Hidden Costs in Paediatric Psychiatry Consultation Liaison Services

LENUS (Irish Health Repository)

Kehoe, C

2018-03-01

It is recognised that children attending paediatric services have an increased rate of mental health (MH) problems1. Hospital based Mental Health services, interchangeably termed Psychiatric Consultation Liaison Services (PCLS), or Psychological Medicine, exist in the large hospitals, and collaborate with their paediatric colleagues, offering assessment and intervention as required. However, PCLS may also have a role in providing Emergency MH assessments for young people presenting to the Emergency Department (ED), a role independent of their paediatric colleagues. In some cases, these children will need to be admitted to an acute paediatric bed for the management of their mental health illness or psychological distress, awaiting transfer to a child psychiatry specialised bed, or discharge to community services. The profile and costs of these cases are inadequately captured by both HSE CAMHS Annual Reporting System3,4 and the Healthcare Pricing Office (HIPE)2 as they often inadequately record MH referrals. This study explores the costs associated with a cohort of patients presenting to a large paediatric hospital ED, and managed by PCLS, in a one-year period.

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

Science.gov (United States)

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

2017-09-12

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.

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

Science.gov (United States)

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

2010-10-01

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'. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Remote Collaborative 3D Printing - Process Investigation

Science.gov (United States)

2016-04-01

COLLABORATIVE 3D PRINTING - PROCESS INVESTIGATION Cody M. Reese, PE CAD MODEL PRINT MODEL PRINT PREVIEW PRINTED PART AERIAL VIRTUAL This...REMOTE COLLABORATIVE 3D PRINTING - PROCESS INVESTIGATION 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER Cody M. Reese...release; distribution is unlimited. 13. SUPPLEMENTARY NOTES 14. ABSTRACT The Remote Collaborative 3D Printing project is a collaboration between

[Early clinical trials in paediatric oncology in Spain: a nationwide perspective].

Science.gov (United States)

Bautista, Francisco; Gallego, Soledad; Cañete, Adela; Mora, Jaume; Díaz de Heredia, Cristina; Cruz, Ofelia; Fernández, José María; Rives, Susana; Berlanga, Pablo; Hladun, Raquel; Juan Ribelles, Antonio; Madero, Luis; Ramírez, Manuel; Fernández Delgado, Rafael; Pérez-Martínez, Antonio; Mata, Cristina; Llort, Anna; Martín Broto, Javier; Cela, María Elena; Ramírez, Gema; Sábado, Constantino; Acha, Tomás; Astigarraga, Itziar; Sastre, Ana; Muñoz, Ascensión; Guibelalde, Mercedes; Moreno, Lucas

2017-09-01

Cancer is the leading cause of death between the first year of life and adolescence, and some types of diseases are still a major challenge in terms of cure. There is, therefore, a major need for new drugs. Recent findings in cancer biology open the door to the development of targeted therapies against individual molecular changes, as well as immunotherapy. Promising results in adult anti-cancer drug development have not yet been translated into paediatric clinical practice. A report is presented on the activity in early paediatric oncology trials (phase I-II) in Spain. All members of the Spanish Society of Paediatric Haematology Oncology (SEHOP) were contacted in order to identify early clinical trials in paediatric cancer opened between 2005 and 2015. A total of 30 trials had been opened in this period: 21 (70%) in solid tumours, and 9 (30%) in malignant haemopathies. A total of 212 patients have been enrolled. The majority was industry sponsored (53%). Since 2010, four centres have joined the international consortium of Innovative Therapies for Children with Cancer (ITCC), which has as its aim to develop novel therapies for paediatric tumours. A significant number of new studies have opened since 2010, improving the treatment opportunities for our children. Results of recently closed trials show the contribution of Spanish investigators, the introduction of molecularly targeted agents, and their benefits. The activity in clinical trials has increased in the years analysed. The SEHOP is committed to develop and participate in collaborative academic trials, in order to help in the advancement and optimisation of existing therapies in paediatric cancer. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Immobilisation in Australian paediatric medical imaging: A pilot study

International Nuclear Information System (INIS)

Noonan, S.; Spuur, K.; Nielsen, S.

2017-01-01

Aims: 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. Methods: 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. Results: 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. Conclusion: 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. - Highlights: • Document the use of paediatric immobilisation techniques in medical imaging. • Investigate differences in practice between

Transfusion therapy in paediatric trauma patients

DEFF Research Database (Denmark)

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

2015-01-01

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...

Paediatric conscious sedation: views and experience of specialists in paediatric dentistry.

Science.gov (United States)

Woolley, S M; Hingston, E J; Shah, J; Chadwick, B L

2009-09-26

The objectives were three-fold: to investigate the level of conscious sedation training received prior to and during specialist training in paediatric dentistry; to establish the use of conscious sedation during and following specialisation; and to determine the attitudes of specialists in paediatric dentistry to conscious sedation. A self-administered postal questionnaire was sent to all specialists in paediatric dentistry registered with the General Dental Council in January 2008. Non-responders were contacted again after a four-week period. A response rate of 60% was achieved. Of the 122 respondents, 67 (55%) had received sedation training as an undergraduate; 89 (75%) had been trained during specialisation. All respondents performed dental treatment under sedation as a trainee and the majority used nitrous oxide inhalation sedation (NOIS). Over 90% of respondents felt that NOIS should be available to all children, both in appropriate primary care settings and in hospitals. One hundred and twenty-one (99%) respondents thought that all trainees in paediatric dentistry should have sedation training. The most popular form of sedation amongst specialists in paediatric dentistry was NOIS. However, some of the respondents felt that children should have access to other forms of sedation in both the primary care and hospital settings. Additional research on other forms of sedation is required to evaluate their effectiveness and safety.

The paediatric acute scrotum: are we still managing correctly?

African Journals Online (AJOL)

Objective The objective of this study was to investigate current investigation and management practice in a general district hospital in the UK of the paediatric acute scrotum. Summary background Diagnosis and management of the paediatric acute scrotum remains an elusive and often challenging area of urology.

Quality and clinical supply considerations of Paediatric Investigation Plans for IV preparations-A case study with the FP7 CloSed project.

Science.gov (United States)

Hanning, Sara M; Orlu Gul, Mine; Winslade, Jackie; Baarslag, Manuel A; Neubert, Antje; Tuleu, Catherine

2016-09-25

A Paediatric Investigation Plan (PIP) is a development plan that aims to ensure that sufficient data are obtained through studies in paediatrics to support the generation of marketing authorisation of medicines for children. This paper highlights some practical considerations and challenges with respect to PIP submissions and paediatric clinical trials during the pharmaceutical development phase, using the FP7-funded Clonidine for Sedation of Paediatric Patients in the Intensive Care Unit (CloSed) project as a case study. Examples discussed include challenges and considerations regarding formulation development, blinding and randomisation, product labelling and shipment and clinical trial requirements versus requirements for marketing authorisation. A significant quantity of information is required for PIP submissions and it is hoped that future applicants may benefit from an insight into some critical considerations and challenges faced in the CloSed project. Copyright © 2016 Elsevier B.V. All rights reserved.

Shared decision-making in the paediatric field: a literature review and concept analysis.

Science.gov (United States)

Park, Eun Sook; Cho, In Young

2017-09-13

The concept of shared decision-making is poorly defined and often used interchangeably with related terms. The aim of this study was to delineate and clarify the concept of shared decision-making in the paediatric field. Rodgers and Knafl's evolutionary concept analysis was used to delineate and clarify the concept. Following a search of the CINAHL, PubMed and MEDLINE databases and online journals between 1995 and 2016, we included a total of 42 articles that referred to shared decision-making in the paediatric field. The attributes included active participation of the three: parents, children and health professionals; collaborative partnership; reaching a compromise; and common goal for child's health. Antecedents were existing several options with different possible outcomes; substantial decisional conflict; recognising child's health situations that decision-making is needed; and willingness to participate in decision-making. Finally, the consequences included decreased decisional conflict; mutual empowerment; improved child health status; and improved quality of paediatric health care. This study provides a theoretical understanding of the concept of shared decision-making in the paediatric field; furthermore, by integrating this concept into paediatric practice, it may help to reduce the gap between theory and practice. The analysis could also provide nursing researchers with insight into paediatric decision-making and establish a foundation to develop future interventions and situation-specific theory for promoting high-quality decision-making in the paediatric field. © 2017 Nordic College of Caring Science.

Contemporary Australian dose area product levels in the fluoroscopic investigation of paediatric congenital heart disease

International Nuclear Information System (INIS)

Jones, T.; Brennan, P.C.; Mello-Thoms, C.; Ryan, E.

2017-01-01

This study examines radiation dose levels delivered to children from birth to 15 y of age in the investigation of congenital heart disease (CHD) at a major Sydney children's hospital. The aims are to compare values with those derived from similar studies, to provide a template for more consistent dose reporting, to establish local and national diagnostic reference levels and to contribute to the worldwide paediatric dosimetry database. A retrospective review of 1007 paediatric procedural records was undertaken. The cohort consisted of 795 patients over a period from January 2007 to December 2012 who have undergone cardiac catheterisation for the investigation of CHD. The age range included was from the day of birth to 15 y. Archived dose area product (DAP) and fluoroscopy time (FT) readings were retrieved and analysed. The mean, median, 25. and 75. percentile DAP levels were calculated for six specific age groupings. The 75. percentile DAP values for the specific age categories were as follows: 0-30 d-1.9 Gy cm 2 , 1-12 months-2.9 Gy cm 2 , 1-3 y-5.3 Gy cm 2 , 3-5 y-6.2 Gy cm 2 , 5-10 y-7.5 Gy cm 2 and 10-15 y-17.3 Gy cm 2 . These levels were found to be lower than the values reported in comparable overseas studies. Individual year-specific levels were determined, and it is proposed that these are more useful than the common grouping method. The age-specific 75. percentile DAP levels outlined in this study can be used as baseline local diagnostic reference levels. The needs for the standardisation of DAP reporting and for a greater range of age-specific diagnostic reference levels have been highlighted. For the first time, Australian dose values for paediatric cardiac catheterisation are presented. (authors)

Drug development: EU paediatric legislation, the European Medicines Agency and its Paediatric Committee--adolescents' melanoma as a paradigm.

Science.gov (United States)

Rose, Klaus; Senn, Stephen

2014-01-01

The European Medicines Agency (EMA) website lists all diseases that officially exist in adults only. The class waiver for juvenile melanoma was revoked in 2008 referring to US SEER statistics. This statistical justification is misleading. Melanoma in adolescents is much rarer than claimed by EMA/Paediatric Committee; < 1 ∕ 4 of adolescents with melanoma need systemic treatment; separate efficacy studies are neither medically justified nor feasible. The scarce adolescent patients should be allowed to participate in adult trials. To force companies to investigate them separately turns them into paediatric hostages, to adapt the term therapeutic orphans coined in 1968 by Shirkey. There are now five melanoma Paediatric Investigation Plans (PIPs). Probably none of the PIP-triggered clinical studies will ever be completed; we propose to call them ghost studies. An oncology research network considering a reasonable trial in melanoma, including adolescents, will compete for recruitment with the PIP-triggered trials designed by regulatory tunnel vision and sponsored by companies under EMA-imposed pressure. EMA/Paediatric Committee's territorial enthusiasm ("our patients") damages oncology research. Copyright © 2014 John Wiley & Sons, Ltd.

Paediatric acute care: Highlights from the Paediatric Acute Care-Advanced Paediatric Life Support Conference, Gold Coast, 2017.

Science.gov (United States)

Teo, Stephen Ss; Rao, Arjun; Acworth, Jason

2018-04-25

The Paediatric Acute Care Conference is an annual conference organised by APLS Australia to advance paediatric acute care topics for clinicians in pre-hospital medicine, EDs, acute paediatrics, intensive care and anaesthesia. The Conference 2017 was held at Surfers Paradise, Queensland. We provide a summary of some of the presentations. © 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Ethical dimensions of paediatric nursing: A rapid evidence assessment.

Science.gov (United States)

Bagnasco, Annamaria; Cadorin, Lucia; Barisone, Michela; Bressan, Valentina; Iemmi, Marina; Prandi, Marzia; Timmins, Fiona; Watson, Roger; Sasso, Loredana

2018-02-01

Paediatric nurses often face complex situations requiring decisions that sometimes clash with their own values and beliefs, or with the needs of the children they care for and their families. Paediatric nurses often use new technology that changes the way they provide care, but also reduces their direct interaction with the child. This may generate ethical issues, which nurses should be able to address in the full respect of the child. Research question and objectives: The purpose of this review is to describe the main ethical dimensions of paediatric nursing. Our research question was, 'What are the most common ethical dimensions and competences related to paediatric nursing?' A rapid evidence assessment. According to the principles of the rapid evidence assessment, we searched the PubMed, SCOPUS and CINAHL databases for papers published between January 2001 and March 2015. These papers were then independently read by two researchers and analysed according to the inclusion criteria. Ethical considerations: Since this was a rapid evidence assessment, no approval from the ethics committee was required. Ten papers met our inclusion criteria. Ethical issues in paediatric nursing were grouped into three areas: (a) ethical issues in paediatric care, (b) social responsibility and (c) decision-making process. Few studies investigate the ethical dimensions and aspects of paediatric nursing, and they are mainly qualitative studies conducted in critical care settings based on nurses' perceptions and experiences. Paediatric nurses require specific educational interventions to help them resolve ethical issues, contribute to the decision-making process and fulfil their role as advocates of a vulnerable population (i.e. sick children and their families). Further research is needed to investigate how paediatric nurses can improve the involvement of children and their families in decision-making processes related to their care plan.

Extrapolation in the development of paediatric medicines: examples from approvals for biological treatments for paediatric chronic immune-mediated inflammatory diseases.

Science.gov (United States)

Stefanska, Anna M; Distlerová, Dorota; Musaus, Joachim; Olski, Thorsten M; Dunder, Kristina; Salmonson, Tomas; Mentzer, Dirk; Müller-Berghaus, Jan; Hemmings, Robert; Veselý, Richard

2017-10-01

The European Union (EU) Paediatric Regulation requires that all new medicinal products applying for a marketing authorisation (MA) in the EU provide a paediatric investigation plan (PIP) covering a clinical and non-clinical trial programme relating to the use in the paediatric population, unless a waiver applies. Conducting trials in children is challenging on many levels, including ethical and practical issues, which may affect the availability of the clinical evidence. In scientifically justified cases, extrapolation of data from other populations can be an option to gather evidence supporting the benefit-risk assessment of the medicinal product for paediatric use. The European Medicines Agency (EMA) is working on providing a framework for extrapolation that is scientifically valid, reliable and adequate to support MA of medicines for children. It is expected that the extrapolation framework together with therapeutic area guidelines and individual case studies will support future PIPs. Extrapolation has already been employed in several paediatric development programmes including biological treatment for immune-mediated diseases. This article reviews extrapolation strategies from MA applications for products for the treatment of juvenile idiopathic arthritis, paediatric psoriasis and paediatric inflammatory bowel disease. It also provides a summary of extrapolation advice expressed in relevant EMA guidelines and initiatives supporting the use of alternative approaches in paediatric medicine development. © 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.

Interventional Radiology in Paediatrics.

Science.gov (United States)

Chippington, Samantha J; Goodwin, Susie J

2015-01-01

As in adult practice, there is a growing role for paediatric interventional radiology expertise in the management of paediatric pathologies. This review is targeted for clinicians who may refer their patients to paediatric interventional radiology services, or who are responsible for patients who are undergoing paediatric interventional radiology procedures. The article includes a brief overview of the indications for intervention, techniques involved and the commonest complications. Although some of the procedures described are most commonly performed in a tertiary paediatric centre, many are performed in most Children's hospitals.

Challenges of safe medication practice in paediatric care--a nursing perspective.

Science.gov (United States)

Star, Kristina; Nordin, Karin; Pöder, Ulrika; Edwards, I Ralph

2013-05-01

To explore nurses' experiences of handling medications in paediatric clinical practice, with a focus on factors that hinder and facilitate safe medication practices. Twenty nurses (registered nurses) from four paediatric wards at two hospitals in Sweden were interviewed in focus groups. The interviews were analysed using content analysis. Six themes emerged from the analysed interviews: the complexity specific for nurses working on paediatric wards is a hindrance to safe medication practices; nurses' concerns about medication errors cause a considerable psychological burden; the individual nurse works hard for safe medication practices and values support from other nurse colleagues; circumstances out of the ordinary are perceived as critical challenges for maintaining patient safety; nurses value clear instructions, guidelines and routines, but these are often missing, variable or changeable; management, other medical professionals, the pharmacy, the pharmaceutical industry and informatics support need to respond to the requirements of the nurses' working situations to improve safe medication practices. Weaknesses were apparent in the long chain of the medication-delivery process. A joint effort by different professions involved in that delivery process, and a nationwide collaboration between hospitals is recommended to increase safe medication practices in paediatric care. ©2013 Foundation Acta Paediatrica. Published by Blackwell Publishing Ltd.

Development of a core set of quality indicators for paediatric primary care practices in Europe, COSI-PPC-EU.

Science.gov (United States)

Ewald, Dominik A; Huss, Gottfried; Auras, Silke; Caceres, Juan Ruiz-Canela; Hadjipanayis, Adamos; Geraedts, Max

2018-06-01

Paediatric ambulatory healthcare systems in Europe are, because of historical reasons, diverse and show strikingly different outcomes. All across Europe, the benchmarking of structures, processes and outcomes could reveal opportunities for improving Paediatric Primary Care (PPC). The aim of this study was to develop a set of Quality Indicators (QIs) to assess and monitor PPC in Europe. In a three-step process, we used the available external evidence and European expert consensus in a modified RAND/UCLA Appropriateness Method (RAM) to develop an indicator set. (1) A broad literature and online research of published QI and guidelines yielded an inventory of 1516 QI. (2) A collaborative panel of paediatric senior experts from the European Academy of Paediatrics (EAP) and the European Confederation of Primary Care Paediatricians (ECPCP) from 15 European countries participated in a first consensus process to reduce the initial indicator inventory by eliminating not PPC-focused indicators and duplicates. (3) In a second consensus process, the panel rated the QI regarding validity and feasibility. The final QI set "COSI-PPC-EU" consists of 42 indicators in five categories of PPC: (A) health promotion/prevention/screening (13 QI), (B) acute care (9 QI), (C) chronic care (8 QI), (D) practice management (3 QI) and (E) patient safety (9 QI). COSI-PPC-EU represents a consented set of a limited number of valid quality indicators for the application in paediatric primary care in different healthcare systems throughout Europe. What is Known: • Paediatric ambulatory healthcare systems in Europe are diverse and show strikingly different outcomes. • There are known gaps in quality performance measures of paediatric primary care in Europe. Pre-existing sets of quality indicators are predominantly limited to national populations, specific diseases and hospital care. What is New: • A set of 42 quality indicators for primary paediatric care in Europe was developed in a multi

Atlas of Bone Scintigraphy in the Developing Paediatric Skeleton: The Normal Skeleton, Variants and Pitfalls

International Nuclear Information System (INIS)

2011-01-01

Since the introduction of 99m technetium polyphosphate in 1972 by Dr. M. Subramanian, bone scintigraphy has become an integral part of the evaluation of paediatric musculoskeletal disorders. Using the current high resolution gamma cameras and 99m technetium-methylene diphosphonate ( 99m Tc-MDP) or 99m Tc 2,3-dicarboxypropane-1,1-diphosphonate ( 99m Tc-DPD), the quality of images available for interpretation is high. From the very earliest days, there has been a certain confusion over normal bone physiology, as depicted by the bone scintigram in paediatric patients. This has resulted in a number of difficulties in detecting subtle abnormalities, especially near the dynamically changing scintigraphic presentation of the physes (growth zones). Examples of abnormalities that might be confused with normal bone activity are osteomyelitis, bucket handle fractures of the long bones, as well as neuroblastoma and leukaemic metastases. The aim of this publication is to provide structured information about the maturation and normal appearance of the skeleton from infancy to adulthood. As such, it reflects the current status of bone scintigraphy. It is hoped that this work will contribute to an enhanced understanding of the dynamic process of naturally occurring metabolic bone changes, which will, in turn, improve the quality of reporting of paediatric bone scans. As the majority of paediatric bone scintigrams are interpreted by non-paediatric nuclear physicians, the availability of this reference atlas should improve the care of children. This atlas is intended to address the needs of nuclear medicine physicians, both residents and specialists. It is intended to serve as an illustrative reference to those not having sufficient exposure to paediatric bone scan investigations, to enable them to maintain adequate competency in this particular application. Experts in paediatric nuclear medicine are often consulted for their opinion on bone scans obtained in their respective

Paediatric talus fracture.

LENUS (Irish Health Repository)

Byrne, Ann-Maria

2012-01-01

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.

Paediatric airway management: basic aspects

DEFF Research Database (Denmark)

Holm-Knudsen, R J; Rasmussen, L S

2009-01-01

Paediatric airway management is a great challenge, especially for anaesthesiologists working in departments with a low number of paediatric surgical procedures. The paediatric airway is substantially different from the adult airway and obstruction leads to rapid desaturation in infants and small...... children. This paper aims at providing the non-paediatric anaesthesiologist with a set of safe and simple principles for basic paediatric airway management. In contrast to adults, most children with difficult airways are recognised before induction of anaesthesia but problems may arise in all children...

Safety in paediatric imaging

International Nuclear Information System (INIS)

Carter, D.; Filice, I.; Murray, D.; Thomas, K.

2006-01-01

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)

Investigating collaborative learning success with physiological coupling indices based on electrodermal activity

NARCIS (Netherlands)

Pijeira-díaz, Hector; Drachsler, Hendrik; Järvelä, Sanna; Kirschner, Paul A.

2017-01-01

Collaborative learning is considered a critical 21st century skill. Much is known about its contribution to learning, but still investigating a process of collaboration remains a challenge. This paper approaches the investigation on collaborative learning from a psychophysiological perspective. An

Paediatric Anxiety Disorders

Directory of Open Access Journals (Sweden)

Beena Johnson

2017-07-01

Full Text Available Anxiety disorders are highly prevalent among children and are associated with serious morbidity. Lifetime prevalence of paediatric anxiety disorders is about fifteen percent. Social phobia, generalized anxiety disorder and separation anxiety disorder are included in the triad of paediatric anxiety disorders. Specific phobia, obsessive compulsive disorder and post-traumatic stress disorder are also commonly seen in children. Overprotection by parents, parental death or separation, female sex, low educational status, family history of anxiety disorder, financial stress in family and adverse childhood experiences are risk factors for the development of anxiety disorders. If not diagnosed and managed at the earliest, paediatric anxiety disorders can cause life threatening problems in the future. Hence early and scientific management of anxiety disorders is essential. Cognitive behavioural therapy is the effective evidence based treatment for paediatric anxiety disorders.

The BRACELET Study: surveys of mortality in UK neonatal and paediatric intensive care trials

Directory of Open Access Journals (Sweden)

Platt Martin

2010-05-01

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

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

Directory of Open Access Journals (Sweden)

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.

Firm handling; the information exchange interaction by parents in paediatric care – An observational study

Directory of Open Access Journals (Sweden)

Carina Berterö

2011-01-01

Full Text Available Background: Information exchange is fundamental in the paediatric care encounter. Health care professionals need further background knowledge to encounter the parents/guardians from their perspective in their minors’ paediatric care. The parents’/guardians’ ability to manage the situation is dependent on their receiving optimal information, which is why it is important to study how information is exchanged.Aim: The aim of this study was to identify, describe and conceptualize how parents/guardians resolved their main concern ininformation exchange with health care professionals in paediatric care situations involving their minors.Methodology: Glaser’s grounded theory method was used and all data were analysed using constant comparative analysis. The observational study took place at three paediatric outpatient units at a university hospital and 24 parents/guardians participated. Data sources were field notes from 37 observations of paediatric care situations and five adherent excerpts from the minors’ medical records. Grounded theory is a method of conceptualising behaviour, which is why an observational study of parents’/guardians’ information exchange and social interaction in the context of nursing care is relevant as research design.Results: Firm handling was revealed as the way the parents/guardians resolved their main concerns when they were exchanging information about their minors’ paediatric care. Firm handling is built on five inter-related categories: representative advocating, collaborating, aim sharing, supportive resourcing and minor bypassing.Conclusions: This knowledge suggests possible ways for health care professionals to design paediatric care that supports, facilitates, strengthens and improves the parents’/guardians’ firm handling. The key issue is to find ways to support parents/guardians and minors so they can participate in health care encounters according to their preferences. Firm handling gives an

EAP viewpoint on unpublished data from paediatric clinical trials.

Science.gov (United States)

Schrier, L; Illy, K; Valiulis, A; Wyder, C; Stiris, T

2018-02-01

European children and paediatricians rely heavily on the fair, complete and timely publication of data obtained from paediatric randomised controlled trials (RCTs). Selective publication and reporting of paediatric RCTs is common practice. Industry-sponsored trials are more likely to remain unpublished, and take longer to get published compared with trials sponsored by others. However, also academic sponsors contribute to inefficiencies in publishing clinical data. Publication bias violates the ethical obligation that investigators have towards study participants, leads to considerable inefficiencies in research and a waste of financial and human resources, and has the potential to distort evidence for treatment approaches. The European Academy of Paediatrics (EAP) therefore actively supports initiatives that increase the public dissemination of paediatric clinical trial data. The EAP will raise awareness about the guidelines for Good Publication Practice among European paediatricians and subspecialty societies.

[Transition - how adolescents with cystic fibrosis their parents experience the change from paediatric to adult care].

Science.gov (United States)

Becher, Christine; Regamey, Nicolas; Spichiger, Elisabeth

2014-12-01

Cystic Fibrosis is the most common autosomal-recessive hereditary disease among white Europeans. The average survival of CF patients has increased to above 40 years and transition from paediatric to adult care has therefore become a significant issue. With this study, experiences of adolescents with CF and their parents with the transition from the paediatric to the adult care were explored. At a Swiss university CF centre, six adolescents and their mothers were recruited. Twelve narrative interviews were conducted on how the phase of transition was experienced. The transcribed interviews were analysed according to the method of hermeneutic phenomenology. Positive and negative experiences with long term routine care in the paediatric service, general themes of adolescence and the quality of the relationship with paediatric doctors influenced the families' experience during transition significantly. For mothers, insensitive information on the CF diagnosis might have influenced the transition experience. The adolescents welcomed an individualized and age appropriate care. Continuity in care, the announcement of, and involvement in the planning of the transfer were of great importance. The families particularly appreciated the timed adaptations of the transfer to individual needs. Flexibility and a strong collaboration between paediatric and adult CF teams are most relevant in the care of families.

Paediatrics: messages from Munich

Directory of Open Access Journals (Sweden)

Fabio Midulla

2015-05-01

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.

ALARA and paediatric imaging in radiation therapy: A survey of Canadian paediatric imaging practice

International Nuclear Information System (INIS)

Rodgerson, Christine

2014-01-01

Purpose: There is little discussion in the literature regarding paediatric imaging dose reduction with respect to conventional imaging carried out in radiotherapy departments. This is in contrast to diagnostic radiography where dose optimization when imaging children is a very current topic. For this reason Canadian radiotherapy clinics were surveyed to look at paediatric imaging practice, knowledge and perspectives with respect to imaging dose reduction. Method: As this was an exploratory study, a questionnaire was developed and sent to radiation therapy clinics across Canada, via email, to assess knowledge of paediatric imaging and dose reduction initiatives. The questionnaire focus was CT simulation and treatment verification imaging of children. Results: Practice and knowledge of paediatric imaging varied across Canada. Forty percent of clinics reported using paediatric specific protocols for CT simulation and 20% of clinics reported using paediatric specific protocols for treatment verification imaging. There was variation in imaging practices among the clinics that reported treating the most children. The survey results show that while some measures are being taken to reduce paediatric imaging dose in radiation therapy, 46.7% of the respondents felt more could be done. Conclusion: The survey demonstrates interest in dose reduction in radiation therapy imaging as well as differences in current practice and knowledge across Canada. Paediatric imaging dose reduction would appear to be an area of practice that would benefit from more study and development of standards of practice

African Journal of Paediatric Surgery

African Journals Online (AJOL)

The African Journal of Paediatric Surgery aims to promote research, post- graduate training and further education among Paediatric surgeons, Paediatric Surgical Trainees and paramedical personnel in the surgery of newborn infants and children particularly in Africa and other tropical regions of the world.AJPS welcomes ...

African Journal of Paediatric Nephrology

African Journals Online (AJOL)

African Journal of Paediatric Nephrology is the official Journal of the African Paediatric Nephrology Association (AFPNA). The journal is dedicated to increasing awareness and knowledge of Paediatric nephrology in Africa and beyond. We publish research articles on renal diseases in children, on fluid and electrolyte ...

Development and implementation of a multi-centre information system for paediatric and infant critical care.

Science.gov (United States)

Maybloom, Bruce; Champion, Zahra

2003-12-01

With no UK collective information system, a need existed to establish an integrated information system for public and private sector hospitals providing paediatric and infant critical care services. A lack of information in the past made it difficult for those procuring, providing and monitoring services to make informed, evidence-based decisions using reliable integrated data. To develop and implement a collective multi-purpose information system for paediatric and infant critical care that was easily adaptable to any UK infant or paediatric critical care setting. Information outputs had to fulfil policy requirements and meet the needs of stakeholders. Two minimum datasets, corresponding data definitions, survey forms and a user database were developed through a process of consultation by utilising an information partnership. Design, content, development and implementation issues were identified, discussed and resolved through a co-ordinated collaborative process. Data collection was implemented in all London and Brighton National Health Service (NHS) general and cardio-thoracic paediatric intensive care (PIC) units, several private PIC units and one NHS tertiary referral neonatal unit (NNU) 24 months from project start. The development of universal integrated information systems for defined settings of care is achievable within reasonable timeframes; however, successful development and implementation requires working within an information partnership to maximise co-ordination, co-operation and collaboration. Those collecting and using data must be identified and involved in all aspects of development from project start. Financial and manpower resources must be well planned. Datasets should be as small as possible in order to make the collection of complete and valid data realistically achievable. When considering service-based information needs, considerable thought should be given to a multi-purpose; multi-use approach based on the most refined minimum dataset

Paediatric radiopharmaceutical administration

DEFF Research Database (Denmark)

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

2014-01-01

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...

Literature overview highlights lack of paediatric donation protocols but identifies common themes that could guide their development.

Science.gov (United States)

Vileito, A; Siebelink, M J; Verhagen, Aae

2018-05-01

Paediatric donation is a unique and extremely sensitive process that requires specific knowledge and competencies. Most countries use protocols for organ and tissue donation to ensure optimal care for the donor and family, but these mainly focus on adults. However, the donation process for children differs from adults in many ways. An overview of the literature was performed to identify protocols for the paediatric population. PubMed, Web of Science, EMBASE and the Internet were searched up to March 2016 for papers or other sources in English related to specific organ and tissue donation protocols for children and neonates. This comprised title, abstract and then full-text screening of relevant data. We included 12 papers and two electronic sources that were mainly from North America and Europe. Most discussed donations after cardiac death. The recurring themes included identifying potential donors, approaching parents, palliative care and collaboration with organ procurement organisations. Most papers called for paediatric donation policies to be standardised. Scientific publications in English on paediatric donation protocols are very scarce. No comprehensive paediatric donation protocol was found. We identified several recurring themes in the literature that could be used to develop such protocols. ©2018 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.

Canadian Paediatric Neurology Workforce Survey and Consensus Statement.

Science.gov (United States)

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

2016-05-01

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.

Paediatric Abdominal Surgical Emergencies in a General Surgical ...

African Journals Online (AJOL)

... organized for general surgeons undertaking paediatric surgical emergencies. More paediatric surgeons should be trained and more paediatric surgical units should established in the country. Key Words: Paediatric Abdominal Surgical Emergencies; Paediatric Surgeons, General Surgeons. Journal of College of Medicine ...

Nigerian Journal of Paediatrics: Editorial Policies

African Journals Online (AJOL)

Dr. Austine I Omoigberale FWACP (Paed) Professor of Paediatrics, Neonatology & Infectious diseases. Dept of Child Health University of Benin Teaching Hospital Benin City Nigeria isigboge@gmail.com +2348030750641. Dr. Felix Akinbami FWACP (Paed) Professor of Paediatrics & Gastroenterology Dept of Paediatrics

Paediatric Early Warning Score - A multi-center randomized controlled intervention study

DEFF Research Database (Denmark)

Jensen, Claus Sixtus; Aagaard, Hanne; Olesen, Hanne Vebert

Paediatric Early Warning System on evolving critical illness and intervention in hospitalised children; a regional multicentre study on implementation of a Paediatric Early Warning System Background: Critical illness in the patient and death can potentially be predicted and prevented. Deterioration...... is critically ill are related to the child’s symptoms of serious illness often being uncharacteristic. Children can seem relatively unaffected until a short time before circulatory insufficiency and cardiac arrest. Thus, there is a need for developing and investigating if an Paediatric Early Warning System...... of the intervention and evaluation. The study involves all paediatric departments and some acute departments in Central Denmark Region. The project both includes quantitative studies and a qualitative evaluation study. The studies will have different designs: • Registry study - exploring and describing life...

The Internet and the paediatric surgeon.

Science.gov (United States)

Srinivas, M; Inumpudi, A; Mitra, D K

1998-12-01

The Internet, which has truly united the world, is an extensive network of inter-linked computers storing immense bytes of information that can be accessed by anyone, transcending all barriers. The paediatric surgery Internet consists of exponentially growing material that deals with information specifically for paediatric surgeons and patients of the paediatric age group. We reviewed the methods available to take advantage of this network to enable busy paediatric surgeons to accrue the benefits easily and efficiently rather than be lost in the information ocean by surfing individually. By getting connected to the Internet, the paediatric surgeon gains enormous information that can be useful for patient care. The Internet has revolutionised scientific publications by virtue of its fast and accurate transmission of manuscripts. Paediatric surgeons can send manuscripts by this channel and also access journals, obviating the inherent lag period of communication by post.

[Promotion of breast feeding in paediatric outpatient settings].

Science.gov (United States)

Böse-O'Reilly, S; Wermuth, I; Hellmann, J; Siebert, U; Lob-Corzilius, T

2008-03-01

With some data and examples it can be shown that the competence and the knowledge of paediatric doctor's assistants and paediatric nurses can and should be improved. The training courses to become a "prevention assistant" have been very positively accepted by doctor's assistants and paediatric nurses, and it seems an appropriate method to reach these aims. Prevention and especially promotion of breast feeding is possible in paediatric outpatient settings. The immediate contact between infants, parents, paediatric doctor's assistants, paediatric nurses, and doctors offers a unique opportunity to promote the health of children, mainly due to the high acceptance of regular check-ups. So why not introduce the promotion of breast feeding in paediatric outpatient settings with specially trained doctor's assistants and paediatric nurses?

Paediatric cardiology programs in countries with limited resources: how to bridge the gap.

Science.gov (United States)

Sulafa, K M Ali

2010-07-01

Establishing paediatric cardiology service in a country with limited resources like Sudan is a challenging task. A paediatric cardiac team was formed then the services in different disciplines were gradually established. Echocardiography (echo) clinics were founded in tertiary and peripheral hospitals. Cardiac catheterization (cath) was established at the Sudan Heart Centre (SHC) in 2004 and over 400 procedures had been performed including interventional catheterization like pulmonary valve dilatation, patent ductus arteriosus and atrial septal defect device closure. Congenital heart surgery started in 2001, currently 200 cases are done each year including closed procedures as well as open heart procedures for patients weighing more than 8 kg. Cardiology-cardiac surgery as well as adult congenital heart disease meetings were held and contributed positively to the services. The cardiology-cardiac surgery scientific club meeting was founded as a forum for academic discussions. A fellowship program was established in 2004 and included seven candidates trained in paediatric cardiology and intensive care. Two training courses had been established: congenital heart disease echo and paediatric electrocardiogram interpretation. Links with regional and international cardiac centres had important roles in consolidating our program. Significant obstacles face our service due to the small number of trained personnel, high cost of procedures, the lack of regular supplies and lack of cardiac intensive care facilities for young infants. Bridging the huge gap needs extensive official as well as non-governmental efforts, training more staff, supporting families and collaboration with regional and international centres.

Paediatric medical emergency calls to a Danish Emergency Medical Dispatch Centre

DEFF Research Database (Denmark)

Andersen, Kasper; Mikkelsen, Søren; Jørgensen, Gitte

2018-01-01

with a supporting physician-manned mobile emergency care unit (56.4%). The classification of medical issues and the dispatched pre-hospital units varied with patient age. DISCUSSION: We believe our results might help focus the paediatric training received by emergency medical dispatch staff on commonly encountered......BACKGROUND: Little is known regarding paediatric medical emergency calls to Danish Emergency Medical Dispatch Centres (EMDC). This study aimed to investigate these calls, specifically the medical issues leading to them and the pre-hospital units dispatched to the paediatric emergencies. METHODS: We...... records to establish how the medical issues leading to these calls were classified and which pre-hospital units were dispatched to the paediatric emergencies. We analysed the data using descriptive statistics. RESULTS: Of a total of 7052 emergency calls in February 2016, 485 (6.9%) concerned patients ≤ 15...

The proposal of Paediatric Virology and its perspectives: An interview with Professor of Paediatrics Maria Theodoridou.

Science.gov (United States)

Mammas, Ioannis N; Spandidos, Demetrios A

2017-10-01

Professor Maria Theodoridou, Emeritus Professor of Paediatrics at the University of Athens, is one of the few paediatricians in Greece, who have experienced almost all the infectious diseases of the second half of the 20th century and their severe consequences, prior to the widespread adoption of immunisations. A milestone during her career was the establishment of a specialised National Reference Unit for the care of paediatric patients with acquired immune deficiency syndrome (AIDS) at the 'Aghia Sophia' Children's Hospital in Athens, Greece. According to Professor Theodoridou, training on the prevention, management and treatment of neonatal and paediatric viral infections represents a new educational challenge for both community as well as hospital-based paediatric health professionals. The debate of the potential strategically principal role of Paediatric Virology subspecialists in the primary, secondary and tertiary clinical practice is definitely necessary and needs further discussion and evaluation, she adds. She describes the difficulties that Greece, a country under a long-standing financial crisis, faces for the hospital-based management of paediatric viral infections and refers to the future advances, which are expected in the field of diagnosis and treatment of viral infections in neonates and children. In the context of the 3rd Workshop on Paediatric Virology, which will be held in Athens on October 7th, 2017, Professor Theodoridou will focus on the immigration crisis and vaccination policy.

Do geography and resources influence the need for colostomy in Hirschsprung's disease and anorectal malformations? A Canadian association of paediatric surgeons: association of paediatric surgeons of Nigeria survey.

Science.gov (United States)

Abdur-Rahman, Lukman O; Shawyer, Anna; Vizcarra, Rachel; Bailey, Karen; Cameron, Brian H

2014-01-01

This survey compared surgical management of Hirschsprung's disease (HD) and anorectal malformations (ARM) in high and low resource settings. An online survey was sent to 208 members of the Canadian Association of Paediatric Surgeons (CAPS) and the Association of Paediatric Surgeons of Nigeria (APSON). The response rate was 76.8% with 127 complete surveys (APSON 34, CAPS 97). Only 29.5% of APSON surgeons had frozen section available for diagnosis of HD. They were more likely to choose full thickness rectal biopsy (APSON 70.6% vs. CAPS 9.4%, P colostomy for HD (APSON 23.5% vs. CAPS 0%, P colostomy in females with vestibular fistula varied widely independent of geography. APSON surgeons were less likely to have enterostomal therapists and patient education resources. Local resources which vary by geographic location affect the management of HD and ARM including colostomy. Collaboration between CAPS and APSON members could address resource and educational needs to improve patient care.

Malnutrition in paediatric oncology patients

African Journals Online (AJOL)

Nutritional status of paediatric cancer patients at diagnosis ... Professor and Executive Head, Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Hospital, .... can lead to decreased oral intake, weight loss.

Social media in paediatric heart disease: professional use and opportunities to improve cardiac care.

Science.gov (United States)

Schumacher, Kurt R; Lee, Joyce M; Pasquali, Sara K

2015-12-01

Social media is any type of communication utilising electronic technology that follows two guiding principles: free publishing or sharing of content and ideas and group collaboration and inter-connectedness. Over the last 10 years, social media technology has made tremendous inroads into all facets of communication. Modalities such as Facebook, YouTube, and Twitter are no longer viewed as new communication technologies. Owing to their tremendous usage, they are now common ways to conduct a dialogue with individuals and groups. Greater than 91% of teenagers and 89% of young adults routinely use social media. Further, 24% of teenagers reported being online "almost constantly". These forms of communication are readily used by individuals cared for in the field of paediatric cardiology; thus, they should carry significant interest for cardiology care providers; however, social media's influence on medicine extends beyond use by patients. It directly affects all medical providers, both users and non-users. Further, social media has the ability to improve care for patients with paediatric heart disease. This article details social media's current influence on paediatric cardiology, including considerations for professional use of social media and potential opportunities to improve cardiac care.

Use of the Delphi process in paediatric cataract management.

Science.gov (United States)

Serafino, Massimiliano; Trivedi, Rupal H; Levin, Alex V; Wilson, M Edward; Nucci, Paolo; Lambert, Scott R; Nischal, Ken K; Plager, David A; Bremond-Gignac, Dominique; Kekunnaya, Ramesh; Nishina, Sachiko; Tehrani, Nasrin N; Ventura, Marcelo C

2016-05-01

To identify areas of consensus and disagreement in the management of paediatric cataract using a modified Delphi approach among individuals recognised for publishing in this field. A modified Delphi method. International paediatric cataract experts with a publishing record in paediatric cataract management. The process consisted of three rounds of anonymous electronic questionnaires followed by a face-to-face meeting, followed by a fourth anonymous electronic questionnaire. The executive committee created questions to be used for the electronic questionnaires. Questions were designed to have unit-based, multiple choice or true-false answers. The questionnaire included issues related to the preoperative, intraoperative and postoperative management of paediatric cataract. Consensus based on 85% of panellists being in agreement for electronic questionnaires or 80% for the face-to-face meeting, and near consensus based on 70%. Sixteen of 22 invited paediatric cataract surgeons agreed to participate. We arrived at consensus or near consensus for 85/108 (78.7%) questions and non-consensus for the remaining 23 (21.3%) questions. Those questions where consensus was not reached highlight areas of either poor evidence or contradicting evidence, and may help investigators identify possible research questions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Genodermatoses in paediatric age group

Directory of Open Access Journals (Sweden)

Kumar Sunil

1996-01-01

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.

Paediatric interventional radiology

International Nuclear Information System (INIS)

McLaren, Clare

2014-01-01

Paediatric interventional radiology (PIR) is a rapidly-growing subspecialty, which offers a wide range of procedures applicable to almost all areas of hospital paediatrics. There are many important differences between paediatric and adult practice in interventional radiology, including disease processes and treatment goals, anatomical considerations, periprocedural patient management, radiation exposure optimisation and legal aspects. The use of retrievable or absorbable interventional devices such as stents will probably become more widespread in PIR practice. Recent advances in the technology of imaging equipment have been accompanied by an increase in the complexity of the work done by the radiographer. These developments present challenges and opportunities related to training and maintenance of skills, staffing arrangements, and the potential for advanced practice. It is likely that specialisation in PIR will become a more common role for radiographers in the future

Development of a paediatric population-based model of the pharmacokinetics of rivaroxaban.

Science.gov (United States)

Willmann, Stefan; Becker, Corina; Burghaus, Rolf; Coboeken, Katrin; Edginton, Andrea; Lippert, Jörg; Siegmund, Hans-Ulrich; Thelen, Kirstin; Mück, Wolfgang

2014-01-01

Venous thromboembolism has been increasingly recognised as a clinical problem in the paediatric population. Guideline recommendations for antithrombotic therapy in paediatric patients are based mainly on extrapolation from adult clinical trial data, owing to the limited number of clinical trials in paediatric populations. The oral, direct Factor Xa inhibitor rivaroxaban has been approved in adult patients for several thromboembolic disorders, and its well-defined pharmacokinetic and pharmacodynamic characteristics and efficacy and safety profiles in adults warrant further investigation of this agent in the paediatric population. The objective of this study was to develop and qualify a physiologically based pharmacokinetic (PBPK) model for rivaroxaban doses of 10 and 20 mg in adults and to scale this model to the paediatric population (0-18 years) to inform the dosing regimen for a clinical study of rivaroxaban in paediatric patients. Experimental data sets from phase I studies supported the development and qualification of an adult PBPK model. This adult PBPK model was then scaled to the paediatric population by including anthropometric and physiological information, age-dependent clearance and age-dependent protein binding. The pharmacokinetic properties of rivaroxaban in virtual populations of children were simulated for two body weight-related dosing regimens equivalent to 10 and 20 mg once daily in adults. The quality of the model was judged by means of a visual predictive check. Subsequently, paediatric simulations of the area under the plasma concentration-time curve (AUC), maximum (peak) plasma drug concentration (C max) and concentration in plasma after 24 h (C 24h) were compared with the adult reference simulations. Simulations for AUC, C max and C 24h throughout the investigated age range largely overlapped with values obtained for the corresponding dose in the adult reference simulation for both body weight-related dosing regimens. However

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

Science.gov (United States)

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

2014-08-05

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.

Variation in radiographic protocols in paediatric interventional cardiology

International Nuclear Information System (INIS)

McFadden, S L; Hughes, C M; Winder, R J

2013-01-01

The aim of this work is to determine current radiographic protocols in paediatric interventional cardiology (IC) in the UK and Ireland. To do this we investigated which imaging parameters/protocols are commonly used in IC in different hospitals, to identify if a standard technique is used and illustrate any variation in practice. A questionnaire was sent to all hospitals in the UK and Ireland which perform paediatric IC to obtain information on techniques used in each clinical department and on the range of clinical examinations performed. Ethical and research governance approval was sought from the Office for Research Ethics Committees Northern Ireland and the individual trusts. A response rate of 79% was achieved, and a wide variation in technique was found between hospitals. The main differences in technique involved variations in the use of an anti-scatter grid and the use of additional filtration to the radiation beam, frame rates for digital acquisition and pre-programmed projections/paediatric specific programming in the equipment. We conclude that there is no standard protocol for carrying out paediatric IC in the UK or Ireland. Each hospital carries out the IC procedure according to its own local protocols resulting in a wide variation in radiation dose. (paper)

Variation in radiographic protocols in paediatric interventional cardiology.

Science.gov (United States)

McFadden, S L; Hughes, C M; Winder, R J

2013-06-01

The aim of this work is to determine current radiographic protocols in paediatric interventional cardiology (IC) in the UK and Ireland. To do this we investigated which imaging parameters/protocols are commonly used in IC in different hospitals, to identify if a standard technique is used and illustrate any variation in practice. A questionnaire was sent to all hospitals in the UK and Ireland which perform paediatric IC to obtain information on techniques used in each clinical department and on the range of clinical examinations performed. Ethical and research governance approval was sought from the Office for Research Ethics Committees Northern Ireland and the individual trusts. A response rate of 79% was achieved, and a wide variation in technique was found between hospitals. The main differences in technique involved variations in the use of an anti-scatter grid and the use of additional filtration to the radiation beam, frame rates for digital acquisition and pre-programmed projections/paediatric specific programming in the equipment. We conclude that there is no standard protocol for carrying out paediatric IC in the UK or Ireland. Each hospital carries out the IC procedure according to its own local protocols resulting in a wide variation in radiation dose.

Summary of the 2015 International Paediatric Heart Failure Summit of Johns Hopkins All Children's Heart Institute.

Science.gov (United States)

Jacobs, Jeffrey P; Quintessenza, James A; Karl, Tom R; Asante-Korang, Alfred; Everett, Allen D; Collins, Susan B; Ramirez-Correa, Genaro A; Burns, Kristin M; Cohen, Mitchell; Colan, Steven D; Costello, John M; Daly, Kevin P; Franklin, Rodney C G; Fraser, Charles D; Hill, Kevin D; Huhta, James C; Kaushal, Sunjay; Law, Yuk M; Lipshultz, Steven E; Murphy, Anne M; Pasquali, Sara K; Payne, Mark R; Rossano, Joseph; Shirali, Girish; Ware, Stephanie M; Xu, Mingguo; Jacobs, Marshall L

2015-08-01

In the United States alone, ∼14,000 children are hospitalised annually with acute heart failure. The science and art of caring for these patients continues to evolve. The International Pediatric Heart Failure Summit of Johns Hopkins All Children's Heart Institute was held on February 4 and 5, 2015. The 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children's Heart Institute was funded through the Andrews/Daicoff Cardiovascular Program Endowment, a philanthropic collaboration between All Children's Hospital and the Morsani College of Medicine at the University of South Florida (USF). Sponsored by All Children's Hospital Andrews/Daicoff Cardiovascular Program, the International Pediatric Heart Failure Summit assembled leaders in clinical and scientific disciplines related to paediatric heart failure and created a multi-disciplinary "think-tank". The purpose of this manuscript is to summarise the lessons from the 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children's Heart Institute, to describe the "state of the art" of the treatment of paediatric cardiac failure, and to discuss future directions for research in the domain of paediatric cardiac failure.

Investigating the Effects of Peer to Peer Prompts on Collaborative Argumentation, Consensus and Perceived Efficacy in Collaborative Learning

Science.gov (United States)

Harney, Owen M.; Hogan, Michael J.; Quinn, Sarah

2017-01-01

In a society which is calling for more productive modes of collaboration to address increasingly complex scientific and social issues, greater involvement of students in dialogue, and increased emphasis on collaborative discourse and argumentation, become essential modes of engagement and learning. This paper investigates the effects of…

Impact of the mother-nurse partnership programme on mother and infant outcomes in paediatric cardiac intensive care unit.

Science.gov (United States)

Uhm, Ju-Yeon; Kim, Hee Soon

2018-04-04

To identify the effects of a mother-nurse partnership programme based on the core components of information sharing, negotiation and participation in care. Specifically, we examined the programme's effects on parental satisfaction, parental self-efficacy, perceived partnership and anxiety, as well as infants' time to reach full oral feeding and length of postoperative hospital stay, following cardiac surgery on infants at a paediatric intensive care unit with a restrictive visiting policy. Quasi-experimental study. An analysis of covariance was used to investigate between-group differences while ensuring homogeneity. A paediatric cardiac ICU. Parental satisfaction, parental self-efficacy, perceived partnership and anxiety. Data from 37 and 36 mothers in the control and experimental groups respectively, were analysed. Compared with controls, experimental group mothers reported significantly higher parental satisfaction (F = 39.29, p partnership (F = 62.30, p < .001) and lower anxiety (F = 12.93, p < .001), upon transfer to the ward. Infant outcomes did not differ between the groups. This programme appears to facilitate collaboration between nurses and mothers and positively influences mothers' emotional and cognitive outcomes following infants' cardiac surgery. Copyright © 2018. Published by Elsevier Ltd.

Interpretation of Chemical Pathology Test Results in Paediatrics ...

African Journals Online (AJOL)

At any time we interprete paediatric chemical pathology test results we must take into consideration a number of factors, which are related with and restricted to paediatric patients. Such factors include the paediatric patient's age that may change from prematurity to above 18 years, and the paediatric patient's body weight ...

Drugs for the paediatric heart

African Journals Online (AJOL)

Head, Paediatric Cardiology Service of the Western Cape, Department of Paediatrics and Child Health, ... His interests also include the care of complex patients ... The pharmacy only has enalapril available – can you substitute this drug for the ...

Discrepancy in reporting among specialist registrars and the role of a paediatric neuroradiologist in reporting paediatric CT head examinations

International Nuclear Information System (INIS)

Nagaraja, S.; Ullah, Q.; Lee, K.J.; Bickle, I.; Hon, L.Q.; Griffiths, P.D.; Raghavan, A.; Flynn, P.; Connolly, D.J.A.

2009-01-01

Aim: To evaluate the discrepancy rate among specialist registrars (SPR) to assess whether seniority had a bearing on the discrepancy rate. To investigate which were the commonly missed abnormalities and the consequences for teaching purposes. To investigate the role of a specialist consultant neuroradiologist in reporting paediatric head computed tomography examinations. Materials and methods: The study was carried out over a 9-month period at the regional paediatric hospital during which time 270 CT head examinations were reported. Reporting in the department is carried out by one of the five general paediatric radiologists (GR) and also a specialist paediatric neuroradiologist (NR). The NR was considered the reference standard, who corroborated in areas of discrepancy with a second senior NR for this study. Of the 270 examinations, 260 were reported by the paediatric NR, 160 were reported by the SPR, GR, and NR, and 51 were reported by an SPR and the NR. In addition, four were reported by the GR and the NR, 45 by the NR only, seven by the GR only, and three cases were reported by the GR and an SPR. The discrepancy rates were calculated for GR versus NR, and SPR versus NR. All the discrepancies were re-evaluated by a second senior NR and confirmed in all cases. The reports of the SPR were further scrutinized. The trainees of training years 1-3 were considered junior and 4-5 were considered senior. Results: There was a discrepancy in 26/164 cases (15.9%) reported by the GR and NR. There was a discrepancy in 59/211 cases (28%) reported by an SPR and NR. The chi-squared test (two-sided) showed a significant difference (p = 0.005) between the two groups. There was a discrepancy in 36/118 cases (30.5%) reported by the junior SPR and NR. There was a discrepancy in 23/93 cases (24.7%) reported by a senior SPR and NR. The chi-squared test (two-sided) showed a non-significant difference (p = 0.353) between the two groups. Conclusion: The performance of the SPR was

The development of paediatric neuroradiology

International Nuclear Information System (INIS)

Harwood-Nash, D.C.

1978-01-01

The development of paediatric neuroradiology is a specific persuasion within neuroradiology and has increased in scope and significance throughout the last ten years. The emergence of computed tomography has altered the indications for types of neuroradiological procedures in infants and children. The sophistication, accuracy, and safety of standard neuroradiological procedures have been increased by the accuracy and safety of computed tomography, particularly in the premature infant. There is a growing need for education and instruction in paediatric neuroradiological techniques and paediatric neuroradiological diseases within the neuroradiological fraternity as a whole. (orig.) [de

Paediatric fever management: continuing education for clinical nurses.

