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关键词： emergency medicine   paediatrics   triage  

摘要： ObjectiveWe implemented a senior doctor at triage (SDT) pilot programme at The Royal Children's Hospital, Melbourne. We examined the impact on ED length of stay, seen on time and fail to wait (FTW) rates. MethodsA SDT model was piloted on Monday and Tuesday afternoons (pilot period) for 10weeks, and compared with equivalent shifts for the preceding 10weeks (pre-pilot period). We determined the differences between the proportions of patients seen on time, length of stay in the ED of less than 4 h and FTW rate, as well as the medians of time to clinician and length of stay in ED. ResultsA total of 2736 patients presented in the pilot period, and 2889 in the pre-pilot. The percentage of patients who were seen on time improved from 52.3% to 68.7% (absolute difference 16.4%, 95% confidence interval [CI] 13.6-19.2%, P<0.001), the percentage of patients who had an ED length of stay of <4 h improved from 58.2% to 72.0% (absolute difference 13.8%, 95% CI 11.1-16.5%, P<0.001) and the FTW rate reduced from 12.5% to 7.1% (absolute difference 5.4%, 95% CI 3.8-7.0%, P<0.001) when the SDT model was operational. ConclusionImplementation of a SDT model in a tertiary paediatric ED resulted in an increased proportion of patients being seen on time, having shorter length of stays in the ED and reduced the number of patients who FTW. Further studies are required to determine whether these improvements are sustained over time.

关键词： Tracheomalacia   Trachea   Brachiocephalic Trunk   Vascular Ring  

摘要： Background Whilst aortopexy is an accepted and established procedure, there remains considerable heterogeneity within the literature, with inconsistencies in both the approach taken and the technique employed. Furthermore, limited data exist on both patient selection and long-term outcomes. This study aimed to report the experience of managing severe tracheomalacia by way of aortopexy in a large UK paediatric centre. Method A retrospective case note review was conducted. Mean follow up was five years. Results Twenty-five patients underwent aortopexy for severe tracheomalacia caused by external vascular compression. Acute life-threatening events precipitated investigation in 72 per cent of cases. Twenty-one patients initially presented to ENT services for investigation, which comprised upper airway endoscopy and imaging with computed tomography angiography. Post-operatively, the majority of patients demonstrated complete resolution of symptoms and were discharged from all associated services. Only four patients required a tracheostomy. Conclusion Aortopexy offers an effective method of treating severe tracheomalacia due to vascular compression.

关键词： allergens   allergic contact dermatitis   children   paediatric   patch testing  

摘要： Background Allergic contact dermatitis (ACD) is an increasingly common diagnosis in children. The objectives of this study were to review our experience with ACD in children in tertiary settings, to ascertain the spectrum of allergens in this population and to subsequently propose the first Australian Paediatric Baseline Series for patch testing. Methods We conducted a retrospective analysis of patch test data from 1993 to 2017 from two tertiary referral patch-testing centres in Melbourne, Victoria. Results A total of 511 children were patch tested during the study period. Of these, 58.3% (298/511) of children tested had a positive patch test, and 65.1% (194/298, or 38.0% of the total) had a relevant positive patch test. The most common relevant patch test reactions were fragrance mix, methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) and methylisothiazolinone (MI), Myroxylon pereirae, nickel sulphate, and colophonium. Conclusion Allergic contact dermatitis is not uncommon in children, and patch testing should be considered in children with suspected ACD or with recalcitrant atopic dermatitis. Based on our experience over 25 years, we propose the first Australian Paediatric Baseline Series.

关键词： Stents   Ductal stenting   Blalock-Taussig shunt   Hybrid palliation   Norwood procedure  

摘要： Stenting the arterial duct emerged in the early 1990s as an alternative to a variety of surgical interventions in neonates with a duct-dependent pulmonary or systemic circulation complex defect. Furthermore, palliative ductal stenting has been applied in older children with severe suprasystemic pulmonary arterial hypertension, as an alternative to surgical shunts, such as Potts anastomosis. Early results of this technique were discouraging, but by learning from the failures of the past, ductal stenting has become a reliable palliative therapy. In this review, we aim to describe the historical evolution of ductal stenting, its different clinical applications and outcomes, and future perspectives for this strategy in congenital cardiac catheterization. (C) 2019 Elsevier Masson SAS. All rights reserved.

