Outcome differences in adolescent blunt severe polytrauma patients managed at pediatric versus adult trauma centers.

Science.gov (United States)

Rogers, Amelia T; Gross, Brian W; Cook, Alan D; Rinehart, Cole D; Lynch, Caitlin A; Bradburn, Eric H; Heinle, Colin C; Jammula, Shreya; Rogers, Frederick B

2017-12-01

Previous research suggests adolescent trauma patients can be managed equally effectively at pediatric and adult trauma centers. We sought to determine whether this association would be upheld for adolescent severe polytrauma patients. We hypothesized that no difference in adjusted outcomes would be observed between pediatric trauma centers (PTCs) and adult trauma centers (ATCs) for this population. All severely injured adolescent (aged 12-17 years) polytrauma patients were extracted from the Pennsylvania Trauma Outcomes Study database from 2003 to 2015. Polytrauma was defined as an Abbreviated Injury Scale (AIS) score ≥3 for two or more AIS-defined body regions. Dead on arrival, transfer, and penetrating trauma patients were excluded from analysis. ATC were defined as adult-only centers, whereas standalone pediatric hospitals and adult centers with pediatric affiliation were considered PTC. Multilevel mixed-effects logistic regression models assessed the adjusted impact of center type on mortality and total complications while controlling for age, shock index, Injury Severity Score, Glasgow Coma Scale motor score, trauma center level, case volume, and injury year. A generalized linear mixed model characterized functional status at discharge (FSD) while controlling for the same variables. A total of 1,606 patients met inclusion criteria (PTC: 868 [54.1%]; ATC: 738 [45.9%]), 139 (8.66%) of which died in-hospital. No significant difference in mortality (adjusted odds ratio [AOR]: 1.10, 95% CI 0.54-2.24; p = 0.794; area under the receiver operating characteristic: 0.89) was observed between designations in adjusted analysis; however, FSD (AOR: 0.38, 95% CI 0.15-0.97; p = 0.043) was found to be lower and total complication trends higher (AOR: 1.78, 95% CI 0.98-3.32; p = 0.058) at PTC for adolescent polytrauma patients. Contrary to existing literature on adolescent trauma patients, our results suggest patients aged 12-17 presenting with polytrauma may experience

Pediatric blunt splenic trauma: a comprehensive review

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Lynn, Karen N.; Werder, Gabriel M.; Callaghan, Rachel M.; Jafri, Zafar H. [William Beaumont Hospital, Department of Diagnostic Radiology, Royal Oak, MI (United States); Sullivan, Ashley N. [St. George' s University School of Medicine, Grenada, West Indies (Grenada); Bloom, David A. [William Beaumont Hospital, Department of Diagnostic Radiology, Royal Oak, MI (United States); William Beaumont Hospital, Section of Pediatric Radiology, Department of Radiology, Royal Oak, MI (United States)

2009-09-15

Abdominal trauma is a leading cause of death in children older than 1 year of age. The spleen is the most common organ injured following blunt abdominal trauma. Pediatric trauma patients present unique clinical challenges as compared to adults, including different mechanisms of injury, physiologic responses, and indications for operative versus nonoperative management. Splenic salvage techniques and nonoperative approaches are preferred to splenectomy in order to decrease perioperative risks, transfusion needs, duration/cost of hospitalization, and risk of overwhelming postsplenectomy infection. Early and accurate detection of splenic injury is critical in both adults and children; however, while imaging findings guide management in adults, hemodynamic stability is the primary determinant in pediatric patients. After initial diagnosis, the primary role of imaging in pediatric patients is to determine the level and duration of care. We present a comprehensive literature review regarding the mechanism of injury, imaging, management, and complications of traumatic splenic injury in pediatric patients. Multiple patients are presented with an emphasis on the American Association for the Surgery of Trauma organ injury grading system. Clinical practice guidelines from the American Pediatric Surgical Association are discussed and compared with our experience at a large community hospital, with recommendations for future practice guidelines. (orig.)

Pediatric blunt splenic trauma: a comprehensive review

International Nuclear Information System (INIS)

Lynn, Karen N.; Werder, Gabriel M.; Callaghan, Rachel M.; Jafri, Zafar H.; Sullivan, Ashley N.; Bloom, David A.

2009-01-01

Abdominal trauma is a leading cause of death in children older than 1 year of age. The spleen is the most common organ injured following blunt abdominal trauma. Pediatric trauma patients present unique clinical challenges as compared to adults, including different mechanisms of injury, physiologic responses, and indications for operative versus nonoperative management. Splenic salvage techniques and nonoperative approaches are preferred to splenectomy in order to decrease perioperative risks, transfusion needs, duration/cost of hospitalization, and risk of overwhelming postsplenectomy infection. Early and accurate detection of splenic injury is critical in both adults and children; however, while imaging findings guide management in adults, hemodynamic stability is the primary determinant in pediatric patients. After initial diagnosis, the primary role of imaging in pediatric patients is to determine the level and duration of care. We present a comprehensive literature review regarding the mechanism of injury, imaging, management, and complications of traumatic splenic injury in pediatric patients. Multiple patients are presented with an emphasis on the American Association for the Surgery of Trauma organ injury grading system. Clinical practice guidelines from the American Pediatric Surgical Association are discussed and compared with our experience at a large community hospital, with recommendations for future practice guidelines. (orig.)

A systematic review of game technologies for pediatric patients.

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Jurdi, Sandra; Montaner, Jorge; Garcia-Sanjuan, Fernando; Jaen, Javier; Nacher, Vicente

2018-06-01

Children in hospital are subjected to multiple negative stimuli that may hinder their development and social interactions. Although game technologies are thought to improve children's experience in hospital, there is a lack of information on how they can be used effectively. This paper presents a systematic review of the literature on the existing approaches in this context to identify gaps for future research. A total of 1305 studies were identified, of which 75 were thoroughly analyzed according to our review protocol. The results show that the most common approach is to design mono-user games with traditional computers or monitor-based video consoles, which serve as a distractor or a motivator for physical rehabilitation for primary school children undergoing fearful procedures such as venipuncture, or those suffering chronic, neurological, or traumatic diseases/injures. We conclude that, on the one hand, game technologies seem to present physical and psychological benefits to pediatric patients, but more research is needed on this. On the other hand, future designers of games for pediatric hospitalization should consider: 1. The development for kindergarten patients and adolescents, 2. Address the psychological impact caused by long-term hospitalization, 3. Use collaboration as an effective game strategy to reduce patient isolation, 4. Have purposes other than distraction, such as socialization, coping with emotions, or fostering physical mobility, 5. Include parents/caregivers and hospital staff in the game activities; and 6. Exploit new technological artifacts such as robots and tangible interactive elements to encourage intrinsic motivation. Copyright © 2018 Elsevier Ltd. All rights reserved.

[Description of the severely injured in the DRG system: is treatment of the severely injured still affordable?].

Science.gov (United States)

Mahlke, L; Lefering, R; Siebert, H; Windolf, J; Roeder, N; Franz, D

2013-11-01

Due to the heterogeneity of severely injured patients (multiple trauma) it is difficult to assign them to homogeneic diagnosis-related groups (DRG). In recent years this has led to a systematic underfunding in the German reimbursement system (G-DRG) for cases of multiply injured patients. This project aimed to improve the reimbursement by modifying the case allocation algorithms of multiply injured patients within the G-DRG system. A retrospective analysis of standardized G-DRG data according to §21 of the Hospital Reimbursement Act (§ 21 KHEntgG) including case-related cost data from 3,362 critically injured patients from 2007 and 2008 from 10 university hospitals and 7 large municipal hospitals was carried out. For 1,241 cases complementary detailed information was available from the trauma registry of the German Trauma Society to monitor the case allocation of multiply injured patients within the G-DRG system. Analysis of coding and grouping, performance of case allocation and the homogeneity of costs in the G-DRG versions 2008-2012 was carried out. The results showed systematic underfunding of trauma patients in the G-DRG version 2008 but adequate cost covering in the majority of cases with the G-DRG versions 2011 and 2012. Cost coverage was foundfor multiply injured patients from the clinical viewpoint who were identified as multiple trauma by the G-DRG system. Some of the overfunded trauma patients had high intensive care costs. Also there was underfunding for multiple injured patients not identified as such in the G-DRG system. Specific modifications of the G-DRG allocation structures could increase the appropriateness of reimbursement of multiply injured patients. Data-based analysis is an essential prerequisite for a constructive development of the G-DRG system and a necessary tool for the active participation of medical specialist societies.

Link for Injured Kids

Science.gov (United States)

Ramirez, Marizen; Toussaint, Maisha; Woods-Jaeger, Briana; Harland, Karisa; Wetjen, Kristel; Wilgenbusch, Tammy; Pitcher, Graeme; Jennissen, Charles

2017-01-01

Objective Injury, the most common type of pediatric trauma, can lead to a number of adverse psychosocial outcomes, including posttraumatic stress disorder. Currently, few evidence-based parent programs exist to support children hospitalized after a traumatic injury. Using methods in evaluation and intervention research, we completed a formative research study to develop a new program of psychological first aid, Link for Injured Kids, aimed to educate parents in supporting their children after a severe traumatic injury. Methods Using qualitative methods, we held focus groups with parents and pediatric trauma providers of children hospitalized at a Level I Children's Hospital because of an injury in 2012. We asked focus group participants to describe reactions to trauma and review drafts of our intervention materials. Results Health professionals and caregivers reported a broad spectrum of emotional responses by their children or patients; however, difficulties were experienced during recovery at home and upon returning to school. All parents and health professionals recommended that interventions be offered to parents either in the emergency department or close to discharge among admissions. Conclusions Results from this study strongly indicate a need for posttrauma interventions, particularly in rural settings, to support families of children to address the psychosocial outcomes in the aftermath of an injury. Findings presented here describe the process of intervention development that responds to the needs of an affected population. PMID:26428077

Long-term functional health status of severely injured patients

NARCIS (Netherlands)

Holtslag, H. R.; Post, M. W.; Lindeman, E.; Van der Werken, Chr.

Background: Studies of the consequences of major trauma have traditionally focused on mortality rates. The aims of this study were, firstly, to investigate the long-term functional health status in a large, unselected group of severely injured patients and to compare this with normative data, and

The Management of Pediatric Genital Injuries at a Pediatric Emergency Department in Japan.

Science.gov (United States)

Takei, Hirokazu; Nomura, Osamu; Hagiwara, Yusuke; Inoue, Nobuaki

2018-04-25

Genital injuries among children are often associated with consumer products or specific activities. There are few descriptive studies from Asia on pediatric genital injuries seen in the emergency department (ED). The aim of this study was to describe the characteristic features of accidental genital injuries among children. A retrospective chart review of children aged 15 years or younger who visited our ED for genital injuries between March 2010 and November 2014 was conducted. Data on age, arrival time at the ED, location of the incident, mechanism of injury, objects, injured organ, consultation with specialists, emergency operation, sedation at the ED, and outcomes were collected and analyzed. One hundred seventy-nine patients were included in this analysis. Girls comprised 71% of the subject pool. The median age was 6 years (interquartile range, 4-9 years). Straddle injuries were the most common form of injury (56%). Male genital injuries occurred mostly outdoors (64%). Common consumer products associated with pediatric genital injuries were furniture (21%), exercise equipment (17%), and bicycles (15%). Thirty-two patients were examined by a surgeon, gynecologist, or urologist. The most commonly injured organs were the penis (55%) in boys and the labia (60%) in girls. Most patients (93%) were treated at the ED and discharged. The characteristics of accidental genital injuries among Japanese children were similar to those of children in other countries. The strategy for preventing genital injuries used in the West might be applicable to the East Asian context.

Coagulopathy: Its Pathophysiology and Treatment in the Injured Patient

Science.gov (United States)

2007-03-30

death. In fact, in their series, 77% of brain-injured patients who died had a coagulopathy at the time of hospital admission.8 Similarly, Faringer et...coagulation process. Arch Surg 1996;131:923–927. 9. Faringer PD, Mullins RJ, Johnson RL, Trunkey DD. Blood component supplementation during massive

[Analysis of the pediatric trauma score in patients wounded with shrapnel; the effect of explosives with high kinetic energy: results of the first intervention center].

Science.gov (United States)

Taş, Hüseyin; Mesci, Ayhan; Demirbağ, Suzi; Eryılmaz, Mehmet; Yiğit, Taner; Peker, Yusuf

2013-03-01

We aimed to assess the pediatric trauma score analysis in pediatric trauma cases due to shrapnel effect of explosives material with high kinetic energy. The data of 17 pediatric injuries were reviewed retrospectively between February 2002 and August 2005. The information about age, gender, trauma-hospital interval, trauma mechanism, the injured organs, pediatric Glasgow coma score (PGCS), pediatric trauma score (PTS), hemodynamic parameters, blood transfusion, interventions and length of hospital stay (LHS) were investigated. While all patients suffered from trauma to the extremities, only four patients had traumatic lower-limb amputation. Transportation time was 1 hour in 65% of cases. While PTS was found as 8 (p=0.007). Morbidity rates of PTS 8 cases were 29.4% and 5.9%, respectively (p=0.026). While LHS was 22.8 days in PTS LHS was found to be only 4 days in PTS >8 cases. This difference was found to be statistically significant (p=0.001). PTS is very efficient and a time-saving procedure to assess the severity of trauma caused by the shrapnel effect. The median heart rate, morbidity, and LHS increased significantly in patients with PTS <=8.

A novel first aid stretcher for immobilization and transportation of spine injured patients.

Science.gov (United States)

Liu, Yan-Sheng; Feng, Ya-Ping; Xie, Jia-Xin; Luo, Zhuo-Jing; Shen, Cai-Hong; Niu, Fang; Zou, Jian; Tang, Shao-Feng; Hao, Jiang; Xu, Jia-Xiang; Xiao, Li-Ping; Xu, Xiao-Ming; Zhu, Hui

2012-01-01

Effective immobilization and transportation are vital to the life-saving acute medical care needed when treating critically injured people. However, the most common types of stretchers used today are wrought with problems that can lead to further medical complications, difficulty in employment and rescue, and ineffective transitions to hospital treatment. Here we report a novel first aid stretcher called the "emergency carpet", which solves these problems with a unique design for spine injured patients. Polyurethane composite material, obtained by a novel process of manually mixing isocyanate and additives, can be poured into a specially designed fabric bag and allowed to harden to form a rigid human-shaped stretcher. The effectiveness of the emergency carpet was examined in the pre-hospital management of victims with spinal fractures. Additionally, it was tested on flat ground and complex terrain as well as in the sea and air. We demonstrated that the emergency carpet can be assembled and solidified on the scene in 5 minutes, providing effective immobilization to the entire injured body. With the protection of the emergency carpet, none of the 20 patients, who were finally confirmed to have spinal column fracture or dislocation, had any neurological deterioration during transportation. Furthermore, the carpet can be handled and transported by multiple means under differing conditions, without compromising immobilization. Finally, the emergency carpet allows the critically injured patient to receive multiple examinations such as X-ray, CT, and MRI without being removed from the carpet. Our results demonstrate that the emergency carpet has ideal capabilities for immobilization, extrication, and transportation of the spine injured patients. Compared with other stretchers, it allows for better mobility, effective immobilization, remarkable conformity to the body, and various means for transportation. The emergency carpet is promising for its intrinsic advantages in

A novel first aid stretcher for immobilization and transportation of spine injured patients.

Directory of Open Access Journals (Sweden)

Yan-Sheng Liu

Full Text Available Effective immobilization and transportation are vital to the life-saving acute medical care needed when treating critically injured people. However, the most common types of stretchers used today are wrought with problems that can lead to further medical complications, difficulty in employment and rescue, and ineffective transitions to hospital treatment. Here we report a novel first aid stretcher called the "emergency carpet", which solves these problems with a unique design for spine injured patients. Polyurethane composite material, obtained by a novel process of manually mixing isocyanate and additives, can be poured into a specially designed fabric bag and allowed to harden to form a rigid human-shaped stretcher. The effectiveness of the emergency carpet was examined in the pre-hospital management of victims with spinal fractures. Additionally, it was tested on flat ground and complex terrain as well as in the sea and air. We demonstrated that the emergency carpet can be assembled and solidified on the scene in 5 minutes, providing effective immobilization to the entire injured body. With the protection of the emergency carpet, none of the 20 patients, who were finally confirmed to have spinal column fracture or dislocation, had any neurological deterioration during transportation. Furthermore, the carpet can be handled and transported by multiple means under differing conditions, without compromising immobilization. Finally, the emergency carpet allows the critically injured patient to receive multiple examinations such as X-ray, CT, and MRI without being removed from the carpet. Our results demonstrate that the emergency carpet has ideal capabilities for immobilization, extrication, and transportation of the spine injured patients. Compared with other stretchers, it allows for better mobility, effective immobilization, remarkable conformity to the body, and various means for transportation. The emergency carpet is promising for its

Motor function outcomes of pediatric patients with hemiplegic cerebral palsy after rehabilitation treatment: a diffusion tensor imaging study

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Jin Hyun Kim

2015-01-01

Full Text Available Previous diffusion tensor imaging (DTI studies regarding pediatric patients with motor dysfunction have confirmed the correlation between DTI parameters of the injured corticospinal tract and the severity of motor dysfunction. There is also evidence that DTI parameters can help predict the prognosis of motor function of patients with cerebral palsy. But few studies are reported on the DTI parameters that can reflect the motor function outcomes of pediatric patients with hemiplegic cerebral palsy after rehabilitation treatment. In the present study, 36 pediatric patients with hemiplegic cerebral palsy were included. Before and after rehabilitation treatment, DTI was used to measure the fiber number (FN, fractional anisotropy (FA and apparent diffusion coefficient (ADC of bilateral corticospinal tracts. Functional Level of Hemiplegia scale (FxL was used to assess the therapeutic effect of rehabilitative therapy on clinical hemiplegia. Correlation analysis was performed to assess the statistical interrelationship between the change amount of DTI parameters and FxL. DTI findings obtained at the initial and follow-up evaluations demonstrated that more affected corticospinal tract yielded significantly decreased FN and FA values and significantly increased ADC value compared to the less affected corticospinal tract. Correlation analysis results showed that the change amount of FxL was positively correlated to FN and FA values, and the correlation to FN was stronger than the correlation to FA. The results suggest that FN and FA values can be used to evaluate the motor function outcomes of pediatric patients with hemiplegic cerebral palsy after rehabilitation treatment and FN is of more significance for evaluation.

A cost analysis of conservative management of spinal cord-injured patients in Nigeria.

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Kawu, A A; Olawepo, A; Salami, A O O; Kuranga, S A; Abdulhameed, S; Esenwah, V C

2011-11-01

A prospective study. To determine the cost of acute phase of injury (ASCI) among spinal cord-injured patients managed conservatively in Nigeria. Gwagwalada, Abuja. Over a 1-year period (1 January 2009 to 31 December 2009), the cost of ASCI of consecutive spinal cord-injured patients, gainfully employed preinjury, who paid the hospital bill directly from their purses and could estimate their daily income, and who were managed conservatively for 6 weeks before discharge to rehabilitation, was prospectively examined. A total of 34 cases of spinal cord-injured patients with a mean age of 35.4 ± 12.8 years were included in this study. The mean cost of ASCI over 6 weeks was $1598.29, an average of 6.4-232.8% of patients' annual income where >50% of the people live on less than a dollar a day. The mean cost of hospitalization was 14.9% of the total cost of ASCI in this study. It was significantly more expensive to treat tetraplegics compared with paraplegics. This study identified the cost of acute phase of spinal cord injury in Nigeria to assist clinicians in planning treatment that could reduce financial burden on the patients but optimize patients' care.

Differences in kinematics of single leg squatting between anterior cruciate ligament-injured patients and healthy controls.

Science.gov (United States)

Yamazaki, J; Muneta, T; Ju, Y J; Sekiya, I

2010-01-01

Seventy to eighty percent of all anterior cruciate ligament (ACL) injuries are due to non-contact injury mechanisms. It has been reported that the majority of injuries due to single leg landing come from valgus positioning of the lower leg. Preventing valgus positioning during single leg landing is expected to help reduce the number of ACL injuries. We found that many ACL-deficient patients cannot perform stable single leg squatting. Therefore, we performed 3D motion analysis of the single-legged half squat for ACL-injured patients to evaluate its significance as a risk factor for ACL injuries. We evaluated the relative angles between the body, thigh, and lower leg using an electromagnetic device during single leg half squatting performed by 63 ACL-injured patients (32 males, 31 females) the day before ACL reconstruction and by 26 healthy control subjects with no knee problems. The uninjured leg of ACL-injured male subjects demonstrated significantly less external knee rotation than that of the dominant leg of the male control. The uninjured leg of ACL-injured female subjects demonstrated significantly more external hip rotation and knee flexion and less hip flexion than that of the dominant leg of the female control. Comparing injured and uninjured legs, the injured leg of male subjects demonstrated significantly less external knee and hip rotation, less knee flexion, and more knee varus than that of the uninjured leg of male subjects. The injured leg of female subjects demonstrated more knee varus than that of the uninjured leg of female subjects. Regarding gender differences, female subjects demonstrated significantly more external hip rotation and knee valgus than male subjects did in both the injured and uninjured legs (P < 0.05). The current kinematic study exhibited biomechanical characteristics of female ACL-injured subjects compared with that of control groups. Kinematic correction during single leg half squat would reduce ACL reinjury in female ACL-injured

Pediatric trampoline injuries.

Science.gov (United States)

Hurson, Conor; Browne, Katherine; Callender, Orla; O'Donnell, Turlough; O'Neill, Anthony; Moore, David P; Fogarty, Esmond E; Dowling, Francis E

2007-01-01

The recreational use of trampolines has increased dramatically during the last 10 years. There has been a striking increase in the number of children presenting to fracture clinics with injuries associated with trampoline use. This increase in trampoline injuries has been reported in North America, but there has been a paucity of research in this area in Europe. We prospectively recorded details of patients presenting to our institution, Our Lady's Children's Hospital, Crumlin (Dublin, Ireland), during the busy summer months of June, July, and August 2005. Details recorded included type and mechanism of injury, the mode of referral, treatment, inpatient days, outpatient visits, specific details relating to trampoline safety, and an analysis of the cost of medical care. There were 101 patients treated for trampoline-related injuries in 3 months from June to August 2005. This represented 1.5% of the total attendances to the emergency department. The average age was 8.5 years (range, 1.4-17.4 years). There were 55 fractures, 38 soft tissue injuries, 5 head injuries, and 5 neck injuries, with an average Pediatric Trauma Score of 11.4. Fifty seven percent (58/101) of patients were on the trampoline with at least 1 other person. Twenty patients (19.8%) were admitted to hospital requiring 71 inpatient days. Twelve patients were treated in theatre. There were 163 fracture clinic visits, 212 x-rays, and 2 magnetic resonance imaging scans. Trampolines are a high-risk activity with the potential for significant orthopaedic injury. In Ireland, we have recently seen a dramatic increase in pediatric trampoline-related injuries mirroring the trend in the United States during the last 10 to 15 years. We found that more than 1 individual on a trampoline is a major risk factor for injury, where the lightest person is 14 times more likely to be injured than the heavier. The lighter person also has a greater chance of being injured with smaller numbers on the trampoline. We reiterate

Reconstruction of Injured Carotid Artery in a Comatose Patient

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Arben Zenelaj

2014-06-01

Full Text Available A man 30 years old,was brought to the emergency department after being injured on the left side of the neck area.Massive bleeding from the wound caused by glass was observed.The patient was in cerebral coma and hemorrahagic shock.The eye pupils remained isochoric during and after the operation.He was taken immediately at the surgery room.The bleeding was stopped by using external compression.Exposure of the left neck blood vessels was carried out.The left common carotid artery and internal jugular vein was revealed.A provisory Pruitt-Inahara shunt was put in the common carotid artery,while teh injured vein was ligated.The suture of the left common carotid artery using Prolen 6-0 completed the procedure.After the surgery the patient was transferred to the intensive care unit.About two hours later he woke up,conscious.The left thoracic drainage because of the hemothorax was applied in the second postoperative day.The patient was lively and discharged from the hospitall in the 14-th postoperative day.The right facial paresis and mild left side hemiparesis persisted.Two months after the event no residual neurologic deficits were observed. [Cukurova Med J 2014; 39(3.000: 598-601

[The challenge of adequate reimbursement for the seriously injured patient in the German DRG system].

Science.gov (United States)

Franz, D; Lefering, R; Siebert, H; Windolf, J; Roeder, N; Mahlke, L

2013-02-01

Critically injured patients are a very heterogeneous group, medically and economically. Their treatment is a major challenge for both the medical care and the appropriate financial reimbursement. Systematic underfunding can have a significant impact on the quality of patient care. In 2009 the German Trauma Society and the DRG-Research Group of the University Hospital Muenster initialised a DRG evaluation project to analyse the validity of case allocation of critically injured patients within the German DRG system versions 2008 and 2011 with additional consideration of clinical data from the trauma registry of the German Trauma Society. Severe deficits within the G-DRG structure were identified and specific solutions were designed and realised. A retrospective analysis was undertaken of standardised G-DRG data (§ 21 KHEntgG) including case-related cost data from 3 362 critically injured patients in the periods 2007 and 2008 from 10 university hospitals and 7 large municipal hospitals. For 1 241 cases of the sample, complementary detailed information was available from the trauma registry of the German Trauma Society to monitor the case allocation of critically injured patients within the G-DRG system. Analyses of coding and grouping, performance of case allocation, and the homogeneity of costs in the G-DRG versions 2008 and 2011 were done. The following situations were found: (i) systematic underfunding of trauma patients in the G-DRG-Version 2008, especially trauma patients with acute paraplegia; (ii) participation in the official G-DRG development for 2011 with 13 proposals which were largely realised; (ii) the majority of cases with cost-covering in the G-DRG version 2011; (iv) significant improvements in the quality of statistical criteria; (v) overfunded trauma patients with high intensive care costs; (vi) underfunding for clinically relevant critically injured patients not identified in the G-DRG system. The quality of the G-DRG system is measured by the

Cardiomyopathy in the pediatric patients

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Shi-Min Yuan

2018-04-01

Full Text Available Pediatric cardiomyopathies are a group of myocardial diseases with complex taxonomies. Cardiomyopathy can occur in children at any age, and it is a common cause of heart failure and heart transplantation in children. The incidence of pediatric cardiomyopathy is increasing with time. They may be associated with variable comorbidities, which are most often arrhythmia, heart failure, and sudden death. Medical imaging technologies, including echocardiography, cardiac magnetic resonance, and nuclear cardiology, are helpful in reaching a diagnosis of cardiomyopathy. Nevertheless, endomyocardial biopsy is the final diagnostic method of diagnosis. Patients warrant surgical operations, such as palliative operations, bridging operations, ventricular septal maneuvers, and heart transplantation, if pharmaceutical therapies are ineffective. Individual therapeutic regimens due to pediatric characteristics, genetic factors, and pathogenesis may improve the effects of treatment and patients' survival. Key Words: cardiomyopathy, classification, pediatrics

Characterization of wound infections among patients injured during the 2011 Libyan conflict.

Science.gov (United States)

Dau, A A; Tloba, S; Daw, M A

2013-04-01

Few studies have analysed the bacterial pathogenesis of infections associated with war-wound in the Eastern Mediterranean region. We analysed surgical wound infections of 1200 patients injured during the Libyan conflict in 2011 and admitted to the emergency services at Tripoli medical centre. Culture swabs or surgical wound debridement samples were collected and cultures were identified and tested for antimicrobial resistance. Of the 1200 patients studied, 498 (42%) were infected with at least 1 pathogen and 57 with >2 pathogens. The most common species were Acinetobacter spp. (isolated from 144 patients), coagulase-negative staphylococci (122), Escherichia coli (107), Pseudomnonas aeruginosa (92) and Klebsiella spp. (86). A high level of resistance to the antibiotics tested was found, especially among Acinetobacter spp. Multi-drug-resistant Gram-negative bacilli were an important complicating factor in wound infections associated with war injuries among injured patients in Libya. Effective policies are needed to control and treat such infections particularly in trauma and emergency services.

Patient/Family Education for Newly Diagnosed Pediatric Oncology Patients.

Science.gov (United States)

Landier, Wendy; Ahern, JoAnn; Barakat, Lamia P; Bhatia, Smita; Bingen, Kristin M; Bondurant, Patricia G; Cohn, Susan L; Dobrozsi, Sarah K; Haugen, Maureen; Herring, Ruth Anne; Hooke, Mary C; Martin, Melissa; Murphy, Kathryn; Newman, Amy R; Rodgers, Cheryl C; Ruccione, Kathleen S; Sullivan, Jeneane; Weiss, Marianne; Withycombe, Janice; Yasui, Lise; Hockenberry, Marilyn

There is a paucity of data to support evidence-based practices in the provision of patient/family education in the context of a new childhood cancer diagnosis. Since the majority of children with cancer are treated on pediatric oncology clinical trials, lack of effective patient/family education has the potential to negatively affect both patient and clinical trial outcomes. The Children's Oncology Group Nursing Discipline convened an interprofessional expert panel from within and beyond pediatric oncology to review available and emerging evidence and develop expert consensus recommendations regarding harmonization of patient/family education practices for newly diagnosed pediatric oncology patients across institutions. Five broad principles, with associated recommendations, were identified by the panel, including recognition that (1) in pediatric oncology, patient/family education is family-centered; (2) a diagnosis of childhood cancer is overwhelming and the family needs time to process the diagnosis and develop a plan for managing ongoing life demands before they can successfully learn to care for the child; (3) patient/family education should be an interprofessional endeavor with 3 key areas of focus: (a) diagnosis/treatment, (b) psychosocial coping, and (c) care of the child; (4) patient/family education should occur across the continuum of care; and (5) a supportive environment is necessary to optimize learning. Dissemination and implementation of these recommendations will set the stage for future studies that aim to develop evidence to inform best practices, and ultimately to establish the standard of care for effective patient/family education in pediatric oncology.

Retrospective Survey of Biopsied Oral Lesions in Pediatric Patients

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Yin-Lin Wang

2009-11-01

Conclusion: The mucous extravasation phenomenon, odontoma, or dentigerous cyst was the most common inflammatory and reactive, neoplastic, or cystic lesion, respectively, in pediatric patients. The relatively high incidence of inflammatory and reactive lesions in pediatric patients implies the importance of stringent oral hygiene in children. Most oral neoplastic lesions in pediatric patients are benign, and malignant oral tumors rarely occur in pediatric patients.

Missed posterior dislocation of the hip in a head-injured patient with ...

African Journals Online (AJOL)

Background: Head injury increases the risk of missed diagnosis by making patient-derived history impossible. The risk of missing a posterior dislocation of the hip in a head-injured patient is aggravated when an ipsilateral femoral shaft fracture co-exists. Adequate radiological evaluation of bone and joints is therefore of ...

Acute lung injury and the acute respiratory distress syndrome in the injured patient

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Bakowitz Magdalena

2012-08-01

Full Text Available Abstract Acute lung injury and acute respiratory distress syndrome are clinical entities of multi-factorial origin frequently seen in traumatically injured patients requiring intensive care. We performed an unsystematic search using PubMed and the Cochrane Database of Systematic Reviews up to January 2012. The purpose of this article is to review recent evidence for the pathophysiology and the management of acute lung injury/acute respiratory distress syndrome in the critically injured patient. Lung protective ventilation remains the most beneficial therapy. Future trials should compare intervention groups to controls receiving lung protective ventilation, and focus on relevant outcome measures such as duration of mechanical ventilation, length of intensive care unit stay, and mortality.

Pediatric Supportive Care (PDQ®)—Patient Version

Science.gov (United States)

Pediatric supportive care is an important aspect of cancer care as children and adolescents face unique challenges compared to adult patients. Learn more about supportive care for pediatric patients during and after treatment in this expert-reviewed summary.

Tele-Pediatric Intensive Care for Critically Ill Children in Syria.

Science.gov (United States)

Ghbeis, Muhammad Bakr; Steffen, Katherine M; Braunlin, Elizabeth A; Beilman, Gregory J; Dahman, Jay; Ostwani, Waseem; Steiner, Marie E

2017-12-12

Armed conflicts can result in humanitarian crises and have major impacts on civilians, of whom children represent a significant proportion. Usual pediatric medical care is often disrupted and trauma resulting from war-related injuries is often devastating. High pediatric mortality rates are thus experienced in these ravaged medical environments. Using simple communication technology to provide real-time management recommendations from highly trained pediatric personnel can provide substantive clinical support and have a significant impact on pediatric morbidity and mortality. We implemented a "Tele-Pediatric Intensive Care" program (Tele-PICU) to provide real-time management consultation for critically ill and injured pediatric patients in Syria with intensive care needs. Over the course of 7 months, 19 cases were evaluated, ranging in age from 1 day to 11 years. Consultation questions addressed a wide range of critical care needs. Five patients are known to have survived, three were transferred, five died, and six outcomes were unknown. Based on this limited undertaking with its positive impact on survival, further development of Tele-PICU-based efforts with attention to implementation and barriers identified through this program is desirable. Even limited Tele-PICU can provide timely and potentially lifesaving assistance to pediatric care providers. Future efforts are encouraged.

Pediatric and youth traffic-collision injuries in Al Ain, United Arab Emirates: a prospective study.

Science.gov (United States)

Grivna, Michal; Eid, Hani O; Abu-Zidan, Fikri M

2013-01-01

To study the mechanism of road traffic collisions (RTC), use of safety devices, and outcome of hospitalized pediatric and youth RTC injured patients so as to give recommendations regarding prevention of pediatric RTC injuries. All RTC injured children and youth (0-19-year-olds) who were admitted to Al Ain City's two major trauma centers or who died after arrival to these centers were prospectively studied from April 2006 to October 2007. Demography of patients, road-user and vehicle types, crash mechanism, usage of safety devices, injured body regions, injury severity, Revised Trauma Score, Glasgow Coma Scale, intensive care unit admissions, hospital stay and mortality were analyzed. 245 patients were studied, 69% were vehicle occupants, 15% pedestrians, 9% motorcyclists and 5% bicyclists. 79% were males and 67% UAE citizens. The most common mechanism of RTC was rollover of vehicle (37%) followed by front impact collision (32%). 32 (13%) of vehicle occupants were ejected from car. 63% of ejected occupants and 70% of motorcyclists sustained head injuries. Only 2% (3/170) vehicle passengers used seatbelts and 13% (3/23) motorcyclists a helmet. Male drivers and UAE nationals were at high risk of RTC as drivers and as motorcyclists. Ejection rate was high because safety restraint use was extremely low in our community. More education and law enforcement focusing especially on car/booster seat use is needed.

Practical considerations in radionuclide imaging of pediatric patients

International Nuclear Information System (INIS)

Conway, J.J.

1984-01-01

A certain proportion of the patients encountered in the practice of nuclear medicine will fall within the pediatric age group. The pediatric age range is usually defined as extending from birth to 18 years. Therefore, the specialist in nuclear medicine may have to deal with pediatric patients weighing as little as 800 g or as much as 300 lb. This encounter may be pleasant or unpleasant, depending upon the physician's knowledge of the techniques required for handling children and obtaining an adequate study and a basic understanding of specific pediatric disorders. Among the issues that must be considered are the equipment, which must be suitable for handling and obtaining optimal images of small children; the development of a basic understanding of the peculiarities of radiopharmaceutical distribution in children, which differs from that in adults; and, importantly, a knowledge of radiation dosimetry as it relates to the pediatric patient. It is beyond the scope of this chapter to present a comprehensive dissertation on the topic of pediatric nuclear medicine. The theme therefore is limited to the general principles and techniques required for nuclear medicine studies on pediatric patients. In addition, studies that exhibit unique characteristics when performed on children are highlighted in an effort to define that essence of pediatric nuclear medicine that differentiates it from the practice of nuclear medicine in adults

Tranexamic acid use in severely injured civilian patients and the effects on outcomes: a prospective cohort study.

Science.gov (United States)

Cole, Elaine; Davenport, Ross; Willett, Keith; Brohi, Karim

2015-02-01

To characterize the relationship between tranexamic acid (TXA) use and patient outcomes in a severely injured civilian cohort, and to determine any differential effect between patients who presented with and without shock. TXA has demonstrated survival benefits in trauma patients in an international randomized control trial and the military setting. The uptake of TXA into civilian major hemorrhage protocols (MHPs) has been variable. The evidence gap in mature civilian trauma systems is limiting the widespread use of TXA and its potential benefits on survival. Prospective cohort study of severely injured adult patients (Injury severity score > 15) admitted to a civilian trauma system during the adoption phase of TXA into the hospital's MHP. Outcomes measured were mortality, multiple organ failure (MOF), venous thromboembolism, infection, stroke, ventilator-free days (VFD), and length of stay. Patients receiving TXA (n = 160, 42%) were more severely injured, shocked, and coagulopathic on arrival. TXA was not independently associated with any change in outcome for either the overall or nonshocked cohorts. In multivariate analysis, TXA was independently associated with a reduction in MOF [odds ratio (OR) = 0.27, confidence interval (CI): 0.10-0.73, P = 0.01] and was protective for adjusted all-cause mortality (OR = 0.16 CI: 0.03-0.86, P = 0.03) in shocked patients. TXA as part of a major hemorrhage protocol within a mature civilian trauma system provides outcome benefits specifically for severely injured shocked patients.

The relationship between physical and psychological complaints and quality of life in severely injured patients.

Science.gov (United States)

van Delft-Schreurs, C C H M; van Son, M A C; de Jongh, M A C; Lansink, K W W; de Vries, J; Verhofstad, M H J

2017-09-01

The purpose of this study was two-fold. The first goal was to investigate which variables were associated with the remaining physical limitations of severely injured patients after the initial rehabilitation phase. Second, we investigated whether physical limitations were attributable to the association between psychological complaints and quality of life in this patient group. Patients who were 18 years or older and who had an injury severity score (ISS)>15 completed a set of questionnaires at one time-point after their rehabilitation phase (15-53 months after their trauma). The Short Musculoskeletal Function Assessment (SMFA) questionnaire was used to determine physical limitations. The Hospital Anxiety and Depression Scale, the Dutch Impact of Event Scale and the Cognitive Failure Questionnaire were used to determine psychological complaints, and the World Health Organization Quality of Life assessment instrument-BREF was used to measure general Quality of Life (QOL). Differences in physical limitations were investigated for several trauma- and patient-related variables using non-parametric independent-sample Mann-Whitney U tests. Multiple linear regression was performed to investigate whether the decreased QOL of severely injured patients with psychological complaints could be explained by their physical limitations. Older patients, patients with physical complaints before the injury, patients with higher ISS scores, and patients who had an injury of the spine or of the lower extremities reported significantly more physical problems. Additionally, patients with a low education level, patients who were living alone, and those who were unemployed reported significantly more long-term physical problems. Severely injured patients without psychological complaints reported significantly less physical limitations than those with psychological complaints. The SMFA factor of Lower extremity dysfunction was a confounder of the association between psychological complaints

Using robotic telecommunications to triage pediatric disaster victims.

Science.gov (United States)

Burke, Rita V; Berg, Bridget M; Vee, Paul; Morton, Inge; Nager, Alan; Neches, Robert; Wetzel, Randall; Upperman, Jeffrey S

2012-01-01

During a disaster, hospitals may be overwhelmed and have an insufficient number of pediatric specialists available to care for injured children. The aim of this study was to determine the feasibility of remotely providing pediatric expertise via a robot to treat pediatric victims. In 2008, Los Angeles County held 2 drills involving telemedicine. The first was the Tri-Hospital drill in which 3 Los Angeles County hospitals, one being a pediatric hospital, participated. The disaster scenario involved a Metrolink train crash, resulting in a large surge of traumatic injuries. The second drill involved multiple agencies and was called the Great California Shakeout, a simulated earthquake exercise. The telemedicine equipment installed is an InTouch Health, Inc, Santa Barbara, CA robotic telecommunications system. We used mixed-methods to evaluate the use of telemedicine during these drills. Pediatric specialists successfully provided remote triage and treatment consults of victims via the robot. The robot proved to be a useful means to extend resources and provide expert consult if pediatric specialists were unable to physically be at the site. Telemedicine can be used in the delayed treatment areas as well as for training first receivers to collaborate with specialists in remote locations to triage and treat seriously injured pediatric victims. Copyright © 2012 Elsevier Inc. All rights reserved.

A Qualitative Study of Multidisciplinary Providers' Experiences With the Transfer Process for Injured Children and Ideas for Improvement.

Science.gov (United States)

Gawel, Marcie; Emerson, Beth; Giuliano, John S; Rosenberg, Alana; Minges, Karl E; Feder, Shelli; Violano, Pina; Morrell, Patricia; Petersen, Judy; Christison-Lagay, Emily; Auerbach, Marc

2018-02-01

Most injured children initially present to a community hospital, and many will require transfer to a regional pediatric trauma center. The purpose of this study was 1) to explore multidisciplinary providers' experiences with the process of transferring injured children and 2) to describe proposed ideas for process improvement. This qualitative study involved 26 semistructured interviews. Subjects were recruited from 6 community hospital emergency departments and the trauma and transport teams of a level I pediatric trauma center in New Haven, Conn. Participants (n = 34) included interprofessional providers from sending facilities, transport teams, and receiving facilities. Using the constant comparative method, a multidisciplinary team coded transcripts and collectively refined codes to generate recurrent themes across interviews until theoretical saturation was achieved. Participants reported that the transfer process for injured children is complex, stressful, and necessitates collaboration. The transfer process was perceived to involve numerous interrelated components, including professions, disciplines, and institutions. The 5 themes identified as areas to improve this transfer process included 1) Creation of a unified standard operating procedure that crosses institutions/teams, 2) Enhancing 'shared sense making' of all providers, 3) Improving provider confidence, expertise, and skills in caring for pediatric trauma transfer cases, 4) Addressing organization and environmental factors that may impede/delay transfer, and 5) Fostering institutional and personal relationships. Efforts to improve the transfer process for injured children should be guided by the experiences of and input from multidisciplinary frontline emergency providers.

Return to work and quality of life in severely injured patients

NARCIS (Netherlands)

Post, R. B.; Van der Sluis, C. K.; Ten Duis, H. J.

2006-01-01

Background. Little is known about the long-term consequences of severe injuries in terms of return to productivity and quality of life. Methods. In this study we focused on the return to work status and quality of life in 53 severely injured patients (AIS/ISS >= 16, mean ISS 24, range 16 - 54), mean

Return to work and quality of life in severely injured patients

NARCIS (Netherlands)

Post, R. B.; Van der Sluis, C. K.; Ten Duis, H. J.

Background. Little is known about the long-term consequences of severe injuries in terms of return to productivity and quality of life. Methods. In this study we focused on the return to work status and quality of life in 53 severely injured patients (AIS/ISS >= 16, mean ISS 24, range 16 - 54), mean

Pediatric Firework-Related Injuries Presenting to United States Emergency Departments, 1990-2014.

Science.gov (United States)

Billock, Rachael M; Chounthirath, Thiphalak; Smith, Gary A

2017-06-01

This study characterizes the epidemiology of nonfatal pediatric firework-related injuries in the United States among children and adolescents by analyzing data from the National Electronic Injury Surveillance System from 1990 through 2014. During this 25-year period, an estimated 136 991 (95% CI = 113 574-160 408) children firework-related injuries. The annual injury rate decreased significantly by 30.4% during this period. Most of those injured were male (75.7%), mean patient age was 10.6 years, and 7.6% required hospital admission. The hands (30.0%) were the most commonly injured body region, followed by head and neck (22.2%), and eyes (21.5%). Sixty percent of injuries were burns. Injuries were most commonly associated with firecrackers (26.2%), aerial devices (16.3%), and sparklers (14.3%). Consumer fireworks pose a serious injury risk to pediatric users and bystanders, and families should be encouraged to attend public firework displays rather than use consumer fireworks.

Correlations of sleep disorders with severity of obstructive airway disease in mustard gas-injured patients.

Science.gov (United States)

Vahedi, Ensieh; Taheri, Saeed; Alaedini, Farshid; Poursaleh, Zohreh; Ameli, Javad; Ghanei, Mostafa

2012-06-01

Mustard gas has serious adverse effects on several organs and functions in humans. In this study, we analyzed potential correlations between obstructive airway disease and sleep disorders in Iranian mustard gas-injured patients. We enrolled 30 male mustard gas-injured veterans and civilians from the Chemical Warfare Exposure Clinic at Baqiyatallah Hospital, Tehran. All the subjects underwent comprehensive polysomnographic and spirometric evaluations for diagnosis of sleep disorders. Patients were categorized into three groups according to the severity of their obstructive airway disease based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria: group 1 (GOLD I and II), group 2 (GOLD III), and group 3 (GOLD IV). Patients with less severe obstructive airway disease had significantly higher rate of hypopnea (p = 0.05) and AHI (p = 0.05). The number of REM events was significantly higher in patients with less severe airway disease (p = 0.028). Stage 1 sleep among patients with higher FEV1 significantly constituted a higher proportion of sleep, and stage 4 sleep was significantly longer in patients with higher DLCO (p = 0.043, both). We found that sleep parameters in SM-exposed patients have some relations with spirometric parameters. Future studies with large patient populations are needed for confirmation of our results, and therapeutic interventions are needed to evaluate endeavors we can do to enhance health and quality of life in our mustard gas-injured population.

Radiation-induced meningiomas in pediatric patients

International Nuclear Information System (INIS)

Moss, S.D.; Rockswold, G.L.; Chou, S.N.; Yock, D.; Berger, M.S.

1988-01-01

Radiation-induced meningiomas rarely have latency periods short enough from the time of irradiation to the clinical presentation of the tumor to present in the pediatric patient. Three cases of radiation-induced intracranial meningiomas in pediatric patients are presented. The first involved a meningioma of the right frontal region in a 10-year-old boy 6 years after the resection and irradiation of a 4th ventricular medulloblastoma. Review of our pediatric tumor cases produced a second case of a left temporal fossa meningioma presenting in a 15-year-old boy with a history of irradiation for retinoblastoma at age 3 years and a third case of a right frontoparietal meningioma in a 15-year-old girl after irradiation for acute lymphoblastic leukemia. Only three cases of meningiomas presenting in the pediatric age group after radiation therapy to the head were detected in our review of the literature

Medical home characteristics and the pediatric patient experience.

Science.gov (United States)

Burnet, Deborah; Gunter, Kathryn E; Nocon, Robert S; Gao, Yue; Jin, Janel; Fairchild, Paige; Chin, Marshall H

2014-11-01

The patient-centered medical home (PCMH) has roots in pediatrics, yet we know little about the experience of pediatric patients in PCMH settings. To examine the association between clinic PCMH characteristics and pediatric patient experience as reported by parents. We assessed the cross-sectional correlation between clinic PCMH characteristics and pediatric patient experience in 24 clinics randomly selected from the Safety Net Medical Home Initiative, a 5-state PCMH demonstration project. PCMH characteristics were measured with surveys of randomly selected providers and staff; surveys generated 0 (worst) to 100 (best) scores for 5 subscales, and a total score. Patient experience was measured through surveying parents of pediatric patients. Questions from the Consumer Assessment of Healthcare Providers and Systems-Clinician and Group instrument produced 4 patient experience measures: timeliness, physician communication, staff helpfulness, and overall rating. To investigate the relationship between PCMH characteristics and patient experience, we used generalized estimating equations with an exchangeable correlation structure. We included 440 parents and 214 providers and staff in the analysis. Total PCMH score was not associated with parents' assessment of patient experience; however, PCMH subscales were associated with patient experience in different directions. In particular, quality improvement activities undertaken by clinics were strongly associated with positive ratings of patient experience, whereas patient care management activities were associated with more negative reports of patient experience. Future work should bolster features of the PCMH that work well for patients while investigating which PCMH features negatively impact patient experience, to yield a better patient experience overall.

Pediatric advanced life support and sedation of pediatric dental patients.

Science.gov (United States)

Kim, Jongbin

2016-03-01

Programs provided by the Korea Association of Cardiopulmonary Resuscitation include Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), and Korean Advanced Life Support (KALS). However, programs pertinent to dental care are lacking. Since 2015, related organizations have been attempting to develop a Dental Advanced Life Support (DALS) program, which can meet the needs of the dental environment. Generally, for initial management of emergency situations, basic life support is most important. However, emergencies in young children mostly involve breathing. Therefore, physicians who treat pediatric dental patients should learn PALS. It is necessary for the physician to regularly renew training every two years to be able to immediately implement professional skills in emergency situations. In order to manage emergency situations in the pediatric dental clinic, respiratory support is most important. Therefore, mastering professional PALS, which includes respiratory care and core cases, particularly upper airway obstruction and respiratory depression caused by a respiratory control problem, would be highly desirable for a physician who treats pediatric dental patients. Regular training and renewal training every two years is absolutely necessary to be able to immediately implement professional skills in emergency situations.

Sonography of iatrogenic pneumothorax in pediatric patients

Science.gov (United States)

2013-01-01

Pneumothorax is defined as the presence of air in the pleural cavity. The incidence of iatrogenic pneumothorax in the pediatric population is 0.3–0.48 in 1000 patients. A conventional chest X-ray, in some cases supplemented with chest computed tomography, is a typical imaging examination used to confirm the diagnosis of pneumothorax. Within the last years, the relevance of transthoracic lung ultrasound in the diagnostic process of this disease entity has greatly increased. This is confirmed by the opinion of a group of experts in ultrasound lung imaging in patients in a life-threatening condition, who strongly recommend a transthoracic ultrasound examination for the diagnosis of pneumothorax in such patients. These data constituted the basis for initiating the prospective studies on the application of this method in pneumothorax diagnosis in patients of pediatric hematology and oncology wards. Aim The aim of the study was to present the possibility of using the transthoracic lung ultrasound in the diagnostic process of pneumothorax in pediatric patients, with particular attention paid to its iatrogenic form. The article discusses sonographic criteria for pneumothorax diagnosis in pediatric patients, including the sensitivity and specificity of the method, in relation to conventional chest X-ray. Material and methods The prospective studies included a group of patients treated in the Clinic of Pediatrics, Pediatric Hematology, Oncology and Endocrinology of the Academic Clinical Centre (Medical University of Gdańsk, Poland) in whom a central venous catheter was placed in the subclavian veins. The studies lasted for one year – from 1 July 2011 to 30 June 2012. The examined group comprised 63 patients – 25 girls (39.7%) and 38 boys (60.3%) aged from 1 to 17. The analysis included the results of 115 ultrasound examinations conducted in this group. Results In t he examined group with suspected or diagnosed neoplasm, iatrogenic pneumothorax was identified in 4 out

Validation of a Pediatric Early Warning Score in Hospitalized Pediatric Oncology and Hematopoietic Stem Cell Transplant Patients.

Science.gov (United States)

Agulnik, Asya; Forbes, Peter W; Stenquist, Nicole; Rodriguez-Galindo, Carlos; Kleinman, Monica

2016-04-01

To evaluate the correlation of a Pediatric Early Warning Score with unplanned transfer to the PICU in hospitalized oncology and hematopoietic stem cell transplant patients. We performed a retrospective matched case-control study, comparing the highest documented Pediatric Early Warning Score within 24 hours prior to unplanned PICU transfers in hospitalized pediatric oncology and hematopoietic stem cell transplant patients between September 2011 and December 2013. Controls were patients who remained on the inpatient unit and were matched 2:1 using age, condition (oncology vs hematopoietic stem cell transplant), and length of hospital stay. Pediatric Early Warning Scores were documented by nursing staff at least every 4 hours as part of routine care. Need for transfer was determined by a PICU physician called to evaluate the patient. A large tertiary/quaternary free-standing academic children's hospital. One hundred ten hospitalized pediatric oncology patients (42 oncology, 68 hematopoietic stem cell transplant) requiring unplanned PICU transfer and 220 matched controls. None. Using the highest score in the 24 hours prior to transfer for cases and a matched time period for controls, the Pediatric Early Warning Score was highly correlated with the need for PICU transfer overall (area under the receiver operating characteristic = 0.96), and in the oncology and hematopoietic stem cell transplant groups individually (area under the receiver operating characteristic = 0.95 and 0.96, respectively). The difference in Pediatric Early Warning Score results between the cases and controls was noted as early as 24 hours prior to PICU admission. Seventeen patients died (15.4%). Patients with higher Pediatric Early Warning Scores prior to transfer had increased PICU mortality (p = 0.028) and length of stay (p = 0.004). We demonstrate that our institution's Pediatric Early Warning Score is highly correlated with the need for unplanned PICU transfer in hospitalized oncology and

Evaluation of bronchiectasis in war chemically-injured patients via high resolution computed tomography

Directory of Open Access Journals (Sweden)

Reza Jalli

2017-12-01

Discussion and conclusion: Findings of chest HRCT demonstrated tubular bronchiectasis was the most frequent type of this disease that involve the chemically injured patients and RLL had been the most frequently involved lobe of the lung with bronchiectasis.

Pediatric and youth traffic-collision injuries in Al Ain, United Arab Emirates: a prospective study.

Directory of Open Access Journals (Sweden)

Michal Grivna

Full Text Available AIM: To study the mechanism of road traffic collisions (RTC, use of safety devices, and outcome of hospitalized pediatric and youth RTC injured patients so as to give recommendations regarding prevention of pediatric RTC injuries. METHODS: All RTC injured children and youth (0-19-year-olds who were admitted to Al Ain City's two major trauma centers or who died after arrival to these centers were prospectively studied from April 2006 to October 2007. Demography of patients, road-user and vehicle types, crash mechanism, usage of safety devices, injured body regions, injury severity, Revised Trauma Score, Glasgow Coma Scale, intensive care unit admissions, hospital stay and mortality were analyzed. RESULTS: 245 patients were studied, 69% were vehicle occupants, 15% pedestrians, 9% motorcyclists and 5% bicyclists. 79% were males and 67% UAE citizens. The most common mechanism of RTC was rollover of vehicle (37% followed by front impact collision (32%. 32 (13% of vehicle occupants were ejected from car. 63% of ejected occupants and 70% of motorcyclists sustained head injuries. Only 2% (3/170 vehicle passengers used seatbelts and 13% (3/23 motorcyclists a helmet. CONCLUSIONS: Male drivers and UAE nationals were at high risk of RTC as drivers and as motorcyclists. Ejection rate was high because safety restraint use was extremely low in our community. More education and law enforcement focusing especially on car/booster seat use is needed.

Pattern of Pressure Sores in Spinal Injured Patients with in the First ...

African Journals Online (AJOL)

Background: Before 2006, all our spinal injured patients were nursed on conventional form mattress without pressure redistributing support surface. Pressure sore was a common complication and was a major contributing factor to prolonged hospitalization. Aim: The aim of this study is to determine the pattern of pressure ...

Vulnerable, but strong: The spinal cord-injured patient during rehabilitation

DEFF Research Database (Denmark)

Angel, Sanne

2010-01-01

A traumatic spinal cord injury affects the body to an extent that the patient requires the assistance of others to survive and recover. The rehabilitation phase puts the patient in a vulnerable position and involves a considerable amount of strength on the patient's part. The aim of this paper...... is to explore the vulnerability of the spinal cord patient and how this vulnerability connects to the necessary strength, as the patient struggles to survive the injury and get through the rehabilitation. The circumstances of 12 traumatic spinal cord-injured patients were observed in the rehabilitation unit...... and after discharge. A phenomenological-hermeneutic narrative approach applying Ricoeur's theory was used. Data were collected by field observation and interviews during the first 2 years after the spinal cord injury. The patient's strength during the rehabilitation was portrayed by their endurance and from...

A cross-sectional study of psychological complaints and quality of life in severely injured patients.

