教学课程资源库 更多>>

关键词： family nursing   hermeneutics   intensive care units-Paediatric   paediatrics  

摘要： Background Family-centred care is the dominant model for providing nursing care in paediatrics. Unit layout has been shown to impact nurses' ability to provide family-centred care. Little is known about the meanings and experiences of paediatric intensive care unit nurses concerning the care they provide to families within their unique physical setting. Aim This study examined paediatric intensive care unit nurses' lived experience of caring for families following a major hospital transformation project, which included the construction of a new unit and quality improvement changes. Study design A hermeneutic-phenomenological design was selected to study a paediatric intensive care unit in a large Canadian paediatric teaching hospital. Methods Data were collected over a 6-month period through individual interviews, photographs, participant observation, and document review. The sample consisted of 15 paediatric intensive care unit nurses who experienced the unit both pre- and post-transformation. Data were analysed in an ongoing fashion using the method described by Benner to identify common and divergent meanings. Results Despite pride in offering a family-friendly environment, nurses' practice prejudiced a family focus in favour of patient-centred care. Nurses in this study negotiated physical and practice spaces with families by interpreting that nurses do not belong in the home-like patient room and exhibiting gatekeeping comportments. Conclusion Although similar nurse comportments have been identified in prior works, no previous studies have identified these as forming a pattern of negotiating spaces with families. Relevance to clinical practice This study provides insights into the lived experience of paediatric intensive care unit nurses in relation to family care, which can stimulate reflections at an organizational level about creating environments where nurses and families can both feel at home.

关键词： central lines   complications   long-term venous access   paediatric   Peripherally inserted central catheters   PICC  

摘要： Background To document the evolution of the Peripherally Inserted Central Catheter service at Princess Margaret Hospital, now Perth Children's Hospital. Methods Between January 2012 and June 2013 patients referred to Anaesthesia for a Peripherally Inserted Central Catheter were prospectively followed up. A repeat audit was conducted between January 2015 and June 2016, following the introduction of a number of measures aimed at improving the service. Results Audit 1: A total of 200 Peripherally Inserted Central Catheter insertions were attempted in 138 patients. Successful placement occurred in 86% of cases (172/200). The median age of patients was 7.71 years (range 0-20). The percentage of Peripherally Inserted Central Catheters remaining in situ for the predicted duration was 49/172 (28.5%). Complications were documented in 78/172 (45.4%) of cases. Audit 2: A total of 310 Peripherally Inserted Central Catheter placements were attempted in 244 patients. Successful insertion rate was 95.5% (296/ 310). The median age of patients was 5.3 years (range 0.0-18.72). The percentage remaining in situ for the predicted duration was 145/296 (49%). Complications were documented in 67/296 (22.6%) of cases. Conclusion The evolution of the Peripherally Inserted Central Catheter service at our free standing Tertiary Paediatric Hospital is well documented following these 2 audits. The introduction of a dedicated Anaesthesia led Peripherally Inserted Central Catheter service at our centre has resulted in improved insertion success rates and a reduction in complications.

关键词： animal-assisted therapy   assessment   children   experience   hospital  

摘要： AimTo evaluate children's experiences of and responses to animal-assisted therapy using a therapy dog as complementary treatment in paediatric hospital care. MethodsThe study was performed using mixed methods, by means of qualitative and quantitative data. Fifty children in a paediatric surgery ward, at a tertiary hospital in Sweden, were included between February 2016 to May 2017. Children answered questions about feelings of well-being and experiences of the hospital stay before and after animal-assisted therapy, and experiences of their interaction with a therapy dog. ResultsThe children's well-being increased from moderately good before to very good after animal-assisted therapy, and the children assessed the hospital stay as better after than before. The vast majority of the children (93%) assessed the interaction with the dog as very good. The children described mixed experiences before and mainly positive aspects of joy, satisfaction and pain relief after animal-assisted therapy. ConclusionThe children's responses before interaction, of both a positive and negative nature, show a focus shift after the interaction with a therapy dog to mainly positive nature regarding self-reported feeling of well-being and experiences of the hospital stay. Using a therapy dog in paediatric hospital care is suitable complementary treatment.

