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关键词： Pedi-IKDC   Pedi-FABS   Pediatric ACL   PAMI   Italian validation  

摘要： Purpose The aim of the present study was to translate, cross-culturally adapt, and assess the psychometric properties of the Pedi-IKDC and Pedi-FABS scores in the Italian paediatric population with various knee pathologies. Methods In accordance with the Paediatric Anterior Cruciate Ligament Monitoring Initiative (PAMI) research protocol, the original English versions of the questionnaires were translated into Italian. All patients aged 8-16 and scheduled for knee surgery were considered eligible in the study. An open-source platform was implemented to collect responses to the surveys which included general patient information, the questionnaires Pedi-IKDC, and Pedi-FABS. Two surveys were sent under stable clinical conditions before surgery (Q(1) and Q(2));a third survey was sent 3-4 months after surgery (Q(3)). The following properties were calculated: reliability, internal consistency, criterion validity, responsiveness, and floor/ceiling effects. Results Eighty-nine patients completed Q(1), 81 patients completed Q(2), and 49 patients completed Q(3). Both questionnaires demonstrated acceptable properties. Pedi-IKDC: standard error of measurement (SEM) = 4.4, smallest detectable change (SDC) = 12.3, interclass correlation coefficient (ICC) = 0.96, Cronbach alpha (alpha) = 0.92, moderate-to-low correlation to Pedi-FABS, effect size (ES) = 0.79, standardized response mean (SRM) = 0.86, floor = 0%, ceiling = 22%. Pedi-FABS: SEM = 2.1, SDC = 5.8, ICC = 0.94, Cronback alpha (alpha) = 0.93, moderate-to-low correlation to Pedi-IKDK, ES = 0.60, SRM = 0.51, floor = 19%, ceiling = 0%. Conclusions The Italian version of Pedi-IKDC and Pedi-FABS is valuable tools for patient assessment, by demonstrating good psychometric properties. In clinical setting, these questionnaires can be used to properly evaluate outcomes in Italian pediatric patients with knee pathologies.

关键词： Paediatric burns   parental perceptions   qualitative research   injury prevention   Malawi  

摘要： Background: Burn injuries disproportionally affect the world's poorest populations. However, there has been a lack of research that has investigated the social, cultural or contextual factors associated with this injury mechanism in these areas. As a result, there is a scarcity of information from which to develop culturally appropriate and targeted burn prevention initiatives. Methods: A community survey was used to identify households to take part in this qualitative study. Semi-structured interviews were conducted with 32 parents from four different villages in Malawi to discuss their experiences of burn injuries sustained by children in the household as well as any existing preventative strategies used. In addition, 29 of the study households took part in an observation exercise to identify and discuss burn hazards present around the home environment. Transcripts and observations were recorded and transcribed verbatim. A thematic approach was used to analyse the data. Results: The final themes could be categorised into three key areas: parental perception of hazards around the home;socio-cultural and developmental factors associated with burn injuries;and parental perception of burns prevention. Factors associated with unintentional burn injuries, as perceived by parents, included: increased exposure to hazards, children's play and development activities, increased fire use during the morning hours and the children's household roles and responsibilities. Although some parents identified possible burns prevention strategies numerous barriers to prevention were highlighted including: poverty, poor housing infrastructure and restrictions, knowledge deficit, inability to provide adequate supervision and the child's behaviour. Conclusions: Parents recognise that there are a number of burn hazards and risks present around the home however factors that prevented them acting included: a lack of knowledge about injury prevention, a lack of household safety equipment, a l

关键词： Trauma   Injury severity, 30-day mortality   Child  

摘要： Background: Adult injury severity metrics are often applied to paediatric populations despite differences in anatomy, physiological and mortality risk. Measures to assess paediatric mortality have not been conducted on a population-wide basis. Purpose: To determine the predictive ability of the International Classification of Injury Severity Score (ICISS) in assessing 30-day mortality in a paediatric population, and to examine temporal trends for serious injury for common paediatric injury mechanisms. Methods: A retrospective analysis of linked injury hospitalisation and mortality data of children aged <= 16 years during 1 July 2002 to 30 June 2012 in Australia was conducted. Both multiplicative-injury and single-worst-injury ICISS were calculated. Logistic regression examined 30-day mortality with a range of predictor variables. The models were assessed in terms of their ability to discriminate survivors and non-survivors, model fit, and ability to explain outcome variance. Results: There were 728,584 index injury admissions and 1,064 (0.15%) deaths within 30-days of hospital admission. The multiplicative-injury ICISS was identified as a better predictor of 30-day mortality than the single worst-injury ICISS;and the best model included age group, gender, all comorbidities, trauma centre type, injury mechanism, and nature of injury as covariates. Temporal trends for serious injury have remained relatively constant over the 10-year period. Examination of specific injury mechanisms showed a significant decline in road trauma and drowning hospitalisations. In comparison, hospitalisations due to fall and self-harm injuries within adolescents increased. Conclusion: ICISS was shown to be excellent indicator for predicting 30-day mortality for all paediatric hospital admissions within a national jurisdiction. The rate of paediatric hospitalisation due to all-cause serious injury has not changed over a 10-year period despite being a national public health area of high prior

关键词： inborn errors of metabolism   paediatric liver disease   urea cycle disorder  

摘要： Ornithine transcarbamylase deficiency (OTCD) is the most common of the urea cycle disorders and follows an X-linked inheritance pattern. The classical form in male infants causes vomiting and lethargy in the neonatal period;if untreated the severe hyperammonaemia can cause acute neurotoxic complications and permanent disability. OTCD may also occur in heterozygote female individuals, though the manifestations are variable. We report 2 cases of female paediatric patients with OTCD, who presented with acute liver failure. Both patients had limited oral intake at the time of presentation, causing an absence of orotic aciduria, which delayed the diagnosis. These cases demonstrate the need to consider urea cycle disorders in children presenting with acute liver failure, and that repeating the urine metabolic screen at the time of an unrestricted diet is warranted if there is a high clinical suspicion.