Science.gov (United States)

van Delft-Schreurs, C C H M; van Bergen, J J M; van de Sande, P; Verhofstad, M H J; de Vries, J; de Jongh, M A C

2014-05-01

The purpose of this study was to examine the incidence of psychological complaints and the relationship of these complaints with the quality of life (QOL) and accident- and patient-related factors among severely injured patients after the rehabilitation phase. Patients of 18 years or older with an injury severity score above 15 were included 15-53 months after their accident. Accident and patient characteristics were obtained from questionnaires and the trauma registry. Several questionnaires (Hospital Anxiety and Depression Scale, Impact of Events Scale, and Cognitive Failure Questionnaire) were used to determine the symptoms of psychological problems (anxiety or depression, post-traumatic stress disorder, or subjective cognitive complaints, respectively). The World Health Organization Quality of Life-Bref was used to determine QOL. A reference group of the Dutch general population was used for comparison of QOL scores. The participation rate was 62 % (n = 173). At the time of the study, 30.1 % (n = 52) of the investigated patients had psychological complaints. No relation between psychological complaints and somatic severity or type of injury was found. Patients who were employed before the accident or resumed working reported less psychological complaints. Use of any medication before the accident and treatment for pre-accidental psychological problems were positively related to psychological complaints afterwards. QOL of severely injured patients was impaired in comparison with the general Dutch population, but only for those with psychological complaints. Psychological complaints seem to be an important and underestimated factor for a decreased QOL among severely injured patients.

Pediatric Injuries at an Annual Motocross Competition: Rates and Severity.

Science.gov (United States)

Williams, Brendan A; McFadden, James P; Teurlings, Tyler L; Blakemore, Laurel C

Pediatric motocross injuries occur frequently and with significant associated morbidity; however, data are limited regarding injury occurring during competition. North Central Florida hosts an annual motocross competition with numerous pediatric competitors. We sought to evaluate the rate and severity of injuries sustained at this event over a multiyear period. Our primary hypothesis was that motocross injury rates and severity in competition exceed that of other competitive sports in this age group. A retrospective review was performed to identify pediatric patients (17 and younger) presenting to a single Level 1 Trauma Center as a result of injury sustained at an annual motocross competition from 2009 to 2012. Demographic, diagnostic, and treatment data were collected including injuries, procedural interventions, and length of hospital stay. Rate, type, and severity of injury were evaluated and compared with established norms of other competitive sports in a similar age group. Over a 4-year period, 51 pediatric motocross competitors sustained 75 injuries. Injured riders were 14.2±2.51 years (range, 8 to 17 y) old and 92% (47/51) male. Forty (78%) patients sustained at least 1 orthopaedic injury and 17 (33%) patients suffered polytrauma. The majority of injuries occurred in the upper extremity (36%). Twenty-four (47%) patients required procedural intervention, 15 of which were operative. Thirty-nine (76%) patients necessitated surgical specialty care. Average injury severity score was 6.5 (1 to 75) and 1 death occurred. The injury rate for pediatric motocross riders in this study was 19.9 injuries per 1000 competitors. High rates of injury occur among pediatric patients in competitive motocross, exceeding those seen in other competitive sports in a comparable age group. Significant morbidity and at least 1 fatality were demonstrated in the group studied. The majority of patients suffer at least 1 orthopaedic injury and nearly all patients require pediatric

Effectiveness of prehospital trauma triage systems in selecting severely injured patients: Is comparative analysis possible?

Science.gov (United States)

van Rein, Eveline A J; van der Sluijs, Rogier; Houwert, R Marijn; Gunning, Amy C; Lichtveld, Rob A; Leenen, Luke P H; van Heijl, Mark

2018-01-27

In an optimal trauma system, prehospital trauma triage ensures transport of the right patient to the right hospital. Incorrect triage results in undertriage and overtriage. The aim of this systematic review is to evaluate and compare prehospital trauma triage system quality worldwide and determine effectiveness in terms of undertriage and overtriage for trauma patients. A systematic search of Pubmed/MEDLINE, Embase, and Cochrane Library databases was performed, using "trauma", "trauma center," or "trauma system", combined with "triage", "undertriage," or "overtriage", as search terms. All studies describing ground transport and actual destination hospital of patients with and without severe injuries, using prehospital triage, published before November 2017, were eligible for inclusion. To assess the quality of these studies, a critical appraisal tool was developed. A total of 33 articles were included. The percentage of undertriage ranged from 1% to 68%; overtriage from 5% to 99%. Older age and increased geographical distance were associated with undertriage. Mortality was lower for severely injured patients transferred to a higher-level trauma center. The majority of the included studies were of poor methodological quality. The studies of good quality showed poor performance of the triage protocol, but additional value of EMS provider judgment in the identification of severely injured patients. In most of the evaluated trauma systems, a substantial part of the severely injured patients is not transported to the appropriate level trauma center. Future research should come up with new innovative ways to improve the quality of prehospital triage in trauma patients. Copyright © 2018. Published by Elsevier Inc.

Pediatric Critical Care Telemedicine Program: A Single Institution Review.

Science.gov (United States)

Hernandez, Maria; Hojman, Nayla; Sadorra, Candace; Dharmar, Madan; Nesbitt, Thomas S; Litman, Rebecca; Marcin, James P

2016-01-01

Rural and community emergency departments (EDs) often receive and treat critically ill children despite limited access to pediatric expertise. Increasingly, pediatric critical care programs at children's hospitals are using telemedicine to provide consultations to these EDs with the goal of increasing the quality of care. We conducted a retrospective review of a pediatric critical care telemedicine program at a single university children's hospital. Between the years 2000 and 2014, we reviewed all telemedicine consultations provided to children in rural and community EDs, classified the visits using a comprehensive evidence-based set of chief complaints, and reported the consultations' impact on patient disposition. We also reviewed the total number of pediatric ED visits to calculate the relative frequency with which telemedicine consultations were provided. During the study period, there were 308 consultations provided to acutely ill and/or injured children for a variety of chief complaints, most commonly for respiratory illnesses, acute injury, and neurological conditions. Since inception, the number of consultations has been increasing, as has the number of participating EDs (n = 18). Telemedicine consultations were conducted on 8.6% of seriously ill children, the majority of which resulted in admission to the receiving hospital (n = 150, 49%), with a minority of patients requiring transport to the university children's hospital (n = 103, 33%). This single institutional, university children's hospital-based review demonstrates that a pediatric critical care telemedicine program used to provide consultations to seriously ill children in rural and community EDs is feasible, sustainable, and used relatively infrequently, most typically for the sickest pediatric patients.

Cerebral Glucose Metabolism and Sedation in Brain-injured Patients: A Microdialysis Study.

Science.gov (United States)

Hertle, Daniel N; Santos, Edgar; Hagenston, Anna M; Jungk, Christine; Haux, Daniel; Unterberg, Andreas W; Sakowitz, Oliver W

2015-07-01

Disturbed brain metabolism is a signature of primary damage and/or precipitates secondary injury processes after severe brain injury. Sedatives and analgesics target electrophysiological functioning and are as such well-known modulators of brain energy metabolism. Still unclear, however, is how sedatives impact glucose metabolism and whether they differentially influence brain metabolism in normally active, healthy brain and critically impaired, injured brain. We therefore examined and compared the effects of anesthetic drugs under both critical (1 mmol/L) extracellular brain glucose levels. We performed an explorative, retrospective analysis of anesthetic drug administration and brain glucose concentrations, obtained by bedside microdialysis, in 19 brain-injured patients. Our investigations revealed an inverse linear correlation between brain glucose and both the concentration of extracellular glutamate (Pearson r=-0.58, P=0.01) and the lactate/glucose ratio (Pearson r=-0.55, P=0.01). For noncritical brain glucose levels, we observed a positive linear correlation between midazolam dose and brain glucose (Pbrain glucose levels, extracellular brain glucose was unaffected by any type of sedative. These findings suggest that the use of anesthetic drugs may be of limited value in attempts to influence brain glucose metabolism in injured brain tissue.

Evaluation of patient satisfaction in pediatric dermatology.

Science.gov (United States)

Ahmed, Sarah; Miller, Jonathan; Burrows, James F; Bertha, Ben Khallouq; Rosen, Paul

2017-11-01

There remains a lack of investigation into which factors patients and families value the most in their experience at pediatric dermatology clinics. Most of the current literature on quality improvement in dermatology does not encompass the pediatric population. To determine the drivers that are most predictive of a positive patient experience, we observed the indirect relationship between several factors of the patient experience and their role in patient satisfaction. Patient satisfaction surveys were distributed after their visits to patients at four pediatric dermatology clinics in one children's academic health system. Data were collected and organized into the top 30 survey variables with which patients expressed satisfaction on a 5-point Likert scale. Pearson product-moment correlation coefficients (r) for each variable with regard to "likelihood of your recommending our practice to others" were calculated. A total of 516 families completed patient satisfaction surveys. Analyses of top box scores showed that the strongest predictors of patient satisfaction were the likelihood of recommending care provider (r = .77, P = dermatology. Identifying such variables that shape patients' assessments of their experience can guide future quality improvement plans in the specialty. © 2017 Wiley Periodicals, Inc.

Can PRP effectively treat injured tendons?

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Wang, James H-C

2014-01-01

PRP is widely used to treat tendon and other tissue injuries in orthopaedics and sports medicine; however, the efficacy of PRP treatment on injured tendons is highly controversial. In this commentary, I reason that there are many PRP- and patient-related factors that influence the outcomes of PRP treatment on injured tendons. Therefore, more basic science studies are needed to understand the mechanism of PRP on injured tendons. Finally, I suggest that better understanding of the PRP action mechanism will lead to better use of PRP for the effective treatment of tendon injuries in clinics.

Microbial pattern of pressure ulcer in pediatric patients

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Paramita, D. A.; Khairina; Lubis, N. Z.

2018-03-01

Pressure ulcer (PU) is a localized trauma to the skin and or tissue beneath which lies in bony prominence due to pressure or pressure that combines with a sharp surface. Several studies have found that PU is a common problem in pediatrics population. Infection at the site of a PU is the most common complication in which the PU may host a resistant microorganism and may turn into a local infection that will be the source of bacteremia in hospitalized patients. To reveal which is the most common microbial species that underlie in pressure ulcer of pediatrics patients.A cross-sectional study was conducted in July-September 2017, involving 18 PU pediatric patients in Haji Adam Malik Hospital. To each subject, swab culture from the ulcer was madein microbial laboratory in Haji Adam Malik Hospital to determine the microbial pattern. This study found that the most common microbial pattern in pressure ulcers of pediatrics patient in Haji Adam Malik Hospital is Acinetobacter baumannii (22.2%).

Buccal Dosage Forms: General Considerations for Pediatric Patients.

Science.gov (United States)

Montero-Padilla, Soledad; Velaga, Sitaram; Morales, Javier O

2017-02-01

The development of an appropriate dosage form for pediatric patients needs to take into account several aspects, since adult drug biodistribution differs from that of pediatrics. In recent years, buccal administration has become an attractive route, having different dosage forms under development including tablets, lozenges, films, and solutions among others. Furthermore, the buccal epithelium can allow quick access to systemic circulation, which could be used for a rapid onset of action. For pediatric patients, dosage forms to be placed in the oral cavity have higher requirements for palatability to increase acceptance and therapy compliance. Therefore, an understanding of the excipients required and their functions and properties needs to be particularly addressed. This review is focused on the differences and requirements relevant to buccal administration for pediatric patients (compared to adults) and how novel dosage forms can be less invasive and more acceptable alternatives.

The Use of Chest Computed Tomographic Angiography in Blunt Trauma Pediatric Population.

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Hasadia, Rabea; DuBose, Joseph; Peleg, Kobi; Stephenson, Jacob; Givon, Adi; Kessel, Boris

2018-02-05

Blunt chest trauma in children is common. Although rare, associated major thoracic vascular injuries (TVIs) are lethal potential sequelae of these mechanisms. The preferred study for definitive diagnosis of TVI in stable patients is computed tomographic angiography imaging of the chest. This imaging modality is, however, associated with high doses of ionizing radiation that represent significant carcinogenic risk for pediatric patients. The aim of the present investigation was to define the incidence of TVI among blunt pediatric trauma patients in an effort to better elucidate the usefulness of computed tomographic angiography use in this population. A retrospective cohort study was conducted including all blunt pediatric (age blunt trauma victims, 119,821patients were younger than 14 years. Twelve (0.0001%, 12/119821) of these children were diagnosed with TVI. The most common mechanism in this group was pedestrian hit by a car. Mortality was 41.7% (5/12). Thoracic vascular injury is exceptionally rare among pediatric blunt trauma victims but does contribute to the high morbidity and mortality seen with blunt chest trauma. Computed tomographic angiography, with its associated radiation exposure risk, should not be used as a standard tool after trauma in injured children. Clinical protocols are needed in this population to minimize radiation risk while allowing prompt identification of life-threatening injuries.

Optimization of electronic prescribing in pediatric patients

NARCIS (Netherlands)

Maat, B.

2014-01-01

Improving pediatric patient safety by preventing medication errors that may result in adverse drug events and consequent healthcare expenditure,is a worldwide challenge to healthcare. In pediatrics, reported medication error rates in general, and prescribing error rates in particular, vary between

Side effects of sugammadex use in pediatric patients

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Sinem Sarı

2013-09-01

Full Text Available Objective: It is accepted that sugammadex show its effectsmore rapidly than the other neuromuscular block antagonistsin many studies, however especially in pediatriccases, it is seen that about its reliability and side effectsare limited in some studies. In our retrospective study,we aimed to present our experiences on sugammadexin terms of its side effects in the pediatric cases in ourhospital for a 1-year period.Methods: The patient files and intraoperative anesthesiarecords, postoperative 24th hour and after postoperative24th hour of the cases that underwent the application ofsugammadex under general anesthesia in pediatric surgeryoperating room in a 1-year period were analyzed.Results: Totally 46 patients received sugammadex; infants(28 days-23 months (n=24, children (2 years-11years (n=16 and adolescent (11-17 years (n=6. Noneof the patients showed hypersensitivity and statisticallysignificant side effects correlated to sugammadex.Conclusion: We think that sugammadex may open newdoors in pediatric patient group with its features. However,more documentation is needed about the safety inpediatric patient group, particularly in infants. J Clin ExpInvest 2013; 4 (3: 265-268Key words: Sugammadex, pediatric patient, side effect

Qualitative evaluation of antibiotic usage in pediatric patients

OpenAIRE

Hindra Irawan Satari; Agus Firmansyah; Theresia Theresia

2011-01-01

Background Antibiotics are among the most commonly prescribed drug for pediatric patients. Inappropriate use of antibiotics can increase morbidity, mortality, patient cost and bacterial antibiotic resistence. Antibiotic uses can be evaluated quantitatively and qualitatively. Objective To qualitatively evaluate antibiotic use in patients using Gyssens algorithm. Methods We performed a descriptive, retrospective study of matient medical records of those admitted to the pediatric ward fro...

Reported Sildenafil Side Effects in Pediatric Pulmonary Hypertension Patients

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Stephanie Leigh Siehr

2015-03-01

Full Text Available Background: Sildenafil, a phosphodiestase type 5 inhibitor, was approved in 2005 for the treatment of pulmonary arterial hypertension (PAH in adults, and is commonly used off-label for pediatric patients. Little is known, however, about sildenafil’s side effects in this population.Methods: Single institution, longitudinal survey-based study performed in an outpatient pediatric cardiology clinic. Pediatric patients on sildenafil (alone or in combination with other PH therapies completed questionnaires regarding frequency of vascular, gastrointestinal, neurologic and hematologic side effects. Results: Between January 2011 and May 2014, 66 pediatric patients with PH on sildenafil filled out 214 surveys, 32 patients (96 surveys on monotherapy, and 43 patients (118 surveys on sildenafil plus an endothelin receptor antagonist (bosentan or ambrisentan and/or a prostacyclin (epoprostenol or treprostinil. Overall, 30% of respondents identified at least one side effect. For all patients on sildenafil, incidence of side effects by system was 37% gastrointestinal, 35% vascular and 22% neurologic. For patients on sildenafil monotherapy, incidence of side effects by system was 24% gastrointestinal, 21% vascular and 18% neurologic compared to patients on combination therapy who reported an incidence of 48% gastrointestinal, 45% vascular and 25% neurologic.Conclusion: Incidence of vascular, gastrointestinal and neurologic side effect in pediatric patients on sildenafil therapy for pulmonary arterial hypertension was 30%. Side effects were more common in patients on combination therapy with an endothelin receptor antagonist and/or prostacyclin than in patients on sildenafil monotherapy.

Predictors of Patient Satisfaction in Pediatric Oncology.

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Davis, Josh; Burrows, James F; Ben Khallouq, Bertha; Rosen, Paul

To understand key drivers of patient satisfaction in pediatric hematology/oncology. The "top-box" scores of patient satisfaction surveys from 4 pediatric hematology/oncology practices were collected from 2012 to 2014 at an integrated Children's Health Network. One item, "Likelihood of recommending practice," was used as the surrogate for overall patient satisfaction, and all other items were correlated to this item. A total of 1244 satisfaction surveys were included in this analysis. The most important predictors of overall patient satisfaction were cheerfulness of practice ( r = .69), wait time ( r = .60), and staff working together ( r = .60). The lowest scoring items were getting clinic on phone, information about delays, and wait time at clinic. Families bringing their children for outpatient care in a hematology/oncology practice want to experience a cheerful and collaborative medical team. Wait time at clinic may be a key driver in the overall experience for families with children with cancer. Future work should be directed at using this evidence to drive patient experience improvement processes in pediatric hematology/oncology.

Postanesthetic Emergence Agitation in Pediatric Patients under General Anesthesia

OpenAIRE

Mohkamkar, Masoumeh; Farhoudi, Fatemeh; Alam-Sahebpour, Alireza; Mousavi, Seyed-Abdullah; Khani, Soghra; Shahmohammadi, Soheila

2014-01-01

Abstract Objective Postanesthetic emergence agitation is a common problem in pediatric postanesthetic care unit with an incidence ranging from 10 to 80%. This study was done to determine the prevalence of emergence agitation and associated risk factors in pediatric patients who underwent general anesthesia. Methods This cross-sectional descriptive and analytic study was performed on 747 pediatric patients aged 3- 7 years that underwent general anesthesia for various elective surgeries at Bou-...

Vincristine-induced peripheral neuropathy in pediatric cancer patients

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Mora, Erika; Smith, Ellen M Lavoie; Donohoe, Clare; Hertz, Daniel L

2016-01-01

Vincristine is a chemotherapeutic agent that is a component of many combination regimens for a variety of malignancies, including several common pediatric tumors. Vincristine treatment is limited by a progressive sensorimotor peripheral neuropathy. Vincristine-induced peripheral neuropathy (VIPN) is particularly challenging to detect and monitor in pediatric patients, in whom the side effect can diminish long term quality of life. This review summarizes the current state of knowledge regarding VIPN, focusing on its description, assessment, prediction, prevention, and treatment. Significant progress has been made in our knowledge about VIPN incidence and progression, and tools have been developed that enable clinicians to reliably measure VIPN in pediatric patients. Despite these successes, little progress has been made in identifying clinically useful predictors of VIPN or in developing effective approaches for VIPN prevention or treatment in either pediatric or adult patients. Further research is needed to predict, prevent, and treat VIPN to maximize therapeutic benefit and avoid unnecessary toxicity from vincristine treatment. PMID:27904761

Injuries, negative consequences, and risk behaviors among both injured and uninjured emergency department patients who report using alcohol and marijuana

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Woolard Robert

2009-01-01

Full Text Available Background: Brief intervention (BI to reduce hazardous drinking and negative consequences such as injury has been effective when given in the emergency department (ED. The effectiveness and effect of BI has varied between injured and uninjured ED patients. This study compares injured and uninjured ED patients who admit to alcohol and marijuana use to determine their need and their readiness for BI. Patients and Methods: Participants volunteered to enter a randomized controlled trial of BI to reduce hazardous alcohol and marijuana use. Adult ED patients who had had alcohol in the last month and smoked marijuana in the last year were recruited. Those patients who were admitted to hospital, were under police custody, or were seeking treatment for substance use or psychiatric disorder were excluded. Research assistants interviewed participants using a validated questionnaire. Data were analyzed using SAS (version 9.1. Binominal tests of proportions, t-test analyses, and transformations were conducted as appropriate. Results: Injured (n = 249 and uninjured (n = 266 study participants reported very high, statistically equivalent (P > 0.05, rates of binge drinking (4-5 days/month, marijuana use (13 days/month, driving under the influence of marijuana or alcohol (>49% in the last 3 months, injury (>83% in the last year, and other negative consequences (>64% in the last 3 months prior to their ED visit. These behaviors and the consequences demonstrate a need for change. Both injured and uninjured subjects were ready to change (>56% and confident they could change (>91% alcohol and marijuana use. Discussion: ED patients who admit to alcohol and marijuana use also use other hazardous substances and participate in high-risk behaviors. In both injured and uninjured patients who admit using alcohol and marijuana, the ED visit is an opportunity to deliver BI to reduce alcohol and marijuana use and associated risk behaviors and the subsequent injury and

Prognosis and predictors of convulsion among pediatric lupus nephritis patients

International Nuclear Information System (INIS)

Beiraghdar, Fatemeh; Einollahi, Behzad; Taheri, Saeed; Panahi, Yunes; Maddani, Abbas; Esfahani, Taher; Sharifi-Bonab, Mir Mohsen

2009-01-01

In this study, we aimed to analyze features and outcome of convulsion in pediatric lupus nephritis patients. We retrospectively reviewed data of 14 Iranian children with lupus nephritis who developed seizures and compared them with a group of the same number of well matched pediatric lupus nephritis patients. Higher serum creatinine levels and higher frequencies of anemia and lymphopenia were observed in the convulsion group. Multivariable logistic regression analysis revealed that the only risk factor for development of convulsion in pediatric lupus patients with nephritis was lymphopenia. Survival analysis showed that convulsion had no impact on patient and renal function outcomes in our pediatric lupus nephritis subjects. In conclusion, we found that lymphopenia is a predictive factor for convulsion occurrence in our patients and special attention to neurological status assessment may be needed in this situation. (author)

Αpproach techniques and psychological support in pediatric patients: literature review

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Anthoula Patsiala

2017-10-01

Full Text Available Effective approaches and psychological support of pediatric patients provided by health professionals are complex processes. The negative reactions and fear that pediatric patients develop during their hospitalization hamper cooperation with health professionals. The pediatric nursing staff is called upon to apply appropriate techniques for managing these situations.The purpose of this paper was to investigate, through contemporary literature review, methods of technical and psychological support of pediatric patients, applied by nurses in everyday clinical practice. The management of negative reactions and fear of pediatric patients requires individualized approach, given the uniqueness of each one of them. However, there are some general measures which may bring the ultimate results. According to literature some of them are: creation of a sincere relationship through targeted discussion, application of documented interactive educational programs to familiarize with nursing and medical procedures, distraction during painful acts, such as venipuncture or bladder catheterization, and finally high perception to identify nonverbal reactions.Awareness and familiarization of health professionals with appropriate methods will improve the relationship between pediatric patients and healthcare providers.

Brown-McLean Syndrome in a Pediatric Patient

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Tourkmani, Abdo Karim; Martinez, Jaime D.; Berrones, David; Juárez-Domínguez, Brenda Y.; Beltrán, Francisco; Galor, Anat

2015-01-01

The purpose of this manuscript is to report the case of a 12-year-old patient who presented for routine ophthalmic examination after congenital cataract surgery performed at 2 months of age. The patient was diagnosed with bilateral Brown-McLean syndrome by slit lamp examination. No treatment was required because the patient was asymptomatic and had a clear central cornea. This is the first described case of Brown-McLean syndrome in a pediatric patient, representing the importance of clinical examination in the pediatric age group after cataract surgery because of the risk for patients of developing peripheral edema. PMID:26034485

Surgical care of the pediatric Crohn's disease patient.

Science.gov (United States)

Stewart, Dylan

2017-12-01

Despite the significant advances in the medical management of inflammatory bowel disease over the last decade, surgery continues to play a major role in the management of pediatric Crohn's disease (CD). While adult and pediatric Crohn's disease may share many clinical characteristics, pediatric Crohn's patients often have a more aggressive phenotype, and the operative care given by the pediatric surgeon to the newly diagnosed Crohn's patient is very different in nature to the surgical needs of adult patients after decades of disease progression. Children also have the unique surgical indication of growth failure to consider in the overall clinical decision making. While surgery is never curative in CD, it has the ability to transform the disease process in children, and appropriately timed operations may have tremendous impact on a child's physical and mental maturation. This monograph aims to address the surgical care of Crohn's disease in general, with a specific emphasis on the surgical treatment of small intestinal and ileocecal involvement. Copyright © 2017 Elsevier Inc. All rights reserved.

Prevalence and consequences of positive blood alcohol levels among patients injured at work

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Caitlin A Foster

2014-01-01

Full Text Available Aims: The aim of this study was to characterize positive blood alcohol among patients injured at work, and to compare the severity of injury and outcome of blood alcohol concentration (BAC positive and negative patients. Settings and Design: A retrospective cohort study was performed at a Level 1 academic trauma center. Patients injured at work between 01/01/07 and 01/01/12 and admitted with positive (BAC+ vs negative (BAC- blood alcohol were compared using bivariate analysis. Results: Out of 823, 319 subjects were tested for BAC (38.8%, of whom 37 were BAC+ (mean 0.151 g/dL, range 0.015-0.371 g/dL. Age (41 years, sex (97.2% men, race, intensive care unit (ICU and hospital length of stay (LOS, and mortality were similar between groups. Nearly half of BAC+ cases were farming injuries (18, 48.6%: Eight involved livestock, five involved all-terrain vehicles (ATVs, three involved heavy equipment, one fell, and one had a firearm injury. Eight (21.6% were construction site injuries involving falls from a roof or scaffolding, five (13.5% were semi-truck collisions, four (10.8% involved falls from a vehicle in various settings, and two (5.4% were crush injuries at an oilfield. BAC+ subjects were less likely to be injured in construction sites and oilfields, including vehicle-related falls (2.3 vs 33.9%, P < 0.0001. Over half of BAC+ (n = 20, 54% subjects were alcohol dependent; three (8.1% also tested positive for cocaine on admission. No BAC+ subjects were admitted to rehabilitation compared to 33 (11.7% of BAC- subjects. Workers′ compensation covered a significantly smaller proportion of BAC+ patients (16.2 vs 61.0%, P < 0.0001. Conclusions: Alcohol use in the workplace is more prevalent than commonly suspected, especially in farming and other less regulated industries. BAC+ is associated with less insurance coverage, which probably affects resources available for post-discharge rehabilitation and hospital reimbursement.

Pharmacological management of obesity in pediatric patients.

Science.gov (United States)

Boland, Cassie L; Harris, John Brock; Harris, Kira B

2015-02-01

To review current evidence of pharmacological options for managing pediatric obesity and provide potential areas for future research. A MEDLINE search (1966 to October 2014) was conducted using the following keywords: exenatide, liraglutide, lorcaserin, metformin, obesity, orlistat, pediatric, phentermine, pramlintide, topiramate, weight loss, and zonisamide. Identified articles were evaluated for inclusion, with priority given to randomized controlled trials with orlistat, metformin, glucagon-like peptide-1 agonists, topiramate, and zonisamide in human subjects and articles written in English. References were also reviewed for additional trials. Whereas lifestyle modification is considered first-line therapy for obese pediatric patients, severe obesity may benefit from pharmacotherapy. Orlistat is the only Food and Drug Administration (FDA)-approved medication for pediatric obesity and reduced body mass index (BMI) by 0.5 to 4 kg/m(2), but gastrointestinal (GI) adverse effects may limit use. Metformin has demonstrated BMI reductions of 0.17 to 1.8 kg/m(2), with mild GI adverse effects usually managed with dose titration. Exenatide reduced BMI by 1.1 to 1.7 kg/m(2) and was well-tolerated with mostly transient or mild GI adverse effects. Topiramate and zonisamide reduced weight when used in the treatment of epilepsy. Future studies should examine efficacy and safety of pharmacological agents in addition to lifestyle modifications for pediatric obesity. Lifestyle interventions remain the treatment of choice in pediatric obesity, but concomitant pharmacotherapy may be beneficial in some patients. Orlistat should be considered as second-line therapy for pediatric obesity. Evidence suggests that other diabetes and antiepileptic medications may also provide weight-loss benefits, but safety should be further evaluated. © The Author(s) 2014.

Computed Tomography of pediatric head trauma

International Nuclear Information System (INIS)

Shin, Kyoung Hee; Cho, Bum Shin; Hahm, Chang Kok

1982-01-01

The development of Computed Tomography (CT) scanning has revolutionized the role of radiology in the management of the pediatric head trauma. The procedure is safe and can be repeated to reasses a changing neurologic picture, thereby correlation the clinical and pathologic changes. This study included evaluation of CT of 178 infants and children with head trauma during the period of 31 months from Feb. 1979 to Aug. 1981 in the Department of Radiology, College of Medicine, Hanyang University. 1. Age distribution of the total 178 pediatric patients was ranging from one month to 16 years. The pediatric patient population was comprised of 128 males and 50 females, and its male to female ratio was about 2.5 : 1. The incidence of age occurring in 3 to 6 years was 38.2% and 7 to 10 years was 29.2%. Therefore the distribution of age between 3 to 6 years and 7 to 10 years was occurred in two-thirds of all pediatric patients. 2. Of all cases of injuries, traffic accidents were 60.1% and falls were 34.8%. 3. Skull fracture were roentgenographically detected in 61 (34.3%). However, the incidence of fractures in pretoddler group (0-2 years) was 61.1% and 7 to 10 years was 37.8%, 3 to 6 years was 36.8%. More common site of skull fracture was occipital bone,next partietal bone. 4. 54.8% of pediatric head trauma due to a full had a skull fracture, as did 25.2 % of those who were injured in traffic accident. 5. Cerebral Computed Tomography (CT) of the total 178 pediatric patients were revealed as following study.: Normal was 74.2%, epidural hematoma was 8.9%, subdural hematoma was 5.1%, cerebral contusion was 4.5%, intracerebral hematoma was 2.2% etc. 6. Of 25 cases of the epidural and subdural hematoma, supratentorial area was 15 cases, infratentorial area was 10 cases. 7. Most of the epidural hematoma was demonstrated a clear mental state. 8. However, intracerebral hematoma and cerebral contusion were occurred almost impairment of mental state

Technology Use, Preferences, and Capacity in Injured Patients at Risk for Posttraumatic Stress Disorder.

Science.gov (United States)

Kelly, Cory M; Van Eaton, Erik G; Russo, Joan E; Kelly, Victoria C; Jurkovich, Gregory J; Darnell, Doyanne A; Whiteside, Lauren K; Wang, Jin; Parker, Lea E; Payne, Thomas H; Mooney, Sean D; Bush, Nigel; Zatzick, Douglas F

2017-01-01

This investigation comprehensively assessed the technology use, preferences, and capacity of diverse injured trauma survivors with posttraumatic stress disorder (PTSD) symptoms. A total of 121 patients participating in a randomized clinical trial (RCT) of stepped collaborative care targeting PTSD symptoms were administered baseline one-, three-, and six-month interviews that assessed technology use. Longitudinal data about the instability of patient cell phone ownership and phone numbers were collected from follow-up interviews. PTSD symptoms were also assessed over the course of the six months after injury. Regression analyses explored the associations between cell phone instability and PTSD symptoms. At baseline, 71.9% (n = 87) of patients reported current cell phone ownership, and over half (58.2%, n = 46) of these patients possessed basic cell phones. Only 19.0% (n = 23) of patients had no change in cell phone number or physical phone over the course of the six months postinjury. In regression models that adjusted for relevant clinical and demographic characteristics, cell phone instability was associated with higher six-month postinjury PTSD symptom levels (p risk for the development of PTSD have unique technology use patterns, including high rates of cell phone instability. These observations should be strongly considered when developing technology-supported interventions for injured patients with PTSD.

The relationship between physical and psychological complaints and quality of life in severely injured patients

NARCIS (Netherlands)

van Delft-Schreurs, K. (Katinka); C.C.H.M. van Delft-Schreurs (C. C H M); M.A.C. van Son; M.A.C. de Jongh (Mariska); K.W.W. Lansink (Koen); J. de Vries (Jolanda); M.H.J. Verhofstad (Michiel)

2017-01-01

textabstractPurpose: The purpose of this study was two-fold. The first goal was to investigate which variables were associated with the remaining physical limitations of severely injured patients after the initial rehabilitation phase. Second, we investigated whether physical limitations were

The dose analysis of 131I treatment in pediatric patients with Graves hyperthyroidism

International Nuclear Information System (INIS)

Zheng Yan; Zhao Deshan; Fu Songhai; Feng Fei; Geng Huixia; Sun Qiting; Lu Keyi; Li Baojun; Li Sijin

2013-01-01

Objective: To analyze the radioactive 131 I dose of treatment in pediatric patients with Graves hyperthyroidism. Method: Fifty one pediatric patients with hyperthyroidism and 150 adult patients with hyperthyroidism were retrospectively analyzed, who were contraindicated or refractory for medical therapy and treated with 131 I in this study. All pediatric and adult patients treated with 131 I were divided into five groups according to the thyroid weight. Group 1: ≤30 g,Group 2: 31∼50 g, Group 3: 51∼70 g, Group 4: 71 ∼90 g and Group 5: >90 g. The pediatric patients were comparable to the adult patients in data distribution of the thyroid weight. All pediatric patients who were either contraindicated or refractory to antithyroid drugs treatment and adult patients received radioactive 131 I treatment with a dose of (2.41±0.71), (3.27±0.97) MBq/g thyroid tissue respectively. The total administrated doses of 131 I in all pediatric and adult patients were (224.36±130.10) MBq and (354.88 ±308.04) MBq respectively. All the pediatric and adult patients treated with 131 I were followed-up (median 32 months, range 24 to 83 months; median 23 months,range 15 to 62 months, respectively). The treatment results were divided into euthyroid, hyperthyroidism, late-onset hypothyroidism and relapsed. Results: The results by followed-up found that 16 and 65 patients became euthyroid, 22 and 56 patients developed late-onset hypothyroidism, 12 and 25 patients still had hyperthyroidism, 1 and 4 patients relapsed after radioiodine therapy in pediatric group and adult group who were treated with 131 I, respectively. The total efficiency was 98% and 97.3%, respectively. There were no statistical significance of treatment effect between pediatric and adult patients (χ 2 =0.058, P>0.05). Conclusion: When the radioactive 131 I dose was administrated in pediatric patients with hyperthyroidism, who were contraindicated or refractory for medical therapy, it is recommended that the

Management of Sexual Disorders in Spinal Cord Injured Patients

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Alexander R Vaccaro

2012-05-01

Full Text Available Spinal cord injured (SCI patients have sexual disorders including erectile dysfunction (ED, impotence, priapism, ejaculatory dysfunction and infertility. Treatments for erectile dysfunction include four steps. Step 1 involves smoking cessation, weight loss, and increasing physical activity. Step 2 is phosphodiesterase type 5 inhibitors (PDE5I such as Sildenafil (Viagra, intracavernous injections of Papaverine or prostaglandins, and vacuum constriction devices. Step 3 is a penile prosthesis, and Step 4 is sacral neuromodulation (SNM. Priapism can be resolved spontaneously if there is no ischemia found on blood gas measurement or by Phenylephrine. For anejaculatory dysfunction, massage, vibrator, electrical stimulation and direct surgical biopsy can be used to obtain sperm which can then be used for intra-uterine or in-vitro fertilization. Infertility treatment in male SCI patients involves a combination of the above treatments for erectile and anejaculatory dysfunctions. The basic approach to and management of sexual dysfunction in female SCI patients are similar as for men but do not require treatment for erectile or ejaculatory problems.

Ventilator-Associated Pneumonia in Neonatal and Pediatric Intensive Care Unit Patients

OpenAIRE

Foglia, Elizabeth; Meier, Mary Dawn; Elward, Alexis

2007-01-01

Ventilator-associated pneumonia (VAP) is the second most common hospital-acquired infection among pediatric intensive care unit (ICU) patients. Empiric therapy for VAP accounts for approximately 50% of antibiotic use in pediatric ICUs. VAP is associated with an excess of 3 days of mechanical ventilation among pediatric cardiothoracic surgery patients. The attributable mortality and excess length of ICU stay for patients with VAP have not been defined in matched case control studies. VAP is as...

The relationship between physical and psychological complaints and quality of life in severely injured patients

NARCIS (Netherlands)

van Delft-Schreurs, K.; van Delft-Schreurs, C.C.H.M.; van Son, M.A.C.; de Jongh, M.A.C.; Lansink, K.W.W.; de Vries, J.; Verhofstad, M.H.J.

2017-01-01

Purpose The purpose of this study was two-fold. The first goal was to investigate which variables were associated with the remaining physical limitations of severely injured patients after the initial rehabilitation phase. Second, we investigated whether physical limitations were attributable to the

Endothelial glycocalyx shedding and vascular permeability in severely injured trauma patients

DEFF Research Database (Denmark)

Rahbar, Elaheh; Cardenas, Jessica C; Baimukanova, Gyulnar

2015-01-01

of trauma patients. METHODS: Plasma samples were collected from 5 healthy consented volunteers and 22 severely injured trauma patients upon admission to the emergency department. ELISA assays were performed to quantify shed HA, HS, CS and syndecan-1 in plasma. A colloid osmometer and Electric Cell......-substrate Impedance Sensing (ECIS) system were used to measure plasma colloid osmotic pressure (COP) and cell permeability, respectively. Thrombin generation was measured using a calibrated automated thrombogram (CAT). Initial vital signs, routine laboratory values, and injury severity scores (ISS) were recorded. Non......COP (≤16 mmHg) had significantly increased syndecan-1 and HA compared to those with normal COP, which corresponded to increased cell permeability via ECIS. CS and HS did not vary between COP groups. Lastly, patients with low COP displayed reduced peak thrombin...

Evaluation of radiation dose to pediatric patients during certain special procedures

International Nuclear Information System (INIS)

Sulieman, A.; Alzimami, K.; Elhag, B.; Babikir, E.; Alsafi, K.

2014-01-01

This study was intended to measure pediatric entrance surface air kerma (ESAK) and effective dose during micturating cystourethrography (MCU), intravenous urography (IVU) and barium studies (barium meal, enema, and swallow) and to propose a local diagnostic reference level (DRL). ESAK was measured for patients using calibrated thermoluminescent dosimeters (TLDs, GR200A). Effective doses (E) were calculated using the National Radiological Protection Board (NRPB) software. A total of 236 special pediatric procedures were investigated. 21.7% of the sample comprised barium procedures, 18.6% were MCU procedures while 59.5% of the sample were IVU procedures. The mean ESAK measurements (mGy) were 2.1±0.8, 3.0±23 and 1.2±0.2 for barium meal, enema and swallow in the same order. The mean patient dose for IVU procedures was 12.4±8.7 mGy per procedure and the mean patient dose per MCU procedure was 5.8±7 mGy. Local DRLs were proposed for all procedures. The patient doses in this study are within the reported values, suggesting that pediatric patients are adequately protected. - Highlights: • Pediatric radiation dose has been evaluated for three of the most common fluoroscopic procedures. • Radiation doses were measured using calibrated TLD GR200A. • Pediatric patients of concern and ESAK doses showed large variations. • The patient doses in this study are within the reported studies suggesting that the pediatric patients are adequately protected

Ultrasound Accuracy in Diagnosing Appendicitis in Obese Pediatric Patients.

Science.gov (United States)

Love, Bryan E; Camelo, Monica; Nouri, Sarvenaz; Kriger, Diego; Ludi, Daniel; Nguyen, Henry

2017-10-01

The use of ultrasound to diagnose appendicitis in pediatric patients has been growing with the improvement of ultrasound technology and operator skills, but its utility in the increasingly obese pediatric population has not been thoroughly investigated. A retrospective review of all pediatric (≤18 years old) patients with appendicitis who were admitted at a single hospital from 2014 to 2016 was conducted. Patients were stratified into body mass index (BMI) percentile categories based on the centers for disease control guidelines. Comparisons were then made. There were 231 patients with an average BMI percentile of 72.6; 99 (42.9%) who had an ultrasound, of which 54 (54.5%) were positive for acute appendicitis, whereas 43 (43.4%) were nondiagnostic. In patients who had a nondiagnostic ultrasound, 37 had a CT demonstrating acute appendicitis. These were compared with 123 patients who had CT alone demonstrating acute appendicitis. The CT-only group was older (12 vs 9, P appendicitis.

Validation of a pediatric early warning system for hospitalized pediatric oncology patients in a resource-limited setting.

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Agulnik, Asya; Méndez Aceituno, Alejandra; Mora Robles, Lupe Nataly; Forbes, Peter W; Soberanis Vasquez, Dora Judith; Mack, Ricardo; Antillon-Klussmann, Federico; Kleinman, Monica; Rodriguez-Galindo, Carlos

2017-12-15

Pediatric oncology patients are at high risk of clinical deterioration, particularly in hospitals with resource limitations. The performance of pediatric early warning systems (PEWS) to identify deterioration has not been assessed in these settings. This study evaluates the validity of PEWS to predict the need for unplanned transfer to the pediatric intensive care unit (PICU) among pediatric oncology patients in a resource-limited hospital. A retrospective case-control study comparing the highest documented and corrected PEWS score before unplanned PICU transfer in pediatric oncology patients (129 cases) with matched controls (those not requiring PICU care) was performed. Documented and corrected PEWS scores were found to be highly correlated with the need for PICU transfer (area under the receiver operating characteristic, 0.940 and 0.930, respectively). PEWS scores increased 24 hours prior to unplanned transfer (P = .0006). In cases, organ dysfunction at the time of PICU admission correlated with maximum PEWS score (correlation coefficient, 0.26; P = .003), patients with PEWS results ≥4 had a higher Pediatric Index of Mortality 2 (PIM2) (P = .028), and PEWS results were higher in patients with septic shock (P = .01). The PICU mortality rate was 17.1%; nonsurvivors had higher mean PEWS scores before PICU transfer (P = .0009). A single-point increase in the PEWS score increased the odds of mechanical ventilation or vasopressors within the first 24 hours and during PICU admission (odds ratio 1.3-1.4). PEWS accurately predicted the need for unplanned PICU transfer in pediatric oncology patients in this resource-limited setting, with abnormal results beginning 24 hours before PICU admission and higher scores predicting the severity of illness at the time of PICU admission, need for PICU interventions, and mortality. These results demonstrate that PEWS aid in the identification of clinical deterioration in this high-risk population, regardless of a hospital

Constipation in pediatric patients with lower urinary tract symptoms

International Nuclear Information System (INIS)

Muhammad, S.; Nawaz, G.; Jamil, I.

2015-01-01

To determine the frequency of constipation in patients with pediatric age group presenting with Lower Urinary Tract Symptoms (LUTS). Study Design: Descriptive study. Place and Duration of Study: Outpatient Department of Urology in Pakistan Kidney Institute at Shifa International Hospital, Islamabad, from November 2012 to February 2014. Methodology: Two hundred pediatric patients presenting with Lower Urinary Tract Symptoms (LUTS) were studied in terms of age, gender, obstructive and irritative types of LUTS along with any associated symptoms. Constipation was assessed by Bristol stool chart in these patients. Patients with exstrophy of bladder were excluded from the study. Descriptive statistics were measured for both qualitative and quantitative variables. For qualitative variables like gender, presenting symptoms, constipation and stool types, percentages and frequencies were calculated. For quantitative variables like age, percentages / mean ± SD were calculated. Results: Mean age was 6.87 ± 3.64 years with a range of 2 - 14 years. Constipation was found in 37.5% of the pediatric patients with lower urinary tract symptoms. Conclusion: Constipation is frequent and overlooked problem in pediatric patients having urinary symptoms. Irritative lower urinary tract symptoms are more common. Children up to 5 years of age are the most common sufferers. Knowing the burden of constipation in such patients can help physicians in better treatment of such cases. (author)

Repetitive Pediatric Anesthesia in a Non-Hospital Setting

International Nuclear Information System (INIS)

Buchsbaum, Jeffrey C.; McMullen, Kevin P.; Douglas, James G.; Jackson, Jeffrey L.; Simoneaux, R. Victor; Hines, Matthew; Bratton, Jennifer; Kerstiens, John; Johnstone, Peter A.S.

2013-01-01

Purpose: Repetitive sedation/anesthesia (S/A) for children receiving fractionated radiation therapy requires induction and recovery daily for several weeks. In the vast majority of cases, this is accomplished in an academic center with direct access to pediatric faculty and facilities in case of an emergency. Proton radiation therapy centers are more frequently free-standing facilities at some distance from specialized pediatric care. This poses a potential dilemma in the case of children requiring anesthesia. Methods and Materials: The records of the Indiana University Health Proton Therapy Center were reviewed for patients requiring anesthesia during proton beam therapy (PBT) between June 1, 2008, and April 12, 2012. Results: A total of 138 children received daily anesthesia during this period. A median of 30 fractions (range, 1-49) was delivered over a median of 43 days (range, 1-74) for a total of 4045 sedation/anesthesia procedures. Three events (0.0074%) occurred, 1 fall from a gurney during anesthesia recovery and 2 aspiration events requiring emergency department evaluation. All 3 children did well. One aspiration patient needed admission to the hospital and mechanical ventilation support. The other patient returned the next day for treatment without issue. The patient who fell was not injured. No patient required cessation of therapy. Conclusions: This is the largest reported series of repetitive pediatric anesthesia in radiation therapy, and the only available data from the proton environment. Strict adherence to rigorous protocols and a well-trained team can safely deliver daily sedation/anesthesia in free-standing proton centers

Collecting core data in severely injured patients using a consensus trauma template: an international multicentre study

DEFF Research Database (Denmark)

Ringdal, Kjetil G; Lossius, Hans Morten; Jones, J Mary

2011-01-01

ABSTRACT: INTRODUCTION: No worldwide, standardised definitions exist for documenting, reporting, and comparing data from severely injured trauma patients. This study evaluated the feasibility of collecting the data variables of the international consensus-derived Utstein Trauma Template. METHODS:...

Pediatric hospitalist comanagement of surgical patients: structural, quality, and financial considerations.

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Rappaport, David I; Rosenberg, Rebecca E; Shaughnessy, Erin E; Schaffzin, Joshua K; O'Connor, Katherine M; Melwani, Anjna; McLeod, Lisa M

2014-11-01

Comanagement of surgical patients is occurring more commonly among adult and pediatric patients. These systems of care can vary according to institution type, comanagement structure, and type of patient. Comanagement can impact quality, safety, and costs of care. We review these implications for pediatric surgical patients. © 2014 Society of Hospital Medicine.

Caring for the injured child in settings of limited resource.

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Stephenson, Jacob

2016-02-01

Children represent the most vulnerable members of our global society, a truth that is magnified when they are physically wounded. In much of the developed world, society has responded by offering protection in the form of law, injury prevention guidelines, and effective trauma systems to provide care for the injured child. Much of our world, though, remains afflicted by poverty and a lack of protective measures. As the globe becomes smaller by way of ease of travel and technology, surgeons are increasingly able to meet these children where they live and in doing so offer their hands and voices to care and protect these young ones. This article is intended as an overview of current issues in pediatric trauma care in the developing world as well as to offer some tips for the volunteer surgeon who may be involved in the care of the injured child in a setting of limited resource availability. Published by Elsevier Inc.

Disrupted latent decision processes in medication-free pediatric OCD patients.

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Erhan, Ceyla; Bulut, Gresa Çarkaxhiu; Gökçe, Sebla; Ozbas, Duru; Turkakin, Esin; Dursun, Onur Burak; Yazgan, Yanki; Balcı, Fuat

2017-01-01

Decision-making in Obsessive Compulsive Disorder has typically been investigated in the adult population. Computational approaches have recently started to get integrated into these studies. However, decision-making research in pediatric OCD populations is scarce. We investigated latent decision processes in 21 medication-free pediatric OCD patients and 23 healthy control participants. We hypothesized that OCD patients would be more cautious and less efficient in evidence accumulation than controls in a two alternative forced choice (2AFC) task. Pediatric OCD patients were less efficient than controls in accumulating perceptual evidence and showed a tendency to be more cautious. In comparison to post-correct decisions, OCD patients increased decision thresholds after erroneous decisions, whereas healthy controls decreased decision thresholds. These changes were coupled with weaker evidence accumulation after errors in both groups. The small sample size limited the power of the study. Our results demonstrate poorer decision-making performance in pediatric OCD patients at the level of latent processes, specifically in terms of evidence accumulation. Copyright © 2016 Elsevier B.V. All rights reserved.

Pleural effusion following blunt splenic injury in the pediatric trauma population.

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Kulaylat, Afif N; Engbrecht, Brett W; Pinzon-Guzman, Carolina; Albaugh, Vance L; Rzucidlo, Susan E; Schubart, Jane R; Cilley, Robert E

2014-09-01

Pleural effusion is a potential complication following blunt splenic injury. The incidence, risk factors, and clinical management are not well described in children. Ten-year retrospective review (January 2000-December 2010) of an institutional pediatric trauma registry identified 318 children with blunt splenic injury. Of 274 evaluable nonoperatively managed pediatric blunt splenic injures, 12 patients (4.4%) developed left-sided pleural effusions. Seven (58%) of 12 patients required left-sided tube thoracostomy for worsening pleural effusion and respiratory insufficiency. Median time from injury to diagnosis of pleural effusion was 1.5days. Median time from diagnosis to tube thoracostomy was 2days. Median length of stay was 4days for those without and 7.5days for those with pleural effusions (psplenic injury (IV-V) (OR 16.5, p=0.001) was associated with higher odds of developing a pleural effusion compared to low-grade splenic injury (I-III). Pleural effusion following pediatric blunt splenic injury has an incidence of 4.4% and is associated with high-grade splenic injuries and longer lengths of stay. While some symptomatic patients may be successfully managed medically, many require tube thoracostomy for progressive respiratory symptoms. Copyright © 2014 Elsevier Inc. All rights reserved.

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.

Kocuria kristinae: a true pathogen in pediatric patients.

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Chen, Hsin-Mao; Chi, Hsin; Chiu, Nan-Chang; Huang, Fu-Yuan

2015-02-01

Kocuria kristinae is a Gram-positive microorganism, which has rarely been reported as a pathogen that causes infection in humans. Recently, a few studies had concluded that this pathogen can indeed cause infection in immunocompromised hosts. However, the number of reports on K. kristinae infection in pediatric patients is still relatively limited. Clinical data on pediatric patients who had K. kristinae cells isolated from their blood specimens during the period from January 2008 to May 2012 in a tertiary-care hospital in northern Taiwan were gathered and analyzed. Among 12 patients with K. kristinae cells isolated from their blood specimens, laboratory test results confirmed seven to have K. kristinae bloodstream infection. Six of them were premature babies, and one had acute leukemia. The infections were all healthcare associated. All the six premature babies had clinical presentation of sepsis and were inserted with percutaneous central venous catheters. One patient had two sets of blood culture positive for K. kristinae infection, and two premature patients had two sets of K. kristinae isolated, one from blood culture and the other from catheter tip culture, both of which were done at the same time. The leukemic child was inserted with a Broviac catheter and had K. kristinae isolated from both blood specimen and Broviac catheter. In the remaining five patients, K. kristinae infection was considered to be contaminant because they had only one set of positive blood culture and had other recognized infections. K. kristinae can cause infections in premature babies and immunocompromised pediatric patients using long-term intravenous catheters. Therefore, K. kristinae should be considered as a true pathogen and proper treatment should be provided to all susceptible pediatric patients. Copyright © 2013. Published by Elsevier B.V.

Peregrination in the problem pediatric patient. The pediatric Münchhausen syndrome?

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Fialkov, M J

1984-10-01

Peregrinating pediatric patients are those who go from physician to physician either within hospitals or from clinic to clinic within a community. They are often the symptom bearers of dysfunctional multiproblem families requiring an interdisciplinary approach to diagnosis and management. Because of the obscure nature of the child's pediatric problems, such children are often shunned by the medical profession and other social agencies, setting in motion a sequence of events that can prove detrimental to the child, his family, the community, and the state. This article illustrates the need for an anticipatory, coordinated approach in the management of this complex psychosocial condition.

Differences in characteristics among new pediatric neurology patients: the effect of a newly established private pediatric neurology practice.

Science.gov (United States)

Van Cleave, Jeanne; Woodruff, Brian; Freed, Gary L

2008-01-01

To investigate changes in volume and characteristics of new patients referred when a private pediatric neurology practice (PP) opened in 2004 in an area served primarily by an academic medical center's (AMC) pediatric neurology practice. Retrospective analysis of medical and billing records to examine changes in volume, diagnosis, and sociodemographic factors of new patients at the AMC from July 2004 to June 2005; the PP during the same period; and the AMC during the year before. One year after the PP opened, 40% more new pediatric neurology patients were seen in this area than the year before. Compared with the AMC, PP saw a greater proportion of seizures (34% vs 26%, P 20 miles from the practice (32% vs 64%, P pediatric neurology patients in this area. After the PP opened, the AMC continued to care for most patients with rare diseases and fewer financial resources. Future research should examine whether the increase in volume reflects relief of pent-up demand or increased referral rates due to eased access, and should elucidate how differences in patient populations at academic and private subspecialty practices relate to access to subspecialty care and financial well-being of academic practices.

Patient doses in CT with special emphasis on pediatric patients in Algeria

International Nuclear Information System (INIS)

Khelassi-Toutaoui, Nadia; Merad, Ahmed; Toutaoui, Aek; Bairi, Souad; Tsapaki, Virginia; Mansouri, Boudjema

2008-01-01

Full text: Purpose: To estimate the frequency of CT examinations in children 0-15 years of age, to investigate whether exposure factors for children are different than for adults and to evaluate patient dose, as part of an International Atomic Energy Agency (IAEA) project on Radiation Protection of patients and Medical Exposure Control (RAF 9033). Material and Methods: Two CT machines were included in the study. Weighted computed tomography dose index (CTDI w ). Results: Pediatric CT examinations accoutered for 12-20% of the total exams performed in the CT facilities. For head, chest and abdomen examinations, mAs were reduced for pediatric patients, mainly on an arbitrary manner. One of the CT machines allowed change of kV and in that case kV was reduced for pediatric patients. Chest, Chest-High Resolution, Abdomen, Lumbar spine and Pelvis CTDI w and DLP were lower and IAEA guidance levels in almost all types of exams. It was observed, however, that DLP in one hospital was almost double than the other hospital that was mostly attributed to larger extent of scan length. ) for a single slice and dose length product (DLP) for a complete examination were used to evaluate patient dose. Kilovoltage (kV) and mAs were the exposure factors investigated. Conclusion: The study showed that pediatric examinations reach up to 1/5 of the total exams performed. It is encouraging that exposure factors are reduced, but a more standard method of reduction should be applied. Patient doses were lower that IAEA standards. Further optimization could be done by reducing scan length. (author)

Diagnostic Dilemma of Cardiac Syncope in Pediatric Patients

Directory of Open Access Journals (Sweden)

Ranya A Hegazy

2008-02-01

Full Text Available Aims Syncope is defined as temporary loss of consciousness and postural tone resulting from an abrupt transient decrease in cerebral blood flow. The present work aimed at determining how diagnostic tests are used in the evaluation of pediatric syncope at a tertiary pediatric referral center and to report on the utility and the yield of these tests.Settings and Design Retrospective study conducted at a tertiary referral arrhythmolology serviceMethods and Material The clinical charts of 234 pediatric patients presenting with a primary complaint of syncope with an average age of 7.48 ± 3.82(3.5-16 years were reviewed by the investigators.Statistical analysis used Statistical Package of social science (SPSS version 9,0 was used for analysis of data.Results The commonest trigger for syncope in the study population was early following exercise (n=65 and the commonest prodrome was palpitation, noted in 25 patients. A murmur was present in 19 of our patients (8.3% while 10.7% (n=25 had abnormal ECGs. Of the 106 echocardiograms done, 14 (13.2% were abnormal. Only two of them were missed by ECG. All patients were offered ambulatory 24 hour ECG. One patient with sick sinus syndrome was diagnosed only with Holter.Conclusions Clues to the presence of cardiac syncope may include acute onset of syncope, frequent episodes, low difference between blood pressure readings in supine and erect positions (after standing for 2 minutes and most importantly an abnormal 12 lead ECG. Transthoracic echo and Holter monitoring have low yield in pediatric syncope.

