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关键词： Chronic non-bacterial osteomyelitis   Chronic recurrent multifocal osteomyelitis   Bone autoinflammation   Lymphoplasmacellular osteomyelitis  

摘要： Purpose of Review To describe in detail the clinical synopsis and pathophysiology of chronic non-bacterial osteomyelitis and SAPHO syndrome. Recent Findings Chronic non-bacterial osteomyelitis (CNO) has been identified as a disease entity for almost 50 years. This inflammatory bone disorder is characterized by osteolytic as well as hyperostotic/osteosclerotic lesions. It is chronic in nature, but it can present with episodic flairs and phases of remission, which have led to the denomination "chronic recurrent osteomyelitis", with its severe multifocal form "chronic recurrent multifocal osteomyelitis" (CRMO). For almost three decades, an infectious aetiology had been considered, since especiallyPropionibacterium acneshad been isolated from bone lesions of individual patients. However, this concept has been challenged since long-term antibiotic therapy did not alter the course of disease and modern microbiological techniques (including PCR) failed to confirm bone infection as an underlying cause. Over recent years, a profound dysregulation of cytokine expression profiles has been demonstrated in innate immune cells of CNO patients. A hallmark of monocytes from CNO patients is the failure to produce immune regulatory cytokines interleukin-10 (IL-10) and IL-19, which have been linked with genetic and epigenetic alterations. Subsequently, a significant upregulation of pro-inflammatory, NLRP3 inflammasome-dependent cytokines (IL-1 beta and TNF-alpha), has been demonstrated. The current knowledge on CNO, the underlying molecular pathophysiology, and modern imaging strategies are summarized;differential diagnoses, treatment options, outcome measures, as well as quality of life studies are discussed.

关键词： Musculoskeletal   Global   Access to care   Awareness   Workforce  

摘要： There is increasing concern about the emerging global non-communicable diseases (NCDs) burden. The focus has mainly been on NCDs in adults but it is important that MSK morbidity in both children and adults is included in strategic planning. There have been considerable advances in the understanding and treatment options for children and young people (CYP) and clinical outcomes are improving for those who can access such high quality care. However vast inequity exists and there are many CYP who live in areas of the world with high burden of health care challenges, compounded by paucity of specialist care and limited access to treatments. The Paediatric Global Musculoskeletal Task Force aims to raise awareness about unmet needs for CYP with MSK conditions, promotion of MSK health through lifestyle and the avoidance of injury. We aim to leverage change through 'working together better'.

关键词： Varicella vaccination   Vaccine hesitancy   Cross-sectional study   Parents   Healthcare providers  

摘要： Background: Varicella vaccination is important in prevention of childhood infection. Aim of this cross-sectional study was to survey attitudes and determinants of support or refusal of varicella vaccination in parents and in paediatric healthcare professionals, mainly health visitors in Hungary prior to the introduction of this vaccine in National Immunization Program in 2019. Methods: Between October 2018 and February 2019, 1042 parents and 198 healthcare professionals completed a self-administered anonymous questionnaire regarding sociodemographic background, knowledge and attitudes towards varicella vaccination, and reasons for non-vaccination. Results: From the participating parents 53.3% have vaccinated at least one of their children. Vaccination rate was significantly higher in families with <3 children, living in the capital, among those who have seen complications of varicella and among parents with university degree. Most important positive determinant was recommendation of the vaccine by healthcare professionals: 77.8% of parents accepted vaccination when recommended by the paediatrician, despite the cost of the vaccine, whereas only 17.3% of parents vaccinated their children when the vaccine was not recommended by paediatrician. Most important reasons for non-vaccination was finding the vaccine unnecessary, concerns regarding side effects, and not believing in the vaccine's effectiveness. Among paediatric healthcare professionals, support rate of universal varicella vaccination was 76.3%. Support rate was higher among those who have seen complications of varicella more often and those who consider varicella a severe infection. Reasons of professionals who do not support universal varicella vaccination were similar to those of vaccine hesitant parents. Practice of intentional exposure of non-immune child to infected ones still exist. Conclusions: Educational programs are needed for parents and health visitors to address concerns regarding vaccination. Paed

关键词： Mandatory vaccine policies   Vaccine hesitancy   Vaccine refusal   Childhood vaccination   Australian 'No Jab' policies   Specialist immunisation services  

