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摘要： Objectives The structured digital dosing guidelines of the web-based Dutch Paediatric Formulary provided the opportunity to develop an integrated paediatric dose calculator. In a simulated setting, we tested the ability of this calculator to reduce calculation errors. Methods Volunteer healthcare professionals were allocated to one of two groups, manual calculation versus the use of the dose calculator. Professionals in both groups were given access to a web-based questionnaire with 14 patient cases for which doses had to be calculated. The effect of group allocation on the probability of making a calculation error was determined using generalized estimated equations (GEE) logistic regression analysis. The causes of all the erroneous calculations were evaluated. Results Seventy-seven healthcare professionals completed the web-based questionnaire: thirty-seven were allocated to the manual group and 40 to the calculator group. Use of the dose calculator resulted in an estimated mean probability of a calculation error of 24.4% (95% CI 16.3-34.8) versus 39.0% (95% CI 32.4-46.1) with use of manual calculation. The mean difference of probability of calculation error between groups was 14.6% (95% CI 3.1-26.2;p = 0.013). In a secondary analysis where calculation error was defined as a 10% or greater deviation from the correct answer, the corresponding figures were 19.5% (95% CI 13-28.2) versus 26.5% (95% CI 21.6-32.1) with a mean difference of 7% between groups (95% CI 2.2-16.3;p = 0.137). Juxtaposition, typo/transcription errors and non-specified errors were more frequent as cause of error in the calculator group;exceeding the maximum dose and wrong correction for age were more frequent in the manual group. The percentage of tenfold errors was 3.1% in the manual group and 3.7% in the calculator group. Conclusions Our study shows that the use of a dose calculator as an add-on to a web-based paediatric formulary can reduce calculation errors. Furthermore, it shows that techn

关键词： ambulatory surgery   anaesthesia   paediatrics   patient admission   quality improvement   risk factors   unplanned hospital admission  

摘要： Background: Failure to discharge home after day-case procedures has a negative impact on patients, families, and hospital finances. There are currently no national paediatric data on the incidence and causes of unplanned admission. We determined the incidence of unplanned admissions after paediatric day-case anaesthesia, and identified risk factors leading to unplanned admission. Methods: During a 6 week period (in October and November 2017), all children aged 16 yr or under receiving general anaesthesia without an inpatient bed on arrival were included. Hospital, surgical, and procedural details;anonymised patient characteristic data;and anaesthetic and surgical experience were collected by local Paediatric Anaesthesia Trainee Research Network coordinators. A mixed-effects binary logistic regression model with backward selection was used to determine variables associated with unplanned admission. Results: Ninety three hospitals across the UK and Ireland participated. There were 25 986 cases, of which 640 were unplanned admissions. The independent risk factors for unplanned admission were ASA-physical status (PS) (ASA-PS 3/4 vs ASA-PS 1;odds ratio [OR]: 2.80 [95% confidence interval {CI}: 2.07-3.77]), duration of procedure (OR: 1.04 [95% CI: 1.03-1.05]), and surgical specialty (vs ear, nose, and throat [highest caseload specialty]: cardiology OR: 1.89 [95% CI: 1.15-3.06], orthopaedics/trauma OR: 0.91 [95% CI: 0.69-1.18], and general surgery OR: 0.59 [95% CI: 0.46-0.77]). The commonest reasons for admission were unexpected surgical complexity, pain, postoperative nausea and vomiting, and late finish. Conclusions: Paediatric patient physical status, some types of surgery and duration of procedure were associated with unplanned day-surgery admissions. Unexpected surgical complexity and patient discomfort in recovery were common factors.

