教学课程资源库 更多>>

关键词： Somatoform disorder   Functional neurological symptom disorder   Adolescent  

摘要： Specialist paediatric services manage a variety of presentations of functional somatic symptoms. We aimed to describe the presentation and management of children and adolescents with somatic symptom and related disorders (SSRDs) requiring admission to a tertiary children's hospital with the objective of informing the development of a local clinical pathway. Patients admitted to any hospital department from May 2016 to November 2017 were identified through an electronic medical record (EMR)-linked diagnosis of SSRD. Each record was reviewed for demographic details and admission histories. The frequency of interspecialty consultations and multidisciplinary team (MDT) family meetings was recorded. One hundred twenty-three patients with SSRD were admitted on 203 occasions to 17 different departments. The median (range) age was 14.3 (7.3-18.3) years. Interspecialty consultations occurred in 84.6% of patients, and MDT family meetings occurred in 18.9% patients. SSRD was diagnosed as an inpatient in 79.9% patients, yet only 40.7% of patients, including those with multiple admissions, had SSRD recorded as a discharge diagnosis. Conclusion: Despite high rates of consultation with hospital teams, the frequency of MDT family meetings was low, and less than half the patients had SSRD documented at discharge. This affirms the value of developing a local clinical pathway.

关键词： antimicrobial therapy   bacteraemia   GeneXpert   matrix‐   assisted laser desorption ionisation time‐   of‐   flight   paediatrics  

摘要： Aim Rapid blood culture pathogen identification facilitated by matrix-assisted laser desorption ionisation time-of-flight and GeneXpert has the potential to improve antibiotic prescribing. This study investigates the impact of these rapid diagnostics on the timeliness of effective and optimal antibiotic prescribing in paediatric patients with bacteraemia. Methods A single centre retrospective cohort study was performed comparing paediatric bacteraemia cases pre- and post-rapid diagnostic implementation. Primary outcomes were the proportion of cases receiving, and median time to administration of effective and optimal antibiotics from blood culture collection. Secondary outcomes included hospital length of stay, intensive care unit admissions, and all-cause mortality. Results A total of 255 bacteraemia cases were subject to final data analysis, 129 in the control cohort (pre-implementation of rapid diagnostics) and 126 in the rapid diagnostics cohort. The median time to effective (2.3 vs. 1.8 h, P = 0.20) and optimal therapy (44.4 vs. 39.1 h, P = 0.66) did not differ significantly between the cohorts. There was also no significant difference found in the number of cases reaching effective (120 vs. 116, P = 0.77) and optimal therapy (66 vs. 62, P = 0.76), length of stay (7 vs. 9 days), all-cause mortality (1.6 vs. 1.6%) and number of intensive care unit admissions (20 vs. 15). Conclusion The implementation of rapid diagnostics, when used in isolation, resulted in no improvement in antibiotic prescribing or patient clinical outcomes. To be effective, rapid diagnostics must be coupled with active real-time antimicrobial stewardship promotion, de-escalation or modification based on early laboratory results.

关键词： Paediatric femur fracture   Fixator assisted   ESIN   Submuscular plating   external fixator   FAST  

摘要： The surgical management of paediatric femur fractures has evolved over the last few decades. Intramedullary stabilization with titanium elastic nail (TENS) is the preferred surgical management for length stable and mid diaphyseal femur fractures in children between 5-11 years of age. However, TENS is not preferred in length unstable fractures and in proximal or distal metaphyseal femur fractures due to higher incidence of angulation and shortening at fracture site. In such scenarios, submuscular plating has come up as an alternative surgical treatment modality which avoids these complications and provide good functional outcome. Many authors have suggested different sur gical variations in techniques of submuscular plating for paediatric femur fracture. We have devised a technique of submuscular plating with help of external fixator (FAST) in paediatric femur fractures which minimises the surgical time and simplifies the procedure. (C) 2021 Published by Elsevier Ltd.

