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关键词： Tinnitus   Child   Audiology   Care provision   Clinical management   Healthcare quality   Service evaluation  

摘要： Background Whilst evidence indicates many children experience troublesome tinnitus, specialist services for children are far less established than those available for adults. To date, there is limited understanding of how paediatric tinnitus is managed in the UK, and to what extent current practice reflects what is recommended. This service evaluation aimed to 1) profile how tinnitus in children is managed in UK clinical practice, and assess to what extent care provided by services reflects advice included in the British Society of Audiology (BSA) Tinnitus in Children Practice Guidance, 2) collate clinician opinions on how services may be optimised, and 3) identify common problems experienced by children who present with bothersome tinnitus in clinic. Methods As part of a larger survey, eight questions regarding services for paediatric tinnitus were distributed to UK NHS audiology services via email and social media. Representatives from eighty-seven services responded between July and September 2017. Results Fifty-three percent of respondents reported that their department provided a paediatric tinnitus service. Among these services, there was widespread use of most BSA recommended assessments and treatments. Less widely used practices were the assessment of mental health (42%), and the use of psychological treatment approaches;cognitive behavioural therapy (CBT) (28%), mindfulness (28%), and narrative therapy (14%). There was varied use of measurement tools to assess tinnitus in children, and a minority of respondents reported using adult tinnitus questionnaires with children. Frequently reported tinnitus-related problems presented by children were sleep difficulties, concentration difficulties at school, situation-specific concentration difficulties, and emotional distress. Conclusions Approaches used to manage children with troublesome tinnitus in UK NHS services are largely consistent and reflective of the current practice guidance. However, findings from this

摘要： Luregn J Schlapbach1,2,3, Warwick Butt4, Graeme MacLaren4,5 on behalf of the Australian & New Zealand Intensive Care Society (ANZICS) Paediatric Study Group 1Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Australia 2Paediatric Intensive Care Unit, Queensland Children’s Hospital, Brisbane, Australia 3Department of Intensive Care Medicine and Neonatology, and Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland. 4Paediatric Intensive Care Unit, The Royal Children’s Hospital, Melbourne, Australia 5Cardiothoracic Intensive Care Unit, National University Health System, Singapore, Singapore We thank Beretta-Piccoli and colleagues for their comment regarding our study defining benefit thresholds for ECMO in children with septic shock [1]. The 2020 Pediatric Surviving Sepsis Campaign [6] guidelines issued a recommendation based on low-quality evidence for venoarterial ECMO as rescue therapy for septic shock “refractory to all other treatments”. The problem is when to consider shock “refractory” [7]. The mortality in refractory shock even without ECMO is not 100%, and clinicians have to weigh risk versus benefit of ECMO. While every day clinical decision-making embraces implicit or explicit benefit threshold estimates, our study provides one of the first objective approaches to this scenario. The first point raised by Beretta-Piccoli et al. relates to the generalizability of the findings, given that central cannulation was the predominant access used in our study. Central cannulation provides higher flows and maintains bilateral carotid perfusion with potentially lower cerebral stroke incidence at the expense of higher overall bleeding and infection risk. While central ECMO currently is limited to cardiosurgical centres, these complications are manageable, and timely referral to such high-volume centres should be emphasized. The second point makes refere

关键词： High flow nasal cannula   Paediatrics   Children   Oxygen therapy   Adjunctive therapy  

摘要： Background Heated Humidified High Flow Nasal Cannula Oxygen Therapy (HHFNC) is increasingly used on the paediatric wards and High Dependency Units (HDU) for different types of pathologies and different age groups. We aimed to describe current practice related to the use of HHFNC on the paediatric wards and HDUs, weaning practices and preferred outcome measures for future research. Methods We carried out a cross-sectional online survey of UK paediatric consultants or their delegates working on the paediatric wards. Descriptive analysis of their geographical, and organizational characteristics, their specialties, and their level of experience was investigated. Reasons for HHFNC initiation, weaning criteria, patients' characteristics and their primary pathologies were also analysed. Results Participation of 218 paediatricians from 81 hospitals (Median: 2.7, Range: 1-11) was registered. HHFNC was provided in most of the surveyed hospitals (93%, 75/81). A High Dependency Unit (HDU) was available in 47 hospitals (58%);less than a third of those have a dedicated paediatrician. Decisions around HHFNC were made solely by paediatricians in (75%) of the cases, mostly at hospitals with no HDU compared to those with dedicated HDUs (70.3% VS 36.6, 95%CI:22.6-50.4%, P < .001). HHFNC was reported by nearly two-thirds (68%) of the practitioners who used it on the wards to be as effective or superior to CPAP (Continuous Positive Airway Pressure) with fewer complications. Failure rate while on HHFNC was identified as the most important outcome measure in any future research followed by the length of need for HHFNC support (37.1, and 28% respectively). Conclusion This survey showed support for developing paediatric-specific national guidance on the use of HHFNC on the wards. Our list of defined research priorities may help guide further collaborative research efforts in this field.

