Sample records for multi-national general paediatric

  1. Provision of general paediatric surgical services in a regional hospital.

    Zgraj, O


    BACKGROUND: In Ireland, specialist paediatric surgery is carried out in paediatric hospitals in Dublin. General surgeons\\/consultants in other surgical specialities provide paediatric surgical care in regional centres. There has been a failure to train general surgeons with paediatric skills to replace these surgeons upon retirement. AIM: To assess paediatric surgical workload in one regional centre to focus the debate regarding the future provision of general paediatric surgery in Ireland. METHODS: Hospital in-patient enquiry (HIPE) system was used to identify total number of paediatric surgical admissions and procedures. Cases assessed requiring hospital transfer. RESULTS: Of 17,478 surgical patients treated, 2,584 (14.8%) were under 14 years. A total of 2,154 procedures were performed. CONCLUSION: Regional centres without dedicated paediatric surgeons deliver care to large numbers of paediatric patients. The demand for care highlights the need for formal paediatric services\\/appropriate surgical training for general surgical trainees.

  2. Resuscitation of general paediatrics in the UK.

    Wacogne, I; Scott-Jupp, R; Chambers, T


    "The report of my death was an exaggeration", said Mark Twain. For a dying specialty, general paediatrics has certainly been looking very healthy recently. It is timely to examine why our specialty was thought to be at such risk, and to explore why, although in many cases shocked and confused, it is well on the way to recovery. This article explores what is needed to keep it healthy to ensure that the general paediatrician is at the centre of the delivery of paediatrics in the UK.

  3. The delivery of general paediatric surgery in Ireland: a survey of higher surgical trainees.

    Boyle, E


    The delivery of general paediatric surgery is changing in Ireland. Fewer paediatric surgical procedures are being performed by newly appointed consultant general surgeons, resulting in increased referrals to the specialist paediatric surgeons of uncomplicated general paediatric surgical problems. We surveyed current higher surgical trainees about their views on provision of paediatric surgical services.

  4. A comparison of paediatric dentists' and general dental practitioners' care patterns in paediatric dental care

    Schorer-Jensma, M.A.; Veerkamp, J.S.J.


    AIM: The aim of this study was to compare the care patterns of paediatric dentists and general dentists in the dental treatment of children in the Netherlands. STUDY DESIGN AND METHODS: A case control study was completed based on the financial records of one of the largest Dutch health insurance com

  5. Sedation versus general anaesthesia in paediatric patients undergoing chest CT

    Lam, W.W.M.; So, N.M.C.; Metreweli, C. [Chinese Univ. of Hong Kong, Dept. of Diagnostic Radiology and Organ Imaging (China); Chen, P.P. [Chinese Univ. of Hong Kong, Anaesthesiology and Intensive Care (China)


    Objective: CT of the chest in paediatric patients often requires sedation or general anaesthesia to minimize motion artefacts. Both sedation and general anaesthesia are associated with atelectasis which obscures the underlying pulmonary pathology. We conducted a prospective study to compare these two methods with respect to degree of motion artefacts and extent of atelectasis. Material and Methods: Nineteen patients undergoing 22 chest CT examinations were randomly selected for either sedation or general anaesthesia. The total area of atelectasis and the degree of motion artefacts were measured. Results: The mean percentage of atelectasis was 6.67% for general anaesthesia and 0.01% for sedation (p=0.01). There was no significant difference in the quality of the images between the sedation patients and the general anaesthesia patients. Conclusion: Whenever the clinical condition permits it, sedation rather than general anaesthesia should be given to paediatric patients undergoing chest CT. (orig.).

  6. Diagnostic accuracy on the management of acute paediatric urinary tract infection in a general paediatric unit

    Fahisham Taib; Bakht Jamal


    Objective: To ascertain diagnostic accuracy of paediatric urinary tract infection (UTI) in a general paediatric unit of a district hospital. Methods: Retrospective case note review and comparing to the final computerised database of Human in-Patient Enquiry (HIPE) at Portiuncula Hospital, Galway, Ireland. All children from 0-16 years of age with the diagnosis of UTI were enrolled within the 3 year study period. The information was first retrieved from HIPE system to capture list of patients. Case notes revision was followed to extract data under standardized pro-forma for demography, accuracy of diagnosis, treatment instituted and investigation ordered. Patients’ data was reviewed according to updated definition. Results: There were 85 cases treated for UTI during the 3 year period, and only 45 cases were considered as genuine UTI according to diagnostic criteria. Out of 45 cases, 16 cases were considered as suspected UTI cases. Escherichia coli was noted to be the commonest organism. Cephradine has been used as the first line treatment as per local guideline;however, different antibiotic regimes were based on physician’s preferences. The sensitivity of the current method of UTI diagnosis remained at 64%when comparing final diagnosis in the HIPE system. Conclusions: UTI can be difficult to accurately diagnosis in certain clinical cases. Decisions made should be individualized and tailored according to clinical suspicion and presentation of the patients. Improvement to ensure accurate diagnosis is vital to ensure correct data capture in the HIPE system thus giving valuable information and resource for future care.

  7. Differences in treatment approach between Dutch paediatric dentists and general practitioners, a case control study

    Kuin, D.; Veerkamp, J.S.J.


    AIM: This case control study was to assess whether paediatric dentists perform significantly more diagnostic, preventive and curative care in a clinical setting then do general dental practitioners. METHODS: 16 paediatric dentists were approached and a matching control group of 16 general dental pra

  8. Paediatric vaccination practice in a division of general practice.

    Cook, I F; Murtagh, J


    Currently the National Health and Medical Research Council (NH&MRC) recommend the use of a 23 gauge, 25 mm long needle inserted 45-60 degrees into the anterolateral thigh for paediatric vaccination. To assess the compliance of general practitioners (GPs) in a rural practice division with vaccination practice (site and needle size and gauge) prescribed for infants and toddlers by the NH&MRC. In 1999, a questionnaire survey was sent by the divisional office to all 150 GPs in the Hunter Rural Division of General Practice. The questionnaire collected demographic data (age, gender, university of graduation, number of paediatric vaccines administered per week) and elicited responses about the site of vaccination and the size and gauge of needle to be used for children 2-18 months and 18 months and older. Completed questionnaires were available from 112 GPs (74.6% completion rate). There was a high level of compliance with the NH&MRC proscription of buttock vaccination with only 4.3% and 4.1% of responses to the question of vaccination site at 2-18 months and 18 months and older respectively nominating this site. The anterolateral thigh was the favoured site for vaccination in children 2-18 months old (77.5% of responses) with the deltoid being the favoured site in children 18 months and older (59.2% of responses). There was a very low level of compliance with the NH&MRC recommended standard needle (23 gauge, 25 mm long, blue hub needle) (3.5% of responses). The orange hub needle (25 gauge, 16 mm long needle) was most favoured (48.7% of responses) with additional strong support for the 25 gauge, 25 mm long needle (40.2% of responses). In the Hunter Rural Division of General Practice there was good compliance with the NH&MRC's recommendations for site of vaccination, but not needle size and gauge to be used in infants and small children. Imprecise wording of these recommendations has created apparent uncertainty about the site of vaccination of children at 18 months of age.

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

    Andrews, Hannah; Singh, Yogen


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

  10. Public Health Aspects of Paediatric Dental Treatment under General Anaesthetic

    William Murray Thomson


    Full Text Available Early childhood caries (ECC has negative psychosocial effects on children, with chronic pain, changed eating habits, disrupted sleep and altered growth very common, and it disrupts the day-to-day lives of their families. The treatment of young children with ECC places a considerable burden on health systems, with a considerable amount having to be provided under general anaesthesia (GA, which is resource-intensive. Justifying its use requires evidence of the efficacy of treatment in improving the lives of affected children and their families. This paper discusses the available evidence and then makes some suggestions for a research agenda.

  11. General care plan in a Paediatric Intensive Care Unit

    Mª Teresa Martín Alonso


    Full Text Available The care plan we expose is a general one applicable to all the children who are admitted in the unit, no matter what pathology they present/display, their physiopathological situation or their age. We present the common nursing actions which are applied to all the patients at the time of their admittance. The factor related to the studied problems is the hospitalization and what it has associate, from separation of the parents and rupture familiar ties, up to immobilization, the use of bloody devices and the generally hostile and stranger background.The protocol is based on the NANDA, the nursing outcomes classification NOC and the nursing intervention classification NIC. It is part of the nursing process and promotes systematized, humanistic and effective care, focuses on the child and his parents.We have selected the most relevant problems, ordered according to the deficits in the different selfcare requirements of Dorotea E. Orem. Each problem has its definition, the outcomes we pretend to reach with our care and the interventions to get the outcomes (these two last topics have the corresponding codification. In them all the most important factor is hospitalization in a unit of intensive care and the separation of the child from his habitual environment.

  12. Continuous positive airway pressure for bronchiolitis in a general paediatric ward; a feasibility study


    Background Continuous positive airway pressure (CPAP) is commonly used to relieve respiratory distress in infants with bronchiolitis, but has mostly been studied in an intensive care setting. Our prime aim was to evaluate the feasibility of CPAP for infants with bronchiolitis in a general paediatric ward, and secondary to assess capillary PCO2 (cPCO2) levels before and during treatment. Methods From May 1st 2008 to April 30th 2012, infants with bronchiolitis at Stavanger University Hospital were treated with CPAP in a general paediatric ward, but could be referred to an intensive care unit (ICU) when needed, according to in-house guidelines. Levels of cPCO2 were prospectively registered before the start of CPAP and at approximately 4, 12, 24 and 48 hours of treatment as long as CPAP was given. We had a continuous updating program for the nurses and physicians caring for the infants with CPAP. The study was population based. Results 672 infants (3.4%) were hospitalized with bronchiolitis. CPAP was initiated in 53 infants (0.3%; 7.9% of infants with bronchiolitis), and was well tolerated in all but three infants. 46 infants were included in the study, the majority of these (n = 33) were treated in the general ward only. These infants had lower cPCO2 before treatment (8.0; 7.7, 8.6)(median; quartiles) than those treated at the ICU (n = 13) (9.3;8.5, 9.9) (p bronchiolitis may be feasible in a general paediatric ward, providing sufficient staffing and training, and the possibility of referral to an ICU when needed. PMID:24886569

  13. The utilization of a paediatric emergency room in a general hospital in Kuwait.

    al-Hay, A A; Boresli, M; Shaltout, A A


    A descriptive study was conducted in Al-Amiri Hospital, Kuwait to evaluate the use of the paediatric emergency room (PER) by children under 12 years of age over an 11-week period. Socio-demographic data on the families, reasons for the visits, the pattern of referral and the diagnoses were reviewed and analyzed. A total of 277 children were enrolled in the study, the majority of whom (81%) were generally well, only 4% requiring admission to hospital. The paediatrician in the emergency room considered that 64% of visits were not emergencies. Some form of treatment and one to two routine investigations were needed in 21% and 21.6%, respectively. Stated reasons for seeking medical care were: symptoms of the child (34%), unavailability of primary clinic at night (22%) and perceived better services in hospital (20%). The median of parental satisfaction at the end of the visit was 95%. We conclude that most visits to the PER at Al-Amiri Hospital are inappropriate and that intensive health education is required to improve use of the PER and to increase public awareness of the difference between primary care and paediatric emergency facilities.

  14. Knowledge of carbohydrate counting and insulin dose calculations among hospital staff in a regional general paediatrics unit.

    O'Gorman, Jennifer R; O'Leary, Orla; Finner, Natalie; Quinn, Anne; O'Gorman, Clodagh S


    The aim of this study was to assess the carbohydrate and insulin knowledge of the staff at Children's Ark at the University Hospital, Limerick. Carbohydrate counting and insulin dose calculations based on carbohydrates and blood sugars are integral to intensive insulin management of type 1 diabetes mellitus (T1DM). The PedCarbQuiz, a validated questionnaire, was modified, and applied to the staff on our general paediatrics ward. 48/70 eligible staff responded (rate 68 %). Overall knowledge was good: 75.5 % was the average score for correctly identifying foods containing carbohydrate. However, poor scores were obtained for calculating multiple items and meal values (average score 29 %), and exact values of insulin required (average score 38 %). These results highlight the need for re-education among staff on a general paediatrics ward, to empower ward staff to contribute effectively to the education and management of patients with T1DM.

  15. Setting up a Paediatric Rapid Access Outpatient Unit: Views of general practice teams

    Pink Jim


    Full Text Available Abstract Background Rapid Access Outpatient Units (RAOUs have been suggested as an alternative to hospital inpatient units for the management of some acutely unwell children. These units can provide ambulatory care, delivered close to home, and may prevent unnecessary hospital admission. There are no qualitative data on the views of primary care practitioners regarding these types of facilities. The aim of the study was to explore the opinions of primary care practitioners regarding a newly established RAOU. Methods The RAOU was established locally at a district general hospital when inpatient beds were closed and moved to an inpatient centre, based six miles away at the tertiary teaching hospital. Qualitative, practice based group interviews with primary care practitioners (general practitioners (GPs, nurse practitioners and practice nurses on their experiences of the RAOU. The data collection consisted of three practice based interviews with 14 participants. The interviews were recorded and transcribed verbatim. Thematic content analysis was used to evaluate the data. Results There was positive feedback regarding ease of telephone access for referral, location, and the value of a service staffed by senior doctors where children could be observed, investigated and discharged quickly. There was confusion regarding the referral criteria for the assessment unit and where to send certain children. A majority of the practitioners felt the utility of the RAOU was restricted by its opening hours. Most participants felt they lacked sufficient information regarding the remit and facilities of the unit and this led to some uneasiness regarding safety and long term sustainability. Conclusion Practitioners considered that the RAOU offered a rapid senior opinion, flexible short term observation, quick access to investigations and was more convenient for patients. There were concerns regarding opening hours, safety of patients and lack of information about

  16. A new tool for the paediatric HIV research: general data from the Cohort of the Spanish Paediatric HIV Network (CoRISpe

    de Jose Ma Isabel


    Full Text Available Abstract There are approximately from 1,100 to 1,200 HIV-infected children in a follow-up in Spain. In 2008 an open, multicentral, retrospective and prospective Cohort of the Spanish Paediatric HIV Network (CoRISpe was founded. The CoRISpe is divided into the node 1 and node 2 representing geographically almost the whole territory of Spain. Since 2008 seventy-five hospitals have been participating in the CoRISpe. All the retrospective data of the HIV-infected children have been kept in the CoRISpe since 1995 and prospective data since 2008. In this article we are going to present the notion of CoRISpe, its role, the structure, how the CoRISpe works and the process how a child is transferred from Paediatric to Adults Units. The main objective of the CoRISpe is to contribute to furthering scientific knowledge on paediatric HIV infection by providing demographic, sociopsychological, clinical and laboratory data from HIV-infected paediatric patients. Its aim is to enable high-quality research studies on HIV-infected children.

  17. Physician behaviour for antimicrobial prescribing for paediatric upper respiratory tract infections: a survey in general practice in Trinidad, West Indies

    Ramdhanie Joseph


    Full Text Available Abstract Background Upper respiratory tract infections (URTIs are among the most frequent reasons for physician office visits in paediatrics. Despite their predominant viral aetiology, URTIs continue to be treated with antimicrobials. We explored general practitioners' (GPs prescribing behaviour for antimicrobials in children (≤ 16 years with URTIs in Trinidad, using the guidelines from the Centers for Disease Control and Prevention (CDC as a reference. Methods A cross-sectional study was conducted on 92 consenting GPs from the 109 contacted in Central and East Trinidad, between January to June 2003. Using a pilot-tested questionnaire, GPs identified the 5 most frequent URTIs they see in office and reported on their antimicrobial prescribing practices for these URTIs to trained research students. Results The 5 most frequent URTIs presenting in children in general practice, are the common cold, pharyngitis, tonsillitis, sinusitis and acute otitis media (AOM in rank order. GPs prescribe at least 25 different antibiotics for these URTIs with significant associations for amoxicillin, co-amoxiclav, cefaclor, cefuroxime, erythromycin, clarithromycin and azithromycin (p 30 years were more likely to prescribe antibiotics for the common cold (p = 0.014. Severity (95.7% and duration of illness (82.5% influenced doctors' prescribing and over prescribing in general practice was attributed to parent demands (75% and concern for secondary bacterial infections (70%. Physicians do not request laboratory investigations primarily because they are unnecessary (86% and the waiting time for results is too long (51%. Conclusions Antibiotics are over prescribed for paediatric URTIs in Trinidad and amoxicillin with co-amoxiclav were preferentially prescribed. Except for AOM, GPs' prescribing varied from the CDC guidelines for drug and duration. Physicians recognise antibiotics are overused and consider parents expecting antibiotics and a concern for secondary

  18. Cost-effectiveness analysis of clinic-based chloral hydrate sedation versus general anaesthesia for paediatric ophthalmological procedures.

    Burnett, Heather F; Lambley, Rosemary; West, Stephanie K; Ungar, Wendy J; Mireskandari, Kamiar


    The inability of some children to tolerate detailed eye examinations often necessitates general anaesthesia (GA). The objective was to assess the incremental cost effectiveness of paediatric eye examinations carried out in an outpatient sedation unit compared with GA. An episode of care cost-effectiveness analysis was conducted from a societal perspective. Model inputs were based on a retrospective cross-over cohort of Canadian children aged 68 successful procedures per child. The result was robust to varying the cost assumptions. Cross-over designs offer a powerful way to assess costs and effectiveness of two interventions because patients serve as their own control. This study demonstrated significant savings when ophthalmological exams were carried out in a hospital outpatient clinic, although with slightly fewer procedures completed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  19. Referral patterns and general anesthesia in a specialized paediatric dental service.

    Alkilzy, Mohammad; Qadri, Ghalib; Horn, Janina; Takriti, Moutaz; Splieth, Christian


    The caries patterns of child populations in Germany have changed during the last 20 years. This affects the referrals and provision of specialist dental care for children. This study has two aims: first, to investigate referrals received by a specialized pediatric dental institution in 1995 and 2008, and second, to assess the treatments performed during full oral rehabilitations under general anesthesia in this institution from 2007 to 2008. All data of referred patients were evaluated for 1995 and 2008 separately. Comparisons were carried out for different socio-demographic, medical, and dental parameters. All patients treated under general anesthesia (GA) between March/2007 and December/2008 were examined retrospectively and their data were analyzed. In 1995 (n = 191), significantly older children were referred to specialized pediatric dental care compared to 2008 (n = 179). In addition, a shift of surgical referrals to very young children with high caries levels was clearly noticed, resulting in considerably more oral rehabilitation performed under GA in 2008 (n = 73). Thus, the mean values of 6.4 fillings and 2.7 extractions per child were quite high. Preventive treatment approaches for primary dentition in Germany need further improvement by focusing on high caries-risk groups, as specialized pediatric dentistry bears the great burden of providing oral rehabilitations under GA in young children. © 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. Paediatric psychological problems.

    Pollack, Allan; Harrison, Christopher; Charles, Janice; Britt, Helena


    A 2011 BEACH-based study showed that over the past 40 years there has been increasing general practitioner (GP) involvement in the management of paediatric mental health in Australia. There has also been a changing mix of psychological conditions managed, including increased management of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders (ASD).

  1. [Multi-national clinical trial in circulatory disorders].

    Takahashi, Kihito


    As Japan becomes more integrated into the global market, pharmaceutical research and development (R&D) in Japan faces considerable challenges. While global simultaneous development including Asian countries has become a common strategy for multi-national pharmaceutical companies, Japan has been frequently set aside because of its provincial regulatory and clinical trial infrastructure. Meanwhile, many improvement programs in pharmaceutical area have been initiated in Japan. With this increased scrutiny, significant improvements in regulatory process, clinical trial costs, and site performance are anticipated over the next few years. RENAAL is the first multi-national clinical trial involving Japanese patients diabetic nephropathy associated with type II diabetes mellitus. In this article, issues which have been observed in the process of conducting multi-national clinical trial were discussed based on the experience with RENAAL. It is hoped that, as we gain more experiences in multi-national clinical trials, solutions for these issues are found in near future.

  2. Recent developments in neonatal and paediatric emergencies

    Turner, Nigel M.

    The present article is intended as an update for anaesthesiologists on recent developments in life-threatening paediatric emergencies and paediatric resuscitation. It is assumed that the reader has at least a basic knowledge of the general principles of emergency medicine, such as the ABCDE-approach

  3. Clonidine In Paediatrics - A Review

    Sujatha Basker


    Full Text Available Clonidine, an alpha-2 agonist is a known antihypertensive agent. Because of its sedative and analgesic effects, it is gaining popularity in anaesthesiology. It can be used to premedicate children, as an adjuvant to regional and general anaesthesia and it has several other applications in paediatric anaesthesia. It has also found use in the paediatric intensive care as a sedative, analgesic and to ensure haemodynamic stability. As in the case ol′any other anaesthetic drug, its use has to be vigilantly monitored.

  4. Paediatric rhinitis

    Roberts, G; Xatzipsalti, M; Borrego, L M


    Rhinitis is a common problem in childhood and adolescence and impacts negatively on physical, social and psychological well-being. This position paper, prepared by the European Academy of Allergy and Clinical Immunology Taskforce on Rhinitis in Children, aims to provide evidence-based recommendat......Rhinitis is a common problem in childhood and adolescence and impacts negatively on physical, social and psychological well-being. This position paper, prepared by the European Academy of Allergy and Clinical Immunology Taskforce on Rhinitis in Children, aims to provide evidence......-based recommendations for the diagnosis and therapy of paediatric rhinitis. Rhinitis is characterized by at least two nasal symptoms: rhinorrhoea, blockage, sneezing or itching. It is classified as allergic rhinitis, infectious rhinitis and nonallergic, noninfectious rhinitis. Similar symptoms may occur with other...... conditions such as adenoidal hypertrophy, septal deviation and nasal polyps. Examination by anterior rhinoscopy and allergy tests may help to substantiate a diagnosis of allergic rhinitis. Avoidance of relevant allergens may be helpful for allergic rhinitis (AR). Oral and intranasal antihistamines and nasal...

  5. Streptococcus pneumoniae and Haemophilus influenzae in paediatric meningitis patients at Goroka General Hospital, Papua New Guinea: serotype distribution and antimicrobial susceptibility in the pre-vaccine era.

    Greenhill, Andrew R; Phuanukoonnon, Suparat; Michael, Audrey; Yoannes, Mition; Orami, Tilda; Smith, Helen; Murphy, Denise; Blyth, Christopher; Reeder, John; Siba, Peter; Pomat, William; Lehmann, Deborah


    Bacterial meningitis remains an important infection globally, with the greatest burden in children in low-income settings, including Papua New Guinea (PNG). We present serotype, antimicrobial susceptibility and outcome data from paediatric meningitis patients prior to introduction of Haemophilus influenzae type b (Hib) and pneumococcal conjugate vaccines (PCVs) in PNG, providing a baseline for evaluation of immunisation programs. Cerebrospinal fluid (CSF) was collected from children admitted to Goroka General Hospital with suspected meningitis between 1996 and 2005. Culture and sensitivity was conducted, and pneumococci and H. influenzae were serotyped. Laboratory findings were linked to clinical outcomes. We enrolled 1884 children. A recognised pathogen was identified in 375 children (19.9%). Streptococcus pneumoniae (n = 180) and Hib (n = 153) accounted for 88.8% of pathogens isolated. 24 different pneumococcal serogroups were identified; non-PCV types 2, 24 and 46 accounted for 31.6% of pneumococcal meningitis. 10- and 13-valent PCVs would cover 44.1% and 45.4% of pneumococcal meningitis respectively. Pneumococcal isolates were commonly resistant to penicillin (21.5%) and 23% of Hib isolates were simultaneously resistant to ampicillin, co-trimoxazole and chloramphenicol. The case fatality rate in patients with a recognised bacterial pathogen was 13.4% compared to 8.5% in culture-negative patients. If implemented in routine expanded programme of immunisation (EPI) with high coverage, current PCVs could prevent almost half of pneumococcal meningitis cases. Given the diversity of circulating serotypes in PNG serotype replacement is of concern. Ongoing surveillance is imperative to monitor the impact of vaccines. In the longer term vaccines providing broader protection against pneumococcal meningitis will be needed.

  6. Recognition of depression in children in general hospital-based paediatric units in Kenya: practice and policy implications

    Mutiso Victoria N


    Full Text Available Abstract Background Physical disorders are commonly comorbid with depression in children attending general medical facilities. However, the depression component is rarely recognised. Methods A questionnaire on sociodemographics and history of presenting medical conditions was administered together with the Children's Depression Inventory (CDI to all 11-year-old to 17-year-old children attending at nine medical facilities. Results In all, 408 children were recruited from 9 health facilities. Whereas the clinicians diagnosed a mental disorder in only 2.5% of the sample studied, 41.3% had CDI scores that suggested mild to moderate depression. The highest proportion of children with depressive symptomatology was found at the Kenyatta National and Teaching Referral Hospital. Conclusion Although prevalence rate for depression among children is high, detection rates remain low. This finding has clinical practice and policy implications within and outside Kenya.

  7. Paediatrics: messages from Munich

    Fabio Midulla


    Full Text Available The aim of this article is to describe paediatric highlights from the 2014 European Respiratory Society (ERS International Congress in Munich, Germany. Abstracts from the seven groups of the ERS Paediatric Assembly (Respiratory Physiology and Sleep, Asthma and Allergy, Cystic Fibrosis, Respiratory Infection and Immunology, Neonatology and Paediatric Intensive Care, Respiratory Epidemiology, and Bronchology are presented in the context of the current literature.

  8. Paediatric radiopharmaceutical administration

    Lassmann, Michael; Treves, S Ted; Borgwardt, Lise


    In 2008 the EANM published their paediatric dosage card. In 2011 the North American consensus guidelines recommended a set of administered activities for paediatric nuclear medicine. During the EANM congress in 2012 a working group of the EANM and the SNMMI met to study the possibility of harmoni...

  9. [Current aspects of paediatric cholesteatomas].

    Thomas, J P; Volkenstein, S; Minovi, A; Dazert, S


    Cholesteatomas can be subclassified into genuine and acquired forms. Whilst epidermoid formations are the generally accepted cause of genuine cholesteatomas, metaplasia, immigration, proliferation and retraction pocket theories have all been proposed to explain the development of acquired cholesteatomas. Clinically, paediatric cholesteatomas exhibit more extensive and aggressive growth than those arising in adulthood. Molecular biological differences in terms of angiogenesis, cytokine expression and particularly the more marked inflammatory responses of the perimatrix could potentially explain these clinical differences. The surgical therapy of paediatric cholesteatomas should be adapted to the individual pathological findings, although where possible a canal wall up procedure is preferred during initial surgery. The "inside-out" mastoidectomy tracking-technique combines the benefits of a good surgical overview with those of a physiological postoperative auditory canal.

  10. Problem Based Learning as a Cultural Tool for Health and Safety Learning in a Multi-national Company

    Adam, Henrik; Petersson, Eva


    problem solving through participation and negotiation. In this way, problem solving emerges through experience situated in specific practices rather than through abstract knowledge. The practice included in this research is a multi-national production company, which over a period of extensive growth......The general background of this study is an interest in how cultural tools contribute to structuring learning activities. The specific interest is to explore how such tools co-determine employees’ problem solving actions in health, safety and environment (HSE) training activities in a multi-national...... company context. Theoretically, the research takes its point of departure in a socio-cultural perspective on the role of cultural tools in learning, and in a complementary interest in the role of communicative framing of learning activities. In the research reported here, the focus is on how employees...

  11. Safety in paediatric imaging

    Carter, D.; Filice, I.; Murray, D.; Thomas, K. [The Hospital for Sick Children, Toronto, Ontario (Canada)


    Those of us working in a dedicated paediatric environment are aware of the important safety issues with regard to paediatrics. Our goal when working with paediatric patients, the goal is to obtain the best quality images while keeping patients safe and their distress to a minimum. This article will discuss some of the issues regarding paediatric safety in a diagnostic imaging department, including radiation doses and the risk to paediatric patients, reducing medication errors, safe sedation practice and environmental safety. Also discussed are some conditions requiring special consideration to maintain patient safety such as epiglottitis and suspected child abuse. Promotion of a patient/family-centered care system will create an environment of trust where parents or guardians will know that their children are being well cared for in a safe, effective environment. (author)

  12. Multi-detector CT in the paediatric urinary tract

    Damasio, M.B., E-mail: [Paediatric Radiology, Giannina Gaslini Institute, Genoa (Italy); Darge, K. [Department of Radiology, Children' s Hospital of Philadelphia, Philadelphia (United States); Riccabona, M. [Department of Radiology, Division of Paediatric Radiology, University Hospital Graz (Austria)


    The use of paediatric multi-slice CT (MSCT) is rapidly increasing worldwide. As technology advances its application in paediatric care is constantly expanding with an increasing need for radiation dose control and appropriate utilization. Recommendations on how and when to use CT for assessment of the paediatric urinary tract appear to be an important issue. Therefore the European Society of Paediatric Radiology (ESPR) uroradiology task force and European Society of Urogenital Radiology (ESUR) paediatric working groups created a proposal for performing renal CT in children that has recently been published. The objective of this paper is to discuss paediatric urinary tract CT (uro-CT) in more detail and depth. The specific aim is not only to offer general recommendations on clinical indications and optimization processes of paediatric CT examination, but also to address various childhood characteristics and phenomena that facilitate understanding the different approach and use of uro-CT in children compared to adults. According to ALARA principles, paediatric uro-CT should only be considered for selected indications provided high-level comprehensive US is not conclusive and alternative non-ionizing techniques such as MR are not available or appropriate. Optimization of paediatric uro-CT protocols (considering lower age-adapted kV and mAs) is mandatory, and the number of phases and acquisition series should be kept as few as possible.

  13. Paediatric talus fracture.

    Byrne, Ann-Maria


    Paediatric talus fractures are rare injuries resulting from axial loading of the talus against the anterior tibia with the foot in dorsiflexion. Skeletally immature bone is less brittle, with higher elastic resistance than adult bone, thus the paediatric talus can sustain higher forces before fractures occur. However, displaced paediatric talus fractures and those associated with high-energy trauma have been associated with complications including avascular necrosis, arthrosis, delayed union, neurapraxia and the need for revision surgery. The authors present the rare case of a talar neck fracture in a skeletally immature young girl, initially missed on radiological review. However, clinical suspicion on the part of the emergency physician, repeat examination and further radiographic imaging revealed this rare paediatric injury.

  14. Paediatric cochlear implantation


    and can conduct impulses carrying auditory information to the brain.2. PAEDIATRIC ... tory mechanisms, including speech ... resources in the auditory cortex.1. Conversely ... culties associated with cochlear ... with cognitive and/or motor devel-.

  15. Nigerian Journal of Paediatrics

    The Nigerian Journal of Paediatrics a quarterly journal publishes original articles, brief reports on ... Prevalence and pattern of intestinal parasites among pupils of private and public primary schools in an urban ... IP Oloyede, PU Essien, 81-83 ...

  16. Paediatric trauma care

    In this review, paediatric trauma care will be considered primarily for ... to technology increases, injury becomes a major source of childhood ..... reached include the nursing profession, workers in industry, ... New York: Freeman, 1984. 21.

  17. Paediatric pain management

    age, however paediatric pain expression is dependent on the child's cognitive development and sociocultural background. Children normally ... Middle childhood ... can use the visual analogue pain (VAP) scale in the same manner as adults.

  18. Multiculturalism and Multi-nation Federalism. New challenges

    Will Kymlicka


    Full Text Available Thank you for the kind introduction and for the very clear summary of the arguments of Multicultural Citizenship. So I thought I’d just mention a couple of the ideas that I’ve been working with more recently. The first concerns this. There are two main types of groups that I’ve been thinking of - immigrant groups and national minorities. What kinds of rights are appropriate for these two different types of groups. I discuss this in the book. I’ve been thinking a little bit just about trying to be more precise about the types of institutions and policies that are appropriate for these two kinds of groups and I’ve changed the terminology a bit. I would now talk about these in terms of immigrant multiculturalism for immigrant groups and multi-nation federalism for national minorities. So let me just say that I hope it’s not dramatically different from what’s in the book but let me just clarify what I mean by those terms, because I will use them.

  19. Paediatric Virology: A rapidly increasing educational challenge

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


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

  20. Genodermatoses in paediatric age group

    Kumar Sunil


    Full Text Available Pattern of genodermatoses in paediatric age group was studied. The relative incidence of genodermatoses in paediatric dermatology out patient department was 0.62%. The commonest genodermatoses observed was ichthyosis.

  1. Paediatric musculoskeletal interventional radiology

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


    Interventional radiology technique is now well established and widely used in the adult population. Through minimally invasive procedures, it increasingly replaces surgical interventions that involve higher percentages of invasiveness and, consequently, of morbidity and mortality. For these advantageous reasons, interventional radiology in recent years has spread to the paediatric age as well. The aim of this study was to review the literature on the development, use and perspectives of these procedures in the paediatric musculoskeletal field. Several topics are covered: osteomuscle neoplastic malignant and benign pathologies treated with invasive diagnostic and/or therapeutic procedures such as radiofrequency ablation in the osteoid osteoma; invasive and non-invasive procedures in vascular malformations; treatment of aneurysmal bone cysts; and role of interventional radiology in paediatric inflammatory and rheumatic inflammations. The positive results that have been generated with interventional radiology procedures in the paediatric field highly encourage both the development of new ad hoc materials, obviously adapted to young patients, as well as the improvement of such techniques, in consideration of the fact that childrens' pathologies do not always correspond to those of adults. In conclusion, as these interventional procedures have proven to be less invasive, with lower morbidity and mortality rates as well, they are becoming a viable and valid alternative to surgery in the paediatric population. PMID:26235144

  2. [What's new in paediatric dermatology?].

    Plantin, P


    Regular analysis of the major journals in dermatology and paediatrics has been used to select forty articles which are representative of the past year in paediatric dermatology. This selection is not exhaustive but rather reflects the interests of the author and also the dominant topics in paediatric dermatology in 2013-2014.

  3. African Journal of Paediatric Surgery

    The African Journal of Paediatric Surgery aims to promote research, post- ... AJPS welcomes original articles, case reports, letters to the editor, editorials, commentaries, special communications and innovations related to ... Vol 11, No 2 (2014) ... A Canadian association of paediatric surgeons: Association of paediatric ...

  4. Key paediatric messages from Amsterdam

    Jonathan Grigg


    Full Text Available The Paediatric Assembly of the European Respiratory Society (ERS maintained its high profile at the 2015 ERS International Congress in Amsterdam. There were symposia on preschool wheeze, respiratory sounds and cystic fibrosis; an educational skills workshop on paediatric respiratory resuscitation; a hot topic session on risk factors and early origins of respiratory diseases; a meet the expert session on paediatric lung function test reference values; and the annual paediatric grand round. In this report the Chairs of the Paediatric Assembly's Groups highlight the key messages from the abstracts presented at the Congress.

  5. Electrodiagnosis in paediatric ophthalmogenetics

    P.A. Pkarian (Patricia)


    textabstractIn the present overview, practical application of the visual evoked potential (VEP) in paediatric neuro-ophthalmology is described across a wide range of ophthalmogenetic disorders, including albinism, Pelizaeus-Merzbacher disease and spastic paraplegia. The VEP approach is based on a fo

  6. How readable are Australian paediatric oral health education materials?

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


    Background The objective of this study was to analyse the readability of paediatric oral health education leaflets available in Australia. Methods Forty paediatric oral health education materials were analysed for general readability according to the following parameters: Thoroughness; Textual framework; Terminology; and Readability (Flesch-Kincaid grade level (FKGL), Gunning Fog index (Fog) and Simplified Measure of Gobbledygook (SMOG)). Results Leaflets produced by the industry were among t...

  7. Recent developments in paediatric neuraxial blocks

    Vrushali Chandrashekhar Ponde


    Full Text Available Paediatric anaesthesia and paediatric regional anaesthesia are intertwined. Almost all surgeries unless contradicted could be and should be supplemented with a regional block. The main objective of this review is to elaborate on the recent advances of the central neuraxial blocks, such as application of ultrasound guidance and electrical stimulation in the pursuit of safety and an objective end point. This review also takes account of the traditional technique and understand the benefits as well the risk of each as compared with the recent technique. The recent trends in choosing the most appropriate peripheral block for a given surgery thereby sparing the central neuroaxis is considered. A penile block for circumcision or a sciatic block for unilateral foot surgery, rather than caudal epidural would have a better risk benefit equation. Readers will find a special mention on the recent thoughts on continuous epidural analgesia in paediatrics, especially its rise and fall, yet its unique importance. Lastly, the issue of block placements under sedation or general anaesthesia with its implication in this special population is dealt with. We conducted searches in MEDLINE (PubMed and assessed the relevance of the abstracts of citations identified from literature searches. The search was carried out in English, for last 10 years, with the following key words: Recent advances in paediatric regional anaesthesia; ultrasound guidance for central neuraxial blocks in children; role of electrical stimulation in neuraxial blocks in children; complications in neuraxial block. Full-text articles of potentially relevant abstracts were retrieved for further review.

  8. Paediatric pharmacokinetics: key considerations

    Batchelor, Hannah Katharine; Marriott, John Francis


    A number of anatomical and physiological factors determine the pharmacokinetic profile of a drug. Differences in physiology in paediatric populations compared with adults can influence the concentration of drug within the plasma or tissue. Healthcare professionals need to be aware of anatomical and physiological changes that affect pharmacokinetic profiles of drugs to understand consequences of dose adjustments in infants and children. Pharmacokinetic clinical trials in children are complicated owing to the limitations on blood sample volumes and perception of pain in children resulting from blood sampling. There are alternative sampling techniques that can minimize the invasive nature of such trials. Population based models can also limit the sampling required from each individual by increasing the overall sample size to generate robust pharmacokinetic data. This review details key considerations in the design and development of paediatric pharmacokinetic clinical trials. PMID:25855821

  9. Prosthetics in Paediatric Dentistry

    Vulićević Zoran


    Full Text Available Premature loss of teeth in children may lead to both functional and esthetic problems. Missing teeth in both anterior and posterior regions may cause malfunctions in mastication and proper pronunciation. If the missing teeth are not replaced, further complications may occur, including adjacent tooth migration, loss of alveolar bone, and irregular occlusion. Considering the sensitive nature of children, loss of teeth may cause the development of insecurities and low self esteem problems. Due to dynamic nature of growth in children and adolescents, prosthetic appliances must not hinder development of orofacial system, and must meet adequate esthetic and functional standards. Dental prosthetic appliances in paediatrics must be planned with respect to the special conditions that led to tooth loss or damage. Multi-disciplinary approach is needed, under constant supervision of paediatric dentist and orthodontist, as well as regular checkups with clinical and radiographical examinations.

  10. Litigation in paediatrics

    Murphu, JFA


    on the issue. This is understandable. Most individuals are healthy during their childhood and have less need of and less interaction with medical services when compared with adults. However, Paediatric litigation does happen and furthermore it is likely to increase in parallel with other specialties. Carroll and Buddenbaum1 have described the pattern of Paediatric litigation in the US. The annual incidence of malpractice claims has been quoted to be as high as 6.6 claims per 100 Paediatricians per year. Almost 30% of Paediatricians have been sued with many being sued on more than one occasion. Of these cases 36% were settled out of court, 33% were dropped by the plaintiff with the remainder going before the judiciary. The authors point out that in the US medical malpractice is a hotly debated issue. Litigation has a questionable impact on health care quality, cost, and access to services. The AMA believes that rising premiums are resulting in the curtailment of medical care particularly in states with high medico-legal rates. The Physician Insurers Association of America (PIAA) is a trade organisation which insures 60% of all private practicing physicians and surgeons has been a useful source of data. In the 20 year period 1985-2005 among a total of 214,226 claims there were 6363 (2.9%) Paediatric claims which ranked it 10th among the 28 specialties covered. The claims arose in equal numbers from the hospital and Paediatrician’s office settings. Common reasons for Paediatric litigation were errors in diagnosis (32%), incorrect performance of a medical or surgical procedure (13%), failure to monitor or manage a case effectively (10%) and medication error (5%). The top five medico-legal conditions were meningitis, routine infant or child checks, newborn respiratory problems, appendicitis and brain-damaged infants as a co-defendant with Obstetrics. Good quality information about litigation is important because the discussion among doctors is frequently confused by

  11. The EU paediatric regulation: effects on paediatric psychopharmacology in Europe.

    Stoyanova-Beninska, Violeta V; Wohlfarth, Tamar; Isaac, Maria; Kalverdijk, Luuk J; van den Berg, Henk; Gispen-de Wied, Christine


    Child and adolescent psychiatry is a relatively young field and the recognition, classification, and treatment of disorders in children and adolescents lag behind those in adults. In recent years there is an increasing awareness of the differences between children and adults in psychopathology and pharmacology. Related to this new paediatric regulations have been introduced. This article reviews the regulatory and legislative measures that were adopted in the EU in 2007 and the subsequent impact of these measures on the field of paediatric psychopharmacology. The consequences of the paediatric regulation in the EU are reflected in several domains: regulatory, research aimed at drug development and clinical practices. In the regulatory domain, the consequences include: new paediatric indications, inclusion of special (class) warnings, specification of dose regimens, and information on safety specific to children and adolescents, and development of new medicinal formulations. The paediatric regulation leads to timely development of paediatric friendly formulations and better quality of the clinical evidence. In clinical practices, an increased awareness of the uniqueness of paediatric pharmacology is emerging among medical professionals, and subsequent improvement of medical care (i.e. correct doses, appropriate formulation, monitoring for expected adverse events). In addition, clinical guidelines will have to be revised more frequently in order to integrate the recently acquired knowledge. The new regulations stimulate transparency and discussions between academia, pharmaceutical industry, and regulators. The purpose is to optimize clinical research and obtain evidence for paediatric psychopharmacology, thereby providing adequate support for treatment.

  12. Drugs for the paediatric heart

    ... Cape, Department of Paediatrics and Child Health, Stellenbosch University ... Paediatric cardiologist, Red Cross War Memorial Children's Hospital, ... Correspondence to: John Lawrenson ( .... Dental work is still .... an area where resuscitation equipment ... Africa and the diagnosis is easy to miss.

  13. Immobilisation in Australian paediatric medical imaging: A pilot study.

    Noonan, S; Spuur, K; Nielsen, S


    The primary aim of this study is to document the use of paediatric immobilisation techniques in medical imaging. Secondary aims are to investigate differences between current practice of paediatric and non-paediatric facilities and radiographer gender and to investigate immobilisation protocols. A SurveyMonkey link was distributed through the Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) newsletter. Radiographer members of ASMIRT were invited to participate. Frequency percentage analysis was undertaken; as the 'frequency of immobilisation' response was on a Likert scale and the ages categorical, a Fisher's exact test could determine dependency. The use of paediatric immobilisation techniques was determined to be related to age. The most commonly used technique in general X-ray was "other people"; in computed tomography, Velcro, verbal reminders and distraction techniques; and in magnetic resonance imaging, sedation and Velcro. A comparison of immobilisation techniques demonstrated that Velcro use in X-ray was dependent on facility (p = 0.017) with paediatric facilities using it up to 17 years. Immobilisation frequency was dependent in 13-17 years (p = 0.035) with paediatric facilities rarely immobilising and non-paediatric facilities never. No dependencies resulted upon comparing genders. Immobilisation frequency was not dependent between protocols or current practice. The use of paediatric immobilisation technique is related to age with "other people", sedation, Velcro, verbal reminders and distraction techniques being regularly used. The dependency of Velcro use and immobilisation frequency in 13-17 years is for unknown reasons and further investigation is required. A larger study should be carried out to validate these findings. Copyright © 2017 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

  14. [The latest in paediatric resuscitation recommendations].

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


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

  15. Metastatic paediatric colorectal carcinoma.

    Woods, R


    A 16-year-old girl presented to our unit with crampy abdominal pain, change in bowel habit, a subjective impression of weight loss and a single episode of haematochezia. She was found to have a rectosigmoid adenocarcinoma and proceeded to laparoscopic anterior resection, whereupon peritoneal metastases were discovered. She received chemotherapy and is alive and well ten month later with no radiological evidence of disease. Colorectal carcinoma is rare in the paediatric population but is increasing in incidence. Early diagnosis is critical to enable optimal outcomes.

  16. The paediatric overview

    Green, Stuart H. [Neurology Department, Institute of Child Health, University of Birmingham, Whittall Street, B4 6NH, Birmingham (United Kingdom)


    Stroke in children, both ischaemic and haemorrhagic, is increasingly recognised as an important paediatric illness. This review looks at the wide number of causes, highlighting the fact that often no single factor is causative on its own. There has been an increased recognition worldwide of the importance of sickle cell disease and of the importance of venous sinus thrombosis. Radiology is mandatory in diagnosis and management. Unfortunately, it is not always possible to extrapolate experience from adult stroke in terms of management of these children, and further detailed trials are necessary to understand the natural history, outcome and best forms of management. (orig.)

  17. Drug utilization and off-label drug use among Spanish emergency room paediatric patients

    Morales-Carpi, Cristina; Estañ, Luis; Rubio, Elena; Lurbe, Empar; Morales-Olivas, Francisco J.


    Abstract Objective To describe the use of medicines and to determine the frequency of off-label use in emergency room paediatric patients. Patients and methods A prospective, observational and descriptive study was carried out in the setting of the paediatric emergency room of a Spanish general hospital. Medicines used by children

  18. Bankruptcy by catastrophes for major multi-nationals: stock exchange sensitivity for three catastrophes

    Van Gulijk, C.; Ale, B.J.M.


    This paper investigates the effect of major catastrophes have on stock exchange values for the major multi-nationals. The paper demonstrates that the Sharpe analysis is more sensitive in identifying effects than just following the daily stock values for assessing market response. It was found that m

  19. Arctic Collaborative Environment: A New Multi-National Partnership for Arctic Science and Decision Support

    Laymon, Charles A,; Kress, Martin P.; McCracken, Jeff E.; Spehn, Stephen L.; Tanner, Steve


    The Arctic Collaborative Environment (ACE) project is a new international partnership for information sharing to meet the challenges of addressing Arctic. The goal of ACE is to create an open source, web-based, multi-national monitoring, analysis, and visualization decision-support system for Arctic environmental assessment, management, and sustainability. This paper will describe the concept, system architecture, and data products that are being developed and disseminated among partners and independent users through remote access.

  20. Paediatric surgery: trends in UK surgical trainees' operative experience.

    Youngson, G G; Adams, S; Winton, E


    This study assesses the effects of the reconfiguration of postgraduate surgical training and changes to work patterns through legislation within UK on the operative experience of trainees completing specialty training in paediatric surgery. Data were collected from the consolidation record of operative experience submitted by every candidate sitting the Intercollegiate Specialty Board Examination in Paediatric Surgery in UK from 1996 through 2004. A number of index procedures were chosen as surrogates of the overall operative experience and underwent detailed analysis. These comprised operations performed in the following categories: Neonatal Surgery, General Paediatric Surgery, Paediatric Urology, Paediatric Oncology, and Emergency Paediatric Surgery. Sixty-three sets of data comprising 12,866 operations were ultimately identified as being suitable for analysis. The average number of operations performed annually by trainees increased over the study period as did the number in each of the operative categories. The number of operations performed with senior assistance or supervision increased over this period by an average of 12.5%. This trend was also evident in emergency surgery where the average number of sample procedures performed by trainees increased by 28% over the study period. In 1995, reforms to the training grade within UK reduced the time spent in specialist training from a previously unregulated period to 72 months of higher surgical training. Subsequent directives in response to health and safety legislation have further abbreviated the length of time spent at the workplace, initially to 72 hours and more recently to 58 hours per week. This combination has been generally perceived throughout the surgical community as prejudicial to acquisition of clinical and operative competence. This study, however, fails to endorse this perception and suggests to the contrary that perhaps through increased delegation, the volume of training operations is being

  1. Frequency of paediatric medical imaging examinations performed at a European teaching hospital over a 7-year period.

    Portelli, Jonathan L; McNulty, Jonathan P; Bezzina, Paul; Rainford, Louise


    The aim of this retrospective cohort study was to gain an insight into frequencies by which a range of medical imaging (MI) examinations were performed on paediatric patients at the main acute general teaching hospital in Malta between 2008 and 2014. Frequency data of MI examinations performed on paediatric patients were retrospectively collected from relevant information systems. All data was coded accordingly to facilitate data analysis. A total of 95,805 MI examinations were performed on 39,707 unique paediatric patients (Medical imaging (MI) examinations are commonly performed in paediatric patients. • In 7 years 95,805 examinations were performed on 39,707 paediatric patients. • Use of ultrasound and MRI in paediatric patients increased annually. • Highest frequency of MI examinations was observed in neonates/infants younger than 1 year. • Awareness of MI utilisation patterns and trends can help inform practice.

  2. [Toxicology screening in paediatrics].

    Garcia-Algar, Óscar; Cuadrado González, Ainoha; Falcon, María


    The prevalence of acute or chronic exposure to substances of abuse in paediatric patients, from the neonatal period to adolescence, is not well established as most cases go unnoticed. Regardless of clinical cases of acute poisoning leading to visits to emergency room, the exposure is usually detected by a questionnaire to the parents or children. In the last few years, new validated analytical methodologies have been developed in order to detect parent drugs and their metabolites in different biological matrices. These biological matrices have different time windows for detection of the exposure: acute (i.e., urine, blood, oral fluid), and chronic (i.e., hair, meconium or teeth). The aim of this paper was to review the scenarios where the use of biological matrices is indicated for the detection of acute or chronic exposure to substances of abuse. Copyright © 2015 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Paediatric and adult malignant glioma

    Jones, Chris; Perryman, Lara; Hargrave, Darren


    Gliomas in children differ from their adult counterparts by their distribution of histological grade, site of presentation and rate of malignant transformation. Although rare in the paediatric population, patients with high-grade gliomas have, for the most part, a comparably dismal clinical outcome...... to older patients with morphologically similar lesions. Molecular profiling data have begun to reveal the major genetic alterations underpinning these malignant tumours in children. Indeed, the accumulation of large datasets on adult high-grade glioma has revealed key biological differences between...... the adult and paediatric disease. Furthermore, subclassifications within the childhood age group can be made depending on age at diagnosis and tumour site. However, challenges remain on how to reconcile clinical data from adult patients to tailor novel treatment strategies specifically for paediatric...

  4. The training paths and practice patterns of Canadian paediatric residency graduates, 2004-2010.

    Hameed, Tahir; Lawrence, Sarah


    The Paediatric Chairs of Canada have been proactive in workforce planning, anticipating paediatric job opportunities in academic centres. To complement this, it is important to characterize the practice profiles of paediatricians exiting training, including those working outside of tertiary care centres. To describe the training paths and the practice patterns of Canadian paediatric residency graduates. A survey was completed in 2010 to 2011 by Canadian program directors regarding residents completing core paediatrics training between 2004 and 2010. Data collection included training path after completing core paediatrics training and practice type after graduation. Of 699 residents completing their core training in paediatrics, training path data were available for 685 (98%). Overall, 430 (63%) residents completed subspecialty training while 255 (37%) completed general paediatrics training only. There was a significant increase in subspecialty training, from 59% in earlier graduates (2004 to 2007) to 67% in later graduates (2008 to 2010) (P=0.037). Practice pattern data after completion of training were available for 245 general paediatricians and 205 subspecialists. Sixty-nine percent of general paediatricians were community based while 85% of subspecialists were hospital based in tertiary or quaternary centres. Of all residents currently in practice, only 36 (8%) were working in rural, remote or underserviced areas. Almost two-thirds of recent Canadian paediatric graduates pursued subspecialty training. There was a significant increase in the frequency of subspecialty training among later-year graduates. Few graduates are practicing in rural or underserviced areas. Further studies are needed to determine whether these trends continue and their impact on the future paediatric workforce in Canada.

  5. Interventional radiology for paediatric trauma

    Sidhu, Manrita K. [Everett Clinic, AIC, Seattle Radiologists, Seattle, WA (United States); University of Washington School of Medicine, Radiology Department, Children' s Hospital and Regional Medical Center, Seattle, WA (United States); Hogan, Mark J. [The Ohio State University, Section of Vascular and Interventional Radiology, Nationwide Children' s Hospital, Columbus, OH (United States); Shaw, Dennis W.W. [University of Washington School of Medicine, Radiology Department, Children' s Hospital and Regional Medical Center, Seattle, WA (United States); Burdick, Thomas [University of Washington School of Medicine, Interventional Radiology, Harborview Medical Center, Seattle, WA (United States)


    Paediatric interventional radiology plays a cornerstone role in the management of paediatric trauma. In the acute setting, interventional radiology techniques allow minimally invasive control of haemorrhage or re-establishment of blood flow. Percutaneous stenting and drainage can allow disruptions in urinary or biliary systems to heal without the need for further surgery. Interventional radiology techniques also have a significant role in treating delayed complications of trauma, including embolization of arterial pseudoaneurysms and pulmonary embolism prophylaxis in individuals immobilized due to the trauma or its operative treatment. (orig.)

  6. Paediatric orofacial tumours: new oral health concern in paediatric patients.

    Omoregie, F O; Akpata, O


    This study aims to determine the incidence, age, gender, orofacial sites and histological pattern of paediatric orofacial tumours in a Nigerian population. The yearly findings will be analysed to identify the interval for increase in the incidence of paediatric orofacial tumours. A 21-year (1990 to 2010) retrospective analysis of paediatric orofacial tumours in children younger than 16 years was carried out in the Department of Oral Pathology/Oral Medicine, University of Benin Teaching Hospital, Benin City, Nigeria. Of the 1013 diagnosed lesions within the study period, there were 137 (13.5%) paediatric orofacial tumours, among which 71 (51.8%) cases occurred within the last 6 years (2005 to 2010). There was male predilection for the lesions (78 males to 59 females, ratio = 1.3:1). The mean age was 9 + 4.3 years, with peak age group of 11 to 15 years (n=60, 43.8%). The mandible (n=44, 32.1%), followed by the maxilla (n=42, 30.7%) and orofacial soft tissue (n=19, 13.9%) were the most common sites. The benign tumours (n=72, 52.6%) were slightly more than the malignant tumours (n=65, 47.4%). There were more malignant tumours (n=23, 16.8%) than benign tumours (n=20, 14.6%) within the last 3 years (2008 to 2010) under review. Burkitt's lymphoma (n=38, 27.7%) was the commonest malignant lesion. This study showed a recent increase in the incidence of paediatric orofacial tumours, particularly due to a higher incidence of Burkitt's lymphoma.

  7. Frequency of paediatric medical imaging examinations performed at a European teaching hospital over a 7-year period

    Portelli, Jonathan L.; Bezzina, Paul [University of Malta, Department of Radiography, Faculty of Health Sciences, Msida (Malta); McNulty, Jonathan P.; Rainford, Louise [University College Dublin, Diagnostic Imaging, School of Medicine and Medical Science, Dublin (Ireland)


    The aim of this retrospective cohort study was to gain an insight into frequencies by which a range of medical imaging (MI) examinations were performed on paediatric patients at the main acute general teaching hospital in Malta between 2008 and 2014. Frequency data of MI examinations performed on paediatric patients were retrospectively collected from relevant information systems. All data was coded accordingly to facilitate data analysis. A total of 95,805 MI examinations were performed on 39,707 unique paediatric patients (<18 years) between 2008 and 2014. Overall, the total number of paediatric MI examinations performed decreased over time, with use varying depending on modality type and paediatric age. Coincidentally the use of ultrasound and MRI increased year after year. Some paediatric patients underwent at least three MI examinations involving the same anatomical region being scanned, and which may collectively contribute to effective doses exceeding 10 mSv. Knowledge of how MI examinations are used within the paediatric population can help practices evaluate and address any trends highlighted for particular examinations or age category of paediatric patients. Furthermore, awareness of current trends of MI in children can be helpful for the planning of future paediatric radiology departments. (orig.)

  8. Autoimmune paediatric liver disease

    Giorgina Mieli-Vergani; Diego Vergani


    Liver disorders with a likely autoimmune pathogenesis in childhood include autoimmune hepatitis (AIH), autoimmune sclerosing cholangitis (ASC),and de novo AIH after liver transplantation.AIH is divided into two subtypes according to seropositivity for smooth muscle and/or antinuclear antibody (SMA/ANA,type 1) or liver kidney microsomal antibody (LKM1,type 2).There is a female predominance in both.LKM1 positive patients tend to present more acutely,at a younger age,and commonly have partial IgA deficiency,while duration of symptoms before diagnosis,clinical signs,family history of autoimmunity, presence of associated autoimmune disorders,response to treatment,and long-term prognosis are similar in both groups. The most common type of paediatric sclerosing cholangitis is ASC.The clinical,biochemical, immunological,and histological presentation of ASC is often indistinguishable from that of AIH type 1.In both,there are high IgG,non-organ specific autoantibodies,and interface hepatitis.Diagnosis is made by cholangiography.Children with ASC respond to immunosuppression satisfactorily and similarly to AIH in respect to remission and relapse rates,times to normalization of biochemical parameters, and decreased inflammatory activity on follow up liver biopsies. However,the cholangiopathy can progress.There may be evolution from AIH to ASC over the years,despite treatment.De novo AIH after liver transplantation affects patients not transplanted for autoimmune disorders and is strikingly reminiscent of classical AIH,including elevated titres of serum antibodies, hypergammaglobulinaemia,and histological findings of interface hepatitis,bridging fibrosis,and collapse.Like classical AIH,it responds to treatment with prednisolone and azathioprine.De novo AIH post liver transplantation may derive from interference by calcineurin inhibitors with the intrathymic physiological mechanisms of T-cell maturation and selection.Whether this condition is a distinct entity or a form of

  9. Prolonged unexplained fatigue in paediatrics

    Bakker, R.J.


    Prolonged Unexplained Fatigue in Paediatrics. Fatigue, as the result of mental or physical exertion, will disappear after rest, drinks and food. Fatigue as a symptom of illness will recover with the recovering of the illness. But when fatigue is ongoing for a long time, and not the result of exertio

  10. Predictors of paediatric injury mortality

    Department of Paediatrics and Child Health, Wesley Guild Hospital Unit, Obafemi Awolowo University ... 90% of global deaths due to injuries in children occur in low-income ... sought and obtained by carefully explaining the purpose and benefits ..... terms of mortality and development of neurological sequelae.4-7,16 In.

  11. Methodologies to assess paediatric adiposity.

    Horan, M


    Childhood obesity is associated with increased risk of adult obesity, cardiovascular disease, diabetes and cancer. Appropriate techniques for assessment of childhood adiposity are required to identify children at risk. The aim of this review was to examine core clinical measurements and more technical tools to assess paediatric adiposity.

  12. Antibiotic prescribing in paediatric populations: a comparison between Viareggio, Italy and Funen, Denmark

    Lusini, Gaia; Lapi, Francesco; Sara, Benocci


    High rates of antibiotic prescribing in paediatric populations represent a major issue because of the problem of antibiotic resistance. North European countries reported an appropriate use of antibiotics in general population; few studies on this issue have been conducted until now, especially in...... in Italy. Therefore a comparison concerning paediatric antibiotic prescribing rates between an Italian administrative area in Tuscany (Viareggio) and the county of Funen (Denmark) was conducted....

  13. Effects of continuing paediatric education in interpersonal communication skills.

    Dulmen, A.M. van; Holl, R.A.


    Paediatric care places great demands on interpersonal communication skills, especially as regards the handling of psychosocial issues. Recent shifts in paediatric morbidity and increases in patient empowerment furthermore emphasize the need for continuing paediatric education in communication

  14. Effects of continuing paediatric education in interpersonal communication skills.

    Dulmen, A.M. van; Holl, R.A.


    Paediatric care places great demands on interpersonal communication skills, especially as regards the handling of psychosocial issues. Recent shifts in paediatric morbidity and increases in patient empowerment furthermore emphasize the need for continuing paediatric education in communication skills

  15. [Current treatment strategies for paediatric burns].

