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关键词： Fall risk assessment   Fall prevention   Fall risk factor   Pediatric  

摘要： Purpose: To identify characteristics of paediatric falls within a healthcare setting. Design and methods: A retrospective analysis of falls occurring within inpatient, outpatient, emergency and community healthcare settings of children aged 0-<18 years was conducted using data from the Children's Health Queensland Hospital and Health Service (CHQ-HHS) Clinical Incident Database and Electronic Medical Record between January 1st 2015 and December 31st 2017. One-sample and two-sample Chi-squared tests with posthoc tests were performed to assess relationships between categorical variables. Results: The final dataset contained 385 fall events. Children 0-2 years fell most frequently (46.75%) and falls were higher in males (55.58%). Falls from bed were the most common mechanism (30.65%). The incidence rate of inpatient falls was 0.53 falls per 1000 bed days in the tertiary hospital setting and 12% of presentations to inpatient community health facilities. Falls from bed were most common in the tertiary hospital inpatient setting (39.84%, p < .001) and the emergency department (72.13%, p < .001). Falls from furniture/equipment constituted 26.04% of outpatient falls. Most falls occurred in the presence of parents/caregivers (79.48%) and 4.66% of falters sustained multiple falls. Conclusions: This study provides a comprehensive review of the characteristics of fall events in CHQ-HHS over a three-year period and summarises the existing literature in paediatric fall prevention. Practice implications: Risk assessment and management plans should focus on education, particularly surrounding bed safety. Our findings have informed the development of an integrated evidence-based paediatric-specific fall risk assessment tool and management plan to prevent falls in hospital and community healthcare settings. (C) 2019 Elsevier Inc. All rights reserved.

摘要： Letter of response re 'Whole spine MRI is not required in investigating uncomplicated paediatric lumbosacral lipoma. The patients in our series had not undergone surgery at the time of the MRI scan. The extended LSL MRI protocol suggested by Prof Wang is interesting and might provide a pragmatic compromise between local and whole neuraxis imaging. [Extracted from the article]

关键词： Faecal calprotectin   Paediatric ulcerative coiltis   Endascopic activity  

摘要： Introduction: Colonoscopy is currently considered to be the gold standard for evaluation of colonic mucosa inflammation in patients with ulcerative colitis (UC), but the procedure is invasive and cannot be repeated frequently, especially in the paediatric population. The aim of this study was to assess the role of faecal calprotectin (FC) as a predictor of endoscopic disease activity in paediatric patients with UC in clinical remission. Material and methods: Single-centre prospective study. Clinical remission was defined as Paediatric Ulcerative Colitis Activity Index <10. Endoscopic findings were assessed according to the Mayo Endoscopic Subscore (MES). MES < 1 was defined as endoscopic remission. All participants provided fresh faecal samples for measurement of FC. Results: A total of 34 visits of 24 children with UC were included in the study. There was a strong positive correlation between FC levels and endoscopic disease activity (n=34, r=0.83. p < 0.001). The median FC levels in the subgroup with endoscopic activity (MES 2-3) were significantly higher than the median FC levels in the subgroup without endoscopic activity (MES <= 1) (1000 mu g/g, IQR 575-1800 mu/gg vs. 100 mu g, IQR 80-223 mu g/g, p < 0.001). At a cut-off of 298.5 mu/g, FC had 92.3% sensitivity, 95.2% specificity and an AUROC 0.974 (SE 0.023, 95% CI 0.93-1, p< 0.001) to predict endoscopic activity. Discussion: FC is an accurate surrogate marker of endoscopic activity in children with clinically quiescent UC. (C) 2019 Published by Elsevier Espana, S.L.U.

摘要： Background The Hall technique (HT) is popular with UK paediatric dentists (PDs). Global PDs perception/use of HT is unknown. Aim To investigate global PDs opinions/use of HT. Materials and methods A cross-sectional questionnaire of 26 questions was sent to specialist PDs across the globe. Results Responses of 709 PDs from six continents were obtained. The majority (n = 654, 92.32%) had heard about HT but only 50.6% (n = 358) used it, with wide country variations. Respectively, 37.5%, 31.5% and 31% were neutral, against or supportive of HT when they initially heard about it. Only 17% of HT users said it was always the treatment of choice for non-pulpal asymptomatic carious primary molars (NPACPMs), 62% would take a pre-operative radiograph, 65% would consider using high speed drills before HT, 63% would never consider HT under general anaesthesia, 56% would use HT under N2O sedation. Finally, in a clinical scenario of a NPACPM in a cooperative 6-year-old, 75% of PDs would choose conventional restorative methods over the HT. Conclusion The HT is recognised, but not used, by an outright majority of PDs across the globe. Identifiable barriers such as lack of training, perception as substandard dentistry and perceived lack of evidence reduced its use.

