p=0.085. Non parametric ANCOVA revealed that only diastolic blood pressure was affected by drug prescription (p=0.001. In 11(15.7% patients in RST group, diarrhea was observed during 24 hours (p=0.001. Oxygen desaturation was observed only in two patients, both in OCH group. Conclusion: Each of the sedative has advantages and disadvantages that should be considered when selecting one for inducing short-term sedation. It seems that rectal sodium thiopental and oral chloral hydrate are equally effective in pediatric PSA and based on patient’s condition we can administrate

  15. Individual and socio-demographic factors related to presenting problem and diagnostic impressions at a pediatric sleep clinic.

    Science.gov (United States)

    Rubens, Sonia L; Patrick, Kristina E; Williamson, Ariel A; Moore, Melisa; Mindell, Jodi A

    2016-09-01

    Individual and socio-demographic factors have been found to be associated with sleep disturbances in children. Few studies have examined these factors among children presenting for care at pediatric sleep clinics. This study examined individual and socio-demographic factors in association with presenting problems and diagnostic impressions for new patients at an interdisciplinary pediatric sleep clinic. Data were collected from electronic medical records of 207 consecutive patients (54% male, 59% White, Meanage = 7.73, SD = 5.62). Older age, female gender, and White race were associated with higher likelihood of presenting with difficulty falling asleep; younger age, male gender, and Black race were associated with higher likelihood of presenting with obstructive sleep apnea (OSA)-related concerns. Older age was associated with diagnostic impressions of inadequate sleep hygiene, insufficient sleep, circadian rhythm disorder/delayed sleep phase disorder, periodic limb movement disorder/restless legs syndrome, and insomnia, while younger age was associated with provisional OSA and behavioral insomnia of childhood (BIC) diagnoses. Male gender was associated with provisional OSA. White race was associated with BIC. Age-based analyses were also conducted to further understand the findings within a developmental context. Age- and gender-related findings converged with prevalence literature on pediatric sleep disorders. Race was only associated with presenting concern and BIC, and one association for neighborhood disadvantage was found within the age-based analysis. Results suggest a potential service delivery gap, with racial/ethnic minority youth being less likely to present for sleep services, despite prevalence data on the increased likelihood of sleep disturbances among these youth. Copyright © 2016 Elsevier B.V. All rights reserved.

  16. Clinical Utility of a Comprehensive, Whole Genome CMA Testing Platform in Pediatrics: A Prospective Randomized Controlled Trial of Simulated Patients in Physician Practices.

    Science.gov (United States)

    Peabody, John; Martin, Megan; DeMaria, Lisa; Florentino, Jhiedon; Paculdo, David; Paul, Michael; Vanzo, Rena; Wassman, E Robert; Burgon, Trever

    2016-01-01

    Developmental disorders (DD), including autism spectrum disorder (ASD) and intellectual disability (ID), are a common group of clinical manifestations caused by a variety of genetic abnormalities. Genetic testing, including chromosomal microarray (CMA), plays an important role in diagnosing these conditions, but CMA can be limited by incomplete coverage of genetic abnormalities and lack of guidance for conditions rarely seen by treating physicians. We conducted a longitudinal, randomized controlled trial investigating the impact of a higher resolution 2.8 million (MM) probe-CMA test on the quality of care delivered by practicing general pediatricians and specialists. To overcome the twin problems of finding an adequate sample size of multiple rare conditions and under/incorrect diagnoses, we used standardized simulated patients known as CPVs. Physicians, randomized into control and intervention groups, cared for the CPV pediatric patients with DD/ASD/ID. Care responses were scored against evidence-based criteria. In round one, participants could order diagnostic tests including existing CMA tests. In round two, intervention physicians could order the 2.8MM probe-CMA test. Outcome measures included overall quality of care and quality of the diagnosis and treatment plan. Physicians ordering CMA testing had 5.43% (ptest had 7.20% (ptest led to a 10.9% (ptest led to significant improvements in condition-specific interventions including an 8.3% (p = 0.04) improvement in evaluation and therapy for gross motor delays caused by Hunter syndrome, a 27.5% (p = 0.03) increase in early cognitive intervention for FOXG1-related disorder, and an 18.2% (ptest significantly improves overall quality as well as diagnosis and treatment quality for simulated cases of pediatric DD/ASD/ID patients, and delivers additional clinical utility over existing CMA tests.

