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关键词： 慢病管理   儿童疾病   研究型医院   儿科学   创新论坛   儿童健康   儿童感染性疾病   临床诊疗规范  

摘要： 2019年11月15日-17日,第四届中国儿童健康与科技创新论坛暨中国研究型医院学会儿科学专业委员会2019年会在武汉召开。本届大会以“儿童健康与科技创新”为主题,重点关注儿童感染性疾病临床诊疗规范、儿童慢病管理、科研开展及成果产出与转化、儿科临床合理用药等相关话题,设立了中国儿童健康与科技创新论坛、青年学者科研论坛、儿童慢病管理、儿童疾病规范诊疗等专题论坛。

关键词： 多元化教学法   中西医结合儿科学   支气管肺炎   教学效果   自主学习  

摘要： 目的:将多元化手段运用于《中西医结合儿科学》中“支气管肺炎”的教学,并对其效果进行评价。通过该方法激发学生的学习热情,提高学生对该门课程的学习效率。方法:研究对象为贵阳中医学院2013级中西医临床医学专业本科1,2班学生。通过对比教学进行教学效果评价。教学内容为《中西医结合儿科学》支气管肺炎。1班实施普通、传统教学方法,2班在传统教学方法基础上进行改革,采用多元化教学法。对比教学后,对2个班级进行问卷调查、随机课堂考核、临床见习反馈等方面评价。结果:回收有效问卷率100%;2班学生对多元化教学法改革认可度较高,对支气管肺炎掌握情况较好,认为教学改革非常好,差异有统计学意义(P<0.05);2班学生认为进临床见习后,对中西医结合儿科学有全新的认识,学习积极性增高,差异有统计学意义(P<0.01);认为分组搞病案讨论能增强自主学习的意识,翻转课堂后更能加深对疾病的认识和记忆;结论:以分类教学法为基础、运用多元化教学模式的方法在《中西医结合儿科学》课程教学中能激发学生的学习兴趣,让学生自主学习,让教师在课堂上以较少的时间让学生轻松掌握知识。为今后该课程的教学改革起到了铺垫作用。

关键词： PBL教学法   小儿外科   儿科学   医学生   实习  

摘要： 目的探讨PBL教学法在小儿外科实习中的应用效果。方法选取深圳市儿童医院小儿外科专业在读硕士实习研究生48名为研究对象,观察组24名实习生接受常规PBL教学;对照组24名实习生接受传统教学组。比较两组成绩考核分数、教学满意度等情况。结果观察组实习生成绩考核分数高于对照组(P<0.05);在教学满意度比较上,观察组学生教学满意度优于对照组(P<0.05)。结论以问题为基础的教学法(PBL)有利于小儿外科实习生的临床学习,有利于提高学生的学习满意度,可在临床教学及实际工作中推广使用。

关键词： Healthy children   Probiotics   L   casei DG((R)) recovery   Lactobacillus paracasei CNCMI1572  

摘要： PurposeAbility to survive the digestive process is a major factor in determining the effectiveness of a probiotic. In this study, the ability of the probiotic L. casei DG((R)) (Lactobacillus paracasei CNCMI1572) to survive gastrointestinal transit in healthy children was investigated for the first *** children aged 3-12 years received L. casei DG((R)) as drinkable solution of 1x10(9) colony forming units (CFU), once daily for 7 consecutive days. Recovery in faecal samples was evaluated at baseline and at different time-points during and after administration. Defecation frequency, faeces consistency, digestive function and product safety were also *** (95%) of the 20 enrolled children presented viable L. casei DG((R)) cells in their faeces at least once during the study, with a maximum count (mean 4.3 log(10) CFU/g2.3) reached between day 4 and 6 from the beginning of consumption. Notably, for 11 (57.9%) of the 19 children with viable cells, L. casei DG((R)) survived in faecal samples up to 3 days after treatment end. Defecation frequency, faeces consistency and digestive function did not change considerably during or after study treatment. Safety of the study product was very *** This study showed for the first time that L. casei DG((R)) survives the gastrointestinal transit when ingested by children with a paediatric probiotic drinkable solution containing 1x10(9) CFU, and persists in the gut up to 3 days after the end of product intake, demonstrating resistance to gastric juices, hydrolytic enzymes and bile acids.