关键词： Films   Freeze-dried wafers   Ondansetron   Buccal delivery   Mucoadhesion   Permeation  

摘要： The objective of this study was the development of different solid formulations, such as wafers and films, for buccal administration of ondansetron, a selective and potent antagonist of 5-hydroxytryptamine 3 receptors used in children for the treatment of nausea and vomiting. Wafers and films have been prepared drying an aqueous solution of pectin, hydroxypropyl methylcellulose, sodium hyaluronate, sodium carboxymethylcellulose, chitosan or gelatin, through lyophilization or oven. Formulations were characterized in terms of morphology, drug solid state and ability to hydrate, adhere to mucosa, release and favour the permeation of the drug through porcine esophageal epithelium, used as model of human buccal epithelium. The most promising formulations were tested for in vitro biocompatibility in human pulp fibroblasts. Films showed greater hydration and mucoadhesion abilities and allowed the release and the permeation of a greater amount of ondansetron with respect to wafers. Chitosan or hyaluronate provided films with the best mucoadhesion properties and good biocompatibility profile. Moreover, chitosan based film allowed to obtain the highest amount of permeated drug and could represent a novel child-appropriate dosage form able to combine the advantages of solid dosage form with the possibility to avoid the swallowing.

关键词： Antibiotic   Overuse   Guideline adherence   Appropriate  

摘要： Background Infections caused by antibiotic resistant pathogens are increasing, with antibiotic overuse a key contributing factor. Objective The CareTrack Kids (CTK) team assessed the care of children in Australia aged 0-15 years in 2012 and 2013 to determine the proportion of care in line with clinical practice guidelines (CPGs) for 17 common conditions. This study analyses indicators relating to paediatric antibiotic overuse to identify those which should be prioritised by antimicrobial stewardship and clinical improvement programs. Method A systematic search was undertaken for national and international CPGs relevant to 17 target conditions for Australian paediatric care in 2012-2013. Recommendations were screened and ratified by reviewers. The sampling frame comprised three states containing 60% of the Australian paediatric population (South Australia, New South Wales and Queensland). Multi-stage cluster sampling was used to select general practices, specialist paediatric practices, emergency departments and hospital inpatient services, and medical records within these. Medical records were reviewed by experienced paediatric nurses, trained to assess eligibility for indicator assessment and compliance with indicators. Adherence rates were estimated. Results Ten antibiotic overuse indicators were identified;three for tonsillitis and one each for seven other conditions. A total of 2621 children were assessed. Estimated adherence for indicators ranged from 13.8 to 99.5% while the overall estimate of compliance was 61.9% (95% CI: 47.8-74.7). Conditions with high levels of appropriate avoidance of antibiotics were gastroenteritis and atopic eczema without signs of infection, bronchiolitis and croup. Indicators with less than 50% adherence were asthma exacerbation in children aged > 2 years (47.1%;95% CI: 33.4-61.1), sore throat with no other signs of tonsillitis (40.9%;95% CI: 16.9, 68.6), acute otitis media in children aged > 12 months who were mildly unwell (13.8%;9

关键词： 科学   专业英语   金课建设  

摘要： 随着社会迅速发展,我国医药产业逐渐走向世界,同时,国际上的医学知识的探讨逐渐增多,国内医学专家发表国外期刊杂志的也越来越多,目前,对于儿科医学生来说,不仅需要有扎实的医学知识基础,掌握熟练的英语技能更符合现代儿科医学生的培养目标。因此,在国内大多数医学院校内,《专业英语》作为儿科学专业学生的必修课,为提升儿科医学生医学英语应用能力有着重要作用。本篇主要通过对我国医学院校儿科学《专业英语》课程现状,进而探讨儿科学《专业英语》关于金课建设的思考。

关键词： Paediatric Castleman disease   Unicentric   Multicentric   Tocilizumab  

摘要： Background Castleman disease (CD) is a rare non-malignant lymphoproliferation of undetermined origin. Two major disease phenotypes can be distinguished: unicentric CD (UCD) and multicentric CD (MCD). Diagnosis confirmation is based on histopathological findings in a lymph node. We attempted to survey all cases of paediatric CD identified to date in France to set up a national registry aiming to improve CD early recognition, treatment and follow-up, within the context of a new national reference center (). Methods In 2016, we e-mailed a questionnaire to members of the French paediatric immunohaematology society, the paediatric rheumatology society and the Reference Centre for Castleman Disease to retrospectively collect cases of paediatric CD (first symptoms before age 18 years). Anatomopathological confirmation was mandatory. Results We identified 23 patients (12 girls) with a diagnosis of UCD (n = 17) and MCD (n = 6) between 1994 and 2018. The mean age at first symptoms was 11.47 +/- 4.23 years for UCD and 8.3 +/- 3.4 years for MCD. The mean diagnosis delay was 8.16 +/- 10.32 months for UCD and 5.16 +/- 5.81 years for MCD. In UCD, the initial symptoms were isolated lymph nodes (n = 10) or lymph node associated with other symptoms (n = 7);fever was present in 3 patients. Five patients with MCD presented fever. No patients had HIV or human herpesvirus 8 infection. Autoinflammatory gene mutations were investigated in five patients. One patient with MCD carried a K695R heterozygous mutation in MEFV, another patient with MCD and Duchenne myopathy carried two variants in TNFRSF1A and one patient with UCD and fever episodes carried two heterozygous mutations, in IL10RA and IL36RN, respectively. Treatment of UCD was mainly surgical resection, steroids, and radiotherapy. Treatment of MCD included tocilizumab, rituximab, anakinra, steroids, chemotherapy, and splenectomy. Overall survival after a mean of 6.1 +/- 6.4 years of follow-up, was 100% for both forms. Conclusion Paed