摘要： Background The expansion of local training programmes is crucial to address the shortages of specialist paediatric surgeons across Sub-Saharan Africa. This study assesses whether the current training programme for paediatric surgery at the College of Surgeons of East, Central and Southern Africa (COSECSA) is exposing trainees to adequate numbers and types of surgical procedures, as defined by local and international guidelines. Methods Using data from the COSECSA web-based logbook, we retrospectively analysed numbers and types of operations carried out by paediatric surgical trainees at each stage of training between 2015 and 2019, comparing results with indicative case numbers from regional (COSECSA) and international (Joint Commission on Surgical Training) guidelines. Results A total of 7,616 paediatric surgical operations were recorded by 15 trainees, at different stages of training, working across five countries in Sub-Saharan Africa. Each trainee recorded a median number of 456 operations (range 56-1111), with operative experience increasing between the first and final year of training. The most commonly recorded operation was inguinal hernia (n = 1051, 13.8%). Trainees performed the majority (n = 5607, 73.6%) of operations recorded in the eLogbook themselves, assisting in the remainder. Trainees exceeded both local and international recommended case numbers for general surgical procedures, with little exposure to sub-specialities. Conclusions Trainees obtain a wide experience in common and general paediatric surgical procedures, the number of which increases during training. Post-certification may be required for those who wish to sub-specialise. The data from the logbook are useful in identifying individuals who may require additional experience and centres which should be offering increased levels of supervised surgical exposure.

关键词： Crohn disease   fecal calprotectin   inflammation   inflammatory bowel disease   intestine   position paper   ulcerative colitis  

摘要： Objectives: The aim of the study was to review the evidence regarding the clinical use and value of fecal calprotectin (FC) measurements in different gastrointestinal disorders in children. Methods: A literature search was conducted in the PubMed, MEDLINE, EMBASE, and Cochrane databases until October 31, 2019. Subtopics were identified and each assigned to individual authors. Results: A total of 28 recommendations were voted on using the nominal voting technique. Recommendations are given related to sampling, measurement methods, and results interpretation. The 14 authors anonymously voted on each recommendation using a 9-point scale (1 strongly disagree to 9 fully agree). Consensus was considered achieved if at least 75% of the authors voted 6, 7, 8, or 9. Conclusions: Consensus was reached for all recommendations. Limitations for the use of FC in clinical practice include variability in extraction methodology, performance of test kits as well as the need to establish local reference ranges because of the influence of individual factors, such as age, diet, microbiota, and drugs. The main utility of FC measurement at present is in the diagnosis and monitoring of inflammatory bowel disease (IBD) as well as to differentiate it from functional gastrointestinal disorders (FAPDs). FC, however, has neither utility in the diagnosis of infantile colic nor to differentiate between functional and organic constipation. A rise in FC concentration, may alert to the risk of developing necrotizing enterocolitis and help identifying gastrointestinal involvement in children with Henoch-Schonlein purpura. FC measurement is of little value in Cow's Milk Protein Allergy, coeliac disease (CD), and cystic fibrosis. FC does neither help to distinguish bacterial from viral acute gastroenteritis (AGE), nor to diagnose Helicobacter Pylori infection, small intestinal bacterial overgrowth (SIBO), acute appendicitis (AA), or intestinal polyps.

关键词： orthopaedics   outpatient   paediatrics   syncope  

摘要： Background The incidence of vasovagal syncope (VVS) precipitated by medical procedures such as blood donation is quoted as between 0.13% and 4.17%. Vasovagal events have been observed to occur following cast removal at our paediatric orthopaedic clinic;however, there is no available information in the existing literature regarding incidence or risk factors. This study aims to identify the incidence and demographic traits of patients experiencing syncopal events following cast removal. Methods Over a 12-month period, paediatric patients experiencing a syncopal or pre-syncopal event during an outpatient appointment for cast removal were prospectively enrolled into the study. Basic demographic data were recorded, as well as injury and procedure details and a description of the event. Statistical analysis as well as calculation of incidence of vasovagal events were performed. Results A total of 6078 patients presented for cast removal in the 12-month period. Twenty syncopal or pre-syncopal events were recorded. Incidence was calculated as 0.32%. Mean patient age was 10.8 years. Male : female ratio was 2.3:1. Mean body mass index (BMI) was 20.08, with a trend for higher prevalence of males under the 50th BMI percentile-for-age. The mean time post-injury was 31.4 days. Ninety-five percent of patients were being treated for an upper limb injury and 30% had injuries that had been treated surgically. There were no associated secondary complications or injuries. Conclusions Incidence of VVS following cast removal is comparable to the values quoted in literature for other medical procedures. Demographic data of our cohort suggested that those who experienced VVS were predominantly young males of lower-than-average BMI.