Science.gov (United States)

Walsh, Anne M; Edwards, Helen E; Courtney, Mary D; Wilson, Jenny E; Monaghan, Sarah J

2006-01-01

This study examined the influence of level of practice, additional paediatric education and length of paediatric and current experience on nurses' knowledge of and beliefs about fever and fever management. Fifty-one nurses from medical wards in an Australian metropolitan paediatric hospital completed a self-report descriptive survey. Knowledge of fever management was mediocre (Mean 12.4, SD 2.18 on 20 items). Nurses practicing at a higher level and those with between one and four years paediatric or current experience were more knowledgeable than novices or more experienced nurses. Negative beliefs that would impact nursing practice were identified. Interestingly, beliefs about fever, antipyretic use in fever management and febrile seizures were similar; they were not influenced by nurses' knowledge, experience, education or level of practice. Paediatric nurses are not expert fever managers. Knowledge deficits and negative attitudes influence their practice irrespective of additional paediatric education, paediatric or current experience or level of practice. Continuing education is therefore needed for all paediatric nurses to ensure the latest clear evidence available in the literature for best practice in fever management is applied.

The paediatric Bohler's angle and crucial angle of Gissane: a case series

Directory of Open Access Journals (Sweden)

Crawford Haemish A

2011-01-01

Full Text Available Abstract Background Bohler's angle and the crucial angle of Gissane can be used to assess calcaneal fractures. While the normal adult values of these angles are widely known, the normal paediatric values have not yet been established. Our aim is to investigate Bohler's angle and the crucial angle of Gissane in a paediatric population and establish normal paediatric reference values. Method We measured Bohler's angle and the crucial angle of Gissane using normal plain ankle radiographs of 763 patients from birth to 14 years of age completed over a five year period from July 2003 to June 2008. Results In our paediatric study group, the mean Bohler's angle was 35.2 degrees and the mean crucial angle of Gissane was 111.3 degrees. In an adult comparison group, the mean Bohler's angle was 39.2 degrees and the mean crucial angle of Gissane was 113.8 degrees. The differences in Bohler's angle and the crucial angle of Gissane between these two groups were statistically significant. Conclusion We have presented the normal values of Bohler's angle and the crucial angle of Gissane in a paediatric population. These values may provide a useful comparison to assist with the management of the paediatric calcaneal fracture.

Consultant paediatric outreach clinics--a practical step in integration.

Science.gov (United States)

Spencer, N J

1993-04-01

Ten years' experience of paediatric outreach clinics is reviewed and evaluated. The advantages and disadvantages of paediatric outreach and its possible place in the new era of contracting and more developed community paediatric services are discussed. It is concluded that paediatric outreach increases parental and professional choice and access to paediatric consultant services, increases service flexibility, reduces unnecessary hospital visits, and enables more rational and relevant clinical decision making. Outreach is particularly relevant in areas of deprivation where paediatric needs are greatest.

Shortening the decade-long gap between adult and paediatric drug formulations: a new framework based on the HIV experience in low- and middle-income countries.

Science.gov (United States)

Penazzato, Martina; Lewis, Linda; Watkins, Melynda; Prabhu, Vineet; Pascual, Fernando; Auton, Martin; Kreft, Wesley; Morin, Sébastien; Vicari, Marissa; Lee, Janice; Jamieson, David; Siberry, George K

2018-02-01

Despite the coordinated efforts by several stakeholders to speed up access to HIV treatment for children, development of optimal paediatric formulations still lags 8 to 10 years behind that of adults, due mainly to lack of market incentives and technical complexities in manufacturing. The small and fragmented paediatric market also hinders launch and uptake of new formulations. Moreover, the problems affecting HIV similarly affect other disease areas where development and introduction of optimal paediatric formulations is even slower. Therefore, accelerating processes for developing and commercializing optimal paediatric drug formulations for HIV and other disease areas is urgently needed. The Global Accelerator for Paediatric Formulations (GAP-f) is an innovative collaborative model that will accelerate availability of optimized treatment options for infectious diseases, such as HIV, tuberculosis and viral hepatitis, affecting children in low- and middle-income countries (LMICs). It builds on the HIV experience and existing efforts in paediatric drug development, formalizing collaboration between normative bodies, research networks, regulatory agencies, industry, supply and procurement organizations and funding bodies. Upstream, the GAP-f will coordinate technical support to companies to design and study optimal paediatric formulations, harmonize efforts with regulators and incentivize manufacturers to conduct formulation development. Downstream, the GAP-f will reinforce coordinated procurement and communication with suppliers. The GAP-f will be implemented in a three-stage process: (1) development of a strategic framework and promotion of key regulatory efficiencies; (2) testing of feasibility and results, building on the work of existing platforms such as the Paediatric HIV Treatment Initiative (PHTI) including innovative approaches to incentivize generic development and (3) launch as a fully functioning structure. GAP-f is a key partnership example enhancing

Anaesthesia for paediatric patients: Minimising the risk

African Journals Online (AJOL)

to paediatric patients need to be offset against the need for optimal utilisation of national ... Risk stratification of paediatric patients for specific procedures in ... support colleagues in smaller district hospitals by means of telephonic advice, the ... techniques that can minimise risk in the paediatric surgical population. S Afr Med ...

An Investigation of Collaborative Leadership

Science.gov (United States)

2013-01-01

has made it difficult to focus on value added collaborative endeavors. Problem Statement Several articles and books have described the theory of...Model carmenwiki.osu.edu/display/libraries/Definition+of+Collaboration Dixon, P. (1999). Nietzsche and Jung: Sailing a deeper night. New York: P. Lang

Provision of general paediatric surgical services in a regional hospital.

LENUS (Irish Health Repository)

Zgraj, O

2012-01-31

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.

Prevalence of malnutrition, obesity and nutritional risk of Australian paediatric inpatients: a national one-day snapshot.

Science.gov (United States)

White, Melinda; Dennis, Nicole; Ramsey, Rebecca; Barwick, Katie; Graham, Christie; Kane, Sarah; Kepreotes, Helen; Queit, Leah; Sweeney, Annabel; Winderlich, Jacinta; Wong See, Denise; Littlewood, Robyn

2015-03-01

Low prevalence rates of malnutrition at 2.5% to 4% have previously been reported in two tertiary paediatric Australian hospitals. The current study is the first to measure the prevalence of malnutrition, obesity and nutritional risk of paediatric inpatients in multiple hospitals throughout Australia. Malnutrition, obesity and nutritional risk prevalence were investigated in 832 and 570 paediatric inpatients, respectively, in eight tertiary paediatric hospitals and eight regional hospitals across Australia on a single day. Malnutrition and obesity prevalence was determined using z-scores and body mass index (BMI) percentiles. High nutritional risk was determined as a Paediatric Yorkhill Malnutrition Score of 2 or more. The prevalence rates of malnourished, wasted, stunted, overweight and obese paediatric patients were 15%, 13.8%, 11.9%, 8.8% and 9.9%, respectively. Patients who identified as Aboriginal and Torres Strait Islander were more likely to have lower height-for-age z-scores (P malnutrition and nutritional risk of Australian paediatric inpatients on a given day was much higher when compared with the healthy population. In contrast, the proportion of overweight and obese patients was less. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Paediatric Malignancies | Joseph | African Journal of Paediatric ...

African Journals Online (AJOL)

malignancies. Other common malignancies included sarcomas 10(14.71%), neurofibromatosis 9(13.24%), nephroblastoma 8(11.77%), acute lymphoblastic leukaemia 5(7.35%) and retinoblastoma 4(5.88%). The less common paediatric malignancies were melanoma, invasive lobular breast carcinoma and squamous cell ...

Framework of collaboration investigation on neutron effect on superconducting magnet materials

International Nuclear Information System (INIS)

Nishimura, Arata; Takeuchi, Takao; Nishijima, Shigehiro; Izumi, Yoshinobu; Takakura, Kosuke; Ochiai, Kentaro; Henmi, Tsutomu; Nishijima, Gen; Watanabe, Kazuo; Sato, Isamu; Kurisita, Hiroaki; Narui, Minoru; Shikama, Tatsuo

2009-01-01

A fusion reactor will generate D-T neutron and the kinetic energy of the neutron will be converted to the thermal energy and electrical energy. The neutron has huge energy and will be able to penetrate a shielding blanket and stream out of ports for neutral beam injections. The penetrated and streamed out neutrons will reach superconducting magnets and make some damages on the magnet system. To investigate the neutron irradiation effects on the superconducting magnet materials, a collaborative network must be organized and the irradiation researches must be performed. This report will describe the framework of the collaboration investigation which has been established among neutronics, superconducting magnet and fusion system. After showing the collaboration scheme, some new results on 14 MeV neutron irradiation effect are presented. Then, a three years new project which was adopted as one of 'Nuclear basic infrastructure strategy study initiatives' by MEXT will be introduced as an example of collaborative program among superconducting materials, fission reactor and high magnetic field technology. (author)

Practical application of natriuretic peptides in paediatric cardiology

DEFF Research Database (Denmark)

Smith, Julie; Goetze, Jens Peter; B. Andersen, Claus

2010-01-01

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...

The educational challenge of Paediatric Virology: An interview with Professor of Neonatology Anne Greenough.

Science.gov (United States)

Mammas, Ioannis N; Spandidos, Demetrios A

2017-10-01

According to Professor Anne Greenough, Professor of Neonatology and Clinical Respiratory Physiology at the King's College London (London, UK), Paediatric Virology is indeed a rapidly increasing educational challenge. Professor Greenough, who in 1992 wrote her book on congenital, perinatal and neonatal infections, believes that during the past 3 decades, paediatric health professionals are becoming increasingly involved in specialised care and follow-up of paediatric patients with viral diseases, who require advanced medical care and innovative technological services. Moreover, she highlights the expected role of new vaccines and antiviral agents that are currently under investigation, as well as the impact of emerging viral diseases that require novel prevention strategies and therapeutic protocols. However, she notes that the number of Paediatric Virologists in any one country is likely to be small; hence, a separate paediatric subspecialty needs to be considered carefully. In the context of the 3rd Workshop on Paediatric Virology, which will be held in Athens, Greece, on October 7th, 2017, Professor Greenough will give her plenary lecture on the impact of viral infections on the long term outcomes of prematurely born infants.

Optimization of paediatric radiation doses with CR systems

International Nuclear Information System (INIS)

Zatelli, Giovanna; Mazzocchi, S.; Ciccarone, A.; Fonda, C.; De Otto, G.

2008-01-01

Full text: Radiation protection of paediatric patients is a primary objective in paediatric radiology due the higher life expectance of the little patients undergoing radiology examinations and due to the higher radiosensitivity of tissues. Aim of this work is the study of the optimization process in paediatric doses needed after the recent installation of a new Computed Radiography System in the Radiology of the Meyer paediatric Hospital, in Florence, Italy. This process involves both the use of new dedicated digitizer (Agfa DX-S) and elaboration software (Agfa NX2.0). The choice of the DX-S systems has been performed in consideration of high resolution (Scanhead technology - DirectriX detector), image sharpness and portability of the cassettes that make DX-S ideal in paediatric applications as neonatal intensive care. The NX software for image processing has been installed with the 'Paediatric' licence that optimizes paediatric images especially for exposures of premature newborns. Paediatric NX automatically selects the paediatric age group, depending on the patient's birth date. Each age group contains enhanced algorithms and settings adapted to age group, for optimized visibility of fine details. All the CR system has been accepted by mean of quality control acceptance tool AGFA AutoQC2, and all the automatic exposure control devices installed on radiographic devices were previously calibrated in accordance to literature with signal to noise vs dose considerations [S. Mazzocchi et al. 'AEC set-up optimization with computed radiography imaging' Radiat. Prot. Dosim. 117, 169-173 2005]. Paediatric patients were then divided into age-weight categories and the Entrance Surface Doses (ESD) were calculated by output x-rays measurements. ESD for thorax examinations were correlated to the image evaluations performed by experienced radiologists following European Guidelines on quality criteria for diagnostic radiographic images in paediatrics (EUR 16261, European

Investigation of effects of a new integrin inhibitor and of its association with radiotherapy on paediatric glioma cell lines; etude des effets d'un nouvel inhibiteur d'integrines et de son association avec la radiotherapie sur des lignees de gliomes pediatriques

Energy Technology Data Exchange (ETDEWEB)

Le Tinier, F.; Meignan, S.; Leblond, P.; Dewitte, A.; Wattez, N.; Lartigau, E.; Lansiaux, A. [Centre Oscar-Lambret, Lille (France)

2011-10-15

The authors report the investigation of the effects of Cilengitide (an integrin inhibitor) alone or in association with ionizing radiation on paediatric glioma cell lines. Five grade-II to IV paediatric glioma cell lines and one high grade adult glioma cell line have been studied. It appears that Cilengitide has a direct effect on paediatric glioma cells, notably before irradiation. Short communication

The neurophysiology of paediatric movement disorders.

Science.gov (United States)

McClelland, Verity M

2017-12-01

To demonstrate how neurophysiological tools have advanced our understanding of the pathophysiology of paediatric movement disorders, and of neuroplasticity in the developing brain. Delineation of corticospinal tract connectivity using transcranial magnetic stimulation (TMS) is being investigated as a potential biomarker for response to therapy. TMS measures of cortical excitability and neuroplasticity are also being used to investigate the effects of therapy, demonstrating neuroplastic changes that relate to functional improvements. Analyses of evoked potentials and event-related changes in the electroencephalogaphy spectral activity provide growing evidence for the important role of aberrant sensory processing in the pathophysiology of many different movement disorders. Neurophysiological findings demonstrate that children with clinically similar phenotypes may have differing underlying pathophysiology, which in turn may explain differential response to therapy. Neurophysiological parameters can act as biomarkers, providing a means to stratify individuals, and are well suited to provide biofeedback. They therefore have enormous potential to facilitate improvements to therapy. Although currently a small field, the role of neurophysiology in paediatric movement disorders is poised to expand, both fuelled by and contributing to the rapidly growing fields of neuro-rehabilitation and neuromodulation and the move towards a more individualized therapeutic approach.

The prevalence of pressure ulcers in the paediatric population.

Science.gov (United States)

Habiballah, Laila; Tubaishat, Ahmad

2016-05-01

A paucity of research related to the problem of pressure ulcers in paediatrics is found, with a variety of reported prevalence rates. To record the prevalence, location and categories of PU in the inpatient paediatric wards, and to identify the characteristics of pressure ulcer patients. A descriptive point prevalence study. All paediatric inpatient wards in two hospitals in Jordan. One of which is a university-affiliated hospital and the other a paediatric public hospital. Isolation, burn and emergency units, outpatients' clinics and psychiatric wards were excluded. One sixty six paediatric patients aged from one day up to 18 years from both hospitals. Patients who met the inclusion criteria were included and examined for the existence of pressure ulcers on one day in each hospital by the primary investigator. The European Pressure Ulcer Advisory Panel classification system was used to categorise each identified ulcer. The characteristics of ulcers were collected as well. Sixteen ulcers were identified in 11 patients, giving a prevalence rate of 6.6%.When Category I ulcers were excluded, the prevalence rate dropped to 2.4%. All except one of the PU patients were being treated in critical care units (n = 10, 90.9%), and most of the ulcers were category one (n = 7, 63.6%) and caused by devices (n = 7, 63.6). The face was the most frequently reported location of PUs (n = 6, 54.5%), followed by the occiput (n = 2, 18.2%). Most PU patients were male (n = 6, 54.5%), and less than 12 months old (n = 8, 72.7%). PU patients had experienced longer hospital stays than patients free from PU (U = 499.0, p = 0.02). Jordanian paediatric patients do have pressure ulcers, with a prevalence rate congruent with previously reported international rates. Most of the ulcers found were caused by devices used in critical care units. This should encourage nurses to pay extra attention to their paediatric patients when they are connected to medical devices. Copyright �

Effective doses in paediatric radiology

International Nuclear Information System (INIS)

Iacob, Olga; Diaconescu, Cornelia; Roca, Antoaneta

2001-01-01

Because of their longer life expectancy, the risk of late manifestations of detrimental radiation effects is greater in children than in adults and, consequently, paediatric radiology gives ground for more concern regarding radiation protection than radiology of adults. The purpose of our study is to assess in terms of effective doses the magnitude of paediatric patient exposure during conventional X-ray examinations, selected for their high frequency or their relatively high doses to the patient. Effective doses have been derived from measurements of dose-area product (DAP) carried out on over 900 patients undergoing X-ray examinations, in five paediatric units. The conversion coefficients for estimating effective doses are those calculated by the NRPB using Monte-Carlo technique on a series of 5 mathematical phantoms representing 0, 1, 5, 10 and 15 year old children. The annual frequency of X-ray examinations necessary for collective dose calculation are those reported in our last national study on medical exposure, conducted in 1995. The annual effective doses from all medical examinations for the average paediatric patient are as follows: 1.05 mSv for 0 year old, 0.98 mSv for 1 year old, 0.53 mSv for 5 year old, 0.65 mSv for 10 year old and 0.70 mSv for 15 year old. The resulting annual collective effective dose was evaluated at 625 man Sv with the largest contribution of pelvis and hip examinations (34%). The annual collective effective associated with paediatric radiology in Romania represent 5% of the annual value resulting from all diagnostic radiology. Examination of the chest is by far the most frequent procedure for children, accounting for about 60 per cent of all annually performed X-ray conventional examinations. Knowledge of real level of patient dose is an essential component of quality assurance programs in paediatric radiology. (authors)

Expectations and satisfaction of academic investigators in nonclinical collaboration with the pharmaceutical industry.

Science.gov (United States)

Amiri, Marjan; Michel, Martin C

2015-06-01

In light of a growing role of research collaborations between academia and the pharmaceutical industry, we have explored expectations and experience of academic investigators with preclinical collaborations. Researchers from Western Europe, North America, and Japan with preclinical publications in the obstructed airways or diabetes fields were invited to anonymously participate in a web-based survey. A total of 134 investigators (28 % of invitees) participated in the two sequentially performed surveys with similar responses in both therapeutic areas. A secondary but prespecified subgroup analysis was based on region of residence, gender, and career level of the investigator. Across all groups, responders considered freedom to publish, obtaining funding and obtaining compounds to be the most important objectives of nonclinical collaborations with the pharmaceutical industry, whereas cultivating professional relationships, getting external scientific input, direct relationship to disease treatment, and involvement with drug development were less important. Among eight attributes of the primary contact person in the company, trustworthiness ranked highest, followed by a collaborative spirit and transparent information sharing; supportiveness, scientific qualification, accessibility, and timeliness of responses ranked lower, and friendliness, lowest. Related to their most recent collaboration, investigators also expressed the highest level of satisfaction with the trustworthiness attribute. On the other hand, the process of reaching a contract was often considered too long and difficult, for which both university and company legal departments were reported as culprits. We conclude that academic researchers are generally satisfied with their preclinical collaboration with the pharmaceutical industry but look for improved contracting procedures.

Vedolizumab in Paediatric Inflammatory Bowel Disease

DEFF Research Database (Denmark)

Ledder, Oren; Assa, Amit; Levine, Arie

2017-01-01

Background: Vedolizumab, an anti-integrin antibody, has proven to be effective in adults with inflammatory bowel disease [IBD], but the data in paediatrics are limited. We describe the short-term effectiveness and safety of vedolizumab in a European multi-centre paediatric IBD cohort. Method......: Retrospective review of children [aged 2-18 years] treated with vedolizumab from 19 centres affiliated with the Paediatric IBD Porto group of ESPGHAN. Primary outcome was Week 14 corticosteroid-free remission [CFR]. Results: In all, 64 children were included (32 [50%] male, mean age 14.5 ± 2.8 years...... minor drug-related adverse events. Only 3 of 16 children who underwent endoscopic evaluation had mucosal healing after treatment (19%). Conclusions: Vedolizumab was safe and effective in this cohort of paediatric refractory IBD. These data support previous findings of slow induction rate of vedolizumab...

A mixed methods evaluation of paediatric trainee preparedness to manage cardiopulmonary arrests.

Science.gov (United States)

Walsh, Órla; Lydon, Sinéad; O'Connor, Paul

2017-12-01

Paediatric cardiopulmonary arrest (CPA) survival rates are strongly linked to the training of the doctors responding to the event. This study sought to characterise the level of experience in managing CPAs among paediatric trainees and to investigate the nontechnical (NTS) required to effectively lead a paediatric CPA team. A mixed-methods research design was used. For the quantitative phase, a questionnaire was developed to assess training, confidence, and experiences related to CPA management. During the qualitative phase, 17 paediatric trainees participated in a series of critical incident technique (CIT) interviews to explore the NTS used during the management of paediatric CPAs. A total of 56 of 131 (37.1% response rate) trainees responded to the preparedness questionnaire. A total of 48.2% of respondents expressed low confidence in their skill as a team leader during the management of a CPA. The CIT interviews highlighted deficiencies in specific NTS (identifying options, prioritising, and identifying and utilising resources). Our results indicate that there is a desire for more training in CPA management among paediatric trainees, in particular as a team leader, which includes a focus on key NTS. What is Known • Levels of preparedness to be a paediatric cardiopulmonary arrests team member/leader are generally lower than desirable. • The importance of nontechnical skills to the effective performance of adult cardiopulmonary arrests teams has been identified. What is New • Levels of preparedness to be a cardiopulmonary arrests team member were higher than reported in US studies. • There is a need for greater training in cardiopulmonary arrest management which includes a focus on key nontechnical skills to include identifying options, prioritising, identifying and utilising resources.

Anaesthetic considerations for paediatric laparoscopy | Lasersohn ...

African Journals Online (AJOL)

Children, infants and neonates represent an anaesthetic challenge because of age-specific anatomical and physiological issues. Apart from paediatric-specific anaesthetic considerations, the paediatric anaesthetist must understand the implications of laparoscopic surgery, and prevent and react appropriately to changes ...

Onset symptoms in paediatric multiple sclerosis

DEFF Research Database (Denmark)

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

2014-01-01

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...

Challenges in paediatric neurosurgery

Directory of Open Access Journals (Sweden)

Pragati Ganjoo

2017-01-01

Full Text Available Improvements in technique, knowledge and expertise have brought about rapid advances in the fields of paediatric neurosurgery and anaesthesia, and many procedures limited earlier to adults are now being increasingly attempted in neonates and small children, with good outcomes. This article highlights the challenges faced by the operating team while handling some of the technically complex procedures like awake craniotomy, interventional neuroradiology, minimally invasive neurosurgery, procedures in intraoperative magnetic resonance imaging suites, and neonatal emergencies in the paediatric population.

Medication communication between nurses and doctors for paediatric acute care: An ethnographic study.

Science.gov (United States)

Borrott, Narelle; Kinney, Sharon; Newall, Fiona; Williams, Allison; Cranswick, Noel; Wong, Ian; Manias, Elizabeth

2017-07-01

To examine how communication between nurses and doctors occurred for managing medications in inpatient paediatric settings. Communication between health professionals influences medication incidents' occurrence and safe care. An ethnographic study was undertaken. Semi-structured interviews, observations and focus groups were conducted in three clinical areas of an Australian tertiary paediatric hospital. Data were transcribed verbatim and thematically analysed using the Medication Communication Model. The actual communication act revealed health professionals' commitment to effective medication management and the influence of professional identities on medication communication. Nurses and doctors were dedicated to providing safe, effective medication therapy for children, within their scope of practice and perceived role responsibilities. Most nurses and junior doctors used tentative language in their communication while senior doctors tended to use direct language. Irrespective of language style, nurses actively engaged with doctors to promote patients' needs. Yet, the medical hierarchical structure, staffing and attendant expectations influenced communication for medication management, causing frustration among nurses and doctors. Doctors' lack of verbal communication of documented changes to medication orders particularly troubled nurses. Nurses persisted in their efforts to acquire appropriate orders for safe medication administration to paediatric patients. Collaborative practice between nurses and doctors involved complex, symbiotic relationships. Their dedication to providing safe medication therapy to paediatric patients facilitated effective medication management. At times, shortcomings in interdisciplinary communication impacted on potential and actual medication incidents. Understanding of the complexities affecting medication communication between nurses and doctors helps to ensure interprofessional respect for each other's roles and inherent demands

Paediatric and adult malignant glioma

DEFF Research Database (Denmark)

Jones, Chris; Perryman, Lara; Hargrave, Darren

2012-01-01

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...

Anaesthesia for Ambulatory Paediatric Surgery: Common ...

African Journals Online (AJOL)

BACKGROUND: Ambulatory surgical care accounts for over 70% of elective procedures in Northern America. Ambulatory paediatric surgical practice is not widespread in Nigeria. This report examined clinical indicators for quality care in paediatric ambulatory surgery using common outcomes after day case procedures as ...

Peer Teaching in der Pädiatrie - Evaluation eines studentischen Tutoriats im Blockpraktikum Kinderheilkunde [Peer Teaching in Paediatrics - Medical Students as Learners and Teachers on a Paediatric Course

Directory of Open Access Journals (Sweden)

Karay, Yassin

2010-11-01

Full Text Available [english] Background: Peer assisted learning is known as an effective educational strategy in medical teaching. We established a peer assisted teaching program by student tutors with a focus on clinical competencies for students during their practical training on paediatric wards. It was the purpose of this study to investigate the effects of a clinical skills training by tutors, residents and consultants on students evaluations of the teaching quality and the effects of a peer teaching program on self assessed clinical competencies by the students.Methods: Medical student peers in their 6 year were trained by an intensive instruction program for teaching clinical skills by paediatric consultants, doctors and psychologists. 109 students in their 5 year (study group participated in a peer assisted teaching program for training clinical skills in paediatrics. The skills training by student peer teachers were supervised by paediatric doctors. 45 students (control group participated in a conventional paediatric skills training by paediatric doctors and consultants. Students from both groups, which were consecutively investigated, completed a questionnaire with an evaluation of the satisfaction with their practical training and a self assessment of their practical competencies. Results: The paediatric skills training with student peer teachers received significantly better ratings than the conventional skills training by paediatric doctors concerning both the quality of the practical training and the support by the teaching medical staff. Self assessed learning success in practical skills was higher rated in the peer teaching program than in the conventional training. Conclusions: The peer assisted teaching program of paediatric skills training was rated higher by the students regarding their satisfaction with the teaching quality and their self assessment of the acquired skills. Clinical skills training by student peer teachers have to be supervised

Ischemic stroke in paediatrics - narrative review of the literature and two cases.

Science.gov (United States)

Klucka, Jozef; Stourac, Petr; Stoudek, Roman; Toukalkova, Michaela; Harazim, Hana; Kosinova, Martina; Stouracova, Alena; Mrlian, Andrej; Suk, Petr; Malaska, Jan

2017-03-01

Stroke is a rare condition in childhood with an estimated incidence of between 1.3-13/100.000 patients. Clinical manifestation and risk factors for paediatric stroke are different from those of adults. The uncommon incidence, age-associated difference and plethora of clinical symptoms make the diagnosis of such strokes extremely difficult and often delayed. The history and clinical examination should point to diseases or predisposing factors. Neuroimaging (DWI MR) is the golden standard for diagnosis of paediatric stroke and other investigations can be considered according to the clinical condition. Despite advances in paediatric stroke research and clinical care, questions remain unanswered regarding acute treatment, secondary prevention and rehabilitation. The treatment recommendations are mainly extrapolated from studies on adult populations. In the review authors summarized the clinical characteristics and diagnostic steps for stroke in children/adolescents based on the most recent international guidelines and practical directions for recognising and managing the child/adolescent with stroke in paediatric emergency. In the two case reports, we describe the clinical course in both stroke patients.

Variation in radiation doses in paediatric cardiac catheterisation procedures

International Nuclear Information System (INIS)

Al-Haj, A. N.; Lobriguito, A. M.; Rafeh, W.

2008-01-01

Paediatric cardiac catheterisation involves diagnostic and therapeutic procedures that range from simple to complex and can subject paediatric patients to varying radiation doses. The study aims to determine the variation in entrance doses in patients in terms of dose-area product (DAP) values and to investigate the methods for optimising radiation protection. A total of 190 paediatric patients belonging to age groups 0, 1, 5 and 10 y who underwent diagnostic and six selected therapeutic procedures at King Faisal Specialist Hospital and Research Centre, Riyadh (Saudi Arabia) were included in the study. Therapeutic procedures include coarctation (COA), patent ductus arteriosus (PDA), radiofrequency ablation, pulmonary, embolisation and septostomy. Fluoroscopy and cine radiography were used in all procedures. Patient demography (weight, age, gender and height), radiographic technique factors, fluoroscopy and cine time, frame rate, and DAP values were taken from patients records. Effective doses for each procedure were estimated from the DAP values. The mean DAP per procedure were analysed for correlation with patient equivalent cylindrical diameter, weight, fluoroscopy time and number of frames. Factors influencing the variation in doses were investigated. Initial results show that PDA occlusion has the highest mean DAP value of 23.21 Gy-cm 2 , while the diagnostic and septostomy procedures have the lowest value of 7.77 and 6.95 Gy-cm 2 , respectively. (authors)

Magnetic tomography within paediatric radiological diagnostics

International Nuclear Information System (INIS)

Smevik, Bjarne; Borthne, Arne

2000-01-01

Background: MRI is a promising imaging technique for diseases in most organ systems in children. Material and methods: this review discusses MRI on the basis of the literature and our own experience. Results: the value of MRI in paediatric neuroradiology is firmly established. In congenital heart defects and other reasons for cardiovascular imaging in children, the non-invasiveness of the method is appealing. MRI is already included in most international paediatric oncology protocols. Paediatric applications for MRI differ from those in adults as they focus on developmental and congenital abnormalities. Furthermore, some pathological conditions are unique to children. MRI is also a promising alternative to established methods for evaluation of the urinary tract. There are some specific problems with MRI in children. Immobilisation and sedation techniques include tight wrapping of the new-born with soft elastic bands, feeding immediately prior to the study and allowing one parent into the magnet with the child. Midazolam and oral chloral hydrate are usually used for sedation. Interpretation: MRI is of particular value in the paediatric age group as the method is capable of highly accurate imaging in a variety of congenital and paediatric diseases without the use of ionising radiation. Faster sequences and better resolution will further increase the use of MRI in children

Job satisfaction and burnout among paediatric nurses.

Science.gov (United States)

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

2016-10-01

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.

Listening to paediatric primary care nurses: a qualitative study of the potential for interprofessional oral health practice in six federally qualified health centres in Massachusetts and Maryland.

Science.gov (United States)

Bernstein, Judith; Gebel, Christina; Vargas, Clemencia; Geltman, Paul; Walter, Ashley; Garcia, Raul; Tinanoff, Norman

2017-03-29

To explore the opportunities for interprofessional collaboration (IPC) to improve paediatric oral health in federally qualified health centres (FQHCs), to identify challenges to IPC-led integration of oral health prevention into the well-child visit and to suggest strategies to overcome barriers. Nurse managers (NMs), nurse practitioners (NPs), paediatric clinical staff and administrators in six FQHCs in two states were interviewed using a semistructured format. Grounded theory research. Topics included feasibility of integration, perceived barriers and strategies for incorporating oral health into paediatric primary care. Qualitative data were coded and analysed using NVivo 10 to generate themes iteratively. Nurses in diverse roles recognised the importance of oral health prevention but were unaware of professional guidelines for incorporating oral health into paediatric encounters. They valued collaborative care, specifically internal communication, joint initiatives and training and partnering with dental schools or community dental practices. Barriers to IPC included inadequate training, few opportunities for cross-communication and absence of charting templates in electronic health records. NMs, NPs and paediatric nursing staff all value IPC to improve patients' oral health, yet are constrained by lack of oral health training and supportive charting and referral systems. With supports, they are willing to take on responsibility for introducing oral health preventive measures into the well-child visit, but will require IPC approaches to training and systems changes. IPC teams in the health centre setting can work together, if policy and administrative supports are in place, to provide oral health assessments, education, fluoride varnish application and dental referrals, decrease the prevalence of early childhood caries and increase access to a dental home for low-income children. Published by the BMJ Publishing Group Limited. For permission to use (where not

Achieving good oral health in children: the importance of a current, relevant and unbiased evidence base in paediatric dentistry.

Science.gov (United States)

Clarkson, J E; Bonetti, D; Worthington, H

2013-06-01

The Cochrane Collaboration was founded in 1993 as an international, non-profit and independent organisation dedicated to making up-to-date, accurate and reliable information about healthcare readily available. This paper discusses how the Cochrane Oral Health Group reviews have contributed to the oral health evidence base used in the development of many international and U.K. dental guidance documents, particularly in the field of paediatric dentistry.

The relevance of the Goudge inquiry to the practice of child protection/forensic paediatrics.

Science.gov (United States)

Skellern, Catherine; Donald, Terence

2014-10-01

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. Copyright © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

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

Directory of Open Access Journals (Sweden)

Kamps Willem A

2007-11-01

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.

Understanding case mix across three paediatric services: could integration of primary and secondary general paediatrics alter walk-in emergency attendances?

Science.gov (United States)

Steele, Lloyd; Coote, Nicky; Klaber, Robert; Watson, Mando; Coren, Michael

2018-05-04

To understand the case mix of three different paediatric services, reasons for using an acute paediatric service in a region of developing integrated care and where acute attendances could alternatively have been managed. Mixed methods service evaluation, including retrospective review of referrals to general paediatric outpatients (n=534) and a virtual integrated service (email advice line) (n=474), as well as a prospective survey of paediatric ambulatory unit (PAU) attendees (n=95) and review by a paediatric consultant/registrar to decide where these cases could alternatively have been managed. The case mix of outpatient referrals and the email advice line was similar, but the case mix for PAU was more acute.The most common parental reasons for attending PAU were referral by a community health professional (27.2%), not being able to get a general practitioner (GP) appointment when desired (21.7%), wanting to avoid accident and emergency (17.4%) and wanting specialist paediatric input (14.1%). More than half of PAU presentations were deemed most appropriate for community management by a GP or midwife. The proportion of cases suitable for community management varied by the reason for attendance, with it highestl for parents reporting not being able to get a GP appointment (85%), and lowest for those referred by community health professionals (29%). One in two attendances to acute paediatric services could have been managed in the community. Integration of paediatric services could help address parental reasons for attending acute services, as well as facilitating the community management of chronic conditions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The global burden of paediatric heart disease

DEFF Research Database (Denmark)

Musa, Ndidiamaka L; Hjortdal, Vibeke; Zheleva, Bistra

2017-01-01

An estimated 15 million children die or are crippled annually by treatable or preventable heart disease in low- and middle-income countries. Global efforts to reduce under-5 mortality have focused on reducing death from communicable diseases in low- and middle-income countries with little...... to no attention focusing on paediatric CHD and acquired heart disease. Lack of awareness of CHD and acquired heart disease, access to care, poor healthcare infrastructure, competing health priorities, and a critical shortage of specialists are important reasons why paediatric heart disease has not been addressed...... in low resourced settings. Non-governmental organisations have taken the lead to address these challenges. This review describes the global burden of paediatric heart disease and strategies to improve the quality of care for paediatric heart disease. These strategies would improve outcomes for children...

Patient exposure in paediatric radiology

International Nuclear Information System (INIS)

Iacob, O.; Diaconescu, C.; Isac, R.

2002-01-01

Because of their longer life expectancy, the risk of late manifestations of detrimental radiation effects is greater in children than in adults and, consequently, paediatric radiology gives ground for more concern regarding radiation protection than radiology of adults. The purpose of our study was to assess, in terms of effective dose, the magnitude of paediatric patient exposure during conventional X-ray examinations, selected for their high frequency or their relatively high doses delivered to patient

Using Wikis to Investigate Communication, Collaboration and Engagement in Capstone Engineering Design Projects

Science.gov (United States)

Berthoud, L.; Gliddon, J.

2018-01-01

In today's global Aerospace industry, virtual workspaces are commonly used for collaboration between geographically distributed multidisciplinary teams. This study investigated the use of wikis to look at communication, collaboration and engagement in 'Capstone' team design projects at the end of an engineering degree. Wikis were set up for teams…

[From paediatric urological care to adult urology. Assessment of a transition consultation for adolescents].

Science.gov (United States)

Even, L; Mouttalib, S; Moscovici, J; Soulie, M; Rischmann, P; Game, X; Galinier, P; Bouali, O

2017-10-01

the definitive nature of his handicap and the need of medical follow-up throughout his life. Transition consultation makes easier the passage from paediatric care to adult urological care. It allows a smooth change of interlocutors, facilitates subsequent care and improves compliance to medical follow-up. It requires a good collaboration between paediatric and adult care units. Transition responds to an increasing request of adolescents, families, and medical teams, since care rupture during adolescence can have functional and psychological consequences. 4. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Advance Care Planning in palliative care: a qualitative investigation into the perspective of Paediatric Intensive Care Unit staff.

Science.gov (United States)

Mitchell, Sarah; Dale, Jeremy

2015-04-01

The majority of children and young people who die in the United Kingdom have pre-existing life-limiting illness. Currently, most such deaths occur in hospital, most frequently within the intensive care environment. To explore the experiences of senior medical and nursing staff regarding the challenges associated with Advance Care Planning in relation to children and young people with life-limiting illnesses in the Paediatric Intensive Care Unit environment and opportunities for improvement. Qualitative one-to-one, semi-structured interviews were conducted with Paediatric Intensive Care Unit consultants and senior nurses, to gain rich, contextual data. Thematic content analysis was carried out. UK tertiary referral centre Paediatric Intensive Care Unit. Eight Paediatric Intensive Care Unit consultants and six senior nurses participated. Four main themes emerged: recognition of an illness as 'life-limiting'; Advance Care Planning as a multi-disciplinary, structured process; the value of Advance Care Planning and adverse consequences of inadequate Advance Care Planning. Potential benefits of Advance Care Planning include providing the opportunity to make decisions regarding end-of-life care in a timely fashion and in partnership with patients, where possible, and their families. Barriers to the process include the recognition of the life-limiting nature of an illness and gaining consensus of medical opinion. Organisational improvements towards earlier recognition of life-limiting illness and subsequent Advance Care Planning were recommended, including education and training, as well as the need for wider societal debate. Advance Care Planning for children and young people with life-limiting conditions has the potential to improve care for patients and their families, providing the opportunity to make decisions based on clear information at an appropriate time, and avoid potentially harmful intensive clinical interventions at the end of life. © The Author(s) 2015.

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

LENUS (Irish Health Repository)

Owens, C

2012-02-01

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.

Pancreaticoduodenectomy in children: optimising outcome of uncommon paediatric procedures.

LENUS (Irish Health Repository)

Yeap, B H

2012-02-01

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.

Congenital malformations in paediatric and neurosurgical practices ...

African Journals Online (AJOL)

Congenital malformations in paediatric and neurosurgical practices: problems and pattern (A preliminary report) ... Open Access DOWNLOAD FULL TEXT ... over a 5-year period (1998 to 2002) with congenital anomalies to the Paediatric Surgery and Neurosurgery units of the University Teaching Hospital, Ilorin, Nigeria.

Paediatric horse-related trauma.

Science.gov (United States)

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

2017-06-01

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 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).

Recent developments in neonatal and paediatric emergencies.

Science.gov (United States)

Turner, Nigel M

2011-07-01

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 and the principle of 'treat first what kills first'; and also that the reader is familiar with the anatomical, physiological and psychological differences between adults and children. The article begins with a description of the background to paediatric emergencies followed by a description of a widely used systematic approach to the assessment of the seriously ill child. In the second half of the article, the principles of the initial treatment for acute, life-threatening problems in children and paediatric resuscitation are discussed with reference to the recent literature. The article ends with a discussion of the changes in latest guidelines for resuscitation of babies at birth.

The role of anaesthetists in paediatric intensive care units

African Journals Online (AJOL)

Adele

to various surgical and critical care disciplines, the usefulness of a paediatric intensive care unit (PICU) rotation was investigated. A brief overview of the experiences of anaesthetic registrars at a. South African teaching hospital rotating through a PICU is pre- sented, as well as the potential advantages for both trainees and.

Distribution of branchial anomalies in a paediatric Asian population.

Science.gov (United States)

Teo, Neville Wei Yang; Ibrahim, Shahrul Izham; Tan, Kun Kiaang Henry

2015-04-01

The objective of the present study was to review the distribution and incidence of branchial anomalies in an Asian paediatric population and highlight the challenges involved in the diagnosis of branchial anomalies. This was a retrospective chart review of all paediatric patients who underwent surgery for branchial anomalies in a tertiary paediatric hospital from August 2007 to November 2012. The clinical notes were correlated with preoperative radiological investigations, intraoperative findings and histology results. Branchial anomalies were classified based on the results of the review. A total of 28 children underwent surgery for 30 branchial anomalies during the review period. Two children had bilateral branchial anomalies requiring excision. Of the 30 branchial anomalies, 7 (23.3%) were first branchial anomalies, 5 (16.7%) were second branchial anomalies, 3 (10.0%) were third branchial anomalies, and 4 (13.3%) were fourth branchial anomalies (one of the four patients with fourth branchial anomalies had bilateral branchial anomalies). In addition, seven children had 8 (26.7%) branchial anomalies that were thought to originate from the pyriform sinus; however, we were unable to determine if these anomalies were from the third or fourth branchial arches. There was inadequate information on the remaining 3 (10.0%) branchial anomalies for classification. The incidence of second branchial anomalies appears to be lower in our Asian paediatric population, while that of third and fourth branchial anomalies was higher. Knowledge of embryology and the related anatomy of the branchial apparatus is crucial in the identification of the type of branchial anomaly.

pattern of long bone fractures in a paediatric population at kenyatta

African Journals Online (AJOL)

attributed to increased sporting activity, which cause up to 39% of the ... severity and location at time of injury in the paediatric age group. Design: This .... investigator. Data management and analysis: Collected data was ..... children and youth.

Diagnostic radiology in paediatric palliative care

International Nuclear Information System (INIS)

Patel, Preena; Koh, Michelle; Carr, Lucinda; McHugh, Kieran

2014-01-01

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.)

Diagnostic radiology in paediatric palliative care

Energy Technology Data Exchange (ETDEWEB)

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

2014-01-15

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.)

Litigation in paediatrics

LENUS (Irish Health Repository)

Murphu, JFA

2011-03-01

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

The paediatric change laboratory: optimising postgraduate learning in the outpatient clinic.

Science.gov (United States)

Skipper, Mads; Musaeus, Peter; Nøhr, Susanne Backman

2016-02-02

This study aimed to analyse and redesign the outpatient clinic in a paediatric department. The study was a joint collaboration with the doctors of the department (paediatric residents and specialists) using the Change Laboratory intervention method as a means to model and implement change in the outpatient clinic. This study was motivated by a perceived failure to integrate the activities of the outpatient clinic, patient care and training of residents. The ultimate goal of the intervention was to create improved care for patients through resident learning and development. We combined the Change Laboratory intervention with an already established innovative process for residents, 3-h meetings. The Change Laboratory intervention method consists of a well-defined theory (Cultural-historical activity theory) and concrete actions where participants construct a new theoretical model of the activity, which in this case was paediatric doctors' workplace learning modelled in order to improve medical social practice. The notion of expansive learning was used during the intervention in conjunction with thematic analysis of data in order to fuel the process of analysis and intervention. The activity system of the outpatient clinic can meaningfully be analysed in terms of the objects of patient care and training residents. The Change Laboratory sessions resulted in a joint action plan for the outpatient clinic structured around three themes: (1) Before: Preparation, expectations, and introduction; (2) During: Structural context and resources; (3) After: Follow-up and feedback. The participants found the Change Laboratory method to be a successful way of sharing reflections on how to optimise the organisation of work and training with patient care in mind. The Change Laboratory approach outlined in this study succeeded to change practices and to help medical doctors redesigning their work. Participating doctors must be motivated to uncover inherent contradictions in their

Radiation dose to the heart in paediatric interventional cardiology

International Nuclear Information System (INIS)

Keiller, D A; Martin, C J

2015-01-01

Recent ICRP publications have reviewed evidence for induction of heart disease. Studies suggest the threshold dose to the heart may be as low as 500 mGy. Doses to the heart from paediatric interventional procedures performed in Glasgow between April 2012 and July 2013 to correct congenital heart defects were investigated to assess the level of potential risk of cardiovascular disease. For common procedures, doses were found to be typically less than 50 mGy, with the highest dose in the period for which data are available estimated to be 330 mGy. These results suggest that any increased risk due to paediatric interventional cardiology is likely to be small, but cumulative doses over a number of years could reach the threshold for effects. (paper)

Ingested foreign bodies in the paediatric patient.

LENUS (Irish Health Repository)

O'Brien, G C

2012-02-03

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.

PAEDIATRIC SURGERY

African Journals Online (AJOL)

in increased mortality in developing nations.6,7 However, it has been shown ... Background: The time from birth to the first paediatric surgical consultation of neonates with gastroschisis is a predictor ... of Helsinki and its later amendments. Informed consent was obtained from the parents of the infants included in the study.

Paediatric interventional radiology

African Journals Online (AJOL)

2016-06-29

Jun 29, 2016 ... Non-operative management is the standard of care in children with blunt solid ... treatment of choice in children with extensive deep venous ... thrombosis. An IVC .... children, a paediatric nurse comfortable with administering.

Future career intentions of higher specialist trainees in general Paediatrics.

Science.gov (United States)

Butler, Grainne; Breatnach, Colm; Harty, Sinead; Gavin, Patrick; O'Donnell, Colm; O'Grady, Michael J

2018-03-27

A survey of paediatric higher specialist trainees was carried out in 2002 assessing career intentions and perception of training. Fourteen years later, with increased numbers of trainees and a national model of care and a tertiary paediatric hospital on the horizon, we re-evaluated the career intentions of the current trainee workforce. To assess the career intentions of the current paediatric higher specialist trainees. A 28-item questionnaire was developed based on a previously validated instrument and distributed online using the Royal College of Physicians of Ireland trainee database. We distributed the questionnaire to 118 eligible trainees and received responses from 92 (78%). Seventy-nine (86%) respondents desire a consultant post in Ireland. Seventy-five (82%) indicated that their preferred consultant post location was in a tertiary paediatric centre. Sixty-two trainees (67%) intend to become subspecialists with 25 (27%) planning a career in general paediatrics. This contrasts with the 2002 survey when 76% wished to work in urban centres and 61% of trainees planned a career in general paediatrics. There appears to be a mismatch between the career goals of the future paediatric consultant workforce and the requirements for staffing paediatric units nationally. This has the potential to complicate the proposed expansion of general paediatricians in regional centres and result in a significant proportion of current trainees failing to secure a post in their desired location.

Paediatric stoma care nursing in the UK and Ireland.

Science.gov (United States)

Waller, Marie

Improving quality of care and developing and maintaining high standards of care are issues that are high on the NHS, nursing, and paediatric care agendas. Stoma formation will have an impact on the wellbeing and lifestyle of the person and their family, whatever the person's age. The specialty of stoma care nursing in the UK and Ireland is well established. However, the sub-specialty of paediatric stoma care nursing is much smaller in its 'membership' and its client group. There are differences in the needs of, and the associated care of, paediatric stoma patients even within this overall patient group. Paediatric stoma care nurses are in an ideal position to increase awareness about the specialty and improve standards of nursing care for neonates, children, adolescents and their families. However, until the establishment of the Paediatric Stoma Nurse Group (PSNG) in 2005, this 'position' had not being utilized. This article discusses the ongoing work of the PSNG to devise standards of paediatric stoma care nursing, best practice guidelines, relevant patient/parental information and establish itself as a valuable, proactive and independent forum for all healthcare professionals involved in the care of children with stomas.

Singapore Paediatric Resuscitation Guidelines 2016.

Science.gov (United States)

Ong, Gene Yong Kwang; Chan, Irene Lai Yeen; Ng, Agnes Suah Bwee; Chew, Su Yah; Mok, Yee Hui; Chan, Yoke Hwee; Ong, Jacqueline Soo May; Ganapathy, Sashikumar; Ng, Kee Chong

2017-07-01

We present the revised 2016 Singapore paediatric resuscitation guidelines. The International Liaison Committee on Resuscitation's Pediatric Taskforce Consensus Statements on Science and Treatment Recommendations, as well as the updated resuscitation guidelines from the American Heart Association and European Resuscitation Council released in October 2015, were debated and discussed by the workgroup. The final recommendations for the Singapore Paediatric Resuscitation Guidelines 2016 were derived after carefully reviewing the current available evidence in the literature and balancing it with local clinical practice. Copyright: © Singapore Medical Association.

Appendicitis in paediatric age group: Correlation between ...

African Journals Online (AJOL)

Introduction: Clinical diagnosis of appendicitis can be challenging, particularly in the paediatric age group. There is an increased risk of perforation in paediatrics; therefore, a need for sensitive and specific diagnostic tool is mandatory. Aim: The aim of this study is to evaluate the role of preoperative inflammatory markers in ...

Can drawing be considered a projective measure for children's distress in paediatric dentistry?

Science.gov (United States)

Aminabadi, Naser Asl; Ghoreishizadeh, Arezoo; Ghoreishizadeh, Mohammadali; Oskouei, Sina Ghertasi

2011-01-01

Several tools have been developed for the measurement of emotional status of the child in paediatric dental clinics including nonverbal self-report techniques. Subjective methods like drawing and Child Drawing: Hospital (CD:H) score have recently been applied in hospitalized children. Studies, however, have not attempted to analyse children's drawings as an aid to investigate the subjective feelings of children in paediatric dental settings. To assess drawing as a measure for child's distress in paediatric dental settings. Fifty-four children, aged 4-11 years, participated in this study. After finishing the first therapeutic session, the child was instructed to draw a picture of a person in a dental clinic. The pictures were scored using CD:H score sheet and the findings were compared with SEM and Frankl scores. CD:H was correlated with both Frankl (correlation coefficient = -0.550) and SEM (correlation coefficient = +0.483) scales (P Drawing is a useful measure of children's emotional status in dental settings in a way that is easier, familiar and more enjoyable for the child patient. © 2010 The Authors. International Journal of Paediatric Dentistry © 2010 BSPD, IAPD and Blackwell Publishing Ltd.

Analysis of patient organizations' needs and ICT use--The APTIC project in Spain to develop an online collaborative social network.

Science.gov (United States)

Hernández-Encuentra, Eulàlia; Gómez-Zúñiga, Beni; Guillamón, Noemí; Boixadós, Mercè; Armayones, Manuel

2015-12-01

The purpose of this first part of the APTIC (Patient Organisations and ICT) project is to design and run an online collaborative social network for paediatric patient organizations (PPOs). To analyse the needs of PPOs in Spain to identify opportunities to improve health services through the use of ICT. A convenience sample of staff from 35 PPOs (54.68% response rate) participated in a structured online survey and three focus groups (12 PPOs). Paediatric patient organizations' major needs are to provide accredited and managed information, increase personal support and assistance and promote joint commitment to health care. Moreover, PPOs believe in the Internet's potential to meet their needs and support their activities. Basic limitations to using the Internet are lack of knowledge and resources. The discussion of the data includes key elements of designing an online collaborative social network and reflections on health services provided. © 2014 John Wiley & Sons Ltd.

Microneedle technology for immunisation: Perception, acceptability and suitability for paediatric use.

Science.gov (United States)

Marshall, Sarah; Sahm, Laura J; Moore, Anne C

2016-02-03

To examine published research which explores the perception and acceptability of microneedle technology for immunisation and to investigate the suitability of this technology for paediatric use. A series of keywords and their synonyms were combined in various combinations and permutations using Boolean operators to sequentially search four databases (PubMed, Web of Science, Embase and CINAHL). Following removal of duplications and irrelevant results, 12 research articles were included in the final literature review. The opinions of patients, parents, children and healthcare professionals (HCP) were collated. A positive perception and a high level of acceptability predominated. Microneedle technology research has been focussed on demonstrating efficacy with minimal focus on determining HCP/public perception and acceptability for paediatric use, exemplified by the paucity of studies presented in this review. Commercial viability will depend on HCP/public acceptability of microneedle technology. An effort must be made to identify the barriers to acceptance and to overcome them by increasing awareness and education in stakeholder groups pertaining to the paediatric population. Copyright © 2016 Elsevier Ltd. All rights reserved.

Fast tracking in paediatric cardiac anaesthesia : an update.

Directory of Open Access Journals (Sweden)

Lake Carol

2002-01-01

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.

Smartphone applications in paediatric radiology: availability and authority

International Nuclear Information System (INIS)

Shelmerdine, Susan C.; Lynch, Jeremy O.

2015-01-01

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.)

Smartphone applications in paediatric radiology: availability and authority

Energy Technology Data Exchange (ETDEWEB)

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)

2015-08-15

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.)