关键词： Airway management   Child   Complications   Emergency medical services   Intubation  

摘要： Background Clinical team composition for prehospital paediatric intubation may affect success and complication rates. We performed a systematic review and meta-analysis to determine the success and complication rates by type of clinical team. Methods We searched MEDLINE, EMBASE, and CINAHL for interventional and observational studies describing prehospital intubation attempts in children with overall success, first-pass success, and complication rates. Eligible studies, data extraction, and assessment of risk of bias were assessed independently by two reviewers. We performed a random-effects meta-analysis of proportions. Results Forty studies (1989 to 2019) described three types of clinical teams: non-physician teams with no relaxants (22 studies, n = 7602), non-physician teams with relaxants (12 studies, n = 2185), and physician teams with relaxants (12 studies, n = 1780). Twenty-two (n = 3747) and 18 (n = 7820) studies were at low and moderate risk of bias, respectively. Non-physician teams without relaxants had lower overall intubation success rate (72%, 95% CI 67-76%) than non-physician teams with relaxants (95%, 95% CI 93-98%) and physician teams (99%, 95% CI 97-100%). Physician teams had higher first-pass success rate (91%, 95% CI 86-95%) than non-physicians with (75%, 95% CI 69-81%) and without (55%, 95% CI 48-63%) relaxants. Overall airway complication rate was lower in physician teams (10%, 95% CI 3-22%) than non-physicians with (30%, 95% CI 23-38%) and without (39%, 95% CI 28-51%) relaxants. Conclusion Physician teams had higher rates of intubation success and lower rates of overall airway complications than other team types. Physician prehospital teams should be utilised wherever practicable for critically ill children requiring prehospital intubation.

关键词： Allergens   Pediatrics   Allergies   Laos   Nickel   Atopic dermatitis   Children   Medical risk factors  

摘要： Background Dermatological services in Laos, South East Asia are limited mainly to the capital and patch testing is currently not available, so no data exists regarding the common cutaneous allergens in this population. Objectives The aim of this study was to document common allergens in paediatric patients with atopic dermatitis attending the allergy clinic in the capital, Vientiane. Patients/Materials/Methods Fifty paediatric patients with atopic dermatitis were patch tested using TRUE Test (R) panels 1 to 3 (35 allergens). Readings were taken at Days 2 and 4. Results Twenty-six positive patch tests were recorded on Day 4 in 15 children (30%). The most common allergens were: gold (18%), nickel (10%), formaldehyde (6%) and p-Phenylenediamine (6%). Other positive allergens were potassium dichromate (2%), cobalt dichloride (2%), Bronopol (2%), paraben mix (2%), fragrance mix 1 (2%) and neomycin (2%). The majority of the patients with positive reactions were female. Conclusions This study represents the first documented patch test results in the Lao population. It is hoped that these findings will help clinicians to advise the families of children with atopic dermatitis on common allergens to avoid and inform future work on contact dermatitis in this population.

摘要： The cause and the management of convulsive status epilepticus are the two most important factors in determining its outcome.1 Benzodiazepines are the recommended first-line drug treatment of convulsive status epilepticus and for which reasonably good scientific evidence based on a number of randomised controlled trials exists to support their use.2 Intravenous phenytoin in the UK and fosphenytoin in the USA are the current recommended first-choice, second-line drug treatments in children aged 6 months and older,3–5 but until recently, this choice has not been based on good randomised controlled trial evidence. Additionally, phenytoin, and, perhaps to a lesser degree, fosphenytoin, is known to be associated with severe and potentially fatal adverse side-effects.8 Now, within a 12-month period, three large randomised controlled trials have reported the efficacy and safety of phenytoin or fosphenytoin compared with levetiracetam and valproate in the management of convulsive status epilepticus in approximately 750 children overall, aged 3 months to 18 years. In The Lancet, James Chamberlain and colleagues7 report on an extension of ESETT,6 after extending enrolment among children.7 ESETT was a double-blind, randomised controlled trial in which 225 children (aged 2–17 years; 55% male) and 237 adults (186 aged 18–65 years; 58% male; and 51 aged >65 years; 41% male) were randomly assigned in a Bayesian response-adaptive manner to fosphenytoin, levetiracetam, or valproate.