关键词： Airflow (AF)   Children   Recurrence plots (RP)   Sleep Apnoea-Hypopnoea Syndrome (SAHS)  

摘要： Background and objective: In-laboratory overnight polysomnography (PSG) is the gold standard method to diagnose the Sleep Apnoea-Hypopnoea Syndrome (SAHS). PSG is a complex, expensive, labour-intensive and time-consuming test. Consequently, simplified diagnostic methods are desirable. We propose the analysis of the airflow (AF) signal by means of recurrence plots (RP) features. The main goal of our study was to evaluate the utility of the information from RPs of the AF signals to detect paediatric SAHS at different levels of severity. In addition, we also evaluated the complementarity with the 3% oxygen desaturation index (ODI3). Methods: 946 AF and blood oxygen saturation (SpO(2)) recordings from children ages 0-13 years were used. The population under study was randomly split into training (60%) and test (40%) sets. RP was computed and 9 RP features were extracted from each AF recording. ODI3 was also calculated from each SpO(2) recording. A feature selection stage was conducted in the training group by means of the fast correlation-based filter (FCBF) methodology to obtain a relevant and non-redundant optimum feature subset. A multi-layer perceptron neural network with Bayesian approach (BY-MLP), trained with these optimum features, was used to estimate the apnoea-hypopnoea index (AHI). Results: 8 of the RP features showed statistically significant differences (p-value <0.01) among the SAHS severity groups. FCBF selected the maximum length of the diagonal lines from RP, as well as the ODI3. Using these optimum features, the BY-MLP model achieved 83.2%, 78.5%, and 91.0% accuracy in the test group for the AHI thresholds 1, 5, and 10 events/h, respectively. Moreover, this model reached a negative likelihood ratio of 0.1 for 1 event/h and a positive likelihood ratio of 13.7 for 10 events/h. Conclusions: RP analysis enables extraction of useful SAHS-related information from overnight AF paediatric recordings. Moreover, it provides complementary information to the wide

关键词： Asia   fungal infection   surgery   treatment  

摘要： Children manifesting soft-tissue fungal infections are uncommonly seen, more so the subgroup of invasive soft-tissue mucormycosis. Invasive fungal infections in various organs respond differently and are often complicated by an immune-compromised host. Repeated and aggressive clearance of disease till an infection-clear margin is obtained is the mainstay of surgical therapy. This is coupled with appropriate antifungal therapy and the management of any underlying medical conditions. From our experience, we propose a surgical algorithm for therapy of soft-tissue mucormycosis in children.

关键词： Obsessive-compulsive disorder   Paediatric   Cognitive behaviour therapy   Barriers   Dissemination   Exposure therapy   Exposure with repsonse prevention  

摘要： Exposure techniques are underutilised in the treatment of anxiety disorders in routine practice, but little is known about the use of exposure with response prevention (ERP) for OCD, particularly in youth. The current study aimed to examine the utilisation of ERP for paediatric OCD via an anonymous online survey completed by clinicians (N = 107). Specifically, we explored the association of clinician characteristics and OCD symptom subtypes with ERP use, as well as clinician-reported barriers to ERP implementation. The majority of clinicians reported commonly using ERP when treating youth with OCD, and rates of ERP use were highest among clinical psychologists. Clinician-held negative beliefs about exposure were significantly associated with lower ERP use. Additionally, clinicians reported being less likely to use ERP to treat hoarding symptoms and taboo obsessions, compared to other OCD symptom subtypes. The most commonly endorsed barriers to successful ERP implementation were aspects of the phenomenology of OCD (e.g. covert compulsions, frequently changing rituals) as opposed to general barriers (e.g. insufficient time during sessions). Overall, our findings suggest that OCD presents unique challenges for clinicians delivering exposure-based therapy. Training should address these OCD-specific obstacles in order to promote dissemination of ERP for youth with OCD.

