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关键词： COVID-19   SARS CoV2   Coronavirus   Paediatric airway   Microlaryngobronchoscopy  

摘要： Paediatric otolaryngology practice involves examining and operating in anatomical locations with high levels of aerosol generation and transmission of COVID-19 to treating clinicians, especially from the asymptomatic patient populations including children. During the COVID-19 pandemic all emergent otolaryngological conditions affecting the airway, oral, and nasal cavities should be managed medically where possible and any operating deferred. We present guidelines for operating on paediatric otolaryngological patients when necessary during the COVID-19 pandemic, and incorporate experience gathered during microlaryngobronchoscopy on a COVID-19 positive infant at our institution.

关键词： academic achievement   assessment   paediatric research   standardised test   teacher rating  

摘要： Aim To determine whether teachers' reports of student academic performance can suffice for research purposes by comparing it with a curriculum-based standardised test. Methods In this longitudinal cohort study of children born at risk of neonatal hypoglycaemia, teachers' global assessment of student performance was compared with assessment tools for teaching and learning (asTTle) at 9-10 years. Performance on asTTLe was rated as being below, at or above that expected on the national curriculum for year and term of schooling. Teachers similarly rated the child's performance against the national curriculum. Results Of 125 children assessed, 104 had paired data for analysis. On asTTLe, 28% were rated below, 55% at and 17% above the expected curriculum level in reading and 24, 54 and 22%, respectively, in mathematics. Equivalent teacher ratings were 23, 58 and 19% in reading and 36, 55 and 9% in mathematics, respectively. However, there was limited agreement between asTTle and teacher rating of achievement in reading (kappa = 0.23 (95% confidence interval 0.07-0.40)) and no significant agreement in mathematics (kappa = 0.07 (95% confidence interval -0.09-0.22)). Only 45% of children performing below the curriculum level in reading and 52% in mathematics were correctly identified by teachers. Conclusion In cohort studies, teacher ratings cannot substitute standardised educational testing.

摘要： There are still no relevant studies indicating that COVID-19 affects the causes of intussusception. Thus, the COVID-19 pandemic should not decrease the number of intussusception cases. In addition, several studies have indicated that encouragement by or even just the presence of parents is an important comfort intervention that could effectively reduce children's distress and pain.1,2 Acknowledgements This research was funded by Sanming Project of Medicine in Shenzhen (grant number SZSM201812055). [Extracted from the article]

摘要： The cricothyroid membrane (CTM) is the recommended site for emergency front-of-neck access (eFONA) in children in a cannot intubate, cannot oxygenate (CICO) scenario. We investigated the following: (1) accuracy of ultrasound in identification and measurement of CTM dimensions; (2) clinician accuracy in CTM localisation by palpation; and (3) the starting point and length of different hypothetical vertical incision strategies required to expose the CTM. The study was a prospective observational study performed in a tertiary paediatric university hospital. Ethical approval was granted by the hospital research ethics committee (REC Ref: GEN/596/17). (1) CTM height measured by ultrasound was compared with that measured by MRI (n=22). (2) We assessed clinician (anaesthesiologist) accuracy in CTM localisation by digital palpation using ultrasound as a reference standard (n=97). (3) We estimated hypothetical eFONA vertical incision lengths required for CTM exposure based on three incision commencement points (clinician estimate of CTM location, the suprasternal notch, and the neck midpoint). A vertical incision that would expose any portion of the CTM was considered successful. All assessments were performed in the extended neck position in ASA physical status 1 and 2 children undergoing elective general anaesthesia. (1) CTM height measured by ultrasound correlated well with that measured using MRI (r=0.98; 95% confidence interval [CI], 0.95–0.99; P<0.0001). Data for (2) and (3) were analysed according to age group (0–1, 1–8, and 9–16 yr old). (2) Clinician accuracy was 29%, 29%, and 38% by age group and did not differ with clinician experience or repetition. (3) Hypothetical incision lengths varied by both age group and by starting point (Table 1). The smallest incision was projected using clinician estimate of CTM location in the 0–1 yr old group and using the neck midpoint in the other groups. Bedside ultrasound is accurate for the measurement of paediatric CTM height. C

关键词： Thermography   Wrist injuries   Sprain   Bone fracture   Paediatrics  

摘要： Wrist injuries are common in paediatric trauma;however, only half of children evaluated with an x-ray for possible fractures will have one. Thermal imaging offers a possible non-ionising method of screening for fractures and thus reducing negative x-ray rates. One hundred five children attending the Emergency Department for wrist injuries were recruited. Two 30-s thermal videos were recorded from injured and uninjured wrists-in flat and 45 degrees elevated positions. A region of interest (ROI) was defined on each wrist. Cases in which the ROI was covered or had ice applied were excluded, leaving 40 patients for analysis. Comparisons of ROI included (i) injured and uninjured wrists-flat and elevated positions;(ii) as in (i) with a reference region on the proximal forearm subtracted;(iii) injured wrist ROI-flat and elevated positions. Fractures and sprains increased the mean skin surface temperature by 1.519% (p = 0.008) and 0.971% (p = 0.055) respectively compared with the uninjured wrist. The mean temperature difference between flat and elevated positions for fractures was 0.268% and - 0.1291% for sprains. This difference was statistically significant for fracture (p = 0.004) but not sprain (p = 0.500). The temperature differences recorded by thermal imaging between fractured and sprained wrists may assist in differentiation of these injuries.