    Küntscher, M V; Hartmann, B


    Paediatric burns occupy the third place in the severe accident statistics in Germany after traffic injuries and drowning. The paper reviews current treatment concepts of pre-hospital management, fluid resuscitation and surgical therapy in paediatric burned patients. Specific features in the approximation of the total body surface area burn and indications for transfer of paediatric burn victims to specialized units are discussed. The therapy of severe paediatric burns requires an interdisciplinary team consisting of especially skilled plastic or paediatric surgeons,anaesthetists, psychiatrists or psychologists, specifically trained nurses, physiotherapists and social workers. The rehabilitation process starts basically with admission to the burn unit. A tight cooperation between therapists and the relatives of the paediatric burn victim is needed for psychological recovery and reintegration into society.'The adaptation to the suffered trauma resulting in life-long disability and disfigurement is the main task of psychotherapy.




    Full Text Available : In the past, any surgical procedures of infants and young children was completed under general anesthesia, after obtaining a medical clearance for hospital admission thus consuming lot of time which potentially introduce the child to a greater risk during general anesthesia. Traditionally methods of using scalpels or electro surgery may produce significant post-operative discomfort, requiring sutures –prolonged wound healing. Thus lasers provide simple, significant and safe in office alternative for children

  17. What's new in paediatric dentistry?

    Vitale, M. C.


    Since the early 80's, the use of laser has been introduced in the daily dental practice and the technological development has also provided over time to optimize its use. Various types of lasers with different wavelengths have been developed for use in a handy, easy and ergonomic manner. In daily paediatric dentistry, laser could be a very useful medical device which can completely replace the traditional high hand-piece and bur to realize a "micro-invasive" dentistry and a "clean" surgery, without bleeding and sutures. According to the international literature and in the light of recent researches, this work could give an overview on assisted laser therapy in paediatric dentistry, highlighting advantages and disadvantages of this new technology and pointing out the high compliance of the young patient.

  18. Hypnosis in paediatric respiratory medicine.

    McBride, Joshua J; Vlieger, Arine M; Anbar, Ran D


    Hypnotherapy is an often misunderstood yet effective therapy. It has been reported to be useful within the field of paediatric respiratory medicine as both a primary and an adjunctive therapy. This article gives a brief overview of how hypnotherapy is performed followed by a review of its applications in paediatric patients with asthma, cystic fibrosis, dyspnea, habit cough, vocal cord dysfunction, and those requiring non-invasive positive pressure ventilation. As the available literature is comprised mostly of case series, retrospective studies, and only a single small randomized study, the field would be strengthened by additional randomized, controlled trials in order to better establish the effectiveness of hypnosis as a treatment, and to identify the processes leading to hypnosis-induced physiologic changes. As examples of the utility of hypnosis and how it can be taught to children with respiratory disease, the article includes videos that demonstrate its use for patients with cystic fibrosis.

  19. Trismus in the paediatric population.

    Shires, Peter M; Chow, Gabriel


    Trismus is a rare presentation affecting neonates, children, and adults. In newborns there are serious implications, with potential to affect feeding, cause airway problems, and make intubation difficult. Causes of trismus seen in the paediatric patient are discussed in this review article; they are divided into intra- and extra-articular types. The extra-articular group consists of congenital and acquired disorders. The acquired group includes infective causes such as tetanus, iatrogenic causes related to drugs, cancer or dental treatment, and trauma causing articulation difficulty or triggering a rare type of bone growth in myositis ossificans. Changes in the mouth resulting from oral submucous fibrosis can undergo malignant transformation. This review aims to raise awareness of potential causes of trismus in paediatric populations, helping clinicians identify the underlying pathology so appropriate strategies for treatment be applied, with the ultimate aim of improving long-term outlook and quality of life for affected children. © 2014 Mac Keith Press.

  20. Paediatric bacteraemias in tropical Australia.

    Er, Jeremy; Wallis, Peter; Maloney, Samuel; Norton, Robert


    Bacteraemias in children are an important cause of morbidity and mortality. Knowledge of local epidemiology and trends is important to inform practitioners of likely pathogens in the sick child. This study aimed to determine trends over time in pathogenic organisms causing paediatric bacteraemia in North Queensland and to audit a hospital's blood culture results with respect to contamination rate. This was a retrospective review of 8385 blood cultures collected from children attending a tertiary centre in North Queensland over a 10-year period (2001-2010). There were 696 positive blood cultures (8.3%) with 70 different bacterial species detected. Gram-positive and Gram-negative bacteria accounted for 48.6% and 51.4% of isolates, respectively. Overall, bacteraemia accounted for 4.7 per 1000 admissions. The rate of contamination was 60.6% among positive blood cultures and 5.0% for all blood cultures sampled. These results were compared with previous published reports. Notable differences were seen in the frequencies of Salmonella and group A Streptococcus bacteraemias in North Queensland when compared with other reports. There was also a decline in vaccine-preventable infections such as S. pneumoniae and an increasing trend of community-acquired MRSA bacteraemia. This study has demonstrated the unique profile of causative pathogens of paediatric bacteraemias in tropical Australia. In light of the increasing prevalence of MRSA, empiric treatment for sepsis for children in this region needs to be reconsidered. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  1. A focus on paediatric hypertension

    Pier Paolo Bassareo; Giuseppe Mercuro


    Hypertension can begin early in childhood, as occasional increases in blood pressure or abnormal blood pressure responses to physical or emotional stress. High blood pressure in juvenile age is defined as a blood pressure repeatedly above the 95th percentile of specific nomograms. Its worldwide prevalence ranges from 1% to about 10%. The purpose of this paper is to perform an overview about characteristics, diagnosis, risk factors, therapy, and prognosis of paediatric hypertension.

  2. Essentials of paediatric infection control

    Moore, Dorothy L


    Young children readily transmit and acquire nosocomial infections. Children are also vulnerable to endogenous infections as a result of the breakdown of their normal defences by disease, invasive procedures or therapy. The increasing acuity of illness in hospitalized children and therapeutic advances have resulted in a patient population that is increasingly at higher risk for nosocomial infections. Antibiotic resistance has emerged as a problem in some paediatric hospitals, usually in intens...

  3. Introduction to Special Issue "Gender, Culture and Alcohol Problems: A Multi-national Study

    Bloomfield, Kim; Gmel, Gerhard; Wilsnack, Sharon


    's experience of alcohol-related problems, (3) gender differences in social inequalities in alcohol use and abuse, (4) gender differences in the influence of combinations of social roles on heavy alcohol use, and (5) how societal-level factors predict women's and men's alcohol use and problems on a regional......This paper provides an introduction to a series of articles reporting results from the EU concerted action "Gender, Culture and Alcohol Problems: A Multi-national Study" which examined differences in drinking among women and men in 13 European and two non-European countries. The gender gap...... in alcohol drinking is one of the few universal gender differences in human social behavior. However, the size of these differences varies greatly from one society to another. The papers in this issue examine, across countries, (1) men's and women's drinking patterns, (2) the prevalence of men's and women...

  4. Lessons Learned in Afghanistan: A Multi-national Military Mental Health Perspective

    Randall C. Nedegaard


    Full Text Available America has been at war for almost 10 years. Because of this, continuing missions in the Middle East require the support and cooperation of our allied North Atlantic Treaty Organization (NATO forces from around the world. In this paper we provide an overview of the mission at Kandahar Air Field (KAF and the Multi-National Role 3 hospital located at KAF. Next, we explain the mental health capabilities and unique perspectives among our teammates from Canada, Great Britain, and the United States to include a discussion of the relevant cross-cultural differences between us. Within this framework we also provide an overview of the mental health clientele seen at KAF during the period of April 2009 through September 2009. Finally, we discuss the successes, limitations, and lessons learned during our deployment to Kandahar, Afghanistan.

  5. How to handle multidisciplinary, multi-national and multi-sectoral projects

    Reitz, Anja; Wallmann, Klaus; Visbeck, Martin


    Collaborative research projects funded by the European Commission are by nature multi-national. Often they bring together different scientific communities as the questions raised in EU project calls can typically only be addressed through the convergence of these previously separated disciplines in one research consortium. Some work programmes even necessitate to team up as different disciplines as natural sciences, social science, legal science and economic science. Examples for such multi- national, -disciplinary and - sectoral projects are the EU projects ECO2 (FP7, concluded) and AtlantOS (H2020). Project managers of such projects need to develop skills beyond the common technical and management skills namely go into the domain of partners and stakeholders psychology and be able to maintain different perspectives on communication and interaction needs regarding cultural-, discipline- and sectoral background. Accordingly, the project manager has besides his technical role as manager at least three further roles: that of a communicator, that of a mediator and that of a person convincing partners of the necessary and selling the project products to the stakeholders. As the typical project manager has not too much power and authority by his position he has to use the power of smart communication and persuasion to overcome potential dissension between disciplines, national reservation or potential conflicts regarding different sectoral views. Accordingly, the project manager of such a complex project would try to arrange the ideal working environment by considering cultural feel, the cooperation of disciplines, information and the control of resources. The way he develops such ideal working environment is by reflection of past, present and future experiences/needs.

  6. Challenges and opportunities of multi-disciplinary, multi-national and multi-sectoral projects

    Reitz, Anja; Hamann, Kristin


    Collaborative research projects e.g. funded or supported by the European Commission are by nature multi-national. Often EU calls bring together different scientific communities to jointly tackle challenges that can only be addressed through the convergence of previously separated disciplines in one research consortium. Some work programmes even necessitate to team up as different disciplines as natural sciences, social science, legal science and economic science. Examples for such multi- national, -disciplinary and - sectoral projects are the EU projects ECO2 (FP7, concluded), AtlantOS (H2020) and MiningImpact (JPI Oceans). Project managers of such projects need to develop skills beyond the common technical and management skills namely go into the domain of partners and stakeholders psychology and be able to maintain different perspectives on communication and interaction needs regarding cultural-, discipline- and sectoral background. Accordingly, the project manager has besides his or her technical role as manager at least three further roles: that of a communicator, that of a mediator and that of a person convincing partners of the necessary and selling the project products to the stakeholders. As the typical project manager has not too much power and authority by his or her position he or she has to use the power of smart communication and persuasion to overcome potential dissension between disciplines, national reservation or potential conflicts regarding different sectoral views. Accordingly, the project manager of such complex projects would try to arrange the ideal working environment by considering cultural feel, the cooperation of disciplines, information and the control of resources. The way he or she develops such ideal working environment is by reflection of past, present and future experiences/needs.

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

    Benjamin Allin

    Full Text Available Identify every paediatric surgical article published in 1998 and every paediatric surgical article published in 2013, and determine which study designs were used and whether they were appropriate for robustly assessing interventions in surgical conditions.A systematic review was conducted according to a pre-specified protocol (CRD42014007629, using EMBASE and Medline. Non-English language studies were excluded. Studies were included if meeting population criteria and either condition or intervention criteria.Children under the age of 18, or adults who underwent intervention for a condition managed by paediatric surgeons when they were under 18 years of age.One managed by general paediatric surgeons.Used for treatment of a condition managed by general paediatric surgeons.Studies were classified according to whether the IDEAL collaboration recommended their design for assessing surgical interventions or not. Change in proportions between 1998 and 2013 was calculated.1581 paediatric surgical articles were published in 1998, and 3453 in 2013. The most commonly used design, accounting for 45% of studies in 1998 and 46.8% in 2013, was the retrospective case series. Only 1.8% of studies were RCTs in 1998, and 1.9% in 2013. Overall, in 1998, 9.8% of studies used a recommended design. In 2013, 11.9% used a recommended design (proportion increase 2.3%, 95% confidence interval 0.5% increase to 4% increase, p = 0.017.A low proportion of published paediatric surgical manuscripts utilise a design that is recommended for assessing surgical interventions. RCTs represent fewer than 1 in 50 studies. In 2013, 88.1% of studies used a less robust design, suggesting the need for a new way of approaching paediatric surgical research.

  8. A systematic evaluation of paediatric medicines information content in clinical decision support tools on smartphones and mobile devices

    Sandra Benavides


    Conclusions Overall, general medicines information CDSTs performed better than paediatricspecific CDSTs in both scope and completeness. Results from this study may help guide CDST selection on mobile devices by healthcare professionalswhose patient populations include paediatrics.

  9. Onset symptoms in paediatric multiple sclerosis

    Boesen, Magnus Spangsberg; Sellebjerg, Finn; Blinkenberg, Morten


    INTRODUCTION: Paediatric multiple sclerosis (MS) carries a relatively higher mortality and morbidity than adult MS. Paediatric MS symptoms and paraclinical findings at the first demyelinating event have never before been characterised in a Danish setting. The aim of this study was to compare...

  10. Processes of care in paediatric rehabilitation

    Siebes, R.C.


    In this thesis the paediatric rehabilitation treatment process in the Netherlands is described with a focus on the parents' perspective. To what extent are parents involved in the different stages of the paediatric rehabilitation treatment process? What is being done in treatment? Is there a clear r

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

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


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

  12. Common tasks and problems in paediatric trauma radiology

    Paertan, Gerald E-mail:; Pamberger, Petra; Blab, Edmund; Hruby, Walter


    Scope of this article is to give practical hints for the most common, typical and important topics of trauma radiology in children to those radiologists who are not exclusively occupied with paediatric imaging. Due to the increased radiation sensitivity of children compared with adults balancing radiation protection and necessary image quality is of utmost importance. Outlines for this optimisation process are given. Especially in imaging of the extremities perhaps the greatest difficulties are posed by the dynamically changing face of the immature, growing, only partially ossified skeleton. Lack of experience must be compensated by meticulous comparison with the normal skeletal development as shown in standard textbooks, and by knowledge of the radiological image of the developmental variants. Besides general remarks about paediatric trauma radiology, some important topics are discussed into more detail. Especially the elbow joint poses a challenge for those less experienced with its radiological appearance in children. More than in adults, ultrasound should remain the primary imaging modality of choice especially in the assessment of abdominal trauma, and CT be tailored to radiological and clinical findings. Imaging and diagnosis of non-accidental injury (NAI) may be a less common task for the general radiologist, however, the severe social implications of physical child abuse mandate a basic knowledge about the radiological symptoms and the imaging management of this problem for all physicians occupied with paediatric radiology.

  13. Improving Treatment Response for Paediatric Anxiety Disorders

    Ege, Sarah; Reinholdt-Dunne, Marie Louise


    Cognitive behavioural therapy (CBT) is considered the treatment of choice for paediatric anxiety disorders, yet there remains substantial room for improvement in treatment outcomes. This paper examines whether theory and research into the role of information-processing in the underlying psychopat......Cognitive behavioural therapy (CBT) is considered the treatment of choice for paediatric anxiety disorders, yet there remains substantial room for improvement in treatment outcomes. This paper examines whether theory and research into the role of information-processing in the underlying...... psychopathology of paediatric anxiety disorders indicate possibilities for improving treatment response. Using a critical review of recent theoretical, empirical and academic literature, the paper examines the role of information-processing biases in paediatric anxiety disorders, the extent to which CBT targets...... in improving response to CBT for paediatric anxiety disorders. Many important questions remain to be answered....

  14. Transfusion therapy in paediatric trauma patients

    Nystrup, Kristin Brønnum; Stensballe, Jakob; Bøttger, Morten


    Haemorrhage is a leading cause of death in paediatric trauma patients. Predefined massive transfusion protocols (MTP) have the potential to significantly reduce mortality by treating haemorrhagic shock and coagulopathy, in adhering to the principles of haemostatic resuscitation with rapid...... in paediatric trauma patients is challenging, and the optimal blood product ratio that will increase survival in massively bleeding paediatric trauma patients has yet to be determined. To date, only a few small descriptive studies and case reports have investigated the use of predefined MTP in paediatric trauma...... patients.MTP with increased FFP or PLT to RBC ratios combined with viscoelastic haemostatic assay (VHA) guided haemostatic resuscitation have not yet been tested in paediatric populations but based on results from adult trauma patients, this therapeutic approach seems promising.Considering the high...

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

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


    There is a lack of nurse specialists in many paediatric hospitals in Sweden. This lack of competence is devastating for childhood cancer care because it is a highly specialised area that demands specialist knowledge. Continuing education of nurses is important to develop nursing practice and also to retain them. The aim of this study was to evaluate a Swedish national educational programme in paediatric oncology nursing. The nurses who participated came from all of the six paediatric oncology centres as well as from general paediatric wards. At the time of the evaluation, three groups of registered nurses (n=66) had completed this 2year, part-time educational programme. A study specific questionnaire, including closed and open-ended questions was sent to the 66 nurses and 54 questionnaires were returned. Answers were analysed using descriptive statistics and qualitative content analysis. The results show that almost all the nurses (93%) stayed in paediatric care after the programme. Furthermore, 31% had a position in management or as a consultant nurse after the programme. The vast majority of the nurses (98%) stated that the programme had made them more secure in their work. The nurses were equipped, through education, for paediatric oncology care which included: knowledge generating new knowledge; confidence and authority; national networks and resources. They felt increased confidence in their roles as paediatric oncology nurses as well as authority in their encounters with families and in discussions with co-workers. New networks and resources were appreciated and used in their daily work in paediatric oncology. The programme was of importance to the career of the individual nurse and also to the quality of care given to families in paediatric oncology. The national educational programme for nurses in Paediatric Oncology Care meets the needs of the highly specialised care. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Paediatric Dupuytren′s disease

    Pradeoth Mukundan Korambayil


    Full Text Available Dupuytren′s disease of the hand has only been rarely reported in children and is rarer still in infants. Only a few histologically confirmed diagnoses are found in literature. We report a case in a 4-month-old infant with Dupuytren′s disease of palm and thumb who required surgery at 6 months of age. Histology confirmed the diagnosis of Dupuytren′s disease. The purpose of this report is to show the importance of differential diagnosis of nodules and fibrotic bands in children′s hands as paediatric patients may be seen by a variety of treating physicians, not only plastic surgeons or pathologists.

  17. Canadian Paediatric Neurology Workforce Survey and Consensus Statement.

    Doja, Asif; Orr, Serena L; McMillan, Hugh J; Kirton, Adam; Brna, Paula; Esser, Michael; Tang-Wai, Richard; Major, Philippe; Poulin, Chantal; Prasad, Narayan; Selby, Kathryn; Weiss, Shelly K; Yeh, E Ann; Callen, David Ja


    Little knowledge exists on the availability of academic and community paediatric neurology positions. This knowledge is crucial for making workforce decisions. Our study aimed to: 1) obtain information regarding the availability of positions for paediatric neurologists in academic centres; 2) survey paediatric neurology trainees regarding their perceptions of employment issues and career plans; 3) survey practicing community paediatric neurologists 4) convene a group of paediatric neurologists to develop consensus regarding how to address these workforce issues. Surveys addressing workforce issues regarding paediatric neurology in Canada were sent to: 1) all paediatric neurology program directors in Canada (n=9) who then solicited information from division heads and from paediatric neurologists in surrounding areas; 2) paediatric neurology trainees in Canada (n=57) and; 3) community paediatric neurologists (n=27). A meeting was held with relevant stakeholders to develop a consensus on how to approach employment issues. The response rate was 100% from program directors, 57.9% from residents and 44% from community paediatric neurologists. We found that the number of projected positions in academic paediatric neurology is fewer than the number of paediatric neurologists that are being trained over the next five to ten years, despite a clinical need for paediatric neurologists. Paediatric neurology residents are concerned about job availability and desire more career counselling. There is a current and projected clinical demand for paediatric neurologists despite a lack of academic positions. Training programs should focus on community neurology as a viable career option.

  18. Citation context and impact of 'sleeping beauties' in paediatric research.

    Završnik, Jernej; Kokol, Peter; Del Torso, Stefano; Blažun Vošner, Helena


    Objectives 'Sleeping beauties', i.e. publications that are not cited for a long while, present interesting findings in science. This study analysed the citation trends of sleeping beauties in paediatric research. Methods The study used bibliometric software to analyse the papers citing sleeping beauties in paediatric research, to understand the context in which paediatric sleeping beauties were finally cited and the impact of these sleeping beauties on paediatric research. Results Two paediatric sleeping beauties, addressing medical homes and the transition from paediatric to adult health care, respectively, awakened in response to organizational needs. Both presented novel concepts of paediatric service organization that became important because of an increased need for optimization of services. Conclusion All sleeping beauties bring new knowledge that becomes important only after several years. Paediatric sleeping beauties exhibited unique characteristics; however, their presence in paediatric research shows that knowledge acquisition in paediatrics resembles that in other disciplines.

  19. HACEK Infective Endocarditis: Characteristics and Outcomes from a Large, Multi-National Cohort

    Chambers, Stephen T.; Murdoch, David; Morris, Arthur; Holland, David; Pappas, Paul; Almela, Manel; Fernández-Hidalgo, Nuria; Almirante, Benito; Bouza, Emilio; Forno, Davide; del Rio, Ana; Hannan, Margaret M.; Harkness, John; Kanafani, Zeina A.; Lalani, Tahaniyat; Lang, Selwyn; Raymond, Nigel; Read, Kerry; Vinogradova, Tatiana; Woods, Christopher W.; Wray, Dannah; Corey, G. Ralph; Chu, Vivian H.


    The HACEK organisms (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species) are rare causes of infective endocarditis (IE). The objective of this study is to describe the clinical characteristics and outcomes of patients with HACEK endocarditis (HE) in a large multi-national cohort. Patients hospitalized with definite or possible infective endocarditis by the International Collaboration on Endocarditis Prospective Cohort Study in 64 hospitals from 28 countries were included and characteristics of HE patients compared with IE due to other pathogens. Of 5591 patients enrolled, 77 (1.4%) had HE. HE was associated with a younger age (47 vs. 61 years; pendocarditis was more common in HE (35%) than non-HE (24%). The outcome of prosthetic valve and native valve HE was excellent whether treated medically or with surgery. Current treatment is very successful for the management of both native valve prosthetic valve HE but further studies are needed to determine why HE has a predilection for younger people and to cause stroke. The small number of patients and observational design limit inferences on treatment strategies. Self selection of study sites limits epidemiological inferences. PMID:23690995

  20. The State of Leadership Education in Emergency Medical Services: A Multi-national Qualitative Study.

    Leggio, William Joseph


    This study investigated how leadership is learned in Emergency Medical Services (EMS) from a multi-national perspective by interviewing EMS providers from multiple nations working in Riyadh, Kingdom of Saudi Arabia. A phenomenological, qualitative methodology was developed and 19 EMS providers from multiple nations were interviewed in June 2013. Interview questions focused on how participants learned EMS leadership as an EMS student and throughout their careers as providers. Data were analyzed to identify themes, patterns, and codes to be used for final analysis to describe findings. Emergency Medical Services leadership is primarily learned from informal mentoring and on-the-job training in less than supportive environments. Participants described learning EMS leadership during their EMS education. A triangulation of EMS educational resources yielded limited results beyond being a leader of patient care. The only course that yielded results from triangulation was EMS Management. The need to develop EMS leadership courses was supported by the findings. Findings also supported the need to include leadership education as part of continuing medical education and training. Emergency Medical Services leadership education that prepares students for the complexities of the profession is needed. Likewise, the need for EMS leadership education and training to be part of continuing education is supported. Both are viewed as a way to advance the EMS profession. A need for further research on the topic of EMS leadership is recognized, and supported, with a call for action on suggested topics identified within the study.

  1. Parental knowledge of paediatric vaccination

    Borràs Eva


    Full Text Available Abstract Background Although routine vaccination is a major tool in the primary prevention of some infectious diseases, there is some reluctance in a proportion of the population. Negative parental perceptions of vaccination are an important barrier to paediatric vaccination. The aim of this study was to investigate parental knowledge of paediatric vaccines and vaccination in Catalonia. Methods A retrospective, cross-sectional study was carried out in children aged Results An association was observed between greater vaccination coverage of the 4:4:4:3:1 schedule (defined as: 4 DTPa/w doses, 4 Hib doses, 4 OPV doses, 3 MenC doses and 1 MMR dose and maternal age >30 years (OR: 2.30; 95% CI: 1.20–4.43 and with a knowledge of vaccination score greater than the mean (OR: 0.45; 95% CI: 0.28–0.72. The score increased with maternal educational level and in parents of vaccinated children. A total of 20.47% of parents stated that vaccines could have undesirable consequences for their children. Of these, 23.26% had no specific information and 17.83% stated that vaccines can cause adverse reactions and the same percentage stated that vaccines cause allergies and asthma. Conclusion Higher vaccination coverage is associated with older maternal age and greater knowledge of vaccination. Vaccination coverage could be raised by improving information on vaccines and vaccination.

  2. Information technology in paediatric rheumatology.

    Consolaro, Alessandro; Morgan, Esi M; Giancane, Gabriella; Rosina, Silvia; Lanni, Stefano; Ravelli, Angelo


    Information technology in paediatric rheumatology has seen several exciting developments in recent years. The new multidimensional questionnaires for juvenile idiopathic arthritis, juvenile dermatomyositis, and juvenile autoinflammatory diseases integrate all major parent- and child-reported outcomes (PCROs) used in these diseases into a single tool, and provide an effective guide to manage, document change in health, assess effectiveness of therapeutic interventions, and verify the parent and child satisfaction with illness outcome. The Pharmachild registry is aimed to gain information concerning the long-term effectiveness and safety of the medications currently used in juvenile idiopathic arthritis, particularly biologic agents, through collection of prospective data in a large, multinational sample of patients. Children and their parents are directly involved in the data collection by means of the regular completion of a digital version of a multidimensional questionnaire. The Patient-Reported Outcomes Measurement Information System (PROMIS) employs modern measurement science to advance assessment of PCROs, particularly HRQL, and offers multidimensional profile measures. The conceptual link of paediatric PROMIS with adult instruments facilitates harmonisation of assessments made in children and adolescents with those carried out in young adults in the process of transition of medical care. Development of electronic versions of questionnaires that permit their completion through smartphones or touch-screen devices will revolutionise information collection from parents and children, foster the regular collection of PCROs in routine care, and ultimately improve the quality of self-reported health data, and patient outcomes.

  3. Ethnic diversity outpatient clinic in paediatrics

    Dahhan Nordin


    Full Text Available Abstract Background The health status of chronic sick ethnic minority children in the Netherlands is unequal compared with indigenous Dutch children. In order to optimize the health care for these children a specific patient-oriented clinic in ethnic-cultural diversity: the Mosaic Outpatient Clinic (MOC was integrated in the general Paediatric Outpatient Departments (POPD of three hospitals in Amsterdam. Methods Feasibility of the MOC, factors influencing the health care process and encountered bottlenecks in health care were studied in ethnic minority children with asthma, diabetes type 1 or metabolic disease originating from Morocco, Turkey and Surinam. Feasibility was determined by the number of patients attended, support from the paediatric medical staff and willingness of the patients to participate. Influences on the health care process comprised parents' level of knowledge of disease, sense of disease severity, level of effort, linguistic skills, health literacy, adherence to treatment and encountered bottlenecks in the health care process. Moreover, the number of admissions and visits to the POPD in the years before, during and after the MOC were analysed. Results In 2006 a total of 189 ethnic minority children were seen. Integration of the MOC within the general POPD of the hospital is feasible. The ability of the parents to speak and understand Dutch was found to be 58%, functional health literacy was 88%; sufficient knowledge of disease and sense of disease severity were 59% and 67%, respectively. The main bottlenecks in the healthcare process: poor knowledge of disease, limited sense of disease severity and low health literacy in the parents proved to be the best predictors for decreased adherence. After attending the MOC there was a decrease in the number of admissions and visits to the POPD for asthma while the number of visits increased in patients with diabetes and the amount of no-shows decreased in patients with a metabolic

  4. Conflict escalation in paediatric services: findings from a qualitative study.

    Forbat, Liz; Teuten, Bea; Barclay, Sarah


    To explore clinician and family experiences of conflict in paediatric services, in order to map the trajectory of conflict escalation. Qualitative interview study, employing extreme-case sampling. Interviews were analysed using an iterative thematic approach to identify common themes regarding the experience and escalation of conflict. Thirty-eight health professionals and eight parents. All participants had direct experience of conflict, including physical assault and court proceedings, at the interface of acute and palliative care. Two teaching hospitals, one district general hospital and two paediatric hospices in England, in 2011. Conflicts escalate in a predictable manner. Clearly identifiable behaviours by both clinicians and parents are defined as mild, moderate and severe. Mild describes features like the insensitive use of language and a history of unresolved conflict. Moderate involves a deterioration of trust, and a breakdown of communication and relationships. Severe marks disintegration of working relationships, characterised by behavioural changes including aggression, and a shift in focus from the child's best interests to the conflict itself. Though conflicts may remain at one level, those which escalated tended to move sequentially from one level to the next. Understanding how conflicts escalate provides clinicians with a practical, evidence-based framework to identify the warning signs of conflict in paediatrics. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  5. Framework conditions facilitating paediatric clinical research

    Alfarez Deborah


    Full Text Available Abstract The use of unlicensed and "off-label" medicines in children is widespread. Between 50-80% of the medicines currently administered to children have neither been tested nor authorized for their use in the paediatric population which represents approximately 25% of the whole European population. On 26 January 2007, entered into force the European Regulation of Paediatric Medicines. It aims at the quality of research into medicines for children but without subjecting the paediatric population to unnecessary clinical trial. This article addresses ethical and legal issues arising from the regulation and makes recommendations for the framework conditions facilitating the development of clinical research with children.

  6. Impact of the European paediatric legislation in paediatric rheumatology: past, present and future.

    Ruperto, Nicolino; Vesely, Richard; Saint-Raymond, Agnes; Martini, Alberto


    Conducting clinical trials in paediatric rheumatology has been difficult mainly because of the lack of funding for academic studies and the lack of interest by pharmaceutical companies in the small and non-rewarding paediatric market. The situation changed dramatically a few years ago with the introduction of the Best Pharmaceuticals for Children Act in the USA and of specific legislation for the development of paediatric medicines (Paediatric Regulation) in the European Union (EU). The EU Paediatric Regulation had a positive impact in paediatric rheumatology-in particular, on the development of new treatments for children with juvenile idiopathic arthritis (JIA). Some problems remain, however, such as greater harmonisation of the regulatory aspects of medicines, how to handle me-too agents, how to conduct adequate pharmacokinetic studies and develop age-appropriate formulations, ethical problems in study review and implementation, and a change in the current JIA classification. The introduction of specific legislation, coupled with the existence of large international networks such as the Pediatric Rheumatology Collaborative Study Group (PRCSG at, covering North America, and the Paediatric Rheumatology International Trials Organisation (PRINTO at, covering more than 50 countries, has led to great advances in paediatric rheumatology. Future changes might increase the possibility of conducting trials with similar approaches in other paediatric rheumatological conditions and provide evidence-based treatments for children affected by rheumatic diseases.

  7. Chvostek's sign in paediatric practice.

    Hasan, Zeeshaan U; Absamara, Rania; Ahmed, Mas


    Chvostek's Sign was first described in 1876, as a clinical clue associated with patients who suffered from latent tetany, and is induced by percussion of the angle of the jaw. However, over the years many clinicians have called into question the strength of the association with latent tetany, particularly in paediatric practice. This review examines the variation in techniques used to elicit the sign in studies conducted on this phenomenon in children as well as how differences in the classification of a positive Chvostek's sign have lead to varied reports on the strength of the association. Furthermore, an appraisal of the literature regarding the proposed mechanism of Chvostek's sign is reported alongside analysing other diseases which have been associated with Chvostek's sign to uncover any unifying mechanism for the presence of this clinical sign in children.

  8. Steroid assays in paediatric endocrinology.

    Honour, John W


    Most steroid disorders of the adrenal cortex come to clinical attention in childhood and in order to investigate these problems, there are many challenges to the laboratory which need to be appreciated to a certain extent by clinicians. The analysis of sex steroids in biological fluids from neonates, over adrenarche and puberty present challenges of specificities and concentrations often in small sample sizes. Different reference ranges are also needed for interpretations. For around 40 years, quantitative assays for the steroids and their regulatory peptide hormones have been possible using immunoassay techniques. Problems are recognised and this review aims to summarise the benefits and failings of immunoassays and introduce where tandem mass spectrometry is anticipated to meet the clinical needs for steroid analysis in paediatric endocrine investigations. It is important to keep a dialogue between clinicians and the laboratory, especially when any laboratory result does not make sense in the clinical investigation.

  9. Therapeutic clowning in paediatric practice.

    Finlay, Fiona; Baverstock, Anna; Lenton, Simon


    Over the past 30 years, there has been much research into the health benefits of humour and laughter. Although often viewed very positively, rigorous evaluation of the therapeutic effect of clowning is complex. Clowning is a multi-modal intervention, which may have an impact on medical conditions, procedures, family functioning and health care teams. Clowns help children to adapt to their hospital surroundings and can distract from, and demystify, painful or frightening procedures through 'doses of fun' to complement traditional clinical interventions. This paper provides a review of the paediatric literature and reveals studies looking at the effect of clown interventions on various practical procedures and individual medical conditions, and the effects of clowning within clinical teams.

  10. Diagnostic reference levels for paediatric computed tomography ...

    Objectives: To establish local diagnostic reference levels (LDRLs) for ... and dose length product (DLP) data from uncontrasted paediatric head CT scans ... LDRL values were compared with several national DRLs from Europe and Australia.

  11. Job satisfaction and burnout among paediatric nurses.

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


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

  12. Paediatric Neurological Conditions Seen at the Physiotherapy ...

    Paediatric Neurological Conditions Seen at the Physiotherapy Department of Federal Medical Centre, ... of published works on the patterns of neurological conditions seen in Nigerian physiotherapy clinics of rural locations. ... Article Metrics.

  13. Paediatric horse-related trauma.

    Theodore, Jane E; Theodore, Sigrid G; Stockton, Kellie A; Kimble, Roy M


    This retrospective cohort study reported on the epidemiology of horse-related injuries for patients presenting to the only tertiary paediatric trauma hospital in Queensland. The secondary outcome was to examine the use of helmets and adult supervision. Traumatic brain injury (TBI) was examined in relation to helmet use. Morbidity and mortality were also recorded. Included were all patients presenting with any horse-related trauma to the Royal Children's Hospital in Brisbane from January 2008 to August 2014. Data were retrospectively collected on patient demographics, hospital length of stay (LOS), mechanism of injury (MOI), safety precautions taken, diagnoses and surgical procedures performed. Included in the analysis were 187 incidents involving 171 patients. Most patients were aged 12-14 years (36.9%) and female (84.5%). The most common MOI were falls while riding horses (97.1%). Mild TBI (24.6%) and upper limb fractures (20.9%) were common injuries sustained. Patients who wore helmets had significantly reduced hospital LOS and severity of TBI when compared with those who did not wear helmets (P < 0.001 and P = 0.028, respectively). Morbidity was reported in 7.5% of patients. There were three deaths in Queensland. Helmet use is recommended for non-riders when handling horses, in addition to being a compulsory requirement whilst horse riding. Prompts in documentation may assist doctors to record the use of safety attire and adult supervision. This will allow future studies to further investigate these factors in relation to clinical outcomes. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  14. The european paediatric legislation: benefits and perspectives

    Rocchi Francesca


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

  15. Exploring resilience in paediatric oncology nursing staff.

    Zander, Melissa; Hutton, Alison; King, Lindy


    Resilience has been suggested as an important coping strategy for nurses working in demanding settings, such as paediatric oncology. This qualitative study explored paediatric oncology nurses' perceptions of their development of resilience and how this resilience underpinned their ability to deal with work-related stressors. Five paediatric oncology nurses were interviewed about their understanding of the concept of resilience, their preferred coping mechanisms, and their day-today work in paediatric oncology. Using thematic analysis, the interviews were subsequently grouped together into seventeen initial themes. These themes were then grouped into seven major aspects that described how the participants perceived resilience underpinned their work. These "seven aspects of forming resilience" contributed to an initial understanding of how paediatric oncology nurses develop resilience in the face of their personal and professional challenges. Several key strategies derived from the findings, such as improved rostering, support to a nurse's friend and family, and a clinical support nursing role, could be implemented at an organizational level to support resilience development within the paediatric oncology setting.




    Full Text Available Purpose: To evaluate the demography, aetiology, type and outcome of paediatric ocular trauma in tertiary centre in Malaysia. Method: We retrospectively studied 118 eyes from 117 patients over a period of 36 months (January 2006 to December 2008. All ocular injuries in patients aged 12 and below seen in the Ophthalmology Department for the first time were included in thisstudy. Results: Mean age of patients was 6.1±3.0 years. 68 cases (58.2% occurred in pre-school children, whereas 49 (41.9% in school-aged children. Boys accounted for 65.8% of cases. There was no predilection for either right or the left eye. 47% of cases (56 patients occurred in Malay. Most of the injuries took place at home when the children were alone (p<0.05. Sharp objects were the commonest cause (45 cases, 38.1%. The majority of cases (103, 87.3% were considered preventable. The frequency of open and closed globe injury was similar. Hyphema was more common in closed globe injury compared to open globe injury (p<0.05. Other associated injuries such as cataract, vitreous hemorrhage and retinal hemorrhage are similar between the two groups. Visual outcome is generally poor with only 34 eyes (28.8% had no visual impairment. Conclusion: Ocular trauma in children is an important cause of visual loss. Most cases occurred at home and were preventable. Prevention through education is the best approach.

  17. Long- term outcome of paediatric patients with ANCA vasculitis

    Pusey Charles D


    Full Text Available Abstract Background Primary systemic vasculitis presenting in childhood is an uncommon but serious condition. As these patients transfer to adult clinics for continuing care, defining long term outcomes with emphasis on disease and treatment- related morbidity and mortality is important. The aim of this study is to describe the long- term clinical course of paediatric patients with ANCA vasculitis. Methods The adult patients in our vasculitis clinics who had presented in childhood, with a follow up time of greater than 10 years were included. We also reviewed the literature for articles describing the clinical outcome of paediatric patients with ANCA vasculitis. Results We describe the clinical course of 8 adults who presented in childhood with ANCA vasculitis. 7 patients had Wegener's granulomatosis and 1 had microscopic polyangiitis. The median age at presentation was 11.5 years, and follow up time ranged form 11 to 30 years. Induction therapy for all patients was steroids and/or cyclophosphamide. Maintenance therapy was with azathioprine or mycophenolate mofetil. Biological agents were used in 3 patients for relapsed disease in adulthood only. Seven patients achieved complete remission. All patients experienced disease relapse, with a median of 4 episodes. Kidney function was generally well preserved, with median eGFR 76 ml/min. Only one patient developed end-stage renal failure and one patient died after 25 years of disease. Treatment-related morbidity rates were high; 7 suffered from infections, 4 were infertile, 2 had skeletal complications, and 1 developed malignancy. Conclusion Close long- term follow up of paediatric patients with ANCA vasculitis is imperative, as this patient cohort is likely to live long enough to develop significant treatment and disease- related morbidities. Prospective cohort studies with novel therapies including paediatric patients are crucial to help us determine the best approach to managing this complex group


    B. Dharmaraju


    Full Text Available AIMS AND OBJECTIVES To know various causes, sex distribution, socioeconomic status, onset, severity, visual prognosis of paediatric strabismus. METHODOLOGY The present study was undertaken for a period of 18 months. All the patients were selected from those attending the outpatient department. 50 cases of squint were evaluated thoroughly to know the various factors responsible for squint and how it was caused. RESULTS Total Number of Patients who attended OPD were 72,431 (4000 per month. Total Number of Paediatric squint cases among them were 121. So, Incidence of Paediatric squint in general OP was-0.16%. In the present study of total 121 paediatric squint cases, 21 cases did not fulfil the inclusion criteria and in the remaining 100, cases were included by taking every 2nd patient. Esotropia is seen in 38 children contributing to 76% of total and exotropia is seen in 12 children contributing 24% of total cases. Most common cause of esotropia is Essential Infantile Esotropia contributing to 31% of total esotropias. Males are affected more commonly than females with an incidence of 60%. Esotropia is seen in 38 children contributing to 76% of total and exotropia is seen in 12 children contributing 24% of total cases. In this study, males are affected more commonly than females contributing to 60% of total and females constitute 40% of the total. In this study, incidence of paediatric squint is more commonly seen in lower socioeconomic population contributing 60% of the total. 15 cases are of congenital in onset constituting 30% of total and 35 cases are of acquired in onset constituting 70% of total. Small angle Esotropia and large angle Esotropia: In this study out of total 38 cases of esotropia, large angle esotropias are more common and contributing to 89% of the total. Out of total 50 cases, 16% had an angle of 30⁰. Out of 50 cases, significant family history was present in 15 cases contributing to 30% of total cases. Following early

  19. Poverty and childhood undernutrition in developing countries: a multi-national cohort study.

    Petrou, Stavros; Kupek, Emil


    The importance of reducing childhood undernutrition has been enshrined in the United Nations' Millennium Development Goals. This study explores the relationship between alternative indicators of poverty and childhood undernutrition in developing countries within the context of a multi-national cohort study (Young Lives). Approximately 2000 children in each of four countries - Ethiopia, India (Andhra Pradesh), Peru and Vietnam - had their heights measured and were weighed when they were aged between 6 and 17 months (survey one) and again between 4.5 and 5.5 years (survey two). The anthropometric outcomes of stunted, underweight and wasted were calculated using World Health Organization 2006 reference standards. Maximum-likelihood probit estimation was employed to model the relationship within each country and survey between alternative measures of living standards (principally a wealth index developed using principal components analysis) and each anthropometric outcome. An extensive set of covariates was incorporated into the models to remove as much individual heterogeneity as possible. The fully adjusted models revealed a negative and statistically significant coefficient on wealth for all outcomes in all countries, with the exception of the outcome of wasted in India (Andhra Pradesh) and Vietnam (survey one) and the outcome of underweight in Vietnam (surveys one and two). In survey one, the partial effects of wealth on the probabilities of stunting, being underweight and wasting was to reduce them by between 1.4 and 5.1 percentage points, 1.0 and 6.4 percentage points, and 0.3 and 4.5 percentage points, respectively, with each unit (10%) increase in wealth. The partial effects of wealth on the probabilities of anthropometric outcomes were larger in the survey two models. In both surveys, children residing in the lowest wealth quintile households had significantly increased probabilities of being stunted in all four study countries and of being underweight in

  20. HACEK infective endocarditis: characteristics and outcomes from a large, multi-national cohort.

    Stephen T Chambers

    Full Text Available The HACEK organisms (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species are rare causes of infective endocarditis (IE. The objective of this study is to describe the clinical characteristics and outcomes of patients with HACEK endocarditis (HE in a large multi-national cohort. Patients hospitalized with definite or possible infective endocarditis by the International Collaboration on Endocarditis Prospective Cohort Study in 64 hospitals from 28 countries were included and characteristics of HE patients compared with IE due to other pathogens. Of 5591 patients enrolled, 77 (1.4% had HE. HE was associated with a younger age (47 vs. 61 years; p<0.001, a higher prevalence of immunologic/vascular manifestations (32% vs. 20%; p<0.008 and stroke (25% vs. 17% p = 0.05 but a lower prevalence of congestive heart failure (15% vs. 30%; p = 0.004, death in-hospital (4% vs. 18%; p = 0.001 or after 1 year follow-up (6% vs. 20%; p = 0.01 than IE due to other pathogens (n = 5514. On multivariable analysis, stroke was associated with mitral valve vegetations (OR 3.60; CI 1.34-9.65; p<0.01 and younger age (OR 0.62; CI 0.49-0.90; p<0.01. The overall outcome of HE was excellent with the in-hospital mortality (4% significantly better than for non-HE (18%; p<0.001. Prosthetic valve endocarditis was more common in HE (35% than non-HE (24%. The outcome of prosthetic valve and native valve HE was excellent whether treated medically or with surgery. Current treatment is very successful for the management of both native valve prosthetic valve HE but further studies are needed to determine why HE has a predilection for younger people and to cause stroke. The small number of patients and observational design limit inferences on treatment strategies. Self selection of study sites limits epidemiological inferences.

  1. Transarterial embolisation of a large focal nodular hyperplasia, using microspheres, in a paediatric patient.

    Oliveira, Catarina; Gil-Agostinho, Alfredo; Gonçalves, Isabel; Noruegas, Maria José


    Benign liver tumours are uncommon in children, haemangiomas being the most frequent. Focal nodular hyperplasia (FNH) represents about 2% of paediatric liver tumours. In children, as in adults, a conservative approach is generally recommended. However, large lesions (greater than 5 cm) are more frequent in the paediatric age group, and in these cases, as well as in growing lesions, surgical removal may be advised. Transarterial embolisation (TAE) has been a successful alternative option described in older patients, especially in cases where surgical removal is not possible. This minimally invasive procedure may also become an option in the paediatric group. The authors report the case of a boy with a large FNH treated with TAE using microspheres. 2015 BMJ Publishing Group Ltd.

  2. Current demand of paediatric otolaryngology input for children with Down's syndrome in a tertiary referral centre.

    Khalid-Raja, M; Tzifa, K


    This study aimed to evaluate the activity of paediatric otolaryngology services required for children with Down's syndrome in a tertiary referral centre. A review of the paediatric otolaryngology input for children with Down's syndrome was performed; data were obtained from the coding department for a two-year period and compared with other surgical specialties. Between June 2011 and May 2013, 106 otolaryngology procedures were performed on children with Down's syndrome. This compared to 87 cardiac and 81 general paediatrics cases. The most common pathologies in children with Down's syndrome were obstructive sleep apnoea, otitis media, hearing loss and cardiac disease. The most common otolaryngology procedures performed were adenoidectomy, tonsillectomy, grommet insertion and bone-anchored hearing aid implant surgery. ENT manifestations of Down's syndrome are common. Greater provisions need to be made to streamline the otolaryngology services for children and improve transition of care to adult services.

  3. Knowledge of carbohydrate counting and insulin dose calculations in paediatric patients with type 1 diabetes mellitus

    Natalie Finner


    General significance: This study demonstrates that in a representative Irish regional paediatric T1DM clinic, knowledge of carbohydrates and insulin is poorer than in a US based sample, although this knowledge is better among patients treated with CSII compared with MDI. This highlights the need for improved resources for diabetes and carbohydrate counting education for patients with T1DM.

  4. Long-term safety in living kidney donors for paediatric transplantation. Single-centre prospective study

    Javier Martin


    Conclusions: Risk of CKD and hypertension in living kidney donors for paediatric recipients, who are carefully monitored throughout their evolution, is similar to that of the general population. Therefore, this technique appears to be safe in both the short and long term.

  5. Skin lesions in children admitted to the paediatric intensive care unit: an observational study

    Sillevis Smitt, J.H.; van Woensel, J.B.M.; Bos, A.P.


    We analysed, by a prospective observational study over a 3-year period, the frequency and character of dermatological symptoms and diseases in children admitted to a tertiary general paediatric intensive care unit (PICU) of a university hospital. Skin problems were observed in 42 of 1,800 children

  6. Paediatric diagnostic audiology testing in South Africa.

    Moodley, Selvarani


    With the increased emphasis on the importance of early identification of paediatric hearing loss within developing countries such as South Africa and Nigeria there has been a recognition of the ethical obligation to ensure access to timely diagnostic and intervention services for children identified with hearing loss; regardless of their geographic or socioeconomic status. There are limited studies on diagnosis of paediatric hearing loss in a developing world context. The objective of this study was to determine processes used for diagnosis of paediatric hearing loss in South Africa, across the private and public healthcare sectors, and to profile the age of testing for each component of the diagnostic test battery. Diagnostic audiology testing data of 230 children enrolled in an early intervention programme was analysed to profile the reporting of diagnostic audiology testing as well as diagnostic audiology procedures employed. Results were analysed according to province as well as healthcare sector to compare diagnostic services across regions as well as healthcare sectors. The differences in audiology practice and tests employed with paediatric clients across the regions of Gauteng, Kwazulu Natal and Western Cape indicates that services across regions and across the public and private sector are not equitable. Each region is equally unlikely to complete a full, comprehensive diagnostic evaluation on paediatric clients. The age of testing highlights the increased age of diagnosis of hearing loss. Paediatric diagnostic audiology is a section of Early Hearing Detection and Intervention services that requires attention in terms of the appropriateness of procedures as well as equity of services. Further studies on diagnostic practice and resources in South Africa will provide information on factors that are preventing adherence to international best practice guidelines for paediatric diagnostic audiology. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  7. EULAR recommendations for vaccination in paediatric patients with rheumatic diseases

    Heijstek, M. W.; de Bruin, L. M. Ott; Bijl, M.; Borrow, R.; van der Klis, F.; Kone-Paut, I.; Fasth, A.; Minden, K.; Ravelli, A.; Abinun, M.; Pileggi, G. S.; Borte, M.; Wulffraat, N. M.


    Evidence-based recommendations for vaccination of paediatric patients with rheumatic diseases (PaedRD) were developed by following the EULAR standardised procedures for guideline development. The EULAR task force consisted of (paediatric) rheumatologists/immunologists, one expert in vaccine

  8. A comparison of student motivation in selecting bachelors of nursing or paediatric nursing at an Italian university.

    Zampieron, A; Buja, A; Dorigo, M; Bonso, O; Corso, M


    To investigate students' reasons for choosing general or paediatric nursing, and to compare motivation factors and personal characteristics between the two professions. In Italy, nursing students can choose between two distinct career paths: general and paediatric nursing. However, it is unclear what factors motivate a student to choose between these two pathways. A cross-sectional approach was used to compare a sample of general and paediatric nursing students enrolled in a university in northeast Italy. We administered a questionnaire that covered socio-demographic characteristics and included an instrument of motivation developed by Zysberg & Berry to 224 students enrolled in the 3-year classes. We analysed 215 questionnaires (96%). Paediatric nurses were generally younger, had attended a college preparatory high school and had previously failed another university programme. Many students, in both groups, had a relative who was a nurse, or had cared for a sick friend or family member. Students did not vary significantly in how they evaluated items included in the questionnaire. A career in nursing should be advised for students who are motivated to help other people. Paediatric nursing was identified as an acceptable career choice by students of college preparatory high schools or by students who had initially enrolled in a different university programme. General nursing was a satisfactory choice by students with previous work experience. © 2012 The Authors. International Nursing Review © 2012 International Council of Nurses.

  9. Minimally invasive paediatric cardiac surgery.

    Bacha, Emile; Kalfa, David


    The concept of minimally invasive surgery for congenital heart disease in paediatric patients is broad, and has the aim of reducing the trauma of the operation at each stage of management. Firstly, in the operating room using minimally invasive incisions, video-assisted thoracoscopic and robotically assisted surgery, hybrid procedures, image-guided intracardiac surgery, and minimally invasive cardiopulmonary bypass strategies. Secondly, in the intensive-care unit with neuroprotection and 'fast-tracking' strategies that involve early extubation, early hospital discharge, and less exposure to transfused blood products. Thirdly, during postoperative mid-term and long-term follow-up by providing the children and their families with adequate support after hospital discharge. Improvement of these strategies relies on the development of new devices, real-time multimodality imaging, aids to instrument navigation, miniaturized and specialized instrumentation, robotic technology, and computer-assisted modelling of flow dynamics and tissue mechanics. In addition, dedicated multidisciplinary co-ordinated teams involving congenital cardiac surgeons, perfusionists, intensivists, anaesthesiologists, cardiologists, nurses, psychologists, and counsellors are needed before, during, and after surgery to go beyond apparent technological and medical limitations with the goal to 'treat more while hurting less'.

  10. Good long-term survival after paediatric heart transplantation

    Kruse, Charlotte Duhn; Helvind, Morten; Jensen, Tim


    The brain-death criterion was introduced in Denmark in 1990. The first Danish paediatric heart transplantation (HTx) was performed at Copenhagen University Hospital, Rigshospitalet, in Copenhagen in 1991. We describe our experiences during the first 20 years with paediatric HTx.......The brain-death criterion was introduced in Denmark in 1990. The first Danish paediatric heart transplantation (HTx) was performed at Copenhagen University Hospital, Rigshospitalet, in Copenhagen in 1991. We describe our experiences during the first 20 years with paediatric HTx....

  11. Good long-term survival after paediatric heart transplantation

    Kruse, Charlotte Duhn; Helvind, Morten; Jensen, Tim


    The brain-death criterion was introduced in Denmark in 1990. The first Danish paediatric heart transplantation (HTx) was performed at Copenhagen University Hospital, Rigshospitalet, in Copenhagen in 1991. We describe our experiences during the first 20 years with paediatric HTx.......The brain-death criterion was introduced in Denmark in 1990. The first Danish paediatric heart transplantation (HTx) was performed at Copenhagen University Hospital, Rigshospitalet, in Copenhagen in 1991. We describe our experiences during the first 20 years with paediatric HTx....

  12. Citation context and impact of 'sleeping beauties' in paediatric research

    Završnik, Jernej; Kokol, Peter; del Torso, Stefano; Blažun, Helena


    Objectives: ‘Sleeping beauties’, i.e. publications that are not cited for a long while, present interesting findings in science. This study analysed the citation trends of sleeping beauties in paediatric research. Methods: The study used bibliometric software to analyse the papers citing sleeping beauties in paediatric research, to understand the context in which paediatric sleeping beauties were finally cited and the impact of these sleeping beauties on paediatric research. Results: ...

  13. [A Paediatric Orthopaedic outpatient clinic referral patterns].

    Moraleda, L; Castellote, M


    The aim of this study was to identify the commonest referrals to a paediatric orthopaedic outpatient clinic and, therefore, to be able to improve the paediatric residency program in managing musculoskeletal problems. Demographic data, referrals and final diagnosis were collected prospectively on all patients that were evaluated in a paediatric orthopaedic outpatient clinic. The majority of referrals were to evaluate musculoskeletal pain (37%), foot deformity (20%), spine deformity (15%), walking pattern (11%), alignment of the lower limbs (4%), and development of the hip (4%). A normal physical examination or a normal variation was observed in 42% of patients. A mild condition was observed in 17% of patients that should have only been referred to a paediatric orthopaedic clinic after failing to resolve pain with anti-inflammatories or physiotherapy. A mild deformity that only needed treatment if it became symptomatic was seen in 8% of patients. The majority of referrals were due to a normal variation or mild conditions that only required symptomatic treatment. Paediatric residency programs do not reflect the prevalence of musculoskeletal conditions in clinical practice. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  14. Oral medicines for children in the European paediatric investigation plans

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


    INTRODUCTION: Pharmaceutical industry is no longer allowed to develop new medicines for use in adults only, as the 2007 Paediatric Regulation requires children to be considered also. The plans for such paediatric development called Paediatric Investigation Plans (PIPs) are subject to agreement by th

  15. Practical application of natriuretic peptides in paediatric cardiology

    Smith, Julie; Goetze, Jens P; Andersen, Claus B


    It is still uncertain if cardiac natriuretic peptides are useful biomarkers in paediatric cardiology. In this review we identify four clinical scenarios in paediatric cardiology, where clinical decision-making can be difficult, and where we feel the paediatric cardiologists need additional...

  16. Practical application of natriuretic peptides in paediatric cardiology

    Smith, Julie; Goetze, Jens P; Andersen, Claus B


    It is still uncertain if cardiac natriuretic peptides are useful biomarkers in paediatric cardiology. In this review we identify four clinical scenarios in paediatric cardiology, where clinical decision-making can be difficult, and where we feel the paediatric cardiologists need additional...

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

    McDougall, Rosalind J; Notini, Lauren


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

  18. Diagnostic radiology in paediatric palliative care

    Patel, Preena; Koh, Michelle; Carr, Lucinda; McHugh, Kieran [Great Ormond Street Hospital, Radiology Department, London (United Kingdom)


    Palliative care is an expanding specialty within paediatrics, which has attracted little attention in the paediatric radiological literature. Paediatric patients under a palliative care team will have numerous radiological tests which we traditionally categorise under organ systems rather than under the umbrella of palliative medicine. The prevalence of children with life-limiting illness is significant. It has been estimated to be one per thousand, and this may be an underestimate. In this review, we will focus on our experience at one institution, where radiology has proven to be an invaluable partner to palliative care. We will discuss examples of conditions commonly referred to our palliative care team and delineate the crucial role of diagnostic radiology in determining treatment options. (orig.)

  19. Is paediatric trauma severity overestimated at triage?

    DO, H Q; Hesselfeldt, R; Steinmetz, J


    BACKGROUND: Severe paediatric trauma is rare, and pre-hospital and local hospital personnel experience with injured children is often limited. We hypothesised that a higher proportion of paediatric trauma victims were taken to the regional trauma centre (TC). METHODS: This is an observational...... follow-up study that involves one level I TC and seven local hospitals. We included paediatric (trauma patients with a driving distance to the TC > 30 minutes. The primary end-point was the proportion of trauma patients arriving in the TC. RESULTS: We included 1934...... trauma patients, 238 children and 1696 adults. A total of 33/238 children (13.9%) vs. 304/1696 adults (17.9%) were transported to the TC post-injury (P = 0.14). Among these, children were significantly less injured than adults [median Injury Severity Score (ISS) 9 vs. 14, P 

  20. Virtual colonoscopy in paediatric patients

    Carrascosa, Patricia [Diagnostico Maipu, Av. Maipu 1668, Vicente Lopez (B1602ABQ), Buenos Aires (Argentina)], E-mail:; Lopez, Elba Martin; Capunay, Carlos; Vallejos, Javier; Carrascosa, Jorge [Diagnostico Maipu, Av. Maipu 1668, Vicente Lopez (B1602ABQ), Buenos Aires (Argentina)


    Objective: To determine the usefulness of perspective-filet view for polypoid lesions in paediatric patients in comparison with conventional virtual colonoscopy (VC) analysis and optical colonoscopy. Methods: Sixty-one patients (mean age 5 years old) with a previous episode of rectal bleeding were studied using a 16 slices CT scanner. All patients underwent a colonic preparation. Two acquisitions were done in supine and prone positions with slices of 2 mm thickness; increment 1 mm, 30-50 mA; 90-120 kV. In a workstation an experienced radiologist reviewed images twice. The first read was done using the conventional virtual colonoscopy technique with the evaluation of two-dimensional (2D), three-dimensional (3D) and endoscopical images. Later, in a second session, perspective-filet view was used. It shows a 360 deg. unrolled visualization of the inner colon. The presence, size and location of the lesions were determined. A record of the reading time was made. Results: At per patient evaluation the conventional virtual colonoscopy analysis obtained a sensitivity of 86% and a specificity of 98%. The perspective-filet view obtained a sensitivity of 91% and a specificity of 99%. In the evaluation on a per lesion basis the conventional analysis had a sensitivity of 81% and a specificity of 88%. Perspective-filet view, had a sensitivity of 82% and specificity of 90%. The average total reading time using conventional colonoscopy technique was 18 {+-} 3 min, versus 4 {+-} 1 min using the perspective-filet view. Conclusion: Virtual colon dissection with perspective-filet view is more time-efficient than conventional virtual colonoscopy evaluation with correct correlation in results.

  1. Nonunion of paediatric talar neck fracture

    Jindal Nipun


    Full Text Available 【Abstract】Fractures of the paediatric talus are infrequent injuries, most complicated by posttraumatic arthrosis and avascular necrosis in the course of treatment. Non- union in children has not been reported before in literature. We report a case of a 12-year-old boy who had a nonunion of Hawkins type II fracture of talar neck. The nonunion was treated surgically with a good clinical outcome. The goals of management in nonunion of paediatric talar neck fracture are different from those in fresh fractures. A suboptimal reduction should be acceptable without trying a radical surgery which may cause further impairment.

  2. A disjointed effort: paediatric musculoskeletal examination.

    Gill, Irwin


    Musculoskeletal (MSK) symptoms are a frequent cause of emergency department attendance for children, and while most often indicative of benign or self-limiting disease, such symptoms can occasionally be the first presentation of serious illness such as leukaemia or juvenile idiopathic arthritis. MSK examination, however, is often not included as part of the routine paediatric examination. The authors aimed to evaluate how often and how thoroughly MSK examination was performed during admissions to the paediatric ward and to compare it with the examination of other symptoms in relation to the presenting complaint and eventual diagnosis.

  3. Paediatric Metabolic Conditions of the Liver

    Elroy P. Weledji


    Full Text Available Paediatric metabolic disorders with the most clinical manifestations of deranged hepatic metabolism are discussed. The conditions which will be stressed are those for which effective treatment is available and early diagnosis is essential. Accurate diagnosis of other disorders for which no treatment is, as yet, available is also important as a guide to prognosis and for accurate genetic counselling. With the advancement in amniocentesis techniques there is a growing role for gene therapy. For selected metabolic disorders, paediatric liver transplantations have been successful.

