教学课程资源库 更多>>

关键词： Tacrolimus   Intra-patient variability   Rejection   Graft survival   Non-adherence  

摘要： Background Late acute cellular rejection (LACR) is associated with poorer graft outcomes and non-adherence. Non-adherence to tacrolimus can be indirectly assessed by the intra-patient variability (IPV) of tacrolimus trough levels. The threshold of IPV associated with rejection is not known. Methods We conducted a case-control study comparing 25 patients with biopsy-proven LACR against 25 stable controls matched for age group, primary diagnosis and time post-transplant. IPV was calculated using coefficient of variance (CV) and mean absolute deviation (MAD) using tacrolimus levels in the preceding 12 months. We also assessed the percentage time for tacrolimus levels < 4 mu g/L (Tac < 4) and the concentration/weight-adjusted dose (C/D) ratio as a proxy marker of tacrolimus metaboliser status. Results LACR patients had higher CV (median, IQR 44%, 36-61% v. 24%, 19-35%, p < 0.0001) and higher MAD (33%, 25-48% v. 19%, 15-26%, p < 0.0001). TheMAD was less affected by outlying tacrolimus results. Receiver operating curve analysis of the MAD resulted in a sensitivity of 76% and specificity of 76% at a threshold of 26% (AUC 0.85, p < 0.05). LACR patients had more Tac < 4 (50% v. 26%, p < 0.05). There was no difference in C/D suggesting that good IPV can be maintained in fast metabolisers. Patients with LACR had significantly increased creatinine at 12-month follow-up despite treatment (108 v. 5 umol/L increase from baseline) and four patients lost their allograft. Conclusions Monitoring of tacrolimus IPV using the MAD may be a clinical marker for LACR. A threshold IPVof 26% can potentially be used as a therapeutic target pending further validation studies.

关键词： Acute care   family-centred care   intellectual disability   nursing   paediatrics  

摘要： Children with intellectual disability (ID) experience chronic and pervasive limitations across intellectual and adaptive functioning. They are also at risk of developing co-morbidities. They are likely to be hospitalised more frequently and for longer periods of time than other children. The purpose of this study was to understand the experiences of nurses when caring for children and teenagers with ID in an acute paediatric hospital setting. The aim of the research was to inform future directions for the delivery of equitable and effective care for this vulnerable population. This study used a qualitative thematic analysis of individual interviews conducted with eight registered and enrolled nurses who provided care to children and adolescents with ID in an Australian paediatric acute hospital setting. Themes which emerged from this analysis were (1) Recognising similarities and managing differences;(2) Nurse-parent relationships;and (3) Caring for children with ID requires additional time. This study highlights that navigating care delivery and relationships when working with young people with ID and their caregivers in an acute care setting is complex. Nursing children with ID in hospital requires sophisticated skills. To ensure quality healthcare for patients with ID, a range of strategies are proposed.

关键词： Continuum   Skill-based education   Continuing medical education   Distance learning   MIR training  

摘要： The Spanish Paediatric Association (AEP) has, among its objectives, to develop activities aimed at the training of its members. Thus, in 2013, it began its most ambitious training project, the virtual platform, "Continuum". Now it presents a new section aimed at Internal Medicine Residents (MIR) in Paediatrics and their tutors: I Prepare My Rotation By (PMRP), which has as objectives to reduce the variation in MIR training, to help the tutors in their teaching function, to facilitate collaborative and skill-based learning, reflective training, and the resolving of the particular problems of the professional profile of each paediatric speciality. PMRP is split into three main sections: "From where do we starb" (with the sub-sections: self assessment questionnaire and learning agreement),,Situations to resolve (where the clinical scenarios that have been selected in the learning agreement are broken down), and To where have we gob" (which includes again the sub-sections at the beginning of the rotation in order to check if the expected objectives have been reached, and the assessment report). It also has other resources: prior knowledge, portfolio, and discussion forum. Five features of the proposed training model should be highlighted: the clinical scenario as a starting point;skill-based learning (based on the Global Paediatric Educational Consortium);the assessment as a training stimulus;the power of collaborative learning, and the participation of the different specialist societies of the AEP in the development of its contents. (C) 2019 Published by Elsevier Espana, S.L.U. on behalf of Asociacion Espanola de Pediatria.