关键词： COVID-19   acute chest syndrome   sickle cell disease   children   intensive care  

摘要： Keywords: COVID-19; acute chest syndrome; sickle cell disease; children; intensive care EN COVID-19 acute chest syndrome sickle cell disease children intensive care e21 e24 4 07/01/20 20200701 NES 200701 Introduction Concern has been raised for patients with sickle cell disease (SCD) and the new viral infection severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as patients with SCD are particularly prone to infectious diseases and acute chest syndrome (ACS). GLO:1XW/01jul20:*** PHOTO (COLOR): 1 Clinical timeline of the four patients with COVID-19. gl All four patients presented with ACS. International expert consensus statement on chest imaging in pediatric COVID-19 patient management: imaging findings, imaging study reporting and imaging study recommendations. [Extracted from the article]

关键词： Trauma   Paediatric condyle fracture   Conservative management   Strasbourg Osteosynthesis Research Group  

摘要： Introduction: Mandibular fractures account for over 50% of all facial fractures in children, with the majority of these occurring at the condyle. There is currently no consensus on the management of mandibular condyle fractures in the paediatric population. Treatment options range from conservative management, with or without maxillomandibular fixation (MMF) and physiotherapy, to open reduction and internal fixation (ORIF). Methods: This was a retrospective review of all patients who attended Alder Hey Children's Hospital with fractured condyle(s) between the years 2000 and 2015. All patients were managed non-surgically and included those managed conservatively and/or with MMF. The following variables were recorded: age, sex, mechanism of injury, concomitant mandibular fractures, imaging, SORG classification, complications and follow-up intervals. The following exclusion criteria applied: patients who underwent open reduction internal fixation of their condylar fracture and patients aged 16 years or over. Results: Forty-nine patients (38 male, 11 female) underwent non-surgical management of condylar fractures during the 15-year study period. The mean age at time of injury was 12 years (range 2-15 years). The etiology of fractures comprised mechanical falls (n = 22), assault (n = 14), sport (n = 5), road traffic accident (n = 3), epileptic fit (n = 1), and unknown mechanism (n = 4). The mean length of hospital stay was 3 days, ranging from 0 to 14 days. Thirty-seven patients had a concomitant mandibular fracture and 12 had an isolated unilateral condylar fracture. Follow-up intervals ranged from 1 to 133 weeks, with a median length of 12 weeks. Fifteen patients underwent MMF, while 34 had soft diet and physiotherapy only. Ninety-two per cent of patients had no complications. No patient had failure of treatment requiring a return to theatre and/or ORIF. Occlusion, interincisal distance, asymmetry and TMJ symptoms were examined in 43/49 patients who attended their post

关键词： Major incident   triage   paediatric triage   life-saving interventions  

摘要： A short cut review was carried out to establish whether existing paediatric major incident triage tools identify patients requiring life-saving interventions. Sixteen papers presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. In summary, there is limited evidence for the validity of existing paediatric major incident triage tools.

关键词： clinical teaching fellow programme   clinical teaching fellow   consultant   institution   learning relationship   medical student  

摘要： Aim Bedside teaching performed by experienced clinicians is an expected component of medical student training. As clinicians often have high clinical demands and a lack of formal training in teaching methods, clinical teaching fellowships have been established. In clinical teaching fellowships, clinicians with an interest and expertise in medical education provide medical students with standardised teaching. Studies about the impact of clinical teaching fellowships have demonstrated benefits for both clinical teaching fellows (CTFs) and medical students. However, studies have not evaluated the impact of these fellowships on other clinicians or learning relationships within the institution. In this study, we aimed to address this gap by gathering data on the perspectives of CTFs, medical students and hospital consultants. Method A mixed-method design was used, utilising a combination of surveys for CTFs, medical students and hospital consultants and semi-structured telephone interviews for CTFs. Quantitative and qualitative data were obtained. Results The combination of data from CTFs, medical students and consultants enabled a more comprehensive understanding of the impact of the CTF programme within the institution. Although benefits were identified for CTFs and medical students, the consultant group noted that they were less involved in teaching medical students and that the CTFs were not well integrated into the ward team. Conclusion This research highlights the importance of considering not only direct outcomes of teaching and learning but broader influences on more implicit teaching opportunities and relationships within hospital teams.

关键词： COVID-19   Wuhan   SARS-CoV-2   vertical transmission   Paediatrics  

摘要： Background Coronavirus disease 2019 (COVID-19) is a pandemic first originated in Wuhan the capital of Hubei province, China in December 2019 and then spread globally. It is caused by SARS-CoV-2. Until 1^st April 2020, the number of cases worldwide was recorded to be 823,626 with 40,598 deaths. Most of the reported cases were adults with few cases described in children and *** We performed a systematic review and meta-analysis to analyse the disease characterisation in paediatric age group including the possibility of vertical transmission to the *** Articles published up to 2^nd April 2020 in PubMed and google Scholar were considered for this *** The most frequently reported symptoms were cough 49% (95% CI: 42 - 55%) and fever 47% (95% CI: 41- 53%). Lymphopenia and increased Procalcitonin were recorded in (21%, 95% CI: 12 - 30%) and (28%, 95% CI: 18 - 37%) respectively. No sex difference for COVID-19 was found in paediatric age group (p = 0.7). Case fatality rate was 0%. Four out of 58 neonates (6.8%) born to COVID-19 confirmed mothers tested positive for the *** The disease trajectory in Paediatric patients has good prognosis compared to adults. Intensive care unit and death are rare. Vertical transmission and virus shedding in breast milk are yet to be established.