High Flow Nasal Cannula Oxygen Therapy can be used safely in the general paediatric ward using Paediatric Early Warning Scores

NARCIS (Netherlands)

Morsing, IE; Tinnevelt, Marcel; Jansen, Nicolaas J.G.; Koomen, E

2015-01-01

High Flow Nasal Cannula oxygen therapy (HFNC) is nowadays widely used at paediatric intensive care units (PICU) to provide a safe and comfortable (warm and humidified) oxygen delivery in children with respiratory distress. At general paediatric wards HFNC is hardly used because intensive observation

Population pharmacokinetics of tamsulosin hydrochloride in paediatric patients with neuropathic and non-neuropathic bladder

Science.gov (United States)

Tsuda, Yasuhiro; Tatami, Shinji; Yamamura, Norio; Tadayasu, Yusuke; Sarashina, Akiko; Liesenfeld, Karl-Heinz; Staab, Alexander; Schäfer, Hans-Günter; Ieiri, Ichiro; Higuchi, Shun

2010-01-01

AIMS The main objective of this study was to characterize the population pharmacokinetics of tamsulosin hydrochloride (HCl) in paediatric patients with neuropathic and non-neuropathic bladder. A secondary objective was to compare the pharmacokinetics in paediatric patients and adults. METHODS Tamsulosin HCl plasma concentrations in 1082 plasma samples from 189 paediatric patients (age range 2–16 years) were analyzed with NONMEM, applying a one compartment model with first-order absorption. Based on the principles of allometry, body weight was incorporated in the base model, along with fixed allometric exponents. Covariate analysis was performed by means of a stepwise forward inclusion and backward elimination procedure. Simulations based on the final model were used to compare the pharmacokinetics with those in adults. RESULTS Beside the priori-implemented body weight, only α1-acid glycoprotein had an effect on both apparent clearance and apparent volume of distribution. No other investigated covariates, including gender, age, race, patient population and concomitant therapy with anti-cholinergics, significantly affected the pharmacokinetics of tamsulosin HCl (P tamsulosin HCl in paediatric patients was established and it described the data well. There was no major difference in the pharmacokinetics of tamsulosin HCl between paediatric patients (age range 2–16 years) and adults when the effect of body weight was taken into consideration. PMID:20642551

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

Science.gov (United States)

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

2016-01-01

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

Outcome measures for clinical trials in paediatric IBD: an evidence-based, expert-driven practical statement paper of the paediatric ECCO committee

NARCIS (Netherlands)

Ruemmele, Frank M.; Hyams, Jeffrey S.; Otley, Anthony; Griffiths, Anne; Kolho, Kaija-Leena; Dias, Jorge Amil; Levine, Arie; Escher, Johanna C.; Taminiau, Jan; Veres, Gabor; Colombel, Jean-Frederic; Vermeire, Séverine; Wilson, David C.; Turner, Dan

2015-01-01

Objective Although paediatric-onset IBD is becoming more common, few medications have a registered paediatric indication. There are multiple hurdles to performing clinical trials in children, emphasising the importance of choosing an appropriate outcome measure, which can facilitate enrolment, and

Achieving social-ecological fit through bottom-up collaborative governance: an empirical investigation

Directory of Open Access Journals (Sweden)

Angela M. Guerrero

2015-12-01

Full Text Available Significant benefits can arise from collaborative forms of governance that foster self-organization and flexibility. Likewise, governance systems that fit with the extent and complexity of the system under management are considered essential to our ability to solve environmental problems. However, from an empirical perspective the fundamental question of whether self-organized (bottom-up collaborative forms of governance are able to accomplish adequate fit is unresolved. We used new theory and methodological approaches underpinned by interdisciplinary network analysis to address this gap by investigating three governance challenges that relate to the problem of fit: shared management of ecological resources, management of interconnected ecological resources, and cross-scale management. We first identified a set of social-ecological network configurations that represent the hypothesized ways in which collaborative arrangements can contribute to addressing these challenges. Using social and ecological data from a large-scale biodiversity conservation initiative in Australia, we empirically determined how well the observed patterns of stakeholder interactions reflect these network configurations. We found that stakeholders collaborate to manage individual parcels of native vegetation, but not for the management of interconnected parcels. In addition, our data show that the collaborative arrangements enable management across different scales (local, regional, supraregional. Our study provides empirical support for the ability of collaborative forms of governance to address the problem of fit, but also suggests that in some cases the establishment of bottom-up collaborative arrangements would likely benefit from specific guidance to facilitate the establishment of collaborations that better align with the ways ecological resources are interconnected across the landscape. In our case study region, this would improve the capacity of stakeholders to

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

Directory of Open Access Journals (Sweden)

K Gnassingbé

2011-01-01

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.

Collaboration and E-collaboration

DEFF Research Database (Denmark)

Razmerita, Liana; Kirchner, Kathrin

2015-01-01

Understanding student’s perception of collaboration and how collaboration is supported by ICT is important for its efficient use in the classroom. This article aims to investigate how students perceive collaboration and how they use new technologies in collaborative group work. Furthermore......, it tries to measure the impact of technology on students’ satisfaction with collaboration outcomes. In particular, the study aims to address the following research questions: Which demographic information (e.g. gender and place of origin) is significant for collaboration and ecollaboration? and Which...... are the perceived factors that influence the students’ group performance? The findings of this study emphasize that there are gender and cultural differences with respect to the perception of e-collaboration. Furthermore, the article summarizes in a model the most significant factors influencing group performance....

Paediatric sunburn: the experience of an Australian paediatric burns unit.

Science.gov (United States)

Mah, Latifa; Di Giovine, Paul; Quinn, Linda; Sparnon, Anthony

2013-08-01

The number of hospital presentations and admissions for treatment of sunburn remains significant, despite efforts to educate the public regarding sun protection. Current literature chiefly examines public health campaigns and sun protection behaviours and attitudes. There are very few articles that explore paediatric sunburn requiring hospital presentation. This study was therefore undertaken to provide a snapshot of this issue and to identify patterns and causative factors in the development of severe sunburn requiring hospital presentation. Data were collected for retrospective analysis from case records of patients who presented with sunburn and were registered on the Burns Service database at the Women's and Children's Hospital in South Australia. This study includes patients who presented during the period of October 2006 to March 2011. There were 81 cases identified over the period of 2006-2011 from the Burns database that had sufficient information for the purpose of this study. Factors such as outdoor activity and water sports were predictably apparent, with patients being burned on days with extremely high ultraviolet ratings. Key patterns that emerged were location of sunburn and sun protection use, which were gender and age specific. Larger-scale studies are warranted to further delineate the contributing factors and to identify the specific populations of children at risk of sunburn. Future educational programmes can therefore target these subgroups and behaviours for effective prevention of sunburn. Tailored campaigns that address these factors may be of greater impact in reducing hospital presentations and admissions of significant sunburn. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Survey on sedation in paediatric dentistry: a global perspective.

Science.gov (United States)

Wilson, Stephen; Alcaino, Eduardo A

2011-09-01

Paediatric dentists receive training in sedation during their advanced education training, but evidence suggests that this training varies widely. The purpose of this study was to survey members of the International Association of Paediatric Dentistry (IAPD) and the European Academy of Paediatric Dentistry (EAPD) on their opinion on pharmacological and other behavioural management techniques and their training related to provision of oral health care of paediatric patients in the dental setting. A request was made for access to the IAPD and EAPD membership email addresses. The responses were recorded anonymously and data uploaded into spss (version 9) and analysed using descriptive analysis and chi-square with and without tabulation processes. A total of 311 respondents of 1973 targeted individuals answered the survey. The response rate was 16%. The majority of the respondents came from the continent of Europe, Asia, and the Americas. The most frequent type of sedation was general anaesthesia (52% of the respondents), followed by nitrous oxide (46%) and then oral sedation (44%). At least 91% of the respondents indicated that they were interested in the development of continuing education on the topic of sedation. Paediatric dentists around the world use relatively few behaviour management techniques, including pharmacological management. There is a definite interest in continuing education in the area of sedation. The Authors. International Journal of Paediatric Dentistry © 2011 BSPD, IAPD and Blackwell Publishing Ltd.

Sleep quality and mood in mothers and fathers accommodated in the family-centred paediatric ward.

Science.gov (United States)

Angelhoff, Charlotte; Edéll-Gustafsson, Ulla; Mörelius, Evalotte

2018-02-01

To describe sleep quality and mood in parents accommodated with their sick child in a family-centred paediatric ward. Secondary aims were to compare mothers' and fathers' sleep quality and mood in the paediatric ward and to compare the parents' sleep quality and mood between the paediatric ward and in a daily-life home setting after discharge. Frequent interruptions, ward noise and anxiety affect parents' sleep quality and mood negatively when accommodated with their sick child in paediatric wards. Poor sleep quality and negative mood decrease the parents' ability to sustain attention and focus, and to care for their sick child. This was a prospective and descriptive study. Eighty-two parents (61 mothers and 21 fathers) with children (median age 6.25 years) admitted to six paediatric wards participated in the study. Uppsala Sleep Inventory, a sleep diary and the Mood Adjective Checklist were used to measure sleep quality and mood. The parents had a good sleep quality in the paediatric ward even though they had more nocturnal awakenings compared to home. Moreover, they were less alert, less interested and had reduced concentration, and were more tired, dull and passive in the hospital than at home after discharge. Vital sign checks, noises made by the staff and medical treatment were given reasons influencing sleep. Poor sleep quality correlated with negative mood. Parents' sleep quality in family-centred paediatric care is good. However, the habitual sleep efficacy before admittance to the hospital is lower than expected and needs to be further investigated. The healthcare professionals should acknowledge parents' sleep and mood when they are accommodated with their sick child. Further should care at night be scheduled and sleep promoted for the parents to maintain health and well-being in the family. © 2017 John Wiley & Sons Ltd.

Parental knowledge of paediatric vaccination

Directory of Open Access Journals (Sweden)

Borràs Eva

2009-05-01

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.

Professional and organizational commitment in paediatric occupational therapists: the influence of practice setting.

Science.gov (United States)

Seruya, Francine M; Hinojosa, Jim

2010-09-01

The professional and organizational commitment of paediatric occupational therapists working in two distinct practice settings, schools and medically based settings, was investigated. A web-based survey program was used to administer a questionnaire to occupational therapists employed in New York, New Jersey and Connecticut. The study employed social identity theory as a guiding perspective in understanding therapists' professional and organizational commitment. One hundred and fifty-seven paediatric therapists responded to the Professional Commitment Questionnaire and the Organizational Commitment Questionnaire to gauge their commitment to both the profession and their employing organizations. Results indicated that paediatric therapists, regardless of employment setting, have high professional commitment. Paediatric occupational therapists employed in medically based settings indicated statistically significant higher organizational commitment than their school-based counterparts. For therapists that work in school settings, the presence of a professional cohort did not influence professional commitment scores. As the study employed a web-based survey methodology, only individuals who were members of associations and had access to a computer and the Internet were able to participate. Further study might include widening the participant pool as well as adding additional instruments to explore both professional and organizational commitment on a more national scale. Copyright 2010 John Wiley & Sons, Ltd.

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

LENUS (Irish Health Repository)

Boyle, E

2012-12-01

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.

Admission, discharge and triage guidelines for paediatric intensive care units in Spain.

Science.gov (United States)

de la Oliva, Pedro; Cambra-Lasaosa, Francisco José; Quintana-Díaz, Manuel; Rey-Galán, Corsino; Sánchez-Díaz, Juan Ignacio; Martín-Delgado, María Cruz; de Carlos-Vicente, Juan Carlos; Hernández-Rastrollo, Ramón; Holanda-Peña, María Soledad; Pilar-Orive, Francisco Javier; Ocete-Hita, Esther; Rodríguez-Núñez, Antonio; Serrano-González, Ana; Blanch, Luis

2018-05-01

A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous inten-sive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition. Copyright © 2017. Publicado por Elsevier España, S.L.U.

Clinician's gaze behaviour in simulated paediatric emergencies.

Science.gov (United States)

McNaughten, Ben; Hart, Caroline; Gallagher, Stephen; Junk, Carol; Coulter, Patricia; Thompson, Andrew; Bourke, Thomas

2018-03-07

Differences in the gaze behaviour of experts and novices are described in aviation and surgery. This study sought to describe the gaze behaviour of clinicians from different training backgrounds during a simulated paediatric emergency. Clinicians from four clinical areas undertook a simulated emergency. Participants wore SMI (SensoMotoric Instruments) eye tracking glasses. We measured the fixation count and dwell time on predefined areas of interest and the time taken to key clinical interventions. Paediatric intensive care unit (PICU) consultants performed best and focused longer on the chest and airway. Paediatric consultants and trainees spent longer looking at the defibrillator and algorithm (51 180 ms and 50 551 ms, respectively) than the PICU and paediatric emergency medicine consultants. This study is the first to describe differences in the gaze behaviour between experts and novices in a resuscitation. They mirror those described in aviation and surgery. Further research is needed to evaluate the potential use of eye tracking as an educational tool. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Is clinical performance adversely affected by wearing gloves during paediatric peripheral intravenous cannulation?

Science.gov (United States)

Zhang, Michael; Lee, Mark; Knott, Susan

2014-10-01

To investigate if wearing protective gloves during paediatric intravenous cannulation affects performance of the procedure. This was a prospective observational study. Peripheral intravenous cannulation (PIVC) performed within the Paediatric ED was observed and recorded over a 12 month period. Data were compared between those clinicians wearing gloves and those not wearing gloves during PIVC. One thousand and twenty paediatric cannulations were recorded during the observed period. The mean age of the children was 5.79 years. The overall success rate of cannulation was 86.18% and first attempt success rate 76.08%. Overall, gloves were used by 54.31% of clinicians to establish vascular access; glove use was lowest in the registrar group (41.11% compliance rate). The glove-wearing group had comparable overall success rate of 85.74% (475/554) to the no-gloves group of 86.70% (404/466). The difference was not statistically significant (P > 0.05). Higher incidence of significant blood spillage during the procedure was observed among clinicians wearing no gloves (16.74%) in comparison with their glove-wearing counterparts (9.03%, P glove-wearing group and no-gloves group (3.94% vs 3.76%, P > 0.05). The present study shows that the use of protective gloves was not associated with adverse outcomes of clinical performance during paediatric cannulation. The low compliance rate of gloves use is alarming, and many clinicians might be exposed to potential blood-borne infections. Clinicians should be encouraged and supported to use gloves for paediatric cannulation. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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

Science.gov (United States)

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

2014-01-01

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 (de Pediatría. Published by Elsevier Espana. All rights reserved.

Algorithm for optimisation of paediatric chest radiography

International Nuclear Information System (INIS)

Kostova-Lefterova, D.

2016-01-01

The purpose of this work is to assess the current practice and patient doses in paediatric chest radiography in a large university hospital. The X-ray unit is used in the paediatric department for respiratory diseases. Another purpose was to recommend and apply optimized protocols to reduce patient dose while maintaining diagnostic image quality for the x-ray images. The practice of two different radiographers was studied. The results were compared with the existing practice in paediatric chest radiography and the opportunities for optimization were identified in order to reduce patient doses. A methodology was developed for optimization of the x-ray examinations by grouping children in age groups or according to other appropriate indication and creating an algorithm for proper selection of the exposure parameters for each group. The algorithm for the optimisation of paediatric chest radiography reduced patient doses (PKA, organ dose, effective dose) between 1.5 and 6 times for the different age groups, the average glandular dose up to 10 times and the dose for the lung between 2 and 5 times. The resulting X-ray images were of good diagnostic quality. The subjectivity in the choice of exposure parameters was reduced and standardization has been achieved in the work of the radiographers. The role of the radiologist, the medical physicist and radiographer in the process of optimization was shown. It was proven the effect of teamwork in reducing patient doses at keeping adequate image quality. Key words: Chest Radiography. Paediatric Radiography. Optimization. Radiation Exposure. Radiation Protection

Optimal assessment of paediatric IBD with MRI and barium follow-through.

Science.gov (United States)

Giles, Edward; Hanci, Ozan; McLean, Alison; Power, Niall; Cole, Angela; Croft, Nicholas M; McDonald, Kirsteen; Chippington, Sam; Naik, Sandhia

2012-06-01

The present UK criterion standard for assessing children with suspected inflammatory bowel disease (IBD) is upper endoscopy, ileocolonoscopy, and barium follow-through (BaFT). Significant doses of radiation, unpalatable contrast, and volume intolerance are involved with BaFT. Practice in investigating Crohn disease (CD) is changing with the increasing use of magnetic resonance imaging (MRI). The aim of the present study was to compare BaFT and a new abdominal MRI protocol in a paediatric IBD population. All consecutive patients with a new diagnosis of IBD or requiring reassessment from September 2008 to December 2010 were investigated with both abdominal MRI and BaFT in accordance with a specific local paediatric IBD protocol. The studies were reported by nonblinded radiologists with an interest in gastrointestinal imaging. The reports were compared in conjunction with case note review. Eighty-seven patients underwent both BaFT and MRI abdomen. Thirty-one percent of patients had additional pathology on MRI, not seen on the BaFT. Sixty-seven percent of patients (n=59) had an MRI finding equivalent to BaFT. Using histology as a criterion standard for detecting terminal ileal disease, BaFT had a sensitivity and specificity of 76% and 67%, and MRI had a sensitivity and specificity of 83% and 95%, respectively. This is the largest series of small bowel MRI in a paediatric population. MRI reports were at least equivalent to BaFT. MRI had higher sensitivity and, particularly, specificity in detecting terminal ileal pathology. These findings suggest that MRI should become the criterion standard investigation in children with IBD in centres with appropriate expertise, with zero radiation exposure being highly advantageous.

[Admission, discharge and triage guidelines for paediatric intensive care units in Spain].

Science.gov (United States)

de la Oliva, Pedro; Cambra-Lasaosa, Francisco José; Quintana-Díaz, Manuel; Rey-Galán, Corsino; Sánchez-Díaz, Juan Ignacio; Martín-Delgado, María Cruz; de Carlos-Vicente, Juan Carlos; Hernández-Rastrollo, Ramón; Holanda-Peña, María Soledad; Pilar-Orive, Francisco Javier; Ocete-Hita, Esther; Rodríguez-Núñez, Antonio; Serrano-González, Ana; Blanch, Luis

2018-05-01

A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous inten-sive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition. Copyright © 2017 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Multidetector row CT for imaging the paediatric tracheobronchial tree

International Nuclear Information System (INIS)

Papaioannou, Georgia; Young, Carolyn; Owens, Catherine M.

2007-01-01

The introduction of multidetector row computed tomography (MDCT) scanners has altered the approach to imaging the paediatric thorax. In an environment where the rapid acquisition of CT data allows general hospitals to image children instead of referring them to specialist paediatric centres, it is vital that general radiologists have access to protocols appropriate for paediatric applications. Thus a dramatic reduction in the delivered radiation dose is ensured with optimal contrast bolus delivery and timing, and inappropriate repetition of the scans is avoided. This article focuses on the main principles of volumetric CT imaging that apply generically to all MDCT scanners. We describe the reconstruction techniques for imaging the paediatric thorax and the low-dose protocols used in our institution on a 16-slice detector CT scanner. Examples of the commonest clinical applications are also given. (orig.)

Weight-band dosing tables: simplifying paediatric art | Nuttall ...

African Journals Online (AJOL)

One of the obstacles to scaling up paediatric antiretroviral therapy (ART) coverage in resource-limited settings is the relative complexity of paediatric dosing. There is a need to simplify ART in order to facilitate treatment initiation and ongoing management of infants and children by health care providers, as well as to support ...

Management of paediatric spontaneous pneumothorax: a multicentre retrospective case series.

Science.gov (United States)

Robinson, Paul D; Blackburn, Carol; Babl, Franz E; Gamage, Lalith; Schutz, Jacquie; Nogajski, Rebecca; Dalziel, Stuart; Donald, Colin B; Druda, Dino; Krieser, David; Neutze, Jocelyn; Acworth, Jason; Lee, Mark; Ngo, Peter K

2015-10-01

Paediatric guidelines are lacking for management of spontaneous pneumothorax. Adult patient-focused guidelines (British Thoracic Society 2003 and 2010) introduced aspiration as first-line intervention for primary spontaneous pneumothorax (PSP) and small secondary spontaneous pneumothoraces (SSP). Paediatric practice is unclear, and evidence for aspiration success rates is urgently required to develop paediatric-specific recommendations. Retrospective analysis of PSP and SSP management at nine paediatric emergency departments across Australia and New Zealand (2003-2010) to compare PSP and SSP management. 219 episodes of spontaneous pneumothorax occurred in 162 children (median age 15 years, 71% male); 155 PSP episodes in 120 children and 64 SSP episodes in 42 children. Intervention in PSP vs SSP episodes occurred in 55% (95% CI 47% to 62%) vs 70% (60% to 79%), pmanagement, PSP and SSP management did not differ and ICC insertion was the continuing preferred intervention. Overall success of aspiration was lower than reported results for adults, although success was greater for small than for large pneumothoraces. Paediatric prospective studies are urgently required to determine optimal paediatric interventional management strategies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Do geography and resources influence the need for colostomy in Hirschsprung′s disease and anorectal malformations? A Canadian association of paediatric surgeons: Association of paediatric surgeons of Nigeria survey

Directory of Open Access Journals (Sweden)

Lukman O. Abdur-Rahman

2014-01-01

Full Text Available Background: This survey compared surgical management of Hirschsprung′s disease (HD and anorectal malformations (ARM in high and low resource settings. Materials and Methods: An online survey was sent to 208 members of the Canadian Association of Paediatric Surgeons (CAPS and the Association of Paediatric Surgeons of Nigeria (APSON. Results: The response rate was 76.8% with 127 complete surveys (APSON 34, CAPS 97. Only 29.5% of APSON surgeons had frozen section available for diagnosis of HD. They were more likely to choose full thickness rectal biopsy (APSON 70.6% vs. CAPS 9.4%, P < 0.05 and do an initial colostomy for HD (APSON 23.5% vs. CAPS 0%, P < 0.05. Experience with trans-anal pull-through for HD was similar in both groups (APSON 76.5%, CAPS 66.7%. CAPS members practising in the United States were more likely to perform a one-stage pull-through for HD during the initial hospitalization (USA 65.4% vs. Canada 28.3%, P < 0.05. The frequency of colostomy in females with vestibular fistula varied widely independent of geography. APSON surgeons were less likely to have enterostomal therapists and patient education resources. Conclusions: Local resources which vary by geographic location affect the management of HD and ARM including colostomy. Collaboration between CAPS and APSON members could address resource and educational needs to improve patient care.

Sudden death in paediatrics as a traumatic experience for critical care nurses.

Science.gov (United States)

Lima, Lígia; Gonçalves, Sandra; Pinto, Cândida

2018-01-01

Research shows that nurses working in critical care units and in particular, paediatric units, are at risk of developing symptoms of secondary traumatic stress (STS). However, little attention has been given to this phenomenon when associated with situations of sudden death in paediatrics. This study aimed to examine the impact of sudden death in paediatrics on nurses working in paediatrics critical care units and to explore nurses' experiences of this event. This study used a mixed-methods design. The Impact of Event Scale - Revised was used for investigating the presence of STS symptoms. In addition, an interview was conducted with six nurses. Fifty-seven percent of nurses responded to the surveys and six nurses were interviewed. The results showed that the sudden death of children and adolescents is an event that elicits symptoms of STS in nurses. The quantitative assessment, revealed that 19·4% presented total scores indicating high impact. The participants interviewed described experiences of subjective distress, such as intrusive thoughts, avoidance and hyperarousal. Other factors were also reported as influencing the experience of the sudden death of a child/adolescent, namely, the child's age, the cause of death and the family's reaction to the loss. According to the participants, the emotional impact was also determined by parenthood, previous training and professional experience. Sudden death in paediatric critical care units is one of the most difficult situations in nursing practice and elicits STS symptoms, which may severely impact the physical and psychological health of nurses and ultimately affect the quality of the provided care. This study emphasizes the need for promoting better conditions for professional practice, namely, with regard to emotional support, as well as training programmes for skills development in the area of management of traumatic situations and of communication with clients. © 2017 British Association of Critical Care

Pattern of Paediatric Trauma in North Western Nigeria | Mungadi ...

African Journals Online (AJOL)

Socio-economic emancipation, intra-city traffic considerations, abrogation of child labour and provision of adequate water supply should reduce these accidents. Trauma prevention and care programme in developing countries should always address paediatric injuries. KEY Words: Paediatric, Trauma, North Western, ...

Developing implementation strategies for firearm safety promotion in paediatric primary care for suicide prevention in two large US health systems: a study protocol for a mixed-methods implementation study.

Science.gov (United States)

Wolk, Courtney Benjamin; Jager-Hyman, Shari; Marcus, Steven C; Ahmedani, Brian K; Zeber, John E; Fein, Joel A; Brown, Gregory K; Lieberman, Adina; Beidas, Rinad S

2017-06-24

The promotion of safe firearm practices, or firearms means restriction, is a promising but infrequently used suicide prevention strategy in the USA. Safety Check is an evidence-based practice for improving parental firearm safety behaviour in paediatric primary care. However, providers rarely discuss firearm safety during visits, suggesting the need to better understand barriers and facilitators to promoting this approach. This study, Adolescent Suicide Prevention In Routine clinical Encounters, aims to engender a better understanding of how to implement the three firearm components of Safety Check as a suicide prevention strategy in paediatric primary care. The National Institute of Mental Health-funded Mental Health Research Network (MHRN), a consortium of 13 healthcare systems across the USA, affords a unique opportunity to better understand how to implement a firearm safety intervention in paediatric primary care from a system-level perspective. We will collaboratively develop implementation strategies in partnership with MHRN stakeholders. First, we will survey leadership of 82 primary care practices (ie, practices serving children, adolescents and young adults) within two MHRN systems to understand acceptability and use of the three firearm components of Safety Check (ie, screening, brief counselling around firearm safety and provision of firearm locks). Then, in collaboration with MHRN stakeholders, we will use intervention mapping and the Consolidated Framework for Implementation Research to systematically develop and evaluate a multilevel menu of implementation strategies for promoting firearm safety as a suicide prevention strategy in paediatric primary care. Study procedures have been approved by the University of Pennsylvania. Henry Ford Health System and Baylor Scott & White institutional review boards (IRBs) have ceded IRB review to the University of Pennsylvania IRB. Results will be submitted for publication in peer-reviewed journals. © Article

Quality control in the radiological examinations of paediatric patients

International Nuclear Information System (INIS)

Gaiba, W.; Rossi, A.; Vos, C.V.; Giacomelli, G.; Galletti, S.; Rimondi, E.

1985-01-01

With a view to minimising the dose absorbed by the paediatric patient during radiological investigations, the most usual X-ray examinations performed in paediatrics were checked in order to standardise and optimise the techniques used. The present study deals with the quality control of the X-ray beam used in radiological diagnosis of young patients, particularly considering that hips and pelvis pathologies can be widespread and that very often it is not possible to shield the patient's gonads during the examination. The electrical and geometrical parameters which minimise the absorbed dose but are compatible with obtaining valid diagnostic information are selected. An anthromorphic phantom reproducing bone and lung inhomogeneities was constructed to the average size of a 12-month-old baby. Inside the phantom TLD 4F 100 dosimeters were located in order to evaluate the absorbed doses. The technique which proved more convenient is indicated and suggested for routine work. (author)

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

LENUS (Irish Health Repository)

Ó hAiseadha, Coilín

2016-05-01

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.

A disjointed effort: paediatric musculoskeletal examination.

LENUS (Irish Health Repository)

Gill, Irwin

2012-07-01

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.

Paediatric head injuries in the Kwazulu-Natal Province of South Africa: a developing country perspective.

Science.gov (United States)

Okyere-Dede, Ebenezer K; Nkalakata, Munyaradzi C; Nkomo, Tshepo; Hadley, G P; Madiba, Thandinkosi E

2013-01-01

We investigated the causes, management and outcome of head injuries in paediatric patients admitted to the paediatric surgery unit at King Edward VIII Hospital over a 3-year period, from 1999 to 2001. There were 506 patients (331 male; M:F ratio 2:1) and the mean age was 71.99 +36.8 months (2 weeks to 180 months). The injuries were due to: motor vehicle crashes (324); falls (121); assault (30); inadvertent injury (23); and unknown (11). Forty-nine patients (9%) were admitted with a Glasgow Coma Scale ≤8. The most common intracranial pathology on computed tomography was: intracranial haematoma/haemorrhage (44); contusion (16); and brain oedema (10). Nineteen patients (3.4%) underwent neurosurgical intervention and the rest were managed conservatively. Eighteen died in hospital (3.6%). The mean hospital stay was 5 ± 12 days. Twenty-three patients (4.5%) were discharged with neurological sequelae. Few paediatric patients are admitted with severe head injury: the majority from blunt injury caused by motor vehicle crashes. Management mainly requires simple neurological observation in a general ward with a surprisingly good prognosis. Specific protocols for paediatric head injuries have been proposed based on these findings.

Paediatric Pain Management: Using Complementary and Alternative Medicine.

Science.gov (United States)

Evans, Subhadra; Tsao, Jennie C I; Zeltzer, Lonnie K

2008-09-01

Children undergo acute painful procedures and many also experience chronic pain.Due to their developing systems, infants and children may be at greater risk than adults for protracted pain sensitivity.There is a need to manage acute and chronic paediatric pain to reduce children's suffering and to prevent future pain problems.Consistent with a biopsychosocial perspective, complementary and alternative medicine (CAM) should be considered in management of acute and chronic paediatric pain.Although research is limited for paediatric pain, CAM interventions receiving the most empirical attention include hypnotherapy, acupuncture and music therapy. Evidence also exists for the therapeutic benefits of yoga, massage, humor therapy and the use of certain biological based therapies.

The experience of transition in adolescents and young adults transferring from paediatric to adult care

DEFF Research Database (Denmark)

Fegran, Liv; Ludvigsen, Mette Spliid; Aagaard, Hanne

Introduction: Despite research and implementation of transition models in the last decades, transfer from paediatric to adult care still poses great challenges. Predominantly studies on health care transition have been based on the perspective of experts or health care professionals. Aim...... of familiar surroundings and relationships combined with insecurity and a feeling of being unprepared for what was ahead. Four sub-themes illustrating these experiences were identified: facing changes of significant relationships, moving from familiar to unknown ward cultures, timing of transfer and achieving...... as competent collaborators in their own transfer is crucial, and may protect them from additional health problems in a vulnerable phase of their life....

Is paediatric trauma severity overestimated at triage?

DEFF Research Database (Denmark)

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

2014-01-01

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 

Reducing dose in paediatric CT: a preliminary study of radiographers' knowledge

International Nuclear Information System (INIS)

Heagney, J.; Lewis, S.; Chaffey, C.; Howlett, G.; Moran, A.; McLean, D.

2003-01-01

The objective of this study is to evaluate the responses of Australian radiographers in comparison with current literature on paediatric protocols and scanning recommendations in order to determine how and if paediatric Computed Tomography (CT) exposure reductions are taking place within Medical Imaging Departments. Subjects and Methods: The method involved a dual format; consisting of surveying 30 CT radiographers, and additionally, interviewing 5 senior CT radiographers. Of the 30 surveys completed, one was completed by a PDY radiographer, 7 by CT Senior radiographers and 22 by CT radiographers. The survey contained a range of questions about appropriate paediatric CT scanning parameters and protocols. Five CT Seniors were interviewed to ascertain the current level and opinion of training in paediatric protocols, in-house educational programs and the implementation of radiation dose saving parameters. Radiographers demonstrated reasonable ability to identify suitable paediatric protocols and believed the in-house CT protocols resident to their medical imaging department to be adequate, despite many utilising exposures higher than those from recommended literature. The interviews revealed that no further training in CT paediatric dose reduction was currently available, however survey responses indicated that further training would be beneficial. This study demonstrates that radiographers are aware of the need to reduce exposure parameters for paediatric CT and tend to follow protocols in place within their workplace, regardless of suitability and patient needs. Copyright (2003) Australian Institute of Radiography

Reducing dose in paediatric CT: a preliminary study of radiographers' Knowledge

International Nuclear Information System (INIS)

Heagney, Jillian; Lewis, Sarah; Chaffey, Clare; Howlett, Genevieve; Moran, Alexander; McLean, Donald

2003-01-01

The objective of this study is to evaluate the responses of Australian radiographers in comparison with current literature on paediatric protocols and scanning recommendations in order to determine how and if paediatric Computed Tomography (CT) exposure reductions are taking place within Medical Imaging Departments. Subjects and Methods: The method involved a dual format; consisting of surveying 30 CT radiographers, and additionally, interviewing 5 senior CT radiographers. Of the 30 surveys completed, one was completed by a PDY radiographer, 7 by CT Senior radiographers and 22 by CT radiographers. The survey contained a range of questions about appropriate paediatric CT scanning parameters and protocols. Five CT Seniors were interviewed to ascertain the current level and opinion of training in paediatric protocols, in-house educational programs and the implementation of radiation dose saving parameters. Radiographers demonstrated reasonable ability to identify suitable paediatric protocols and believed the in-house CT protocols resident to their medical imaging department to be adequate, despite many utilising exposures higher than those from recommended literature. The interviews revealed that no further training in CT paediatric dose reduction was currently available, however survey responses indicated that further training would be beneficial. This study demonstrates that radiographers are aware of the need to reduce exposure parameters for paediatric CT and tend to follow protocols in place within their workplace, regardless of suitability and patient needs Copyright (2003) Australian Institute of Radiography

Sustainable Benefits of a Community Hospital-Based Paediatric Asthma Clinic.

Science.gov (United States)

Kuzik, Brian A; Chen, Chee P; Hansen, Miriam J; Montgomery, Paula L

2017-01-01

In 2011, we reported that our paediatric asthma clinic (PAC) appeared to significantly reduce the burden of paediatric asthma in our community. Supported by these results, the PAC underwent a gradual threefold expansion while maintaining the same model of care. We now report on the outcome of that expansion and demonstrate that our PAC continues to significantly reduce the burden of paediatric asthma in our community. As previously, newly enrolled PAC patients continue to show a 12-month reduction in asthma-related emergency department (ED) visits and admissions exceeding 60% and 80%, respectively. This consistent short-term benefit, coupled with clinic expansion, has contributed to a significant improvement in our rate of paediatric asthma-related ED visits or hospitalizations when compared to other Ontario hospitals.

Renal imaging in paediatrics

International Nuclear Information System (INIS)

Porn, U.; Hahn, K.; Fischer, S.

2003-01-01

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.) [de

Epidemiological investigation of Candida species causing bloodstream infection in paediatric small bowel transplant recipients.

Science.gov (United States)

Suhr, Mallory J; Gomes-Neto, João Carlos; Banjara, Nabaraj; Florescu, Diana F; Mercer, David F; Iwen, Peter C; Hallen-Adams, Heather E

2017-06-01

Small bowel transplantation (SBT) can be a life-saving medical procedure. However, these recipients experience high risk of bloodstream infections caused by Candida. This research aims to characterise the SBT recipient gut microbiota over time following transplantation and investigate the epidemiology of candidaemia in seven paediatric patients. Candida species from the recipients' ileum and bloodstream were identified by internal transcribed spacer sequence and distinguished to strain by multilocus sequence typing and randomly amplified polymorphic DNA. Antifungal susceptibility of bloodstream isolates was determined against nine antifungals. Twenty-two ileostomy samples harboured at least one Candida species. Fungaemia were caused by Candida parapsilosis, Candida albicans, Candida glabrata, Candida orthopsilosis and Candida pelliculosa. All but three bloodstream isolates showed susceptibility to all the antifungals tested. One C. glabrata isolate showed multidrug resistance to itraconazole, amphotericin B and posaconazole and intermediate resistance to caspofungin. Results are congruent with both endogenous (C. albicans, C. glabrata) and exogenous (C. parapsilosis) infections; results also suggest two patients were infected by the same strain of C. parapsilosis. Continuing to work towards a better understanding of sources of infection-particularly the exogenous sources-would lead to targeted prevention strategies. © 2017 Blackwell Verlag GmbH.

Measurement of adult and paediatric patient doses during head CT scan

International Nuclear Information System (INIS)

Suliman, S. A.

2011-03-01

CT represents only 5% of all x-ray imaging and yet the radiation from CT examination is 40% to 67% of all medical radiation. The dose from single CT examinations can range from 1.0 mSv to 27.0 mSv. The radiation given by diagnostic CT is comparable to the low dose received by Japanese survivors of the atomic bombs. As per united nations scientific committee UNSCEAR 2000(2), CT contributes over 34% collective dose from diagnostic x-ray examinations in the world. This figure is much larger than this for developed countries, approaching as much as 50% to 70% even thought the frequency of CT examinations in these countries is of the order of 5 to 12%. It thus implies a small but statistically significant increased risk for developing cancer as a result of the radiation. The objective of the study were to investigate doses from CT examinations of adult and paediatric patients in brain CT examination and compare the doses with international standard as provided in DRLs. A total of 59 patients (paediatric and adults) were examined at the department of radiology, Al Ribat University Hospital-Khartoum. The mean age was 40.80 years for adults while the mean weight was 70.04 kg and the mean age for paediatric was 5.10 years while the mean weight was 20kg. DLP for adults were 1000.25 mGy.cm, 733.33 for paediatrics. The mean effective dose for adults patient was 0.48 mSv in rang (0.49-0.44)mSv, while for paediatric patients was 0.31 mSv in rang between (0.49-0.11) mSv. The DRL was 1120 mGy.cm, a value which is higher than the European Guidelines on quality criteria for computed tomography. The study has shown a great need for referring criteria, continuous training of staff in radiation dose optimization concepts. Further studies are required in order to establish a reference level in Sudan.(Author)

An audit of paediatric intussusception radiological reduction at the ...

African Journals Online (AJOL)

Methods. This retrospective analytic cohort study assessed data from the records of all paediatric patients with the diagnosis of idiopathic intussusception discharged from the Department of Paediatric Surgery between 1 January 2003 and 30 September 2011. Results. Thirty-five children with intussusception were identified.

[The latest in paediatric resuscitation recommendations].

Science.gov (United States)

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

2017-04-01

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.

The impact of legislation on drug substances used off-label in paediatric wards--a nationwide study.

Science.gov (United States)

Haslund-Krog, Sissel; Mathiasen, René; Christensen, Hanne Rolighed; Holst, Helle

2014-04-01

This nationwide study is aimed at describing to what extent the European Paediatric Regulation has met therapeutic needs in children. Data for each drug substance in defined daily doses (DDD) were extracted from the national Danish data base. We evaluated if drug substances were used off-label and whether they had a paediatric investigation plan (PIP). This study did not include drug prescriptions for individual paediatric patients; thus, it was not possible to make use of all off-label categories previously used. Additionally, paediatric standard assortments (SA) were compared to the European survey on paediatric medicinal products. Thirteen percent of the 100 most used drug substances were determined as being used off-label, four of which had a PIP and one had a full waiver. Only one of the three drug substances used off-label most often, accounting for 85 % of such use, had a PIP. Neonates were included in one-third of PIPs and adolescents in 15. Nineteen out of 21 PIPs had a waiver and 14 PIPs were deferred. In line with the European survey, carbapenems, corticosteroids and proton pump inhibitors were frequent found in SAs. PIPs only cover a small proportion of the drugs found to be used off-label in this study. Despite waivers granted, drug substances were used nonetheless. Unmet regulatory needs are still considerable in some therapeutic areas in neonates as well as in children.

A systematic review of patient-reported outcome measures in paediatric otolaryngology.

Science.gov (United States)

Powell, J; Powell, S; Robson, A

2018-01-01

Recently, there has been increased emphasis on the development and application of patient-reported outcome measures. This drive to assess the impact of illness or interventions, from the patient's perspective, has resulted in a greater number of available questionnaires. The importance of selecting an appropriate patient-reported outcome measure is specifically emphasised in the paediatric population. The literature on patient-reported outcome measures used in paediatric otolaryngology was reviewed. A comprehensive literature search was conducted using the databases Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and PsycInfo, using the terms: 'health assessment questionnaire', 'structured questionnaire', 'questionnaire', 'patient reported outcome measures', 'PROM', 'quality of life' or 'survey', and 'children' or 'otolaryngology'. The search was limited to English-language articles published between 1996 and 2016. The search yielded 656 articles, of which 63 were considered relevant. This included general paediatric patient-reported outcome measures applied to otolaryngology, and paediatric otolaryngology disease-specific patient-reported outcome measures. A large collection of patient-reported outcome measures are described in the paediatric otolaryngology literature. Greater standardisation of the patient-reported outcome measures used in paediatric otolaryngology would assist in pooling of data and increase the validation of tools used.

Circulating rotavirus genotypes in the Irish paediatric population prior to the introduction of the vaccination programme.

Science.gov (United States)

Yandle, Z; Coughlan, S; Drew, R J; O'Flaherty, N; O'Gorman, J; De Gascun, C

2017-11-01

Rotavirus is the leading cause of viral gastroenteritis in children, and it is anticipated that the introduction of the Rotarix™ vaccine (GlaxoSmithKline Biologicals S.A., Rixensart, Belgium) into the Irish immunisation schedule will result in a significant reduction of rotavirus-associated disease. In the pre- and post-vaccination eras, it is important to determine circulating strains of rotavirus to assess vaccine effectiveness, to monitor vaccine failures, and to detect potential emerging strains. This study was a collaboration between the Temple Street Children's University Hospital (TSCUH), Dublin, and the National Virus Reference Laboratory (NVRL), Dublin, to determine the then circulating rotavirus strains in a paediatric hospital. In the 2015/2016 period (July 2015-June 2016) 89 faecal samples from paediatric patients (53 from TSCUH, 36 from other hospitals) were characterised. The results showed G1P[8] to be the predominant genotype (57%), followed by G9P[8] (34%), G4P[8] (6%), G2P[4] (2%), and G12P[8] (1%). This distribution of genotypes is comparable to those found in other European countries prior to vaccination suggesting that the vaccine should be highly efficacious in the Irish population.

Magnetic resonance spectroscopy metabolite profiles predict survival in paediatric brain tumours.

Science.gov (United States)

Wilson, Martin; Cummins, Carole L; Macpherson, Lesley; Sun, Yu; Natarajan, Kal; Grundy, Richard G; Arvanitis, Theodoros N; Kauppinen, Risto A; Peet, Andrew C

2013-01-01

Brain tumours cause the highest mortality and morbidity rate of all childhood tumour groups and new methods are required to improve clinical management. (1)H magnetic resonance spectroscopy (MRS) allows non-invasive concentration measurements of small molecules present in tumour tissue, providing clinically useful imaging biomarkers. The primary aim of this study was to investigate whether MRS detectable molecules can predict the survival of paediatric brain tumour patients. Short echo time (30ms) single voxel (1)H MRS was performed on children attending Birmingham Children's Hospital with a suspected brain tumour and 115 patients were included in the survival analysis. Patients were followed-up for a median period of 35 months and Cox-Regression was used to establish the prognostic value of individual MRS detectable molecules. A multivariate model of survival was also investigated to improve prognostic power. Lipids and scyllo-inositol predicted poor survival whilst glutamine and N-acetyl aspartate predicted improved survival (pmodel of survival based on three MRS biomarkers predicted survival with a similar accuracy to histologic grading (p5e-5). A negative correlation between lipids and glutamine was found, suggesting a functional link between these molecules. MRS detectable biomolecules have been identified that predict survival of paediatric brain tumour patients across a range of tumour types. The evaluation of these biomarkers in large prospective studies of specific tumour types should be undertaken. The correlation between lipids and glutamine provides new insight into paediatric brain tumour metabolism that may present novel targets for therapy. Copyright © 2012 Elsevier Ltd. All rights reserved.

A review of paediatric anaesthetic-related mortality, serious adverse ...

African Journals Online (AJOL)

Keywords: mortality, outcomes, paediatric anaesthesia, perioperative, risks. Introduction ... informed decisions on patient care.2,17,18 ... use of a case mix and institutional audit with a small sample size.2,27,28, ..... Anesthesia safety: model or myth? .... Thomas J. Paediatric anaesthesia: a risky business?: guest editorial. S.

Current educational status of paediatric rheumatology in Europe: the results of PReS survey.

Science.gov (United States)

Demirkaya, E; Ozen, S; Türker, T; Kuis, W; Saurenmann, R K

2009-01-01

To understand the status of education and problems in paediatric rheumatology practice in Europe, through a survey. A 26-item questionnaire was conducted during the 14th Congress of the Paediatric Rheumatology European Society in Istanbul, 2007. Physicians who were practicing or studying within the field of paediatric rheumatology for at least one year were included in the survey. One hundred and twenty eight physicians, 79 paediatric rheumatologists (including 5 paediatric immunologists and 10 paediatric nephrologists), 34 paediatric rheumatology fellows and 15 adult rheumatologists completed the survey. The physicians were from: Europe 95 (81.9%), South America 12 (10.4%), Middle East 5 (4.3%), Asia 2 (1.7%), Africa 2 (1.7%). The duration of training for paediatric rheumatology ranged between 1-5 years (mean: 3.12+/-1.11). Sixty physicians scored their education as unsatisfactory and among those, 48 physicians were from Europe. Physicians reported good skills in the following items; intraarticular injections (83.3%); soft tissue injections (47.6%); evaluation of radiographs (67.5%); whereas competence in the evaluation of computed tomography/magnetic resonance imaging (30.5%); and musculoskeletal sonography (16.7%) was much lower. A need for improved basic science and rotations among relevant fields were specifically expressed. Being a relatively new speciality in the realm of paediatrics, paediatric rheumatology education at the European level needs to be further discussed, revised and uniformed.

Patient dosimetry study of a paediatric CT examination

International Nuclear Information System (INIS)

Hranitzky, C.; Stadtmann, H.

2011-01-01

Dosimetry studies are of increasing interest in diagnostic high-dose applications such as computed tomography especially for examinations of children. A routine CT scan protocol for paediatric head and neck imaging was investigated at a new multi-detector CT scanner using LiF:Mg,Cu,P thermoluminescence dosemeters (TLDs) and a 0.125 cm 3 thimble ionization chamber. Calibrations of the detectors in terms of absorbed dose to water were carried out at the Dosimetry Laboratory Seibersdorf in standard radiation fields. The dosimetry method was validated in the spiral CT X-ray field by comparing TLD and ionization chamber measurement results in cylindrical PMMA phantoms. Absorbed dose results were within stated uncertainties. An anthropomorphic phantom representing a child of about 5 years was loaded with TLD chips at various organ and tissue positions in the head and neck region as well as at some critical organ locations. Organ dose values were calculated from TLD based average absorbed dose with about 5% total uncertainty, e.g. 22 mGy (eyes), 21 mGy (thyroid), 19 mGy (brain), 3.4 mGy (thymus), and 0.03 mGy (testes). For comparison purposes an effective dose of 1.9 mSv was estimated for the investigated paediatric CT examination based on ICRP-103 age-independent tissue-weighting factors.

STUDY ON NONINFECTIOUS DERMATOSES IN PAEDIATRIC AGE

Directory of Open Access Journals (Sweden)

Ananthi Mahalingam

2017-09-01

Full Text Available BACKGROUND Paediatric dermatology is a unique subspecialty in that child is not a miniature adult. Paediatric dermatoses differ from that of the adults in clinical presentation, treatment and prognosis. Various studies from India have shown infections and infestations to be the most common paediatric dermatoses. This study was planned to determine the epidemiological pattern of common noninfectious dermatoses in our paediatric patients as no such data are available from this part of the country. A cross-sectional study was undertaken to study the prevalence of the noninfectious dermatoses in all the new paediatric patients attending the Skin Outpatient Department (OPD at Villupuram Medical College over a period of three years. MATERIALS AND METHODS A total number of 550 children in the age group ranging from newborn to 12 years with noninfectious dermatoses attending the OPD for the first time were enrolled in the study. RESULTS Physiological changes of skin was the most common dermatoses in the newborn age group, while eczema was the most common dermatoses in infants, preschool and school going children. In the infants, eczema was followed by pigmentary disorders, mongolian spots, vascular nevi, ichthyosis, epidermolysis bullosa, alopecia areata and papular urticaria in the order of prevalence. Among preschool going children, eczema was followed by papular urticaria, papulosquamous disorders, pigmentary disorders, hair disorders, nevi, drug reactions, keratinisation disorders, urticaria, etc. In the school going age group, eczema was followed by papulosquamous disorders, pigmentary disorders, papular urticaria, nutritional disorders, ichthyosis, nevi, miliaria, drug reaction, hair disorders, photodermatoses, urticaria, collagen vascular disease and vascular nevi in the order of prevalence. CONCLUSION Eczema, papulosquamous disorders, papular urticaria, pigmentary disorders seem to be the most common noninfectious dermatoses in children. However

Family functioning in paediatric obsessive compulsive and related disorders.

Science.gov (United States)

Murphy, Yolanda E; Flessner, Christopher A

2015-11-01

Research among youths with obsessive compulsive disorder (OCD) has shown a significant relationship between illness severity, treatment outcome, and the family environment yet little work has been undertaken among the broader class of obsessive compulsive and related disorders (OCRDs) - Trichotillomania, body dysmorphic disorder (BDD), skin picking disorder (SPD), and hoarding. The aim of this study was to (1) review the family functioning literature among paediatric OCRDs, (2) address limitations to previous studies, and (3) highlight areas in need of further research. A review of the literature was conducted using several databases (i.e., Google Scholar, PubMed, ScienceDirect) and employing key search terms (e.g., 'family functioning', 'paediatric OCD'). The resultant articles examined several domains subsumed under the broader heading of family environment including parental mental health, parenting practices, family dynamics, family involvement with symptoms, and family emotional climate. The literature reviewed demonstrated a strong relationship between paediatric OCD and adverse family functioning (e.g., parental symptoms of anxiety and depression, family accommodation, family strain and stress, parental guilt and fear) in all identified domains. While family functioning research in paediatric HPD was relatively scant, research suggested similar familial dysfunction (e.g., limited independence, low family cohesion, family violence). Collectively, only 1 article, examining BDD, assessed family functioning within other OCRDs. This review supports the need for further research in the OCRDs. Limitations to the available literature and targeted suggestions for future research are discussed. The domains of family environment in this study indicate specific family functioning deficits that may serve as aetiological and/or maintenance factors in paediatric OCRDs, possibly contributing to the understanding of these complex disorders. The recognition of family deficits

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

Energy Technology Data Exchange (ETDEWEB)

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)

2009-05-15

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.)

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

International Nuclear Information System (INIS)

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

2009-01-01

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.)

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

Science.gov (United States)

Barkmann, Claus; Siem, Anna-Katharina; Wessolowski, Nino; Schulte-Markwort, Michael

2013-10-10

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. 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. 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. 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.

Radiation risks knowledge in resident and fellow in paediatrics: a questionnaire survey.

Science.gov (United States)

Salerno, Sergio; Marchese, Paola; Magistrelli, Andrea; Tomà, Paolo; Matranga, Domenica; Midiri, Massimo; Ugazio, Alberto G; Corsello, Giovanni

2015-03-22

Analyse through a multi-choice anonymous questionnaire the knowledge's level in paediatric residents and fellows in two different main Italian hospital, looking mainly to the information to patients and relatives related to risks of ionizing radiation used in common radiological investigations in children. 65 multi choice questionnaires were distributed to paediatric residents and fellows of two different hospitals, an University Hospital (A.O.U.P. "P. Giaccone"- University of Palermo) and a national reference centre for paediatrics (Ospedale Pediatrico Bambino Gesù - Rome). The questionnaire included twelve multiple-choice questions with the aim of analyzing the knowledge about ionizing radiation related risks in infants and children who undergo common diagnostic radiology investigations. The data obtained were processed using software Stata/MP version 11.2. In order to measure the level of expertise of each interviewee a binary indicator was built. The value 1 was assigned if the percentage of correct answers exceeds the median of the distribution and 0 for values not exceeding the median. The association between the level of competence and demographic characteristics (gender, age) and training experience was measured by means of α(2) test. 51/65 questionnaires were completed, returned and analysed (87.7%). Only 18 surveyed (35%), (95% IC = [22%-48%]) can be defined as competent in radiation risk knowledge for common radiological investigations, considering the percentage of correct answers at least of 50% (sufficient knowledge was given with a minimum score of 8 correct answers out of 12). The study demonstrates an urgent need to implement the radiation protection knowledge in the training programme of paediatricians, that improve if just a short targeted training is performed.

Paediatric medical emergency calls to a Danish Emergency Medical Dispatch Centre: a retrospective, observational study.

Science.gov (United States)

Andersen, Kasper; Mikkelsen, Søren; Jørgensen, Gitte; Zwisler, Stine Thorhauge

2018-01-05

Little is known regarding paediatric medical emergency calls to Danish Emergency Medical Dispatch Centres (EMDC). This study aimed to investigate these calls, specifically the medical issues leading to them and the pre-hospital units dispatched to the paediatric emergencies. We performed a retrospective, observational study on paediatric medical emergency calls managed by the EMDC in the Region of Southern Denmark in February 2016. We reviewed audio recordings of emergency calls and ambulance records to identify calls concerning patients ≤ 15 years. We examined EMDC dispatch records to establish how the medical issues leading to these calls were classified and which pre-hospital units were dispatched to the paediatric emergencies. We analysed the data using descriptive statistics. Of a total of 7052 emergency calls in February 2016, 485 (6.9%) concerned patients ≤ 15 years. We excluded 19 and analysed the remaining 466. The reported medical issues were commonly classified as: "seizures" (22.1%), "sick child" (18.9%) and "unclear problem" (12.9%). The overall most common pre-hospital response was immediate dispatch of an ambulance with sirens and lights with a supporting physician-manned mobile emergency care unit (56.4%). The classification of medical issues and the dispatched pre-hospital units varied with patient age. We believe our results might help focus the paediatric training received by emergency medical dispatch staff on commonly encountered medical issues, such as the symptoms and conditions pertaining to the symptom categories "seizures" and "sick child". Furthermore, the results could prove useful in hypothesis generation for future studies examining paediatric medical emergency calls. Almost 7% of all calls concerned patients ≤ 15 years. Medical issues pertaining to the symptom categories "seizures", "sick child" and "unclear problem" were common and the calls commonly resulted in urgent pre-hospital responses.

Does fluoroscopy improve outcomes in paediatric forearm fracture reduction?

International Nuclear Information System (INIS)

Menachem, S.; Sharfman, Z.T.; Perets, I.; Arami, A.; Eyal, G.; Drexler, M.; Chechik, O.

2016-01-01

Aim: To compare the radiographic results of paediatric forearm fracture reduced with and without fluoroscopic enhancement to investigate whether fractures reduced under fluoroscopic guidance would have smaller residual deformities and lower rates of re-reduction and surgery. Materials and methods: A retrospective cohort analysis was conducted comparing paediatric patients with acute forearm fracture in two trauma centres. Demographics and radiographic data from paediatric forearm fractures treated in Trauma Centre A with the aid of a C-arm fluoroscopy were compared to those treated without fluoroscopy in Trauma Centre B. Re-reduction, late displacement, post-reduction deformity, and need for surgical intervention were compared between the two groups. Results: The cohort included 229 children (175 boys and 54 girls, mean age 9.41±3.2 years, range 1–16 years) with unilateral forearm fractures (83 manipulated with fluoroscopy and 146 without). Thirty-four (15%) children underwent re-reduction procedures in the emergency department. Fifty-three (23%) children had secondary displacement in the cast, of which 18 were operated on, 20 were re-manipulated, and the remaining 15 were kept in the cast with an acceptable deformity. Twenty-nine additional children underwent operation for reasons other than secondary displacement. There were no significant differences in re-reduction and surgery rates or in post-reduction deformities between the two groups. Conclusion: The use of fluoroscopy during reduction of forearm fractures in the paediatric population apparently does not have a significant effect on patient outcomes. Reductions performed without fluoroscopy were comparably accurate in correcting deformities in both coronal and sagittal planes. - Highlights: • Compared outcomes of pediatric forearm fracture reduction with and without fluoroscopy. • The use of fluoroscopy during reduction of forearm fractures in the pediatric population apparently does not have a

MR imaging of paediatric uterovaginal anomalies

International Nuclear Information System (INIS)

Lang, I.M.; Babyn, P.; Oliver, G.D.