摘要： Aim To evaluate neuropsychiatric comorbidities in children and adolescents with hypothalamic hamartoma. Method We retrospectively analysed case notes for all individuals with hypothalamic hamartoma referred to Great Ormond Street Hospital, London, between 2000 and 2016. In addition, a systematic review aiming to identify all previous paediatric case series was performed. Psychiatric symptoms, demographics, physical comorbidities, and cognitive functioning were recorded for all cases where possible. Analyses were performed to determine which factors were associated with psychopathology and potential mechanisms investigated. Results Forty-six cases were included in the case series (28 males, 18 females;mean age at assessment 11y 8mo [1y 11mo-16y 11mo, SD 4y 0mo]). Twenty-nine papers representing data from 264 cases met inclusion criteria for the systematic review. Overall, at least 50% of cases presented with psychopathology. Epilepsy, intellectual disability, and male sex were associated with externalizing disorders (attention-deficit/hyperactivity disorder, conduct and oppositional defiance disorders, and rage attacks). Intellectual disability mediated the effects of epilepsy on externalizing psychopathology. No factors were associated with internalizing disorders (anxiety and depressive disorders), although these were not well reported. Interpretation Psychiatric comorbidities are highly prevalent in the presentation of paediatric hypothalamic hamartoma. The aetiology of psychopathology comprises a range of interacting biological and psychosocial factors with particular influence from epilepsy. Further research is required to achieve an evidence base for treatment. What this paper adds Over half of children with hypothalamic hamartoma present with psychiatric comorbidity. Externalizing and internalizing disorders are present in approximately 60% and 30% of children with hypothalamic hamartomas respectively. Epilepsy and male sex are associated with externalizing ps

关键词： anesthesia history   Association of Paediatric Anaesthetists of Great Britain and Ireland   Edward Sumner   Great Ormond Street Hospital   pediatric anesthesia   Pediatric Anesthesia journal  

摘要： Dr Edward Sumner (1940) enjoyed a remarkably productive career as consultant pediatric anesthetist at the Great Ormond Street Hospital for Children. His leadership in clinical care helped his department rise to eminence. He trained hundreds of registrars in pediatric anesthesia and educated thousands more through invited lectures and by co-editing leading textbooks of neonatal and pediatric anesthesia. During his long tenure as Editor-in-Chief of Pediatric Anesthesia, he led the growth of the young journal to prominence. Based on an interview and a long-standing professional and personal friendship of forty-four years, this article reviews Ted Sumner's outstanding contributions to the specialty of pediatric anesthesia and to the development of a strong international community of pediatric anesthesiologists.

关键词： Emergency care   Triage   Critical ill children   Africa   ETAT   Task-shifting  

摘要： Introduction: The majority of emergency paediatric death in African countries occur within the first 24 h of admission. A coloured triage system is widely implemented in high-income countries and the emergency triage and assessment treatment (ETAT) is recommended by the World Health Organization, but not put into practice in Mozambique. We implemented a three-colour triage system in a rural district hospital with lay-staff workers conducting the first triage. Methods: A retrospective, before and after, mortality analysis was performed using routine patient files from the district hospital between 2014 and 2017. The triage system was implemented in August 2016. Inclusion criteria were children under 15 years of age that entered the emergency centre. Primary outcome was child mortality rate. Secondary outcomes included the percentage agreement between the clinical and non-clinical staff and the duration from triage to first treatment. We used a negative binomial model in STATA 15 to compare mortality rates, and Kappa statistics to estimate the agreement between clinical and non-clinical staff. Results: 4176 admissions were included. The mortality rate ratio (MMR) was 45% lower after the start of the intervention (2016;MRR = 0.55;0.38, 0.81;p = 0.002), compared to before. To estimate the agreement between non-clinical and clinical staff, 548 (of the 671) patient files were included. The agreement was estimated at 88.7% (Kappa = 0.644;p < 0.001). The median waiting time decreased with urgency of the triage: 2 h33 for 'green'/least serious (IQR 1 h58-3 h30), 21 min for yellow/serious (IQR 0 h10-0 h58) and nine minutes for 'red'/urgent (IQR 2-40 min). Conclusion: In a rural setting with nurse-led clinical care and non-clinician staff working at the triage reception, implementation of a three-coloured triage system was feasible. Triage and ETAT training was associated with a decrease of 45% of paediatric deaths. The impact on mortality, low cost, and ease of the implementa

