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关键词： medication   paediatric   poisoning   suicide attempts   systematic review  

摘要： Aim: This study evaluated medication poisoning in paediatric patients through a systematic review and a retrospective documentary analysis in a Brazilian toxicological centre. Methods: The data were systematically collected on PubMed, Scopus and SciELO databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We included epidemiologic and prevalence studies that were published in English or Portuguese from 2013 to 2017 and covered paediatric patients. The retrospective incidence study was carried out in a Brazilian toxicological centre and was a documentary analysis of paediatric medication poisoning cases from 2005 to 2015. Results: The systematic review comprised 13 papers covering 895 206 poisoning cases from six different countries. The main agents of intoxication were analgesics and antihistamines. The eight papers that explored the reasons for the poisonings showed that 93% of those 762 863 cases were accidental. The Brazilian toxicological centre recorded 443 paediatric patients poisoned by medication such as benzodiazepines, analgesics and antibiotics and found that 63.2% were accidental. However, it agreed with the global findings in many other aspects. Conclusion: The systematic review showed a sustained number of paediatric medication toxicity cases worldwide and the key findings were broadly reflected by the retrospective study carried out in the Brazilian toxicological centre.

关键词： Paediatric cardiology   didactics   online learning   COVID-19  

摘要： The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on medical educational curricula. We aimed to examine the impact of these unprecedented changes on the formal education of paediatric cardiology fellows through a nationwide survey. A REDCap (TM)-based voluntary anonymous survey was sent to all current paediatric cardiology fellows in the United States of America in May, 2020. Of 143 respondents, 121 were categorical fellows, representing over one-fourth of all categorical paediatric cardiology fellows in the United States of America. Nearly all (140/143, 97.9%) respondents utilised online learning during the pandemic, with 134 (93.7%) reporting an increase in use compared to pre-pandemic. The percentage of respondents reporting curriculum supplementation with outside lectures increased from 11.9 to 88.8% during the pandemic. Respondents considered online learning to be "equally or more effective" than in-person lectures in convenience (133/142, 93.7%), improving fellow attendance (132/142, 93.0%), improving non-fellow attendance (126/143, 88.1%), and meeting individual learning needs (101/143, 70.6%). The pandemic positively affected the lecture curriculum of 83 respondents (58.0%), with 35 (24.5%) reporting no change and 25 (17.5%) reporting a negative effect. A positive effect was most noted by those whose programmes utilised supplemental outside lectures (62.2 versus 25.0%, p = 0.004) and those whose lecture frequency did not decrease (65.1 versus 5.9%, p < 0.001). Restrictions imposed by the COVID-19 pandemic have greatly increased utilisation of online learning platforms by medical training programmes. This survey reveals that an online lecture curriculum, despite inherent obstacles, offers advantages that may mitigate some negative consequences of the pandemic on fellowship education.

关键词： child   mHealth   paediatrics   resuscitation  

摘要： Aim: The aim was to investigate the use of paper-based and electronic prescribing and resuscitation aids in paediatric emergency care from a departmental and indi vidual physician perspective. Methods: A two-stage web-based self-report questionnaire was performed. In stage (i), a lead investigator at PERUKI sites completed a department-level survey;in stage (ii), individual physicians recorded their personal practice. Results: The site survey was completed by 46/54 (85%) of PERUKI sites. 198 physicians completed the individual physicians' survey. Individual physicians selected the use of formulary apps for checking of medication dosages nearly as often as hardcopy formularies. The APLS WETFLAG calculation and hardcopy aids were widely accepted in both surveys. A third of sites accepted and half of the individual physicians selected resuscitation apps on the personal mobile device as paediatric resuscitation aids. Conclusion: Our survey shows a high penetrance of the British National Formulary app, a success of NHS digital policy and strategy. Despite potential advantages, many physicians in our survey do not use resuscitation apps. Reluctance to engage with apps is likely to be multifactorial and includes human factors. These obstacles need to be overcome to create a digital healthcare culture.

关键词： machine learning   nursing   outcome   paediatric   prediction model   pressure injury   random forest  

摘要： Aims We sought to explore factors associated with early pressure injury progression and build a model for predicting these outcomes using a machine learning approach. Design A retrospective cohort study. Methods In this study, we recruited paediatric patients, with hospital-acquired stage I pressure injury or suspected deep tissue injury, who met the inclusion criteria between 1 January 2015-31 October 2018. We divided patients into two groups, namely healing or delayed healing, then followed them up for 7 days. We analysed patient pressure injury characteristics, demographics, treatment, clinical situation, vital signs, and blood test results, then build prediction models using the Random Forest and eXtreme Gradient Boosting approaches. Results The best prediction model, trained and tested using Random Forest with 10 variables, achieved an accuracy, sensitivity, specificity, and area under the curve of 0.82 (SD 0.06), 0.80 (SD 0.08), 0.84 (SD 0.08), and 0.89 (SD 0.06), respectively. The most contributing variables, in order of importance, included serum creatinine, red blood cell, and haematocrit. Conclusion An awareness of specific conditions and areas that could lead to delayed healing pressure injury in paediatric patients is needed. Impact This evidence-based prediction model, coupled with the aforementioned clinical indicators, is expected to enhance early prediction of outcomes in paediatric patients thereby improve the quality of care and the outcome of children with PIs.