Evaluation of Severity Score in Patients with Lower Limb and Pelvic Fractures Injured in Motor Vehicle Front-Impact Collisions.

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Gokalp, Mehmet Ata; Hekimoglu, Yavuz; Gozen, Abdurrahim; Guner, Savas; Asirdizer, Mahmut

2016-12-01

BACKGROUND Lower limb and pelvic injuries and fractures occur at a very high incidence in motor vehicle accidents. In this study, the characteristics (e.g., body side, bone location, and fracture severity) of lower limb and pelvic fractures that occurred during front-impact collisions were correlated with the injured patients' sex, age, and position in the vehicle. MATERIAL AND METHODS We retrospectively evaluated 191 patients (136 males, 55 females) who were injured in motor vehicle accidents, specifically in frontal collisions. RESULTS This study revealed that most of lower limb and pelvic fractures occurred in males (71.2%; p=.000), 19-36 years old (55.5%; p=.000), small vehicles (86.4%; p=.000), and rear seat passengers (49.2%; p=.000). Fractures most commonly occurred in the left side of the body (46.6%; p=.000) and upper legs (37.7%; p=.000). Severity scores were higher (2.76) in males than females (2.07). No statistically significant was found in severity scores of patients and other personal characteristics and fracture features of patients with lower limb and pelvic fractures who were injured in a vehicle during front-impact collisions (p>0.05). CONCLUSIONS The results of this study will be useful for the automobile industry, forensics and criminal scientists, and for trauma research studies.

Nonhemorrhagic brain lesions detected by magnetic resonance imaging in closed head injured patients

International Nuclear Information System (INIS)

Kinoshita, Yoshihiro; Hiraide, Atsushi; Yoshioka, Toshiji; Sugimoto, Tadashi; Ichimura, Teruhisa; Saito, Akira; Ohno, Yoshioki.

1990-01-01

This study evaluated the diagnostic usefulness of magnetic resonance imaging (MRI) in 83 closed head injured patients in whom CT failed to detect focal intra or extraaxial hematoma and/or apparent brain contusion. The patients were divided into three groups on the basis of unconsciousness duration: Group 1 comprised 50 patients diagnosed as having classical cerebral concussion; group 2 comprised 19 patients who presented to the hospital with 6-hr unconsciousness and was recovered within a week; and group 3 comprised 14 patients whose unconsciousness persisted for a week or more. There was no CT evidence of abnormal findings for group 1; and intraventricular hemorrhage and subarachnoid hemorrhage were visualized on CT in 26% and 16%, respectively, for group 2 and 71% and 14% for group 3. Intraaxial nonhemorrhagic lesions were detected on T2-weighted MRI. According to high signal intensity, diffuse axonal injury and cortical contusion could be distinguished; i.e., in the former the corpus callosum, basal ganglia, or brain stem showed a high signal intensity, and in the latter the frontal, temporal, or parietal lobe adjacent to the skull showed a low signal intensity. T2-weighted MRI revealed cortical contusion in 6% for group 1, 37% for group 2, and 14% for group 3; and diffuse axonal injury in 42% for group 2 and 79% for group 3. For 62 patients with normal CT findings, diffuse axonal injury was detected in 88%. There was a good correlation between intraventricular hemorrhage on CT and diffuse axonal injury on MRI. In conclusion, T2-weighted MRI was significantly superior to CT in detecting nonhemorrhagic lesions, and it was of great help for predicting neurologic recovery in closed head injured patients without apparent focal lesions on CT. (N.K.)

An update on local anesthesia for pediatric dental patients

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Peedikayil, Faizal C.; Vijayan, Ajoy

2013-01-01

Pain control is an important part of dentistry, particularly in the management of children. Behavior guidance, and dose and technique of administration of the local anesthetic are important considerations in the successful treatment of a pediatric patient. The purpose of the present review is to discuss the relevant data on topics involved, and on the current methods available in the administration of local anesthesia used for pediatric dental patients. PMID:25885712

An update on local anesthesia for pediatric dental patients

OpenAIRE

Peedikayil, Faizal C.; Vijayan, Ajoy

2013-01-01

Pain control is an important part of dentistry, particularly in the management of children. Behavior guidance, and dose and technique of administration of the local anesthetic are important considerations in the successful treatment of a pediatric patient. The purpose of the present review is to discuss the relevant data on topics involved, and on the current methods available in the administration of local anesthesia used for pediatric dental patients.

Pediatric irritable bowel syndrome patient and parental characteristics differ by care management type

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This study evaluates whether certain patient or parental characteristics are associated with gastroenterology (GI) referral versus primary pediatrics care for pediatric irritable bowel syndrome (IBS). A retrospective clinical trial sample of patients meeting pediatric Rome III IBS criteria was assem...

The utility of presacral drainage in penetrating rectal injuries in adult and pediatric patients.

Science.gov (United States)

Savoie, Kate B; Beazley, Thomas M; Cleveland, Brent; Khaneki, Sina; Markel, Troy A; Hammer, Peter M; Savage, Stephanie; Williams, Regan F

2017-11-01

With changing weaponry associated with injuries in civilian trauma, there is no clinical census on the utility of presacral drainage (PSD) in penetrating rectal injuries (PRIs), particularly in pediatric patients. Patients with PRI from July 2004-June 2014 treated at two free-standing children's hospitals and two adult level 1 trauma centers were compared by age (pediatric patients ≤16 years) and PSD. A stratified analysis was performed based on age. The primary outcome was pelvic/presacral abscess. We identified 81 patients with PRI; 19 pediatric, 62 adult. Forty patients had PSD; only three pediatric patients had a drain. Adult patients were more likely to have sustained gunshot wounds (84%), whereas pediatric patients were more likely to sustain impalement injuries (59%). Pediatric patients were more likely to have distal extraperitoneal injuries (56% versus 27% in adults, P = 0.03). PSD was more common in adult patients (59% versus 14%, P = 0.0004), African-Americans (71% versus 11% Caucasian, P adult and pediatric patients. There were three cases of pelvic/presacral abscess, all in the adult patients (P = 0.31); one patient with PSD and two without PSD (P = 0.58). In stratified analysis, there were no differences in any infectious complication between those with and without PSD. Pelvic/presacral abscess is a rare complication of PRI, especially in pediatric patients. PSD is not associated with decreased rates of infectious complications and may not be necessary in the treatment of PRI. Copyright © 2017 Elsevier Inc. All rights reserved.

Sexuality and sexual dysfunction in spinal cord-injured men in Turkey.

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Akman, Ramazan Yavuz; Coşkun Çelik, Evrim; Karataş, Metin

2015-01-01

To provide a comprehensive evaluation of sexual function and dysfunction in spinal cord-injured men based on self-reports of patients. Forty-seven spinal cord-injured men who completed the spinal shock and rehabilitation period were included. Patients were asked to complete a questionnaire developed to assess social status, sexual activities, abilities, and sexuality education after injury. Neurologic levels of patients were classified according to American Spinal Cord Injury Association protocol. Erectile function was evaluated by International Index of Erectile Function-5 (IIEF-5) questionnaire. Patients were aged between 20 and 62 years (mean: 35.2). Twenty-eight patients had T10 and above, 15 between T11 and L2, and 4 cauda conus injury. While 61.7% of the patients declared sexual activity, 93.6% declared some degree of erection. Mean IIEF-5 score was 5.3 and 87.3% of the patients had moderate to severe erectile dysfunction. Continuation of sexual activity after injury is very important and has a great impact on quality of life and interpersonal relationships for spinal cord-injured men. More attention must be given to sexuality after spinal cord injury. A very high rate of sexual dysfunction in spinal cord-injured patients was found and the importance of sexual education was emphasized in this study.

Role of T2 weighted magnetic resonance image in chronic phase of head injured patients

International Nuclear Information System (INIS)

Uzura, Masahiko; Taguchi, Yoshio; Watanabe, Hiroyuki; Chiba, Syunmei; Matsuzawa, Motoshi

2002-01-01

In neuroimaging studies of head injury, addition of echo planar imaging (EPI) T2-weighted images (WI) to routine MR images has been useful in demonstrating small hemorrhagic lesions as magnetic susceptibility artifacts (MSAs). MSAs are often found in the acute or subacute phases of head injured patients with diffuse axonal injury. We studied MSAs in follow-up MR images of patients with diffuse brain injury and discuss the role of EPI T2-WI in patients with chronic phase of head injured patients. This series consisted of 20 patients with diffuse brain injury diagnosed clinically. Their head CT findings were classified into Diffuse Injury I or II according to the CT classification of Marshall et al. All patients underwent long-term follow-up MR examinations. MR findings in chronic phase were divided into three categories in terms of MSAs: group A, MSAs remaining even after disappearance of small traumatic lesions in both T2-WI and fluid attenuated inversion recovery (FLAIR) images (11 cases); group B, MSA (s) that disappeared in association with disappearance of small traumatic lesions (4 cases); and group C, MSAs that remained but could not be differentiated from non-traumatic lesions such as hemorrhagic lacunae or cavernoma (5 cases). Adding EPI T2-WI to routine MR images can provide useful information in visualizing old traumatic lesions of the brain in patients with diffuse brain injury even if no neuroimaging studies in acute or subacute phase. (author)

Avoiding Errors in the Management of Pediatric Polytrauma Patients.

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Chin, Kenneth; Abzug, Joshua; Bae, Donald S; Horn, Bernard D; Herman, Martin; Eberson, Craig P

2016-01-01

Management of pediatric polytrauma patients is one of the most difficult challenges for orthopaedic surgeons. Multisystem injuries frequently include complex orthopaedic surgical problems that require intervention. The physiology and anatomy of children and adolescent trauma patients differ from the physiology and anatomy of an adult trauma patient, which alters the types of injuries sustained and the ideal methods for management. Errors of pediatric polytrauma care are included in two broad categories: missed injuries and inadequate fracture treatment. Diagnoses may be missed most frequently because of a surgeon's inability to reliably assess patients who have traumatic brain injuries and painful distracting injuries. Cervical spine injuries are particularly difficult to identify in a child with polytrauma and may have devastating consequences. In children who have multiple injuries, the stabilization of long bone fractures with pediatric fixation techniques, such as elastic nails and other implants, allows for easier care and more rapid mobilization compared with cast treatments. Adolescent polytrauma patients who are approaching skeletal maturity, however, are ideally treated as adults to avoid complications, such as loss of fixation, and to speed rehabilitation.

Management of Pediatric Delirium in Pediatric Cardiac Intensive Care Patients: An International Survey of Current Practices.

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Staveski, Sandra L; Pickler, Rita H; Lin, Li; Shaw, Richard J; Meinzen-Derr, Jareen; Redington, Andrew; Curley, Martha A Q

2018-06-01

The purpose of this study was to describe how pediatric cardiac intensive care clinicians assess and manage delirium in patients following cardiac surgery. Descriptive self-report survey. A web-based survey of pediatric cardiac intensive care clinicians who are members of the Pediatric Cardiac Intensive Care Society. Pediatric cardiac intensive care clinicians (physicians and nurses). None. One-hundred seventy-three clinicians practicing in 71 different institutions located in 13 countries completed the survey. Respondents described their clinical impression of the occurrence of delirium to be approximately 25%. Most respondents (75%) reported that their ICU does not routinely screen for delirium. Over half of the respondents (61%) have never attended a lecture on delirium. The majority of respondents (86%) were not satisfied with current delirium screening, diagnosis, and management practices. Promotion of day/night cycle, exposure to natural light, deintensification of care, sleep hygiene, and reorientation to prevent or manage delirium were among nonpharmacologic interventions reported along with the use of anxiolytic, antipsychotic, and medications for insomnia. Clinicians responding to the survey reported a range of delirium assessment and management practices in postoperative pediatric cardiac surgery patients. Study results highlight the need for improvement in delirium education for pediatric cardiac intensive care clinicians as well as the need for systematic evaluation of current delirium assessment and management practices.

Nonoperative management of pancreatic injuries in pediatric patients

International Nuclear Information System (INIS)

Cigdem, M.K.; Senturk, S.; Onen, A.; Siga, M.; Akay, H.; Otcu, S.

2011-01-01

Nonoperative management of minor pancreatic injury is the generally accepted approach. However, the management of major pancreatic injury remains controversial in pediatric patients. The aim of the present study was to determine the safety and efficacy of nonoperative management of pancreatic injury in pediatric patients. Between 2003 and 2009, 31 patients, 28 male and 3 female, with pancreatic injury due to blunt abdominal trauma were treated in our clinic. All patients were evaluated by ultrasonography, computed tomography (CT), and evaluation of serum amylase levels. Patients with ongoing hemodynamic instability after resuscitation or signs of bowel perforation underwent immediate laparotomy, and the remaining patients were conservatively treated. Conservative treatment consisted of nasogastric tube replacement, total parenteral nutrition, monitoring of amylase levels, and serial clinical examination. The most common mechanism of injury was a fall (35.4%). Ten patients (32.2%) had associated extraabdominal injuries, and 18 patients (58.1%) had associated abdominal injuries. The spleen was the most common site of intra-abdominal injury that was associated with pancreatic trauma. Initial amylase levels were normal in 5 patients, whose CT scans revealed pancreatic injury. Twenty-five patients (80.6%) were conservatively treated. Six patients (19.4%) required surgical intervention because of a hollow viscus or diaphragmatic injury and hemodynamic instability. A pseudocyst developed in 11 of the 25 patients who were nonoperatively treated; 6 patients required intervention for the pseudocyst (percutaneous drainage and cystogastrostomy). No patient succumbed to injury. The majority of the pancreatic injuries in pediatric patients can be successfully treated conservatively, unless there is hemodynamic instability and a hollow viscus injury. The most common complication is a pseudocyst. (author)

Nine-point plan to improve care of the injured patient: A case study from Kenya.

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Bachani, Abdulgafoor M; Botchey, Isaac; Paruk, Fatima; Wako, Daniel; Saidi, Hassan; Aliwa, Bethuel; Kibias, Simon; Hyder, Adnan A

2017-12-01

Injury rates in low- and middle-income countries are among the greatest in the world, with >90% of unintentional injury occurring in low- or middle-income countries. The risk of death from injuries is 6 times more in low- and middle-income countries than in high-income countries. This increased rate of injury is partly due to the lack of availability and access to timely and appropriate medical care for injured individuals. Kenya, like most low- and middle-income countries, has seen a 5-fold increase in injury fatalities throughout the past 4 decades, in large part related to the absence of a coordinated, integrated system of trauma care. We aimed to assess the trauma-care system in Kenya and to develop and implement a plan to improve it. A trauma system profile was performed to understand the landscape for the care of the injured patient in Kenya. This process helped identify key gaps in care ranging from prehospital to hospital-based care. In response to this observation, a 9-point plan to improve trauma care in Kenya was developed and implemented in close collaboration with local stakeholders. The 9-point plan was centered on engagement of the stakeholders, generation of key data to guide and improve services, capacity development for prehospital and hospital care, and strengthening policy and legislation. There is an urgent need for coordinated strategies to provide appropriate and timely medical care to injured individuals in low- or middle-income countries to decrease the burden of injuries and related fatalities. Our work in Kenya shows that such an integrated system of trauma care could be achieved through a step-by-step integrated and multifaceted approach that emphasizes engagement of local stakeholders and evidence-based approaches to ensure effectiveness, efficiency, and sustainability of system-wide improvements. This plan and lessons learned in its development and implementation could be adaptable to other similar settings to improve the care of the

Strengthening student communication through pediatric simulated patient encounters

Directory of Open Access Journals (Sweden)

Ryan Whitt

2014-08-01

Full Text Available As medical students enter the role of physician, clinical outcomes not only rely on their mastery of clinical knowledge, but also on the effectiveness in which they can communicate with patients and family members. While students typically have numerous opportunities to practice clinical communication with adult patients, such practice in pediatric settings is limited. This study examines if simulated patient (SP encounters strengthen third-year medical students’ communication skills during the pediatrics clerkship. During 2011-2013, three SP encounters (comprising 3 pediatric scenarios were incorporated into a pediatrics clerkship at one United States medical school to give students a safe venue to practice advanced communication with observation and direct feedback. Third-year medical students engaged in the scenarios and received both written and oral feedback from an evaluator observing the encounter. With IRB approval, students’ self-perceived confidence and abilities at performing the advanced communication skills were measured using an eightitem, Likert scale questionnaire administered pre and post the SP encounter. Pre- and post-questionnaires (n = 215; response rate, 96% analyzed using a Wilcoxon-matched pairs signed-rank test demonstrated statistically significant increases in students’ perception of their confidence and abilities regarding their performance (P < 0.05; Bonferroni correction, P < 0.006. There was an increases in student confidence and self-perceived ability in: first, communicating with children and family members of young patients; second, managing confrontational situations involving parents; third, performing a thorough psychosocial history with an adolescent; and fourth, using Evidence Based Medicine to motivate parents.

Ultrasound-guided peripheral and truncal blocks in pediatric patients

Directory of Open Access Journals (Sweden)

Mohamed Bilal Delvi

2011-01-01

Full Text Available Ultrasound has added a feather in the cap of the anesthesiologists as real-time nerve localization and drug deposition around the nerve structure under real-time guidance is now a reality, as the saying "seeing is believing" has been proven true with the advent of ultrasound in anesthesia. Pediatric patients are a unique group regarding their anatomical and physiological features in comparison with adults; regional blocks in adults with the anatomical landmark and surface marking are almost uniform across the adult population. The landmark technique in pediatric patients is not reliable in all patients due to the variability in the age and size; the advent of ultrasound in assisting nerve localization has changed the way regional blocks are achieved in children and the range of blocks performed on adults can now be performed on pediatric patients; with advances in the technology and dexterity of ultrasound equipment, the chances of success of blocks has increased with a smaller dose of the local anesthetic in comparison to the traditional methods. Anesthesiologists are now able to perform blocks with more accuracy and avoid complications like intravascular injection and injury to the pleura and peritoneum during routine practice with the assistance of high-frequency transducers and top of the range portable ultrasound machines; catheters can be inserted to provide a continuous analgesia in the postoperative period. This review article describes the common peripheral blocks in pediatric patients; the readers are encouraged to gain experience by attending workshops, hands-on practice under supervision, and conduct random controlled trials pertaining to ultrasound-guided blocks in the pediatric age group. The recent literature is encouraging and further research is promising; a wide range of blocks being described in detail by many prominent experts from all over the world.

The effect of computerized tailored brief advice on at-risk drinking in subcritically injured trauma patients

DEFF Research Database (Denmark)

Neumann, Tim; Neuner, Bruno; Weiss-Gerlach, Edith

2006-01-01

One-third of injured patients treated in the emergency department (ED) have an alcohol use disorder (AUD). Few are screened and receive counseling because ED staff have little time for additional tasks. We hypothesized that computer technology can screen and provide an intervention that reduces at...

Anomaly-Related Pathologic Atlantoaxial Displacement in Pediatric Patients.

Science.gov (United States)

Pavlova, Olga M; Ryabykh, Sergey O; Burcev, Alexander V; Gubin, Alexander V

2018-06-01

To analyze clinical and radiologic features of pathologic atlantoaxial displacement (PAAD) in pediatric patients and to compose a treatment algorithm for anomaly-related PAAD. Criteria of different types of PAAD and treatment algorithms have been widely reported in the literature but are difficult to apply to patients with odontoid abnormalities, C2-C3 block, spina bifida C1, and children. We evaluated results of treatment of 29 pediatric patients with PAAD caused by congenital anomalies of the craniovertebral junction (CVJ), treated in Ilizarov Center in 2009-2017, including 20 patients with atlantoaxial displacement (AAD) and 9 patients with atlantoaxial rotatory fixation. There were 14 males (48.3%) and 15 females (51.7%). We singled out 3 groups of patients: nonsyndromic (6 patients, 20.7%), Klippel-Feil syndrome (13 patients, 44.8%), and syndromic (10 patients, 34.5%). Odontoid abnormalities and C1 dysplasia were widely represented in the syndromic group. Local symptoms predominated in the nonsyndromic and KFS groups. In the syndromic group, all patients had AAD and myelopathy. A pronounced decrease of space available for chord C1 and increase of anterior atlantodental interval were noted compared with other groups. We present a unified treatment algorithm of pediatric anomaly-related PAAD. Syndromic AAD are often accompanied by anterior and central dislocation and myelopathy and atlantooccipital dissociation. These patients require early aggressive surgical treatment. Nonsyndromic and Klippel-Feil syndrome AAD, atlantoaxial subluxation, and atlantoaxial fixation often manifest by local symptoms and need to eliminate CVJ instability. Existing classifications of symptomatic atlantoaxial displacement are not always suitable for patients with CVJ abnormalities. Copyright © 2018 Elsevier Inc. All rights reserved.

Impact of boarding pediatric psychiatric patients on a medical ward.

Science.gov (United States)

Claudius, Ilene; Donofrio, J Joelle; Lam, Chun Nok; Santillanes, Genevieve

2014-05-01

Psychiatric disorders account for an increasing number of pediatric hospitalizations. Due to lack of psychiatric beds, patients on involuntary psychiatric holds may be admitted to medical units. Our objectives were to evaluate the rate of admission of psychiatric patients to a medical unit, psychiatric care provided, and estimated cost of care. The study involved retrospective chart review of all patients on involuntary psychiatric holds presenting to 1 pediatric emergency department from July 2009 to December 2010. We determined the rate of admission to a medical unit, the rate of counseling or psychiatric medication administration, and the estimated cost of nonmedical admissions (boarding) of patients on the medical unit. A total of 555 (50.1%) of 1108 patients on involuntary psychiatric holds were admitted to the pediatric medical unit. The majority (523 [94.2%]) were admitted for boarding because no psychiatric bed was available. Thirty-two (6.1%) patients admitted for isolated psychiatric reasons had counseling documented, and 105 (20.1%) received psychiatric medications. Patients admitted to an affiliated psychiatric hospital were significantly more likely to receive counseling and medications. Psychiatric patients were boarded in medical beds for 1169 days at an estimated cost of $2 232 790 or $4269 per patient over the 18-month period. We found high admission rates of patients on involuntary psychiatric holds to a pediatric medical unit with little psychiatric treatment in 1 hospital. Further research in other centers is required to determine the extent of the issue. Future studies of longer term outcomes (including readmission rates and assessments of functioning) are needed.

Percutaneous nephrolithotomy in pediatric patients: is computerized tomography a must?

Science.gov (United States)

Gedik, Abdullah; Tutus, Ali; Kayan, Devrim; Yılmaz, Yakup; Bircan, Kamuran

2011-02-01

The aim of this study was to retrospectively evaluate the results of pediatric percutaneous nephrolithotomy (PNL) cases, and discuss the results and necessity of non-contrast computerized tomography (CT) in these cases. In all, 48 pediatric patients who underwent PNL were retrospectively evaluated. Before PNL, either intravenous urography or CT was performed. In all patients, we evaluated the PNL time, scopy time with stone burden, and complications. During the PNL procedure, we switched to open surgery in two cases: in one because of renal pelvis perforation and in the other because of transcolonic access. In one patient who was scheduled to undergo PNL, we performed open surgery, primarily because we detected a retrorenal colon with CT. The stone burden in 45 patients who underwent PNL was 445 ± 225 mm(2), the PNL time was 51 ± 23 min, and the scopy time was 6.1 ± 2.7 min. We removed nephrostomy tubes 1-4 days after the procedure. In two patients, 24 h after removal of nephrostomy tubes, we inserted double J stents because of prolonged urine extravasation from the tract. In all, 34 of the 45 patients were stone-free, 5 patients had clinically insignificant stone fragments, and 6 patients had residual stones. PNL is a safe and effective method in the treatment of pediatric patients with kidney stones. Clinical experience is the most important factor in obtaining stone-free results. CT should be performed in all pediatric patients in order to prevent colon perforation.

[Music as an adjuvant treatment for anxiety in pediatric oncologic patients].

Science.gov (United States)

Sepúlveda-Vildósola, Ana Carolina; Herrera-Zaragoza, Octavio René; Jaramillo-Villanueva, Leonel; Anaya-Segura, Armando

2014-01-01

Music has been used as adjuvant therapy for anxiety and it is based on scientific principles. Tone, rhythm, harmony and time are crucial for its efficacy. Chemotherapy treatment frequently produces important stress in pediatric patients. This may delay treatment occasionally. Our objective was to determine if adjuvant therapy with music reduces anxiety in pediatric oncologic patients under ambulatory chemotherapy. Time series design. We included patients from 8 to 16 years of age who received ambulatory intravenous chemotherapy at the Hospital de Pediatría, Centro Médico Nacional Siglo XXI. They received treatment as usual on the first day, and music therapy during the second day of chemotherapy. A visual scale was used to categorize the level of anxiety prior and after treatment on both days. We included 22 patients. All patients experienced both moderate and high levels of anxiety prior to chemotherapy treatment on both days. There was a statistically significant reduction of anxiety on both groups after chemotherapy, but with lower levels of anxiety in the intervention group. There is an additional benefit with the use of music therapy in the reduction of anxiety in pediatric patients who receive ambulatory chemotherapy.

Pediatric Early Warning Systems aid in triage to intermediate versus intensive care for pediatric oncology patients in resource-limited hospitals.

Science.gov (United States)

Agulnik, Asya; Nadkarni, Anisha; Mora Robles, Lupe Nataly; Soberanis Vasquez, Dora Judith; Mack, Ricardo; Antillon-Klussmann, Federico; Rodriguez-Galindo, Carlos

2018-04-10

Pediatric oncology patients hospitalized in resource-limited settings are at high risk for clinical deterioration resulting in mortality. Intermediate care units (IMCUs) provide a cost-effective alternative to pediatric intensive care units (PICUs). Inappropriate IMCU triage, however, can lead to poor outcomes and suboptimal resource utilization. In this study, we sought to characterize patients with clinical deterioration requiring unplanned transfer to the IMCU in a resource-limited pediatric oncology hospital. Patients requiring subsequent early PICU transfer had longer PICU length of stay. PEWS results prior to IMCU transfer were higher in patients requiring early PICU transfer, suggesting PEWS can aid in triage between IMCU and PICU care. © 2018 Wiley Periodicals, Inc.

Management Issues in Critically Ill Pediatric Patients with Trauma.

Science.gov (United States)

Ahmed, Omar Z; Burd, Randall S

2017-10-01

The management of critically ill pediatric patients with trauma poses many challenges because of the infrequency and diversity of severe injuries and a paucity of high-level evidence to guide care for these uncommon events. This article discusses recent recommendations for early resuscitation and blood component therapy for hypovolemic pediatric patients with trauma. It also highlights the specific types of injuries that lead to severe injury in children and presents challenges related to their management. Copyright © 2017 Elsevier Inc. All rights reserved.

[Drug administration to pediatric patients: Evaluation of the nurses' preparation habits in pediatric units].

Science.gov (United States)

Ménétré, S; Weber, M; Socha, M; Le Tacon, S; May, I; Schweitzer, C; Demoré, B

2018-04-01

In hospitals, the nursing staff is often confronted with the problem of the preparation and administration of drugs for their pediatric patients because of the lack of indication, pediatric dosage, and appropriate galenic form. The goal of this study was to give an overview of the nurses' preparation habits in pediatric units and highlight their daily problems. This single-center prospective study was conducted through an observation of the nursing staff during the drug preparation process in medicine, surgery and intensive care units. We included 91 patients (55 boys and 36 girls), with an average age of 6.3 years (youngest child, 10 days old; oldest child, 18 years old). We observed a mean 2.16 drug preparations per patient [1-5]. We collected 197 observation reports regarding 66 injectable drugs and 131 oral drugs (71 liquid forms and 60 solid forms). The majority of these reports concerned central nervous system drugs (63/197), metabolism and digestive system drugs (50/197), and anti-infective drugs (46/197). The study highlights the nurses' difficulties: modification of the solid galenic forms, lack of knowledge on oral liquid form preservation or reconstitution methods, withdrawal of small volumes, and vague and noncompliant labeling. This study led to the creation of a specific working group for pediatrics. This multidisciplinary team meets on a regular basis to work toward improving the current habits to both simplify and secure drug administration to hospitalized children. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Pediatric catastrophic antiphospholipid syndrome: descriptive analysis of 45 patients from the "CAPS Registry".

Science.gov (United States)

Berman, Horacio; Rodríguez-Pintó, Ignasi; Cervera, Ricard; Gregory, Simone; de Meis, Ernesto; Rodrigues, Carlos Ewerton Maia; Aikawa, Nádia Emi; de Carvalho, Jozélio Freire; Springer, Janusz; Niedzwiecki, Maciej; Espinosa, Gerard

2014-02-01

Given the lack of information about catastrophic antiphospholipid syndrome (APS) in pediatric patients, the objective of the current study was to describe the clinical characteristics, laboratory features, treatment, and outcome of pediatric patients with catastrophic APS and compare them with the adult patients with catastrophic APS. We identified patients who were under 18years of age at time of catastrophic APS diagnosis included in the international registry of patients with catastrophic APS (CAPS Registry). Their main demographic and clinical characteristics, laboratory features, treatment, and outcome were described and compared with those of adult patients with catastrophic APS. From the 446 patients included in the CAPS Registry as of May 2013, 45 (10.3%) patients developed 46 catastrophic events before 18years of age (one patient presented two episodes). Overall, 32 (71.1%) patients were female and the mean age was 11.5±4.6years (range, 3months-18years). A total of 31 (68.9%) patients suffered from primary APS and 13 (28.9%) from systemic lupus erythematosus (SLE). The main differences between the two groups of patients were the higher prevalence of infections as precipitating factor for catastrophic event in the pediatric population (60.9% versus 26.8% in the adult population, p<0.001) and of peripheral vessel thrombosis (52.2% versus 34.3%, p=0.017). In addition, catastrophic APS was the first manifestation of APS more frequently in pediatric patients (86.6% versus 45.2%, p<0.001). Interestingly, pediatric patients showed a trend of lower mortality, although the difference was not statistically significant (26.1% versus 40.2%; odds ratio, 1.9; 95% confidence interval, 0.96-3.79; p=0.063). No differences were found neither in the laboratory features nor in the isolated or combination treatments between groups. Catastrophic APS in pediatric patients is a rare disease. There are minimal differences in the clinical and laboratory features, treatment, and

Mucoceles of the oral cavity in pediatric patients

Directory of Open Access Journals (Sweden)

Chung Wei Wu

2011-07-01

Full Text Available Mucoceles are quite common in the oral cavity, but reports on pediatric patients are very rare. The aims of this study were to present our data and experience in the treatment of mucoceles of the oral cavity in pediatric patients, to compare them with those of other countries, and to remind the pediatric physician to devote much attention to lesions of the oral cavity in children. This retrospective study is based on the record of the patients who received surgical treatment for mucoceles of the oral cavity with pathologic confirmation at the Department of Dentistry, Kaohsiung Medical University Hospital, Taiwan, between 2000 and 2004. Patients younger than 18 years were included in this study. The analyzed data included age, gender, site, size, histopathologic findings, surgical methods, and complications. There were a total of 289 patients with mucoceles confirmed by histopathologic examination. As many as 64 patients were younger than 18 years. Of the 64, 34 were girls and 30 were boys; 89.1% of the lesions were in the lower lip; and 48.4% of the lesions were less than 5 mm in diameter. Histopathologic findings showed that all mucoceles were of the extravasation type. As many as 30 patients were treated by carbon dioxide laser vaporization, and two cases recurred (6.67%; 34 patients were treated by surgical excision, and the recurrence rate (5.88% was not statistically different for the treatment methods. The laser vaporization has the advantage of less bleeding, no sutures, and saving time, especially suitable for children with oral mucocele.

Ventilator-associated pneumonia in neonatal and pediatric intensive care unit patients.

Science.gov (United States)

Foglia, Elizabeth; Meier, Mary Dawn; Elward, Alexis

2007-07-01

Ventilator-associated pneumonia (VAP) is the second most common hospital-acquired infection among pediatric intensive care unit (ICU) patients. Empiric therapy for VAP accounts for approximately 50% of antibiotic use in pediatric ICUs. VAP is associated with an excess of 3 days of mechanical ventilation among pediatric cardiothoracic surgery patients. The attributable mortality and excess length of ICU stay for patients with VAP have not been defined in matched case control studies. VAP is associated with an estimated $30,000 in attributable cost. Surveillance for VAP is complex and usually performed using clinical definitions established by the CDC. Invasive testing via bronchoalveolar lavage increases the sensitivity and specificity of the diagnosis. The pathogenesis in children is poorly understood, but several prospective cohort studies suggest that aspiration and immunodeficiency are risk factors. Educational interventions and efforts to improve adherence to hand hygiene for children have been associated with decreased VAP rates. Studies of antibiotic cycling in pediatric patients have not consistently shown this measure to prevent colonization with multidrug-resistant gram-negative rods. More consistent and precise approaches to the diagnosis of pediatric VAP are needed to better define the attributable morbidity and mortality, pathophysiology, and appropriate interventions to prevent this disease.

Improving working memory performance in brain-injured patients using hypnotic suggestion

DEFF Research Database (Denmark)

Lindeløv, Jonas K.; Overgaard, Rikke; Overgaard, Morten

2017-01-01

be effectively restored by suggesting to hypnotized patients that they have regained their pre-injury level of working memory functioning. Following four 1-h sessions, 27 patients had a medium-sized improvement relative to 22 active controls (Bayes factors of 342 and 37.5 on the two aggregate outcome measures...... group was crossed over to the working memory suggestion and showed superior improvement. By the end of the study, both groups reached a performance level at or above the healthy population mean with standardized mean differences between 1.55 and 2.03 relative to the passive control group. We conclude...... that, if framed correctly, hypnotic suggestion can effectively improve working memory following acquired brain injury. The speed and consistency with which this improvement occurred, indicate that there may be a residual capacity for normal information processing in the injured brain....

Multiple injuries after earthquakes: a retrospective analysis on 1,871 injured patients from the 2008 Wenchuan earthquake.

Science.gov (United States)

Lu-Ping, Zhao; Rodriguez-Llanes, Jose Manuel; Qi, Wu; van den Oever, Barbara; Westman, Lina; Albela, Manuel; Liang, Pan; Gao, Chen; De-Sheng, Zhang; Hughes, Melany; von Schreeb, Johan; Guha-Sapir, Debarati

2012-05-17

Multiple injuries have been highlighted as an important clinical dimension of the injury profile following earthquakes, but studies are scarce. We investigated the pattern and combination of injuries among patients with two injuries following the 2008 Wenchuan earthquake. We also described the general injury profile, causes of injury and socio-demographic characteristics of the injured patients. A retrospective hospital-based analysis of 1,871 earthquake injured patients, totaling 3,177 injuries, admitted between 12 and 31 May 2008 to the People's Hospital of Deyang city (PHDC). An electronic, webserver-based database with International Classification of Diseases (ICD)-10-based classification of earthquake-related injury diagnoses (IDs), anatomical sites and additional background variables of the inpatients was used. We analyzed this dataset for injury profile and number of injuries per patient. We then included all patients (856) with two injuries for more in-depth analysis. Possible spatial anatomical associations were determined a priori. Cross-tabulation and more complex frequency matrices for combination analyses were used to investigate the injury profile. Out of the 1,871 injured patients, 810 (43.3%) presented with a single injury. The rest had multiple injuries; 856 (45.8%) had two, 169 (9.0%) patients had three, 32 (1.7%) presented with four injuries, while only 4 (0.2%) were diagnosed with five injuries. The injury diagnoses of patients presenting with two-injuries showed important anatomical intra-site or neighboring clustering, which explained 49.1% of the combinations. For fractures, the result was even more marked as spatial clustering explained 57.9% of the association pattern. The most frequent combination of IDs was a double-fracture, affecting 20.7% of the two-injury patients (n = 177). Another 108 patients (12.6%) presented with fractures associated with crush injury and organ-soft tissue injury. Of the 3,177 injuries, 1,476 (46.5%) were

Can We Tune Our Pediatric Patients?

OpenAIRE

Jindal, Ritu; Kaur, Rajwinder

2011-01-01

For the pedodontic team, a child?s dental anxiety poses major management problems. Previously, wide variety of aversive techniques have been used with varying success rates to manage anxious child patients. The present trend advocates the use of nonaversive techniques like distraction in the management of anxious pediatric patients. So the aim of this study is to compare the effect of audio distraction with the normal set up operatory. Thirty patients of age between 4 and 8 years were include...

Interdisciplinary development and implementation of communication checklist for postoperative management of pediatric airway patients.

Science.gov (United States)

Kim, Sang W; Maturo, Stephen; Dwyer, Danielle; Monash, Bradley; Yager, Phoebe H; Zanger, Kerstin; Hartnick, Christopher J

2012-01-01

The authors describe their multidisciplinary experience in applying the Institute of Health Improvement methodology to develop a protocol and checklist to reduce communication error during transfer of care for postoperative pediatric surgical airway patients. Preliminary outcome data following implementation of the protocol and checklist are also presented. Prospective study from July 1, 2009, to February 1, 2011. Tertiary care center. Subjects. One hundred twenty-six pediatric airway patients who required coordinated care between Massachusetts Eye and Ear Infirmary and Massachusetts General Hospital. Two sentinel events involving airway emergencies demonstrated a critical need for a standardized, comprehensive instrument that would ensure safe transfer of care. After development and implementation of the protocol and checklist, an initial pilot period on the first set of 9 pediatric airway patients was reassessed. Subsequent prospective 11-month follow-up data of 93 pediatric airway patients were collected and analyzed. A multidisciplinary pediatric team developed and implemented a formalized, postoperative checklist and transfer protocol. After implementation of the checklist and transfer protocol, prospective analysis showed no adverse events from miscommunication during transfer of care over the subsequent 11-month period involving 93 pediatric airway patients. There has been very little written in the quality and safety patient literature about coordinating effective transfer of care between the pediatric surgical and medical subspecialty realms. After design and implementation of a simple, electronically based transfer-of-care checklist and protocol, the number of postsurgical pediatric airway information transfer and communication errors decreased significantly.

Pleurodesis for effusions in pediatric oncology patients at end of life

International Nuclear Information System (INIS)

Hoffer, Fredric A.; Hancock, Michael L.; Rai, Shesh N.; Hinds, Pamela S.; Oigbokie, Nikita; Rao, Bhaskar

2007-01-01

Pleurodesis for end-of-life care has been used in adults for decades, but little is known about the usefulness of this technique in improving the quality of care for pediatric patients. To assess whether intractable pleural effusions in pediatric oncology patients at end of life could be sufficiently relieved by pleurodesis. Eleven pleurodeses were performed with doxycycline in seven pediatric cancer patients (age 3-21 years) with intractable pleural effusions at the end of life. Five patients had unilateral pleurodeses and two had a unilateral followed by bilateral pleurodeses. Respiratory rates decreased in all seven patients (P = 0.016) and aeration improved significantly after chest tube placement (P = 0.033). The chest tubes were placed a median of 1 day before pleurodesis. Eight of nine chest tubes (89%) were removed before discharge at a median of 3 days after pleurodesis. Pain secondary to the pleurodesis lasted 1 day or less. Improvement in the respiratory rate remained after pleurodesis and chest tube removal (P = 0.031). Five of seven patients (70%) were able to leave the hospital to return home. The five patients discharged lived 10 to 49 days (median 19 days) after discharge. Pediatric oncology patients with intractable effusions at end of life can have respiratory benefit from pleurodeses and, as a result, are more likely to return home for terminal care. (orig.)

Pleurodesis for effusions in pediatric oncology patients at end of life

Energy Technology Data Exchange (ETDEWEB)

Hoffer, Fredric A. [St. Jude Children' s Research Hospital, Department of Radiological Sciences, Memphis, TN (United States); Children' s Hospital and Regional Medical Center, Department of Radiology, R-5438, Seattle, WA (United States); Hancock, Michael L.; Rai, Shesh N. [St. Jude Children' s Research Hospital, Department of Biostatistics, Memphis, TN (United States); Hinds, Pamela S. [St. Jude Children' s Research Hospital, Division of Nursing Research, Memphis, TN (United States); Oigbokie, Nikita [St. Jude Children' s Research Hospital, Department of Radiological Sciences, Memphis, TN (United States); Rao, Bhaskar [St. Jude Children' s Research Hospital, Department of Surgery, Memphis, TN (United States)

2007-03-15

Pleurodesis for end-of-life care has been used in adults for decades, but little is known about the usefulness of this technique in improving the quality of care for pediatric patients. To assess whether intractable pleural effusions in pediatric oncology patients at end of life could be sufficiently relieved by pleurodesis. Eleven pleurodeses were performed with doxycycline in seven pediatric cancer patients (age 3-21 years) with intractable pleural effusions at the end of life. Five patients had unilateral pleurodeses and two had a unilateral followed by bilateral pleurodeses. Respiratory rates decreased in all seven patients (P = 0.016) and aeration improved significantly after chest tube placement (P = 0.033). The chest tubes were placed a median of 1 day before pleurodesis. Eight of nine chest tubes (89%) were removed before discharge at a median of 3 days after pleurodesis. Pain secondary to the pleurodesis lasted 1 day or less. Improvement in the respiratory rate remained after pleurodesis and chest tube removal (P = 0.031). Five of seven patients (70%) were able to leave the hospital to return home. The five patients discharged lived 10 to 49 days (median 19 days) after discharge. Pediatric oncology patients with intractable effusions at end of life can have respiratory benefit from pleurodeses and, as a result, are more likely to return home for terminal care. (orig.)

Pediatric morphea (localized scleroderma): review of 136 patients.

Science.gov (United States)

Christen-Zaech, Stéphanie; Hakim, Miriam D; Afsar, F Sule; Paller, Amy S

2008-09-01

Morphea is an autoimmune inflammatory sclerosing disorder that may cause permanent functional disability and disfigurement. We sought to determine the clinical features of morphea in a large pediatric cohort. We conducted a retrospective chart review of 136 pediatric patients with morphea from one center, 1989 to 2006. Most children showed linear morphea, with a disproportionately high number of Caucasian and female patients. Two patients with rapidly progressing generalized or extensive linear morphea and arthralgias developed restrictive pulmonary disease. Initial oral corticosteroid treatment and long-term methotrexate administration stabilized and/or led to disease improvement in most patients with aggressive disease. Retrospective analysis, relatively small sample size, and risk of a selected referral population to the single site are limitations. These data suggest an increased prevalence of morphea in Caucasian girls, and support methotrexate as treatment for problematic forms. Visceral manifestations rarely occur; the presence of progressive problematic cutaneous disease and arthralgias should trigger closer patient monitoring.

Putting patient participation into practice in pediatrics-results from a qualitative study in pediatric oncology.

Science.gov (United States)

Ruhe, Katharina Maria; Wangmo, Tenzin; De Clercq, Eva; Badarau, Domnita Oana; Ansari, Marc; Kühne, Thomas; Niggli, Felix; Elger, Bernice Simone

2016-09-01

Adequate participation of children and adolescents in their healthcare is a value underlined by several professional associations. However, little guidance exists as to how this principle can be successfully translated into practice. A total of 52 semi-structured interviews were carried out with 19 parents, 17 children, and 16 pediatric oncologists. Questions pertained to participants' experiences with patient participation in communication and decision-making. Applied thematic analysis was used to identify themes with regard to participation. Three main themes were identified: (a) modes of participation that captured the different ways in which children and adolescents were involved in their healthcare; (b) regulating participation, that is, regulatory mechanisms that allowed children, parents, and oncologists to adapt patient involvement in communication and decision-making; and (c) other factors that influenced patient participation. This last theme included aspects that had an overall impact on how children participated. Patient participation in pediatrics is a complex issue and physicians face considerable challenges in facilitating adequate involvement of children and adolescents in this setting. Nonetheless, they occupy a central role in creating room for choice and guiding parents in involving their child. Adequate training of professionals to successfully translate the principle of patient participation into practice is required. •Adequate participation of pediatric patients in communication and decision-making is recommended by professional guidelines but little guidance exists as to how to translate it into practice. What is New: •The strategies used by physicians, parents, and patients to achieve participation are complex and serve to both enable and restrict children's and adolescents' involvement.

Mucoceles of the oral cavity in pediatric patients.

Science.gov (United States)

Wu, Chung Wei; Kao, Yu-Hsun; Chen, Chao-Ming; Hsu, Han Jen; Chen, Chun-Ming; Huang, I-Yueh

2011-07-01

Mucoceles are quite common in the oral cavity, but reports on pediatric patients are very rare. The aims of this study were to present our data and experience in the treatment of mucoceles of the oral cavity in pediatric patients, to compare them with those of other countries, and to remind the pediatric physician to devote much attention to lesions of the oral cavity in children. This retrospective study is based on the record of the patients who received surgical treatment for mucoceles of the oral cavity with pathologic confirmation at the Department of Dentistry, Kaohsiung Medical University Hospital, Taiwan, between 2000 and 2004. Patients younger than 18 years were included in this study. The analyzed data included age, gender, site, size, histopathologic findings, surgical methods, and complications. There were a total of 289 patients with mucoceles confirmed by histopathologic examination. As many as 64 patients were younger than 18 years. Of the 64, 34 were girls and 30 were boys; 89.1% of the lesions were in the lower lip; and 48.4% of the lesions were less than 5mm in diameter. Histopathologic findings showed that all mucoceles were of the extravasation type. As many as 30 patients were treated by carbon dioxide laser vaporization, and two cases recurred (6.67%); 34 patients were treated by surgical excision, and the recurrence rate (5.88%) was not statistically different for the treatment methods. The laser vaporization has the advantage of less bleeding, no sutures, and saving time, especially suitable for children with oral mucocele. Copyright © 2011 Elsevier Taiwan LLC. All rights reserved.

Pediatric invasive fungal rhinosinusitis: An investigation of 17 patients.

Science.gov (United States)

Vinh, Daniel; Yim, Michael; Dutta, Ankhi; Jones, John K; Zhang, Wei; Sitton, Matthew

2017-08-01

To investigate outcomes of pediatric patients at a single institution with invasive fungal rhinosinusitis (IFRS) and to determine variables that impact overall survival. All pediatric patients at a large tertiary children's hospital diagnosed with IFRS confirmed by surgical pathology from 2009 to 2015 were retrospectively reviewed. Demographics, underlying diseases, symptoms, antifungal therapy, absolute neutrophil count (ANC), surgical management,and outcomes were analyzed. Seventeen patients were identified with IFRS with an average age of 8.7 years and 53% male. Hematologic malignancy was the most common (n = 13) underlying disease. The most common presenting symptoms were fever (82%) and congestion (41%). 15 patients had severe neutropenia (Absolute Neutrophil Count (ANC) IFRS. Overall survival at 6 months was 41%. Pediatric IFRS is a life-threatening disease that requires a coordinated surgical and medical approach. Despite a relatively high local control rate, overall mortality remains disappointingly high, reflecting the disease's underlying pathogenesis - lack of host defense and risk of disseminated fungal infection. Further investigation is necessary to reveal optimal management with regards to antifungal therapy, surgery, and utility of labs. Copyright © 2017 Elsevier B.V. All rights reserved.

Accuracy of prehospital triage protocols in selecting severely injured patients: A systematic review.

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van Rein, Eveline A J; Houwert, R Marijn; Gunning, Amy C; Lichtveld, Rob A; Leenen, Luke P H; van Heijl, Mark

2017-08-01

Prehospital trauma triage ensures proper transport of patients at risk of severe injury to hospitals with an appropriate corresponding level of trauma care. Incorrect triage results in undertriage and overtriage. The American College of Surgeons Committee on Trauma recommends an undertriage rate below 5% and an overtriage rate below 50% for prehospital trauma triage protocols. To find the most accurate prehospital trauma triage protocol, a clear overview of all currently available protocols and corresponding outcomes is necessary. The aim of this systematic review was to evaluate the current literature on all available prehospital trauma triage protocols and determine accuracy of protocol-based triage quality in terms of sensitivity and specificity. A search of Pubmed, Embase, and Cochrane Library databases was performed to identify all studies describing prehospital trauma triage protocols before November 2016. The search terms included "trauma," "trauma center," or "trauma system" combined with "triage," "undertriage," or "overtriage." All studies describing protocol-based triage quality were reviewed. To assess the quality of these type of studies, a new critical appraisal tool was developed. In this review, 21 articles were included with numbers of patients ranging from 130 to over 1 million. Significant predictors for severe injury were: vital signs, suspicion of certain anatomic injuries, mechanism of injury, and age. Sensitivity ranged from 10% to 100%; specificity from 9% to 100%. Nearly all protocols had a low sensitivity, thereby failing to identify severely injured patients. Additionally, the critical appraisal showed poor quality of the majority of included studies. This systematic review shows that nearly all protocols are incapable of identifying severely injured patients. Future studies of high methodological quality should be performed to improve prehospital trauma triage protocols. Systematic review, level III.

Guillain-Barre syndrome: A possibility in a spinal cord injured patient

Directory of Open Access Journals (Sweden)

Jagatsinh Yogendrasinh

2007-01-01

Full Text Available A 28-year-old male had paraplegia as a result of fracture dislocation of T12/L1 six years ago. He was functioning independently until four weeks ago, when he started complaining of trunkal paraesthesia which later progressed to include the upper extremities. The initial diagnosis was that of posttraumatic syringomyelia (PTS. While awaiting the MRI scan he developed weakness of upper limbs. The weakness restricted his self-care activities including transfers. The MRI did not show any evidence of syringomyelia. Neurological consultation and assessment yielded provisional diagnosis of Guillain-Barre syndrome (GBS. The patient was treated with immunoglobulins and regained 90% of his previous neurological status. This case is reported to raise awareness among clinicians to include the possibility of the GBS in the differential diagnosis of progressive neurological loss on top of existing neurological deficiency in spinal cord injured patients.

Music distraction - its efficacy in management of anxious pediatric dental patients

Directory of Open Access Journals (Sweden)

Marwah N

2005-01-01

Full Text Available Managing the anxiety of pediatric dental patient has long been the purview of dentists over many years. Various techniques have been used with moderate and variant success rates over the last few years. The main aim of this study was to ascertain if music distraction is an effective means of managing anxiety in pediatric dental patients. Forty children aged between 4 and 8 years were selected for the study. The assessment of anxiety was done using Venham′s picture test, Venham′s anxiety rating scale, pulse rate, and oxygen saturation during different treatment visits. The values were statistically analyzed and it was concluded that audio distraction did decrease the anxiety level in pediatric dental patients, but not to a very significant level.

Preparation of pediatric patients for treatment with proton beam therapy

International Nuclear Information System (INIS)

Mizumoto, Masashi; Oshiro, Yoshiko; Ayuzawa, Kaoru; Miyamoto, Toshio; Okumura, Toshiyuki; Fukushima, Takashi; Fukushima, Hiroko; Ishikawa, Hitoshi; Tsuboi, Koji; Sakurai, Hideyuki

2015-01-01

Purpose: Anesthesia is often used in proton beam therapy (PBT) for pediatric patients and this may prolong the treatment time. The aim of the study was to examine preparation of pediatric patients to allow smooth performance of PBT. Material and methods: Preparation was initiated 1–2 days before treatment planning CT and continued for 10 days. The patient first visited the facility to become familiar with the treatment room and staff. As the second step, the patient stayed in the treatment bed for a certain time with their mother, and then stayed on the treatment bed alone. Special fixtures painted with characters, music, and gifts were also prepared. Results: From 2010 to 2014, 111 pediatric patients underwent PBT. These patients were divided into 3 groups: 40 who could follow instructions well (group A, median age: 13.6 years old), 60 who could communicate, but found it difficult to stay alone for a long time (group B, median age: 4.6 years old), and 11 who could not follow instructions (group C, median age: 1.6 years old). Preparation was used for patients in group B. The mean treatment times in groups A, B and C were 13.6, 17.1, and 15.6 min, respectively, on PBT treatment days 2–6, and 11.8, 13.0, and 16.9 min, respectively, for the last 5 days of PBT treatment. The time reduction was significant in group B (p = 0.003). Conclusion: Preparation is useful for pediatric patients who can communicate. This approach allows PBT to be conducted more smoothly over a shorter treatment time

Zolpidem and Sleep in Pediatric Burn Patients with Attention Deficit/Hyperactivity Disorder.

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Cronin, Stephanie D; Gottschlich, Michele M; Gose, Lacy M; Kagan, Richard J

2015-01-01

Existing research shows that hospitalized patients, especially pediatric burn patients, are often sleep deprived. A pre-existing diagnosis of attention deficit/hyperactivity disorder (ADHD) further compounds a burn patient's inability to sleep. This retrospective study compared the effectiveness of zolpidem on patients with acute burns with ADHD (n = 23) and patients with acute burns without ADHD (n = 23). Effectiveness was defined based on the need for a change in the sleep medication or an increase in the zolpidem dose during the first 12 days of treatment. This study found that sleep dysfunction was similar in pediatric burn patients with and without a concurrent diagnosis of ADHD. Sixteen (69.6%) patients with and 13 (56.5%) patients without ADHD required a sleep medication change (p = 0.541). Further, while patients with ADHD required a sleep medication change (median = 5 days) sooner than those without ADHD (median = 9 days), it appears that zolpidem is not an effective drug for managing sleep in pediatric burn patients with or without ADHD.

Obesity and outcomes following burns in the pediatric population.

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Ross, Evan; Burris, Agnes; Murphy, Joseph T

2014-03-01

While obesity is associated with increased mortality and decreased functional outcomes in adult burn patients, the ramifications of larger than average body size in the pediatric burn population are less well understood. The present study examines whether obesity was associated with poor outcomes following pediatric burn injuries. Thermal injury data for patients ≤ 18 years of age admitted to a Level III burn center over ten years (n=536) was analyzed. Obesity was defined as ≥ 95 th percentile of weight for height according to the WHO growth charts (obese (n=154) and non-obese (n=382) children. All data was collected in accordance with IRB regulations. Obese and non-obese thermally-injured children did not differ in TBSA, percentage of full thickness burn, or overall mortality. However, these groups were significantly different with respect to age (obese=7.16 ± 0.46 years, non-obese=9.38 ± 0.32 years, pobese=4.89 ± 1.3 days, non-obese=2.67 ± 0.49 days, pobese (n=46) and non-obese (n=129) did not differ significantly with respect to age, TBSA, percentage of full thickness burn or other outcome measures. However, significant differences between these groups were noted for ICU LOS (obese=18.59 ± 5.18 days, non-obese=9.51 ± 1.82 days, pobese=11.65 ± 3.91 days, non-obese=3.92 ± 0.85 days, pobese pediatric patients required longer and more intensive medical support in the form of BICU care and respiratory intervention. Counter to findings in adult populations, differences in mortality were not observed. Collectively, these findings suggest obesity as a risk factor for increased morbidity in the pediatric burn population. © 2014 Elsevier Inc. All rights reserved.