1999-01-01

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.)

Prosthetics in Paediatric Dentistry

Directory of Open Access Journals (Sweden)

Vulićević Zoran

2017-07-01

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.

STUDY ABOUT CLINICAL APPLICATION OF BRAIN ATLAS IN PAEDIATRICS

Institute of Scientific and Technical Information of China (English)

MENG Fanhang; LIU Cuiping; RENG Xiaoping; JIANG Lian

2002-01-01

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.

The undergraduate paediatric surgery curriculum in Nigeria – how ...

African Journals Online (AJOL)

This study aimed to: (i) identify main objectives of paediatric surgery at he undergraduate level; (ii) establish students' knowledge with regard to these objectives; (iii) evaluate the input of both specialists and non-specialists to these objectives; and (iv) examine the status of undergraduate paediatric surgery instruction in our ...

Prebiotics as a modulator of gut microbiota in paediatric obesity.

Science.gov (United States)

Nicolucci, A C; Reimer, R A

2017-08-01

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.

Use of antibiotics in paediatric long-term care facilities.

Science.gov (United States)

Murray, M T; Johnson, C L; Cohen, B; Jackson, O; Jones, L K; Saiman, L; Larson, E L; Neu, N

2018-06-01

Adult long-term care (LTC) facilities have high rates of antibiotic use, raising concerns about antimicrobial resistance. Few studies have examined antibiotic use in paediatric LTC facilities. To describe antibiotic use in three paediatric LTC facilities and to describe the factors associated with use. A retrospective cohort study was conducted from September 2012 to December 2015 in three paediatric LTC facilities. Medical records were reviewed for demographics, healthcare-associated infections (HAIs), antimicrobial use and diagnostic testing. Logistic regression was used to identify predictors for antibiotic use. The association between susceptibility testing results and appropriate antibiotic coverage was determined using Chi-squared test. Fifty-eight percent (413/717) of residents had at least one HAI, and 79% (325/413) of these residents were treated with at least one antibiotic course, totalling 2.75 antibiotic courses per 1000 resident-days. Length of enrolment greater than one year, having a neurological disorder, having a tracheostomy, and being hospitalized at least once during the study period were significantly associated with receiving antibiotics when controlling for facility (all P facilities is widespread. There is further need to assess antibiotic use in paediatric LTC facilities. Evaluation of the adverse outcomes associated with inappropriate antibiotic use, including the prevalence of resistant organisms in paediatric LTC facilities, is critical. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Radiopharmaceutical activities administered for paediatric nuclear medicine procedures in Australia

International Nuclear Information System (INIS)

Towson, J.E.; Smart, R.C.; Rossleigh, M.A.; Children's Hospital, Randwick, NSW

2000-01-01

A survey of radiopharmaceutical activities used at the eight hospital centres specialising in paediatric nuclear medicine in Australia was conducted in 1999-2000 by the Australian and New Zealand Society of Nuclear Medicine and the Australasian Radiation Protection Society. Data on the maximum and minimum administered activities was obtained for 43 paediatric imaging procedures. The maximum values were significantly less than the corresponding Reference Activities for adults determined in a previous study. Activities for individual patients are calculated using surface area scaling at five centres and body weight scaling at three centres. The median values of A max and A min are recommended as Paediatric Reference Activities. The effective dose to patients of various sizes for the Paediatric Reference Activities and both methods of scaling was calculated for each procedure. Copyright (2000) Australasian Radiation Protection Society Inc

A Webometric Investigation of Visibility and Collaboration of Iranian Nanotechnology Websites

Directory of Open Access Journals (Sweden)

Faramarz Sohili

2007-07-01

Full Text Available The present investigation intends to review the extent of visibility, impact and collaboration of Iranian nanotechnology websites using webometric method of link analysis. The sample consists of all websites dealing with nanotechnology in Iran. Findings showed that these sites have low visibility, web impact factor and page count. Iranian Nanotechnology Initiative, Nano Ideas and Iranian Nanotechnology Association had the highest number of inlinks and therefore highest visibility, while Nanotechnology Department Website had the lowest visibility. Findings also indicated that Amir Kabir Technical University Nanotechnology Committee website, Iran Nanotechnology initiative and Nano Ideas websites had the highest web impact factor, while Kashan University Institute for Nano Science and Technology had the lowest web impact factor. It was further established that Iranian Nanotech websites collaborate within two clusters. A Multi-dimensional scale was used.

Use of complementary/alternative medicine among paediatric patients

DEFF Research Database (Denmark)

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

2003-01-01

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......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...... patients suffering from gastrointestinal diseases or hospitalised for observation. More than 50% of the users experienced positive effects and 6% had side-effects from AM. Of the CAM users, 11% or 2% of the total paediatric population used CAM instead of conventional medicines. CONCLUSION...

[Current situation of the organisation, resources and activity in paediatric cardiology in Spain].

Science.gov (United States)

Sánchez Ferrer, Francisco; Castro García, Francisco José; Pérez-Lescure Picarzo, Javier; Roses Noguer, Ferrán; Centeno Malfaz, Fernándo; Grima Murcia, María Dolores; Brotons, Dimpna Albert

2018-04-26

The results are presented on the «current situation of the organisation, resources and activity in paediatric cardiology in Spain». It was promoted by the Spanish Society of Paediatric Cardiology and Congenital Heart disease. An analysis was carried out on the results obtained from a specifically designed questionnaire, prepared by the Spanish Society of Paediatric Cardiology and Congenital Heart disease, that was sent to all hospitals around the country that offer the speciality of paediatric cardiology. A total of 86 questionnaires were obtained, including 14 hospitals that perform cardiac surgery on children. A total of 190 paediatric cardiology consultants, 40 cardiac surgeons, and 27 middle grade doctors performing their paediatric residency (MIR program) were identified. All hospitals had adequate equipment to perform an optimal initial evaluation of any child with a possible cardiac abnormality, but only tertiary centres could perform complex diagnostic procedures, interventional cardiology, and cardiac surgery. In almost all units around the country, paediatric cardiology consultants were responsible for outpatient clinics and hospital admissions, whereas foetal cardiology units were still mainly managed by obstetricians. The number of diagnostic and therapeutic procedures was similar to those reported in the first survey, except for a slight decrease in the total number of closed cardiac surgery procedures, and a proportional increase in the number of therapeutic catheterisations. Paediatric Cardiology in Spain is performed by paediatric cardiology consultants that were trained initially as general paediatricians, and then completed a paediatric cardiology training period. Almost all units have adequate means for diagnosis and treatment. Efforts should be directed to create a national registry that would not only allow a prospective quantification of diagnostic and therapeutic procedures, but also focus on their clinical outcomes. Copyright © 2018

A practical approach to anaesthesia for paediatric liver transplantation

African Journals Online (AJOL)

A practical approach to anaesthesia for paediatric liver transplantation. Jenny Thomas, M McCulloch, W Spearman, T Butt, A Numanoglu ... In more recent years, the use of reduced size and living related organs has increased the donor pool for infants and children. Paediatric liver transplantation in South Africa, up until the ...

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

OpenAIRE

L?pez-Herce, Jes?s; Matamoros, Martha M.; Moya, Luis; Almonte, Enma; Coronel, Diana; Urbano, Javier; Carrillo, ?ngel; del Castillo, Jimena; Menc?a, Santiago; Moral, Ram?n; Ordo?ez, Flora; S?nchez, Carlos; Lagos, Lina; Johnson, Mar?a; Mendoza, Ovidio

2017-01-01

Background To describe the design and to present the results of a paediatric and neonatal cardiopulmonary resuscitation (CPR) training program adapted to Latin-America. Methods 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 tea...

Parental experiences with a paediatric palliative care team: A qualitative study.

Science.gov (United States)

Verberne, Lisa M; Schouten-van Meeteren, Antoinette Yn; Bosman, Diederik K; Colenbrander, Derk A; Jagt, Charissa T; Grootenhuis, Martha A; van Delden, Johannes Jm; Kars, Marijke C

2017-12-01

Parents of children with a life-limiting disease have to rely on themselves at home while adequate paediatric palliative care is lacking. In several countries, paediatric palliative care teams are introduced to ensure continuity and quality of care and to support the child and the family. Yet, little is known about how parents experience such multidisciplinary teams. To obtain insight into the support provided by a new paediatric palliative care team from the parents' perspective. An interpretative qualitative interview study using thematic analysis was performed. A total of 47 single or repeated interviews were undertaken with 42 parents of 24 children supported by a multidisciplinary paediatric palliative care team located at a university children's hospital. The children suffered from malignant or non-malignant diseases. In advance, parents had limited expectations of the paediatric palliative care team. Some had difficulty accepting the need for palliative care for their child. Once parents experienced what the team achieved for their child and family, they valued the team's involvement. Valuable elements were as follows: (1) process-related aspects such as continuity, coordination of care, and providing one reliable point of contact; (2) practical support; and (3) the team members' sensitive and reliable attitude. As a point of improvement, parents suggested more concrete clarification upfront of the content of the team's support. Parents feel supported by the paediatric palliative care team. The three elements valued by parents probably form the structure that underlies quality of paediatric palliative care. New teams should cover these three valuable elements.

Manifestations of metacognitive activity during the collaborative planning of chemistry practical investigations

Science.gov (United States)

Mathabathe, Kgadi Clarrie; Potgieter, Marietjie

2017-07-01

This paper elaborates a process followed to characterise manifestations of cognitive regulation during the collaborative planning of chemistry practical investigations. Metacognitive activity was defined as the demonstration of planning, monitoring, control and evaluation of cognitive activities by students while carrying out the chemistry task. Inherent in collaborative learning is the social aspect of metacognition, which in this study was evidenced in social cognitive regulation (notably of intra- and interpersonal metacognitive regulations) as groups of students went about planning their practical investigations. Discussions of two of the learning groups (n = 4; n = 3) as they planned the extended practical investigation were recorded, transcribed and analysed for indicators of any inherent metacognitive activity. The process of characterising the manifestations of metacognition resulted in the development of a coding system which specifies not only the regulatory strategies at play but the type of regulation (self or other), the area of regulation (cognition, task performance or behaviour) as well as the depth of regulatory contributions (high or low). The fine-grained coding system allowed for a finer theoretical elucidation of the social nature of metacognition. The implications of this study for metacognition and chemistry education research are highlighted.

Re-envisioning paediatric nurse training in a re-engineered health care system

Directory of Open Access Journals (Sweden)

Minette Coetzee

2014-10-01

Method: In response to the Committee on Morbidity and Mortality in Children recommendation, a colloquium was convened as a national forum for schools of nursing, departments of health, health care facilities, clinicians and regulatory bodies to advance children’s nursing in South Africa. Objectives: The goals of the colloquium were to thoroughly investigate the situation in South Africa’s paediatric nurse training, plot ways to strengthen and expand postgraduate paediatric programmes to meet priority child health needs, and to build relationships between the various schools and stakeholders. Results: Outcomes included the clarification and strengthening of a ‘stakeholder grid’ in nurse training, recognition of the need for more active teaching and learning strategies in curricula linked to national child health priorities, as well as the need to develop and support clinical nursing practice in facilities.

The paediatric surgeon and his working conditions in Francophone ...

African Journals Online (AJOL)

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 1st May to 30th October 2008. The African Society of paediatric ...

Use of Zoledronic Acid in Paediatric Craniofacial Fibrous Dysplasia

Directory of Open Access Journals (Sweden)

Chiara Di Pede

2016-01-01

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.

Identifying paediatric nursing-sensitive outcomes in linked administrative health data

Directory of Open Access Journals (Sweden)

Wilson Sally

2012-07-01

Full Text Available Abstract Background There is increasing interest in the contribution of the quality of nursing care to patient outcomes. Due to different casemix and risk profiles, algorithms for administrative health data that identify nursing-sensitive outcomes in adult hospitalised patients may not be applicable to paediatric patients. The study purpose was to test adult algorithms in a paediatric hospital population and make amendments to increase the accuracy of identification of hospital acquired events. The study also aimed to determine whether the use of linked hospital records improved the likelihood of correctly identifying patient outcomes as nursing sensitive rather than being related to their pre-morbid conditions. Methods Using algorithms developed by Needleman et al. (2001, proportions and rates of records that identified nursing-sensitive outcomes for pressure ulcers, pneumonia and surgical wound infections were determined from administrative hospitalisation data for all paediatric patients discharged from a tertiary paediatric hospital in Western Australia between July 1999 and June 2009. The effects of changes to inclusion and exclusion criteria for each algorithm on the calculated proportion or rate in the paediatric population were explored. Linked records were used to identify comorbid conditions that increased nursing-sensitive outcome risk. Rates were calculated using algorithms revised for paediatric patients. Results Linked records of 129,719 hospital separations for 79,016 children were analysed. Identification of comorbid conditions was enhanced through access to prior and/or subsequent hospitalisation records (43% of children with pressure ulcers had a form of paralysis recorded only on a previous admission. Readmissions with a surgical wound infection were identified for 103 (4.8/1,000 surgical separations using linked data. After amendment of each algorithm for paediatric patients, rates of pressure ulcers and pneumonia reduced by

Identifying paediatric nursing-sensitive outcomes in linked administrative health data.

Science.gov (United States)

Wilson, Sally; Bremner, Alexandra P; Hauck, Yvonne; Finn, Judith

2012-07-20

There is increasing interest in the contribution of the quality of nursing care to patient outcomes. Due to different casemix and risk profiles, algorithms for administrative health data that identify nursing-sensitive outcomes in adult hospitalised patients may not be applicable to paediatric patients. The study purpose was to test adult algorithms in a paediatric hospital population and make amendments to increase the accuracy of identification of hospital acquired events. The study also aimed to determine whether the use of linked hospital records improved the likelihood of correctly identifying patient outcomes as nursing sensitive rather than being related to their pre-morbid conditions. Using algorithms developed by Needleman et al. (2001), proportions and rates of records that identified nursing-sensitive outcomes for pressure ulcers, pneumonia and surgical wound infections were determined from administrative hospitalisation data for all paediatric patients discharged from a tertiary paediatric hospital in Western Australia between July 1999 and June 2009. The effects of changes to inclusion and exclusion criteria for each algorithm on the calculated proportion or rate in the paediatric population were explored. Linked records were used to identify comorbid conditions that increased nursing-sensitive outcome risk. Rates were calculated using algorithms revised for paediatric patients. Linked records of 129,719 hospital separations for 79,016 children were analysed. Identification of comorbid conditions was enhanced through access to prior and/or subsequent hospitalisation records (43% of children with pressure ulcers had a form of paralysis recorded only on a previous admission). Readmissions with a surgical wound infection were identified for 103 (4.8/1,000) surgical separations using linked data. After amendment of each algorithm for paediatric patients, rates of pressure ulcers and pneumonia reduced by 53% and 15% (from 1.3 to 0.6 and from 9.1 to 7.7 per

Developing family-friendly signage in a South African paediatric healthcare setting

Directory of Open Access Journals (Sweden)

Angela L. Leonard

2014-11-01

Full Text Available Background: Multiple renovations and changing flow in a tertiary children’s hospital in Cape Town resulted in numerous signs being posted in the corridors and units, making wayfinding extremely complex. A request from nursing management prompted the formation of a learning collaborative of nurses from all departments to improve wayfinding signage. Objectives: The project aimed to contribute to a family-friendly environment by reviewing the current situation and developing signage to improve wayfinding and convey essential information to parents, caregivers and patients. Methods: A participative action research method followed a four-stage process to facilitate the development of family-friendly signage. Nurse participants reviewed existing signage and collaboratively developed new signage templates and posted signs. The signage was then evaluated using a rapid appraisal questionnaire involving 50 parents and nurse respondents. At each stage of data collection, the matic content analysis was used to analyse data gathered in process meetings and the reflections of participating nurses. Results: A design template and then 44 new signs were developed and used to replace old signage. Respondents reported that the new signs were noticeable, looked attractive and were easily understandable. Conclusion: Intentional and active participation of nurses in clinical paediatric settings ensured collaborative data gathering and analysis. An inclusive research design allowed for insights into the words and tone of posted signs that nurse participants had not noticed previously. The participative redesign of signage resulted in a sense of ownership of the signs.The support and involvement of hospital management throughout ensured that the resulting signage received wide acceptance.

Developing family-friendly signage in a South African paediatric healthcare setting.

Science.gov (United States)

Leonard, Angela L; Verster, Anchen; Coetzee, Minette

2014-11-28

Multiple renovations and changing flow in a tertiary children's hospital in Cape Town resulted in numerous signs being posted in the corridors and units, making wayfinding extremely complex. A request from nursing management prompted the formation of a learning collaborative of nurses from all departments to improve wayfinding signage. The project aimed to contribute to a family-friendly environment by reviewing the current situation and developing signage to improve wayfinding and convey essential information to parents, caregivers and patients. A participative action research method followed a four-stage process to facilitate the development of family-friendly signage. Nurse participants reviewed existing signage and collaboratively developed new signage templates and posted signs. The signage was then evaluated using a rapid appraisal questionnaire involving 50 parents and nurse respondents. At each stage of data collection, thematic content analysis was used to analyse data gathered in process meetings and the reflections of participating nurses. A design template and then 44 new signs were developed and used to replace old signage. Respondents reported that the new signs were noticeable, looked attractive and were easily understandable. Intentional and active participation of nurses in clinical paediatric settings ensured collaborative data gathering and analysis. An inclusive research design allowed for insights into the words and tone of posted signs that nurse participants had not noticed previously. The participative redesign of signage resulted in a sense of ownership of the signs.The support and involvement of hospital management throughout ensured that the resulting signage received wide acceptance.

Paediatric treadmill friction injuries.

Science.gov (United States)

Jeremijenko, Luke; Mott, Jonathan; Wallis, Belinda; Kimble, Roy

2009-05-01

The aim of this study was to report on the severity and incidence of children injured by treadmills and to promote the implementation of safety standards. This retrospective review of children with treadmill friction injuries was conducted in a single tertiary-level burns centre in Australia between January 1997 and June 2007. The study revealed 37 children who sustained paediatric treadmill friction injuries. This was a presentation of 1% of all burns. Thirty-three (90%) of the injuries occurred in the last 3.5 years (January 2004 to June 2007). The modal age was 3.2 years. Thirty-three (90%) injuries were either full thickness or deep partial friction burns. Eleven (30%) required split thickness skin grafts. Of those who became entrapped, 100% required skin grafting. This study found that paediatric treadmill friction injuries are severe and increasing in incidence. Australian standards should be developed, implemented and mandated to reduce this preventable and severe injury.

Dosimetry in Diagnostic Radiology for Paediatric Patients

International Nuclear Information System (INIS)

2013-01-01

Concern about the radiation dose to children from diagnostic radiology examinations has recently been popularly expressed, particularly as related to computed tomography (CT) procedures. This involves the observation that children can receive doses far in excess of those delivered to adults, in part due to the digital nature of the image receptors that may give no warning to the operator of the dose to the patient. Concern for CT examinations should be extended to the broad range of paediatric diagnostic radiological procedures responsible for radiation doses in children, especially as factors, such as increased radiosensitivity and the longer life expectancy of children, increase the associated radiation risk. In all cases, owing to the added paediatric radiological examination factor of patient size and its associated impact on equipment selection, clinical examination protocol and dosimetric audit, the determination of paediatric dose requires a distinct approach from adult dosimetry associated with diagnostic radiological examinations. In response to this, there is a need to inform health professionals about standardized methodologies used to determine paediatric dose for all major modalities such as general radiography, fluoroscopy and CT. Methodologies for standardizing the conduct of dose audits and their use for the derivation and application of diagnostic reference levels for patient populations, that vary in size, are also required. In addition, a review is needed of the current knowledge on risks specific to non-adults from radiation, and also an analysis of the management of factors contributing to dose from paediatric radiological examinations. In 2007, the IAEA published a code of practice, Dosimetry in Diagnostic Radiology: An International Code of Practice, as Technical Reports Series No. 457 (TRS 457). TRS 457 recommends procedures for dosimetric measurement and calibration for the attainment of standardized dosimetry, and addresses requirements

Paediatric Crohn's disease: a radiological review

International Nuclear Information System (INIS)

Ali, S.I.; Carty, H.M.L.

2000-01-01

Paediatric Crohn's disease can be a serious and complex condition which is not always easy to diagnose if it presents in an atypical manner. Although the pathological processes are the same in adults and children, the clinical presentation and disease distribution can be different in children. The impact of the disease can also be much more significant in a growing and developing child than in an adult. Numerous investigations are available to establish the diagnosis, define the complications and to demonstrate the extra-intestinal manifestations. Close co-operation is required between the clinician and radiologist when investigating a child suspected of having Crohn's disease or its symptoms to minimise the radiation dose and the psychological and physical trauma. We review the clinical and radiological aspects of Crohn's disease and discuss the imaging modalities available in diagnosing Crohn's disease and its complications and suggest an investigation pathway as used in our institution. (orig.)

Accuracy of radiographer reporting of paediatric brain CT

International Nuclear Information System (INIS)

Brandt, Andrew; Louw, Brand; Dekker, Gerrit; Andronikou, Savvas; Wieselthaler, Nicki; Kilborn, Tracy; Bertelsman, Jessica; Dreyer, Catherine

2007-01-01

Radiographer reporting has been studied for plain films and for ultrasonography, but not in paediatric brain CT in the emergency setting. To study the accuracy of radiographer reporting in paediatric brain CT. We prospectively collected 100 paediatric brain CT examinations. Films were read from hard copies using a prescribed tick sheet. Radiographers with 12 years' and 3 years' experience, respectively, were blinded to the history and were not trained in diagnostic film interpretation. The radiographers' results were compared with those of a consultant radiologist. Three categories were defined: abnormal scans, significant abnormalities and insignificant abnormalities. Both radiographers had an accuracy of 89.5% in reading a scan correctly as abnormal, and radiographer 1 had a sensitivity of 87.8% and radiographer 2 a sensitivity of 96%. Radiographer 1 had an accuracy in detecting a significant abnormality of 75% and radiographer 2 an accuracy of 48.6%, and the sensitivities for this category were 61.6% and 52.9%, respectively. Results for detecting the insignificant abnormalities were poorer. Selected radiographers could play an effective screening role, but lacking the sensitivity required for detecting significant abnormality, they could not be the final diagnostician. We recommend that the study be repeated after both radiographers have received formal training in interpretation of paediatric brain CT. (orig.)

Participation in paediatric perioperative care: 'what it means for parents'.

Science.gov (United States)

Sjöberg, Carina; Svedberg, Petra; Nygren, Jens M; Carlsson, Ing-Marie

2017-12-01

To explore what it means for parents to participate in their children's paediatric perioperative care. Allowing parents to participate in paediatric perioperative care can make a major difference for children in terms of their well-being, a decreased need for painkillers, fewer sleeping disorders and a more positive experience for both parties. The nurse anaesthetist should have a holistic view and develop a shared vision for the child, the parents and for themselves to perform successful paediatric perioperative care. Descriptive qualitative study. The study was conducted in 2014. Data were collected in 20 narrative interviews with 15 mothers and five fathers who had experience of participating in their child's paediatric perioperative day surgery. The analysis was carried out with qualitative content analysis to describe the variations, differences and similarities in the experiences. The analysis revealed a main category that describes that parental participation in the context of paediatric perioperative care in day surgery meant 'having strength to participate despite an increased vulnerability'. Three generic categories with additional subcategories explained what was essential for the parents to be able to preserve this strength and participate in their child's care despite their increased vulnerability. The generic categories were named, 'gaining information about what will happen', 'being seen as a resource' and 'gaining access to the environment'. Efforts should be made to improve parents' roles and opportunities to participate in paediatric perioperative care. Nurse anaesthetists have a crucial role in enabling parents' participation and need knowledge to develop strategies and nursing interventions that meet parents' needs. © 2017 John Wiley & Sons Ltd.

A day in the life of a paediatric surgeon: a PAPSA research study ...

African Journals Online (AJOL)

Objectives This study aimed to create a snapshot picture of the global workload of paediatric surgeons and identify differences between countries. Methods Surgeons from 13 paediatric surgical units in different countries across the world were asked to record the number and type of admissions to the paediatric surgery ...

What's new in paediatric dentistry?

Science.gov (United States)

Vitale, M. C.

2016-03-01

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.

Exciting times: Towards a totally minimally invasive paediatric urology service

OpenAIRE

Lazarus, John

2011-01-01

Following on from the first paediatric laparoscopic nephrectomy in 1992, the growth of minimally invasive ablative and reconstructive procedures in paediatric urology has been dramatic. This article reviews the literature related to laparoscopic dismembered pyeloplasty, optimising posterior urethral valve ablation and intravesical laparoscopic ureteric reimplantation.

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

NARCIS (Netherlands)

Zwaanswijk, M.; Tates, K.; Dulmen, S. van; Hoogerbrugge, M.; Kamps, W.A.; Bensing, J.M.

2007-01-01

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

Radiological protection of paediatric patients: An overview

International Nuclear Information System (INIS)

Ringertz, H.G.; Bremmer, S.

2001-01-01

Paediatric patients require special attention with respect to radiation protection, for various reasons. The difference between a 1 kg premature baby and a 100 kg teenager puts special demands on the radiographic techniques used, and the increased radiosensitivity of growing tissue and the patients' longer life expectancy put greater demands on the justification of the procedures to be carried out. The optimization procedure involves practical aspects such as immobilization, body build specific exposure parameters and body build specific anatomical knowledge. These and other aspects of paediatric radiological protection are discussed in this overview. (author)

Investigating the experiences in a school-based occupational therapy program to inform community-based paediatric occupational therapy practice.

Science.gov (United States)

Rens, Lezahn; Joosten, Annette

2014-06-01

A collaborative approach with teachers is required when providing community-based occupational therapy to educationally at risk children. Collaborators share common goals and interact and support each other but challenges arise in providing collaborative occupational therapy in settings outside the school environment. The aim of this study was to capture experiences of teachers and occupational therapists working within a school-based occupational therapy program to determine if their experiences could inform collaborative practice. In this pilot study, participant responses to questionnaires (n = 32) about their experiences formed the basis for focus groups and individual interviews. Two focus group were conducted, one with teachers (n = 11) and one with occupational therapy participants (n = 6). Individual interviews were conducted with the supervising occupational therapist, school principal and two leading teachers. Descriptive statistics were used to analyse the data from closed questions, and thematic analysis using a constant comparison approach was used to analyse open ended questions, focus groups and interviews. Three main themes emerged: (i) the need for occupational therapists to spend time in the school, to explain their role, build relationships, understand classroom routines and the teacher role; (ii) occupational therapists need to not see themselves as the expert but develop equal partnerships to set collaborative goals and (iii) occupational therapists advocating for all parties to be informed throughout the occupational therapy process. The pilot study findings identified teacher and therapist experiences within the school setting that could inform improved collaborative practice with teachers and community-based occupational therapists and these findings warrant further investigation. © 2013 Occupational Therapy Australia.

Peer mentoring: evaluation of a novel programme in paediatrics.

Science.gov (United States)

Eisen, Sarah; Sukhani, Seema; Brightwell, Alex; Stoneham, Sara; Long, Andrew

2014-02-01

Mentoring is important for personal and professional development of doctors. Peer mentoring is a core skill in the UK paediatric postgraduate curriculum. However, there is a paucity of peer mentoring programmes aimed at postgraduate doctors in training (postgraduate trainees), and there are no such schemes within paediatrics described in the literature. We developed a regional peer mentoring programme for postgraduate trainees in paediatrics to assess demand and need for peer mentoring and to explore the benefits for both peer mentees and mentors. Junior postgraduate trainees, randomly selected from volunteers, received peer mentoring from more senior trainees for 1 year. Peer mentors were selected by competitive application and undertook tailored training followed by an experiential learning programme. The programme was evaluated using structured questionnaires. 90% (76/84) of first-year postgraduate trainees in paediatrics applied to participate, demonstrating high demand. 18 peer mentor-mentee pairs were matched. Peer mentors and mentees reported high satisfaction rates, acquisition of new and transferable skills and changed behaviours. All peer mentors intended to use the skills in their workplace and, later, as an educational supervisor. Our programme represents a novel approach to meeting the demonstrated demand and the curriculum requirement for peer mentoring, and enabled peer mentors and mentees to develop a valuable and versatile skill set. To our knowledge, it is the first such programme in paediatrics and provides a feasibility model that may be adapted locally to allow education providers to offer this important experience to postgraduate trainees.

Complementary and alternative medicine use among paediatric emergency department patients.

Science.gov (United States)

Taylor, David McDonald; Dhir, Reetika; Craig, Simon S; Lammers, Thalia; Gardiner, Kaya; Hunter, Kirrily; Joffe, Paul; Krieser, David; Babl, Franz E

2015-09-01

To determine the period prevalence and nature of complementary and alternative medicine (CAM) use among paediatric emergency department (ED) patients and the perceptions of CAM among the CAM administrators. A survey was undertaken in four Victorian EDs (January to September 2013). A convenience sample of parents/carers accompanying paediatric patients completed a self-administered questionnaire. The main outcome measures were CAM use and perceptions of CAM. The parents/carers of 883 patients participated. Three hundred eighty-eight (43.9%, 95% confidence interval (CI) 40.6-47.3) and 53 (6.0%, 95% CI 4.6-7.8) patients had taken a CAM within the previous 12 months and on the day of presentation, respectively. There were no gender differences between CAM users and non-users (P = 0.83). The use of CAM was significantly more common among older patients (P effective than prescription medicines and safe when taken with prescription medicines. CAM use is common among paediatric ED patients although rarely reported to the ED doctor. Parents/carers who administer CAM have differing perceptions of CAM safety from those who do not. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Tape measure to aid prescription in paediatric resuscitation.

OpenAIRE

Hughes, G; Spoudeas, H; Kovar, I Z; Millington, H T

1990-01-01

A tape measure, based on 50th centile weight for height and designed to permit easy drug dosage calculation, endotracheal tube size and DC cardioversion current dosages in childrens' emergencies, was tested for reliability by medical and nursing staff with varying paediatric experience. We found that the tape measure gave a reproducible estimate of weight and suggest that its use would facilitate decision making by inexperienced medical and nursing staff in paediatric resuscitation when there...

Paediatric Pain Management: Using Complementary and Alternative Medicine

OpenAIRE

Evans, Subhadra; Tsao, Jennie C.I; Zeltzer, Lonnie K.

2008-01-01

Children undergo acute painful procedures and many also experience chronic pain.Due to their developing systems, infants and children may be at greater risk than adults for protracted pain sensitivity.There is a need to manage acute and chronic paediatric pain to reduce children's suffering and to prevent future pain problems.Consistent with a biopsychosocial perspective, complementary and alternative medicine (CAM) should be considered in management of acute and chronic paediatric pain.Altho...

Heterogeneity in cervical spine assessment in paediatric trauma: A survey of physicians' knowledge and application at a paediatric major trauma centre.

Science.gov (United States)

Buckland, Aaron J; Bressan, Silvia; Jowett, Helen; Johnson, Michael B; Teague, Warwick J

2016-10-01

Evidence-based decision-making tools are widely used to guide cervical spine assessment in adult trauma patients. Similar tools validated for use in injured children are lacking. A paediatric-specific approach is appropriate given important differences in cervical spine anatomy, mechanism of spinal injury and concerns over ionising radiation in children. The present study aims to survey physicians' knowledge and application of cervical spine assessment in injured children. A cross-sectional survey of physicians actively engaged in trauma care within a paediatric trauma centre was undertaken. Participation was voluntary and responses de-idenitified. The survey comprised 20 questions regarding initial assessment, imaging, immobilisation and perioperative management. Physicians' responses were compared with available current evidence. Sixty-seven physicians (28% registrars, 17% fellows and 55.2% consultants) participated. Physicians rated altered mental state, intoxication and distracting injury as the most important contraindications to cervical spine clearance in children. Fifty-four per cent considered adequate plain imaging to be 3-view cervical spine radiographs (anterior-posterior, lateral and odontoid), whereas 30% considered CT the most sensitive modality for detecting unstable cervical spine injuries. Physicians' responses reflected marked heterogeneity regarding semi-rigid cervical collars and what constitutes cervical spine 'clearance'. Greater consensus existed for perioperative precautions in this setting. Physicians actively engaged in paediatric trauma care demonstrate marked heterogeneity in their knowledge and application of cervical spine assessment. This is compounded by a lack of paediatric-specific evidence and definitions, involvement of multiple specialties and staff turnover within busy departments. A validated decision-making tool for cervical spine assessment will represent an important advance in paediatric trauma. © 2016 Australasian

The effect of increased body mass index on patient dose in paediatric radiography

Energy Technology Data Exchange (ETDEWEB)

Ladia, Arsenoi P., E-mail: arsenoh@gmail.com; Skiadopoulos, Spyros G., E-mail: skiado@upatras.gr; Karahaliou, Anna N., E-mail: akarahaliou@upatras.gr; Messaris, Gerasimos A.T., E-mail: messaris@upatras.gr; Delis, Harry B., E-mail: hdelis@gmail.com; Panayiotakis, George S., E-mail: panayiot@upatras.gr

2016-10-15

Radiation protection is of particular importance in paediatric radiology. In this study, the influence of increased body mass index (BMI) in radiation dose and associated risk was investigated for paediatric patients aged 5–6.5 years, undergoing chest (64 patients) or abdomen (64 patients) radiography. Patients were categorized into normal and overweight, according to the BMI classification scheme. Entrance surface dose (ESD), organ dose, effective dose (ED) and risk of exposure induced cancer death (REID) were calculated using the Monte Carlo based code PCXMC 2.0. Statistically significant increase in patient radiation dose and REID was obtained for overweight patients as compared to normal ones, in both chest and abdomen examinations (Wilcoxon singed-rank test for paired data, p < 0.001). The percentage increase in overweight as compared to normal patients of ESD, organ dose (maximum value), ED and REID was 13.6%, 24.4%, 18.9% and 20.6%, respectively, in case of chest radiographs. Corresponding values in case of abdomen radiographs were 15.0%, 24.7%, 21.8% and 19.8%, respectively. An increased BMI results in increased patient radiation dose in chest and abdomen paediatric radiography.

Ophthalmological screening of a paediatric cochlear implant population: a retrospective analysis and 12-year follow-up.

LENUS (Irish Health Repository)

Falzon, K

2010-06-01

To determine the nature and prevalence of ophthalmological findings for a cohort of children in a paediatric cochlear implant program and to assist the clinician in devising an investigative plan for this population.

Cuffed endotracheal tubes in paediatrics

African Journals Online (AJOL)

cuffed endotracheal tubes (CETTs) in children who are younger than eight years old. Most paediatric ... the smallest functional part of the infant airway, because the ... During the 2003 severe acute respiratory syndrome (SARS) outbreak in ...

The practice of paediatric cardiology in Nigeria: A Review | Chinawa ...

African Journals Online (AJOL)

Background: The practice of Paediatric cardiology in Nigeria is at its early phase and it is being choked in an environment overwhelmed with economic, ethnic and political issues. Paediatric cardiology covers a broad area of medicine. This includes diagnosis, medical treatment, interventional cardiology, prenatal diagnosis ...

Impact of the learning environment on career intentions of paediatric ...

African Journals Online (AJOL)

training on career intentions, specifically in terms of paediatrics, in a ... SA paediatric interns work in an environment with a high ... already challenging learning environment (LE) for interns. ... doctors during internship may influence career trajectories in a direction that is discordant with .... Cronbach's alpha for the teaching,.

Efficacy of paediatric anaesthetic trolleys: A call for a basic standard and layout.

Science.gov (United States)

Griffiths, Sian E; Boleat, Elizabeth; Goodwin, Alison; Sheikh, Asme; Goonasekera, Chulananda

2015-01-01

Providing safe anaesthesia to children especially in emergency situations goes hand in hand with instant availability of appropriately sized equipment and monitoring. This is best achieved using a designated paediatric anaesthetic trolley containing essential equipment. Guidance for the contents of such trolleys is neither explicit nor standard. We used a survey and a qualitative enquiry to develop a checklist suitable for standardisation of contents and layout of paediatric anaesthetic trolleys. We conducted an observational study of our current practice and paediatric anaesthetic trolleys in a tertiary care hospital. We also performed a qualitative enquiry from experienced paediatric anaesthetists and operating department practitioners.We developed an empirical checklist to ensure the minimum 'essential' equipment is available on these trolleys and implemented a standard layout to facilitate its use. We identified 11 areas in our hospital where anaesthesia is provided to children, each with a designated paediatric anaesthetic trolley. There were considerable deficiencies of items in all areas with no standard pattern or layout. Different types of trolleys contributed to the confusion. In addition, overstocking of inappropriate items hindered its efficient use. Standardising the contents and layout of the paediatric anaesthetic trolley is an essential pre-requisite for safer paediatric anaesthetic practice.

Tertiary paediatric emergency department use in children and young people with cerebral palsy.

Science.gov (United States)

Meehan, Elaine; Reid, Susan M; Williams, Katrina; Freed, Gary L; Babl, Franz E; Sewell, Jillian R; Rawicki, Barry; Reddihough, Dinah S

2015-10-01

The aim of this study was to describe the pattern of tertiary paediatric emergency department (ED) use in children and young people with cerebral palsy (CP). A retrospective analysis of ED data routinely collected at the two tertiary paediatric hospitals in Victoria, Australia, cross-matched with the Victorian Cerebral Palsy Register. Data pertaining to the ED presentations of 2183 registered individuals born 1993-2008 were obtained. Between 2008 and 2012, 37% (n = 814) of the CP cohort had 3631 tertiary paediatric ED presentations. Overall, 40% (n = 332) of presenters were residing in inner metropolitan Melbourne; 44% (n = 356) in outer Melbourne; and 13% (n = 108) in regional Victoria. Presenters were more likely than non-presenters to be younger, non-ambulant and have epilepsy. In total, 71% of presentations were triaged as Australasian Triage Scale 1-3 (urgent), and 44% resulted in a hospital admission. Disorders of the respiratory, neurological and gastrointestinal systems, and medical device problems were responsible for 72% of presentations. Many of the tertiary paediatric ED presentations in this group were appropriate based on the high admission rate and the large proportion triaged as urgent. However, there is evidence that some families are bypassing local services and travelling long distances to attend the tertiary paediatric ED, even for less urgent complaints that do not require hospital admission. Alternative pathways of care delivery, and strategies to promote the management of common problems experienced by children and young people with CP in non-paediatric EDs or primary care settings, may go some way towards reducing unnecessary tertiary paediatric ED use in this group. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Report of the Paediatric Nurse Education Review Group

OpenAIRE

Department of Health (Ireland)

2000-01-01

10.12.2000 The Department of Health and Children is implementing the recommendations of the Commission on Nursing (1998). It agreed with the Nursing Alliance in early 2000 to set up working groups to inform the implementation of specific recommendations in relation to nurse education. One of these working groups was to address paediatric nurse education. In March 2000, a Steering Group to oversee a review of paediatric nurse education was convened and the following terms of reference agre...

The pattern of paediatric blast injury in Afghanistan.

Science.gov (United States)

Thompson, Daniel C; Crooks, R J; Clasper, J C; Lupu, A; Stapley, S A; Cloke, D J

2017-10-21

Between 2009 and 2015, 3746 children died, and 7904 were injured as a result of armed conflict within Afghanistan. Improvised explosive devices (IEDs) and explosive remnants of war accounted for 29% of child casualties in 2015. The aim of this study was to review the burden of paediatric blast injuries admitted to Camp Bastion, Afghanistan, and to investigate the hypothesis that children suffer proportionally more head injuries than adults. A retrospective analysis was undertaken of prospectively collected data derived from the UK Joint Theatre Trauma Registry of ambulant paediatric (aged 2-15 years) admissions with blast injuries at the Role 3 Field Hospital, Camp Bastion from June 2006 to March 2013. The data set included demographic information, injury profile and severity (New Injury Severity Score) and operative findings. The pattern of injuries were investigated by looking at trends in the number and severity of injuries sustained by each body region. During this period, 295 admissions were identified, 76% of whom were male, with an overall mortality rate of 18.5%. The most common blast mechanism was an IED (68%) causing 80% of fatalities. The lower extremities were the most commonly injured body region, accounting for 31% of total injuries and occurring in 62% of cases. 24.3% of children between 2 and 7 years suffered severe head or neck injuries compared with 19.8% of children aged between 8 and 15 years. 34% of head injuries were rated unsurvivable and accounted for 88% of fatalities. 77% of cases required an operation with a mean operating time of 125 min. The most common first operations were debridement of soft tissues (50%), laparotomy (16%) and lower limb amputation (11%). Although paediatric blast casualties represented a small percentage of the overall workload at Camp Bastion Role 3 Medical Facility, the pattern of injuries seen suggests that children are more likely to sustain severe head, face and neck injuries than adults. © Article author

Paediatric traumatic cardiac arrest: a Delphi study to establish consensus on definition and management.

Science.gov (United States)

Rickard, Annette C; Vassallo, James; Nutbeam, Tim; Lyttle, Mark D; Maconochie, Ian K; Enki, Doyo G; Smith, Jason E

2018-04-28

Paediatric traumatic cardiac arrest (TCA) is associated with low survival and poor outcomes. The mechanisms that underlie TCA are different from medical cardiac arrest; the approach to treatment of TCA may therefore also need to differ to optimise outcomes. The aim of this study was to explore the opinion of subject matter experts regarding the diagnosis and treatment of paediatric TCA, and to reach consensus on how best to manage this group of patients. An online Delphi study was conducted over three rounds, with the aim of achieving consensus (defined as 70% agreement) on statements related to the diagnosis and management of paediatric TCA. Participants were invited from paediatric and adult emergency medicine, paediatric anaesthetics, paediatric ICU and paediatric surgery, as well as Paediatric Major Trauma Centre leads and representatives from the Resuscitation Council UK. Statements were informed by literature reviews and were based on elements of APLS resuscitation algorithms as well as some concepts used in the management of adult TCA; they ranged from confirmation of cardiac arrest to the indications for thoracotomy. 73 experts completed all three rounds between June and November 2016. Consensus was reached on 14 statements regarding the diagnosis and management of paediatric TCA; oxygenation and ventilatory support, along with rapid volume replacement with warmed blood, improve survival. The duration of cardiac arrest and the lack of a response to intervention, along with cardiac standstill on ultrasound, help to guide the decision to terminate resuscitation. This study has given a consensus-based framework to guide protocol development in the management of paediatric TCA, though further work is required in other key areas including its acceptability to clinicians. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Care dependency of hospitalized children: testing the Care Dependency Scale for Paediatrics in a cross-cultural comparison.

Science.gov (United States)

Tork, Hanan; Dassen, Theo; Lohrmann, Christa

2009-02-01

This paper is a report of a study to examine the psychometric properties of the Care Dependency Scale for Paediatrics in Germany and Egypt and to compare the care dependency of school-age children in both countries. Cross-cultural differences in care dependency of older adults have been documented in the literature, but little is known about the differences and similarities with regard to children's care dependency in different cultures. A convenience sample of 258 school-aged children from Germany and Egypt participated in the study in 2005. The reliability of the Care Dependency Scale for Paediatrics was assessed in terms of internal consistency and interrater reliability. Factor analysis (principal component analysis) was employed to verify the construct validity. A Visual Analogue Scale was used to investigate the criterion-related validity. Good internal consistency was detected both for the Arabic and German versions. Factor analysis revealed one factor for both versions. A Pearson's correlation between the Care Dependency Scale for Paediatrics and Visual Analogue Scale was statistically significant for both versions indicating criterion-related validity. Statistically significant differences between the participants were detected regarding the mean sum score on the Care Dependency Scale for Paediatrics. The Care Dependency Scale for Paediatrics is a reliable and valid tool for assessing the care dependency of children and is recommended for assessing the care dependency of children from different ethnic origins. Differences in care dependency between German and Egyptian children were detected, which might be due to cultural differences.

A pioneer of Australian paediatrics: Dr Henry Edward Brown (1858-1931).

Science.gov (United States)

Isles, Alan F; Roper, Peter; Pearn, John H

2014-11-13

The emergence of paediatrics as a specialty in Australian medicine dates from the last two decades of the 19th century. Among the pioneers of pre-Federation paediatrics, we include Dr Henry Edward Brown (1858-1931), an Irish-born physician and surgeon who became the first paediatrician to practise in the northern half of the Australian continent. In 1885, he was appointed as the medical superintendent of the Rockhampton Children's Hospital, itself a pioneer institution in the care of sick and injured children. Dr H.E. Brown also served as medical officer of health concurrently in three Queensland shires. He was a leader in the literary and sporting life of the busy port town of Rockhampton and a scholar and significant philanthropist in the domain of French literature. His life was and remains an exemplar of a class of pre-Federation paediatricians who established the ethos of clinical and societal service, which remains as a core feature of the speciality discipline of paediatrics in the 21st century. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

HIV infection, tuberculosis and workload in a general paediatric ward

African Journals Online (AJOL)

South African Journal of Child Health ... To describe the impact of HIV infection and tuberculosis on the workload of a general paediatric ward at Red Cross War Memorial Children's Hospital in 2007. Methods. Prospective descriptive surveillance of the patient composition of a general paediatric ward over a 1-year period.

Caring for paediatric patient as to broaden radiography spectrum

International Nuclear Information System (INIS)

Atiti, J.S.M.

2006-01-01

The paediatric patient is a special group of patients in the hospital set up. thus their special needs contribute to about 75% of quality imaging services offered. Age, Psychological aspects, parents participation, departmental atmosphere and environmental make them special. this presentation aims at installing into Imaging Technologies a sense of Responsibility for purpose of improving the resultant quality of Imaging services offered to paediatrics

Developing a Culture to Facilitate Research Capacity Building for Clinical Nurse Consultants in Generalist Paediatric Practice

Directory of Open Access Journals (Sweden)

Lesley Wilkes

2013-01-01

Full Text Available This paper reports a research capacity building exercise with a group of CNCs practicing in the speciality of paediatrics in New South Wales (NSW, Australia. It explores the first step in building a research culture, through identifying the research priorities of members of the NSW Child Health Networks Paediatric Clinical Nurse Consultant group, and this forms the major focus of this paper. A nominal group technique (NGT was utilised with sixteen members to identify research topics for investigation which were considered a priority for improving children's health care. The group reviewed and prioritised 43 research topics in children's health which were identified in the literature. As a result of conducting this research prioritisation exercise, the group chose two research topics to investigate: reasons for children representing to the Emergency Department and a comparison of the use of high-flow and low-flow nasal prongs in children with bronchiolitis. The research team will continue to mentor the nurses throughout their research projects which resulted from the NGT. One bridge to leadership development in enhancing patient care is translating knowledge to practice and policy development. This study leads the way for a group of CNCs in paediatric nursing to combine their research capacity and influence clinical knowledge.

Evaluation of effectiveness of a paediatric simulation course in procedural skills for paediatric residents - A pilot study.

Science.gov (United States)

AlShammari, Abdullah; Inayah, Aman; Afsar, Nasir Ali; Nurhussen, Akram; Siddiqui, Amna; Anwer, Muhammad Lucman; Obeidat, Sadek; Bakro, Mohammed Khaled; Abu Assale, Tawfik Samer; Almidani, Eyad; Alsonbul, Abdullah; Alhaider, Sami; Hussain, Ibrahim Bin; Khadawardi, Emad; Zafar, Muhammad

2018-02-01

To explore the effects of simulation training on paediatric residents' confidence and skills in managing advanced skills in critical care. The study was conducted at Alfaisal University, Riyadh, Saudi Arabia, from March to June 2016, and comprised junior residents in paediatrics. All paediatric residents (years 1 and 2) were recruited into two workshops, held one week apart. The first workshop covered lumbar puncture/ cerebrospinal fluid interpretation, oral intubation, bone marrow aspiration, and critical airway management. The second workshop covered chest tube insertion, pleural tap, insertion of central line, and arthrocentesis. The participants were surveyed using a 5-point Likert scale survey pre- and post-course, assessing their confidence. Their practical skills were assessed using a pre-objective structured clinical examination on the same day and post-course objective structured clinical examination a week later on selected skills. The outcome measures were: (1) pre-/post-course confidence rating, and (2) pre-/post-course objective structured clinical examination results. Data was analysed using SPSS 20. Of the 16 participants, 8(50%) were boys and 8(50%) girls. Besides, 13(81%) residents were in year-1 and 3(19%) in year-2. Median post-course confidence level ranks for all the skills were higher (pskills and confidence in performing critical tasks.

Paediatric nuclear medicine imaging.

Science.gov (United States)

Biassoni, Lorenzo; Easty, Marina

2017-09-01

Nuclear medicine imaging explores tissue viability and function by using radiotracers that are taken up at cellular level with different mechanism. This imaging technique can also be used to assess blood flow and transit through tubular organs. Nuclear medicine imaging has been used in paediatrics for decades and this field is continuously evolving. The data presented comes from clinical experience and some milestone papers on the subject. Nuclear medicine imaging is well-established in paediatric nephro-urology in the context of urinary tract infection, ante-natally diagnosed hydronephrosis and other congenital renal anomalies. Also, in paediatric oncology, I-123-meta-iodobenzyl-guanidine has a key role in the management of children with neuroblastic tumours. Bone scintigraphy is still highly valuable to localize the source of symptoms in children and adolescents with bone pain when other imaging techniques have failed. Thyroid scintigraphy in neonates with congenital hypothyroidism is the most accurate imaging technique to confirm the presence of ectopic functioning thyroid tissue. Radionuclide transit studies of the gastro-intestinal tract are potentially useful in suspected gastroparesis or small bowel or colonic dysmotility. However, until now a standardized protocol and a validated normal range have not been agreed, and more work is necessary. Research is ongoing on whether magnetic resonance imaging (MRI), with its great advantage of great anatomical detail and no ionizing radiations, can replace nuclear medicine imaging in some clinical context. On the other hand, access to MRI is often difficult in many district general hospitals and general anaesthesia is frequently required, thus adding to the complexity of the examination. Patients with bone pain and no cause for it demonstrated on MRI can benefit from bone scintigraphy with single photon emission tomography and low-dose computed tomography. This technique can identify areas of mechanical stress at

Ethics consultation in paediatric and adult emergency departments: an assessment of clinical, ethical, learning and resource needs.

Science.gov (United States)

Colaco, Keith A; Courtright, Alanna; Andreychuk, Sandra; Frolic, Andrea; Cheng, Ji; Kam, April Jacqueline

2018-01-01

We sought to understand ethics and education needs of emergency nurses and physicians in paediatric and adult emergency departments (EDs) in order to build ethics capacity and provide a foundation for the development of an ethics education programme. This was a prospective cross-sectional survey of all staff nurses and physicians in three tertiary care EDs. The survey tool, called Clinical Ethics Needs Assessment Survey, was pilot tested on a similar target audience for question content and clarity. Of the 123 participants surveyed, 72% and 84% of nurses and physicians fully/somewhat agreed with an overall positive ethical climate, respectively. 69% of participants reported encountering daily or weekly ethical challenges. Participants expressed the greatest need for additional support to address moral distress (16%), conflict management with patients or families (16%) and resource issues (15%). Of the 23 reported occurrences of moral distress, 61% were associated with paediatric mental health cases. When asked how the ethics consultation service could be used in the ED, providing education to teams (42%) was the most desired method. Nurses report a greater need for ethics education and resources compared with their physician colleagues. Ethical challenges in paediatric EDs are more prevalent than adult EDs and nurses voice specific moral distress that are different than adult EDs. These results highlight the need for a suitable educational strategy, which can be developed in collaboration with the leadership of each ED and team of hospital ethicists. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Implementing paediatric early warning scores systems in the Netherlands: future implications.

NARCIS (Netherlands)

Groot, J.F. de; Damen, N.; Loos, E. de; Steeg, L. van de; Rosias, P.; Bruijn, M.; Goorhuis, J.; Wagner, C.

2018-01-01

Background: Paediatric Early Warning Scores (PEWS) are increasingly being used for early identification and management of clinical deterioration in paediatric patients. A PEWS system includes scores, cut-off points and appropriate early intervention. In 2011, The Dutch Ministry of Health advised

SAMJ Monitoring of rotavirus infection in a paediatric hospital by ...

African Journals Online (AJOL)

During the spring of 1987 and the autumn of 1988, stool specimens were collected from infants and young children in the paediatric unit at H. F. Verwoerd Hospital, Pretoria, and examined for the presence of rotaviruses to assess the potential for hospital-acquired infection in the paediatric wards. Stool samples were also ...

Monitoring of rotavirus infection in a paediatric hospital by RNA ...

African Journals Online (AJOL)

During the spring of 1987 and the autumn of 1988, stool specimens were collected from infants and young children in the paediatric unit at H. F. Verwoerd Hospital, Pretoria, and examined for the presence of rotaviruses to assess the potential for hospital-acquired infection in the paediatric wards. Stool samples were also ...

Paediatric case mix in a rural clinical school is relevant to future practice.