关键词： MIH   HSPM   Hypomineralisation   Prevalence   Presentation  

摘要： Purpose The purpose of the study was to determine the prevalence and presentation patterns of molar incisor hypomineralisation (MIH) and hypomineralised second primary molars (HSPM) in the Division of Paediatric Dentistry at The Hospital for Sick Children (SickKids) in Toronto, Canada. Methods A cross-sectional study of 429 eligible participants was carried out by nine trained and calibrated examiners. The European Academy of Paediatric Dentists (EAPD) criteria for diagnosis and documentation of MIH and HSPM defects were used. Results Molar incisor hypomineralisation and HSPM prevalence was 12.4% and 5.2%, respectively. Regarding MIH, the affected molars and incisors attributed to 5.6% of the total prevalence, the remaining having only molars affected. Demarcated white opacities were most common in MIH (60%) and HSPM (67%), followed by yellow/brown opacities (MIH 22%, HSPM 9%), post-eruptive breakdown (MIH 8%, HSPM 24%), atypical caries (MIH 6%, HSPM 0%), and atypical restorations (MIH 4%, HSPM 0%). In both MIH and HSPM, single surface hypomineralised lesions were significantly more common than multi-surface lesions (p < 0.0001). Most lesions affected buccal enamel (MIH 55%, HSPM 47%). Lesion extension was most frequently less than 1/3 of a tooth surface (MIH 58%, HSPM 67%) and this was significantly more common in teeth affected by HSPM than MIH (p = 0.03). Individuals with HSPM were more likely to present with two affected molars than individuals with MIH (p = 0.03). Hypomineralised second primary molars were not predictive for MIH. Conclusions The prevalence of MIH and HSPM was within the range of published studies. The most common MIH and HSPM lesions affected single surface of a tooth, mostly on the buccal surface and were less than 1/3 of the surface area size.

摘要： Background Paediatric pain remains one of the most misunderstood, under-diagnosed and under-treated medical problems in children. Aim To investigate the accuracy of acute pain assessment and management in the Paediatric Emergency Department in Lithuanian University of Health Sciences Hospital. Methods We performed a retrospective record analysis before (the year 2017) and after (the year 2018) paediatric pain training course was conducted. In total, 1,000 randomly selected outpatient records were analysed. We divided all patients into two groups: group A records from 2017 and group B from 2018. Patients were further divided into trauma and non-trauma and subdivided into four different age groups. We collected patient age, the origin of pain, pain characteristics, pain score and medication. Results We compared 500 children in each group. Groups A and B consisted of 154 (30.8%) and 116 (23.2%) trauma patients, respectively. The pain was scored less in group A (420 children;84%) compared to group B (94.4% of all 500 patients, p < .001). In all age groups, the pain was assessed more often, and pain medication was prescribed more often in group B compared to group A (p < .001). There was a tendency to assess pain more often in group A non-trauma patients (p = .054). However, pain relief in trauma patients was less adequate compared to non-trauma. Conclusion Our research showed improvement in pain evaluation and treatment after systemic and local changes in paediatric emergency department (PED). In group B, pain was evaluated more frequently, and patients received pain medication more often than in group A. Teenagers are still less likely to receive analgesics than toddlers. Tendency remains to give fewer painkillers to trauma patients compared to non-trauma children. Significance This is one of the few studies in the Baltic region analysing changes in children's pain assessment and management in the PED after systemic and local adjustments. Our data show an impact of sys

关键词： Epinephrine   Paediatric cardiac arrest   Resuscitation  

摘要： Bradycardia with poor perfusion is common and accounts for nearly 50% of all paediatric in-hospital cardiac arrests (CA).[1] The commonest aetiology of paediatric CA is hypoxia due to respiratory compromise. They assessed the risk of return of sustained circulation (ROSC), survival and favourable neurological outcome for those patients who received epinephrine within the first 10 min compared with those who never received epinephrine or had not yet received epinephrine at a similar time point. Previous studies mainly included children who had already progressed to pulseless CA rather than in a bradycardic CA with a pulse.[[2], [10]] Perhaps epinephrine is more useful improving myocardial coronary perfusion when there is none in pulseless CA. [Extracted from the article]

关键词： Simulated patient   Simulated participant   Standardized patient   Communication   Professionalism  

摘要： Surgical training is long and complex. At the core of clinical practice is communication. Voice is central to relationships of care. Communication and other person-centred competencies are well articulated in surgical training programs. Simulated participant (SP) methodology has seen significant development over its contemporary history. Most commonly in paediatrics SPs portray the roles of parents. However, children and adolescents as SPs are increasingly employed to support the development and assessment of the complex concept of voice. There are specific considerations in all phases of SP-based work, and these are heightened for children and adolescents. This article explores contemporary SP practices in health professional education with a focus on paediatric surgery training. (C) 2020 Elsevier Inc. All rights reserved.

