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关键词： CHD   futility   end of life   cost   cardiac critical care   palliative care  

摘要： Introduction: Studies have suggested 5-20% of paediatric ICU patients may receive care felt to be futile. No data exists on the prevalence and impact of futile care in the Paediatric Cardiac ICU. The aim is to determine the prevalence and economic impact of futile care. Materials and method: Retrospective cohort of patients with congenital cardiac disease 0-21 years old, with length of stay >30 days and died (2015-2018). Documentation of futility by the medical team was retrospectively and independently reviewed. Results: Of the 127 deaths during the study period, 51 (40%) had hospitalisation >30 days, 13 (25%) had received futile care and 26 (51%) withdrew life-sustaining treatment. Futile care comprised 0.69% of total patient days with no difference in charges from patients not receiving futile care. There was no difference in insurance, single motherhood, education, income, poverty, or unemployment in families continuing futile care or electing withdrawal of life-sustaining treatment. Black families were less likely than White families to elect for withdrawal (p = 0.01), and Hispanic families were more likely to continue futile care than non-Hispanics (p = 0.044). Conclusions: This is the first study to examine the impact of futile care and characteristics in the paediatric cardiac ICU. Black families were less likely to elect for withdrawal, while Hispanic families more likely to continue futile care. Futile care comprised 0.69% of bed days and little burden on resources. Cultural factors should be investigated to better support families through end-of-life decisions.

关键词： Cardiac rehabilitation   Fontan   high-intensity interval training   telemedicine  

摘要： Introduction: We evaluated the safety and feasibility of high-intensity interval training via a novel telemedicine ergometer (MedBIKE (TM)) in children with Fontan physiology. Methods: The MedBIKE (TM) is a custom telemedicine ergometer, incorporating a video game platform and live feed of patient video/audio, electrocardiography, pulse oximetry, and power output, for remote medical supervision and modulation of work. There were three study phases: (I) exercise workload comparison between the MedBIKE (TM) and a standard cardiopulmonary exercise ergometer in 10 healthy adults. (II) In-hospital safety, feasibility, and user experience (via questionnaire) assessment of a MedBIKE (TM) high-intensity interval training protocol in children with Fontan physiology. (III) Eight-week home-based high-intensity interval trial programme in two participants with Fontan physiology. Results: There was good agreement in oxygen consumption during graded exercise at matched work rates between the cardiopulmonary exercise ergometer and MedBIKE (TM) (1.1 +/- 0.5 L/minute versus 1.1 +/- 0.5 L/minute, p = 0.44). Ten youth with Fontan physiology (11.5 +/- 1.8 years old) completed a MedBIKE (TM) high-intensity interval training session with no adverse events. The participants found the MedBIKE (TM) to be enjoyable and easy to navigate. In two participants, the 8-week home-based protocol was tolerated well with completion of 23/24 (96%) and 24/24 (100%) of sessions, respectively, and no adverse events across the 47 sessions in total. Conclusion: The MedBIKE (TM) resulted in similar physiological responses as compared to a cardiopulmonary exercise test ergometer and the high-intensity interval training protocol was safe, feasible, and enjoyable in youth with Fontan physiology. A randomised-controlled trial of a home-based high-intensity interval training exercise intervention using the MedBIKE (TM) will next be undertaken.

关键词： 儿科学   护理学  

ISBN: (纸本)9787536978782

摘要： 本书内容共12章，包括儿科护理技术、新生儿护理、小儿各系统常见病的护理和儿科标准化护理管理，较为详细地讲述了小儿临床护理学的知识和儿科标准化护理的基本内容。第一章介绍了儿科护理技术。第二章介绍了新生儿护理的相关内容。后面的章节分别从循环系统、呼吸系统、消化系统、神经系统、泌尿系统、内分泌系统、血液系统、免疫系统等小儿常见病的护理传染病护理。第十一章介绍了小儿常见传染病护理。第十二章儿科标准化护理管理的内容。

关键词： adenotonsillectomy   adenotonsillotomy   paediatric obstructive sleep apnoea   strengths and difficulties questionnaire  