  17. Evaluation of efficacy of restorative dental treatment provided under general anesthesia at hospitalized pediatric dental patients of Isfahan

    Science.gov (United States)

    Eshghi, Alireza; Samani, Mahdi Jafarzadeh; Najafi, Naghme Feyzi; Hajiahmadi, Maryam

    2012-01-01

    Background: General anesthesia (GA) allows dental treatment to be rendered under optimal conditions, theoretically ensuring ideal outcomes. The aim of this study was to determine the efficacy of restorative dental procedures performed under GA. Materials and Methods: In this cross-sectional retrospective study, 305 pediatric patients who had been treated under GA 6 to 24 months before our survey at Isfahan's hospitalized dentistry center were examined. The examination was performed on dental chair with oral mirror and dental probe. The results were recorded in a special form for each patient for statistical analysis and evaluation of restorations to be successful or failed. Statistical analysis was performed by chi-square and fisher exact tests for comparison between success rates of restorations and Kendall's tau-b test for evaluating the effect of time on success rates of them (P < 0.05). Results: Stainless steel crown restorations had significantly better results vs class I and class II amalgam and class I and class II tooth color restorations. All types of posterior tooth color restorations had statistically same results with amalgam restorations. Anterior composite resin build-up represented significantly low success rates. The failure rates of stainless steel crown and anterior composite resin build-up restorations did not correlate with the time of follow-up (P = 0.344 and P = 0.091, respectively). Conclusion: Stainless steel crown restorations had significantly better results vs other posterior restorations. The failure rates of stainless steel crown and anterior composite resin build-up restorations did not correlate with the time of follow-up in comparison of other restorations. PMID:23162592

  18. Promoting innovation in pediatric nutrition.

    Science.gov (United States)

    Bier, Dennis M

    2010-01-01

    Truly impactful innovation can only be recognized in retrospect. Moreover, almost by definition, developing algorithmic paths on roadmaps for innovation are likely to be unsuccessful because innovators do not generally follow established routes. Nonetheless, environments can be established within Departments of Pediatrics that promote innovating thinking. The environmental factors necessary to do so include: (1) demand that academic Pediatrics Departments function in an aggressively scholarly mode; (2) capture the most fundamental science in postnatal developmental biology; (3) focus education and training on the boundaries of our knowledge, rather than the almost exclusive attention to what we think we already know; (4) devote mentoring, time and resources to only the most compelling unanswered questions in the pediatric sciences, including nutrition; (5) accept only systematic, evidence-based answers to clinical questions; (6) if systematic, evidence-based data are not available, design the proper studies to get them; (7) prize questioning the answers to further move beyond the knowledge limit; (8) support the principle that experiments in children will be required to convincingly answer clinical questions important to children, and (9) establish the multicenter resources in pediatric scientist training, clinical study design and implementation, and laboratory and instrument technologies required to answer today's questions with tomorrow's methods.

  19. Topical imiquimod treatment of cutaneous vascular disorders in pediatric patients: clinical evaluation on the efficacy and safety

    Institute of Scientific and Technical Information of China (English)

    Xiao-hong MAO; Jian-you WANG; Jian-liang YAN

    2012-01-01

    Objective:To evaluate the clinical effect of topical imiquimod treatment on cutaneous vascular disorders in pediatric patients.Methods:A retrospective investigation was conducted in 25 pediatric patients with cutaneous vascular disorders,including 19 infantile hemangiomas (IHs) (12 superficial/7 mixed type),5 nevus flammeus (NF),and 1 pyogenic granuloma (PG).Imiquimod 5% cream was applied every other day for 4 to 16 weeks (average 9.6weeks).Results:Of the 19 IHs treated,an overall efficacy of 52.6% was achieved,with a clinical resolution rate of 15.8%,excellent rate of 26.3%,and moderate rate of 10.5%.The superficial type responded the best at 66.7%,while the mixed type showed only 28.6% effectiveness,which was predominantly from their superficial parts.No obvious response was noted in the 5 patients with NF.Side effects were observed in 78.9% of the patients,mostly mild to moderate local irritations and occasionally severe reactions such as thick crusting and ulceration.Systemic side events were observed in 4 IH patients including fever and digestive tract reactions.No recurrence was observed during the follow-up examination.Conclusions:Topical imiquimod could be an alternative option for the treatment of uncomplicated superficial IHs with satisfactory tolerability.