Science.gov (United States)

Wright, Helen M; Maley, Moira A L; Playford, Denese E; Nicol, Pam; Evans, Sharon F

2017-11-29

Exposure to a representative case mix is essential for clinical learning, with logbooks established as a way of demonstrating patient contacts. Few studies have reported the paediatric case mix available to geographically distributed students within the same medical school. Given international interest in expanding medical teaching locations to rural contexts, equitable case exposure in rural relative to urban settings is topical. The Rural Clinical School of Western Australia locates students up to 3500 km from the urban university for an academic year. There is particular need to examine paediatric case mix as a study reported Australian graduates felt unprepared for paediatric rotations. We asked: Does a rural clinical school provide a paediatric case mix relevant to future practice? How does the paediatric case mix as logged by rural students compare with that by urban students? The 3745 logs of 76 urban and 76 rural consenting medical students were categorised by presenting symptoms and compared to the Australian Institute of Health and Welfare (AIHW) database Major Diagnostic Categories (MDCs). Rural and urban students logged core paediatric cases, in similar order, despite the striking difference in geographic locations. The pattern of overall presenting problems closely corresponded to Australian paediatric hospital admissions. Rural students logged 91% of cases in secondary healthcare settings; urban students logged 90% of cases in tertiary settings. The top four presenting problems were ENT/respiratory, gastrointestinal/urogenital, neurodevelopmental and musculoskeletal; these made up 60% of all cases. Rural and urban students logged similar proportions of infants, children and adolescents, with a variety of case morbidity. Rural clinical school students logged a mix of core paediatric cases relevant to illnesses of Australian children admitted to public hospitals, with similar order and pattern by age group to urban students, despite major differences

A Clinical Study of Phenomenology and Comorbidity of Paediatric Bipolar Disorder

Science.gov (United States)

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

2012-01-01

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…

Paediatric Blunt Liver Trauma in a Dutch Level 1 Trauma Center

NARCIS (Netherlands)

Nellensteijn, D.; Porte, R. J.; van Zuuren, W.; ten Duis, H. J.; Hulscher, J. B. F.

2009-01-01

Introduction: Paediatric blunt hepatic trauma treatment is changing from operative treatment (OT) to non-operative treatment (NOT). In 2000 the American Pediatric Surgical Association has published guidelines for NOT of these injuries. Little is known about the treatment of paediatric liver trauma

Alternative diagnoses at paediatric appendicitis MRI

International Nuclear Information System (INIS)

Moore, M.M.; Kulaylat, A.N.; Brian, J.M.; Khaku, A.; Hulse, M.A.; Engbrecht, B.W.; Methratta, S.T.; Boal, D.K.B.

2015-01-01

As the utilization of MRI in the assessment for paediatric appendicitis increases in clinical practice, it is important to recognize alternative diagnoses as the cause of abdominal pain. The purpose of this review is to share our institution's experience using MRI in the evaluation of 510 paediatric patients presenting with suspected appendicitis over a 30 month interval (July 2011 to December 2013). An alternative diagnosis was documented in 98/510 (19.2%) patients; adnexal pathology (6.3%, n = 32), enteritis–colitis (6.3%, n = 32), and mesenteric adenitis (2.2%, n = 11) comprised the majority of cases. These common entities and other less frequent illustrative cases obtained during our overall institutional experience with MRI for suspected appendicitis are reviewed

Radiopharmaceutical activities administered for paediatric nuclear medicine procedures in Australia

International Nuclear Information System (INIS)

Towson, J.E.; Smart, R.C.; Rossleigh, M.A.

2001-01-01

A survey of radiopharmaceutical activities used at the eight hospital centres specialising in paediatric nuclear medicine in Australia was conducted in 1999-2000 by the Australian and New Zealand Society of Nuclear Medicine and the Australasian Radiation Protection Society. Data on the maximum and minimum administered activities (A max and A min ) as obtained for 43 paediatric imaging procedures are presented. The results are also available on the ANZSNM and ARPS websites at: http://www.anzsnm.org.au and http://www.arps.org.au. The A max values were significantly less than the corresponding Reference Activities for adults determined in a previous study. Activities for individual patients are calculated using surface area scaling at five centres and body weight scaling at three centres. The median values of A max and A min are recommended as Paediatric Reference Activities. The effective dose to patients of various sizes for the Paediatric Reference Activities and both methods of scaling was calculated for each procedure. Copyright (2000) The Australian and New Zealand Society of Nuclear Medicine Inc

Paediatric diarrhoea rehydration therapy revisited

African Journals Online (AJOL)

Alive. 1539. 2035. Patients and methods. At the end of 1985, one of four paediatric inpatient wards ... handbooks, but thereafter a protocol was evolved in which emphasis was ... In the absence of an adequate short-stay facility, this ward had to ...

European evidence-based recommendations for diagnosis and treatment of paediatric antiphospholipid syndrome: the SHARE initiative.

Science.gov (United States)

Groot, Noortje; de Graeff, Nienke; Avcin, Tadej; Bader-Meunier, Brigitte; Dolezalova, Pavla; Feldman, Brian; Kenet, Gili; Koné-Paut, Isabelle; Lahdenne, Pekka; Marks, Stephen D; McCann, Liza; Pilkington, Clarissa A; Ravelli, Angelo; van Royen-Kerkhof, Annet; Uziel, Yosef; Vastert, Sebastiaan J; Wulffraat, Nico M; Ozen, Seza; Brogan, Paul; Kamphuis, Sylvia; Beresford, Michael W

2017-10-01

Antiphospholipid syndrome (APS) is rare in children, and evidence-based guidelines are sparse. Consequently, management is mostly based on observational studies and physician's experience, and treatment regimens differ widely. The Single Hub and Access point for paediatric Rheumatology in Europe (SHARE) initiative was launched to develop diagnostic and management regimens for children and young adults with rheumatic diseases. Here, we developed evidence-based recommendations for diagnosis and treatment of paediatric APS. Evidence-based recommendations were developed using the European League Against Rheumatism standard operating procedure. Following a detailed systematic review of the literature, a committee of paediatric rheumatologists and representation of paediatric haematology with expertise in paediatric APS developed recommendations. The literature review yielded 1473 articles, of which 15 were valid and relevant. In total, four recommendations for diagnosis and eight for treatment of paediatric APS (including paediatric Catastrophic Antiphospholipid Syndrome) were accepted. Additionally, two recommendations for children born to mothers with APS were accepted. It was agreed that new classification criteria for paediatric APS are necessary, and APS in association with childhood-onset systemic lupus erythematosus should be identified by performing antiphospholipid antibody screening. Treatment recommendations included prevention of thrombotic events, and treatment recommendations for venous and/or arterial thrombotic events. Notably, due to the paucity of studies on paediatric APS, level of evidence and strength of the recommendations is relatively low. The SHARE initiative provides international, evidence-based recommendations for diagnosis and treatment for paediatric APS, facilitating improvement and uniformity of care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use

Retrospective evaluation of paediatric oral biopsies over a 10-year period in Western India.

Science.gov (United States)

Patil, S S; Kontham, U R; Kontham, R K; Chowdhery, A

2017-06-01

This retrospective study reviewed the paediatric oral biopsies received over 10 years at a teaching hospital and dental college in India. It is important that paediatric dentists know the diagnostic tendencies of oral pathological conditions in children, and possess updated information for their diagnosis and treatment. Biopsies of patients 17 years of age or younger were selected. Computerised data regarding age, gender, anatomic location, and histopathological diagnosis was retrieved and classified into nine categories. Of a total 2959 oral biopsies, 359 cases (12.1%) were in the paediatric population with a slight male predominance. Salivary gland pathology (21.4%) was most frequently observed followed by dental pathology, maxillofacial tumours and maxillofacial cysts. More than a third of cases (35.9%) were found to occur in the mandible. Five cases of malignancies were found, two of which were salivary gland tumours. The majority of lesions identified were of a benign nature necessitating minimal intervention; however, it is important to recognise that malignant lesions can occur in children. Any swelling, especially related to the salivary glands, must be investigated immediately, so as to prevent mortality and reduce morbidity. Diverse classifications used by previous authors make comparison of data challenging.

The establishment of local diagnostic reference levels for paediatric interventional cardiology

International Nuclear Information System (INIS)

McFadden, S.; Hughes, C.; D'Helft, C.I.; McGee, A.; Rainford, L.; Brennan, P.C.; McCrum-Gardner, E.; Winder, R.J.

2013-01-01

Background: There is a paucity of information worldwide on radiation exposure in paediatric interventional cardiology. At present Nationally established Diagnostic Reference Levels exist for adult interventional cardiology procedures in the UK but little data is available for paediatrics. In addition, interventional cardiology has been identified as one the highest contributors to medical exposure to ionising radiation and children are more radiosensitive than adults. Objective: This study sought to determine current radiation dose levels in paediatric interventional cardiology (IC) with a view to establishing local diagnostic reference levels (LDRL). Methods: Radiation dose and examination details were recorded for 354 paediatric patients examined by IC in a specialised paediatric centre in Europe. Radiation doses were recorded using a Dose Area Product meter along with examination details. Procedures were categorised as either diagnostic (A) or therapeutic (B). Data was further sub-divided into five age ranges; (1) newborn <1 year (2) 1 <5 years (3) 5 <10 years (4) 10 <15 years (5) 15 years and over. Proposed LDRL were calculated from the mean dose area product readings. Results: The mean patient age was 2.6 years (range 0.0 days–16 years) and weight was 14.9 kg (range 2.4–112 kg). LDRL for the five age groupings were calculated as 190, 421, 582, 1289 and 1776 cGycm² respectively. Conclusion: Local dose reference levels have been proposed for paediatric IC and can be used as a benchmark for other hospitals to compare against their own radiation doses

MRI of the marrow in the paediatric skeleton

International Nuclear Information System (INIS)

Foster, K.; Chapman, S.; Johnson, K.

2004-01-01

Magnetic resonance imaging (MRI) has greatly advanced evaluation of marrow diseases of the paediatric skeleton. As with many other aspects of paediatric radiology it is important to recognize the normal variations in the appearance of the marrow that occur in the growing child. These normal variations need to be differentiated from diseases and conditions that affect the marrow. This review describes the normal changes that occur in children with age, and the appearances of the pathological changes seen in infection, infiltration, haematological disorders, transplantation and radiation therapy

Paediatric tracheostomy-An 11 year experience at a Scottish paediatric tertiary referral centre.

Science.gov (United States)

Douglas, C M; Poole-Cowley, J; Morrissey, S; Kubba, H; Clement, W A; Wynne, D

2015-10-01

The aim of this paper was to review the indications, complications and outcomes for tracheostomy at a Scottish paediatric tertiary referral hospital. All patients undergoing tracheostomy between January 2001 and September 2012 were identified. A retrospective case note analysis was performed. 111 tracheostomies were done in the study period. The mean number per year was 11 (3-12). Full data was available for 95 patients. There were 56 (59%) males and 39 (41%) females. Age at time of tracheostomy ranged from one day to 15 years, the mean age of tracheostomy insertion was 69 weeks. The majority of patients, 75 (79%), were under one year old when they had their tracheostomy. The most common indication was long-term ventilation (20%), followed by craniofacial abnormality causing airway obstruction (18%), followed by subglottic stenosis (14%). 37% of patients were decannulated. This series reflects current trends in the indications for paediatric tracheostomy, with chronic lung disease of prematurity being the most common indication. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

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

Science.gov (United States)

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

2014-09-01

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.

A review of epidemiology of paediatric elbow injuries in sports.

Science.gov (United States)

Magra, Merzesh; Caine, Dennis; Maffulli, Nicola

2007-01-01

The elbow is a common site of orthopaedic injury in the paediatric population. The number of these injuries continues to rise following increased levels of participation in paediatric recreational and competitive sport. Injuries to the paediatric elbow can be classified as either overuse or acute. Delineating injury patterns to the elbow in children can be challenging, given the cartilaginous composition of the distal humerus and the multiple secondary ossification centres that appear and unite with the epiphysis at defined ages. Pitching in baseball, serving in tennis, spiking in volleyball, passing in American football and launching in javelin-throwing can all produce elbow pathology by forceful valgus stress, with medial stretching, lateral compression and posterior impingement. In children and adolescents, the epiphyseal plate is weaker than the surrounding ligaments, predisposing them to epiphyseal plate injuries. On the other hand, post-pubescent or skeletally mature athletes are more prone to tendinous or ligamentous injury. Injuries may cause significant impact on the athlete, parents and healthcare system. With the exception of baseball, there are few prospective cohort studies on the epidemiological trends of childhood elbow injuries in other sports. This paper aims to describe the epidemiological trends in paediatric elbow injuries related to sports, suggests prevention strategies and discusses the scope for further research. A web-based search of existing articles pertaining to paediatric elbow injuries in sports was performed. The implications of acute and overuse injuries and the possibility of permanent damage should be understood by parents, coaches and the athletes. Proper understanding of the intrinsic and extrinsic risk factors that could lead to elbow injuries is thus required. Measures to prevent elbow injuries should include proper coaching, warm-up, officiation, legislation, medical expertise and protective gear. There are still many

Overview and recent developments in the medical management of paediatric uveitis.

Science.gov (United States)

Pilly, Bertrand; Heath, Greg; Tschuor, Patrizia; Lightman, Susan; Gale, Richard P

2013-09-01

Although rarer than its adult counterpart, non-infectious uveitis remains a significant cause of ocular morbidity in children. Owing to the chronicity of the disorder and when refractory to first-line treatment, namely corticosteroids, systemic immunosuppressive treatment may be required to control the disease. Following a literature search using the keywords 'paediatric uveitis', 'juvenile idiopathic arthritis-associated uveitis', 'immunosuppression' and 'treatment', we reviewed the range and effectiveness of treatments employed in the management of non-infectious, paediatric uveitis. Corticosteroids (topical, periocular, intraocular or systemic) remain the initial drug of choice in ameliorating the signs and symptoms of non-infectious paediatric uveitis. Failure to control the disease and/or failure to reduce the oral dose of prednisolone at least 0.15 mg/kg within 4 weeks often requires additional immunosuppressant therapy. Methotrexate and azathioprine have shown to be effective in the management of juvenile idiopathic arthritis (JIA)-associated uveitis with the former considered the first-line corticosteroid-sparing agent. Biologic therapies are increasingly used earlier in the disease with investigators in the UK currently recruiting patients for the SYCAMORE trial evaluating the efficacy of methotrexate and adalimumab vs methotrexate alone for the treatment for JIA-associated uveitis. Until further randomised controlled trials are conducted, the use of other biologic agents should only be used with an appreciation that there are potentially unknown side-effects and that there is not a full knowledge of their efficacy.

The efficacy of an extended scope physiotherapy clinic in paediatric orthopaedics.

LENUS (Irish Health Repository)

O Mir, Marie

2016-04-01

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.

Adalimumab for the treatment of refractory noninfectious paediatric uveitis.

Science.gov (United States)

Muñoz-Gallego, Alicia; Barral, Estefanía; Enríquez, Eugenia; Tejada, Pilar; Barceló, Ana; de Inocencio, Jaime

2017-06-01

To report the experience of our center with the use of adalimumab (ADA) for the treatment of severe refractory noninfectious paediatric uveitis. The study is a retrospective case series of all paediatric patients with refractory uveitis who were treated with ADA at the Paediatric Uveitis Unit of our center from 2008 to 2015. We present 12 patients (6 Juvenile idiopathic arthritis-associated uveitis, 4 idiopathic panuveitis, 1 early-onset sarcoidosis-associated panuveitis, and 1 intermediate uveitis), with uveitis in 19/24 eyes. Once ADA therapy was started, all the patients presented improved activity according to Standardization of Uveitis Nomenclature (SUN) criteria. Nine out of the 12 patients had structural damage before ADA could be started: cataract (n = 4), glaucoma (n = 2), cystic macular edema (n = 1), exudative retinal detachment (n = 1), and optic disk edema (n = 5). Visual acuity improved or maintained stable in 17/19 affected eyes, and only 2 eyes decreased its visual acuity because of structural damage, which was already present before ADA therapy. In our experience, ADA presents a good safety profile and is efficacious in the treatment of paediatric patients with different forms of refractory noninfectious uveitis.

Finally in Italy the School of Specialisation in Paediatric Dentistry!

Science.gov (United States)

Marzo, G

2017-06-01

After over two decades of discussions, promises and indecisions, the year 2016 marked the birth of the School of Specialisation in Paediatric Dentistry, which is now a reality. The importance of dental post-graduate specialisation schools has been debated since the Degree Course in Dentistry was established. Previously, in Italy only two dental branches - Oral Surgery and Orthodontics - had obtained the recognition that a School of Specialisation entails. Today, with specific training and the newly- established hyper-specialisation in Paediatric Dentistry, the future of the profession is brighter than ever. This will allow dental professionals to provide the best cure to our young patients but it especially marks and recognises the importance of prevention in general. Having established a Specialty School in Paediatric Dentistry is also important to keep the pace with the other European countries where this postgraduate course has been already offered for many years. In my opinion, training professionals with a solid specialisation based both on cultural insights and hands-on clinical activities translates into the possibility of making true prevention. The ultimate goal of paediatric dentists, as well as paediatricians, is certainly to treat young patients but also and above all to accompany them toward an adulthood possibly free of pathologies. With an eye to a future where Paediatric Dentistry will be at the core of dental and orthodontic prevention, I wish great success to all the many specialisation schools established within the Italian Universities.

Quality of outpatient paediatric chest radiography - a pilot study

International Nuclear Information System (INIS)

Engelmann, D.; Duetting, T.; Wunsch, R.; Troeger, J.

2001-01-01

A quality control of outpatient paediatric chest X-rays was conducted in a sample of patients of one paediatric practice. During a period of eight months the technical image quality was analysed considering both diagnostic aspects and radiation protection. The quality of the 139 examined chest X-rays was inadequate concerning the collimation and focussing of the X-rays and the positioning of the patients. Exposure was estimated as average, sharpness was rated as good. In total 14% of the X-rays were not suitable for medical diagnosis. Image quality of the X-rays of infants (children younger than 6 years) was significantly lower compared to the total sample. Radiation protection standards were not fulfilled. As a conclusion from our results, improvements in outpatient paediatric radiography are urgently necessary. Quality control committees should pay particular attention in radiographs of infants. (orig.) [de

Survey on paediatric tumour boards in Europe: current situation and results from the ExPo-r-Net project.

Science.gov (United States)

Juan Ribelles, A; Berlanga, P; Schreier, G; Nitzlnader, M; Brunmair, B; Castel, V; Essiaf, S; Cañete, A; Ladenstein, R

2018-01-08

Under the ExPO-r-NeT project (European Expert Paediatric Oncology Reference Network for Diagnostics and Treatment), we aimed to identify paediatric oncology tumour boards in Europe to investigate the kind of technologies and logistics that are in place in different countries and to explore current differences between regions. A 20-question survey regarding several features of tumor boards was designed. Data collected included infrastructure, organization, and clinical decision-making information from the centres. The survey was distributed to the National Paediatric Haematology and Oncology Societies that forwarded the survey to the sites. For comparative analysis, respondents were grouped into four geographical regions. The questionnaire was distributed amongst 30 countries. Response was obtained from 23 (77%) that altogether have 212 paediatric oncology treating centres. A total of 121 institutions answered (57%). Ninety-one percent of the centres hold multidisciplinary boards; however, international second consultations are performed in 36% and only 15% participate on virtual tumor boards. Videoconferencing facilities and standard operational procedures (SOPs) are available in 49 and 43% of the centres, respectively. There were statistically significant differences between European regions concerning meeting infrastructure and organization/logistics: specific room, projecting equipment, access to medical records, videoconferencing facilities, and existence of SOPs. Paediatric tumor boards are a common feature in Europe. To reduce inequalities and have equal access to healthcare, a virtual network is needed. Important differences on the functioning and access to technology between regions in Europe have been observed and need to be addressed.

Work stress, occupational burnout and depression levels: a clinical study of paediatric intensive care unit nurses in Taiwan.

Science.gov (United States)

Lin, Tzu-Ching; Lin, Huey-Shyan; Cheng, Su-Fen; Wu, Li-Min; Ou-Yang, Mei-Chen

2016-04-01

This study aimed to examine the relationship between work stress and depression; and investigate the mediating effect of occupational burnout among nurses in paediatric intensive care units. The relationships among work stress, occupational burnout and depression level have been explored, neither regarding occupational burnout as the mediating role that causes work stress to induce depression nor considering the paediatric intensive care unit context. A cross-sectional correlational design was conducted. One hundred and forty-four female paediatric intensive care unit nurses from seven teaching hospitals in southern Taiwan were recruited as the participants. Data were collected by structured questionnaires including individual demographics, the Nurse Stress Checklist, the Occupational Burnout Inventory and the Taiwan Depression Questionnaire. The results indicated that after controlling for individual demographic variables, the correlations of work stress with occupational burnout, as well as work stress and occupational burnout with depression level were all positive. Furthermore, occupational burnout may exert a partial mediating effect on the relationship between work stress and depression level. This study provides information about work stress, occupational burnout and depression level, and their correlations, as well as the mediating role of occupational burnout among paediatric intensive care unit nurses. It suggests government departments and hospital administrators when formulating interventions to prevent work stress and occupational burnout. These interventions can subsequently prevent episodes of depression in paediatric intensive care unit nurses, thereby providing patients with a safe and high-quality nursing environment. © 2016 John Wiley & Sons Ltd.

Good practice recommendations for paediatric outpatient parenteral antibiotic therapy (p-OPAT) in the UK: a consensus statement.

Science.gov (United States)

Patel, Sanjay; Abrahamson, Ed; Goldring, Stephen; Green, Helen; Wickens, Hayley; Laundy, Matt

2015-02-01

There is compelling evidence to support the rationale for managing children on intravenous antimicrobial therapy at home whenever possible, including parent and patient satisfaction, psychological well-being, return to school/employment, reductions in healthcare-associated infection and cost savings. As a joint collaboration between the BSAC and the British Paediatric Allergy, Immunity and Infection Group, we have developed good practice recommendations to highlight good clinical practice and governance within paediatric outpatient parenteral antibiotic therapy (p-OPAT) services across the UK. These guidelines provide a practical approach for safely delivering a p-OPAT service in both secondary care and tertiary care settings, in terms of the roles and responsibilities of members of the p-OPAT team, the structure required to deliver the service, identifying patients and pathologies that are suitable for p-OPAT, ensuring appropriate vascular access, antimicrobial choice and delivery and the clinical governance aspects of delivering a p-OPAT service. The process of writing a business case to support the introduction of a p-OPAT service is also addressed. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

La cuerda dulce – a tolerability and acceptability study of a novel approach to specimen collection for diagnosis of paediatric pulmonary tuberculosis

Directory of Open Access Journals (Sweden)

Escombe A Roderick

2006-04-01

Full Text Available Abstract Background Recent data demonstrate the utility of the string test for the diagnosis of sputum-scarce HIV-associated TB in adults. We hypothesized that, if well-tolerated by children, this simple tool might offer a breakthrough in paediatric TB diagnosis. Thus the objective of this study, undertaken in the paediatric service of the Hospital Nacional Dos de Mayo, Lima, Perú, was to determine the tolerability and acceptability of the string test to paediatric TB suspects, their parents and nursing staff. Methods 22 paediatric subjects aged 3–14 years (median 8 under investigation for TB were invited to undergo 2 string tests (four-hour downtime each. Subjective and objective pain and discomfort rating scales were used to assess the perception of the subject, parent and attending nurse. Results Patients as young as 4 years tolerated the procedure extremely well with 84% willing to undergo a second procedure. Peak discomfort at the time of swallowing and of string retrieval was mild (30% of maximum possible score and brief as judged by visual analogue ratings and objective indicators. Good concordance of parent/child and objective/subjective ratings strengthened the validity of these findings. Conclusion The string test is well tolerated and achievable for most paediatric TB suspects as young as 4 years. A formal prospective paediatric efficacy study is now needed.

Audit of availability and distribution of paediatric cardiology services and facilities in Nigeria.

Science.gov (United States)

Ekure, Ekanem N; Sadoh, Wilson E; Bode-Thomas, Fidelia; Orogade, Adeola A; Animasahun, Adeola B; Ogunkunle, Oluwatoyin O; Babaniyi, Iretiola; Anah, Maxwell U; Otaigbe, Barbara E; Olowu, Adebiyi; Okpokowuruk, Frances; Omokhodion, Samuel I; Maduka, Ogechi C; Onakpoya, Uvie U; Adiele, Daberechi K; Sani, Usman M; Asani, Mustapha; Yilgwan, Christopher S; Daniels, Queennette; Uzodimma, Chinyere C; Duru, Chika O; Abdulkadir, Mohammad B; Afolabi, Joseph K; Okeniyi, John A

Paediatric cardiac services in Nigeria have been perceived to be inadequate but no formal documentation of availability and distribution of facilities and services has been done. To evaluate and document the currently available paediatric cardiac services in Nigeria. In this questionnaire-based, cross-sectional descriptive study, an audit was undertaken from January 2010 to December 2014, of the personnel and infrastructure, with their distributions according to geopolitical zones of Nigeria. Forty-eight centres participated in the study, with 33 paediatric cardiologists and 31 cardiac surgeons. Echocardiography, electrocardiography and pulse oximetry were available in 45 (93.8%) centres while paediatric intensive care units were in 23 (47.9%). Open-heart surgery was performed in six (12.5%) centres. South-West zone had the majority of centres (20; 41.7%). Available paediatric cardiac services in Nigeria are grossly inadequate and poorly distributed. Efforts should be intensified to upgrade existing facilities, establish new and functional centres, and train personnel.

In vitro analysis of the cariogenic and erosive potential of paediatric ...

African Journals Online (AJOL)

We evaluated in vitro the cariogenic and erosive potential of antitussive liquid oral medications for paediatric use. Fifteen paediatric liquid antitussives were sampled. The endogenous pH was evaluated by potentiometry, titratable acidity was measured according to the method adopted by the Association of Official Analytical ...

Parental experiences with a paediatric palliative care team: A qualitative study

NARCIS (Netherlands)

Verberne, Lisa M.; Schouten-van Meeteren, Antoinette Yn; Bosman, Diederik K.; Colenbrander, Derk A.; Jagt, Charissa T.; Grootenhuis, Martha A.; van Delden, Johannes Jm; Kars, Marijke C.

2017-01-01

Background: Parents of children with a life-limiting disease have to rely on themselves at home while adequate paediatric palliative care is lacking. In several countries, paediatric palliative care teams are introduced to ensure continuity and quality of care and to support the child and the

In-hospital paediatric accidents: an integrative review of the literature.

Science.gov (United States)

Da Rin Della Mora, R; Bagnasco, A; Sasso, L

2012-12-01

Paediatric hospitals can be perceived by children, parents, health professionals as 'safe' places, but accidents do occur. To review publications relating to in-hospital paediatric accidents and highlight the state-of-the-science concerning this issue especially in relation to falls, and the evolution of research addressing this issue. Integrative review of papers published before March 2011 on accidents and falls occurred in hospitalized children. Electronic databases (PubMed, Cumulative Index to Nursing and Allied Health Literature and Cochrane Library databases) and further hand searching through references were searched. The inclusion criteria were articles involving observational, quasi-experimental or experimental studies in English or Italian. Exclusion criteria were articles addressing the outcomes of falls caused by suspect violence on children. Thirteen studies in English were included. Of the 13 studies conducted between 1963 and 2010, 10 had been conducted in the last 5 years; 10 in the USA. The studies were divided into two categories: contextualization and prevention of the 'accident' or 'fall' phenomenon (10 studies), and fall risk assessment (three studies). The most frequent type of design was observational explorative/descriptive. Several areas of investigation were explored (hazardous environment, children's characteristics correlated to accidents/falls, characteristics of the accidents/falls and their outcomes, paediatric fall risk factors and risk assessment tools, fall risk prevention programmes, parents' perceptions of accident/fall risks, etc.). No comparable methods were used to investigate the contextualization and prevention of the 'accident' and 'fall' phenomena; proposed fall risk assessment tools were not evaluated for their reliability and validity. Consensus would be needed around the approach to accidents in terms of: the definition of 'accident' and 'fall'; 'fall-related injury' and respective classifications; the frequency and

Paediatric trauma and safety in the media: An audit of its coverage in ...

African Journals Online (AJOL)

Objectives. In view of the high rate of paediatric trauma in South Africa, we investigated how much attention – and of what nature – was given in printed media to these incidents, and to the broader subject of child safety. Methods. Over 4 months, every article in the Cape Argus and Weekend Argus that pertained to either: (i) ...

Radiographic appearances of uncommon paediatric implants and devices

Energy Technology Data Exchange (ETDEWEB)

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

2015-06-15

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.)

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

Energy Technology Data Exchange (ETDEWEB)

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)

2016-12-15

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.)

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

International Nuclear Information System (INIS)

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

2016-01-01

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.)

Teaching ethics to paediatrics residents: the centrality of the therapeutic alliance.

Science.gov (United States)

Taylor, Holly A; McDonald, Erin L; Moon, Margaret; Hughes, Mark T; Carrese, Joseph A

2009-10-01

Previous research on ethical issues encountered by medical professionals in training and practice have presented the thematic content of the cases they encounter rather than the activities in which clinicians engage and in which they most often encounter ethical issues. We conducted a direct observation study of paediatrics residents and their preceptors seeing patients in an out-patient general paediatrics clinic. Our objectives were to describe the everyday ethics-related issues paediatrics residents encounter as they interact with patients. Our ultimate goal is to use this knowledge to enhance current efforts to teach ethics to paediatrics residents. The study team directly observed paediatrics residents discussing patients with their faculty preceptors (19 half-day sessions, 76 hours) in an out-patient general paediatrics clinic located in an urban academic medical centre. Each interaction between resident and preceptor about a single patient was considered a case for further analysis. A total of 247 cases were recorded. Forty-one of the cases were coded as having ethics-related content. A constant comparative method of qualitative data analysis revealed that residents were most likely to encounter ethical issues when engaged in the following activities: (i) maintaining a therapeutic alliance with the caregiver (e.g. the parent); (ii) prioritising patient or family needs; (iii) adjusting to the power embodied by the role of doctors, and (iv) distinguishing suboptimal care from abuse or neglect. In addition, our findings indicate that it is through their efforts to maintain the therapeutic alliance with the caregivers of their patients that residents engage in and integrate three processes: developing their medical knowledge; adhering to professional norms, and balancing the power inherent in the doctor's role with their responsibility to serve the patient's interests. Medical faculty tasked with teaching ethics to paediatrics residents can utilise the results

WHO and national lists of essential medicines in Mexico, Central and South America, and the Caribbean: are they adequate to promote paediatric endocrinology and diabetes care?

Science.gov (United States)

Rowlands, Amanda; Acosta-Gualandri, Alejandra; Guevara-Aguirre, Jaime; Chanoine, Jean-Pierre

2016-01-01

Paediatric endocrinology and diabetes is a paediatric specialty with less common conditions and higher cost medicines. Access to medicines for our specialty in low and middle income countries remains limited. We analysed the content of the WHO (children and adults) and of all available national Model Lists of Essential Medicines (EMLs) for Mexico, the Caribbean, Central and South America from a paediatric endocrinology and diabetes standpoint. A master list of medicines deemed necessary in paediatric endocrinology and diabetes was established and compared with the WHO and national EMLs, taking into account the gross national income. The WHO EMLs, which are largely recognised as an international benchmark and drive the content of the national EMLs, included many but not all medicines present on our master list. Interestingly, several national EMLs from richer countries included medicines that were not present in the WHO EMLs. Our analysis suggests that these medicines could be considered by the WHO for inclusion in their EMLs, which may promote the adoption of more medicines by individual countries. We also propose several changes to the WHO and national EMLs that could facilitate access to medicines in our specialty: age cut-off for a child using physical maturity rather than a set age limit; greater standardisation of the formatting of the national EMLs for easier comparison and collaborations between countries; greater emphasis on age-specificity and population-specificity for some medicines; and formatting of the EMLs in a disease-focused manner rather than as individual medicines. PMID:28588968

Knowledge and use of evidence-based nutrition : a survey of paediatric dietitians

NARCIS (Netherlands)

Thomas, DE; Kukuruzovic, R; Martino, B; Chauhan, SS; Elliott, EJ

2003-01-01

Objective To survey paediatric dietitians' knowledge and use of evidence-based nutrition (EBN). Design Cross-sectional survey using reply-paid questionnaires. Subjects Paediatric dietitians in Australian teaching hospitals. Main outcome measures Age, sex, appointment, clinical practice, research

Scotland's GP paediatric scholarship: an evaluation.

Science.gov (United States)

MacVicar, Ronald; Borland, Lyndsey; McHale, Sharon; Goh, Dayeel; Potter, Alex

2018-05-01

In a previous publication we described the implementation and early evaluation of general practice paediatric scholarships in Scotland. We suggested that it was too early to be able to determine whether this significant investment will produce a return for Scotland in terms of enhanced roles in providing, leading or developing children's services in primary care or at the primary care/secondary care interface. This paper presents the results of a survey of the impact of the scholarship for the first six cohorts of the scholarship (119 General Practitioners). The response rate was 76%. Of the 90 respondents, almost half (44) have developed roles or areas of special paediatric interest either within or out with the practice, or in three cases both within and out with the practice. A total of 37 (43%) of those that continue to work within general practice reported that they have developed areas of special interest of benefit to the practice. Qualitative analysis of free text questions suggested that scholars had benefited from their experience in terms of increased confidence in dealing with child health problems, developing links with secondary care colleagues, and personal gain with respect to role development. What is already known in this area: Changes in GP Training have been suggested in order to provide a workforce that can meet the needs of infants, children and young people. Studies have shown a positive impact of paediatric trainees and GP trainees learning together. Little attention has however been given to the potential to support trained GPs to develop their expertise in child health. What this work adds: Early evaluation of the Scottish Paediatric Scholarship suggested a high degree of satisfaction. This more robust evaluation suggests that almost half (44/90 respondents) have developed roles or areas of special paediatric interest either within or out with the practice, or in three cases both within and out with the practice. Suggestions for future

Plasma EBV microRNAs in paediatric renal transplant recipients.

Science.gov (United States)

Hassan, Jaythoon; Dean, Jonathan; De Gascun, Cillian F; Riordan, Michael; Sweeney, Clodagh; Connell, Jeff; Awan, Atif

2018-06-01

Epstein-Barr virus (EBV) was the first human virus identified to express microRNA (miRNA). To date, 44 mature miRNAs are encoded for within the EBV genome. EBV miRNAs have not been profiled in paediatric renal transplant recipients. In this study, we investigated circulating EBV miRNA profiles as novel biomarkers in paediatric renal transplant patients. Forty-two microRNAs encoded within 2 EBV open reading frames (BART and BHRF) were examined in renal transplant recipients who resolved EBV infection (REI) or maintained chronic high viral loads (CHL), and in non-transplant patients with acute infectious mononucleosis (IM). Plasma EBV-miR-BART2-5p was present in higher numbers of IM (7/8) and CHL (7/10) compared to REI (7/12) patients. A trend was observed between the numbers of plasma EBV miRNAs expressed and EBV viral load (p < 0.07). Several EBV-miRs including BART7-3p, 15, 9-3p, 11-3p, 1-3p and 3-3p were detected in IM and CHL patients only. The lytic EBV-miRs, BHRF1-2-3p and 1-1, indicating active viral replication, were detected in IM patients only. One CHL patient developed post-transplant lymphoproliferative disease (PTLD) after several years and analysis of 10 samples over a 30-month period showed an average 24-fold higher change in plasma EBV-miR-BART2-5p compared to the CHL group and 110-fold higher change compared to the REI group. Our results suggest that EBV-miR-BART2-5p, which targets the stress-induced immune ligand MICB to escape recognition and elimination by NK cells, may have a role in sustaining high EBV viral loads in CHL paediatric kidney transplant recipients.

Let’s Improv It: The Embodied Investigation of Social Collaboration

Directory of Open Access Journals (Sweden)

Klara Łucznik

2017-11-01

Full Text Available How do we share embodied knowledge? How do we understand the world through our bodies? How can we effectively interpret and communicate somatic experiences to a wider audience? These questions emerged during a collaborative research project Let’s Improv It (August 2016, Plymouth University, which set out to explore how kinaesthetic empathy and multisensory perception help us to understand our own actions, intentions and emotions, as well as those of others. We additionally questioned the role and perception of physical and emotional touch within embodied knowledge. After a five-day practice-led investigation, a 20-minute improvised somatic movement score was developed with the aim of providing a novel experience of touch and movement. The authors collectively delivered the score and reflected on the outcomes of this experience over the course of a year (2016–2017. In this paper, we explore how our research project expanded the boundaries of the conventional concepts of knowledge and cognition. We see such participatory sessions, in which movement and embodied experience freely unfold in time and space, as a ‘laboratory’ in which we examine the underlying mechanisms of collaboration. We reflect on how such an experience can be seen as a creative process, or as an emergent, collaborative artwork. The participants are both the creators and, simultaneously, the audience of our improvised experience. The experience provided a non-judgmental context for physical engagement and observation, which is an outcome that will be introduced alongside participants’ feedback. Overall, the project revealed that shared embodied knowledge is highly appreciated, particularly among those without previous experience with embodied enquiry or movement research.

Hypnosis in paediatric respiratory medicine.

Science.gov (United States)

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

2014-03-01

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. Copyright © 2013 Elsevier Ltd. All rights reserved.

FORUM Paediatric living donor liver transplantation

African Journals Online (AJOL)

879 November 2012, Vol. 102, No. 11 SAMJ. REVIEW. Paediatric living donor liver transplantation ... been excellent after left lateral segmentectomy, with a usually quoted ... has led to the development of new surgical techniques to increase.

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

LENUS (Irish Health Repository)

Noctor, E

2015-06-01

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.

What impact did a Paediatric Early Warning system have on emergency admissions to the paediatric intensive care unit? An observational cohort study.

Science.gov (United States)

Sefton, G; McGrath, C; Tume, L; Lane, S; Lisboa, P J G; Carrol, E D

2015-04-01

The ideology underpinning Paediatric Early Warning systems (PEWs) is that earlier recognition of deteriorating in-patients would improve clinical outcomes. To explore how the introduction of PEWs at a tertiary children's hospital affects emergency admissions to the Paediatric Intensive Care Unit (PICU) and the impact on service delivery. To compare 'in-house' emergency admissions to PICU with 'external' admissions transferred from District General Hospitals (without PEWs). A before-and-after observational study August 2005-July 2006 (pre), August 2006-July 2007 (post) implementation of PEWs at the tertiary children's hospital. The median Paediatric Index of Mortality (PIM2) reduced; 0.44 vs 0.60 (pemergency admissions to PICU. A 39% reduction in emergency admission total beds days reduced cancellation of major elective surgical cases and refusal of external PICU referrals. Following introduction of PEWs at a tertiary children's hospital PIM2 was reduced, patients required less PICU interventions and had a shorter length of stay. PICU service delivery improved. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Impact of Housing in Paediatrics Burns Cases: A Review of ...

African Journals Online (AJOL)

Objective: To determine the impact of housing on paediatric Burns Cases in Lagos Design: Prospective Study Subject: 40 children aged 10 days to 10 years admitted for Management after sustaining burns. Main Outcome Measurements: Housing plays a significant role in paediatric Burns Cases. Results: 70% of a total of ...

The changing nature of relationships between parents and healthcare providers when a child dies in the paediatric intensive care unit.

Science.gov (United States)

Butler, Ashleigh E; Hall, Helen; Copnell, Beverley

2018-01-01

To explore bereaved parents' interactions with healthcare providers when a child dies in a paediatric intensive care unit. Although most children admitted to a paediatric intensive care unit will survive, 2-5% will die during their stay. The parents of these children interact and form relationships with numerous healthcare staff during their child's illness and death. Although previous studies have explored the parental experience of child death in intensive care generally, the nature of their relationships with healthcare providers during this time remains unknown. This study used a constructivist grounded theory approach. Data were collected via semi-structured, audio-recorded interviews with 26 bereaved parents from four paediatric intensive care units over 18 months in 2015-2016. Constant comparative analysis and theoretical memos were used to analyse the data. The theory "Transitional togetherness" demonstrates the changing nature of the parent-healthcare provider relationship across three key phases of the parents' journey. Phase one, "Welcoming expertise," focuses on the child's medical needs, with the healthcare provider dominant in the relationship. Phase two, "Becoming a team," centres around the parents' need to recreate a parental role and work collaboratively with healthcare providers. Finally, "Gradually disengaging" describes the parents' desire for the relationship to continue after the child's death as a source of support until no longer needed. Findings from this study offer valuable insights into the changing nature of the parent-healthcare provider relationship and highlight the key foci of the relationship at each stage of the parental journey. © 2017 John Wiley & Sons Ltd.

A qualitative study of decision-making on Phase III randomized clinical trial participation in paediatric oncology

DEFF Research Database (Denmark)

Ingersgaard, Marianne Vie; Tulstrup, Morten; Schmiegelow, Kjeld

2018-01-01

AIM: To explore parents' and adolescents' motives for accepting/declining participation in the ALL2008 trials and adolescents' involvement in the decision-making process. BACKGROUND: Children and adolescents with acute lymphoblastic leukaemia treated on the Nordic Society of Paediatric Haematology...... the adolescents' decision. There were no differences between motivations of preferences held by parents of children or adolescents, respectively. Decisions were based on subjective values attributed to cure contra toxicity and individual preferences for either standard or experimental treatment. The possibility....... FINDINGS: Adolescents and parents emphasized the importance of adolescents' active participation in decisions regarding enrolment into clinical trials. A majority of adolescents were either final or collaborative decision-makers. Parents stated that in case of disagreement, they would overrule...

Evaluation of three paediatric weight estimation methods in Singapore.

Science.gov (United States)

Loo, Pei Ying; Chong, Shu-Ling; Lek, Ngee; Bautista, Dianne; Ng, Kee Chong

2013-04-01

Rapid paediatric weight estimation methods in the emergency setting have not been evaluated for South East Asian children. This study aims to assess the accuracy and precision of three such methods in Singapore children: Broselow-Luten (BL) tape, Advanced Paediatric Life Support (APLS) (estimated weight (kg) = 2 (age + 4)) and Luscombe (estimated weight (kg) = 3 (age) + 7) formulae. We recruited 875 patients aged 1-10 years in a Paediatric Emergency Department in Singapore over a 2-month period. For each patient, true weight and height were determined. True height was cross-referenced to the BL tape markings and used to derive estimated weight (virtual BL tape method), while patient's round-down age (in years) was used to derive estimated weights using APLS and Luscombe formulae, respectively. The percentage difference between the true and estimated weights was calculated. For each method, the bias and extent of agreement were quantified using Bland-Altman method (mean percentage difference (MPD) and 95% limits of agreement (LOA)). The proportion of weight estimates within 10% of true weight (p₁₀) was determined. The BL tape method marginally underestimated weights (MPD +0.6%; 95% LOA -26.8% to +28.1%; p₁₀ 58.9%). The APLS formula underestimated weights (MPD +7.6%; 95% LOA -26.5% to +41.7%; p₁₀ 45.7%). The Luscombe formula overestimated weights (MPD -7.4%; 95% LOA -51.0% to +36.2%; p₁₀ 37.7%). Of the three methods we evaluated, the BL tape method provided the most accurate and precise weight estimation for Singapore children. The APLS and Luscombe formulae underestimated and overestimated the children's weights, respectively, and were considerably less precise. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Detection of toxigenic Clostridium difficile in paediatric patients.

Science.gov (United States)

Falces-Romero, Iker; Troyano-Hernáez, Paloma; García-Bujalance, Silvia; Baquero-Artigao, Fernando; Mellado-Peña, María José; García-Rodríguez, Julio

2017-07-06

Our main objective was a revision of clinical, microbiological and epidemiological results of Clostridium difficile-associated infection in paediatric patients (2010-2015). We compared the diagnoses performed by detection of toxins in feces and those performed by real-time PCR. This retrospective study included 82 paediatric patients. Detection of toxigenic C. difficile was performed sequentially, in diarrheal feces and under clinical request. A total of 39% of the patients were attended at Haematology-oncology Unit and >50% of them had previously received cephalosporins. Fever associated with diarrhea was more frequent in the group of toxin detection, whereas not receiving specific antibiotic treatment was more frequent in the group of positive PCR, without statistically significant differences. We highlight the presence of C. difficile infection in children under 2years old. A diagnostic testing in selected paediatric patients would be advisable when there is clinical suspicion of infection. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

[Co-authorship and Spanish pediatric scientific collaboration networks (2006-2010)].

Science.gov (United States)

Aleixandre Benavent, R; González de Dios, J; Alonso Arroyo, A; Bolaños Pizarro, M; Castelló Cogollos, L; González Alcaide, G; Vidal Infer, A; Navarro Molina, C; Coronado Ferrer, S; González Muñoz, M; Málaga Guerrero, S

2013-06-01

Scientific collaboration is very important, as it is the basis of the scientific development of every discipline. The aim of this paper is to identify the indicators of scientific collaboration and co-authorship networks of Spanish researchers and institutions publishing in national and international paediatric, multidisciplinary or other knowledge areas journals during the period 2006-2010. The papers studied were obtained from the databases including, Science Citation Index Expanded, Scopus, Índice Médico Español and Índice Bibliográfico Español en Ciencias de la Salud, by means of applying different search profiles. All the papers signed by co-authors were quantified in order to identify the authorship and institutional collaboration networks. Furthermore the degree, betweenness index, and closeness index were obtained as a measurement of the structural analysis. Co-authorships were represented graphically by the network analysis and display software Pajek. A total of 7971 articles were published during the period 2006-2010, with 90.55% completed in collaboration. Using a threshold of 10 or more co-authorships, 77 research groups in Pediatrics were identified. Most papers were published in collaboration between institutions of the same Autonomous Community (42.28%), and 14.84% with international collaboration. The analysis of institutional participation enabled a large nucleus or institutional collaboration network to be identified, with 52 linked institutions. International collaboration was led by the USA and European countries, such as United Kingdom, Germany and Italy. Authors, institutions and the most active working groups in Spanish pediatrics were identified, which is very interesting information to establish contacts to increase the existing networks, to prevent redundancies, and to take advantage of the new emerging groups. It is necessary to promote the collaboration of Spanish researchers, especially with their international colleagues, since a

Prolonged unexplained fatigue in paediatrics

NARCIS (Netherlands)

Bakker, R.J.

2010-01-01

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

Methodologies to assess paediatric adiposity.

LENUS (Irish Health Repository)

Horan, M

2014-05-04

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.

STUDY OF PAEDIATRIC SOLID TUMOURS FOR A PERIOD OF 5 YEARS

Directory of Open Access Journals (Sweden)

Basumitra Das

2017-12-01

Full Text Available BACKGROUND Paediatric Solid Neoplasms (PSN are a global problem. There is significant variation of incidence of paediatric solid neoplasms in various regions of the world. Benign tumours are more common than cancer. In an effort to better understand the prevalence of paediatric solid tumours in our region, a retrospective review of the tumours diagnosed histopathologically was carried out. MATERIALS AND METHODS This is a retrospective study undertaken in a tertiary care hospital for a period of five years. All the benign and malignant paediatric solid tumours of children below 14 years from January 2012 to December 2016 were retrieved and analysed according to age, sex and histopathological diagnosis. Leukaemias were excluded from our study. All tumours were diagnosed on conventional haematoxylin and eosin-stained sections. RESULTS A total of 109 cases of solid paediatric tumours were received during this period. Of these, maximum of 30 tumours were of soft tissue tumours followed by Central Nervous System (CNS and bone tumours with 24 and 23 cases, respectively. 7 cases of blastomas were also observed. CONCLUSION This study showed benign and malignant tumours to be of near-equal prevalence. Soft tissue tumours were the most common. Ratio of benign tumours to malignant were almost equal below 4 years. Malignant tumours were higher in 5-9 years group.

Investigating 6th graders' use of a tablet-based app supporting synchronous use of multiple tools designed to promote collaborative knowledge building in science

Science.gov (United States)

Sherwood, Carrie-Anne

At this pivotal moment in time, when the proliferation of mobile technologies in our daily lives is influencing the relatively fast integration of these technologies into classrooms, there is little known about the process of student learning, and the role of collaboration, with app-based learning environments on mobile devices. To address this gap, this dissertation, comprised of three manuscripts, investigated three pairs of sixth grade students' synchronous collaborative use of a tablet-based science app called WeInvestigate . The first paper illustrated the methodological decisions necessary to conduct the study of student synchronous and face-to-face collaboration and knowledge building within the complex WeInvestigate and classroom learning environments. The second paper provided the theory of collaboration that guided the design of supports in WeInvestigate, and described its subsequent development. The third paper detailed the interactions between pairs of students as they engaged collaboratively in model construction and explanation tasks using WeInvestigate, hypothesizing connections between these interactions and the designed supports for collaboration. Together, these manuscripts provide encouraging evidence regarding the potential of teaching and learning with WeInvestigate. Findings demonstrated that the students in this study learned science through WeInvestigate , and were supported by the app - particularly the collabrification - to engage in collaborative modeling of phenomena. The findings also highlight the potential of the multiple methods used in this study to understand students' face-to-face and technology-based interactions within the "messy" context of an app-based learning environment and a traditional K-12 classroom. However, as the third manuscript most clearly illustrates, there are still a number of modifications to be made to the WeInvestigate technology before it can be optimally used in classrooms to support students' collaborative

The ESSKA paediatric anterior cruciate ligament monitoring initiative.

Science.gov (United States)

Moksnes, Håvard; Engebretsen, Lars; Seil, Romain

2016-03-01

To survey and describe the treatment of paediatric anterior cruciate ligament (ACL) injuries performed by orthopaedic surgeons affiliated with the European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA). A closed e-survey was submitted to all registered members and affiliates of ESSKA in July 2013. All recipients were invited to participate in the survey by answering 34 questions online. The list of potential respondents was extracted from the ESSKA office database. Invitation was sent to 2236 ESSKA members and affiliates, and received 491 (22%) unique responses. Among the respondents, 445 (91%) were orthopaedic surgeons, with 354 (72%) stating that they were involved in treatment of paediatric ACL injuries. The main findings were that there are substantial differences with regard to preferred treatment algorithms, surgical techniques and long-term follow-up procedures. The summed estimate of skeletally immature children with ACL injury seen by the responders in 2012 was minimum 1923 individuals, and a minimum of 102 clinically relevant post-operative growth disturbances were registered. The present survey documents that the incidences of paediatric ACL injuries and idiopathic growth disturbances may be higher than previously estimated. Treatment algorithms and surgical techniques are highly diverse, and consensus could not be identified. It is worrying that only half the surgeons reported to follow-up children until skeletal maturity after surgical treatment. The results of this survey highlight the importance of international multicentre studies on paediatric ACL treatment and the development of an outcome registry to enable prospective data collections. IV.

Five challenges to ethical communication for interprofessional paediatric practice: A social work perspective.

Science.gov (United States)

Delany, Clare; Richards, Angela; Stewart, Helen; Kosta, Lauren

2017-07-01

In paediatric clinical care, what is said to a parent or carer as well as when, where, and how it is said, directly advances or diminishes parents' capacities to understand available options and to contribute to decisions about treatment for their child. This makes interprofessional and patient communication an ethical endeavour. Social workers are uniquely situated to observe, participate in, and provide an active link in the communication between families and other health team members. This article reports phenomenological research exploring ethical issues encountered by social workers in their everyday practice communicating with families and other health professionals in a paediatric hospital context in Australia. Data were collected via semi-structured interviews with nine social workers and analysed thematically. Participants described two main communication-based roles: to support families through information provision and to contribute collaboratively to the interprofessional team involved in caring for a child and family. We grouped participants' descriptions of conflict between these roles into five main "communication challenges": (1) holding troublesome knowledge; (2) the need for diplomacy; (3) conciliation; (4) every man and his dog in family meetings; and (5) systems and processes presenting a brick wall. The five communication challenges provide empirically derived examples of how communication occurring within interprofessional health teams and between individual clinicians and parents can act to diminish or enhance parents' experience of care for their hospitalised child. Identifying these challenges may help to inform how communication within interprofessional teams and between clinicians and patients can benefit children and their parents.

[Cerebrovascular accidents in paediatric care. Our experience gained over an 18-year period].

Science.gov (United States)

Ruiz del Olmo-Izuzquiza, Ignacio; de Arriba-Muñoz, Antonio; López-Pisón, Javier; García-Iñiguez, Juan Pablo; Romero-Gil, Ruth; Monge-Galindo, Lorena; Pérez-Delgado, Raquel; Peña-Segura, José Luis

This study reviews our experience over the last 18 years with paediatric patients diagnosed with non-haemorrhagic cerebrovascular accidents (CVA) after the perinatal period. Data were collected for the period between May 1990 and May 2008 (n = 10 270 children) and special attention was given to cases with no previous pathology. We found 41 cases that were diagnosed with post-natal non-haemorrhagic CVA, of which 13 did not present any known pathology at the onset of the symptoms. Nine patients were diagnosed as having ischaemic CVA (ICVA), three cases had thrombosis of the venous sinuses and there was one case of haemorrhagic infarction (HI). No causation was found in five cases, three of which were heterozygotic for the C677T mutation of methylenetetrahydrofolate reductase. ICVA was caused by fibromuscular dysplasia, aneurysm of the auricular septum and patent foramen ovale, homocystinuria and chickenpox. A recent ear infection and diminished levels of protein C were noted in two cases of venous thrombosis. Five patients with ICVA and the case of HI were treated with oral antiaggregants, anticoagulants were administered in two of the thromboses, and the remaining cases did not receive any treatment. Seven patients (four ICVA, two thromboses and the HI) did not present any kind of sequelae, four ICVA presented different degrees of hemiparesis and two died (one ICVA and one thrombosis). The scarcity of studies and therapeutic clinical trials in the paediatric age makes it difficult to lay down clear guidelines of conduct, especially from the therapeutic point of view. The different specialists involved must collaborate with each other.

Barriers and facilitators to the implementation of a paediatric palliative care team

NARCIS (Netherlands)

Verberne, Lisa M; Kars, Marijke C; Schepers, Sasja A; Schouten-van Meeteren, Antoinette Y N; Grootenhuis, Martha A; van Delden, Johannes J M

2018-01-01

BACKGROUND: Over the last decade, paediatric palliative care teams (PPCTs) have been introduced to support children with life-limiting diseases and their families and to ensure continuity, coordination and quality of paediatric palliative care (PPC). However, implementing a PPCT into an organisation

Barriers and facilitators to the implementation of a paediatric palliative care team

NARCIS (Netherlands)

Verberne, Lisa M.; Kars, Marijke C.; Schepers, Sasja A.; Schouten-van Meeteren, Antoinette Y. N.; Grootenhuis, Martha A.; van Delden, Johannes J. M.