摘要： Introduction: 'No Jab, No Play' and 'No Jab, No Pay' mandatory immunisation policies were introduced in the state of Victoria and Australia-wide, respectively, in January 2016. They restrict access to childcare/kindergarten and family assistance payments respectively, for under-vaccinated children. We aimed to describe the proportion of attendees to immunisation services of a tertiary hospital, the Royal Children's Hospital Melbourne (RCH), who were motivated by the policies to discuss or catch-up vaccination. We explored the association between motivation by policies, vaccine hesitancy (VH) and intent to seek medical exemption, with vaccine-uptake. Methods: Parents/Guardians and clinicians completed surveys October 2016-May 2017 from the nurse-led immunisation Drop in Centre (DIC) or physician-led Specialist Immunisation Clinic (SIC). Vaccine-uptake was measured using the Australian Immunisation Register (AIR) at baseline, 1 and 7 months post-attendance. The association between vaccine-uptake, motivation by policies and VH was explored by logistic regression. Results: Of 607 children, 393 (65%) were from the DIC and 214 (35%) SIC. 74 (12%) parents were motivated by the policies to attend immunisation services and 19% were VH. Only 50% of VH parents planned to catch-up vaccination for enrolment to childcare/kindergarten. Seven months post-attendance there was no association between motivation by policies and full vaccination status (difference 10%, OR 0.42, CI 0.17-1.1, p 0.08). Fewer children were fully immunised at 7 months if their parents were VH (difference 18%;OR 0.24, CI 0.1-0.54, p < 0.001) or seeking medical exemption (difference 33%, OR 0.08, CI 0.01-0.6, p 0.015). Conclusion: The 'No Jab' policies motivated attendance to a tertiary immunisation service. However, children of vaccine hesitant parents and those seeking medical exemption to immunisation were less likely to be fully immunised after attendance, than at baseline. The 'No Jab' policies may not be

关键词： Food allergy   Nutrition   Pediatrics   Vegan  

摘要： Vegan diets - defined as the exclusion of all foods of animal origin from the diet- are becoming popular. In recent years, the prevalence of food allergy has also increased, and disproportionately affects children. When vegan diets and food allergy co-occur, this combination can be challenging and pose risks of nutritional deficiencies, particularly during childhood. In this paper, we aim to summarise the major concerns regarding vegan diets and food allergy, review the literature on this topic, and provide some suggestions for healthcare providers, particularly dietitians and nutritionists, who work with food allergic, vegan patients and their family. When working with this patient population, a regular and complete medical nutrition history, including screening for any possible nutritional deficiencies, is warranted. Likewise, the routine tracking of serum markers (especially iodine, iron, zinc, calcium, Vitamins B12, D, B2, and A, selected n-3 fatty acids and protein, which are more abundant in animal vs. plant foods) and symptoms of co-morbid diseases, including asthma, is important, as comorbid diseases may increase energy and nutrient requirements. For infants and children, anthropometry ought to be tracked longitudinally at regular intervals to identify any deviations from the child's previous growth pattern, and to accommodate any increased requirements for growth and development. Correct diagnoses, education and allergy management must be disseminated to the family in a clear and appropriate manner. Children with allergy may have increased nutritional needs due to comorbidity. This is complicated by coincident food allergy and vegan diet as both impose diet restrictions (limiting sources of important nutrients, need for dietary variety and/or increased consumption due to reduced bioavaliability).

关键词： Childhood cancer   resilience   growth   care   survivorship   auto-ethnography  

摘要： The author presents an interpersonal experience between the author and her son during childhood cancer treatment and care, illustrating the complex relationship between childhood cancer and the term 'resilience'. During treatment and care, nurses used the term 'resilience' in an apparent attempt to reassure her. However, the author found that the concept distanced her from her and her son's experience, creating emotional distress for him. She discovered that the everyday use of resilience, devoid of its research connotations, has the potential to create barriers in understanding these experiences for the patient and the caregiver. For example, this everyday use did not account for the relationship that resilience has with growth. It is not just important in terms of diagnosing a tumour, it is also important for supporting the agency of a child and the cultivation of trustworthiness. A focus on growth supports the notion of an "active resilience," a process informed by research literature to help medical staff and families develop the child patient's capability for growing into resilience throughout the survivorship experience. By neglecting this relationship with growth, resilience was found to silence the agency and voice of the author's child which added to the difficulty that she had in providing care. As more children survive cancer, a meaningful use of the term resilience can support their recovery from the adversities of treatment and a life of adverse outcomes. The ethnographic detail provides the context necessary for contributing to and unpacking the normative use of the term resilience in paediatric oncology.