  20. The Liver Biopsy in Modern Clinical Practice: A Pediatric Point-of-View

    OpenAIRE

    Ovchinsky, Nadia; Moreira, Roger K; Lefkowitch, Jay H.; Lavine, Joel E.

    2012-01-01

    Liver biopsy remains the foundation of evaluation and management of liver disease in children, although the role of the liver biopsy is changing with development of alternative methods of diagnosis and advancement of hepatic imaging techniques. The indications for liver biopsy are evolving as current knowledge of etiologies, noninvasive biomarker alternatives and treatment options in pediatric liver disease are expanding. The procedure can often be complicated in children by technical difficu...

  1. Development of the 24/7 Nurse Practitioner Model on the Inpatient Pediatric General Surgery Service at a Large Tertiary Care Children's Hospital and Associated Outcomes.

    Science.gov (United States)

    Rejtar, Marketa; Ranstrom, Lee; Allcox, Christina

    Nurse practitioners (NPs) have been providing high-quality and safe patient care for a few decades, and evidence showing the extent of their impact is emerging. This article describes the implementation of a 24/7 NP patient care model on an inpatient pediatric general surgery service in a tertiary free-standing Children's Hospital in the Northeastern United States. The literature shows that there is limited evidence regarding NP models of care and their effect on patient outcomes. In response to policy changes leading to reduction of resident work hours and a more acute and complex inpatient pediatric general surgery patient population, our existing NP model evolved into a 24/7 NP Model in June 2011. The results from two quality improvement projects showed positive registered nurse and attending surgeon staff satisfaction with the 24/7 NP Model of care and a decreased trend of unplanned intensive care unit patient transfers after the 24/7 NP Model implementation. These findings further support the evidence in the literature that NPs provide safe and quality patient care. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  2. Danish clinical guidelines for examination and treatment of overweight and obese children and adolescents in a pediatric setting

    DEFF Research Database (Denmark)

    Johansen, Anders; Holm, Jens-Christian; Pearson, Seija

    2015-01-01

    Overweight children are at an increased risk of becoming obese adults, which may lead to shorter life expectancies in the current generation of children as compared to their parents. Furthermore, being an overweight child has a negative psycho-social impact. We consider obesity in children...... as a "chronic care model" based on "best clinical practice" inspired by an American expert committee and the daily practice of The Children's Obesity Clinic at Copenhagen University Hospital Holbaek. Children and adolescents should be referred for examination and treatment in a pediatric setting when BMI...... circumference, growth, pubertal stage, blood pressure, neurology and skin and provide comprehensive paraclinical investigations for obesity and obesity related conditions. Treatment of obesity in children and adolescents is fully dependent on the combined effort of the entire family. This cannot...

  3. Danish clinical guidelines for examination and treatment of overweight and obese children and adolescents in a pediatric setting

    DEFF Research Database (Denmark)

    Johansen, Anders; Holm, Jens-Christian; Pearson, Seija

    2015-01-01

    Overweight children are at an increased risk of becoming obese adults, which may lead to shorter life expectancies in the current generation of children as compared to their parents. Furthermore, being an overweight child has a negative psycho-social impact. We consider obesity in children...... as a "chronic care model" based on "best clinical practice" inspired by an American expert committee and the daily practice of The Children's Obesity Clinic at Copenhagen University Hospital Holbaek. Children and adolescents should be referred for examination and treatment in a pediatric setting when BMI...... circumference, growth, pubertal stage, blood pressure, neurology and skin and provide comprehensive paraclinical investigations for obesity and obesity related conditions. Treatment of obesity in children and adolescents is fully dependent on the combined effort of the entire family. This cannot...

  4. Evaluation of clinical and laboratory findings of pediatric and adult patients with oropharyngeal tularemia in Turkey: a combination of surgical drainage and antibiotic therapy increases treatment success.