Dose survey of pediatric and adult patients in Sudan

International Nuclear Information System (INIS)

Mohamadain, K.E.M.; Azevedo, A.C.P.; And others

2006-01-01

A survey of radiation doses to children and adults from diagnostic radiography has been carried out in seven hospitals in Sudan. In four hospitals only pediatric examinations were died. In two hospitals only adult patients were recorded and in one hospital both kinds of patients (pediatric and adults) were evaluated. For pediatric patients only chest x-ray examination was evaluated and children were divided according to age ranges: from (0-1) and 5) years for chest AP only and from (5-10) and (10-15) for chest PA. For adult patients the examinations were chest AP and PA, abdomen AP and skull AP and PA. Entrance Surface Dose SD) and the Effective Dose (E) were calculated using the Dose Cal software. The mean ESD r children, measured in p.Gy, ranged from (45-53) and (53-56) for (0-1) and (1-5) years, respectively and from (55-71) and (68-85) for (5-10) and (10-15) years, respectively. In two of le pediatric hospitals the mean ESD values were greater than the CEC Reference Dose Levels. In El bulk and Si nar hospitals the values ranged from 167-261 and 186-308 μGy for the age ranges (0-1) and (1-5) respectively and 167-194 and 279-312 μGy for the age ranges of (5-10) and (10-15) respectively. For adult patients the ESD and E dose values evaluated in Alfisal hospital presented values comparable with the CEC Reference Dose Level. However for Alshorta hospital the values were higher for the chest AP and PA with results for ESD 0.446 and 0.551 mGy respectively

Radiation Dose Estimation for Pediatric Patients Undergoing Cardiac Catheterization

Science.gov (United States)

Wang, Chu

Patients undergoing cardiac catheterization are potentially at risk of radiation-induced health effects from the interventional fluoroscopic X-ray imaging used throughout the clinical procedure. The amount of radiation exposure is highly dependent on the complexity of the procedure and the level of optimization in imaging parameters applied by the clinician. For cardiac catheterization, patient radiation dosimetry, for key organs as well as whole-body effective, is challenging due to the lack of fixed imaging protocols, unlike other common X-ray based imaging modalities. Pediatric patients are at a greater risk compared to adults due to their greater cellular radio-sensitivities as well as longer remaining life-expectancy following the radiation exposure. In terms of radiation dosimetry, they are often more challenging due to greater variation in body size, which often triggers a wider range of imaging parameters in modern imaging systems with automatic dose rate modulation. The overall objective of this dissertation was to develop a comprehensive method of radiation dose estimation for pediatric patients undergoing cardiac catheterization. In this dissertation, the research is divided into two main parts: the Physics Component and the Clinical Component. A proof-of-principle study focused on two patient age groups (Newborn and Five-year-old), one popular biplane imaging system, and the clinical practice of two pediatric cardiologists at one large academic medical center. The Physics Component includes experiments relevant to the physical measurement of patient organ dose using high-sensitivity MOSFET dosimeters placed in anthropomorphic pediatric phantoms. First, the three-dimensional angular dependence of MOSFET detectors in scatter medium under fluoroscopic irradiation was characterized. A custom-made spherical scatter phantom was used to measure response variations in three-dimensional angular orientations. The results were to be used as angular dependence

Are severely injured trauma victims in Norway offered advanced pre-hospital care? National, retrospective, observational cohort.

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Wisborg, T; Ellensen, E N; Svege, I; Dehli, T

2017-08-01

Studies of severely injured patients suggest that advanced pre-hospital care and/or rapid transportation provides a survival benefit. This benefit depends on the disposition of resources to patients with the greatest need. Norway has 19 Emergency Helicopters (HEMS) staffed by anaesthesiologists on duty 24/7/365. National regulations describe indications for their use, and the use of the national emergency medical dispatch guideline is recommended. We assessed whether severely injured patients had been treated or transported by advanced resources on a national scale. A national survey was conducted collecting data for 2013 from local trauma registries at all hospitals caring for severely injured patients. Patients were analysed according to hospital level; trauma centres or acute care hospitals with trauma functions. Patients with an Injury Severity Score (ISS) > 15 were considered severely injured. Three trauma centres (75%) and 17 acute care hospitals (53%) had data for trauma patients from 2013, a total of 3535 trauma registry entries (primary admissions only), including 604 victims with an ISS > 15. Of these 604 victims, advanced resources were treating and/or transporting 51%. Sixty percent of the severely injured admitted directly to trauma centres received advanced services, while only 37% of the severely injured admitted primarily to acute care hospitals received these services. A highly developed and widely distributed HEMS system reached only half of severely injured trauma victims in Norway in 2013. © 2017 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.

Extracorporeal shock wave lithotripsy is safe and effective for pediatric patients with chronic pancreatitis.

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Wang, Dan; Bi, Ya-Wei; Ji, Jun-Tao; Xin, Lei; Pan, Jun; Liao, Zhuan; Du, Ting-Ting; Lin, Jin-Huan; Zhang, Di; Zeng, Xiang-Peng; Ye, Bo; Zou, Wen-Bin; Chen, Hui; Xie, Ting; Li, Bai-Rong; Zheng, Zhao-Hong; Li, Zhao-Shen; Hu, Liang-Hao

2017-05-01

Background and aims  Pancreatic extracorporeal shock wave lithotripsy (P-ESWL) is recommended as the first-line treatment for pancreatic stones. However, how well P-ESWL performs in pediatric patients remains unclear. We aimed to evaluate the safety and efficacy of P-ESWL for pediatric patients with chronic pancreatitis. Methods  This prospective observational study was conducted in patients with painful chronic pancreatitis who underwent P-ESWL. Patients aged under 18 years were included in the pediatric group; patients aged over 18 years who underwent P-ESWL in the same period were assigned to the control group. For investigation of long-term follow-up, the pediatric group were matched with patients from the control group in a 1:1 ratio. The primary outcomes were P-ESWL complications and pain relief. The secondary outcomes included: stone clearance, physical and mental health, quality of life score, and growth and developmental state. Results  From March 2011 to March 2015, P-ESWL was performed in 1135 patients (72 in the pediatric group, 1063 in the control group). No significant differences were observed in the occurrence of P-ESWL complications between the two groups (11.1 % vs. 12.8 %; P  = 0.68). Among the 67 pediatric patients (93.1 %) who underwent follow-up for 3.0 years (range 1.3 - 5.2), complete pain relief was achieved in 52 patients (52 /67; 77.6 %); this value was not significantly different from that of the matched controls (55 /69; 79.7 %; P  = 0.94). Conclusions  P-ESWL is safe and effective for pediatric patients with chronic pancreatitis. It can promote significant pain relief and stone clearance, and can benefit growth and development. © Georg Thieme Verlag KG Stuttgart · New York.

Use of dual energy X-ray absorptiometry in pediatric patients.

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Wasserman, Halley; O'Donnell, Jennifer M; Gordon, Catherine M

2017-11-01

Dual Energy X-ray Absorptiometry (DXA) is a vital tool for assessing bone health in patients at risk for fragility fractures. In pediatric patients, this technology is used in conjunction with clinical fracture history to diagnosis osteoporosis and monitor treatment response. Childhood and adolescence is characterized by linear growth and bone mass accrual; thus there are important differences in the interpretation of bone measurements obtained by DXA in these young patients. This review aims to explore the current indications for DXA use and interpretation of DXA in the pediatric age group using currently available reference databases. Limitations of DXA in pediatric patients, specifically in children with short stature, will be explored. We will review several pathophysiologic mechanisms that may lead to low bone density in children, discussing representative diseases and the recommendations for monitoring bone health with DXA in these conditions. Finally, we will highlight new methods by which DXA imaging can gather additional information on bone health in children and may improve our ability to predict fractures and osteoporosis. Copyright © 2016 Elsevier Inc. All rights reserved.

Pneumothorax in pediatric patients: management strategies to improve patient outcomes [digest].

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Harris, Matthew; Rocker, Joshua; Pade, Kathryn H

2017-03-22

The clinical presentation of pneumothorax is highly variable. Spontaneous pneumothoraces may present with subtle symptoms when a small air leak is present, but can progress to hemodynamic instability in the setting of tension physiology. The etiologies are broad and the severity can vary greatly. A trauma patient with a pneumothorax may also have the added complexity of other potentially life-threatening injuries. While there is a wealth of evidence-based guidelines for the management of pneumothoraces in the adult literature, the approach to pediatric patients is largely extrapolated from that literature without a significant evidence base. In this issue, aspects of the history and physical examination, the use of various diagnostic imaging modalities, and the range of interventions available to the emergency clinician are discussed. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

Sedation of Pediatric Patients in Magnetic Resonance Imaging

National Research Council Canada - National Science Library

Ricks, Alesia

2000-01-01

.... The purpose of this study was to explore the combination sedative of ketamine, midazolam, and atropine administered intramuscularly and determine if it is safe and effective for pediatric patients...

Radiation Measurement And Risk Estimation For Pediatric Patients During Routine Diagnostic Examination

International Nuclear Information System (INIS)

Bushra, E.; Sulieman, A.; Osman, H.

2011-01-01

The aim of the present work was to evaluate Entrance Surface Dose (ESD) to the patient using Thermo luminescence dosimeters (TLD) during some common routine pediatrics X-ray examinations in main pediatrics hospitals in Sudan. ESD and Effective Dose (E) for pediatrics have been carried out for 250 patients undergoing five different examinations. The mean ESD ranged for neonates ranged between 0.17 mGy-0.30 mGy per radiograph with scattered thyroid dose 0.01 to 0.19 mGy. The risk of radiation induced cancer of was 0.13 x 10-6.

Characterizing mortality in pediatric tracheostomy patients.

Science.gov (United States)

Funamura, Jamie L; Yuen, Sonia; Kawai, Kosuke; Gergin, Ozgul; Adil, Eelam; Rahbar, Reza; Watters, Karen

2017-07-01

To assess the longitudinal risk of death following tracheostomy in the pediatric age group. Retrospective cohort study. Hospital records of 513 children (≤18 years) at a tertiary care children's hospital who underwent tracheostomy between 1984 and 2015 were reviewed. The primary outcome measure was time from tracheostomy to death. Secondary patient demographic and clinical characteristics were assessed, with likelihood of death using χ 2 tests and the Cox proportional hazards model. Median age at time of tracheostomy was 0.8 years (interquartile range, 0.3-5.2 years).The highest mortality rate (27.8%) was observed in patients in the 13- to 18-year-old age category; their mortality rate was significantly higher when compared to the lowest mortality risk group patients (age 1-4 years, P = .031). Timing of death was evenly distributed: 1 year after tracheostomy (35.3%). Patients who underwent tracheostomy for cardiopulmonary disease had an increased risk of mortality compared with airway obstruction (adjusted hazard ratio: 3.53, 95% confidence interval: 1.72-7.24, P tracheostomy have a high mortality rate, with an increased risk of death associated with a cardiopulmonary indication for undergoing tracheostomy. The majority of deaths occur after the index hospitalization during which the tracheostomy was performed. BPD and CHD are independent predictors of mortality in pediatric tracheostomy patients. 4 Laryngoscope, 127:1701-1706, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Clinical forms of shoulder instability in pediatric patients

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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.

Present status of severe head injured patients with an admission glasgow coma scale score of 3 based on the Japan neurotrauma data bank

International Nuclear Information System (INIS)

Uzura, Masahiko

2011-01-01

Severe head injured patients presenting with Glasgow Coma Scale (GCS) score of 3 have been hesitated to treat aggressively. We analyzed present status of patients with GCS score of 3 from the Project 2004 in the Japan Neurotrauma Data Bank. Among 1,101 cases registered, 805 cases with GCS score of 8 or less on admission. Of those, 215 cases with GCS score of 3 were classified the survival group (51 cases) and the dead group (164 cases) and compared each group. These results showed that the characteristics associated with favorable outcome including absence of cardiopulmonary arrest, no abnormality of pupil findings, stable condition of respiration and circulation, serum glucose level (less than 184 mg/dl), absence of initial CT findings including skull base fracture, pneumocephalus and subarachnoid hemorrhage, no serious extracranial injures including Injury Severity Scale score of less than 25, critic al care including intracranial pressure monitoring and temperature management. We suggest that it is important to treat brain and systemic problems aggressively in severe head injured patients with GCS score of 3. (author)

Outdoor recreational fires: a review of 329 adult and pediatric patients.

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Neaman, Keith C; Do, Viet H; Olenzek, Emily K; Baca, Marissa; Ford, Ronald D; Wilcox, Richard M

2010-01-01

Outdoor recreational fires are a frequent occurrence during the summer months and can be associated with burns resulting in significant morbidity. Both pediatric and adult populations can be affected, and their mechanism of injury is often different. Understanding these mechanisms is important when designing prevention programs. It is the goal of this study to review our experience with outdoor recreational fires. All patients who presented to Spectrum Health Blodgett Regional Burn Unit for burns secondary to an outdoor recreational fire over an 8-year period were reviewed. Demographic data, mechanism of injury, body area involved, TBSA burned, treatments undertaken, and subsequent complications were recorded. Pediatric patients (aged 16 years and younger) were analyzed independently, and risk factors were determined. A total of 329 patients suffered burns secondary to outdoor recreational fires over the length of the study. More than 35% required inpatient treatment, with an average length of stay of 4.8 days. Hands were the most frequently affected body part, with the mean TBSA involved being 3.5%. Ninety-four patients (28.6%) required split-thickness skin grafting. The most common mechanism of injury in both adult and pediatric populations was falling into an ongoing fire. Wound infection was the most common complication. Alcohol intoxication was associated with a higher burn severity and complication rate. Pediatric patients represented 39.8% of the sample. Burns secondary to outdoor recreational fires are associated with significant morbidity. Adult prevention programs should target awareness with respect to alcohol consumption and campfires secondary to the morbidity associated with these injuries. Pediatric patients are particularly susceptible, and parents should remain diligent about campfire safety and be educated about the inherent dangers of both active and extinguished fires.

Multi-drug resistant Acinetobacter infections in critically injured Canadian forces soldiers

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Brisebois Ronald

2007-08-01

Full Text Available Abstract Background Military members, injured in Afghanistan or Iraq, have returned home with multi-drug resistant Acinetobacter baumannii infections. The source of these infections is unknown. Methods Retrospective study of all Canadian soldiers who were injured in Afghanistan and who required mechanical ventilation from January 1 2006 to September 1 2006. Patients who developed A. baumannii ventilator associated pneumonia (VAP were identified. All A. baumannii isolates were retrieved for study patients and compared with A. baumannii isolates from environmental sources from the Kandahar military hospital using pulsed-field gel electrophoresis (PFGE. Results During the study period, six Canadian Forces (CF soldiers were injured in Afghanistan, required mechanical ventilation and were repatriated to Canadian hospitals. Four of these patients developed A. baumannii VAP. A. baumannii was also isolated from one environmental source in Kandahar – a ventilator air intake filter. Patient isolates were genetically indistinguishable from each other and from the isolates cultured from the ventilator filter. These isolates were resistant to numerous classes of antimicrobials including the carbapenems. Conclusion These results suggest that the source of A. baumannii infection for these four patients was an environmental source in the military field hospital in Kandahar. A causal linkage, however, was not established with the ventilator. This study suggests that infection control efforts and further research should be focused on the military field hospital environment to prevent further multi-drug resistant A. baumannii infections in injured soldiers.

Diagnostic radiation exposure in pediatric trauma patients.

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Brunetti, Marissa A; Mahesh, Mahadevappa; Nabaweesi, Rosemary; Locke, Paul; Ziegfeld, Susan; Brown, Robert

2011-02-01

The amount of imaging studies performed for disease diagnosis has been rapidly increasing. We examined the amount of radiation exposure that pediatric trauma patients receive because they are an at-risk population. Our hypothesis was that pediatric trauma patients are exposed to high levels of radiation during a single hospital visit. Retrospective review of children who presented to Johns Hopkins Pediatric Trauma Center from July 1, 2004, to June 30, 2005. Radiographic studies were recorded for each patient and doses were calculated to give a total effective dose of radiation. All radiographic studies that each child received during evaluation, including any associated hospital admission, were included. A total of 945 children were evaluated during the study year. A total of 719 children were included in the analysis. Mean age was 7.8 (±4.6) years. Four thousand six hundred three radiographic studies were performed; 1,457 were computed tomography (CT) studies (31.7%). Average radiation dose was 12.8 (±12) mSv. We found that while CT accounted for only 31.7% of the radiologic studies performed, it accounted for 91% of the total radiation dose. Mean dose for admitted children was 17.9 (±13.8) mSv. Mean dose for discharged children was 8.4 (±7.8) mSv (pcumulative radiation exposure can be high. In young children with relatively long life spans, the benefit of each imaging study and the cumulative radiation dose should be weighed against the long-term risks of increased exposure.

Upper extremity open fractures in hospitalized road traffic accident patients: adult versus pediatric cases.

Science.gov (United States)

Rubin, Guy; Peleg, Kobi; Givon, Adi; Rozen, Nimrod

2017-10-24

Fractures in pediatrics show epidemiological characteristics which are different from fractures in adults. The objective of this study was to examine the injury profiles of open upper extremity fractures (UEFs) in all modes of injury related to road traffic accidents (RTAs) in adult and pediatric hospitalized patients. Data on 103,465 RTA patients between 1997 and 2013 whose records were entered in a centralized country trauma database were reviewed. Data on open UEFs related to mode of injury (car, motorcycle, bicycle, and pedestrian) was compared between adult (18+ years) and pediatric (0-17 years) RTA patients. Of 103,465 RTA cases, 17,263 (16.7%) had UEFs. Of 73,087 adults, 13,237 (18.1%) included UEFs and of 30,378 pediatric cases, 4026 (13.2%) included UEFs (p open fractures. Adults had a greater risk for open fractures (2221, 13%) than the pediatric cases (522, 10.3%) (p open UEFs than the pediatric group (11 vs 8%, p = 0.0012). This study demonstrates the difference between adult and pediatric open fractures in hospitalized RTAs. We showed that adults had a greater risk for open UEFs compared to children, and the adult pedestrian group particularly had a significantly higher risk for open UEFs than the pediatric group.

The readability of pediatric patient education materials on the World Wide Web.

Science.gov (United States)

D'Alessandro, D M; Kingsley, P; Johnson-West, J

2001-07-01

Literacy is a national and international problem. Studies have shown the readability of adult and pediatric patient education materials to be too high for average adults. Materials should be written at the 8th-grade level or lower. To determine the general readability of pediatric patient education materials designed for adults on the World Wide Web (WWW). GeneralPediatrics.com (http://www.generalpediatrics.com) is a digital library serving the medical information needs of pediatric health care providers, patients, and families. Documents from 100 different authoritative Web sites designed for laypersons were evaluated using a built-in computer software readability formula (Flesch Reading Ease and Flesch-Kincaid reading levels) and hand calculation methods (Fry Formula and SMOG methods). Analysis of variance and paired t tests determined significance. Eighty-nine documents constituted the final sample; they covered a wide spectrum of pediatric topics. The overall Flesch Reading Ease score was 57.0. The overall mean Fry Formula was 12.0 (12th grade, 0 months of schooling) and SMOG was 12.2. The overall Flesch-Kincaid grade level was significantly lower (Peducation materials on the WWW are not written at an appropriate reading level for the average adult. We propose that a practical reading level and how it was determined be included on all patient education materials on the WWW for general guidance in material selection. We discuss suggestions for improved readability of patient education materials.

Pediatric Burns in the Bedouin Population in Southern Israel

Directory of Open Access Journals (Sweden)

Arnon D. Cohen

2007-01-01

Full Text Available Burn trauma is an important public health concern, with increased risk for burns in children. A cross-sectional study was performed to describe the epidemiological characteristics and risk factors for burns in hospitalized Bedouin children in Soroka University Medical Center during the years 2001–2002. In a population of 558 hospitalized burn-injured patients, 282 Bedouin children were identified. Two hundred and sixty five patients (94.0% had burns involving less than 20% of the body surface area. Cause of the burns was scald in 190 patients (67.4%, fire in 80 patients (28.4%, chemical in 8 patients (2.8%, and explosion in 2 patients (0.7%. Two female patients (0.7% aged 11 and 17 years died of their burns that were caused by fire. The mean length of hospitalization was 9.8 days. Pediatric burn injury has become a significant public health problem in the Bedouin population of the Negev. To reduce the burden of burn injury, it is necessary to increase current efforts in prevention of burns.

How pediatric surgeons use social media to attract new patients.

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Romano, Ron; Baum, Neil

2014-08-01

Social media has changed the landscape of online interaction for all doctors including pediatric surgeons. Of course the public including our patients and potential new patients having immediate access to these sites through mobile devices and iPads has contributed immensely to this phenomenon. Nonetheless, it seems that we are all rushing to get in front of our target audience and to engage in a relationship with them in a cost-effective fashion. This article will discuss the role of the Internet and media and how you can use this technology to attract new pediatric patients to your practice. Georg Thieme Verlag KG Stuttgart · New York.

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

2015-01-01

Abstract 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. PMID:26287927

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.

Commentary: The Diagnosis of Delirium in Pediatric Patients

Science.gov (United States)

Martini, D. Richard

2005-01-01

Pediatric patients seem to be especially vulnerable to toxic, metabolic, or traumatic CNS insults and are at greater risk of delirium with fever regardless of the etiology. Developmental limitations, in the areas of communication and cognition, prevent a thorough evaluation of the young patient for delirium. Only the most severe cases are…

COMPARISON OF REAL-TIME MICROVASCULAR ABNORMALITIES IN PEDIATRIC AND ADULT SICKLE CELL ANEMIA PATIENTS

Science.gov (United States)

Cheung, Anthony T.W.; Miller, Joshua W.; Craig, Sarah M.; To, Patricia L.; Lin, Xin; Samarron, Sandra L.; Chen, Peter C.Y.; Zwerdling, Theodore; Wun, Ted; Li, Chin-Shang; Green, Ralph

2010-01-01

The conjunctival microcirculation in 14 pediatric and 8 adult sickle cell anemia (SCA) patients was studied using computer-assisted intravital microscopy. The bulbar conjunctiva in SCA patients in both age groups exhibited a blanched/avascular appearance characterized by decreased vascularity. SCA patients from both age groups had many of the same abnormal morphometric {vessel diameter, vessel distribution, morphometry (shape), tortuosity, arteriole:venule (A:V) ratio, and hemosiderin deposits} and dynamic {vessel sludging/sludged flow, boxcar blood (trickled) flow and abnormal flow velocity} abnormalities. A severity index (SI) was computed to quantify the degree of vasculopathy for comparison between groups. The severity of vasculopathy differed significantly between the pediatric and adult patients (SI: 4.2 ± 1.8 vs 6.6 ± 2.4; p=0.028), indicative of a lesser degree of overall severity in the pediatric patients. Specific abnormalities that were less prominent in the pediatric patients included abnormal vessel morphometry and tortuosity. Sludged flow, abnormal vessel distribution, abnormal A:V ratio, and boxcar flow, appeared in high prevalence in both age groups. The results indicate that SCA microvascular abnormalities develop in childhood and the severity of vasculopathy likely progresses with age. Intervention and effective treatment/management modalities should target pediatric patients to ameliorate, slow down or prevent progressive microvascular deterioration. PMID:20872552

Clinical analysis of bronchoscopic electrocoagulation in pediatric patients

Science.gov (United States)

Ni, Caiyun; Yu, Huafeng; Han, Xiaorong; Meng, Chen; Zhang, Yanqing

2014-01-01

This study is to explore the efficacy and safety of bronchoscopic electrocoagulation treatment for pediatric disease of poor ventilation. Seventy pediatric patients of airway stenosis and obstruction as well as pharyngeal and laryngeal cysts received bronchoscopic electrocoagulation treatment, including 15 cases of epiglottic cyst, 13 cases of cicatricial hyperplasia of fibrous tissue after trachea intubation, 5 cases of foreign body in bronchus and 37 cases of endobronchial tuberculosis. Before and after the last electrocoagulation treatment, treatment efficacy was evaluated by examining the patients’ clinical presentations and lesions in airway under bronchoscope, examining chest CT and pulmonary function, and estimating pulmonary atelectasis and ventilation function. Seventy cases of pediatric patients were treated by bronchoscopic electrocoagulation, with the total treatment number of 106 times. Among them, 66 cases were treated with marked efficacy and 4 cases were with effective treatment. There was no invalid treatment. The treatment efficacy was 100% without complications. Bronchoscopic electrocoagulation treatment is a fast, effective and safe therapeutic method in treating airway stenosis and obstruction, such as foreign body in bronchus, granulation tissue hyperplasia, and epiglottic cysts. It is worthy of being widely applied in clinic. PMID:25664086

Evaluation of Patient Satisfaction Surveys in Pediatric Orthopaedics.

Science.gov (United States)

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

2015-01-01

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

Hospital-Level Variation in Practice Patterns and Patient Outcomes for Pediatric Patients Hospitalized With Functional Constipation.

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Librizzi, Jamie; Flores, Samuel; Morse, Keith; Kelleher, Kelly; Carter, Jodi; Bode, Ryan

2017-06-01

Constipation is a common pediatric condition with a prevalence of 3% to 5% in children aged 4 to 17 years. Currently, there are no evidence-based guidelines for the management of pediatric patients hospitalized with constipation. The primary objective was to evaluate practice patterns and patient outcomes for the hospital management of functional constipation in US children's hospitals. We conducted a multicenter, retrospective cohort study of children aged 0 to 18 years hospitalized for functional constipation from 2012 to 2014 by using the Pediatric Health Information System. Patients were included by using constipation and other related diagnoses as classified by International Classification of Diseases, Ninth Revision . Patients with complex chronic conditions were excluded. Outcome measures included percentage of hospitalizations due to functional constipation, therapies used, length of stay, and 90-day readmission rates. Statistical analysis included means with 95% confidence intervals for individual hospital outcomes. A total of 14 243 hospitalizations were included, representing 12 804 unique patients. The overall percentage of hospitalizations due to functional constipation was 0.65% (range: 0.19%-1.41%, P hospitalization included: electrolyte laxatives: 40% to 96%; sodium phosphate enema: 0% to 64%; mineral oil enema: 0% to 61%; glycerin suppository: 0% to 37%; bisacodyl 0% to 47%; senna: 0% to 23%; and docusate 0% to 11%. Mean length of stay was 1.97 days (range: 1.31-2.73 days, P hospitalized with functional constipation across US children's hospitals. Collaborative initiatives to adopt evidence-based best practices guidelines could help standardize the hospital management of pediatric functional constipation. Copyright © 2017 by the American Academy of Pediatrics.

Reiki training for caregivers of hospitalized pediatric patients: a pilot program.

Science.gov (United States)

Kundu, Anjana; Dolan-Oves, Rebecca; Dimmers, Martha A; Towle, Cara B; Doorenbos, Ardith Z

2013-02-01

To explore the feasibility of a Reiki therapy-training program for the caregivers of pediatric medical or oncology inpatients, at a large pediatric hospital, a series of Reiki training classes were offered by a Reiki Master. At completion of the training, an interview was conducted to elicit participant's feedback regarding the effectiveness and feasibility of the training program. Seventeen of the 18 families agreed to participate. Most families (65%) attended three Reiki training sessions, reporting that Reiki benefitted their child by improving their comfort (76%), providing relaxation (88%), and pain relief (41%). All caregivers identified becoming an active participant in their child's care as a major gain from participation in the Reiki training. A hospital-based Reiki training program for caregivers of hospitalized pediatric patients is feasible and can positively impact patients and their families. More rigorous research regarding the benefits of Reiki in the pediatric population is needed. Copyright © 2012 Elsevier Ltd. All rights reserved.

Reiki training for caregivers of hospitalized pediatric patients: A pilot program☆

Science.gov (United States)

Kundu, Anjana; Dolan-Oves, Rebecca; Dimmers, Martha A.; Towle, Cara B.; Doorenbos, Ardith Z.

2013-01-01

To explore the feasibility of a Reiki therapy-training program for the caregivers of pediatric medical or oncology inpatients, at a large pediatric hospital, a series of Reiki training classes were offered by a Reiki Master. At completion of the training, an interview was conducted to elicit participant’s feedback regarding the effectiveness and feasibility of the training program. Seventeen of the 18 families agreed to participate. Most families (65%) attended three Reiki training sessions, reporting that Reiki benefitted their child by improving their comfort (76%), providing relaxation (88%), and pain relief (41%). All caregivers identified becoming an active participant in their child’s care as a major gain from participation in the Reiki training. A hospital-based Reiki training program for caregivers of hospitalized pediatric patients is feasible and can positively impact patients and their families. More rigorous research regarding the benefits of Reiki in the pediatric population is needed. PMID:23337565

A novel drainage technique during micropercutaneous nephrolithotomy in pediatric patients: double angiocath.

Science.gov (United States)

Penbegul, Necmettin; Utangac, Mehmet Mazhar; Daggulli, Mansur; Dede, Onur; Bozkurt, Yasar; Bodakci, Mehmet Nuri; Atar, Murat

2016-06-01

Micropercutaneous nephrolithotomy (microperc) is a recently introduced percutaneous nephrolithotomy (PNL) technique that has the smallest tract size. The absence of an amplatz sheath during the microperc technique is a fundamental difference that distinguishes it from all other types of PNL (standard, mini, ultramini). Increasing of the intrarenal pelvic pressure (IPP) was demonstrated by the authors in adult patients but this problem may be even more serious in pediatric patients. Previously, the authors defined the use of a 14 gauge angiocath needle and sheath (microsheath) during microperc surgery for pediatric patient to reduce the IPP. In this novel technique, a second angiocath is used to access the renal collecting system to drain fluid during surgery. This technique is more effective in reducing IPP during microperc, especially in pediatric patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Recovery of injured Broca's portion of arcuate fasciculus in the dominant hemisphere in a patient with traumatic brain injury

OpenAIRE

Jang, Sung Ho; Ha, Ji Wan; Kim, Hyun Young; Seo, You Sung

2017-01-01

Abstract Rationale: Recovery of injured AF in patients with traumatic brain injury (TBI) has not been reported. In this study, we report on a patient with TBI who recovered from an injury to Broca's portion of AF in the dominant hemisphere, diagnosed by diffusion tensor tractography (DTT). Patient concerns: A 28-year-old right-handed male patient suffered head trauma resulting from sliding while riding a motorcycle. Diagnoses: He was diagnosed with a traumatic contusional hemorrhage in the le...

Computed radiography dose optimization in pediatric patients

International Nuclear Information System (INIS)

Juste, B.; Verdu, G.; Tortosa, R.; Villaescusa, J.I.

2008-01-01

Radiation dose reduction in pediatric X-ray imaging is especially important because of children radiation sensitivity. For any radiographic examination performed at a fixed radiographic tube potential, the patient absorbed dose is directly proportional to the value of milliampere-seconds (mAs) selected by the operator. Nevertheless, reducing X-ray exposure has the unavoidable disadvantage of increasing the quantum noise in the resultant image. The objective of this work is to identify the minimum tube current setting required for maintaining accurate examinations, to modify, if required, the daily protocols applied at La Fe de Valencia Universitary Hospital. To accomplish this goal, a noise addition software has been developed in order to study the diagnostic accuracy as a function of reducing dose by artificially increasing the image noise. The noise addition tool has been applied to several thorax images acquired from pediatric unit to simulate new lower dose radiographies and allow medical researchers to study how lower dose affects the patient pneumonia diagnosis. (author)

Malignancy and mortality in pediatric patients with inflammatory bowel disease

DEFF Research Database (Denmark)

de Ridder, Lissy; Turner, Dan; Wilson, David C

2014-01-01

working group of ESPGHAN conducted a multinational-based survey of cancer and mortality in pediatric IBD. METHODS: A survey among pediatric gastroenterologists of 20 European countries and Israel on cancer and/or mortality in the pediatric patient population with IBD was undertaken. One representative...... were diagnosed with IBD (ulcerative colitis, n = 21) at a median age of 10.0 years (inter quartile range, 3.0-14.0). Causes of mortality were infectious (n = 14), cancer (n = 5), uncontrolled disease activity of IBD (n = 4), procedure-related (n = 3), other non-IBD related diseases (n = 3), and unknown...

Patient/Family Education for Newly Diagnosed Pediatric Oncology Patients: Consensus Recommendations from a Children’s Oncology Group Expert Panel

Science.gov (United States)

Landier, Wendy; Ahern, JoAnn; Barakat, Lamia P.; Bhatia, Smita; Bingen, Kristin M.; Bondurant, Patricia G.; Cohn, Susan L.; Dobrozsi, Sarah K.; Haugen, Maureen; Herring, Ruth Anne; Hooke, Mary C.; Martin, Melissa; Murphy, Kathryn; Newman, Amy R.; Rodgers, Cheryl C.; Ruccione, Kathleen S.; Sullivan, Jeneane; Weiss, Marianne; Withycombe, Janice; Yasui, Lise; Hockenberry, Marilyn

2016-01-01

There is a paucity of data to support evidence-based practices in the provision of patient/family education in the context of a new childhood cancer diagnosis. Since the majority of children with cancer are treated on pediatric oncology clinical trials, lack of effective patient/family education has the potential to negatively affect both patient and clinical trial outcomes. The Children’s Oncology Group Nursing Discipline convened an interprofessional expert panel from within and beyond pediatric oncology to review available and emerging evidence and develop expert consensus recommendations regarding harmonization of patient/family education practices for newly diagnosed pediatric oncology patients across institutions. Five broad principles, with associated recommendations, were identified by the panel, including recognition that (1) in pediatric oncology, patient/family education is family-centered; (2) a diagnosis of childhood cancer is overwhelming and the family needs time to process the diagnosis and develop a plan for managing ongoing life demands before they can successfully learn to care for the child; (3) patient/family education should be an interprofessional endeavor with 3 key areas of focus: (a) diagnosis/treatment, (b) psychosocial coping, and (c) care of the child; (4) patient/family education should occur across the continuum of care; and (5) a supportive environment is necessary to optimize learning. Dissemination and implementation of these recommendations will set the stage for future studies that aim to develop evidence to inform best practices, and ultimately to establish the standard of care for effective patient/family education in pediatric oncology. PMID:27385664

Acute kidney injury in pediatric patients: diagnosis and management in the emergency department [digest].

Science.gov (United States)

Mohrer, Daniel; Langhan, Melissa; Chaudhari, Pradip

2017-05-22

Pediatric acute kidney injury is a condition that is underdiagnosed among children seen in the emergency department, and it has been associated with significant morbidity and mortality, including increased risk for chronic kidney disease. The most common etiologies in pediatric patients are now known to be due to hypovolemia, sepsis, shock, and cardiac dysfunction. This issue compares 3 classification systems for the diagnosis and staging of acute kidney injury and reviews the etiologies that lead to kidney injury in children. The management of pediatric acute kidney injury focuses on identifying patients at high risk, monitoring intravascular volume status, avoiding nephrotoxic medication exposure, and involving a pediatric nephrologist once acute kidney injury is diagnosed. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

Pediatric care as part of the US Army medical mission in the global war on terrorism in Afghanistan and Iraq, December 2001 to December 2004.

Science.gov (United States)

Burnett, Mark W; Spinella, Philip C; Azarow, Kenneth S; Callahan, Charles W

2008-02-01

Our objective in this report was to describe the epidemiologic features of and workload associated with pediatric admissions to 12 US Army military hospitals deployed to Iraq and Afghanistan. The Patient Administration Systems and Biostatistics Activity database was queried for all local national patients Afghanistan and Iraq between December 2001 and December 2004. Pediatric admissions during the study period were 1012 (4.2%) of 24,227 admissions, occupying 10% of all bed-days. The median length of stay was 4 days (interquartile range: 1-8 days). The largest proportion of children were 11 to 17 years of age (332 of 757 children; 44%), although 45 (6%) of 757 children hospitalized were Afghanistan and Iraq. Military medical planners must continue to improve pediatric medical support, including personnel, equipment, and medications that are necessary to treat children injured during combat operations, as well as those for whom the existing host nation medical infrastructure is unable to provide care.

Clinical Features and Outcome of Ebola Virus Disease in Pediatric Patients

DEFF Research Database (Denmark)

Damkjær, Mads; Rudolf, Frauke; Mishra, Sharmistha

2016-01-01

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....

A Quantitative Ethnopharmacological Documentation of Natural Pharmacological Agents Used by Pediatric Patients in Mauritius

Directory of Open Access Journals (Sweden)

M. Fawzi Mahomoodally

2014-01-01

Full Text Available The pediatric population constitutes the most vulnerable patients due to a dearth of approved drugs. Consequently, there is a pressing need to probe novel natural pharmacological agents in an endeavour to develop new drugs to address pediatric illnesses. To date, no studies have explored the use of natural therapies for pediatric health care in Mauritius. Parents (n=325 from different regions of the island were interviewed. Quantitative indexes such as fidelity level (FL, informant consensus factor (FIC, and use-value (UV were calculated. Thirty-two plants were reported to be used by pediatric patients. Gastrointestinal disorders (FIC=0.97 encompassing regurgitation, infantile colic, and stomach aches were the most common ailments managed with herbs. Matricaria chamomilla used for infantile colic and its pharmacological properties has previously been documented for pediatric patients. Product from A. mellifera (UV = 0.75 was the most utilized zootherapy for managing cough. Most plants and animal products reported in this study have bioactive constituents supported by existing scientific literature but their use for the pediatric population is scant. The present ethnopharmacological study has opened new perspectives for further research into their pharmacology, which can subsequently support and facilitate timely pediatric medicinal product development.

Music distraction - its efficacy in management of anxious pediatric dental patients

OpenAIRE

Marwah N; Prabhakar A; Raju O

2005-01-01

Managing the anxiety of pediatric dental patient has long been the purview of dentists over many years. Various techniques have been used with moderate and variant success rates over the last few years. The main aim of this study was to ascertain if music distraction is an effective means of managing anxiety in pediatric dental patients. Forty children aged between 4 and 8 years were selected for the study. The assessment of anxiety was done using Venham′s picture test, Venham′s...

Pediatrics patient in computed tomography: risk awareness among medical staff

International Nuclear Information System (INIS)

Arandjic, D.; Ciraj-Bjelac, O.; Kosutic, D.; Lazarevic, Dj.

2009-01-01

In this paper the results of investigation about risk awareness in pediatrics computed tomography among medical staff are presented. Questionnaires were distributed along seven hospitals, 84 people were enrolled in this investigation. The results showed awareness of the potential risks associated with ionizing radiation in computed tomography. However, there is still widespread underestimation of relative doses and risks in case of pediatric patients. (author) [sr

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

Directory of Open Access Journals (Sweden)

Taise Rocha Macedo

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

Sodium valproate-induced enuresis in a pediatric bipolar patient

Directory of Open Access Journals (Sweden)

Cheng W

2013-10-01

Full Text Available Wentao Cheng,1,* Xiaoling Lin,2,* Dali Lu1 1Department of Pediatric and Geriatric Psychiatry, Fuzhou Neuropsychiatric Hospital, Fuzhou, Fujian, People's Republic of China; 2School of Nursing of Central South University, Changsha, Hunan, People's Republic of China *These authors contributed equally to this work Abstract: Sodium valproate (SV is effective and well tolerated for the treatment of epilepsy and mood disorders. There are several cases of SV-induced enuresis noted in epileptic patients. No alternative medication has been suggested to manage this problem. We present the first case of a pediatric bipolar patient who developed diurnal and nocturnal enuresis during SV therapy. Clinicians should be aware of this side effect, as it has not been reported in nonepileptic patients, and it may be detrimental to treatment adherence. Keywords: sodium valproate, enuresis, bipolar disorder

Factors associated with successful decannulation in pediatric tracheostomy patients.

Science.gov (United States)

Takahashi, Nozomi; Takano, Kenichi; Mitsuzawa, Hiroaki; Kurose, Maokoto; Himi, Tetsuo

2017-10-01

To investigate the outcome of pediatric tracheostomy and identify predictive factors for successful decannulation. We performed a retrospective chart review of a series of 42 consecutive patients of less than 24 months of age who underwent a tracheostomy between 2012 and 2015. Successful decannulation was achieved in 11 patients (26%). Thirty-one patients (74%) remained tracheostomy-dependent. Of the 11 patients who were successfully decannulated, 10 (91%) had only structural disorders and nine (82%) were able to walk unassisted; importantly, nine (82%) were able to swallow following decannulation. In contrast, of the 31 patients who did not tolerate decannulation, 21 (68%) had functional disorders and 18 (58%) were unable to walk unassisted; 20 (65%) of the tracheostomy-dependent patients were unable to swallow after undergoing surgery. Following pediatric tracheostomy procedures, patients with solely structural disorders were significantly more likely to be successfully decannulated compared to patients with functional disorders. Furthermore, the capacity to walk unassisted and swallow after surgery is associated with positive outcomes for decannulation. Our results suggest that an objective evaluation of the ability to walk unassisted, and to ingest food, may be useful for predicting the outcome and effects of tracheostomy procedures and decannulation in children.

Considerations for conducting qualitative research with pediatric patients for the purpose of PRO development.

Science.gov (United States)

Patel, Zabin S; Jensen, Sally E; Lai, Jin-Shei

2016-09-01

To provide an overview of methodological considerations when conducting qualitative research with pediatric patients for the purpose of patient-reported outcome measure development A literature review of qualitative methods in pediatric measure development was completed. Eight clinicians providing care to pediatric patients were interviewed for their expert input. Thematic analysis of the literature and clinician interviews was used to identify themes for consideration. Findings from the literature and expert interviews emphasized the way in which cognitive, linguistic, and social developmental factors affect pediatric patients' understanding of their condition and ability to communicate about their experiences in an interview. There was consensus among the experts that traditional semi-structured interviews with children younger than eight lack characteristics necessary to yield meaningful information about condition and symptom report because they may fail to capture children's understanding and awareness of their condition and may limit their ability to express themselves comfortably. Our findings include recommended strategies to optimize data collected in qualitative interviews with pediatric patients, including modifications to the interview process to establish rapport, construction of interview questions to ensure they are developmentally appropriate, and the use of supplementary techniques to facilitate communication. When employing qualitative methods in pediatric measure development, interview guides, methods, and length require careful tailoring to ensure the child's perspectives are captured. This may be best achieved through research performed with narrow age bands that employs flexibility in methods to allow children a comfortable way in which to communicate about their experiences.

[Optimized resource mobilization and quality of treatment of severely injured patients through a structured trauma room alarm system].

Science.gov (United States)

Spering, C; Roessler, M; Kurlemann, T; Dresing, K; Stürmer, K M; Lehmann, W; Sehmisch, S

2017-12-12

The treatment of severely injured patients in the trauma resuscitation unit (TRU) requires an interdisciplinary and highly professional trauma team approach. The complete team needs to be waiting for the patient in the TRU on arrival. Treating severely injured patients in the TRU, the trauma team connects the initial preclinical emergency stabilization with the subsequent sophisticated treatment. Thus, the trauma team depends on concise information from the emergency personnel at the scene to provide its leader with further information as well as an accurate alarm including all departments necessary to stabilize the patient in the TRU. Aiming at an accurate and most efficient trauma team alarm, this study was designed to provide and analyze an alarm system which mobilizes the trauma team in a stepwise fashion depending on the pattern of injuries and the threat to life. The trauma team alarm system was analyzed in a prospective data acquisition at a level I trauma center over a period of 12 months. Evaluation followed the acquisition phase and provided comparison to the status prior to the establishment of the alarm system. All items underwent statistical testing using t‑tests (p  0.01). The duration from arrival of the patient in the TRU to the initial multislice computed tomography (CT) scan was reduced by 6 min while the total period of treatment in the TRU was reduced by 17 min. After the alarm system to gradually mobilize the trauma team was put into action, team members left the TRU if unneeded prior to finishing the initial treatment in only 4% of the cases. The patient fatality rate was 8.8% (injury severity score, ISS = 23 points) after establishment of the alarm system compared to 12.9% (ISS = 25 points) before. The implementation of an accurate and patient status-based alarm system to mobilize the trauma team can improve the quality of treatment while the duration of treatment of the severely injured patients in the TRU can be decreased. It

Comparison of different tests to determine difficult intubation in pediatric patients

Directory of Open Access Journals (Sweden)

Mehmet Turan Inal

2014-12-01

Full Text Available Background: The difficulties with airway management is the main reason for pediatric anesthesia-related morbidity and mortality. Objective: To assess the value of modified Mallampati test, Upper-Lip-Bite test, thyromental distance and the ratio of height to thyromental distance to predict difficult intubation in pediatric patients. Design: Prospective analysis. Measurements and results: Data were collected from 5 to 11 years old 250 pediatric patients requiring tracheal intubation. The Cormack and Lehane classification was used to evaluate difficult laryngoscopy. Sensitivity, specificity, positive predictive value and AUC values for each test were measured. Results: The sensitivity and specificity of modified Mallampati test were 76.92% and 95.54%, while those for ULBT were 69.23% and 97.32%. The optimal cutoff point for the ratio of height to thyromental distance and thyromental distance for predicting difficult laryngoscopy was 23.5 (sensitivity, 57.69%; specificity, 86.61% and 5.5 cm (sensitivity, 61.54%; specificity, 99.11%. The modified Mallampati was the most sensitive of the tests. The ratio of height to thyromental distance was the least sensitive test. Conclusion: These results suggested that the modified Mallampati and Upper-Lip-Bite tests may be useful in pediatric patients for predicting difficult intubation.

Fertility Preservation for Pediatric Patients: Current State and Future Possibilities.

Science.gov (United States)

Johnson, Emilie K; Finlayson, Courtney; Rowell, Erin E; Gosiengfiao, Yasmin; Pavone, Mary Ellen; Lockart, Barbara; Orwig, Kyle E; Brannigan, Robert E; Woodruff, Teresa K

2017-07-01

This review provides an overview of pediatric fertility preservation. Topics covered include the patient populations who could benefit, the current state of fertility preservation options and research, and considerations related to ethics and program development. A broad Embase® and PubMed® search was performed to identify publications discussing investigational, clinical, ethical and health care delivery issues related to pediatric fertility preservation. Relevant publications were reviewed and summarized. Populations who could benefit from fertility preservation in childhood/adolescence include oncology patients, patients with nononcologic conditions requiring gonadotoxic chemotherapy, patients with differences/disorders of sex development and transgender individuals. Peripubertal and postpubertal fertility preservation options are well established and include cryopreservation of oocytes, embryos or sperm. Prepubertal fertility preservation is experimental. Multiple lines of active research aim to develop technologies that will enable immature eggs and sperm to be matured and used to produce a biological child in the future. Ethical challenges include the need for parental proxy decision making and the fact that fertility preservation procedures can be considered not medically necessary. Successful multidisciplinary fertility preservation care teams emphasize partnerships with adult colleagues, prioritize timely consultations and use standardized referral processes. Some aspects of fertility preservation are not covered by insurance and out-of-pocket costs can be prohibitive. Pediatric fertility preservation is an emerging, evolving field. Fertility preservation options for prepubertal patients with fertility altering conditions such as cancer and differences/disorders of sex development are currently limited. However, multiple lines of active research hold promise for the future. Key considerations include establishing a multidisciplinary team to provide

Nosocomial Bloodstream Infections in Brazilian Pediatric Patients: Microbiology, Epidemiology, and Clinical Features

Science.gov (United States)

Pereira, Carlos Alberto Pires; Marra, Alexandre R.; Camargo, Luis Fernando Aranha; Pignatari, Antônio Carlos Campos; Sukiennik, Teresa; Behar, Paulo Renato Petersen; Medeiros, Eduardo Alexandrino Servolo; Ribeiro, Julival; Girão, Evelyne; Correa, Luci; Guerra, Carla; Carneiro, Irna; Brites, Carlos; Reis, Marise; de Souza, Marta Antunes; Tranchesi, Regina; Barata, Cristina U.; Edmond, Michael B.

2013-01-01

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. PMID:23861860

Pediatric patients with severe head injury in Japan Neurotrauma Data Bank. Analysis of the prognostic factors

International Nuclear Information System (INIS)

Miki, Tamotsu; Haraoka, Jo

2009-01-01

The purpose of this study is to evaluate the clinical characteristics of the pediatric patients in the Japan Neurotrauma Data Bank: Project 2004. Project 2004 consisted of severe head injury patients with a Glasgow Coma Scale (GCS) score of 8 or less on admission or during course and patients who were operated for traumatic intracranial lesion between 2004-2006. The subjects were 101 pediatric patients aged 15 years old or less (mean: 7.8 y/o). We retrospectively examined the patients' age, GCS, cause of injury, duration and time of patient transfer, pupillary abnormality, body temperature, serum glucose level, Injury Severity Score (ISS) excluding cranio-cervical score, skull fracture, CT classification of the Traumatic Coma Data Bank (TCDB), main lesion of focal brain injury on CT, and traumatic subarachnoid hemorrhage (SAH) on CT. The mortality rate in children is lower than in adults: 18.8% vs. 39.7%. The factors that correlated to the poor outcome in pediatric patients are lower GCS score on admission, pupillary abnormality, hyperglycemia (more than 200 mg/dl), complications of severe other organ injury, diffuse injury III according to classification of CT, acute subdural hematoma and SAH. Pathophysiologically pediatric patients are not miniatures of adult patients. The data of Project 2004 is extremely significant and indicates the profile of one general view of pediatric patients with severe head injury in Japan. However, further collection of data and careful analysis are necessary for standardizing pediatric head trauma care. (author)

Serum amino acid abnormalities in pediatric patients with chronic ...

African Journals Online (AJOL)

Background: Plasma amino acid concentrations have been reported to be abnormal in patients with chronic renal failure. L-Arginine has been used to improve endothelial function by increasing nitric oxide (NO) bioavailability. The present study aim at investigating the status of plasma amino acids in pediatric patients with ...

Approach to Pediatric Patients during Surgical Interventions

OpenAIRE

Seher Ünver; Meltem Yıldırım

2013-01-01

A child’s surgical period usually contains unpleasant and difficult experiences, for the child and the parents. The child in this period experiences greater anxiety and distress. On the other hand, pediatric patients have complex states that directly effects their perioperative care during. Because their perioperative care includes not only the knowledge of general surgical procedure and care of a patient in the operating room. It also includes the specific understanding of a child’s airway, ...

Nutrition support of the pediatric patient with AIDS.

Science.gov (United States)

Bentler, M; Stanish, M

1987-04-01

Maintaining optimal nutrition in the pediatric patient with Acquired Immune Deficiency Syndrome (AIDS) is challenging, but it may be one of the most effective therapies. Patients experience numerous complications that compromise nutritional status. Infection, fever, diarrhea, feeding problems, and decreased intake all contribute to malnutrition, which in turn predisposes the patient even more to infection and malabsorption. Nutrition assessment should be done routinely so that new problems may be identified and treated. High-calorie, high-protein feedings, vitamin supplementation, and, when necessary, gavage feedings or parenteral nutrition are recommended to improve nutritional status and prevent further deficits. Maintaining optimal nutrition in the pediatric patient with Acquired Immune Deficiency Syndrome (AIDS) poses a significant challenge to the health care team. Patients may experience numerous complications that compromise nutritional status. The patient is at high risk for opportunistic infections, especially of the lungs, central nervous system, gastrointestinal (GI) tract, and skin. Such infections are common causes of morbidity and mortality. Impaired nutritional status may further impair the patient's immunocompetence. A study by Kotler and Gaety demonstrated severe progressive malnutrition in adult AIDS patients, with the lowest measures of lean body mass occurring in those patients close to death at the time of the study. While no studies of children with AIDS have been done to date, we have subjectively observed feeding problems, weight loss, and malnutrition in most of the patients we have seen.

Sedation and Monitoring in the Pediatric Patient during Gastrointestinal Endoscopy.

Science.gov (United States)

Chung, Hyun Kee; Lightdale, Jenifer R

2016-07-01

Sedation is a fundamental component of pediatric gastrointestinal procedures. The 2 main types of sedation for pediatric endoscopy remain general anesthesia and procedural sedation. Although anesthesiologist-administered sedation protocols are more common, there is no ideal regimen for endoscopy in children. This article discusses specific levels of sedation for endoscopy as well as various regimens that can be used to achieve each. Risks and considerations that may be specific to performing gastrointestinal procedures in children are reviewed. Finally, potential future directions for sedation and monitoring that may change the practice of pediatric gastroenterology and ultimately patient outcomes are examined. Copyright © 2016 Elsevier Inc. All rights reserved.

Malnutrition in Hospitalized Pediatric Patients: Assessment, Prevalence, and Association to Adverse Outcomes.

Science.gov (United States)

Daskalou, Efstratia; Galli-Tsinopoulou, Assimina; Karagiozoglou-Lampoudi, Thomais; Augoustides-Savvopoulou, Persefone

2016-01-01

Malnutrition is a frequent finding in pediatric health care settings in the form of undernutrition or excess body weight. Its increasing prevalence and impact on overall health status, which is reflected in the adverse outcomes, renders imperative the application of commonly accepted and evidence-based practices and tools by health care providers. Nutrition risk screening on admission and nutrition status evaluation are key points during clinical management of hospitalized pediatric patients, in order to prevent health deterioration that can lead to serious complications and growth consequences. In addition, anthropometric data based on commonly accepted universal growth standards can give accurate results for nutrition status. Both nutrition risk screening and nutrition status assessment are techniques that should be routinely implemented, based on commonly accepted growth standards and methodology, and linked to clinical outcomes. The aim of the present review was to address the issue of hospital malnutrition in pediatric settings in terms of prevalence, outline nutrition status evaluation and nutrition screening process using different criteria and available tools, and present its relationship with outcome measures. Key teaching points • Malnutrition-underweight or excess body weight-is a frequent imbalance in pediatric settings that affects physical growth and results in undesirable clinical outcomes. • Anthropometry interpretation through growth charts and nutrition screening are cornerstones for the assessment of malnutrition.To date no commonly accepted anthropometric criteria or nutrition screening tools are used in hospitalized pediatric patients. • Commonly accepted nutrition status and screening processes based on the World Health Organization's growth standards can contribute to the overall hospital nutrition care of pediatric patients.

The effect of nightly nasal CPAP treatment on nocturnal hypoxemia and sleep disorders in mustard gas-injured patients.

Science.gov (United States)

Vahedi, Ensieh; Fazeli Varzaneh, Ali Reza; Ghanei, Mostafa; Afsharpaiman, Shahla; Poursaleh, Zohre

2014-12-01

Sleep-related breathing disorders are associated with unusual respiratory pattern or an abnormal reduction in gas exchange during sleep that is common in sulfur mustard (SM) exposure. We compared 57 Iranian male patients injured with SM and had any complaints of sleep problems with an age-matched group of 21 Iranian male patients who had complaints of sleep problems and were not chemically injured; this group had Epworth Sleepiness Scale (ESS) above 10 and whom referred for polysomnography. Split-night studies were performed for patients with diagnostic polysomnography for obstructive sleep apnea (OSA) and respiratory events. We then studied respiratory events including episodes of OSA, apnea-hypopnea index (AHI) and respiratory disturbance index (RDI). The mean age in mustard-exposed patients was 48.14±8.04 years and in age-matched group, 48.19±8.39 years. In mustard exposed patients, there were statistical differences for the episodes of OSA (p=0.001), AHI (p=0.001), and RDI (p=0.001) between two segments of split-night studies. In the age-matched group, there were statistically differences for each parameter (episodes of OSA (p=0.001), AHI (p=0.001), and RDI (p=0.001)). There were no significant differences between two groups. This study indicated that the incidence of respiratory events and nocturnal hypoxemia during sleep in mustard-exposed patients were high and treatment with CPAP significantly reduced all these events.

A-Frame free Vascularized Fibular Graft and Femoral Lengthening for Osteosarcoma Pediatric Patients.

Science.gov (United States)

Cashin, Megan; Coombs, Christopher; Torode, Ian

2018-02-01

Pediatric limb reconstruction after resection of a malignant tumor presents specific challenges. Multiple surgical techniques have been used to treat these patients. This paper describes a staged surgical technique for the reconstruction of large distal femoral defects due to tumor resection in skeletally immature patients. Three pediatric patients with osteosarcoma of the distal femur underwent staged reconstruction. Neoadjuvant chemotherapy was followed by en bloc tumor resection and immediate reconstruction of the distal femoral defect with a vascularized free fibular autograft utilizing a unique A-frame construct combined with intramedullary nail fixation. The second stage was a planned gradual lengthening of the healed construct, over a custom-made magnetically driven expandable intramedullary nail. All patients achieved bony union and satisfactory length with minimal complications. The patients all returned to full, unlimited physical activities. The early results confirm that the described technique is a safe and reliable procedure for the reconstruction of large femoral defects in pediatric patients with osteosarcoma. Level IV-therapeutic.