关键词： Out-of-hospital cardiac arrest   Paediatrics   Advanced airway management   Time-dependent propensity score analysis   Risk-set matching  

摘要： Background: Although prehospital advanced airway management (AAM) (i.e., endotracheal intubation [ETI] and insertion of supraglottic airways [SGA]) has been performed for paediatric out-of-hospital cardiac arrest (OHCA), the effect of AAM has not been fully studied. We evaluated the association between prehospital AAM for paediatric OHCA and patient outcomes. Methods: We conducted an observational cohort study, using the All-Japan Utstein Registry between 2014 and 2016. We included paediatric patients (age <18 years) with OHCA. We calculated time-dependent propensity score at each minute after initiation of cardiopulmonary resuscitation by EMS providers, using a Fine-Gray regression model. We sequentially matched patients who received AAM during cardiac arrest to patients at risk of receiving AAM within the same minute (risk-set matching). The primary outcome was 1-month survival. Secondary outcome was 1-month survival with favourable functional status, defined as Cerebral Performance Category score of 1 or 2. Results: We analysed 3801 paediatric patients with OHCA. 481 patients (12.7%) received AAM and 3320 (87.3%) did not. Among the 3801 analysed patients, 912 patients underwent risk-set matching. In the matched cohort, AAM was not associated with 1-month survival (AAM: 52/456 [11.4%] vs. no AAM: 44/456 [9.6%];risk ratio [RR], 1.15 [95% CI, 0.76-1.73];risk difference [RD], 1.5% [-3.0 to 6.1%]) or favourable functional status (AAM: 9/456 [2.0%] vs. no AAM: 10/456 [2.2%];RR, 0.69 [95% CI, 0.26-1.79];RD, -0.8% [-2.9 to 1.3%]). Conclusion: Among paediatric patients with OHCA, we found that prehospital AAM was not associated with 1-month survival or favourable functional status.

关键词： Haemophilia   Emergency care   Factor   Prophytaxis   Haemarthrosis   Central venous catheter infection   Inhibitor  

摘要： introduction: Haemophilia is a rare disease and its management can pose a challenge to Emergency Department paediatricians. Aim: To describe the frequency and reasons for consultation by haemophilic children in the ED. Materials and methods: Longitudinal retrospective study was conducted in a paediatric Emergency Department of a tertiary care hospital. The study included haemophiliacs A and B, ages 0 to 16 years old, and who had consulted the Emergency Department for whatever reason over a span of 6 years (2011-2016). The data analysed include: age, type and severity of haemophilia, reason for query, prophylactic status, complementary examinations, established diagnosis, treatment, and number of visits to the Emergency Department. Results: The analysis included 116 males with a total of 604 Emergency Department visits. The mean age was 5.5 years, and the median age was 5.3 years. A total of 101 patients were categorised as haemophiliac A (38 mild, 4 moderate, 59 severe), and 15 as haemophiliac B (9 mild, 3 moderate, 3 severe). The main reasons for initial Emergency Department visits (ranked by triage) were: musculoskeletal problems/injury or bleeding (66.7%), causes unrelated to haemophilia (29%), suspected central venous catheter related infection (2.8%), and routine clotting factor infusion (1.5%). Additional tests were conducted during 335 visits (55.5%). Factor replacement was undertaken in 317 visits (52.5%). A total of 103 episodes (17.1%) required hospital admission, due to: head trauma (35.9%), central venous catheter-related infection (13.6%), haemarthrosis (8.7%), muscle haematoma (6.8%), and haematuria (5.8%). Conclusion: Haemophilic patients went to the Emergency Department for common paediatric causes, but also requested consultation on specific problems related to haemophilia, with musculoskeletal problems/injury or bleeding being the main issues. The paediatric Emergency Department is an indispensable component of haemophilia care. (C) 2019 Asociacion