    Science.gov (United States)

    Gozel, Mustafa Gokhan; Engin, Aynur; Altuntas, Emine Elif; Salk, İsmail; Kaya, Ali; Celik, Cem; Dokmetas, Ilyas; Bakir, Mehmet; Elaldi, Nazif

    2014-01-01

    We analyzed the clinical and laboratory findings of both pediatric and adult patients with oropharyngeal tularemia. We also compared the therapeutic outcomes of patients who underwent surgical drainage of lymph nodes early or late during antibiotic therapy. A total of 68 patients with oropharyngeal tularemia, including 26 children and 42 adults, were enrolled in this study. The average duration between symptom onset and hospital admission was 20.8 days (4-60 days) in the pediatric group and 32.6 days (4-90 days) in the adult group (P = 0.009). The most frequently observed clinical symptoms were sore throat (100% and 100%), fever (96.2% and 90.5%), tonsillitis (69.2% and 78.6%), and rash (15.4% and 11.9%) in the pediatric and adult groups, respectively. However, the frequencies of erythema, tenderness, and fluctuant of enlarged lymph nodes were significantly higher in the adult group than in the pediatric group (P = 0.005, P = 0.029, and P = 0.041, respectively). Treatment failure was observed in 2 (7.7%) pediatric patients and 4 (9.5%) adult patients, for a total of 6 (8.8%) treatment failures in the study group. Similar clinical findings and treatment outcomes were observed in both groups. We concluded that a combination of surgical drainage and antibiotic therapy increases treatment success for patients diagnosed with oropharyngeal tularemia.

  5. Combined radiotherapy and chemotherapy for pediatric medulloblastoma: a clinical study of 33 cases

    Directory of Open Access Journals (Sweden)

    Wei ZHENG

    2011-06-01

    Full Text Available Objective To retrospectively review the clinical characteristics of medulloblastoma,discuss the optimized treatment regimen,and analyze the prognostic influential factors.Methods Thirty-three children with pathologically certified medulloblastoma(aged 3-14 years with average of 6.5 years,admitted from Aug.2004 to Dec.2007,received radiotherapy within 3 weeks post surgery.Ratiotherapy consisted of 28~36Gy whole craniospinal radiation and a supplementary radiation aimed at tumors by three-dimensional conformal radiotherapy(3D-CRT for a total dose of 50~54Gy(conventional fraction dose of 1.8-2.0Gy.A part of patients received hyperfractionation radiotherapy(1.0Gy/f,2f/d for alleviating the tardive adverse events.Meanwhile,a synchronized chemotherapy,consisting of lomustine + vincristine + cisplatin,or isophosphamide + carboplatin + etoposide,was administered after the completion of whole craniospinal radiation,and 3-5 courses of sequential chemotherapy were given after the overall radiotherapy was finished.According to the metastasis,and the residual tumor and its size,the 33 patients were divided into 2 groups as follows: low-risk group(n=24: no metastases,total or sub-total excision of tumors(residual tumors ≤1.5cm3;high-risk group(n=9: either metastases or residual tumor > 1.5cm3.The 3-year survival rates of two groups were then compared.Results The combined radiotherapy and chemotherapy was effective to 10 of the 11 patients(90.9% with residual tumors.Out of the 33 patients,31 obtained complete remission(93.9%,and 2 patients showed partial remission or stable status(3.0%,respectively.The median survival time of 33 patients was 51 months,3-year disease free survival(DFS was 75.8%,and 3-year overall survival(OS was 78.8%,including 33.3% in high-risk group and 95.8% in low-risk group(P < 0.01.The major side effects occurred in haematological system and digestive system,such as an incidence of 21.2%(7/33 with grade Ⅲ-Ⅳ bone marrow suppression

  6. Regional Implementation of a Pediatric Cardiology Syncope Algorithm Using Standardized Clinical Assessment and Management Plans (SCAMPS) Methodology.

    Science.gov (United States)

    Paris, Yvonne; Toro-Salazar, Olga H; Gauthier, Naomi S; Rotondo, Kathleen M; Arnold, Lucy; Hamershock, Rose; Saudek, David E; Fulton, David R; Renaud, Ashley; Alexander, Mark E

    2016-02-19

    Pediatric syncope is common. Cardiac causes are rarely found. We describe and assess a pragmatic approach to these patients first seen by a pediatric cardiologist in the New England region, using Standardized Clinical Assessment and Management Plans (SCAMPs). Ambulatory patients aged 7 to 21 years initially seen for syncope at participating New England Congenital Cardiology Association practices over a 2.5-year period were evaluated using a SCAMP. Findings were iteratively analyzed and the care pathway was revised. The vast majority (85%) of the 1254 patients had typical syncope. A minority had exercise-related or more problematic symptoms. Guideline-defined testing identified one patient with cardiac syncope. Syncope Severity Scores correlated well between physician and patient perceived symptoms. Orthostatic vital signs were of limited use. Largely incidental findings were seen in 10% of ECGs and 11% of echocardiograms. The 10% returning for follow-up, by design, reported more significant symptoms, but did not have newly recognized cardiac disease. Iterative analysis helped refine the approach. SCAMP methodology confirmed that the vast majority of children referred to the outpatient pediatric cardiology setting had typical low-severity neurally mediated syncope that could be effectively evaluated in a single visit using minimal resources. A simple scoring system can help triage patients into treatment categories. Prespecified criteria permitted the effective diagnosis of the single patient with a clear cardiac etiology. Patients with higher syncope scores still have a very low risk of cardiac disease, but may warrant attention. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  7. Social pediatrics: weaving horizontal and vertical threads through pediatric residency.