关键词： 网络教学   临床实习   新型冠状病毒肺炎   儿科学  

摘要： 目的探索网络教学方式在新型冠状病毒肺炎疫情期间儿科学临床实习中的应用效果。方法采用问卷调查方法,选取2020年2月至2020年3月在浙江大学医学院附属儿童医院实习的45名临床医学专业学生为研究对象,采用网络平台开展实习教学。儿科实习结束后,通过问卷调查了解学生和教师对网络教学方式的评价。结果95.6%(43/45)的学生认为网络教学方式对掌握理论知识有一定的帮助;分别有80.0%(36/45)和88.9%(40/45)学生肯定网络教学方式对提高学习积极性和自主学习能力有作用;86.7%(39/45)的学生表示在网络实习过程中可以及时得到反馈和帮助;62.2%(28/45)的学生认为网络教学方式可以在一定程度上有助于掌握临床技能。同时,带教教师愿意采用网络教学方式并认同其积极作用。结论疫情期间,网络教学方式在儿科学临床实习中可以在一定程度上帮助学生掌握理论知识和建立临床思维,提高学生学习的主观能动性,对不能常规进行的临床实习有弥补作用。

关键词： 儿科学   反复呼吸道感染   中医治疗优化方案   中医药疗法  

摘要： 目的观察反复出现呼吸道感染的患儿实施中医治疗优化方案的治疗效果。方法选取2018年1月—2019年1月收治的反复呼吸道感染患儿40例,按照奇偶法将样本均分为优化组和常例组,常例组实施常规治疗方法,优化组实施中医治疗优化方案,比较2组患儿的临床疗效、免疫球蛋白水平(简称:IgA)、在随访期内发生呼吸道感染的次数以及患儿家长对治疗的满意度。结果优化组患儿的治疗总有效率(95.00%)明显高于常例组(65.00%)(χ~2=5.6250,P=0.0177);治疗前,优化组患儿体内的免疫球蛋白水平(0.93±0.32)g/L与常例组(0.94±0.35)g/L数据相近,差异无统计学意义(t=0.0943,P=0.9254);治疗后,优化组患儿体内的免疫球蛋白水平(1.64±0.59)g/L明显好于常例组(1.25±0.38)g/L(t=2.4852,P=0.0175);优化组患儿在随访期内出现呼吸道感染的次数明显少于常例组(P<0.05);优化组患儿家长对治疗的满意度(95.00%)明显高于常例组(55.00%)(χ~2=8.5333,P=0.0034)。结论为反复出现呼吸道感染的患儿实施中医治疗优化方案的治疗效果较为显著,不仅可以改善患儿的免疫球蛋白水平,还可以减少患儿出现呼吸道感染的情况,提升患儿家长的满意度,值得推广应用。

关键词： Mini-CEX   临床护理   儿科学   人文护理  

摘要： 研究针对Mini-CEX的的内涵进行分析,并结合儿科护理学的实际要求提出了针对性的建议,在儿科护理实践教学中应进一步加强专业教师的培养,突出人文护理理念的培养,紧密结合临床实践开展专项护理技能提升,使Mini-CEX成员提升护理人员临床技能的有效工具。

关键词： 翻转课堂   儿科学   临床技能培训  

摘要： 目的探索翻转课堂教学模式在儿科学临床技能培训中的应用效果。方法选取安徽医科大学临床医学专业学生作为研究对象,分为对照组30例,采用传统教学法;观察组30例,采用翻转课堂教学模式。比较两组的儿科临床技能考核和理论知识成绩以及教学满意度调查结果。结果观察组操作技能考核和理论知识成绩均明显高于对照组(P<0.001)。观察组对教学模式认同度、学习兴趣、培养自主学习能力及理论知识和临床实践结合度的满意度明显高于对照组(P<0.001)。结论翻转课堂应用于儿科学临床技能培训中效果显著,可提高学生的学习兴趣,有利于自主学习能力的培养。