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关键词： awareness   confidence   diabetes   periodontitis   training  

摘要： Diabetes and periodontal disease are non-communicable chronic diseases that have a bi-directional relationship. The European Federation of Periodontology and International Diabetes Federation recommend patients with diabetes should be screened for periodontal disease and referred to a dental professional where appropriate. This study investigated the awareness among Paediatric Diabetes Care Teams across England and Wales of diabetes as a risk factor for periodontal disease. The study enquired to the practices, training, and confidence of health care professionals in relation to periodontal disease. A semi-structured online questionnaire was sent to all health care professionals working within Paediatric Diabetes Care Teams across England and Wales. Findings showed that 76.2% of participants were aware that periodontitis is a possible complication of diabetes. Only 5.2% screened for periodontal issues, while 27% of respondents stated that oral advice is not typically given to patients at their clinics and 92.3% said that there is no access to a periodontal service within their clinics. There were 76.4% participants who stated that patients are rarely or never referred to an external dental service for their periodontal health. Only 4.8% of respondents said they have received training for recognizing patients who require dental care for their periodontal health, while 23.2% feel confident identifying children who require referral and 85.4% of participants feel they would benefit from further training in periodontal health. In conclusion, patients are not routinely being informed of the risk of periodontitis or being screened or referred for it. Further training would be perceived as beneficial.

关键词： Herbal medicinal products   Pharmaco-epidemiological study   Children   Adolescents   PhytoVIS project  

摘要： In paediatrics, clinical study data are limited, especially on herbal medicinal products. To address this gap, 2063 datasets from the paediatric population were evaluated in the PhytoVIS data base. By screening for paediatric data, information on indication, gender, treatment, co-medication and tolerability were evaluated. The majority of patients was treated because of common cold, fever, digestive complaints, skin diseases, sleep disturbances and anxiety. The perceived effect of the therapy was rated in 84% of the patients as very good or good without adverse events. The data shed light on a still neglected field of phyto-pharmacotherapy by giving information on the use of herbal medicines in an unselected cohort of paediatric patients. The results confirm the good clinical effects and safety of herbal medicinal products in this patient population and show that they are widely used in *** is Known:center dot In Germany, about 85% of children receive one or more herbal medicinal products per *** dot Despite international initiatives to promote clinical research in paediatrics, there are still many gaps of knowledge in the use of drugs in *** is New:center dot The PhytoVIS project evaluated 2063 data sets from the paediatric population using herbal medicinal *** dot The majority of patients was treated because of common cold, fever, digestive complaints, skin diseases, sleep disturbances and anxiety, and 84% of the patients rated the therapy as very good or good without adverse events.

关键词： Health services   Inflammation  

关键词： Paediatrics   palliative care   hospice care   hospice and palliative care nursing   education   nursing   health care surveys   qualitative research  

摘要： Background: Children with serious illness who receive hospice care often interface with nurses who lack training, experience and comfort in the provision of paediatric palliative and hospice care. Hospice nurse preferences for paediatric-specific training are not well known. Aim: To describe the types of paediatric-specific training received and educational content preferred by hospice nurses. Design: Population-level dissemination of a cross-sectional survey with qualitative analysis of open-ended survey items. Setting/participants: Nurses from 71 community-based hospice organizations across 3 states completed the survey. Results: An open-ended response was provided by 278/551 (50.5%) survey respondents. A total of 55 respondents provided 58 descriptions of prior paediatric-specific training, including a formal 2-day course (n = 36;65.5%), on-the-job education (n = 13, 23.6%), online training (n = 5, 9.1%), nursing school (n = 2, 3.6%) and paediatric advanced life support courses (n = 2, 3.6%). A total of 67 respondents described 74 hospice-led educational efforts, largely comprised of a 2-day course (n = 39;54.2%) or provision of written materials (n = 11;15.3%). A total of 189 respondents described 258 preferences for paediatric-specific training, with nearly half (n = 93;49.2%) requesting 'any' or 'all' types of education and the remainder requesting education around medication use (n = 48;25.4%), symptom assessment/management (n = 32;16.9%), pain assessment/management (n = 28;14.8), communication (n = 29;15.3%) and psychosocial assessment/management (n = 28;14.8). Conclusions: Hospice nurses self-report inadequate exposure to educational resources and programs, in conjunction with a strong desire for increased paediatric-specific training. Identification of targetable gaps should inform the development of educational resources, policies and other supportive interventions to improve delivery of care to children and families in the community.