  4. Implementation of a competency assessment tool for agency nurses working in an acute paediatric setting.

    Hennerby, Cathy


    AIM: This paper reports on the implementation of a competency assessment tool for registered general agency nurses working in an acute paediatric setting, using a change management framework. BACKGROUND: The increased number of registered general agency nurses working in an acute children\\'s hospital alerted concerns around their competency in working with children. These concerns were initially raised via informal complaints about \\'near misses\\

  5. Paediatric surveillance of pertussis in 1998

    Melker HE de; Neppelenbroek SN; Schellekens JFP; Suijkerbuijk AWM; Conyn- van Spaendonck MAE; CIE; LIS


    Objective: To gain insight into the severity of pertussis in hospitalised cases. Methods: In 1998, hospitalisation data were collected through paediatric surveillance. Results: From 115 hospitalisation admissions collected, 55% of the patients were younger than 3 months of age and not vaccinated; 12

  6. Ingested foreign bodies in the paediatric patient.

    O'Brien, G C


    BACKGROUND: Paediatric foreign body (FB) ingestion is a common problem and while most can be managed conservatively, a sub-population require intervention. AIMS: To establish clear guidelines for management of paediatric FB ingestion. METHODS: A retrospective chart review analysing all paediatric admissions with FB ingestion over a 10-year period from 1990 to 1999. RESULTS: Of 339 patients presenting to the accident and emergency department with FB ingestion, 59 required admission. Ingestion was accidental in 93.0% of patients. The reasons for admission were as follows: large FBs; dangerous FBs; and living far from the hospital. Nineteen patients (32.2%) were discharged without intervention. Thirty-seven (62.7%) required endoscopic retrieval. In two, the FB was not identified at endoscopy. Only three (5%) required surgery. CONCLUSION: Conservative management of FB ingestion in the paediatric population is possible in the majority of cases. However, a minority require intervention. While guidelines for intervention are ill-defined, definitive indications include symptomatic patients, or dangerous objects.

  7. Whole-body MRI in paediatric oncology

    Nievelstein, Rutger A J; Littooij, Annemieke S.


    Imaging plays a crucial role in the diagnosis and follow-up of paediatric malignancies. Until recently, computed tomography (CT) has been the imaging technique of choice in children with cancer, but nowadays there is an increasing interest in the use of functional imaging techniques like positron em

  8. Antibiotic utilisation for hospitalised paediatric patients

    Luinge, K; Kimpen, JLL; van Houten, M.A.


    Antibiotics are among the most commonly prescribed drugs in paediatrics. Because of an overall rise in health care costs, lack of uniformity in drug prescribing and the emergence of antibiotic resistance, monitoring and control of antibiotic use is of growing concern and strict antibiotic policies a

  9. Diagnosis. Severity scoring system for paediatric FMF.

    Livneh, Avi


    Severity scoring systems for adult familial Mediterranean fever (FMF) are established and used as important clinical and analytical tools in disease management and research. A recent paper highlights the need for a paediatric FMF severity measure. How should such a score be built and what challenges might be faced?

  10. A review of paediatric tuberculosis in Denmark

    Hatleberg, Camilla; Prahl, Julie B; Rasmussen, Jeppe Nørgaard


    Paediatric tuberculosis (TB) is a key indicator for recent transmission and presents a reservoir for the disease. We describe trends in epidemiology, microbiological characteristics and treatment outcome in Denmark between 2000 and 2009. Data was retrieved from the national TB surveillance system...

  11. Guidelines on Vaccinations in Paediatric Haematology and Oncology Patients

    Simone Cesaro


    Full Text Available Objective. Vaccinations are the most important tool to prevent infectious diseases. Chemotherapy-induced immune depression may impact the efficacy of vaccinations in children. Patients and Methods. A panel of experts of the supportive care working group of the Italian Association Paediatric Haematology Oncology (AIEOP addressed this issue by guidelines on vaccinations in paediatric cancer patients. The literature published between 1980 and 2013 was reviewed. Results and Conclusion. During intensive chemotherapy, vaccination turned out to be effective for hepatitis A and B, whilst vaccinations with toxoid, protein subunits, or bacterial antigens should be postponed to the less intensive phases, to achieve an adequate immune response. Apart from varicella, the administration of live-attenuated-virus vaccines is not recommended during this phase. Family members should remain on recommended vaccination schedules, including toxoid, inactivated vaccine (also poliomyelitis, and live-attenuated vaccines (varicella, measles, mumps, and rubella. By the time of completion of chemotherapy, insufficient serum antibody levels for vaccine-preventable diseases have been reported, while immunological memory appears to be preserved. Once immunological recovery is completed, usually after 6 months, response to booster or vaccination is generally good and allows patients to be protected and also to contribute to herd immunity.

  12. Guidelines on Vaccinations in Paediatric Haematology and Oncology Patients

    Cesaro, Simone; Giacchino, Mareva; Fioredda, Francesca; Barone, Angelica; Battisti, Laura; Bezzio, Stefania; Frenos, Stefano; De Santis, Raffaella; Livadiotti, Susanna; Marinello, Serena; Zanazzo, Andrea Giulio; Caselli, Désirée


    Objective. Vaccinations are the most important tool to prevent infectious diseases. Chemotherapy-induced immune depression may impact the efficacy of vaccinations in children. Patients and Methods. A panel of experts of the supportive care working group of the Italian Association Paediatric Haematology Oncology (AIEOP) addressed this issue by guidelines on vaccinations in paediatric cancer patients. The literature published between 1980 and 2013 was reviewed. Results and Conclusion. During intensive chemotherapy, vaccination turned out to be effective for hepatitis A and B, whilst vaccinations with toxoid, protein subunits, or bacterial antigens should be postponed to the less intensive phases, to achieve an adequate immune response. Apart from varicella, the administration of live-attenuated-virus vaccines is not recommended during this phase. Family members should remain on recommended vaccination schedules, including toxoid, inactivated vaccine (also poliomyelitis), and live-attenuated vaccines (varicella, measles, mumps, and rubella). By the time of completion of chemotherapy, insufficient serum antibody levels for vaccine-preventable diseases have been reported, while immunological memory appears to be preserved. Once immunological recovery is completed, usually after 6 months, response to booster or vaccination is generally good and allows patients to be protected and also to contribute to herd immunity. PMID:24868544

  13. Guidelines on vaccinations in paediatric haematology and oncology patients.

    Cesaro, Simone; Giacchino, Mareva; Fioredda, Francesca; Barone, Angelica; Battisti, Laura; Bezzio, Stefania; Frenos, Stefano; De Santis, Raffaella; Livadiotti, Susanna; Marinello, Serena; Zanazzo, Andrea Giulio; Caselli, Désirée


    Vaccinations are the most important tool to prevent infectious diseases. Chemotherapy-induced immune depression may impact the efficacy of vaccinations in children. A panel of experts of the supportive care working group of the Italian Association Paediatric Haematology Oncology (AIEOP) addressed this issue by guidelines on vaccinations in paediatric cancer patients. The literature published between 1980 and 2013 was reviewed. During intensive chemotherapy, vaccination turned out to be effective for hepatitis A and B, whilst vaccinations with toxoid, protein subunits, or bacterial antigens should be postponed to the less intensive phases, to achieve an adequate immune response. Apart from varicella, the administration of live-attenuated-virus vaccines is not recommended during this phase. Family members should remain on recommended vaccination schedules, including toxoid, inactivated vaccine (also poliomyelitis), and live-attenuated vaccines (varicella, measles, mumps, and rubella). By the time of completion of chemotherapy, insufficient serum antibody levels for vaccine-preventable diseases have been reported, while immunological memory appears to be preserved. Once immunological recovery is completed, usually after 6 months, response to booster or vaccination is generally good and allows patients to be protected and also to contribute to herd immunity.

  14. Bounded rationality alters the dynamics of paediatric immunization acceptance.

    Oraby, Tamer; Bauch, Chris T


    Interactions between disease dynamics and vaccinating behavior have been explored in many coupled behavior-disease models. Cognitive effects such as risk perception, framing, and subjective probabilities of adverse events can be important determinants of the vaccinating behaviour, and represent departures from the pure "rational" decision model that are often described as "bounded rationality". However, the impact of such cognitive effects in the context of paediatric infectious disease vaccines has received relatively little attention. Here, we develop a disease-behavior model that accounts for bounded rationality through prospect theory. We analyze the model and compare its predictions to a reduced model that lacks bounded rationality. We find that, in general, introducing bounded rationality increases the dynamical richness of the model and makes it harder to eliminate a paediatric infectious disease. In contrast, in other cases, a low cost, highly efficacious vaccine can be refused, even when the rational decision model predicts acceptance. Injunctive social norms can prevent vaccine refusal, if vaccine acceptance is sufficiently high in the beginning of the vaccination campaign. Cognitive processes can have major impacts on the predictions of behaviour-disease models, and further study of such processes in the context of vaccination is thus warranted.

  15. Paediatric HIV treatment failure: a silent epidemic

    Jonathan M Bernheimer


    Full Text Available Paediatric antiretroviral treatment (ART failure is an under-recognized issue that receives inadequate attention in the field of paediatrics and within HIV treatment programmes. With paediatric ART failure rates ranging from 19.3% to over 32% in resource limited settings, a comprehensive evaluation of the causes of failure along with approaches to address barriers to treatment adherence are urgently needed.In partnership with the local Department of Health, a pilot programme has been established by Medecins Sans Frontieres (MSF in Khayelitsha, South Africa, to identify and support paediatric HIV patients with high viral loads and potential treatment failure. Through detailed clinical and psychosocial evaluations and adherence support with an innovative counselling model, treatment barriers are identified and addressed.Demographic and clinical characteristics from the cohort show a delayed median start date for ART, prolonged viraemia including a large number of patients who have never achieved viral load (VL suppression, a low rate of regimen changes despite failure, and a high percentage of pre-adolescent and adolescent patients who have not gone through the disclosure process.Stemming this epidemic of paediatric treatment failure requires programmatic responses to high viral loads in children, starting with improved “case finding” of previously undiagnosed HIV-infected children and adolescents. Viral load testing needs to be prioritized over CD4 count monitoring, and flagging systems to identify high VL results should be developed in clinics. Clinicians must understand that successful treatment begins with good adherence, and that simple adherence support strategies can often dramatically improve adherence. Moreover, appropriate adherence counselling should begin not when the child fails to respond to treatment. Establishing good adherence from the beginning of treatment, and supporting ongoing adherence during the milestones in these

  16. Diagnostic accuracy on the management of acute paediatric urinary tract infection in a general paediatric unit

    Fahisham Taib


    Conclusions: UTI can be difficult to accurately diagnosis in certain clinical cases. Decisions made should be individualized and tailored according to clinical suspicion and presentation of the patients. Improvement to ensure accurate diagnosis is vital to ensure correct data capture in the HIPE system thus giving valuable information and resource for future care.

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

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


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

  18. Paediatric UK demyelinating disease longitudinal study (PUDDLS

    Likeman Marcus


    Full Text Available Abstract Background There is evidence that at least 5% of Multiple sclerosis (MS cases manifest in childhood. Children with MS present with a demyelinating episode involving single or multiple symptoms prior to developing a second event (usually within two years to then meet criteria for diagnosis. There is evidence from adult cohorts that the incidence and sex ratios of MS are changing and that children of immigrants have a higher risk for developing MS. A paediatric population should reflect the vanguard of such changes and may reflect trends yet to be observed in adult cohorts. Studying a paediatric population from the first demyelinating event will allow us to test these hypotheses, and may offer further valuable insights into the genetic and environmental interactions in the pathogenesis of MS. Methods/Design The Paediatric UK Demyelinating Disease Longitudinal Study (PUDDLS is a prospective longitudinal observational study which aims to determine the natural history, predictors and outcomes of childhood CNS inflammatory demyelinating diseases. PUDDLS will involve centres in the UK, and will establish a cohort of children affected with a first CNS inflammatory demyelinating event for long-term follow up by recruiting for approximately 5 years. PUDDLS will also establish a biological sample archive (CSF, serum, and DNA, allowing future hypothesis driven research. For example, the future discovery of a biomarker will allow validation within this dataset for the evaluation of novel biomarkers. Patients will also be requested to consent to be contacted in the future. A secondary aim is to collaborate internationally with the International Paediatric Multiple Sclerosis Study Group when future collaborative studies are proposed, whilst sharing a minimal anonymised dataset. PUDDLS is the second of two jointly funded studies. The first (UCID-SS is an epidemiological surveillance study that already received ethical approvals, and started on the 1st

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



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

  20. Institutional review boards' attitudes towards remuneration in paediatric research

    Flege, Marius M; Thomsen, Simon F


    Remuneration in paediatric research poses an ethical dilemma. Too large a sum might cause parents to enrol their children in research projects with no benefit for the child, whereas too modest a sum might hamper recruitment. The institutional review boards have the responsibility to only approve...... remuneration in paediatric trials with ethically sound research plans. However, little is known about which factors influence institutional review boards' evaluation of remuneration in paediatric research....

  1. Leucocyte esterase in the rapid diagnosis of paediatric septic arthritis.

    Kelly, E G


    Septic arthritis may affect any age group but is more common in the paediatric population. Infection is generally bacterial in nature. Prompt diagnosis is crucial, as delayed treatment is associated with lifelong joint dysfunction. A clinical history and application of Kocher\\'s criteria may indicate that there is a septic arthritis. However, definitive diagnosis is made on culture of septic synovial fluid. The culture process can take over 24h for the initial culture to yield bacterial colonies. Leucocyte esterase is released by leucocytes at the site of an infection. We hypothesise that leucocyte esterase can be utilized in the rapid diagnosis of septic arthritis and shorten the time to decisive treatment whilst simultaneously decreasing unnecessary treatment of non-septic joints.

  2. Adverse drug reactions in the paediatric population in Denmark

    Aagaard, Lise; Weber, Camilla Blicher; Hansen, Ebba Holme


    . The majority of ADRs reported were from the following SOCs: general disorders and administration site conditions (31%), skin and subcutaneous tissue disorders (18%) and nervous system disorders (15%). Reports encompassed medicines from ATC group J: vaccines and anti-infectives for systemic use (65%); and ATC......BACKGROUND: The potential risk of adverse drug reactions (ADRs) in the paediatric population has become a public health concern and regulatory agencies in Europe and the US have acknowledged that there is a need for more research in this area. Spontaneous reporting systems can provide important new...... information about ADRs. OBJECTIVE: To characterize ADRs in children reported in Denmark over a period of one decade. METHODS: We analysed ADRs reported to the Danish Medicines Agency from 1998 to 2007 for individuals aged from birth to 17 years. Data were analysed with respect to time, age and sex, category...

  3. Dental fluorosis in the paediatric patient.

    Atia, Gahder-Sara; May, Joanna


    Exposure to excessive fluoride intake during the early childhood years can disrupt the normal development of enamel, resulting in dental fluorosis. This varies in severity, ranging from white opacities in mild cases to more severe black and brown discoloration or enamel pitting. This article aims to give the reader a better understanding of the aetiology, diagnosis and subsequent treatment of dental fluorosis in the paediatric patient. Fluorosis can have a marked effect on dental aesthetics. The prevalence of fluorosis in the United Kingdom may increase following the publication of Delivering Better Oral Health, published by the Department of Health in 2007, which suggested changes to fluoride levels in children's toothpastes. This article highlights the importance of accurate diagnosis of fluorosis and also explains the treatment options available to paediatric patients.

  4. Paediatric nephrology: the last 50 years.

    Kausman, Joshua Y; Powell, Harley R


    In 1965, the specialty of paediatric nephrology was in its infancy. Following the development of a landmark collaborative research study, the International Study of Kidney Disease in Childhood in the mid-1960s, the first specialist societies were formed: the European Society of Pediatric Nephrology in 1967 and the American Society of Pediatric Nephrology in 1969. The extraordinary improvements in care delivered to children with kidney disease over the past 50 years are too broad to cover in any one paper. They traverse the spectrum of diagnosis, classification, therapeutics, social well-being and transition to adult care. We have selected four case scenarios to highlight these changes in key areas of paediatric nephrology: post-streptococcal glomerulonephritis, nephrotic syndrome, haemolytic uraemic syndrome and neonatal dialysis and childhood transplantation.



    Abstract Summary Hypereosinophilic syndromes (HES) include a group of heterogeneous diseases characterized by the persistent increase of the number of eosinophils in blood and bone marrow. Few cases of paediatric hypereosinophilia (pHES) have been described in the literature. Early identification of pHES that may evolve towards a lymphomyeloproliferative disease is relevant in light of prognostic and therapeutic implications. Molecular features of 10 pHES patients were analysed...

  6. Imaging of accidental paediatric head trauma

    Tang, Phua Hwee [KK Women' s and Children' s Hospital, Department of Diagnostic Imaging, Singapore (Singapore); Lim, Choie Cheio Tchoyoson [National Neuroscience Institute, Department of Neuroradiology, Singapore (Singapore)


    Head trauma is the most common form of injury sustained in serious childhood trauma and remains one of the top three causes of death despite improved road planning and safety laws. CT remains the first-line investigation for paediatric head trauma, although MRI may be more sensitive at picking up the full extent of injuries and may be useful for prognosis. Follow-up imaging should be tailored to answer the specific clinical question and to look for possible complications. (orig.)

  7. Ciprofloxacin safety in paediatrics: a systematic review

    Adefurin, Abiodun; Sammons, Helen; Jacqz-Aigrain, Evelyne; Choonara, Imti


    Objective To determine the safety of ciprofloxacin in paediatric patients in relation to arthropathy, any other adverse events (AEs) and drug interactions. Methods A systematic search of MEDLINE, EMBASE, CINAHL, CENTRAL and bibliographies of relevant articles was carried out for all published articles, regardless of design, that involved the use of ciprofloxacin in any paediatric age group ≤17 years. Only articles that reported on safety were included. Results 105 articles met the inclusion criteria and involved 16 184 paediatric patients. There were 1065 reported AEs (risk 7%, 95% CI 3.2% to 14.0%). The most frequent AEs were musculoskeletal AEs, abnormal liver function tests, nausea, changes in white blood cell counts and vomiting. There were six drug interactions (with aminophylline (4) and methotrexate (2)). The only drug related death occurred in a neonate who had an anaphylactic reaction. 258 musculoskeletal events occurred in 232 paediatric patients (risk 1.6%, 95% CI 0.9% to 2.6%). Arthralgia accounted for 50% of these. The age of occurrence of arthropathy ranged from 7 months to 17 years (median 10 years). All cases of arthropathy resolved or improved with management. One prospective controlled study estimated the risk of arthropathy as 9.3 (OR 95% CI 1.2 to 195). Pooled safety data of controlled trials in this review estimated the risk of arthropathy as 1.57 (OR 95% CI 1.26 to 1.97). Conclusion Musculoskeletal AEs occur due to ciprofloxacin use. However, these musculoskeletal events are reversible with management. It is recommended that further prospective controlled studies should be carried out to evaluate the safety of ciprofloxacin, with particular focus on the risk of arthropathy. PMID:21785119

  8. Creating and being created: the changing panorama of paediatric rehabilitation.

    Helders, Paul J M; Engelbert, Raoul H H; Custers, Jan W H; Gorter, Jan Willem; Takken, Tim; van der Net, Janjaap


    Paediatric rehabilitation as a discipline is rapidly changing, especially during the last decades. In the past, paediatric rehabilitation was characterized by merely adult intervention strategies in a miniaturized form, delivered by a merely adult patients-oriented profession. Theories on childhood development, however, changed, as did the focus of interventions: from impairments to function, from the child itself to family, community and peers. The call for outcome-oriented and evidence-based medicine lastly, changed paediatric rehabilitation into a mature paediatric profession with it's own scientific framework. This is reflected among other things in the increasing number of paediatric measures and instruments specifically geared to the paediatric rehabilitation profession, for example the Gross Motor Function Measure, Paediatric Evaluation of Disability Inventory and Movement ABC. More recently, paediatric exercise physiologists are pointing to the benefits of an active lifestyle and training for patients with chronic diseases and disabilities. Several studies have evaluated the effects of such training programmes and came up with positive results. It shows that paediatric rehabilitation continues to develop as a dynamic profession, having growth, childhood development and childhood activities as it's core business.

  9. Fitting and flailing: recognition of paediatric antiphospholipid syndrome.

    Freeman, H; Patel, J; Fernandez, D; Sharples, P; Ramanan, A V


    Antiphospholipid syndrome (APS) is a systemic autoimmune condition where the presence of antiphospholipid antibodies is thought to predispose to thrombotic events. It is uncommon in the paediatric population, but current diagnostic criteria are based on adult population studies, making assessment of its true paediatric prevalence difficult. We present two cases of paediatric APS, who presented with primary neurological events, and discuss approaches to diagnosis, interpretation of screening investigations, including antinuclear antibodies (ANA), anti-extractable nuclear antigen (ENA) antibodies and lupus anticoagulant. Possible approaches to the management of paediatric APS are discussed.

  10. Paediatric Virology in the Hippocratic Corpus

    Mammas, Ioannis N.; Spandidos, Demetrios A.


    Hippocrates (Island of Kos, 460 B.C.-Larissa, 370 B.C.) is the founder of the most famous Medical School of the classical antiquity. In acknowledgement of his pioneering contribution to the new scientific field of Paediatric Virology, this article provides a systematic analysis of the Hippocratic Corpus, with particular focus on viral infections predominating in neonates and children. A mumps epidemic, affecting the island of Thasos in the 5th century B.C., is described in detail. ‘Herpes’, a medical term derived from the ancient Greek word ‘ἕρπειν’, meaning ‘to creep’ or ‘crawl’, is used to describe the spreading of cutaneous lesions in both childhood and adulthood. Cases of children with exanthema ‘resembling mosquito bites’ are presented in reference to varicella or smallpox infection. A variety of upper and lower respiratory tract viral infections are described with impressive accuracy, including rhinitis, pharyngitis, tonsillitis, laryngitis, bronchiolitis and bronchitis. The ‘cough of Perinthos’ epidemic, an influenza-like outbreak in the 5th century B.C., is also recorded and several cases complicated with pneumonia or fatal outcomes are discussed. Hippocrates, moreover, describes conjunctivitis, otitis, lymphadenitis, meningoencephalitis, febrile convulsions, gastroenteritis, hepatitis, poliomyelitis and skin warts, along with proposed treatment directions. Almost 2,400 years later, Hippocrates' systematic approach and methodical innovations can inspire paediatric trainees and future Paediatric Virology subspecialists. PMID:27446241

  11. Paediatric suicidal burns: A growing concern.

    Segu, Smitha; Tataria, Rachana


    An alarming rise in rates of paediatric population committing self-immolation acts is a growing social and medical problem. In recent times there seems to be a rising concern in paediatric population. A study was conducted at a government tertiary care burn centre over 5 years in paediatric age group of middle and upper lower class families. Most had deep partial thickness burns. Psychiatric and personality disorder were found in 24.03% and 31.46% patients respectively. Kerosene was the main agent chosen to inflict injury. The average length of hospital stay was 19.8 days. The crude mortality rate observed was 38.2%. With cultural and socio-economic changes children and adolescents are exposed to increased levels of stress and peer pressure leaving them vulnerable. A multidisciplinary care involving medical, psychological and social support is required. Identifying children at risk and proper counselling and support can form an important strategy at prevention rather than cure. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  12. Injuries in the competitive paediatric motocross athlete.

    Arena, C B; Holbert, J A; Hennrikus, W L


    The purpose of this study is to report the spectrum of injuries sustained by competitive paediatric motocross athletes at a level I trauma centre. A retrospective study of paediatric competitive motocross injuries treated at a level I trauma centre between 2004 and 2014 was performed. Athletes were included if aged less than 18 years and injured while practising or competing on a competitive motocross track. Medical records were reviewed for age, gender, race, location of accident, use of safety equipment, mechanism of injury, injury type and severity, Glasgow Coma Score at hospital presentation and Injury Severity Score (ISS). In total, 35 athletes were studied. The average age was 14 years. One athlete died. Thirty athletes were injured during competition; five were injured during practice. Twenty-four athletes (69%) suffered an orthopaedic injury with a total of 32 fractures and two dislocations. Two fractures were open (6.3%). Lower extremity fractures were twice as common as upper extremity fractures. Surgery was more common for lower extremity fractures-83% versus 30%. The most common fractures were femoral shaft (18.8%), fibula (12.5%), clavicle (12.5%), tibial shaft (9.4%) and forearm (9.4%). Competitive paediatric motocross athletes suffer serious, potentially life-threatening injuries despite the required use of protective safety equipment. Femoral shaft, fibula and clavicle were found to be the most commonly fractured bones. Further prospective research into track regulations, protective equipment and course design may reduce the trauma burden in this athlete population.

  13. Regional Military Integration in West Africa: A Case Study of the Multi-National Joint Task Force in the Fight against Boko Haram


    REGIONAL MILITARY INTEGRATION IN WEST AFRICA: A CASE STUDY OF THE MULTI-NATIONAL JOINT TASK FORCE IN THE FIGHT AGAINST BOKO HARAM......ABSTRACT The militant Jihadist group Boko Haram has established itself as a regional threat in the areas surrounding the Lake Chad Basin (LCB) of

  14. Integrating Clinical Decision Making and Patient Care at the Paediatric Emergency Department -focusing on children with serious infections-

    E. De Vos-Kerkhof (Evelien)


    markdownabstractThe general aim of this thesis was to integrate clinical decision making and patient care in the clinical practice of the paediatric ED, focusing on children at risk for serious infections. Serious infections still cause morbidity and mortality and this underlines the importance of

  15. HIV infection, tuberculosis and workload in a general paediatric ward

    obtained from children <6 months old at primary health care clinics in the Western ... HIV DNA PCR tests performed at hospitals in the province. Of. 1 722 tests .... any one time point. This percentage ..... must be fast-tracked for HAART soon after diagnosis.14 This ... was implemented whereby all HIV-infected infants were.


    David Lito


    Conclusion: Aetiology identification for CL can be challenging. Although the majority of children with CL can be managed in an outpatient setting, there are cases that require in-hospital diagnostic investigation or intensive care. Since Portugal presents a medium incidence of tuberculosis, clinicians should maintain a high -level of suspicion for the emergence of multiresistant M. tuberculosis.

  17. Macrophage Activation Syndrome in Paediatric Rheumatic Diseases.

    Islam, M I; Talukder, M K; Islam, M M; Laila, K; Rahman, S A


    Macrophage activation syndrome (MAS) is a potentially fatal complication of rheumatic disorders, which commonly occurs in systemic juvenile idiopathic arthritis (sJIA).This study was carried out with the aims of describing the clinical features, laboratory findings and outcomes of MAS associated with paediatric rheumatic diseases in the Department of Paediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU) and compare these results with previous studies on MAS. This retrospective study was conducted in the paediatric rheumatology wing of the Department of Paediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Clinical and laboratory profile of all the diagnosed cases of MAS were analyzed from the medical records from January 2010 to July 2015. Among 10 MAS patients, 6 were female and 4 were male. Seven patients of systemic JIA, two patients of SLE and one patient with Kawasaki Disease developed MAS in their course of primary disease. Mean duration of primary disease prior to development of MAS was 2.9 years and mean age of onset was 9.1 years. High continued fever and new onset hepatosplenomegaly were the hallmark of the clinical presentation. White blood cell count and platelet count came down from the mean of 16.2 to 10.2×10⁹/L and 254 to 90×10⁹/L. Mean erythrocyte sedimentation rate was dropped from 56 to 29 mm/hr. Six patients had abnormal liver enzyme level (ALT) and 5 had evidence of coagulopathy (prolonged prothrombin time and APTT) at the onset of disease. Hyperferritinnemia were found in all the patients. Bone marrow study was done in 5 patients but features of hamophagocytosis were found only in 2 patients. All patients received intravenous steroid and 3 patients who did not respond to steroid received additional cyclosporine. Mortality rate was 30% in this series. Macrophage activation syndrome is a fatal complication of paediatric rheumatic diseases among which s-JIA was predominant. Early diagnosis and

  18. Paediatric ICU burns in Finland 1994-2004.

    Papp, Anthony; Rytkönen, Tanja; Koljonen, Virve; Vuola, Jyrki


    The paediatric burn population requiring intensive care in Finland has never been examined before. The aim of this study was firstly to determine the aetiology, incidence and prognosis of paediatric burns requiring intensive care in Finland and secondly to compare the possible differences between the two national burn centres. All burn patients' charts were retrospectively reviewed in two national burn centres from an 11-year-period. Patients whose ICU stay was more than 48h, were included. Forty-five children who were hospitalized in the two burn centres during the study period met the inclusion criteria. They represent 2.4% (45/1898) of all burns victims hospitalized in these burn centres during that time giving an incidence of 0.1/100,000 per year in Finland. The median age was 5 years, every third patient was 0-2 years old and 75.6% were male. Most burns were scalds (42.2%), which caused all burns (100%) in age group 0-2 years. Flame burns were most frequent (83%) in the age group 6-10 years. In the 11-16 years old patients, high voltage/electric burns caused 50% of all burns and flame the other 50%. The overall median TBSA in all burns was 26%. The median (range) hospital stay was 12 days (2-193) (0.88 days/% burned) and the median (range) ICU days was 7 (2-64) (0.29 days/%). Intubation and respirator therapy was needed in 31 (46%) patients. There were no patients who needed haemofiltration or haemodialysis and no mortality. Only six patients (13%) were treated conservatively and 39 (87%) surgically. Dressing changes under general anaesthesia were preferred in Helsinki (37 times) and especially in the paediatric hospital (32 times) compared to Kuopio (7 times). Allografts were used only in Helsinki in 4 patients whereas artificial skin was used only in Kuopio in 15 patients. The overall cost of care was very similar in both centres being 1292-1425 euros per hospital day. There were some small differences between the two burn centres in treatment policies. Most

  19. European cardiovascular magnetic resonance (EuroCMR registry – multi national results from 57 centers in 15 countries

    Bruder Oliver


    Full Text Available Abstract Background The EuroCMR registry sought to evaluate indications, image quality, safety and impact on patient management of clinical routine CMR in a multi-national European setting. Furthermore, interim analysis of the specific protocols should underscore the prognostic potential of CMR. Methods Multi-center registry with consecutive enrolment of patients in 57 centers in 15 countries. More than 27000 consecutive patients were enrolled. Results The most important indications were risk stratification in suspected CAD/Ischemia (34.2%, workup of myocarditis/cardiomyopathies (32.2%, as well as assessment of viability (14.6%. Image quality was diagnostic in more than 98% of cases. Severe complications occurred in 0.026%, always associated with stress testing. No patient died during or due to CMR. In 61.8% CMR findings impacted on patient management. Importantly, in nearly 8.7% the final diagnosis based on CMR was different to the diagnosis before CMR, leading to a complete change in management. Interim analysis of suspected CAD and risk stratification in HCM specific protocols revealed a low rate of adverse events for suspected CAD patients with normal stress CMR (1.0% per year, and for HCM patients without LGE (2.7% per year. Conclusion The most important indications in Europe are risk stratification in suspected CAD/Ischemia, work-up of myocarditis and cardiomyopathies, as well as assessment of viability. CMR imaging is a safe procedure, has diagnostic image quality in more than 98% of cases, and its results have strong impact on patient management. Interim analyses of the specific protocols underscore the prognostic value of clinical routine CMR in CAD and HCM. Condensed abstract The EuroCMR registry sought to evaluate indications, image quality, safety and impact on patient management of clinical routine CMR in a multi-national European setting in a large number of cases (n > 27000. Based on our data CMR is frequently performed in

  20. Paediatric day-case neurosurgery in a resource challenged setting: Pattern and practice

    Afolabi Muyiwa Owojuyigbe


    Full Text Available Background: It has been generally observed that children achieve better convalescence in the home environment especially if discharged same day after surgery. This is probably due to the fact that children generally tend to feel more at ease in the home environment than in the hospital setting. Only few tertiary health institutions provide routine day-case surgery for paediatric neurosurgical patients in our sub-region. Objective: To review the pattern and practice of paediatric neurosurgical day-cases at our hospital. Patients and Methods: A prospective study of all paediatric day-case neurosurgeries carried out between June 2011 and June 2014. Results: A total of 53 patients (34 males and 19 females with age ranging from 2 days to 14 years were seen. Majority of the patients (77.4% presented with congenital lesions, and the most common procedure carried out was spina bifida repair (32% followed by ventriculoperitoneal shunt insertion (26.4% for hydrocephalus. Sixty-eight percentage belonged to the American Society of Anesthesiologists physical status class 2, whereas the rest (32% belonged to class 1. General anaesthesia was employed in 83% of cases. Parenteral paracetamol was used for intra-operative analgesia for most of the patients. Two patients had post-operative nausea and vomiting and were successfully managed. There was no case of emergency re-operation, unplanned admission, cancellation or mortality. Conclusion: Paediatric day-case neurosurgery is feasible in our environment. With careful patient selection and adequate pre-operative preparation, good outcome can be achieved.

  1. Evaluation and characterization of digital X-ray equipment for paediatric cardiology in the Hospital Gregorio Maranon; Evaluacion y caracterizacion de la dinamica de trabajo y de la dosis recibida por el paciente en la sala de hemodinamica infantil del Hospital General Universitario Gregorio Maranon

    Calama Santiago, J. A.; Gonzalez Ruiz, C.; Infante Utrilla, M. A.; Zanfano Hidalgo, R.; Penedo cobos, J. M.; Sierra Diaz, F.; Olivares Munoz, M. P.


    The purchase of a digital X-Ray equipment specific for paediatric cardiology in 2003 has allowed a careful examination of the technical characteristics of these patients. This data review includes the analysis of a dose index with several variable factors such as weight, size and age of patients, purpose, type and characteristics of the study and its development over time as a results of the experience gained by the staff involved. (Author)

  2. An examination of health selection among U.S. immigrants using multi-national data.

    Ro, Annie; Fleischer, Nancy L; Blebu, Bridgette


    While migrants are widely believed to be positively selected on health, there has been very little empirical exploration of the actual health differential between migrants and non-migrants. This paper explored: 1) the extent of health selection by comparing US immigrants from 19 sending countries to their non-migrating counterparts still residing in the countries of origin; 2) country-level correlates of health selection; and 3) whether country-level health selection accounted for differences in self-rated health between immigrants and US-born Whites. We combined nationally-representative international data with data from US immigrants from the 2003-2007 Current Population Survey. The health selectivity measure was the Net Difference Index (NDI), which compares the distribution of self-rated health between migrants and non-migrants. We calculated Spearman correlation and bivariate regression coefficients between the NDI and economic, health, distance, and migration characteristics of the sending countries. We used generalized estimating equation models to examine the association between country-level health selection and immigrants' current self-rated health. We found immigrants from South America to show the most positive health selection. Health selection was significantly correlated with visa mode of entry, where family networks decrease, but work-related networks increase health selection. There was little evidence that country-level health selection explained differences in the self-rated health of US immigrants relative to US-born Whites. Our findings do not support the idea that country-level health selection underlies the "healthy immigrant effect".

  3. Antidepressant Utilization and Suicide in Europe: An Ecological Multi-National Study.

    Ricardo Gusmão

    Full Text Available Research concerning the association between use of antidepressants and incidence of suicide has yielded inconsistent results and is the subject of considerable controversy. The first aim is to describe trends in the use of antidepressants and rates of suicide in Europe, adjusted for gross domestic product, alcohol consumption, unemployment, and divorce. The second aim is to explore if any observed reduction in the rate of suicide in different European countries preceded the trend for increased use of antidepressants.Data were obtained for 29 European countries between 1980 and 2009. Pearson correlations were used to explore the direction and magnitude of associations. Generalized linear mixed models and Poisson regression distribution were used to clarify the effects of antidepressants on suicide rates, while an autoregressive adjusted model was used to test the interaction between antidepressant utilization and suicide over two time periods: 1980-1994 and 1995-2009.An inverse correlation was observed in all countries between recorded Standardised Death Rate (SDR for suicide and antidepressant Defined Daily Dosage (DDD, with the exception of Portugal. Variability was marked in the association between suicide and alcohol, unemployment and divorce, with countries depicting either a positive or a negative correlation with the SDR for suicide. Every unit increase in DDD of an antidepressant per 1000 people per day, adjusted for these confounding factors, reduces the SDR by 0.088. The correlation between DDD and suicide related SDR was negative in both time periods considered, albeit more pronounced between 1980 and 1994.Suicide rates have tended to decrease more in European countries where there has been a greater increase in the use of antidepressants. These findings underline the importance of the appropriate use of antidepressants as part of routine care for people diagnosed with depression, therefore reducing the risk of suicide.

  4. A paediatric bone index derived by automated radiogrammetry

    Thodberg, H.H.; van Rijn, R.R.; Tanaka, T.; Martin, D.D.; Kreiborg, S.


    Hand radiographs are obtained routinely to determine bone age of children. This paper presents a method that determines a Paediatric Bone Index automatically from such radiographs. The Paediatric Bone Index is designed to have minimal relative standard deviation (7.5%), and the precision is

  5. EULAR recommendations for vaccination in paediatric patients with rheumatic diseases

    Heijstek, M. W.; de Bruin, L. M. Ott; Bijl, M.; Borrow, R.; van der Klis, F.; Kone-Paut, I.; Fasth, A.; Minden, K.; Ravelli, A.; Abinun, M.; Pileggi, G. S.; Borte, M.; Wulffraat, N. M.


    Evidence-based recommendations for vaccination of paediatric patients with rheumatic diseases (PaedRD) were developed by following the EULAR standardised procedures for guideline development. The EULAR task force consisted of (paediatric) rheumatologists/immunologists, one expert in vaccine evaluati

  6. Use of Zoledronic Acid in Paediatric Craniofacial Fibrous Dysplasia

    Chiara Di Pede


    Full Text Available We describe a case of a paediatric patient affected by mandibular fibrous dysplasia (FD with severe and chronic pain who was successfully treated with zoledronic acid (ZOL: a third-generation bisphosphonate. Further research is needed to assess its safety and efficacy as a treatment option for FD in the paediatric population.

  7. The Manchester Triage System in paediatric emergency care

    M. van Veen (Mirjam)


    textabstractIn the first part of the thesis performance of the Manchester Triage System in paediatric emergency care was evaluated. In chapter 1 we reviewed the literature to evaluate realibility and validity of triage systems in paediatric emergency care. The Manchester Triage System was used to tr

  8. Paediatric lung function testing : determinants and reference values

    Koopman, Marije


    Paediatric lung function tests provide objective measures in diagnosis and follow-up of lung diseases, and give insight in the pathophysiology of lung growth and development. In the first part of the thesis, paediatric lung function tests were used to investigate determinants of lung growth and

  9. Complications of paediatric elbow trauma treatment by traditional bonesetters.

    Butt, Mohammad Farooq; Dhar, Shabir Ahmad; Gani, Naseem Ul; Kawoosa, Altaf A


    This is a retrospective review of paediatric elbow trauma, which was initially treated by bonesetters and subsequently reported to the hospital for management. This paper describes the pattern of trauma and the complications of unscientific management. The report also recommends a basic training program for the bonesetters so as to make them aware of the potential complications involved in managing paediatric elbow trauma.

  10. Paediatric lung function testing : determinants and reference values

    Koopman, Marije


    Paediatric lung function tests provide objective measures in diagnosis and follow-up of lung diseases, and give insight in the pathophysiology of lung growth and development. In the first part of the thesis, paediatric lung function tests were used to investigate determinants of lung growth and deve

  11. Spatial Structure and Location of Multi-national Corporations in China——A Case Study of Samsung


    The investment of Samsung Electronics in China is divided into three types: production companies, sales companies and R&D institutions. Based on an analysis of the spatial structure of Samsung's three types of investment and parent company, it is put forward that regional bias exists during the operation of a multi-national corporation (MNC) in China, i.e., regional biases of technology, price, sales as well as decision-making. Front office and back ofrice, two terms related closely with the location of modern MNCs, are defined and locational principles of each are studied. It is pointed out that production companies and R&D institutions belong to back office, while sales company falls into the type of front office. Based on a summarization on the spatial distribution of production companies, sales companies and R&D institutions, the locational principles of front office and back office are then applied in explaining the location of Samsung's operating entities in China. By analyzing the spatial structure and locational principles of Samsung, a typical MNC in China, this paper aims to understand the internal operating mechanism of modern MNCs and then bring assistance to related policies to cope with those problems about MNCs that have attracted growing attention in recent years.

  12. Undergraduate experience and self-assessed confidence in paediatric dentistry: comparison of three UK dental schools.

    Rodd, H D; Farman, M; Albadri, S; Mackie, I C


    Previous studies have suggested that dental students may not receive sufficient clinical experience in core paediatric dentistry skills. This study aimed to compare dental undergraduates' self-reported experience and confidence in paediatric dentistry within three UK dental schools (Liverpool, Manchester and Sheffield). In April/May 2009, 147 final year dental students completed an anonymous questionnaire which captured their experience of seven core clinical skills in both hospital and outreach settings. A visual analogue scale was also employed to record perceived levels of confidence for six generic activities including: examination, diagnosis and treatment planning; patient selection for treatment under general anaesthesia; operative dentistry; preventive dentistry; management of dento-alveolar trauma, and provision of routine care for children on qualification. The key finding was that Liverpool, Manchester and Sheffield dental students received comparable clinical experiences in paediatric dentistry, which appeared to satisfy the requirements of the General Dental Council's The first five years. One hundred percent had carried out fissure sealants and restorations, and 87-98% had experience of extractions. Outreach placements were crucial in ensuring students had sufficient opportunity to undertake core skills, notably extractions and pulp therapies. All students reported a lack of confidence in dental trauma management which warrants greater emphasis in the undergraduate curriculum.

  13. Pancreaticoduodenectomy in children: optimising outcome of uncommon paediatric procedures.

    Yeap, B H


    Contemporary surgical practice is increasingly dominated by subspecialisation in response to improved outcome from high volume centres, though uncertainties persist for uncommon paediatric procedures. Three paediatric pancreaticoduodenectomies performed at Our Lady\\'s Children\\'s Hospital, Dublin, over a period of 9 years were evaluated to substantiate their continuing performance by paediatric rather than adult pancreatic surgeons. With ages ranging from 18 months to 8 years old, the mean operating time was 263 minutes, while the average hospital stay was 12 days. There was no perioperative mortality, although complication rate was 100%. Re-operation was required in 33%. The long term outcome of this small paediatric cohort was comparable to adult series despite the low patient accrual, underscoring the advantages of a multidisciplinary approach afforded by tertiary paediatric institutions for intricate yet infrequent operations in children.

  14. A comparison of the epidemiology of paediatric burns in Scotland and South Africa.

    Teo, A I C; Van As, A B; Cooper, J


    In South Africa burns affect 3.2% of the population annually and are particularly common among children. In Scotland paediatric burns are generally much less common and less severe. This study aimed to explore the epidemiological differences in the emergency presentation of paediatric burns in the Royal Aberdeen Children's Hospital (RACH) in Scotland and the Red Cross War Memorial Children's Hospital (RXH) in Cape Town. Data was retrieved retrospectively for all paediatric burns presenting in 2009 from RACH patient records and the RXH trauma database. Data was recorded in Microsoft Excel for subsequent statistical analysis. During 2009 RACH received 192 children with burns (1% total emergencies) and RXH received 994 (11% total emergencies). Children ≤ 2 years old were the most commonly injured age group in both centres. At RXH most children came from informal settlements and were of low socioeconomic status, while RACH patients were evenly distributed among all socioeconomic groups. Burn injuries were significantly more likely to present in the evening at both centres (pburns involved the hands and were single site (79%) while at RXH most were multiple site (76%) and involved the face. At RACH the commonest modes of injury were scald (45%) and contact burn (43%), while at RXH scalds accounted for the majority (77%). At RACH 89% children were discharged immediately, whereas 49% of RXH patients were admitted to the burn unit. Paediatric burns are more common and generally more severe in Cape Town than in Aberdeen. All children have the right to a safe environment and protection from harm; to reduce the high burns incidence in Cape Town preventative strategies should be targeted at creating safer homes.

  15. Evidence-based paediatric surgical oncology.

    Losty, Paul D


    Surgeons play a pivotal role in the decision-making and multidisciplinary management of childhood solid tumours.(1) Evidence-based medicine-"aims to optimise decision making by emphasising on the use of best evidence from well-designed conducted research." This article offers a brief overview in an effort to demonstrate how a selection of well-conducted, recently published studies can help address some topical and controversial themes in paediatric surgical oncology practice. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Juvenile idiopathic arthritis: the paediatric perspective

    Jordan, Alison [Birmingham Children' s Hospital, Department of Adolescent Rheumatology, Birmingham (United Kingdom); McDonagh, Janet E. [Birmingham Children' s Hospital, Institute of Child Health, Birmingham (United Kingdom)


    Paediatric rheumatology is a relatively new specialty that has developed rapidly over the last 30 years. There have been major advances, which have included improvements in the classification and management of juvenile idiopathic arthritis (JIA). The former has led to enhanced international collaboration with disease registries, multicentre research and the development of new therapeutic agents. This has resulted in improved disease control and remission induction in many. There is, however, still significant morbidity associated with JIA during childhood, adolescence and adulthood, and challenges for the future include early identification of those with a poorer prognosis, appropriate administration of safe therapies and optimizing outcomes as young people move through adolescence into adulthood. (orig.)

  17. Onset symptoms in paediatric multiple sclerosis

    Boesen, Magnus Spangsberg; Sellebjerg, Finn; Blinkenberg, Morten


    at disease onset, cerebrospinal fluid findings, magnetic resonance imaging (MRI) and evoked potentials at the first demyelinating event. These data were compared with similar nationwide data from adults in Denmark. RESULTS: The median age was 14 (range 10-15) years at the first demyelinating event......: 66-100%) of paediatric MS subjects, 77% (CI: 46-95%) had an elevated IgG index and 85% (CI: 55-98%) had oligoclonal bands in the cerebrospinal fluid. MRI showed characteristic white matter lesions in all children (CI: 80-100%). CONCLUSION: MS symptoms at the first demyelinating event and diagnostic...

  18. [Emergency medical aid in a paediatrics context].

    Branchard, Delphine; Tentillier, Éric; Gillet, Stéphane; Naud, Julien


    In France, the organisation of aid involves the intervention of the emergency medical services (Samu), which coordinate the medical regulation platforms for site 15 and the mobile emergency and intensive care services (Smur). Since they were created, the Samu have been tirelessly adapting their response to the various characteristics of pre-hospital assignments. Pre- and inter-hospital paediatrics has seen the development of specialised teams with the aim of providing effective aid which is adapted to the youngest and most vulnerable patients.

  19. The Investigation of Proptosis in Paediatric Practice

    Ms Sayantani Ghosh


    Full Text Available A retrospective review of 65 cases of paediatric proptosispresenting to a rural teaching hospital in India, from February2006 to June 2008. There were 17 cases with orbital cellulitisand 15 with retinoblastoma. We report the history, clinicalexamination, radiological findings and diagnosis. Most caseshad a characteristic history and pathognomonic eye signs.Computer Tomography (CT correlated with histopathology inmost cases. CT is widely available, even within a remotesetting, and is a convenient investigation. Thus, a detailedhistory, clinical examination and CT scan were the mostfruitful approach to the diagnosis of childhood proptosis inthis series.

  20. ICRP publication 121: radiological protection in paediatric diagnostic and interventional radiology.

    Khong, P-L; Ringertz, H; Donoghue, V; Frush, D; Rehani, M; Appelgate, K; Sanchez, R


    Paediatric patients have a higher average risk of developing cancer compared with adults receiving the same dose. The longer life expectancy in children allows more time for any harmful effects of radiation to manifest, and developing organs and tissues are more sensitive to the effects of radiation. This publication aims to provide guiding principles of radiological protection for referring clinicians and clinical staff performing diagnostic imaging and interventional procedures for paediatric patients. It begins with a brief description of the basic concepts of radiological protection, followed by the general aspects of radiological protection, including principles of justification and optimisation. Guidelines and suggestions for radiological protection in specific modalities - radiography and fluoroscopy, interventional radiology, and computed tomography - are subsequently covered in depth. The report concludes with a summary and recommendations. The importance of rigorous justification of radiological procedures is emphasised for every procedure involving ionising radiation, and the use of imaging modalities that are non-ionising should always be considered. The basic aim of optimisation of radiological protection is to adjust imaging parameters and institute protective measures such that the required image is obtained with the lowest possible dose of radiation, and that net benefit is maximised to maintain sufficient quality for diagnostic interpretation. Special consideration should be given to the availability of dose reduction measures when purchasing new imaging equipment for paediatric use. One of the unique aspects of paediatric imaging is with regards to the wide range in patient size (and weight), therefore requiring special attention to optimisation and modification of equipment, technique, and imaging parameters. Examples of good radiographic and fluoroscopic technique include attention to patient positioning, field size and adequate collimation, use

  1. Citation context and impact of ‘sleeping beauties’ in paediatric research

    Završnik, Jernej; del Torso, Stefano; Blažun Vošner, Helena


    Objectives ‘Sleeping beauties’, i.e. publications that are not cited for a long while, present interesting findings in science. This study analysed the citation trends of sleeping beauties in paediatric research. Methods The study used bibliometric software to analyse the papers citing sleeping beauties in paediatric research, to understand the context in which paediatric sleeping beauties were finally cited and the impact of these sleeping beauties on paediatric research. Results Two paediatric sleeping beauties, addressing medical homes and the transition from paediatric to adult health care, respectively, awakened in response to organizational needs. Both presented novel concepts of paediatric service organization that became important because of an increased need for optimization of services. Conclusion All sleeping beauties bring new knowledge that becomes important only after several years. Paediatric sleeping beauties exhibited unique characteristics; however, their presence in paediatric research shows that knowledge acquisition in paediatrics resembles that in other disciplines. PMID:27834306

  2. The imaging of paediatric thoracic trauma

    Moore, Michael A.; Westra, Sjirk J. [Massachusetts General Hospital and Harvard Medical School, Department of Radiology, Boston, MA (United States); Wallace, E.C. [UMass Memorial Medical Center and University of Massachusetts Medical School, Department of Radiology, Worcester, MA (United States)


    Major chest trauma in a child is associated with significant morbidity and mortality. It is most frequently encountered within the context of multisystem injury following high-energy trauma such as a motor vehicle accident. The anatomic-physiologic make-up of children is such that the pattern of ensuing injuries differs from that in their adult counterparts. Pulmonary contusion, pneumothorax, haemothorax and rib fractures are most commonly encountered. Although clinically more serious and potentially life threatening, tracheobronchial tear, aortic rupture and cardiac injuries are seldom observed. The most appropriate imaging algorithm is one tailored to the individual child and is guided by the nature of the traumatic event as well as clinical parameters. Chest radiography remains the first and most important imaging tool in paediatric chest trauma and should be supplemented with US and CT as indicated. Multidetector CT allows for the accurate diagnosis of most traumatic injuries, but should be only used in selected cases as its routine use in all paediatric patients would result in an unacceptably high radiation exposure to a large number of patients without proven clinical benefit. When CT is used, appropriate modifications should be incorporated so as to minimize the radiation dose to the patient whilst preserving diagnostic integrity. (orig.)

  3. Recent advances in paediatric cardiac anaesthesia

    Mahesh Vakamudi


    Full Text Available Paediatric cardiac anaesthesia involves anaesthetizing very small children with complex congenital heart disease for major surgical procedures. The unique nature of this patient population requires considerable expertise and in-depth knowledge of the altered physiology. There have been several developments in the last decade in this subspecialty that has contributed to better care and improved outcome in this vulnerable group of patients. The purpose of this review is to present some of the recent advances in the anesthetic management of these children from preoperative evaluation to postoperative care. This article reviews the role of magnetic resonance imaging and contrast-enhanced magnetic resonance angiography in preoperative evaluation, the use of ultrasound to secure vascular access, the use of cuffed endotracheal tubes, the optimal haematocrit and the role of blood products, including the use of recombinant factor VIIa. It also deals with the advances in technology that have led to improved monitoring, the newer developments in cardiopulmonary bypass, the use of centrifugal pumps and extracorporeal membrane oxygenation and the role of DHCA. The role of new drugs, especially the α-2 agonists in paediatric cardiac anesthetic practice, fast tracking and effective postoperative pain management have also been reviewed.

  4. MR imaging of paediatric uterovaginal anomalies

    Lang, I.M.; Babyn, P. [Hospital for Sick Children, Toronto, ON (Canada). Dept. of Diagnostic Imaging; Oliver, G.D. [Hospital for Sick Children, Toronto, ON (Canada). Dept. of Gynaecology


    Background. Transabdominal ultrasound (US) has not proved completely reliable in Muellerian duct anomalies. One study has shown it useful in obstructed uterovaginal anomalies. We are unaware of a study that has used endovaginal ultrasound in children to investigate uterovaginal anomalies. Magnetic resonance imaging (MRI) is now gaining wide acceptance in imaging congenital abnormalities of the genital tract. Objective. To identify the problems and potential pitfalls of using MRI to evaluate the female genital tract in paediatric patients. Materials and methods. A retrospective review of the MRI scans of 19 patients, aged 3 months to 19 years (mean 14 years), with uterovaginal anomalies. Results. The uterovaginal anomalies were categorised into three groups: (1) congenital absence of the Muellerian ducts, or the Mayer-Rokitansky-Kuster-Hauser syndrome (n = 7), (2) disorders of vertical fusion (n = 2) and (3) disorders of lateral fusion (n = 10). Conclusions. MRI is a reliable method for evaluating paediatric uterovaginal anomalies, but should be analysed in conjunction with other imaging modalities (US and genitography). Previous surgery makes interpretation more difficult and, if possible, MRI should be carried out prior to any surgery. An accurate MRI examination can be extremely helpful prior to surgery and it is important for the radiologist to have knowledge of how these complex anomalies are managed and what pitfalls to avoid. (orig.) With 7 figs., 4 tabs., 24 refs.

  5. A paediatric X-ray exposure chart

    Knight, Stephen P, E-mail: [Department of Medical Imaging, Royal Children' s Hospital, Brisbane, Queensland (Australia)


    The aim of this review was to develop a radiographic optimisation strategy to make use of digital radiography (DR) and needle phosphor computerised radiography (CR) detectors, in order to lower radiation dose and improve image quality for paediatrics. This review was based on evidence-based practice, of which a component was a review of the relevant literature. The resulting exposure chart was developed with two distinct groups of exposure optimisation strategies – body exposures (for head, trunk, humerus, femur) and distal extremity exposures (elbow to finger, knee to toe). Exposure variables manipulated included kilovoltage peak (kVp), target detector exposure and milli-ampere-seconds (mAs), automatic exposure control (AEC), additional beam filtration, and use of antiscatter grid. Mean dose area product (DAP) reductions of up to 83% for anterior–posterior (AP)/posterior–anterior (PA) abdomen projections were recorded postoptimisation due to manipulation of multiple-exposure variables. For body exposures, the target EI and detector exposure, and thus the required mAs were typically 20% less postoptimisation. Image quality for some distal extremity exposures was improved by lowering kVp and increasing mAs around constant entrance skin dose. It is recommended that purchasing digital X-ray equipment with high detective quantum efficiency detectors, and then optimising the exposure chart for use with these detectors is of high importance for sites performing paediatric imaging. Multiple-exposure variables may need to be manipulated to achieve optimal outcomes.

  6. [Treatment of pain in hospital paediatrics].

    Molina, J; Sagaseta de Ilúrdoz, M; Busto, N; Lezáun, I; Cía, M L; Carrascosa, S; Azanza, M J


    The paper presents a review of pain at the paediatric age, which can be considered a question of maximum interest given the novel application of analgesia or other procedures for avoiding and controlling the different types of pain in the course of normal practice during childhood. After a brief introduction on the history of pain and the scarce attention that it has received until recently, the concepts and different actions for dealing with pain are set out, which depend on its aetiology and localisation: pain in oncology, post-operational pain, pain in chronic or acute diseases, pain in intensive care, etc. Tables are presented with the normal doses used at these ages in the different situations required by the child and which the professional might find himself facing. The non-pharmacological attitude is set out as this can be of great use in the initial stages of controlling pain at these ages, and the different forms of sedation and analgesia at the paediatric age are explained, with regard to the medicines employed, the form of administering them and the importance of a multidisciplinary team: paediatricians, child anaesthetists, nursing personnel as well as the necessary technical support for taking the corresponding action.

  7. Psychophysical testing of visual prosthetic devices: a call to establish a multi-national joint task force

    Rizzo, Joseph F., III; Ayton, Lauren N.


    Recent advances in the field of visual prostheses, as showcased in this special feature of Journal of Neural Engineering , have led to promising results from clinical trials of a number of devices. However, as noted by these groups there are many challenges involved in assessing vision of people with profound vision loss. As such, it is important that there is consistency in the methodology and reporting standards for clinical trials of visual prostheses and, indeed, the broader vision restoration research field. Two visual prosthesis research groups, the Boston Retinal Implant Project (BRIP) and Bionic Vision Australia (BVA), have agreed to work cooperatively to establish a multi-national Joint Task Force. The aim of this Task Force will be to develop a consensus statement to guide the methods used to conduct and report psychophysical and clinical results of humans who receive visual prosthetic devices. The overarching goal is to ensure maximum benefit to the implant recipients, not only in the outcomes of the visual prosthesis itself, but also in enabling them to obtain accurate information about this research with ease. The aspiration to develop a Joint Task Force was first promulgated at the inaugural 'The Eye and the Chip' meeting in September 2000. This meeting was established to promote the development of the visual prosthetic field by applying the principles of inclusiveness, openness, and collegiality among the growing body of researchers in this field. These same principles underlie the intent of this Joint Task Force to enhance the quality of psychophysical research within our community. Despite prior efforts, a critical mass of interested parties could not congeal. Renewed interest for developing joint guidelines has developed recently because of a growing awareness of the challenges of obtaining reliable measurements of visual function in patients who are severely visually impaired (in whom testing is inherently noisy), and of the importance of

  8. Psychological consultation in a paediatric setting: A qualitative analysis of staff experiences of a psychosocial forum.

    Douglas, Jessica L; Benson, Sally


    The use of psychosocial forums in paediatric settings has been recommended as a means of providing psychological consultancy. However, no research has explored staff perceptions of these meetings or whether they have a positive impact on patient care. In this study, six members of a paediatric gastroenterology multidisciplinary team were interviewed about their experience of a weekly psychosocial forum using a qualitative approach. The data revealed that staff regarded the forum as an essential and useful part of the service. Staff reported a number of benefits to their clinical work as a result of attending the forum, in addition to the general benefits of having a clinical psychologist available to see patients. However, staff also made recommendations for improving the forum. The results suggest that psychosocial forums may provide an efficient means of delivering specialist psychological consultation for patients with psychological difficulties, in line with Department of Health recommendations for paediatric services. Future research should aim to investigate the effectiveness of psychosocial forums in different settings and to establish the cost-effectiveness of these meetings. © The Author(s) 2014.