关键词： Paediatric   Splenic injury   Trauma   Length of stay  

摘要： BackgroundNon-operative management (NOM) is generally accepted as a treatment method of traumatic paediatric splenic rupture. However, considerable variations in management exist. This study analyses local trends in aetiology and management of paediatric splenic injuries and evaluates the implementation of the guidelines proposed by the American Paediatric Surgical Association (APSA) in a level 1 trauma *** charts of paediatric patients with blunt splenic injury (BSI) who were admitted or transferred to a level 1 trauma centre between 2003 and 2020 were retrospectively assessed. Information pertaining to demographics, mechanism of injury, injury description, associated injuries, intervention and outcomes were analysed and compared to international *** were 130 patients with BSI identified (63.1% male), with a mean age of 11.3 4.0 and a mean Injury Severity Score (ISS) of 21.6 13.7. Bicycle accidents were the most common trauma mechanism (23.1%). Sixty-four percent were multi-trauma patients, 25% received blood transfusions, and 31% were haemodynamically unstable. Mean injury grade was 3.0, with 30% of patients having a high-grade injury. In total, 75% of patients underwent NOM with a 100% efficacy rate. Total splenectomy rate was 6.2%. Four patients died due to brain *** with a high-grade BSI (grades IV-V) had a significantly higher ISS and longer bedrest and more often presented with an active blush on computed tomography (CT) scans than patients with a low-grade BSI (grades I-III). Non-operative management was mainly the choice of treatment in both groups (76.6% and 79.5%, respectively). Haemodynamic instability was a predictor for operative management (OM) (p = 0.001). Predictors for a longer length of stay (LOS) included concomitant injuries, haemodynamic instability and OM (all p < 0.02). Interobserver agreement in the grading of BSI is moderate, with a Cohens Kappa coefficient of ***-operative manag

关键词： Physiotherapy   Shoulder instability   User centred design   Clinical decision support system   Paediatrics  

摘要： BackgroundCurrently the diagnosis of shoulder instability, particularly in children, is difficult and can take time. These diagnostic delays can lead to poorer outcome and long-term complications. A Diagnostic Decision Support System (DDSS) has the potential to reduce time to diagnosis and improve outcomes for patients. The aim of this study was to develop a concept map for a future DDSS in shoulder *** modified nominal focus group technique, involving three clinical vignettes, was used to elicit physiotherapists decision-making ***-five physiotherapists, (18F:7 M) from four separate clinical sites participated. The themes identified related to 'Variability in diagnostic processes and lack of standardised practice' and 'Knowledge and attitudes towards novel technologies for facilitating assessment and clinical decision making'.ConclusionNo common structured approach towards assessment and diagnosis was identified. Lack of knowledge, perceived usefulness, access and cost were identified as barriers to adoption of new technology. Based on the information elicited a conceptual design of a future DDSS has been proposed. Work to develop a systematic approach to assessment, classification and diagnosis is now *** Registraty This was not a clinical trial and so no clinical trial registry is needed.

关键词： Paediatric cancer   SARS-CoV-2  

摘要： Background Children with cancer are frequently immunocompromised. While children are generally thought to be at less risk of severe SARS-CoV-2 infection than adults, comprehensive population-based evidence for the risk in children with cancer is unavailable. We aimed to produce evidence of the incidence and outcomes from SARS-CoV-2 in children with cancer attending all hospitals treating this population across the UK. Methods Retrospective and prospective observational study of all children in the UK under 16 diagnosed with cancer through data collection from all hospitals providing cancer care to this population. Eligible patients tested positive for SARS-CoV-2 on reverse transcription polymerase chain reaction (RT-PCR). The primary end-point was death, discharge or end of active care for COVID-19 for those remaining in hospital. Results Between 12 March 2020 and 31 July 2020, 54 cases were identified: 15 (28%) were asymptomatic, 34 (63%) had mild infections and 5 (10%) moderate, severe or critical infections. No patients died and only three patients required intensive care support due to COVID-19. Estimated incidence of hospital identified SARS-CoV-2 infection in children with cancer under 16 was 3%. Conclusions Children with cancer with SARS-CoV-2 infection do not appear at increased risk of severe infection compared to the general paediatric population. This is reassuring and supports the continued delivery of standard treatment.