关键词： child health   emergency medical Services   epidemiology   health status disparities   hospitalisation   respiratory tract diseases  

摘要： Background Socio-economically deprived children face a disproportionate burden of respiratory diseases. The association between area-level material and social deprivation and emergency department (ED) visits and hospitalisations for paediatric respiratory diseases has not been explored. Objectives We evaluated health inequalities in emergency department (ED) visits and hospitalisations for paediatric respiratory diseases according to material and social deprivation indexes. Methods This population-based retrospective cohort study deterministically linked birth, ED visits and hospitalisation data, and census-based, area-level deprivation indexes for all singleton children born in the province of Alberta, Canada, between 2005 and 2010 who had at least one recorded ED visit or hospitalisation for respiratory diseases in their first five years of life. We classified ED visits and hospitalisations for seven respiratory diseases by deprivation indexes. Concentration indexes (CInd) and area-level concentration curves measured health gradients across deprivation groups. Rate ratios (RR) evaluated associations between deprivation indexes and respiratory episodes of care. Results The study cohort included 198 572 newborns. The highest CInd were found in ED visits for other acute lower respiratory tract infections (oLRTI;CInd -0.22, 95% confidence interval [CI] -0.32, -0.12) and bronchiolitis (CInd -0.21, 95% CI -0.29, -0.12), and for pneumonia hospitalisations (CInd -0.23, 95% CI -0.33, -0.13). Croup ED visits had a low inequality degree. Compared to social deprivation, the material deprivation index presented a more consistent health gradient of increased episodes of care with increasing deprivation. oLRTI ED visits (RR 2.60, 95% CI 2.34, 2.92) and pneumonia hospitalisations (RR 2.57, 95% CI 2.31, 2.86) presented the largest inequalities between the least and most materially deprived groups. Conclusions We found a concentration of ED visits and hospitalisations for paediatri

关键词： child   meta-analysis   obstructive sleep apnoea   rapid maxillary expansion  

摘要： Background Obstructive sleep apnoea (OSA) affects many children, and adenotonsillar hypertrophy is the most common cause of paediatric OSA. Aim Despite the growing treatment options, there is no comprehensive comparison of all interventions. We aimed to compare and rank the effectiveness of various treatments in a network meta-analysis. Design Literature was searched from inception to 13 May 2018 for paediatric OSA with adenotonsillar hypertrophy. The outcomes were the changes in apnoea-hypopnea index (AHI), oxyhaemoglobin desaturation index (ODI), and lowest arterial oxygen saturation (SaO(2)). Frequentist approach to network meta-analysis was used. Treatment hierarchy was summarized according to the surfaces under the cumulative ranking curves. Results Fourteen trials comprising 1064 paediatric OSA participants evaluating ten interventions (adenotonsillectomy, adenotonsillectomy + pharyngoplasty, adenotonsillotomy, antimicrobial therapy, steroids, leukotriene receptor antagonists [LTRAs], steroids + LTRAs, rapid maxillary expansion [RME], placebo, and no treatment) were identified for network meta-analysis. In terms of effectiveness in AHI reduction, surgical approach was still the most effective intervention than no treatment. RME was one of the most effective interventions to improve lowest SaO(2). No comparisons showed statistical significance in reducing ODI. Conclusions Irrespective of the intervention used, complete resolution of OSA was not achieved in most trials.