  9. When to start paediatric testing of the adult HIV cure research agenda?

    Shah, Seema K


    Ethical guidelines recommend that experimental interventions should be tested in adults first before they are tested and approved in children. Some challenge this paradigm, however, and recommend initiating paediatric testing after preliminary safety testing in adults in certain cases. For instance, commentators have argued for accelerated testing of HIV vaccines in children. Additionally, HIV cure research on the use of very early therapy (VET) in infants, prompted in part by the Mississippi baby case, is one example of a strategy that is currently being tested in infants before it has been well tested in adults. Because infants’ immune systems are still developing, the timing of HIV transmission is easier to identify in infants than in adults, and infants who receive VET might never develop the viral reservoirs that make HIV so difficult to eradicate, infants may be uniquely situated to achieve HIV cure or sustained viral remission. Several commentators have now argued for earlier initiation of HIV cure interventions other than (or in addition to) VET in children. HIV cure research is therefore a good case for re-examining the important question of when to initiate paediatric research. I will argue that, despite the potential for HIV cure research to benefit children and the scientific value of involving children in this research, the HIV cure agenda should not accelerate the involvement of children for the following reasons: HIV cure research is highly speculative, risky, aimed at combination approaches and does not compare favourably with the available alternatives. I conclude by drawing general implications for the initiation of paediatric testing, including that interventions that have to be used in combination with others and cures for chronic diseases may not be valuable enough to justify early paediatric testing. PMID:27259546


    MENG Fanhang; LIU Cuiping; RENG Xiaoping; JIANG Lian


    Objectives To explore clinical application on brain atlas in paediatrics. Methode: Brain atlas was applied in diagnosis and treatment of paediatric diseases and its clinical value was discussed in 1990 ~2001. The manifestation of these diseases in brain atlas were analysed and the manifestation of CT of 67 cases and manifestations of EEG of 37 cases with that of BA were compared. Results The changes of cerebral electrical activity of these diseases were reflected objectively and showed directly in BA. Conclusion Brain atlas not only can point out quality of disease but also define position of disease. Therefore, brain atlas has important clinical value in paediatrics.

  11. Clinical practice audit concerning antimicrobial prophylaxis in paediatric neurosurgery: results from a German paediatric oncology unit.

    Weiss, Katja; Simon, Arne; Graf, Norbert; Schöpe, Jakob; Oertel, Joachim; Linsler, Stefan


    Perioperative antimicrobial prophylaxis (PAP) has been identified as an important target for internal audits, concerning the judicious use of antibiotics. Paediatric oncology patients with brain tumours face an increased risk of surgical site infection (SSI) after neurosurgery and receive routine PAP in this setting. All patients younger than 18 years admitted to the paediatric oncology centre (POC) with a neurosurgical intervention. Systematic audit of routine clinical data is divided in two groups: retrospective (Jan 01, 2012-March 31, 2014) and prospective (April 01, 2014-March 31, 2015) referring to an internal PAP guideline, invented in Jan. 2014). Surveillance of SSI up to 30 days after the operation with standard criteria (Centres for Disease Control and Prevention, USA). In total, 53 neurosurgical operations were analysed in 33 paediatric oncology patients. Twelve patients received more than one operation. The detailed analysis of PAP revealed prophylactic cefuroxim doses about 30 mg/kg instead of 50 mg/kg and no repeated dosing in operations lasting longer than 4 h. In addition, Cefotaxim, which is not indicated as PAP in neurosurgery, was used instead of Cefuroxim (or Ampicillin-Sulbactam) in 23 % of all cases in the retrospective and 18 % of all cases in the prospective audit. PAP for more than 3 doses (>24 h) was administered in 66 % in the retrospective group and in 60 % in the prospective group (p = n.s.). In both groups, no SSI was detected. This first comprehensive audit of PAP in paediatric oncology patients undergoing neurosurgery outlines significant opportunities to improve clinical practice in terms of correct dosing, the correct choice of the antibiotic, a correct timing schedule and a shorter duration of PAP. In addition, our results illustrate in detail the challenges in clinical practice when an evidence-based approach to improve a standard workflow has to be implemented.

  12. e-Education in paediatric surgery: a role for recorded seminars in areas of low bandwidth in sub-Saharan Africa.

    Hadley, G P; Mars, M


    There is a shortage of surgeons in Africa, and this shortage is particularly acute in paediatric surgery with most paediatric patients being cared for by general surgeons. The use of information technology to augment teaching in paediatric surgery in Africa is appealing but often unsuccessful due to the costs involved and a lack of bandwidth. A simple solution is needed to allow sharing of teaching sessions that are normally conducted by videoconference in areas in which bandwidth is adequate. Weekly paediatric surgical interactive seminars that are regularly shared by videoconference by three centres in South Africa have been recorded onto DVDs. These have been bundled into monthly packages and couriered to four medical schools in East and Central Africa. Recipients have been at liberty to use them as they saw fit. After 6 months, a survey was conducted to determine the usefulness of the exercise. At all recipient sites, the seminars were used as part of the teaching of general surgical trainees and paediatric surgical fellows at those medical schools with appropriate training programmes. Three of the four schools used the seminars in undergraduate courses. All regarded the seminars as useful and all but one as of adequate visual and sound quality. The in-house teaching at the medical school in Durban is now shared by over 140 surgical trainees and students in four countries in which a lack of bandwidth precludes videoconferencing, and this low-tech low-cost solution has proved effective in resource-poor settings.

  13. [Quality of initial trauma care in paediatrics].

    Ibáñez Pradas, Vicente; Pérez Montejano, Rut


    Trauma care in Spain is not provided in specific centres, which means that health professionals have limited contact to trauma patients. After the setting up of a training program in paediatric trauma, the aim of this study was to evaluate the quality of the initial care provided to these patients before they were admitted to the paediatric intensive care unit (PICU) of a third level hospital (trauma centre), as an indirect measurement of the increase in the number of health professionals trained in trauma. Two cohorts of PICU admissions were reviewed, the first one during the four years immediately before the training courses started (Group 1, period 2001-2004), and the second one during the 4 years (Group 2, period 2012-2015) after nearly 500 professionals were trained. A record was made of the injury mechanism, attending professional, Glasgow coma score (GCS), and paediatric trauma score (PTS). Initial care quality was assessed using five indicators: use of cervical collar, vascular access, orotracheal intubation if GCS ≤ 8, gastric decompression if PTS≤8, and number of actions carried out from the initial four recommended (neck control, provide oxygen, get vascular access, provide IV fluids). Compliance was compared between the 2 periods. A P<.05 was considered statistically significant. A total of 218 patient records were analysed, 105 in Group 1, and 113 in Group 2. The groups showed differences both in injury mechanism and in initial care team. A shift in injury mechanism pattern was observed, with a decrease in car accidents (28% vs 6%; P<.0001). Patients attended to in low complexity hospitals increased from 29.4% to 51.9% (P=.008), and their severity decreased when assessed using the GCS ≤ 8 (29.8% vs 13.5%; P=.004), or PTS≤8 (48.5% vs 29.7%; P=.005). As regards quality indicators, only the use of neck collar improved its compliance (17.3% to 32.7%; P=.01). Patients who received no action in the initial care remained unchanged (19% vs 11%%; P=.15

  14. Eosinophilic heart disease in a paediatric patient.

    Dedieu, Natalie; Giardini, Alessandro; Khambadkone, Sachin; Marek, Jan


    A 12-year-old child with no previous medical history was referred with a 4-day history of cough, shortness of breath, and peripheral blood eosinophilia. Transthoracic echocardiography showed a soft tissue infiltrating the left ventricular free wall, the lateral mitral annulus, and the mitral valve leaflets. A soft tissue strand connecting the lateral left atrial wall and mitral leaflets across the mitral valve orifice was also identified, causing reduced opening and functional mitral stenosis. The diagnosis of Löeffler endocarditis was made, and after 10 weeks of treatment with oral prednisolone, there was complete resolution of symptoms and of the infiltrative tissue with normalization of mitral valve function. The present case highlights some atypical features of eosinophilic heart disease-like occurrence in paediatric age, the complete preservation of the right ventricle and left ventricular apex, and the presentation with mitral stenosis compared with mitral regurgitation typically observed in the late phase of the disease.

  15. Informed consent & ethical issues in paediatric psychopharmacology.

    Malhotra, Savita; Subodh, B N


    Issues relating to informed consent and ethics in paediatric psychopharmacology limit research in this population. Children vary in their levels of cognitive development, and presence of psychiatric disorder may further impair their ability to give informed consent. In decisional impairment subjects, various methods used for consent are assent/dissent; inclusion of advance directives; and/or alternative decision-makers. India is emerging as a new market for clinical trials in recent years. Moreover, in India the sociocultural realities are different from those in the western countries making it necessary for professionals to be cautious in conducting drug trials. In this review, issues regarding informed consent in children and adolescent with psychiatric diagnosis are discussed for information, discussion and debate by professionals, parents, society and legal experts to create awareness and to facilitate development of guidelines that are appropriate and applicable to the Indian system.

  16. Action, prevention and epidemiology of paediatric obesity

    Lissau, Inge


    UNLABELLED: The overall aim of this paper is to describe important issues regarding paediatric obesity as a public health problem. This paper focuses on actions taken, and on the prevalence of obesity in children, teens and adults in Denmark. In addition, the paper describes some important...... prevention studies, all of which are performed outside Denmark. Thus, this paper is not a classical review but rather a highlight of some aspects that the author finds important. The latest Danish national figures show a marked increase in the prevalence of obesity, especially among young men-a sevenfold...... increase from 1987 to 2000 (0.7 to 4.9%). Among young women aged 16-24, the increase is threefold in the same period. Among teens, the prevalence has increased by 2-3 times in recent decades. Nevertheless, compared to other European countries and the US, Denmark has a relatively low prevalence of obesity...

  17. New hazards in paediatric poisoning presentations.

    Moore, C


    Accidental ingestion is an important preventable cause of childhood morbidity. All accidental ingestion presentations (n = 478) to a tertiary paediatric ED from January 2010 to December 2011 were analysed. These results were compared with a similar study in the same institution ten years previously in 2001 and showed that while accidental ingestions constituted a higher proportion of presentations (0.5% in this study v 0.45% in 2001), fewer had investigations performed (21% v 35%) and fewer were admitted (7% v 20%). Accidental ingestions account for 0.5% of presentations and are an important focus of home safety information for parents and guardians. Paracetamol (n = 67, 14%) and liquid detergent capsules (n = 44, 9.2%) were the two most common substances implicated in these presentations, and have the potential to cause severe morbidity and mortality.

  18. Paediatric radiology from a psychosocial lens

    Tracy Sharbaugh


    Full Text Available Globally, hospitals and medical centres have a reputation of causing individual patients an increased level of anxiety, stress and pain owing to their foreign environments, intimidating examinations and rigorous treatments. Because of children’s cognitive and developmental levels of understanding and communication, they are more susceptible to increased levels of stress and trauma associated with medical examinations and hospitalisation. Certified Child Life Specialists (CCLSs are professionals trained in child development and family systems expertise who work directly with children and families to meet their psychosocial and emotional needs in order to help them overcome some of life’s most challenging events, including hospitalisation, illness and trauma. This article aims to address the history of the child life profession and the significance of child life in a paediatric imaging unit, and to discuss the current and future status of psychosocial services in South Africa.

  19. Review article: Paediatric bone and joint infection.

    Stott, N Susan


    Paediatric musculoskeletal infection remains an important cause of morbidity. Methicillin sensitive Staphylococcus aureus is still the most common organism although the incidence of methicillin resistant S. aureus in the community is rising. Osteomyelitis and septic arthritis due to Haemophilus influenzae is decreasing in incidence secondary to immunisation and in some units has been replaced by infections with the gram negative bacillus, Kingella kingae. Recent prospective studies indicate that uncomplicated osteomyelitis can be treated by three to four weeks of antibiotics. However, there is still a small group of children who will have overwhelming disseminated infection. These children require aggressive surgical and medical intervention. Two recent reports have identified an increased incidence of septic arthritis in children who have hemophilia and are HIV positive.

  20. glomerular filtration rate profiles in paediatric patients on cancer ...


    May 28, 2013 ... optimising the dose of many drugs used in paediatric oncology for allowing clinical monitoring of the ... anticancer drugs and has been shown to be a leading cause of ..... with cancer. Cancer chemotherapy and pharmacology.

  1. A 3D digital medical photography system in paediatric medicine.

    Williams, Susanne K; Ellis, Lloyd A; Williams, Gigi


    In 2004, traditional clinical photography services at the Educational Resource Centre were extended using new technology. This paper describes the establishment of a 3D digital imaging system in a paediatric setting at the Royal Children's Hospital, Melbourne.

  2. Use of complementary/alternative medicine among paediatric patients

    Madsen, Hanne; Andersen, Susie; Nielsen, Rasmus Gaardskaer


    UNLABELLED: The use of complementary/alternative medicine (CAM) is increasing. The aim was to characterise the use of CAM among patients in a paediatric department. All patients (aged 0-18 years), out-patients or hospitalised, in contact with the Department of Paediatrics, Odense University......: Of the paediatric patients, 53% had tried complementary/alternative medicine, which was used as a supplement to conventional medicine although we did not know how long it was used. Paediatric patients should be interviewed about their use of complementary/alternative medicine with regard to side...... Hospital during a 2 week period in the autumn of 2001 were asked to participate. In total, 622 (92%) patients participated. The data were collected in an interviewer administered questionnaire during a short structured interview with the patient and parents. CAM was divided into herbal medicine (herbal...

  3. Apartheid and healthcare access for paediatric systemic lupus ...

    lupus erythematosus (SLE), as a framework for evaluating the structural challenges to ... Paediatric SLE (pSLE) is more severe than the adult disease, and children with SLE .... exploration using a geographical information system. Soc Sci Med ...

  4. Irreducible Inguinal Hernias in the Paediatric Age Group | Ezomike ...

    Irreducible Inguinal Hernias in the Paediatric Age Group. ... Nigerian Journal of Medicine ... Irreducibility is an ever present risk in untreated inguinal hernias and its management remains an important part of pediatric surgery practice. When a ...

  5. Adverse drug reactions from psychotropic medicines in the paediatric population

    Aagaard, Lise; Hansen, Ebba H


    ADRs reported for psychotropic medicines in the Danish paediatric population over a decade. FINDINGS: All spontaneous ADR reports from 1998 to 2007 for children from birth to 17 years of age were included. The unit of analysis was one ADR. We analysed the distribution of ADRs per year, seriousness, age......ABSTRACT: BACKGROUND: The prescribing of psychotropic medicines for the paediatric population is rapidly increasing. In attempts to curb the use of psychotropic medicine in the paediatric population, regulatory authorities have issued various warnings about risks associated with use...... of serious ADRs reported in children from birth up to 2 years of age were presumably caused by mothers' use of psychotropic medicines during pregnancy. CONCLUSION: The high number of serious ADRs reported for psychotropic medicines in the paediatric population should be a concern for health care...

  6. Clinical features of paediatric pulmonary hypertension : a registry study

    Berger, Rolf M. F.; Beghetti, Maurice; Humpl, Tilman; Raskob, Gary E.; Ivy, D. Dunbar; Jing, Zhi-Cheng; Bonnet, Damien; Schulze-Neick, Ingram; Barst, Robyn J.


    Background Paediatric pulmonary hypertension, is an important cause of morbidity and mortality, and is insufficiently characterised in children. The Tracking Outcomes and Practice in Pediatric Pulmonary Hypertension (TOPP) registry is a global, prospective study designed to provide information about

  7. Percutaneous K-wire fixation in paediatric Supracondylar fractures ...

    Percutaneous K-wire fixation in paediatric Supracondylar fractures of humerus: A retrospective study. ... Nigerian Medical Journal ... conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2005 to July 2010.

  8. Paediatric cardiac anaesthesia in sickle cell disease: a case series

    This case series details experience of four paediatric patients with SCD who underwent corrective cardiac surgery at Red ..... Increased LV stroke volume, increased cardiac output & heart rate ... Hydroxyurea treatment may cause bone marrow.

  9. Pattern recognition in paediatric ecgs: the hidden secrets to clinical ...

    typical ECG patterns commonly found in routine paediatric cardiac examination, ECG .... an anterolateral myocardial infarct pattern. Deep Q waves .... The light, which can penetrate tissue and bone, stimulates cell mitochondria to kick-start a ...

  10. Cost of treatment of paediatric femoral shaft fractures: compression ...

    Cost of treatment of paediatric femoral shaft fractures: compression plating versus conservative treatment. ... Log in or Register to get access to full text downloads. ... Results: Thirty-one patients who had ORIF and 31 matched controls were ...

  11. paediatric endocrine disorders at the university college hospital ...

    infectious diseases, childhood endocrine disorders constitute a significant cause of morbidity and mortality.2. In developed countries, paediatric ... present in 6.4%, obesity in 3.2% while the least common disorder was Diabetes insipidus (1%).

  12. Eliminating paediatric infections and keeping mothers alive

    Gray G


    Full Text Available The global plan of reducing the number of new child HIV infections and a reduction in the number of HIV-related maternal deaths by 2015 will require inordinate political commitment and strengthening of health systems in Sub-Saharan Africa where the burden of HIV infections in pregnant women is the highest. Preventing HIV infection in women of child-bearing age and unwanted pregnancies in HIV-positive women forms the cornerstone of long-term control of paediatric HIV infections. To achieve the goal of eliminating paediatric HIV infection by 2015, health systems strengthening to address prevention of mother-to-child HIV transmission cascade attrition and focusing on the elimination of breastmilk transmission is critical. Understanding the pathogenesis of breastmilk transmission and the mechanisms by which antiretroviral therapy impacts on transmission through this compartment will drive future interventions. Identifying and retaining HIV-positive pregnant women in care and committed to long-term antiretroviral therapy will improve maternal outcomes and concomitant reductions in maternal mortality. Research assessing the natural history of HIV infection and long-term outcomes in women who interrupt antiretroviral therapy post-weaning is urgently required. Data on the outcome of women who opt to continue the long-term use of antiretroviral therapy after initiating therapy during pregnancy will determine future policy in countries considering option B+. The prevalence of antiretroviral resistance and impact on survival in infants who sero-convert whilst receiving neonatal prophylaxis, or are exposed to maternal HAART through breastmilk at a population level, are currently unknown. In addition to the provision of biomedical interventions, healthcare workers and policy makers must address the structural, cultural and community issues that impact on treatment uptake, adherence to medication and retention in care.

  13. Paediatric acute retropharyngeal abscesses: An experience

    Khan A Nazir


    Full Text Available Background: To describe our experience of paediatric patients with acute retropharyngeal abscess in terms of clinical presentation, diagnosis, management and complications. Materials and Methods: A prospective study was done for a period of 4 years (Jan 2009 to Jan 2013 on paediatric patients (< 15 years with acute retropharyngeal abscess at two tertiary hospitals in Srinagar. Diagnosis was made on the basis of X-ray, CECT scan findings and confirmed on incision and drainage. Pus was aspirated from all patients and sent for culture and sensitivity. Data for clinical presentation, X-ray, CECT scan findings, causes, complications, bacteriology and management were collected. Thirty-five abscesses were drained while 5 with small abscesses on CECT were managed conservatively. Results: A total of 40 patients were diagnosed as acute retropharyngeal abscesses. Males were commonly affected, and most of the patients were less than 6 years of age. Most common symptom at presentation was fever (35 followed by neck pain (30 Dysphagia/odynophagia (22, swelling in neck (19. Most common clinical sign observed was oropharyngeal swelling and limitation of neck movements (30, cervical swelling/lymphadenopathy in 22 patients. Torticollosis and drooling were seen in 15 patients. Complications were seen in 8 patients. Most common X-ray finding was pre-vertebral thickening. Success rate with primary surgical drainage was 95% while 3 patients in conservative group failed. Conclusion: Children with RPA most commonly present with restricted neck movements, fever and cervical lymphadenopathy, and rarely with respiratory distress or stridor. Surgical intervention is necessary for most of these patients.

  14. Paediatric cyclical Cushing's disease due to corticotroph cell hyperplasia.

    Noctor, E


    Cushing\\'s disease is very rare in the paediatric population. Although uncommon, corticotroph hyperplasia causing Cushing\\'s syndrome has been described in the adult population, but appears to be extremely rare in children. Likewise, cyclical cortisol hypersecretion, while accounting for 15 % of adult cases of Cushing\\'s disease, has only rarely been described in the paediatric population. Here, we describe a very rare case of a 13-year old boy with cyclical cortisol hypersecretion secondary to corticotroph cell hyperplasia.

  15. The family history: An integral component of paediatric health assessment

    Shugar, Andrea L


    Conducting the paediatric health history is a vital skill for the paediatrician. However, published guidelines on this topic often fail to emphasize the value that the family history adds to paediatric health assessment. For the healthy child, the family history may reveal risk factors for juvenile and/or adult-onset conditions, the adverse effects of which may be ameliorated with medical intervention or surveillance. For the child with a health problem, a detailed family history may help to ...

  16. Paediatric rheumatology practice in the UK benchmarked against the British Society for Paediatric and Adolescent Rheumatology/Arthritis and Musculoskeletal Alliance Standards of Care for juvenile idiopathic arthritis.

    Kavirayani, Akhila; Foster, Helen E


    To describe current clinical practice against the BSPAR/ARMA Standards of Care (SOCs) for children and young people (CYP) with incident JIA. Ten UK paediatric rheumatology centres (including all current centres nationally accredited for paediatric rheumatology higher specialist training) participated in a retrospective case notes review using a pretested pro forma based on the SOC. Data collected per centre included clinical service configuration and the initial clinical care for a minimum of 30 consecutive new patients seen within the previous 2 years and followed up for at least 6 months. A total of 428 CYP with JIA (median age 11 years, range 1-21 years) were included, with complete data available for 73% (311/428). Against the key SOCs, 41% (175/428) were assessed ≤10 weeks from symptom onset, 60% (186/311) ≤4 weeks from referral, 26% (81/311) had eye screening at ≤6 weeks, 83% (282/341) had joint injections at ≤6 weeks, 59% (184/311) were assessed by a nurse specialist at ≤4 weeks and 45% (141/311) were assessed by a physiotherapist at ≤8 weeks. A median of 6% of patients per centre participated in clinical trials. All centres had access to eye screening and prescribed biologic therapies. All had access to a nurse specialist and physiotherapist. Most had access to an occupational therapist (8/10), psychologist (8/10), joint injection lists (general anaesthesia/inhaled analgesia) (9/10) and designated transitional care clinics (7/10). This first description of UK clinical practice in paediatric rheumatology benchmarked against the BSPAR/ARMA SOCs demonstrates variable clinical service delivery. Considerable delay in access to specialist care is evident and this needs to be addressed in order to improve clinical outcomes.

  17. Diagnostic reference levels for paediatric radiography in Finland

    Kiljunen, T.; Jaervinen, H.; Parviainen, T.; Komppa, T. [Radiation and Nuclear Safety Authority - STUK, Helsinki, (Finland). Radiation Practices Regulation; Savolainen, S. [Helsinki University Central Hospital, Helsinki (Finland). Dept. of Radiology


    The Radiation and Nuclear Safety Authority (STUK) in Finland has responsibility to set the national Diagnostic Reference Levels (DRLs) for the most common radiological examinations. Paediatric patients deserve a special attention due to the higher radiation risk compared with adults. The purpose was to present a method which takes into account patient size when setting DRLs in paediatrics. The overall data used in the study consisted of patient doses collected from eight hospitals: for 700 chest examinations, 100 micturating cystourethography (MCU) fluoroscopy examinations and 10 - 30 other conventional or fluoroscopy examinations. The method established by the National Radiation Protection Board (UK) for setting DRLs was found to produce extra uncertainty in the procedure and it was also troublesome to use. Reference levels for paediatric chest examinations could be given as linear curve on half logarithmic scale as a function of patient projection thickness. STUK has been collecting the data on paediatric patient doses in almost 30 Finnish hospitals as the current available data is insufficient and partly outdated. The collection is carried out by a questionnaire in which hospitals record paediatric patient doses of chest, skull, sinus, abdomen, pelvis and micturating cystourethography examinations. The DRLs will be given during the year 2005 for the most common paediatric radiographic examinations.

  18. Pattern of paediatric trauma in Sokoto, North West Nigeria

    Muhammad Oboirien


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

  19. Fast tracking in paediatric cardiac anaesthesia : an update.

    Lake Carol


    Full Text Available A care plan in which cardiac surgical patients progress quickly through the perioperative course to hospital discharge is often referred to as a Fast Track. Such care plans have been used extensively in adult cardiac patients but are also applicable to paediatric patients. Although no randomised controlled trials are available to document a reduction in hospital costs and avoidance of iatrogenic complications with paediatric fast tracks, many healthcare administrators encourage their use. Fast Track clinical guidelines usually include same day surgery, use of short- acting anaesthetic drugs, early extubation, effective pain management, and reduced intensive care unit stays. These protocols are certainly appropriate for simple procedures such as repair of atrial or ventricular septal defects or ligation of a patent ductus arteriosus. However, many paediatric cardiac anaesthesiologists consider that all paediatric patients without significant pulmonary or residual cardiac pathology can be managed using expedited postoperative protocols. Essential components in a "fast track" protocol include use of minimally invasive surgical techniques, modified ultrafiltration during cardiopulmonary bypass, transoesophageal echocardiography to evaluate the cardiac repair, and postoperative pain control. Using such techniques, 80-90% of paediatric patients can be extubated in the operating room or within 2-4 hours postoperatively. Despite the opinions of recognised experts, an appropriately sized and powered multicentre, controlled, randomised, prospective study is still needed to conclusively document the efficiency and effectiveness of the Fast Track in paediatric cardiac patients.

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

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


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

  1. Feasibility of perfusion cardiovascular magnetic resonance in paediatric patients

    Kellenberger Christian


    Full Text Available Abstract Aims As coronary artery disease may also occur during childhood in some specific conditions, we sought to assess the feasibility and accuracy of perfusion cardiovascular magnetic resonance (CMR in paediatric patients. Methods and results First-pass perfusion CMR studies were performed under pharmacological stress with adenosine and by using a hybrid echo-planar pulse sequence with slice-selective saturation recovery preparation. Fifty-six perfusion CMR examinations were performed in 47 patients. The median age was 12 years (1 month-18 years, and weight 42.8 kg (2.6-82 kg. General anaesthesia was required in 18 patients. Mean examination time was 67 ± 19 min. Diagnostic image quality was obtained in 54/56 examinations. In 23 cases the acquisition parameters were adapted to patient's size. Perfusion CMR was abnormal in 16 examinations. The perfusion defects affected the territory of the left anterior descending coronary artery in 11, of the right coronary artery in 3, and of the circumflex coronary artery in 2 cases. Compared to coronary angiography, perfusion CMR showed a sensitivity of 87% (CI 52-97% and a specificity of 95% (CI 79-99%. Conclusion In children, perfusion CMR is feasible and accurate. In very young children (less than 1 year old, diagnostic image quality may be limited.

  2. Paediatric non-alcoholic fatty liver disease: an overview.

    AlKhater, S A


    Non-alcoholic fatty liver disease (NAFLD) is a progressive disease that encompasses a spectrum of liver diseases, ranging from simple steatosis to non-alcoholic steatohepatitis (NASH). Data related to survival in children are scarce, but these data firmly associate NAFLD with higher risks of hepatic and non-hepatic morbidities and mortalities compared with the general population. More recently, the association between NAFLD and cardiovascular disease among children has increasingly been recognized. Given that obesity is a major risk factor for the disease, paediatric NAFLD is becoming a global issue, paralleling the dramatic rise in obesity worldwide. NASH, which is more common in obese children, has the potential to advance to liver fibrosis and failure. It is unclear why certain patients undergo such transformation but this susceptibility is likely related to an interaction between a genetically susceptible host and the surrounding environment. Currently, treatment is largely conservative and includes lifestyle modification, attainable through healthy weight reduction via diet and exercise. In this review, current knowledge about NAFLD in children is summarized. This review aims to increase the awareness of the medical community about a hidden public health issue and to identify current gaps in the literature while providing directions for future research. © 2015 World Obesity.

  3. A Retrospective Analysis of Spontaneous Adverse Drug Reactions Reports Relating to Paediatric Patients.

    Rosliana Rosli

    Full Text Available Spontaneous reporting on adverse drug reactions (ADR has been established in Malaysia since 1987, and although these reports are monitored by the Malaysia drug monitoring authority, the National Pharmaceutical Control Bureau, information about ADRs in the paediatric patient population still remains unexplored. The aims of this study, therefore, were to characterize the ADRs reported in respect to the Malaysian paediatric population and to relate the data to specific paediatric age groups.Data on all ADRs reported to the National Pharmaceutical Control Bureau between 2000 and 2013 for individuals aged from birth to 17 years old were analysed with respect to age and gender, type of reporter, suspected medicines (using the Anatomical Therapeutic Chemical classification, category of ADR (according to system organ class as well as the severity of the ADR.In total, 11,523 ADR reports corresponding to 22,237 ADRs were analysed, with half of these reporting one ADR per report. Vaccines comprised 55.7% of the 11,523 ADR reports with the remaining being drug related ADRs. Overall, 63.9% of ADRs were reported for paediatric patients between 12 and 17 years of age, with the majority of ADRs reported in females (70.7%. The most common ADRs reported were from the following system organ classes: application site disorders (32.2%, skin and appendages disorders (20.6%, body as a whole general disorders (12.8% and central and peripheral nervous system disorders (11.2%. Meanwhile, ADRs in respect to anti-infectives for systemic use (2194/5106; 43.0% were the most frequently reported across all age groups, followed by drugs from the nervous system (1095/5106; 21.4%. Only 0.28% of the ADR cases were reported as fatal. A large proportion of the reports were received from healthcare providers in government health facilities.ADR reports concerning vaccines and anti-infectives were the most commonly reported in children, and are mainly seen in adolescents, with most of

  4. [Spanish funded paediatric research: Contribution of Anales de Pediatría to its dissemination].

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


    To identify Spanish funded paediatric research published in general paediatric journals included in the Web of Science (WoS) from 2010 to 2014) and those published in the Anales de Pediatría. To examine the relationship between funding and the prestige of the journals. To describe the journal conditions to meet the open access criteria. Spanish funded paediatric articles (FA) were identified by using the WoS Funding Agency field, and by reviewing the original documents for the Anales de Pediatria (AP). For the FA published in AP the number and kind of funding agencies were identified. The possible differences in citations between FA and non-funded was assessed for articles published in this journal using the Kruskal-Wallis non-parametric test. For general journals, the patterns of distribution of FA and non-FA were investigated according to the quartile of the journal. The journal's self-archiving conditions were described using Sherpa/romeo database. Funding was received for 27.5%, being 16.6% for those published in AP. In these, 105 funding agencies were identified, with 80% being national. The FA published in AP did not receive significantly more citations. In general journals, the presence of FA is greater in Q1 and Q2 journals. More than half (56%) of articles were published in subscription journals. All journals that publish FA allow self-archiving in repositories, but with embargos of at least 12 months. The role of AP in the dissemination of FA is still limited. Embargos in self-archiving permits compliance of Spanish open access mandate, but may hinder compliance in Europe. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Bed Utilisation in an Irish Regional Paediatric Unit A Cross-Sectional Study Using the Paediatric Appropriateness Evaluation Protocol (PAEP)

    Ó hAiseadha, Coilín


    Increasing demand for limited healthcare resources raises questions about appropriate use of inpatient beds. In the first paediatric bed utilisation study at a regional university centre in Ireland, we conducted a cross-sectional study to audit the utilisation of inpatient beds at the Regional Paediatric Unit (RPU) in University Hospital Limerick (UHL), Limerick, Ireland and also examined hospital activity data, to make recommendations for optimal use of inpatient resources.

  6. Fiberoptic intubation in a paediatric patient with severe temporomandibular joint (TMJ) ankylosis.

    Asghar, Ali; Shamim, Faisal; Aman, Asiyah


    Craniofacial abnormalities are associated with mandibular hypoplasia, reduced mandibular space with overcrowding of soft tissues and maxillary hypoplasia. Decreased mouth opening and limitation in jaw protrusion are independent predictors of difficult airway in such patients. The relative difficult problem becomes even graver in the paediatric age group because of their small mouth opening and un-cooperativeness. A child with severe temporomandibular joint (TMJ) ankylosis presented with negligible mouth opening and required surgical correction under general anaesthesia. Successful intubation was performed with endotracheal tube size 5.5 mm using an adult 4.3 mm fiberoptic bronchoscope under inhalational as well as topical anaesthesia.

  7. Paediatric cardiac intensive care unit: current setting and organization in 2010.

    Fraisse, Alain; Le Bel, Stéphane; Mas, Bertrand; Macrae, Duncan


    Over recent decades, specialized paediatric cardiac intensive care has emerged as a central component in the management of critically ill, neonatal, paediatric and adult patients with congenital and acquired heart disease. The majority of high-volume centres (dealing with over 300 surgical cases per year) have dedicated paediatric cardiac intensive care units, with the smallest programmes more likely to care for paediatric cardiac patients in mixed paediatric or adult intensive care units. Specialized nursing staff are also a crucial presence at the patient's bedside for quality of care. A paediatric cardiac intensive care programme should have patients (preoperative and postoperative) grouped together geographically, and should provide proximity to the operating theatre, catheterization laboratory and radiology department, as well as to the regular ward. Age-appropriate medical equipment must be provided. An optimal strategy for running a paediatric cardiac intensive care programme should include: multidisciplinary collaboration and involvement with paediatric cardiology, anaesthesia, cardiac surgery and many other subspecialties; a risk-stratification strategy for quantifying perioperative risk; a personalized patient approach; and anticipatory care. Finally, progressive withdrawal from heavy paediatric cardiac intensive care management should be institutionalized. Although the countries of the European Union do not share any common legislation on the structure and organization of paediatric intensive care or paediatric cardiac intensive care, any paediatric cardiac surgery programme in France that is agreed by the French Health Ministry must perform at least '150 major procedures per year in children' and must provide a 'specialized paediatric intensive care unit'.

  8. Clowning as a supportive measure in paediatrics - a survey of clowns, parents and nursing staff


    Background Hospital clowns, also known as clown doctors, can help paediatric patients with the stress of a hospitalization and to circumvent the accompanying feelings of fear, helplessness and sadness, thus supporting the healing process. The objectives of the present study were to clarify the structural and procedural conditions of paediatric clowning in Germany and to document the evaluations of hospital clowns, parents and hospital staff. Methods A nationwide online survey of hospital clowns currently active in paediatric departments and an accompanying field evaluation in Hamburg hospitals with surveys of parents and hospital staff were conducted. In addition to items developed specifically for the study regarding general conditions, procedures, assessments of effects and attitudes, the Work Satisfaction Scale was used. The sample included n = 87 hospital clowns, 37 parents and 43 hospital staff members. Results The online survey showed that the hospital clowns are well-trained, motivated and generally satisfied with their work. By their own estimate, they primarily boost morale and promote imagination in the patients. However, hospital clowns also desire better interdisciplinary collaboration and financial security as well as more recognition of their work. The Hamburg field study confirmed the positive results of the clown survey. According to the data, a clown intervention boosts morale and reduces stress in the patients. Moreover, there are practically no side effects. Both parents and hospital staff stated that the patients as well as they themselves benefited from the intervention. Conclusions The results match those of previous studies and give a very positive picture of hospital clowning, so that its routine use and expansion thereof can be recommended. Furthermore, the intervention should be subject to the rules of evidence-based medicine like other medical treatments. PMID:24112744

  9. Dietary salt intake and time to relapse in paediatric multiple sclerosis

    Nourbakhsh, Bardia; Graves, Jennifer; Casper, T Charles; Lulu, Sabeen; Waldman, Amy; Belman, Anita; Greenberg, Benjamin; Weinstock-Guttman, Bianca; Aaen, Gregory; Tillema, Jan-Mendelt; Hart, Janace; Ness, Jayne; Rubin, Jennifer; Krupp, Lauren; Gorman, Mark; Benson, Leslie; Rodriguez, Moses; Chitnis, Tanuja; Rose, John; Barcellos, Lisa; Waubant, Emmanuelle


    .... Methods Paediatric-onset MS and patients with clinically isolated syndrome (CIS) within 4 years of disease onset were recruited from 15 paediatric MS centres in the USA as part of a case-control study...

  10. Gait and Lower Limb Observation of Paediatrics (GALLOP): development of a consensus based paediatric podiatry and physiotherapy standardised recording proforma.

    Cranage, Simone; Banwell, Helen; Williams, Cylie M


    Paediatric gait and lower limb assessments are frequently undertaken in podiatry and physiotherapy clinical practice and this is a growing area of expertise within Australia. No concise paediatric standardised recording proforma exists to assist clinicians in clinical practice. The aim of this study was to develop a gait and lower limb standardised recording proforma guided by the literature and consensus, for assessment of the paediatric foot and lower limb in children aged 0-18 years. Expert Australian podiatrists and physiotherapists were invited to participate in a three round Delphi survey panel using the online Qualtrics(©) survey platform. The first round of the survey consisted of open-ended questions on paediatric gait and lower limb assessment developed from existing templates and a literature search of standardised lower limb assessment methods. Rounds two and three consisted of statements developed from the first round responses. Questions and statements were included in the final proforma if 70 % or more of the participants indicated consensus or agreement with the assessment method and if there was support within the literature for paediatric age-specific normative data with acceptable reliability of outcome measures. There were 17 of the 21 (81 %) participants who completed three rounds of the survey. Consensus was achieved for 41 statements in Round one, 54 statements achieved agreement in two subsequent rounds. Participants agreed on 95 statements relating to birth history, developmental history, hip measurement, rotation of the lower limb, ankle range of motion, foot posture, balance and gait. Assessments with acceptable validity and reliability were included within the final Gait and Lower Limb Observation of Paediatrics (GALLOP) proforma. The GALLOP proforma is a consensus based, systematic and standardised way to collect information and outcome measures in paediatric lower limb assessment. This standardised recording proforma will assist

  11. Secondary surgery in paediatric facial paralysis reanimation.

    Terzis, Julia K; Olivares, Fatima S


    Ninety-two children, the entire series of paediatric facial reanimation by a single surgeon over thirty years, are presented. The objective is to analyse the incidence and value of secondary revisions for functional and aesthetic refinements following the two main stages of reanimation. The reconstructive strategy varied according to the denervation time, the aetiology, and whether the paralysis was uni- or bilateral, complete or partial. Irrespective of these variables, 89% of the patients required secondary surgery. Post-operative videos were available in seventy-two cases. Four independent observers graded patients' videos using a scale from poor to excellent. The effect of diverse secondary procedures was measured computing a mean-percent-gain score. Statistical differences between treatment groups means were tested by the t-test and one-way ANOVA. Two-thirds of the corrective and ancillary techniques utilized granted significantly higher mean-scores post-secondary surgery. A comparison of pre- and post-operative data found valuable improvements in all three facial zones after secondary surgery. In conclusion, inherent to dynamic procedures is the need for secondary revisions. Secondary surgery builds in the potential of reanimation surgery, effectively augmenting functional faculties and aesthesis.

  12. Paediatric cardiac catheterization: an information sheet.

    Bonnet, Caroline; Greffier, Angelique


    The need to inform patients using validated scientific data is acknowledged internationally. The obligation to inform patients is based on a fundamental principle of French law: the principle of the unavailability of the human body. Before engaging in diagnostic or therapeutic strategies such as paediatric cardiac catheterization, the healthcare professional must explain the disease, the advantages and drawbacks of each treatment strategy and their foreseeable benefit/risk ratio in order to help older children and their parents come to a decision. To obtain this required consent and before the care is provided, the infant and their legal representative must have received clear, accurate and understandable information. An information sheet cannot substitute for verbal information. Guidelines for good practices on the delivery of information have been established by the Health Authorities and officially recognized in a decree from the Ministry of Health. These documents allow professionals to draft a written information document for patients and healthcare users. This document must help the patient to take part in decisions that concern them. The law of 4th March 2002 regarding the rights of patients and the quality of the healthcare system states that 'in cases of litigation, it is the responsibility of the professional or the healthcare establishment to provide proof that the information was given to the person concerned in the conditions set out in the present article. This proof can be brought by any means'.

  13. Whole-body MRI in paediatric oncology.

    Nievelstein, Rutger A J; Littooij, Annemieke S


    Imaging plays a crucial role in the diagnosis and follow-up of paediatric malignancies. Until recently, computed tomography (CT) has been the imaging technique of choice in children with cancer, but nowadays there is an increasing interest in the use of functional imaging techniques like positron emission tomography and single-photon emission tomography. These later techniques are often combined with CT allowing for simultaneous acquisition of image data on the biological behaviour of tumour, as well as the anatomical localisation and extent of tumour spread. Because of the small but not negligible risk of radiation induced secondary cancers and the significantly improved overall survival rates of children with cancer, there is an increasing interest in the use of alternative imaging techniques that do not use ionising radiation. Magnetic resonance imaging (MRI) is a radiation-free imaging tool that allows for acquiring images with a high spatial resolution and excellent soft tissue contrast throughout the body. Moreover, recent technological advances have resulted in fast diagnostic sequences for whole-body MR imaging (WB-MRI), including functional techniques such as diffusion weighted imaging. In this review, the current status of the technique and major clinical applications of WB-MRI in children with cancer will be discussed.

  14. Steam vaporizers: A danger for paediatric burns.

    Lonie, Sarah; Baker, Paul; Teixeira, Rodrigo


    Steam vaporizers are used to humidify air in dry environments. They are marketed to moisten children's airway secretions and thus to help relieve symptoms associated with upper respiratory tract infections. Unfortunately the steam emitted from the unit can also pose a significant risk of burns to children. Our study aimed to ascertain patterns of injury and treatment outcomes from steam burns resulting from these devices. Potential preventative measures are discussed. Children who had sustained vaporizer scald burns were identified at the outpatient burns clinic over a 10-month period (November 2014-August 2015). Medical records were reviewed retrospectively and data collected on pattern of injury, management and outcomes. Ten children were treated for vaporizer steam burns over the study period. The mean age was 1.6 years and 8 (80%) patients were male. Operative intervention was undergone in 5 (50%) cases; four acutely and one as a secondary reconstructive procedure. Hand burns accounted for 8 (80%) of cases. Steam vaporizers can cause significant burns in the paediatric population. Toddlers were most at risk, frequently sustaining hand burns that underwent skin grafting. Greater public awareness of the danger is indicated and measures to prevent such injuries should be addressed by appropriate authorities. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  15. Paediatrics and psychoanalysis--Miss Anna Freud.


    Miss Anna Freud died during the winter at the age of 86. She had been a pioneer in the understanding of children through psychoanalysis and a great champion of the rights of children. Her life began in Vienna as the youngest child of Sigmund Freud, and her early work with children was in Austria. In 1938, because of the Nazi régime and even though she was nursing her father during his terminal illness, she had to escape with him to London. Her work with homeless children and with those in residential nurseries in London during the second world war is well known, as is her work on child development and psychopathology in the postwar years. But one less well known aspect of her life that was of immense importance to a few fortunate British paediatricians was the 'paediatric group' that she ran for over a quarter of a century and which Dr Christine Cooper recalled at the memorial meeting in London earlier this year. PMID:6344806

  16. Paediatric analgesia in an Emergency Department.

    Hawkes, C


    Timely management of pain in paediatric patients in the Emergency Department (ED) is a well-accepted performance indicator. We describe an audit of the provision of analgesia for children in an Irish ED and the introduction of a nurse-initiated analgesia protocol in an effort to improve performance. 95 children aged 1-16 presenting consecutively to the ED were included and time from triage to analgesia, and the rate of analgesia provision, were recorded. The results were circulated and a nurse initiated analgesia protocol was introduced. An audit including 145 patients followed this. 55.6% of patients with major fractures received analgesia after a median time of 54 minutes, which improved to 61.1% (p = 0.735) after 7 minutes (p = 0.004). Pain score documentation was very poor throughout, improving only slightly from 0% to 19.3%. No child had a documented pain score, which slightly improved to 19.3%. We recommend other Irish EDs to audit their provision of analgesia for children.

  17. Radionuclide studies in paediatric nephro-urology

    Piepsz, Amy E-mail:


    The main tool of radionuclide techniques applied to paediatric uro-nephrology is the quantitation of function, which is an information not easily obtained by other diagnostic modalities. The radiation burden is low. Drug sedation is only rarely needed, whatever the age of the patient. Accurate determination of glomerular filtration rate can be obtained by means of an intravenous injection of Cr-51 EDTA and one or two blood samples. Tc-99m DMSA scintigraphy is an accurate method for evaluation of regional cortical impairment during acute pyelonephritis and later on, for detection of permanent scarring. Tc-99m MAG3 renography is nowadays a well-standardized method for accurate estimation of the split renal function and of renal drainage with or without furosemide challenge. This technique is particularly indicated in uni- or bilateral uropathies with or without renal and/or ureteral dilatation. Direct and indirect radionuclide cystography are two alternative modalities for X-ray MCUG. Their relative place in the strategy of management of vesicoureteral reflux is discussed.

  18. Patient Doses in Paediatric Fluoroscopic Examinations in Finland

    Servomaa, A.; Komppa, T.; Heikkila, M.; Parviainen, T


    Dose-area products (DAP) in paediatric fluoroscopic examinations were measured at paediatric clinics in three university hospitals. The purpose was to provide supplementary data for development of reference doses, and for determination of relations between patient size and dose, in examinations involving both radiography and fluoroscopy for paediatric patients of various ages. The number of paediatric patients was 217. The most common fluoroscopic examinations were: micturating cystourethrography (MCU), 103 patients; barium enema (anography), 39 patients; barium meal and follow, 20 patients; and oesophagus, nine patients. Data on the patients and examination techniques, and the dose-area products are reported for various examinations and age groups. In the MCU examinations the mean DAP values were 560{sup 2} for the age group of 0 years: 910{sup 2} for the age group of 1-4 years; 880{sup 2} for the age group of 5-9 years; and 4600{sup 2} for the age group of 10-15 years. The radiation doses to which paediatric patients are exposed in fluoroscopic examinations vary over a large scale, even within narrow age bands, and comparisons between the doses are difficult because of wide ranges in patient size. This indicates the need for developing a method for taking account of the effects of patients size before deriving reference doses. (author)

  19. Prebiotics as a modulator of gut microbiota in paediatric obesity.

    Nicolucci, A C; Reimer, R A


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

  20. Smartphone applications in paediatric radiology: availability and authority

    Shelmerdine, Susan C. [Great Ormond Street Hospital, Specialist Registrar in Clinical Radiology, Department of Clinical Radiology, London (United Kingdom); Lynch, Jeremy O. [Chelsea and Westminster Hospital, Specialist Registrar in Clinical Radiology, Department of Clinical Radiology, London (United Kingdom)


    With the widespread ownership of smartphones, many health care professionals question the degree to which medically related smartphone applications are reliable. To assess the variety of smartphone applications relating to paediatric radiology and the presence of health care professional involvement in their development. As a secondary objective, we explore whether there are gaps within the paediatric radiology app market. The most popular smartphone marketplaces (Apple iTunes App Store, Blackberry Mobile Market, Google Play Android Market, Nokia Ovi, Samsung and Microsoft Windows Marketplace) were searched for terms relating to paediatric radiology. Cost, review ratings, number of downloads, health care involvement and target audience were recorded. Nine paediatric radiology applications were found in the Apple iTunes App Store and nine in the Google Play Android Market. The target audiences for all applications were health care professionals. None were available for patients or their caregivers. All applications were reported to have medical expertise in their development. All paediatric radiology applications were developed with the aid of a health care professional. Due to the small number available online, there is a potential gap in the marketplace for further applications in this field, possibly aimed at patients and their families. (orig.)

  1. Smartphone applications in paediatric radiology: availability and authority.

    Shelmerdine, Susan C; Lynch, Jeremy O


    With the widespread ownership of smartphones, many health care professionals question the degree to which medically related smartphone applications are reliable. To assess the variety of smartphone applications relating to paediatric radiology and the presence of health care professional involvement in their development. As a secondary objective, we explore whether there are gaps within the paediatric radiology app market. The most popular smartphone marketplaces (Apple iTunes App Store, Blackberry Mobile Market, Google Play Android Market, Nokia Ovi, Samsung and Microsoft Windows Marketplace) were searched for terms relating to paediatric radiology. Cost, review ratings, number of downloads, health care involvement and target audience were recorded. Nine paediatric radiology applications were found in the Apple iTunes App Store and nine in the Google Play Android Market. The target audiences for all applications were health care professionals. None were available for patients or their caregivers. All applications were reported to have medical expertise in their development. All paediatric radiology applications were developed with the aid of a health care professional. Due to the small number available online, there is a potential gap in the marketplace for further applications in this field, possibly aimed at patients and their families.

  2. Paediatric cardiopulmonary resuscitation training program in Latin-America: the RIBEPCI experience.

    López-Herce, Jesús; Matamoros, Martha M; Moya, Luis; Almonte, Enma; Coronel, Diana; Urbano, Javier; Carrillo, Ángel; Del Castillo, Jimena; Mencía, Santiago; Moral, Ramón; Ordoñez, Flora; Sánchez, Carlos; Lagos, Lina; Johnson, María; Mendoza, Ovidio; Rodriguez, Sandra


    To describe the design and to present the results of a paediatric and neonatal cardiopulmonary resuscitation (CPR) training program adapted to Latin-America. A paediatric CPR coordinated training project was set up in several Latin-American countries with the instructional and scientific support of the Spanish Group for Paediatric and Neonatal CPR. The program was divided into four phases: CPR training and preparation of instructors; training for instructors; supervised teaching; and independent teaching. Instructors from each country participated in the development of the next group in the following country. Paediatric Basic Life Support (BLS), Paediatric Intermediate (ILS) and Paediatric Advanced (ALS) courses were organized in each country adapted to local characteristics. Five Paediatric Resuscitation groups were created sequentially in Honduras (2), Guatemala, Dominican Republican and Mexico. During 5 years, 6 instructors courses (94 students), 64 Paediatric BLS Courses (1409 students), 29 Paediatrics ILS courses (626 students) and 89 Paediatric ALS courses (1804 students) were given. At the end of the program all five groups are autonomous and organize their own instructor courses. Training of autonomous Paediatric CPR groups with the collaboration and scientific assessment of an expert group is a good model program to develop Paediatric CPR training in low- and middle income countries. Participation of groups of different countries in the educational activities is an important method to establish a cooperation network.

  3. The use of the Statscan digital X-ray unit in paediatric polytrauma

    Pitcher, Richard D. [University of Cape Town, Division of Paediatric Radiology, Red Cross War Memorial Children' s Hospital, School of Child and Adolescent Health, Cape Town (South Africa); Wilde, Jim C.H. [University of Cape Town, Division of Paediatric Surgery, Red Cross War Memorial Children' s Hospital, School of Child and Adolescent Health, Cape Town (South Africa); University of Amsterdam, Paediatric Surgical Centre of Amsterdam, Emma Children' s Hospital, Academic Medical Centre, Amsterdam (Netherlands); Douglas, Tania S. [University of Cape Town, MRC/UCT Medical Imaging Research Unit, Department of Human Biology, Cape Town (South Africa); As, Arjan Bastiaan van [University of Cape Town, Division of Paediatric Surgery, Red Cross War Memorial Children' s Hospital, School of Child and Adolescent Health, Cape Town (South Africa)


    We present a 3-year review of clinical paediatric experience with the statscan (Lodox Systems, Johannesburg, South Africa), a low-dose, digital, whole-body, slit-scanning X-ray machine. While focusing on the role of the unit in paediatric polytrauma, insight into its applications in other paediatric settings is provided. (orig.)

  4. The use of the Statscan digital X-ray unit in paediatric polytrauma.

    Pitcher, Richard D; Wilde, Jim C H; Douglas, Tania S; van As, Arjan Bastiaan


    We present a 3-year review of clinical paediatric experience with the Statscan (Lodox Systems, Johannesburg, South Africa), a low-dose, digital, whole-body, slit-scanning X-ray machine. While focusing on the role of the unit in paediatric polytrauma, insight into its applications in other paediatric settings is provided.

  5. Paediatric radiation oncology in the care of childhood cancer: A position paper by the International Paediatric Radiation Oncology Society (PROS).

    Kortmann, Rolf-Dieter; Freeman, Carolyn; Marcus, Karen; Claude, Line; Dieckmann, Karin; Halperin, Edward; Esiashvili, Natia; Paulino, Arnold; Mahajan, Anita; Seiersen, Klaus; Ahern, Verity; Ricardi, Umberto; Carrie, Christian


    Paediatric malignancies are a challenge for the radiation oncologist due to their rarity, the great variety of histological types, and the complexity of treatment concepts that evolve over time. The Paediatric Radiation Oncology Society (PROS) is the only internationally operating society for paediatric radiation oncology. The objectives of PROS are to set a world-wide standard of excellence with respect to radiation oncology aspects in curing children and adolescents with cancer, to provide a forum for communication between radiation oncologists, and to exchange information with all professionals involved in the management of paediatric and adolescent cancer. Challenges include the need to promote education and support practice in low and middle income countries (LMIC) as well as the cost and availability of modern treatment technologies for all but most especially these countries. Collaborations with other societies that include for example the education programmes provided jointly with ESTRO, and the upgraded technical platform of the PROS web site offer new possibilities to enhance the efficacy of PROS in education and support of paediatric radiation oncology practice world-wide. PROS has made an important contribution to the management of childhood malignancies over the past decade and new and developing collaborations between PROS and other societies or organizations will ultimately lead to a reduction in world-wide health care inequalities.

  6. Implementation of a competency assessment tool for agency nurses working in an acute paediatric setting.

    Hennerby, Cathy; Joyce, Pauline


    This paper reports on the implementation of a competency assessment tool for registered general agency nurses working in an acute paediatric setting, using a change management framework. The increased number of registered general agency nurses working in an acute children's hospital alerted concerns around their competency in working with children. These concerns were initially raised via informal complaints about 'near misses', parental dissatisfaction, perceived competency weaknesses and rising cost associated with their use. [Young's (2009) Journal of Organisational Change, 22, 524-548] nine-stage change framework was used to guide the implementation of the competency assessment tool within a paediatric acute care setting. The ongoing success of the initiative, from a nurse manager's perspective, relies on structured communication with the agency provider before employing competent agency nurses. Sustainability of the change will depend on nurse managers' persistence in attending the concerns of those resisting the change while simultaneously supporting those championing the change. These key communication and supporting roles highlight the pivotal role held by nurse managers, as gate keepers, in safe-guarding children while in hospital. Leadership qualities of nurse managers will also be challenged in continuing to manage and drive the change where resistance might prevail. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.

  7. A review of paediatric telehealth for pre- and post-operative surgical patients.

    Smith, Anthony C; Garner, Lisa; Caffery, Liam J; McBride, Craig A


    The Queensland Telepaediatric Service (QTS) was established in the year 2000 to deliver a broad range of paediatric specialist health services from the Royal Children's Hospital (RCH) in Brisbane, mainly via videoconference. During a 13-year study period, the QTS facilitated 18,949 video consultations, comprising Mental Health (42%), Medicine (30%), Surgery (21%) and Other (8%). We reviewed the surgical services provided through the QTS. There were 3880 video consultations with a paediatric surgeon. Most of these (91%) used fixed videoconferencing units, 8% were delivered via mobile units (robots) and 1% were delivered using Skype. Surgical consultations were provided by telehealth to 106 sites: 89% in Queensland and the rest to other states. The main surgical specialties were burns (50%), ear, nose and throat (19%), general surgery (21%), orthopaedics (9%) and vascular anomalies (2%). During a 12-month audit period, there were 224 teleconsultations in general surgery; the most common reason for referral was for undescended testes (17%). During the study period there was a significant growth in all surgical telehealth activity: linear regression showed an annual increase of 17 cases per year (P surgical component, although there was also a reduction in the burns component. Telehealth has potential for other specialist consultations which require periodic assessment and review.

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

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


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

  9. Review of simulation in paediatrics: The evolution of a revolution

    Rahul eOjha


    Full Text Available Recent changes in medical education have highlighted the importance of experiential learning. Simulation is one model that has gained significant attention in the last decade and has been widely adopted as a training and assessment tool in medical education. Paediatric simulation has been utilized to teach various skills including resuscitation and trauma management, procedural skills and team training. It is also a valuable tool for health care educators, as it allows learners to achieve competence without putting patients at risk. Recent literature demonstrates increased retention of knowledge and skills after simulation based training. Further research is required to improve current simulation curriculums, develop validated assessment tools and to demonstrate improved clinical outcomes after simulation based training. We conducted an online search of original and review articles related to simulation and paediatric medical education and provide an overview of the role and utility of simulation in paediatrics.

  10. A field guide to current advances in paediatric movement disorders.

    Silveira-Moriyama, Laura; Lin, Jean-Pierre


    Recent advances in neurogenetics, neuroimmunology and nonpharmacological treatments have reshaped the field of paediatric movement disorders. In this review, we put recent findings into context providing a framework to enable navigation of the expanding literature in this field. Anti-NMDA receptor encephalitis has proven to be a significant cause of treatable movement disorder in children and to present a multifaceted link with herpes simplex encephalitis. The growing use of next-generation sequencing in both research and clinical practice has unravelled an expanding number of genes related to paediatric movement disorders as well as expanding spectrums of variable expressivity and phenotypic pleiotropy for various genes. Behavioural therapies have been proven efficacious in Tourette's syndrome and are likely to be helpful in complex motor stereotypies. Management of dystonia remains a clinical priority and challenge. The rapid advance of translational medicine has had major impacts on the field of paediatric movement disorders including diagnosis and treatment of these conditions.

  11. An epidemiological study of 500 paediatric burn patients in Mumbai, India

    Verma S


    Full Text Available Aim: To study the epidemiological data of paediatric burn patients to determine the role of demographic distribution and epidemiological parameters for assessment of mortality rate and development of burn prevention strategy. Materials and Methods : Epidemiological data of 500 patients admitted to the Burns and Plastic Surgery Unit of B.J. Wadia Hospital, Mumbai over a period of six years (2000-2005 was reviewed from medical records. Age, sex, demographic distribution, seasonal variation, total body surface area (TBSA involved, type and place of burn injury, parental occupation, family size, first aid and mortality rate were studied. Result: Median age group for patient was 3.44 years (range one month to 14 years. The majority (24% of burns occurred in children between the one to two years age group. Male to female sex ratio was 1.38:1. Most of the patients were from the defined demographic region served by the hospital. A significant number of patients however were from outside this region. Burn injury occurred predominantly during winter. Most common type of burn was scalds which occurred mainly in domestic circumstances. In the majority of patients, less than 10% TBSA was involved. All patients were managed as per the unit protocol. Mortality rate was 10.4%. Mortality rate was high in patients having more than 40% TBSA involvement. Seventy-three per cent of the total deaths occurred in the patients coming from regions outside the demographic region served by the hospital. Parental occupation, family size and the first aid did not affect the mortality rate. Conclusion: Availability of a burn care unit in the vicinity can decrease the mortality rates in the paediatric burn patients. An intense and focused burn prevention campaign to educate the general population about dangerous aetiological factors will decrease the incidence of paediatric burns.

  12. Collaboration between paediatric surgery and other medical specialties in Nigeria

    Philemon E Okoro


    Full Text Available Background: The quality of service and success of patient care and research in most fields of medicine depend on effective collaboration between different specialties. Paediatric surgery is a relatively young specialty in Nigeria and such collaborations are desirable. This survey assesses the nature and extent of collaboration between paediatric surgery and other specialties in Nigeria. Materials and Methods: This is a questionnaire survey carried out in November 2008 among paediatric surgeons and their trainees practising in Nigeria. Questionnaires were distributed and retrieved either by hand or e-mailing. The responses were then collated and analysed using the SPSS 17.0. Results: Forty-seven respondents were included in the survey. Forty-five (95.7% respondents thought that there was inadequate collaboration and that there was a need for an increased collaboration between paediatric surgery and other specialties. Anaesthesia, paediatrics and radiology are among the specialties where collaborations were most required but not adequately received. Collaboration had been required from these specialties in areas of patient care, training and research. Reasons for inadequate collaboration included the paucity of avenues for inter-specialty communication and exchange of ideas 33 (70.3%, lack of awareness of the need for collaboration 32 (68.1%, tendency to apportion blames for bad outcome 13 (27.7%, and mutual suspicion 8 (17%. Conclusion: There is presently inadequate collaboration between paediatric surgery and other specialties in Nigeria. There is a need for more inter-specialty support, communication, and exchange of ideas in order to achieve desirable outcomes.