2018-01-01

Over the last decade, paediatric palliative care teams (PPCTs) have been introduced to support children with life-limiting diseases and their families and to ensure continuity, coordination and quality of paediatric palliative care (PPC). However, implementing a PPCT into an organisation is a

Paediatric Virology in the Hippocratic Corpus

Science.gov (United States)

Mammas, Ioannis N.; Spandidos, Demetrios A.

2016-01-01

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

The Swiss regulatory framework for paediatric health research.

Science.gov (United States)

Junod, Valerie

2008-07-01

Medical research on minors entails both risks and benefits. Under Swiss law, clinical trials on children, including nontherapeutic drug trials, are permissible. However, ethics committees must systematically verify that all clinical studies have a favorable risk-benefit profile. Additional safeguards are designed to ensure that children are not unnecessarily involved in research and that proper consent is always obtained. Federal Swiss law is undergoing revision to extend these protections beyond clinical trials to a broad array of health research. The Swiss drug agency also seeks to improve the incentives for pharmaceutical firms to develop new paediatric drugs and relevant paediatric drug labels.

Radiographers' and radiology practitioners' opinion, experience and practice of benefit-risk communication and consent in paediatric imaging

International Nuclear Information System (INIS)

Portelli, J.L.; McNulty, J.P.; Bezzina, P.; Rainford, L.

2016-01-01

Objectives: To investigate radiographers' and radiology practitioners' opinion, experience and practice of radiation benefit-risk communication and consent for paediatric imaging examinations. Methods: A cross-sectional survey was conducted amongst radiographers and radiology practitioners working at a primary paediatric referral centre in Malta, so as to acquire information about their interactions with paediatric patients and/or their parents, particularly their opinion and practice of communicating benefit-risk information and seeking consent for imaging examinations. Results: The return of 112 questionnaires provided a response rate of 66.7%. Findings revealed varied practice relating to the provision of benefit-risk information, whereby details concerning examination benefits and potential risks are not always conveyed. For 89% of participants, parental consent was sought for paediatric imaging examinations in their current practice. Only 36.7% of participants indicated that they were highly confident in their ability to communicate benefit-risk information. The study findings also revealed that parents can truly be worried about the associated radiation exposure, with some even refusing an imaging examination as a result of such concerns. Conclusions: The practice of communicating benefit-risk information to paediatric patients and/or their parents is varied. A possible gap in benefit-risk communication education and/or training was identified, which may impact radiographers' and radiology practitioners' confidence in conveying such information. Education/training activities for radiographers and radiology practitioners are therefore necessary to foster improved benefit-risk dialogues and help provide reassurance to parents/guardians about the benefits of appropriately indicated paediatric imaging examinations. - Highlights: • The practice of communicating radiation benefit-risk information to parents of paediatric patients is varied. �

A clinical update on paediatric lupus

African Journals Online (AJOL)

Personal reference lists of the 3 authors were used in this update. ... with a paediatric specialist so that a tailored management plan can be made, depending ..... Cassidy JT, Petty RE, Laxer RM, Lindsley L.Textbook of Pediatric Rheumatology.

Paediatric autoimmune encephalopathies: clinical features, laboratory investigations and outcomes in patients with or without antibodies to known central nervous system autoantigens

Science.gov (United States)

Hacohen, Yael; Wright, Sukhvir; Waters, Patrick; Agrawal, Shakti; Carr, Lucinda; Cross, Helen; De Sousa, Carlos; DeVile, Catherine; Fallon, Penny; Gupta, Rajat; Hedderly, Tammy; Hughes, Elaine; Kerr, Tim; Lascelles, Karine; Lin, Jean-Pierre; Philip, Sunny; Pohl, Keith; Prabahkar, Prab; Smith, Martin; Williams, Ruth; Clarke, Antonia; Hemingway, Cheryl; Wassmer, Evangeline; Vincent, Angela; Lim, Ming J

2013-01-01

Objective To report the clinical and investigative features of children with a clinical diagnosis of probable autoimmune encephalopathy, both with and without antibodies to central nervous system antigens. Method Patients with encephalopathy plus one or more of neuropsychiatric symptoms, seizures, movement disorder or cognitive dysfunction, were identified from 111 paediatric serum samples referred from five tertiary paediatric neurology centres to Oxford for antibody testing in 2007–2010. A blinded clinical review panel identified 48 patients with a diagnosis of probable autoimmune encephalitis whose features are described. All samples were tested/retested for antibodies to N-methyl-D-aspartate receptor (NMDAR), VGKC-complex, LGI1, CASPR2 and contactin-2, GlyR, D1R, D2R, AMPAR, GABA(B)R and glutamic acid decarboxylase. Results Seizures (83%), behavioural change (63%), confusion (50%), movement disorder (38%) and hallucinations (25%) were common. 52% required intensive care support for seizure control or profound encephalopathy. An acute infective organism (15%) or abnormal cerebrospinal fluid (32%), EEG (70%) or MRI (37%) abnormalities were found. One 14-year-old girl had an ovarian teratoma. Serum antibodies were detected in 21/48 (44%) patients: NMDAR 13/48 (27%), VGKC-complex 7/48(15%) and GlyR 1/48(2%). Antibody negative patients shared similar clinical features to those who had specific antibodies detected. 18/34 patients (52%) who received immunotherapy made a complete recovery compared to 4/14 (28%) who were not treated; reductions in modified Rankin Scale for children scores were more common following immunotherapies. Antibody status did not appear to influence the treatment effect. Conclusions Our study outlines the common clinical and paraclinical features of children and adolescents with probable autoimmune encephalopathies. These patients, irrespective of positivity for the known antibody targets, appeared to benefit from immunotherapies and further

New hazards in paediatric poisoning presentations.

LENUS (Irish Health Repository)

Moore, C

2015-02-01

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.

Collaborative Economy

DEFF Research Database (Denmark)

collaborative economy and tourism Dianne Dredge and Szilvia Gyimóthy PART I - Theoretical explorations 2.Definitions and mapping the landscape in the collaborative economy Szilvia Gyimóthy and Dianne Dredge 3.Business models of the collaborative economy Szilvia Gyimóthy 4.Responsibility and care...... and similar phenomena are among these collective innovations in tourism that are shaking the very bedrock of an industrial system that has been traditionally sustained along commercial value chains. To date there has been very little investigation of these trends, which have been inspired by, amongst other...... in the collaborative economy Dianne Dredge 5.Networked cultures in the collaborative economy Szilvia Gyimóthy 6.Policy and regulatory perspectives in the collaborative economy Dianne Dredge PART II - Disruptions, innovations and transformations 7.Regulating innovation in the collaborative economy: An examination...

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

NARCIS (Netherlands)

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

2010-01-01

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

Paediatric nuclear medicine

Energy Technology Data Exchange (ETDEWEB)

Da Costa, H [Bhabha Atomic Research Centre, Bombay (India). Radiation Medicine Centre

1978-05-01

The use of radiopharmaceutical agents for the diagnosis of diseases frequently encountered in the paediatric age group is outlined. The agents suitable for scanning of brain, thyroid, kidney, liver and spleen are mentioned and their efficacy in diagnosis of pathological conditions based on practical experience is reported. Bromide partition test for diagnosis of intracranial tuberculosis and /sup 131/I uptake test for thyroid study are also described. Dose of the agent is smaller than that in the case of adults and depends upon the child's body weight.

Gonad protection for the paediatric patient

International Nuclear Information System (INIS)

Gyll, C.

1988-01-01

A brief article gives examples of hip radiographs of paediatric patients showing misplacement of shields for gonad protection. Shields cut out of lead-PVC sheeting or the fenestration method of shielding are proposed as more successful methods of gonad shielding. (UK)

Investigating the Relationship between Learning Style Preferences and Teaching Collaboration Skills and Technology

DEFF Research Database (Denmark)

Kim, Seung L.; Sonnenwald, Diane H.

2002-01-01

This paper reports on an exploratory study that investigates the relationship between participants' learning style preferences and their perceptions of a professional workshop on collaboration and technology to support collaboration. The Learning Preference Scale-Students (LPSS) (Owens & Barnes...... style, and Group 2 showed a strong preference for competitive and cooperative learning styles. Group 1 rated the workshop more positively than Group 2. However, Group 2 reported a larger increase in self-efficacy compared to those in Group 1 (18.9% vs. 6.0%). Both groups provided different suggestions...... regarding the content of the workshop. Group 1 suggested adding more discussions and group exercises, whereas Group 2 suggested adding explicit theory or rules to govern behavior. These findings indicate that learning styles should be considered as a potential variable that influences learning outcomes...

Paediatric patient navigation models of care in Canada: An environmental scan.

Science.gov (United States)

Luke, Alison; Doucet, Shelley; Azar, Rima

2018-05-01

(1) To provide other organizations with useful information when implementing paediatric navigation programs and (2) to inform the implementation of a navigation care centre in New Brunswick for children with complex health conditions. This environmental scan consisted of a literature review of published and grey literature for paediatric patient navigation programs across Canada. Additional programs were found following discussions with program coordinators and navigators. Interviews were conducted with key staff from each program and included questions related to patient condition; target population and location; method delivery; navigator background; and navigator roles. Data analysis included analysis of interviews and identification of common themes across the different programs. We interviewed staff from 19 paediatric navigation programs across Canada. Programs varied across a number of different themes, including: condition and disease type, program location (e.g., hospital or clinic), navigator background (e.g., registered nurse or peer/lay navigator) and method of delivery (e.g., phone or face-to-face). Overall, navigator roles are similar across all programs, including advocacy, education, support and assistance in accessing resources from both within and outside the health care system. This scan offers a road map of Canadian paediatric navigation programs. Knowledge learned from this scan will inform stakeholders who are either involved in the delivery of paediatric patient navigation programs or planning to implement such a program. Specifically, our scan informed the development of a navigation centre for children with complex health conditions in New Brunswick.

Investigating Technical and Pedagogical Usability Issues of Collaborative Learning with Wikis

Science.gov (United States)

Hadjerrouit, Said

2012-01-01

Wikis have been recently promoted as tools that foster collaborative learning. However, there has been little research devoted to the criteria that are suitable to address issues pertinent to collaborative learning. This paper proposes a set of criteria to explore technical and pedagogical usability issues of collaborative learning with wikis. The…

Reduced N400 Semantic Priming Effects in Adult Survivors of Paediatric and Adolescent Traumatic Brain Injury

Science.gov (United States)

Knuepffer, C.; Murdoch, B. E.; Lloyd, D.; Lewis, F. M.; Hinchliffe, F. J.

2012-01-01

The immediate and long-term neural correlates of linguistic processing deficits reported following paediatric and adolescent traumatic brain injury (TBI) are poorly understood. Therefore, the current research investigated event-related potentials (ERPs) elicited during a semantic picture-word priming experiment in two groups of highly functioning…

Improving Treatment Response for Paediatric Anxiety Disorders

DEFF Research Database (Denmark)

Ege, Sarah; Reinholdt-Dunne, Marie Louise

2016-01-01

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...... interpretational biases, evidence regarding the effects of CBT on attentional biases is mixed. Novel treatment methods including attention bias modification training, attention feedback awareness and control training, and mindfulness-based therapy may hold potential in targeting attentional biases, and thereby...

Action, prevention and epidemiology of paediatric obesity

DEFF Research Database (Denmark)

Lissau, Inge

2005-01-01

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...... regarding a national action plan against obesity. CONCLUSION: This paper highlights some important aspects of the epidemiology, prevention and actions in the field of paediatric obesity with special focus on Denmark.......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...

Magnetic resonance imaging protocols for paediatric neuroradiology

International Nuclear Information System (INIS)

Saunders, Dawn E.; Thompson, Clare; Gunny, Roxanne; Jones, Rod; Cox, Tim; Chong, Wui Khean

2007-01-01

Increasingly, radiologists are encouraged to have protocols for all imaging studies and to include imaging guidelines in care pathways set up by the referring clinicians. This is particularly advantageous in MRI where magnet time is limited and a radiologist's review of each patient's images often results in additional sequences and longer scanning times without the advantage of improvement in diagnostic ability. The difficulties of imaging small children and the challenges presented to the radiologist as the brain develops are discussed. We present our protocols for imaging the brain and spine of children based on 20 years experience of paediatric neurological MRI. The protocols are adapted to suit children under the age of 2 years, small body parts and paediatric clinical scenarios. (orig.)

A concept analysis of holistic nursing care in paediatric nursing

OpenAIRE

A.A. Tjale; J. Bruce

2007-01-01

Holistic nursing care is widely advocated and is espoused in the philosophy of the South African Nursing Council. This concept is unclear, variously interpreted and poorly understood in paediatric nursing. This study was undertaken to examine the meaning of holistic nursing care and to develop a framework for holistic nursing care, which can be utilised in nurse education settings and in clinical nursing practice in the context of paediatric nursing. A qualitative, interpretive, explorative a...

Determinants of virological outcome and adverse events in African children treated with paediatric nevirapine fixed-dose-combination tablets

NARCIS (Netherlands)

Bienczak, A.; Denti, P.; Cook, A.; Wiesner, L.; Mulenga, V.; Kityo, C.; Kekitiinwa, A.; Gibb, D.M.; Burger, D.M.; Walker, A.S.; McIlleron, H.

2017-01-01

BACKGROUND: Nevirapine is the only nonnucleoside reverse transcriptase inhibitor currently available as a paediatric fixed-dose-combination tablet and is widely used in African children. Nonetheless, the number of investigations into pharmacokinetic determinants of virological suppression in African

An interprofessional approach to improving paediatric medication safety

Directory of Open Access Journals (Sweden)

Kennedy Neil

2010-02-01

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.

Donor-Recipient Size Mismatch in Paediatric Renal Transplantation

Directory of Open Access Journals (Sweden)

J. Donati-Bourne

2014-01-01

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.

Paediatric x-ray examinations in Rio de Janeiro

International Nuclear Information System (INIS)

Azevedo, A C P; Osibote, O A; Boechat, M C B

2006-01-01

This work presents the results of a dose survey performed for paediatric patients and carried out in two large paediatric public hospitals in Rio de Janeiro city. The entrance surface dose (ESD) and the effective dose (ED) were evaluated for chest, skull, abdomen, lumbar spine, cervical spine and pelvis in antero-posterior (AP), postero-anterior (PA) and lateral (LAT) projections. For each examination, four age groups 0-1, 1-5, 5-10 and 10-15 years were studied. The DoseCal software was used to calculate these doses. Wide variations for the same type of examination and projection have been detected. These variations were evident, in Brazil, from previous work. In spite of the present results being still preliminary, they can give an idea of what paediatric ESDs are like in Brazil. Also, with respect to the entrance surface dose, some of the results are above the reference levels, which cause high ED, as well. On the other hand, the wide range of ESD reflects the disparity of radiographic techniques and demonstrates that the ALARA principle is not being applied in Brazilian hospitals and becomes a concern in terms of public health

The effect of adaptive statistical iterative reconstruction on the assessment of diagnostic image quality and visualisation of anatomical structures in paediatric cerebral CT examinations

International Nuclear Information System (INIS)

Larsson, Joel; Baath, Magnus; Thilander-Klang, Anne; Ledenius, Kerstin

2016-01-01

The purpose of this study was to investigate the effect of adaptive statistical iterative reconstruction (ASiR) on the visualisation of anatomical structures and diagnostic image quality in paediatric cerebral computed tomography (CT) examinations. Forty paediatric patients undergoing routine cerebral CT were included in the study. The raw data from CT scans were reconstructed into stacks of 5 mm thick axial images at various levels of ASiR. Three paediatric radiologists rated six questions related to the visualisation of anatomical structures and one question on diagnostic image quality, in a blinded randomised visual grading study. The evaluated anatomical structures demonstrated enhanced visibility with increasing level of ASiR, apart from the cerebrospinal fluid space around the brain. In this study, 60 % ASiR was found to be the optimal level of ASiR for paediatric cerebral CT examinations. This shows that the commonly used 30 % ASiR may not always be the optimal level. (authors)

Paediatric pelvic imaging: improvement in gonad shield placement by multidisciplinary audit

Energy Technology Data Exchange (ETDEWEB)

McCarty, M.; Waugh, R.; McCallum, H.; Montgomery, R.J.; Aszkenasy, O.M. [South Cleveland Hospital, Middlesbrough (United Kingdom)

2001-09-01

In 1996, there were local reports of poor gonad protection for paediatric pelvic radiographs. To investigate the nature of the problem and make necessary improvements. Materials and methods: A retrospective audit of 218 paediatric pelvic radiographs was undertaken in 1997. Each radiograph was assessed for the presence of a gonad shield, appropriateness of the device and its position. A multidisciplinary team was formed with representation from radiology, radiography, orthopaedics and medical physics to investigate ways of improving technique and reducing patient dose. These included radiographer training and the introduction of digital fluoroscopy as an alternative imaging technique in follow-up patients. There were further rounds of data collection in 1998 and 1999. In round 1, a gonad shield was present in 77.9 % of boys' films and 76 % of girls' films where one should have been, increasing to 85.2 % and 85.4 % respectively by round 3 of the audit (P < 0.05). Only 31.6 % of boys' devices and 21.9 % of girls' devices were correctly positioned in round 1, increasing to 78.3 % and 94.3 %, respectively, by round 3 of the audit (P < 0.05). After round 1, no inappropriate devices were used. Audit was an effective tool in gaining the resources needed to improve technique and reduce radiation exposure in children. The multidisciplinary approach was vital in the success of this project. (orig.)

Paediatric pelvic imaging: improvement in gonad shield placement by multidisciplinary audit.

Science.gov (United States)

McCarty, M; Waugh, R; McCallum, H; Montgomery, R J; Aszkenasy, O M

2001-09-01

In 1996, there were local reports of poor gonad protection for paediatric pelvic radiographs. To investigate the nature of the problem and make necessary improvements. A retrospective audit of 218 paediatric pelvic radiographs was undertaken in 1997. Each radiograph was assessed for the presence of a gonad shield, appropriateness of the device and its position. A multidisciplinary team was formed with representation from radiology, radiography, orthopaedics and medical physics to investigate ways of improving technique and reducing patient dose. These included radiographer training and the introduction of digital fluoroscopy as an alternative imaging technique in follow-up patients. There were further rounds of data collection in 1998 and 1999. In round 1, a gonad shield was present in 77.9 % of boys' films and 76 % of girls' films where one should have been, increasing to 85.2 % and 85.4 % respectively by round 3 of the audit (P < 0.05). Only 31.6 % of boys' devices and 21.9 % of girls' devices were correctly positioned in round 1, increasing to 78.3 % and 94.3 %, respectively, by round 3 of the audit (P < 0.05). After round 1, no inappropriate devices were used. Audit was an effective tool in gaining the resources needed to improve technique and reduce radiation exposure in children. The multidisciplinary approach was vital in the success of this project.

Paediatric pelvic imaging: improvement in gonad shield placement by multidisciplinary audit

International Nuclear Information System (INIS)

McCarty, M.; Waugh, R.; McCallum, H.; Montgomery, R.J.; Aszkenasy, O.M.

2001-01-01

In 1996, there were local reports of poor gonad protection for paediatric pelvic radiographs. To investigate the nature of the problem and make necessary improvements. Materials and methods: A retrospective audit of 218 paediatric pelvic radiographs was undertaken in 1997. Each radiograph was assessed for the presence of a gonad shield, appropriateness of the device and its position. A multidisciplinary team was formed with representation from radiology, radiography, orthopaedics and medical physics to investigate ways of improving technique and reducing patient dose. These included radiographer training and the introduction of digital fluoroscopy as an alternative imaging technique in follow-up patients. There were further rounds of data collection in 1998 and 1999. In round 1, a gonad shield was present in 77.9 % of boys' films and 76 % of girls' films where one should have been, increasing to 85.2 % and 85.4 % respectively by round 3 of the audit (P < 0.05). Only 31.6 % of boys' devices and 21.9 % of girls' devices were correctly positioned in round 1, increasing to 78.3 % and 94.3 %, respectively, by round 3 of the audit (P < 0.05). After round 1, no inappropriate devices were used. Audit was an effective tool in gaining the resources needed to improve technique and reduce radiation exposure in children. The multidisciplinary approach was vital in the success of this project. (orig.)

Paediatric oncology in the developing world: an African perspective.

Science.gov (United States)

Nkrumah, F K

1987-09-01

Nutritional deficiency and infectious diseases constitute major paediatric priorities in most developing countries in Africa today. It is suggested that successful implementation of the various cost-effective intervention programmes which address themselves to these priorities will gradually unveil other paediatric problems presently considered of low priority. These will include the malignant diseases of childhood. The very high cost of cancer detection and treatment will demand carefully reasoned and planned approaches in most Third World countries. The implications of this in relation to childhood malignancies in Africa are discussed.

Paediatric trauma imaging: Why do we need separate guidance?

International Nuclear Information System (INIS)

Negus, S.; Danin, J.; Fisher, R.; Johnson, K.; Landes, C.; Somers, J.; Fitzsimmons, C.; Ashford, N.; Foster, J.

2014-01-01

It is often assumed that the pattern of injury in children mirrors that of the adult population, but children have different anatomical proportions and the relative elasticity of their tissues results in different injury patterns. The authors of this review are members of the British Society of Paediatric Radiologists subgroup and developed the recently published 47 paediatric trauma protocols for imaging children involved in major blunt trauma. The following article has been written to bring these guidelines to the attention of the wider community of UK radiologists, and explain the rationale behind the recommendations

Investigating the cost-effectiveness of videotelephone based support for newly diagnosed paediatric oncology patients and their families: design of a randomised controlled trial

Directory of Open Access Journals (Sweden)

Theodoros Deborah

2007-03-01

Full Text Available Abstract Background Providing ongoing family centred support is an integral part of childhood cancer care. For families living in regional and remote areas, opportunities to receive specialist support are limited by the availability of health care professionals and accessibility, which is often reduced due to distance, time, cost and transport. The primary aim of this work is to investigate the cost-effectiveness of videotelephony to support regional and remote families returning home for the first time with a child newly diagnosed with cancer Methods/design We will recruit 162 paediatric oncology patients and their families to a single centre randomised controlled trial. Patients from regional and remote areas, classified by Accessibility/Remoteness Index of Australia (ARIA+ greater than 0.2, will be randomised to a videotelephone support intervention or a usual support control group. Metropolitan families (ARIA+ ≤ 0.2 will be recruited as an additional usual support control group. Families allocated to the videotelephone support intervention will have access to usual support plus education, communication, counselling and monitoring with specialist multidisciplinary team members via a videotelephone service for a 12-week period following first discharge home. Families in the usual support control group will receive standard care i.e., specialist multidisciplinary team members provide support either face-to-face during inpatient stays, outpatient clinic visits or home visits, or via telephone for families who live far away from the hospital. The primary outcome measure is parental health related quality of life as measured using the Medical Outcome Survey (MOS Short Form SF-12 measured at baseline, 4 weeks, 8 weeks and 12 weeks. The secondary outcome measures are: parental informational and emotional support; parental perceived stress, parent reported patient quality of life and parent reported sibling quality of life, parental satisfaction

It takes two to tango : Investigating the antecedents and consequences of effective collaboration between designers and managers in innovation projects

NARCIS (Netherlands)

Tabeau, K.E.

2016-01-01

Designers are increasingly playing a strategic role in innovation projects. They can do this, amongst others, by more effectively collaborating with the managers of these projects. This thesis investigates the antecedents and consequences of effective collaboration between designers and managers in

Training fellows in paediatric cardiology: the Harvard experience.

Science.gov (United States)

Brown, David W; Allan, Catherine K; Newburger, Jane W

2016-12-01

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.

Texting preferences in a Paediatric residency.

Science.gov (United States)

Draper, Lauren; Kuklinski, Cadence; Ladley, Amy; Adamson, Greg; Broom, Matthew

2017-12-01

Text messaging is ubiquitous among residents, but remains an underused educational tool. Though feasibility has been demonstrated, evidence of its ability to improve standardised test scores and provide insight on resident texting preferences is lacking. The authors set out to evaluate: (1) satisfaction with a hybrid question-and-answer (Q&A) texting format; and (2) pre-/post-paediatric in-training exam (ITE) performance. A prospective study with paediatrics and internal medicine-paediatrics residents. Residents were divided into subgroups: adolescent medicine (AM) and developmental medicine (DM). Messages were derived from ITE questions and sent Monday-Friday with a 20 per cent variance in messages specific to the sub-group. Residents completed surveys gauging perceptions of the programme, and pre- and post-programme ITE scores were analysed. Forty-one residents enrolled and 32 (78%) completed a post-programme survey. Of those, 21 (66%) preferred a Q&A format with an immediate text response versus information-only texts. The percentage change in ITE scores between 2013 and 2014 was significant. Comparing subgroups, there was no significant difference between the percentage change in ITE scores. Neither group performed significantly better on either the adolescent or developmental sections of the ITE. Text messaging… remains an underused educational tool CONCLUSIONS: Overall, participants improved their ITE scores, but no improvement was seen in the targeted subgroups on the exam. Although Q&A texts are preferred by residents, further assessment is required to assess the effect on educational outcomes. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

ORIGINAL ARTICLES HIV transmission during paediatric health ...

African Journals Online (AJOL)

prevalence in paediatric health care settings in Africa, risks for horizontal ... 29 West Governer Road, Hershey, Pennsylvania, USA. David Gisselquist, PhD ..... tolerance policy for HIV transmission through health care. February 2004, Vol.

Paediatric laparoscopic hernia repair: Ex vivo skills in the reduced training era

Directory of Open Access Journals (Sweden)

Chris Parsons

2013-01-01

Full Text Available Introduction: Changes to surgical working hours have resulted in shorter training times and fewer learning opportunities. Tools that develop surgical skills ex-vivo are of particular interest in this era. Laparoscopic skills are regarded as essential by many for modern paediatric surgery practice. Several generic skills models have been reported and validated. However, there is limited evidence regarding the role of procedure specific models. Here, a laparoscopic paediatric hernia repair model is trialled with surgical trainees and their competence compared with consultant colleagues. Patients and Methods: An ex-vivo paediatric inguinal hernia repair model was devised. Surgical trainees from 5 specialist centres were recruited and performed multiple standardised repairs. Results: 23 trainees performed 192 repairs. Experts performed 10 repairs for comparison. Trainees were timed performing the repair and their accuracy measured. With repeated attempts trainee′s timings and accuracy improved until by the 10 th repair they were no different from benchmark consultant scores. Conclusion: A simple, procedure specific ex-vivo training model has been evaluated for laparoscopic hernia training in paediatric surgery. The results suggest improvements in competence with repetition. Trainee and benchmark consultant scores are no different by the 10 th trainee attempt. We conclude that this model may have a valuable role in the training and assessment of future paediatric surgeons.

Review of simulation in paediatrics: The evolution of a revolution

Directory of Open Access Journals (Sweden)

Rahul eOjha

2015-11-01

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.

Summarized institutional experience of paediatric airway surgery†.

Science.gov (United States)

Hoetzenecker, Konrad; Schweiger, Thomas; Schwarz, Stefan; Roesner, Imme; Leonhard, Matthias; Denk-Linnert, Doris-Maria; Schneider-Stickler, Berit; Bigenzahn, Wolfgang; Klepetko, Walter

2016-04-01

The management of paediatric airway stenosis is complex, and requires a dedicated team, consisting of thoracic surgeons, phoniatricians, logopaedics, paediatricians and anaesthetists. The majority of paediatric laryngotracheal stenosis is a sequela of prematurity and prolonged post-partal intubation/tracheostomy. Surgical correction is often difficult due to a frequent combination of glottic and subglottic defects. In 2012, the Laryngotracheal Program Vienna was launched. Since then, 18 paediatric patients were surgically treated for (laryngo-)tracheal problems. The median age of our patients was 26 months (range 2-180 months). Laryngotracheal stenosis extending up to the level of the vocal cords was evident in 9 patients. Three children were diagnosed with an isolated subglottic, and four with a short-segment tracheal stenosis or malacia. Two patients had a long-segment congenital malformation together with vascular ring anomalies. Five children were pretreated by rigid endoscopy before surgical correction, 12 of our 18 patients had a tracheostomy, 3 children were intubated at the time of operation. Different techniques of corrections were applied: laryngotracheal reconstruction (n = 4), extended partial cricotracheal resection (n = 4), cricotracheal resection with or without anterior split or dorsal mucosal flap (n = 4), slide tracheoplasty (n = 2), tracheal resection (n = 4). In 8 patients, a rib cartilage interposition was necessary in order to obtain a sufficient lumen enlargement and in 7 of these patients, an LT-Mold was placed to stabilize the reconstruction. We lost 2 patients, who were referred to our institution after failure of multiple preceding interventions, 2 and 3 months after the operation. Twelve patients are currently in an excellent condition, one is in an acceptable condition without a need for an intervention. Two patients required an endoscopic reintervention 18 and 33 months after the operation, 1 child is currently still cannulated

A CLINICAL STUDY AND MANAGEMENT OF PAEDIATRIC CATARACT, OUR EXPERIENCE

Directory of Open Access Journals (Sweden)

Satish D. Shet

2017-09-01

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

Global shortage of neonatal and paediatric antibiotic trials: rapid review.

Science.gov (United States)

Thompson, Georgina; Barker, Charlotte I; Folgori, Laura; Bielicki, Julia A; Bradley, John S; Lutsar, Irja; Sharland, Mike

2017-10-13

There have been few clinical trials (CTs) on antibiotics that inform neonatal and paediatric drug labelling. The rate of unlicensed and off-label prescribing in paediatrics remains high. It is unclear whether the current neonatal and paediatric antibiotic research pipeline is adequate to inform optimal drug dosing. Using the ClinicalTrials.gov registry, this review aims to establish the current global status of antibiotic CTs in children up to 18 years of age. Studies were identified using key word searches of the ClinicalTrials.gov registry and were manually filtered using prespecified inclusion/exclusion criteria. 76 registered open CTs of antibiotics in children were identified globally; 23 (30%) were recruiting newborns (only 8 (11%) included preterm neonates), 52 (68%) infants and toddlers, 58 (76%) children and 54 (71%) adolescents. The majority of registered trials were late phase (10 (15%) phase 3 and 23 (35%) phase 4/pharmacovigilance). Two-thirds were sponsored by non-profit organisations, compared with pharmaceutical companies (50 (66%) vs 26 (34%), respectively). A greater proportion of non-profit funded trials were efficacy-based strategic trials (n=34, 68%), in comparison with industry-led trials, which were most often focused on safety or pharmacokinetic data (n=17, 65%). Only 2 of the 37 antibiotics listed on the May 2016 Pew Charitable Trusts antibiotic development pipeline, currently being studied in adults, appear to be currently recruiting in open paediatric CTs. This review highlights that very few paediatric antibiotic CTs are being conducted globally, especially in neonates. There is a striking disparity noted between antibiotic drug development programmes in adults and children. © 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.

Case mix in paediatric rheumatology: implications for training in Australia.

Science.gov (United States)

Lim, Sern Chin; Allen, Roger C; Munro, Jane E; Akikusa, Jonathan D

2012-05-01

Despite a move towards the provision of specialist training in Australia in settings that extend beyond the public hospital system, formal comparisons of case mix between public and private specialty clinics have rarely been performed. It is therefore unclear for many specialties how well training in one setting prepares trainees for practice in the other. This study aims to compare the case mix of paediatric rheumatology patients seen in public and private settings and the referral sources of patients in each. An audit of all new patients seen in the public and private paediatric rheumatology clinics on campus at Royal Children's Hospital between June 2009 and January 2011. Data related to demographics, primary diagnosis, referral source and location seen were abstracted and compared. Eight hundred and seventy-six new patients were seen during the period of interest. Of these, 429 patients (48.9%) were seen in private clinics. The commonest diagnostic categories for both type of clinics were non-inflammatory musculoskeletal pain/orthopaedic conditions (public 39.4%, private 33.6%) followed by juvenile idiopathic arthritis (public 16.6%, %, private 18.6%), other skin/soft tissue disorders (public 8.7%, private 9.6%) and pain syndromes (public 4.9%, private 11.4%). Patients with haematological and vasculitic disorders were predominantly seen in public clinics. The commonest source of referrals to both clinics was general practitioners (public 40.6%, private 53.1%). The case mix in private paediatric rheumatology clinics closely mirrors that of public clinics at our centre. Training in either setting would provide sufficient case-mix exposure to prepare trainees for practice in the other. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Birth weight and risk of paediatric Hodgkin lymphoma: Findings from a population-based record linkage study in California.

Science.gov (United States)

Triebwasser, Corey; Wang, Rong; DeWan, Andrew T; Metayer, Catherine; Morimoto, Libby; Wiemels, Joseph L; Kadan-Lottick, Nina; Ma, Xiaomei

2016-12-01

To evaluate the relationship between birth weight (along with a variety of pre and perinatal characteristics) and the risk of paediatric Hodgkin lymphoma (HL) diagnosed at age birth records from 1978-2009 and cancer diagnosis data from 1988-2011 to conduct a population-based case-control study with 1216 cases and 4485 controls (matched on birth month and year, sex, and race/ethnicity). Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) of paediatric HL overall and by age of diagnosis, controlling for other perinatal factors. Compared to children with a normal birth weight (2500-3999 g), those who had a high birth weight (≥4000 g) had an increased risk of paediatric HL overall (OR = 1.23, 95% CI: 1.02-1.48) after adjusting for birth order, maternal age at the time of delivery, and paternal age at the time of delivery. The magnitude of association appeared larger for subgroups of children whose age of diagnosis was 0-10 years (OR = 1.56, 95% CI: 1.04-2.24) or 15-19 years (OR = 1.43, 95% CI: 1.11-1.83), while no association was observed in 11-14 year olds. Compared with firstborn children, those who were third or higher in birth order had a reduced risk of paediatric HL overall (OR = 0.80, 95% CI: 0.67-0.95), and this association also varied by age of diagnosis. In this study with the largest number of paediatric HL cases, high birth weight was associated with an increased disease risk for most but not all ages of diagnosis. The different findings by age of diagnosis regarding both birth weight and birth order underscore the importance to stratify paediatric HL by age at diagnosis in future etiological investigations. Copyright © 2016 Elsevier Ltd. All rights reserved.

Assessment of paediatric CT exposure in a Portuguese hospital

International Nuclear Information System (INIS)

Neves, A.; Nunes, A.; Rufino, M.; Madeira, P.; Vaz, P.; Pascoal, A.

2012-01-01

In this study, the characterisation of radiation exposure of paediatric patients in computerised tomography (CT) procedures was performed for a Portuguese hospital. Dosimetric data and technical parameters used for CT examinations were retrieved, compiled and analysed over a period of 1 y. Five paediatric age groups were considered, covering the age interval from 0 (newborn) to 18 y old and, for each age group, the relative frequency of the most frequent CT examinations (head, ears, sinuses, chest and abdomen examinations) is analysed. The exposure settings used (kilovolt and milli-ampere) were compared with the values established in the local (hospital) clinical protocols for consistency analysis. Average CT dose index vol and dose length product values, per age group, are presented as well as the corresponding estimated mean effective dose values. Results showed an evident need for a protocol review, in order to adjust practices to international guidelines for performing optimised paediatric CT examinations. Also, an increased awareness of staff to Radiological Protection principles in CT in particular, these of utmost importance, seems necessary. (authors)

Significant regional heterogeneity of coronary flow reserve in paediatric hypertrophic cardiomyopathy

International Nuclear Information System (INIS)

Tadamura, E.; Kudoh, T.; Kubo, S.; Konishi, J.; Motooka, M.; Nohara, R.; Matsumori, A.; Sasayama, S.; Matsuda, T.; Tamaki, N.

2000-01-01

Previous studies have indicated that cardiac events in young patients with hypertrophic cardiomyopathy (HCM) are related to ischaemia rather than to arrhythmia. We measured coronary flow reserve in paediatric HCM and compared the values with those in adult HCM. We studied 12 patients with HCM including six paediatric ( 20 years old: mean 62 years), and six healthy young adults (mean 29 years) as controls. Every patient underwent magnetic resonance imaging (MRI) for anatomical assessment. Myocardial blood flow at rest and after dipyridamole infusion was measured with dynamic nitrogen-13 ammonia positron emission tomography (PET). Partial volume effect was corrected for using the anatomical data obtained with MRI. In adult patients with HCM, coronary flow reserve in the hypertrophied septal region was not significantly different from that in the non-hypertrophied lateral wall (1.38±0.29 vs 1.77±0.39, respectively). In the paediatric patients, coronary flow reserve in the hypertrophied septal region was significantly lower than in the non-hypertrophied lateral wall (0.84±0.33 vs 2.74±0.90, respectively, P<0.01). In addition, coronary flow reserve in adult patients was lower than in control subjects both in the septal wall (1.38±0.29 vs 2.94±0.35, respectively, P<0.0001) and in the lateral wall (1.77±0.39 vs 2.85±0.69, respectively, P<0.05). In contrast, coronary flow reserve in paediatric patients was not significantly different from that in control subjects in the lateral wall (2.74±0.90 vs 2.85±0.69, respectively), while absolute reduction of myocardial blood flow was noted after pharmacological vasodilatation in the hypertrophied septal region. In conclusion, significant regional differences of coronary flow reserve were present in the paediatric patients with HCM. These results suggest that paediatric patients with HCM intrinsically have the potential to experience significant regional ischaemia even in the absence of coronary stenosis. (orig.)

The European Paediatric Mycology Network (EPMyN): Towards a Better Understanding and Management of Fungal Infections in Children.

Science.gov (United States)

Warris, Adilia

The European Paediatric Mycology Network (EPMyN) was launched in 2014 to create a European platform for research and education in the field of paediatric mycology. The EPMyN aims to address the lack of paediatric specific evidence and knowledge needed to (1) improve the management and outcome of invasive fungal infections in children and neonates and to (2) enhance and develop paediatric antifungal stewardship programmes.

Paediatric doses from diagnostic radiology in Victoria

International Nuclear Information System (INIS)

Boal, T.J.; Cardillo, I.; Einsiedel, P.F.

1998-01-01

This study examines doses to paediatric patients from diagnostic radiology. Measurements were made at 29 hospitals and private radiology practices in the state of Victoria. Entrance skin doses in air were measured for the exposure factors used by hospital radiology departments and private radiology practices for a standard size 1, 5, 10 and 15 year old child, for the following procedures: chest AP/PA, lat; abdomen AP; pelvis AP; lumbar spine AP, lat; and skull AP, lat. There was a large range of doses for each particular procedure and age group. Factors contributing to the range of doses were identified. Guidance levels for paediatric radiology based on the third quartile value of the skin entrance doses have been recommended and are compared with guidance levels. Copyright (1998) Australasian Physical and Engineering Sciences in Medicine

Whole-body MRI in paediatric oncology

NARCIS (Netherlands)

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

Building capacity in the rural physiotherapy workforce: a paediatric training partnership.

Science.gov (United States)

Williams, E N; McMeeken, J M

2014-01-01

Building capacity in the rural physiotherapy workforce: a paediatric training partnership' provided 6 months postgraduate paediatric clinical and academic training for two physiotherapists in rural Australia. It is described as a model for improving services and workforce retention. The need for 'an appropriate, skilled and well-supported health workforce' is the third goal in Australia's National Strategic Framework for Rural and Remote Health 2011. The World Health Organization recently published its first global policy for improving the retention of rural and remote health workers. Education is its first recommendation and aims to 'design continuing education and professional development programmes that meet the needs of rural health workers and that are accessible from where they live and work, so as to support their retention …'. Additionally, '… to be successful, continuing education needs to be linked to career paths, as well as with other education interventions'. The problem is a lack of paediatric physiotherapy expertise in rural areas due to an absence of postgraduate clinical training opportunities in the rural workforce. The result is fragmented local services for families who are forced to travel to metropolitan services, costly in terms of both time and money. The aims were to improve local paediatric physiotherapy clinical services, provide physiotherapists additional access to professional development and subsequently provide a career path to retain these health professionals. Evaluation of the project used purpose-built questionnaires as there are no specific indicators to monitor the performance of systems and services that are available to children and families in Australia. The paediatric physiotherapy training program was enabled through initial funding for a 12-month pilot project. Further government funding built on that success for this reported 6-month project. Funding to employ the postgraduate physiotherapists was essential to the

Paediatric Low-Vision Assessment and Management in a Specialist Clinic in the UK

Science.gov (United States)

Lennon, Julie; Harper, Robert; Biswas, Sus; Lloyd, Chris

2007-01-01

This article presents a survey of the demographical, educational and visual functional characteristics of children attending a specialist paediatric low-vision assessment clinic at Manchester Royal Eye Hospital. Comprehensive data were collected retrospectively from children attending the paediatric low-vision clinic between January 2003 and…

Hospital-in-the-Home — essential to an integrated model of paediatric care

LENUS (Irish Health Repository)

Hensey, CC

2017-01-01

The National Clinical Programme for Paediatrics and Neonatology is proposing a model of care that will determine the future delivery of children’s health services in Ireland1. The focus is on the provision of an integrated service with improved co-ordination between primary, secondary, and tertiary level facilities. A parallel goal is improvements in chronic care and medical care in the home. An expanded role for ambulatory care and hospital at home schemes with a reduced reliance on inpatient care is proposed in line with international best practice. Achieving these goals requires a paradigm shift in delivery of children’s health care, and reconfiguration of current services to deliver multidisciplinary care in hospital and at home. The recently approved planning application for the new children’s hospital provides an opportunity and heralds a change in the structure of paediatric services in Ireland. It will act as the nexus of paediatric care throughout Ireland; supporting paediatric services nationally through outreach programmes, and ensuring children are treated as close to home as possible. A Hospital-in-the-Home (HITH) program would help meet these objectives; and could provide home based acute paediatric care, leading to economic benefits, and the delivery of quality family-centred care.

Dose conversion coefficients for paediatric CT examinations with automatic tube current modulation

International Nuclear Information System (INIS)

Schlattl, H; Zankl, M; Becker, J; Hoeschen, C

2012-01-01

A common dose-saving technique used in modern CT devices is automatic tube current modulation (TCM), which was originally designed to also reduce the dose in paediatric CT patients. In order to be able to deduce detailed organ doses of paediatric models, dose conversion coefficients normalized to CTDI vol for an eight-week-old baby and seven- and eight-year-old children have been computed accounting for TCM. The relative difference in organ dose conversion coefficients with and without TCM is for many organs and examinations less than 10%, but can in some cases amount up to 30%, e.g., for the thyroid in the chest CT of the seven-year-old child. Overall, the impact of TCM on the conversion coefficients increases with increasing age. Besides TCM, also the effect of collimation and tube voltage on organ dose conversion coefficients has been investigated. It could be shown that the normalization to CTDI vol leads to conversion coefficients that can in most cases be considered to be independent of collimation and tube voltage. (paper)

Paediatric ultrasonography of the liver, hepatobiliary tract and pancreas

Energy Technology Data Exchange (ETDEWEB)

Rijn, R.R. van, E-mail: r.r.vanrijn@amc.uva.nl [Department of Radiology, Emma Children' s Hospital – Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Nievelstein, R.A.J. [Department of Radiology, Wilhelmina Children' s Hospital – University Medical Center, Heidelberglaan 100, 3584 CX Utrecht (Netherlands)

2014-09-15

In the field of paediatric radiology ultrasonography (US) is the most versatile imaging tool available. Children in general, by virtue of their body composition, are excellent candidates for US exams in whom abdominal anatomy and pathology can be visualised in great detail. The fact that during the US study a clinical history can be obtained strongly adds to the value of the US exam. This does require investment in time and expertise and ideally a paediatric radiologist performing the exam. In this review the role of ultrasonography (US) of the liver, biliary tract and pancreas in children is discussed.

Investigating the Effects of Prompts on Argumentation Style, Consensus and Perceived Efficacy in Collaborative Learning

Science.gov (United States)

Harney, Owen M.; Hogan, Michael J.; Broome, Benjamin; Hall, Tony; Ryan, Cormac

2015-01-01

This paper investigates the effects of task-level versus process-level prompts on levels of perceived and objective consensus, perceived efficacy, and argumentation style in the context of a computer-supported collaborative learning session using Interactive Management (IM), a computer facilitated thought and action mapping methodology. Four…

The World Congress of Paediatric Cardiology and Cardiac Surgery: "The Olympics of our profession".

Science.gov (United States)

Hugo-Hamman, Christopher; Jacobs, Jeffery Phillip

2012-12-01

The first World Congress of Paediatric Cardiology was held in London, United Kingdom, in 1980, organised by Dr. Jane Somerville and Prof. Fergus Macartney. The idea was that of Jane Somerville, who worked with enormous energy and enthusiasm to bring together paediatric cardiologists and surgeons from around the world. The 2nd World Congress of Paediatric Cardiology took place in New York in 1985, organised by Bill Rashkind, Mary Ellen Engle, and Eugene Doyle. The 3rd World Congress of Paediatric Cardiology was held in Bangkok, Thailand, in 1989, organised by Chompol Vongraprateep. Although cardiac surgeons were heavily involved in these early meetings, a separate World Congress of Paediatric Cardiac Surgery was held in Bergamo, Italy, in 1988, organised by Lucio Parenzan. Thereafter, it was recognised that surgeons and cardiologists working on the same problems and driven by a desire to help children should really rather meet together. A momentous decision was taken to initiate a Joint World Congress of Paediatric Cardiology and Cardiac Surgery. A steering committee was established with membership comprising the main organisers of the four separate previous Congresses, and additional members were recruited in an effort to achieve numerical equality of cardiologists and surgeons and a broad geographical representation. The historic 1st "World Congress of Paediatric Cardiology and Cardiac Surgery" took place in Paris in June, 1993, organised by Jean Kachaner. The next was to be held in Japan, but the catastrophic Kobe earthquake in 1995 forced relocation to Hawaii in 1997. Then followed Toronto, Canada (2001, organised by Bill Williams and Lee Benson), Buenos Aires, Argentina (2005, organised by Horatio Capelli and Guillermo Kreutzer), and most recently Cairns, Australia (2009, organised by Jim Wilkinson). Having visited Europe (1993), Asia-Pacific (1997), North America (2001), South America (2005), and Australia (2009), and reflecting the "African Renaissance", the

Job-sharing in paediatric training in Australia: availability and trainee perceptions.

Science.gov (United States)

Whitelaw, C M; Nash, M C

2001-04-16

To examine the current availability of job-sharing in paediatric training hospitals in Australia and to evaluate job-sharing from the trainees' perspective. National survey with structured telephone interviews and postal questionnai res. The eight major paediatric training hospitals in Australia. Directors of Paediatric Physician Training (DPPTs) at each hospital (or a staff member nominated by them) provided information by phone interview regarding job-sharing. All paediatric trainees who job-shared in 1998 (n=34) were sent written questionnaires, of which 25 were returned. Hospitals differed in terms of whether a trainee was required to give a reason for wishing to job-share, and what reasons were acceptable. One hospital stated that two specialty units (Intensive Care and Neonatal Intensive Care) were excluded from job-sharing, and another stated that certain units were unlikely to be allocated job-sharers. The remaining six hospitals said that all units were available for job-sharing, but the majority of their trainees disagreed. Only one hospital had a cap on the number of job-share positions available yearly. Trainees perceived benefits of job-sharing to include decreased tiredness, increased enthusiasm for work, and the ability to strike a balance between training and other aspects of life. Trainees believed job-sharing did not adversely affect the quality of service provided to patients, and that part-time training was not of lower quality than full-time training. Job-sharing in Australian paediatric training hospitals varies in terms of the number of positions available, eligibility criteria, and which units are available for job-sharing. In our survey, trainees' experience of job-sharing was overwhelmingly positive.

Ocular involvement in paediatric haemolytic uraemic syndrome.

Science.gov (United States)

Sturm, Veit; Menke, Marcel N; Landau, Klara; Laube, Guido F; Neuhaus, Thomas J

2010-11-01

The aim of this study was to estimate the frequency and severity of ocular involvement in paediatric patients with haemolytic uraemic syndrome (HUS). The study was designed as an institutional, retrospective, observational case series. Charts for all 87 paediatric patients with HUS treated at the University Children's Hospital Zurich between 1995 and 2007 were reviewed. Patients with ocular involvement were identified and clinical findings presented. Three of 69 examined patients with HUS showed ocular involvement. Ophthalmic findings in two children were consistent with bilateral Purtscher retinopathy, showing multiple haemorrhages, exudations and superficial retinal whitening. The third child presented with bilateral isolated central intraretinal haemorrhages as a milder form of ocular involvement. In one of the children with Purtscher retinopathy, laser photocoagulation was required for bilateral rubeosis irides and development of disc neovascularization. Longterm outcomes in the two severely affected children showed decreased visual acuity caused by partial atrophy of the optic nerves. In the milder case visual acuity was not impaired at any time. A minority of paediatric patients with HUS developed ocular involvement. Acute ocular findings varied in severity from isolated intraretinal haemorrhages to Purtscher-like retinopathy with retinal ischaemia. Longterm complications included the development of neovascularizations and consecutive optic nerve atrophy. Although ocular involvement in HUS seems to be rare, physicians should be aware of this complication because of its possible vision-endangering consequences. © 2009 The Authors. Journal compilation © 2009 Acta Ophthalmol.

The emerging trend of non-operative treatment in paediatric type I open forearm fractures.

Science.gov (United States)

Zhang, H; Fanelli, M; Adams, C; Graham, J; Seeley, M

2017-08-01

Open fractures are considered an orthopaedic emergency and are generally an indication for operative debridement. Recent studies have questioned this approach for the management of Gustilo-Anderson Type I open fractures in the paediatric population. This meta-analysis studies the non-operative management of Type I open paediatric forearm fractures. An Ovid MEDLINE and PubMed database literature search was performed for studies that involved a quantified number of Gustilo-Anderson Type I open forearm fractures in the paediatric population, which were treated without operative intervention. A fixed-effect meta-analysis, weighting each study based on the number of patients, and a pooled estimate of infection risk (with 95% confidence interval (CI)) was performed. The search results yielded five studies that were eligible for inclusion. No included patients had operative debridement and all were treated with antibiotics. The number of patients in each study ranged from 3 to 45, with a total of 127 paediatric patients in the meta-analysis. The infection rate was 0% for all patients included. The meta-analysis estimated a pooled infection risk of 0% (95% CI 0 to 2.9). The five included studies had a total of 127 patients with no cases of infection after non-operative management of Type I open paediatric forearm fractures. The infection rate of Type I fractures among operatively managed patients is 1.9%. The trend in literature towards non-operative treatment of paediatric Type I open fractures holds true in this meta-analysis.

Improving Treatment Response for Paediatric Anxiety Disorders: An Information-Processing Perspective.

Science.gov (United States)

Ege, Sarah; Reinholdt-Dunne, Marie Louise

2016-12-01

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 information-processing biases, and possibilities for improving treatment response. The literature reviewed indicates a role for attentional and interpretational biases in anxious psychopathology. While there is theoretical grounding and limited empirical evidence to indicate that CBT ameliorates interpretational biases, evidence regarding the effects of CBT on attentional biases is mixed. Novel treatment methods including attention bias modification training, attention feedback awareness and control training, and mindfulness-based therapy may hold potential in targeting attentional biases, and thereby in improving treatment response. The integration of novel interventions into an existing evidence-based protocol is a complex issue and faces important challenges with regard to determining the optimal treatment package. Novel interventions targeting information-processing biases may hold potential in improving response to CBT for paediatric anxiety disorders. Many important questions remain to be answered.

Thyroid doses and risk to paediatric patients undergoing neck CT examinations

Energy Technology Data Exchange (ETDEWEB)

Spampinato, Maria Vittoria; Tipnis, Sameer; Huda, Walter [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Tavernier, Joshua [Medical University of South Carolina, College of Medicine, Charleston, SC (United States)

2015-07-15

To estimate thyroid doses and cancer risk for paediatric patients undergoing neck computed tomography (CT). We used average CTDI{sub vol} (mGy) values from 75 paediatric neck CT examinations to estimate thyroid dose in a mathematical anthropomorphic phantom (ImPACT Patient CT Dosimetry Calculator). Patient dose was estimated by modelling the neck as mass equivalent water cylinder. A patient size correction factor was obtained using published relative dose data as a function of water cylinder size. Additional correction factors included scan length and radiation intensity variation secondary to tube-current modulation. The mean water cylinder diameter that modelled the neck was 14 ± 3.5 cm. The mathematical anthropomorphic phantom has a 16.5-cm neck, and for a constant CT exposure, would have thyroid doses that are 13-17 % lower than the average paediatric patient. CTDI{sub vol} was independent of age and sex. The average thyroid doses were 31 ± 18 mGy (males) and 34 ± 15 mGy (females). Thyroid cancer incidence risk was highest for infant females (0.2 %), lowest for teenage males (0.01 %). Estimated absorbed thyroid doses in paediatric neck CT did not significantly vary with age and gender. However, the corresponding thyroid cancer risk is determined by gender and age. (orig.)

Onset symptoms in paediatric multiple sclerosis

DEFF Research Database (Denmark)

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

2014-01-01

: 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...

EG-01EPIGENETIC INACTIVATION OF ARGININE BIOSYNTHESIS PATHWAY IN PAEDIATRIC HIGH GRADE GLIOMA

Science.gov (United States)

Channathodiyil, Prasanna; Kardooni, Hoda; Khozoie, Combiz; Nelofer, Syed; Darling, John; Morris, Mark; Warr, Tracy

2014-01-01

Aberrant cellular metabolism contributes significantly to the growth and proliferation of several tumour types. Identification of genes that control critical metabolic pathways is a major factor in the development of novel therapies that target metabolic defects in tumour cells. Our aim is to identify such genes in paediatric high grade glioma that are altered due to promoter hyper-methylation of cytosine residues in CpG dinucleotides. Genome wide DNA methylation profiling using Illumina infinium methylation 450K bead chip array was performed on 18 well-characterised short term cultures derived from paediatric high grade astrocytoma including 3 from diffuse intrinsic pontine glioma. Data analyses were based on beta scores of probes for each gene as measures of intensities of methylation. Genes were selected with beta scores of tumour > =0.70 and that of normal human astrocytes < =0.30. We identified that two vital genes involved in the regulation of arginine biosynthetic pathway, argininosuccinate synthetase 1(ASS1) and argininosuccinate lyase (ASL) were methylated in 9/18 (50%) cases. Hyper methylation was confirmed by methylation-specific PCR and up-regulation of gene expression following treatment with 2 µM 5-aza-2'-deoxyctidine. Down-regulation of ASS1 in hyper methylated samples was confirmed by Western blot analysis. Our findings report epigenetic deregulation of ASS1 and ASL in a subset of paediatric high grade glioma. The enzymes encoded by these genes are essential elements of urea cycle that function together in the de novo synthesis of arginine from citrulline. Tumour cells with deficient ASS1/ASL depend on external sources of arginine for survival and have been reported to be sensitive to autophagic cell death induced by arginine starvation. Therefore, further investigation may render the possibility of arginine-deprivation therapy in such sub type of paediatric high grade glioma. This therapeutic approach is of interest as tumour cells with abnormal

Current status of the clinical development and implementation of paediatric artemisinin combination therapies in Sub-Saharan Africa.

