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关键词： COVID-19   Childhood heart disease   Adult congenital heart disease   Pandemic response  

摘要： At the time of writing (25 May 2020), there have been nearly 4.4 million infections and 300,000 deaths worldwide related to COVID-19, an infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Australia (currently 6,900 infections and 98 deaths) and New Zealand (1,500 infections and 21 deaths) have thus far been less affected than other regions. Risk factors for more severe disease include older age and pre-existing cardiovascular disease. The purposes of this document from the Paediatric and Congenital Council of the Cardiac Society of Australia and New Zealand (CSANZ) are to: 1) To review the mechanisms for cardiac involvement in COVID-19, specifically as they may impact patients with childhood and adult congenital heart disease (CHD);2) To review the impact of SARS-CoV-2 infection in the paediatric population;3) To review available data on the risks related to COVID-19 for childhood heart disease and adult CHD;4) To provide guidance for childhood heart disease and adult CHD units in our Australasian region to re-organise services during the pandemic, so as to protect a highly specialised workforce and yet continue to provide an essential service;and 5) To review risk reduction strategies for acquiring COVID-19 for patients with childhood heart disease or adult CHD. Eleven (11) recommendations relevant to the care of children with heart disease and adults with CHD to mitigate the impact of COVID-19 are highlighted through the document.

关键词： Closed reduction   complications   cubitus varus   open reduction   percutaneous wiring   pink pulseless   supracondylar fracture  

摘要： The supracondylar humeral fracture is the most common elbow fracture in children, accounting for just under one-fifth of all paediatric fractures and 60% of paediatric elbow fractures. Modifications of the Gartland classification have been made over the years. The mainstay treatment option is that of closed reduction and percutaneous wiring. However, there remains no gold standard in the management of this injury. Outcomes from other treatment options, including traction and external fixator application have been described and report good results. There remains controversy in the wiring configuration used, and there is no consensus on the approach to be used when faced with an irreducible fracture. This article aims to provide an up-to-date overview of the current practices in the management of this common injury, including the ‘pink pulseless’ hand, ‘poorly perfused white’ hand, surgical techniques, and the associated complications that can ensue. © 2020

关键词： Paediatric   Trauma   Motorcycle   Motocross   Competitive   Recreational   Injury   Pre-hospital   Ambulance  

摘要： Background: Paediatric participation in competitive and recreational off-road motorcycle sports is increasing in popularity worldwide, however injuries frequently occur and the sport is associated with significant morbidity. Objective: This study describes the profile of paediatric off-road motorcycle trauma attended by emergency medical services (EMS) in Victoria, Australia. Methods: A retrospective review included paediatric (<16 years) competitive and recreational off-road motorcycle patients attended by EMS between 2010 and 2017 in the State of Victoria, Australia. Patient characteristics and injuries sustained were described using descriptive statistics. Predictors of EMS transport were identified using multivariable logistic regression analyses. Results: There were 1,479 paediatric motocross patients attended by EMS between 2010 and 2017. This represents 1.6% of the total state-wide EMS paediatric trauma (<16 years) workload, and equates to an average incidence of 22.2 per 100,000 population. The median age of patients was 13 years (IQR: 10-14) and 89.5% were male. The most common final diagnoses recorded by paramedics were 'fractures' (25.5%, n = 377) and 'unspecified pain' (19.5%, n = 289). Administration of analgesia (76.3%) was the most common EMS management, followed by spinal immobilisation (54.7%) and splinting (33.4%). The vast majority (91.5%) of patients were transported to hospital by EMS. Following admission, 38 (2.6%) patients were confirmed to have sustained major trauma, 78.9% of which had been transported direct from scene to a major trauma centre for definitive care. Median ISS for confirmed major trauma patients was 14 (IQR: 14-22). Four (0.4%) patients received pre-hospital CPR. All four sustained injuries from recreational off-road, motorcycle activities and all four cases died, two at the scene and two in-hospital. Conclusion: Off-road motorcycle activities are an important cause of death and injury in Victorian children, as highlighted an

关键词： Pediatric hand burns   End-effector robotic rehabilitation   Range of motion   Hand grip strength   Hand function  

摘要： Purpose: To evaluate the effectiveness of the robotic-assisted exercise with virtual gaming on total active range of motion (ROM) of the digits, hand grip strength (HGS), and hand function in children with hand burns. Methods: Thirty-three children with burn caused by thermal injury (flame or scald) with the involvement of the wrist and hand, total body surface area (TBSA) <30%, and age between 6-12 years, were included in this study. The patients were randomly allocated to one of the two groups;control group (n = 16;received 60-min of the traditional hand rehabilitation program, three times per week for two successive months) and experimental group (n = 17;engaged in an additional 20 min of interactive robot-enhanced hand rehabilitation besides the traditional rehabilitation). Outcomes measured were the total active ROM of the digits, HGS, and hand function at three occasions during the study: at the baseline, post-treatment, and 3 months follow-up. Results: In the experimental group, results regarding total active (ROM) of the digits, HGS, and hand function were statistically significant in comparison to the control group either after treatment (P < .05, P = .04, and P = .005) respectively or at the follow-up (P < .05, P = .023, and P = .012) respectively favoring the experimental group. Conclusion: The robot-enhanced exercise with virtual gaming can increase total active ROM of the fingers' digits, improve HGS, and hand function in children with hand burns. (C) 2020 Elsevier Ltd and ISBI. All rights reserved.