  13. Assessment of paediatric hydronephrosis using output efficiency

    Saundres, C.A.B.; Choong, K.K.L.; Gruenewald, S.M. [Westmead Hospital, Westmead, NSW (Australia). Dept of Nuclear Medicine


    Full text: Diuretic renography is an important tool in the evaluation of paediatric hydronephrosis. Recently a newly developed parameter, output efficiency (OE) has allowed normalisation of washout according to renal function. We retrospectively reviewed the diagnostic accuracy of OE in 56 children (70 hydronephrotic kidneys). There were 16 females and 41 males (mean age 1.4 years, range 3 weeks-12 years). Diuretic renography ({sup 99m}Tc-MAG3) was performed using i.v. volume expansion (15 mL/kg), frusemide diuresis (1mg/kg) and urethral catheterisation if VUR was present. Final diagnosis was made using surgery (n = 15) or clinical outcome (n = 42). Clinical follow up exceeded one year and included repeat MAG3 scan (n = 20), resolving hydronephrosis on ultrasound (n = 15) or percutaneous antegrade pyelogram (n = 1). Initial scans were classified as obstructed (n 13), indeterminate (n = 13) or non obstructed (n = 30) based on standard qualitative and quantitative criteria. Using a normal range of >84%, OE correctly predicted 12/13 (92%) obstructed kidneys and 44/44 non-obstructed kidneys (100%). In the indeterminate group, three kidneys developed obstruction at follow -up and 10 became non obstructed. Initial OE predicted outcome in two and four kidneys respectively. Overall, OE sensitivity and specificity were 88% and 89%. In the subgroup of patients (n = 19) with reduced differential function (<40%) the sensitivity of OE was 100% and specificity was 75%. This compares to 83% and 66% for Tl/2 in this subgroup. Therefore OE is a useful marker of renal outflow tract obstruction and maybe superior to other parameters such as Tl/2 particularly when renal function is reduced. 1 tab.

  14. Nasotracheal intubation depth in paediatric patients.

    Kemper, M; Dullenkopf, A; Schmidt, A R; Gerber, A; Weiss, M


    The aim of this study was to compare intubation depth using the Microcuff paediatric endotracheal tube (PET) placed with the intubation depth mark between the vocal cords with that of different published formulae/recommendations for nasotracheal intubation depth in children. Children aged from birth to 10 yr undergoing elective surgery with nasotracheal intubation were included. Tracheal tubes were adjusted according to the intubation depth mark between the vocal cords using direct laryngoscopy. Nasal intubation depth was recorded and the distance 'tube tip to carina' was measured endoscopically. Based on the recorded nasal intubation depth and measured distance 'tube tip to carina', the position of tube tip and cuff was calculated according to six published formulae/recommendations. Seventy-six children were studied. For the Microcuff PET, the median tube tip advancement within the trachea was 52.9% (41.1-73.8%) of tracheal length. The shortest distance from the 'tube tip to carina' was 15 mm for a 3.5 mm internal diameter tube. If the six published formulae/recommendations had been used, this would have resulted in endobronchial tube placement in up to 9.1% of cases, and the tube tip would have been placed above the glottis in up to 2.6% of cases. The upper border of the cuff would have been placed in the subglottic area in up to 42.1% of cases and in a supraglottic position in up to 63.2% of cases. This study indicates that nasal intubation with the intubation depth mark placed between the vocal cords was superior to formula-based nasotracheal tube positioning. The latter would result in a high rate of endobronchial intubations, excessively high cuff positions and even tracheal extubations. © The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email:


    Keshava Murthy


    Full Text Available : Intussusception is a life-threatening illness and occurs when a portion of the intestine folds like a telescope with one segment slipping inside another segment. Hirschsprung was the first to publish a series of reports on successful hydrostatic reduction in 1876. Intussusception remains one of the most commonly encountered paediatric surgical emergencies. Enema reduction still remains the mainstay of non-operative care today. Barium and more recently air contrast enemas have been the initial diagnostic and therapeutic investigation of choice. Successful reduction rates vary widely from 42 to 95% (eee. AIMS AND OBJECTIVES: Aims and objectives of this article with a series of cases of intussusception is to review the various clinical presentation and to study the effectiveness of non-surgical intervention using contrast or AIR enema reduction under fluoroscopic guidance. METHODS AND RESULTS: A prospective study from October 2010 to September 2015 was carried out in hospitals in Bangalore. Complete review of medical records for clinical and demographic information was only performed for those cases fulfilling diagnostic criteria. During the study, A total of 62 patients diagnosed cases were included in this study. Cases identified in the study were similar in presentation and demographics as those observed in other South Asian Countries. These patients were haemodynamically stabilized and were subjected to definitive procedure; enema reduction was tried in all patients. Multimodalities of management included nonoperative reduction that is hydrostatic enema reduction in 2 cases (3.2, barium enema reduction 45 cases (72.5 and air enema recution in 12 cases (19.3, finally 3 cases (4.8 which failed enema reduction were operated. One case (1.61 intussusception - associated death was recorded. CONCLUSION: Surgical intervention in intussusception can be prevented by nonoperative reduction, especially if presented early and no signs of peritonitis.

  16. Portfolios for assessment of paediatric specialist registrars.

    Melville, C; Rees, M; Brookfield, D; Anderson, J


    In 1997 the Royal College of Paediatrics and Child Health introduced portfolios to guide and monitor the learning of specialist registrars. We studied their value for assessment. Using Bigg's SOLO criteria we devised a marking scheme based on 6 domains of competence: clinical, communication, teaching and learning, ethics and attitudes, management and evaluation, and creation of evidence. We rated portfolios according to quality of evidence presented and expectations by year of training. We similarly assessed trainee performance in the annual record of in-training assessment (RITA) interview. Specific advice based on the results of the first portfolio assessments was circulated to all trainees, instructing them to increase the structure and decrease the bulk of portfolios. A second sample of portfolios was reviewed a year later, using similar evaluations, to determine the effects. A total of 76 portfolios were assessed in year 1 by a single rater; 30 portfolios were assessed in year 2 by 2 independent raters. The quality of documentation improved from year 1 to year 2 but there was no significant increase in portfolio scores. The inter-rater correlation coefficient of the portfolio assessment method was 0.52 (Cohen's kappa 0.35). The inter-rater correlation coefficient of the RITA interview was 0.71 (Cohen's kappa 0.38). There was moderate inter-assessment correlation between portfolios and RITA interviews (kappa 0.26 in year 1 and 0.29 in year 2). Generalisability analysis suggested that 5 successive ratings by a single observer or independent ratings by 4 observers on the same occasion would be needed to yield a generalisability coefficient > 0.8 for overall portfolio rating. This method of portfolio assessment is insufficiently reliable as a sole method for high stakes, single-instance assessment, but has a place as part of a triangulation process. Repeated portfolio assessment by paired observers would increase reliability. Longer term studies are required to

  17. Paediatric intraventricular meningiomas. A report of two cases

    Sushma Ramraje


    Full Text Available Meningiomas are rare in children comprising less than 3% of paediatric brain tumours and only 1.5-1.8% of all intracranial neoplasms. Intraventricular meningiomas (IVM account for 0.5-5% of all meningiomas. They arise in the ventricles from arachnoid cap cells contained within the choroid plexus, the tela choroidea, or the velum interpositum. Paediatric tumours also show an association with neurofibromatosis type 2 and previous radiation exposure.We present two cases of intraventricular meningiomas, both in children. The age and site of the lesion in the two cases are uncommon. Excision of the lesions caused a total subsidence of the symptoms with no reported recurrences.

  18. Demographics of paediatric renal replacement therapy in Europe

    Chesnaye, Nicholas; Bonthuis, Marjolein; Schaefer, Franz;


    BACKGROUND: The ESPN/ERA-EDTA Registry collects data on European children with end-stage renal disease receiving renal replacement therapy (RRT) who are listed on national and regional renal registries in Europe. In this paper we report on the analysis of demographic data collected from 2009...... to 2011. METHODS: Data on primary renal disease, incidence, prevalence, 4-year survival, transplantation rate and causes of death in paediatric patients receiving RRT were extracted from the ESPN/ERA-EDTA Registry for 37 European countries. RESULTS: The incidence of RRT in paediatric patients in Europe...

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

    O'Keeffe, Mick


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

  20. Computational hybrid anthropometric paediatric phantom library for internal radiation dosimetry

    Xie, Tianwu; Kuster, Niels; Zaidi, Habib


    covering statistical distributions of body morphometry in the paediatric population. The paediatric phantoms of the Virtual Population Series (IT'IS Foundation, Switzerland) were modified to match target anthropometric parameters, including body mass, body length, standing height and sitting height...... to create 1100 female and male phantoms with 10th, 25th, 50th, 75th and 90th body morphometries. Evaluation was performed qualitatively using 3D visualization and quantitatively by analysing internal organ masses. Overall, the newly generated phantoms appear very reasonable and representative of the main...

  1. Radiographic appearances of uncommon paediatric implants and devices

    Urquia, Arlen; Watson, Tom A.; Arthurs, Owen J. [Great Ormond Street Hospital NHS Foundation Trust, Department of Radiology, London (United Kingdom)


    As childhood survival of chronic illness improves, long-term implanted devices will be encountered more frequently in routine radiology. In our paediatric tertiary referral hospital, we have come across several types of implanted devices that were not confidently recognised or identified by front-line staff and were often only identified by discussion with the patient, family or clinical team. This pictorial review highlights the appearance of nonvascular devices on paediatric radiographs in order to help clinicians identify the most frequent complications and to improve awareness of these important devices. (orig.)

  2. [Nutritional assessment in hospitalized children in a Paediatric service].

    Velandia, Silvia; Hodgson, Maria Isabel; Le Roy, Catalina

    Malnutrition in hospitalized children is associated with increased morbidity and mortality. To determine the nutritional status in children admitted to the Hospital Clínico de la Universidad Católica de Chile. A retrospective, cross-sectional study was conducted on hospital patients less than 17 years old within the period from November 2010 to April 2011. A record was made of the demographic data, admission diagnosis, biochemistry results (albumin, haemoglobin, haematocrit), hospital stay, and anthropometry data. Nutritional diagnosis was expressed as standard deviation (SD) for weight-for-height (WFH) by WHO in children younger than 5 y, and body mass index (BMI) by CDC-NCHS in older children. Height-for-age (HFA) ≤-2SD indicated stunted growth. A total of 365 children, including 201 boys (55.1%), were evaluated. The median age was 3.35 years (IQR: 1.2-8.2). The most frequent reason for admission was heart disease (30.4%). The median hospital stay was 2 days (IQR: 2.0-4.0). Undernutrition was observed in 3.3% of the children, 8% were nutritionally at risk, 15% were overweight, and 10.9% were obese. As regards HFA, short stature was reported in 12.9%. There was a significant relationship between lower age and heart disease, and higher age with gastrointestinal and neurological diseases. By ordinal logistic regression for each year of age, the weight/height ratio (ZP/T) increases by 6.9% (OR=1.07). The biochemistry results (albumin, haemoglobin and haematocrit levels) were not associated with nutritional status. A high percentage of children at risk of undernutrition was found. The percentage overweight was similar to the general Chilean paediatric population. Early detection will allow an opportune intervention, and nutritional monitoring at discharge. Copyright © 2016 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Efficiency of applications of radiation in paediatrics; Wirksamkeit von Strahlenanwendungen in der Kinderheilkunde

    Fendel, H.; Schneider, K.; Kohn, M.; Bakowski, C.; Endemann, B.; Freidhof, C.; Stein, E.


    This initial research project was intended to elaborate and provide a retrospective survey and a collection of basic data showing the efficiency of frequent diagnostic applications of radiation in paediatrics. The results of the study are summarized as follows: Paediatricians` advanced training for treatment of frequent disease in children obviously has been ignoring the significance of affections of the urinary tract, so that in general doctors are giving preference to sonography as an entrance examination for young infants, and diagnostic radiology frequently is applied too late. There is urgent need for in-depth quality assurance measures in diagnostic radiology of infants. The codes of practice first published by the Bundesaerztekammer in 1989 and revised and amended in 1995 are only paper in many hospitals and practices. One reason is outdated equipment. Equipment specifications for paediatric applications have to be distributed in order to avoid gross mistakes in diagnostic imaging. Also, the lack of experience of doctors and radiographers in diagnostic radiology of infants and young children adds up to the technical deficiencies. Regulatory requirements need to be established in order to ensure acquisition and proof of expert training and knowledge in paediatric radiology and radiography, and suitable advanced training. Further research projects are needed in order to ascertain the impact of novel and recent methods, as for instance digital radiography, on radiation dose and image quality. Further, data have to be collected on the radiation dose administered during fluoroscopy and computed tomography in paediatrics. (orig./MG) [Deutsch] Ziel des Forschungsvorhabens war zunaechst die Basisdaten ueber haeufige Roentgenaufnahmen in der Paediatrie zu erheben. Die Erhebungen fuehrten zu folgenden Schlussfolgerungen: Die Fortbildung der Paediater bei haeufigen Erkrankungen im Kindesalter beruecksichtigt offensichtlich nicht ausreichend Erkrankungen des Harntraktes

  4. Tinea capitis in a paediatric population.

    Hackett, B C; O'Connell, K; Cafferkey, M; O'Donnell, B F; Keane, F M


    Tinea capitis is an increasing problem in Europe. The pattern of infection is changing with an increase in pathogenic anthropophilic dermatophytes particularly Trichophyton tonsurans. We aimed to determine the frequency of tinea capitis in a paediatric population attending dermatology outpatients and examine the clinical spectrum of disease. A retrospective analysis was performed of all laboratory proven tinea capitis cases presenting to the dermatology outpatient department at The Children's University Hospital, Temple Street over an 18-month period (1st January 2004 to 30th of June 2005 inclusive). Sixty-two children had tinea capitis of whom 53 (85.5%) were of African descent. Thirty-five (56%) were male and 27 female (44%). The average age at presentation was 4.02 years (age range 1-163 months) with five cases occurring in children less than one year of age. The most common pathogen was the anthropophilic dermatophyte Trichophyton tonsurans, accounting for 47 (75.8%) of all cases of tinea capitis. Eight (12.9%) were secondary to Microsporum ferrigineum, 2 (3.2%) secondary to Trichophyton violaceum, both Trichophyton soudanese and Trichophyton verruosum accounted for 1.6% each. The zoophilic organism Microsporum canis was diagnosed in 3 cases (4.8%). Presenting signs included scaling of the scalp (35.47%), scaling of the scalp and alopecia (53.24%), and alopecia and kerion (11.29%/o). The duration of symptoms was recorded in 52 patients with the average duration 8.38 months (range 0.5-72 months). In 20 cases an associated skin involvement on other areas of the body was recorded. All patients at diagnosis were either on no, suboptimal or inappropriate treatment. The prevalence of tinea capitis is increasing in this hospital based cohort. The main pathogen is now Trichophyton tonsurans. Children of African descent are at increased risk of infection. The diagnosis is poorly recognized and needs to be highlighted as a public health issue. There is a need for

  5. Cardiac Arrest after Local Anaesthetic Toxicity in a Paediatric Patient

    Liana Maria Torres de Araújo Azi


    Full Text Available We report a case of a paediatric patient undergoing urological procedure in which a possible inadvertent intravascular or intraosseous injection of bupivacaine with adrenaline in usual doses caused subsequent cardiac arrest, completely reversed after administration of 20% intravenous lipid emulsion. Early diagnosis of local anaesthetics toxicity and adequate cardiovascular resuscitation manoeuvres contribute to the favourable outcome.

  6. A practical approach to paediatric emergencies in the radiology department

    Turner, Nigel McBeth

    Acute life-threatening events involving children in the radiology department are rare. Nonetheless, radiologists should be competent in the relatively simple procedures required to maintain or restore vital functions in paediatric patients, particularly if their practice involves seriously ill or

  7. 3 T MRI in paediatrics: Challenges and clinical applications

    Dagia, Charuta [Department of Medical Imaging, Royal Children' s Hospital and Murdoch Childrens Research Institute, Flemington Road, Parkville 3052 (Australia); Ditchfield, Michael [Department of Medical Imaging, Royal Children' s Hospital and Murdoch Childrens Research Institute, Flemington Road, Parkville 3052 (Australia)], E-mail:


    3 T MRI is being increasingly performed for clinical purposes in paediatrics, primarily because of the potential to improve spatial and temporal resolution - these can assist in overcoming the unique anatomic, physiologic and behavioural challenges of imaging children. The increased spatial resolution improves the capacity to image small patients; with particular reference to smaller structures such as the inner ear, brachial plexus, biliary system and the vascular system. The challenges inherent to imaging at high field strength remain pertinent especially, the altered T1 contrast, artefacts (susceptibility, chemical shift and B1 inhomogeneity) and safety issues, including specific absorption rate - several of these are circumvented due to software and hardware advances, or by trade off of some of the increased signal. The above mentioned challenges also create opportunities at 3 T, with improvement in MR angiography, arterial spin labelling, functional MRI, susceptibility weighted imaging, and MR spectroscopy - all of which have distinctive applications in paediatrics. Whole body imaging also becomes more practical because of the capacity for faster scans. 3 T MRI has the potential to image all the systems in paediatrics. However, neonatal brain and paediatric spine imaging have specific challenges at 3 T. Several factors also limit cardiac imaging at present. Further improvements in coil technology and newer sequences may help overcome the challenges that remain.

  8. Unmet needs in paediatric psychopharmacology : Present scenario and future perspectives

    Persico, Antonio M.; Arango, Celso; Buitelaar, Jan K.; Correll, Christoph U.; Glennon, Jeffrey C.; Hoekstra, Pieter J.; Moreno, Carmen; Vitiello, Benedetto; Vorstman, Jacob; Zuddas, Alessandro


    Paediatric psychopharmacology holds great promise in two equally important areas of enormous biomedical and social impact, namely the treatment of behavioural abnormalities in children and adolescents, and the prevention of psychiatric disorders with adolescent- or adult-onset. Yet, in striking cont

  9. Paediatric endocrine disorders as seen at the University of Benin ...

    Methods: In this retrospective study, the case files of children seen in the paediatric endocrinemetabolic ... Information obtained included age at presentation, gender, principal complaints, and final diagnosis. ... of Child Health, UBTH during the ten-year period under review and 99 (0.72%) of these had endocrine disorders.

  10. Paediatric rheumatology clinic population in Southeast Asia: are we different?

    Arkachaisri, Thaschawee; Tang, Swee-Ping; Daengsuwan, Tassalapa; Phongsamart, Gun; Vilaiyuk, Soamarat; Charuvanij, Sirirat; Hoh, Sook Fun; Tan, Justin Hung Tiong; Das, Lena; Ang, Elizabeth; Lim, Wendy; Chan, Yiong Huak; Bernal, Christine B


    To examine the descriptive epidemiology of the patient population referred to paediatric rheumatology centres (PRCs) in Southeast Asia (SEA) and to compare the frequency of conditions encountered with other PRC populations. A web-based Registry for Childhood Onset Paediatric Rheumatic Diseases was established in 2009 and seven PRCs in four SEA countries, where paediatric rheumatologists are available, participated in a prospective 24 month data collection (43 months for Singapore). The number of patients analysed was 4038 (788 from Malaysia, 711 from the Philippines, 1943 from Singapore and 596 from Thailand). Over 70% of patients evaluated in PRCs in Malaysia, the Philippines and Thailand had rheumatic diseases (RDs), as compared with one-half of the proportion seen in Singaporean PRCs, which was similar to the Western PRC experience. Among RDs diagnosed (n = 2602), JIA was the most common disease encountered in Malaysia (41%) and Thailand (61%) as compared with systemic vasculitides in the Philippines (37%) and Singapore (35%) among which Henoch-Schönlein purpura was the most prevalent. SLE and related diseases were more common, but idiopathic pain syndrome and abnormal immunological laboratory tests were rarer than those seen in the West. JIA subtype distributions were different among countries. Among non-RDs (n = 1436), orthopaedic and related conditions predominated (21.7-59.4%). The frequencies of RDs seen by SEA PRCs were different from those in the West. Systemic vasculitides and SLE were common in addition to JIA. Paediatric rheumatologist availability and healthcare accessibility partially explain these observed discrepancies.

  11. Movement disorders induced by gastrointestinal drugs: two paediatric cases.

    Elzinga-Huttenga, J.; Hekster, Y.A.; Bijl, A.; Rotteveel, J.J.


    A number of frequently prescribed gastrointestinal drugs can cause movement disorders in children, as well as in adults. In our centre for paediatric neurology, we saw a 3-year-old girl with abnormal movements mostly of the legs with an inner restlessness (akathisia) while using cisapride. Another

  12. Therapeutic upper gastrointestinal tract endoscopy inPaediatric Gastroenterology

    Imdadur Rahman; Praful Patel; Philip Boger; Shahnawaz Rasheed; Mike Thomson; Nadeem Ahmad Afzal


    Since the first report of use of endoscopy in childrenin the 1970s, there has seen an exponential growthin published experience and innovation in the field. Inthis review article we focus on modern age therapeuticendoscopy practice, explaining use of traditional aswell as new and innovative techniques, for diagnosisand treatment of diseases in the paediatric uppergastrointestinal tract.

  13. Therapeutic upper gastrointestinal tract endoscopy in Paediatric Gastroenterology.

    Rahman, Imdadur; Patel, Praful; Boger, Philip; Rasheed, Shahnawaz; Thomson, Mike; Afzal, Nadeem Ahmad


    Since the first report of use of endoscopy in children in the 1970s, there has seen an exponential growth in published experience and innovation in the field. In this review article we focus on modern age therapeutic endoscopy practice, explaining use of traditional as well as new and innovative techniques, for diagnosis and treatment of diseases in the paediatric upper gastrointestinal tract.

  14. Typhoid fever in children presenting to paediatric medical wards of ...

    Typhoid fever in children presenting to paediatric medical wards of Ahmadu ... and management outcomes of children admitted with typhoid fever during a ... All the children had pre-admission antibiotics, while 93.3% had abdominal pain, ... had laparotomy but there was no mortality, and all were discharged after recovery.

  15. Movement disorders induced by gastrointestinal drugs: two paediatric cases.

    Elzinga-Huttenga, J.; Hekster, Y.A.; Bijl, A.; Rotteveel, J.J.


    A number of frequently prescribed gastrointestinal drugs can cause movement disorders in children, as well as in adults. In our centre for paediatric neurology, we saw a 3-year-old girl with abnormal movements mostly of the legs with an inner restlessness (akathisia) while using cisapride. Another p

  16. The prevalence of intestinal parasites in paediatric diarrhoeal and ...

    Preferred Customer

    1242, Addis Ababa, Ethiopia; 3Department of Paediatrics and Child Health, P.O. Box 405, Addis ..... caregivers or parents may be different for boys compared ... with and result in severe consequences in HIV/AIDS .... Natural history of Giardia lamblia and cryptosporidium infections in a cohort of Israeli Bedouin infants: A.

  17. Reliability and validity of triage systems in paediatric emergency care

    M. van Veen (Mirjam); H.A. Moll (Henriëtte)


    textabstractBackground. Triage in paediatric emergency care is an important tool to prioritize seriously ill children. Triage can also be used to identify patients who do not need urgent care and who can safely wait. The aim of this review was to provide an overview of the literature on reliability

  18. Paediatric Drug Development and Formulation Design-a European Perspective

    Nales, D.A.; Kozarewicz, Piotr; Aylward, Brian; de Vries, Rutger; Egberts, Toine C G; Rademaker, Carin M A; Schobben, Alfred F A M


    The availability of licensed paediatric drugs is lagging behind those for adults, and there is a lack of safe formulations in suitable doses that children are able and willing to take. As a consequence, children are commonly treated with off-label or unlicensed drugs. As off-label and unlicensed dru

  19. Molecular mechanisms involved in chemoresistance in paediatric acute lymphoblastic leukaemia

    Stanković Tatjana


    Full Text Available Acute lymphoblastic leukaemia (ALL is the most common paediatric cancer. Despite cure rates approaching 80%, resistance to treatment and disease relapse remain a significant clinical problem. Identification of the genes and biological pathways responsible for chemoresistance is therefore crucial for the design of novel therapeutic approaches aiming to improve patient survival. Mutations in the membrane transporter P-glycoprotein genes, genetic variations in drug-metabolising enzymes and defects in apoptotic pathways are mechanisms of chemoresistance common to a wide spectrum of cancers and also play a role in paediatric ALL. In addition, several recent microarray studies have identified transcriptional profiles specifically associated with chemoresistance and pointed to a number of potentially novel therapeutic targets. These microarray studies have shown that genes discriminating between clinically responsive and resistant leukaemias tend to be involved in cellular processes such as regulation of cell cycle, proliferation, and DNA repair. Here we review the outcomes of these microarray studies and also present our own investigations into apoptotic resistance to DNA double strand breaks (DSBs in paediatric ALL. We present stratification of paediatric ALL by the profile of DNA damage response following ionising radiation (IR in vitro. This approach allows classification of ALL tumours at presentation into IR-apoptotic sensitive and IR-apoptotic resistant. Furthermore, apoptotic resistant leukaemias exhibit abnormal response of NFkB pathway following irradiation and inhibition of this pathway can sensitise leukaemic cells to IR-induced DSBs.

  20. An Audit of Anaesthesia for Paediatric Neurosurgical Procedures in ...


    Paediatric patients may present with various cranio - spinal conditions which require .... severe head injury and in 6 infants with hydrocephalus. Eight patients that died .... This may be as a result of stimulation of the floor of the third ventricle by ...

  1. Gonad shielding in paediatric pelvic radiography: disadvantages prevail over benefit

    Frantzen, M.J.; Robben, S.; Postma, A.A.; Zoetelief, J.; Wildberger, J.E.; Kemerink, G.J.


    Objective To re-evaluate gonad shielding in paediatric pelvic radiography in terms of attainable radiation risk reduction and associated loss of diagnostic information. Methods A study on patient dose and the quality of gonad shielding was performed retrospectively using 500 pelvic radiographs of ch

  2. Paediatric intensive care is feasible in a neonatal department

    Jensen, Anne-Mette Bæk; Lundstrøm, Kaare E.; Reinholdt, Jes;


    Intensive care of infants below one year of age has been centralized in a paediatric intensive care unit (PICU) related to the neonatal intensive care unit (NICU) at Rigshospitalet, the University Hospital in Copenhagen in eastern Denmark (approximately 2.5 million inhabitants) since 2002. The aim...

  3. [The emotions of caregivers in neonatal and paediatric intensive care].

    Birsan, Sandrine; Guichoux, Julie; Rodriguez, Marie-Pierre; Brissaud, Olivier


    When treating a child hospitalised in a neonatal or paediatric unit, the emotions of the child's parents are of particular concern for the caregivers. The emotional experience of the nursing teams, however, is rarely taken into account, despite it having an impact on the quality of the support. Group discussion and individual reflection around professionals' emotions is essential.

  4. Measuring adherence to treatment of paediatric HIV/AIDS.

    Naar-King, S; Frey, M; Harris, M; Arfken, C


    Parent, child, physician report and pill counts were used to measure adherence in paediatric HIV. Relationships to viral load were assessed. Pill counts were considered invalid. Adherence measures did not correlate with one another. Physicians reported lower adherence than parents, but parent and physician report correlated with viral load. The clinical and research utility of the various measures are discussed.

  5. Paediatric primary care in Europe: variation between countries

    van Esso, Diego; del Torso, Stefano; Hadjipanayis, Adamos;


    Although it is known that differences in paediatric primary care (PPC) are found throughout Europe, little information exists as to where, how and who delivers this care. The aim of this study was to collect information on the current existing situation of PPC in Europe....

  6. Pattern and outcome of admissions as seen in the paediatric ...



    Jan 10, 2013 ... lighting the disease pattern among the Paediatric popula- tion in Bayelsa State, the ... children's ward when they are stable to continue management. ... Febrile seizures. 17. 40. 21. 1. 79 (4.5). Protein Energy Mal- nutrition. 18. 12. 0. 1. 31(1.8) ... ous group included acute renal failure, Guillien barre syndrome ...

  7. Control groups in paediatric epilepsy research: do first-degree cousins show familial effects?

    Hanson, Melissa; Morrison, Blaise; Jones, Jana E; Jackson, Daren C; Almane, Dace; Seidenberg, Michael; Zhao, Qianqian; Rathouz, Paul J; Hermann, Bruce P


    To determine whether first-degree cousins of children with idiopathic focal and genetic generalized epilepsies show any association across measures of cognition, behaviour, and brain structure. The presence/absence of associations addresses the question of whether and to what extent first-degree cousins may serve as unbiased controls in research addressing the cognitive, psychiatric, and neuroimaging features of paediatric epilepsies. Participants were children (aged 8-18) with epilepsy who had at least one first-degree cousin control enrolled in the study (n=37) and all enrolled cousin controls (n=100). Participants underwent neuropsychological assessment and brain imaging (cortical, subcortical, and cerebellar volumes), and parents completed the Child Behaviour Checklist (CBCL). Data (based on 42 outcome measures) from cousin controls were regressed on the corresponding epilepsy cognitive, behavioural, and imaging measures in a linear mixed model and case/control correlations were examined. Of the 42 uncorrected correlations involving cognitive, behavioural, and neuroimaging measures, only two were significant (p0.25). Similar results held for the cognition/behaviour and brain imaging measures separately. Given the lack of association between cases and first-degree cousin performances on measures of cognition, behaviour, and neuroimaging, the results suggest a non-significant genetic influence on control group performance. First-degree cousins appear to be unbiased controls for cognitive, behavioural, and neuroimaging research in paediatric epilepsy.

  8. Pro patria et spes gentis: military medicine, paediatric surgery and those who care for children.

    Pearn, John


    Children and military medicine have many links. On humanitarian and disaster deployments, the surgery of war has increasingly seen children as the focus of clinical salvage. When Romans spoke of children, they used the phrase 'spes gentis'-'the hope of the race'. In modern times, there developed a synergy, in the context of defensive war, that its prosecution depended not only on the defence of territory but also on its hopes for continuation of people and culture, into the future. In the 19th century, in Australia, several regiments had the motto 'Pro Aris et Focis'-'For the Defence of Hearth and Home'. Hearth implies the family and that implies children. From the point of view of an attending military clinician, the centrum of all medical care is the patient himself, and that centrality is reflected equally in the helplessness of a bomb-blast or gunshot victim as it is in the vulnerability of a sick or injured infant or child. The life and service of Major General Rupert Downes (1885-1945), whom the Downes Memorial Lecture commemorates, reflected this nexus. His career was that of a national leader in military medicine and that of paediatric surgery. The 2011 Rupert Downes Lecture explores and documents the extraordinary corpus of service of Australian paediatric surgeons and their contributions to military medicine from the 19th to the 21st centuries.

  9. Imaging guided interventional procedures in paediatric uroradiology--a case based overview

    Riccabona, M. E-mail:; Sorantin, E.; Hausegger, K


    Objective: To describe the potential and application of interventional image guided procedures in the paediatric urinary tract. Patients and methods: The different techniques are illustrated using case reports. The examples comprise established indications such as percutaneous nephrostomy for compromised kidneys in obstructive uropathy and infection, sonographic guided renal biopsy including monitoring or treatment of complications after biopsy, and evaluation and balloon dilatation of childhood renal artery stenosis. There are new applications such as treatment of stenosis in cutaneous ureterostomy or sonographically guided catheterism for deployment of therapeutic agents. Results: Generally, the procedures are safe and successful. However, complications may occur, and peri-/post-interventional monitoring is mandatory to insure early detection and adequate management. Sometimes additional treatment such as percutaneous embolisation of a symptomatic post biopsy arterio-venous fistula, or a second biopsy for recurrent disease may become necessary. Conclusion: Imaging guided interventional procedures are performed successfully in a variety of diseases of the paediatric urinary tract. They can be considered a valuable additional modality throughout infancy and childhood.

  10. Young patients', parents', and survivors' communication preferences in paediatric oncology: Results of online focus groups

    Kamps Willem A


    Full Text Available Abstract Background Guidelines in paediatric oncology encourage health care providers to share relevant information with young patients and parents to enable their active participation in decision making. It is not clear to what extent this mirrors patients' and parents' preferences. This study investigated communication preferences of childhood cancer patients, parents, and survivors of childhood cancer. Methods Communication preferences were examined by means of online focus groups. Seven patients (aged 8–17, 11 parents, and 18 survivors (aged 8–17 at diagnosis participated. Recruitment took place by consecutive inclusion in two Dutch university oncological wards. Questions concerned preferences regarding interpersonal relationships, information exchange and participation in decision making. Results Participants expressed detailed and multi-faceted views regarding their needs and preferences in communication in paediatric oncology. They agreed on the importance of several interpersonal and informational aspects of communication, such as honesty, support, and the need to be fully informed. Participants generally preferred a collaborative role in medical decision making. Differences in views were found regarding the desirability of the patient's presence during consultations. Patients differed in their satisfaction with their parents' role as managers of the communication. Conclusion Young patients' preferences mainly concur with current guidelines of providing them with medical information and enabling their participation in medical decision making. Still, some variation in preferences was found, which faces health care providers with the task of balancing between the sometimes conflicting preferences of young cancer patients and their parents.

  11. Paediatric non-alcoholic fatty liver disease: a practical overview for non-specialists.

    Mann, Jake P; Goonetilleke, Rajiv; McKiernan, Pat


    Non-alcoholic fatty liver disease (NAFLD) is the most common paediatric liver disease with a prevalence of almost 10%; therefore, the majority of affected patients are under the care of general practitioners and non-specialists. The condition is caused by central obesity with insulin resistance with additional factors influencing inflammatory activity (steatohepatitis). Ongoing inflammation leads to fibrosis and end-stage liver disease, though this will usually occur after children have transitioned into adult care. However, their main morbidity and mortality is from type 2 diabetes and complications of atherosclerosis. The minority of children undergo biopsy but currently there is no other method to accurately assess the stage of disease. Management is focused at weight loss through a combination of diet and exercise. Here, we present a current review of paediatric NAFLD aimed at non-specialists, with practice points for implementation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to


    Revi N


    Full Text Available AIM Preoperative anxiety is one of the most common problems faced by anyone practising paediatric anaesthesia. Various drugs have been used in various routes to get a calm but cooperative child before induction of anaesthesia. Midazolam and dexmedetomidine have already proved their value in paediatric premedication. This study was conducted to compare the effects of these two drugs given intranasally. MATERIALS AND METHODS 100 children falling under the inclusion criteria were assigned to groups of 50 each. They received either intranasal midazolam 0.2 mg/kg (group M or intranasal dexmedetomidine 2 mcg/kg (Group D as premedication. They were compared with regards to the sedation status, anxiety levels and cardiovascular status every 10 minutes, at parental separation and at face mask application. RESULTS The mean sedation score obtained at all-time intervals, at parental separation and more importantly at mask induction were much lower for the midazolam group compared to the dexmedetomidine group. The mean anxiety levels, in general, were lower in the midazolam group, but they attained statistical significance only at 10 minutes and at mask induction. The heart rate measured up to 20 minutes after drug administration did not show much difference between both groups, but at 30 minutes, 40 minutes and at parental separation, heart rate was found to be lower in the dexmedetomidine group. CONCLUSION Intranasal dexmedetomidine and intranasal midazolam are equally effective in providing satisfactory parental separation, but intranasal midazolam produced superior conditions for mask acceptance than intranasal dexmedetomidine.

  13. The diagnosis of attention-deficit/hyperactivity disorder in Australian children: Current paediatric practice and parent perspective.

    Efron, Daryl; Sciberras, Emma; Hiscock, Harriet; Jongeling, Brad; Lycett, Kate; Bisset, Matthew; Smith, Grant


    In a sample of newly diagnosed children with attention-deficit/hyperactivity disorder (ADHD), the aims were to examine (1) paediatrician assessment and management practices; (2) previous assessments and interventions; (3) correspondence between parent-report and paediatrician identification of comorbidities; and (4) parent agreement with diagnosis of ADHD. cross-sectional, multi-site practice audit with questionnaires completed by paediatricians and parents at the point of ADHD diagnosis. private/public paediatric practices in Western Australia and Victoria, Australia. paediatricians: elements of assessment and management were indicated on a study-designed data form. Parents: ADHD symptoms and comorbidities were measured using the Conners 3 ADHD Index and Strengths and Difficulties Questionnaire, respectively. Sleep problems, previous assessments and interventions, and agreement with ADHD diagnosis were measured by questionnaire. Twenty-four paediatricians participated, providing data on 137 patients (77% men, mean age 8.1 years). Parent and teacher questionnaires were used in 88% and 85% of assessments, respectively. Medication was prescribed in 75% of cases. Comorbidities were commonly diagnosed (70%); however, the proportion of patients identified by paediatricians with internalising problems (18%), externalising problems (15%) and sleep problems (4%) was less than by parent report (51%, 66% and 39%). One in seven parents did not agree with the diagnosis of ADHD. Australian paediatric practice in relation to ADHD assessment is generally consistent with best practice guidelines; however, improvements are needed in relation to the routine use of questionnaires and the identification of comorbidities. A proportion of parents do not agree with the diagnosis of ADHD made by their paediatrician. © 2016 The Author. Journal of Paediatrics and Child Health © 2016 Paediatrics and Child Health Division (Royal Australasian College of Physicians).


    Satish D. Shet


    Full Text Available BACKGROUND Control of childhood blindness is one of the priorities identified for achieving the goals of Vision-2020 by WHO. This is considered a priority because blind-years (number of years that a blind person lives after going blind due to childhood blindness are second only to cataract and half of childhood blindness is avoidable (treatable/preventable. Paediatric cataract accounts for 12% of the 1.4 million blind children globally. The prevalence of childhood cataract has been reported as 1 to 15 cases in 10,000 children in developing countries. Compared to industrialised countries, this figure is 10 times higher. Early detection and timely treatment of various childhood disorders such as congenital cataract are the most crucial factors for successful outcome. A suitable measure to address amblyopia and posterior capsule opacification post operatively is imperative for successful visual rehabilitation of such children. The objectives of this study were- 1 To study the clinical profile of paediatric cataract. 2 To evaluate the visual outcome after cataract surgery in these patients. 3 To evaluate different causes of visual impairment following management. MATERIALS AND METHODS A prospective study conducted at Karnataka institute of medical sciences department of ophthalmology from October 2015 to September 2016. All children below 14 years of age presenting with cataract will undergo thorough ophthalmologic examination and cataract surgery. RESULTS The results of the present study with 25 paediatric patients (36 eyes indicates that excellent vision can be expected after cataract surgery and posterior chamber IOL implantation coupled with appropriate amblyopia therapy. CONCLUSION The paediatric cataract patients are referred from primary health centers, and district hospital from north Karnataka to KIMS Hubli. All paediatric patients are from lower socio economic status. Early detection of cataracts and referrals to the ophthalmologist can

  15. Indications for admission, treatment and improved outcome of paediatric haematology/oncology patients admitted to a tertiary paediatric ICU.

    Owens, C


    BACKGROUND: Overall survival in paediatric cancer has improved significantly over the past 20 years. Treatment strategies have been intensified, and supportive care has made substantial advances. Historically, paediatric oncology patients admitted to an intensive care unit (ICU) have had extremely poor outcomes. METHODS: We conducted a retrospective cohort study over a 3-year period in a single centre to evaluate the outcomes for this particularly vulnerable group of patients admitted to a paediatric ICU. RESULTS: Fifty-five patients were admitted a total of 66 times to the ICU during the study period. The mortality rate of this group was 23% compared with an overall ICU mortality rate of 5%. 11\\/15 patients who died had an underlying haematological malignancy. Twenty-eight percent of children with organism-identified sepsis died. CONCLUSIONS: While mortality rates for paediatric oncology patients admitted to a ICU have improved, they are still substantial. Those with a haematological malignancy or admitted with sepsis are most at risk.

  16. The Reliability and Validity of a Paediatric Script Concordance Test with Medical Students, Paediatric Residents and Experienced Paediatricians

    Jean-Francois Lemay


    Conclusions:  These results support other findings indicating the SC test format can be used to differentiate between the clinical reasoning skills of novices, intermediates and experts in paediatrics.  An alternative scoring method that includes one best answer and partial marks was also supported for grading SC test items.

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

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


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

  18. The advantages of using photographs and video images in telephone consultations with a specialist in paediatric surgery

    Ibrahim Akkoyun


    Full Text Available Background: The purpose of this study was to evaluate the advantages of a telephone consultation with a specialist in paediatric surgery after taking photographs and video images by a general practitioner for the diagnosis of some diseases. Materials and Methods: This was a prospective study of the reliability of paediatric surgery online consultation among specialists and general practitioners. Results: Of 26 general practitioners included in the study, 12 were working in the city and 14 were working in districts outside the city. A total of 41 pictures and 3 videos of 38 patients were sent and evaluated together with the medical history and clinical findings. These patients were diagnosed with umbilical granuloma (n = 6, physiological/pathological phimosis (n = 6, balanitis (n = 6, hydrocele (n = 6, umbilical hernia (n = 4, smegma cyst (n = 2, reductable inguinal hernia (n = 1, incarcerated inguinal hernia (n = 1, paraphimosis (n = 1, burried penis (n = 1, hypospadias (n = 1, epigastric hernia (n = 1, vulva synechia (n = 1, and rectal prolapse (n = 1. Twelve patients were asked to be referred urgently, but it was suggested that only two of these patients, who had paraphimosis and incarcerated inguinal hernia be referred in emergency conditions. It was decided that there was no need for the other ten patients to be referred to a specialist at night or at the weekend. All diagnoses were confirmed to be true, when all patients underwent examination in the pediatric surgery clinic in elective conditions. Conclusion: Evaluation of photographs and video images of a lesion together with medical history and clinical findings via a telephone consultation between a paediatric surgery specialist and a general practitioner provides a definitive diagnosis and prevents patients from being referred unnecessarily.

  19. Problem Based Learning as a Cultural Tool for Health and Safety Learning in a Multi-national Company

    Adam, Henrik; Petersson, Eva


    -national company context. Theoretically, the research takes its point of departure in a socio-cultural perspective on the role of cultural tools in learning, and in a complementary interest in the role of communicative framing of learning activities. In the research reported here, the focus is on how employees...... and several organisational changes, has not managed to secure adequate safety culture. Safety implementation processes traditionally involve a large amount of training; which is associated with reduced productivity for the time spent on training. Therefore, the company in question wants to find ways......The general background of this study is an interest in how cultural tools contribute to structuring learning activities. The specific interest is to explore how such tools co-determine employees’ problem solving actions in health, safety and environment (HSE) training activities in a multi...

  20. Paediatric early warning scores on a children's ward: a quality improvement initiative.

    Ennis, Linda


    The aim of this quality improvement initiative was to incorporate a paediatric early warning score (PEWS) and track and trigger system in the routine care of children in an acute general children\\'s ward at a regional hospital in the Republic of Ireland. In the absence of a nationally recommended specific PEWS strategy, a local plan was developed. The experience of structuring and implementing the PEWS and track and trigger system is presented in this article. Data from the first year of use were collected to evaluate the clinical utility and effectiveness of this system. In the busy acute children\\'s service, the PEWS initiative was found to benefit processes of early detection, prompt referral and timely, appropriate management of children at potential risk of clinical deterioration. Nursing staff were empowered and supported to communicate concerns immediately and to seek rapid medical review, according to an agreed PEWS escalation plan. Outcomes were significantly improved.

  1. Paediatric pancreatic problems: A five-year experience

    Lahoti B


    Full Text Available Background: To analyse a tertiary care experience with various pancreatic problems in the paediatric age group and clarify the frequency of various pancreatic diseases in the same patient population as well as the role of surgical or conservative management in their treatment. Patients and Methods: All patients with clinical suspicion of disease pertaining to the pancreas, substantiated by laboratory investigations or imaging modalities over a period of five years are included in our study. Results: Of the total 228 patients with various pancreatic problems, who presented to us, mostly with acute pancreatitis and pancreatic trauma, 64 needed surgical interventions. The total mortality rate encountered was a meagre 3.5%. Conclusion: Paediatric pancreatic disorders are not so infrequent; and a high index of suspicion aided by the newer modalities of investigation greatly helps in the appropriate and timely management.

  2. Radiation dose measurement of paediatric patients in Estonia

    Kepler, K. [Training Centre of Medical Physics and Biomedical Engineering, University of Tartu (Estonia); Lintrop, M. [Department of Radiology, Tartu University Hospital, Tartu (Estonia); Servomaa, A.; Parviainen, T. [STUK - Radiation and Nuclear Safety Authority, Helsinki (Finland); Eek, V.; Filippova, I. [Estonian Radiation Protection Centre, Tallinn (Estonia)


    According to the Medical Exposure Directive (97/43/Euratom) the radiation doses to patients should be measured in every hospital and doses should be compared to the reference doses established by the competent authorities. Special attention should be paid to the paediatric x-ray examinations, because the paediatric patients are more radiosensitive than adult patients. The requirement of measurements of radiation dose to patients is not yet included in the Estonian radiation act, but the purpose to join the European Communities makes the quality control in radiology very actual in Estonia. The necessity exists to introduce suitable measurement methods in the Xray departments of Estonian hospitals for establishing feedback system for radiologists, radiographers and medical physicists in optimising the radiation burden of patients and image quality. (orig.)

  3. Sentinel lymph node biopsy in paediatric melanoma. A case series.

    Sánchez Aguilar, M; Álvarez Pérez, R M; García Gómez, F J; Fernández Ortega, P; Borrego Dorado, I


    The incidence of melanoma in children is uncommon, being particularly rare in children under 10 years-old. However, this disease is increasing by a mean of 2% per year. As in adults, the lymph node status is the most important prognostic factor, crucial to performing the selective sentinel lymph node biopsy (SLNB). We report 3 cases of paediatric patients of 3, 4 and 8 years-old, in which SLNB was performed for malignant melanoma. Paediatric age implies greater technical difficulty to the scintigraphy scan due to poor patient cooperation, with mild sedation required in some cases, and only being able to acquire planar images in other cases. SPECT/CT was only performed in the oldest patient. In our cases, SLNB was useful for selecting the least invasive surgery in order to reduce morbidity. Copyright © 2014 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

  4. Acceptable nationwide outcome after paediatric inguinal hernia repair

    Bisgaard, Thue; Kehlet, H; Oehlenschlager, J;


    PURPOSE: The primary objective was to describe 30-day outcomes after primary inguinal paediatric hernia repair. METHODS: Prospectively collected data from the National Patient Registry covering a 2-year study period 1 January 2005 to 31 December 2006 were collected. Unexpected outcomes were defined...... was not associated with the inguinal hernia repair. The usual technique was a simple sutured plasty (96.5 %). Emergency repair was performed in 54 patients (2.2 %) mainly in children between 0 and 2 years (79.6 %). During the 1 year follow-up, reoperation for recurrent inguinal hernia was performed in 8 children...... after elective repair (recurrence rate 0.3 %). Paediatric repairs were for most parts performed in surgical public hospitals, and most departments performed less than 10 inguinal hernia repairs within the 2 years study period. CONCLUSION: These nationwide results are acceptable with low numbers...

  5. Incidence of severe critical events in paediatric anaesthesia (APRICOT)

    Habre, Walid; Disma, Nicola; Virag, Katalin


    immediate intervention and that led (or could have led) to major disability or death. This study is registered with, number NCT01878760. FINDINGS: Between April 1, 2014, and Jan 31, 2015, 31 127 anaesthetic procedures in 30 874 children with a mean age of 6·35 years (SD 4·50) were...... a relatively high rate of severe critical events during the anaesthesia management of children for surgical or diagnostic procedures in Europe, and a large variability in the practice of paediatric anaesthesia. These findings are substantial enough to warrant attention from national, regional, and specialist...... societies to target education of anaesthesiologists and their teams and implement strategies for quality improvement in paediatric anaesthesia. FUNDING: European Society of Anaesthesiology....

  6. Learning preference and personality type: their association in paediatric residents.

    Greenberg, L W; Goldberg, R M; Foley, R P


    The objective of this study was to determine if there is a relationship between the learning preferences and personality types of residents in paediatrics. As part of a study to teach residents in paediatrics how to teach, the authors administered the Learning Preference Inventory (LPI) and Fundamental Interpersonal Relationship Orientation (FIRO-B) instruments to 55 residents in paediatrics at all three levels of training. The instruments provided data that were used to provide feedback to residents on their learning preferences and interaction styles, as well as how these factors might affect teaching and learning in the clinical setting. The Pearson correlation coefficient was used to determine relationships between the LPI and the FIRO-B. Fifty-two of the 55 residents (95%) completed the instruments. The results revealed that residents' learning preferences were significantly related to their personality types. For example, residents with high inclusion and affection scores on the FIRO-B preferred learning with others, which was significantly related to their high interpersonal scores on the LPI. Residents with low inclusion and affection scores were more likely to prefer independent learning (high individual and student-structured scores on the LPI) and abstract learning at statistically significant levels. The scores obtained by residents in paediatrics on the LPI were strongly correlated with those obtained on the FIRO-B. These data may have important implications for the way in which staff recruit, counsel and teach residents. The fact that the LPI is easy to administer and does not purport to measure personality styles makes it an acceptable educational tool that can be used in many areas of training.

  7. Insufficient serum caspofungin levels in a paediatric patient on ECMO

    Koch, Birgit C. P.; Wildschut, Enno D; Goede, Anna L. de; Hoog, Matthijs; Brüggemann, Roger J M


    Caspofungin, aechinocandin, is a relatively new lipophilic antifungal drug. Little is known concerning the pharmacokinetics of caspofungin in children. Extracorporeal membrane oxygenation (ECMO) allows prolonged cardiopulmonary support in patients with life-threatening respiratory or cardiac failure. Pharmacokinetics may be altered by ECMO. We describe the case of a paediatric patient on ECMO with severe pneumonia and sepsis, who had subtherapeutic exposure of caspofungin despite normal to hi...

  8. The role of computed tomography in modern paediatric uroradiology

    Maudgil, D.D.; McHugh, K. E-mail:


    Computed tomography (CT) has developed a well-recognised role within paediatric uroradiology, especially in imaging of trauma, malignancy (in particular Wilms' tumour), atypical infection, and congenital urogenital abnormalities. CT can also be used for problem solving in nephrolithiasis and renal transplant assessment. These applications are illustrated and discussed, with an emphasis on particular information that can be gained from the CT study.

  9. Computational hybrid anthropometric paediatric phantom library for internal radiation dosimetry

    Xie, Tianwu; Kuster, Niels; Zaidi, Habib


    Hybrid computational phantoms combine voxel-based and simplified equation-based modelling approaches to provide unique advantages and more realism for the construction of anthropomorphic models. In this work, a methodology and C++ code are developed to generate hybrid computational phantoms covering statistical distributions of body morphometry in the paediatric population. The paediatric phantoms of the Virtual Population Series (IT’IS Foundation, Switzerland) were modified to match target anthropometric parameters, including body mass, body length, standing height and sitting height/stature ratio, determined from reference databases of the National Centre for Health Statistics and the National Health and Nutrition Examination Survey. The phantoms were selected as representative anchor phantoms for the newborn, 1, 2, 5, 10 and 15 years-old children, and were subsequently remodelled to create 1100 female and male phantoms with 10th, 25th, 50th, 75th and 90th body morphometries. Evaluation was performed qualitatively using 3D visualization and quantitatively by analysing internal organ masses. Overall, the newly generated phantoms appear very reasonable and representative of the main characteristics of the paediatric population at various ages and for different genders, body sizes and sitting stature ratios. The mass of internal organs increases with height and body mass. The comparison of organ masses of the heart, kidney, liver, lung and spleen with published autopsy and ICRP reference data for children demonstrated that they follow the same trend when correlated with age. The constructed hybrid computational phantom library opens up the prospect of comprehensive radiation dosimetry calculations and risk assessment for the paediatric population of different age groups and diverse anthropometric parameters.

  10. [Efficacy of treatment with I(131) in paediatric Graves disease].

    Enes Romero, P; Martín-Frías, M; de Jesús, M; Caballero Loscos, C; Alonso Blanco, M; Barrio Castellanos, R


    Radioiodine is an important therapeutic option in young patients with Grave's disease (GD). In the United States it is a widespread therapy, but in Europe its use in paediatrics is still controversial. To report our experience in radioiodine therapy of paediatric GD patients and analyse its effectiveness and safety. We retrospectively studied our paediatric population (<18 years of age) with GD, diagnosed from 1982 to 2012. A curative option was offered to patients who did not respond to anti-thyroid drug (AT) at puberty. We analysed, the patient characteristics, TSH, T4, T3 and thyroid antibodies levels, AT response, remission post I(131), side effects, and hypothyroidism rates. A total of 50 patients were diagnosed with GD from 1982 to 2012. All patients received AT as initial treatment (mean duration: 35.3±25.9 months). Permanent remission was achieved in 46%. Thyroidectomy was performed in 5 patients, and 14 patients received I(131) (mean dose: 10.9±1.09 mCi). Remission with I(131) was obtained in 100%. The rate of permanent hypothyroidism was 90%. There was no progression of ophthalmopathy or side effects in any patients treated with I(131.) Radioiodine treatment of paediatric GD patients is safe, leads to complete remission at the expense of hypothyroidism, and does not exacerbate ophthalmopathy. It can be considered in patients older than 5 years, who do no not respond to AT or with significant side effects with this medication. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  11. Trichilemmal Cyst of the Penis in a Paediatric Patient

    Samuel Madan; Rashi Joshi


    Paediatric penile cysts are uncommon. We report a five-year-old child with an asymptomatic progressively growing cyst on the ventral aspect of the penis after a hypospadias repair. The patient presented to the Cooper Health Clinic, Dubai, United Arab Emirates, in March 2012. A complete excision of the cyst was performed. Histology results delineated a capsulated benign trichilemmal cyst. No recurrence or complications were reported in the 26 months following the excision. We recommend an earl...

  12. A retrospective study of oral lichen planus in paediatric population

    Kabita Chatterjee


    Full Text Available Aim: Well documented cases of oral lichen planus, a cell mediated immune condition is infrequently reported in paediatric population. This study was undertaken to obtain epidemiological data retrospectively and also to explore the possibility of any association that might exist among the clinical and histopathological features in paediatric patients suffering from oral lichen planus. Subjects and Methods: A retrospective study was carried out on 22 patients, younger than 18 years with clinical and histopathological diagnosis of oral lichen planus over a period of 14 years. The clinical characteristics and histopathological features were observed. The statistical analysis of the data was performed using Statistical Analysis Software (SAS, Version 9.1. Results: Analysis of data of 22 patients revealed that the average age of patient is 15.18 years with equal male and female predilection. The most common site is buccal mucosa (50% and most frequent clinical form is erosive (63.64%. Focusing on the histopathological findings, parakeratosis was found in 86.36% of the cases, acanthosis in 63.64% of cases, moderate basal cell degeneration was identified in 63.64% of cases and dense lymphocytic infiltration at juxtaepithelial connective tissue region was found in 59.09% of cases. Conclusions: Oral lichen planus in paediatric population is rare and appeared between 8 to 18 years of age. There is no significant gender predominance. The most common clinical form is erosive, manifesting mainly in buccal mucosa. Histopathological findings characteristic of oral lichen planus in paediatric patients include parakeratosis, acanthosis, liquefaction degeneration of basal cells and lymphocytic infiltration in the subepithelial layer.

  13. [Knowledge of health care ethics in paediatric residents].

    Hernández González, A; Rodríguez Núñez, A; Cambra Lasaosa, F J; Quintero Otero, S; Ramil Fraga, C; García Palacios, M V; Hernández Rastrollo, R; Ruiz Extremera, M A


    Bioethics has been recently incorporated in to the educational programs of both medical students and medical residents as part of their curriculum. However, its training based on clinical practice is not well structured. To evaluate the knowledge of bioethics in Spanish paediatric residents, and to analyse how this relates to the medical education during graduate and post-graduate training. A questionnaire with 20 multiple choice questions was designed to evaluate the knowledge in basic ethics with potential implications in clinical practice. We evaluated the education received during graduate and post-graduate training, and the main ethical conflicts faced. A total of 210 completed questionnaires were received from medical residents in paediatrics from 20 different Spanish hospitals, of whom 47 of these were first year residents (R1), 49 were second year residents (R2), 57 were third year residents (R3), and the remaining 57 were final year residents (R4). The mean number of correct answers was 16.8 out of 20. No differences were found between residents in different years of training, nor were there any differences between the group that had received specific training in bioethics versus those who had not. Residents were more likely to give wrong answers related with informed consent, the law on the freedom of the patient, principles of quality of life, the case analysis system, and the dimension of distributive justice. Limitation of therapeutic efforts was identified as the main ethical problem faced in clinical practice by Spanish residents in paediatrics. Most of the knowledge of bioethics is acquired during graduate training, and improved very little throughout the period of medical residence. Our results suggest that efforts are required in organising and structuring the education in bioethics during the training of residents in paediatrics. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  14. The paediatric surgeon and his working conditions in Francophone sub-Saharan Africa

    K Gnassingbé


    Full Text Available Background: This study described the current conditions of work of paediatric surgeons in Francophone sub-Saharan Africa (FSSA and set the debate at the level of the humanist thinking in medicine. Patients and Methods: This was a multicentre study from 1 st May to 30 th October 2008. The African Society of paediatric surgeons′ directory was used to identify paediatric surgeons in the Francophone′s countries in Sub Saharan Africa. The parameters studied were number of surgeons per country, means of training, working conditions, remunerations, needs for continuous training and the research. Results: A total of 41 paediatric surgeons (68.33% responded. The average number of paediatric surgeons per country was 5. The means of training included government scholarships among 7 paediatric surgeons (17.07%, scholarship from a non-governmental organisations in 14 (34.15% and self-sponsorships in 20 (48.78%. The average salary was 450 Euros (€ (range: 120-1 400 Euros. Most of the paediatric surgeons (68.29% had internet services for continuous update courses and research. Thirty six paediatric surgeons (87.80% had no subscription to specialised scientific journals. Conclusion: The paediatric surgeon in FSSA faces many problems related to his working and living conditions that may have a negative impact on their competences.

  15. review article paediatric malaria: a ten-year retrospective study at ...


    Medical Microbiology & Parasitology Laboratories, National Hospital, Abuja, Nigeria ... Keywords: Malaria, paediatric patients, parasite density, prevalence, laboratory diagnosis, treatment. .... or the plus sign scheme is used to report parasite.

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

    Ó Mír, M; O'Sullivan, C


    One in eight paediatric primary care presentations is for a musculoskeletal (MSK) disorder. These patients are frequently referred to paediatric orthopaedic surgeons; however, up to 50% of referrals are for normal variants. This results in excessive wait-times and impedes access for urgent surgical cases. Adult MSK medicine has successfully utilised advanced practice physiotherapists (APP) managing non-surgical candidates, with documented benefits both to patients and services. There is a gap in the literature with regard to APP in paediatric orthopaedics. In this review, we investigate demands on paediatric orthopaedic services, examine the literature regarding APP in paediatric orthopaedics and explore the value the role has to offer current outpatient services. Paediatric orthopaedic services are under-resourced with concurrent long wait times. Approximately 50% of referrals are for normal variants, which do not require specialist intervention. Poor musculoskeletal examination skills and low diagnostic confidence amongst primary care physicians have been identified as a cause of inappropriate referrals. APP clinics for normal variants have reported independent management rate and discharge rates of 95% and marked reduction in patient wait times. There is limited evidence to support the APP in paediatric orthopaedics. Further studies are needed investigating diagnostic agreement, patient/stakeholder satisfaction, patient outcomes and economic evaluation. Paediatric orthopaedics is in crisis as to how to effectively manage the overwhelming volume of referrals. Innovative multidisciplinary solutions are required so that the onus is not solely on physicians to provide all services. The APP in paediatric orthopaedics may be part of the solution.

  17. Burn epidemiology and cost of medication in paediatric burn patients.

    Koç, Zeliha; Sağlam, Zeynep


    Burns are common injuries that cause problems to societies throughout the world. In order to reduce the cost of burn treatment in children, it is extremely important to determine the burn epidemiology and the cost of medicines used in burn treatment. The present study used a retrospective design, with data collected from medical records of 140 paediatric patients admitted to a burn centre between 1 January 2009 and 31 December 2009. Medical records were examined to determine burn epidemiology, medication administered, dosage, and duration of use. Descriptive statistical analysis was completed for all variables; chi-square was used to examine the relationship between certain variables. It was found that 62.7% of paediatric burns occur in the kitchen, with 70.7% involving boiling water; 55.7% of cases resulted in third-degree burns, 19.3% required grafting, and mean duration of hospital stay was 27.5 ± 1.2 days. Medication costs varied between $1.38 US dollars (USD) and $14,159.09, total drug cost was $46,148.03 and average cost per patient was $329.63. In this study, the medication cost for burn patients was found to be relatively high, with antibiotics comprising the vast majority of medication expenditure. Most paediatric burns are preventable, so it is vital to educate families about potential household hazards that can be addressed to reduce the risk of a burn. Programmes are also recommended to reduce costs and the inappropriate prescribing of medication.