关键词： Malaria   Paediatrics   Spain  

摘要： Introduction: Malaria is considered to be the fourth leading cause of infant mortality after pneumonia, complications related to premature birth, and perinatal asphyxia. Material and methods: A retrospective and descriptive study of cases of malaria confirmed and treated by the Paediatric Infectious Diseases Unit (age lower than 15 years) at the La Fe Hospital, Valencia, over the period 1993 to 2015. Results: A total of 54 cases of paediatric malaria were diagnosed in the period 1993-2015, with 51.8% of these occurring in males, and 46.2% of patients were aged below 5 years. The majority of children came from Equatorial Guinea (68.5%). Only 5.6% had received antimalarial prophylaxis. Plasmodium falciparum was found to be the causal species in 81.4% of cases. Seven patients (13%) presented with complicated malaria. The most widely used treatment was quinine, either alone or in combination with other drugs. Atovaquone/proguanil was used from 2010 onwards and was indicated in 20.3% of the patients. The combination of artesunate/piperaquine/dihydroartemisinin began to be used in 2013. No deaths or relevant side effects were reported, and the clinical response was favourable in all children (100%). Conclusions: Malaria is still a prevalent disease in this population, a consequence of immigration, and tourism to endemic countries. Malaria should be considered as a likely diagnosis in a febrile child who comes from, or has travelled to, an endemic region in the past year. (C) 2019 Asociacion Espanola de Pediatria. Published by Elsevier Espana, S.L.U.

关键词： MRI   POPCMS   Posterior fossa   Longitudinal   Machine learning  

摘要： Post-operative cerebellar mutism syndrome (POPCMS) in children is a post- surgical complication which occurs following the resection of tumors within the brain stem and cerebellum. High resolution brain magnetic resonance (MR) images acquired at multiple time points across a patient's treatment allow the quantification of localized changes caused by the progression of this syndrome. However, MR images are not necessarily acquired at regular intervals throughout treatment and are often not volumetric. This restricts the analysis to 2D space and causes difficulty in intra- and inter-subject comparison. To address these challenges, we have developed an automated image processing and analysis pipeline. Multi-slice 2D MR image slices are interpolated in space and time to produce a 4D volumetric MR image dataset providing a longitudinal representation of the cerebellum and brain stem at specific time points across treatment. The deformations within the brain over time are represented using a novel metric known as the Jacobian of deformations determinant. This metric, together with the changing grey-level intensity of areas within the brain over time, are analyzed using machine learning techniques in order to identify biomarkers that correspond with the development of POPCMS following tumor resection. This study makes use of a fully automated approach which is not hypothesis-driven. As a result, we were able to automatically detect six potential biomarkers that are related to the development of POPCMS following tumor resection in the posterior fossa.

关键词： cinacalcet   CKD-MBD   consensus statement   dialysis   paediatrics  

摘要： Secondary hyperparathyroidism (SHPT) is an important complication of advanced chronic kidney disease (CKD) in children, which is often difficult to treat with conventional therapy. The calcimimetic cinacalcet is an allosteric modulator of the calcium-sensing receptor. It has proven to be effective and safe in adults to suppress parathyroid hormone (PTH), but data on its use in children are limited. To date, studies in children only consist of two randomized controlled trials, nine uncontrolled interventional or observational studies, and case reports that report the efficacy of cinacalcet as a PTH-lowering compound. In 2017, the European Medical Agency approved the use of cinacalcet for the treatment of SHPT in children on dialysis inwhom SHPT is not adequately controlled with standard therapy. Since evidence-based guidelines are so far lacking, we present a position statement on the use of cinacalcet in paediatric dialysis patients based on the available evidence and opinion of experts from the European Society for Paediatric Nephrology, Chronic Kidney Disease-Mineral and Bone Disorder and Dialysis Working Groups, and the ERA-EDTA. Given the limited available evidence the strength of these statements are weak to moderate, and must be carefully considered by the treating physician and adapted to individual patient needs as appropriate. Audit and research recommendations to study key outcome measures in paediatric dialysis patients receiving cinacalcet are suggested.