关键词： Aboriginal   Torres Strait Islander   Paediatric burns   Psychosocial interventions   Pain   Anxiety   Distress   Psychological trauma  

摘要： BackgroundPaediatric burns are highly painful and traumatising injuries that are overrepresented among Aboriginal and Torres Strait Islander people. Paediatric burn patients' pain remains poorly managed by pharmacological interventions, leading to increased anxiety, distress, and trauma in patients and their caregivers. Non-pharmacological psychosocial interventions have been suggested as effective in reducing pain and psychological morbidities among paediatric burn patients and their caregivers;however, their degree of effectiveness and appropriateness for Aboriginal and Torres Strait Islander people is *** non-date restricted systematic review was conducted through four databases. Studies published in English assessing psychosocial interventions on paediatric burn patients' physical pain along with theirs and/or their caregiver's anxiety, distress, or trauma symptoms were identified and included in this review. Included studies were assessed for their ability to reduce one of the outcomes of interests and for their reflection of Aboriginal and Torres Strait Islander peoples' perspectives of *** the 3178 identified references, 17 were eligible. These include distraction based techniques (n =8), hypnosis/familiar imagery (n =2), therapeutic approaches (n =4), and patient preparation/procedural control (n =3). Distraction techniques incorporating procedural preparation reduced pain, while discharge preparation and increased 'patient control' reduced patient and caregiver anxiety;and internet based Cognitive Behaviour Therapy reduced short-term but not long-term post-traumatic stress symptoms. No interventions reflected Aboriginal and Torres Strait Islander peoples' perspectives of health;and few targeted caregivers or focused on reducing their *** development and assessment of psychosocial interventions to appropriately meet the needs of Aboriginal and Torres Strait Islander paediatric burn patients is required.

关键词： 信息技术   幼儿教育   科学教育  

摘要： 信息化社会对教育的要求越来越高,信息技术在幼儿教育中获得的应用也越来越多。随着幼儿园传统教学的缺陷不断显露出来,如何将信息技术更为高效的应用于幼儿园教学的课堂中,是本文的主要研究内容。本文从幼儿园教学的五大个领域之一的“科学”进行入手,从科学的角度,分析信息技术如何以新颖的方式展示教育活动的内容,刺激幼儿的感官,激发幼儿的学习兴趣,巩固幼儿的认知,培养幼儿主动探索、自主学习等能力。

关键词： Neuromuscular disease   Duchenne muscular dystrophy   Spinal muscular atrophy   Charcot-Marie-tooth disease   Myopathy   Weakness   Paediatric   Gait   Functional ambulation   Assessment  

摘要： Background Weakness is the primary impairment in paediatric neuromuscular diseases, impacting gait and gait-related functional activities in ambulant children affected by these rare and often degenerative diseases. Gait speed is an indicator of health and disability, yet gait is a complex, multi-faceted activity. Using the International Classification of Function, Health and Disability (ICF) model, assessment of gait and functional ambulation should consider the impairments, activity limitations and participation restrictions due to disease, and factors related to the environment and the individual person. Methods This narrative review involved a literature search of databases including Medline, Embase and Pubmed from 1946 to October 2019. Inclusion criteria included assessments of gait, endurance and ambulatory function in paediatric (0-18 years) neuromuscular diseases. Results Fifty-two papers were identified reporting assessments of gait speed, timed function, endurance and ambulatory capacity, gait-related balance and qualitative descriptive assessments of gait function and effect of disease on gait and gait-related activities. Gait speed is an indicator of disability and children with neuromuscular disease walk slower than typically developing peers. Increasing disease severity and age were associated with slower walking in children with Duchenne muscular dystrophy and Charcot-Marie-Tooth disease. The six-minute walk test is used widely as a test of endurance and ambulatory capacity;six-minute walk distance was substantially reduced across all paediatric neuromuscular diseases. Endurance and ambulatory capacity was more limited in children with spinal muscular atrophy type 3, congenital muscular dystrophy and older boys with Duchenne muscular dystrophy. Only a few papers considered normalisation of gait parameters accounting for the effect on gait of height in heterogeneous groups of children and linear growth in longitudinal studies. Balance related to gait wa

关键词： 儿科学   儿童生长发育   预防接种   医学科学   疾病防治   健康状况   状况评估   生长曲线图  

摘要： 儿童是世界上最重要的资源,儿童的健康状况是全社会发展的基石。儿科学是一门研究促进儿童生长发育、身心健康和疾病防治的医学科学,儿童生长发育知识是儿科学发展的基石。最全面了解儿童的成长过程与健康状况即是每名儿童拥有生长曲线图、发育状况评估与预防接种的详细资料。

关键词： 中西医结合医院   重点专科建设   浙江省中医   中医儿科学   重大疾病   中医药防治   儿科   呼吸病  

摘要： 浙江省中西医结合医院儿科创建于1950年,是杭州市乃至全省具有影响力、中西医结合特色明显的小儿专科。其中中医儿科学已列入"十三五"浙江省中医药(中西医结合)重点学科建设计划和"十三五"浙江省中医药(中西医结合)重点专科建设计划。

关键词： 精品科技期刊   中华医学会系列杂志   核心期刊   资料管理系统   来源期刊   儿科学   核心学术期刊   儿科临床  

摘要： 《中华实用儿科临床杂志》(原《实用儿科临床杂志》)是由中国科学技术协会主管、中华医学会主办的中华医学会系列杂志,是以儿科临床与基础研究为主要报道内容的儿科学类核心期刊。本刊为儿科学类核心期刊、中国科技论文统计源期刊(中国科技核心期刊),RCCSE中国核心学术期刊,中国科学引文数据库(CSCD)来源期刊,中国科学技术协会精品科技期刊,被中国生物医学文献数据库(CBNWisc)、QUick全文资料管理系统(FTME).