  18. EULAR recommendations for vaccination in paediatric patients with rheumatic diseases.

    Heijstek, M W; Ott de Bruin, L M; Bijl, M; Borrow, R; van der Klis, F; Koné-Paut, I; Fasth, A; Minden, K; Ravelli, A; Abinun, M; Pileggi, G S; Borte, M; Wulffraat, N M


    Evidence-based recommendations for vaccination of paediatric patients with rheumatic diseases (PaedRD) were developed by following the EULAR standardised procedures for guideline development. The EULAR task force consisted of (paediatric) rheumatologists/immunologists, one expert in vaccine evaluation, one expert in public health and infectious disease control, and one epidemiologist. A systematic literature review was conducted in MEDLINE, EMBASE, and abstracts of the EULAR and American College of Rheumatology meetings of 2008/9. The level of evidence and strength of recommendation were based on customary scoring systems. Delphi voting was applied to assess the level of agreement between task force members. 107 papers and eight abstracts were used. The majority of papers considered seasonal influenza (41) or pneumococcal (23) vaccination. 26 studies were performed specifically in paediatric patients, and the majority in adult rheumatoid arthritis and systemic lupus erythematosus patients. Fifteen recommendations were developed with an overall agreement of 91.7%. More research is needed on the safety and immunogenicity of (live-attenuated) vaccination in PaedRD, particularly in those using biologicals, and the effect of vaccination on prevention of infections.

  19. Model-Driven Paediatric Cardiomyopathy Pathways - A Clinical Impact Assessment.

    Stroetmann, Karl A; Thiel, Rainer


    Intermediate results from an ongoing health technology assessment exercise of a simulation model of paediatric cardiomyopathy are reported. Comprehensive data on paediatric cardiomyopathy/heart failure, treatment options, incidence and prevalence, prognoses for different outcomes to be expected were collected. Based on this knowledge, a detailed clinical pathway model was developed and validated against the clinical workflow in a tertiary paediatric care hospital. It combines three disease stages and various treatment options with estimates of the probabilities of a child moving from one stage to another. To reflect the complexity of initial decision taking by clinicians, a three-stage Markov model was combined with a decision tree approach - a Markov decision process. A Markov Chain simulation tool was applied to compare estimates of transition probabilities and cost data of present standard of care treatment options for a cohort of children over ten years with expected improvements from using a clinical decision support tool based on the disease model under development. Early results indicate a slight increase of overall costs resulting from the extra cost of using such a tool in spite of some savings to be expected from improved care. However, the intangible benefits in life years saved of severely ill children and the improvement in QoL to be expected for moderately ill ones should more than compensate for this.

  20. Forecasting paediatric malaria admissions on the Kenya Coast using rainfall.

    Karuri, Stella Wanjugu; Snow, Robert W


    Malaria is a vector-borne disease which, despite recent scaled-up efforts to achieve control in Africa, continues to pose a major threat to child survival. The disease is caused by the protozoan parasite Plasmodium and requires mosquitoes and humans for transmission. Rainfall is a major factor in seasonal and secular patterns of malaria transmission along the East African coast. The goal of the study was to develop a model to reliably forecast incidences of paediatric malaria admissions to Kilifi District Hospital (KDH). In this article, we apply several statistical models to look at the temporal association between monthly paediatric malaria hospital admissions, rainfall, and Indian Ocean sea surface temperatures. Trend and seasonally adjusted, marginal and multivariate, time-series models for hospital admissions were applied to a unique data set to examine the role of climate, seasonality, and long-term anomalies in predicting malaria hospital admission rates and whether these might become more or less predictable with increasing vector control. The proportion of paediatric admissions to KDH that have malaria as a cause of admission can be forecast by a model which depends on the proportion of malaria admissions in the previous 2 months. This model is improved by incorporating either the previous month's Indian Ocean Dipole information or the previous 2 months' rainfall. Surveillance data can help build time-series prediction models which can be used to anticipate seasonal variations in clinical burdens of malaria in stable transmission areas and aid the timing of malaria vector control.

  1. An observational study of hand hygiene compliance in paediatric wards.

    Randle, Jacqueline; Firth, Joseph; Vaughan, Natalie


    To measure healthcare workers', children's and visitors' hand hygiene compliance in a paediatric oncology ward and a paediatric respiratory ward in an English hospital. Children are especially vulnerable to healthcare-associated infections, yet few studies have reported on hand hygiene compliance in paediatric clinical areas. This was an observational study. We measured hand hygiene compliance over an eight-hour period in two hospital wards using the 'five moments of hand hygiene' observation tool. We monitored a total of 407 hand hygiene opportunities. Overall opportunities for compliance were 74% for healthcare workers (n = 315) and children and visitors 23% (n = 92). Compliance was 84% for allied health professionals, 81% for doctors, 75% for nurses and 73% for ancillary and other staff. Hand hygiene compliance varied depending on which of the five moments of hygiene healthcare workers were undertaking (p hygiene compliance, and for visitors to the oncology ward, hand hygiene compliance was higher (p hygiene compliance; however, visitors' compliance was low. Among healthcare workers, levels of compliance were higher compared with previous reported estimates. Visitors had the lowest level of compliance yet owing to the nature of the clinical environments, nearly a quarter of care is delivered by them rather than healthcare workers, and so, this offers opportunities for specific future interventions aimed at families and carers. © 2012 Blackwell Publishing Ltd.

  2. An interprofessional approach to improving paediatric medication safety

    Kennedy Neil


    Full Text Available Abstract Background Safe drug prescribing and administration are essential elements within undergraduate healthcare curricula, but medication errors, especially in paediatric practice, continue to compromise patient safety. In this area of clinical care, collective responsibility, team working and communication between health professionals have been identified as key elements in safe clinical practice. To date, there is limited research evidence as to how best to deliver teaching and learning of these competencies to practitioners of the future. Methods An interprofessional workshop to facilitate learning of knowledge, core competencies, communication and team working skills in paediatric drug prescribing and administration at undergraduate level was developed and evaluated. The practical, ward-based workshop was delivered to 4th year medical and 3rd year nursing students and evaluated using a pre and post workshop questionnaire with open-ended response questions. Results Following the workshop, students reported an increase in their knowledge and awareness of paediatric medication safety and the causes of medication errors (p Conclusion This study has helped bridge the knowledge-skills gap, demonstrating how an interprofessional approach to drug prescribing and administration has the potential to improve quality and safety within healthcare.

  3. Paediatric intraocular lens implants: accuracy of lens power calculations.

    O'Gallagher, M K; Lagan, M A; Mulholland, C P; Parker, M; McGinnity, G; McLoone, E M


    PurposeThis study aims to evaluate the accuracy of lens prediction formulae on a paediatric population.MethodsA retrospective case-note review was undertaken of patients under 8 years old who underwent cataract surgery with primary lens implantation in a regional referral centre for paediatric ophthalmology, excluding those whose procedure was secondary to trauma. Biometric and refractive data were analysed for 43 eyes, including prediction errors (PE). Statistical measures used included mean absolute error (MAE), median absolute error (MedAE), Student's t-test and Lin's correlation coefficient.ResultsThe mean PE using the SRK-II formula was +0.96 D (range -2.47D to +2.41 D, SD 1.33 D, MAE 1.38 D, MedAE 1.55, n=15). The mean PE was smaller using SRK/T (-0.18 D, range -3.25 D to +3.95 D, SD 1.70 D, MAE 1.30 D, MedAE 1.24, n=27). We performed an analysis of the biometry data using four different formula (Hoffer Q, Holladay 1, SRK-II and SRK/T). Hoffer Q showed a smaller MedAE than other formulae but also a myopic bias.ConclusionOur clinical data suggest SRK/T was more accurate in predicting post-operative refraction in this cohort of paediatric patients undergoing cataract surgery. Hoffer Q may have improved accuracy further.

  4. Antibiotic resistance and irrational prescribing in paediatric clinics in Greece.

    Toska, Aikaterini; Geitona, Mary

    Greece is among the countries with the highest rates of antimicrobial resistance (AMR) and simultaneous antibiotic consumption. The aim of this study was to assess the perceptions and knowledge of AMR and irrational antibiotic prescribing of nurses working in paediatric hospitals in Greece. A self-administered questionnaire was distributed to nurses in paediatric hospitals and paediatric clinics in Greece. Descriptive and multivariate statistical analyses were performed. Levels of significance were two-tailed and statistical significance was p=0.05. A total of 87% of participants reported irrational prescribing to be an important cause of AMR. Diagnostic uncertainty was stated by 55.5% as the main cause of irrational antibiotic prescribing and 94% suggested the use of protocols and guidelines as the main measure to control overprescribing. Parental demand for antibiotics in hospitals has increased according to 51.8% of respondents. Strong correlation was observed between social-demographic characteristics and antibiotic resistance, as well as irrational prescribing. Assessing nurses' knowledge and perceptions of antimicrobial resistance and irrational prescribing is vital as nurses actively participate in the antibiotics administration process and antimicrobial management in Greece. Their involvement could contribute to educate patients and parents on the public-health implications of overprescribing and antimicrobial resistance.

  5. Communication skills of healthcare professionals in paediatric diabetes services.

    Hambly, H; Robling, M; Crowne, E; Hood, K; Gregory, J W


    To identify training needs in communication skills and to assess training preferences of staff working in paediatric diabetes services, which will inform the development of a learning programme in behaviour change counselling for healthcare professionals. Three hundred and eighty-five staff in 67 UK paediatric diabetes services were sent questionnaires to determine their previous communication skills training, to measure their self-reported view of the importance of and confidence in addressing common clinical problems and to assess the perceived feasibility of training methods to improve skillfulness. Two hundred and sixty-six questionnaires (69%) were returned from 65 services. Sixteen per cent of doctors, nurses and dietitians reported no previous training in communication skills and 47% had received no training since graduating. Respondents rated psychosocial issues as more important to address than medical issues within consultations (t = 8.93, P important component of consultations involving young people with diabetes, but healthcare professionals find it easier to address medical issues. This represents a key training need in communication skills for diabetes professionals. The survey will inform the development of a tailored learning programme for health professionals in UK paediatric diabetes clinics.

  6. Donor-Recipient Size Mismatch in Paediatric Renal Transplantation

    J. Donati-Bourne


    Full Text Available Introduction. End stage renal failure in children is a rare but devastating condition, and kidney transplantation remains the only permanent treatment option. The aim of this review was to elucidate the broad surgical issues surrounding the mismatch in size of adult kidney donors to their paediatric recipients. Methods. A comprehensive literature search was undertaken on PubMed, MEDLINE, and Google Scholar for all relevant scientific articles published to date in English language. Manual search of the bibliographies was also performed to supplement the original search. Results. Size-matching kidneys for transplantation into children is not feasible due to limited organ availability from paediatric donors, resulting in prolonged waiting list times. Transplanting a comparatively large adult kidney into a child may lead to potential challenges related to the surgical incision and approach, vessel anastomoses, wound closure, postoperative cardiovascular stability, and age-correlated maturation of the graft. Conclusion. The transplantation of an adult kidney into a size mismatched paediatric recipient significantly reduces waiting times for surgery; however, it presents further challenges in terms of both the surgical procedure and the post-operative management of the patient’s physiological parameters.

  7. Economics and ethics of paediatric respiratory extra corporeal life support.

    Callaghan, M; Doyle, Y; O'Hare, B; Healy, M; Nölke, L


    Extra corporeal membrane oxygenation (ECMO) is a form of life support, which facilitates gas exchange outside the body via an oxygenator and a centrifugal pumping system. A paediatric cardiac ECMO programme was established in 2005 at Our Lady's Children's Hospital, Crumlin (OLCHC) and to date 75 patients have received ECMO, the majority being post operative cardiac patients. The outcome data compares favourably with international figures. ECMO has been most successful in the treatment of newborn infants with life threatening respiratory failure from conditions such as meconium aspiration, respiratory distress syndrome and respiratory infections. There is no formal paediatric respiratory ECMO programme at OLCHC, or anywhere else in Ireland. Currently, neonates requiring respiratory ECMO are transferred to centres in Sweden or the UK at an average cost of 133,000 Euros/infant, funded by the Health Service Executive E112 treatment abroad scheme. There is considerable morbidity associated with the transfer of critically ill infants, as well as significant psycho-social impact on families. OLCHC is not funded to provide respiratory ECMO, although the equipment and expertise required are similar to cardiac ECMO and are currently in place. The average cost of an ECMO run at OLCHC is 65,000 Euros. There is now a strong argument for a fully funded single national cardiac and respiratory paediatric ECMO centre, similar to that for adult patients.

  8. Management of pulps exposed during carious tissue removal in adults: a multi-national questionnaire-based survey.

    Stangvaltaite, Lina; Schwendicke, Falk; Holmgren, Christopher; Finet, Marion; Maltz, Marisa; Elhennawy, Karim; Kerosuo, Eero; Doméjean, Sophie


    The aim of the present study was to investigate and compare the management of pulps exposed during carious tissue removal by French, German, and Norwegian general dental practitioners (GDPs). We further aimed to assess possible dentist- and patient-related factors associated with these management decisions. A structured questionnaire was send via mail to a simple random sample of dentists. The analyzed sample consisted of 661 (33%) French GDPs, 622 (25%) German GDPs, and 199 (34%) Norwegian GDPs. No single management method gained uniform consensus in any of the three countries. However, the most preferred management option in all three countries was direct pulp capping (DPC) (68-93%) mainly performed with calcium hydroxide paste/slurry (CH). Alternatively, root canal treatment was performed (7-22%). The reasons that guided GDPs were the same in all three countries; "good results" and "ease of use, familiar with the technique." Having read scientific articles about cariology/operative dentistry in the last 5 years increased the odds for the preference of DPC instead of root canal treatment (OR = 2.1, 95% CI 1.3-3.2). Among GDPs in France, Germany, and Norway, there was no uniform management option for pulp exposures during carious tissue removal. DPC with CH was the most preferred management, even though the current evidence suggests DPC with mineral trioxide aggregate (MTA) to be more successful. The outcome expectations and the assumed ease of use were reasons for GDPs' choice. Moreover, knowledge on current evidence towards such management options influenced treatment decisions. GDPs are encouraged to adopt management options based on current scientific evidence.

  9. Malaria paediatric hospitalization between 1999 and 2008 across Kenya.

    Okiro, Emelda A; Alegana, Victor A; Noor, Abdisalan M; Mutheu, Juliette J; Juma, Elizabeth; Snow, Robert W


    Intervention coverage and funding for the control of malaria in Africa has increased in recent years, however, there are few descriptions of changing disease burden and the few reports available are from isolated, single site observations or are of reports at country-level. Here we present a nationwide assessment of changes over 10 years in paediatric malaria hospitalization across Kenya. Paediatric admission data on malaria and non-malaria diagnoses were assembled for the period 1999 to 2008 from in-patient registers at 17 district hospitals in Kenya and represented the diverse malaria ecology of the country. These data were then analysed using autoregressive moving average time series models with malaria and all-cause admissions as the main outcomes adjusted for rainfall, changes in service use and populations-at-risk within each hospital's catchment to establish whether there has been a statistically significant decline in paediatric malaria hospitalization during the observation period. Among the 17 hospital sites, adjusted paediatric malaria admissions had significantly declined at 10 hospitals over 10 years since 1999; had significantly increased at four hospitals, and remained unchanged in three hospitals. The overall estimated average reduction in malaria admission rates was 0.0063 cases per 1,000 children aged 0 to 14 years per month representing an average percentage reduction of 49% across the 10 hospitals registering a significant decline by the end of 2008. Paediatric admissions for all-causes had declined significantly with a reduction in admission rates of greater than 0.0050 cases per 1,000 children aged 0 to 14 years per month at 6 of 17 hospitals. Where malaria admissions had increased three of the four sites were located in Western Kenya close to Lake Victoria. Conversely there was an indication that areas with the largest declines in malaria admission rates were areas located along the Kenyan coast and some sites in the highlands of Kenya. A

  10. Psychosocial predictors of non-adherence and treatment failure in a large scale multi-national trial of antiretroviral therapy for HIV: data from the ACTG A5175/PEARLS trial.

    Steven A Safren

    Full Text Available PEARLS, a large scale trial of antiretroviral therapy (ART for HIV (n = 1,571, 9 countries, 4 continents, found that a once-daily protease inhibitor (PI based regimen (ATV+DDI+FTC, but not a once-daily non-nucleoside reverse transcriptase inhibitor/nucleoside reverse transcriptase inhibitor (NNRTI/NRTI regimen (EFV+FTC/TDF, had inferior efficacy compared to a standard of care twice-daily NNRTI/NRTI regimen (EFV+3TC/ZDV. The present study examined non-adherence in PEARLS.Outcomes: non-adherence assessed by pill count and by self-report, and time to treatment failure. Longitudinal predictors: regimen, quality of life (general health perceptions  =  QOL-health, mental health  =  QOL-mental health, social support, substance use, binge drinking, and sexual behaviors. "Life-Steps" adherence counseling was provided.In both pill-count and self-report multivariable models, both once-a-day regimens had lower levels of non-adherence than the twice-a-day standard of care regimen; although these associations attenuated with time in the self-report model. In both multivariable models, hard-drug use was associated with non-adherence, living in Africa and better QOL-health were associated with less non-adherence. According to pill-count, unprotected sex was associated with non-adherence. According to self-report, soft-drug use was associated with non-adherence and living in Asia was associated with less non-adherence. Both pill-count (HR = 1.55, 95% CI: 1.15, 2.09, p<.01 and self-report (HR = 1.13, 95% CI: 1.08, 1.13, p<.01 non-adherence were significant predictors of treatment failure over 72 weeks. In multivariable models (including pill-count or self-report nonadherence, worse QOL-health, age group (younger, and region were also significant predictors of treatment failure.In the context of a large, multi-national, multi-continent, clinical trial there were variations in adherence over time, with more simplified regimens generally being

  11. Application of the 2012 revised diagnostic definitions for paediatric multiple sclerosis and immune-mediated central nervous system demyelination disorders

    van Pelt, E. Danielle; Neuteboom, Rinze F.; Ketelslegers, Immy A.; Boon, Maartje; Catsman-Berrevoets, Coriene E.; Hintzen, Rogier Q.


    Background Recently, the International Paediatric Multiple Sclerosis Study Group (IPMSSG) definitions for the diagnosis of immune-mediated acquired demyelinating syndromes (ADS) of the central nervous system, including paediatric multiple sclerosis (MS), have been revised. Objective To evaluate the

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

    Kreeftmeijer-Vegter, Annemarie Rosan; de Boer, Anthonius; van der Vlugt-Meijer, Roselinda H; de Vries, Peter J


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

  13. Systematic Review: Nutrition and Physical Activity in the Management of Paediatric Nonalcoholic Fatty Liver Disease.

    Gibson, Philippa S; Lang, Sarah; Dhawan, Anil; Fitzpatrick, Emer; Blumfield, Michelle L; Truby, Helen; Hart, Kathryn H; Moore, J Bernadette


    The aim of the study was to evaluate efficacy of nutrition and physical activity interventions in the clinical management of paediatric nonalcoholic fatty liver disease. The prevalence of paediatric nonalcoholic fatty liver disease continues to rise alongside childhood obesity. Weight loss through lifestyle modification is currently first-line treatment, although supplementation of specific dietary components may be beneficial. Medline, CINAHL, EMBASE, Scopus, and Cochrane Libraries were systematically searched to identify randomized controlled trials assessing nutritional and physical activity interventions. Primary outcome measures were changes to liver biomarkers assessed by imaging, histology, or serum liver function tests. Study quality was evaluated using the American Dietetic Association Quality Criteria Checklist. Fifteen articles met eligibility criteria investigating nutritional supplementation (vitamin E [n = 6], probiotics [n = 2], omega-3 fatty acids [n = 5]), dietary modification (low glycaemic load [n = 1] and reducing fructose intake [n = 1]). No randomized controlled trials examining physical activity interventions were identified. Vitamin E was ineffective at improving alanine transaminase levels, whereas omega-3 fatty acids decreased hepatic fat content. Probiotics gave mixed results, whereas reduced fructose consumption did not improve primary outcome measures. A low glycaemic load diet and a low-fat diet appeared equally effective in decreasing hepatic fat content and transaminases. Most studies were deemed neutral as assessed by the American Dietetic Association Quality Criteria Checklist. The limited evidence base inhibits the prescription of specific dietary and/or lifestyle strategies for clinical practice. General healthy eating and physical activity guidelines, promoting weight loss, should remain first-line treatment until high-quality evidence emerges that support specific interventions that offer additional clinical

  14. Clinical experience with desflurane for paediatric anaesthesia outside the operating room.

    Alonso, M; Builes, L; Morán, P; Ortega, A; Fernández, E; Reinoso-Barbero, F


    Desflurane has been used in paediatric patients for several surgical indications. This article analyses the efficacy and safety of desflurane for diagnostic-therapeutic procedures in remote areas far from operating room in a group of selected patients with no known associated respiratory disease. A retrospective analysis was performed on 2,072 general anaesthesia procedures stored in a computer database, in which desflurane was used in a Paediatric Pain Unit during the years 2013 and 2014. An analysis was also performed using the patient demographics, type of procedure, anaesthetic technique, type of airway management, patient cooperation, and incidence of anaesthetic complications. The study included 876 patients, with a mean age of 8.8 years. The main procedures were bone marrow aspirates (23%), lumbar punctures (20%), panendoscopies (15%), and colonoscopies (5%). Induction was intravenous with propofol (26%) or inhalation with sevoflurane in the remaining 74%. Maintenance consisted of remifentanil and desflurane at mean end tidal concentrations of 6.2±2.1%. The airway was managed through a nasal cannula or face mask in spontaneous ventilation. The effectiveness was 98%, and the incidence of side effects was 15%, which included agitation (6%), headache (4%), nausea-vomiting (3%), and laryngospasm (2%). The maintenance with desflurane (at concentrations close to the hypnotic-MAC in spontaneous ventilation) was effective, with a rapid recovery, and with a low incidence of adverse effects. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Long-term safety in living kidney donors for paediatric transplantation. Single-centre prospective study.

    Martin Benlloch, J; Román Ortiz, E; Mendizabal Oteiza, S

    There is enough evidence concerning the short-term safety of living donors after kidney transplantation. However, long-term complications continue to be studied, with a particular interest in young donors. Previous studies have been conducted in older donors for adult renal patients. We present a study of long-term complications in kidney donors for our paediatric population. We carried out a long-term donor study for the 54 living kidney-donor transplantations performed at our department from 1979 to June 2014. We monitored the glomerular filtration rate (GFR) on the basis of 24-hour urine creatinine clearance, 24-hour proteinuria and the development of arterial hypertension in the 48 donors who were followed up for more than one year. Only the 39 patients who were exclusively followed up by our department have been included in the results analysis. GFR through creatinine clearance was stable after an initial decrease. No proteinuria was observed in any of the cases. One patient developed chronic kidney disease (CKD), which resulted in a cumulative incidence of 2%. GFR below 60mL/min/1.73 m(2) was not reported in any other patients. Arterial hypertension was diagnosed in 25% of donors, 90% of which were treated with antihypertensives. Risk of CKD and hypertension in living kidney donors for paediatric recipients, who are carefully monitored throughout their evolution, is similar to that of the general population. Therefore, this technique appears to be safe in both the short and long term. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  16. Effectiveness and Comparison of Various Audio Distraction Aids in Management of Anxious Dental Paediatric Patients.

    Navit, Saumya; Johri, Nikita; Khan, Suleman Abbas; Singh, Rahul Kumar; Chadha, Dheera; Navit, Pragati; Sharma, Anshul; Bahuguna, Rachana


    Dental anxiety is a widespread phenomenon and a concern for paediatric dentistry. The inability of children to deal with threatening dental stimuli often manifests as behaviour management problems. Nowadays, the use of non-aversive behaviour management techniques is more advocated, which are more acceptable to parents, patients and practitioners. Therefore, this present study was conducted to find out which audio aid was the most effective in the managing anxious children. The aim of the present study was to compare the efficacy of audio-distraction aids in reducing the anxiety of paediatric patients while undergoing various stressful and invasive dental procedures. The objectives were to ascertain whether audio distraction is an effective means of anxiety management and which type of audio aid is the most effective. A total number of 150 children, aged between 6 to 12 years, randomly selected amongst the patients who came for their first dental check-up, were placed in five groups of 30 each. These groups were the control group, the instrumental music group, the musical nursery rhymes group, the movie songs group and the audio stories group. The control group was treated under normal set-up & audio group listened to various audio presentations during treatment. Each child had four visits. In each visit, after the procedures was completed, the anxiety levels of the children were measured by the Venham's Picture Test (VPT), Venham's Clinical Rating Scale (VCRS) and pulse rate measurement with the help of pulse oximeter. A significant difference was seen between all the groups for the mean pulse rate, with an increase in subsequent visit. However, no significant difference was seen in the VPT & VCRS scores between all the groups. Audio aids in general reduced anxiety in comparison to the control group, and the most significant reduction in anxiety level was observed in the audio stories group. The conclusion derived from the present study was that audio distraction

  17. [Treatment of acute otitis media in paediatrics: a meta-analysis].

    Esposito, Silvano; Novelli, Andrea; Noviello, Silvana


    Otitis represents the second most common infection of the upper respiratory tract, its treatment being the most common cause for prescribing antibiotics in the United States. A large number of antimicrobials, especially beta-lactams and macrolides, are generally used for treating acute otitis media (AOM) in paediatric patients, owing to their antibacterial spectrum including the main aetiological pathogens. Efficacy, safety and compliance of Cefaclor were compared with those of other antibiotics in the treatment of paediatric AOM in a meta-analysis of randomized controlled trials published between 1981 and 2004. Overall, evaluations were performed on 24 studies (Medline/PubMed, keywords "Cefaclor and otitis") which proved eligible (jadad score > or = 1); sixteen out of the 24 studies were multicentre, seven were double-blind. Mostly, the comparator agent was a beta-lactam, in four and three cases it was a macrolide or the association trimethoprim-sulfamethoxazole, respectively. Efficacy and safety were end-points of all studies whereas only 9 studies evaluated compliance. For the majority of studies (16/24) Cefaclor was administered for 10-day course. The analysis was based on a 2 x 2 contingency table with classification by treatment and number of improvements/cures, side-effects, and compliance of individual studies. The global estimate of the effective treatments was obtained with the weighted mean of the log OR (Odd Ratio) according to Mantel-Haenszel and associated confidence intervals (CI) at 95%. All the calculations were performed using SAS v.8. Chi-square test was performed. Clinical efficacy evaluation, number of improvements/cures, did not evidence a statistically significant difference among Cefaclor and comparators (86.8% vs 88.7%; Odds Ratio 0.77, IC 0.61/0.94). In the Cefaclor-treated patients, adverse events were observed in a statistically significant lower percentage compared to other antibiotics: 13.3% vs 19.4% (P antibiotics usually employed in


    Savitri D. Kabade


    Full Text Available BACKGROUND The successful conduct of anaesthesia in children depends on adequate premedication, which not only comforts the anxious child but also comforts the parents or guardians. Atomized Intranasal Midazolam is quickly absorbed through the nasal mucosa, resulting in a rapid and reliable onset of action. Clonidine has several applications in paediatric anaesthesia as a premedication and as an adjuvant in general as well as regional anaesthesia. Thus, in search of a novel premedication technique, we conducted a study to compare the effectiveness of atomized intranasal midazolam with intranasal clonidine for preoperative sedation in paediatric patients undergoing elective surgery. MATERIALS AND METHODS After obtaining Institutional Ethical Committee clearance and parent’s consent, a prospective, randomised, double-blinded clinical study was conducted in 78 children of ASA I and II, belonging to 2 - 10 years age, posted for various elective surgery. Group M (n= 39 received atomized intranasal midazolam (0.3 mg/kg and Group C (n= 39 received clonidine (4 mcg/kg instilled into both the nostrils. Sedation score (Ramsay, separation score, mask acceptance, recovery and vital parameters were recorded. Statistical analysis of data was done using IBM-SPSS version 21.0. RESULTS Mean sedation scores (± SD were higher in Group M than in Group C (at 5th minute 1.58 ± 0.55 in Group M and 1.15 ± 0.36 in Group C with P= 0.002, at 10th minute 2.34 ± 0.97 in Group M and 1.75 ± 0.71 in Group C with P= 0.008. Separation scores and mask acceptance were better with Group M than Group C. Haemodynamic parameters were similar in both the groups and no major adverse effects were noted. CONCLUSION Atomized intranasal midazolam produces superior sedation levels, child-parent separation and mask acceptance compared to intranasal clonidine in children.

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

    Jayaprakash, R.


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

  20. Guidelines for 18F-FDG PET and PET-CT imaging in paediatric oncology

    Stauss, J.; Franzius, C.; Pfluger, T.


    by the EANM Paediatric Committee, do not intend to compete with the existing guidelines, but rather aim at providing additional information on issues particularly relevant to PET imaging of children with cancer. CONCLUSION: The guidelines summarize the views of the Paediatric Committee of the European...

  1. The duration of effect of infliximab maintenance treatment in paediatric Crohn's disease is limited

    de Bie, C. I.; Kindermann, A.; Kokke, F. T. M.; Damen, G. M.; Kneepkens, C. M. F.; van Rheenen, P. F.; Schweizer, J. J.; Hoekstra, J. H.; Norbruis, O. F.; Ten, W. E. Tjon A.; Vreugdenhil, A. C.; Deckers-Kocken, J. M.; Gijsbers, C. F. M.; Escher, J. C.; de Ridder, L.; Hummel, T.


    P>Background Infliximab is effective for induction and maintenance of remission in children with moderately to severely active Crohn's disease (CD). Aim To evaluate the long-term efficacy of infliximab treatment in paediatric CD. Methods In this observational, multicentre study, all paediatric CD pa

  2. The duration of effect of infliximab maintenance treatment in paediatric Crohn's disease is limited.

    Bie, C.I. De; Hummel, T.Z.; Kindermann, A.; Kokke, F.T.; Damen, G.M.; Kneepkens, C.M.; Rheenen, P.F. van; Schweizer, J.J.; Hoekstra, J.H.; Norbruis, O.F.; Tjon a Ren, W.E.; Vreugdenhil, A.C.; Deckers-Kocken, J.M.; Gijsbers, C.F.; Escher, J.C.; Ridder, L. de


    BACKGROUND: Infliximab is effective for induction and maintenance of remission in children with moderately to severely active Crohn's disease (CD). AIM: To evaluate the long-term efficacy of infliximab treatment in paediatric CD. METHODS: In this observational, multicentre study, all paediatric CD

  3. Vaccination of paediatric patients with rheumatic diseases. Navigating through turbulent waters

    Heijstek, M.W.


    In this thesis we focus on the safety and efficacy of vaccinations in paediatric patients with rheumatic diseases. With the European League Against Rheumatism (EULAR), we constructed recommendations for vaccination of paediatric patients with rheumatic diseases based on available evidence. Evidence

  4. Beyond counting cases: Public health impacts of national Paediatric Surveillance Units

    Grenier, D.; Elliott, E.J.; Zurynski, Y.; Rodrigues Pereira, R.; Preece, M.; Lynn, R.; Kries, R. von; Zimmermann, H.; Dickson, N.P.; Virella, D.


    Paediatric Surveillance Units (PSUs) have been established in 14 countries and facilitate national, prospective, active surveillance for a range of conditions, with monthly reporting by child health specialists. The International Network of Paediatric Surveillance Units (INoPSU) was established in 1

  5. Plate fixation of paediatric fractures of the distal tibia and fibula.

    He, Bingshu; Wang, Jun


    The role of surgery in the management of paediatric long-bone shaft fractures remains a matter of debate. We present a series of paediatric patients with unstable fractures of the distal tibia and fibula, treated with titanium plate fixation. Excellent results were obtained after plate fixation.

  6. A Clinical Study of Phenomenology and Comorbidity of Paediatric Bipolar Disorder

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


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

  7. Object-oriented business process analysis of the cooperative soft tissue sarcoma trial of the german society for paediatric oncology and haematology (GPOH).

    Weber, R; Knaup, P; Knietitg, R; Haux, R; Merzweiler, A; Mludek, V; Schilling, F H; Wiedemann, T


    The German Society for Paediatric Oncology and Haematology (GPOH) runs nation-wide multicentre clinical trials to improve the treatment of children suffering from malignant diseases. We want to provide methods and tools to support the centres of these trials in developing trial specific modules for the computer-based DOcumentation System for Paediatric Oncology (DOSPO). For this we carried out an object-oriented business process analysis for the Cooperative Soft Tissue Sarcoma Trial at the Olgahospital Stuttgart for Child and Adolescent Medicine. The result is a comprehensive business process model consisting of UML-diagrams and use case specifications. We recommend the object-oriented business process analysis as a method for the definition of requirements in information processing projects in the field of clinical trials in general. For this our model can serve as basis because it slightly can be adjusted to each type of clinical trial.

  8. Paediatric heart failure research: role of the National Heart, Lung, and Blood Institute.

    Burns, Kristin M


    The National Heart, Lung, and Blood Institute, of the National Institutes of Health, is committed to supporting research in paediatric heart failure. The Institute's support of paediatric heart failure research includes both investigator-initiated grants and Institute initiatives. There were 107 funded grants in paediatric heart failure over the past 20 years in basic, translational and clinical research, technology development, and support of registries. Such research includes a broad diversity of scientific topics and approaches. The Institute also supports several initiatives for paediatric heart failure, including the Pediatric Circulatory Support Program, the Pumps for Kids, Infants, and Neonates (PumpKIN) Program, PediMACS, and the Pediatric Heart Network. This review article describes the National Heart, Lung, and Blood Institute's past, present, and future efforts to promote a better understanding of paediatric heart failure, with the ultimate goal of improving outcomes.

  9. Performance characteristics of the French version of the severity hierarchy score for paediatric sleep apnoea screening in clinical settings.

    Nguyên, Xuân-Lan; Lévy, Pierre; Beydon, Nicole; Gozal, David; Fleury, Bernard


    Paediatric obstructive sleep apnoea syndrome (OSAS) is a highly prevalent condition carrying increased risk for impaired cognitive and cardiovascular function. The standard diagnosis consists of full-night polysomnography (PSG), but limited access to PSG leads to substantial under-diagnosis. The use of a validated and simple diagnostic screening tool to predict OSAS could prioritise night sleep recordings in children at risk of OSAS, and help in clinical decision-making. This study aimed to prospectively assess the performance of the French version of the severity hierarchy score (SHS) in paediatric OSAS. This score consists of a discriminative subset of six respiratory items, and has already been validated in English for screening OSAS in the general paediatric population. A total of 96 children (mean age 7.1 ± 2.4 years; BMI z-score: -0.03 ± 1.50) were recruited; they had been were referred to two academic sleep centres in France for the putative diagnosis of sleep-disordered breathing. The parents completed the SHS questionnaire prior to PSG. Sensitivity and specificity of the SHS for detecting moderate OSAS, defined by an apnoea-hypopnoea index (AHI) of ≥5/hours of total sleep time (TST), were assessed, and ROC analysis was performed. An SHS score of >2.75 exhibited an 82% sensitivity, 81% specificity, and 92% negative predictive value for detecting an AHI of ≥5/hour TST in the cohort. The French version of the SHS emerged as favourably suited for the screening for OSAS in children. Copyright © 2016 Elsevier B.V. All rights reserved.

  10. Characteristics of paediatric burns in Sichuan province: epidemiology and prevention.

    Liu, Yong; Cen, Ying; Chen, Jun-Jie; Xu, Xue-Wen; Liu, Xiao-Xue


    This study analysed the epidemiology of paediatric burns in Sichuan province, China, for the formulation of prevention programmes for this population. A retrospective review was performed of paediatric patients admitted to the Burn Centre of West China Hospital during 2003-2009, including patient demographics, burn aetiology, time and place of burn, rural or urban population, and education level and burn knowledge of the patients' guardians. A total of 1387 paediatric burn patients, mean age 3.21 years (range 0-14 years) were admitted. The majority (72.1%) were 0-3 years old, and the male/female ratio was 2.39:1. Most common aetiologies were scalds (81.3%), flames (17.1%), and electricity (1.3%), while chemical burns were rare. The ratio of indoor versus outdoor location was 4.93:1, and the rural/urban ratio was 4.03:1. Burns were classified as: total burn surface area (TBSA) ranging from 0% to 5%, (23.9% of patients); TBSA between 5% and 15% (33.2%); TBSA between 15% and 25% (29.8%); TBSA greater than 25% (13.1%). There was a higher prevalence from April to September, and the peak times were mealtime and bathtime. The education level was lower in the rural group. Both urban and rural groups had little knowledge of first aid for burns. Burn prevention programmes should promote improved living conditions, with prevention education addressed directly to the guardians of children. Copyright © 2011. Published by Elsevier Ltd.

  11. Forecasting paediatric malaria admissions on the Kenya Coast using rainfall

    Stella Wanjugu Karuri


    Full Text Available Background: Malaria is a vector-borne disease which, despite recent scaled-up efforts to achieve control in Africa, continues to pose a major threat to child survival. The disease is caused by the protozoan parasite Plasmodium and requires mosquitoes and humans for transmission. Rainfall is a major factor in seasonal and secular patterns of malaria transmission along the East African coast. Objective: The goal of the study was to develop a model to reliably forecast incidences of paediatric malaria admissions to Kilifi District Hospital (KDH. Design: In this article, we apply several statistical models to look at the temporal association between monthly paediatric malaria hospital admissions, rainfall, and Indian Ocean sea surface temperatures. Trend and seasonally adjusted, marginal and multivariate, time-series models for hospital admissions were applied to a unique data set to examine the role of climate, seasonality, and long-term anomalies in predicting malaria hospital admission rates and whether these might become more or less predictable with increasing vector control. Results: The proportion of paediatric admissions to KDH that have malaria as a cause of admission can be forecast by a model which depends on the proportion of malaria admissions in the previous 2 months. This model is improved by incorporating either the previous month's Indian Ocean Dipole information or the previous 2 months’ rainfall. Conclusions: Surveillance data can help build time-series prediction models which can be used to anticipate seasonal variations in clinical burdens of malaria in stable transmission areas and aid the timing of malaria vector control.

  12. Congenital anomalies in paediatric surgery in North India

    Babita Jangra


    Full Text Available Background: Congenitalmal formation represents defects in morphogenesis during early foetal life. Congenital anomalies account for 8-15% of perinatal deaths and 13-16% of neonatal deaths in India. The proportion of perinatal deaths due to congenital malformations is increasing as a result of reduction of mortality due to other causes owing to the improvement in perinatal and neonatal care. Materials and Methods: A retrospective record based study was conducted in the Paediatric Surgery Department of a Tertiary Care Institute of North India. The records of over a decade (2003-2012 were analysed. A total of 4305 cases of congenital anomalies were recorded in the study. All the data were entered in the excel spread sheet and analysed in SPSS version 17. (Statistical Package for the Social Sciences, a software package used for statistical analysis, officially named "IBM SPSS Statistics". Results: Over the decade, a total of 14264 children were admitted in the paediatric surgery department with various problems. Out of these about one-third children (30.18% had one or other type of congenital anomalies. This trend remained almost constant over the decade within a range of 26.8-33.6%. About half of the total congenital anomalies belonged to the gastro-intestinal tract, followed by genitourinary tract, central nervous system and other anomalies. All the anomalies were more common in males and were found in children belonging to rural communities. Conclusions: All the neonates should be examined with scrutiny for overt as well as occult congenital anomalies and Paediatric surgical care should be considered as an essential component of child health programmes in developing populations. Moreover, it is necessary to establish a registry system for congenital anomalies.

  13. Paediatric solid tumours in Nigerian children: A changing pattern?

    Tanko Na′anlep


    Full Text Available Background: Childhood cancer is fast becoming an important paediatric problem in Nigeria and several parts of Africa, with the progressive decline of infectious and nutritional diseases. The following study was a 5-year retrospective review of paediatric solid tumours as seen at the Jos University Teaching Hospital, Nigeria. Objective: To determine the relative frequencies of childhood solid malignant tumours in Jos, Central Nigeria and compare with reports of previous studies both locally and abroad. Materials and Methods: Cancer registers and medical records of patients were used to extract demographic data, specimen number and/or codes. Archival materials were retrieved from the histopathology laboratory and sections were made from paraffin embedded blocks of these specimens. Slides of these histological sections were reviewed and reclassified where necessary. The relative frequencies were then determined. Results: One hundred and eighty one solid tumours of children were diagnosed within the study period. Ninety-four (51% were benign and 87 (49% malignant. Male: Female ratio was 1.3:1. The commonest malignant tumour diagnosed was rhabdomyosarcoma which accounted for 27 (31%, comprising of 15 (55.6%, 11 (40.7% and 1 (3.7% embryonal, alveolar and pleomorphic rhabdomyosarcomas, respectively. Non Hodgkin lymphoma and Burkitt lymphoma accounted for 17 (19.5% and 12 (13.8%, respectively. Conclusion: Based on the result of our study, we conclude that the commonest solid malignancy of childhood in Jos, Nigeria is rhabdomyosarcoma. This has implications for diagnosis, management and prognosis of theses soft tissue sarcomas in our paediatric population.

  14. [Influence of postcode on paediatric admissions in Seville].

    Tornero Patricio, Sebastián; Charris-Castro, Liliana; Granero Asencio, Mercedes; Daponte Codina, Antonio


    The postcode (where the home is situated) is an indicator of socioeconomic status and is associated with morbidity, mortality, and the use of health services. The aim of this study was to analyse its effects on paediatric admissions and to determine the rates of the most common causes of paediatric admissions in Seville. An observational cross-sectional study with two analysis units: under 15 year-old "admissions" in public hospitals in Seville (n=2,660) and "city districts" of Seville (n=11). The independent variable analysed was whether the postcode of the admitted patients was within a Regional Government designated "area with social transformation needs". The analysis of the admissions was performed using X(2)-test, Fisher test and Student-t test, with the description of rates using the calculation of crude and specific rates, and by rate ratio. Children living in districts with a lower socioeconomic status were on average 7 months younger (P<.001), and they were significantly more likely to be admitted via the emergency department (P<.001). There was no statistical difference detected in either the length of hospital stay or mortality. The crude admission rate ratio was higher in districts with a lower socioeconomic status (1.8), with a higher specific rate ratio detected in admissions due to asthma, respiratory infections, inguinal hernia, and epilepsy/convulsions. Paediatric hospital admission rates of the main diagnoses were higher in districts with a lower socioeconomic status. Children living in these districts were more likely to be admitted younger and via the emergency department. Copyright © 2016. Publicado por Elsevier España, S.L.U.

  15. Development of research priorities in paediatric pain and palliative care.

    Liossi, Christina; Anderson, Anna-Karenia; Howard, Richard F


    Priority setting for healthcare research is as important as conducting the research itself because rigorous and systematic processes of priority setting can make an important contribution to the quality of research. This project aimed to prioritise clinical therapeutic uncertainties in paediatric pain and palliative care in order to encourage and inform the future research agenda and raise the profile of paediatric pain and palliative care in the United Kingdom. Clinical therapeutic uncertainties were identified and transformed into patient, intervention, comparison and outcome (PICO) format and prioritised using a modified Nominal Group Technique. Members of the Clinical Studies Group in Pain and Palliative Care within National Institute for Health Research (NIHR) Clinical Research Network (CRN)-Children took part in the prioritisation exercise. There were 11 clinically active professionals spanning across a wide range of paediatric disciplines and one parent representative. The top three research priorities related to establishing the safety and efficacy of (1) gabapentin in the management of chronic pain with neuropathic characteristics, (2) intravenous non-steroidal anti-inflammatory drugs in the management of post-operative pain in pre-schoolers and (3) different opioid formulations in the management of acute pain in children while at home. Questions about the long-term effect of psychological interventions in the management of chronic pain and various pharmacological interventions to improve pain and symptom management in palliative care were among the 'top 10' priorities. The results of prioritisation were included in the UK Database of Uncertainties about the Effects of Treatments (DUETS) database. Increased awareness of priorities and priority-setting processes should encourage clinicians and other stakeholders to engage in such exercises in the future.

  16. Phase synchronization in electroencephalographic recordings prognosticates outcome in paediatric coma.

    Nenadovic, Vera; Perez Velazquez, Jose Luis; Hutchison, James Saunders


    Brain injury from trauma, cardiac arrest or stroke is the most important cause of death and acquired disability in the paediatric population. Due to the lifetime impact of brain injury, there is a need for methods to stratify patient risk and ultimately predict outcome. Early prognosis is fundamental to the implementation of interventions to improve recovery, but no clinical model as yet exists. Healthy physiology is associated with a relative high variability of physiologic signals in organ systems. This was first evaluated in heart rate variability research. Brain variability can be quantified through electroencephalographic (EEG) phase synchrony. We hypothesised that variability in brain signals from EEG recordings would correlate with patient outcome after brain injury. Lower variability in EEG phase synchronization, would be associated with poor patient prognosis. A retrospective study, spanning 10 years (2000-2010) analysed the scalp EEGs of children aged 1 month to 17 years in coma (Glasgow Coma Scale, GCS, <8) admitted to the paediatric critical care unit (PCCU) following brain injury from TBI, cardiac arrest or stroke. Phase synchrony of the EEGs was evaluated using the Hilbert transform and the variability of the phase synchrony calculated. Outcome was evaluated using the 6 point Paediatric Performance Category Score (PCPC) based on chart review at the time of hospital discharge. Outcome was dichotomized to good outcome (PCPC score 1 to 3) and poor outcome (PCPC score 4 to 6). Children who had a poor outcome following brain injury secondary to cardiac arrest, TBI or stroke, had a higher magnitude of synchrony (R index), a lower spatial complexity of the synchrony patterns and a lower temporal variability of the synchrony index values at 15 Hz when compared to those patients with a good outcome.

  17. Phase synchronization in electroencephalographic recordings prognosticates outcome in paediatric coma.

    Vera Nenadovic

    Full Text Available Brain injury from trauma, cardiac arrest or stroke is the most important cause of death and acquired disability in the paediatric population. Due to the lifetime impact of brain injury, there is a need for methods to stratify patient risk and ultimately predict outcome. Early prognosis is fundamental to the implementation of interventions to improve recovery, but no clinical model as yet exists. Healthy physiology is associated with a relative high variability of physiologic signals in organ systems. This was first evaluated in heart rate variability research. Brain variability can be quantified through electroencephalographic (EEG phase synchrony. We hypothesised that variability in brain signals from EEG recordings would correlate with patient outcome after brain injury. Lower variability in EEG phase synchronization, would be associated with poor patient prognosis. A retrospective study, spanning 10 years (2000-2010 analysed the scalp EEGs of children aged 1 month to 17 years in coma (Glasgow Coma Scale, GCS, <8 admitted to the paediatric critical care unit (PCCU following brain injury from TBI, cardiac arrest or stroke. Phase synchrony of the EEGs was evaluated using the Hilbert transform and the variability of the phase synchrony calculated. Outcome was evaluated using the 6 point Paediatric Performance Category Score (PCPC based on chart review at the time of hospital discharge. Outcome was dichotomized to good outcome (PCPC score 1 to 3 and poor outcome (PCPC score 4 to 6. Children who had a poor outcome following brain injury secondary to cardiac arrest, TBI or stroke, had a higher magnitude of synchrony (R index, a lower spatial complexity of the synchrony patterns and a lower temporal variability of the synchrony index values at 15 Hz when compared to those patients with a good outcome.

  18. Medical management of paediatric burn injuries: best practice.

    Kim, Leo K P; Martin, Hugh C O; Holland, Andrew J A


    Burns commonly occur in children and their first aid remains inadequate despite burn prevention programmes. While scald injuries predominate, contact and flame burns remain common. Although typically less severe injuries overall than those in adults, hypertrophic scarring complicating both the burn wound and even donor sites occur more frequently in children. The heterogeneous nature of burn wounds, coupled with the difficulties associated with the early clinical assessment of burn depth, has stimulated the application of novel technologies to predict burn wound outcome. This review explores current best practice in the management of paediatric burns, with a focus on prevention, optimal first aid, resuscitation, burn wound prediction and wound management strategies.

  19. Transition of care from paediatric to adult rheumatology.

    McDonagh, Janet E


    The origin of paediatric rheumatology in the UK mainly lies in adult rheumatology and this has proved invaluable in terms of transition provision, education and training, and collaborative research. The last 5 years have seen adolescent rheumatology gather momentum with the creation of an objective evidence base, a sound foundation for future work addressing the many unanswered questions and hypotheses in the area of transitional care. The aim of this paper is to review the evidence supporting the recent developments in transitional care within rheumatology. Acknowledging the non-categorical nature of transition, the author will also refer to evidence from other chronic illnesses which has informed these developments.

  20. Paediatric post-traumatic cortical defects of the distal radius

    Roach, Richard T.; Summers, Bruce N. [Department of Orthopaedics, Princess Royal Hospital, Telford (United Kingdom); Cassar-Pullicino, Victor [Department of Radiology, Robert Jones and Agnes Hunt Hospital, Oswestry, Shropshire (United Kingdom)


    Paediatric post-traumatic cortical defects, although rare, are predominately seen affecting the distal radius following a greenstick or torus fracture. We review the literature and present a further two cases supported by CT and MRI. Images from an acute greenstick fracture are also presented to help understand the pathogenesis. Defects are typically solitary on plain radiographs and are usually noticed late, proximal to the site of compression. They are non-expansile in an otherwise healthy child. CT and MRI may reveal smaller multiple subperiosteal defects. Typical defects require no further management other than reassurance and advice that they may occasionally cause discomfort but resolve with time. (orig.)

  1. Defective Natural Killer cell antiviral capacity in paediatric HBV infection

    Heiberg, Ida Louise; Laura J., Pallett; Winther, Thilde Nordmann


    cell frequency, phenotype and function in HBV-infected children relative to uninfected children. We observed a selective defect in NK cell IFN-γ production, with conserved cytolytic function, mirroring the functional dichotomy observed in adult infection. Reduced expression of NKp30 on NK cells...... suggests a role of impaired NK-Dendritic Cell (DC) cellular interactions as a potential mechanism leading to reduced IFN-γ production. The finding that NK cells are already defective in paediatric CHB, albeit less extensively than in adult CHB, has potential implications for the timing of antiviral therapy...

  2. Hantavirus Pulmonary Syndrome: Report of the First Canadian Paediatric Case

    Bonita E Lee


    Full Text Available Hantavirus pulmonary syndrome (HPS was first recognized as a severe respiratory illness transmitted through rodent excreta in the southwestern United States in 1993. As of November 1997, 175 cases have been reported in the United States. The mortality rate of this disease has been reported to be as high as 52% in the United States, and the majority of the cases (94% involved adults. Twenty-one cases have been recognized in Canada. This paper describes the first Canadian paediatric case and discusses some of the clinical features of this disease.

  3. Opportunities of psychosocial mHealth interventions in paediatric cancer

    Carmina Castellano-Tejedor


    Full Text Available Paediatric patients diagnosed with cancer will experience a myriad of different physical and psychological disturbances and/or sequelae, secondary to their disease and treatment. Concerning mental health, it is common that a sizable amount of them will experience some level of distress, feelings of fear, uncertainty about recurrence or progression, and also certain degree of grief and loss. Despite these being normal and expected reactions to cancer if circumscribed and time-limited, recent review studies indicate that up to 40% of oncology patients will end up developing depression

  4. Cystic change in primary paediatric optic nerve sheath meningioma.

    Narayan, Daniel; Rajak, Saul; Patel, Sandy; Selva, Dinesh


    Primary optic nerve sheath meningiomas (PONSM) are rare in children. Cystic meningiomas are an uncommon subgroup of meningiomas. We report a case of paediatric PONSM managed using observation alone that underwent cystic change and radiological regression. A 5-year-old girl presented with visual impairment and proptosis. Magnetic resonance (MR) imaging demonstrated a PONSM. The patient was left untreated and followed up with regular MR imaging. Repeat imaging at 16 years of age showed the tumour had started to develop cystic change. Repeat imaging at 21 years of age showed the tumour had decreased in size.




    Full Text Available ABSTRACT: Ovarian tumors are r are in children and constitute 1% of all childhood malignancies and 8% of abdominal tumors. Large cysts and those complicated by torsion make their presence clear by their symptomatology. However, ovarian pathology is still mostly discovered at laparotomy for presumptive appendicitis. Accurate diagnosis of these tumors at such a young age is a great challenge to surgeons and pathologists. This article reviews the clinical presentation, radiological imaging, gross and histopathological findings at the Pathol ogy Department of a Paediatric Referral centre in Hyderabad

  6. Migraine & paediatric obesity: a plausible link?

    Sarit Ravid


    Full Text Available Obesity and migraine are both highly prevalent disorders in the general population, influenced by genetic and environmental risk factors. In recent studies, obesity was found to be a strong risk factor for transformed migraine and, among migraineurs, obesity was associated with frequent headaches and higher disability scores. Suggested mechanisms included: (i obesity as a pro-inflammatory state may be associated with neurovascular inflammation in patients with migraine; (ii elevated levels of plasma calcitonin gene-related peptide (CGRP in obese individuals may play a role as an important post-synaptic mediator of trigeminovascular inflammation in migraine; (iii dismodulation in the hypothalamic neuropeptide, orexin, in obese persons may be associated with increased susceptibility to neurogenic inflammation causing migraine attacks; and (iv leptin and adiponectin can activate proinflammatory cytokine release that is involved in the pathogenesis of migraine. In addition, both conditions are associated with psychiatric co-morbidities, such as depression and anxiety, that can further increase headache frequency and disability. Therefore, the effect of obesity on migraine outcome is important. Weight and BMI should be measured and calculated in all children presenting with migraine, and weight control should be a part of the treatment.

  7. The HOPE (Helping to Outline Paediatric Eating Disorders) Project: development and debut of a paediatric clinical eating disorder registry


    Background The HOPE (Helping to Outline Paediatric Eating Disorders) Project is an ongoing registry study made up of a sequential cross-sectional sample prospectively recruited over 17 years, and is designed to answer empirical questions about paediatric eating disorders. This paper introduces the HOPE Project, describes the registry sample to-date, and discusses future directions and challenges and accomplishments. The project and clinical service were established in a tertiary academic hospital in Western Australia in 1996 with a service development grant. Research processes were inbuilt into the initial protocols and data collection was maintained in the following years. Recognisable progress with the research agenda accelerated only when dedicated research resources were obtained. The registry sample consists of consecutive children and adolescents assessed at the eating disorder program from 1996 onward. Standardised multidisciplinary data collected from family intake interview, parent and child clinical interviews, medical review, parent, child and teacher psychometric assessments, and inpatient admission records populate the HOPE Project database. Results The registry database to-date contains 941 assessments, of whom 685 met DSM-IV diagnostic criteria for an eating disorder at admission. The majority of the sample were females (91%) from metropolitan Perth (83%). The cases with eating disorders consist of eating disorders not otherwise specified (68%), anorexia nervosa (25%) and bulimia nervosa (7%). Among those with eating disorders, a history of weight loss since illness onset was almost universal (96%) with fear of weight gain (71%) common, and the median duration of illness was 8 months. Conclusions Over the next five years and more, we expect that the HOPE Project will make a strong scientific contribution to paediatric eating disorders research and will have important real-world applications to clinical practice and policy as the research unfolds

  8. Autoimmune hepatitis from the paediatric perspective.

    Roberts, Eve A


    Autoimmune hepatitis (AIH) is an important entity within the broad spectrum of autoimmune hepatobiliary disease comprised of AIH, primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC). Since the 1960s, AIH has been investigated with extensive clinical research aimed at effective therapeutic intervention. It was one of the first liver diseases where treatment was demonstrated to prolong survival. AIH occurs in children, as well as in adults. Its clinical manifestations in children may differ from classic adult AIH. These differences have elucidated certain aspects of AIH and hepatobiliary disease in general. There are two major patterns of AIH: type 1, with anti-smooth muscle antibodies and type 2, with anti-liver/kidney microsomal antibodies. The second type of AIH was first identified in children and is more common in younger patients. AIH often presents as acute disease in children and also in adults: the nomenclature has dropped the allusion to chronicity. Some children who have sclerosing cholangitis present with clinical disease closely resembling AIH; this AIH-like PSC, termed autoimmune sclerosing cholangitis (ASC), is also found in adults. Children with AIH may have identifiable monogenic disorders of immune regulation such as autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED). Like adults with AIH, children with AIH usually respond very favourably to immunosuppressive treatment with corticosteroids ± azathioprine. True cures seem to be rare, although many children achieve a stable remission. Nonetheless children with AIH may develop cirrhosis and some require liver transplantation. Early diagnosis and improved treatment strategies may further improve the outlook for children with AIH.

  9. Outcomes of moderate sedation in paediatric dental patients.

    Özen, B; Malamed, S F; Cetiner, S; Özalp, N; Özer, L; Altun, C


    The aim of this study was to evaluate the outcomes of moderate sedation with nitrous oxide/oxygen (N(2) O/O(2)) alone or combined with different dosages and administration routes of midazolam in uncooperative paediatric dental patients using the Bispectral Index System (BIS). This one-year clinical study examined first-visit moderate sedation performed in 240 healthy children aged 4-6 years. Subjects were randomly divided into four groups according to drug, route and dosage, as follows: Group 1 - 0.20 mg/kg midazolam (40 mg/ml) delivered intranasally; Group 2 - 0.75 mg/kg midazolam (15 mg/3 ml) delivered orally; Group 3 - 0.50 mg/kg midazolam (15 mg/3 ml) delivered orally. All children in these three groups also received inhalation sedation with 50%-50% N(2) O/O(2), whereas children in Group 4 received inhalation sedation with 50%-50% N(2) O/O(2) only. The outcome of sedation was evaluated as either 'successful', 'failed' or 'not accepted'. The highest success rate was found in Group 1 (0.20 mg/kg intranasally, 87%), followed by Group 2 (0.75 mg/kg orally, 79%). The overall mean success rate for all groups was 73%. Moderate sedation can be successfully used in the clinical management of paediatric dental patients, with both intranasal and oral sedation using midazolam in conjunction with nitrous oxide found to be effective methods. © 2012 Australian Dental Association.

  10. Psychosocial factors and treatment adherence in paediatric HIV/AIDS.

    Naar-King, S; Arfken, C; Frey, M; Harris, M; Secord, E; Ellis, D


    A social ecological model provides a promising framework for understanding the individual, family, and societal factors contributing to non-adherence to treatment of paediatric HIV. This study explored which factors relevant to this model are associated with caregivers' adherence and child health outcomes. A cross-sectional design was utilized to assess relationships among current individual, familial, extra-familial factors, caregiver adherence, and viral load. Data were collected from 43 caregivers, and viral load data were obtained from the medical records of their HIV+ children. Caregiver drug and alcohol use and HIV+ status were associated with non-adherence and elevated viral load. Negative outcome expectancy was associated with lower adherence but was not significant in the multivariate analyses. Family factors were not significant, but these measures had low reliability in this sample. Extra-familial factors such as dissatisfaction with medical specialty care and more stressful life events were not directly associated with adherence but were related to increased caregiver substance use. Results of this first study to explore multiple predictors of adherence and health outcomes in paediatric HIV require replication with larger samples, but findings suggest caregiver characteristics that place children at risk for disease progression due to poor adherence to treatment.