New serological markers in pediatric patients with inflammatory bowel disease

Science.gov (United States)

Kovács, Márta; Müller, Katalin Eszter; Papp, Mária; Lakatos, Péter László; Csöndes, Mihály; Veres, Gábor

2014-01-01

The spectrum of serological markers associated with inflammatory bowel disease (IBD) is rapidly growing. Due to frequently delayed or missed diagnoses, the application of non-invasive diagnostic tests for IBD, as well as differentiation between ulcerative colitis (UC) and Crohn’s disease (CD), would be useful in the pediatric population. In addition, the combination of pancreatic autoantibodies and antibodies against Saccharomyces cerevisiae antibodies/perinuclear cytoplasmic antibody (pANCA) improved the sensitivity of serological markers in pediatric patients with CD and UC. Some studies suggested that age-associated differences in the patterns of antibodies may be present, particularly in the youngest children. In CD, most patients develop stricturing or perforating complications, and a significant number of patients undergo surgery during the disease course. Based on recent knowledge, serum antibodies are qualitatively and quantitatively associated with complicated CD behavior and CD-related surgery. Pediatric UC is characterized by extensive colitis and a high rate of colectomy. In patients with UC, high levels of anti-CBir1 and pANCA are associated with the development of pouchitis after ileal pouch-anal anastomosis. Thus, serologic markers for IBD can be applied to stratify IBD patients into more homogeneous subgroups with respect to disease progression. In conclusion, identification of patients at an increased risk of rapid disease progression is of great interest, as the application of early and more aggressive pharmaceutical intervention could have the potential to alter the natural history of IBD, and reduce complications and hospitalizations. PMID:24803798

Bioimpedance measurement of body water correlates with measured volume balance in injured patients.

Science.gov (United States)

Rosemurgy, A S; Rodriguez, E; Hart, M B; Kurto, H Z; Albrink, M H

1993-06-01

Bioimpedance technology is being used increasingly to determine drug volume of distribution, body water status, and nutrition repletion. Its accuracy in patients experiencing large volume flux is not established. To address this, we undertook this prospective study in 54 consecutive seriously injured adults who had emergency celiotomy soon after arrival in the emergency department. Bioimpedance measurements were obtained in the emergency department before the patient was transported to the operating room, on completion of celiotomy, and 24 hours and 48 hours after celiotomy. Bioimpedance measurements of body water were compared with measured fluid balance. If insensible losses are subtracted from measured fluid balance, the percentage of body weight, which is body water determined by bioimpedance, closely follows fluid flux. This study supports the use of bioimpedance measurements in determining total body water even during periods of surgery, blood loss, and vigorous resuscitation.

Risk factors for venous thromboembolic events in pediatric surgical patients: Defining indications for prophylaxis.

Science.gov (United States)

Cairo, Sarah B; Lautz, Timothy B; Schaefer, Beverly A; Yu, Guan; Naseem, Hibbut-Ur-Rauf; Rothstein, David H

2017-12-27

Venous thromboembolism (VTE) in pediatric surgical patients is a rare event. The risk factors for VTE in pediatric general surgery patients undergoing abdominopelvic procedures are unknown. The American College of Surgeon's National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database (2012-2015) was queried for patients with VTE after abdominopelvic general surgery procedures. Patient and operative variables were assessed to identify risk factors associated with VTE and develop a pediatric risk score. From 2012-2015, 68 of 34,813 (0.20%) patients who underwent abdominopelvic general surgery procedures were diagnosed with VTE. On multivariate analysis, there was no increased risk of VTE based on concomitant malignancy, chemotherapy, inflammatory bowel disease, or laparoscopic surgical approach, while a higher rate of VTE was identified among female patients. The odds of experiencing VTE were increased on stepwise regression for patients older than 15 years and those with preexisting renal failure or a diagnosis of septic shock, patients with American Society of Anesthesia (ASA) classification ≥ 2, and for anesthesia time longer than 2 h. The combination of age > 15 years, ASA classification ≥ 2, anesthesia time > 2 h, renal failure, and septic shock was included in a model for predicting risk of VTE (AUC = 0.907, sensitivity 84.4%, specificity 88.2%). VTE is rare in pediatric patients, but prediction modeling may help identify those patients at heightened risk. Additional studies are needed to validate the factors identified in this study in a risk assessment model as well as to assess the efficacy and cost-effectiveness of prophylaxis methods. Level III, retrospective comparative study. Copyright © 2018. Published by Elsevier Inc.

Radiation risk index for pediatric CT. A patient-derived metric

International Nuclear Information System (INIS)

Samei, Ehsan; Tian, Xiaoyu; Paul Segars, W.; Frush, Donald P.

2017-01-01

There is a benefit in characterizing radiation-induced cancer risk in pediatric chest and abdominopelvic CT: a singular metric that represents the whole-body radiation burden while also accounting for age, gender and organ sensitivity. To compute an index of radiation risk for pediatric chest and abdominopelvic CT. Using a protocol approved by our institutional review board, 42 pediatric patients (age: 0-16 years, weight: 2-80 kg) were modeled into virtual whole-body anatomical models. Organ doses were estimated for clinical chest and abdominopelvic CT examinations of the patients using validated Monte Carlo simulations of two major scanner models. Using age-, size- and gender-specific organ risk coefficients, the values were converted to normalized effective dose (by dose length product) (denoted as the k factor) and a normalized risk index (denoted as the q factor). An analysis was performed to determine how these factors are correlated with patient age and size for both males and females to provide a strategy to better characterize individualized risk. The k factor was found to be exponentially correlated with the average patient diameter. For both genders, the q factor also exhibited an exponential relationship with both the average patient diameter and with patient age. For both factors, the differences between the scanner models were less than 8%. The study defines a whole-body radiation risk index for chest and abdominopelvic CT imaging, that incorporates individual estimated organ dose values, organ radiation sensitivity, patient size, exposure age and patient gender. This indexing metrology enables the assessment and potential improvement of chest and abdominopelvic CT performance through surveillance of practice dose profiles across patients and may afford improved informed communication. (orig.)

Radiation risk index for pediatric CT. A patient-derived metric

Energy Technology Data Exchange (ETDEWEB)

Samei, Ehsan [Duke University Medical Center, Department of Radiology, Carl E. Ravin Advanced Imaging Laboratories, Durham, NC (United States); Duke University Medical Center, Department of Biomedical Engineering, Electrical and Computer Engineering, Durham, NC (United States); Duke University Medical Center, Medical Physics Graduate Program, Durham, NC (United States); Tian, Xiaoyu [Duke University Medical Center, Department of Radiology, Carl E. Ravin Advanced Imaging Laboratories, Durham, NC (United States); Paul Segars, W. [Duke University Medical Center, Department of Radiology, Carl E. Ravin Advanced Imaging Laboratories, Durham, NC (United States); Duke University Medical Center, Medical Physics Graduate Program, Durham, NC (United States); Frush, Donald P. [Duke University Medical Center, Medical Physics Graduate Program, Durham, NC (United States); Duke University Medical Center, Division of Pediatric Radiology, Department of Radiology, Durham, NC (United States)

2017-12-15

There is a benefit in characterizing radiation-induced cancer risk in pediatric chest and abdominopelvic CT: a singular metric that represents the whole-body radiation burden while also accounting for age, gender and organ sensitivity. To compute an index of radiation risk for pediatric chest and abdominopelvic CT. Using a protocol approved by our institutional review board, 42 pediatric patients (age: 0-16 years, weight: 2-80 kg) were modeled into virtual whole-body anatomical models. Organ doses were estimated for clinical chest and abdominopelvic CT examinations of the patients using validated Monte Carlo simulations of two major scanner models. Using age-, size- and gender-specific organ risk coefficients, the values were converted to normalized effective dose (by dose length product) (denoted as the k factor) and a normalized risk index (denoted as the q factor). An analysis was performed to determine how these factors are correlated with patient age and size for both males and females to provide a strategy to better characterize individualized risk. The k factor was found to be exponentially correlated with the average patient diameter. For both genders, the q factor also exhibited an exponential relationship with both the average patient diameter and with patient age. For both factors, the differences between the scanner models were less than 8%. The study defines a whole-body radiation risk index for chest and abdominopelvic CT imaging, that incorporates individual estimated organ dose values, organ radiation sensitivity, patient size, exposure age and patient gender. This indexing metrology enables the assessment and potential improvement of chest and abdominopelvic CT performance through surveillance of practice dose profiles across patients and may afford improved informed communication. (orig.)

Effect of sildenafil on erectile dysfunction in spinal Cord injured ...

African Journals Online (AJOL)

Effect of sildenafil on erectile dysfunction in spinal Cord injured patients. ... Trauma was the etiology in 87.5% of the cases (44% were road accidents). 12/16 patients were paraplegics (10 above ... in SCI patients. This approach is compatible with the efforts to improve the quality of life and rehabilitation of these patients.

Neuroimaging findings in pediatric patients with seizure from an ...

African Journals Online (AJOL)

Background: Pediatric seizures in developing countries are often poorly investigated and consequently poorly managed. ..... irrespective of age or sex of the patient; considering that, .... clinical presenting symptom in children with brain tumors.

Roseomonas mucosa Isolated from Bloodstream of Pediatric Patient ▿

Science.gov (United States)

Bard, J. Dien; Deville, J. G.; Summanen, P. H.; Lewinski, M. A.

2010-01-01

We report a case of catheter-related bacteremia associated with Roseomonas mucosa isolated from an immunocompromised pediatric patient with a history of multiple episodes of urinary tract infection and bacteremia. PMID:20534804

Transpalatal distraction for the management of maxillary constriction in pediatric patients.

Science.gov (United States)

Adolphs, Nicolai; Ernst, Nicole; Hoffmeister, Bodo; Raguse, Jan-Dirk

2015-01-01

The management of severe maxillary constriction can be challenging. For that purpose surgically assisted maxillary expansion by transpalatal distraction (TPD) can typically be recommended after skeletal maturity. However in selected cases bone borne transpalatal distraction devices can contribute to improve maxillary constriction considerably earlier already during mixed dentition. To assess the possibility of bone borne transpalatal distraction in pediatric patients. Clinical paper. Since 2010 TPD has been applied to six pediatric patients during mixed dentition when severe maxillary constriction was present and conventional orthodontic widening has already failed. Individually selected devices (Surgitec, Belgium) were inserted in general anaesthesia and distraction was performed according to well known parameters. Maxillary constriction could be improved in all six patients without any drawbacks by bone borne devices during mixed dentition. Skeletal conditions were obviously improved for subsequent orthodontic or orthognathic therapy without functional impairment. Follow-up is up to 36 months after device removal. Transpalatal Distraction is recommendable in selected pediatric patients if massive growth disturbance is present or has to be expected. TPD allows for individually adapted maxillary expansion by selection and positioning of appropriate devices in combination with intraoperative testing of maxillary movements and controlled bone removal.

Irinotecan for relapsed Wilms tumor in pediatric patients

DEFF Research Database (Denmark)

Hol, Janna A; van den Heuvel-Eibrink, Marry M; Graf, Norbert

2018-01-01

While irinotecan has been studied in various pediatric solid tumors, its potential role in Wilms tumor (WT) is less clear. We evaluated response and outcome of irinotecan-containing regimens in relapsed WT and compared our results to the available literature. Among 14 evaluable patients, one...

The impact of intrapulmonary shunting after liver transplantation in pediatric patients

Directory of Open Access Journals (Sweden)

Chi-Di Liang

2012-06-01

Conclusion: Among pediatric ESLD patients with preoperative IPS, approximately 6% continue to have mild IPS after LT. Patients with mild IPS after LT remain asymptomatic and have good liver graft function.

[Depressive disorder in Mexican pediatric patients with systemic lupus erythematosus (SLE)].

Science.gov (United States)

Carbajal-Alonso, Hilda Lilian; García-Moreno, Norberta Prisilia; Rodríguez-Arreola, Brenda; Barrera de León, Juan Carlos

2016-01-01

To identify the prevalence of depression in Mexican pediatric patients with systemic lupus erythematosus. Analytical transversal study including patients aged 7-16 years with a diagnosis of systemic lupus erythematosus seen at the Pediatric Rheumatology Consultation Service. The disease was classified by means of the MEX-SLEDAI questionnaire. Descriptive statistics with central tendency and dispersion and comparative measurements with chi-squared and Mann-Whitney U tests. Logistic regression and association with odds ratios. SPSS v.21.0 statistical software package. We evaluated 45 patients who presented depression, n=9 (20%), including eight females (89%) and one male (11%), median age 13 years (range, 7-16) in children with depression vs. 13 years (range, 9-14) p=0.941, depression more frequent in schoolchildren. Habitual residence, disease evolution time, and duration of the immunosuppressor did not show a significant difference between both groups. Divorced parents p=0.037. Neuropsychiatric manifestations of lupus presented in 2.2% of all patients and in 100% of patients with depression. Disease activity index (MEX-SLEDAI) did not demonstrate a relationship with the presence of depression. Prevalences in pediatric populations are less that that reported in adults, association with disease activity, evolution time, and immunosuppressor use and duration not found.

Pediatric Asthma

Science.gov (United States)

... Science Education & Training Home Conditions Asthma (Pediatric) Asthma (Pediatric) Make an Appointment Refer a Patient Ask a ... meet the rising demand for asthma care. Our pediatric asthma team brings together physicians, nurses, dietitians, physical ...

Pediatric Stroke

Science.gov (United States)

... and Patient Resources Home » Patients & Families » About Stroke » Pediatric Stroke » Introduction Introduction What is a Stroke? Ischemic Stroke Intracerebral Hemorrhage Subarachnoid Hemorrhage Pediatric Stroke Introduction Types of Stroke Diagnosis and Treatment ...

Device therapy in pediatric and congenital heart disease patients

Directory of Open Access Journals (Sweden)

Naokata Sumitomo, MD, PhD

2014-12-01

Conclusions: Despite the limited experience, limitations of device implantations owing to the size of the devices, and necessity for nonendocardial electrode placement, device implantations are required in more pediatric and CHD patients than expected.

Subclinical nephritic syndrome in children cohabiting with pediatric patients, Presenting acute nephritic syndrome

OpenAIRE

Guerrero-Tinoco Gustavo Adolfo; Julio-Barrios Emil

2012-01-01

Introduction: subclinical nephritic syndrome is the presence of hematuria, hypocomplementemiaand/or proteinuria without the presence of signs and/or symptoms.Objective: to determine the incidence of subclinical nephritic syndrome in childrenliving with pediatric patients diagnosed with acute nephritic syndrome.Methods: family visit to identify children living together in the two previous months, with pediatric patients hospitalized with acute nephritic syndrome, at Hospital InfantilNapoleon F...

Radiation dose associated with CT-guided drain placement for pediatric patients

Energy Technology Data Exchange (ETDEWEB)

Schwartz, Cody J.; Isaacson, Ari J.; Fordham, Lynn Ansley; Ivanovic, Marija; Dixon, Robert G. [University of North Carolina at Chapel Hill, Department of Radiology, UNC Health Care, Chapel Hill, NC (United States); Taylor, J.B. [University of North Carolina at Chapel Hill, Environment, Health and Safety, Chapel Hill, NC (United States)

2017-05-15

To date, there are limited radiation dose data on CT-guided procedures in pediatric patients. Our goal was to quantify the radiation dose associated with pediatric CT-guided drain placement and follow-up drain evaluations in order to estimate effective dose. We searched the electronic medical record and picture archiving and communication system (PACS) to identify all pediatric (<18 years old) CT-guided drain placements performed between January 2008 and December 2013 at our institution. We compiled patient data and radiation dose information from CT-guided drain placements as well as pre-procedural diagnostic CTs and post-procedural follow-up fluoroscopic abscess catheter injections (sinograms). Then we converted dose-length product, fluoroscopy time and number of acquisitions to effective doses using Monte Carlo simulations and age-appropriate conversion factors based on annual quality-control testing. Fifty-two drainages were identified with mean patient age of 11.0 years (5 weeks to 17 years). Most children had diagnoses of appendicitis (n=23) or inflammatory bowel disease (n=11). Forty-seven patients had diagnostic CTs, with a mean effective dose of 7.3 mSv (range 1.1-25.5 mSv). Drains remained in place for an average of 16.9 days (range 0-75 days), with an average of 0.9 (0-5) sinograms per patient in follow-up. The mean effective dose for all drainages and follow-up exams was 5.3 mSv (0.7-17.1) and 62% (32/52) of the children had effective doses less than 5 mSv. The majority of pediatric patients who have undergone CT-guided drain placements at our institution have received total radiation doses on par with diagnostic ranges. This information could be useful when describing the dose of radiation to parents and providers when CT-guided drain placement is necessary. (orig.)

Radiation dose associated with CT-guided drain placement for pediatric patients

International Nuclear Information System (INIS)

Schwartz, Cody J.; Isaacson, Ari J.; Fordham, Lynn Ansley; Ivanovic, Marija; Dixon, Robert G.; Taylor, J.B.

2017-01-01

To date, there are limited radiation dose data on CT-guided procedures in pediatric patients. Our goal was to quantify the radiation dose associated with pediatric CT-guided drain placement and follow-up drain evaluations in order to estimate effective dose. We searched the electronic medical record and picture archiving and communication system (PACS) to identify all pediatric (<18 years old) CT-guided drain placements performed between January 2008 and December 2013 at our institution. We compiled patient data and radiation dose information from CT-guided drain placements as well as pre-procedural diagnostic CTs and post-procedural follow-up fluoroscopic abscess catheter injections (sinograms). Then we converted dose-length product, fluoroscopy time and number of acquisitions to effective doses using Monte Carlo simulations and age-appropriate conversion factors based on annual quality-control testing. Fifty-two drainages were identified with mean patient age of 11.0 years (5 weeks to 17 years). Most children had diagnoses of appendicitis (n=23) or inflammatory bowel disease (n=11). Forty-seven patients had diagnostic CTs, with a mean effective dose of 7.3 mSv (range 1.1-25.5 mSv). Drains remained in place for an average of 16.9 days (range 0-75 days), with an average of 0.9 (0-5) sinograms per patient in follow-up. The mean effective dose for all drainages and follow-up exams was 5.3 mSv (0.7-17.1) and 62% (32/52) of the children had effective doses less than 5 mSv. The majority of pediatric patients who have undergone CT-guided drain placements at our institution have received total radiation doses on par with diagnostic ranges. This information could be useful when describing the dose of radiation to parents and providers when CT-guided drain placement is necessary. (orig.)

Assessment of Liver Stiffness in Pediatric Fontan Patients Using Transient Elastography

Directory of Open Access Journals (Sweden)

Becky Chen

2016-01-01

Full Text Available Background. Hepatic fibrosis is a potential complication following Fontan surgery and heralds long-term risk for cirrhosis. Transient elastography (TE is a rapid, noninvasive method to assess liver fibrosis by measuring liver stiffness. Objectives. To compare liver stiffness and liver biochemistries in pediatric Fontan patients with age- and sex-matched controls and to determine patients’ acceptance of TE. Methods. Patients were recruited from British Columbia Children’s Hospital. Twenty-two Fontan patients (15 males were identified. Demographic information and cardiac data were collected. TE was measured using size-appropriate probes. Results. The median age of the Fontan cohort was 13.7 (5.9–16.8 years. Time from Fontan surgery to TE was 9.6 (1.0–12.9 years. The median Fontan circuit pressure was 13 (11–14 mmHg. TE values were higher in Fontan patients versus controls (18.6 versus 4.7 kPa, p<0.001. There was no association between TE values and patient age (r=0.41, p=0.058, time since Fontan surgery (r=0.40, p=0.062, or median Fontan circuit pressure (CVP (r=0.35, p=0.111. Patients found TE to be nonpainful, convenient, and safe. Conclusions. TE is feasible to assess liver stiffness in children following Fontan surgery. Pediatric Fontan patients have markedly elevated liver stiffness values. TE may have important utility in liver care follow-up of pediatric Fontan patients.

Medical errors in hospitalized pediatric trauma patients with chronic health conditions

Directory of Open Access Journals (Sweden)

Xiaotong Liu

2014-01-01

Full Text Available Objective: This study compares medical errors in pediatric trauma patients with and without chronic conditions. Methods: The 2009 Kids’ Inpatient Database, which included 123,303 trauma discharges, was analyzed. Medical errors were identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. The medical error rates per 100 discharges and per 1000 hospital days were calculated and compared between inpatients with and without chronic conditions. Results: Pediatric trauma patients with chronic conditions experienced a higher medical error rate compared with patients without chronic conditions: 4.04 (95% confidence interval: 3.75–4.33 versus 1.07 (95% confidence interval: 0.98–1.16 per 100 discharges. The rate of medical error differed by type of chronic condition. After controlling for confounding factors, the presence of a chronic condition increased the adjusted odds ratio of medical error by 37% if one chronic condition existed (adjusted odds ratio: 1.37, 95% confidence interval: 1.21–1.5, and 69% if more than one chronic condition existed (adjusted odds ratio: 1.69, 95% confidence interval: 1.48–1.53. In the adjusted model, length of stay had the strongest association with medical error, but the adjusted odds ratio for chronic conditions and medical error remained significantly elevated even when accounting for the length of stay, suggesting that medical complexity has a role in medical error. Higher adjusted odds ratios were seen in other subgroups. Conclusion: Chronic conditions are associated with significantly higher rate of medical errors in pediatric trauma patients. Future research should evaluate interventions or guidelines for reducing the risk of medical errors in pediatric trauma patients with chronic conditions.

Eosinophilic Esophagitis in Brazilian Pediatric Patients

Directory of Open Access Journals (Sweden)

Mayra Isabel Correia Pinheiro

2013-01-01

Full Text Available We examined 11 pediatric patients with eosinophilic esophagitis with a tardy diagnosis. The symptoms were initially thought to be related to other diseases, leading to the use of inadequate therapeutic approaches. The patients were between 3 and 17 years old (mean 7.8 ± 3.8 years, and 8 of the patients were male. Common symptoms included abdominal pain, regurgitation, difficulty in gaining weight, vomiting, dysphagia, and coughing. The mean age for the onset of symptoms was 4.3 ± 2.9 years. Endoscopic findings included normal mucosa in five (45% patients, thickening of the mucosa with longitudinal grooves in three (27%, erosive esophagitis in two (18%, and a whitish stippling in one (9% patient. Treatment included the use of a topical corticosteroid for 10 patients. In eight (73% cases, the treatment made the symptoms disappear. Ten patients underwent histopathological management after treatment, with a decrease in the number of eosinophils.

Technical study of craniospinal irradiation in pediatric patients with patient position and field matching

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Itoh, Masanori; Ise, Toshihide; Umezu, Mikio [Kangawa Children' s Medical Center, Yokohama (Japan); Hioki, Minoru

2000-05-01

Craniospinal irradiation (CSI) in leukemia and medulloblastoma patients is usually a three-field technique that involves parallel-opposed lateral cranial fields adjacent and orthogonal to a posterior spinal field. Since sedation is often necessary for pediatric patients, the supine position is more favorable than the prone position for respiratory monitoring. We practiced CSI in the supine position in one case of leukemia and three cases of medulloblastoma. Each location of the isocenter was determined by moving the couch to fit the center of the CSI on the basis of incisura intertragica. The angles of collimator rotation and couch rotation were calculated according to each treatment field size. The junction was also moved 2 cm day by day during the course of treatment so that over- and underdose at the junction would be prevented. The supine position did not allow us to visually confirm the proper junction between the lateral cranial fields and the spinal field. However, we succeeded in practicing complete conjunction between the fields by proper collimator and couch rotations on the assessment of the film-dose method. CSI in the supine position is naturally comfortable for pediatric patients and seems effective in pediatric treatments, which often require respiratory monitoring for sedation. (author)

p-Cresyl sulfate and indoxyl sulfate in pediatric patients on chronic dialysis

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Hye Sun Hyun

2013-04-01

Full Text Available &lt;b&gt;Purpose:&lt;/b&gt; Indoxyl sulfate and p- cresyl sulfate are important protein-bound uremic retention solutes whose levels can be partially reduced by renal replacement therapy. These solutes originate from intestinal bacterial protein fermentation and are associated with cardiovascular outcomes and chronic kidney disease progression. The aims of this study were to investigate the levels of indoxyl sulfate and p- cresyl sulfate as well as the effect of probiotics on reducing the levels of uremic toxins in pediatric patients on dialysis. &lt;b&gt;Methods:&lt;/b&gt; We enrolled 20 pediatric patients undergoing chronic dialysis; 16 patients completed the study. The patients underwent a 12-week regimen of VSL#3, a high-concentration probiotic preparation, and the serum levels of indoxyl sulfate and p- cresyl sulfate were measured before treatment and at 4, 8, and 12 weeks after the regimen by using fluorescence liquid chromatography. To assess the normal range of indoxyl sulfate and p- cresyl sulfate we enrolled the 16 children with normal glomerular filtration rate who had visited an outpatient clinic for asymptomatic microscopic hematuria that had been detected by a school screening in August 2011. &lt;b&gt;Results:&lt;/b&gt; The baseline serum levels of indoxyl sulfate and p- cresyl sulfate in the patients on chronic dialysis were significantly higher than those in the children with microscopic hematuria. The baseline serum levels of p- cresyl sulfate in the peritoneal dialysis group were significantly higher than those in the hemodialysis group. There were no significant changes in the levels of these uremic solutes after 12-week VSL#3 treatment in the patients on chronic dialysis. &lt;b&gt;Conclusion:&lt;/b&gt; The levels of the uremic toxins p- cresyl sulfate and indoxyl sulfate are highly elevated in pediatric patients on dialysis, but there was no significant effect by

Pediatric portal hypertension

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Vogel, Clarissa Barbon

2017-01-01

Abstract: Pediatric portal hypertension management is a team approach between the patient, the patient's family, the primary caregiver, and specialty providers. Evidence-based practice guidelines have not been established in pediatrics. This article serves as a review for the primary care NP in the management of pediatric portal hypertension, discussing the etiology, pathophysiology, and clinical presentation of pediatric portal hypertension, diagnostic tests, and treatment and management options. PMID:28406835

Resting-state functional magnetic resonance imaging for surgical planning in pediatric patients: a preliminary experience.

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Roland, Jarod L; Griffin, Natalie; Hacker, Carl D; Vellimana, Ananth K; Akbari, S Hassan; Shimony, Joshua S; Smyth, Matthew D; Leuthardt, Eric C; Limbrick, David D

2017-12-01

OBJECTIVE Cerebral mapping for surgical planning and operative guidance is a challenging task in neurosurgery. Pediatric patients are often poor candidates for many modern mapping techniques because of inability to cooperate due to their immature age, cognitive deficits, or other factors. Resting-state functional MRI (rs-fMRI) is uniquely suited to benefit pediatric patients because it is inherently noninvasive and does not require task performance or significant cooperation. Recent advances in the field have made mapping cerebral networks possible on an individual basis for use in clinical decision making. The authors present their initial experience translating rs-fMRI into clinical practice for surgical planning in pediatric patients. METHODS The authors retrospectively reviewed cases in which the rs-fMRI analysis technique was used prior to craniotomy in pediatric patients undergoing surgery in their institution. Resting-state analysis was performed using a previously trained machine-learning algorithm for identification of resting-state networks on an individual basis. Network maps were uploaded to the clinical imaging and surgical navigation systems. Patient demographic and clinical characteristics, including need for sedation during imaging and use of task-based fMRI, were also recorded. RESULTS Twenty patients underwent rs-fMRI prior to craniotomy between December 2013 and June 2016. Their ages ranged from 1.9 to 18.4 years, and 12 were male. Five of the 20 patients also underwent task-based fMRI and one underwent awake craniotomy. Six patients required sedation to tolerate MRI acquisition, including resting-state sequences. Exemplar cases are presented including anatomical and resting-state functional imaging. CONCLUSIONS Resting-state fMRI is a rapidly advancing field of study allowing for whole brain analysis by a noninvasive modality. It is applicable to a wide range of patients and effective even under general anesthesia. The nature of resting

Treating Mucocele in Pediatric Patients Using a Diode Laser: Three Case Reports

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Sara M. Bagher

2018-05-01

Full Text Available A mucocele is the most common minor salivary gland disease and among the most common biopsied oral lesions in pediatric patients. Clinically, a mucocele appears as a round well-circumscribed painless swelling ranging from deep blue to mucosa alike in color. Mucoceles rarely resolve on their own and surgical removal under local anesthesia is required in most cases. Different treatment options are described in the literature, including cryosurgery, intra-lesion injection of corticosteroid, micro-marsupialization and conventional surgical removal using a scalpel, and laser ablation. Therefore, the goal of this paper was to report three cases of mucocele removal in pediatric patients using a diode laser with a one-month follow-up. Mucoceles were removed by a pediatric dentist using a diode laser with a wavelength of 930 nm in continuous mode and a power setting of 1.8 Watts. In all cases, no bleeding occurred during or after the procedure and there was no need for suturing. On clinical examination during the one-month follow-up, in all three cases there was minimal or no scarring, minimal post-operative discomfort or pain, and no recurrence. Diode lasers provide an effective, rapid, simple, bloodless and well accepted procedure for treating mucocele in pediatric patients. Minimal post-operative discomfort and scarring was reported by all the three patients.

Treating Mucocele in Pediatric Patients Using a Diode Laser: Three Case Reports.

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Bagher, Sara M; Sulimany, Ayman M; Kaplan, Martin; Loo, Cheen Y

2018-05-09

A mucocele is the most common minor salivary gland disease and among the most common biopsied oral lesions in pediatric patients. Clinically, a mucocele appears as a round well-circumscribed painless swelling ranging from deep blue to mucosa alike in color. Mucoceles rarely resolve on their own and surgical removal under local anesthesia is required in most cases. Different treatment options are described in the literature, including cryosurgery, intra-lesion injection of corticosteroid, micro-marsupialization and conventional surgical removal using a scalpel, and laser ablation. Therefore, the goal of this paper was to report three cases of mucocele removal in pediatric patients using a diode laser with a one-month follow-up. Mucoceles were removed by a pediatric dentist using a diode laser with a wavelength of 930 nm in continuous mode and a power setting of 1.8 Watts. In all cases, no bleeding occurred during or after the procedure and there was no need for suturing. On clinical examination during the one-month follow-up, in all three cases there was minimal or no scarring, minimal post-operative discomfort or pain, and no recurrence. Diode lasers provide an effective, rapid, simple, bloodless and well accepted procedure for treating mucocele in pediatric patients. Minimal post-operative discomfort and scarring was reported by all the three patients.

Pediatric Sinusitis

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... ENTCareers Marketplace Find an ENT Doctor Near You Pediatric Sinusitis Pediatric Sinusitis Patient Health Information News media interested in ... sinuses are present at birth. Unlike in adults, pediatric sinusitis is difficult to diagnose because symptoms of ...

Patient doses from fluoroscopically guided cardiac procedures in pediatrics

International Nuclear Information System (INIS)

Martinez, L C; Vano, E; Gutierrez, F; Rodriguez, C; Gilarranz, R; Manzanas, M J

2007-01-01

Infants and children are a higher risk population for radiation cancer induction compared to adults. Although some values on pediatric patient doses for cardiac procedures have been reported, data to determine reference levels are scarce, especially when compared to those available for adults in diagnostic and therapeutic procedures. The aim of this study is to make a new contribution to the scarce published data in pediatric cardiac procedures and help in the determination of future dose reference levels. This paper presents a set of patient dose values, in terms of air kerma area product (KAP) and entrance surface air kerma (ESAK), measured in a pediatric cardiac catheterization laboratory equipped with a biplane x-ray system with dynamic flat panel detectors. Cardiologists were properly trained in radiation protection. The study includes 137 patients aged between 10 days and 16 years who underwent diagnostic catheterizations or therapeutic procedures. Demographic data and technical details of the procedures were also gathered. The x-ray system was submitted to a quality control programme, including the calibration of the transmission ionization chamber. The age distribution of the patients was 47 for 2 respectively for the four age bands. These KAP values increase by a factor of 8 when moving through the four age bands. The probability of a fatal cancer per fluoroscopically guided cardiac procedure is about 0.07%. Median values of ESAK for the four age bands were 46, 50, 56 and 163 mGy, which lie far below the threshold for deterministic effects on the skin. These dose values are lower than those published in previous papers

Analysis of online patient education materials in pediatric ophthalmology.

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John, Ann M; John, Elizabeth S; Hansberry, David R; Thomas, Prashant J; Guo, Suqin

2015-10-01

Patients increasingly consult online resources for healthcare information. The American Medical Association (AMA) and National Institutes of Health (NIH) recommend that online education resources be written between a 3rd- and 7th-grade level. This study assesses whether online health information abides by these guidelines. Ten pediatric ophthalmology conditions were entered into a commonly used search engine, Google.com, and analyzed using 10 validated readability scales. Scientific articles and articles written on patient forums were excluded. The 10 conditions--amblyopia, cataract, conjunctivitis, corneal abrasion, nystagmus, retinoblastoma, retinopathy of prematurity, strabismus, stye, and glaucoma--were also searched and analyzed separately from widely used websites, including Wikipedia and WebMD, as well as those of professional societies, including the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) and the American Optometric Association (AOA). The majority of articles were written above recommended guidelines. All scales showed that the 100 articles were written at a mean grade-level of 11.75 ± 2.72. Only 12% of articles were written below a 9th-grade level and only 3% met recommended criteria. The articles accrued separately from Wikipedia, WebMD, AAPOS, and AOA also had average grade levels above the recommended guidelines. The readability of online patient education material exceeds NIH and AMA guidelines. This disparity can adversely affect caregiver comprehension of such resources and contribute to poor decision making. Pediatric ophthalmology online articles are generally written at a level too high for average caregiver comprehension. Revision of articles can increase satisfaction, improve outcomes, and facilitate the patient-ophthalmologist relationship. Published by Elsevier Inc.

Blood conservation operations in pediatric cardiac patients: a paradigm shift of blood use.

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Karimi, Mohsen; Florentino-Pineda, Ivan; Weatherred, Ted; Qadeer, Ahsan; Rosenberg, Carol Ann; Hudacko, Andrea; Ryu, Duchwan

2013-03-01

Red blood cell transfusion is associated with high morbidity in pediatric patients undergoing cardiac operations. The aim of this study was to evaluate the clinical effects and outcomes of blood conservation for our pediatric patients undergoing cardiac operations. We retrospectively analyzed a collected database of 168 pediatric patients who underwent biventricular (BV) and univentricular (UV) cardiac operations from 2006 to 2010. Patients were grouped into no blood conservation (n = 86 [BV = 74, UV = 12]) and blood conservation (n = 82 [BV = 68, UV = 14]) cohorts. There were no statistical differences in age, sex, weight, and preoperative or postoperative hemoglobin levels in the BV groups. Even though the blood conservation group had longer cardiopulmonary bypass (CPB) (p conservation group, there were no statistical differences in age, sex, weight, CPB and cross-clamp times, preoperative and postoperative hemoglobin levels, and red blood cell transfusions despite lower intraoperative hemoglobin levels (p conservation group. Logistic regression analysis demonstrated a significant correlation between intraoperative blood transfusion and increased inotropic score, longer duration on the ventilator, and increased length of hospitalization. Blood conservation in pediatric cardiac operations is associated with fewer ventilator days, lower inotropic scores, and shorter lengths of stay. These findings, in addition to attendant risks and side effects of blood transfusion and the rising cost of safer blood products, justify blood conservation in pediatric cardiac operations. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Pediatric neurocritical care.

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Murphy, Sarah

2012-01-01

Pediatric neurocritical care is an emerging multidisciplinary field of medicine and a new frontier in pediatric critical care and pediatric neurology. Central to pediatric neurocritical care is the goal of improving outcomes in critically ill pediatric patients with neurological illness or injury and limiting secondary brain injury through optimal critical care delivery and the support of brain function. There is a pressing need for evidence based guidelines in pediatric neurocritical care, notably in pediatric traumatic brain injury and pediatric stroke. These diseases have distinct clinical and pathophysiological features that distinguish them from their adult counterparts and prevent the direct translation of the adult experience to pediatric patients. Increased attention is also being paid to the broader application of neuromonitoring and neuroprotective strategies in the pediatric intensive care unit, in both primary neurological and primary non-neurological disease states. Although much can be learned from the adult experience, there are important differences in the critically ill pediatric population and in the circumstances that surround the emergence of neurocritical care in pediatrics.

Impact of Music in Reducing Patient Anxiety During Pediatric Ultrasound

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Kesselman, Andrew; Bergen, Michael; Stefanov, Dimitre; Goldfisher, Rachelle; Amodio, John

2016-01-01

The use of noninvasive ultrasound examinations can potentially result in significant anxiety in the pediatric population. The purpose of this study was to assess the influence of music during pediatric ultrasound examinations to reduce anxiety measured by heart rate. A total of 44 patients were recruited; 21 controls and 23 experimental. Each participant was randomized to either music or no music (control) after parental consent was obtained. Pulse oximeters were used to monitor heart rate at...

Epidemiology of Pediatric Traumatic Spinal Cord Injury in a Population-Based Cohort, 1998-2012.

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Saunders, Lee L; Selassie, Anbesaw; Cao, Yue; Zebracki, Kathy; Vogel, Lawrence C

2015-01-01

Traumatic spinal cord injury (SCI) that occurs in children and adolescents who are still developing represents a different challenge than SCI in adults. However, information on the epidemiology and incidence of SCI in a population-based cohort is lacking. To describe the epidemiology of pediatric SCI in a population-based cohort in the United States and to assess trend in incidence over a 15-year period (1998-2012). Children and adolescents (0-21 years) with SCI were identified through the South Carolina SCI Surveillance Registry using hospital discharge records from 1998 to 2012. Overall age-adjusted incidence rates were calculated for each year, and incidence rates were stratified by age, gender, and race. The overall age-adjusted incidence rate was 26.9 per million population, and there was a trend (P = .0583) toward decreasing incidence of pediatric SCI. When stratified by race, there was a significant decrease in incidence among Whites(P = .0052) but not among non-Whites. Younger participants were more likely to be female, to be injured through sports, and to be more likely to have concomitant traumatic brain injury. Since 1998, the proportion of older pediatric patients (16-22 years) with SCI has increased, as has the proportion of non-White patients. Although there was an overall trend toward decreasing incidence in this population-based cohort, when stratified by race, this trend only occurred in the White population.

Analysis of Unplanned Intensive Care Unit Admissions in Postoperative Pediatric Patients.

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Landry, Elizabeth K; Gabriel, Rodney A; Beutler, Sascha; Dutton, Richard P; Urman, Richard D

2017-03-01

Currently, there are only a few retrospective, single-institution studies that have addressed the prevalence and risk factors associated with unplanned admissions to the pediatric intensive care unit (ICU) after surgery. Based on the limited amount of studies, it appears that airway and respiratory complications put a child at increased risk for unplanned ICU admission. A more extensive and diverse analysis of unplanned postoperative admissions to the ICU is needed to address risk factors that have yet to be revealed by the current literature. To establish a rate of unplanned postoperative ICU admissions in pediatric patients using a large, multi-institution data set and to further characterize the associated risk factors. Data from the National Anesthesia Clinical Outcomes Registry were analyzed. We recorded the overall risk of unplanned postoperative ICU admission in patients younger than 18 years and performed univariate and multivariate logistic regression analysis to identify the associated patient, surgical, and anesthetic-related characteristics. Of the 324 818 cases analyzed, 211 reported an unexpected ICU admission. There was an increased likelihood of unplanned postoperative ICU in infants (age anesthesia were also associated with unplanned ICU admissions. This study establishes a rate of unplanned ICU admission following surgery in the heterogeneous pediatric population. This is the first study to utilize such a large data set encompassing a wide range of practice environments to identify risk factors leading to unplanned postoperative ICU admissions. Our study revealed that patient, surgical, and anesthetic complexity each contributed to an increased number of unplanned ICU admissions in the pediatric population.

Non union of an epiphyseal fibular fracture in a pediatric patient.

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Mirmiran, Roya; Schuberth, John M

2006-01-01

There are few reports on delayed or nonunion in the pediatric ankle fracture. The authors present a case of a nonunion of a mid-epiphyseal fracture of the distal fibula, described as a type 7 pediatric fracture. Both the occurrence of this injury pattern and a nonunion has not been reported in the same patient. Operative reduction of the nonunion resulted in a satisfactory outcome.

Patient-specific dose estimation for pediatric chest CT

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Li Xiang; Samei, Ehsan; Segars, W. Paul; Sturgeon, Gregory M.; Colsher, James G.; Frush, Donald P. [Medical Physics Graduate Program, Duke University, Durham, North Carolina 27705 and Department of Radiology, Duke Advanced Imaging Laboratories, Duke University Medical Center, Durham, North Carolina 27705 (United States); Medical Physics Graduate Program, Duke University, Durham, North Carolina 27705 (United States); Department of Radiology, Duke Advanced Imaging Laboratories, Duke University Medical Center, Durham, North Carolina 27705 (United States); Department of Physics, Duke University, Durham, North Carolina 27710 (United States); and Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708 (United States); Medical Physics Graduate Program, Duke University, Durham, North Carolina 27705 and Department of Radiology, Duke Advanced Imaging Laboratories, Duke University Medical Center, Durham, North Carolina 27705 (United States); Department of Radiology, Duke Advanced Imaging Laboratories, Duke University Medical Center, Durham, North Carolina 27705 (United States); Medical Physics Graduate Program, Duke University, Durham, North Carolina 27705 and Global Applied Science Laboratory, GE Healthcare, Waukesha, Wisconsin 53188 (United States); Medical Physics Graduate Program, Duke University, Durham, North Carolina 27705 and Department of Radiology, Division of Pediatric Radiology, Duke University Medical Center, Durham North Carolina 27710 (United States)

2008-12-15

Current methods for organ and effective dose estimations in pediatric CT are largely patient generic. Physical phantoms and computer models have only been developed for standard/limited patient sizes at discrete ages (e.g., 0, 1, 5, 10, 15 years old) and do not reflect the variability of patient anatomy and body habitus within the same size/age group. In this investigation, full-body computer models of seven pediatric patients in the same size/protocol group (weight: 11.9-18.2 kg) were created based on the patients' actual multi-detector array CT (MDCT) data. Organs and structures in the scan coverage were individually segmented. Other organs and structures were created by morphing existing adult models (developed from visible human data) to match the framework defined by the segmented organs, referencing the organ volume and anthropometry data in ICRP Publication 89. Organ and effective dose of these patients from a chest MDCT scan protocol (64 slice LightSpeed VCT scanner, 120 kVp, 70 or 75 mA, 0.4 s gantry rotation period, pitch of 1.375, 20 mm beam collimation, and small body scan field-of-view) was calculated using a Monte Carlo program previously developed and validated to simulate radiation transport in the same CT system. The seven patients had normalized effective dose of 3.7-5.3 mSv/100 mAs (coefficient of variation: 10.8%). Normalized lung dose and heart dose were 10.4-12.6 mGy/100 mAs and 11.2-13.3 mGy/100 mAs, respectively. Organ dose variations across the patients were generally small for large organs in the scan coverage (<7%), but large for small organs in the scan coverage (9%-18%) and for partially or indirectly exposed organs (11%-77%). Normalized effective dose correlated weakly with body weight (correlation coefficient: r=-0.80). Normalized lung dose and heart dose correlated strongly with mid-chest equivalent diameter (lung: r=-0.99, heart: r=-0.93); these strong correlation relationships can be used to estimate patient-specific organ

Implementation of a patient blood management program in pediatric scoliosis surgery.

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Pérez-Ferrer, A; Gredilla-Díaz, E; de Vicente-Sánchez, J; Sánchez Pérez-Grueso, F; Gilsanz-Rodríguez, F

2016-02-01

To determine whether the implementation of a blood conservation program, and the adoption and progressive association of different methods, reduces transfusion requirements in pediatric patients undergoing scoliosis surgery of different origins. Quasi-experimental, nonrandomized, descriptive study, approved by the Ethics Committee for Research of our institution. 50 pediatric patients (ASA I-III) aged 5 to 18 years, undergoing scoliosis surgery of any etiology by a single posterior or double approach (anterior and posterior) were included. A historical group with no alternatives to transfusion: Group No ahorro=15 patients (retrospective data collection) was compared with another 3 prospective study groups: Group HNA (acute normovolemic hemodilution)=9 patients; Group HNA+Rec (intraoperative blood salvage)=14 patients, and Group EPO (HNA+Rec+erythropoietin±preoperative donation)=12 patients; according with the implementation schedule of the transfusion alternatives in our institution. The rate of transfusion in different groups (No ahorro, HNA, HNA+Rec, EPO) was 100, 66, 57, and 0% of the patients, respectively, with a mean±SD of 3.40±1.59; 1.33±1.41; 1.43±1.50; 0±0 RBC units transfused per patient, respectively. Statistically significant differences (P<.001) were found in both the transfusion rate and number of RBC units. The application of a multimodal blood transfusion alternatives program, individualized for each pediatric patient undergoing scoliosis surgery can avoid transfusion in all cases. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Pediatric Patients' Malnutrition and Its Relation to Hospitalization Times and Causes.

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Guimarey, Luis M.; And Others

1984-01-01

Relates the nutritional status of 1,378 hospitalized pediatric patients to length of hospitalization and definitive hospitalization diagnosis. Findings indicated the length of hospitalization time increased markedly with malnutrition, especially for patients with diarrhea. (BJD)

Pediatric patients with common variable immunodeficiency: long-term follow-up.

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Mohammadinejad, P; Aghamohammadi, A; Abolhassani, H; Sadaghiani, M S; Abdollahzade, S; Sadeghi, B; Soheili, H; Tavassoli, M; Fathi, S M; Tavakol, M; Behniafard, N; Darabi, B; Pourhamdi, S; Rezaei, N

2012-01-01

Common variable immunodeficiency (CVID) is the most common form of symptomatic primary immunodeficiency disease. It is characterized by hypogammaglobulinemia, increased predisposition to infections, autoimmunity, and cancer. This study was performed to evaluate the clinical and immunological features of a group of pediatric patients with CVID. The study population comprised 69 individuals with CVID diagnosed during childhood. The patients were followed up for a mean (SD) period of 5.2 (4.3) years. The mean diagnostic delay was 4.4 (3.6) years, which was significantly lower in patients who were diagnosed recently. Children were classified according to 5 clinical phenotypes: infections only (n=39), polyclonal lymphocytic infiltration (n=17), autoimmunity (n=12), malignancy (n=7), and enteropathy (n=3). Postdiagnosis survival (10-year) was 71%. The high percentages of pediatric patients with CVID in Iran may be due to the considerable prevalence of parental consanguinity in the region and an underlying genetic background.

Temporary balloon occlusion as therapy for uncontrollable arterial hemorrhage in multiply injured patients

International Nuclear Information System (INIS)

Rieger, J.; Linsenmaier, U.; Rock, C.; Pfeifer, K.J.; Euler, E.

1999-01-01

Purpose: Presentation of temporary balloon occlusion as an interventional radiological method for managing hemorrhage in multiply injured patients with uncontrollable loss of blood. Method: Temporary, non-selective arterial occlusion by introduction of a balloon catheter contralaterally to the source of bleeding has been performed since 1992 on 7 patients with multiple injuries, hemorrhagic shock requiring reanimation, and angiographic demonstration of an arterial hemorrhage in the supply region of the internal iliac artery with complex pelvic fracture. In each case a PTA balloon catheter was introduced transfemorally, non-selectively positioned proximal to the bleeding source, and left in place for 24-48 h under manometric control. Control angiographies were performed prior to catheter removal. Results: The bleeding was stopped immediately in all 7 patients. The hemodynamic stability made transport and thus further surgical management and/or a short-term treatment in the intensive-care station possible. Control angiographies confirmed that the bleeding had stopped in all patients. Conclusions: We recommend temporary balloon occlusion as a rapid and effective method for the management of bleeding in otherwise uncontrollable traumatic hemorrhages in the supply region of the internal iliac artery. (orig.) [de

Assessment of the Correlation between Appointment Scheduling and Patient Satisfaction in a Pediatric Dental Setup

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Amar N. Katre

2014-01-01

Full Text Available Introduction. The practice of modern pediatric dentistry requires delivery of quality care in combination with adherence to excellent business as well as time management principles. A definite appointment schedule should be presented to the parents on the first or second appointment. More importantly, the prescribed schedule should be followed to the best of the professional abilities of the pediatric dentist. Aims. The aim of the study was to assess the co-relation between appointment scheduling and patient satisfaction in a pediatric dental setup with the objective of understanding the parameters related to appointment scheduling to increase patient satisfaction. Method. A total of 40 patients, who visited the Department of Pediatric and Preventive Dentistry, YMT Dental College & Hospital, for dental treatment were selected on a random basis. A questionnaire with a set of 6 questions with a rating scale of 1–5 to assess the patient satisfaction related to appointment scheduling was prepared. Results. A significant number of the patients were happy with the existing appointment scheduling system barring a few exceptions.

Response to pazopanib in two pediatric patients with pretreated relapsing synovial sarcoma.

Science.gov (United States)

Casanova, Michela; Basso, Eleonora; Magni, Chiara; Bergamaschi, Luca; Chiaravalli, Stefano; Carta, Roberto; Tirtei, Elisa; Massimino, Maura; Fagioli, Franca; Ferrari, Andrea

2017-01-21

Pazopanib is an oral multikinase inhibitor that has proved effective in adults treated for relapsing soft tissue sarcoma and synovial sarcoma in particular. Two cases are reported here of pediatric patients with pretreated relapsing synovial sarcoma whose tumors showed a prolonged response to pazopanib given on compassionate grounds. These results suggest that new agents found effective in adult patients might achieve similar results in adolescents with the same disease. Facilitating the availability of new drugs for children and adolescents is a major challenge for pediatric oncologists.

Nurses' Perceptions of Pediatric Intensive Care Unit Environment and Work Experience After Transition to Single-Patient Rooms.

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Kudchadkar, Sapna R; Beers, M Claire; Ascenzi, Judith A; Jastaniah, Ebaa; Punjabi, Naresh M

2016-09-01

The architectural design of the pediatric intensive care unit may play a major role in optimizing the environment to promote patients' sleep while improving stress levels and the work experience of critical care nurses. To examine changes in nurses' perceptions of the environment of a pediatric critical care unit for promotion of patients' sleep and the nurses' work experience after a transition from multipatient rooms to single-patient rooms. A cross-sectional survey of nurses was conducted before and after the move to a new hospital building in which all rooms in the pediatric critical care unit were single-patient rooms. Nurses reported that compared with multipatient rooms, single-patient private rooms were more conducive to patients sleeping well at night and promoted a more normal sleep-wake cycle (P noise in single-patient rooms (33%) than in multipatient rooms (79%; P pediatric intensive care unit environment for promoting patients' sleep and the nurses' own work experience. ©2016 American Association of Critical-Care Nurses.

The prevalence and impact of prescription controlled substance use among injured patients at a Level I trauma center.

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Cannon, Robert; Bozeman, Matthew; Miller, Keith Roy; Smith, Jason Wayne; Harbrecht, Brian; Franklin, Glen; Benns, Matthew

2014-01-01

There has been increasing attention focused on the epidemic of prescription drug use in the United States, but little is known about its effects in trauma. The purpose of this study was to define the prevalence of prescription controlled substance use among trauma patients and determine its effects on outcome. A retrospective review of all patients admitted to a Level 1 trauma center from January 1, 2011, to December 31, 2011, was performed. Patients dying within 24 hours or without home medication reconciliations were excluded. Data review included preexisting benzodiazepine or narcotic use, sex, age, mechanism of injury, Injury Severity Scores (ISSs), intensive care unit (ICU) and overall length of stay, ventilator days, and overall cost. SAS version 9.3 was used for the analysis, and p ≤ 0.05 was considered significant. A total of 1,700 patients met inclusion criteria. Of these, 340 (20.0%) were on prescription narcotics and/or benzodiazepines at the time of admission. Patients in the narcotic/benzodiazepine group were significantly older (48 years vs. 43 years) and more likely to be women (43.7% vs. 28.9%). There was no difference in mechanism, ISS, or the presence of head injury between groups. Both ICU length of stay (3.3 days vs. 2.1 days) and total length of stay (7.8 days vs. 6.1 days) were significantly longer in patients on outpatient narcotics and/or benzodiazepines. Excluding severely injured patients, the need for mechanical ventilation was also increased among outpatient controlled substance users (15.8% vs. 11.0%). There is a substantial prevalence of preexisting controlled substance use (20%) among patients at our Level 1 trauma center. Preexisting controlled substance use is associated with longer total hospital and ICU stays. Among mildly to moderately injured patients, preinjury controlled substance is also associated with the need for mechanical ventilation. Prognostic study, level III.

Epidemiology of acute otitis in pediatric patients

Directory of Open Access Journals (Sweden)

Maddalena Perotti

2011-03-01

Full Text Available Introduction. Acute otitis is one of the most common pediatric infectious diseases that requires an accurate diagnosis in order to direct appropriate therapy to reduce the risk of complications. In this study pathogens collected from pediatric patients and their antibiotic susceptibility patterns were evaluated. Methods. Between May 2009 and May 2010, 739 samples (swabs taken from nasopharynx in case of acute otitis media and/or from ears in case of acute external otitis, collected from 680 patients, suffering of otalgia, admitted to the emergency department of our Hospital were studied.The specimens were submitted for routine bacterial cultures and the susceptibility tests were performed according to Clinical Laboratory Standards. Nitrocefin was used to detect ß-lactamase activity. Results. 316 samples (42.8% of 739 were negative, 102 (13.8% were positive for Streptococcus pneumoniae, 97 (13.1% for Moraxella catarrhalis, 68 (9.2% for Haemophilus influenzae, 62 (8.4% for Pseudomonas aeruginosa, 49 (6.6% for Staphylococcus aureus, 36 (4.9% for Streptococcus pyogenes, 5 (0.7% for Gram negative and 4 (0.5% for Candida spp. Antibiotic susceptibility tests showed that amikacin, ceftazidime, ciprofloxacin, imipenem, meropenem and piperacillin/tazobactam were active against all Gram negative strains isolated.We found one strain of MRSA. Of 102 Streptococcus pneumoniae, 5 (4.9% were penicillin resistant and 25 (24.5% were erythromycin resistant, showing the prevalence of constitutive phenotype (80%. All M. catarrhalis strains were ß-lactamase producers while all H. influenzae were ß-lactamase negatives. Conclusions. The prevalent etiological agents in pediatric acute otitis are S. pneumoniae, M. catharralis, and H. influenzae, as reported in literature. In external acute otitis P. aeruginosa prevails in particular in summer.

Surgical outcomes after total pancreatectomy and islet cell autotransplantation in pediatric patients.

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Wilson, Gregory C; Sutton, Jeffrey M; Salehi, Marzieh; Schmulewitz, Nathan; Smith, Milton T; Kucera, Stephen; Choe, Kyuran A; Brunner, John E; Abbott, Daniel E; Sussman, Jeffrey J; Ahmad, Syed A

2013-10-01

This study aims to review surgical outcomes of pediatric patients undergoing total pancreatectomy with islet cell autotransplantation (TP/IAT) for the treatment of chronic pancreatitis (CP). All pediatric patients (≤18 years old) undergoing TP/IAT over a 10-year period (December 2002-June 2012) were identified for inclusion in a single-center, observational cohort study. Retrospective chart review was performed to identify pertinent preoperative, perioperative, and postoperative data, including narcotic usage, insulin requirements, etiology of pancreatitis, previous operative interventions, operative times, islet cell yields, duration of hospital stay, and overall quality of life. Quality of life was assessed using the Short Form-36 health questionnaire. Fourteen pediatric patients underwent TP/IAT for the treatment of CP at the University of Cincinnati with a mean age of 15.9 years (range, 14-18) and a mean body mass index of 21.8 kg/m(2) (range, 14-37). Of the patients, 50% (n = 7) were male and 29% had undergone previous pancreatic operations (1 each of Whipple, Puestow, Frey, and Berne procedures). Etiology of pancreatitis was idiopathic for 57% (n = 8); the remainder had identified genetic mutations predisposing to pancreatitis (CFTR, n = 4; SPINK1, n = 1; PRSS1, n = 1). Mean operative time was 532 minutes (range, 360-674) with an average hospital duration of stay of 16 days (range, 7-37). Islet cell isolation resulted in mean islet cell equivalents (IEQ) of 500,443 in patients without previous pancreatic surgery versus 413,671 IEQ in patients with prior pancreatic surgery (P = .12). Median patient follow-up was 9 months from surgery (range, 1-78). Preoperatively, patients required on average 32.7 morphine equivalent mg per day (MEQ), which improved to 13.9 MEQ at most recent follow-up. Eleven patients (79%) were narcotic independent. None of the patients were diabetic preoperatively. All of the patients were discharged after the operation with scheduled

Assessing Selenium, Manganese, and Iodine Status in Pediatric Patients Receiving Parenteral Nutrition.