    Science.gov (United States)

    van den Heuvel, Meta; Martimianakis, Maria Athina Tina; Levy, Rebecca; Atkinson, Adelle; Ford-Jones, Elizabeth; Shouldice, Michelle

    2017-01-13

    Social pediatrics teaches pediatric residents how to understand disease within their patients' social, environmental and political contexts. It's an essential component of pediatric residency training; however there is very little literature that addresses how such a broad-ranging topic can be taught effectively. The aim of this study was to determine and characterize social pediatric education in our pediatric residency training in order to identify strengths and gaps. A social pediatrics curriculum map was developed, attending to 3 different dimensions: (1) the intended curriculum as prescribed by the Objectives of Training for Pediatrics of the Royal College of Physicians and Surgeons of Canada (RCPSC), (2) the formal curriculum defined by rotation-specific learning objectives, and (3) the informal/hidden curriculum as reflected in resident and teacher experiences and perceptions. Forty-one social pediatric learning objectives were extracted from the RCPSC Objectives of Training for Pediatrics, most were listed in the Medical Expert (51%) and Health Advocate competencies (24%). Almost all RCPSC social pediatric learning objectives were identified in more than one rotation and/or seminar. Adolescent Medicine (29.2%), Pediatric Ambulatory Medicine (26.2%) and Developmental Pediatrics (25%) listed the highest proportion of social pediatric learning objectives. Four (10%) RCPSC social pediatric objectives were not explicitly named within learning objectives of the formal curriculum. The informal curriculum revealed that both teachers and residents viewed social pediatrics as integral to all clinical encounters. Perceived barriers to teaching and learning of social pediatrics included time constraints, particularly in a tertiary care environment, and the value of social pediatrics relative to medical expert knowledge. Despite the lack of an explicit thematic presentation of social pediatric learning objectives by the Royal College and residency training program

  8. Regional anesthesia for pediatrics

    OpenAIRE

    Türk, Hacer Şebnem; Işıl, Canan Tülay; Açık, Mehmet Eren; Ediz, Naim; Sayın, Pınar; Tombul, Merih; Oba, Sibel

    2015-01-01

    Objectives: Relevancy to regional anesthesia in pediatrics has increased, because it is complementary to general anesthesia, allows conscious postoperative analgesia without respiratory depression, technical difficulties have been defeated and new local anesthetics have been improved. Therefore we reported data of patients who underwent pediatric surgery and received regional anesthesia.Patients and methods: We retrospectively analyzed data of all patients, who were operated in the pediatric ...

  9. 儿童烧伤脓毒症的临床特点及诊断%Clinical characteristics and diagnosis of sepsis in pediatric burn patients

    Institute of Scientific and Technical Information of China (English)

    彭毅志

    2013-01-01

    Pediatric burn patients account for more than 1/3 of the inpatients in the same period,and its incidence surpasses that of burn patients in other age groups.However,it brings about much difficulty to treat pediatric burn patients complicated by sepsis,which brings a significantly higher mortality than that of the adult.Moreover,the physiological characteristics,development of organs,drug metabolism,and body response to burn injury in children are obviously different from those of the adult.Therefore,it is clinically important to understand the clinical characteristics of sepsis in pediatric burn patients in order to improve the diagnosis and treatment of this ailment.

  10. Parent Health Literacy and Communication With Diabetes Educators in a Pediatric Diabetes Clinic: A Mixed Methods Approach.