关键词： ankle   biomechanical phenomena   gait analysis   haemophilia   paediatrics  

摘要： Aim To compare foot joint kinetics and energetics in male paediatric boys with and without blood-induced ankle joint destruction to these of matched control groups. Methods A cross-sectional study was conducted in which 3D gait analysis data were collected from thirty-five male children (6-21 years) with severe or moderate haemophilia and twenty-six typically developing boys. Structural integrity of the tarsal foot joints of all haemophilic patients was assessed using the IPSG-MRI scale. All participants walked barefoot while adopting a physiological gait pattern. Three subgroups were created based on the IPSG-MRI scores: a group with no joint involvement (HealthyHaemo), with uni- or bilaterally involvement (PathoHaemo) and with only unilaterally involvement (Haemo_Unilateral_Patho). Results The PathoHaemo group presented a significant lower Lisfranc peak dorsiflexion angular velocity (34.7 degrees/s vs 71.4 degrees/s,P = .000, Cohen d = 1.31) and a significantly higher Lisfranc peak plantarflexion angular velocity (-130.5 degrees/s vs -51.8 degrees/s,P = .000, Cohen d = 0.98) compared to the control group. The Haemo_Unilateral_Patho side had a significant higher Chopart peak dorsiflexion angular velocity compared to the Haemo_Unilateral_Healthy side (41.7 degrees/s vs 31.9 degrees/s,P = .002, Cohen d = 1.16). Conclusion No evidence for mild and severe gait deviations could be demonstrated. Internal moments, used as a surrogate measure of joint loading, quantified by the multi-segment foot model were found to be similar within the three subanalyses. We suggest that the ongoing musculoskeletal development in children compensates for structural damage to the ankle joint.

关键词： complications   ileal pouch-anal anastomosis   pediatric   pouch formation   pouchitis   surgical  

摘要： Introduction: Contemporary pediatric data on pouch outcomes are sparse, especially in the era of laparoscopic surgeries. We aimed to assess outcomes and predictors in children with ulcerative colitis/inflammatory bowel disease (IBD)-unclassified who underwent colectomy and ileal pouch-anal anastomosis. Methods: This was a multicenter retrospective cohort study from 17 IBD centers affiliated with the pediatric IBD Porto group of ESPGHAN. An electronic REDcap system was used to collate baseline characteristics, demographic, clinical, management and surgical data, short- and long-term outcomes, and to identify potential predictors of pouch outcome. Results: Of the 129 patients included, 86 (67%) developed pouchitis during follow-up of median 40 months (interquartile range 26-72), of whom 33 (26%) with chronic pouchitis. Patients operated on by surgeons performing <10 pouch surgeries/year had a higher rate of chronic pouchitis (11/27 [41%] vs 8/54 [15%],P = 0.013) on both univariable and multivariable analyses and also associated with time to pouchitis (P = 0.018) and chronic pouchitis (P = 0.020). At last follow-up, overall pouch performance was rated good/excellent in 86 (74%) patients. Time from colectomy to pouch formation was not associated with pouch outcomes. Despite higher rate of nonsevere surgical complications among children undergoing colectomy at <10 years of age (7/16 [44%] vs 10/92 [11%],P = 0.003), functional outcome and pouchitis rate did not differ. Conclusions: Pouchitis rate in children with ulcerative colitis/IBD unclassified is high. Surgeon experience is the major modifiable risk factor for pouch outcome. Our analyses suggest that pouch surgery can also be performed successfully in young children.

关键词： management   nurses   organisational communication   paediatric   satisfaction  

摘要： Aims To explore the differences in organisational communication satisfaction between ward paediatric nurses and middle managers, and to assess whether there is a difference in organisational communication satisfaction between paediatric nurses and middle managers with different educational levels, years of nursing and managerial experience, contracted hours, area of work, age and gender. Background Previous studies reported a connection between job satisfaction, work commitment and organisational communication;however, nurses' and nursing middle managers' satisfaction with organisational communication has not been extensively studied in recent years and not at all among paediatric nurses. Methods A cross-sectional quantitative research design using online and hard copy self-reported questionnaires was used. Data were collected at one point in time from paediatric nurses and middle (nursing) managers working in a tertiary paediatric hospital in Australia. Statistical methods were employed for data analysis. Results The middle management group were significantly more dissatisfied with organisational communication than the paediatric ward nurse group. Middle managers were found in this study to effectively manage and maintain communication lines with the personnel who reported to them;however, communication within the management cohort itself was found to be suboptimal. Conclusion Further research to understand how horizontal and vertical communications at the nurse manager and executive level can be optimised is required. Implications for nursing management It is anticipated that the findings from this study may increase the understanding of communication satisfaction between paediatric nurses and middle managers. The study has highlighted the need for improvement with information flow in the management cohort with the addition of extra managerial support and empowerment.