Science.gov (United States)

Johnsen, Jacob Clarke; Reese, Susan Anne; Mackay, Mark; Anderson, Collin R; Jackson, Daniel; Paul, Irasema Libertad

2017-08-01

Pediatric patients who are receiving parenteral nutrition (PN) unsupplemented with trace minerals can become deficient. Due to shortages in trace mineral products and the 2004 American Society for Parenteral and Enteral Nutrition report stating that individualized trace element supplementation may be warranted, a review was conducted concerning the trace minerals selenium (Se), manganese (Mn), and iodine (I). A retrospective review of pediatric patients receiving PN that contained Se and Mn was conducted to determine if a difference existed between them and patients receiving PN without Se and Mn. Statistical analysis was done to assess a difference between trace mineral levels and the time to deficiency between supplemented and unsupplemented patients. Unsupplemented I patients had urine I levels assessed to determine deficiencies in patients receiving PN. Plasma Se levels were measured at a mean of 20 days for supplemented patients (n = 131) and 19 days for nonsupplemented patients (n = 57) with no difference between groups ( P = .2973). Plasma Mn levels were measured at a mean of 28 days, showing no statistical difference ( P = .721). Of the 177 nonsupplemented I patients, 74% demonstrated I deficiencies without supplementation. Time to the development of a Se, Mn, or I deficiency is important to guide supplementation of exclusive PN in children when trace mineral products are short in supply. Our retrospective experience supports assessment of the trace minerals Se at 21 days and Mn at 30 days. It also suggests that some pediatric patients receiving PN are deficient in I.

Anesthesia Experiences During Magnetic Imaging Process on Pediatric Patients

OpenAIRE

Öztürk, Ömür; Üstebay, Sefer; Bilge, Ali

2017-01-01

We aim to study the quality of sedation and complications ratios during anesthesia applied with sodium thiopental and propofol and the reason of the magnetic imaging requests on pediatric patients retrospectively according to the hospital data. Material and Method: In this study, 109 patients, aged from 3 months to 5 years, that have been applied magnetic imaging process under anesthesia, have been examined retrospectively. Results: Pentotal sodium has been applied to 53 patients and propofol...

Dental management of a pediatric patient with Burkitt lymphoma: a case report.

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Padmanabhan, M Y; Pandey, R K; Kumar, Archana; Radhakrishnan, Aparna

2012-06-01

Recent advancements in the field of cancer diagnosis and chemotherapy have led to higher rates of survival for children with malignant tumors. More than 75% of pediatric patients diagnosed with malignancies survive more than 5 years. These advancements have resulted in additional responsibilities for dental professionals to diagnose, evaluate, prevent, stabilize, and manage the oral and dental problems that can compromise the quality of life of these children. This case report highlights the importance of professional and self-administered oral prophylactic measures and patient compliance in the successful oral rehabilitation of a pediatric patient with Burkitt lymphoma. © 2012 Special Care Dentistry Association and Wiley Periodicals, Inc.

Epidemiology of pediatric spinal cord injury in the United States: years 1997 and 2000.

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Vitale, Michael G; Goss, Jordan M; Matsumoto, Hiroko; Roye, David P

2006-01-01

The purpose of this study is to report the current incidence rates of pediatric spinal cord injury (SCI) in the United States and identify specific high-risk populations as a knowledge basis for improving the prevention and treatment of this traumatic injury. The Kids' Inpatient Database (KID) and the National Trauma Data Bank (NTDB) were used to investigate the etiology of pediatric SCI. Significant differences in the annual incidence rate of pediatric SCI were found to exist between patient populations stratified by race and sex. African Americans (1.53 cases/100,000 children) exhibit a significantly higher rate of pediatric SCI than native Americans (1.00), Hispanics (0.87), and Asians (0.36), whereas Asians show a significantly lower incidence than all other races. Also, boys (2.79) are more than twice as likely to experience SCI as girls (1.15). The overall incidence of pediatric SCI in the United States is 1.99 cases per 100,000 children. From these data, it is estimated that 1455 children are admitted to US hospitals each year for treatment of SCI. The etiology of pediatric SCI was also investigated, and the major causative factors were identified: motor vehicle accident (56%), accidental fall (14%), firearm injury (9%), and sports injury (7%). Of those children injured in a motor vehicle accident, 67.7% (n = 107) were reported as not wearing a seatbelt. The role of alcohol and drugs was also investigated and found to be involved in 30% (n = 82) of all pediatric SCI cases. Using discharge records from a public database, it is possible to identify high-risk demographic groups and activities that predispose a child to SCI. With a more thorough understanding of the etiology of pediatric SCI, clinicians and parents are better equipped to devise measures for prevention and treatment of this injury.

The Use of Home Spirometry in Pediatric Cystic Fibrosis Patients

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Aarti Shakkottai MD

2017-02-01

Full Text Available Medication adherence is poor among pediatric cystic fibrosis (CF patients, with adolescents having one of the lowest adherence rates. We wanted to identify an adherence intervention that would be acceptable to CF adolescents and assess its feasibility. We surveyed 40 adolescents with CF and asked about barriers to and motivators for their own adherence and to generate ideas for potential adherence interventions. Since most of the respondents chose frequent spirometry at home and medication reminders for interventions, we selected 5 subjects, 10 to 14 years of age, with CF to test the feasibility of home spirometry and medication reminders in pediatric CF patients. This article summarizes the results of both the survey and the feasibility pilot study.

Recovery of an injured cingulum concurrent with improvement of short-term memory in a patient with mild traumatic brain injury.

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Jang, Sung Ho; Kim, Seong Ho; Seo, Jeong Pyo

2018-01-01

We reported on a patient with mild traumatic brain injury (TBI) who showed recovery of an injured cingulum concurrent with improvement of short-term memory, which was demonstrated on follow-up diffusion tensor tractography (DTT). A 55-year-old male patient suffered head trauma resulting from falling from approximately 2 m while working at a construction site. The patient showed mild memory impairment (especially short-term memory impairment) at 3 months after onset: Memory Assessment Scale (global memory: 95 (37%ile), short-term memory: 75 (5%ile), verbal memory: 80 (9%ile) and visual memory: 112 (79%ile)). By contrast, at 2 years after onset, his mild memory impairment had improved to a normal state: Memory Assessment Scale (global memory: 104 (61%ile), short-term memory: 95 (37%ile), verbal memory: 101 (53%ile) and visual memory: 106 (66%ile)). On 3-month DTT, discontinuation of the right anterior cingulum was observed over the genu of the corpus callosum, while on 2-year DTT, the discontinued right anterior cingulum was elongated to the right basal forebrain. In conclusion, recovery of an injured cingulum concurrent with improvement of short-term memory was demonstrated in a patient with mild TBI.

Defining predictors of mortality in pediatric trauma patients ...

African Journals Online (AJOL)

Background: The aim of this study was to describe our cohort of pediatric trauma patients and to analyze their physiological data. The intention was to highlight the difficulty in using systolic blood pressure (SBP) readings in this population and to investigate the role of base excess (BE) in predicting clinical outcomes in ...

A pair-matched comparison of return to pivoting sports at 1 year in ACL-injured patients after a nonoperative versus operative treatment course

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Grindem, Hege; Eitzen, Ingrid; Moksnes, Håvard; Snyder-Mackler, Lynn; Risberg, May Arna

2013-01-01

Background The wish to return to level I pivoting sports is a major indication of ACL-reconstruction. Patients usually return to pivoting sports between 6 months and 1 year postoperatively, but no matched study has so far examined 1-year return to sport rates in nonoperatively and operatively treated ACL-injured patients. Hypothesis ACL-injured patients following a nonoperative treatment course, including recommendation of activity modification, will have lower return to pivoting sport rates than operatively treated patients 1 year after baseline testing/surgery, when matched by preinjury sports activity, age and sex. Study Design Pair-matched cohort study Methods Sixty-nine nonoperatively treated ACL-injured patients were pair-matched with 69 operatively treated patients (n=138), based on specific preinjury sport, age and sex. Nonoperatively treated patients were recommended not to return to level I sports. Patients were defined as nonoperatively or operatively treated according to their status at follow-up. The baseline and follow-up testing included registration of sports participation, KT-1000 measurements, 4 hop tests, and patient-reported outcome measures. McNemar’s test and paired t-tests or Wilcoxon’s test were used to compare outcomes of nonoperatively and operatively treated patients. Results No significant baseline differences were found. At 12.9±1.2 months (mean ± standard deviation) after baseline testing (nonoperative) and 12.7±1.2 months after surgery (operative), there was no significant difference in overall return to sport rates (nonoperative: 68.1 %, operative: 68.1 %, p=1.000), or in return to level I sport rates (nonoperative: 54.8 %, operative: 61.9 %, p=0.664). Nonoperatively treated patients who participated in level I sports prior to injury had a significantly lower return to sport rate (54.8 %) than nonoperatively treated patients who participated in level II sports (88.9 %, p=0.003). The nonoperatively treated patients had

Incidence and risk factors for hypogammaglobulinemia in pediatric patients following allo-SCT.

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Frangoul, H; Min, E; Wang, W; Chandrasekhar, R; Calder, C; Evans, M; Manes, B; Bruce, K; Brown, V; Ho, R; Domm, J

2013-11-01

We evaluated the incidence and risk factors for hypogammaglobulinemia after allogeneic hematopoietic SCT (HSCT) in pediatric patients. Ig levels were measured pre-transplant, every 2 weeks until day 100 and then monthly post SCT in 185 patients undergoing myeloablative HSCT. Median age was 9 years; 142 (77%) had malignant disease and 114 (62%) received stem cells from an unrelated source. Hypogammaglobulinemia (IgG SCT. The cumulative incidence of hypogammaglobulinemia at 1 year was higher among patients who developed acute GVHD (97% vs 54%, PSCT (P<0.001) and development of acute GVHD (P<0.001) were all significantly associated with higher risk of hypogammaglobulinemia post HSCT. We conclude that hypogammaglobulinemia is common, following allogeneic HSCT in pediatric patients, especially in those with malignant diseases, those who receive an unrelated transplant or patients who develop GVHD.

Prehospital Care for the Adult and Pediatric Seizure Patient: Current Evidence Based Recommendations

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Eric C. Silverman

2017-04-01

Full Text Available Introduction: We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of adult and pediatric patients with a seizure and to compare these recommendations against the current protocol used by the 33 emergency medical services (EMS agencies in California. Methods: We performed a review of the evidence in the prehospital treatment of patients with a seizure, and then compared the seizure protocols of each of the 33 EMS agencies for consistency with these recommendations. We analyzed the type and route of medication administered, number of additional rescue doses permitted, and requirements for glucose testing prior to medication. The treatment for eclampsia and seizures in pediatric patients were analyzed separately. Results: Protocols across EMS Agencies in California varied widely. We identified multiple drugs, dosages, routes of administration, re-dosing instructions, and requirement for blood glucose testing prior to medication delivery. Blood glucose testing prior to benzodiazepine administration is required by 61% (20/33 of agencies for adult patients and 76% (25/33 for pediatric patients. All agencies have protocols for giving intramuscular benzodiazepines and 76% (25/33 have protocols for intranasal benzodiazepines. Intramuscular midazolam dosages ranged from 2 to 10 mg per single adult dose, 2 to 8 mg per single pediatric dose, and 0.1 to 0.2 mg/kg as a weight-based dose. Intranasal midazolam dosages ranged from 2 to 10 mg per single adult or pediatric dose, and 0.1 to 0.2 mg/kg as a weight-based dose. Intravenous/intrasosseous midazolam dosages ranged from 1 to 6 mg per single adult dose, 1 to 5 mg per single pediatric dose, and 0.05 to 0.1 mg/kg as a weight-based dose. Eclampsia is specifically addressed by 85% (28/33 of agencies. Forty-two percent (14/33 have a protocol for administering magnesium sulfate, with intravenous dosages ranging from 2 to 6 mg, and 58% (19/33 allow benzodiazepines to be

Evaluation of the occurrence and diagnose definitions for Nocturnal Polyuria in Spinal Cord Injured patients during rehabilitation.

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Viaene, Annick; Denys, Marie-Astrid; Goessaert, An-Sofie; Claeys, Jana; Raes, Ann; Roggeman, Saskia; Everaert, Karel

2017-11-03

Little is known about the occurrence of nocturnal polyuria in spinal cord injured (SCI) patients and the definitions which are preferable in this population. To determine the occurrence of nocturnal polyuria (NP) in spinal cord injured patients during in-patient rehabilitation in the Ghent University Hospital. To study the influence of different time periods (daytime, bed rest and sleep) on the accuracy of the existing diagnose definitions for NP specifically for this type of patients. Retrospective study using patient records. SCI patients during hospital based rehabilitation between 2011 and 2014. Seventy-four SCI patients were selected and their records of frequency-volume charts were examined, after exclusion of unreliable data, forty-seven patients were retained for the current study. Retrospective study using data from frequency-volume charts of either two or three days from patients with SCI. Nocturnal urine production (NUP) and nocturnal polyuria index (NPi) were calculated. There was a significant increase in diuresis, calculated as urine production, between day time and bed rest (p=0.008) and between day time and sleep (p=0.001). All patients showed nocturnal polyuria during a 12-hour night time period (including both bed rest and sleep) and 39 patients showed nocturnal polyuria during the 8 hour period of sleep. There was no significant difference in mean urine production between bed rest and sleep. Prevalence of NP did not significantly differ between the complete or incomplete SCI patients or between patients with higher and lower SCI levels. This study showed that the occurrence of nocturnal polyuria in patients with SCI is high and that it is important to consider which definitions of NP are used for diagnosis. Increase in diuresis is observed during bed rest and sleep and the diagnose is correctly estimated when nocturnal urine production definitions are used in both time periods. In accordance with what was expected, diagnose of NP was

The Evaluation of Nosocomial Infections in Pediatric Patients with Extracorporeal Membrane Oxygenation Support

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Pelin Ayyıldız

Full Text Available Abstract Introduction: Extracorporeal membrane oxygenation (ECMO has become a standard technique over the past few decades in intensive care unit (ICU. Objective: A review of pediatric patients who received ECMO support in the pediatric cardiac ICU was conducted to determine the incidence, risk factors and causal organisms related to acquired infections and assess the survival rates of ECMO patients with nosocomial infections. Methods: Sixty-six patients who received ECMO support in the pediatric cardiac ICU between January 2011 and June 2014 were included in the study. Demographic, echocardiographic, hemodynamic features and surgical procedures were reviewed. Results: Sixty-six patients received a total of 292.5 days of venoarterial ECMO support. Sixty were postoperative patients. Forty-five patients were weaned from ECMO support with an ECMO survival rate of 68.2%. The rate of infection was 116.2/1000 ECMO days. Prolonged ICU stay, duration of ventilation and ECMO were found associated with development of nosocomial infection and only the duration of ECMO was an independent risk factor for nosocomial infections in ECMO patients. Conclusion: The correction of the underlying process leading to ECMO support and shortening the length of ECMO duration together with stricter application of ECMO indications would improve the infection incidence and hospital surveillance of the patient group.

Sugammadex for reversal of rocuronium-induced neuromuscular blockade in pediatric patients

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Won, Young Ju; Lim, Byung Gun; Lee, Dong Kyu; Kim, Heezoo; Kong, Myoung Hoon; Lee, Il Ok

2016-01-01

Abstract Background: Previous studies have shown that sugammadex, a modified γ-cyclodextrin, is a well-tolerated agent for the reversal of neuromuscular blockade (NMB) induced by a steroidal neuromuscular blocking drug in adult patients. However, its use has not been reviewed in pediatric patients. The aim of this meta-analysis was to evaluate the efficacy and safety of sugammadex in the reversal of rocuronium-induced NMB during surgery under general anesthesia in pediatric patients. Methods: A literature search was performed using the Pubmed, EMBASE: Drugs and pharmacology, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. Analysis was conducted using RevMan 5.3. Data collected from different trials were pooled; the weighted mean difference or the pooled risk ratio and the corresponding 95% confidence interval (CI) were used for analysis, and heterogeneity (I2) assessment was performed. Results: Six randomized controlled trials comparing 253 pediatric patients (age range, 2–18 years) were included in the final analysis. The mean time taken to reach a train-of-four ratio of ≥0.9 was significantly shorter in the sugammadex groups (2 and 4 mg/kg) than in the control group (neostigmine or placebo), although the heterogeneity was high. The weighted mean differences of the 2 and 4 mg/kg sugammadex groups were −7.15 (95% CI: −10.77 to −3.54; I2 = 96%; P = 0.0001) and −17.32 (95% CI: −29.31 to −5.32; I2 = 98%; P = 0.005), respectively. The extubation time in the sugammadex group was shorter than that in the control group; the weighted mean difference of the sugammadex group was −6.00 (95% CI: −11.46 to −0.53; I2 = 99%; P = 0.03). There was no significant difference between the groups in terms of the incidence of postanesthetic adverse events; the pooled risk ratio was 0.67 (95% CI: 0.27–1.71; I2 = 59%; P = 0.41). Conclusion: We suggest that sugammadex is fast and

Effects of a radiation dose reduction strategy for computed tomography in severely injured trauma patients in the emergency department: an observational study

Directory of Open Access Journals (Sweden)

Kim Soo Hyun

2011-11-01

Full Text Available Abstract Background Severely injured trauma patients are exposed to clinically significant radiation doses from computed tomography (CT imaging in the emergency department. Moreover, this radiation exposure is associated with an increased risk of cancer. The purpose of this study was to determine some effects of a radiation dose reduction strategy for CT in severely injured trauma patients in the emergency department. Methods We implemented the radiation dose reduction strategy in May 2009. A prospective observational study design was used to collect data from patients who met the inclusion criteria during this one year study (intervention group from May 2009 to April 2010. The prospective data were compared with data collected retrospectively for one year prior to the implementation of the radiation dose reduction strategy (control group. By comparison of the cumulative effective dose and the number of CT examinations in the two groups, we evaluated effects of a radiation dose reduction strategy. All the patients met the institutional adult trauma team activation criteria. The radiation doses calculated by the CT scanner were converted to effective doses by multiplication by a conversion coefficient. Results A total of 118 patients were included in this study. Among them, 33 were admitted before May 2009 (control group, and 85 were admitted after May 2009 (intervention group. There were no significant differences between the two groups regarding baseline characteristics, such as injury severity and mortality. Additionally, there was no difference between the two groups in the mean number of total CT examinations per patient (4.8 vs. 4.5, respectively; p = 0.227. However, the mean effective dose of the total CT examinations per patient significantly decreased from 78.71 mSv to 29.50 mSv (p Conclusions The radiation dose reduction strategy for CT in severely injured trauma patients effectively decreased the cumulative effective dose of the total

Total artificial heart in the pediatric patient with biventricular heart failure.

Science.gov (United States)

Park, S S; Sanders, D B; Smith, B P; Ryan, J; Plasencia, J; Osborn, M B; Wellnitz, C M; Southard, R N; Pierce, C N; Arabia, F A; Lane, J; Frakes, D; Velez, D A; Pophal, S G; Nigro, J J

2014-01-01

Mechanical circulatory support emerged for the pediatric population in the late 1980s as a bridge to cardiac transplantation. The Total Artificial Heart (TAH-t) (SynCardia Systems Inc., Tuscon, AZ) has been approved for compassionate use by the Food and Drug Administration for patients with end-stage biventricular heart failure as a bridge to heart transplantation since 1985 and has had FDA approval since 2004. However, of the 1,061 patients placed on the TAH-t, only 21 (2%) were under the age 18. SynCardia Systems, Inc. recommends a minimum patient body surface area (BSA) of 1.7 m(2), thus, limiting pediatric application of this device. This unique case report shares this pediatric institution's first experience with the TAH-t. A 14-year-old male was admitted with dilated cardiomyopathy and severe biventricular heart failure. The patient rapidly decompensated, requiring extracorporeal life support. An echocardiogram revealed severe biventricular dysfunction and diffuse clot formation in the left ventricle and outflow tract. The decision was made to transition to biventricular assist device. The biventricular failure and clot formation helped guide the team to the TAH-t, in spite of a BSA (1.5 m(2)) below the recommendation of 1.7 m(2). A computed tomography (CT) scan of the thorax, in conjunction with a novel three-dimensional (3D) modeling system and team, assisted in determining appropriate fit. Chest CT and 3D modeling following implantation were utilized to determine all major vascular structures were unobstructed and the bronchi were open. The virtual 3D model confirmed appropriate device fit with no evidence of compression to the left pulmonary veins. The postoperative course was complicated by a left lung opacification. The left lung anomalies proved to be atelectasis and improved with aggressive recruitment maneuvers. The patient was supported for 11 days prior to transplantation. Chest CT and 3D modeling were crucial in assessing whether the device would

Management of the pediatric nuclear medicine patient (or children are not small adults)

International Nuclear Information System (INIS)

Kieffer, C.T.; Suto, P.A.

1983-01-01

The first of a four-part continuing education series on pediatric nuclear medicine is presented. Included are: (1) clinical indications for performing nuclear medicine studies in children; (2) comparison of nuclear medicine procedures for adult and pedicatric patients; (3) appropriate radiopharmaceuticals for performing pediatric studies; (4) radiation protection techniques (5) the principles of pediatric radiopharmaceutical dose calculation and common calculation methods; (6) possible injection sites and administration methods (7) radiopharmaceutical clearance times and imaging times in adults and children; (8) the collimators of choice for most procedures performed in children; (9) certain behaviors exhibited by children according to their stage of emotional development and children's response to the hospital setting; and (10) patient immobilization techniques and advantages of physical restraint over sedation

Communication Preferences of Pediatric Cancer Patients: Talking about Prognosis and Their Future Life

Science.gov (United States)

Brand, Sarah R; Fasciano, Karen; Mack, Jennifer W

2017-01-01

Purpose The American Academy of Pediatrics recommends that healthcare providers communicate information to patients in a truthful and developmentally appropriate manner. However there is limited guidance about how to translate these recommendations into clinical practice. The aim of this study was to explore how young cancer patients experienced communication around their illness, especially communication about possible outcomes from disease or treatment. Methods Participants included young people ages 8 to under 18 years with cancer (N=16). Semi-structured interviews focused on their expectations about the future, the process of information exchange, and their preferences for communication within the pediatric oncology setting. Results Overall, participants wanted medical information to be provided to them by their healthcare providers and wanted to be direct participants in medical conversations. However, many participants displayed some ambivalence or conveyed conflicting wishes for prognostic information. For example, some participants reported that they were satisfied with what they knew, but later raised lingering questions. While not the focus of the study, almost every participant discussed social concerns as a key concern for their present and future life. Conclusions While most pediatric cancer patients want to be involved in conversations about their cancer care, including conversations about prognosis, this is an individual and sometimes fluctuating decision, and healthcare providers should be encouraged to discuss preferences for involvement with patients and families. This study highlights the importance of understanding the developmental factors that make pediatric patients unique, especially with regards to their patterns of communication. PMID:27747479

Iodine Supplementation for Pediatric Patients Receiving Long-Term Parenteral Nutrition.

Science.gov (United States)

Santoro, Jonathan D; Nespor, Colleen; Poole, Robert L; Kerner, John A

2016-04-01

Patients dependent on parenteral nutrition (PN) are among a group at risk of developing iodine deficiency. Supplementation with iodine in this population has been debated in a number of studies, resulting in variable clinical practices. The Committee on Clinical Practice Issues of the American Society for Clinical Nutrition recommends a dose of 1 mcg/kg/d of parenteral iodine for patients receiving PN. At our institution, PN trace elements do not include iodine, although this is not the case internationally. Our study sought to assess iodine levels and thyroid function in a cohort of PN-dependent pediatric patients. A retrospective analysis studied 32 pediatric patients with a variety of medical diagnoses who received PN as a primary means of nutrition for 6 months or longer. Patients received variable proportions of their total caloric intake as PN, which ranged from 14%-100%. Iodine and thyroid function levels were obtained by serum sampling. No patient in our cohort of 32 demonstrated thyroid dysfunction or developed iodine deficiency. The length of time on PN and the percentage of total nutrition intake as PN were not associated with iodine levels (P Parenteral and Enteral Nutrition.

Managing acute complications of sickle cell disease in pediatric patients [digest].

Science.gov (United States)

Subramaniam, Sathyaseelan; Chao, Jennifer H; Chaudhari, Pradip

2016-11-22

Sickle cell disease is a chronic hematologic disease with a variety of acute, and often recurring, complications. Vaso-occlusive crisis, a unique but common presentation in sickle cell disease, can be challenging to manage. Acute chest syndrome is the leading cause of death in patients with sickle cell disease, occurring in more than half of patients who are hospitalized with a vaso-occlusive crisis. Uncommon diagnoses in children, such as stroke, priapism, and transient red cell aplasia, occur more frequently in patients with sickle cell disease and necessitate a degree of familiarity with the disease process and its management. Patients with sickle cell trait generally have a benign course, but are also subject to serious complications. This issue provides a current review of evidence-based management of the most common acute complications of sickle cell disease seen in pediatric patients in the emergency department. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

Identification of Candida dubliniensis in a study of HIV-seropositive pediatric dental patients.

Science.gov (United States)

Brown, D M; Jabra-Rizk, M A; Falkler, W A; Baqui, A A; Meiller, T F

2000-01-01

The combination of an immature immune system and suppressed cellular immunity in children with HIV infections provides optimal conditions for rapid disease progression. As a result, pediatric AIDS has become a major epidemiological challenge. Oral fungal colonization remains one of the most common opportunistic infections observed in both adult and pediatric HIV infected patients. Although Candida albicans is the most frequently isolated opportunistic fungal species, a recently characterized Candida species, C. dubliniensis, has gained considerable attention due to its almost exclusive association with HIV-seropositive individuals. The purpose of this study was to prospectively screen for the presence of C. dubliniensis among pediatric HIV+ patients. Oral samples taken from twenty-seven children were cultured for the presence of yeast. All positive yeast isolates obtained were screened for the presence of C. dubliniensis by use of tests for germ tube and chlamydospore production, detection of inability to grow at 45 degrees C, by colony color on CHROMagar Candida medium, coaggregation with Fusobacterium nucleatum ATCC 49256 and by the results of sugar assimilation testing with the API 20C AUX yeast identification system. Among the 27 patients tested, 3 patients were found to harbor C. dubliniensis, one of which also grew C. glabrata; 12 patients were colonized with C. albicans, while the remaining 12 patients were negative for yeast. Identification of the three C. dubliniensis isolates was genetically confirmed by electrophoretic karyotyping. All three C. dubliniensis isolates were found to be susceptible to fluconazole (MIC pediatric HIV seropositive population and support the need for further investigation into the prevalence and pathogenesis of C. dubliniensis.

Pediatric Electrocardiographic Imaging (ECGI) Applications

Science.gov (United States)

Silva, Jennifer N. A.

2014-01-01

Summary Noninvasive electrocardiographic imaging (ECGI) has been used in pediatric and congenital heart patients to better understand their electrophysiologic substrates. In this article we focus on the 4 subjects related to pediatric ECGI: 1) ECGI in patients with congenital heart disease and Wolff-Parkinson-White syndrome, 2) ECGI in patients with hypertrophic cardiomyopathy and pre-excitation, 3) ECGI in pediatric patients with Wolff-Parkinson-White syndrome, and 4) ECGI for pediatric cardiac resynchronization therapy. PMID:25722754

Evaluation of P-Wave Dispersion, Diastolic Function, and Atrial Electromechanical Conduction in Pediatric Patients with Subclinical Hypothyroidism.

Science.gov (United States)

Irdem, Ahmet; Aydın Sahin, Derya; Kervancioglu, Mehmet; Baspinar, Osman; Sucu, Murat; Keskin, Mehmet; Kilinc, Metin

2016-09-01

This study aimed to evaluate ventricular diastolic dysfunction, inter- and intraatrial conduction delay, and P-wave dispersion in pediatric patients with subclinical hypothyroidism. The study comprised a total of 30 pediatric patients with subclinical hypothyroidism (SH) (mean age 7.8 ± 3.2 years) and 30 healthy children (mean age 8.4 ± 3.6 years) as the control group. A SH diagnosis was made in the event of increased serum thyroid-stimulating hormone (TSH) and decreased serum free triiodothyronine (T3 ) and free thyroxine (T4 ) concentrations. Conventional Doppler imaging (TDI) showed low mitral early diastolic E-wave velocity and E/A ratio (P wave velocity (P = 0.001) in hypothyroidism patients. Moreover, patients with hypothyroidism had significantly lower left ventricular (LV) septal Em velocity and Em /Am ratios compared with the control group (P wave dispersion was significantly different in the pediatric patients with hypothyroidism (P wave dispersion, and ventricle diastolic dysfunction in pediatric patients with hypothyroidism. © 2016, Wiley Periodicals, Inc.

Efficacy and safety of lung recruitment in pediatric patients with acute lung injury.

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Boriosi, Juan P; Sapru, Anil; Hanson, James H; Asselin, Jeanette; Gildengorin, Ginny; Newman, Vivienne; Sabato, Katie; Flori, Heidi R

2011-07-01

To assess the safety and efficacy of a recruitment maneuver, the Open Lung Tool, in pediatric patients with acute lung injury and acute respiratory distress syndrome. Prospective cohort study using a repeated-measures design. Pediatric intensive care unit at an urban tertiary children's hospital. Twenty-one ventilated pediatric patients with acute lung injury. Recruitment maneuver using incremental positive end-expiratory pressure. The ratio of partial pressure of arterial oxygen over fraction of inspired oxygen (Pao2/Fio2 ratio) increased 53% immediately after the recruitment maneuver. The median Pao2/Fio2 ratio increased from 111 (interquartile range, 73-266) prerecruitment maneuver to 170 (interquartile range, 102-341) immediately postrecruitment maneuver (p interquartile range, 116-257) 4 hrs postrecruitment maneuver (p interquartile range, 127-236) 12 hrs postrecruitment maneuver (p interquartile range, 44-60) prerecruitment maneuver compared with 48 torr (interquartile range, 43-50) immediately postrecruitment maneuver (p = .69), 45 torr (interquartile range, 41-50) at 4 hrs postrecruitment maneuver (p interquartile range, 38-51) at 12 hrs postrecruitment maneuver. Recruitment maneuvers were well tolerated except for significant increase in Paco2 in three patients. There were no serious adverse events related to the recruitment maneuver. Using the modified open lung tool recruitment maneuver, pediatric patients with acute lung injury may safely achieve improved oxygenation and ventilation with these benefits potentially lasting up to 12 hrs postrecruitment maneuver.

In-hospital mortality pattern of severely injured children

DEFF Research Database (Denmark)

Do, Hien Quoc; Steinmetz, Jacob; Rasmussen, Lars S

2012-01-01

the mortality pattern of severely injured children admitted to a Danish level I trauma centre. METHODS: We included trauma patients aged 15 years or less, who subsequent a trauma team activation were admitted during the 9-year period 1999-2007. Data were collected prospectively for subjects who had a length...

Age Limit of Pediatrics.

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Hardin, Amy Peykoff; Hackell, Jesse M

2017-09-01

Pediatrics is a multifaceted specialty that encompasses children's physical, psychosocial, developmental, and mental health. Pediatric care may begin periconceptionally and continues through gestation, infancy, childhood, adolescence, and young adulthood. Although adolescence and young adulthood are recognizable phases of life, an upper age limit is not easily demarcated and varies depending on the individual patient. The establishment of arbitrary age limits on pediatric care by health care providers should be discouraged. The decision to continue care with a pediatrician or pediatric medical or surgical subspecialist should be made solely by the patient (and family, when appropriate) and the physician and must take into account the physical and psychosocial needs of the patient and the abilities of the pediatric provider to meet these needs. Copyright © 2017 by the American Academy of Pediatrics.

Pharmacologic behavior management of pediatric dental patients diagnosed with attention deficit disorder/attention deficit hyperactivity disorder.

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Kerins, Carolyn A; McWhorter, Alton G; Seale, N Sue

2007-01-01

The purpose of this study was to conduct a survey of Texas pediatric dentists to determine: (1) the percentage of patients they treat with attention deficit disorder (ADD)/attention deficit hyperactivity disorder (ADHD); (2) the behavior management techniques that are utilized to treat their patients who suffer from ADD/ADHD; and (3) the relative success rates of these techniques in their practices. A 17-question, single-answer, multiple choice survey was mailed to 343 Texas pediatric dentists. The mailing list was obtained from American Academy of Pediatric Dentistry and Texas Academy of Pediatric Dentistry member rosters. One mailing was sent, including a self-addressed stomped envelope, for returned responses. A 54% response rate (186 surveys) revealed that nitrous oxide was the most frequently used pharmacologic behavior management technique; however, demerol/promethazine/nitrous oxide was rated as effective most often for treating ADD/ADHD patients. Practitioners believe the incidence of attention deficit disorder/attention deficit hyperactivity disorder is increasing, and they are familiar with the medications used to treat the conditions. Texas pediatric dentists are using a variety of sedation techniques and are interested in developing guidelines for sedation of these patients.

HYSTOMORPHOLOGIC CHANGES IN INJURED MENISCI IN CHILDREN

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V. B. Bogatov

2010-01-01

Full Text Available The purpose of the work was studying histological changes in the injured menisci in children. The histological evaluation of injured menisci received during arthroscopy was performed. The prescription of injury varied from several days till 3 years. It was shown that injured fragment of the meniscus is viable up to 3 months since trauma. It was also obvious that active migration of the meniscus cells occur in the injured fragment and microvessels are seen in 50% of the meniscus tissues.

Utero-vaginal abnormalities: MR imaging in pediatric patients

International Nuclear Information System (INIS)

Bailez, Marcela; Daneff, Monica; Balestrini, Maria A.; Gomez Zanetta, Santiago; Rabellino, Martin; Bruno, Claudio H.

2003-01-01

Purpose: To correlate the pre-surgical findings in MRI with the surgical results in Muellerian malformations. Material and methods: 14 pediatric patients were studied by MRI. MRI findings were divided in 4 groups according to the classification of the American Fertility Society (modified by Rock). Patient's age ranged between 12-17 years. Results: In our series 4 patients were included in Group I, 4 cases in Group II, 4 in Group III and only 2 in Group IV. All patients underwent reconstructive surgery based on MRI findings. Conclusions: In our series MRI was a useful method for the pre-surgical evaluation of Muellerian malformations. (author)

Injured athletes' perceptions about social support.

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Clement, Damien; Shannon, Vanessa R

2011-11-01

According to the buffering hypothesis, social support moderates the harmful effects of stress and, in turn, indirectly affects injured athletes' health and well-being. Previous research suggests that perceptions of social support influence athletes' psychological reactions, as well as their rehabilitation adherence, but additional research in this area is warranted. To examine injured athletes' perceptions regarding satisfaction, availability, and contribution for each of the 8 types of social support. Descriptive. Mid-Atlantic Division II and III institutions. 49 injured athletes. Social support was assessed using a modified version of the Social Support Survey. Injured athletes were significantly more satisfied with social support provided by athletic trainers (ATCs) than that provided by coaches and teammates. In addition, injured athletes reported that social support provided by ATCs contributed significantly more to their overall well-being. Athletes reported several significant differences regarding satisfaction and contribution to well-being among the 8 different types of social support. Injury, an unavoidable part of sport, is often accompanied by negative psychological reactions. This reaction may have a negative influence on an athlete's experience of injury and rehabilitation. Findings suggest that perceptions of social support provided by ATCs have the greatest influence on injured athletes' rehabilitation and well-being.

Camouflage therapy workshop for pediatric dermatology patients: a review of 6 cases.

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Padilla-España, L; del Boz, J; Ramírez-López, M B; Fernández-Sánchez, M E

2014-06-01

Certain skin conditions, such as vitiligo, acne, vascular malformations, and surgical scars, can impair the quality of life of pediatric patients, especially adolescents-even to the point of hindering psychosocial development. We review the cases of 6 patients with discoloration or scarring, predominantly of the face, who attended our cosmetic camouflage workshops from January through December 2012. The quality-of-life impact of their skin disorder was assessed before and after workshop attendance. Cosmetic camouflage is an easily replicated, cheap, and noninvasive adjunctive treatment of great potential value in managing skin conditions that impair the physical and emotional well-being of pediatric patients. Copyright © 2013 Elsevier España, S.L. y AEDV. All rights reserved.

Active stretching for lower extremity muscle tightness in pediatric patients with lumbar spondylolysis.

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Sato, Masahiro; Mase, Yasuyoshi; Sairyo, Koichi

2017-01-01

It was reported that hamstring muscle tightness may increase mechanical loading on the lumbar spine. Therefore, we attempt to decrease tightness in the leg muscles in pediatric patients. Forty-six pediatric patients with spondylolysis underwent rehabilitation. We applied active stretching to the hamstrings, quadriceps, and triceps surae. Tightness in each muscle was graded as good, fair, or poor. We educated each patient on how to perform active stretching at home. They were re-evaluated for muscle tightness 2 months later. Tightness at baseline and after 2 months was as follows: for the hamstrings, good in 3 patients, fair in 9, and poor in 34 and significant improved after 2 months (p<0.05), with improvement by least 1 grade seen in 86% of patients with fair or poor at baseline; for the quadriceps, 7, 3, and 30 patients had good, fair and poor, with significant improvements in 72% (p<0.05). For the triceps surae, 6, 3 and 10 patients had good, fair and poor, which improved significantly (p<0.05). Home-based active stretching was effective for relieving muscle tightness in the leg in a pediatric population. Adolescent athletes should perform such exercise to maintain flexibility and prevent lumbar disorders. J. Med. Invest. 64: 136-139, February, 2017.

Pediatric patients transferred for operative management of appendicitis: are they at a disadvantage?

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Farach, Sandra M; Danielson, Paul D; Walford, N Elizabeth; Harmel, Richard P; Chandler, Nicole M

2015-09-01

Many pediatric patients are initially diagnosed with appendicitis at referring hospitals and are subsequently transferred to pediatric facilities. We aimed to compare outcomes of patients transferred to a pediatric referral center to those who present primarily for operative management of appendicitis. A retrospective review of 326 patients with operative appendicitis from July 2012 to July 2013 was performed. Demographic data, clinical parameters, and outcomes were analyzed. Transferred (n=222, 68%) and primary patients (n=104, 32%) were similar except for mean age (primary 12.4 vs. transferred 11.2 years, pprimary patients. Primary patients were more likely to present between the hours of 09:00 and 17:59 (52%), while transferred arrived equally across all hours. Both groups were more likely to present with acute appendicitis (primary 56% vs. transfer 61%, p=NS). There was no difference in time of diagnosis to time of appendectomy, length of hospital stay, or 30 day complications (primary 8.6% vs. transfer 5.8%, p=NS). Patients transferred for definitive care of appendicitis are not found to have more advanced disease or have increased complications; however, they are exposed to significantly more ionizing radiation during evaluation for appendicitis. Copyright © 2015 Elsevier Inc. All rights reserved.

Kidney transplant in pediatric patients with severe bladder pathology.

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Sierralta, María Consuelo; González, Gloria; Nome, Claudio; Pinilla, Cesar; Correa, Ramón; Mansilla, Juan; Rodríguez, Jorge; Delucchi, Angela; Ossandón, Francisco

2015-11-01

The aim of the current study was to compare results in pediatric renal transplantation of patients with and without SBP. Between 2001 and 2013, a total of 168 kidney transplants were performed at our center. A retrospective analysis was performed and recipients were divided into two groups: NB and SBP. Incidence of surgical complications after procedure, and graft and patient survival were evaluated. A total of 155 recipients (92%) with complete data were analyzed, and 13 recipients that had had previous bladder surgeries were excluded (11 with VUR surgery and two with previous kidney transplants), of the 155 recipients: 123 (79%) patients had NB, and 32 (21%) patients had SBP, with a median follow-up of 60 (1-137) and 52 (1-144) months, respectively. Among post-transplant complications, UTI (68.8% vs. 23%, p < 0.0001) and symptomatic VUR to the graft (40.6% vs. 7.3%, p < 0.0001) were significantly higher in the SBP group. There was no significant difference in overall graft and patient survival between groups. Renal transplantation is safe in pediatric recipients with SBP; however, urologic complications such as UTI and VUR were significantly higher in this group. Graft and patient survival was similar in SBP and NB groups. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Thoracic Aorta 3D Hemodynamics in Pediatric and Young Adult Patients With Bicuspid Aortic Valve

NARCIS (Netherlands)

Allen, Bradley D.; van Ooij, Pim; Barker, Alex J.; Carr, Maria; Gabbour, Maya; Schnell, Susanne; Jarvis, Kelly B.; Carr, James C.; Markl, Michael; Rigsby, Cynthia; Robinson, Joshua D.

2015-01-01

Background: To evaluate the 3D hemodynamics in the thoracic aorta of pediatric and young adult bicuspid aortic valve (BAV) patients. Methods: 4D flow MRI was performed in 30 pediatric and young adult BAV patients (age: 13.9 +/- 4.4 (range: [3.4, 20.7]) years old, M:F = 17:13) as part of this

Sugammadex versus neostigmine in pediatric patients: a prospective randomized study

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Turhan Kara

2014-12-01

Full Text Available Background and objectives: Acetylcholinesterase inhibitors may cause postoperative residual curarization when they are used for reversal of neuromuscular blockade. Sugammadex reverses neuromuscular blockade by chemical encapsulation and is not associated with the side effects that may occur with the use of anticholinesterase agents. Because of increased outpatient surgical procedures postoperative residual curarization and rapid postoperative recovery have a greater importance in the pediatric patient population. The aim of this study was to compare the efficacy of sugammadex and neostigmine on reversing neuromuscular blockade in pediatric patients undergoing outpatient surgical procedures. Methods: 80 patients, aged 2-12 years, scheduled for outpatient surgery were enrolled in this randomized prospective study. Neuromuscular blockade was achieved with 0.6 mgkg−1 rocuronium and monitorized with train-of-four. Group RN (n = 40 received 0.03 mgkg−1 neostigmine, Group RS (n = 40 received 2 mgkg−1 sugammadex for reversal of rocuronium. Extubation time (time from the reversal of neuromuscular blockade to extubation, train-of-four ratio during this time, time to reach train-of-four > 0.9, and probable complications were recorded. Results: There was no significant difference between the patients' characteristics. Extubation time and time to reach train-of-four > 0.9 were significantly higher in Group RN (p = 0.001, p = 0.002. Train-of-four at the time of neostigmine/sugammadex injection in Group RN were significantly higher than in the RS group (p = 0.020. Extubation train-of-four ratio was significantly lower in Group RN (p = 0.002. Conclusion: Sugammadex provides safer extubation with a shorter recovery time than neostigmine in pediatric patients undergoing outpatient surgical procedures.

Primary immunodeficiency investigation in patients during and after hospitalization in a pediatric Intensive Care Unit

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Erica Suavinho

2014-03-01

Full Text Available Objective: To analyze whether the patients with severe infections, admitted in the Pediatric Intensive Care Unit of the Hospital de Clínicas of the Universidade Federal de Uberlândia, underwent the active screening for primary immunodeficiencies (PID. Methods: Retrospective study that assessed the data records of patients with any severe infections admitted in the Pediatric Intensive Care Unit, covering a period from January 2011 to January 2012, in order to confirm if they performed an initial investigation for PID with blood count and immunoglobulin dosage. Results: In the studied period, 53 children were hospitalized with severe infections in the Pediatric Intensive Care Unit, and only in seven (13.2% the initial investigation of PID was performed. Among these patients, 3/7 (42.8% showed quantitative alterations in immunoglobulin G (IgG levels, 1/7 (14.3% had the diagnosis of cyclic neutropenia, and 1/7 (14.3% presented thrombocytopenia and a final diagnosis of Wiskott-Aldrich syndrome. Therefore, the PID diagnosis was confirmed in 5/7 (71.4% of the patients. Conclusions: The investigation of PID in patients with severe infections has not been routinely performed in the Pediatric Intensive Care Unit. Our findings suggest the necessity of performing PID investigation in this group of patients.

New Onset Insomnia in a Pediatric Patient: A Case of Anti-NMDA Receptor Encephalitis

OpenAIRE

Tamar N. Goldberg; Michael F. Cellucci

2017-01-01

Anti-NMDAR encephalitis is becoming more widely recognized as a cause of encephalopathy in both adults and children. Certain clinical features such as mood lability, movement disorders, speech dysfunction, seizures, and autonomic instability in a pediatric patient should prompt immediate concern and evaluation for autoimmune encephalitis among providers. We present the case of a pediatric patient with anti-NMDAR encephalitis in which the symptom prompting medical evaluation was insomnia. Inso...

FDG PET/CT appearance of local osteosarcoma recurrences in pediatric patients

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Sharp, Susan E.; Gelfand, Michael J. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Shulkin, Barry L.; McCarville, M.B. [St. Jude Children' s Research Hospital, Department of Diagnostic Imaging, Memphis, TN (United States)

2017-12-15

Osteosarcoma is the most common pediatric malignant bone tumor, frequently surgically managed with limb salvage rather than amputation. Local recurrences are seen in up to 9% of osteosarcoma patients, with CT and MRI imaging often limited by metal artifacts. To describe the [F-18]2-fluoro-2-deoxyglucose (FDG) PET/CT appearance of local osteosarcoma recurrences with correlation to findings on other imaging modalities. A retrospective review of pediatric osteosarcoma patients imaged with FDG PET/CT was performed in patients with pathologically proven local recurrences. FDG PET/CT findings were reviewed and correlated with available comparison imaging studies. Ten local osteosarcoma recurrences in eight pediatric osteosarcoma patients were imaged with FDG PET/CT. All eight patients had a local recurrence after limb salvage; two patients had a second local recurrence after amputation. All local recurrences were seen with FDG PET/CT, demonstrating solid (n=5) or peripheral/nodular (n=5) FDG uptake patterns. Maximum standard uptake values (SUVs) ranged from 3.0 to 15.7. In five recurrences imaged with FDG PET/CT and MRI, MRI was limited or nondiagnostic in three. In four recurrences imaged with FDG PET/CT and bone scan, the bone scan was negative in three. Local osteosarcoma recurrences are well visualized by FDG PET/CT, demonstrating either solid or peripheral/nodular FDG uptake with a wide range of maximum SUVs. FDG PET/CT demonstrates the full extent of local recurrences, while MRI can be limited by artifact from metallic hardware. PET/CT appears to be more sensitive than bone scan in detecting local osteosarcoma recurrences. (orig.)

Comparison of propofol effect with Ketamine for sedation induction in pediatric patients who underwent cardiol catheterization

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Houshang Shahryari

2010-04-01

Full Text Available Background: The goals for sedation in pediatric patients scheduled to undergo cardiac catheterization include immobility, analgesia, cardiovascular and respiratory stability. We investigated the effects of Propofol and Ketamine on hemodynamic, respiratory status, sedation level, pain score and recovery period in pediatric patients undergoing cardiac catheterization. Methods: We preformed a randomized clinical trial study on 40 pediatric patients. The patients were randomly assigned to two groups, so that 20 patients received Ketamine and 20 patients received Propofol. In all patients, sedation was started with Midazolam (0.03mg/kg, then followed by Propofol in the first group and Ketamine in the second one. The hemodynamic responses, respiratory parameters, recovery characteristics (Ramsey scale, pain score VAS and relevant adverse effects of the two groups were recorded. Data was analyzed using Paired T Test, ANOVA and Stearman correlation coefficient. Results: Five patients in the Propofol group andon patients in the Ketamine group experienced a transient decrease in mean systolic blood pressure greater than 10% of baseline(p=0.034. Time to full recovery (mean ± SD was not significantly different in the Propofol group and Ketamine group (1.8 min vs. 2.9 min, P > 0.05. Pain scores were significantly different in both groups (P= 0.010. Patients’ heart rates were significantly higher in Ketamine group(P=0.029. No significant difference in respiratory rate was recorded in both groups(p›0.05. Conclusion: Both Ketamine and Propofol are useful and safe in pediatric patients undergoing cardiac catheterization but it seems that it is better to use Propofol in stable hemodynamic pediatric patients under continuous blood pressure monitoring.

Post-transplant outcomes in pediatric ventricular assist device patients: A PediMACS-Pediatric Heart Transplant Study linkage analysis.

Science.gov (United States)

Sutcliffe, David L; Pruitt, Elizabeth; Cantor, Ryan S; Godown, Justin; Lane, John; Turrentine, Mark W; Law, Sabrina P; Lantz, Jodie L; Kirklin, James K; Bernstein, Daniel; Blume, Elizabeth D

2017-12-13

Pediatric ventricular assist device (VAD) support as bridge to transplant has improved waitlist survival, but the effects of pre-implant status and VAD-related events on post-transplant outcomes have not been assessed. This study is a linkage analysis between the PediMACS and Pediatric Heart Transplant Study databases to determine the effects of VAD course on post-transplant outcomes. Database linkage between October 1, 2012 and December 31, 2015 identified 147 transplanted VAD patients, the primary study group. The comparison cohort was composed of 630 PHTS patients without pre-transplant VAD support. The primary outcome was post-transplant survival, with secondary outcomes of post-transplant length of stay, freedom from infection and freedom from rejection. At implant, the VAD cohort was INTERMACS Profile 1 in 33 (23%), Profile 2 in 89 (63%) and Profile 3 in 14 (10%) patients. The VAD cohort was older, larger, and less likely to have congenital heart disease (p < 0.0001). However, they had greater requirements for inotrope and ventilator support and increased liver and renal dysfunction (p < 0.0001), both of which normalized at transplant after device support. Importantly, there were no differences in 1-year post-transplant survival (96% vs 93%, p = 0.3), freedom from infection (81% vs 79%, p = 0.9) or freedom from rejection (71% vs 74%, p = 0.87) between cohorts. Pediatric VAD patients have post-transplant outcomes equal to that of medically supported patients, despite greater pre-implant illness severity. Post-transplant survival, hospital length of stay, infection and rejection were not affected by patient acuity at VAD implantation or VAD-related complications. Therefore, VAD as bridge to transplant mitigates severity of illness in children. Copyright © 2017 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Patient doses from fluoroscopically guided cardiac procedures in pediatrics

Science.gov (United States)

Martinez, L. C.; Vano, E.; Gutierrez, F.; Rodriguez, C.; Gilarranz, R.; Manzanas, M. J.

2007-08-01

Infants and children are a higher risk population for radiation cancer induction compared to adults. Although some values on pediatric patient doses for cardiac procedures have been reported, data to determine reference levels are scarce, especially when compared to those available for adults in diagnostic and therapeutic procedures. The aim of this study is to make a new contribution to the scarce published data in pediatric cardiac procedures and help in the determination of future dose reference levels. This paper presents a set of patient dose values, in terms of air kerma area product (KAP) and entrance surface air kerma (ESAK), measured in a pediatric cardiac catheterization laboratory equipped with a biplane x-ray system with dynamic flat panel detectors. Cardiologists were properly trained in radiation protection. The study includes 137 patients aged between 10 days and 16 years who underwent diagnostic catheterizations or therapeutic procedures. Demographic data and technical details of the procedures were also gathered. The x-ray system was submitted to a quality control programme, including the calibration of the transmission ionization chamber. The age distribution of the patients was 47 for <1 year; 52 for 1-<5 years; 25 for 5-<10 years and 13 for 10-<16 years. Median values of KAP were 1.9, 2.9, 4.5 and 15.4 Gy cm2 respectively for the four age bands. These KAP values increase by a factor of 8 when moving through the four age bands. The probability of a fatal cancer per fluoroscopically guided cardiac procedure is about 0.07%. Median values of ESAK for the four age bands were 46, 50, 56 and 163 mGy, which lie far below the threshold for deterministic effects on the skin. These dose values are lower than those published in previous papers.

The Lived Experiences of Nurses Caring For Dying Pediatric Patients.

Science.gov (United States)

Curcio, Danna L

2017-01-01

Nurses and healthcare professionals may have difficulty adjusting to and comprehending their experiences when a patient’s life ends. This has the potential to interfere with patient care. Reflection on past events and actions enables critical discovery of strategies to benefit both nurses and patients. This qualitative phenomenological study explores the lived experiences of nurses caring for dying pediatric patients. The philosophical underpinning of Merleau-Ponty (2008), in combination with the research method of van Manen (1990), was used for this study. The Roy Adaptation Model (RAM) (Roy, 2009; Roy & Andrews, 1991) was the nursing model that guided the study to help understand that nurses are an adaptive system, using censoring as a compensatory adaptive process to help function for a purposeful cause. Nine female nurse participants with one to four years of experience were interviewed. The context of the experiences told by nurses caring for dying pediatric patents uncovered seven essential themes of empathy, feelings of ambivalence, inevitability, inspiration, relationship, self-preservation, and sorrow, and these themes demonstrated a connection formed between the nurse and the patient.

The burden of infection in severely injured trauma patients and the relationship with admission shock severity.

Science.gov (United States)

Cole, Elaine; Davenport, Ross; Willett, Keith; Brohi, Karim

2014-03-01

Infection following severe injury is common and has a major impact on patient outcomes. The relationship between patient, injury, and physiologic characteristics with subsequent infections is not clearly defined. The objective of this study was to characterize the drivers and burden of all-cause infection in critical care trauma patients. A prospective cohort study of severely injured adult patients admitted to critical care was conducted. Data were collected prospectively on patient and injury characteristics, baseline physiology, coagulation profiles, and blood product use. Patients were followed up daily for infectious episodes and other adverse outcomes while in the hospital. Three hundred patients (Injury Severity Score [ISS] >15) were recruited. In 48 hours or less, 29 patients (10%) died, leaving a cohort of 271. One hundred forty-one patients (52%) developed at least one infection. Three hundred four infections were diagnosed overall. Infection and noninfection groups were matched for age, sex, mechanism, and ISS. Infection rates were greater with any degree of admission shock and threefold higher in the most severely shocked cohort (p < 0.01). In multivariate analysis, base deficit (odds ratio [OR], 1.78, 95% confidence interval [CI], 1.48-1.94; p < 0.001) and lactate (OR, 1.36; 95% CI, 1.10-1.69; p = 0.05) were independently associated with the development of infection. Outcomes were significantly worse for the patients with infection. In multivariate logistic regression, infection was the only factor independently associated with multiple-organ failure (p < 0.001; OR, 15.4; 95% CI, 8.2-28.9; r = 0.402), ventilator-free days (p < 0.001; β, -4.48; 95% CI, -6.7 to -2.1; r = 0.245), critical care length of stay (p < 0.001; β, 13.2; 95% CI, 10.0-16.4; r = 0.466), and hospital length of stay (p < 0.001; β, 31.1; 95% CI, 24.0-38.2; r = 0.492). Infectious complications are a burden for severely injured patients and occur early in the critical care stay

Transfusion reactions in pediatric compared with adult patients: a look at rate, reaction type, and associated products.