关键词： maximum standardized uptake value   metabolic tumour volume   positron emission tomography   computed tomography   prognostic value   total lesion glycolysis  

摘要： Introduction In the present study, we aimed to investigate the prognostic value of metabolic parameters, including maximum standardized uptake value (SUVmax), total metabolic tumour volume (tMTV) and total lesion glycolysis (TLG), measured at baseline F-18-FDG PET/CT in paediatric lymphoma. Methods From March 2013 to April 2019, 47 patients with paediatric lymphoma, including 38 males and nine females with an average age of 14.87 years, who underwent F-18-FDG PET/CT scan prior to treatment were retrospectively included in this study. SUVmax, MTV and TLG were recorded. Survival curves were established according to the Kaplan-Meier curves and log-rank test. Mann-Whitney U-test was used to assess differences in metabolic parameters between different clinical outcomes. Results The median follow-up time was 36 months (range of 3-74 months). The 2-year progression-free survival (PFS) of the low TLG and high TLG groups was 95.24% (20/21) and 57.69% (15/26), respectively (P = 0.004). TLG and tMTV were significantly higher in progression-free patients compared with the progression group. Univariate analysis showed that B symptoms (P = 0.014), effusion (P = 0.010), tMTV (P = 0.008) and TLG (P = 0.004) were the predictive factors for PFS. The tMTV (P = 0.005), TLG (P = 0.005) and effusion (P = 0.003) were associated with OS. Multivariate analysis revealed that TLG was the only independent prognostic factor for PFS (HR = 11.133, 95% CI = 1.435-86.405, P = 0.021). Conclusions Collectively, TLG of baseline F-18-FDG PET/CT was an independent prognostic factor for PFS in patients with paediatric lymphoma.

关键词： Infiltration   Intravenous administration   Peripheral venous catheterisation   Phlebitis   Systematic review  

摘要： Background: Most paediatric patients have at least one peripheral intravenous catheter insertion during their hospitalisation. Despite the important function of peripheral intravenous catheters for delivery of intravenous therapy, failure and complications rates are widely reported;however these results have not been synthesised. Objective: To provide an overall estimate of peripheral intravenous catheter failure and related complications in the paediatric population. Design: Systematic review and meta-analysis Data sources: The electronic databases, Cochrane Central Register of Controlled Trials, US National Library of Medicine National Institutes of Health, Cumulative Index of Nursing and Allied Health, Embase, Joanna Briggs Institute databases and ProQuest Dissertations and Theses, from January 2000 to January 2019 was conducted. Review methods: Observational studies and randomised controlled trials were independently screened by paired reviewers, and then eligible studies had data extracted and assessed for quality. Key outcomes of interest were any peripheral intravenous catheter complication, either as a composite measure or individually reported, including infiltration, extravasation, phlebitis, accidental removal, occlusion, leakage, local or catheter-associated infection. Results were pooled for analysis or summarised in a narrative synthesis. Results: Thirty two studies met the inclusion criteria. Overall, the pooled incidence of peripheral intravenous catheter failure as a composite measure was 38% (n = 6,492;95% CI 0.32 - 0.45) by device and 34% (n = 3,654, 95% CI 0.29 - 0.39) by patients. Infiltration was the most common individual reason for failure with 10% pooled incidence (95% CI 0.07 - 0.14) followed by accidental removal, occlusion, and leakage. Incidence of total phlebitis (any symptoms) was 5% (95% CI 0.02 - 0.10), with extravasation at 1% (95% CI 0.00 - 0.02). Studies ranged in methodological quality as appraised by the relevant tool. Conclusio

关键词： acute lymphoblastic leukaemia   corticosteroids   hyperglycaemia   insulin  

摘要： Corticosteroids are incorporated into protocols for the treatment of acute lymphoblastic leukaemia, and hyperglycaemia is a recognised side effect. Corticosteroids exert their hyperglycaemic effect with a multifactorial mechanism. Complications of hyperglycaemia include an increased risk of infection - bacterial, viral and fungal. Approximately half of the children who develop corticosteroid-associated hyperglycaemia are predicted to require insulin treatment, with age and obesity having found to be predictive factors. Fasting and random glucose values can be used to define hyperglycaemia. This review focuses on the published evidence for significant predictive factors for the development of corticosteroid-induced hyperglycaemia and provides guidance on management.