Science.gov (United States)

Agnandji, Selidji Todagbe; Kurth, Florian; Bélard, Sabine; Mombo-Ngoma, Ghyslain; Basra, Arti; Fernandes, José Francisco; Soulanoudjingar, Solange Solmeheim; Adegnika, Akim Ayola; Ramharter, Michael

2011-10-01

Timely treatment of infected children with artemisinin based combination therapies is an essential tool for the effective control and potential elimination of malaria. Until recently only tablet formulations have been available for the treatment of children leading to problems of swallowability, palatability and dosing. In consequence, paediatric drug formulations of artemisinin-based combination therapy (ACT) have been developed, showing a clinically significant improvement of tolerability in young children and of their implementation is an increasingly important public health issue. In this mini-review, we focus on the recent development of paediatric ACTs and their use in practice. Paediatric ACTs are formulated as syrup, powder for suspension, dispersible tablets and granules. Overall, the use of paediatric formulation results in an improved management of clinical malaria in young children. To date, only two paediatric ACTs have been certified with WHO prequalification status as an internationally accepted quality standard. Many more paediatric ACTs are available and in use in sub-Saharan Africa despite a lack of publicly available evidence from stringent clinical development programs. The conduct of effectiveness studies to support the introduction of paediatric ACTs in official treatment recommendations is crucial in the global strategy of malaria elimination and quality assurance of available products is a public health priority.

Dose constraints in paediatric radiotherapy; Contraintes de dose en radiotherapie pediatrique

Energy Technology Data Exchange (ETDEWEB)

Bernier, V. [Groupe de radiotherapie pediatrique SFCE, Centre Alexis-Vautrin, 54 - Nancy (France)

2010-10-15

The author discusses the issue of dose constraints for organs at risk when performing paediatric radiotherapy, and outlines that this issue is only partially resolved by the QUANTEC publication (quantitative estimates of normal tissue effects in the clinic). Then, he presents a guide elaborated by the French group of paediatric radiotherapists. This guide reviews organs at risk, imagery delineation requirements, dose constraints and short-, medium- and long-term consequences of organ irradiation. Short communication

Collaborative Learning in the Cloud

DEFF Research Database (Denmark)

Kirchner, Kathrin; Razmerita, Liana

2015-01-01

This present study aims to investigate how students perceive collaboration and identifies associated technologies used to collaborate. In particular we aim to address the following research questions: What are the factors that impact satisfaction with collaboration? How do these factors differ in...... in different collaborative settings? Based on data from 75 students from Denmark and Germany, the article identifies collaborative practices and factors that impact positively and negatively satisfaction with collaboration....

Recent advances in paediatric gastroenterology.

Science.gov (United States)

Hansen, Richard; Russell, Richard K; Muhammed, Rafeeq

2015-09-01

Over the last few years, many changes have been introduced in the diagnosis and management of paediatric gastrointestinal problems. This review highlights the recent developments in Helicobacter pylori infection, eosinophilic oesophagitis, coeliac disease and inflammatory bowel disease. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Balancing research interests and patient interests: a qualitative study into the intertwinement of care and research in paediatric oncology.

Science.gov (United States)

Dekking, Sara A S; van der Graaf, Rieke; Kars, Marijke C; Beishuizen, Auke; de Vries, Martine C; van Delden, Johannes J M

2015-05-01

Traditionally, in ethical guidelines and in research ethics literature, care and research are clearly separated based on their different objectives. In contrast, in paediatric oncology, research and care are closely combined. Currently, it is unknown how relevant actors in paediatric oncology perceive this combination of research and care. We conducted a qualitative study into the experiences of those involved in Dutch paediatric oncology with the intertwinement of research and care and the dual role of paediatric oncologists as researchers and treating physicians. A qualitative study approach, using two focus groups and 19 semi-structured, in-depth interviews with paediatric oncologists, research coordinators, parents of children with cancer, and adolescents with cancer. Four themes characterize how actors experience the intertwinement of research and care in paediatric oncology. First, research is considered of major importance, and paediatric oncology professionals convey this message to patients and their parents. Second, there is ambiguity about categorization of studies into cancer therapy as either research or treatment. Third, role conflicts appear within the work of the paediatric oncologists. Finally, the various benefits of combining treatment with research are emphasized. Research is regarded as a fundamental and indispensable characteristic of paediatric oncology practice. Paediatric oncology professionals, parents, and patients have a very positive outlook on combining research and care, but they may not be sufficiently critical with respect to potential conflicts. Increased reflection on how to optimally combine research and care could serve as an important protection of the interests of children with cancer and their parents. © 2015 Wiley Periodicals, Inc.

Compliance with dental treatment recommendations by rural paediatric patients after a live-video teledentistry consultation: A preliminary report.

Science.gov (United States)

McLaren, Sean W; Kopycka-Kedzierawski, Dorota T

2016-04-01

The purpose of this research was to assess the compliance rate with recommended dental treatment by rural paediatric dental patients after a live-video teledentistry consultation. A retrospective dental chart review was completed for 251 rural paediatric patients from the Finger Lakes region of New York State who had an initial teledentistry appointment with a paediatric dentist located remotely at the Eastman Institute for Oral Health in Rochester, NY. The recommended treatment modalities were tabulated and comprehensive dental treatment completion rates were obtained. The recommended treatment modality options of: treatment in the paediatric dental clinic; treatment using nitrous oxide anxiolysis; treatment with oral sedation; treatment in the operating room with general anaesthesia; or teleconsultation were identified for the 251 patients. Compliance rates for completed dental treatment based on initial teleconsultation recommendations were: 100% for treatment in the paediatric dental clinic; 56% for nitrous oxide patients; 87% for oral sedation; 93% for operating room; and 90% for teleconsultations. The differences in the compliance rates for all treatment modalities were not statistically significant (Fisher's exact test, p > 0.05). Compliance rates for completed comprehensive dental treatment for this rural population of paediatric dental patients were quite high, ranging from 56% to 100%, and tended to be higher when treatment was completed in fewer visits. Live-video teledentistry consultations conducted among rural paediatric patients and a paediatric dentist in the specialty clinic were feasible options for increasing dental treatment compliance rates when treating complex paediatric dental cases. © The Author(s) 2015.

Learning to diagnose using patient video case in paediatrics: perceptive and cognitive processes

OpenAIRE

Balslev, Thomas

2012-01-01

Thomas Balslev, a paediatric neurologist and educational researcher, defended his thesis on 24 November 2011. The thesis included five published papers, and investigated learning with authentic, brief patient video cases. With analysis of a video case in a small group, learning processes and sharing of knowledge was intensely stimulated. Small group discussion and subsequent listening to an expert’s think-aloud were particularly effective approaches to enhance diagnostic accuracy among non-ex...

Gonad shielding in paediatric pelvic radiography: Effectiveness and practice

International Nuclear Information System (INIS)

Warlow, Thomas; Walker-Birch, Peter; Cosson, Philip

2014-01-01

The use of Gonad Shields (GS) has been advocated during pelvic radiography since the 1950's, particularly in children where the risks from radiation are higher. Previous literature reports that GS are often omitted and rarely used correctly. Objectives: Presentation of findings concerning use of GS in the context of previous data in the literature, and recommend any appropriate actions. Method: A retrospective analysis of images from an existing DICOM Digital Teaching Library (DTL) was conducted. Images of the pelvis from paediatric patients were reviewed and scored on whether a GS was present and (if present) whether the shield was considered to adequately protect the gonads. Results: 130 images were reviewed. 70 male and 60 female. The gonads were deemed to be protected by a shield in 22 images (17%), inadequately protected when a shield was used in 44 images (34%) with the remaining 64 images (49%) having no shield at all. A lack of adequate protection for the gonads was found, with females more likely to be inadequately protected than males (χ 2  = 19.009, df = 1, p < 0.001). These findings become more clinically significant when reports of ovaries lying outside of the pelvic basin (in paediatric patients) are considered. Conclusions: The current practice of gonad shielding is neither effective nor beneficial for female paediatric patients, incorrect shield placement can often require repeat exposures. This finding is commensurate with previous literature. Therefore, gonad shielding is no longer an appropriate optimization tool for female paediatric patients during conventional radiography of the pelvis, and should be abandoned

Families' perceived benefits of home visits for managing paediatric obesity outweigh the potential costs and barriers.

Science.gov (United States)

Gehring, Nicole D; Ball, Geoff D C; Perez, Arnaldo; Holt, Nicholas L; Neuman, Daniel; Spence, Nicholas; Mercier, Laura; Jetha, Mary

2018-02-01

Home visits have successfully been used to deliver various health services, but what role could they play in paediatric weight management? Low treatment initiation and high attrition prompted our multidisciplinary paediatric weight management clinic to investigate how families perceived the benefits and barriers of home visits. We focused on children with obesity aged 2-17 who were enrolled in our tertiary-level clinic in Alberta, Canada. None had received a home visit. The families were interviewed face-to-face from October 2015 to October 2016, and we used a qualitative description methodological framework and manifest content analysis. The parents were the main interviewees. Of the 56 families, 89% were interested in a home visit, 82% wanted support from a dietician and 54% from an exercise specialist. The perceived benefits of home visits included comprehensive assessment (95%), convenience (86%), tailored care (29%) and family involvement (13%), while the costs and barriers included clinicians' potential judgmental attitudes (30%), loss of privacy (19%) and distractions (10%). Some thought clinicians would find home visits inconvenient (25%), with bureaucratic challenges (14%) and sustainability issues (5%). Families felt home visits were a convenient option for managing paediatric obesity and identified important benefits and barriers that could guide such interventions. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Paediatric acute asthma management in Australia and New Zealand : practice patterns in the context of clinical practice guidelines

NARCIS (Netherlands)

Babl, F. E.; Sheriff, N.; Borland, M.; Acworth, J.; Neutze, J.; Krieser, D.; Ngo, P.; Schutz, J.; Thomson, F.; Cotterell, E.; Jamison, S.; Francis, P.

Objectives: To compare clinical practice guideline (CPG) recommendations and reported physician management of acute paediatric asthma in the 11 largest paediatric emergency departments, all of which have CPGs, in Australia (n= 9) and New Zealand (n= 2). All 11 sites participate in the Paediatric

Clinical dehydration and glomerular filtration rate in acute paediatric gastroenteritis.

Science.gov (United States)

Milani, Gregorio P; Fossali, Emilio F; Perri, Alessandra; Vettori, Arianna; Grillo, Paolo; Agostoni, Carlo

2013-08-01

To evaluate changes in glomerular filtration rate in acute gastroenteritis. The correlation between two clinical diagnostic scales and glomerular filtration rate has been investigated in 113 children with acute gastroenteritis in a paediatric emergency setting. A significant reduction of GFR was found in 10% children less than, and 5% children higher than, 2 years of age with acute gastroenteritis. The differences observed as for risk of renal hypoperfusion suggests to consider the age of children as an important determinant to consider the dehydration status in acute gastroenteritis. ©2013 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Paediatric radiology. 2. enl. and tot. rev. ed.

International Nuclear Information System (INIS)

Benz-Bohm, G.

2005-01-01

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.) [de

What Do We Know about Knowledge Brokers in Paediatric Rehabilitation? A Systematic Search and Narrative Summary.

Science.gov (United States)

Schleifer Taylor, Jacqueline; Verrier, Molly C; Landry, Michel D

2014-01-01

To conduct a systematic review of the literature related to the use of knowledge brokers within paediatric rehabilitation, and specifically to determine (1) how knowledge brokers are defined and used in paediatric rehabilitation and (2) whether knowledge brokers in paediatric rehabilitation have demonstrably improved the performance of health care providers or organizations. The MEDLINE, CINAHL, EMBASE, and AMED databases were systematically searched to identify studies relating to knowledge brokers or knowledge brokering within paediatric rehabilitation, with no restriction on the study design or primary aim. Following review of titles and abstracts, those studies identified as potentially relevant were assessed based on the inclusion criteria that they: (1) examined some aspect of knowledge brokers/brokering in paediatric rehabilitation; (2) included sufficient descriptive detail on how knowledge brokers/brokering were used; and(3) were peer-reviewed and published in English. Of 1513 articles retrieved, 4 met the inclusion criteria, 3 of which referenced the same knowledge broker initiative. Two papers used mixed methods, one qualitative methodology, and one case presentation. Because of the different methods used in the included studies, the findings are presented in a narrative summary. This study provides an overview of the limited understanding of knowledge brokers within paediatric rehabilitation. Knowledge broker initiatives introduced within paediatric rehabilitation have been anchored in different theoretical frameworks, and no conclusions can be drawn as to the optimum combination of knowledge brokering activities and methods, nor about optimal duration, for sustained results.

The 2017 Seventh World Congress of Paediatric Cardiology and Cardiac Surgery: "The Olympics of our Profession".

Science.gov (United States)

Cohen, Mitchell I; Jacobs, Jeffrey P; Cicek, Sertac

2017-12-01

The 1st World Congress of Paediatric Cardiology was held in London, United Kingdom, in 1980, organised by Dr Jane Somerville and Prof. Fergus Macartney. The idea was that of Jane Somerville, who worked with enormous energy and enthusiasm to bring together paediatric cardiologists and surgeons from around the world. The 2nd World Congress of Paediatric Cardiology took place in New York in 1985, organised by Bill Rashkind, Mary Ellen Engle, and Eugene Doyle. The 3rd World Congress of Paediatric Cardiology was held in Bangkok, Thailand, in 1989, organised by Chompol Vongraprateep. Although cardiac surgeons were heavily involved in these early meetings, a separate World Congress of Paediatric Cardiac Surgery was held in Bergamo, Italy, in 1988, organised by Lucio Parenzan. Thereafter, it was recognised that surgeons and cardiologists working on the same problems and driven by a desire to help children would really rather meet together. A momentous decision was taken to initiate a Joint World Congress of Paediatric Cardiology and Cardiac Surgery. A steering committee was established with membership comprising the main organisers of the four separate previous Congresses and additional members were recruited in an effort to achieve numerical equality of cardiologists and surgeons and a broad geographical representation. The historic 1st "World Congress of Paediatric Cardiology and Cardiac Surgery" took place in Paris in June, 1993, organised by Jean Kachaner. The next was to be held in Japan, but the catastrophic Kobe earthquake in 1995 forced relocation to Hawaii in 1997. Then followed Toronto, Canada, 2001, organised by Bill Williams and Lee Benson; Buenos Aires, Argentina, 2005, organised by Horatio Capelli and Guillermo Kreutzer; Cairns, Australia, 2009, organised by Jim Wilkinson; Cape Town, South Africa, 2013, organised by Christopher Hugo-Hamman; and Barcelona, Spain, 2017, organised by Sertac Cicek. With stops in Europe (1993), Asia-Pacific (1997), North America

Skills of primary healthcare physicians in paediatric cardiac auscultation.

Science.gov (United States)

Germanakis, Ioannis; Petridou, Eleni T H; Varlamis, George; Matsoukis, Ioannis L; Papadopoulou-Legbelou, Kiriaki; Kalmanti, Maria

2013-02-01

To evaluate the performance of primary healthcare physicians in paediatric cardiac auscultation and the impact of a multimedia-based teaching intervention. A total of 106 primary healthcare physicians (77 paediatricians, 14 general practitioners and 15 medical graduates) attended four paediatric cardiac auscultation teaching courses based on virtual patients' presentation (digital phonocardiography). Their auscultatory performance was documented at the beginning of each course and at the end of two of the courses. Participants initially detected 73% of abnormal murmurs and 17% of additional sounds, while 22% of innocent murmurs were interpreted as abnormal. Overall cardiac auscultation performance, assessed by a combined auscultation score, was low and independent of training level (graduates: 39.5/trainees: 42.8/board certified: 42.6, p = 0.89) or specialty (paediatricians: 42.7/general practitioners: 43.1, p = 0.89). Multimedia-based teaching was associated with a significant improvement in abnormal murmur (92.5%) and additional sound (40%) detection (p auscultation, independent of training level or specialty, still leave potential for improvement. Multimedia-based teaching interventions represent an effective means of improving paediatric cardiac auscultatory skills. ©2012 The Author(s)/Acta Paediatrica ©2012 Foundation Acta Paediatrica.

Communication skills of healthcare professionals in paediatric diabetes services.

Science.gov (United States)

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

2009-05-01

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.

Inadequate vitamin D levels are associated with culture positive sepsis and poor outcomes in paediatric intensive care.

Science.gov (United States)

Onwuneme, Chike; Carroll, Aoife; Doherty, Dermot; Bruell, Heike; Segurado, Ricardo; Kilbane, Mark; Murphy, Nuala; McKenna, Malachi J; Molloy, Eleanor J

2015-10-01

This study aimed to assess vitamin D status, and its determinants, in paediatric patients with suspected sepsis who were admitted to a paediatric intensive care unit (PICU). We also investigated the association between vitamin D status and clinical outcomes. Serum 25-hydroxy vitamin D (25OHD) and clinical determinants were prospectively assessed in children with suspected sepsis (<12 years old) admitted to the PICU. The relationship between 25OHD and clinical outcomes was evaluated. Vitamin D status was also assessed in control children of a similar age. We enrolled 120 children with suspected sepsis admitted to the PICU and 30 paediatric controls. 25OHD was <50 nmol/L in 59% of the children admitted to the PICU and 25OHD was lower than in the controls (47 ± 29 vs 66 ± 26 nmol/L, p < 0.001). After adjusting for potential confounders, 25OHD was strongly associated with culture positive sepsis (p < 0.001), the paediatric index of mortality (p = 0.026) and the duration of mechanical ventilation (p = 0.008). There was a negative correlation between 25OHD and C-reactive protein (CRP): each 0.1% decrease in 25OHD increased CRP (p = 0.04). Children admitted to the PICU with suspected sepsis had lower 25OHD than controls and inadequate 25OHD status was associated with confirmed sepsis and poor outcomes. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Radiation Protection in Paediatric Radiology

International Nuclear Information System (INIS)

2012-01-01

Over the past decade and a half, special issues have arisen regarding the protection of children undergoing radiological examinations. These issues have come to the consciousness of a gradually widening group of concerned professionals and the public, largely because of the natural instinct to protect children from unnecessary harm. Some tissues in children are more sensitive to radiation and children have a long life expectancy, during which significant pathology can emerge. The instinct to protect children has received further impetus from the level of professional and public concern articulated in the wake of media responses to certain publications in the professional literature. Many institutions have highlighted the need to pay particular attention to the special problems of protecting paediatric patients. The International Commission on Radiological Protection has noted it and the IAEA's General Safety Requirements publication, Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards (BSS), requires it. This need has been endorsed implicitly in the advisory material on paediatric computed tomography scanning issued by bodies such as the US Food and Drug Administration and the National Cancer Institute in the United States of America, as well as by many initiatives taken by other national and regional radiological societies and professional bodies. A major part of patient exposure, in general, and paediatric exposure, in particular, now arises from practices that barely existed two decades ago. For practitioners and regulators, it is evident that this innovation has been driven both by the imaging industry and by an ever increasing array of new applications generated and validated in the clinical environment. Regulation, industrial standardization, safety procedures and advice on best practice lag (inevitably) behind industrial and clinical innovations. This Safety Report is designed to consolidate and provide timely advice on

Informed consent in paediatric critical care research--a South African perspective.

Science.gov (United States)

Morrow, Brenda M; Argent, Andrew C; Kling, Sharon

2015-09-09

Medical care of critically ill and injured infants and children globally should be based on best research evidence to ensure safe, efficacious treatment. In South Africa and other low and middle-income countries, research is needed to optimise care and ensure rational, equitable allocation of scare paediatric critical care resources. Ethical oversight is essential for safe, appropriate research conduct. Informed consent by the parent or legal guardian is usually required for child research participation, but obtaining consent may be challenging in paediatric critical care research. Local regulations may also impede important research if overly restrictive. By narratively synthesising and contextualising the results of a comprehensive literature review, this paper describes ethical principles and regulations; potential barriers to obtaining prospective informed consent; and consent options in the context of paediatric critical care research in South Africa. Voluntary prospective informed consent from a parent or legal guardian is a statutory requirement for child research participation in South Africa. However, parents of critically ill or injured children might be incapable of or unwilling to provide the level of consent required to uphold the ethical principle of autonomy. In emergency care research it may not be practical to obtain consent when urgent action is required. Therapeutic misconceptions and sociocultural and language issues are also barriers to obtaining valid consent. Alternative consent options for paediatric critical care research include a waiver or deferred consent for minimal risk and/or emergency research, whilst prospective informed consent is appropriate for randomised trials of novel therapies or devices. We propose that parents or legal guardians of critically ill or injured children should only be approached to consent for their child's participation in clinical research when it is ethically justifiable and in the best interests of both

The status of paediatric medicines initiatives around the world--What has happened and what has not?

Science.gov (United States)

Hoppu, Kalle; Anabwani, Gabriel; Garcia-Bournissen, Facundo; Gazarian, Madlen; Kearns, Gregory L; Nakamura, Hidefumi; Peterson, Robert G; Sri Ranganathan, Shalini; de Wildt, Saskia N

2012-01-01

This review was conducted to examine the current status of paediatric medicines initiatives across the globe. The authors made a non-systematic descriptive review of current world situation. Two regions, the United States (US) and the European Union (EU), and the World Health Organization (WHO) have introduced strong paediatric initiatives to improve children's health through improving access to better paediatric medicines. The experience from the US initiative indicates that it is possible to stimulate development and study of paediatric medicines and provide important new information for improvement of paediatric therapy. The early results from the EU initiative are similarly encouraging. In Canada, Japan, Australia and other developed countries, specific paediatric medicines initiatives have been less extensive and weaker, with modest results. Disappointingly, current evidence suggests that results from clinical trials outside the US often do not benefit children in the country in which the trials were largely conducted. Pharmaceutical companies that have derived a financial benefit commensurate with the cost of doing the paediatric trials in one country do not seem to be making the results of these trials available to all countries if there is no financial incentive to the company. The WHO campaign 'make medicines child size' has produced substantive accomplishments in building improved foundations to improve mechanisms that will enhance children's access to critical medicines in resource-limited settings. However, practically all of this work has been performed using an amalgamation of short-term funding from a variety of sources as opposed to a sustained, programmatic commitment. Although much still needs to be done, it's clear that with concerted efforts and appropriate resources, change is possible but slow. Retaining and fostering public and political interest in paediatric medicines is challenging, but pivotal for success.

MIH: epidemiologic clinic study in paediatric patient.

Science.gov (United States)

Condò, R; Perugia, C; Maturo, P; Docimo, R

2012-04-01

The Molar Incisor Hypomineralization (MIH) is a qualitative and quantitative defect of the enamel structure of the first permanent molars, which may vary from 1 to 4 with involvement of maxillary and jaw permanent incisors. AIM.: Aim of this study is that to evaluate, among 1500 paediatric patients chosen at random aged between 0 and 14 years, afferent by the Paediatric Dentistry of the Azienda Ospedialiera Policlinico Tor Vergata of Rome from 1996 to 2011, the incidents and the prevalence of the MIH distribution, and furthermore to ascertain the possible relationship with the data described in the literature. RESULTS AND DISCUSSION.: From the sample of 1500 paediatric patients, the number of those affections from MIH has turned out to be pairs to 110 (7.3%) aged between 4 and 15 years, and an average age equal to 9.7. The incidence of the hypoplastic defects is greater in the elements of the permanents series in which the functional class mainly interested is that of the first molars, with a percentage of 39.8%. Regarding the elements of the deciduous series affections from hypoplasia, they turn out to be in all in number of 20 represented in 80% of the cases from the seconds molars while in the remaining 20% of the cases the items involved are the central incisors. About the percentage of elements involved in the MIH: the molars, involved with a frequency of 56%, turn out to be more hit regarding incisors (44%). As reported in the literature, it can be asserted that the MIH can hit in equal measure both the male sex that feminine one. CONCLUSIONS.: MIH represents a condition quite frequent in the paediatric population. In managing this anomaly takes an essential role in the early diagnosis and in the differential one. The study done underlined the importance of a correct application of the therapeutic protocol which, starting from a careful diagnosis and articulating themselves in the execution of preventive treatments and in severe cases restorative and

A review of paediatric tuberculosis in Denmark

DEFF Research Database (Denmark)

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

2014-01-01

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...

Microcytosis and possible early iron deficiency in paediatric inpatients: a retrospective audit

Directory of Open Access Journals (Sweden)

Kitson Sarah

2009-05-01

Full Text Available Abstract Background Iron deficiency anaemia is a common paediatric problem worldwide, with significant neurodevelopmental morbidity if left untreated. A decrease in the mean corpuscular volume (MCV can be used as a surrogate marker for detecting early iron deficiency prior to definitive investigation and treatment. An audit cycle was therefore undertaken to evaluate and improve the identification, follow-up and treatment of abnormally low MCV results amongst the paediatric inpatients in an English district general hospital. Methods The audit cycle was performed retrospectively over two three-month periods (February to April 2006; September to November 2006, amongst patients aged between one month and 16 years that had full blood counts performed whilst admitted on the paediatric ward. Patients with at least one abnormally low MCV result were identified, and their notes reviewed. We looked for any underlying explanation for the result, adequate documentation of the result as abnormal, and instigation of follow-up or treatment. In-between the two audit periods, the results of the first audit period were presented to the medical staff and suggestions were made for improvements in documentation and follow-up of abnormal results. The z-test was used to test for equality of proportions between the two audit samples. Results Out of 701 inpatients across both audit periods that had full blood counts, 61 (8.7% had a low MCV result. Only 15% of patients in each audit period had an identifiable explanation for their low MCV values. Amongst the remaining 85% with either potentially explicable or inexplicable results, there was a significant increase in documentation of results as abnormal from 25% to 91% of cases between the first and second audit periods (p = 0.00 using z-test. However, there was no accompanying increase in the proportion of patients who received follow-up or treatment for their abnormal results. Conclusion Abnormal red cell indices that

What?s New in Paediatric Sepsis

OpenAIRE

Farrell, Deborah; Nadel, Simon

2016-01-01

Severe sepsis and septic shock remains a leading cause of mortality and morbidity in children. There is ongoing uncertainty regarding the optimal treatment pathways however the initial management of sepsis is crucial. This article is designed to be an informal and personal review of recent developments in paediatric sepsis over the past 3?years.

The effect of canal fill on paediatric femur fractures treated with titanium elastic nails.

Science.gov (United States)

Nielsen, E; Bonsu, N; Andras, L M; Goldstein, R Y

2018-02-01

Traditional teaching for fixation of paediatric femur fractures recommends 80% nail diameter/medullary canal diameter ratio (ND/MCD) for successful maintenance of reduction. Prior studies have investigated this with stainless steel Enders nails. Our aim was to assess the impact of ND/MCD on maintenance of reduction and malunion rates in paediatric femur fractures treated with flexible intramedullary nails (FINs). Retrospective data was collected on all paediatric patients treated with FINs for diaphyseal femur fractures at a single tertiary care institution over a ten-year period. Patients with co-morbidities affecting bone quality were excluded. Patients were subdivided into groups based on ND/MCD. A total of 66 patients met inclusion criteria. Mean ND/MCD was 76.3% (32.9% to 98.8%, SD 14.3). In all, 50% (n = 33/66) of patients had > 80% ND/MCD, and only 13.6% (n = 9/66) of patients had less than 60% ND/MCD. When controlling for fracture stability, ND/MCD had no correlation with mean shortening (p = 0.07) There was no correlation between ND/MCD and angulation in the sagittal (p = 0.96) or coronal plane (p = 0.20). Three patients fit malunion criteria. ND/MCD for these patients were 40%, 67% and 79%. There was no correlation between ND/MCD and shortening or malangulation. The majority of patients in this series with less than 80% fill with FIN healed within acceptable parameters. III.

Physicians' self-reported practice behaviour regarding fertility-related discussions in paediatric oncology in Sweden.

Science.gov (United States)

Armuand, G M; Nilsson, J; Rodriguez-Wallberg, K A; Malmros, J; Arvidson, J; Lampic, C; Wettergren, L

2017-10-01

The aim of this study was to investigate practice behaviours of Swedish physicians with regard to discussing the impact of cancer treatment on fertility with paediatric oncology patients and their parents, and to identify factors associated with such discussions. A cross-sectional survey study was conducted targeting all physicians in Sweden working in paediatric oncology care settings. Participants responded to a questionnaire measuring practice behaviour, attitudes, barriers, and confidence in knowledge. Multivariable logistic regression was used to determine factors associated with seldom discussing fertility. More than half of the physicians routinely talked with their patients/parents about the treatment's potential impact on fertility (male patients: 62%; female patients: 57%; P = 0.570). Factors associated with less frequently discussing fertility with patients/parents were working at a non-university hospital (male patients: OR 11.49, CI 1.98-66.67; female patients: OR 33.18, CI 4.06-271.07), concerns that the topic would cause worry (male patients: OR 8.23, CI 1.48-45.89; female patients: OR 12.38, CI 1.90-80.70), and perceiving the parents as anxious (male patients: OR 7.18, CI 1.20-42.85; female patients: OR 11.65, CI 1.32-103.17). Based on our findings, we recommend structured training in how to communicate about fertility issues in stressful situations, which in turn might increase fertility-related discussions in paediatric oncology. © 2017 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.

Assessment of clinical image quality in paediatric abdominal CT examinations: dependency on the level of adaptive statistical iterative reconstruction (ASiR) and the type of convolution kernel

International Nuclear Information System (INIS)

Larsson, Joel; Baath, Magnus; Thilander-Klang, Anne; Ledenius, Kerstin; Caisander, Haakan

2016-01-01

The purpose of this study was to investigate the effect of different combinations of convolution kernel and the level of Adaptive Statistical iterative Reconstruction (ASiR TM ) on diagnostic image quality as well as visualisation of anatomical structures in paediatric abdominal computed tomography (CT) examinations. Thirty-five paediatric patients with abdominal pain with non-specified pathology undergoing abdominal CT were included in the study. Transaxial stacks of 5-mm-thick images were retrospectively reconstructed at various ASiR levels, in combination with three convolution kernels. Four paediatric radiologists rated the diagnostic image quality and the delineation of six anatomical structures in a blinded randomised visual grading study. Image quality at a given ASiR level was found to be dependent on the kernel, and a more edge-enhancing kernel benefited from a higher ASiR level. An ASiR level of 70 % together with the Soft TM or Standard TM kernel was suggested to be the optimal combination for paediatric abdominal CT examinations. (authors)

Common tasks and problems in paediatric trauma radiology

International Nuclear Information System (INIS)

Paertan, Gerald; Pamberger, Petra; Blab, Edmund; Hruby, Walter

2003-01-01

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

Common tasks and problems in paediatric trauma radiology

Energy Technology Data Exchange (ETDEWEB)

Paertan, Gerald E-mail: gerald.paertan@smz.magwien.gv.at; Pamberger, Petra; Blab, Edmund; Hruby, Walter

2003-10-01

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.

Metastatic paediatric colorectal carcinoma.

LENUS (Irish Health Repository)

Woods, R

2012-03-01

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.

Voluntary Informed Consent in Paediatric Oncology Research.

Science.gov (United States)

Dekking, Sara A S; Van Der Graaf, Rieke; Van Delden, Johannes J M

2016-07-01

In paediatric oncology, research and treatments are often closely combined, which may compromise voluntary informed consent of parents. We identified two key scenarios in which voluntary informed consent for paediatric oncology studies is potentially compromised due to the intertwinement of research and care. The first scenario is inclusion by the treating paediatric oncologist, the second scenario concerns treatments confined to the research context. In this article we examine whether voluntary informed consent of parents for research is compromised in these two scenarios, and if so whether this is also morally problematic. For this, we employ the account of voluntary consent from Nelson and colleagues, who assert that voluntary consent requires substantial freedom from controlling influences. We argue that, in the absence of persuasion or manipulation, inclusion by the treating physician does not compromise voluntariness. However, it may function as a risk factor for controlling influence as it narrows the scope within which parents make decisions. Furthermore, physician appeal to reciprocity is not controlling as it constitutes persuasion. In addition, framing information is a form of informational manipulation and constitutes a controlling influence. In the second scenario, treatments confined to the research context qualify as controlling if the available options are restricted through manipulation of options. Although none of the influences is morally problematic in itself, a combination of influences may create morally problematic instances of involuntary informed consent. Therefore, safeguards should be implemented to establish an optimal environment for parents to provide voluntary informed consent in an integrated research-care context. © 2015 John Wiley & Sons Ltd.

Evaluating paediatric brain injury services in NSW.

Science.gov (United States)

Badge, H; Hancock, J; Waugh, M-C

2010-01-01

Rehabilitation professionals strive to provide high-quality evidence-based services for children. Developing systems to measure and monitor the benefits of our services, and health outcomes for children is complex and challenging. The Community Outcome Project aims to introduce systematic outcome measurement across the network of paediatric community-based brain injury services within the New South Wales Brain Injury Rehabilitation Program (BIRP) to support clinical practice and service evaluation. A literature review informed the development of the evaluative framework and identified available paediatric outcome measures which may be appropriate. Extensive consultation with clinicians supported project planning and identified clinical priorities that the outcome measures needed to capture. Outcome measures were shortlisted by matching them to identified clinical priorities, and then trialled in clinical practice. Qualitative feedback regarding clinical utility and feasibility was obtained from clinical staff. The process has utilized change management strategies to ensure the success of the project and keep staff engaged. The process identified the three main clinical priorities for outcome measurement - family functioning, school performance and participation. Three outcome measures were chosen for the pilot project that is currently underway. They are Family Burden of Injury Interview, Academic Competence and Evaluation Scales and Child and Adolescent Scale of Participation. Plans for analyses of outcome data within the paediatric BIRP services are discussed. Extensive preparation is required to optimize staff engagement in a project that systematically introduces outcome measures that are useful to clinicians, clients and service providers. Managing the change required is a key focus of the project. Benefits and costs to clinicians and services will be discussed.

Reducing the risk of radiocarcinogenesis in paediatric patients treated with external beam radiotherapy

International Nuclear Information System (INIS)

Taylor, M.L.; Franich, R.D.; Kron, Tomas

2010-01-01

Full text: The aim of this study was to determine readily-implementable means of out-of-field dose reduction in paediatric patients undergoing external beam radiotherapy for intracranial lesions. [n this way, the risk of secondary cancer induction may be reduced. Dose measurements were taken using LiF:Mg, Cu, P TLD 1 00 H chips in a 5 year old paediatric phantom. Multiple TLDs were placed at: the right and left lenses of the eye, optic nerve, brain, thyroid, lungs, heart, kidneys, abdomen and gonads. Varian 600 C and Varian Trilogy linear accelerators, both at 6 MV, were investigated, using different delivery parameters. Most of the out-of-field dose at large distances is attributable to leakage. The difference between stereotactic and larger field sizes is less significant far from the primary field. Out-of-field dose from the Trilogy was 40% higher than the 600 e . Aligning the craniocaudal axis of the patient with the x-plane of the collimator results in a dose reduction of 40%, for both machines. - A simple shielding arrangement may halve out-of-field dose. (author)

Inconsistencies in authoritative national paediatric workforce data sources.

Science.gov (United States)

Allen, Amy R; Doherty, Richard; Hilton, Andrew M; Freed, Gary L

2017-12-01

Objective National health workforce data are used in workforce projections, policy and planning. If data to measure the current effective clinical medical workforce are not consistent, accurate and reliable, policy options pursued may not be aligned with Australia's actual needs. The aim of the present study was to identify any inconsistencies and contradictions in the numerical count of paediatric specialists in Australia, and discuss issues related to the accuracy of collection and analysis of medical workforce data. Methods This study compared respected national data sources regarding the number of medical practitioners in eight fields of paediatric speciality medical (non-surgical) practice. It also counted the number of doctors listed on the websites of speciality paediatric hospitals and clinics as practicing in these eight fields. Results Counts of medical practitioners varied markedly for all specialties across the data sources examined. In some fields examined, the range of variability across data sources exceeded 450%. Conclusions The national datasets currently available from federal and speciality sources do not provide consistent or reliable counts of the number of medical practitioners. The lack of an adequate baseline for the workforce prevents accurate predictions of future needs to provide the best possible care of children in Australia. What is known about the topic? Various national data sources contain counts of the number of medical practitioners in Australia. These data are used in health workforce projections, policy and planning. What does this paper add? The present study found that the current data sources do not provide consistent or reliable counts of the number of practitioners in eight selected fields of paediatric speciality practice. There are several potential issues in the way workforce data are collected or analysed that cause the variation between sources to occur. What are the implications for practitioners? Without accurate

[Knowledge of health care ethics in paediatric residents].

Science.gov (United States)

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

2014-02-01

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.

Only Moderate Intra- and Inter-observer Agreement between Radiologists and Surgeons when Grading Blunt Paediatric Hepatic Injury on CT Scan

NARCIS (Netherlands)

Nellensteijn, D. R.; ten Duis, H. J.; Oldenziel, J.; Polak, W. G.; Hulscher, J. B. F.

2009-01-01

Introduction: The American Pediatric Surgical Association developed guidelines for the management of haemodynamically stable children with hepatic or splenic injury, based on grade of injury on CF scan. This study investigated the intra- and inter-observer agreement of radiologists, paediatric

Chiropractic care for paediatric and adolescent Attention-Deficit/Hyperactivity Disorder: A systematic review

Directory of Open Access Journals (Sweden)

Bonello Rod

2010-06-01

Full Text Available Abstract Background Psychostimulants are first line of therapy for paediatric and adolescent AD/HD. The evidence suggests that up to 30% of those prescribed stimulant medications do not show clinically significant outcomes. In addition, many children and adolescents experience side-effects from these medications. As a result, parents are seeking alternate interventions for their children. Complementary and alternative medicine therapies for behavioural disorders such as AD/HD are increasing with as many as 68% of parents having sought help from alternative practitioners, including chiropractors. Objective The review seeks to answer the question of whether chiropractic care can reduce symptoms of inattention, impulsivity and hyperactivity for paediatric and adolescent AD/HD. Methods Electronic databases (Cochrane CENTRAL register of Controlled Trials, Cochrane Database of Systematic reviews, MEDLINE, PsycINFO, CINAHL, Scopus, ISI Web of Science, Index to Chiropractic Literature were searched from inception until July 2009 for English language studies for chiropractic care and AD/HD. Inclusion and exclusion criteria were applied to select studies. All randomised controlled trials were evaluated using the Jadad score and a checklist developed from the CONSORT (Consolidated Standards of Reporting Trials guidelines. Results The search yielded 58 citations of which 22 were intervention studies. Of these, only three studies were identified for paediatric and adolescent AD/HD cohorts. The methodological quality was poor and none of the studies qualified using inclusion criteria. Conclusions To date there is insufficient evidence to evaluate the efficacy of chiropractic care for paediatric and adolescent AD/HD. The claim that chiropractic care improves paediatric and adolescent AD/HD, is only supported by low levels of scientific evidence. In the interest of paediatric and adolescent health, if chiropractic care for AD/HD is to continue, more rigorous

PO02 - Clinical profile of children admitted to a paediatric intensive care unit due to acute clinical deterioration

DEFF Research Database (Denmark)

Jensen, Claus Sixtus; Aagaard, Hanne; Olesen, Hanne Vebert

2016-01-01

Theme: Intensive care Background: There has been an increased number of critically ill patients admitted to paediatric departments. Only a few studies have described the various causes of unplanned admission to paediatric intensive care units (PICU) due to clinical deterioration. However...... and exploring life-threatening situations leading to unexpected transfers to PICU in hospitalised children. The study includes all paediatric departments in the Central Denmark Region. PERSPECTIVE: This study will provide knowledge to assist the research efforts to identify and improve the management...... of critical ill children in paediatric wards....

Diagnostic Accuracy of CT in Paediatric Intracranial Neoplastic Lesions - Radiologic and Pathologic Correlation

International Nuclear Information System (INIS)

Qureshi, A.

2011-01-01

The frequency of paediatric tumours in developing countries could be attributed to the increased percentage (39% of total population of children) in the overall population. Therefore, extensive researches should be under taken in the field of Paediatric Oncology in the third world. Objective: This study was conducted to determine the diagnostic accuracy of CT by comparing the pre-operative radiological findings of paediatric brain tumours with post-operative histopathological findings on the basis of characteristic radiological features of various tumours. Materials and Methods: This was a hospital based prospective, cross-sectional and descriptive study carried out in Radiology Dept, KEMU / Mayo Hospital, Lahore. Study was conducted over a period of 3 years from June 2005 till June 2008 and comprised of 100 cases of paediatric brain tumours up to 12 years of age. Cases were also collected from Mayo and Children Hospital, Lahore. Results: Topographically, supratentorial tumours were found more than infratentorial 55 : 45. Low grade were more common than high grade 73 : 27. The most common tumour was astrocytoma with 52 cases. Medulloblastoma ranked the second with 16 cases followed by craniopharyngioma with 12 cases. Conclusion: The diagnostic accuracy of CT scan was found to be 83% when correlated with histopathology. CT proved fairly accurate in detection of paediatric intracranial neoplastic lesions. As CT is relatively commonly available inexpensive modality than MRI so it can be used as non invasive imaging modality. (author)

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

Science.gov (United States)

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

2016-03-01

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.

Investigating JEEM empirically: a story of co-authorship and collaboration

OpenAIRE

Schymura, Michael; Löschel, Andreas

2012-01-01

We examine the incidence and extent of co-authorship and intellectual collaboration in the leading journal of environmental and resource economics: the Journal of Environmental Economics and Management. Previous studies of general economic journals have offered empirical evidence for the fact that intellectual collaboration is most prevalent in the field of environmental and resource economics. However, no previous study has examined this finding more carefully. This is a gap in the literatur...

Evaluation of the entrance skin dose due to paediatric chest X-rays examinations carried out at a great hospital in Rio de Janeiro city

International Nuclear Information System (INIS)

Mohamadain, K.E.M.; Azevedo, A.C.P.; Rosa, L.A.R. da; Mota, H.C.; Goncalves, O.D.; Guebel, M.R.N.

2001-01-01

A dosimetric survey in paediatric radiology is currently being carried out at the paediatric unit of a great hospital in Rio de Janeiro city, aiming the assessment of patient doses and image quality. The aim of this work was to estimate the entrance skin dose for frontal and lateral chest X-rays exposure to paediatric patients. Three examination techniques were investigated, namely PA, AP and lateral positions. For entrance skin dose evaluation, two different TL dosimeters were used, namely LiF:Mg,Ti and CaSO4:Dy. The age intervals considered were 0-1 year, 1-5 years, 5-10 years and 10-15 years. The results obtained with both dosimeters are similar and the entrance skin dose values evaluated for the different age intervals considered are compared with previous values found in Brazil and also in Europe. (author)

Sedation for paediatric auditory electrophysiology in South Africa

African Journals Online (AJOL)

emergency departments and nuclear medicine.1 Added to this is the periodic need ... electrophysiology in the paediatric population in South Africa were not found. ..... to inadequate information technology infrastructure as well as limited data ...

Managing guidelines to support parents with the hospitalisation of their child in a private paediatric unit

OpenAIRE

2008-01-01

The purpose of this research study was to describe managerial guidelines to support parents with the hospitalisation of their child in a private paediatric unit. The study explored and described: · the nursing care experiences of parents regarding the hospitalisation of their child in a paediatric unit; · managerial guidelines to support parents with their lived experiences of their child’s hospitalisation in a private paediatric unit. To achieve the purpose and the objectives of the research...

Initial in vitro testing of a paediatric continuous-flow total artificial heart.

Science.gov (United States)

Fukamachi, Kiyotaka; Karimov, Jamshid H; Horvath, David J; Sunagawa, Gengo; Byram, Nicole A; Kuban, Barry D; Moazami, Nader

2018-06-01

Mechanical circulatory support has become standard therapy for adult patients with end-stage heart failure; however, in paediatric patients with congenital heart disease, the options for chronic mechanical circulatory support are limited to paracorporeal devices or off-label use of devices intended for implantation in adults. Congenital heart disease and cardiomyopathy often involve both the left and right ventricles; in such cases, heart transplantation, a biventricular assist device or a total artificial heart is needed to adequately sustain both pulmonary and systemic circulations. We aimed to evaluate the in vitro performance of the initial prototype of our paediatric continuous-flow total artificial heart. The paediatric continuous-flow total artificial heart pump was downsized from the adult continuous-flow total artificial heart configuration by a scale factor of 0.70 (1/3 of total volume) to enable implantation in infants. System performance of this prototype was evaluated using the continuous-flow total artificial heart mock loop set to mimic paediatric circulation. We generated maps of pump performance and atrial pressure differences over a wide range of systemic vascular resistance/pulmonary vascular resistance and pump speeds. Performance data indicated left pump flow range of 0.4-4.7 l/min at 100 mmHg delta pressure. The left/right atrial pressure difference was maintained within ±5 mmHg with systemic vascular resistance/pulmonary vascular resistance ratios between 1.4 and 35, with/without pump speed modulation, verifying expected passive self-regulation of atrial pressure balance. The paediatric continuous-flow total artificial heart prototype met design requirements for self-regulation and performance; in vivo pump performance studies are ongoing.

Paediatric Neurological Conditions Seen at the Physiotherapy ...

African Journals Online (AJOL)

Paediatric neurological conditions constitute a major cause of disability in childhood. However there seems to be an apparent dearth of published works on the patterns of neurological conditions seen in Nigerian physiotherapy clinics of rural locations. This study aimed at describing the spectrum of neurological conditions ...

Parental satisfaction with paediatric care, triage and waiting times.

Science.gov (United States)

Fitzpatrick, Nicholas; Breen, Daniel T; Taylor, James; Paul, Eldho; Grosvenor, Robert; Heggie, Katrina; Mahar, Patrick D

2014-04-01

The present study aims to determine parental and guardian's perceptions of paediatric emergency care and satisfaction with care, waiting times and triage category in a community ED. A structured questionnaire was provided to parents or guardians of paediatric patients presenting to emergency. The survey evaluated parent perceptions of waiting time, environment/facilities, professionalism and communication skills of staff and overall satisfaction of care. One hundred and thirty-three completed questionnaires were received from parents of paediatric patients. Responses were overall positive with respect to the multiple domains assessed. Parents generally considered waiting times to be appropriate and consistent with triage categories. Overall satisfaction was not significantly different for varying treatment or waiting times. Patients triaged as semi-urgent were of the opinion that waiting times were less appropriate than urgent, less-urgent or non-urgent patients. On the basis of the present study, patient perceptions and overall satisfaction of care does not appear to be primarily influenced by time spent waiting or receiving treatment. Attempts made at the triage process to ensure that semi-urgent patients have reasonable expectations of waiting times might provide an opportunity to improve these patients' expectations and perceptions. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Intratidal recruitment/derecruitment persists at low and moderate positive end-expiratory pressure in paediatric patients.

Science.gov (United States)

Wirth, Steffen; Artner, Lisa; Broß, Tobias; Lozano-Zahonero, Sara; Spaeth, Johannes; Schumann, Stefan

2016-12-01

In paediatric patients positive end-expiratory pressure (PEEP) is traditionally set lower than in adults. We investigated whether moderately higher PEEP improves respiratory mechanics and regional ventilation. Therefore, 40 children were mechanically ventilated with PEEP 2 and 5cmH 2 O. Volume-dependent compliance profiles were analysed as a measure of intratidal recruitment/derecruitment. Regional ventilation was assessed using electrical impedance tomography. Mean compliance was 17.9±9.9mLcmH 2 O -1 (PEEP 2cmH 2 O), and 19.0±10.9mLcmH 2 O -1 (PEEP 5 cmH 2 O, pventilation. In conclusion, mechanically ventilated paediatric patients undergo intratidal recruitment/derecruitment which occurs more prominently in younger than in older children. A PEEP of 5cmH 2 O does not fully prevent intratidal recruitment/derecruitment but homogenizes regional ventilation in comparison to 2cmH 2 O. Copyright © 2016 Elsevier B.V. All rights reserved.

Comparative study of caudal bupivacaine versus bupivacaine with tramadol for postoperative analgesia in paediatric cancer patients

Institute of Scientific and Technical Information of China (English)

Mohammed Hegazy; Ayman A. Ghoneim

2013-01-01

Objective: Caudal epidural analgesia has become very common analgesic technique in paediatric surgery. Add-ing tramadol to bupivacaine for caudal injection prolongs duration of analgesia with minimal side effects. The aim of the study was to investigate the different effects of caudal bupivacaine versus bupivacaine with thamadol for postoperative analgesia in paediatric cancer patients. Methods: A prospective randomized controlled trial was conducted over 40 paediatric cancer pa-tients who were recruited from Children Cancer Hospital of Egypt (57357 Hospital). Patients were randomized into 2 groups: bupivacaine group (group B, 20 patients) to receive single shot caudal block of 1 mL/kg 0.1875% bupivacaine; tramadol group (group T, 20 patients) prepared as group B with the addition of 1 mg/kg caudal tramadol. Results: The mean duration of analgesia was significantly longer among group T than group B [(24 ± 13.7) hours versus (7 ± 3.7) hours respectively with P = 0.001]. Group T showed a significantly lower mean FLACC score than group B (2.2 ± 0.9 versus 3.6 ± 0.6 with P = 0.002). The difference in FLACC score was comparable on arrival, and after 2 and 4 hours. At 8 and 12 hours the group B recorded significantly higher scores (P = 0.002 and 0.0001 respectively). There were no significant differences between the groups as regards sedation score [the median in both groups was 1 (0–1) with P value = o.8]. No one developed facial flush or pruritis. Conclusion: Caudal injection of low dose tramadol 1 mg/kg with bupivacaine 0.1875% is proved to be effective, long standing technique for postoperative analgesia in major paediatric cancer surgery and almost devoid of side effect.

Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition

NARCIS (Netherlands)

Morin, Luc; Ray, Samiran; Wilson, Clare; Remy, Solenn; Benissa, Mohamed Rida; Jansen, Nicolaas J. G.; Javouhey, Etienne; Peters, Mark J.; Kneyber, Martin; De Luca, Daniele; Nadel, Simon; Schlapbach, Luregn Jan; Maclaren, Graeme; Tissieres, Pierre

2016-01-01

Purpose Although overall paediatric septic shock mortality is decreasing, refractory septic shock (RSS) is still associated with high mortality. A definition for RSS is urgently needed to facilitate earlier identification and treatment. We aim to establish a European society of paediatric and

Refractory septic shock in children : a European Society of Paediatric and Neonatal Intensive Care definition

NARCIS (Netherlands)

Morin, Luc; Ray, Samiran; Wilson, Clare; Remy, Solenn; Benissa, Mohamed Rida; Jansen, Nicolaas J. G.; Javouhey, Etienne; Peters, Mark J.; Kneyber, Martin; De Luca, Daniele; Nadel, Simon; Schlapbach, Luregn Jan; Maclaren, Graeme; Tissieres, Pierre

2016-01-01

Although overall paediatric septic shock mortality is decreasing, refractory septic shock (RSS) is still associated with high mortality. A definition for RSS is urgently needed to facilitate earlier identification and treatment. We aim to establish a European society of paediatric and neonatal

Paediatric organophosphate poisoning - a rural hospital experience ...

African Journals Online (AJOL)

Objectives. To document the presentation and course of organophosphate poisoning (OPP) in children and to record the frequency of atropine toxicity during treatment. Design. A retrospective observational study was conducted of all recorded paediatric cases of OPP admitted to a regional hospital over a 5-year period from ...

A collaborative epidemiological investigation into the criminal fake artesunate trade in South East Asia.

Directory of Open Access Journals (Sweden)

Paul N Newton

2008-02-01

Full Text Available Since 1998 the serious public health problem in South East Asia of counterfeit artesunate, containing no or subtherapeutic amounts of the active antimalarial ingredient, has led to deaths from untreated malaria, reduced confidence in this vital drug, large economic losses for the legitimate manufacturers, and concerns that artemisinin resistance might be engendered.With evidence of a deteriorating situation, a group of police, criminal analysts, chemists, palynologists, and health workers collaborated to determine the source of these counterfeits under the auspices of the International Criminal Police Organization (INTERPOL and the Western Pacific World Health Organization Regional Office. A total of 391 samples of genuine and counterfeit artesunate collected in Vietnam (75, Cambodia (48, Lao PDR (115, Myanmar (Burma (137 and the Thai/Myanmar border (16, were available for analysis. Sixteen different fake hologram types were identified. High-performance liquid chromatography and/or mass spectrometry confirmed that all specimens thought to be counterfeit (195/391, 49.9% on the basis of packaging contained no or small quantities of artesunate (up to 12 mg per tablet as opposed to approximately 50 mg per genuine tablet. Chemical analysis demonstrated a wide diversity of wrong active ingredients, including banned pharmaceuticals, such as metamizole, and safrole, a carcinogen, and raw material for manufacture of methylenedioxymethamphetamine ('ecstasy'. Evidence from chemical, mineralogical, biological, and packaging analysis suggested that at least some of the counterfeits were manufactured in southeast People's Republic of China. This evidence prompted the Chinese Government to act quickly against the criminal traders with arrests and seizures.An international multi-disciplinary group obtained evidence that some of the counterfeit artesunate was manufactured in China, and this prompted a criminal investigation. International cross

Potential of modern sonographic techniques in paediatric uroradiology

Energy Technology Data Exchange (ETDEWEB)

Riccabona, Michael E-mail: michael.riccabona@kfunigraz.ac.at

2002-08-01

Objective: To describe the potential of modern sonographic techniques in paediatric uroradiology. Method: Ultrasound (US)--now being the primary imaging tool--has revolutionised imaging diagnostic in the urinary tract. Constant developments and technical refinements have secured the role of US in uroradiology. Colour Doppler Sonography (CDS) and innovative applications such as the transperineal approach or application of m-mode US to the urinary tract have helped to develop US from just a basic tool to a sophisticated and respected method. The ongoing introduction of new and even more sophisticated methods further enhance the sonographic potential, which shall be demonstrated by a more detailed discussion of these methods. Results: Harmonic imaging, extended field of view US, amplitude coded CDS, echo-enhanced US, and three-dimensional US as the most recent new sonographic techniques are successfully applicable to paediatric urinary tract disease. They improve sonographic diagnosis in many conditions, such as detection of vesico-ureteral reflux, renal parenchymal volume assessment, comprehensive visualisation of hydronephrosis and complex pathology, evaluation of renal perfusional disturbances or defects, superior documentation with improved comparability for follow-up, or simply by offering clearer tissue delineation and differentiation. Conclusion: Modern US techniques are successfully applicable to neonates, infants, and children, further boosting the value of US in the paediatric urinary tract. However, as handling became more sophisticated, and artefacts have to be considered, modern urosonography became not only a more powerful, but also a more demanding method, with the need for expert knowledge and dedicated training.