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Oakley, Fredrick D; Woods, Marcella; Arnold, Shanna; Young, Pampee P

2015-03-01

The majority of reports on transfusion reactions address adult patients. Less is known about the types, incidence, and other clinical details of transfusion reactions in pediatric populations. Furthermore, to our knowledge, there have been no previous reports directly comparing these aspects between adults and pediatric patient populations to assess if there are differences. Between the period of January 1, 2011, and February 1, 2013, all reported adult and pediatric transfusion reactions at Vanderbilt University Medical Center (VUMC) were evaluated by transfusion medicine clinical service. The information was subsequently shared with the hemovigilance database. Data provided to hemovigilance included age, sex, blood product associated with the reaction, severity of the reaction, and the type of transfusion reactions. These were collated with hospital and blood bank information system-acquired data on overall admission and product transfusion. A total of 133,671 transfusions were performed at VUMC during the study period including 20,179 platelet (PLT) transfusions, 31,605 plasma transfusions, 79,933 red blood cell (RBC) transfusions, and 2154 cryoprecipitate transfusions. Over the same period, 108 pediatric and 277 adult transfusion reactions were recorded. This corresponds to an incidence of 6.2 reactions per 1000 transfusions within the pediatric (age reactions per 1000 transfusions within the adult population. In both adult and pediatric populations, transfusion reactions were most commonly associated with PLT, followed by RBC, and then plasma transfusions. Within the pediatric population, subset analysis identified multiple differences when compared to the adult population, including an increased incidence of allergic transfusion reactions (2.7/1000 vs. 1.1/1000, p reactions (1.9/1000 vs. 0.47/1000, p reactions (0.29/1000 vs. 0.078/1000, p reaction incidence was the same between sexes in adults, in pediatric patients, reactions were more common in male

Prevalence of hypercalcemia of malignancy among pediatric cancer patients in the UK Clinical Practice Research Datalink database

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Jick S

2017-06-01

Full Text Available Susan Jick,1 Lin Li,1 Victor M Gastanaga,2 Alexander Liede,2 Rohini K Hernandez2 1Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Lexington, MA, USA; 2Center for Observational Research, Amgen Inc., Thousand Oaks and South San Francisco, CA, USA Background: The reported proportion of cancer patients who experience hypercalcemia of malignancy (HCM is low, particularly in the pediatric population, ranging between <1% and 5%. HCM can be observed with any type of tumor in children and occurs most commonly with leukemia. While HCM is a potentially fatal condition, the prevalence of HCM is not well understood in pediatric cancer patients. Methods: Using the UK Clinical Practice Research Datalink, we identified pediatric cancer patients with recorded corrected serum calcium (CSC from 2003 through 2014. Hypercalcemic patients (CSC ≥10.8 mg/dL were classified into 4 CSC levels. We estimated the annual prevalence of HCM using Byar’s method. Results: Among 517 pediatric cancer patients, leukemia, lymphoma, and brain tumors were the most frequent cancer types. The prevalence of HCM overall (grade 1 or higher ranged from 0.24% to 0.81% between 2003 and 2014. There were too few cases to compare prevalence by type of cancer. Conclusion: We provide the first systematic analysis using a UK population-based data source to estimate the number of pediatric cancer patients affected with HCM by grade. Our findings showed that the prevalence of pediatric HCM was very low (0.24%–0.81% over the 12-year study period, which is consistent with previous study of adult cancer patients in the UK (0.20%–0.67%. Keywords: hypercalcemia, pediatric, cancer, prevalence, Clinical Practice Research Datalink

International consensus on the diagnosis and management of pediatric patients with hereditary angioedema with C1 inhibitor deficiency.

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Farkas, H; Martinez-Saguer, I; Bork, K; Bowen, T; Craig, T; Frank, M; Germenis, A E; Grumach, A S; Luczay, A; Varga, L; Zanichelli, A

2017-02-01

The consensus documents published to date on hereditary angioedema with C1 inhibitor deficiency (C1-INH-HAE) have focused on adult patients. Many of the previous recommendations have not been adapted to pediatric patients. We intended to produce consensus recommendations for the diagnosis and management of pediatric patients with C1-INH-HAE. During an expert panel meeting that took place during the 9th C1 Inhibitor Deficiency Workshop in Budapest, 2015 (www.haenet.hu), pediatric data were presented and discussed and a consensus was developed by voting. The symptoms of C1-INH-HAE often present in childhood. Differential diagnosis can be difficult as abdominal pain is common in pediatric C1-INH-HAE, but also commonly occurs in the general pediatric population. The early onset of symptoms may predict a more severe subsequent course of the disease. Before the age of 1 year, C1-INH levels may be lower than in adults; therefore, it is advisable to confirm the diagnosis after the age of one year. All neonates/infants with an affected C1-INH-HAE family member should be screened for C1-INH deficiency. Pediatric patients should always carry a C1-INH-HAE information card and medicine for emergency use. The regulatory approval status of the drugs for prophylaxis and for acute treatment is different in each country. Plasma-derived C1-INH, recombinant C1-INH, and ecallantide are the only agents licensed for the acute treatment of pediatric patients. Clinical trials are underway with additional drugs. It is recommended to follow up patients in an HAE comprehensive care center. The pediatric-focused international consensus for the diagnosis and management of C1-INH-HAE patients was created. © 2016 The Authors. Allergy Published by John Wiley & Sons Ltd.

Place of death of pediatric cancer patients in a single institute during 7 years.

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Yanai, Tomoko; Hirase, Satoshi; Matsunoshita, Natsuki; Yamamoto, Nobuyuki; Ninchoji, Takeshi; Kubokawa, Ikuko; Mori, Takeshi; Hayakawa, Akira; Takeshima, Yasuhiro; Iijima, Kazumoto; Matsuo, Masafumi

2012-06-27

Place of death is an important issue at the end-of-life. It is poorly understood in pediatric cancer patients in Japan. This study aimed to clarify place of death of children with cancer as well as variables associated with place of death. Study population was pediatric cancer patients who died in the Department of Pediatrics at Kobe University Hospital during the last 7 years. The medical records were retrospectively reviewed regardless of cause of death to derive data relating to patients' characteristics and disease. 18 patients were included. Median age at death was 12.2 years old. 6 patients including 5 children in complete remission had hematological disease and 12 patients suffered from solid tumors. 4 patients (22.2%) died at home, whereas 14 patients (77.8%) died in the hospital including 6 ICU deaths. No one died in hospices. Preference of patients was unavailable due to the lack of inquiry. Factors influencing place of death (home, ICU, non-ICU) were disease (hematological disease vs. solid tumor, p=0.010, brain tumor vs. non-brain tumor, p=0.023), disease status (complete remission vs. non-complete remission, p=0.0014) and preference of families (p=0.029). Among 6 families who expressed preference, no disparity was observed between actual and preferred place of death. This is the first English publication of place of death of pediatric cancer patients in Japan. The low percentage of home death, factors influencing place of death and the lack of disparity between actual and preferred place of death were indicated. Further studies are required to better understand place of death.

Barriers to Implementing a Reporting and Learning Patient Safety System: Pediatric Chiropractic Perspective.

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Pohlman, Katherine A; Carroll, Linda; Hartling, Lisa; Tsuyuki, Ross T; Vohra, Sunita

2016-04-01

A reporting and learning system is a method of monitoring the occurrence of incidents that affect patient safety. This cross-sectional survey asked pediatric chiropractors about factors that may limit their participation in such a system. The list of potential barriers for participation was developed using a systematic approach. All members of the 2 pediatric councils associated with US national chiropractic organizations were invited to complete the survey (N = 400). The cross-sectional survey was created using an online survey tool (REDCap) and sent directly to member emails addressed by the respective executive committees. Of the 400 potential respondents, 81 responded (20.3%). The most common limitations to participating were identified as time pressure (96%) and patient concerns (81%). Reporting and learning systems have been utilized to increase safety awareness in many high-risk industries. To be successful, future patient safety studies with pediatric chiropractors need to ensure these barriers are understood and addressed. © The Author(s) 2015.

Effects of immigration enforcement legislation on Hispanic pediatric patient visits to the pediatric emergency department.

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Beniflah, Jacob D; Little, Wendalyn K; Simon, Harold K; Sturm, Jesse

2013-12-01

To compare the visits by Hispanic patients to the pediatric emergency department (PED) before and after passage of Georgia House Bill 87 (HB87). This bill grants local law enforcement the authority to enforce immigration laws. A retrospective chart review of all Hispanic patients who presented to the PED in a 4-month period after implementation of HB87 in 2011 was conducted and compared with the same period in 2009 and 2010. Data compared included patient acuity score, disposition, payer status, and demographics. Fewer Hispanic patients presented to the ED after passage of the bill (18.3% vs 17.1%, P immigration legislation.

Cerebrovascular disease in pediatric patients

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Rotta Newra Tellechea

2002-01-01

Full Text Available Although rare in childhood, stroke may have a serious impact when it happens in this stage of life. Also, it may be the first sign of a systemic disease. We report 12 cases of patients with stroke treated in the Neuropediatrics Unit of Hospital de Clínicas de Porto Alegre (HCPA from March 1997 to March 2000. All patients, from term infants to 12-year-old children hospitalized in the Pediatrics Unit of HCPA, had clinical suspicion of stroke, which was later confirmed by radiological studies. Patient follow up ranged from 1 to 6 years (mean = 3.4 years. Presenting symptoms were hemiparesis in 9 patients, seizures in 7, deviation of labial commissure in 3, and loss of consciousness in 1. The increase in the number of cases of childhood stroke identified and later confirmed by noninvasive methods had helped in the determination of different ethiologies of stroke: the most frequent being hematologic, cardiac and genetic diseases. However, our study included 6 newborns with stroke whose ethiology was not identified. Seven children with seizures received phenobarbital. Six term infants had neonatal seizures secondary to stroke and restricted to the first 72 hours of life.

[Analysis of development, safety and efficacy of percutaneous nephrolithotomy for management of upper urinary tract calculi in pediatric patients].

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Yu, L P; Xu, T

2017-08-18

To evaluate the development, safety and efficacy of percutaneous nephrolithotomy(PNL) for management of upper urinary tract calculi in pediatric patients. In the study, 77 pediatric patients undergoing 87 PNLs through mini or standard tract for upper urinary tract calculi between January 2005 and December 2016 in Peking University People's hospital were reviewed, including 69 renal calculi, 6 upper ureteral calculi, 12 renal and upper ureteral calculi, 35 single calculi, 43 multiple calculi and 9 staghorn calculi. The development and efficacy of PNL in pediatric patients were studied by analyzing the characteristics and clinical indexes, and by reviewing the associated literature. The Clavien classification system was used to evaluate the complications after PNL. A total of 87 PNLs were performed in 77 pediatric patients. Eighty-one upper urinary tract calculi were managed through a single tract(93.1%), 5 pediatric patients were managed through 2 tracts(5.7%), and 1 pediatric patient was managed through 3 tracts(1.2%). The mean operating time was (77.0±29.8) min. The stone-free rate after one session was 100% for single calculi and 71.2% for multiple or staghorn calculi, 5(5.8%) children underwent auxiliary procedure to remove the residual calculi and the final stone-free rate of PNL was 88.5%. One of the main complications of pediatric PNL was fever. Sixteen (18.4%) had moderate fever(38-39 °C), 5 (5.7%) had high fever (39-40 °C) and there were no severe complications of infection, such as sepsis or septic shock. The mean hemoglobin loss was (10.3±16.1) g/L and the serum creatinine rise was (7.0±13.3) μmol/L. One(1.2%) pediatric patient suffered ureteroscopic lithotripsy because of the obstruction by the residual stone in ureter. No injury of organs or retroperitoneal urinary extravasation occurred. General assessment of the complications showed Clavien grade I complications in 14 (16.1%) pediatric patients, grade II in 7(8.0%) children and grade III in 1

Oligodendrogliomas in pediatric and adult patients: an outcome-based study from the Surveillance, Epidemiology, and End Result database

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Lau CSM

2017-05-01

Full Text Available Christine SM Lau,1,2 Krishnaraj Mahendraraj,1 Ronald S Chamberlain1–4 1Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA; 2Saint George’s University School of Medicine, Grenada, West Indies; 3Department of Surgery, New Jersey Medical School, Rutgers University, Newark, NJ, 4Department of Surgery, Banner MD Anderson Cancer Center, Gilbert, AZ, USA Introduction: Oligodendrogliomas (OGs account for <20% of all intracranial tumors and 25% of gliomas. Despite improvements in imaging techniques allowing for earlier diagnosis, OG is rare among the pediatric population. This study examines a large cohort of OG patients in an effort to define the demographic, clinical, and pathologic factors associated with clinical and survival outcomes.Methods: Data on 7,001 OG patients were abstracted from the Surveillance, Epidemiology, and End Result (SEER database (1973–2013. Pediatric patients were defined as ≤19 years old, and adult patients were defined as age ≥20 years.Results: Among 7,001 OG patients, 6.5% were pediatric (mean age 12 ± 6 years, and 93.5% were adult (mean age 46 ± 15 years. Overall, OGs were more common among males, with a male-to-female ratio of 1.28:1. Overall, OGs were more common among Caucasians (76.9% and also among the African American (10.8% pediatric vs. 4.0% adult and Hispanic (12.8% pediatric vs. 11.8% adult. OGs occurred most commonly in the temporal lobe of pediatric patients and the frontal lobes of adults. Surgical resection was the primary treatment modality for both pediatric and adult populations (70.6% and 40.5%, followed by combined surgery and radiation (19.7% and 41.2%. Surgical resection was associated with significantly improved survival in both groups. Pediatric patients had a lower overall mortality (19.8% vs. 48.5% and lower cancer-specific mortality (17.6% vs. 36.8%.Conclusion: OGs most often present in Caucasian males in their fifth decade of life with tumors >4 cm in size

Emergency department visits by pediatric patients for poisoning by prescription opioids.

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Tadros, Allison; Layman, Shelley M; Davis, Stephen M; Bozeman, Rachel; Davidov, Danielle M

2016-09-01

Prescription medication abuse is an increasingly recognized problem in the United States. As more opioids are being prescribed and abused by adults, there is an increased risk of both accidental and intentional exposure to children and adolescents. The impact of pediatric exposures to prescription pain pills has not been well studied. We sought to evaluate emergency department (ED) visits for poisoning by prescription opioids in pediatric patients. This retrospective study looked at clinical and demographic data from the Nationwide Emergency Department Sample (NEDS) from 2006 to 2012. There were 21,928 pediatric ED visits for prescription opioid poisonings and more than half were unintentional. There was a bimodal age distribution of patients, with slightly more than half occurring in females. The majority of patients were discharged from the ED. More visits in the younger age group (0-5 years) were unintentional, while the majority of visits in the adolescent age group (15-17 years) were intentional. Mean charge per discharge was $1,840 and $14,235 for admissions and surmounted to over $81 million in total charges. Poisonings by prescription opioids largely impact both young children and adolescents. These findings can be used to help target this population for future preventive efforts.

A model to predict progression in brain-injured patients.

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Tommasino, N; Forteza, D; Godino, M; Mizraji, R; Alvarez, I

2014-11-01

The study of brain death (BD) epidemiology and the acute brain injury (ABI) progression profile is important to improve public health programs, organ procurement strategies, and intensive care unit (ICU) protocols. The purpose of this study was to analyze the ABI progression profile among patients admitted to ICUs with a Glasgow Coma Score (GCS) ≤8, as well as establishing a prediction model of probability of death and BD. This was a retrospective analysis of prospective data that included all brain-injured patients with GCS ≤8 admitted to a total of four public and private ICUs in Uruguay (N = 1447). The independent predictor factors of death and BD were studied using logistic regression analysis. A hierarchical model consisting of 2 nested logit regression models was then created. With these models, the probabilities of death, BD, and death by cardiorespiratory arrest were analyzed. In the first regression, we observed that as the GCS decreased and age increased, the probability of death rose. Each additional year of age increased the probability of death by 0.014. In the second model, however, BD risk decreased with each year of age. The presence of swelling, mass effect, and/or space-occupying lesion increased BD risk for the same given GCS. In the presence of injuries compatible with intracranial hypertension, age behaved as a protective factor that reduced the probability of BD. Based on the analysis of the local epidemiology, a model to predict the probability of death and BD can be developed. The organ potential donation of a country, region, or hospital can be predicted on the basis of this model, customizing it to each specific situation.

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

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Despina Koumpagioti

2014-07-01

Full Text Available OBJECTIVE: to meta-analyze studies that have assessed the medication errors rate in pediatric patients during prescribing, dispensing, and drug administration. SOURCES: searches were performed in the PubMed, Cochrane Library, and Trip databases, selecting articles published in English from 2001 to 2010. SUMMARY OF THE FINDINGS: a total of 25 original studies that met inclusion criteria were selected, which referred to pediatric inpatients or pediatric patients in emergency departments aged 0-16 years, and assessed the frequency of medication errors in the stages of prescribing, dispensing, and drug administration. CONCLUSIONS: the combined medication error rate for prescribing errors to medication orders was 0.175 (95% Confidence Interval: [CI] 0.108-0.270, the rate of prescribing errors to total medication errors was 0.342 (95% CI: 0.146-0.611, that of dispensing errors to total medication errors was 0.065 (95% CI: 0.026-0.154, and that ofadministration errors to total medication errors was 0.316 (95% CI: 0.148-0.550. Furthermore, the combined medication error rate for administration errors to drug administrations was 0.209 (95% CI: 0.152-0.281. Medication errors constitute a reality in healthcare services. The medication process is significantly prone to errors, especially during prescription and drug administration. Implementation of medication error reduction strategies is required in order to increase the safety and quality of pediatric healthcare.

PET imaging in pediatric oncology

International Nuclear Information System (INIS)

Shulkin, B.L.

2004-01-01

High-quality PET imaging of pediatric patients is challenging and requires attention to issues commonly encountered in the practice of pediatric nuclear medicine, but uncommon to the imaging of adult patients. These include intravenous access, fasting, sedation, consent, and clearance of activity from the urinary tract. This paper discusses some technical differences involved in pediatric PET to enhance the quality of scans and assure the safety and comfort of pediatric patients. (orig.)

Experiences with 6-mercaptopurine and azathioprine therapy in pediatric patients with severe ulcerative colitis.

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Kader, H A; Mascarenhas, M R; Piccoli, D A; Stouffer, N O; Baldassano, R N

1999-01-01

The effectiveness of 6-mercaptopurine combined with azathioprine in treating severe ulcerative colitis has been shown in several adult studies. Reported pediatric experiences are rare. The purpose of this study was to investigate the safety and the potential efficacy of 6-mercaptopurine and azathioprine in the treatment of active ulcerative colitis in a pediatric population. The medical records of patients with active ulcerative colitis who were under observation at The Children's Hospital of Philadelphia and its satellite clinics from January 1984 through December 1997 were retrospectively reviewed. Patients were included who had received a diagnosis of ulcerative colitis, who met no criteria for Crohn's colitis, and who had received treatment with 6-mercaptopurine and azathioprine. They were then analyzed for the development of side effects, the indication to use 6-mercaptopurine and azathioprine, and the ability to discontinue corticosteroid use in those patients taking 5-acetylsalicylic acid products who were corticosteroid-dependent or whose disease was refractory to treatment. Excluded from the corticosteroid analyses were patients who underwent surgery for their disease and patients treated with 5-acetylsalicylic acid only. Statistical analysis was performed by the Kaplan-Meier survival curve and paired Student's t-test. In a review of 200 medical records of patients with active ulcerative colitis, 20 patients met the criteria. The patients' average age at the initiation of treatment with 6-mercaptopurine and azathioprine was 13.8 years. Sixteen patients (80%) were corticosteroid dependent and 3 (15%) had ulcerative colitis refractory to corticosteroid treatment. One patient had severe colitis treated with 5-acetylsalicylic acid only. Discontinuation of corticosteroid was accomplished in 12 (75%) of 16 patients. The median time to discontinuation of corticosteroid after initiation of 6-mercaptopurine and azathioprine therapy was 8.4 months. Eight patients

Anesthesia-related mortality in pediatric patients: a systematic review.

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Gonzalez, Leopoldo Palheta; Pignaton, Wangles; Kusano, Priscila Sayuri; Módolo, Norma Sueli Pinheiro; Braz, José Reinaldo Cerqueira; Braz, Leandro Gobbo

2012-01-01

This systematic review of the Brazilian and worldwide literature aimed to evaluate the incidence and causes of perioperative and anesthesia-related mortality in pediatric patients. Studies were identified by searching EMBASE (1951-2011), PubMed (1966-2011), LILACS (1986-2011), and SciElo (1995-2011). Each paper was revised to identify the author(s), the data source, the time period, the number of patients, the time of death, and the perioperative and anesthesia-related mortality rates. Twenty trials were assessed. Studies from Brazil and developed countries worldwide documented similar total anesthesia-related mortality rates (anesthesia-related mortality rates in the past decade. Higher anesthesia-related mortality rates (2.4-3.3 per 10,000 anesthetics) were found in studies from developing countries over the same time period. Interestingly, pediatric perioperative mortality rates have increased over the past decade, and the rates are higher in Brazil (9.8 per 10,000 anesthetics) and other developing countries (10.7-15.9 per 10,000 anesthetics) compared with developed countries (0.41-6.8 per 10,000 anesthetics), with the exception of Australia (13.4 per 10,000 anesthetics). The major risk factors are being newborn or less than 1 year old, ASA III or worse physical status, and undergoing emergency surgery, general anesthesia, or cardiac surgery. The main causes of mortality were problems with airway management and cardiocirculatory events. Our systematic review of the literature shows that the pediatric anesthesia-related mortality rates in Brazil and in developed countries are similar, whereas the pediatric perioperative mortality rates are higher in Brazil compared with developed countries. Most cases of anesthesia-related mortality are associated with airway and cardiocirculatory events. The data regarding anesthesia-related and perioperative mortality rates may be useful in developing prevention strategies.

Anesthesia-related mortality in pediatric patients: a systematic review

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Leopoldo Palheta Gonzalez

2012-01-01

Full Text Available This systematic review of the Brazilian and worldwide literature aimed to evaluate the incidence and causes of perioperative and anesthesia-related mortality in pediatric patients. Studies were identified by searching EMBASE (1951-2011, PubMed (1966-2011, LILACS (1986-2011, and SciElo (1995-2011. Each paper was revised to identify the author(s, the data source, the time period, the number of patients, the time of death, and the perioperative and anesthesia-related mortality rates. Twenty trials were assessed. Studies from Brazil and developed countries worldwide documented similar total anesthesia-related mortality rates (<1 death per 10,000 anesthetics and declines in anesthesia-related mortality rates in the past decade. Higher anesthesia-related mortality rates (2.4-3.3 per 10,000 anesthetics were found in studies from developing countries over the same time period. Interestingly, pediatric perioperative mortality rates have increased over the past decade, and the rates are higher in Brazil (9.8 per 10,000 anesthetics and other developing countries (10.7-15.9 per 10,000 anesthetics compared with developed countries (0.41-6.8 per 10,000 anesthetics, with the exception of Australia (13.4 per 10,000 anesthetics. The major risk factors are being newborn or less than 1 year old, ASA III or worse physical status, and undergoing emergency surgery, general anesthesia, or cardiac surgery. The main causes of mortality were problems with airway management and cardiocirculatory events. Our systematic review of the literature shows that the pediatric anesthesia-related mortality rates in Brazil and in developed countries are similar, whereas the pediatric perioperative mortality rates are higher in Brazil compared with developed countries. Most cases of anesthesiarelated mortality are associated with airway and cardiocirculatory events. The data regarding anesthesia-related and perioperative mortality rates may be useful in developing prevention

Exercise interventions for patients with pediatric cancer during inpatient acute care: A systematic review of literature.

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Rustler, Vanessa; Hagerty, Meaghan; Daeggelmann, Julia; Marjerrison, Stacey; Bloch, Wilhelm; Baumann, Freerk T

2017-11-01

Physical inactivity has been shown to exacerbate negative side effects experienced by pediatric patients undergoing cancer therapy. Exercise interventions are being created in response. This review summarizes current exercise intervention data in the inpatient pediatric oncology setting. Two independent reviewers collected literature from three databases, and analyzed data following the PRISMA statement for systematic reviews and meta-analyses. Ten studies were included, representing 204 patients. Good adherence, positive trends in health status, and no adverse events were noted. Common strategies included individual, supervised, combination training with adaptability to meet fluctuating patient abilities. We recommend that general physical activity programming be offered to pediatric oncology inpatients. © 2017 Wiley Periodicals, Inc.

[Aortic root dilatation rate in pediatric patients with Marfan syndrome treated with losartan].

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Mariucci, Elisabetta; Guidarini, Marta; Donti, Andrea; Lovato, Luigi; Wischmeijer, Anita; Angeli, Emanuela; Gargiulo, Gaetano D; Picchio, Fernando M; Bonvicini, Marco

2015-12-01

Medical therapy with angiotensin II receptor blockers/angiotensin-converting enzyme inhibitors and/or beta-blockers was reported to reduce aortic root dilatation rates in pediatric patients with Marfan syndrome. No data are available in the literature on losartan effects after 3 years of therapy. The aim of our study was to establish whether losartan reduces aortic root dilatation rates in pediatric patients with Marfan syndrome in the mid and long term. This is a retrospective analysis of 38 pediatric patients with Marfan syndrome followed at the Marfan Clinic of S. Orsola-Malpighi Hospital of the University of Bologna (Italy). Aortic diameters were measured at sinuses of Valsalva and proximal ascending aorta with transthoracic echocardiography. After a mean follow-up of 4.5 ± 2.5 years (range 2-9 years), aortic root z score at sinuses of Valsalva and proximal ascending aorta remained stable. The average annual rate of change in aortic root z score was -0.1 ± 0.4 and 0 ± 0.3 at sinuses of Valsalva and proximal ascending aorta, respectively. The mean dose of losartan was 0.7 ± 0.3 mg/kg/day. Three patients were non-responders, probably because of late beginning or low dose of therapy. Eight patients underwent cardiac surgery (aortic root surgery in 5 and mitral valve repair in 3), all of them started losartan later in life. Despite the retrospective design of the study and the small sample size, a beneficial effect of losartan therapy was observed in pediatric patients with Marfan syndrome in the mid and long term. Late beginning or low doses of losartan can turn off the effects of therapy.

Ear, nose and thorat disorders in pediatric patients at a rural hospital in Senegal.

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Tall, Hady; Bah, Fatoumata Yarie; Nasser, Timi; Sambou, Aly; Diallo, Bay Karim

2017-05-01

The main health problems encountered in pediatric population in Senegal are low birth weigth malnutrition and infection. However, there is a lack of data on pediatric ENT diseases from west african population. This is no published data on any research work on pattern ENT pediatric done in Senegal. This study aimed at determining the pattern of common pediatric ENT diseases. This was a retrospective descriptive study involving review of medical record of patients aged 0-16 years who presented ENT diseases from April 2011 to May 2013 (2 years). within the study period a total of 1329 children were seen. We found 696 children male and 633 female, sex ratio (M/F) is 1.1. Mean age of patients seen was 06 years. Nasal disorders (54,6%) were found to be the commonest group of ENT, followed by ear disorders (22,8%) thorat (22,7%). Hypertrophic adenoid (27,9%) allergic rhinitis (22,9%) and pharyngitis (17,7%) are the most common ENT problems in our pediatric population. The main health problems encountered in pediatric population in Senegal are low birth weigth malnutrition and infection. This study indicated hypertrophic adenoid (27,9%) allergic rhinitis (22,9%) and pharyngitis (17,7%) are the most common ENT problems in our pediatric population. However, this study can provide basic data for heath plan and future local research work. Copyright © 2017 Elsevier B.V. All rights reserved.

[Peritonitis in pediatric patients receiving peritoneal dialysis].

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Jellouli, Manel; Ferjani, Meriem; Abidi, Kamel; Hammi, Yosra; Boutiba, Ilhem; Naija, Ouns; Zarrouk, Chokri; Ben Abdallah, Taieb; Gargah, Tahar

2015-12-01

Peritonitis on catheter of dialysis represents the most frequent complication of the peritoneal dialysis (PD) in the pediatric population. It remains a significant cause of morbidity and mortality. In this study, we investigated the risk factors for peritonitis in children. In this study, we retrospectively collected the records of 85 patients who were treated with PD within the past ten years in the service of pediatrics of the University Hospital Charles-Nicolle of Tunis. Peritonitis rate was 0.75 episode per patient-year. Notably, peritonitis caused by Gram-positive organisms were more common. Analysis of infection risk revealed three significant independent factors: the poor weight (P=0.0045), the non-automated PD (P=0.02) and the short delay from catheter insertion to starting PD (P=0.02). The early onset peritonitis was significantly associated with frequent peritonitis episodes (P=0.0008). The mean duration between the first and second episode of peritonitis was significantly shorter than between PD commencement and the first episode of peritonitis. We revealed a significant association between Gram-negative peritonitis and the presence of ureterostomy (0.018) and between Gram-positive peritonitis and the presence of exit-site and tunnel infections (0.02). Transition to permanent hemodialysis was needed in many children but no death occurred in patients with peritonitis. Considering the important incidence of peritonitis in our patients, it is imperative to establish a targeted primary prevention. Nutritional care must be provided to children to avoid poor weight. The automated dialysis has to be the modality of choice. Copyright © 2015 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

Metabolic crisis in severely head-injured patients: is ischemia just the tip of the iceberg?

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Carre, Emilie; Ogier, Michael; Boret, Henry; Montcriol, Ambroise; Bourdon, Lionel; Jean-Jacques, Risso

2013-10-11

Ischemia and metabolic crisis are frequent post-traumatic secondary brain insults that negatively influence outcome. Clinicians commonly mix up these two types of insults, mainly because high lactate/pyruvate ratio (LPR) is the common marker for both ischemia and metabolic crisis. However, LPR elevations during ischemia and metabolic crisis reflect two different energetic imbalances: ischemia (Type 1 LPR elevations with low oxygenation) is characterized by a drastic deprivation of energetic substrates, whereas metabolic crisis (Type 2 LPR elevations with normal or high oxygenation) is associated with profound mitochondrial dysfunction but normal supply of energetic substrates. The discrimination between ischemia and metabolic crisis is crucial because conventional recommendations against ischemia may be detrimental for patients with metabolic crisis. Multimodal monitoring, including microdialysis and brain tissue oxygen monitoring, allows such discrimination, but these techniques are not easily accessible to all head-injured patients. Thus, a new "gold standard" and adapted medical education are required to optimize the management of patients with metabolic crisis.

Metabolic crisis in severely head-injured patients: is ischemia just the tip of the iceberg?

Directory of Open Access Journals (Sweden)

Emilie eCarre

2013-10-01

Full Text Available Ischemia and metabolic crisis are frequent post-traumatic secondary brain insults that negatively influence outcome. Clinicians commonly mix up these two types of insults, mainly because high lactate/pyruvate ratio (LPR is the common marker for both ischemia and metabolic crisis. However, LPR elevations during ischemia and metabolic crisis reflect two different energetic imbalances: ischemia (Type 1 LPR elevations with low oxygenation is characterized by a drastic deprivation of energetic substrates, whereas metabolic crisis (Type 2 LPR elevations with normal or high oxygenation is associated with profound mitochondrial dysfunction but normal supply of energetic substrates. The discrimination between ischemia and metabolic crisis is crucial because conventional recommendations against ischemia may be detrimental for patients with metabolic crisis. Multimodal monitoring, including microdialysis and brain tissue oxygen monitoring, allows such discrimination, but these techniques are not easily accessible to all head-injured patients. Thus, a new gold standard and adapted medical education are required to optimize the management of patients with metabolic crisis.

Parathyroid hormone in pediatric patients with β-thalassemia major ...

African Journals Online (AJOL)

The aim of the study is to estimate the level of serum parathyroid hormone and its relation to bone mineral density in transfusion dependent beta-thalassemia major children. Subjects and methods: We measured serum calcium, phosphorus and parathyroid hormone in a sample of pediatric patients with thalassemia, ...

Prosthetic rehabilitation in a pediatric patient with hypohidrotic ectodermal dysplasia: a case report.

Science.gov (United States)

Quintanilha, Luís Eduardo Lavigne Paranhos; Carneiro-Campos, Luís Eduardo; Antunes, Lívia Azeredo Alves; Antunes, Leonardo Santos; Fernandes, Claudio Pinheiro; Abreu, Fernanda Volpe

2017-01-01

Hypohidrotic ectodermal dysplasia (HED) is a rare ectodermal disease with a systemic expression. Oral abnormalities are common and may include hypodontia and shape irregularities in the primary and permanent dentitions. Rehabilitation of the dental arches in pediatric patients with HED is a challenge because HED is a multifactorial disease that demands a complicated treatment approach and most dentists have limited experience or training in the necessary treatment. In addition, pediatric patients often lack the patience or ability to cooperate with complex prosthetic treatment. This case report describes a simplified technique used to fabricate complete dentures for a 4-year-old HED patient in 4 sessions.

Managing pediatric dental patients: issues raised by the law and changing views of proper child care.

Science.gov (United States)

Bross, Donald C

2004-01-01

The purpose of this paper was to examine legal issues regarding the management of pediatric dental patients and changing views of proper child care. Standards of care in pediatric dentistry are not static. They change in response to research, patterns of reimbursement, patient and parental expectations of reasonable care, and consensus among practitioners. The law pertaining to accountability for pediatric dental patient treatment largely reflects standards of care established by the pediatric dentistry profession. However, the law can also reflect changes in public expectations of reasonable care that can effectively outrun the discipline's efforts to reflect new knowledge or changing public concerns. A major impetus for considering the care of children in all settings has been the increasing recognition of suboptimal children's care, as well as concerns that children have either been abused or neglected in a number of settings. Too often, practices towards children have been untested and based only on the assumption that what is done is "for the child's own good." Pediatric dentists can respond to changing standards of reasonable care for pediatric dental patients, as expressed in legal decisions. They can also usefully consider how attention to child maltreatment has sensitized parents to be better consumers of services on their children's behalf. Rather than reacting only to public pressures for better means of behavior management, the challenge is to exceed expectations via new research and thoughtful anticipation of improvements that can be made.

Computed tomography is not justified in every pediatric blunt trauma patient with a suspicious mechanism of injury.

Science.gov (United States)

Hershkovitz, Yehuda; Zoarets, Itai; Stepansky, Albert; Kozer, Eran; Shapira, Zahar; Klin, Baruch; Halevy, Ariel; Jeroukhimov, Igor

2014-07-01

Computed tomography (CT) has become an important tool for the diagnosis of intra-abdominal and chest injuries in patients with blunt trauma. The role of CT in conscious asymptomatic patients with a suspicious mechanism of injury remains controversial. This controversy intensifies in the management of pediatric blunt trauma patients, who are much more susceptible to radiation exposure. The objective of this study was to evaluate the role of abdominal and chest CT imaging in asymptomatic pediatric patients with a suspicious mechanism of injury. Forty-two pediatric patients up to 15 years old were prospectively enrolled. All patients presented with a suspicious mechanism of blunt trauma and multisystem injury. They were neurologically intact and had no signs of injury to the abdomen or chest. Patients underwent CT imaging of the chest and abdomen as part of the initial evaluation. Thirty-one patients (74%) had a normal CT scan. Two patients of 11 with an abnormal CT scan required a change in management and were referred for observation in the Intensive Care Unit. None of the patients required surgical intervention. The routine use of CT in asymptomatic pediatric patients with a suspicious mechanism of blunt trauma injury is not justified. Copyright © 2014 Elsevier Inc. All rights reserved.

Dexmedetomidine-related polyuria in a pediatric patient.

Science.gov (United States)

Adams, Phillip S; Cassara, Antonio

2016-04-01

Polyuria related to pharmacologic α2-adrenoreceptor agonism has been well described in vitro and in animal models and is thought to be the result of functional antagonism of arginine vasopressin. Despite its widespread use as a sedative and anesthetic adjunct, very few reports of dexmedetomidine-related polyuria in humans exist in the literature. We present the first description of a pediatric patient manifesting polyuria and hypernatremia in association with dexmedetomidine infusion for posterior spinal fusion.

Recovery of forward stepping in spinal cord injured patients does not transfer to untrained backward stepping.

Science.gov (United States)

Grasso, Renato; Ivanenko, Yuri P; Zago, Myrka; Molinari, Marco; Scivoletto, Giorgio; Lacquaniti, Francesco

2004-08-01

Six spinal cord injured (SCI) patients were trained to step on a treadmill with body-weight support for 1.5-3 months. At the end of training, foot motion recovered the shape and the step-by-step reproducibility that characterize normal gait. They were then asked to step backward on the treadmill belt that moved in the opposite direction relative to standard forward training. In contrast to healthy subjects, who can immediately reverse the direction of walking by time-reversing the kinematic waveforms, patients were unable to step backward. Similarly patients were unable to perform another untrained locomotor task, namely stepping in place on the idle treadmill. Two patients who were trained to step backward for 2-3 weeks were able to develop control of foot motion appropriate for this task. The results show that locomotor improvement does not transfer to untrained tasks, thus supporting the idea of task-dependent plasticity in human locomotor networks.

in pediAtriC CystiC FiBrosis pAtients

Directory of Open Access Journals (Sweden)

Zuzanna Gorski

2016-12-01

Full Text Available Introduction. Cystic fibrosis (CF is an autosomal recessive disease affecting the epithelial lining of the respiratory tract andexocrine glands (1-5. many children suffering from CF are often diagnosed and treated for various co-morbidities, includingchronic rhinosinusitis (Crs and nasal polyposis (np (3, 4, 6, 7, which will remain the focus of this article.Aim. the aim of this study was to examine the characteristic of patients with cystic fibrosis (CF admitted to the pediatricotolaryngology department due to coexisting chronic rhinosinusitis (Crs or nasal polyposis (np. the study focused on thedemographics, symptoms and management of children with CF with coexisting Crs and/or np. the data was then compared tothe results that had been presented in the literature.Material and methods. A retrospective study of 26 pediatric patients previously diagnosed with CF that were admitted to thedepartment of pediatric otolaryngology of the medical University of Warsaw between 2010 and 2015 was conducted. patients’medical histories were carefully reviewed. data on patients’ age, gender, symptoms and CF comorbidities were collected. thenumber and type of procedures performed on each patient were documented. Further assessment of the localization of polypswas performed in all np-positive patients.Results. the study included 26 patients (15 males and 11 females. mean age was 9 years. Crs and np was present in 100% and88.5% of the patients, respectively. 23 children underwent a total of 35 sinus surgeries due to Crs and/or np. 6 patients requiredone or more revision surgeries, with a total revision rate of 54.1%. Adenoidectomy (At and/or adenotonsillectomy (Att wasperformed in 10 patients. 5 children were disqualified from the surgery, due to various reasons. the most common localizationof np was maxillary sinus, followed by ethmoid sinus, sphenoid sinus, frontal sinus, and nasal cavity.Conclusions. due to a wide range of clinical findings in many organs

Esthetic and functional reconstruction after parotidectomy in pediatric patients - A case series.

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Bryant, Lucas M; Cognetti, David; Baker, Adam; Roy, Sudeep; Johnston, Douglas R; Curry, Joseph; Krein, Howard

2015-12-01

Parotidectomy is a mainstay of treatment for benign and malignant parotid lesions in children and adults. Depending on surgical methods used and tumor size, parotidectomy may result in significant facial disfigurement as well as functional challenges. We describe a series of four pediatric patients, ages 13-16 who presented to our clinic with a parotid mass. All patients underwent parotidectomy with immediate reconstruction by local tissue rearrangement or free fat graft. Esthetic and functional reconstruction after parotidectomy is not well described in pediatric otolaryngology literature. A review of current literature and description of reconstructive methods is included. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Digital radiography of the chest in pediatric patients

International Nuclear Information System (INIS)

Puig, S.

2003-01-01

The hopes placed in digital radiography have been fulfilled only partly in pediatric radiology. Specifically, the option of gaining reduced radiation exposure in combination with a similar or even improved image quality was hard to realize. The only portable digital system available for a long time were storage phosphors which were disadvantaged by an extremely limited dose-quantum-efficiency (DQE) in comparison to digital flat panel detectors. New developments and the introduction of the dual-reading system led to image qualities comparable to film-screen-systems with high resolution and achievable without dose increase, sometimes even with dose reduction. A study using an animal model suggests that these systems can even be used in preterm infants with very low birth weights. A new portable flat panel detector by Canon may improve digital chest radiography in pediatric patients. (orig.) [de

"A day in my life" photography project: the silent voice of pediatric bone marrow transplant patients.

Science.gov (United States)

Breitwieser, Carrie L; Vaughn, Lisa M

2014-01-01

A photovoice project was conducted with pediatric bone marrow transplant (BMT) patients to examine their coping skills and interpretation of their experience during a BMT, especially when hospitalized. We also wanted to determine how photovoice could be used within a pediatric BMT unit. Sixteen children (ages 4-14) and 2 young adults (ages 22 and 25) from a pediatric BMT unit participated in the project. Six BMT outpatients participated in the data analysis and evaluation phase. Fourteen clinical staff evaluated the impact of the project on their practice. Three primary themes emerged from the pre- and post-BMT photos, accompanying detailed notes, and BMT outpatient analysis of the photos: (a) BMT is "torture," (b) BMT is "time slipping away," and (c) BMT requires normalization, comfort, distraction, and support. BMT patients and staff concluded that photovoice helped express and release emotions regarding the challenges of BMT. BMT staff noted that the results of this project reminded them of the importance of being patient-centered and mindful of patient experience and the therapeutic relationship. © 2014 by Association of Pediatric Hematology/Oncology Nurses.

Health-related quality of life evaluated by Pediatric Quality of Life Inventory 4.0 in pediatric leprosy patients with musculoskeletal manifestations.

Science.gov (United States)

Neder, Luciana; van Weelden, Marlon; Viola, Gabriela Ribeiro; Lourenço, Daniela Mencaroni; Len, Claudio A; Silva, Clovis A

2015-01-01

To evaluate the health-related quality of life (HRQL) in pediatric leprosy patients. A cross-sectional study included 47 leprosy patients and 45 healthy subjects. The HRQL was measured by Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0), and evaluated physical, emotional, social and school domains. The leprosy patients were classified by Ridley and Jopling classification criteria and assessed according to clinical musculoskeletal manifestations, laboratory and radiographic examinations. The median of current age was similar in leprosy patients and controls [12(6-18) vs. 15(5-18)years, p = 0.384], likewise the frequencies of female gender (p = 0.835) and middle/lower Brazilian socio-economic classes (p = 1.0). The domain school activities according the child-self report was significantly lower in leprosy patients compared to controls in the age group of 13-18 years [75(45-100) vs. 90(45-100), p = 0.021]. The other domains were alike in both groups (p > 0.05). At least one musculoskeletal manifestation (arthralgia, arthritis and/or myalgia) was observed in 15% of leprosy patients and none in controls (p = 0.012). Further comparison between all leprosy patients showed that the median of the physical capacity domain [81.25(50-100) vs. 98.44(50-100), p = 0.036] and school activities domain by child-self report [60(50-85) vs. 80(45-100), p = 0.042] were significantly lower in patients with musculoskeletal manifestations compared to patients without these manifestations. No differences were evidenced between the other HRQL parameters in both groups, reported by patients and parents (p > 0.05). Reduced physical capacity and school activities domains were observed in pediatric leprosy patients with musculoskeletal manifestations. Copyright © 2015 Elsevier Editora Ltda. All rights reserved.

Effect of early vs. late tracheostomy on clinical outcomes in critically ill pediatric patients.

Science.gov (United States)

Lee, J-H; Koo, C-H; Lee, S-Y; Kim, E-H; Song, I-K; Kim, H-S; Kim, C-S; Kim, J-T

2016-10-01

Few studies investigated the optimal timing for tracheostomy and its influence on the clinical outcomes in critically ill pediatric patients. This study evaluated the differences in clinical outcomes between early and late tracheostomy in pediatric intensive care unit (ICU) patients. We assessed 111 pediatric patients. Patients who underwent a tracheostomy within 14 days of mechanical ventilation (MV) were assigned to the early tracheostomy group, whereas those who underwent tracheostomy after 14 days of MV were included in the late tracheostomy group. Clinical outcomes, including mortality, duration of MV, length of ICU and hospital stays, and incidence of ventilator-associated pneumonia (VAP) were compared between the groups. Of the 111 pediatric patients, 61 and 50 were included in the early and late tracheostomy groups, respectively. Total MV duration and the length of ICU and hospital stay were significantly longer in the late tracheostomy group than in the early tracheostomy group (all P tracheostomy was 2.6 and 3.8 in the early and late tracheostomy groups, respectively. There were no significant differences in mortality rate between the groups. No severe complications were associated with tracheostomy itself. Tracheostomy performed within 14 days after the initiation of MV was associated with reduced duration of MV and length of ICU and hospital stay. Although there was no effect on mortality rate, children may benefit from early tracheostomy without severe complications. © 2016 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Predictors of serious bacterial infections in pediatric burn patients with fever.

Science.gov (United States)

Vyles, David; Sinha, Madhumita; Rosenberg, David I; Foster, Kevin N; Tran, Melissa; Drachman, David

2014-01-01

To determine predictors of serious bacterial infections in pediatric burn patients with fever (core temp ≥38.5°C), the authors conducted a retrospective review of medical records of pediatric (0-18 years) patients admitted to the Arizona Burn Center between 2008 and 2011 with greater than 5% TBSA and inpatient hospitalization for ≥72 hours. The study group comprised patients with a febrile episode during their inpatient stay. Serious bacterial infection (the primary outcome variable) was defined as: bacteremia, urinary tract infection, meningitis (blood, urine, or cerebrospinal fluid culture positive for a pathogen respectively), pneumonia, line, and wound infection. A generalized estimating equation analysis was done to predict the presence or absence of serious bacterial infection. Of 1082 pediatric burn patients hospitalized during the study period, 353 met the study eligibility criteria. A total of 108 patients (30.6%) had at least one fever episode (fever group). No difference in demographic characteristics was noted between the fever and no-fever groups; significant differences were observed for: third-degree TBSA, second-degree TBSA, total operating room visits, length of stay, Injury Severity Score, and death. A total of 47.2% of the patients had one or more episodes of fever with serious bacterial infection. In a generalized estimating equation predictive model, presence of a central line, second-, and third-degree TBSA were predictive of serious bacterial infection in burn patients with fever. In this study, individual clinical variables such as tachypnea and tachycardia were not predictive of serious bacterial infections, but the presence of a central line, and larger TBSA were significant predictors of serious bacterial infections. Younger age (P =.08) and ventilator support (P =.057) also approached significance as predictors of serious bacterial infections.

Distributed plasticity of locomotor pattern generators in spinal cord injured patients.

Science.gov (United States)

Grasso, Renato; Ivanenko, Yuri P; Zago, Myrka; Molinari, Marco; Scivoletto, Giorgio; Castellano, Vincenzo; Macellari, Velio; Lacquaniti, Francesco

2004-05-01

Recent progress with spinal cord injured (SCI) patients indicates that with training they can recover some locomotor ability. Here we addressed the question of whether locomotor responses developed with training depend on re-activation of the normal motor patterns or whether they depend on learning new motor patterns. To this end we recorded detailed kinematic and EMG data in SCI patients trained to step on a treadmill with body-weight support (BWST), and in healthy subjects. We found that all patients could be trained to step with BWST in the laboratory conditions, but they used new coordinative strategies. Patients with more severe lesions used their arms and body to assist the leg movements via the biomechanical coupling of limb and body segments. In all patients, the phase-relationship of the angular motion of the different lower limb segments was very different from the control, as was the pattern of activity of most recorded muscles. Surprisingly, however, the new motor strategies were quite effective in generating foot motion that closely matched the normal in the laboratory conditions. With training, foot motion recovered the shape, the step-by-step reproducibility, and the two-thirds power relationship between curvature and velocity that characterize normal gait. We mapped the recorded patterns of muscle activity onto the approximate rostrocaudal location of motor neuron pools in the human spinal cord. The reconstructed spatiotemporal maps of motor neuron activity in SCI patients were quite different from those of healthy subjects. At the end of training, the locomotor network reorganized at both supralesional and sublesional levels, from the cervical to the sacral cord segments. We conclude that locomotor responses in SCI patients may not be subserved by changes localized to limited regions of the spinal cord, but may depend on a plastic redistribution of activity across most of the rostrocaudal extent of the spinal cord. Distributed plasticity underlies

Orthobiologics in Pediatric Sports Medicine.

Science.gov (United States)

Bray, Christopher C; Walker, Clark M; Spence, David D

2017-07-01

Orthobiologics are biological substances that allow injured muscles, tendons, ligaments, and bone to heal more quickly. They are found naturally in the body; at higher concentrations they can aid in the healing process. These substances include autograft bone, allograft bone, demineralized bone matrix, bone morphogenic proteins, growth factors, stem cells, plasma-rich protein, and ceramic grafts. Their use in sports medicine has exploded in efforts to increase graft incorporation, stimulate healing, and get athletes back to sport with problems including anterior cruciate ligament ruptures, tendon ruptures, cartilage injuries, and fractures. This article reviews orthobiologics and their applications in pediatric sports medicine. Copyright © 2017 Elsevier Inc. All rights reserved.

Quantitative Evaluation of Segmentation- and Atlas-Based Attenuation Correction for PET/MR on Pediatric Patients.

Science.gov (United States)

Bezrukov, Ilja; Schmidt, Holger; Gatidis, Sergios; Mantlik, Frédéric; Schäfer, Jürgen F; Schwenzer, Nina; Pichler, Bernd J

2015-07-01

Pediatric imaging is regarded as a key application for combined PET/MR imaging systems. Because existing MR-based attenuation-correction methods were not designed specifically for pediatric patients, we assessed the impact of 2 potentially influential factors: inter- and intrapatient variability of attenuation coefficients and anatomic variability. Furthermore, we evaluated the quantification accuracy of 3 methods for MR-based attenuation correction without (SEGbase) and with bone prediction using an adult and a pediatric atlas (SEGwBONEad and SEGwBONEpe, respectively) on PET data of pediatric patients. The variability of attenuation coefficients between and within pediatric (5-17 y, n = 17) and adult (27-66 y, n = 16) patient collectives was assessed on volumes of interest (VOIs) in CT datasets for different tissue types. Anatomic variability was assessed on SEGwBONEad/pe attenuation maps by computing mean differences to CT-based attenuation maps for regions of bone tissue, lungs, and soft tissue. PET quantification was evaluated on VOIs with physiologic uptake and on 80% isocontour VOIs with elevated uptake in the thorax and abdomen/pelvis. Inter- and intrapatient variability of the bias was assessed for each VOI group and method. Statistically significant differences in mean VOI Hounsfield unit values and linear attenuation coefficients between adult and pediatric collectives were found in the lungs and femur. The prediction of attenuation maps using the pediatric atlas showed a reduced error in bone tissue and better delineation of bone structure. Evaluation of PET quantification accuracy showed statistically significant mean errors in mean standardized uptake values of -14% ± 5% and -23% ± 6% in bone marrow and femur-adjacent VOIs with physiologic uptake for SEGbase, which could be reduced to 0% ± 4% and -1% ± 5% using SEGwBONEpe attenuation maps. Bias in soft-tissue VOIs was less than 5% for all methods. Lung VOIs showed high SDs in the range of 15% for

Management of ureteric stone in pediatric patients

Directory of Open Access Journals (Sweden)

Eugene Minevich

2010-01-01

Full Text Available The management of ureteral stones in children is becoming more similar to that in adults. A number of factors must be taken into account when selecting one′s choice of therapy for ureteral stone in children such as the size of the stone, its location, its composition, and urinary tract anatomy. Endoscopic lithotripsy in children has gradually become a major technique for the treatment of ureteral stones. The stone-free rate following urteroscopic lithotripsy for ureteral stones has been reported in as high as 98.5-100%. The safety and efficacy of Holmium:YAG laser lithotripsy make it the intracorporeal lithotriptor of choice. Given its minimally invasive features, extracorporeal shock wave lithotripsy (ESWL has become a primary mode of treatment for the pediatric patients with reno-ureteral stones. Stone-free rates have been reported from 59% to 91% although some patients will require more than one treatment session for stone clearance. It appears that the first-line of therapy in the child with distal and mid-ureteral stones should be ureteroscopic lithotripsy. While ESWL is still widely considered the first-line therapy for proximal ureteral calculi, there is an increasing body of evidence that shows that endoscopic or ESWL are equally safe and efficacious in those clinical scenarios. Familiarity with the full spectrum of endourological techniques facilitates a minimally invasive approach to pediatric ureteral stones.

Anesthesia-related mortality in pediatric patients: a systematic review

OpenAIRE

Gonzalez, Leopoldo Palheta; Pignaton, Wangles; Kusano, Priscila Sayuri; Módolo, Norma Sueli Pinheiro; Braz, José Reinaldo Cerqueira; Braz, Leandro Gobbo

2012-01-01

This systematic review of the Brazilian and worldwide literature aimed to evaluate the incidence and causes of perioperative and anesthesia-related mortality in pediatric patients. Studies were identified by searching EMBASE (1951-2011), PubMed (1966-2011), LILACS (1986-2011), and SciElo (1995-2011). Each paper was revised to identify the author(s), the data source, the time period, the number of patients, the time of death, and the perioperative and anesthesia-related mortality rates. Twenty...

Periostitis secondary to interleukin-11 (Oprelvekin, Neumega). Treatment for thrombocytopenia in pediatric patients

International Nuclear Information System (INIS)

Milman, Edward; Berdon, Walter E.; Ruzal-Shapiro, Carrie; Garvin, James H.; Cairo, Mitchell S.; Bessmertny, Olga

2003-01-01

Interleukin-11 (Oprelvekin, Neumega) is a newly introduced thrombopoietic growth factor that stimulates production, differentiation, and maturation of megakaryocytes and platelets. Reversible periostitis has been reported as the side effect of the drug in primates and in the phase I/II trials. We report our experience with 5 cases of periostitis, occurring in thrombocytopenic children with three non-malignant and two malignant conditions, out of 24 pediatric patients treated with IL-11 at 75 μg/kg per day for a median of 17 days. The findings were noted in the clavicle or the proximal humerus. Two patients also had forearm and lower-extremity long-bone involvement. All patients had normal bones before IL-11 was given, changes occurred in both non-malignant and malignant diseases, and periostitis disappeared after use of the drug was discontinued. The distribution and appearance of the changes are similar to prostaglandin E1 and hypervitaminosis A. The changes are reversible after termination of treatment and are most noted in younger patients. The exact mechanism is not clear. The detection of periostitis makes it essential for the radiologists to enquire as to what medications patients are receiving. The pediatric doses (75 g/kg/d) are above those recommended for adult patients (50 g/kg/d) and this may account for the pediatric bone changes of periostitis. (orig.)

Use of intravenous acetaminophen (paracetamol) in a pediatric patient at the end of life: case report.

Science.gov (United States)

Marks, Adam D; Keefer, Patricia; Saul, D'Anna

2013-12-01

For the better part of 100 years, acetaminophen (or paracetamol as it is known outside of the United States) has been a common first-line analgesic in pediatrics and is typically well tolerated with minimal side effects. Its use as an anti-pyretic is also well-documented and thus it is used broadly for symptom control in the general pediatric population. In pediatric palliative care, acetaminophen is also used as an adjuvant to opioid therapy for pain as well as an anti-pyretic. For many pediatric patients near end-of-life, however, the ability to tolerate oral intake is diminished and rectal suppository administration can be distressing or contraindicated as in the setting of neutropenia, thus limiting use of acetaminophen by its usual routes. In Europe and Australia, an intravenous formulation of acetaminophen has been used for many years and has only recently become available in the United States. Here, we describe a case using intravenous acetaminophen in a pediatric patient at the end of life.

CBT for Pediatric Migraine: A Qualitative Study of Patient and Parent Experience.

Science.gov (United States)

Kroon Van Diest, Ashley M; Ernst, Michelle M; Vaughn, Lisa; Slater, Shalonda; Powers, Scott W

2018-03-08

The goal of this study was to determine which cognitive behavioral therapy (CBT-HA) treatment components pediatric headache patient stakeholders would report to be most helpful and essential to reducing headache frequency and related disability to develop a streamlined, less burdensome treatment package that would be more accessible to patients and families. Pediatric migraine is a prevalent and disabling condition. CBT-HA has been shown to reduce headache frequency and related disability, but may not be readily available or accepted by many migraine sufferers due to treatment burden entailed. Research is needed to determine systematic ways of reducing barriers to CBT-HA. Qualitative interviews were conducted with 10 patients and 9 of their parents who had undergone CBT-HA. Interviews were analyzed using an inductive thematic analysis approach based upon modified grounded theory. Patients were 13-17.5 years of age (M = 15.4, SD = 1.63) and had undergone CBT-HA ∼1-2 years prior to participating in the study. Overall, patients and their parents reported that CBT-HA was helpful in reducing headache frequency and related disability. Although patients provided mixed reports on the effectiveness of different CBT-HA skills, the majority of patients indicated that the mind and body relaxation skills of CBT-HA (deep breathing, progressive muscle relaxation, and activity pacing in particular) were the most helpful and most frequently used skills. Patients and parents also generally reported that treatment was easy to learn, and noted at least some aspect of treatment was enjoyable. Results from these qualitative interviews indicate that mind and body CBT-HA relaxation skills emerged as popular and effective based on patient and parent report. Future research examining the effectiveness of streamlined pediatric migraine nonpharmacological interventions should include these patient-preferred skills. © 2018 American Headache Society.