  11. The Extent of Consumer Product Involvement in Paediatric Injuries

    Jesani Catchpoole


    Full Text Available A challenge in utilising health sector injury data for Product Safety purposes is that clinically coded data have limited ability to inform regulators about product involvement in injury events, given data entry is bound by a predefined set of codes. Text narratives collected in emergency departments can potentially address this limitation by providing relevant product information with additional accompanying context. This study aims to identify and quantify consumer product involvement in paediatric injuries recorded in emergency department-based injury surveillance data. A total of 7743 paediatric injuries were randomly selected from Queensland Injury Surveillance Unit database and associated text narratives were manually reviewed to determine product involvement in the injury event. A Product Involvement Factor classification system was used to categorise these injury cases. Overall, 44% of all reviewed cases were associated with consumer products, with proximity factor (25% being identified as the most common involvement of a product in an injury event. Only 6% were established as being directly due to the product. The study highlights the importance of utilising injury data to inform product safety initiatives where text narratives can be used to identify the type and involvement of products in injury cases.

  12. The Extent of Consumer Product Involvement in Paediatric Injuries.

    Catchpoole, Jesani; Walker, Sue; Vallmuur, Kirsten


    A challenge in utilising health sector injury data for Product Safety purposes is that clinically coded data have limited ability to inform regulators about product involvement in injury events, given data entry is bound by a predefined set of codes. Text narratives collected in emergency departments can potentially address this limitation by providing relevant product information with additional accompanying context. This study aims to identify and quantify consumer product involvement in paediatric injuries recorded in emergency department-based injury surveillance data. A total of 7743 paediatric injuries were randomly selected from Queensland Injury Surveillance Unit database and associated text narratives were manually reviewed to determine product involvement in the injury event. A Product Involvement Factor classification system was used to categorise these injury cases. Overall, 44% of all reviewed cases were associated with consumer products, with proximity factor (25%) being identified as the most common involvement of a product in an injury event. Only 6% were established as being directly due to the product. The study highlights the importance of utilising injury data to inform product safety initiatives where text narratives can be used to identify the type and involvement of products in injury cases.

  13. Persistent disruption of ciliated epithelium following paediatric lung transplantation.

    Thomas, Biju; Aurora, Paul; Spencer, Helen; Elliott, Martin; Rutman, Andrew; Hirst, Robert A; O'Callaghan, Christopher


    It is unclear whether ciliary function following lung transplantation is normal or not. Our aim was to study the ciliary function and ultrastructure of epithelium above and below the airway anastomosis and the peripheral airway of children following lung transplantation. We studied the ciliary beat frequency (CBF) and beat pattern, using high speed digital video imaging and ultrastructure by transmission electron microscopy, of bronchial epithelium from above and below the airway anastomosis and the peripheral airway of 10 cystic fibrosis (CF) and 10 non-suppurative lung disease (NSLD) paediatric lung transplant recipients. Compared to epithelium below the anastomosis, the epithelium above the anastomosis in the CF group showed reduced CBF (median (interquartile range): 10.5 (9.0-11.4) Hz versus 7.4 (6.4-9.2) Hz; pepithelium above the anastomosis, the epithelium below the anastomosis showed marked ultrastructural abnormalities (median duration post-transplant 7-12 months). Ciliary dysfunction is a feature of native airway epithelium in paediatric CF lung transplant recipients. The epithelium below the airway anastomosis shows profound ultrastructural abnormalities in both CF and NSLD lung transplant recipients, many months after transplantation.

  14. Liver transplantation in children using organs from young paediatric donors.

    Herden, Uta; Ganschow, Rainer; Briem-Richter, Andrea; Helmke, Knut; Nashan, Bjoern; Fischer, Lutz


    Nowadays, most paediatric liver transplant recipients receive a split or other technical variant graft from adult deceased or live donors, because of a lack of available age- and size matched paediatric donors. Few data are available, especially for liver grafts obtained from very young children (transplantations between 1989 and 2009. Recipients were divided into five groups (1-5) depending on donor age (transplantations from deceased donors were performed; 1- and 5-year graft survival rates were 75%, 80%, 78%, 81%, 74% and 75%, 64%, 70%, 67%, 46%, and 1- and 5-year patient survival rates were 88%, 91%, 90%, 89%, 78% and 88%, 84%, 84%, 83%, 63% for groups 1-5, respectively, without significant difference. Eight children received organs from donors younger than 1 year and 45 children received organs from donors between 1 and 6 years of age. Overall, vascular complications occurred in 13.2% of patients receiving organs from donors younger than 6 years. Analysis of our data revealed that the usage of liver grafts from donors younger than 6 years is a safe procedure. The outcome was comparable with grafts from older donors with excellent graft and patient survival, even for donors younger than 1 year.

  15. Headache in the paediatrics patients, clinical-EEG Correlation.

    Marcelino Lizano Rabelo


    Full Text Available A descriptive study was made, with the objective to describe to a clinical group of variables epidemiologists and of laboratory of 108 patients to whom it was made to them and EEG and whose fundamental symptom was the headache; in the period January to December of 2009. The data was taken from the registry of patients of the neurophysiology department of Paediatric Hospital. The variables of the study were: age, sex, type of headache, results of the EEG, and characteristics of pathological EEG activity. The results were expressed in graphical and analyzed tables and of percentage form. The patients of 14 to 16 years predominated (40,7%, female patient (53,7%, clinically the observed recurrent acute migraine in 60 cases was the one that prevailed, as well as normality in the EEG (81,5%, the pathological cases we observed focal paroxysms in 15 patients (75% and focal alterations in 80% of the pathological EEG. Conclusions: In our environment the migraine in the paediatric patient is a frequent pathology that motivates the accomplishment of diverse studies among them the EEG, being this normal one in most of the cases and the non-specific alterations, the recurrent acute migraine and female patients prevailed.

  16. Correlation of Clinicohaematological Parameters in Paediatric Dengue: A Retrospective Study

    Ramakrishna Pai Jakribettu


    Full Text Available Dengue is one of the arthropod-borne (arbo viral diseases transmitted by female mosquito Aedes aegypti. Dengue fever has a wide spectrum of clinical presentation ranging from flu-like illness to severe complicated stage of dengue hemorrhagic fever leading to mortality. This was a retrospective study conducted in a tertiary care hospital in Coastal Karnataka, South India, to know the correlation between the clinical presentation and haematological parameters in the paediatric cases presented with dengue symptoms. A total of 163 paediatric cases who presented fever and dengue-like illness were included in the study. Of which, 69 were confirmed dengue patients. Critical analysis showed that there was a significant difference in the haematological parameters like total leucocyte count, percent differential leucocyte count, and platelets count, in the erythrocyte sedimentation rate (P<0.05 to 0.0001. Additionally, when compared to nondengue patients, even the liver function and renal function parameters were significantly deranged (P<0.05 to 0.0001. Stratification based on NS1, IgG, and IgM showed significant alterations in the haematological, hepatic, and renal parameters. With respect to the treatment a small percentage of patients, that is, 8% (4 patients, required platelet transfusion as their counts went below 20,000/μL. Two patients succumbed to their illness while three required ICU stay.

  17. Neonatology/Paediatrics – Guidelines on Parenteral Nutrition, Chapter 13

    Fusch, C.


    Full Text Available There are special challenges in implementing parenteral nutrition (PN in paediatric patients, which arises from the wide range of patients, ranging from extremely premature infants up to teenagers weighing up to and over 100 kg, and their varying substrate requirements. Age and maturity-related changes of the metabolism and fluid and nutrient requirements must be taken into consideration along with the clinical situation during which PN is applied. The indication, the procedure as well as the intake of fluid and substrates are very different to that known in PN-practice in adult patients, e.g. the fluid, nutrient and energy needs of premature infants and newborns per kg body weight are markedly higher than of older paediatric and adult patients. Premature infants <35 weeks of pregnancy and most sick term infants usually require full or partial PN. In neonates the actual amount of PN administered must be calculated (not estimated. Enteral nutrition should be gradually introduced and should replace PN as quickly as possible in order to minimise any side-effects from exposure to PN. Inadequate substrate intake in early infancy can cause long-term detrimental effects in terms of metabolic programming of the risk of illness in later life. If energy and nutrient demands in children and adolescents cannot be met through enteral nutrition, partial or total PN should be considered within 7 days or less depending on the nutritional state and clinical conditions.

  18. Nonoriginal Malappropriate Eponymous Nomenclature: examples relevant to paediatric orthopaedics.

    Aresti, Nick; Ramachandran, Manoj


    Eponyms are widely used in medicine and their use has been the subject of much debate recently. Advocates stress their historical significance, their ability to simplify complex terminology and their addition of character to science. Opponents cite the controversy among those eponyms and highlight the lack of both scientific and historical accuracy. The law of Nonoriginal Malappropriate Eponymous Nomenclature (NOMEN) suggests that no phenomenon is named after the individual(s) who originally described it. We aimed to determine whether this law is applicable to various clinical conditions and signs relevant to paediatric orthopaedics. We selected a series of 10 eponyms and performed a thorough literature review. In all cases, a description was identified preceding that from whom the disease received its eponymous name. We were also able to identify what we believe to be the earliest recorded description of each disease and sign. Our examples confirm the law of NOMEN in the field of paediatric orthopaedics. We suggest that irregularities in the descriptions and meanings of eponyms are identified and updated. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

  19. Key drivers of patient experience in ambulatory paediatric cardiology.

    Allam, Shalini D; Mehta, Mary; Ben Khallouq, Bertha; Burrows, James F; Rosen, Paul


    Patient experience is becoming a central focus of healthcare. A broad range of studies on how to increase patient satisfaction ratings exists; however, they lack the specificity to adequately guide physicians and hospitals on how to improve patient experience. The objective of this study was to define the aspects of patient experience within paediatric cardiologist practices that can serve as predictors of excellent patient satisfaction. From 1 January, 2013 to 28 February, 2015 (26 months), outpatients who visited paediatric cardiologists were asked to complete a 39-question patient satisfaction survey regarding their experience. Surveys were collected over a 26-month period by Press Ganey, an independent provider of patient satisfaction surveys. Participants were asked to rate their experience on a 1-5 Likert-scale: a score of 1 demonstrated a "poor" experience, whereas a score of 5 demonstrated a "very good" experience. This retrospective study of 2468 responses determined that cheerfulness of the practice (r=0.85, pexperience is vital to achieve greater patient satisfaction and, ultimately, better patient outcomes.

  20. Global health: A lasting partnership in paediatric surgery

    Kokila Lakhoo


    Full Text Available Background: To emphasise the value of on-going commitment in Global Health Partnerships. Materials and Methods: A hospital link, by invitation, was set up between United Kingdom and Tanzania since 2002. The project involved annual visits with activities ranging from exchange of skill to training health professionals. Furthermore, the programme attracted teaching and research activities. For continuity, there was electronic communication between visits. Results: Six paediatric surgeons are now fully trained with three further in training in Africa. Paediatric surgery services are now separate from adult services. Seven trainee exchanges have taken place with four awarded fellowships/scholarships. Twenty-three clinical projects have been presented internationally resulting in eight international publications. The programme has attracted other health professionals, especially nursing and engineering. The Tropical Health and Education Trust prize was recently achieved for nursing and radiography. National Health Service has benefited from volunteering staff bringing new cost-effective ideas. A fully funded medical student elective programme has been achieved since 2008. Conclusion: Global Health Partnerships are an excellent initiative in establishing specialist services in countries with limited resources. In the future, this will translate into improved patient care as long as it is sustained and valued by long term commitment.

  1. Australian paediatric hyperbaric oxygen therapy 1998-2011.

    Frawley, G; Bennett, M; Thistlethwaite, K; Banham, N


    For a large number of ischaemic, infective, inflammatory or traumatic conditions, hyperbaric oxygen therapy is either the only treatment or an adjunct that significantly reduces morbidity and mortality. The primary aim of this review is to identify clinical conditions treated in a paediatric population referred to Australian hyperbaric units. Secondary aims are to describe outcomes of treatment and detail any complications occurring during treatment or during transfer between units. This was a retrospective cohort study (January 1998-December 2011) of children treated at four Australian hyperbaric medical units. A total of 112 children underwent 1099 hyperbaric treatments for 14 indications. Ages were not normally distributed with a median age of 14 years (interquartile range 11-16; range 0.25-16 years). Treatments were completed as planned in 81.5% of cases with 25 patients' treatment terminated at the request of physicians, parents or patients. Complications relating to hyperbaric oxygen therapy occurred in 58 treatments (5.3%). Central nervous system oxygen toxicity occurred in 1:366 treatments. Our findings indicate that provision of hyperbaric oxygen therapy to children is feasible in major regional hyperbaric units and is associated with low complication rates. Management of children in an adult hyperbaric facility, however, requires significant cooperation between paediatric, intensive care and hyperbaric consultants, as the need for transfer to another hospital and prolonged transports often impacts on optimal ongoing surgical and intensive care management.

  2. Discrimination of paediatric brain tumours using apparent diffusion coefficient histograms

    Bull, Jonathan G.; Clark, Christopher A. [UCL Institute of Child Health, Imaging and Biophysics Unit, London (United Kingdom); Saunders, Dawn E. [Great Ormond Street Hospital for Children NHS Trust, Department of Radiology, London (United Kingdom)


    To determine if histograms of apparent diffusion coefficients (ADC) can be used to differentiate paediatric brain tumours. Imaging of histologically confirmed tumours with pre-operative ADC maps were reviewed (54 cases, 32 male, mean age 6.1 years; range 0.1-15.8 years) comprising 6 groups. Whole tumour ADC histograms were calculated; normalised for volume. Stepwise logistic regression analysis was used to differentiate tumour types using histogram metrics, initially for all groups and then for specific subsets. All 6 groups (5 dysembryoplastic neuroectodermal tumours, 22 primitive neuroectodermal tumours (PNET), 5 ependymomas, 7 choroid plexus papillomas, 4 atypical teratoid rhabdoid tumours (ATRT) and 9 juvenile pilocytic astrocytomas (JPA)) were compared. 74% (40/54) were correctly classified using logistic regression of ADC histogram parameters. In the analysis of posterior fossa tumours, 80% of ependymomas, 100% of astrocytomas and 94% of PNET-medulloblastoma were classified correctly. All PNETs were discriminated from ATRTs (22 PNET and 4 supratentorial ATRTs) (100%). ADC histograms are useful in differentiating paediatric brain tumours, in particular, the common posterior fossa tumours of childhood. PNETs were differentiated from supratentorial ATRTs, in all cases, which has important implications in terms of clinical management. (orig.)

  3. External validation of the paediatric risk of malignancy index.

    Hermans, A J; Kluivers, K B; Massuger, L F; Coppus, S F


    This study aimed to validate the paediatric risk of malignancy index (PRMI), as previously published. External validation study. Academic hospital: Radboud University Medical Center. Female paediatric patients under the age of 18 years diagnosed with, or treated for, an adnexal mass between January 1999 and October 2013. Information was collected on diagnosis, presenting symptoms, and signs and imaging characteristics. The PRMI was calculated for each patient. Sensitivity, specificity, and positive and negative predictive values were calculated, and the results were visualised using a receiver operating characteristic curve (ROC curve). Histological diagnosis, discriminative performance using the area under the curve (AUC) of the ROC curve and sensitivity and specificity. Seventy-eight patients were included, with a median age of 12 years. A malignant mass was found in 17 patients (21.8%). The PRMI with a cut-off value of 7 resulted in a sensitivity of 70.1% (95% CI 44.1-89.6%) and a specificity of 85.3% (95% CI 73.8-93.0%). The area under the ROC curve was 0.868 (95% CI 0.756-0.980). The PRMI showed less discriminative capacity than originally published, but its performance was still good; however, further prospective validation studies are needed to define whether the model is useful in daily clinical practice. © 2015 Royal College of Obstetricians and Gynaecologists.

  4. [Epidemiology and bacteriological diagnosis of paediatric acute osteoarticular infections].

    Ferroni, A


    Acute paediatric osteo-articular infections require a fast and sensitive diagnosis allowing a treatment directed to the causative pathogen. Many micro-organisms can be incriminated, but Staphylococcus aureus and Kingella kingae markedly prevail. K. kingae became the first bacterial species responsible for septic arthritis in children septic arthritis relies upon analysis of articular fluid, which requires systematic inoculation of a blood culture vial to increase the recovery rate of K. kingae. If the culture is negative, it is recommended to carry out a universal PCR or a PCR targeted to the main germs responsible for septic arthritis. Indeed, PCR represents an undeniable benefice for the diagnosis of paediatric septic arthritis, particularly for the DNA detection of K. kingae. The diagnosis of acute osteomyelitis relies primarily upon blood cultures, since the bone puncture is not a systematic procedure in this setting. Their efficiency is low, and there is still a need to look for other arguments of diagnosis such as search of possible portals of entry or specific serologies.

  5. The return of individual research findings in paediatric genetic research.

    Hens, Kristien; Nys, Herman; Cassiman, Jean-Jacques; Dierickx, Kris


    The combination of the issue of return of individual genetic results/incidental findings and paediatric biobanks is not much discussed in ethical literature. The traditional arguments pro and con return of such findings focus on principles such as respect for persons, autonomy and solidarity. Two dimensions have been distilled from the discussion on return of individual results in a genetic research context: the respect for a participant's autonomy and the duty of the researcher. Concepts such as autonomy and solidarity do not fit easily in the discussion when paediatric biobanks are concerned. Although parents may be allowed to enrol children in minimal risk genetic research on stored tissue samples, they should not be given the option to opt out of receiving important health information. Also, children have a right to an open future: parents do not have the right to access any genetic data that a biobank holds on their children. In this respect, the guidelines on genetic testing of minors are applicable. With regard to the duty of the researcher the question of whether researchers have a more stringent duty to return important health information when their research subjects are children is more difficult to answer. A researcher's primary duty is to perform useful research, a policy to return individual results must not hamper this task. The fact that vulnerable children are concerned, is an additional factor that should be considered when a policy of returning results is laid down for a specific collection or research project.

  6. Measurement of effective dose for paediatric scoliotic patients

    Lee, Chih-I. [School of Medical Radiation Sciences, University of Sydney, Lidcombe NSW 1825 (Australia); McLean, Donald [School of Medical Radiation Sciences, University of Sydney, Lidcombe NSW 1825 (Australia)]. E-mail:; Robinson, John [School of Medical Radiation Sciences, University of Sydney, Lidcombe NSW 1825 (Australia)


    Purpose: Paediatric radiation dose from scoliosis X-ray examinations is of concern because of its routine nature. Few studies have calculated effective dose which is the primary indicator of radiation risk. This study reports on the use of a new flexible Monte Carlo software package PCXMC14 for such calculation from documented radiographic and patient data. Method: Patient and radiographic data were collected from 54 patient examinations for both postero-anterior (PA) and lateral X-ray projections. A spreadsheet mainly based on radiographic calibration was used to process the raw data and compute entrance air kerma for input in the PCXMC program. A partitioning model was developed to more accurately estimate the effect of an aluminium wedge filter. Results: Results showed the effective dose ranged from 81 to 123 {mu}Sv for the PA projection and 124 to 207 {mu}Sv for the lateral projection, with patient weights varying from 20 to 70 kg. Conclusions: This study demonstrates the usefulness of the PCXMC program to evaluate the effective dose in paediatric scoliosis radiography.

  7. New viral gastrointestinal agents associated with paediatrics illness

    Sara Giordana Rimoldi


    Full Text Available Objective Aim of our study was investigate the presence of enteric viruses like Norovirus, Bocavirus and Rotavirus in hospitalized children belong to Paediatrics Clinics of L. Sacco Hospital. Material and methods 150 faecal samples were investigated from January 2008- 2009, by PCR real time for Norovirus and Bocavirus; Rotavirus was detected by enzyme immunoassay. Results We obtain a positive result on total samples in percentage of 36%: Rotaviruses are estimated to cause more than 20% of gastroenteritis cases; Noroviruses 7.3% cases; Bocaviruses 6.6% cases. Rotaviruses infections occurred in children 1-4 years of age and for 2 cases at 7 and 13 years old. Illness typically happened in the cooler months from January to March even if there were few positive cases in September/October. Noroviruses and Bocaviruses infections occurred in children 1-2 years of age and their seasonality were respectively from September to December and from January to March for Bocaviruses. Conclusions The present results point out the importance to detect new viral gastrointestinal agents associated with paediatric illness.

  8. The emerging global epidemic of paediatric inflammatory bowel disease--causes and consequences.

    Malmborg, P; Hildebrand, H


    Two decades ago, paediatric inflammatory bowel disease (IBD) drew only modest interest from the international paediatric community. Since then, dramatically globally increasing incidence rates have made childhood-onset IBD a priority for most paediatric gastroenterologists. The emerging pandemia of paediatric IBD has fuelled a quest to identify the recent changes in early life exposures that could explain the increasing risk for IBD amongst today's children. Treatment of children with IBD should aim for symptom control but should also target restoration of growth and prevention of pubertal delay. The paediatric IBD phenotype seems to be characterized by more extensive disease location, and some comparative studies have suggested that childhood-onset IBD also represents a more severe phenotype than the adult-onset IBD form. In this review, we analyse recent global incidence trends of paediatric IBD. We present an update on the known and suggested risk factors that could explain the emerging global epidemia of paediatric IBD. We also draw attention to differences in treatment between children and adults with IBD. Finally, we highlight latest follow-up studies that question the proposed dynamic and aggressive nature of childhood-onset IBD.

  9. Statement of principles on the return of research results and incidental findings in paediatric research: a multi-site consultative process.

    Sénécal, Karine; Rahimzadeh, Vasiliki; Knoppers, Bartha M; Fernandez, Conrad V; Avard, Denise; Sinnett, Daniel


    This paper proposes a set of recommendations for the return of research results and incidental findings in paediatrics. The Network of Applied Genetic Medicine of Quebec spearheaded the initiative to develop the Statement of Principles on the Return of Research Results and Incidental Findings, which was the result of a consultation process with clinical and research experts in the field. To formulate the Statement of Principles, the authors (i) reviewed empirical and grey literature on the return of research results and incidental findings in Europe and Canada, (ii) conducted a qualitative study of stakeholder groups, (iii) developed, and (iv) validated the recommendations through consultations with the stakeholder groups. The Statement of Principles provides a useful disclosure tool for deciding when, and under what circumstances to return research results and incidental findings. It addresses the issue of return of results in genetic research generally, and has also specific principles for various research contexts, including paediatric research. It delineates ethical issues unique to paediatric research, and provides a framework to guide research ethics committees as well as the research community in addressing these issues.

  10. Teaching paediatric resuscitation skills in a developing country: introduction of the Advanced Paediatric Life Support course into Vietnam.

    Young, Simon; Hutchinson, Adrian; Nguyen, Van Tu; Le, Thanh Hai; Nguyen, Dich Van; Vo, Thi Kim Hue


    In 2001, a nationwide study revealed deficiencies in the emergency care of seriously ill and injured children in Vietnam. In response, a project was initiated to conduct the Advanced Paediatric Life Support course in Vietnam and ascertain whether this course would provide a practical and sustainable method of improving the knowledge and skills of medical and nursing staff in this area. After approval to use the course was secured and funding obtained, the project commenced in 2003. Key Vietnamese personnel travelled to Australia to complete the course, undertake instructor training and gain organizational experience. Teaching materials were translated, reviewed and modified to account for local diseases and clinical practices while maintaining the fundamental principles of the parent course. Commencing in March 2004, 10 courses were conducted by Australian and Vietnamese instructors, training 239 doctors and nurses from a wide variety of clinical backgrounds. Additionally, three instructor courses were conducted, training 52 new instructors. As the skill and confidence of the Vietnamese instructors grew, the number and responsibilities of the international faculty reduced. The infrastructure now exists for the course to operate in a sustainable fashion within Vietnam. We believe that this project demonstrates that the course can be successfully modified to provide teaching in paediatric emergency care in a developing country.

  11. [Age-dependent visceral medicine: paediatric visceral medicine - visceral medical paediatrics - considerations on the short bowel syndrome in childhood].

    Krause, H; Heiduk, M; Wachowiak, R; Till, H


    There are several reasons for the possible development of a short bowel syndrome, which, however, occurs only rarely. The main causes consist of extended intestinal resections in cases of congenital anomalies (e.g., gastroschisis, intestinal atresia or dysplasia) or ischaemic lesions due to a volvulus. In addition, an intestinal stoma at a more upper segment of the GI tract can result in the functional manifestation of a short bowel syndrome. The differentiation between temporary and persisting types is essential for initiation of an adequate treatment. Loss or exclusion of organic resorption area at the inner surface of the (small) intestine can be associated with numerous pathological consequences requiring treatment. As a principle consideration from the paediatric point of view, the potential of intestinal adaptation needs to be assessed. Basic conservative treatment options are parenteral and enteral nutrition regimens, in particular, to prevent complications (such as D-lactate acidosis). The main surgical approaches are the procedures called LILT (longitudinal intestinal lengthening and tailoring) according to Bianchi and STEP (serial transverse enteroplasty). The technique to create intestinal segments of antiperistalsis has been abandoned. Because of the encouraging results of intestinal transplantation, this novel treatment option has gained greater attention over the past few years and is now also an option for paediatric patients. The limiting factor and thus major complication is the central venous catheter for long-term treatment. Catheter-related complications are still the main reason for a considerable mortality in these children.

  12. The efficacy of an extended scope physiotherapy clinic in paediatric orthopaedics.

    O Mir, Marie


    The demand for paediatric orthopaedic care is growing, and providing the service required is an increasingly challenging task. Physiotherapist-led triage clinics are utilised in adult orthopaedics to enable the provision of care to patients who may not require a surgical consult. The Physiotherapy Orthopaedic Triage Clinic (POTC) was established in Our Lady\\'s Children\\'s Hospital Crumlin in response to increasing demands on the paediatric orthopaedic service. The clinic is run by physiotherapists working in an advanced practice role (APP), and is the first paediatric clinic of its type and scale in the Republic of Ireland.

  13. Paediatric leptospirosis: A population based case-control study from Chennai, India.

    Narayanan, R; Sumathi, G; Prabhakaran, S G; Shanmughapriya, S; Natarajaseenivasan, K


    The surveillance in Chennai identified 134 children and 443 adults clinically suspected for leptospirosis. Of these, 35 (26.1%) children and 118 (26.6%) adults had laboratory confirmed diagnosis for leptospirosis. The paediatric leptospirosis exhibited a higher frequency of classic features of Weil's disease. The prevalent serovar encountered was Icterohaemorrhagiae with no difference in the pattern of infecting serovars between the two groups. Further, confirmation of diagnosis was achieved by polymerase chain reaction (PCR) with a positivity of 28.4% (specificity 96%). Univariate analysis showed significant association of paediatric leptospirosis with rat infestation (odds ratio 87.4). Thus, PCR facilitates early diagnosis of febrile illness among paediatric cases.

  14. Differences in phenotype and disease course in adult and paediatric inflammatory bowel disease

    Jakobsen, Christian; Bartek, Jiri; Wewer, Anne Vibeke;


    Background Few studies have compared phenotype and disease course in children and adults with inflammatory bowel disease (IBD). Aim To compare phenotype, treatment and disease course in children (IBD. Methods Two population-based cohorts comprising paediatric...... or disease course. Cumulative 5-year surgery rates for paediatric and adult patients were 5% and 9% for UC (N.S.) and 18% and 21% for CD (N.S.), respectively. Conclusions Paediatric UC patients had more extensive disease, were more often treated with systemic steroids and AZA, had a higher frequency...

  15. The BRACELET Study: surveys of mortality in UK neonatal and paediatric intensive care trials

    Platt Martin


    Full Text Available Abstract Background The subject of death and bereavement in the context of randomised controlled trials in neonatal or paediatric intensive care is under-researched. The objectives of this phase of the Bereavement and RAndomised ControlLEd Trials (BRACELET Study were to determine trial activity in UK neonatal and paediatric intensive care (2002-06; numbers of deaths before hospital discharge; and variation in mortality across intensive care units and trials and to determine whether bereavement support policies were available within trials. These are essential prerequisites to considering the implications of future policies and practice subsequent to bereavement following a child's enrolment in a trial. Methods The units survey involved neonatal units providing level 2 or 3 care, and paediatric units providing level II care or above; the trials survey involved trials where allocation was randomized and interventions were delivered to intensive care patients, or to parents but designed to affect patient outcomes. Results Information was available from 191/220 (87% neonatal units (149 level 2 or 3 care; and 28/32 (88% paediatric units. 90/177 (51% eligible responding units participated in one or more trial (76 neonatal, 14 paediatric and 54 neonatal units and 6 paediatric units witnessed at least one death. 50 trials were identified (36 neonatal, 14 paediatric. 3,137 babies were enrolled in neonatal trials, 210 children in paediatric trials. Deaths ranged 0-278 (median [IQR interquartile range] 2 [1, 14.5] per neonatal trial, 0-4 (median [IQR] 1 [0, 2.5] per paediatric trial. 534 (16% participants died post-enrolment: 522 (17% in neonatal trials, 12 (6% in paediatric trials. Trial participants ranged 1-236 (median [IQR] 21.5 [8, 39.8] per neonatal unit, 1-53 (median [IQR] 11.5 [2.3, 33.8] per paediatric unit. Deaths ranged 0-37 (median [IQR] 3.5 [0.3, 8.8] per neonatal unit, 0-7 (median [IQR] 0.5 [0, 1.8] per paediatric unit. Three trials had a

  16. Fast MR Imaging of the Paediatric Abdomen with CAIPIRINHA-Accelerated T1w 3D FLASH and with High-Resolution T2w HASTE: A Study on Image Quality

    Mengxia Li


    Full Text Available The aim of this study was to explore the applicability of fast MR techniques to routine paediatric abdominopelvic MRI at 1.5 Tesla. “Controlled Aliasing in Parallel Imaging Results in Higher Acceleration-” (CAIPIRINHA- accelerated contrast-enhanced-T1w 3D FLASH imaging was compared to standard T1w 2D FLASH imaging with breath-holding in 40 paediatric patients and to respiratory-triggered T1w TSE imaging in 10 sedated young children. In 20 nonsedated patients, we compared T2w TIRM to fat-saturated T2w HASTE imaging. Two observers performed an independent and blinded assessment of overall image quality. Acquisition time was reduced by the factor of 15 with CAIPIRINHA-accelerated T1w FLASH and by 7 with T2w HASTE. With CAIPIRINHA and with HASTE, there were significantly less motion artefacts in nonsedated patients. In sedated patients, respiratory-triggered T1w imaging in general showed better image quality. However, satisfactory image quality was achieved with CAIPIRINHA in two sedated patients where respiratory triggering failed. In summary, fast scanning with CAIPIRINHA and HASTE presents a reliable high quality alternative to standard sequences in paediatric abdominal MRI. Paediatric patients, in particular, benefit greatly from fast image acquisition with less breath-hold cycles or shorter sedation.

  17. Creating a unique, multi-stakeholder Paediatric Oncology Platform to improve drug development for children and adolescents with cancer.

    Vassal, Gilles; Rousseau, Raphaël; Blanc, Patricia; Moreno, Lucas; Bode, Gerlind; Schwoch, Stefan; Schrappe, Martin; Skolnik, Jeffrey; Bergman, Lothar; Bradley-Garelik, Mary Brigid; Saha, Vaskar; Pearson, Andy; Zwierzina, Heinz


    Seven years after the launch of the European Paediatric Medicine Regulation, limited progress in paediatric oncology drug development remains a major concern amongst stakeholders - academics, industry, regulatory authorities, parents, patients and caregivers. Restricted increases in early phase paediatric oncology trials, legal requirements and regulatory pressure to propose early Paediatric Investigation Plans (PIPs), missed opportunities to explore new drugs potentially relevant for paediatric malignancies, lack of innovative trial designs and no new incentives to develop drugs against specific paediatric targets are some unmet needs. Better access to new anti-cancer drugs for paediatric clinical studies and improved collaboration between stakeholders are essential. The Cancer Drug Development Forum (CDDF), previously Biotherapy Development Association (BDA), with Innovative Therapy for Children with Cancer Consortium (ITCC), European Society for Paediatric Oncology (SIOPE) and European Network for Cancer Research in Children and Adolescents (ENCCA) has created a unique Paediatric Oncology Platform, involving multiple stakeholders and the European Union (EU) Commission, with an urgent remit to improve paediatric oncology drug development. The Paediatric Oncology Platform proposes to recommend immediate changes in the implementation of the Regulation and set the framework for its 2017 revision; initiatives to incentivise drug development against specific paediatric oncology targets, and repositioning of drugs not developed in adults. Underpinning these changes is a strategy for mechanism of action and biology driven selection and prioritisation of potential paediatric indications rather than the current process based on adult cancer indications. Pre-competitive research and drug prioritisation, early portfolio evaluation, cross-industry cooperation and multi-compound/sponsor trials are being explored, from which guidance for innovative trial designs will be

  18. Magnetic resonance imaging based functional imaging in paediatric oncology.

    Manias, Karen A; Gill, Simrandip K; MacPherson, Lesley; Foster, Katharine; Oates, Adam; Peet, Andrew C


    Imaging is central to management of solid tumours in children. Conventional magnetic resonance imaging (MRI) is the standard imaging modality for tumours of the central nervous system (CNS) and limbs and is increasingly used in the abdomen. It provides excellent structural detail, but imparts limited information about tumour type, aggressiveness, metastatic potential or early treatment response. MRI based functional imaging techniques, such as magnetic resonance spectroscopy, diffusion and perfusion weighted imaging, probe tissue properties to provide clinically important information about metabolites, structure and blood flow. This review describes the role of and evidence behind these functional imaging techniques in paediatric oncology and implications for integrating them into routine clinical practice. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Health-e-Child a grid platform for european paediatrics

    Skaburskas, K; Shade, J; Manset, D; Revillard, J; Rios, A; Anjum, A; Branson, A; Bloodsworth, P; Hauer, T; McClatchey, R; Rogulin, D


    The Health-e-Child (HeC) project [1], [2] is an EC Framework Programme 6 Integrated Project that aims to develop a grid-based integrated healthcare platform for paediatrics. Using this platform biomedical informaticians will integrate heterogeneous data and perform epidemiological studies across Europe. The resulting Grid enabled biomedical information platform will be supported by robust search, optimization and matching techniques for information collected in hospitals across Europe. In particular, paediatricians will be provided with decision support, knowledge discovery and disease modelling applications that will access data in hospitals in the UK, Italy and France, integrated via the Grid. For economy of scale, reusability, extensibility, and maintainability, HeC is being developed on top of an EGEE/gLite [3] based infrastructure that provides all the common data and computation management services required by the applications. This paper discusses some of the major challenges in bio-medical data integr...

  20. Unusual presentations of osteoarticular tuberculosis in two paediatric patients

    Cheung, Jason Pui Yin; Ho, Kenneth Wai Yip; Lam, Ying Lee; Shek, Tony Wai Hung


    Tuberculosis is a universal mimicker and thus could be a differential diagnosis of any osteolytic lesion. Bone biopsy is crucial in these cases for culture and histological proof of tuberculous infection. This is a case report of two paediatric patients with unusual presentations of tuberculosis. One patient presented with knee pain and had imaged findings of an osteolytic lesion at the epiphysis. Interval scan showed spread of the lesion through the physis to the metaphyseal region. The second patient presented with hip pain and an osteolytic lesion of the acetabulum. He was subsequently found to have involvement of the brain and spine as well. Both patients were diagnosed with tuberculosis by bone biopsy for culture and pathological examination. They were treated successfully with antituberculous medications without chronic sequelae. These two patients showed that early recognition and prompt treatment are critical for management of tuberculosis to avoid chronic sequelae. PMID:23087272

  1. Urinary catheter related nosocomial infections in paediatric intensive care unit.

    Tullu M


    Full Text Available The present prospective study was carried out in the Paediatric Intensive Care Unit (PICU of a tertiary care teaching hospital in Mumbai. The objective was to determine the incidence, risk factors, mortality and organisms responsible for urinary catheter related infections (UCRI. Colonization and/or bacteriuria was labelled as urinary catheter related infection (UCRI. Forty-four patients with 51 urinary catheters were studied. Incidence of UCRI was 47.06%. Age, female sex and immunocompromised status did not increase the risk of UCRI. Duration of catheter in-situ and duration of stay in the PICU were associated with higher risk of UCRI. The mortality was not increased by UCRI. Commonest organism isolated in UCRI was E. coli, which had maximum susceptibility to nitrofurantoin and amikacin.

  2. PET/CT in paediatric malignancies - An update

    Subramanyam Padma


    Full Text Available 18F-fluorodeoxyglucose positron emission tomography (FDG-PET is a well-established imaging modality in adult oncological practice. Its role in childhood malignancies needs to be discussed as paediatric malignancies differ from adults in tumor subtypes and they have different tumor biology and FDG uptake patterns. This is also compounded by smaller body mass, dosimetric restrictions, and physiological factors that can affect the FDG uptake. It calls for careful planning of the PET study, preparing the child, the parents, and expertise of nuclear physicians in reporting pediatric positron emission tomography/computed tomography (PET/CT studies. In a broad perspective, FDG-PET/CT has been used in staging, assessment of therapy response, identifying metastases and as a follow-up tool in a wide variety of pediatric malignancies. This review outlines the role of PET/CT in childhood malignancies other than hematological malignancies such as lymphoma and leukemia.

  3. Pioneers of paediatrics: Professor Salah Abdelrahman Ali Taha


    This article highlights the contributions of Professor Salah Abdelrahman Ali Taha (1927–1988), one of the pioneers in paediatrics in Sudan and Saudi Arabia. He graduated from Kitchener School of Medicine (renamed, Faculty of Medicine, University of Khartoum[U of K]) in 1952 and was awarded an MD from the U of K in 1973, having accomplished a survey on the prevalence and underlying causes of childhood malnutrition in 14 villages. His impact was remarkable in establishing child health services in Sudan and Saudi Arabia, and in laying the foundation of the Department of Pediatrics, College of Medicine, King Saud University. He was also an active researcher in various fields in child health, and was pioneering in those related to nutrition. Following his return to Sudan, Dr Salah A Taha was elected Member of Parliament from his rural district in Gezira State and was the Speaker of the House of Parliament in 1986. PMID:27493360

  4. [Use of inflammatory markers for monitoring paediatric asthma].

    Vidal G, Alberto


    The assessment of asthma control takes into account the symptoms, quality of life, lung function, and inflammatory markers. In the last few years, there has been a large increase in the number of publications related to the study of biomarkers in the management of paediatric asthma. Despite the large variety of inflammatory markers described in research studies, only a small group has shown to be useful in monitoring the disease. Induced sputum eosinophils offer the most solid evidence in assessing asthma control. Exhaled breath condensate and urinary leucotrienes could be useful in the future if there is standardisation in their procedures and interpretation of the results. Nitric oxide, basic eosinophil cationic protein, and bronchial biopsy with bronchoalveolar lavage, only appeared to be useful in a reduced group of patients. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Managing dysphonia in paediatric patients with complex airway conditions.

    Ojha, S; Setlur, J; Bunting, G; Hartnick, C J


    To suggest a phonosurgical management strategy that can be used for children who have previously undergone laryngotracheal reconstruction. This cases series describes three children who presented with complex, multi-level airway stenosis and marked dysphonia. Phonosurgical intervention involved endoscopic and open approaches, and was combined with voice therapy. A phonosurgical reconstruction management algorithm is suggested for evaluating and treating these complex conditions. Pre-operative assessment is critical, and should involve voice analysis and glottal anatomy assessment using office laryngoscopy and stroboscopy. The risks must be weighed up against the benefit of vocal improvement. Surgical intervention should involve combined endoscopic and open approaches. Voice restoration after paediatric airway reconstruction is a complex challenge. Surgical intervention should be conducted in a step-by-step manner to reduce the risk of worsening dysphonia and airway compromise. The risks and benefits must be carefully explored and discussed.

  6. Recommended Nordic paediatric reference intervals for 21 common biochemical properties

    Hilsted, Linda; Rustad, Pål; Aksglæde, Lise;


    Abstract Paediatric reference intervals based on samples from healthy children are difficult to establish and consequently data are often from hospitalized children. Furthermore, biases may present in published data due to differences in the analytical methods employed. Blood samples from 1429...... healthy Danish children were collected for establishing reference intervals for 21 common biochemical properties (Alanine transaminase, Albumin, Alkaline phosphatase, Aspartate transaminase, Bilirubin, Calcium, Cholesterol, Creatinine, Creatine kinase, HDL-Cholesterol, Iron, Lactate dehydrogenase, LDL...... values of X for the properties and statistical calculations carried out as performed in the NORIP study. Thus commutable (regarding analytical method) reference intervals for 20 properties were established and for LDL-Cholesterol reference intervals were reported for the specific analytical method...

  7. Normal perinatal and paediatric postmortem magnetic resonance imaging appearances

    Arthurs, Owen J. [Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London (United Kingdom); UCL Institute of Child Health, London (United Kingdom); Barber, Joy L. [Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London (United Kingdom); Taylor, Andrew M. [Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London (United Kingdom); UCL Institute of Cardiovascular Science, Centre for Cardiovascular Imaging, London (United Kingdom); Sebire, Neil J. [UCL Institute of Child Health, London (United Kingdom); Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London (United Kingdom)


    As postmortem imaging becomes more widely used following perinatal and paediatric deaths, the correct interpretation of images becomes imperative, particularly given the increased use of postmortem magnetic resonance imaging. Many pathological processes may have similar appearances in life and following death. A thorough knowledge of normal postmortem changes is therefore required within postmortem magnetic resonance imaging to ensure that these are not mistakenly interpreted as significant pathology. Similarly, some changes that are interpreted as pathological if they occur during life may be artefacts on postmortem magnetic resonance imaging that are of limited significance. This review serves to illustrate briefly those postmortem magnetic resonance imaging changes as part of the normal changes after death in fetuses and children, and highlight imaging findings that may confuse or mislead an observer to identifying pathology where none is present. (orig.)

  8. Sideroblastic anaemia. A review of seven paediatric cases.

    Hamel, B C; Schretlen, E D


    Sideroblastic Anaemias are characterised by a) chronic hypochromic anemia, b) ringed sideroblasts in the bone marrow, c) an increase in total body iron, d) ineffective erythropoiesis and e) often abnormal concentrations of F.E.P. A classification of Sideroblastic Anaemia is given and the pathophysiology of Sideroblastic Anaemia is discussed. A series of seven paediatric cases with Sideroblastic Anaemia is presented and the results of studies of the iron, vitamin B6 and porphyrin metabolism are discussed. In two cases arguments for an ALA-synthetase deficiency are given. All five males were diagnosed as hereditary X-linked Sideroblastic Anaemia, one female as I.R.S.A. and the other female, who showed the features of the X-linked type, as congenital Sideroblastic Anaemia.

  9. Prevention of measles spread on a paediatric ward.

    Tapisiz, A; Polat, M; Kara, S S; Tezer, H; Simsek, H; Aktas, F


    Since measles is a highly contagious respiratory infection with significant airborne transmission risk in hospitals, effective prevention measures are crucial. After a mother accompanying her child on a paediatric ward lacking a negative pressure room was diagnosed with measles, exposed persons without evidence of immunity (documentary evidence of receiving two doses of measles-mumps-rubella vaccine) were treated with vaccination or intravenous immunoglobulin (IVIG). The interruption of transmission with these treatments was evaluated. There were 44 children and 101 adults exposed to the index patient. Twenty-five children and 88 adults were considered immune, providing evidence of immunity. Nineteen children and 13 adults were either given vaccination or IVIG for post-exposure prophylaxis (PEP). There were no additional cases of measles after 3 weeks follow-up. We conclude that measles is highly preventable by adequate PEP with vaccination or IVIG in a healthcare setting that lacks the benefit of a negative pressure room.

  10. Trichilemmal Cyst of the Penis in a Paediatric Patient

    Samuel Madan


    Full Text Available Paediatric penile cysts are uncommon. We report a five-year-old child with an asymptomatic progressively growing cyst on the ventral aspect of the penis after a hypospadias repair. The patient presented to the Cooper Health Clinic, Dubai, United Arab Emirates, in March 2012. A complete excision of the cyst was performed. Histology results delineated a capsulated benign trichilemmal cyst. No recurrence or complications were reported in the 26 months following the excision. We recommend an early and complete excision of all penile cysts to prevent the risk of urethral obstruction, infection, inflammation and rare malignant changes. This is the first reported case of a penile trichilemmal cyst in a child.

  11. Hospital to home paediatric enteral nutrition--parents need support.

    Shortall, C


    This study assessed the provision of education and support to parents of children on home enteral nutrition (HEN), current dietetic support available and perceived challenges facing parents and carers. From the 39 responses (13%), 29 (83%, n = 35) parents suggested services for HEN need improvement. 29 (74%, n = 39) parents wanted more structured follow up and 22 (56%) would like one person to co-ordinate HEN, education and discharge. 7 parents (18%) reported a need for further education of health care professionals (HCP). Hospital dietitians were the most common HCPs reported to provide support to patients following discharge. Specialist paediatric HEN dietetic services working in a dedicated HEN team, who would provide accurate training and education and liaise with both parents and community care services post discharge should be in place. This would facilitate transfer to community care, reduce hospital re-admissions, outpatient department attendances and costs.

  12. Mental health problems among nurses in paediatric cardiac intensive care.

    Tito, Renata Santos; Baptista, Patrícia Campos Pavan; da Silva, Fabio José; Felli, Vanda Elisa Andres


    At present, there are growing rates of psychiatric symptoms among some occupational categories, with emphasis on health professionals who work in hospitals. This study aimed to identify the occurrence of mental health problems (anxiety and depression) among 92 nursing workers in a paediatric cardiac intensive care unit. This is an exploratory, cross-sectional study, with a quantitative approach. The research was conducted in a public university hospital specialising in cardiology, pneumology, and thoracic and cardiac surgery. The data were collected between June and July of 2012 through socio-demographic and Self-Reporting Questionnaire (SRQ-20) instruments. The analysis of the results revealed the occurrence of mental health problems in 45% (41) of the workers. There was the prevalence of tension, nervousness and worry symptoms, followed by headache. Findings highlight the need for protective measures towards the mental health of workers who assist children with serious heart disease.

  13. Zinc in hair and urine of paediatric patients.

    van Wouwe, J P; de Wolff, F A; van Gelderen, H H


    Zinc concentrations in hair and urine were measured in groups of children varying in one condition - short stature, or after prolonged upper respiratory infection, or during non-infectious diarrhea, or while on chemotherapy for acute lymphatic leukaemia and in healthy controls. As compared with controls, hair zinc was significantly low after respiratory infection (p less than 0.0001) and high in short stature (p less than 0.01). Urinary zinc was increased during initial chemotherapy (p less than 0.001) and diarrhea (p less than 0.02). It is shown that zinc deficiency occurs in one of the common symptoms in paediatric medicine, namely upper respiratory tract infection. The high overlap (34-88%) proves hair and urine zinc to be of no use for reliable individual diagnostic statements.

  14. The Paediatric Surgeon in Africa: Luxury or necessity G.P. (Larry ...



    Dec 2, 2004 ... training who allowed me to develop an interest ... training in the surgical diseases of childhood. Paediatric Surgeons ... As clinicians concerned with the welfare of children it is .... national budgets, they reflect the real poverty of.

  15. The use of diverting colostomies in paediatric peri-anal burns ...


    Aug 3, 2013 ... bacterial profile of the burn wounds, wound healing, graft take and ... 2 Department of Paediatric Surgery, University of Cape Town and Red Cross War Memorial .... nursing. In 2 children the colostomy was sited in a recently.

  16. Pattern of Paediatric OpI2tba1micAdmissi012s

    Onabolu OO. Pattern of Paediatric Ophthalmic Admissions into the Ogun State University ... per cent) and tumours, (15 per cent) were the four main groups of ocular diseases seen. Measles infection was .... right sided abdominal mass. He died ...

  17. Pattern of paediatric emergencies and outcome as seen in a teritary ...

    Background: The pattern of diseases in many resource-poor countries has changed in ... there has been increasing incidences of non-communicable diseases. ... of paediatric diseases and outcome as seen in a children emergency unit.

  18. Post-neonatal medical admissions into the paediatric ward of Ebonyi ...

    The youngest child was six weeks old and the oldest, 15 years; 69.1 percent were ... Conclusion: The morbidity and mortality in the children were mostly due to infectious and communicable diseases. ... Nigerian Journal of Paediatrics Vol.

  19. Psychostimulant prescribing trends in a paediatric population in Ireland: a national cohort study

    Boland, Fiona; Galvin, Rose; Reulbach, Udo; Motterlini, Nicola; Kelly, Dervla; Bennett, Kathleen; Fahey, Tom


    Psychotropic paediatric prescribing trends are increasing internationally. The aim of this study is to examine the prevalence and secular trends in psychotropic prescribing in Irish children and adolescents between 2002 and 2011...


    Sugumari Chandrasegaran; Mahesh Prabhu Subramaniyan


    PURPOSE To assess the prevalence of Streptococcal sore throat infections in the paediatric age group in order to provide prompt treatment at an early stage to reduce the fatal consequences of post-infectious sequelae...

  1. 1H magnetic resonance spectroscopy of the brain in paediatrics: The diagnosis of creatine deficiencies

    Sijens, P.E.; Oudkerk, M.


    The diagnosis of creatine deficiencies, a paediatric application of magnetic resonance spectroscopy that has already become a diagnostic tool in clinical practice, is reviewed and illustrated with results from recent examinations

  2. Rational use of diagnostic imaging in paediatrics. The report of a World Health Organization study group

    Merten, D.F.; Palmer, P.E.S.; Sweet, E.M.; Fendel, H.; Faure, C.; Fujioka, M.


    The purpose of WHO Technical Report 757 is to provide guidance to physicians who must decide what imaging techniques are best suited to specific clinical problems in paediatric practice, and to those who perform these various diagnostic procedures.

  3. Radiation burden to paediatric patients due to micturating cystourethrography examinations in a Dutch children's hospital

    Schultz, F.W.; Geleijns, J.; Holscher, H.C.; Weststrate, J.; Zonderland, H.M.; Zoetelief, J.


    Micturating cystourethrography (MCU) examinations of paediatric patients in a major Dutch children's hospital (JKZ) were evaluated to generate quantitative information on effective dose (E). A standard examination involves three radiographs plus fluoroscopy. Observed total dose-area product (DAP) fo

  4. Oral manifestation of HIV/AIDS infections in paediatric Nigerian patients

    Adebola, Adetokunbo Rafel; Adeleke, Solomon Ibiyemi; Mukhtar, Maryam; Osunde, Otasowie Daniel; Akhiwu, Benjamin Idemudia; Ladeinde, Akinola


    The aims of this study were to determine the pattern and frequency of oral lesions and to compare the prevalence of HIV-related oral lesions in paediatric Nigerian patients on HAART with those not on HAART...

  5. 1H magnetic resonance spectroscopy of the brain in paediatrics: The diagnosis of creatine deficiencies

    Sijens, P.E.; Oudkerk, M.


    The diagnosis of creatine deficiencies, a paediatric application of magnetic resonance spectroscopy that has already become a diagnostic tool in clinical practice, is reviewed and illustrated with results from recent examinations

  6. The relevance of the Goudge inquiry to the practice of child protection/forensic paediatrics.

    Skellern, Catherine; Donald, Terence


    In 2008 Ontario, Canada the Goudge Inquiry arose following increasing concerns about practices surrounding forensic pathology and the investigation of paediatric deaths. Some of the considerations and recommendations have relevance to child protection/forensic paediatricians, particularly in relation to their responsibilities in opinion formulation and as expert witnesses. By examining the Inquiry recommendations, this paper applies them in relation to child protection/forensic paediatrics by discussing forensic medicine and its legal context, how interpretation of published reports and data should be used in opinion formulation; issues of 'diagnosis' versus 'opinion'; issues specific to child protection paediatrics; quality control; aspects of report writing and terminological considerations. It concludes with an adaptation of key recommendations directly from those of Goudge, applied to the context of paediatric forensic medicine undertaken in child protection assessments.

  7. Pharmacy and formulation support for paediatric clinical trials in England.

    Wan, Mandy; Al Hashimi, Ali; Batchelor, Hannah


    Availability and sourcing of investigational drugs for paediatric clinical trials is known to be a challenge for investigator-led clinical trials. The National Institute of Health Research Clinical Research Network: Children (CRN: Children) provides support for formulations and pharmacy related issues to researchers planning and setting up paediatric clinical trials within England. This paper reviews pharmacy and formulation support provided to a consecutive series of investigator-led clinical studies supported by CRN:Children. Case studies are included to describe some of the unique pharmaceutical challenges encountered. 44 trials were reviewed and a total of 103 products were required to support these clinical trials. UK authorised products were suitable for use for 62 of these 103 products. In the remaining 41 cases, 4 could be sourced as an authorised product within the European Union and the remaining 37 required bespoke manufacture. Bespoke manufacture of an investigational drug or placebo is costly. Typical costs for the initial development and testing of a bespoke investigational drug or placebo were in the range of £30,000-100,000 per product. The estimated cost for 19 out of 45 trials was available; in summary, the costs on a per patient per day of therapy basis ranged from under £1 to almost £600; short studies involving multiple agents are obviously the most expensive. This range is dependent upon the need for bespoke manufacture and also the number of participants within the trial. The arrangements for investigational drug supply can greatly affect the study design, regulatory requirements, trial logistics, as well as the total cost of research. As investigational product related activities are often costly, necessitating months of advance planning, it is imperative that specialist inputs are sought from the very start of the study design and planning process. Copyright © 2016 Elsevier B.V. All rights reserved.

  8. Burden of paediatric influenza in Western Europe: a systematic review

    Antonova Evgeniya N


    Full Text Available Abstract Background Influenza illness in children causes significant clinical and economic burden. Although some European countries have adopted influenza immunisation policies for healthy children, the debate about paediatric influenza vaccination in most countries of the European Union is ongoing. Our aim was to summarise influenza burden (in terms of health outcomes and economic burden in children in Western Europe via a systematic literature review. Methods We conducted a systematic literature search of PubMed, EMBASE, and the Cochrane Library (1970-April 2011 and extracted data on influenza burden in children (defined as aged ≤ 18 years from 50 publications (13 reporting laboratory-confirmed influenza; 37 reporting influenza-like illness. Results Children with laboratory-confirmed influenza experienced hospitalisations (0.3%-20%, medical visits (1.7-2.8 visits per case, antibiotic prescriptions (7%-55%, and antipyretic or other medications for symptomatic relief (76%-99%; young children and those with severe illness had the highest rates of health care use. Influenza in children also led to absenteeism from day care, school, or work for the children, their siblings, and their parents. Average (mean or median length of absence from school or day care associated with confirmed influenza ranged from 2.8 to 12.0 days for the children, from 1.3 to 6.0 days for their siblings, and from 1.3 to 6.3 days for their parents. Influenza negatively affected health-related quality of life in children with asthma, including symptoms and activities; this negative effect was smaller in vaccinated children than in non-vaccinated children. Conclusions Influenza burden in children is substantial and has a significant direct impact on the ill children and an indirect impact on their siblings and parents. The identified evidence regarding the burden of influenza may help inform both influenza antiviral use in children and paediatric immunisation policies in

  9. Profile of urinary tract infections in paediatric patients

    Palak Gupta


    Full Text Available Background & objectives: This cross-sectional study was conducted at a tertiary care centre in Puducherry, south India, with the aim of finding the profile of the paediatric urinary tract infection (UTI, bacterial pathogens involved, and also to observe vesicoureteric reflux (VUR and renal scarring in these patients. Methods: A total of 524 paediatric patients ≤13 yr, suspected to have UTI, were included in the study. Urine samples were collected, processed for uropathogen isolation and antibiotic susceptibility test was performed as per the Clinical and Laboratory Standards Institute (CLSI guidelines. Thirty two culture proven children with UTI underwent micturating cysto-urethrography (MCU and dimercaptosuccinic acid (DMSA scanning was done for 69 children. Results: o0 f the 524 children, 186 (35.4% had culture proven UTI with 105 (56.4% being infants, 50 (27.4% between 1-5 yr, 30 (16.12% between 5-13 yr and 129 (69.35% males. Posterior urethral valve (PUV was noted in three, hydronephrosis in one, VUR in 18 and renal scarring in 33. VUR as well as renal scarring were more in males >1 yr of age. A significant association (P=0.0054 was noted with a combined sensitivity and specificity of these investigations being 83 and 90 per cent, respectively of the MCU and DMSA scans for detecting VUR. Escherichia coli was the most common pathogen isolated, sensitive to nitrofurantoin, followed by cefoperazone-sulbactam, aminoglycosides and meropenem. Interpretation & conclusions: Our results indicate that UTI varies with age and gender and extensive evaluation is required in boys under one year of age with UTI. This study also highlights the better efficacy of aminoglycosides, cefoperazone-sulbactam and nitrofurantoin in vitro compared with meropenem in Gram-negative uropathogens.

  10. Paediatric radiology. 2. enl. and tot. rev. ed.; Kinderradiologie

    Benz-Bohm, G. (ed.)


    This book presents a current, comprehensive and clearly written introduction to the often-neglected field of paediatric radiology, from important aspects of radiation protection to the specific anatomic features of the growing skeleton and the special anatomy of the thorax and abdomen of newborns and infants. Special knowledge is imparted on the radiology of trauma effects in infant age and the 'battered child syndrome'. The diseases and findings are presented in an organ-specific and topographic manner. There are special chapters on sonography, CT and MRT in infants. The structure of the book serves two purposes. First, the reader can obtain information on specific diseases; secondly, the particular features of examination techniques and the specifics of paediatric radiology are presented. (orig.) [German] Der grosse Umfang des Faches Radiologie hat schon vor vielen Jahren dazu gefuehrt, dass die Kinderradiologie als eigener Schwerpunkt eingerichtet und weiter entwickelt wurde. Bedeutung und Besonderheiten der Kinderradiologie werden aber dennoch in der Weiterbildung des Allgemeinradiologen nicht genuegend beruecksichtigt und gewuerdigt. Intensives Training und ausreichende eigene Erfahrung bei kinderradiologischen Untersuchungen sind nur bedingt gegeben bzw. werden in der Weiterbildung vermittelt. Umso wichtiger ist eine aktuelle, gruendliche und gut nachvollziehbare Aufarbeitung aller kinderradiologischen Themen zum Nachlesen und Nachschlagen. Dazu gehoert die Darstellung wichtiger Aspekte des Strahlenschutzes, die Eroerterung spezieller anatomischer Gegebenheiten des wachsenden Skeletts sowie der besonderen Anatomie von Thorax und Abdomen beim Saeugling und Kleinkind. Auch die Radiologie der Traumafolgen im Kindesalter und das ''Battered child syndrome'' verlangen besondere Expertise und Kenntnisse. Die Autoren haben alle fuer die Radiologie wesentlichen Erkrankungen des Kindesalters organbezogen bzw. topographisch aufgearbeitet

  11. 'Best interests' in paediatric intensive care: an empirical ethics study.

    Birchley, Giles; Gooberman-Hill, Rachael; Deans, Zuzana; Fraser, James; Huxtable, Richard


    In English paediatric practice, English law requires that parents and clinicians agree the 'best interests' of children and, if this is not possible, that the courts decide. Court intervention is rare and the concept of best interests is ambiguous. We report qualitative research exploring how the best interests standard operates in practice, particularly with decisions related to planned non-treatment. We discuss results in the light of accounts of best interests in the medical ethics literature. We conducted 39 qualitative interviews, exploring decision making in the paediatric intensive care unit, with doctors, nurses, clinical ethics committee members and parents whose children had a range of health outcomes. Interviews were audio-recorded and analysed thematically. Parents and clinicians indicated differences in their approaches to deciding the child's best interests. These were reconciled when parents responded positively to clinicians' efforts to help parents agree with the clinicians' view of the child's best interests. Notably, protracted disagreements about a child's best interests in non-treatment decisions were resolved when parents' views were affected by witnessing their child's physical deterioration. Negotiation was the norm and clinicians believed avoiding the courts was desirable. Sensitivity to the long-term interests of parents of children with life-limiting conditions is defensible but must be exercised proportionately. Current approaches emphasise negotiation but offer few alternatives when decisions are at an impasse. In such situations, the instrumental role played by a child's deterioration and avoidance of the courts risks giving insufficient weight to the child's interests. New approaches to decision making are needed. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  12. Paediatric bladder augmentation and substitution: From diversions to tissue engineering.