关键词： En-bloc kidney transplant   Paediatric donor   Renal transplantation  

关键词： biomedical research   communication barriers   communication methods   community participation   laboratory research   paediatrics   patient engagement   public and patient involvement   rheumatology   stakeholder participation  

摘要： Context Public and patient involvement is increasingly becoming an expectation of research funders and policy makers. Not all areas of health research are public-facing. Here, we outline an approach for building the skills and developing the relationships required for downstream public and patient involvement in pre-clinical adolescent rheumatology research. Objective To design a methodology for improving researcher-adolescent communications specifically aimed at mutual relationship building for PPI. Deliberate and effective preparation in advance of research involvement to improve the downstream success of that involvement. Design A research seminar and research skills workshop conducted entirely in 'plain English' for adolescents and their siblings aged 10-20. Upskilling of pre-clinical researchers for effective public involvement. Setting and participants Study co-design between the voluntary charity Irish Children's Arthritis Network and the academic research centre UCD Centre for Arthritis Research. Fifteen adolescents aged 10-20 years old living with arthritis, four pre-clinical researchers and one qualitative researcher investigating adolescent or paediatric arthritis. Main variables studied Relationship building and communications for effective downstream public involvement in pre-clinical and laboratory research. Results The methodology outlined here was received extremely positively. Both researchers and adolescents living with arthritis felt more comfortable communicating, more knowledgeable about juvenile arthritis and research, and more able to engage in co-operative dialogue. Discussion Engaging early, considering the needs of the community and developing appropriate involvement methodology can enable involvement in pre-clinical research. Conclusions Dedicating resources to building relationships and skills necessary for co-operative research involvement can overcome some of the barriers to public involvement in pre-clinical and laboratory-based resear

关键词： Paediatric airway foreign body   Inhalation foreign body   Aspiration   Choking   Inhaled  

摘要： Background: Whenever a paediatric airway foreign body (PAFB) is suspected, decisions may be difficult without a clearly defined or accepted treatment algorithm. History and examination are commonly non-diagnostic and the risks associated with either watchful waiting or proceeding to MLB are significant. This paper reviews a 10 year cohort of suspected PAFBs for the predictive utility of history, examination and investigations and subsequent positive findings at MLB. Objectives: 1. To review cases of suspected PAFB undergoing MLB in Perth, Western Australia over 10 years 2. To examine the relative strengths of history, examination and imaging for predicting the presence of a foreign body, and their utility in treatment decision making 3. To characterise the epidemiology of our cohort and to Evaluate our complication rate 4. To consider the limitations and benefits of the use of CT imaging in such cases Study design: The medical records of 127 children who underwent MLB for suspected PAFB between 2007 and 2016 were examined. The data was retrospectively reviewed for epidemiological details, history, examination, radiological findings and MLB outcomes. Results: Sensitivity for PAFB on MLB with all three;history, examination and imaging (x-ray) positive for PAFB was 87.7%. Of the patients who were both symptom and sign positive (n = 96), chest x-ray findings did not significantly alter the chance of finding a PAFB. Chest x-ray had a low specificity (17%) in symptom and sign positive patients. Conversely, sensitivity of chest x-ray was high (88%), for symptom and sign positive patients. Conclusions: For a child with both signs and symptoms, xray is unlikely to assist in decision making around suspected PAFB. When only sign or symptom is present, positive imaging may significantly increase the chance that PAFB is the *** patients with a low suspicion of PAFB, consideration of a CT can be a helpful means of excluding a PAFB and avoiding an unnecessary general anaesth