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摘要： Introduction Children admitted to paediatric and neonatal intensive care units may be at high risk from medication errors and preventable adverse drug events. Objective The objective of this systematic review was to review empirical studies examining the prevalence and nature of medication errors and preventable adverse drug events in paediatric and neonatal intensive care units. Data Sources Seven electronic databases were searched between January 2000 and March 2019. Study Selection Quantitative studies that examined medication errors/preventable adverse drug events using direct observation, medication chart review, or a mixture of methods in children <= 18 years of age admitted to paediatric or neonatal intensive care units were included. Data Extraction Data on study design, detection method used, rates and types of medication errors/preventable adverse drug events, and medication classes involved were extracted. Results Thirty-five unique studies were identified for inclusion. In paediatric intensive care units, the median rate of medication errors was 14.6 per 100 medication orders (interquartile range 5.7-48.8%, n = 3) and between 6.4 and 9.1 per 1000 patient-days (n = 2). In neonatal intensive care units, medication error rates ranged from 4 to 35.1 per 1000 patient-days (n = 2) and from 5.5 to 77.9 per 100 medication orders (n = 2). In both settings, prescribing and medication administration errors were found to be the most common medication errors, with dosing errors the most frequently reported error subtype. Preventable adverse drug event rates were reported in three paediatric intensive care unit studies as 2.3 per 100 patients (n = 1) and 21-29 per 1000 patient-days (n = 2). In neonatal intensive care units, preventable adverse drug event rates from three studies were 0.86 per 1000 doses (n = 1) and 0.47-14.38 per 1000 patient-days (n = 2). Anti-infective agents were commonly involved with medication errors/preventable adverse drug events in both setti

关键词： Mycoses   Paediatric   Advanced HIV disease   HIV   AIDS   LMICs  

摘要： Purpose of Review Fungal infections account for significant morbidity and mortality in HIV-infected children particularly in developing countries where there is lack of skilled personnel and infrastructure to make the appropriate diagnosis. This is further compounded by poor availability and accessibility of the antifungals needed to treat these infections. The purpose of this review is to highlight the paucity of data on AIDS-related mycoses in the paediatric age group and make appropriate recommendations to address challenges associated with mycoses in this population. Recent Findings These infections are categorised in two broad groups in this population: mucocutaneous, which commonly affects nutrition and adherence to therapy and invasive fungal infections which are life-threatening. A literature search revealed a total of 29 published literatures across all AIDS-related mycoses in the paediatric population. Research to determine the true burden of the problem and greater funding with implementation of a package of care that will result in substantial reductions in morbidity and mortality in relation to AIDS-related mycoses in children are needed. It is imperative that the programmatic optimal package of care for children with advanced HIV disease is designed and implemented.

关键词： urinary bisphenol A   cubic spline model  

摘要： Background Several studies have reported bisphenol A (BPA) as a potential risk factor for paediatric obesity, but the findings were inconsistent among these studies. Methods Using data from the National Health and Nutrition Examination Survey from 2003 to 2014, we conducted a serial cross-sectional study to examine the association between urinary BPA and paediatric obesity among children aged 6 and 19 years. The association between paediatric obesity and urinary BPA concentrations with or without urinary creatinine adjustments was assessed using multivariable regression and cubic spline models fitted for regression models. Results We observed decreasing trends in urinary BPA concentrations from 2003 to 2014. The associations between urinary BPA concentrations and obesity were inconsistent across the years of survey and even after different models for urinary creatinine adjustments were used. Children with obesity were positively associated with urinary creatinine concentrations, but was not with creatinine-adjusted models. Furthermore, children with higher urinary BPA concentrations had elevated odds of obesity during 2003 to 2008, whereas these associations were inconsistent during 2009 to 2014. Conclusions The associations between paediatric obesity and urinary BPA concentrations differed across the years of survey and creatinine adjustments. Further studies are required to assess these discrepancies.

关键词： Paediatrics   short stature   growth hormone therapy   growth hormone deficiency   Turner syndrome   small for gestational age  

摘要： It is over sixty years since the first administration of human growth hormone (GH) to children with GH deficiency, and over thirty years since recombinant human GH has been available for treatment of GH deficiency and a wider range of non-GH deficiency disorders. From a diagnostic perspective, genetic analysis, using single gene or Sanger sequencing and more recently next generation or whole exome sequencing, has brought advances in the diagnosis of specific causes of short stature, which has enabled therapy to be targeted more accurately. Genetic discoveries have ranged from defects of pituitary development and GH action to abnormalities in intracellular mechanisms, paracrine regulation and cartilage matrix formation. The strategy of GH therapy using standard doses has evolved to individualised GH dosing, depending on diagnosis and predictors of growth response. Evidence of efficacy of GH in GH deficiency, Turner syndrome and short children born small for gestational age is reviewed. The importance of critical assessment of growth response is discussed, together with the recognition and management of a poor or unsatisfactory growth response and the organisational issues related to prevention, detection and intervention regarding suboptimal adherence to GH therapy.

关键词： aggression   agitation   diagnosis   distress   management   mental disorders  

摘要： Assessing and managing acute behavioural disturbance in the acute setting is challenging for paediatricians at all stages of their careers. In this article we use a case example of an acutely agitated teenager in a sequence in which they might present to a colleague on the ground. We follow them through considerations of differential diagnosis, investigation, acute management of the disturbance as well as through legal and ethical considerations. We provide details of investigations as well as acute management and point to further resources that the clinician might use. As a mix of psychiatrists and paediatricians we consider a broad differential and bring our understanding of these cases together with the goal of giving a colleague the information they need. © 2019 Elsevier Ltd

摘要： We appreciate their suggestion to expand the investigation of the association of hemodynamic data during cardiopulmonary resuscitation (CPR) with survival to include the systolic arterial blood pressure (SBP). Our interest in hemodynamic data during CPR has been to compare the effects of ETCO SB 2 sb -guided CPR with those of standard CPR in initial studies.[[1]] In those studies, we chose parameters associated with three perfusion pressures during CPR that included: cerebral perfusion, mean arterial blood pressure (MAP) - mean intracranial pressure (ICP); systemic perfusion, MAP - mean central venous pressure (CVP); and myocardial (or coronary) perfusion, diastolic arterial blood pressure (DBP) - diastolic CVP. [Extracted from the article]

关键词： Scattering   radiation   heart defects   congenital   angiography  

摘要： Introduction: The air gap technique (AGT) is an approach to radiation dose optimisation during fluoroscopy where an "air gap" is used in place of an anti-scatter grid to reduce scatter irradiation. The AGT is effective in adults but remains largely untested in children. Effects are expected to vary depending on patient size and the amount of scatter irradiation produced. Methods: Fluoroscopy and cineangiography were performed using a Phillips Allura Fluoroscope on tissue simulation anthropomorphic phantoms representing a neonate, 5-year-old, and teenager. Monte Carlo simulations were then used to estimate effective radiation dose first using a standard recommended imaging approach and then repeated using the AGT. Objective image quality assessments were performed using an image quality phantom. Results: Effective radiation doses for the neonate and 5-year-old phantom increased consistently (2-92%) when the AGT was used compared to the standard recommended imaging approaches in which the anti-scatter grid is removed at baseline. In the teenage phantom, the AGT reduced effective doses by 5-59%, with greater dose reductions for imaging across the greater thoracic dimension of lateral projection. The AGT increased geometric magnification but with no detectable change in image blur or contrast differentiation. Conclusions: The AGT is an effective approach for dose reduction in larger patients, particularly for lateral imaging. Compared to the current dose optimisation guidelines, the technique may be harmful in smaller children where scatter irradiation is minimal.