摘要： Aim Our previous randomised controlled trial of children with obstructive sleep apnoea (OSA) showed no significant differences between adenotonsillectomy (ATE) and adenotonsillotomy (ATT) in improving nocturnal respiration and quality of life after 1 year. The aim of this report was to evaluate the effects on behavioural symptoms using the Strengths and Difficulties Questionnaire (SDQ). Methods Children between 2 and 6 years with OSA were randomised to ATT or ATE. Parents, blinded to method, answered the SDQ while their child underwent polysomnography before and 1 year after surgery. Differences between the total SDQ scores were analysed between the treatment groups. Results The SDQ was filled out in 87% of the cases preoperatively, and in 86% postoperatively. At follow-up, the mean total SDQ score was 9.6 SD +/- 5.1 in the ATE group (n = 31), and 8.2 +/- 6.7 in the ATT group (n = 37),P = .09. The mean total SDQ score for all was preoperatively 10.6 +/- 5.0, and postoperatively 8.8 +/- 6.0,P = .0002. Conclusion There were no significant differences in SDQ scores between the groups at follow-up, indicating that the more conservative ATT is a treatment option in paediatric OSA. The whole group of patients showed a significant improvement after surgery.

关键词： Eye manifestations   Eyelid diseases   Magnetic resonance imaging   Paediatrics   Trauma  

关键词： Epstein-Barr virus   haemolytic anaemia   haemophagocytic lymphohistiocytosis   infectious mononucleosis   peripheral haemophagocytosis  

关键词： Cochlear implant   Perimodiolar   Lateral wall   Impedance   NRT   Behavioural   Threshold   T-   C-level  

摘要： Purpose (1) To compare the in vivo impedances of electrical contacts of the Nucleus Contour Advance (CA) perimodiolar electrodes and the Nucleus Slim Straight (SS) lateral wall electrodes. (2) To compare the relation between the electrode contact impedances and the behavioural T-/C-levels for both types of electrodes. Methods Retrospective case review in two quaternary otologic referral centres was performed. Data on the impedance of the electrode contacts and the T-/C-levels have been collected from 70 consecutive paediatric CI patients. Results (1) SS electrodes show significantly higher impedance values of the contacts compared to the CA electrodes. This can be explained by differences in the active surface of the electrode contacts and is true for the whole electrode arrays. (2) There are significant negative correlations observed between the impedances of the electrode contacts and the behaviourally measured T-/C-levels. (3) The strength correlation between the electrode impedances and the behavioural T-/C-levels is significantly higher and the T-/C-level variability is lower for the perimodiolar CA electrodes than for the lateral wall SS electrodes. Conclusions There exist significant differences in the contact impedance between different cochlear implant electrode arrays. These differences could influence the implant programming parameters and should be considered in any protocols related to automatic implant programming based on objective measures. The predictive value of the electrode impedances for the behavioural T-/C-levels is higher for the perimodiolar CA electrodes than for the lateral wall SS electrodes.

关键词： adult   multiple sclerosis   pediatrics   brain   disability  

关键词： Cancer   Chemotherapy   Haematopoietic stem cell transplantation   Methotrexate   Oral mucositis   Paediatric oncology  

摘要： The use of photobiomodulation therapy (PBMT) in the prevention of oral mucositis (OM) in paediatric care has increased. In this article, we report data of paediatric oncology/haematopoietic stem cell transplantation (HSCT) patients treated with PBMT to prevent chemotherapy-induced OM. A retrospective study was conducted at a Brazilian referral service. Prophylactic PBMT was used in children and adolescents (<= 17 years) following the protocol: InGaAIP, 660 nm, 100 mW, 2 J, 3.33 W/cm(2), and 20 s per point. Demographic data and OM severity scores were assessed. A regression model tested the association between OM with prophylactic PBMT and antineoplastic therapy. A total of 148 individuals who had undergone 358 chemotherapy cycles were analysed. A higher occurrence of OM was observed in HSCT and osteosarcoma (OS) patients. Except for HSCT, OM was associated with methotrexate (MTX) use in all disease groups. PBMT significantly reduced OM severity in acute lymphoblastic leukaemia (ALL) and OS patients. OM grade was 3.16 and 5.45 times higher among individuals with ALL and OS, who had not undergone prophylactic PBMT compared with those who had undergone prophylactic PBMT (p< 0.001). PBMT prevented chemotherapy-induced OM. Individuals who used MTX and did not undergo prophylactic PBMT were at increased risk of OM.