Potential of modern sonographic techniques in paediatric uroradiology

International Nuclear Information System (INIS)

Riccabona, Michael

2002-01-01

Objective: To describe the potential of modern sonographic techniques in paediatric uroradiology. Method: Ultrasound (US)--now being the primary imaging tool--has revolutionised imaging diagnostic in the urinary tract. Constant developments and technical refinements have secured the role of US in uroradiology. Colour Doppler Sonography (CDS) and innovative applications such as the transperineal approach or application of m-mode US to the urinary tract have helped to develop US from just a basic tool to a sophisticated and respected method. The ongoing introduction of new and even more sophisticated methods further enhance the sonographic potential, which shall be demonstrated by a more detailed discussion of these methods. Results: Harmonic imaging, extended field of view US, amplitude coded CDS, echo-enhanced US, and three-dimensional US as the most recent new sonographic techniques are successfully applicable to paediatric urinary tract disease. They improve sonographic diagnosis in many conditions, such as detection of vesico-ureteral reflux, renal parenchymal volume assessment, comprehensive visualisation of hydronephrosis and complex pathology, evaluation of renal perfusional disturbances or defects, superior documentation with improved comparability for follow-up, or simply by offering clearer tissue delineation and differentiation. Conclusion: Modern US techniques are successfully applicable to neonates, infants, and children, further boosting the value of US in the paediatric urinary tract. However, as handling became more sophisticated, and artefacts have to be considered, modern urosonography became not only a more powerful, but also a more demanding method, with the need for expert knowledge and dedicated training

Safety of Levetiracetam in Paediatrics: A Systematic Review.

Directory of Open Access Journals (Sweden)

Oluwaseun Egunsola

Full Text Available To identify adverse events (AEs associated with Levetiracetam (LEV in children.Databases EMBASE (1974-February 2015 and Medline (1946-February 2015 were searched for articles in which paediatric patients (≤18 years received LEV treatment for epilepsy. All studies with reports on safety were included. Studies involving adults, mixed age population (i.e. children and adults in which the paediatric subpopulation was not sufficiently described, were excluded. A meta-analysis of the RCTs was carried out and association between the commonly reported AEs or treatment discontinuation and the type of regimen (polytherapy or monotherapy was determined using Chi2 analysis.Sixty seven articles involving 3,174 paediatric patients were identified. A total of 1,913 AEs were reported across studies. The most common AEs were behavioural problems and somnolence, which accounted for 10.9% and 8.4% of all AEs in prospective studies. 21 prospective studies involving 1120 children stated the number of children experiencing AEs. 47% of these children experienced AEs. Significantly more children experienced AEs with polytherapy (64% than monotherapy (22% (p<0.001. Levetiracetam was discontinued in 4.5% of all children on polytherapy and 0.9% on monotherapy (p<0.001, the majority were due to behavioural problems.Behavioural problems and somnolence were the most prevalent adverse events to LEV and the most common causes of treatment discontinuation. Children on polytherapy have a greater risk of adverse events than those receiving monotherapy.

Psychometric analysis of subjective sedation scales used for critically ill paediatric patients.

Science.gov (United States)

Ge, Xiaohua; Zhang, Tingting; Zhou, Lingling

2018-01-01

This study evaluated the psychometric properties of subjective sedation scales using one psychometric scoring system to identify the appropriate scale that is most suitable for clinical care practice. A number of published sedation assessment scales for paediatric patients are currently used to attempt to achieve a moderate depth of sedation to avoid the undesirable effects caused by over- or undersedation. However, there has been no systematic review of these scales. We searched the Cochrane Library, PubMed, EMBASE, the Cumulative Index to Nursing and Allied Health Literature, etc., to obtain relevant articles. The quality of the selected studies was evaluated according to the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. Articles that had been published or were in press and discussed the psychometric properties of sedation scales were included. The population comprised critically ill infants and non-verbal children ranging in age from 0 to 18 years who underwent sedation in an intensive care unit. Data were independently extracted by two investigators using a standard data extraction checklist: 43 articles were included in this review, and 13 sedation scales were examined. The quality of the psychometric evidence for the Comfort Scale and Comfort Behaviour Scale was 'very good', with the Comfort Scale having a higher quality (total weighted scores, Comfort Scale = 17·3 and Comfort Behaviour Scale = 15·5). We suggest that the scales be systematically and comprehensively tested in terms of development method, reliability, validation, feasibility and correlation with clinical outcome. The Comfort Scale and Comfort Behaviour Scale are useful tools for measuring sedation in paediatric patients. Nursing staff should choose one subjective sedation scale that is suitable for assessing paediatric patients' depth of sedation. We recommend the Comfort Scale and Comfort Behaviour Scale as optimal choices if the clinical

IV paracetamol effect on propofol-ketamine consumption in paediatric patients undergoing ESWL.

Science.gov (United States)

Eker, H Evren; Cok, Oya Yalçin; Ergenoğlu, Pınar; Ariboğan, Anış; Arslan, Gülnaz

2012-06-01

Electroshock wave lithotripsy (ESWL) is a painful procedure performed with sedoanalgesia in paediatric patients. The propofol-ketamine combination may be the preferable anaesthesia for this procedure, and propofol-ketamine consumption may be decreased with the administration of intravenous (IV) paracetamol. In this study we investigated the effect of IV paracetamol administration on propofol-ketamine consumption, recovery time and frequency of adverse events in paediatric patients undergoing ESWL. Sixty children, ranging in age from 1 to 10 years and with American Society of Anesthesiologists Physical Status 1-2, were included in this prospective, randomized, double-blinded study. Thirty minutes prior to the procedure children randomly assigned to Group I received IV 15 mg/kg paracetamol, and those randomly assigned to Group II received 1.5 mL/kg IV saline infusion 30 min. The propofol-ketamine combination was prepared by mixing 25 mg propofol and 25 mg ketamine in a total 10 mL solution in the same syringe. After the administration of 0.1 mg/kg midazolam and 10 μg/kg atropine to both groups and during the procedure, the propofol-ketamine combination was administered at 0.5 mg/kg doses to achieve a Wisconsin sedation score of 1 or 2. Oxygen saturation and heart rate were recorded at 5-min intervals. Propofol-ketamine consumption, recovery times and adverse events were also recorded. Demographic data were similar between groups. Propofol-ketamine consumption (Group I, 25.2 ± 17.7 mg; Group II, 35.4 ± 20.1 mg; p = 0.04) and recovery times (Group I, 19.4 ± 7.9 min; Group II, 29.6 ± 11.4 min; p ESWL procedures in paediatric patients and shortens recovery time.

[The Use of the Objective Structured Clinical Examination for Paediatric residents in the City of Buenos Aires].

Science.gov (United States)

Hamui, Magalí; Ferreira, Juan Pablo; Paganini, Agustina; Torres, Fernando; Ossorio, María Fabiana; Yulitta, Horacio; Eiguchi, Kumiko; Ferrero, Fernando

2016-01-01

The Objective Structured Clinical Examination (OSCE) is considered the reference standard for competence evaluation, but its use in Latin America is limited. The City of Buenos Aires Government (CBAG) administers a Paediatric residency system that includes 400 residents distributed in 13 hospitals, sharing an admission system and education program. We aim to describe the experience of administering an OSCE for evaluating all the Paediatric residents of the CBAG. Descriptive study, including all paediatric residents of the CBAG, belonging to 13 hospitals (2 paediatric and 11 general), ending their first year of training. The OSCE included 10 stations. Eighty-five residents participated in the OSCE, and 88.2% (95% CI 79.7-93.5) passed the examination. There were no significant differences in the pass rate between residents from paediatric hospitals and from general hospitals (89.5 vs. 85.7%; OR=1.4; 95% CI 0.4-5.5; P=.8). In 2015, the OSCE was administered to all paediatric residents of the CBAG for the first time. This experience allowed identifying weaknesses in the education system, in order to develop strategies to overcome them. Copyright © 2016 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Subgroups of Paediatric Acute Lymphoblastic Leukaemia Might Differ Significantly in Genetic Predisposition to Asparaginase Hypersensitivity.

Directory of Open Access Journals (Sweden)

Nóra Kutszegi

Full Text Available L-asparaginase (ASP is a key element in the treatment of paediatric acute lymphoblastic leukaemia (ALL. However, hypersensitivity reactions (HSRs to ASP are major challenges in paediatric patients. Our aim was to investigate genetic variants that may influence the risk to Escherichia coli-derived ASP hypersensitivity. Sample and clinical data collection was carried out from 576 paediatric ALL patients who were treated according to protocols from the Berlin-Frankfurt-Münster Study Group. A total of 20 single nucleotide polymorphisms (SNPs in GRIA1 and GALNT10 genes were genotyped. Patients with GRIA1 rs4958351 AA/AG genotype showed significantly reduced risk to ASP hypersensitivity compared to patients with GG genotype in the T-cell ALL subgroup (OR = 0.05 (0.01-0.26; p = 4.70E-04, while no such association was found in pre-B-cell ALL. In the medium risk group two SNPs of GRIA1 (rs2055083 and rs707176 were associated significantly with the occurrence of ASP hypersensitivity (OR = 0.21 (0.09-0.53; p = 8.48E-04 and OR = 3.02 (1.36-6.73; p = 6.76E-03, respectively. Evaluating the genders separately, however, the association of rs707176 with ASP HSRs was confined only to females. Our results suggest that genetic variants of GRIA1 might influence the risk to ASP hypersensitivity, but subgroups of patients can differ significantly in this respect.

Computational hybrid anthropometric paediatric phantom library for internal radiation dosimetry

Science.gov (United States)

Xie, Tianwu; Kuster, Niels; Zaidi, Habib

2017-04-01

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.

Paediatric population neuroimaging and the Generation R Study

DEFF Research Database (Denmark)

White, Tonya; Muetzel, Ryan L.; El Marroun, Hanan

2018-01-01

Paediatric population neuroimaging is an emerging field that falls at the intersection between developmental neuroscience and epidemiology. A key feature of population neuroimaging studies involves large-scale recruitment that is representative of the general population. One successful approach f...

Influence of awareness and availability of medical alternatives on parents seeking paediatric emergency care.

Science.gov (United States)

Ellbrant, Julia A; Åkeson, S Jonas; Karlsland Åkeson, Pia M

2018-06-01

Direct seeking of care at paediatric emergency departments may result from an inadequate awareness or a short supply of medical alternatives. We therefore evaluated the care-seeking patterns, availability of medical options and initial medical assessments - with overall reference to socioeconomic status - of parents at an urban paediatric emergency department in a Scandinavian country providing free paediatric healthcare. The parents of children assessed by paediatric emergency department physicians at a Swedish university hospital over a 25-day winter period completed a questionnaire on recent medical contacts and their reasons for attendance. Additional information was obtained from ledgers, patient records and population demographics. In total, 657 of 713 eligible patients (92%) were included. Seventy-nine per cent of their parents either failed to or managed to establish medical contact before the emergency department visit, whereas 21% sought care with no attempt at recent medical contact. Visits with a failed telephone or primary care contact (18%) were more common outside office hours ( p=0.014) and were scored as less urgent ( p=0.014). A perceived emergency was the main reason for no attempt at medical contact before the visit. Direct emergency department care-seeking was more common from the city district with the lowest socioeconomic status ( p=0.027). Although most parents in this Swedish study tried to seek medical advice before attending a paediatric emergency department, perceived emergency, a short supply of telephone health line or primary care facilities and lower socioeconomic status contributed to direct care-seeking by almost 40% of parents. Pre-hospital awareness and the availability of medical alternatives with an emphasis on major differences in socioeconomic status should therefore be considered to further optimize care-seeking in paediatric emergency departments.

A focus on paediatric hypertension

Directory of Open Access Journals (Sweden)

Pier Paolo Bassareo

2015-04-01

Full Text Available 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.

Radiation dose in paediatric cardiac catheterisation: A systematic literature review

International Nuclear Information System (INIS)

Gould, R.; McFadden, S.L.; Hughes, C.M.

2017-01-01

Objectives: It is believed that children are more sensitive to ionising radiation than adults. This work reviewed the reported radiation dose estimates for paediatric cardiac catheterisation. A systematic literature review was performed by searching healthcare databases for studies reporting radiation dose using predetermined key words relating to children having cardiac catheterisation. The quality of publications was assessed using relevant Critical Appraisal Skills Programme questions and their reported radiation exposures were evaluated. Key findings: It is only in recent years that larger cohort observations have been undertaken. Although radiation dose from paediatric cardiac catheterisation has decreased in recent years, the literature indicated that it remains varied and potentially substantial. Conclusion: Standardisation of weight categories and procedure types such as those recommended by the PiDRL project could help compare current and future radiation dose estimates. - Highlights: • 31 articles reporting radiation dose from paediatric cardiac catheterisation were reviewed. • In recent years, larger cohorts (>1000) have been reported. • Radiation dose to children has been lowered in the last decade but remains varied. • Future dosimetry should be consistent for weight categories and procedure types.

Simulated learning environment experience in nursing students for paediatric practice.

Science.gov (United States)

Mendoza-Maldonado, Yessy; Barría-Pailaquilén, René Mauricio

The training of health professionals requires the acquisition of clinical skills in a safe and efficient manner, which is facilitated by a simulated learning environment (SLE). It is also an efficient alternative when there are limitations for clinical practice in certain areas. This paper shows the work undertaken in a Chilean university in implementing paediatric practice using SLE. Over eight days, the care experience of a hospitalized infant was studied applying the nursing process. The participation of a paediatrician, resident physician, nursing technician, and simulated user was included in addition to the use of a simulation mannequin and equipment. Simulation of care was integral and covered interaction with the child and family and was developed in groups of six students by a teacher. The different phases of the simulation methodology were developed from a pedagogical point of view. The possibility of implementing paediatric clinical practice in an efficient and safe way was confirmed. The experience in SLE was highly valued by the students, allowing them to develop different skills and abilities required for paediatric nursing through simulation. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

Antibiotic Prescribing for Oro-Facial Infections in the Paediatric Outpatient: A Review

Directory of Open Access Journals (Sweden)

Najla Dar-Odeh

2018-04-01

Full Text Available There are many reports on the complications associated with antibiotics abuse during the treatment of paediatric patients, particularly those related to antimicrobial resistance. The dental profession is no exception; there is growing evidence that dental practitioners are misusing antibiotics in the treatment of their paediatric patients. This review is directed to dental practitioners who provide oral healthcare to children. It is also directed to medical practitioners, particularly those working in emergency departments and encountering children with acute orofacial infections. A systematic search of literature was conducted to explore the clinical indications and recommended antibiotic regimens for orofacial infections in paediatric outpatients. The main indications included cellulitis, aggressive periodontitis, necrotizing ulcerative gingivitis, and pericoronitis. Amoxicillin was found to be the most commonly recommended antibiotic for short durations of 3–5 days, with metronidazole or azithromycin being the alternative antibiotics in penicillin-sensitive patients.

Adrenal Disorders and the Paediatric Brain: Pathophysiological Considerations and Clinical Implications

Directory of Open Access Journals (Sweden)

Vincenzo Salpietro

2014-01-01

Full Text Available Various neurological and psychiatric manifestations have been recorded in children with adrenal disorders. Based on literature review and on personal case-studies and case-series we focused on the pathophysiological and clinical implications of glucocorticoid-related, mineralcorticoid-related, and catecholamine-related paediatric nervous system involvement. Childhood Cushing syndrome can be associated with long-lasting cognitive deficits and abnormal behaviour, even after resolution of the hypercortisolism. Exposure to excessive replacement of exogenous glucocorticoids in the paediatric age group (e.g., during treatments for adrenal insufficiency has been reported with neurological and magnetic resonance imaging (MRI abnormalities (e.g., delayed myelination and brain atrophy due to potential corticosteroid-related myelin damage in the developing brain and the possible impairment of limbic system ontogenesis. Idiopathic intracranial hypertension (IIH, a disorder of unclear pathophysiology characterised by increased cerebrospinal fluid (CSF pressure, has been described in children with hypercortisolism, adrenal insufficiency, and hyperaldosteronism, reflecting the potential underlying involvement of the adrenal-brain axis in the regulation of CSF pressure homeostasis. Arterial hypertension caused by paediatric adenomas or tumours of the adrenal cortex or medulla has been associated with various hypertension-related neurological manifestations. The development and maturation of the central nervous system (CNS through childhood is tightly regulated by intrinsic, paracrine, endocrine, and external modulators, and perturbations in any of these factors, including those related to adrenal hormone imbalance, could result in consequences that affect the structure and function of the paediatric brain. Animal experiments and clinical studies demonstrated that the developing (i.e., paediatric CNS seems to be particularly vulnerable to alterations induced by

Digital stethoscopes compared to standard auscultation for detecting abnormal paediatric breath sounds.

Science.gov (United States)

Kevat, Ajay C; Kalirajah, Anaath; Roseby, Robert

2017-07-01

Our study aimed to objectively describe the audiological characteristics of wheeze and crackles in children by using digital stethoscope (DS) auscultation, as well as assess concordance between standard auscultation and two different DS devices in their ability to detect pathological breath sounds. Twenty children were auscultated by a paediatric consultant doctor and digitally recorded using the Littman™ 3200 Digital Electronic Stethoscope and a Clinicloud™ DS with smart device. Using spectrographic analysis, we found those with clinically described wheeze had prominent periodic waveform segments spanning expiration for a period of 0.03-1.2 s at frequencies of 100-1050 Hz, and occasionally spanning shorter inspiratory segments; paediatric crackles were brief discontinuous sounds with a distinguishing waveform. There was moderate concordance with respect to wheeze detection between digital and standard binaural stethoscopes, and 100% concordance for crackle detection. Importantly, DS devices were more sensitive than clinician auscultation in detecting wheeze in our study. Objective definition of audio characteristics of abnormal paediatric breath sounds was achieved using DS technology. We demonstrated superiority of our DS method compared to traditional auscultation for detection of wheeze. What is Known: • The audiological characteristics of abnormal breath sounds have been well-described in adult populations but not in children. • Inter-observer agreement for detection of pathological breath sounds using standard auscultation has been shown to be poor, but the clinical value of now easily available digital stethoscopes has not been sufficiently examined. What is New: • Digital stethoscopes can objectively define the nature of pathological breath sounds such as wheeze and crackles in children. • Paediatric wheeze was better detected by digital stethoscopes than by standard auscultation performed by an expert paediatric clinician.

Paediatric nurses' understanding of the process and procedure of double-checking medications.

Science.gov (United States)

Dickinson, Annette; McCall, Elaine; Twomey, Bernadette; James, Natalie

2010-03-01

To understand paediatric nurses' understanding and practice regarding double-checking medication and identify facilitators and barriers to the process of independent double-checking (IDC). A system of double-checking medications has been proposed as a way of minimising medication error particularly in situations involving high-risk medications, complex processes such as calculating doses, or high-risk patient populations such as infants and children. While recommendations have been made in support of IDC in paediatric settings little is known about nursing practice and the facilitators and barriers to this process. A descriptive qualitative design was used. Data were collected via three focus group interviews. Six to seven paediatric nurses participated in homogenous groups based on level of practice. Data were analysed using thematic analysis. This study demonstrates that, while IDC is accepted and promoted as best practice in a paediatric setting, there is a lack of clarity as to what this means. This study supports other studies in relation to the influence of workload, distraction and environmental factors on the administration process but highlights the need for more research in relation to the impact of the power dynamic between junior and senior nurses. The issue of automaticity has been unexplored in relation to nursing practice but this study indicates that this may have an important influence on how care is delivered to patients. While the focus of this study was in the paediatric setting, the findings have relevance to other settings and population groups. The adoption of IDC in health care settings must have in place: policy and guidelines that clearly define the process of checking, educational support, an environment that supports peer critique and review, well-designed medication areas and accessible resources to support drug administration.

Prevalence of burnout in paediatric nurses: A systematic review and meta-analysis.

Science.gov (United States)

Pradas-Hernández, Laura; Ariza, Tania; Gómez-Urquiza, José Luis; Albendín-García, Luis; De la Fuente, Emilia I; Cañadas-De la Fuente, Guillermo A

2018-01-01

Although burnout in paediatric nurses has been addressed in previous research, the heterogeneous nature of the results obtained and of the variables studied highlights the need for a detailed analysis of the literature. The aim of this study was to analyse the literature on burnout characteristics, reported prevalence, severity and risk factors, to achieve a better understanding of the risk of emotional exhaustion, depersonalisation and feelings of low personal accomplishment. For this purpose, we carried out a systematic review and meta-analysis of the literature. The databases consulted were CINAHL, LILACS, PubMed, the Proquest Platform (Proquest Health & Medical Complete), Scielo and Scopus. This study used the search equation "burnout AND "pediatric nurs*", and was conducted in July 2017. The search produced 34 studies targeting burnout in paediatric nurses, with no restrictions on the date of publication. Many of these studies detected moderate-high values for the three dimensions of burnout, and highlighted sociodemographic, psychological and job-related variables associated with this syndrome. The sample population for the meta-analysis was composed of 1600 paediatric nurses. The following prevalence values were obtained: (i) emotional exhaustion, 31% (95% CI: 25-37%); (ii) depersonalisation, 21% (95% CI: 11-33%); (iii) low personal accomplishment, 39% (95% CI: 28-50%). A significant number of paediatric nurses were found to have moderate-high levels of emotional exhaustion and depersonalisation, and low levels of personal accomplishment. These nurses, therefore, were either experiencing burnout or at high risk of suffering it in the future. These results support the need for further study of the risk factors for burnout in paediatric nurses. They also highlight the importance of developing interventions or therapies to help prevent or attenuate the above symptoms, thus helping nurses cope with the workplace environment and with situations that may lead to

An Analysis of Collaborative Problem-Solving Activities Mediated by Individual-Based and Collaborative Computer Simulations

Science.gov (United States)

Chang, C.-J.; Chang, M.-H.; Liu, C.-C.; Chiu, B.-C.; Fan Chiang, S.-H.; Wen, C.-T.; Hwang, F.-K.; Chao, P.-Y.; Chen, Y.-L.; Chai, C.-S.

2017-01-01

Researchers have indicated that the collaborative problem-solving space afforded by the collaborative systems significantly impact the problem-solving process. However, recent investigations into collaborative simulations, which allow a group of students to jointly manipulate a problem in a shared problem space, have yielded divergent results…

Limited availability of childhood overweight and obesity treatment programmes in Danish paediatric departments

DEFF Research Database (Denmark)

Eg, Marianne; Cortes, Dina; Johansen, Anders

2016-01-01

INTRODUCTION: The prevalence of children and adolescents with overweight and obesity has tripled over the past 30 years. One in five children in Denmark is overweight, a condition which is accompanied by serious medical and psychosocial complications. So far, an overview of the Danish treatment...... of departments offered less comprehensive programmes. The final third offered no multidisciplinary treatment programme for the target group. The criteria for referral to the paediatric departments that offered obesity programmes were heterogeneous. FUNDING: Funding for this study was received from Region...... of childhood overweight and obesity has been lacking. METHODS: Telephone interviews with all Danish paediatric departments were conducted in 2014. The results, constituting a baseline, were analysed using the clinical guidelines for overweight and obesity published by the Danish Paediatric Society's Overweight...

Limited availability of childhood overweight and obesity treatment programmes in Danish paediatric departments

DEFF Research Database (Denmark)

Eg, Marianne; Cortes, Dina; Johansen, Anders

2016-01-01

INTRODUCTION: The prevalence of children and adolescents with overweight and obesity has tripled over the past 30 years. One in five children in Denmark is overweight, a condition which is accompanied by serious medical and psychosocial complications. So far, an overview of the Danish treatment...... of departments offered less comprehensive programmes. The final third offered no multidisciplinary treatment programme for the target group. The criteria for referral to the paediatric departments that offered obesity programmes were heterogeneous. FUNDING: Funding for this study was received from Region...... of childhood overweight and obesity has been lacking. METHODS: Telephone interviews with all Danish paediatric departments were conducted in 2014. The results, constituting a baseline, were analysed using the clinical guidelines for overweight and obesity published by the Danish Paediatric Society’s Overweight...

Assessment of Parents' Satisfaction with Paediatric Surgery Services ...

African Journals Online (AJOL)

Ademuyıwa O Adesoji

Items 1 - 14 ... Services at a Tertiary Hospital in South West Nigeria: A Quality Control ... literate parents of paediatric post-op patients were serially recruited from the pediatric .... such as poor electricity and water supply in a survey of dental.

ASSESSMENT OF CLINICAL IMAGE QUALITY IN PAEDIATRIC ABDOMINAL CT EXAMINATIONS: DEPENDENCY ON THE LEVEL OF ADAPTIVE STATISTICAL ITERATIVE RECONSTRUCTION (ASiR) AND THE TYPE OF CONVOLUTION KERNEL.

Science.gov (United States)

Larsson, Joel; Båth, Magnus; Ledenius, Kerstin; Caisander, Håkan; Thilander-Klang, Anne

2016-06-01

The purpose of this study was to investigate the effect of different combinations of convolution kernel and the level of Adaptive Statistical iterative Reconstruction (ASiR™) on diagnostic image quality as well as visualisation of anatomical structures in paediatric abdominal computed tomography (CT) examinations. Thirty-five paediatric patients with abdominal pain with non-specified pathology undergoing abdominal CT were included in the study. Transaxial stacks of 5-mm-thick images were retrospectively reconstructed at various ASiR levels, in combination with three convolution kernels. Four paediatric radiologists rated the diagnostic image quality and the delineation of six anatomical structures in a blinded randomised visual grading study. Image quality at a given ASiR level was found to be dependent on the kernel, and a more edge-enhancing kernel benefitted from a higher ASiR level. An ASiR level of 70 % together with the Soft™ or Standard™ kernel was suggested to be the optimal combination for paediatric abdominal CT examinations. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC).

Science.gov (United States)

Kneyber, Martin C J; de Luca, Daniele; Calderini, Edoardo; Jarreau, Pierre-Henri; Javouhey, Etienne; Lopez-Herce, Jesus; Hammer, Jürg; Macrae, Duncan; Markhorst, Dick G; Medina, Alberto; Pons-Odena, Marti; Racca, Fabrizio; Wolf, Gerhard; Biban, Paolo; Brierley, Joe; Rimensberger, Peter C

2017-12-01

Much of the common practice in paediatric mechanical ventilation is based on personal experiences and what paediatric critical care practitioners have adopted from adult and neonatal experience. This presents a barrier to planning and interpretation of clinical trials on the use of specific and targeted interventions. We aim to establish a European consensus guideline on mechanical ventilation of critically children. The European Society for Paediatric and Neonatal Intensive Care initiated a consensus conference of international European experts in paediatric mechanical ventilation to provide recommendations using the Research and Development/University of California, Los Angeles, appropriateness method. An electronic literature search in PubMed and EMBASE was performed using a combination of medical subject heading terms and text words related to mechanical ventilation and disease-specific terms. The Paediatric Mechanical Ventilation Consensus Conference (PEMVECC) consisted of a panel of 15 experts who developed and voted on 152 recommendations related to the following topics: (1) general recommendations, (2) monitoring, (3) targets of oxygenation and ventilation, (4) supportive measures, (5) weaning and extubation readiness, (6) normal lungs, (7) obstructive diseases, (8) restrictive diseases, (9) mixed diseases, (10) chronically ventilated patients, (11) cardiac patients and (12) lung hypoplasia syndromes. There were 142 (93.4%) recommendations with "strong agreement". The final iteration of the recommendations had none with equipoise or disagreement. These recommendations should help to harmonise the approach to paediatric mechanical ventilation and can be proposed as a standard-of-care applicable in daily clinical practice and clinical research.

Playing in "Trelis Weyr": Investigating Collaborative Practices in a "Dragons of Pern" Role-Play-Game Forum

Science.gov (United States)

Alley, Kathleen M.

2013-01-01

This descriptive case study examined adolescents' and emerging adults' literate and social practices within the context of a role-play-game (RPG) forum, investigating the ways participants read and collaboratively composed within this space. As a researcher, I was interested in how this space functioned and how the interactions between…

Understanding the Influence of Socioeconomic Environment on Paediatric Antiretroviral Treatment Coverage: Towards Closing Treatment Gaps in Sub-Saharan Africa.

Science.gov (United States)

Adeyinka, Daniel A; Evans, Meirion R; Ozigbu, Chamberline E; van Woerden, Hugo; Adeyinka, Esther F; Oladimeji, Olanrewaju; Aimakhu, Chris; Odoh, Deborah; Chamla, Dick

2017-03-01

Many sub-Saharan African countries have massively scaled-up their antiretroviral treatment (ART) programmes, but many national programmes still show large gaps in paediatric ART coverage making it challenging to reduce AIDS-related deaths among HIV-infected children. We sought to identify enablers of paediatric ART coverage in Africa by examining the relationship between paediatric ART coverage and socioeconomic parameters measured at the population level so as to accelerate reaching the 90-90-90 targets. Ecological analyses of paediatric ART coverage and socioeconomic indicators were performed. The data were obtained from the United Nations agencies and Forum for a new World Governance reports for the 21 Global Plan priority countries in Africa with highest burden of mother-to-child HIV transmission. Spearman's correlation and median regression were utilized to explore possible enablers of paediatric ART coverage. Factors associated with paediatric ART coverage included adult literacy (r=0.6, p=0.004), effective governance (r=0.6, p=0.003), virology testing by 2 months of age (r=0.9, p=0.001), density of healthcare workers per 10,000 population (r=0.6, p=0.007), and government expenditure on health (r=0.5, p=0.046). The paediatric ART coverage had a significant inverse relationship with the national mother-to-child transmission (MTCT) rate (r=-0.9, pgender inequality index (r=-0.6, p=0.006). Paediatric ART coverage had no relationship with poverty and HIV stigma indices. Low paediatric ART coverage continues to hamper progress towards eliminating AIDS-related deaths in HIV-infected children. Achieving this requires full commitment to a broad range of socioeconomic development goals. Copyright© by the National Institute of Public Health, Prague 2017

Identification of a common language describing paediatric physiotherapy practice for children with additional support needs, to support communication with those outside the physiotherapy profession.

Science.gov (United States)

Hunter, Cathleen; Maciver, Donald; Howden, Stella; Forsyth, Kirsty; Adamson, Amanda; Bremner, Lynne

2013-03-01

Children with additional support needs (ASNs) often require physiotherapy intervention to help maximise their participation within the primary school setting. The aim of this research was to investigate paediatric physiotherapy practice in supporting primary school aged children with ASNs, in order to identify a language to describe this, which could be used to support communication with teachers, parents and others outside the profession. Using a qualitative research multiple methods design, 2 focus groups and 5 structured interviews were held to investigate physiotherapy practice for this group. Senior paediatric physiotherapists (n=13) from a range of specialities, with experience of supporting primary school aged children with ASNs. Focus groups and interviews were digitally recorded, transcribed verbatim and analysed to establish links and patterns: followed by a cyclical process of respondent validation, and expert review. Eight targets for physiotherapy intervention and twelve technique headings were synthesised from the data. The language used for labelling and description of these was aimed to be easily understood by colleagues outside the profession. The findings clearly identified the role of the paediatric physiotherapist as being to support primary school aged children with ASNs to acquire aspects of postural control, mobility and cardio-respiratory function. By grouping the data into eight areas of challenge as the focus of intervention, and twelve commonly used techniques, the researchers generated a language which can be used by paediatric physiotherapists to support communication with teachers, parents and others outside the profession, when describing their intent and interactions regarding these children. Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Twenty-nine-month follow-up of a paediatric zirconia dental crown.

Science.gov (United States)

Lopez Cazaux, Serena; Hyon, Isabelle; Prud'homme, Tony; Dajean Trutaud, Sylvie

2017-06-14

The aim of this paper is to present the long-term follow-up of one paediatric zirconia crown on a deciduous molar. Preformed crowns are part of the armamentarium in paediatric dentistry. In recent years, aesthetic alternatives to preformed metal crowns have been developed, first preveneered crowns and then zirconia crowns. This paper describes the restoration of a primary molar with a zirconia crown (EZ-Pedo, Loomis, California, USA) in an 8-year-old boy. In this clinical case, the protocol for the implementation and maintenance of zirconia crowns is detailed. The patient was followed up for 29 months until the natural exfoliation of his primary molar. The adaptation of the zirconia crown, the gingival health and the wear on the opposing tooth were considered. In this case, the paediatric zirconia crown allowed sustainable functional restoration while restoring a natural appearance of the tooth. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Paediatric surgical abdominal emergencies in a north central ...

African Journals Online (AJOL)

Paediatric surgical abdominal emergencies in a north central Nigerian centre. ... The causes of PSAEs vary worldwide, and the management is challenging, often with unimaginably poor outcome if not carefully handled. The aim of this ... Keywords: abdominal emergencies, acute abdomen, children, morbidity, mortality ...

Demographics of paediatric renal replacement therapy in Europe

DEFF Research Database (Denmark)

Chesnaye, Nicholas; Bonthuis, Marjolein; Schaefer, Franz

2014-01-01

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...... during the study period was 5.5 cases per million age-related population (pmarp) in patients aged 0-14 years and varied markedly between countries (interquartile range 3.4-7.0 years). The prevalence of RRT was 27.9 pmarp and increased with age, with 67 % of prevalent patients living with a functioning...

International Longitudinal Paediatric Reference Standards for Bone Mineral Content

Science.gov (United States)

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

2014-01-01

To render a diagnosis pediatricians rely upon reference standards for bone mineral density or bone mineral content, which are based on cross-sectional data from a relatively small sample of children. These standards are unable to adequately represent growth in a diverse pediatric population. Thus, the goal of this study was to develop sex and site specific standards for BMC using longitudinal data collected from four international sites in Canada and the United States. Data from four studies were combined; Saskatchewan Paediatric Bone Mineral Accrual Study (n=251), UBC Healthy Bones Study (n=382); Penn State Young Women’s Health Study (n=112) and Stanford’s Bone Mineral Accretion study (n=423). Males and females (8 to 25 years) were measured for whole body (WB), total proximal femur (PF), femoral neck (FN) and lumbar spine (LS) BMC (g). Data were analyzed using random effects models. Bland-Altman was used to investigate agreement in predicted and actual data. Age, height, weight and ethnicity independently predicted BMC accrual across sites (P accrual; Hispanic 75.4 (28.2) g less BMC accrual; Blacks 82.8 (26.3) g more BMC accrual with confounders of age, height and weight controlled. Similar findings were found for PF and FN. Female models for all sites were similar with age, height and weight all independent significant predictors of BMC accrual (P accounting for age, size, sex and ethnicity. In conclusion, when interpreting BMC in paediatrics we recommend standards that are sex, age, size and ethnic specific. PMID:19854308

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

Science.gov (United States)

Andrews, Hannah; Singh, Yogen

2016-03-01

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.

Aetiological patterns and management outcome of paediatric head trauma: one-year prospective study.

Science.gov (United States)

Emejulu, J K C; Shokunbi, M T

2010-09-01

Trauma is the most common cause ofpaediatric deaths. In 75% ofpaediatric trauma deaths, head injury is responsible, and most are from falls. Recent reports from Nigeria, however, appear to indicate a predominance of road traffic accidents, instead of falls. To evaluate the aetiology of paediatric head trauma, management protocols and outcome from our Centre, in order to acquire a baseline data base and recommend measures to reduce childhood trauma. A prospective study of all paediatric head trauma cases presenting to Nnamdi Azikiwe University Teaching Hospital, Nnewi, for 12months from April 21, 2006 to April 20, 2007, was done and collated data subsequently analyzed. The paediatric age group was taken as = 15 years, and grading of head injury was with the Glasgow Coma Scale (3-15) and the modified scale for non-verbal children; while outcome was measured with the Glasgow Outcome Scale (1-5). Out of 334 patients treated within the period of study, 210 were head trauma cases. Of these, 52 were paediatric head trauma, representing 24.8% of all head trauma cases; and 19.2% (10 of 52) of them were aged 0-2 years. About 62% (32 of 52) were males. Falls and RTA were each responsible in 25 (48.1%) cases. Mild head injury occurred in 31 (59.6%), and 49 (94.2%) patients were evaluated by plain radiography. Treatment was conservative in 39 (75%) cases; with satisfactory outcome in 36 (69.2%), and a mortality rate of 15.4%. Road traffic injury, mostly from motorcycles, has become the major cause of morbidity and mortality amongst the paediatric age group, especially the male gender, and outcome from management is mostly satisfactory.

The learning environment of paediatric interns in South Africa.

Science.gov (United States)

Naidoo, Kimesh L; Van Wyk, Jacqueline M; Adhikari, Miriam

2017-11-29

South African (SA) paediatric interns (recently qualified medical graduates) work in a high disease burdened and resource deficient environment for two years, prior to independent practice. Perceptions of this learning environment (LE) influences their approaches to training as well as the outcomes of this period of development. Obstacles to creating a supportive LE and supervisor interaction affects the quality of this training. Measuring perceptions of the LE with validated instruments can help inform improvements in learning during this crucial period of medical education. The aims of this study was to determine the psychometric qualities of the Postgraduate Hospital Educational Environment Measure (PHEEM) amongst paediatric interns across four hospital complexes in South Africa and to measure the LE as perceived by both interns and their supervisors. Construct validity was tested using factor analysis and internal consistency was measured with Cronbach's alpha. A total of 209 interns and 60 supervisors (69% intern response rate) responded to the questionnaire. The PHEEM was found to be very reliable with an overall Cronbach's alpha of 0.943 and 0.874 for intern and supervisors respectively. Factor analysis using a 3-factor solution accounted for 42% of the variance with the teaching subscale having the best fit compared with the other sub-scales of the original tool. Most interns perceived the learning environment as being more positive than negative however, their perceptions differed significantly from that of their supervisors. Poor infrastructural support from institutions, excessive workloads and inadequate supervision were factors preventing optimal training of paediatric interns. The SA version of the PHEEM tool used was found to be a reliable and valid instrument for use in interns amongst high disease burdened contexts. Various obstacles to creating an ideal learning environment for paediatric interns were identified to be in need of urgent review. Key

Knowledge translation studies in paediatric emergency medicine: A systematic review of the literature.

Science.gov (United States)

Wilson, Catherine L; Johnson, David; Oakley, Ed

2016-02-01

Systematic review of knowledge translation studies focused on paediatric emergency care to describe and assess the interventions used in emergency department settings. Electronic databases were searched for knowledge translation studies conducted in the emergency department that included the care of children. Two researchers independently reviewed the studies. From 1305 publications identified, 15 studies of varied design were included. Four were cluster-controlled trials, two patient-level randomised controlled trials, two interrupted time series, one descriptive study and six before and after intervention studies. Knowledge translation interventions were predominantly aimed at the treating clinician, with some targeting the organisation. Studies assessed effectiveness of interventions over 6-12 months in before and after studies, and 3-28 months in cluster or patient level controlled trials. Changes in clinical practice were variable, with studies on single disease and single treatments in a single site showing greater improvement. Evidence for effective methods to translate knowledge into practice in paediatric emergency medicine is fairly limited. More optimal study designs with more explicit descriptions of interventions are needed to facilitate other groups to effectively apply these procedures in their own setting. © 2016 The Authors Journal of Paediatrics and Child Health © 2016 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Oncologists’ view of informed consent and shared decision making in paediatric radiation oncology

International Nuclear Information System (INIS)

Olson, Robert A.; Bobinski, Mary Ann; Ho, Anita; Goddard, Karen J.

2012-01-01

Background and purpose: Cure rates of paediatric malignancies have dramatically improved with therapy intensification, at the cost of late treatment side effects. A survey was developed, centred around medulloblastoma scenarios, in order to explore paediatric oncology physicians’ views on discussing late effects and involving parents in treatment decisions. Materials and methods: Participants were 59 paediatric radiation and medical oncologists or fellows from USA (22), Canada (18), Europe (16), Australia (2), and Asia (1). Results: Ninety-five percent of respondents indicated late effects discussion prior to multimodality treatment was important. Of those who supported it, 100%, 83%, 64%, and 48% thought discussing cognitive impairment, infertility, stroke, and seizures as potential late effects was important, respectively. Only 71% of respondents believed parents should be involved in treatment decisions, which did not significantly vary by respondent age, country, specialty, gender, or years in practice. Conclusions: The majority of oncologists who treat children believe discussing late effects with parents is important. However, there is mixed opinion on which late effects should be discussed and whether parents should be involved in deciding which treatments should be pursued. Research into perceived barriers to shared decision making and effective methods of improving the informed consent process in paediatric malignancies is needed.

Myocarditis in Paediatric Patients: Unveiling the Progression to Dilated Cardiomyopathy and Heart Failure

Directory of Open Access Journals (Sweden)

Inês Teixeira Farinha

2016-11-01

Full Text Available Myocarditis is a challenging and potentially life-threatening disease associated with high morbidity in some paediatric patients, due to its ability to present as an acute and fulminant disease and to ultimately progress to dilated cardiomyopathy. It has been described as an inflammatory disease of the myocardium caused by diverse aetiologies. Viral infection is the most frequent cause of myocarditis in developed countries, but bacterial and protozoal infections or drug hypersensitivity may also be causative agents. The prompt diagnosis in paediatric patients is difficult, as the spectrum of clinical manifestation can range from no myocardial dysfunction to sudden cardiac death. Recent studies on myocarditis pathogenesis have revealed a triphasic nature of this disease, which influences the diagnostic and therapeutic strategies to adopt in each patient. Endomyocardial biopsy remains the gold standard for diagnosing myocarditis, and several non-invasive diagnostic tools can be used to support the diagnosis. Intravenous immunoglobulin has become part of routine practice in the treatment of myocarditis in paediatric patients at many centres, but its true effect on the cardiac function has been the target of many studies. The aim of this review is to approach the recently discovered facets of paediatric myocarditis regarding its progression to dilated cardiomyopathy.

Lack of a standardised UK care pathway resulting in national variations in management and outcomes of paediatric small area scalds.

Science.gov (United States)

Trevatt, Alexander E J; Kirkham, Emily N; Allix, Bradley; Greenwood, Rosemary; Coy, Karen; Hollén, Linda I; Young, Amber E R

2016-09-01

There is a paucity of evidence guiding management of small area partial thickness paediatric scalds. This has prevented the development of national management guidelines for these injuries. This research aimed to investigate whether a lack of evidence for national guidelines has resulted in variations in both management and outcomes of paediatric small area scalds across England and Wales (E&W). A national survey of initial management of paediatric scalds ≤5% Total Body Surface Area (%TBSA) was sent to 14 burns services in E&W. Skin graft rates of anonymised burns services over seven years were collected from the international Burns Injury Database (iBID). Average skin grafting rates across services were compared. Length of stay and proportion of patients receiving general anaesthesia for dressing application at each service were also compared. All 14 burns services responded to the survey. Only 50% of services had a protocol in place for the management of small area burns. All protocols varied in how partial thickness paediatrics scalds ≤5% TBSA should be managed. There was no consensus as to which scalds should be treated using biosynthetic dressings. Data from iBID for 11,917 patients showed that the average reported skin grafting rate across all burns services was 2.3% (95% CI 2.1, 2.6) but varied from 0.3% to 7.1% (P<0.001). Service provider remained associated with likelihood of skin grafting when variations in the %TBSA case mix seen by each service were controlled for (χ(2)=87.3, P<0.001). The use of general anaesthetics across services varied between 0.6 and 35.5% (P<0.001). The median length of stay across services varied from 1 to 3 days (P<0.001). A lack of evidence guiding management of small-area paediatric scalds has resulted in variation in management of these injuries across E&W. There is also significant variation in outcomes for these injuries. Further research is indicated to determine if care pathways and outcomes are linked. An evidence

Paediatric Investigators Collaborative Network on Infections in Canada (PICNIC study of aseptic meningitis

Directory of Open Access Journals (Sweden)

Robinson Joan L

2006-04-01

Full Text Available Abstract Background The seasonality, clinical and radiographic features and outcome of aseptic meningitis have been described for regional outbreaks but data from a wider geographic area is necessary to delineate the epidemiology of this condition. Methods A retrospective chart review was completed of children presenting with aseptic meningitis to eight Canadian pediatric hospitals over a two-year period. Results There were 233 cases of proven enteroviral (EV meningitis, 495 cases of clinical aseptic meningitis and 74 cases of possible aseptic meningitis with most cases occurring July to October. Headache, vomiting, meningismus and photophobia were more common in children ≥ 5 years of age, while rash, diarrhea and cough were more common in children Conclusion The clinical presentation of aseptic meningitis varies with the age of the child. Absence of CSF pleocytosis is common in infants

Cost Burden for Accessing Paediatric Emergency Services at a ...

African Journals Online (AJOL)

TNHJOURNALPH

modalities and economic impacts for accessing paediatric ... Descriptive analysis of the data was done using SPSS ... being discharged home from the emergency ... their homes to the hospital. ..... respondents could be affected by recall bias.

Intense imagery movements: a common and distinct paediatric subgroup of motor stereotypies.

Science.gov (United States)

Robinson, Sally; Woods, Martin; Cardona, Francesco; Baglioni, Valentina; Hedderly, Tammy

2014-12-01

The aim of this article is to describe a subgroup of children who presented with stereotyped movements in the context of episodes of intense imagery. This is of relevance to current discussions regarding the clinical usefulness of diagnosing motor stereotypies during development. The sample consisted of 10 children (nine males, one female; mean age 8y 6mo [SD 2y 5mo], range 6-15y). Referrals were from acute paediatricians, neurologists, and tertiary epilepsy services. Children were assessed by multidisciplinary teams with expertise in paediatric movement disorders. Stereotypies presented as paroxysmal complex movements involving upper and lower limbs. Imagery themes typically included computer games (60%), cartoons/films (40%), and fantasy scenes (30%). Comorbid developmental difficulties were reported for 80% of children. Brain imaging and electrophysiological investigations had been conducted for 50% of the children before referral to the clinic. The descriptive term 'intense imagery movements' (IIM) was applied if (after interview) the children reported engaging in acts of imagery while performing stereotyped movements. We believe these children may form a common and discrete stereotypy subgroup, with the concept of IIM being clinically useful to ensure the accurate diagnosis and clinical management of this paediatric movement disorder. © 2014 Mac Keith Press.

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

Science.gov (United States)

2013-01-01

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

A literature review of comfort in the paediatric critical care patient.

Science.gov (United States)

Bosch-Alcaraz, Alejandro; Falcó-Pegueroles, Anna; Jordan, Iolanda

2018-03-08

To investigate the meaning of comfort and to contextualise it within the framework of paediatric critical care. The concept of comfort is closely linked to care in all health contexts. However, in specific settings such as the paediatric critical care unit, it takes on particular importance. A literature review was conducted. A literature search was performed of articles in English and Spanish in international health science databases, from 1992-March 2017, applying the quality standards established by the PRISMA methodology and the Joanna Briggs Institute. A total of 1,203 publications were identified in the databases. Finally, 59 articles which met the inclusion criteria were entered in this literature review. Almost all were descriptive studies written in English and published in Europe. The concept of comfort was defined as the immediate condition of being strengthened through having the three types of needs (relief, ease and transcendence) addressed in the four contexts of experience (physical, psychospiritual, social and environmental). Only two valid and reliable tools for assessing comfort were found: the Comfort Scale and the Comfort Behavior Scale. Comfort is subjective and difficult to assess. It has four facets: physical, emotional, social and environmental. High levels of noise and light are the inputs that cause the most discomfort. Comfort is a holistic, universal concept and an important component of quality nursing care. © 2018 John Wiley & Sons Ltd.

Pseudomonas aeruginosa diversity in distinct paediatric patient groups

DEFF Research Database (Denmark)

Tramper-Stranders, G.A.; Ent, C.K. van der; Wolfs, T.F.

2008-01-01

the other groups. A group of clonal isolates was observed among patients from the CF-chronic and CF-1 groups. These or different clonal isolates were not encountered among the three other patient groups. No characteristic resistance pattern could be identified among isolates from the distinct patient groups......Pseudomonas aeruginosa is a pathogen that often infects patients who are either immunocompromised or have local defects in host defences. It is known that cystic fibrosis (CF) patients are sometimes infected with certain clonal isolates. It is not clear whether these clonal isolates also infect non......-CF patients and whether clonality of isolates occurs in other patient groups. The aim of this study was to investigate P. aeruginosa diversity and the occurrence of clones within five distinct paediatric patient groups susceptible to P. aeruginosa infection. P. aeruginosa isolates were cultured from 157...

Recommending Research Profiles for Multidisciplinary Academic Collaboration

Science.gov (United States)

Gunawardena, Sidath Deepal

2013-01-01

This research investigates how data on multidisciplinary collaborative experiences can be used to solve a novel problem: recommending research profiles of potential collaborators to academic researchers seeking to engage in multidisciplinary research collaboration. As the current domain theories of multidisciplinary collaboration are insufficient…

Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC)

NARCIS (Netherlands)

Kneyber, Martin C. J.; de Luca, Daniele; Calderini, Edoardo; Jarreau, Pierre-Henri; Javouhey, Etienne; Lopez-Herce, Jesus; Hammer, Jurg; Macrae, Duncan; Markhorst, Dick G.; Medina, Alberto; Pons-Odena, Marti; Racca, Fabrizio; Wolf, Gerhard; Biban, Paolo; Brierley, Joe; Rimensberger, Peter C.

2017-01-01

Purpose: Much of the common practice in paediatric mechanical ventilation is based on personal experiences and what paediatric critical care practitioners have adopted from adult and neonatal experience. This presents a barrier to planning and interpretation of clinical trials on the use of specific

Sickness presenteeism: The prevalence of coming to work while ill among paediatric resident physicians in Canada.

Science.gov (United States)

Mitchell, Kevin J; Vayalumkal, Joseph V

2017-05-01

Sickness presenteeism is defined as the act of attending one's job despite ill-health. Recently, physicians and other health care workers have become the focus of sickness presenteeism research, because presenteeism in this population can put patients at risk of infection. There are currently no data on this topic among physicians in Canada. The aim of this study was to investigate sickness presenteeism in paediatric resident physicians in Canada. We conducted an anonymous, online, cross-sectional survey study in which all paediatric residents in Canada were eligible. Outcomes of interest included prevalences of sickness presenteeism, sickness during the study period and voluntary self-appointed personal protective equipment use when engaging in sickness presenteeism. Response rate was 56.5% (N=323). During the previous 2 months, 61% (95% confidence interval [CI] 55.7 to 66.3) of respondents reported having experienced an illness and 59% (95% CI 53.7 to 64.5) of respondents had come to work sick. Of those who reported becoming ill during the study period, 97.0% (95% CI 94.6 to 99.4) reported coming to work while sick. There was no difference in prevalence when comparing across post-graduate year training levels. Extra personal protective equipment was used by 86% (95% CI 82.1 to 91.7) when engaging in sickness presenteeism. Sickness presenteeism is a common phenomenon among paediatric resident physicians. Our results should influence residents and supervising staff physicians to encourage appropriate self-care at home, rather than presenteeism.

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

Science.gov (United States)

Owojuyigbe, Afolabi Muyiwa; Komolafe, Edward O.; Adenekan, Anthony T.; Dada, Muyiwa A.; Onyia, Chiazor U.; Ogunbameru, Ibironke O.; Owagbemi, Oluwafemi F.; Talabi, Ademola O.; Faponle, Fola A.

2016-01-01

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. PMID:27251657

Realities of paediatric pharmacotherapy in the developing world.

Science.gov (United States)

Hoppu, Kalle; Sri Ranganathan, Shalini; Dodoo, Alex N O

2011-08-01

Diseases causing high mortality in children under 5 years of age in resource limited settings (RLS) could be treated if children in these countries had access to existing medicines. It took 30 years before the WHO Essential Medicines List (EML) considered the issue of medicines for children, with the first EML for children being published in 2007. Recent data indicate that less than half of the key paediatric essential medicines are available in countries of sub-Saharan Africa. Problems include substandard medicines, irrational use of medicines, inefficiency and even possible corruption in pharmaceutical management systems. These are global issues which affect RLS most. Clinical trials in developing countries for the benefit of children are needed but challenging in several ways. In this review, the authors will consider the following areas where progress could improve paediatric pharmacotherapy in RLS: registration and regulation of medicines, rational use of medicines, clinical trials in children and restriction of corruption in pharmaceutical management systems.

The imaging of paediatric thoracic trauma

Energy Technology Data Exchange (ETDEWEB)

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)

2009-05-15

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.)

The imaging of paediatric thoracic trauma

International Nuclear Information System (INIS)

Moore, Michael A.; Westra, Sjirk J.; Wallace, E.C.

2009-01-01

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.)

An analysis of radiation dose reduction in paediatric interventional cardiology by altering frame rate and use of the anti-scatter grid

International Nuclear Information System (INIS)

McFadden, S L; Hughes, C M; Winder, Robert J; Mooney, R B