关键词： Paediatric cardiac surgery   Complication prediction   Machine learning  

关键词： Antibiotics   Paediatrics   Antimicrobial stewardship   Resistance  

摘要： Objectives Antibiotic prescribing in paediatric care is highly prevalent, and quite often, children are prescribed for conditions, like upper respiratory tract infections, which are self-limiting and viral in aetiology. The purpose of this study was to identify potential new targets for provincial antimicrobial stewardship efforts. Methods Antibiotic prescription data for children were extracted from a provincial prescription database, linked to physician billing data in order to obtain diagnostic information, and then combined with demographic data in order to obtain patient age, sex and geographic location. Prescription rates were calculated, and trends were examined by major anatomical therapeutic chemical (ATC) classification. Results Our cohort included an average of 271,134 children per year and 1,767,652 antibiotic prescriptions. Antibiotic utilization increased 4.5% (from 453 to 474 prescriptions per 1000 population). The greatest increases in prescribing were seen in children aged 0-2 years. Increased indication-specific rates of prescribing were observed in children aged 0-2 years, across every category. Although antibiotic use for upper respiratory tract infections decreased, prescribing rates remain as high as 5 times more than other indications. Conclusion Past studies have widely illustrated decreasing or static rates of prescribing in British Columbia. However, these results signal a potential problem in the sphere of paediatric antibiotic prescribing, wherein rates have been increasing since 2013. Despite the success of provincial efforts in reducing the use of broad-spectrum penicillins, marked surges in the use of classes like tetracyclines, quinolones and other antibacterials identify a new potential target for provincial stewardship.

关键词： Panoramic radiography   Orthopantomogram   Children   Caries   Dental infections   Dental trauma   Dental anomalies   Developmental disorders   Pathological conditions  

摘要： Purpose To systematically review the evidence of the diagnostic efficacy of panoramic radiographs (PRs) in the following six clinical situations: caries, acute dental infections, dental trauma, dental anomalies, Developmental disorders and pathological conditions in children. The research question posed by the EAPD was: "In which clinical situations and age groups is it indicated/contra-indicated to prescribe PRs in relation to these six clinical situations, in children". Methods An electronic search of the following databases was conducted: MEDLINE via OVID, EMBASE via OVID, The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Database of Systematic Reviews (CDSR), the Database of s of Reviews of Effects (DARE) and the Cochrane Health Technology Assessment (HTA), to identify relevant studies published from 1990 to 2018. The systematic review was performed according to the PRISMA guidelines. Study screening, data extraction and risk of bias assessment of included studies was carried out independently and in duplicate using the QUADAS 2 tool. Results The search resulted in 3420 potentially relevant studies, and following screening 175 full texts were obtained, of which 16 were finally included in the review. Meta-analysis was not possible for any of the aforementioned clinical situations, therefore the included studies were tabulated in terms of qualitative descriptive hierarchy of evidence for diagnostic. Conclusion Based on currently available evidence there is a need for high quality diagnostic accuracy efficacy studies to address important diagnostic tasks in these six clinical situations in children, as there is a lack of scientific evidence concerning PRs in children, as there would support the production of guidelines for prescribing PRs in children along with their relative indications and contra-indications.

关键词： CHD   pediatric   Cardiac ICU   survey   length of stay  

摘要： Objective: To determine the Final ICU Need in the 24 hours prior to ICU discharge for children with cardiac disease by utilising a single-centre survey. Methods: A cross-sectional survey was utilised to determine Final ICU Need, which was categorised as "Cardiovascular", "Respiratory", "Feeding", "Sedation", "Systems Issue", or "Other" for each encounter. Survey responses were obtained from attending physicians who discharged children (<= 18 years of age with ICU length of stay >24 hours) from the Cardiac ICU between April 2016 and July 2018. Measurements and results: Survey response rate was 99% (n = 1073), with 667 encounters eligible for analysis. "Cardiovascular" (61%) and "Respiratory" (26%) were the most frequently chosen Final ICU Needs. From a multivariable mixed effects logistic regression model fitted to "Cardiovascular" and "Respiratory", operations with significantly reduced odds of having "Cardiovascular" Final ICU Need included Glenn palliation (p = 0.003), total anomalous pulmonary venous connection repair (p = 0.024), truncus arteriosus repair (p = 0.044), and vascular ring repair (p < 0.001). Short lengths of stay (<7.9 days) had significantly higher odds of "Cardiovascular" Final ICU Need (p < 0.001). "Cardiovascular" and "Respiratory" Final ICU Needs were also associated with provider and ICU discharge season. Conclusions: Final ICU Need is a novel metric to identify variations in Cardiac ICU utilisation and clinical trajectories. Final ICU Need was significantly influenced by benchmark operation, length of stay, provider, and season. Future applications of Final ICU Need include targeting quality and research initiatives, calibrating provider and family expectations, and identifying provider-level variability in care processes and mental models.