    Science.gov (United States)

    Howe, Carol J; Cipher, Daisha J; LeFlore, Judy; Lipman, Terri H

    2015-01-01

    Low health literacy is associated with poor communication between adults and providers, but little is known about how parents' health literacy influences communication in pediatric encounters. We examined how parent health literacy affected communication between parents and diabetes educators in a pediatric diabetes clinic. A mixed methods study was conducted including a cross-sectional survey of 162 parents and semi-structured interviews with a subsample of 24 parents of a child with Type 1 diabetes. Parent and child characteristics, parents' report of quality of communication, and parent health literacy were assessed. Logistic regression was performed to determine associations between health literacy and 4 subscales of the Interpersonal Processes of Care (IPC) survey; directed content analyses of interview data were completed. Although health literacy was not significantly associated with the IPC subscales, results from directed content analyses revealed different communication experiences for parents by health literacy classification. Low health literate parents were confused by diabetes jargon, preferred hands-on teaching, and wished for information to be communicated in simple language, broken down into key points, and repeated. Parents with adequate health literacy wanted comprehensive information communicated through ongoing dialogue. Findings indicate that learner-driven curricula may be most appropriate for diabetes education.

  11. Tag SNP polymorphism of CCL2 and its role in clinical tuberculosis in Han Chinese pediatric population.

    Directory of Open Access Journals (Sweden)

    Wei-Xing Feng

    Full Text Available BACKGROUND: Chemokine (C-C motif ligand 2 CCL2/MCP-1 is among the key signaling molecules of innate immunity; in particular, it is involved in recruitment of mononuclear and other cells in response to infection, including tuberculosis (TB and is essential for granuloma formation. METHODOLOGY/PRINCIPAL FINDINGS: We identified a tag SNP for the CCL2/MCP-1 gene (rs4586 C/T. In order to understand whether this SNP may serve to evaluate the contribution of the CCL2 gene to the expression of TB disease, we further analysed distribution of its alleles and genotypes in 301 TB cases versus 338 non-infected controls (all BCG vaccinated representing a high-risk pediatric population of North China. In the male TB subgroup, the C allele was identified in a higher rate (P = 0.045, and, acting dominantly, was found to be a risk factor for clinical TB (P = 0.029. Homozygous TT genotype was significantly associated with lower CSF mononuclear leukocyte (ML counts in patients with tuberculous meningitis (TBM (P = 0.001. CONCLUSIONS/SIGNIFICANCE: The present study found an association of the CCL2 tag SNP rs4586 C allele and pediatric TB disease in males, suggesting that gender may affect the susceptibility to TB even in children. The association of homozygous TT genotype with decreased CSF mononuclear leukocyte (ML count not only suggests a clinical significance of this SNP, but indicates its potential to assist in the clinical assessment of suspected TBM, where delay is critical and diagnosis is difficult.

  12. The use of office-based sedation and general anesthesia by board certified pediatric dentists practicing in the United States.

    Science.gov (United States)

    Olabi, Nassim F; Jones, James E; Saxen, Mark A; Sanders, Brian J; Walker, Laquia A; Weddell, James A; Schrader, Stuart M; Tomlin, Angela M

    2012-01-01

    The purpose of this study is to explore the use of office-based sedation by board-certified pediatric dentists practicing in the United States. Pediatric dentists have traditionally relied upon self-administered sedation techniques to provide office-based sedation. The use of dentist anesthesiologists to provide office-based sedation is an emerging trend. This study examines and compares these two models of office-based sedations. A survey evaluating office-based sedation of diplomates of the American Board of Pediatric Dentistry (ABPD) based on gender, age, years in practice, practice types, regions, and years as a diplomate of the ABPD was completed by 494 active members. The results were summarized using frequencies and percentages. Relationships of dentist age, gender, and number of years in practice with the use of intravenous (IV) sedation was completed using two-way contingency tables and Mantel-Haenszel tests for ordered categorical data. Relationships of office-based sedation use and the type of one's practice were examined using Pearson chi-square tests. Of the 1917 surveys e-mailed, 494 completed the survey for a response rate of 26%. Over 70% of board-certified US pediatric dentists use some form of sedation in their offices. Less than 20% administer IV sedation, 20 to 40% use a dentist anesthesiologist, and 60 to 70% would use dentist anesthesiologists if one were available.

  13. Myasthenia gravis in pediatric and elderly patients

    Institute of Scientific and Technical Information of China (English)

    刘伟; 刘国津; 范志民; 盖学良

    2003-01-01

    Objective To determine whether the clinical and pathologic characteristics and prognoses of myasthenia gravis (MG) patients below 15 years differ from those patients over 50 years after thymectomy.