    Pike, John Grant


    To review the evolution of urinary diversion, bladder augmentation and bladder replacement in the paediatric population over the past century and to outline the possible direction of future management. Original and review articles obtained from a PubMed search of English language publications dating from 1970 to 2001. The search terms were "bladder augmentation", "bladder substitution", "bladder autoaugmentation", "ureterocystoplasty" and "bladder engineering". The age group was "all child 0-18". Articles selected were those with relevance to the scope of the topic. The articles were analyzed with the primary focus being the problems encountered with various forms of urinary diversion, bladder augmentation and bladder replacement, and the subsequent evolution of materials and techniques. Bladder tissue may need to be replaced in the paediatric population because of congenital malformation, disease or trauma. The unique structure and function of urothelium and bladder muscle make this a challenging task. Management has evolved from a mindset of attempting to divert urine from the bladder completely to that of trying to preserve what is salvageable of the organ. Historically and contemporarily, the gastrointestinal tract has provided the raw material for urinary diversion, bladder augmentation and bladder substitution. Experience, however, has highlighted the potential complications inherent in the use of the bowel in the urinary tract including mucus production, stone disease, metabolic abnormalities, growth retardation, spontaneous perforation and malignancy. However, despite these drawbacks, the bowel is the gold standard in terms of functional utility and longevity. In efforts to develop alternatives, research has focused on the use of both natural and synthetic materials. With these materials, a whole new list of potential problems has been characterized. Tissue engineering may hold promise in resolving the issues of bladder replacement or repair by providing

  13. Italian contributions to Turkish paediatrics during the Ottoman Empire.

    Yurdakok, Murat; Cataldi, Luigi


    The Ottoman Empire maintained close relations with the neighbouring Italian city states in the 16th and 17th century. Yacub Pasha (1425-1481), personal physician of Mehmed II the Conqueror, was an Italian Jew who advanced to the title of pasha and vizier. Domenico Hierosolimitano (ca. 1552-1622), the third physician to Sultan Murad III, was a Jerusalemite rabbi. His book is an important source about everyday life and medical practice in Istanbul at the time. Nuh bin Abd al-Mennab (1627-1707), also of Italian stock, was the Chief Physician of the Ottoman Empire, who translated a pharmacopoeia into Turkish. In the same century, two Italians, Israel Conegliano (Conian) and Tobia Cohen became private physicians to leading Ottoman pashas and the Grand Vizier. A. Vuccino (1829-1893) and Antoine Calleja Pasha (1806-1893) taught at the Istanbul Medical School. Italy was a favoured country for medical education during the early period of Ottoman westernisation. Sanizade Mehmet Ataullah Efendi (1771-1826) translated the first medical book printed in the Ottoman Empire from Italian into Turkish. Mustafa Behcet Efendi (1774-1833), chief physician to the Sultan and the founder of the first western medical school in Turkey, translated several medical books from Italian into Turkish. The first printed pharmacopeia in the Ottoman Empire was also originally Italian In the 19th century, Edouard Ottoni and his son Giuseppe Ottoni were well-known military pharmacists, both under the name of Faik Pasha. Probably the most influential physician of Italian origin was Giovanni Battista Violi (1849-1928), who had practiced paediatrics in Turkey for more than fifty years. Violi was the founder of the first children's hospital, the first vaccine institute, and the first paediatric journal in the Ottoman Empire.

  14. Surgical site infections in paediatric otolaryngology operative procedures.

    Ifeacho, S N; Bajaj, Y; Jephson, C G; Albert, D M


    An assessment of the rate of surgical site infections associated with elective paediatric otolaryngology surgical procedures. Prospective data was collected for a 3-week period for all children undergoing surgery where either mucosa or skin was breached. The parents of the children were requested to complete a questionnaire at 30 days after the operation. Data was collected on 80 consecutive cases. The majority of cases were admitted on the day of the procedure. The procedures included adenotonsillectomy (24), grommets (12), cochlear implantation (6), bone-anchored hearing aid (2), submandibular gland excision (1), branchial sinus excision (1), cystic hygroma excision (3), nasal glioma excision (1), microlaryngobronchoscopy (13), tracheostomy (3) and other procedures (14). Nearly half the cases had more than one operation done at the same time. 26/80 (32.5%) patients had a temporary or permanent implant inserted at the time of operation (grommet, bone-anchored hearing aid, cochlear implant). 25/80 (31%) operative fields were classed as clean and 55/80 (68.7%) as clean contaminated operations. The duration of the operation varied from 6 min to 142 min. Hospital antibiotic protocol was adhered to in 69/80 (86.3%) cases but not in 11/80 cases. In our series, 3/80 (3.7%) patients had an infection in the postoperative period. Surgical site infections do occur at an appreciable rate in paediatric otolaryngology. With the potential for serious consequences, reduction in the risk of surgical site infections is important. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  15. Radiation dose and image quality for paediatric interventional cardiology

    Vano, E [Radiology Department, Medicine School, Complutense University and San Carlos University Hospital, 28040 Madrid (Spain); Ubeda, C [Clinical Sciences Department, Faculty of the Science of Health, Tarapaca University, 18 de Septiembre 2222, Arica (Chile); Leyton, F [Institute of Public Health of Chile, Marathon 1000, Nunoa, Santiago (Chile); Miranda, P [Hemodynamic Department, Cardiovascular Service, Luis Calvo Mackenna Hospital, Avenida Antonio Varas 360, Providencia, Santiago (Chile)], E-mail:


    Radiation dose and image quality for paediatric protocols in a biplane x-ray system used for interventional cardiology have been evaluated. Entrance surface air kerma (ESAK) and image quality using a test object and polymethyl methacrylate (PMMA) phantoms have been measured for the typical paediatric patient thicknesses (4-20 cm of PMMA). Images from fluoroscopy (low, medium and high) and cine modes have been archived in digital imaging and communications in medicine (DICOM) format. Signal-to-noise ratio (SNR), figure of merit (FOM), contrast (CO), contrast-to-noise ratio (CNR) and high contrast spatial resolution (HCSR) have been computed from the images. Data on dose transferred to the DICOM header have been used to test the values of the dosimetric display at the interventional reference point. ESAK for fluoroscopy modes ranges from 0.15 to 36.60 {mu}Gy/frame when moving from 4 to 20 cm PMMA. For cine, these values range from 2.80 to 161.10 {mu}Gy/frame. SNR, FOM, CO, CNR and HCSR are improved for high fluoroscopy and cine modes and maintained roughly constant for the different thicknesses. Cumulative dose at the interventional reference point resulted 25-45% higher than the skin dose for the vertical C-arm (depending of the phantom thickness). ESAK and numerical image quality parameters allow the verification of the proper setting of the x-ray system. Knowing the increases in dose per frame when increasing phantom thicknesses together with the image quality parameters will help cardiologists in the good management of patient dose and allow them to select the best imaging acquisition mode during clinical procedures.

  16. Radiation dose and image quality for paediatric interventional cardiology

    Vano, E.; Ubeda, C.; Leyton, F.; Miranda, P.


    Radiation dose and image quality for paediatric protocols in a biplane x-ray system used for interventional cardiology have been evaluated. Entrance surface air kerma (ESAK) and image quality using a test object and polymethyl methacrylate (PMMA) phantoms have been measured for the typical paediatric patient thicknesses (4-20 cm of PMMA). Images from fluoroscopy (low, medium and high) and cine modes have been archived in digital imaging and communications in medicine (DICOM) format. Signal-to-noise ratio (SNR), figure of merit (FOM), contrast (CO), contrast-to-noise ratio (CNR) and high contrast spatial resolution (HCSR) have been computed from the images. Data on dose transferred to the DICOM header have been used to test the values of the dosimetric display at the interventional reference point. ESAK for fluoroscopy modes ranges from 0.15 to 36.60 µGy/frame when moving from 4 to 20 cm PMMA. For cine, these values range from 2.80 to 161.10 µGy/frame. SNR, FOM, CO, CNR and HCSR are improved for high fluoroscopy and cine modes and maintained roughly constant for the different thicknesses. Cumulative dose at the interventional reference point resulted 25-45% higher than the skin dose for the vertical C-arm (depending of the phantom thickness). ESAK and numerical image quality parameters allow the verification of the proper setting of the x-ray system. Knowing the increases in dose per frame when increasing phantom thicknesses together with the image quality parameters will help cardiologists in the good management of patient dose and allow them to select the best imaging acquisition mode during clinical procedures.

  17. Quadrennial review of a paediatric emergency assessment unit.

    Aitken, Penny; Birch, Simon; Cogman, Genevieve; Glasper, Edward A; Wiltshire, Maureen

    The primary aim of this article is to report on one aspect of a quadrennial study designed to explore the appropriateness and impact of the development of a paediatric emergency assessment unit (PEAU) as a response to increases in paediatric emergencies presenting to a south-western regional child health unit. In particular, this article will present the findings of a prospective audit of admissions to the PEAU over a 1-month period during the latter part of 2002. The primary method of data collection utilized a structured survey instrument developed using a design and automatic data computer software package, completed by the nursing staff. Anonymized descriptive data were obtained from 223 children admitted to the PEAU during one calendar moth and authorized by the appropriate clinical directorate audit committee as part of its ongoing commitment to the full implementation of clinical governance. The data presented primarily relate to children admitted during the official opening times of the PEAU, and those presenting out of hours. The data analysis demonstrates a reduction in the number of children staying overnight in hospital since the opening of the PEAU, with the majority of children being referred by their own family doctor. Only one child in the sample was readmitted to the PEAU within 24 hours, and two within 24 hours of discharge as inpatients. Although thought to be pertinent, only one child admitted after official closing of the PEAU and out of hours was described as being admitted for social reasons. The International Classification of Diagnosis (ICD) 10 (World Health Organization (WHO), 1994) classifications of the children admitted to the PEAU reflect those found in other similar studies. Overall, the results of this investigation demonstrate that a PEAU can offer an efficient service to GPs, families and others as a route of referral, thus mitigating unnecessary overnight stays for individual children.

  18. Epidemiology and management of paediatric head injury in eastern Nepal

    Agrawal A


    Full Text Available Background: In children, majority of the head injuries are minor and management of critically ill children depend on a team approach using well-rehearsed, systematic management protocols that can be implemented within hours after injury. This study was carried out to ascertain the epidemiology and management of know the demographic profile and etiology of paediatric head injury in our setting, to know the clinical and radiological characteristics of head injury patients and to know the treatment options and outcome in paediatric head injuries. Patients and Methods: Details of all children (age < 16 years with head injury seen in 1 year from 01.04.2005 to 31.03.2006 were retrospectively reviewed. Demographic profile, clinical details, investigations, treatment offered, and outcome were noted in a proforma. All data were analyzed by appropriate SPSS 11.0 statistical software tools. Results: There were total 43 patients. Young male children were more commonly affected in present series with a mean age of 7.67 years (median - 5.010 years, range 6 months-16 year. Fall (65.11% was the most common mode of injury followed by road traffic accidents (RTAs (25.6%. Mild head injuries (65.11% were most common. Most common complaint was loss of consciousness and all the patients with severe head injury presented loss of consciousness. All patients with mild head showed good recovery; with moderate head injury, nine patients showed good recovery and three patients recovered with moderate disability. Patients with severe head injury (three patients had 100% mortality. Conclusions: In urban areas of Nepal, RTAs like vehicular crashes, motor cycle accidents, and pedestrian hit by moving vehicle are more common and in rural areas fall from height are commoner. We need to develop child safety legislations and risk-specific intervention programs in Nepal.

  19. Paediatric rheumatology: a subspecialty in its infancy that is making leaps and bounds

    Ooi, Pei Ling; Shek, Lynette Pei-Chi


    Paediatric rheumatology is an exciting field exploding with new knowledge of autoimmune and autoinflammatory conditions and how to treat them. It is, however, a relatively new subspecialisation in Asia. There is thus a great need to educate the public and medical community about paediatric rheumatic diseases so that children with such conditions are given the highest possibility of achieving normal function in their daily lives. PMID:24862745

  20. Complication rate after circumcision in a paediatric surgical setting should not be neglected

    Thorup, Jørgen; Thorup, Sebastian Cortes; Ifaoui, Inge Botker Rasmussen


    As a consequence of the discussion on whether the health benefits of newborn male circumcision outweigh the risks and the discrepancies in reported figures of complications, we evaluated our results from a paediatric surgical department.......As a consequence of the discussion on whether the health benefits of newborn male circumcision outweigh the risks and the discrepancies in reported figures of complications, we evaluated our results from a paediatric surgical department....

  1. UK National Clinical Guidelines in Paediatric Dentistry: stainless steel preformed crowns for primary molars.

    Kindelan, S A; Day, P; Nichol, R; Willmott, N; Fayle, S A


    This revised Clinical Guideline in Paediatric Dentistry replaces the previously published sixth guideline (Fayle SA. Int J Paediatr Dent 1999; 9: 311-314). The process of guideline production began in 1994, resulting in first publication in 1997. Each guideline has been circulated widely for consultation to all UK consultants in paediatric dentistry, council members of the British Society of Paediatric Dentistry (BSPD), and to people of related specialities recognized to have expertise in the subject. The final version of this guideline is produced from a combination of this input and thorough review of the published literature. The intention is to encourage improvement in clinical practice and to stimulate research and clinical audit in areas where scientific evidence is inadequate. Evidence underlying recommendations is scored according to the SIGN classification and guidelines should be read in this context. Further details regarding the process of paediatric dentistry guideline production in the UK is described in the Int J Paediatr Dent 1997; 7: 267-268.

  2. Paediatric and congenital cardiac surgery in emerging economies: surgical 'safari' versus educational programmes.

    Corno, Antonio F


    To attract the interest of all people potentially involved in humanitarian activities in the emerging economies, in particular giving attention to the basic requirements of the organization of paediatric cardiac surgery activities, the requirements for a successful partnership with the local existing organizations and the basic elements of a patient-centred multidisciplinary integrated approach. Unfortunately, for many years, the interventions in the low and middle income countries were largely limited to short-term medical missions, not inappropriately nicknamed 'surgical safari', because of negative general and specific characteristics. The negative aspects and the limits of the short-term medical missions can be overcome only by long-term educational programmes. The most suitable and consistent models of long-term educational programmes have been combined and implemented with the personal experience to offer a proposal for a long-term educational project, with the following steps: (i) site selection; (ii) demographic research; (iii) site assessment; (iv) organization of surgical educational teams; (v) regular frequency of surgical educational missions; (vi) programme evolution and maturation; (vii) educational outreach and interactive support. Potential limits of a long-term educational surgical programme are: (i) financial affordability; (ii) basic legal needs; (iii) legal support; (iv) non-profit indemnification. The success should not be measured by the number of successful operations of any given mission, but by the successful operations that our colleagues perform after we leave. Considering that the children in need outnumber by far the people able to provide care, in this humanitarian medicine there should be plenty of room for cooperation rather than competition. The main goal should be to provide teaching to local staff and implement methods and techniques to support the improvement of the care of the patients in the long run. This review focuses on the

  3. Parental perceptions of giardiasis: a study in an outpatient paediatric hospital setting in havana, cuba.

    Almirall, Pedro; Escobedo, Angel A; Salazar, Yohana; Alfonso, Maydel; Avila, Ivonne; Cimerman, Sergio; Dawkins, Isabel V


    Background. Giardia lamblia is an important cause of diarrhoeal disease throughout the world. Giardiasis- a mild and self-limiting disease that this protozoan causes- is perceived as a harmful disease. Aim. To explore the general level of awareness about giardiasis, clinical features, mode of transmission, prevention, and consequences and describe the sources and channels of information caregivers would prefer using to be informed about this disease. Methods. A cross-sectional survey was conducted among caregivers attending to the outpatient paediatric hospital setting in Havana. Results. A total of 202 caregivers were interviewed. Nearly 73% considered giardiasis as a modern problem, and 39% considered that it could be a fatal disease. Although 76.7% were aware that small intestine is the organ affected, other localizations were cited. Abdominal pain and diarrhoea were recognized as the commonest symptoms. Around one-third could identify that giardiasis may spread through drinking unboiled water and unwashed vegetables other incorrect ways were mentioned; respondents with more than 12 years of formal education were more likely to have better knowledge. Discussion. Strategies to control giardiasis need to be through an integrated approach aiming at boosting caregivers' knowledge and encouraging healthcare workers to act as a readily available source for health information.

  4. The relationship between behavioural problems in preschool children and parental distress after a paediatric burn event.

    Bakker, Anne; van der Heijden, Peter G M; van Son, Maarten J M; van de Schoot, Rens; Vandermeulen, Els; Helsen, Ann; Van Loey, Nancy E E


    This study examines mother- and father-rated emotional and behaviour problems in and worries about 0- to 5-year-old children at 3 and 12 months after a burn event and the relation with parental distress. Mothers (n = 150) and fathers (n = 125) representing 155 children participated in this study. Child emotional and behaviour problems and parental worries about the child were assessed with the Child Behavior Checklist at both time points. Parents' level of acute subjective distress was assessed within the first month after the burn event with the Impact of Event Scale. Mothers and fathers held comparable views of their child's emotional and behaviour problems, which were generally within the normal limits. Parents' own acute stress reactions were significantly related to parent-rated child behaviour problems at 3 and 12 months postburn. A substantial part of mothers' and fathers' worries about the child concerned physical and emotional aspects of the burn trauma, and potential future social problems. Parents with high acute stress scores more often reported burn-related concerns about their child at 3 and 12 months postburn. Health-care professionals should be informed that parents' distress in the subacute phase of their child's burn event may be related to subsequent worries about their child and to (parent-observed) child emotional and behaviour problems. The authors recommend a family perspective, with particular attention for the interplay between parents' distress and parent-reported child behaviour problems and worries, in each phase of paediatric burn care.

  5. Sequencing paediatric antiretroviral therapy in the context of a public health approach

    Ragna S Boerma


    Full Text Available Introduction: As access to prevention of mother-to-child transmission (PMTCT efforts has increased, the total number of children being born with HIV has significantly decreased. However, those children who do become infected after PMTCT failure are at particular risk of HIV drug resistance, selected by exposure to maternal or paediatric antiretroviral drugs used before, during or after birth. As a consequence, the response to antiretroviral therapy (ART in these children may be compromised, particularly when non-nucleoside reverse transcriptase inhibitors (NNRTIs are used as part of the first-line regimen. We review evidence guiding choices of first- and second-line ART. Discussion: Children generally respond relatively well to ART. Clinical trials show the superiority of protease inhibitor (PI- over NNRTI-based treatment in young children, but observational reports of NNRTI-containing regimens are usually favourable as well. This is reassuring as national guidelines often still recommend the use of NNRTI-based treatment for PMTCT-unexposed young children, due to the higher costs of PIs. After failure of NNRTI-based, first-line treatment, the rate of acquired drug resistance is high, but HIV may well be suppressed by PIs in second-line ART. By contrast, there are currently no adequate alternatives in resource-limited settings (RLS for children failing either first- or second-line, PI-containing regimens. Conclusions: Affordable salvage treatment options for children in RLS are urgently needed.

  6. Paediatric tonsillectomy: radiofrequency-based plasma dissection compared to cold dissection with sutures

    Di Rienzo Businco, L; Coen Tirelli, G


    Summary Aim of this study was to compare post-operative recovery over 14 days in children submitted to tonsillectomy using a bipolar radiofrequency-based plasma device (Coblation®, Evac 70, ArthroCare Corp, Sunnyvale, CA, USA) to cold dissection. Paediatric patients (n = 42) aged 5-16 years old with chronic tonsillitis underwent tonsillectomy using cold dissection with suture ligatures or a plasma device (Evac 70, ArthroCare Corp, Sunnyvale, CA, USA). Pain intensity on the first day, use of analgesics, type of diet, and days of pain, fever, nausea, and absence from school were determined. Groups were compared using time-to-event (Kaplan-Meier) curves and statistically evaluated using the Breslow (generalized Wilcoxon) test. Children undergoing plasma tonsillectomy reported significantly less pain on the first post-operative day (1.2 ± 0.9 vs. 3.5 ± 1.5, p tonsillectomy was adopted for the majority of cases. Benefits of the plasma device include the possibility both to excise tissue and coagulate bleeding vessels using the same device whilst improving quality of post-operative recovery over cold dissection with suture ligatures. PMID:18669070

  7. Paediatric MRI under sedation: is it necessary? What is the evidence for the alternatives?

    Edwards, Andrea D.; Arthurs, Owen J. [Addenbrooke' s Hospital, Cambridge University Hospitals NHS Foundation Trust, Department of Radiology, Cambridge (United Kingdom)


    To achieve diagnostic images during MRI examinations, small children need to lie still to avoid movement artefact. To reduce patient motion, obviate the need for voluntary immobilisation or breath-holding and therefore obtain high-quality images, MRI of infants is frequently carried out under sedation or general anaesthesia, but this is not without risk and expense. However, many other techniques are available for preparing children for MRI, which have not been fully evaluated. Here, we evaluate the advantages and disadvantage of sedation and anaesthesia for MRI. We then evaluate the alternatives, which include neonatal comforting techniques, sleep manipulation, and appropriate adaptation of the physical environment. We summarize the evidence for their use according to an established hierarchy. Lastly, we discuss several factors that will influence the choice of imaging preparation, including patient factors, imaging factors and service provision. The choice of approach to paediatric MRI is multi-factorial, with limited scientific evidence for many of the current approaches. These considerations may enable others to image children using MRI under different circumstances. (orig.)

  8. Secondary neutron doses received by paediatric patients during intracranial proton therapy treatments.

    Sayah, R; Farah, J; Donadille, L; Hérault, J; Delacroix, S; De Marzi, L; De Oliveira, A; Vabre, I; Stichelbaut, F; Lee, C; Bolch, W E; Clairand, I


    This paper's goal is to assess secondary neutron doses received by paediatric patients treated for intracranial tumours using a 178 MeV proton beam. The MCNPX Monte Carlo model of the proton therapy facility, previously validated through experimental measurements for both proton and neutron dosimetry, was used. First, absorbed dose was calculated for organs located outside the clinical target volume using a series of hybrid computational phantoms for different ages and considering a realistic treatment plan. In general, secondary neutron dose was found to decrease as the distance to the treatment field increases and as the patient age increases. In addition, secondary neutron doses were studied as a function of the beam incidence. Next, neutron equivalent dose was assessed using organ-specific energy-dependent radiation weighting factors determined from Monte Carlo simulations of neutron spectra at each organ. The equivalent dose was found to reach a maximum value of ∼155 mSv at the level of the breasts for a delivery of 49 proton Gy to an intracranial tumour of a one-year-old female patient. Finally, a thorough comparison of the calculation results with published data demonstrated the dependence of neutron dose on the treatment configuration and proved the need for facility-specific and treatment-dependent neutron dose calculations.

  9. We strongly support childhood immunisation-statement from the European Academy of Paediatrics (EAP).

    Dornbusch, Hans Juergen; Hadjipanayis, Adamos; Del Torso, Stefano; Mercier, Jean-Christophe; Wyder, Corinne; Schrier, Lenneke; Ross-Russell, Robert; Stiris, Tom; Ludvigsson, Jonas F


    The eradication of smallpox and the elimination of several other infectious diseases from much of the world has provided convincing evidence that vaccines are among the most effective interventions for promoting health. The current scepticism about immunisation among members of the new US administration carries a risk of decreasing immunisation rates also in Europe. While only a small minority of the population are strongly anti-vaccine, their public activities have significantly influenced an uncertainty among the general population about both the safety of and the necessity for vaccination. Therefore, the EAP calls for greater publically available, scientifically supported information on vaccination, particularly targeted at health care providers, for the further development of electronically based immunisation information systems (IIS). We further call on all European countries to work together both in legislative and public health arenas in order to increase vaccination coverage among the paediatric population. In the interest of children and their parents, the EAP expresses its strong support for childhood immunisation and recommended vaccination schedules. We are prepared to work with governments and media and share the extensive evidence demonstrating the effectiveness and safety of vaccines.

  10. Parent satisfaction with primary repair of paediatric cleft lip in Southwest China.

    Ha, P; Li, C; Shi, B


    The purpose of this study was to investigate the key factors in relation to parent satisfaction with the primary repair of paediatric cleft lip. One hundred and ninety-five children born with cleft lip and/or palate aged between 3 months and 1 year were recruited, along with their caregivers. All patients underwent primary cleft lip repair, and a telephone interview was held with their main caregivers at 3 months postoperative. The level of satisfaction with each item included in a simplified Cleft Evaluation Profile was ascertained and recorded. Patient clinical data were obtained from the medical records. One hundred and thirty-eight (71%) parents reported satisfaction with the general outcome of surgery. Parents were satisfied with the appearance of the lip and profile of the face, but were dissatisfied with the appearance of the nose and teeth. Mothers of patients showed lower satisfaction levels than fathers and grandparents. Parental satisfaction with the appearance of the lip was lower for patients without a cleft palate than for those with a cleft palate. The results of this study suggest that most Chinese parents of children who undergo primary cleft lip repair express satisfaction with the surgical outcomes. Satisfaction with the appearance of the nose and teeth is low and this needs to be improved. Other factors are likely to influence expressions of satisfaction.

  11. A survey of paediatric HIV programmatic and clinical management practices in Asia and sub-Saharan Africa—the International epidemiologic Databases to Evaluate AIDS (IeDEA

    IeDEA Pediatric Working Group


    Full Text Available Introduction: There are limited data on paediatric HIV care and treatment programmes in low-resource settings. Methods: A standardized survey was completed by International epidemiologic Databases to Evaluate AIDS paediatric cohort sites in the regions of Asia-Pacific (AP, Central Africa (CA, East Africa (EA, Southern Africa (SA and West Africa (WA to understand operational resource availability and paediatric management practices. Data were collected through January 2010 using a secure, web-based software program (REDCap. Results: A total of 64,552 children were under care at 63 clinics (AP, N=10; CA, N=4; EA, N=29; SA, N=10; WA, N=10. Most were in urban settings (N=41, 65% and received funding from governments (N=51, 81%, PEPFAR (N=34, 54%, and/or the Global Fund (N=15, 24%. The majority were combined adult–paediatric clinics (N=36, 57%. Prevention of mother-to-child transmission was integrated at 35 (56% sites; 89% (N=56 had access to DNA PCR for infant diagnosis. African (N=40/53 but not Asian sites recommended exclusive breastfeeding up until 4–6 months. Regular laboratory monitoring included CD4 (N=60, 95%, and viral load (N=24, 38%. Although 42 (67% sites had the ability to conduct acid-fast bacilli (AFB smears, 23 (37% sites could conduct AFB cultures and 18 (29% sites could conduct tuberculosis drug susceptibility testing. Loss to follow-up was defined as >3 months of lost contact for 25 (40% sites, >6 months for 27 sites (43% and >12 months for 6 sites (10%. Telephone calls (N=52, 83% and outreach worker home visits to trace children lost to follow-up (N=45, 71% were common. Conclusions: In general, there was a high level of patient and laboratory monitoring within this multiregional paediatric cohort consortium that will facilitate detailed observational research studies. Practices will continue to be monitored as the WHO/UNAIDS Treatment 2.0 framework is implemented.

  12. Development of a 10-year-old paediatric thorax finite element model validated against cardiopulmonary resuscitation data.

    Jiang, Binhui; Cao, Libo; Mao, Haojie; Wagner, Christina; Marek, Stan; Yang, King H


    Thoracic injury in the paediatric population is a relatively common cause of severe injury and has an accompanying high mortality rate. However, no anatomically accurate, complex paediatric chest finite element (FE) component model is available for a 10-year old in the published literature. In this study, a 10-year-old thorax FE model was developed based on internal and external geometries segmented from medical images. The model was then validated against published data measured during cardiopulmonary resuscitation performed on paediatric subjects.

  13. Could (Disseminated and Residual Minimal Disease be a useful prognostic marker in non-Hodgkin paediatric Lymphomas?

    Lara Mussolin


    Full Text Available Minimal Disseminated Disease (MDD represents the small number of tumour cells in the patients' bone marrow at the time of diagnosis, whereas Minimal Residual Disease (MRD represents the small number of tumour cells remaining in the bone marrow during treatment. Generally, MDD and MRD are measured by polymerase chain reaction, a highly sensitive technique. For a long time, bone marrow involvement has been considered an uncommon event in solid tumours. However, in recent years, several studies demonstrated that MDD and MRD could be powerful tools in paediatric non-Hodgkin lymphoma for stratifying patients in different prognostic groups. Risk stratification in future clinical trials on non-Hodgkin lymphoma based on these newly identified risk categories should be useful to improve therapies in order to increase survival for high-risk patients and decrease toxicity for low-risk patients. 

  14. PET/CT-guided treatment planning for paediatric cancer patients: a simulation study of proton and conventional photon therapy

    Kornerup, Josefine S.; Brodin, N. P.; Bjork-Eriksson, T.;


    OBJECTIVE: To investigate the impact of including fluorine-18 fludeoxyglucose ((18)F-FDG) positron emission tomography (PET) scanning in the planning of paediatric radiotherapy (RT). METHODS: Target volumes were first delineated without and subsequently re-delineated with access to (18)F-FDG PET......) and estimated risk of secondary cancer (SC). RESULTS: Considerable deviations between CT- and PET/CT-guided target volumes were seen in 3 out of the 11 patients studied. However, averaging over the whole cohort, CT or PET/CT guidance introduced no significant difference in the shape or size of the target...... volumes, target dose coverage, irradiated volumes, estimated NTCP or SC risk, neither for IMPT nor 3DCRT. CONCLUSION: Our results imply that the inclusion of PET/CT scans in the RT planning process could have considerable impact for individual patients. There were no general trends of increasing...

  15. Systematic meta-analyses and field synopsis of genetic and epigenetic studies in paediatric inflammatory bowel disease

    Li, Xue; Song, Peige; Timofeeva, Maria; Meng, Xiangrui; Rudan, Igor; Little, Julian; Satsangi, Jack; Campbell, Harry; Theodoratou, Evropi


    We provide a comprehensive field synopsis of genetic and epigenetic associations for paediatric Inflammatory Bowel Disease (IBD). A systematic review was performed and included 84 genetic association studies reporting data for 183 polymorphisms in 71 genes. Meta-analyses were conducted for 20 SNPs in 10 genes of paediatric Crohn’s disease (CD) and for 8 SNPs in 5 genes of paediatric ulcerative colitis (UC). Five epigenetic studies were also included, but formal meta-analysis was not possible. Venice criteria and Bayesian false discovery probability test were applied to assess the credibility of associations. Nine SNPs in 4 genes were considered to have highly credible associations with paediatric CD, of which four variants (rs2066847, rs12521868, rs26313667, rs1800629) were not previously identified in paediatric GWAS. Differential DNA methylation in NOD2 and TNF-α, dysregulated expression in let-7 and miR-124 were associated with paediatric IBD, but not as yet replicated. Highly credible SNPs associated with paediatric IBD have also been implicated in adult IBD, with similar magnitudes of associations. Early onset and distinct phenotypic features of paediatric IBD might be due to distinct epigenetic changes, but these findings need to be replicated. Further progress identifying genetic and epigenetic susceptibility of paediatric IBD will require international collaboration, population diversity and harmonization of protocols. PMID:27670835

  16. Analysis of Values of Youth Staff with Multi-national Companies in China%跨国公司在华青年员工价值取向及其引导路径

    郭得力; 王铁山; 胡啸兵


    Youth staff of multi-national companies,which appear with the opening-up policy and Chinese going-out strategy,is one of group growing increasingly influential in China these years.Under the perspective of scientific development view,the paper firstly clarifies the values of youth staff with multi-national companies politically,economically,socially,emotionally,as well as religiously based on reference with relevant literature;and then works out a portfolio of measures to guarantee the youth group forming healthy values.%跨国公司在华青年员工是中国改革开放和中西方经济文化交流而产生的一个社会影响力日渐提升的新兴群体。在科学发展观视阈下,对当今跨国公司在华青年员工的价值取向从政治、经济、社会、情感和信仰等方面进行系统解析,引导跨国公司在华青年价值取向健康发展,是一条行之有效的引导路径。

  17. The paediatric flat foot and general anthropometry in 140 Australian school children aged 7 - 10 years

    Evans Angela M


    Full Text Available Abstract Background Many studies have found a positive relationship between increased body weight and flat foot posture in children. Methods From a study population of 140 children aged seven to 10 years, a sample of 31 children with flat feet was identified by screening with the FPI-6. Basic anthropometric measures were compared between subjects with and without flat feet as designated. Results The results of this study, in contrast to many others, question the association of flat feet and heavy children. A significant relationship between foot posture and weight (FPI (L r = -0.186 (p Conclusions This study presents results which conflict with those of many previous investigations addressing the relationship between children's weight and foot posture. In contrast to previous studies, the implication of these results is that heavy children have less flat feet. Further investigation is warranted using a standardized approach to assessment and a larger sample of children to test this apparent contradiction.

  18. Setting up a Paediatric Rapid Access Outpatient Unit: views of general practice teams.

    Williams, L.; Fryer, J.; Andrew, R.; Powell, C.; Pink, J.; Elwyn, G.


    BACKGROUND: Rapid Access Outpatient Units (RAOUs) have been suggested as an alternative to hospital inpatient units for the management of some acutely unwell children. These units can provide ambulatory care, delivered close to home, and may prevent unnecessary hospital admission. There are no quali

  19. Renal imaging in paediatrics; Nuklearmedizinische Nierendiagnostik in der Paediatrie

    Porn, U.; Hahn, K.; Fischer, S. [Klinik und Poliklinik fuer Nuklearmedizin, Ludwig-Maximilians-Univ. Muenchen (Germany)


    The most frequent renal diseases in paediatrics include urinary tract infections, hydronephrosis, kidney anomalies and reflux. The main reason for performing DMSA scintigraphy in paediatrics is the detection of cortical abnormalities related to urinary tract infection. Because the amount of tracer retained in the tubular cells is associated with the distribution of functioning renal parenchyma in the kidney, it is possible, to evaluate the split renal function. In comparison to ultrasound and intravenous urography the sensitivity in the detection of acute as well as chronic inflammatory changes is very high, however less specific. An indication for a renography in neonates and children is beside an estimation of the total renal function and the calculation of the split renal function, the assessment of renal drainage in patients with unclear dilatation of the collecting system in ultrasound. The analysis of the time activity curve provides, especially for follow-up studies, a reproducible method to assess the urinary outflow. The diuretic scintigraphy allows the detection of urinary obstruction. Subsequently it is possible to image the micturition phase to detect vesico-ureteric reflux (indirect MCU) after drainage of tracer from the renal pelvis. An reflux in the ureters or the pelvicalyceal system is visible on the scintigraphic images and can be confirmed by time activity curves. A more invasive technique is the direct isotope cystography with bladder catheterization. The present paper should give an overview about the role of nuclear medicine in paediatric urology. (orig.) [German] Die haeufigsten nephrourologischen Erkrankungen in der Paediatrie umfassen die entzuendlichen Veraenderungen des Nierenparenchyms, Harnstauungen, Nierenanomalien und Refluxerkrankungen. Die statische Nierenszintigraphie mit {sup 99m}Tc-DMSA hat in der Paediatrie vor allem zur Evaluierung von Narbenbildungen bei Pyelonephritis ihren Stellenwert. Da die tubulaere Speicherung von DMSA

  20. Testicular atrophy following paediatric primary orchidopexy: A prospective study.

    Durell, J; Johal, N; Burge, D; Wheeler, R; Griffiths, M; Kitteringham, L; Stanton, M; Manoharan, S; Steinbrecher, H; Malone, P; Griffin, S J


    With the Nordic consensus statement advocating orchidopexy at an earlier age, the present study sought to investigate the outcomes of primary paediatric orchidopexy at a tertiary UK centre. To prospectively assess testicular atrophy following primary orchidopexy for undescended testes in a paediatric population. Secondary outcomes were complication rates and whether outcomes were dependent on grade of operating surgeon. Prospective data regarding age at operation, classification of the undescended testis, length of follow-up, and subjective comparison of intraoperative and postoperative testicular volumes compared with the contralateral testis were collected. Testicular atrophy was defined as >50% loss of testicular volume or a postoperative testicular volume atrophy occurred in 2.6% of cases. There was no reported testicular re-ascent. All secondary acquired cases underwent a previous ipsilateral hernia repair. There was no significant difference in outcomes comparing the grade of surgeon (consultant n = 8, trainee/staff-grade surgeon n = 7-8). There was a trend towards postoperative catch-up growth in approximately one fifth of cases. Previous studies have reported a testicular atrophy rate of 5%. The present study reported a similar rate of 2.6%. In agreement with a previous publication, it was also found that testicular atrophy was not dependent on the grade of operating surgeon. The mechanism for testicular catch-up growth is not well understood. Animal studies have supported the hypothesis that increased temperature has a detrimental effect on testicular volume. However, follow-up in the present cohort was short (median 6.9 months), making interpretation of this finding difficult. It is acknowledged that clinical palpation alone to determine testicular volume potentially introduces intra-observer and inter-observer error. However, prospective studies using ultrasound to determine testicular volumes following orchidopexy have reported catch-up growth. This

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

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


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

  2. Facing the Cultural Differences and Developing the Cultural Identity-Cultural Thoughts of Global Operation of Multi-national Corporations%正视文化差异发展文化认同--跨国公司全球经营中的文化思维



    With the transition of the multi-national corporations to the global corporations in the world, the multi-national corporations are turning from multinational to global market. In the multi-national corporation management, cultural conflicts caused by global cultural differences are continuing and have many adverse effects. In the face of global cultural differences, many well-known multi-national corporations in the world develop commonly the cultural identity to ensure the smooth progress of business activities of multi-national corporations.%随着世界范围内跨国公司向全球公司的转型,跨国公司也正在从跨国经营转向全球经营。在跨国公司经营中,由全球文化差异所导致的文化冲突不断,进而对跨国公司经营产生许多不利的影响。面对全球文化差异,世界上众多著名跨国公司不约而同地通过发展文化认同,促进不同文化之间的交流、理解与沟通,从而保证了跨国公司经营活动的顺利进行。

  3. Access to paediatric essential medicines: a survey of prices, availability, affordability and price components in Shaanxi Province, China.

    Xiao Wang

    Full Text Available OBJECTIVE: To evaluate the prices and availability of paediatric essential medicines in Shaanxi Province, China. METHODS: Price and availability data for 28 paediatric essential medicines were collected from 60 public hospitals and 60 retail pharmacies in six areas of Shaanxi Province using a standardised methodology developed by the World Health Organization and Health Action International, during November to December 2012. Affordability was measured as the number of days' wages required for the lowest-paid unskilled government worker to purchase standard treatments for common conditions. Data on medicine price components were collected from hospitals, wholesalers and distributors to obtain price mark-ups. FINDINGS: The mean availabilities of originator brands (OBs and lowest-priced generics (LPGs were 10.8% and 27.3% in the public hospitals and 11.9% and 20.6% in the private pharmacies. The public procurement and retail prices were 2.25 and 2.59 times the international reference prices (IRPs for three OBs, and 0.52 and 0.93 times for 20 LPGs. In the private sector, the final prices for OBs and LPGs were 3.89 and 1.25 times their IRPs. The final price in the private sector was 2.7% lower than in the public sector for OBs, and 14.1% higher for LPGs. Generally, standard treatments cost less than 1 day's wages in both sectors. Distribution mark-ups applied to brand salbutamol in Xi'an was 65.5%, and up to 185.3% for generic. Cumulative mark-ups for LPGs in Ankang were also high, from 33% to 50%. The manufacturer's selling price is the largest contributor to the final price in both areas. CONCLUSIONS: The government should approve a list of national paediatric essential medicines. The availability, price and affordability of these should be improved in both public hospitals and private pharmacies to enable children to obtain effective treatment. Measures should be taken to improve the efficiency of the centralised medicine purchasing system.

  4. Treatment of paediatric scalp psoriasis with calcipotriene/betamethasone dipropionate scalp formulation: effectiveness, safety and influence on children's quality of life in daily practice

    Oostveen, A.M.; Jong, E.M.G.J. de; Donders, A.R.T.; Kerkhof, P.C.M. van de; Seyger, M.M.B.


    BACKGROUND: Evidence on efficacy and safety of topical treatments for paediatric scalp psoriasis is lacking. OBJECTIVE: This study aims to evaluate the effectiveness and safety of calcipotriene/betamethasone dipropionate scalp formulation for paediatric scalp psoriasis in daily clinical practice.

  5. Tolvaptan use during hyperhydration in paediatric intracranial lymphoma with SIADH

    Ruben H Willemsen


    Full Text Available An 11-year-old boy developed severe syndrome of inappropriate antidiuretic hormone secretion (SIADH after diagnosis of an intracranial B-cell lymphoma. His sodium levels dropped to 118–120 mmol/L despite 70% fluid restriction. For chemotherapy, he required hyperhydration, which posed a challenge because of severe hyponatraemia. Tolvaptan is an oral, highly selective arginine vasopressin V2-receptor antagonist, which has been licensed in adults for the management of SIADH and has been used in treating paediatric heart failure. Tolvaptan gradually increased sodium levels and allowed liberalisation of fluid intake and hyperhydration. Tolvaptan had profound effects on urinary output in our patient with increases up to 8 mL/kg/h and required close monitoring of fluid balance, frequent sodium measurements and adjustments to intake. After hyperhydration, tolvaptan was stopped, and the lymphoma went into remission with reversal of SIADH. We report one of the first uses of tolvaptan in a child with SIADH, and it was an effective and safe treatment to manage severe SIADH when fluid restriction was not possible or effective. However, meticulous monitoring of fluid balance and sodium levels and adjustments of fluid intake are required to prevent rapid sodium changes.

  6. [Transition from paediatric to adult cystic fibrosis care centre].

    Durieu, I; Reynaud, Q; Nove-Josserand, R


    The number of adolescents and young adults with chronic diseases has increased dramatically over the last decade. This led paediatric teams to organize the transition to adult centres with the aim to ensure the quality of care and prognosis, adherence to survey and treatment. To promote a good work and family life is also a challenge. Several studies have shown the importance of a successful transition in cystic fibrosis (CF) in order to prevent complications and loss monitoring and to improve the perception of patients and their families. In France in 2003, cystic fibrosis centres (CRCM) have been identified and among them of adult CF centres. The regular increase of the adult centre's active file requires improving the transition process. It is necessary to improve the transition process and to prepare the young patient and their family early during adolescence. The process in place should concern the whole aspects of care, i.e., medical, psychological and educational. The transition to adulthood will be successful if it results in a stable state of the disease allowing family and career plans. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  7. Health-e-Child: a grid platform for european paediatrics

    Skaburskas, K.; Estrella, F.; Shade, J.; Manset, D.; Revillard, J.; Rios, A.; Anjum, A.; Branson, A.; Bloodsworth, P.; Hauer, T.; McClatchey, R.; Rogulin, D.


    The Health-e-Child (HeC) project [1], [2] is an EC Framework Programme 6 Integrated Project that aims to develop a grid-based integrated healthcare platform for paediatrics. Using this platform biomedical informaticians will integrate heterogeneous data and perform epidemiological studies across Europe. The resulting Grid enabled biomedical information platform will be supported by robust search, optimization and matching techniques for information collected in hospitals across Europe. In particular, paediatricians will be provided with decision support, knowledge discovery and disease modelling applications that will access data in hospitals in the UK, Italy and France, integrated via the Grid. For economy of scale, reusability, extensibility, and maintainability, HeC is being developed on top of an EGEE/gLite [3] based infrastructure that provides all the common data and computation management services required by the applications. This paper discusses some of the major challenges in bio-medical data integration and indicates how these will be resolved in the HeC system. HeC is presented as an example of how computer science (and, in particular Grid infrastructures) originating from high energy physics can be adapted for use by biomedical informaticians to deliver tangible real-world benefits.

  8. Drug utilisation profile in the Italian paediatric population.

    Clavenna, Antonio; Berti, Alessandra; Gualandi, Lucia; Rossi, Elisa; De Rosa, Marisa; Bonati, Maurizio


    In order to evaluate the prescribing pattern in the Italian paediatric population, prescriptions involving 923,353 children under 14 years old and dispensed during 2006 by the retail pharmacies of 22 Italian local health units were analysed. A total of 561,237 children (61%) received at least one drug prescription. The prescription prevalence rate was highest in children 3 years of age (78%), decreased with increasing age and was higher in boys than in girls (chi(2)=655; pprescriptions and 4.8 boxes. Antibiotics and anti-asthmatics were the more prescribed therapeutic classes and represented 80% of prescriptions. Amoxicillin+clavulanic acid was the most prescribed drug (24% of the overall population; 17% of all boxes), followed by inhaled beclometasone and amoxicillin. A total of 620 different drugs were prescribed and the ten leading drugs represented 64% of the prescribed boxes. Six of the ten most prescribed drugs were the same in all age groups. Wide differences were found in the prevalence rate between the different local health units; these ranged between 50.1 and 68.4% (pprescription prevalence increased in the 2000-2002 period (from 62.2 to 68.3%) and slightly decreased afterwards. Despite some limitations, the systematic monitoring of prescriptions is a valuable tool for evaluating the appropriateness of the care.

  9. Quantification of metformin and glyburide in blood for paediatric endocrinology

    Radamés Alemón-Medina


    Full Text Available Background: The recent use of antidiabetic drugs such as metformin and glyburide for the treatment and control of childhood obesity, insulin resistance and type II diabetes mellitus in children and adolescents, has encouraged physicians to determine plasma levels of these drugs for the right dose adjustment. Objective: To implement and validate a UPLC-UV method to quantify metformin and glyburide in blood samples. Materials and methods: Only a 0.1 mL-volume blood sample was used. Both drugs are removed by precipitation with methanol. Quantitation was carried out with mobile phase of 4.6 mM potassium phosphate monobasic (KH2PO4 0.1 M pH = 6.5, sodium dodecyl sulphate (SDS and acetonitrile (63:7:30, at 0.8 mL/min through a VARIAN Pursuit® C8 150 x 3.9 mm column at 40°C, 236 nm. Results: The method allows the measurement of 20 to 600 nanograms of metformin and from 100 to 2 000 nanograms of glyburide per milliliter of blood. Both drugs are physicochemically stable in blood samples for up to 30 days at 4°C. Conclusion: Our method allows quantification of metformin and gly- buride in paediatric blood samples, to support the clinicians to monitor treatment compliance, bioavailability and pharmacokinetic profiles.

  10. Accounting for care: Healthcare Resource Groups for paediatric critical care.

    Murphy, Janet; Morris, Kevin


    Healthcare Resource Groups are a way of grouping patients in relation to the amount of healthcare resources they consume. They are the basis for implementation of Payment by Results by the Department of Health in England. An expert working group was set up to define a dataset for paediatric critical care that would in turn support the derivation of Healthcare Resource Groups. Three relevant classification systems were identified and tested with data from ten PICUs, including data about diagnoses, number of organ systems supported, interventions and nursing activity. Each PICU provided detailed costing for the financial year 2005/2006. Eighty-three per cent of PICU costs were found to be related to staff costs, with the largest cost being nursing costs. The Nursing Activity Score system was found to be a poor predictor of staff resource use, as was the adult HRG model based on the number of organ systems supported. It was decided to develop the HRGs based on a 'levels of care' approach; 32 data items were defined to support HRG allocation. From October 2007, data have been collected daily to identify the HRGs for each PICU patient and are being used by the Department of Health to estimate reference costs for PICU services. The data can also be used to support improved audit of PICU activity nationally as well as comparison of workload across different units and modelling of staff requirements within a unit.

  11. The use of manual therapy in paediatric physiotherapy

    Skoutelis V


    Full Text Available Introduction: Manual therapy is the most common complementary or alternative treatment approach for orthopedic and non-musculoskeletal conditions in adult patients. In recent years, manual therapy techniques are increasingly used by physiotherapists in therapeutic programmes for children with neurological and orthopedic impairments. There is also a continuous increase in the number of children visits to alternative therapies, especially joint manipulation procedures. The purpose of this project is to examine, via the literature review, the use of manual therapy techniques and their effects in children with neuro-musculoskeletal problems. Method: A search was conducted via scientific databases (MEDLINE/PubMeD, Scopus, OCLC ECO, WilsonWeb, PEDro, Google Scholar, from 1986 to March 2016. The PEDro scale (Physiotherapy Evidence Database was used to assess the methodological quality of the included randomized control trials. Results: The articles included (reviews, systematic reviews, experimental and quasiexperimental studies, case reports investigate the use, the effectiveness and the safety of various manual therapy techniques (mobilization, manipulation, osteopathic manual treatment in cerebral palsy, obstetric palsy, torticollis, adolescent idiopathic scoliosis and spinal pain. Conclusions: Researchers support the application of manual therapy techniques as an efficient and safe therapeutic procedure in children with neurological and musculoskeletal conditions. However, the poor scientific data provide inconclusive evidence for the effectiveness of manual therapy in paediatric population. The small number of studies, the research limitations and the low methodological quality indicate the need for further research to examine the effects and safety of manual therapy to children’s conditions

  12. Association of Neisseria cinerea with ocular infections in paediatric patients.

    Dolter, J; Wong, J; Janda, J M


    Twenty-two strains of Neisseria cinerea were recovered from paediatric patients over a 7-year period and forwarded to the Microbial Diseases Laboratory for biochemical identification and/or confirmation. Eighteen of these 22 strains (82%) were recovered from the eyes of very young children ( 50% occurring during the neonatal period. The majority of eye isolates were involved in a variety of ocular infections including orbital cellulitis, conjunctivitis, and eye discharge (most common); in four of the 13 instances (31%) where laboratory data was available, Neisseria cinerea was recovered in pure culture. Neisseria cinerea isolates were often submitted to the Microbial Diseases Laboratory as possible 'N. gonorrhoeae' or 'Neisseria species' due to problems resulting from the use of commercial assays or unfamiliarity with the organism. These observations indicate that N. cinerea can produce eye infections in very young children, who presumably acquire this organism vertically from the mother during birth. Accurate identification of N. cinerea in such infants can preclude the social trauma and possible legal ramifications which can initially result from its misidentification as N. gonorrhoeae.

  13. LC-UV/MS quality analytics of paediatric artemether formulations

    Kirsten Vandercruyssen; Matthias D’Hondt; Valentijn Vergote; Herwig Jansen; Christian Burvenich; Bart De Spiegeleer


    A highly selective and stability-indicating HPLC-method, combined with appropriate sample preparation steps, is developed for β-artemether assay and profiling of related impurities, including possible degradants, in a complex powder for oral suspension. Following HPLC conditions allowed the required selectivity: a Prevail organic acid (OA) column (250 mm×4.6 mm, 5μm), flow rate set at 1.5 mL/min combined with a linear gradient (where A ¼ 25 mM phosphate buffer (pH 2.5), and B ¼ acetonitrile) from 30% to 75% B in a runtime of 60 min. Quantitative UV-detection was performed at 210 nm. Acetonitrile was applied as extraction solvent for sample preparation. Using acetonitrile-water mixtures as extraction solvent, a compartmental behaviour by a non-solving excipient-bound fraction and an artemether-solubilising free fraction of solvent was demonstrated, making a mobile phase based extraction not a good choice. Method validation showed that the developed HPLC-method is considered to be suitable for its intended regulatory stability-quality characterisation of β-artemether paediatric formulations. Furthermore, LC-MS on references as well as on stability samples was performed allowing identity confirmation of the β-artemether related impurities. MS-fragmentation scheme of β-artemether and its related substances is proposed, explaining the m/z values of the in-source fragments obtained.

  14. Evaluation of the jet injector in paediatric fibreoptic bronchoscopes.

    Sloan, I A; McLeod, M E


    The use of the Sanders venturi system during bronchoscopy in adults has been studied extensively. Its use in paediatric bronchoscopy has been limited because small changes in the characteristics of the system may produce large changes in the patient. With jet ventilation, peak inflation pressures and flow rates are influenced by the driving pressure, diameter and shape of the bronchoscope, the diameter of the injector and its length and angle from the axial line of the bronchoscope. Storz 3 mm, 4 mm and 5 mm rigid fibreoptic bronchoscopes were evaluated in a test lung with an injector of 1.5 mm internal diameter fixed in the side-arm at 20 degrees to the axial line. Pilling 3 mm, 4 mm and 5 mm rigid fibreoptic bronchoscopes were also examined using the standard injector with a 0.89 mm orifice in the axial line. The Storz bronchoscopes produced consistently higher peak inflation pressures and flow rates at all driving pressures in spite of the relatively large angle of the injector from the axial line. Caution is advised in the use of the Storz injector system as excessively high inflation pressures may be reached.

  15. Opioid and benzodiazepine withdrawal symptoms in paediatric intensive care patients.

    Franck, Linda S; Naughton, Ita; Winter, Ira


    The purposes of this prospective repeated measures study were to: (a) describe the occurrence of withdrawal symptoms with the use of a standardised protocol to slowly taper opioids and benzodiazepines; and (b) to test the predictive validity of an opioid and benzodiazepine withdrawal assessment scoring tool in critically ill infants and young children after prolonged opioid and benzodiazepine therapy. Fifteen children (6 weeks-28 months of age) with complex congenital heart disease and/or respiratory failure who received opioids and benzodiazepines for 4 days or greater were evaluated for withdrawal symptoms using a standardized assessment tool. Thirteen children showed moderate to severe withdrawal symptoms a median 3 days after commencement of tapering. Symptom intensity was not related to prior opioid or benzodiazepine exposure, extracorporeal membrane oxygenation (ECMO) therapy or length of tapering. Children who received fentanyl in addition to morphine more often exhibited signs of withdrawal. This study demonstrated that significant withdrawal symptoms occur in critically ill children even with the use of a standardised assessment tool and tapering management protocol. The predictive validity and utility of the Opioid and Benzodiazepine Withdrawal Score (OBWS) was adequate for clinical use, but areas for further improvement of the tool were identified. Problems with the clinical withdrawal prevention and management guidelines were also identified. More research is needed to establish the optimal methods for prevention and management of iatrogenic opioid and benzodiazepine withdrawal in paediatric critical care.

  16. Paediatric adenoidectomy: endoscopic coblation technique compared to cold curettage.

    Di Rienzo Businco, L; Angelone, A M; Mattei, A; Ventura, L; Lauriello, M


    The aim of our study was to assess the efficacy and safety of endoscopic coblator adenoidectomy compared to cold curettage in paediatric patients. Forty homogeneous children (4-16 years of age) with adenoid hypertrophy were divided in 2 groups to receive adenoidectomy using cold curettage (A) or coblator (B). After surgery the following outcomes were evaluated: pain score on first day, days reporting pain, analgesic days, liquid diet days, absent from school days, pain score, days with nausea, days with fever, endoscopic adenoid grade and intraoperative bleeding. Forty days after surgery, basal rhinomanometry and nasal decongestion test were measured. The coblation group reported significantly less pain on the first post-operative day, days reporting pain, analgesic days, liquid diet days and absent school days. Patients in group A showed a higher grade of adenoid persistence by rhinoendoscopy, with high values of nasal resistances at the rhinomanometry even after nasal decongestion, consistent with greater adenoid persistence after cold curettage causing air flow obstruction even after turbinate decongestion. Intra-operative bleeding during coblation was significantly less compared the group undergoing cold curettage. Coblator treatment significantly improved patient recovery compared to curettage. Endoscopic coblation adenoidectomy ensures complete removal of adenoids and reduces postoperative adenoid grade. It can also be considered safer because it is under endoscopic control and can reach the cranial portion of the adenoid and its intranasal extension.

  17. Clinical features of a paediatric asthma population in Trinidad.

    Matthew, Jason; Bekele, Isaac; Pinto Pereira, Lexley Maureen


    Clinical features and management of paediatric asthma, highly prevalent in the Caribbean, was explored in Trinidadian children. Children (2-16 years) with acute [visiting Accident and Emergency (A&E) in the past 12 months (50.2%, 120)] or stable asthma [controlled during the previous 3 months (49.8%, 119)] were studied. There were more (P parents (15.1%) (P 1 (61.9%) and >3 times (26.4%) (P fever and sore throat in the preceding week were respectively 15.2 [odds ratio (OR) = 15.2, 95% confidence interval (CI) = 6.8-34.0], 13.7 (OR = 13.7, 95% CI = 6.7-28.2) and 3.4 (OR = 3.4, 95% CI = 1.7-6.7) times more likely to suffer wheeze exacerbations than stable children. Most stable children (76.5%) inhaled corticosteroids with salbutamol reliever compared with 22.5% of acute asthmatics, whereas 40.8% of the latter group used salbutamol alone compared with 19.3% of stable children (P Childhood wheeze occurs before 3 years and is associated with maternal asthma. Cough, fever and sore throat in the previous week are strongly associated with exacerbations. Defining these associations could enhance preventive approaches to combat childhood asthma. © 2012 Blackwell Publishing Ltd.

  18. Opportunity Costs in Paediatric Training: The Specialist Registrars Experience.

    O’Neill, MB


    In the training process, there is a tension between the work life and home life of trainees. This study explored both the personal impact and the opportunity costs of training from the Specialist Paediatric Registrar (SPR) perspective. The survey explored 1) career progression2) perceived functional effectiveness at work 3) psychological impact of hospital based training and 4) the personal and social cost of training. Fifty-three (71%) SPRs responded of whom 47 (89%)were married or in long term relationships. Seventy-five percent of trainees had a definite career plan with 86% intending to undertake fellowship training. Seventy percent believed they were efficient time managers but 53% had difficulty in making time for academic pursuits and fifty percent experienced negative feelings, which lingered after work and interfered with their relationships at home. Seventy-four percent stated training was undertaken at significant personal cost with only 21% achieving a very satisfactory work\\/life balance. To address these difficulties trainee wellbeing should be addressed at the Basic Specialist Training (BST) level and the career path clearly explained outlining the challenges that are likely to be encountered.

  19. Health-e-Child: a grid platform for european paediatrics

    Skaburskas, K; Estrella, F; Shade, J [CERN, Geneva (Switzerland); Manset, D; Revillard, J; Rios, A [Maat-G Knowledge, Toledo (Spain); Anjum, A; Branson, A; Bloodsworth, P; Hauer, T; McClatchey, R; Rogulin, D [Centre for Complex Cooperative Systems, UWE-Bristol (United Kingdom)], E-mail:


    The Health-e-Child (HeC) project [1], [2] is an EC Framework Programme 6 Integrated Project that aims to develop a grid-based integrated healthcare platform for paediatrics. Using this platform biomedical informaticians will integrate heterogeneous data and perform epidemiological studies across Europe. The resulting Grid enabled biomedical information platform will be supported by robust search, optimization and matching techniques for information collected in hospitals across Europe. In particular, paediatricians will be provided with decision support, knowledge discovery and disease modelling applications that will access data in hospitals in the UK, Italy and France, integrated via the Grid. For economy of scale, reusability, extensibility, and maintainability, HeC is being developed on top of an EGEE/gLite [3] based infrastructure that provides all the common data and computation management services required by the applications. This paper discusses some of the major challenges in bio-medical data integration and indicates how these will be resolved in the HeC system. HeC is presented as an example of how computer science (and, in particular Grid infrastructures) originating from high energy physics can be adapted for use by biomedical informaticians to deliver tangible real-world benefits.

  20. Training fellows in paediatric cardiology: the Harvard experience.

    Brown, David W; Allan, Catherine K; Newburger, Jane W


    The Fellowship Program of the Department of Cardiology at Boston Children's Hospital seeks to train academically oriented leaders in clinical care and laboratory and clinical investigation of cardiovascular disease in the young. The core clinical fellowship involves 3 years in training, comprising 24 months of clinical rotations and 12 months of elective and research experience. Trainees have access to a vast array of research opportunities - clinical, basic, and translational. Clinical fellows interested in basic science may reverse the usual sequence and start their training in the laboratory, deferring clinical training for 1 or more years. An increasing number of clinical trainees apply to spend a fourth year as a senior fellow in one of the subspecialty areas of paediatric cardiology. From the founding of the Department to the present, we have maintained a fundamental and unwavering commitment to training and education in clinical care and research in basic science and clinical investigation, as well as to the training of outstanding young clinicians and investigators.