Prescribing practices for pediatric out-patients: A case study of two ...

African Journals Online (AJOL)

Purpose: The objective of this study was to evaluate drug utilization pattern in the pediatric ... Medication error can affect ... medication error may be caused by many factors ... pharmacokinetic .... prescriber's performance, patients experience at.

Low revision rate after total hip arthroplasty in patients with pediatric hip diseases

DEFF Research Database (Denmark)

Engesæter, Lars B; Engesæter, Ingvild Ø; Fenstad, Anne Marie

2012-01-01

Background The results of primary total hip arthroplasties (THAs) after pediatric hip diseases such as developmental dysplasia of the hip (DDH), slipped capital femoral epiphysis (SCFE), or Perthes' disease have been reported to be inferior to the results after primary osteoarthritis of the hip (OA.......9%) were operated due to pediatric hip diseases (3.1% for Denmark, 8.8% for Norway, and 1.9% for Sweden) and 288,435 THAs (77.8%) were operated due to OA. Unadjusted 10-year Kaplan-Meier survival of THAs after pediatric hip diseases (94.7% survival) was inferior to that after OA (96.6% survival......). Consequently, an increased risk of revision for hips with a previous pediatric hip disease was seen (risk ratio (RR) 1.4, 95% CI: 1.3-1.5). However, after adjustment for differences in sex and age of the patients, and in fixation of the prostheses, no difference in survival was found (93.6% after pediatric hip...

Evaluation of blood and serum markers in spinal cord injured patients with pressure sores.

Science.gov (United States)

Gurcay, Eda; Bal, Ajda; Gurcay, Ahmet G; Cakci, Aytul

2009-03-01

To evaluate blood and serum markers in traumatic spinal cord injured (SCI) patients, with and without pressure sores. This cross-sectional study was performed at the Ministry of Health Diskapi Yildirim Beyazit, and Numune Education and Research Hospitals, Ankara, Turkey, from 2006-2008. A total of 23 SCI patients with pressure sores (group I) and a control group of 25 SCI patients without pressure sores (group II) were evaluated. Characteristics of sores were examined with respect to duration, location, grade, tissue types, surface area, and exudate amount. Recorded laboratory parameters included erythrocyte sedimentation rates (ESR), C-reactive protein (CRP), hemoglobin (Hb), hematocrit (Htc), lymphocytes, white blood cells (WBC), red blood cells (RBC), serum iron, transferrin, total iron-binding capacity (TIBC), ferritin, total protein, albumin, vitamin B12, and zinc. The most common pressure sore location was the sacrum (38%). Compared to the control group, the patients with pressure sores showed anemia with reduced serum iron, transferrin, TIBC, and increased ferritin. They also had increased ESR, CRP, and WBC and reduced lymphocytes, total protein, albumin and zinc. Statistically significant correlations were found between CRP, Hb, Htc, lymphocytes, RBC, WBC, and serum protein levels, and grade of pressure sores. Clinicians should regularly screen patients with respect to blood and serum markers, in order to determine any risks for pressure sores, and they should perform immediate preventive measures based on the patient's condition.

Overuse of helicopter transport in the minimally injured: A health care system problem that should be corrected.

Science.gov (United States)

Vercruysse, Gary A; Friese, Randall S; Khalil, Mazhar; Ibrahim-Zada, Irada; Zangbar, Bardiya; Hashmi, Ammar; Tang, Andrew; O'Keeffe, Terrence; Kulvatunyou, Narong; Green, Donald J; Gries, Lynn; Joseph, Bellal; Rhee, Peter M

2015-03-01

Mortality benefit has been demonstrated for trauma patients transported via helicopter but at great cost. This study identified patients who did not benefit from helicopter transport to our facility and demonstrates potential cost savings when transported instead by ground. We performed a 6-year (2007-2013) retrospective analysis of all trauma patients presenting to our center. Patients with a known mode of transfer were included in the study. Patients with missing data and those who were dead on arrival were excluded from the study. Patients were then dichotomized into helicopter transfer and ground transfer groups. A subanalysis was performed between minimally injured patients (ISS helicopter and 76.7% (3,992) were transferred via ground transport. Helicopter-transferred patients had longer hospital (p = 0.001) and intensive care unit (p = 0.001) stays. There was no difference in mortality between the groups (p = 0.6).On subanalysis of minimally injured patients there was no difference in hospital length of stay (p = 0.1) and early discharge (p = 0.6) between the helicopter transfer and ground transfer group. Average helicopter transfer cost at our center was $18,000, totaling $4,860,000 for 270 minimally injured helicopter-transferred patients. Nearly one third of patients transported by helicopter were minimally injured. Policies to identify patients who do not benefit from helicopter transport should be developed. Significant reduction in transport cost can be made by judicious selection of patients. Education to physicians calling for transport and identification of alternate means of transportation would be both safe and financially beneficial to our system. Epidemiologic study, level III. Therapeutic study, level IV.

Pain-only complaint about cochlear implant device: A five-patient pediatric experience.

Science.gov (United States)

Todd, Norman Wendell; Fainberg, Jolie C; Ukatu, CeIsha Chinwe; Venable, Claudia Y; Segel, Phil

2015-09-01

To present the case histories and management of five pediatric patients who experienced pain at the receiver-stimulator site, but no other indication that the device was failing. Patients were from a sole-surgeon pediatric practice (600 + implant surgeries before June 2013; about even proportions of Advanced Bionics, Cochlear Corporation, and MED-EL devices). The University Institutional Review Board-approved review of sole-surgeon pediatric case series. The onset of pain ranged from 2 to 16 years post implantation. Pain, not amenable to conventional medical therapy, was present regardless of whether or not the external appliance was 'on', or even being worn on the head. Four of the five patients were bilaterally implanted, but pain was only at one receiver-stimulator package. Clinical management ultimately included revision surgery in all five cases, with immediate resolution of the pain in four. For those four, the replacement cochlear implant (CI) performed well; the other patient fears pain if her replacement device is used, but continues enjoying her contralateral implant. At analysis by the company, two of five explanted devices exhibited problems: loss of hermeticity; insulation failure. Though infrequently reported, pain-only complaint by a CI user is a challenging dilemma. Pain may be the sole clinical manifestation of cochlear implant device failure. We offer a flowchart for the care of CI patients with pain, encourage a worldwide registry of such cases, and offer ideas to try to understand better the problem.

Radiographic features of bisphosphonate therapy in pediatric patients

Energy Technology Data Exchange (ETDEWEB)

Grissom, L.E.; Theodore Harcke, H. [Dept. of Medical Imaging, Alfred I. duPont Hospital for Children, Nemours Children' s Clinic, Wilmington, DE (United States)

2003-04-01

Background: Pediatric patients are being treated with bisphosphonates for low bone mineral density. Skeletal radiographic findings have been described with bisphosphonates given orally and intravenously. Objective: To determine and describe the radiographic findings of cyclic intravenous bisphosphonate therapy in the growing skeleton. Materials and methods: Retrospective review of radiographs of 32 patients with osteogenesis imperfecta or cerebral palsy treated with intravenous bisphosphonates on a quarterly schedule. Results: Principal observations were metaphyseal bands and increased bone mineral density. The bands varied in spacing according to the age of the patient, rate of growth, and the location of the metaphysis. Fractures continued to be seen in patients with osteogenesis imperfecta. Conclusion: Cyclic bisphosphonate therapy results in distinctive radiographic findings in the growing skeleton. (orig.)

Radiographic features of bisphosphonate therapy in pediatric patients

International Nuclear Information System (INIS)

Grissom, L.E.; Theodore Harcke, H.

2003-01-01

Background: Pediatric patients are being treated with bisphosphonates for low bone mineral density. Skeletal radiographic findings have been described with bisphosphonates given orally and intravenously. Objective: To determine and describe the radiographic findings of cyclic intravenous bisphosphonate therapy in the growing skeleton. Materials and methods: Retrospective review of radiographs of 32 patients with osteogenesis imperfecta or cerebral palsy treated with intravenous bisphosphonates on a quarterly schedule. Results: Principal observations were metaphyseal bands and increased bone mineral density. The bands varied in spacing according to the age of the patient, rate of growth, and the location of the metaphysis. Fractures continued to be seen in patients with osteogenesis imperfecta. Conclusion: Cyclic bisphosphonate therapy results in distinctive radiographic findings in the growing skeleton. (orig.)

[Hospital-based psychological first aid provided to patients injured in the Lushan earthquake].

Science.gov (United States)

Yin, Min; Li, Xiao-Lin; Li, Jing; Huang, Xue-Hua; Tao, Qing-Lan; Luo, Xi

2015-04-01

In the aftermath of the 7.0 earthquake that struck Lushan in China's Sichuan Province on April 20, 2013, a psychological crisis intervention working group was established in a hospital that was treating earthquake victims. Patients at this hospital received psychological first aid that was delivered in accordance with scientific, systematic, and standardized principles. This first aid employed a "rooting mode" methodology and was designed as a supportive psychological intervention. Mental assessment results showed that the general mental health, acute stress reactions, and anxiety and depression status of all of the 131 injured who received the psychological intervention had significantly improved (p first aid, the approach used to organize the working groups, the main contents of the intervention, specific methods used, and intervention outcomes. This information is provided as a reference for providing localized psychological assistance in the aftermath of a disaster incident.

Clinical Course of Homozygous Hemoglobin Constant Spring in Pediatric Patients.

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Komvilaisak, Patcharee; Jetsrisuparb, Arunee; Fucharoen, Goonnapa; Komwilaisak, Ratana; Jirapradittha, Junya; Kiatchoosakun, Pakaphan

2018-04-17

Hemoglobin (Hb) Constant Spring is an alpha-globin gene variant due to a mutation of the stop codon resulting in the elongation of the encoded polypeptide from 141 to 172 amino acid residues. Patients with homozygous Hb Constant Spring are usually mildly anemic. We retrospectively describe clinical manifestations, diagnosis, laboratory investigations, treatment, and associated findings in pediatric patients with homozygous Hb Constant Spring followed-up at Srinagarind Hospital. Sixteen pediatric cases (5 males and 11 females) were diagnosed in utero (N=6) or postnatal (n=10). Eleven cases were diagnosed with homozygous Hb Constant Spring, 4 with homozygous Hb Constant Spring with heterozygous Hb E, and 1 with homozygous Hb Constant Spring with homozygous Hb E. Three cases were delivered preterm. Six patients had low birth weights. Clinical manifestations included fetal anemia in 6 cases, hepatomegaly in 1 case, hepatosplenomegaly in 2 cases, splenomegaly in 1 case. Twelve cases exhibited early neonatal jaundice, 9 of which required phototherapy. Six cases received red cell transfusions; 1 (3), >1 (3). After the first few months of life, almost all patients had mild microcytic hypochromic anemia and an increased reticulocyte count with a wide red cell distribution (RDW), but no longer required red cell transfusion. At 1 to 2 years of age, some patients still had mild microcytic hypochromic anemia and some had normocytic hypochromic anemia with Hb around 10 g/dL, increased reticulocyte count and wide RDW. Associated findings included hypothyroidism (2), congenital heart diseases (4), genitourinary abnormalities (3), gastrointestinal abnormalities (2), and developmental delay (1). Pediatric patients with homozygous Hb Constant Spring developed severe anemia in utero and up to the age of 2 to 3 months postnatal, requiring blood transfusions. Subsequently, their anemia was mild with no evidence of hepatosplenomegaly. Their Hb level was above 9 g/dL with hypochromic

The ALARA (as low as reasonably achievable) concept in pediatric interventional and fluoroscopic imaging: striving to keep radiation doses as low as possible during fluoroscopy of pediatric patients - a white paper executive summary

International Nuclear Information System (INIS)

Strauss, Keith J.; Kaste, Sue C.

2006-01-01

ALARA represents a practice mandate adhering to the principle of keeping radiation doses to patients and personnel As Low As Reasonably Achievable. This concept is strongly endorsed by the Society for Pediatric Radiology, particularly in the use of procedures and modalities involving higher radiation doses such as CT and fluoroscopic examinations of pediatric patients. There is no doubt that medical imaging, which has undergone tremendous technological advances in recent decades, is integral to patient care. However, these technological advances generally precede the knowledge of end-users concerning the optimal use and correct operation of the resulting imaging equipment, and such knowledge is essential to minimizing potential risks to the patients. Current imaging methods must be optimized for radiation dose reduction in pediatric patients who might be as much as ten times more radiosensitive than adults. Unlike straightforward radiographic examinations, radiation dose to the patient during fluoroscopy is dependent on the operator's training, experience with the fluoroscope, and efficiency in completing a diagnostic study. The range of pediatric radiation doses from fluoroscopy is wide because this examination is performed not only by pediatric radiologists but also by general radiologists who occasionally care for children, interventional cardiologists, gastroenterologists, urologists and others. Thus, a venue where multidisciplinary interaction by this variety of operators can occur serves to improve pediatric patient care

Endoscopic middle ear exploration in pediatric patients with conductive hearing loss.

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Carter, John M; Hoff, Stephen R

2017-05-01

To describe our indications, findings, and outcomes for transcanal endoscopic middle ear exploration in pediatric patients with conductive hearing loss of unknown etiology, without effusions. Prospective case series for all pediatric patients undergoing totally endoscopic transcanal middle ear exploration between April 2012 and October 2015 at a pediatric tertiary care referral hospital. Demographic data, operative findings, and hearing results were reviewed. 21 cases were performed in 20 ears (1 revision). Average age at surgery was 7.98 years and average follow up was 2.1 years. Middle ear pathology identified on CT imaging was confirmed in 55% of cases while identified in 45% of cases where pre-operative imaging was non-diagnostic. 6/20 patients (30%) had an ossicular deformity. 8/20(40%) had bony ossicular fixation. 5/20(25%) had ossicular discontinuity. 2/20(10%) had facial nerve dehiscence impinging on the stapes. 15% had adhesive myringosclerosis or severe granulation causing hearing loss. Prosthetic ossiculoplasty was done in 7/21 (33.3%) of the cases, with 1 TORP, 3 PORPs, and 3 IS joint replacements. Imaging was predictive of intra-operative findings in 13/20 cases (55%). Trainees assisted in 16/21(76%) of cases. The average improvement of PTA was 11.65 dB (range -10 to 36.25), and the average ABG improved 10.19 (range -11.25 to 28.75). There were no perioperative complications or adverse events. The endoscopic transcanal approach for middle ear exploration offers excellent visualization and is one of the best applications for the endoscopes in pediatric otology cases. This is particularly helpful for "unexplained" conductive hearing loss where ossicular deformity/fixation/discontinuity is suspected. The etiology of the conductive hearing loss was definitively found in 100% of cases, and can be repaired in the same sitting when applicable. Copyright © 2017 Elsevier B.V. All rights reserved.

When thoughts become action: an fMRI paradigm to study volitional brain activity in non-communicative brain injured patients.

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Boly, M; Coleman, M R; Davis, M H; Hampshire, A; Bor, D; Moonen, G; Maquet, P A; Pickard, J D; Laureys, S; Owen, A M

2007-07-01

The assessment of voluntary behavior in non-communicative brain injured patients is often challenging due to the existence of profound motor impairment. In the absence of a full understanding of the neural correlates of consciousness, even a normal activation in response to passive sensory stimulation cannot be considered as proof of the presence of awareness in these patients. In contrast, predicted activation in response to the instruction to perform a mental imagery task would provide evidence of voluntary task-dependent brain activity, and hence of consciousness, in non-communicative patients. However, no data yet exist to indicate which imagery instructions would yield reliable single subject activation. The aim of the present study was to establish such a paradigm in healthy volunteers. Two exploratory experiments evaluated the reproducibility of individual brain activation elicited by four distinct mental imagery tasks. The two most robust mental imagery tasks were found to be spatial navigation and motor imagery. In a third experiment, where these two tasks were directly compared, differentiation of each task from one another and from rest periods was assessed blindly using a priori criteria and was correct for every volunteer. The spatial navigation and motor imagery tasks described here permit the identification of volitional brain activation at the single subject level, without a motor response. Volunteer as well as patient data [Owen, A.M., Coleman, M.R., Boly, M., Davis, M.H., Laureys, S., Pickard J.D., 2006. Detecting awareness in the vegetative state. Science 313, 1402] strongly suggest that this paradigm may provide a method for assessing the presence of volitional brain activity, and thus of consciousness, in non-communicative brain-injured patients.

Recovery of injured Broca's portion of arcuate fasciculus in the dominant hemisphere in a patient with traumatic brain injury.

Science.gov (United States)

Jang, Sung Ho; Ha, Ji Wan; Kim, Hyun Young; Seo, You Sung

2017-12-01

Recovery of injured AF in patients with traumatic brain injury (TBI) has not been reported. In this study, we report on a patient with TBI who recovered from an injury to Broca's portion of AF in the dominant hemisphere, diagnosed by diffusion tensor tractography (DTT). A 28-year-old right-handed male patient suffered head trauma resulting from sliding while riding a motorcycle. He was diagnosed with a traumatic contusional hemorrhage in the left frontal lobe, subarachnoid hemorrhage, and subdural hemorrhage in the left fronto-temporal lobe. He underwent craniectomy on the left fronto-temporal area, and hematoma removal for the subdural hemorrhage in the neurosurgery department of a university hospital. Two weeks after the injury, he was transferred to the rehabilitation department of another university hospital. He showed severe aphasia and brain MRI showed leukomalactic lesion in the left frontal lobe. The result WAB for the patient showed severe aphasia, with an aphasia quotient of 45.3 percentile. However, his aphasia improved rapidly by 9 months with an aphasia quotient at the 100.0 percentile. 2-week DTT detected discontinuity in the subcortical white matter at the branch to Broca's area of left AF. By contrast, on 9-month DTT, the discontinued portion of left AF was elongated to the left Broca's area. Recovery of injured Broca's portion of AF in the dominant hemisphere along with excellent improvement of aphasia was demonstrated in a patient with TBI. This study has important implications in brain rehabilitation because the mechanism of recovery from aphasia following TBI has not been elucidated. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

A Review of Apps for Calming, Relaxation, and Mindfulness Interventions for Pediatric Palliative Care Patients

Directory of Open Access Journals (Sweden)

Taelyr Weekly

2018-01-01

Full Text Available Patients and families increasingly use mobile apps as a relaxation and distraction intervention for children with complex, chronic medical conditions in the waiting room setting or during inpatient hospitalizations; and yet, there is limited data on app quality assessment or review of these apps for level of engagement, functionality, aesthetics, or applicability for palliative pediatric patients. The pediatric palliative care study team searched smartphone application platforms for apps relevant to calming, relaxation, and mindfulness for pediatric and adolescent patients. Apps were reviewed using a systematic data extraction tool. Validated Mobile Application Rating Scale (MARS scores were determined by two blinded reviewers. Apps were then characterized by infant, child, adolescent, and adult caregiver group categories. Reviewer discussion resulted in consensus. Sixteen of the 22 apps identified were included in the final analysis. The apps operated on either iOS or Android platforms. All were available in English with four available in Spanish. Apps featured a relaxation approach (12/16, soothing images (8/16, and breathing techniques (8/16. Mood and sleep patterns were the main symptoms targeted by apps. Provision of mobile apps resource summary has the potential to foster pediatric palliative care providers’ knowledge of app functionality and applicability as part of ongoing patient care.

Critical assessment of pediatric neurosurgery patient/parent educational information obtained via the Internet.

Science.gov (United States)

Garcia, Michael; Daugherty, Christopher; Ben Khallouq, Bertha; Maugans, Todd

2018-05-01

OBJECTIVE The Internet is used frequently by patients and family members to acquire information about pediatric neurosurgical conditions. The sources, nature, accuracy, and usefulness of this information have not been examined recently. The authors analyzed the results from searches of 10 common pediatric neurosurgical terms using a novel scoring test to assess the value of the educational information obtained. METHODS Google and Bing searches were performed for 10 common pediatric neurosurgical topics (concussion, craniosynostosis, hydrocephalus, pediatric brain tumor, pediatric Chiari malformation, pediatric epilepsy surgery, pediatric neurosurgery, plagiocephaly, spina bifida, and tethered spinal cord). The first 10 "hits" obtained with each search engine were analyzed using the Currency, Relevance, Authority, Accuracy, and Purpose (CRAAP) test, which assigns a numerical score in each of 5 domains. Agreement between results was assessed for 1) concurrent searches with Google and Bing; 2) Google searches over time (6 months apart); 3) Google searches using mobile and PC platforms concurrently; and 4) searches using privacy settings. Readability was assessed with an online analytical tool. RESULTS Google and Bing searches yielded information with similar CRAAP scores (mean 72% and 75%, respectively), but with frequently differing results (58% concordance/matching results). There was a high level of agreement (72% concordance) over time for Google searches and also between searches using general and privacy settings (92% concordance). Government sources scored the best in both CRAAP score and readability. Hospitals and universities were the most prevalent sources, but these sources had the lowest CRAAP scores, due in part to an abundance of self-marketing. The CRAAP scores for mobile and desktop platforms did not differ significantly (p = 0.49). CONCLUSIONS Google and Bing searches yielded useful educational information, using either mobile or PC platforms. Most

Prevalence of Symptomatic Lumbar Spondylolysis in Pediatric Patients.

Science.gov (United States)

Nitta, Akihiro; Sakai, Toshinori; Goda, Yuichiro; Takata, Yoichiro; Higashino, Kosaku; Sakamaki, Tadanori; Sairyo, Koichi

2016-05-01

Lumbar spondylolysis, a stress fracture of the pars interarticularis, is prevalent in adolescent athletes. Recent advances in diagnostic tools and techniques enable early diagnosis before these fractures progress to complete fractures through the pars. However, because patients often consult family physicians for primary care of low back pain and these physicians may not have access to diagnostic modalities such as magnetic resonance imaging (MRI) and computed tomography, stress fractures can be missed. This study surveyed the prevalence of symptomatic spondylolysis in pediatric patients who consulted an orthopedic clinic for primary care and investigated whether such acute stress fractures may be overlooked without MRI. The prospective study investigated 264 patients who were younger than 19 years and had low back pain. Of the 153 patients (58.0%) with low back pain persisting for longer than 2 weeks, 136 who agreed to undergo MRI were included in the study. This group included 11 elementary school students, 71 junior high school students, and 54 high school students. The overall prevalence of lumbar spondylolysis was 39.7% (54 of 136) and was 9.3% in elementary school students (5 of 11, 45.5%), 59.3% in junior high school students (32 of 71, 45.1%), and 31.5% in high school students (17 of 54, 31.5%). All 54 patients with spondylolysis had a history of athletic activity. Primary care physicians should recognize that approximately 40% of pediatric patients presenting with low back pain persisting for longer than 2 weeks may have spondylolysis and should consider MRI in those with a history of athletic activity. Because the spine is immature in this age group, almost half of affected elementary school and junior high school students may have lumbar spondylolysis. [Orthopedics. 2016; 39(3):e434-e437.]. Copyright 2016, SLACK Incorporated.

Diagnostic radiology on multiple injured patients: interdisciplinary management; Radiologische Diagnostik beim Polytrauma: interdisziplinaeres Management

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Linsenmaier, U.; Pfeifer, K.J. [Inst. fuer Radiologische Diagnostik, Klinikum der Univ. Muenchen (Germany); Kanz, K.G.; Mutschler, W. [Chirurgische Klinik Innenstadt, Klinikum der Univ. Muenchen, (Germany)

2001-06-01

The presence of a radiologist within the admitting area of an emergency department and his capability as a member of the trauma team have a major impact on the role of diagnostic radiology in trauma care. The knowledge of clinical decision criteria, algorithms, and standards of patient care are essential for the acceptance within a trauma team. We present an interdisciplinary management concept of diagnostic radiology for trauma patients, which comprises basic diagnosis, organ diagnosis, radiological ABC, and algorithms of early clinical care. It is the result of a prospective study comprising over 2000 documented multiple injured patients. The radiologist on a trauma team should support trauma surgery and anesthesia in diagnostic and clinical work-up. The radiological ABC provides a structured approach for diagnostic imaging in all steps of the early clinical care of the multiple injured patient. Radiological ABC requires a reevaluation in cases of equivocal findings or difficulties in the clinical course. Direct communication of radiological findings with the trauma team enables quick clinical decisions. In addition, the radiologist can priority-oriented influence the therapy by using interventional procedures. The clinical radiologist is an active member of the interdisciplinary trauma team, not only providing diagnostic imaging but also participating in clinical decisions. (orig.) [German] Die Anwesenheit des Radiologen im Schockraum und dessen Teamfaehigkeit bestimmen den Status der diagnostischen Radiologie in der Traumaversorgung. Voraussetzung zur Mitarbeit im interdisziplinaeren Traumateam ist die detaillierte Kenntnis der wesentlichen Entscheidungskriterien, Algorithmen und Behandlungsablaeufe. Das hier vorgestellte interdisziplinaere Managementkonzept der radiologischen Diagnostik beim Polytrauma mit Basisdiagnostik, Organdiagnostik, radiologischer ABC-Regel und Algorithmen zur fruehklinischen Behandlung beruht auf einer prospektiven Polytraumastudie mit

Outpatient dermatology consultation impacts the diagnosis and management of pediatric oncology patients: A retrospective study.

Science.gov (United States)

Song, Hannah; Robinson, Sarah N; Huang, Jennifer T

2017-11-01

The impact of dermatology consultation on the care of children with oncologic conditions is unknown. To review outpatient dermatology visits and the resulting impact on diagnosis and management of pediatric oncology patients. Retrospective review of pediatric oncology patients with outpatient dermatology visits at a tertiary care center from 2008 to 2015. The most common dermatologic diagnoses in 516 patients were skin infections (21.3%) and nonmalignant skin eruptions (33.4%). A diagnosis of significant impact (ie, malignancy, adverse cutaneous drug reaction, graft-versus-host disease, varicella-zoster virus, or herpes simplex virus infection), was made at the dermatology clinic in 14.7% of visits. Consultation resulted in a change in diagnosis in 59.8% of patients, change in dermatologic management in 72.4% of patients, and change in management of noncutaneous issues in 12.4% of patients. The use of electronic medical records, the nongeneralizable study population, and the retrospective design represent potential limitations. Outpatient dermatology consultation can affect the care of pediatric oncology patients with respect to diagnosis and treatment of skin conditions and management of nondermatologic issues. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Autoantibody Profiling in a Cohort of Pediatric and Adult Patients With Autoimmune Hepatitis.

Science.gov (United States)

Villalta, Danilo; Girolami, Elia; Alessio, Maria Grazia; Sorrentino, Maria Concetta; Tampoia, Marilina; Brusca, Ignazio; Daves, Massimo; Porcelli, Brunetta; Barberio, Giuseppina; Conte, Mariaelisabetta; Pantarotto, Lisa; Bizzaro, Nicola

2016-01-01

Autoimmune hepatitis (AIH) is a rare condition characterized by the presence of autoantibodies distinctive of type 1 AIH (AIH-1) and type 2 AIH (AIH-2). The aim of this study was to evaluate the autoantibody profile in a cohort of pediatric and adult AIH patients, using both indirect immunofluorescence (IIF) and a new multiplexed line-blot assay. Sera from 63 pediatric and 53 adult AIH patients were tested for antinuclear (ANA), antismooth muscle (SMA), anti-liver kidney microsome 1 (anti-LKM1), anti-liver cytosol 1 (anti-LC1) autoantibodies using IIF methods; for anti-LKM1, anti-LC1, and soluble liver antigen/liver-pancreas (anti-SLA/LP) autoantibodies using the line-blot; for anti-F-actin autoantibodies using IIF both on VSM47 cell-line and on rat intestinal epithelial cells. AIH-1 was the most common type of AIH in the adult cohort (73.6%), while AIH-2 was the most common AIH in the pediatric cohort (61.9%). Both in adult and pediatric AIH-2 anti-LKM1 were the prevalent autoantibodies. In pediatric AIH-2 anti-LC1 autoantibodies were more frequent than in adult AIH-2 (59 vs. 28.6%), and in 35.9% of cases they were present alone. In 17 patients anti-LC1 autoantibodies were detected only with the line-blot assay. The levels of anti-LKM1 and of anti-LC1 were not different between adult and pediatric AIH, and the overall agreement between the results obtained with the two IIF methods for F-actin detection was 98.8% (CI 95%: 94.4-99.7%). The line-blot assay showed a higher sensitivity than IIF for anti-LC1 detection. Anti-LKM1 and anti-LC1 autoantibody levels are not different in adults and children. An almost perfect agreement between the two IIF methods for anti-F-actin detection has been observed. © 2014 Wiley Periodicals, Inc.

Association between MDR1 gene polymorphisms and the risk of Crohn's disease in a cohort of Algerian pediatric patients.

Science.gov (United States)

Bouzidi, Amira; Mesbah-Amroun, Hamida; Boukercha, Aziza; Benhassine, Fadila; Belboueb, Réda; Berkouk, Karima; Messadi, Wassila; Touil-Boukoffa, Chafia

2016-12-01

The multi-drug resistance gene (MDR1) has raised increasing interest as a susceptibility gene for Crohn's disease (CD). The role of MDR1 single-nucleotide polymorphisms (SNPs) in the predisposition and behavior of CD in the pediatric population is still elusive. Here, we investigated whether SNPs in MDR1 are associated with CD in Algerian pediatric patients. A case-control study was conducted enrolling 47 pediatric CD patients and 100 controls. All subjects were genotyped for the most common MDR1 SNPs (C3434T, C1236T, and G2677A/T) using PCR-RFLP method. We also explored the association between polymorphisms and clinical sub-phenotypes. We have detected no significant association of C3435T SNP and pediatric CD. However, we observed a significantly higher frequency of the risk alleles, 1236T and 2677T/A among the CD patients compared to controls. Moreover, the risk allele 1236T was associated to a higher risk for resective surgery. Our data suggest that the C1236T and G2677A/T SNPs in the MDR1 gene are associated with CD and the C1236T risk allele with a more severe course of disease in Algerian pediatric patients. Further analysis using larger patients group and functional studies would be interesting to elucidate the role of MDR1 gene in pediatric CD.Pediatric Research (2016); doi:10.1038/pr.2016.163.

Metabolic alkalosis in children: Study of patients admitted to pediatrics center

Directory of Open Access Journals (Sweden)

Sobhani A

2001-07-01

Full Text Available Metabolic alkalosis is characterized by high HCO3- as it is seen in chronic respiratory acidosis, but PH differentiates the two disorders. There is no characteristic symptom or sign. Orthostatic hypotension may be encountered. Weakness and hyporeflexia occur if serum K+ is markerdly low. Tetany and neuromuscular irritability occur rarely. We report the results of retrospective data analysis of metabolic alkalosis in 15463 patients hospitalized Pediatric Medical Center in Tehran during years 1995-1997. We found 50 cases of metabolic alkalosis (rate of 0.32 percent. 64 precent male and 36 percent female. Most of them had growth failure (40% were bellow 3 percentile of height by age, 44% bellow 5 percentile of weight by height. More than 60 percent had hypokalemia, hypocloremia and hyponatremia. The most common cause of Metabolic alkalosis was cystic fibrosis and pyloric stenosis. Fifty percent of cystic fibrosis patients and Bartter cases had metabolic alkalosis. Metabolic alkalosis should be considered in every pediatric patient presented with projectile vomitting.

Development of a radiopharmaceutical dose calculator for pediatric patients undergoing diagnostic nuclear medicine studies

International Nuclear Information System (INIS)

Pandey, Anil Kumar; Sharma, Sanjay Kumar; Sharma, Punit; Gupta, Priyanka; Kumar, Rakesh

2013-01-01

It is important to ensure that as low as reasonably achievable (ALARA) concept during the radiopharmaceutical (RPH) dose administration in pediatric patients. Several methods have been suggested over the years for the calculation of individualized RPH dose, sometimes requiring complex calculations and large variability exists for administered dose in children. The aim of the present study was to develop a software application that can calculate and store RPH dose along with patient record. We reviewed the literature to select the dose formula and used Microsoft Access (a software package) to develop this application. We used the Microsoft Excel to verify the accurate execution of the dose formula. The manual and computer time using this program required for calculating the RPH dose were compared. The developed application calculates RPH dose for pediatric patients based on European Association of Nuclear Medicine dose card, weight based, body surface area based, Clark, Solomon Fried, Young and Webster's formula. It is password protected to prevent the accidental damage and stores the complete record of patients that can be exported to Excel sheet for further analysis. It reduces the burden of calculation and saves considerable time i.e., 2 min computer time as compared with 102 min (manual calculation with the calculator for all seven formulas for 25 patients). The software detailed above appears to be an easy and useful method for calculation of pediatric RPH dose in routine clinical practice. This software application will help in helping the user to routinely applied ALARA principle while pediatric dose administration. (author)

Pediatric acquired brain injury.

Science.gov (United States)

Bodack, Marie I

2010-10-01

Although pediatric patients are sometimes included in studies about visual problems in patients with acquired brain injury (ABI), few studies deal solely with children. Unlike studies dealing with adult patients, in which mechanisms of brain injury are divided into cerebral vascular accident (CVA) and traumatic brain injury (TBI), studies on pediatric patients deal almost exclusively with traumatic brain injury, specifically caused by accidents. Here we report on the vision problems of 4 pediatric patients, ages 3 to 18 years, who were examined in the ophthalmology/optometry clinic at a children's hospital. All patients had an internally caused brain injury and after the initial insult manifested problems in at least one of the following areas: acuity, binocularity, motility (tracking or saccades), accommodation, visual fields, and visual perceptual skills. Pediatric patients can suffer from a variety of oculo-visual problems after the onset of head injury. These patients may or may not be symptomatic and can benefit from optometric intervention. Copyright © 2010 American Optometric Association. Published by Elsevier Inc. All rights reserved.

Characteristics of the technical parameters in the realization of computed tomography studies in pediatric patients in Bogota

International Nuclear Information System (INIS)

Triana, Gustavo; Romero, Javier; Rivero, Oscar; Sosa, Daniel; Patarroyo, Edith

2005-01-01

The use of Computed Tomography (CT) examinations for the diagnosis of common pathologies in pediatric patients has increase. This implies an increase in the radiation doses that pediatric patients received, therefore increasing the risk of secondary mortality due to cancer throughout life. In recent papers, the recommended radiation doses for pediatric patients in agreement with the concept ALARA (As Low As Reasonably Achievable) has settled down. This study evaluates the CT technical parameters of pediatric examinations in Bogota city, and review if they have been fitted with parameters recommended according to age and body weight. Materials and methods: A non-probabilistic sampling of 46 scanning tests were applied to children in six different institutions in Bogota; the technical parameters of kv and second mAs were checked of studies in abdomen, thorax and skeletal muscle system. Results: It was found that the technical parameters used in TC in children are higher of the recommended; the group of 4-year-old is the most affected by dos e of unnecessary radiation. Discussion and conclusions: The information from the protection of the radiation must be spread to the whole radiology personnel of the institutions that fulfill scanning tests of pediatric patients. ar zones that influences the wetland

Fertility Preservation Counseling for Pediatric and Adolescent Cancer Patients.

Science.gov (United States)

Campbell, Jessica E; Assanasen, Chatchawin; Robinson, Randal D; Knudtson, Jennifer F

2016-03-01

Fertility preservation for children and young adults with cancer is an important part of comprehensive patient care. In 2013, the American Society of Clinical Oncology (ASCO) released updated clinical practice guidelines addressing fertility preservation. This study aimed to evaluate if pediatric oncologists were performing fertility preservation counseling, if the new guidelines were being adopted, and how reproductive endocrinologists can educate this patient population and their providers. A cross-sectional study was performed from May 26, 2014, to August 26, 2014. An online survey addressing fertility preservation practice patterns was created and provided to the members of the Children's Oncology Group (COG). Thirty-five percent of the 234 respondents reported reading the new 2013 ASCO guidelines. Ninety-five percent of providers reported mentioning fertility preservation options prior to treatment, most commonly including referral to a reproductive endocrinologist (28%), and sperm banking (57%). The most commonly reported barrier to fertility preservation counseling was the cost of treatment. Fertility preservation counseling is being performed by pediatric oncology providers. Familiarity of the ASCO guidelines is limited, revealing that the established methods for fertility preservation in women--embryo and oocyte cryopreservation--may be offered less than experimental methods in this younger patient population. Such differences in apparent practice patterns highlight the need for more education for providers.

Radiologic head CT interpretation errors in pediatric abusive and non-abusive head trauma patients

International Nuclear Information System (INIS)

Kralik, Stephen F.; Finke, Whitney; Wu, Isaac C.; Ho, Chang Y.; Hibbard, Roberta A.; Hicks, Ralph A.

2017-01-01

Pediatric head trauma, including abusive head trauma, is a significant cause of morbidity and mortality. The purpose of this research was to identify and evaluate radiologic interpretation errors of head CTs performed on abusive and non-abusive pediatric head trauma patients from a community setting referred for a secondary interpretation at a tertiary pediatric hospital. A retrospective search identified 184 patients <5 years of age with head CT for known or potential head trauma who had a primary interpretation performed at a referring community hospital by a board-certified radiologist. Two board-certified fellowship-trained neuroradiologists at an academic pediatric hospital independently interpreted the head CTs, compared their interpretations to determine inter-reader discrepancy rates, and resolved discrepancies to establish a consensus second interpretation. The primary interpretation was compared to the consensus second interpretation using the RADPEER trademark scoring system to determine the primary interpretation-second interpretation overall and major discrepancy rates. MRI and/or surgical findings were used to validate the primary interpretation or second interpretation when possible. The diagnosis of abusive head trauma was made using clinical and imaging data by a child abuse specialist to separate patients into abusive head trauma and non-abusive head trauma groups. Discrepancy rates were compared for both groups. Lastly, primary interpretations and second interpretations were evaluated for discussion of imaging findings concerning for abusive head trauma. There were statistically significant differences between primary interpretation-second interpretation versus inter-reader overall and major discrepancy rates (28% vs. 6%, P=0.0001; 16% vs. 1%, P=0.0001). There were significant differences in the primary interpretation-second interpretation overall and major discrepancy rates for abusive head trauma patients compared to non-abusive head trauma

Radiologic head CT interpretation errors in pediatric abusive and non-abusive head trauma patients

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Kralik, Stephen F.; Finke, Whitney; Wu, Isaac C.; Ho, Chang Y. [Indiana University School of Medicine, Department of Radiology and Imaging Sciences, Indianapolis, IN (United States); Hibbard, Roberta A.; Hicks, Ralph A. [Indiana University School of Medicine, Department of Pediatrics, Section of Child Protection Programs, Indianapolis, IN (United States)

2017-07-15

Pediatric head trauma, including abusive head trauma, is a significant cause of morbidity and mortality. The purpose of this research was to identify and evaluate radiologic interpretation errors of head CTs performed on abusive and non-abusive pediatric head trauma patients from a community setting referred for a secondary interpretation at a tertiary pediatric hospital. A retrospective search identified 184 patients <5 years of age with head CT for known or potential head trauma who had a primary interpretation performed at a referring community hospital by a board-certified radiologist. Two board-certified fellowship-trained neuroradiologists at an academic pediatric hospital independently interpreted the head CTs, compared their interpretations to determine inter-reader discrepancy rates, and resolved discrepancies to establish a consensus second interpretation. The primary interpretation was compared to the consensus second interpretation using the RADPEER trademark scoring system to determine the primary interpretation-second interpretation overall and major discrepancy rates. MRI and/or surgical findings were used to validate the primary interpretation or second interpretation when possible. The diagnosis of abusive head trauma was made using clinical and imaging data by a child abuse specialist to separate patients into abusive head trauma and non-abusive head trauma groups. Discrepancy rates were compared for both groups. Lastly, primary interpretations and second interpretations were evaluated for discussion of imaging findings concerning for abusive head trauma. There were statistically significant differences between primary interpretation-second interpretation versus inter-reader overall and major discrepancy rates (28% vs. 6%, P=0.0001; 16% vs. 1%, P=0.0001). There were significant differences in the primary interpretation-second interpretation overall and major discrepancy rates for abusive head trauma patients compared to non-abusive head trauma

Treating Lennox–Gastaut syndrome in epileptic pediatric patients with third-generation rufinamide

Directory of Open Access Journals (Sweden)

Jessica Gresham

2010-09-01

Full Text Available Jessica Gresham1, Lea S Eiland2,3, Allison M Chung2,41Auburn University, Harrison School of Pharmacy (AUHSOP, 2Department of Pharmacy Practice, AUHSOP, 3University of Alabama, School of Medicine, Huntsville Regional Medical Campus, 4University of South Alabama School of Medicine, Department of Pediatrics, Mobile, Alabama, USAAbstract: Lennox–Gastaut syndrome (LGS is a rare but debilitating pediatric epileptic encephalopathy characterized by multiple intractable seizure types. Treatment of LGS is challenging because of the small number of antiepileptic drugs (AEDs which are effective for this syndrome, as well as the need for polytherapy in the majority of patients. This review focuses on the treatment of LGS with rufinamide, a recently approved third-generation AED with reported efficacy as adjunctive therapy for LGS. All relevant papers identified through a PubMed search on the treatment of LGS with rufinamide were reviewed. To date, the literature suggests improvements in seizure frequency for pediatric patients with LGS on rufinamide. Rufinamide appears to be especially effective for atonic or drop attack seizures. Rufinamide also displays a favorable adverse event profile compared with the older anticonvulsants, as well as a minimal number of drug interactions, making it a promising option for the adjunctive treatment of seizures associated with LGS.Keywords: epilepsy, Lennox-Gastaut syndrome, pediatrics, seizure, rufinamide

A New Weighted Injury Severity Scoring System: Better Predictive Power for Pediatric Trauma Mortality.

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Shi, Junxin; Shen, Jiabin; Caupp, Sarah; Wang, Angela; Nuss, Kathryn E; Kenney, Brian; Wheeler, Krista K; Lu, Bo; Xiang, Henry

2018-05-02

An accurate injury severity measurement is essential for the evaluation of pediatric trauma care and outcome research. The traditional Injury Severity Score (ISS) does not consider the differential risks of the Abbreviated Injury Scale (AIS) from different body regions nor is it pediatric specific. The objective of this study was to develop a weighted injury severity scoring (wISS) system for pediatric blunt trauma patients with better predictive power than ISS. Based on the association between mortality and AIS from each of the six ISS body regions, we generated different weights for the component AIS scores used in the calculation of ISS. The weights and wISS were generated using the National Trauma Data Bank (NTDB). The Nationwide Emergency Department Sample (NEDS) was used to validate our main results. Pediatric blunt trauma patients less than 16 years were included, and mortality was the outcome. Discrimination (areas under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, negative predictive value, concordance) and calibration (Hosmer-Lemeshow statistic) were compared between the wISS and ISS. The areas under the receiver operating characteristic curves from the wISS and ISS are 0.88 vs. 0.86 in ISS=1-74 and 0.77 vs. 0.64 in ISS=25-74 (ppredictive value, negative predictive value, and concordance when they were compared at similar levels of sensitivity. The wISS had better calibration (smaller Hosmer-Lemeshow statistic) than the ISS (11.6 versus 19.7 for ISS=1-74 and 10.9 versus 12.6 for ISS= 25-74). The wISS showed even better discrimination with the NEDS. By weighting the AIS from different body regions, the wISS had significantly better predictive power for mortality than the ISS, especially in critically injured children.Level of Evidence and study typeLevel IV Prognostic/Epidemiological.

The impact of transport of critically ill pediatric patients on rural emergency departments in Manitoba.

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Hansen, Gregory; Beer, Darcy L; Vallance, Jeff K

2017-01-01

Although the interfacility transport (IFT) of critically ill pediatric patients from rural to tertiary health centres may improve outcomes, the impact of IFTs on the rural referring centre is not known. The purpose of this study was to investigate how the IFT of critically ill children affects staffing and functionality of rural emergency departments (EDs) in Manitoba. In 2015, surveys were emailed to the medical directors of all 15 regional EDs within 2 hours' travel time from a tertiary pediatric hospital. The survey consisted of 9 questions that addressed baseline characteristics of the regional EDs and duration of ED staffing changes or closures due to IFT of critically ill pediatric patients. Ten surveys were received (67% response rate); a regional ED catchment population of about 130 000 people was represented. Interfacility transport caused most EDs (60%, with an average catchment population of 15 000) to close or to alter their staffing to a registered nurse only. These temporary changes lasted a cumulative total of 115 hours. Interfacility transport of critically ill pediatric patients resulted in ED closures and staffing changes in rural Manitoba. These findings suggest that long-term sustainable solutions are required to improve access to emergency care.

The Role and Impact of Animals with Pediatric Patients.

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Goddard, Anna Tielsch; Gilmer, Mary Jo

2015-01-01

Animal-facilitated therapy (AFT), more specifically known as animal-assisted therapy (AAT) or "pet therapy," has had an increased presence in the literature with a surge of recent research methodologies exploring this complementary alternative medicine (CAM) intervention. However, limited studies have been conducted in the pediatric population, with many articles anecdotal in nature. A literature review included primary data sources PubMed, PsychINFO, Medline, and CINAHL, and yielded positive and beneficial outcomes to be gained through AAT in the pediatric population. Primary outcome variables of decreased anxiety and pain are the most commonly reported results. Further research studies are indicated to include the effects of AFT with children with different diseases and diagnoses. Exploration of other psychosocial and physical variables, such as self-esteem, would be useful. Interdisciplinary strategies are needed to develop interventions to help reduce patient symptoms and treatment-associated stress, as well as to facilitate healing and wellness beyond traditional medical treatment plans. Complementary therapies are of continued interest to the health care community, especially for pediatric nurses. Effective use of animals to facilitate conversation, lead discussion, or break communication barriers has been demonstrated through both research and anecdotal reports.

MULTIFOCAL RETINAL INFILTRATES WITH PHLEBITIS AND OPTIC NEUROPATHY IN AN HIV-POSITIVE PEDIATRIC PATIENT.

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Kasi, Sundeep K; Vora, Robin A; Martin, Taliva; Cunningham, Emmett T

2015-01-01

To describe an unusual presentation of bilateral HIV-associated multifocal retinal infiltrates with phlebitis and optic neuropathy in a pediatric patient from Zimbabwe, Africa. Retrospective case report of a 15-year-old boy from Zimbabwe, Africa. The patient was found to have bilateral vitritis, multifocal retinitis with phlebitis, and optic neuropathy in the setting of previously unrecognized HIV infection. Vision improved and the clinical findings resolved after treatment with intravenous corticosteroids and highly active retroviral therapy (HAART). The authors describe the occurrence and treatment of bilateral, HIV-associated multifocal retinal infiltrates with phlebitis and HIV-associated optic neuropathy in a pediatric patient from Zimbabwe, Africa.

Idiopathic intracranial hypertension in pediatric patients

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Nada Jirásková

2008-11-01

Full Text Available Nada Jirásková, Pavel RozsívalDepartment of Ophthalmology, University Hospital, Hradec Králové, Czech RepublicPurpose: To evaluate retrospectively the features, treatment, and outcome of idiopathic intracranial hypertension (IIH in children.Methods: Nine patients, 15 years and younger, diagnosed with IIH. Inclusion criteria were papilledema, normal brain computer tomography or magnetic resonance imaging, cerebrospinal fluid pressure greater than 250 mm H2O, normal cerebrospinal fluid content, and a nonfocal neurologic examination except for sixth nerve palsy.Results: Of the nine patients, eight were girls. Five girls were overweight and one boy was obese. The most common presenting symptom was headache (5 patients. Diplopia or strabismus did not occur in our group. Visual field abnormalities were present in all eyes, and severe visual loss resulting in light perception vision occurred in both eyes of one patient. Eight patients were treated medically with acetazolamide alone, and one girl needed a combination of acetazolamide and corticosteroids. This girl also required optic nerve sheath decompression surgery. Resolution of papilledema and recovery of visual function occurred in all patients.Conclusions: Idiopathic intracranial hypertension in prepubertal children is rather uncommon. Prompt diagnosis and management are important to prevent permanent visual loss.Keywords: idiopathic intracranial hypertension, pediatric, treatment

Utilizing a Pediatric Disaster Coalition Model to Increase Pediatric Critical Care Surge Capacity in New York City.

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Frogel, Michael; Flamm, Avram; Sagy, Mayer; Uraneck, Katharine; Conway, Edward; Ushay, Michael; Greenwald, Bruce M; Pierre, Louisdon; Shah, Vikas; Gaffoor, Mohamed; Cooper, Arthur; Foltin, George

2017-08-01

A mass casualty event can result in an overwhelming number of critically injured pediatric victims that exceeds the available capacity of pediatric critical care (PCC) units, both locally and regionally. To address these gaps, the New York City (NYC) Pediatric Disaster Coalition (PDC) was established. The PDC includes experts in emergency preparedness, critical care, surgery, and emergency medicine from 18 of 25 major NYC PCC-capable hospitals. A PCC surge committee created recommendations for making additional PCC beds available with an emphasis on space, staff, stuff (equipment), and systems. The PDC assisted 15 hospitals in creating PCC surge plans by utilizing template plans and site visits. These plans created an additional 153 potential PCC surge beds. Seven hospitals tested their plans through drills. The purpose of this article was to demonstrate the need for planning for disasters involving children and to provide a stepwise, replicable model for establishing a PDC, with one of its primary goals focused on facilitating PCC surge planning. The process we describe for developing a PDC can be replicated to communities of any size, setting, or location. We offer our model as an example for other cities. (Disaster Med Public Health Preparedness. 2017;11:473-478).

Managing the pediatric patient with celiac disease: a multidisciplinary approach

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Isaac DM

2016-10-01

Full Text Available Daniela Migliarese Isaac,1 Jessica Wu,2 Diana R Mager,3,4 Justine M Turner1 1Department of Pediatric Gastroenterology and Nutrition, Faculty of Medicine and Dentistry, University of Alberta; 2Alberta Health Services–Child Health Nutrition Services, Stollery Children’s Hospital; 3Department of Agriculture, Food and Nutritional Science; 4Department of Pediatrics, University of Alberta, Edmonton, AB, Canada Abstract: Celiac disease (CD is an autoimmune reaction to gluten, leading to intestinal inflammation, villous atrophy, and malabsorption. It is the most common autoimmune gastrointestinal disorder, with an increasing prevalence. A life-long gluten-free diet (GFD is an effective treatment to alleviate symptoms, normalize autoantibodies, and heal the intestinal mucosa in patients with CD. Poorly controlled CD poses a significant concern for ongoing malabsorption, growth restriction, and the long-term concern of intestinal lymphoma. Achieving GFD compliance and long-term disease control poses a challenge, with adolescents at particular risk for high rates of noncompliance. Attention has turned toward innovative management strategies to improve adherence and achieve better disease control. One such strategy is the development of multidisciplinary clinic approach, and CD is a complex life-long disease state that would benefit from a multifaceted team approach as recognized by multiple national and international bodies, including the National Institutes of Health. Utilizing the combined efforts of the pediatric gastroenterologist, registered dietitian, registered nurse, and primary care provider (general practitioner or general pediatrician in a CD multidisciplinary clinic model will be of benefit for patients and families in optimizing diagnosis, provision of GFD teaching, and long-term adherence to a GFD. This paper discusses the benefits and proposed structure for multidisciplinary care in improving management of CD. Keywords: celiac disease

Sleep and adverse environmental factors in sedated mechanically ventilated pediatric intensive care patients.

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Al-Samsam, Rim H; Cullen, Pauline

2005-09-01

To document the quantity and architecture of sleep using objective electrophysiologic assessment in sedated mechanically ventilated pediatric intensive care unit patients over a 24-hr period and to investigate the effect of noise and staff interventions on sleep pattern in these subjects. Prospective observational study. Pediatric intensive care unit at a university hospital. A total of 11 patients studied between September 2000 and June 2001, with ages ranging from 3 to 21 months. All patients were intubated, mechanically ventilated, and sedated with morphine and midazolam infusions. Limited sleep polysomnograph, staff interventions, and noise levels were continuously monitored during a 24-hr period. Noise levels were consistently >48 dB(A); the highest night peak reached 103 dB(A). Staff interventions lasted for a mean of 240 (SD 90) mins in a 24-hr period. There was no significant difference in the number of interventions between day and night. Severe alterations to sleep architecture were found throughout the 24 hrs, with no diurnal variations. Active sleep was severely reduced to a mean of 3% (SD 4%; range, 0-11%) of total sleep time. There was severe sleep fragmentation as reflected by the high number (mean, 40 [SD 20]) of wake episodes. The above findings suggest a significant electrophysiologic abnormality of sleep in the pediatric intensive care unit patients. Our pediatric intensive care unit environment is characterized by both, high noise levels and frequent staff interventions. This study has several limitations and future studies are needed, with larger sample size and an attempt to manipulate the environmental factors to minimize their negative effects on sleep.

Measurement of left ventricular ejection fraction in pediatric patients using the nuclear stethoscope

International Nuclear Information System (INIS)

Spicer, R.L.; Rabinovitch, M.; Rosenthal, A.; Pitt, B.

1984-01-01

Left ventricular (LV) ejection fraction (EF) was measured in 25 patients, aged 2 weeks to 20 years (mean 8.6 years), using a portable nonimaging scintillation stethoscope. Technically satisfactory studies were obtained in 23 patients. LVEF was validated by cineangiography in 19 patients and by standard gated blood pool scintigraphy in 4. EF measured by the nuclear stethoscope correlated well with values obtained by cineangiography or scintigraphy over a wide range of EF values (18 to 79%). In children younger than 5 years (n . 11), the correlation was less satisfactory than in those older than 5 years. Although modifications in the instrument and further clinical trials with the stethoscope are needed before the device becomes clinically useful to pediatric cardiologists, our data indicate that the nuclear stethoscope can provide reliable assessment of LVEF in pediatric patients

Occupational wellbeing--management of injured workers with psychosocial barriers.

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Cotton, Peter

2006-12-01

Although most injured workers return to work with minimal intervention, approximately 20% show levels of distress and disability beyond that expected for the injury. The level of morale in a workplace seems to play a major role in this. Workers who experience positive emotions leading to increased morale are more likely to be resilient following injury. It is important for general practitioners to recognise the nonclinical factors that exert a significant influence over employee wellbeing and return to work outcomes. Some management strategies are presented. General practitioners who work collaboratively with all major stakeholders, who identify and manage psychosocial barriers early, who take an active role in promoting positive expectations, and who focus on the immediate problem rather than its industrial associations will achieve better outcomes for their injured patients.

The risk of malignancy among biologic-naïve pediatric psoriasis patients: A retrospective cohort study in a US claims database.

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Gu, Yun; Nordstrom, Beth L

2017-08-01

Little published literature exists regarding malignancy risk in pediatric psoriasis patients. To compare malignancy risk in biologic-naïve pediatric psoriasis patients with a matched pediatric population without psoriasis. This retrospective cohort study used IMS LifeLink Health Plan Claims data covering 1998-2008. Cancer incidence was compared with the US Surveillance, Epidemiology, and End Results (SEER) data using standardized incidence ratios (SIR), and between cohorts using Cox models. Among 9045 pediatric psoriasis patients and 77,206 comparators, 18 probable or highly probable cancers were identified. Pediatric psoriasis patients had a nonsignificantly lower incidence than comparators (hazard ratio [HR] 0.43, 95% confidence interval [CI] 0.05-3.54). The HR increased to 1.67 (95% CI 0.54-5.18) when cancer diagnosed during the first 90 days of follow-up was included. The pediatric psoriasis cohort had a significantly increased lymphoma rate compared with SEER (SIR 5.42, 95% CI 1.62-12.94), but no significant increase relative to the comparator cohort. Misclassification of disease and outcome might have occurred with patients in the claims database. Patients with pediatric psoriasis showed no significant increase in overall cancer risk compared with those without psoriasis. A potential increased risk for lymphoma was observed when compared with the general population. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.