关键词： Meta-analysis   Systematic review   Evidence   Paediatric urology   AMSTAR-2   PRISMA  

摘要： Introduction Systematic reviews and meta-analyses provide a comprehensive summary of research studies and are used to assess clinical evidence, form policy and construct guidelines. This is pertinent to childhood surgery with issues of consent and condition prevalence. The aims of this study were to evaluate the methodological and reporting quality of these reviews and to identify how these reviews might guide clinical practice amongst those conditions most commonly encountered and managed by practicing paediatric urologists. Methods A systematic search of the English literature was performed to identify systematic reviews and meta-analyses focusing on clinical paediatric urology (1/1/1992-1/12/2018) to include common paediatric urological conditions managed by paediatric urology residents/fellows. To these reviews, Assessing the Methodological Quality of Systematic Reviews (AMSTAR)-2 and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) scores were applied. Univariate linear regression and descriptive statistical methods were performed. Results From an initial literature review of 1723 articles, 227 were included in the analysis. Inter-reviewer agreement was high amongst 3 independent reviewers (kappa = 0.92). Eighty-four percent of systematic reviews and meta-analyses were published since 2009 following publication of the PRISMA guidelines. The overall impact factor was 3.38 (0.83-17.58), with adherence to AMSTAR-2 criteria 48.46% and PRISMA criteria 70.1%. From a methodological perspective, 15% of reviews were of moderate quality, 65% were of low quality and 20% reviews were of critically low quality, with none found to have good quality reporting. Conclusions Despite the continued increase of systematic reviews and meta-analyses inpaediatric urology from which many guidelines are based, a significant number of reviews contain poor methodology and, to a lesser extent, poor reporting quality. Journals should consider having specific 'a pr

关键词： Crohn disease   exclusive enteral nutrition   inflammatory bowel disease   resectional surgery   right hemicolectomy  

摘要： Exclusive enteral nutrition (EEN) is effective in inducing remission in paediatric Crohn Disease (CD) and has been shown to reduce inflammation and improve outcomes in adult CD patients when used before resectional surgery. This retrospective study demonstrates that preoperative EEN is achievable in paediatric CD patients undergoing right hemicolectomy and is associated with positive peri-operative outcomes. Seventeen patients (8 who received preoperative EEN and 9 who did not) were included in the study. Six of 8 (75.0%) managed EEN orally;1 via nasogastric tube and another via a previously sited gastrostomy. Use of preoperative EEN was associated with a decreased rate of moderate/severe disease on resection pathology (5/8 [62.5%] vs 9/9 [100%];P=0.04). Larger studies are required to determine the wider potential benefits of preoperative EEN on postoperative outcomes within paediatric practice.

关键词： Emerging technologies   Surgical education   Simulation   Wearable technology   Screen-based learning  

关键词： airway resistance   dysanapsis   exercise  

摘要： New Findings What is the central question of this study? Are sex difference in the central airways present in healthy paediatric patients? What is the main finding and its importance? In patients <= 12 years we found no sex differences in central airway luminal area. After 14 years, the males had significantly larger central airway luminal areas than the females. The sex differences were minimized, but preserved when correcting for height. Luminal area is the main determinant of airway resistance and our finding could help explain sex differences in pulmonary system limitations to exercise in paediatric patients. Cross-sectional airway area is the main determinant of resistance to airflow in the respiratory system. In paediatric patients (<18 years), previous evidence for sex differences in cross-sectional airway area was limited to patients with history of pulmonary disease or cadaveric studies with small numbers of subjects. These studies either only report tracheal data and do not include a range of ages or correct for height. Therefore, we sought to assess sex differences in airway luminal area utilizing paediatric patients of varying ages and no history of respiratory disease. Using three-dimensional reconstructions from high-resolution computed tomography scans, we retrospectively assessed the cross-sectional airway area in healthy paediatric females (n = 97) and males (n = 128) over a range of ages (1-17 years). The areas of the trachea, left main bronchus, left upper lobe, left lower lobe, right main bronchus, intermediate bronchus and right upper lobe were measured at three discrete points by a blinded investigator. No differences between the sexes were noted in the cross-sectional areas of the youngest (ages 1-12 years) patients (P > 0.05). However, in patients >= 14 years the cross-sectional areas were larger in the males compared to females in most airway sites. For instance, the cross-sectional size of the trachea was 25% (218 +/- 44 vs. 163 +/- 24 mm(2