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关键词： Direct identification of blood culture   MALDI-TOF mass spectrometry   Clinical impact   Pediatric   Bloodstream infection  

摘要： ObjectiveRapid diagnostic tools are imperative for timely clinical decision making, particularly in bacteraemic patients. This study evaluated the performance of a fast, inexpensive novel in house method for processing positive blood cultures for immediate identification of microorganisms by matrix-assisted laser desorption ionization-time of flight mass spectrometry (Vitek MS bioMerieux). We prospectively analyzed the clinical impact of such method on the management of pediatric *** total, 360 positive blood cultures were included. Among 318 mono-microbial cultures, in-house method achieved correct identification in 270 (85%) cultures to the species level, whilst 43 (13.5%) gave no identification, and 7 (2.2%) gave discordant identifications. Identification of Gram-negative organisms was accurate to both species and genus level in 99% of isolates, and for Gram positives accuracy was 84% to genus and 81% to species level overall, with accuracy of 100% for Staphylococcus aureus and Enterococcus to the species level. Assessment of the potential impact of direct identification in sixty sequential cases revealed a clear clinical benefit in 35.5% of cases. Benefits included timely antibiotic rationalization, change of medical intervention, and early confirmation of contamination. This study demonstrates a highly accurate in-house method with considerable potential clinical benefits for paediatric care.

关键词： 幼儿   科学素养   实践探究  

摘要： 培养幼儿的科学素养,必须坚持以《幼儿园教育纲要》作为指导方针,扎实推进“生活体验式”科学课程的构思设计,优化幼儿园生活与学习的教育环节,以丰富多彩的幼儿活动为载体,培养幼儿的科学素养和科学探究精神。本文面向培养幼儿科学素养的目标和充分发挥日常生活的教育作用的思考,探究抓住提高幼儿科学素养的契机,以及科学教育走向生活,回归人文教育的本位实践问题。

关键词： General self-efficacy   Perceived organizational support   Perceived professional benefits   Nursing practice environment   Mediating role  

摘要： BackgroundGeneral self-efficacy is considered one of the most influential parameters affecting the quality of clinical practice and nurses' perceived professional benefits (NPPB). Perceived organizational support (POS) is regarded as being central in understanding job-related attitudes, and it is important to enhance POS for nurses to maintain their current employment. NPPB can further reduce nurses' job burnout and turn-over intention. Many studies have explored the relationships among general self-efficacy, POS, nursing practice environment (NPE) and NPPB. However, a moderating effect of NPE has not been fully explored in nurses, especially among paediatric *** descriptive cross-sectional study was conducted from July to October 2018 with 300 paediatric nurses from 3 Class A tertiary hospitals in Jilin Province. The respondents completed the General Self-Efficacy Scale, Perceived Organizational Support Scale, Practice Environment Scale and Nurses' Perceived Professional Benefits Scale. The data were analyzed using path analysis and SPSS (version 23.0, IBM).ResultsGeneral self-efficacy and POS were significantly positively associated with NPPB, which showed that the model had a good fit to the data. NPE was found to play a partial mediating role between POS and NPPB and also had a complete mediating role between general self-efficacy and *** results suggest that general self-efficacy indirectly influences NPPB, and POS directly and indirectly influences NPPB by NPE. Effective measures should be taken to improve nurses' practice environment in hospitals to raise nurses' enthusiasm and confidence in their work.

关键词： Traumatic brain injury   subtle motor function   PANESS   pediatric   executive function  

摘要： Background: Children with traumatic brain injury (TBI) are reported to have persistent deficits in executive functioning and subtle motor functions Aim: This study examined the relationship between subtle motor signs and executive functioning in children with TBI Methods: Eighteen children aged 13-18 years with mild to severe TBI at least one year before study participation and 16 age-matched typically-developing controls were examined using the Revised Physical and Neurological Examination of Subtle Signs (PANESS), a simplified Go/No-go task, portions of the Delis-Kaplan Executive Function System Verbal Fluency and Trail Making tests, and a Wechsler Coding test Results: There were significant associations between PANESS scores and executive functioning measures in children with TBI but not in controls. Conclusion: Results suggest that assessment of subtle motor signs may provide broader information regarding functioning after pediatric TBI.