关键词： clinical ethics   continuity of care   paediatric palliative care   quality of care  

摘要： Aim To explore and compare acute and long-term care professionals' perspectives about paediatric palliative care. Methods Focus group interviews were conducted in 2016-2017 with professionals from acute (Emergency Department, Intensive Care Unit) and long-term care (Complex Care Service, Palliative Care) teams. Results Fifty-eight participants were enrolled. Palliative care definitions were similar throughout groups: to provide active care early in the illness, focusing on the child as a whole and supporting families. Each group perceived a different role in the patient's illness trajectory, reflecting their own culture of care. They demonstrated important differences in their approach to palliative care. Disagreements regarding when or how to discuss goals of care were expressed. Acute care professionals reported discomfort when having to introduce these discussions for the first time, while long-term care professionals perceived negative judgements about their patients' quality of life by acute care teams during health events. Personalised care, communication with families and continuity of care were thought to be key elements to improve care. Conclusion Paediatric palliative care is well recognised throughout specialties, yet continuity of care is challenged by groups' roles and interventions in a patient's illness. A reflective and mutual clinical approach is needed to improve quality of care and professionals' satisfaction.

关键词： competency   learning curve   oesophagogastroduodenoscopy   paediatric endoscopy   training  

摘要： Background: The learning curve in paediatric oesophagogastroduodenoscopy (OGD) is unknown. Using >= 95% D2 (second part of the duodenum) intubation rates as a marker of technical competency, we conducted learning curve analyses to identify when trainees achieve competency in paediatric OGD. Factors associated with competency were also evaluated. Methods: This nationwide study analysed data from paediatric OGD procedures prospectively entered into the UK endoscopy training e-portfolio between 2014 and 2018. Moving average and learning curve cumulative summation analyses were performed to determine procedural numbers required to achieve >= 95% D2 intubation rates. Factors associated with D2 intubation were assessed using a multivariable binary logistic regression approach. Results: A total of 8929 procedures performed by 61 trainees were identified. These 61 trainees had recorded a mean of 124.6 procedures (range 22-571, interquartile range 165). By moving average analysis, 95% D2 intubation was achieved after 79 procedures. By learning curve cumulative summation analysis, 81.6% of trainees were competent after 100 procedures. Multivariable factors associated with unassisted procedural completion included: lifetime procedure count (P < 0.001), higher trainee seniority (P < 0.001), patient age (P = 0.002), outpatient status (P < 0.001), and attendance at a national Basic Skills OGD course (P = 0.011). Conclusions: This study demonstrates that, on average, 79 procedures in paediatric OGD are required to attain the competency outcome of >= 95% D2 intubation rates. By 100 procedures, 81.6% of our sample had achieved >= 95% D2 intubation. The minimum procedural count of 100 set by the UK and international training programmes can be used alongside existing objective assessment measures to safeguard competency within a training cohort.

摘要： Click for the corresponding questions to this CME article.

摘要： Background Paedeatric Zika remains an understudied topic. WHO and the Pan American Health Organization (PAHO) Zika case definitions have not been assessed in children. We aimed to characterise clinical profiles and evaluate the diagnostic performance of the WHO and PAHO case definitions in a large cohort of paediatric Zika cases. Methods From January, 2016 to February, 2017, encompassing the major 2016 Zika epidemic, participants in the Pediatric Dengue Cohort Study (PDCS) in Managua, Nicaragua, were encouraged to visit the study health centre at first indication of any illness. PDCS participants were aged 2-14 years, healthy at enrolment, and recruited before the initiation of the present study. Molecular and serological assays were used to test participants exhibiting any of four broad clinical profiles suspected of resulting from a symptomatic Zika virus infection. These clinical profiles were: fever and at least two of headache, retro-orbital pain, myalgia, arthralgia, rash, haemorrhagic manifestations, and leukopenia;fever and at least two of nausea or vomiting, rash, aches and pains, positive tourniquet test, leukopenia, and any dengue warning sign;undifferentiated fever without evident cause, with or without any other clinical finding;and afebrile rash with or without any other clinical finding. We characterised acute clinical findings (signs, symptoms, and complete blood counts) in both Zika cases and non-Zika cases. Findings We prospectively followed a cohort of about 3700 children, of which 1110 were deemed eligible for inclusion. Four participants with laboratory-confirmed Zika (three co-infections with dengue virus, one missing complete blood count data) and two participants who were non-Zika cases (missing complete blood count data) were excluded from analysis. We analysed 556 laboratory-confirmed Zika and 548 non-Zika cases. The WHO case definition captured 176 confirmed Zika cases, and the PAHO definition 109 confirmed Zika cases, who presented with t