关键词： Cardiac arrest   paediatric   cardiopulmonary resuscitation   low-income county   low-resource setting   sub-Saharan Africa   Utstein guidelines   critical care  

摘要： Background: There are scarce data on outcomes of in-hospital paediatric cardiac arrest (CA) in resource-poor settings and none for World Bank-defined low-income countries. Aim: To report the outcomes of in-hospital paediatric CA from a university-affiliated referral hospital in Malawi. Methods: Data were collected prospectively on patients aged 30 days to 13 years who experienced CA and underwent cardiopulmonary resuscitation (CPR) at Kamuzu Central Hospital in Lilongwe, Malawi from January through June 2017. Utstein-style reporting guidelines for CAs were used to define outcomes;the primary outcome was survival to hospital discharge. A data collection form was used to record patient, arrest and resuscitation characteristics. Results: A total of 135 patients fulfilled the criteria for inclusion in the study. Resuscitation outcomes are presented in Figure 1 using a modified Utstein template. In-hospital CA was associated with 100% mortality. Return of spontaneous circulation (ROSC) was obtained in 6% of patients and sustained ROSC in 4%;24-h survival was zero. The most common admission diagnosis was malaria (51%). Most arrests occurred on the paediatric ward (90%) rather than critical care units. Most resuscitations were led by trainees and mid-level providers (58%) rather than paediatricians (23%). Conclusion: Survival following in-hospital paediatric CA was zero, suggesting that CPR may have no benefit in this tertiary hospital. Future efforts to improve outcomes should focus on advocating better pre-arrest care and research interventions aimed to identify and treat children at risk of CA within the resource constraints of this setting.

关键词： Aggressive incident   child   disability   rehabiliation   workplace violence  

摘要： Aim: Aggressive incidents (AI) are a serious concern in health care and can have negative effects on the physical and emotional well-being staff. This study aimed to determine frequency, characteristics and risk factors for aggressive behavior. Methods: AI were recorded during six months by the staff in a pediatric rehabilitation clinic using the evaluation form for AI (EVA). Patients were divided into the study group (patients who were involved in AI) and controls. Results: 14/105 (13%) of patients were involved in 79 AI. 0.44 AI per day occurred. Most often AI occurred on Mondays and 98% included physical, 22% verbal aggression. Most frequent target (43%) were nurses, followed by therapists (31.6%). Significant risk factors for AI were: previous aggressive behavior (p = .038), lower cognitive and higher mobility sub-scores in the WeeFIM. Conclusion: Findings emphasize the magnitude of AI in pediatric rehabilitation and thus the importance of implement preventive strategies.

关键词： Paediatric   electrophysiology   behavioural measures   instrumentation  

摘要： Objective: To determine audiology student perceptions of two simulated learning environments (SLE) in paediatric audiology. Design: A one-shot case study design. Study sample: Fifteen audiology students who completed questionnaires after participating in two SLEs, one simulating auditory brainstem response (ABR) assessments of neonates in a hospital ward and one simulating visually reinforced orientation audiometry (VROA) assessments of young children in an audiology clinic. Results: The students responded positively to 11/11 areas of audiometric testing and client interaction in both SLEs, to 7/7 aspects of their interactions with the mannequins in both SLEs, and to 8/8 aspects of their interactions with fellow students playing the role of parent in the ABR SLE and 7/8 of these aspects in the VROA SLE. The students reported low levels of anxiety towards both SLEs but rated the ABR SLE more highly than the VROA SLE in areas of preparedness, effectiveness, realism, pre-SLE training, reinforcement of lecture content, and overall usefulness. Conclusions: The participating students responded positively to almost all aspects of both SLEs. Further research is warranted using research designs capable of determining if these SLEs directly improve student abilities as they transition from academic settings to clinical placements in paediatric audiology.

关键词： 过敏性紫癜性肾炎   儿科学   养阴清瘀汤   中医证候积分   生化指标   中医药疗法  

摘要： 目的观察养阴清瘀汤对过敏性紫癜性肾炎患儿的临床疗效。方法将2018年7月—2019年4月收治的96例过敏性紫癜性肾炎患儿,随机分为2组,各48例;对照组采用雷公藤多苷片口服治疗,观察组加用养阴清瘀汤治疗,比较2组临床疗效、中医证候积分及生化指标。结果与对照组相比,观察组总有效率较高,差异有统计学意义(P<0.05);与治疗前相比,2组治疗后中医证候积分、尿红细胞计数、24 h尿蛋白定量、尿β2微球蛋白及尿微量血蛋白水平均较治疗前低,且观察组较对照组低,差异有统计学意义(P<0.05)。结论养阴清瘀汤治疗过敏性紫癜性肾炎患儿可提高临床显效率,改善中医证候及生化指标。

关键词： 精品课程   教学互动   《儿科学》   实时   建设   应用  

摘要： 精品课程指在教师团队、教学内容、教学手段、教材教案、教学管理等各个方面都具备一流水平的典范性课程,它是高等院校教学品质与教学革新工程的关键构成要素。然而,精品课程难以实现实时的互动交流,而网络课程独有的远程性和瞬时性,使其对教学质量具有特别巨大的影响力。所以怎样在教学设计理论的指引下,构筑交互型精品课程远程课堂平台,最大程度地确立学生与老师间、学生与教学资源间的关联,使得它更加匹配学习规则,是文章探讨的基础。期待本次探讨可以阐明出精品课程的关键价值,完成学生综合素质的整体提高。