关键词： Enterovirus   Meningitis   CSF   Pleocytosis   Molecular detection  

关键词： Gender   Gender roles   Gender stereotypes   Male nurses   Nurse-family relationship   Qualitative research  

摘要： Aims (1) To learn how male nurses view and manage their relationships with families of hospitalized children, in contrast to how they view those established by female nurses. (2) To know if male nurses' relationships with families of hospitalized children are influenced by gender roles and stereotypes. Background Relationships are essential in care. Prevailing gender stereotypes suggest that males have more difficulties with relationships than with technical aspects of nursing. Method Descriptive qualitative research in a public tertiary hospital September-December 2015. Participants were male nurses who worked in maternal and child health. Purposive sampling, based on criteria of homogeneity-regularity and heterogeneity-diversity. Semi-structured interviews and content analysis. Findings Twelve male nurses participated. Two key themes emerged. (1) Establishment of professional-family relationship. Male nurses denied that male and female nurses established relationships with families differently, attributing any differences to personality rather than gender. (2) Management of relationships. Male nurses claimed that they set more limits on their relationships with families than female nurses. Discussion Male nurses both disrupted and reproduced gendered stereotypes about relationships with families, revealing new models of masculinity. Conclusion Male nurses reject the stereotype that nursing is a women's profession, but they interpret their relationships with families in terms of gender roles and stereotypes. Implications for nursing and nursing policy These findings contribute to understandings of the influence of gender stereotypes in nursing. They support the work of professional associations and labour unions in Spain and other countries to combat gender stereotypes and gender differences in nursing.

关键词： Clinical Safety Studies   Cosmetovigilance   Dermo-cosmetics   Paediatric Dermatology   Post-market surveillance   Tolerance  

摘要： Background/objectives Paediatric skin, considered sensitive, and infant skin, more susceptible to percutaneous toxicity, require specially formulated cosmetic products. As recently shown, early use of emollients in infants "at risk" of developing atopic dermatitis has shown controversial results in reducing the incidence of atopic dermatitis. Development of dermo-cosmetic products for this specific population should especially ensure tolerance and safety. In absence of good clinical practice guideline, we propose here a stepwise approach for the development of paediatric cosmetic skincare products. Methods Our stepwise methodology for cosmetics aimed at paediatrics, starts with in vitro assessment of product's ingredients safety, followed by preclinical and clinical evaluations of the final product, including sequentially: (1) Repeated Open Application Test (ROAT), (2) Human Repeated Insult Patch Test (HRIPT), (3) In-use dermatological and ophthalmological tolerance studies (sequentially in 3a: healthy adults, 3b: healthy paediatric subjects and finally 3c: paediatric patients). We also describe the integrated cosmetovigilance-toxicological surveillance during the clinical development phase and postmarketing. Results As illustrated with one dermo-cosmetic product intended to be used as a preventative/maintenance treatment for atopic dermatitis in paediatric population, we show that using this stepwise methodology to test a product reduces potential risks of irritation and contact dermatitis in this sensitive population. Conclusion Standardized ethical stepwise development approach is needed to ensure the commercialization of safe and well-tolerated dermo-cosmetics for paediatrics. The approach described here could potentially serve as guidance for evaluation of new paediatric cosmetic products.

关键词： Infants   paediatrics   NSAIDs   post-operative   cardiac   surgery  

摘要： Background: Pain control is an important element of care for patients after surgery, leading to better outcomes, quicker transitions to recovery, and improvement in quality of life. The purpose of this study was to evaluate the safety and efficacy of non-steroidal anti-inflammatory drugs in children after cardiac surgery Materials and Methods: Patients between the ages of 1 month and 18 years of age, who received intravenous or oral non-steroidal anti-inflammataory drugs after cardiac surgery, from November 2015 until September 2017 were included in this study. The primary endpoints were non-steroidal anti-inflammataory drug-associated renal dysfunction and post-operative bleeding. Secondary endpoints examined the effect of non-steroidal anti-inflammataory drug use on total daily dose of narcotics, number of intravenous PRN narcotic doses received, and pain assessment score. Data were analysed using descriptive statistics for frequencies and ranges. Multivariate analysis was performed to measure the association of all predictors and outcomes. Wilcoxon singed-rank test was performed for secondary outcomes. Results: There was no association between the incidence of renal dysfunction and the use of or duration of non-steroidal anti-inflammataory drugs;in addition no association was found with increased chest tube output. There was a statistically significant reduction of patients' median Face, Legs, Activity, Cry, Consolability (FLACC) scores (2-0;p = 0.003), seen within first 24 hours after initiation of ketorolac, and a significant reduction of morphine requirements seen from day 1 to day 2 (0.3 mg/kg versus 0.1 mg/kg;p < 0.001) and number of as-needed doses. Conclusion: Non-steroidal anti-inflammataory drugs in paediatric cardiac surgery patients are safe and effective for post-operative pain management.

关键词： Extracorporeal membrane oxygenation   CHD   cardiac surgery   paediatric   survival  

摘要： Background: Extracorporeal membrane oxygenation has been widely used after paediatric cardiac surgery due to increasing complex surgical repairs in neonates and infants having complex CHDs. Materials and methods: We reviewed retrospectively the medical records of all patients with CHD requiring corrective or palliative cardiac surgery at King Abdulaziz University Hospital that needed extracorporeal membrane oxygenation support between November 2015 and November 2018. Results: The extracorporeal membrane oxygenation population was 30 patients, which represented 4% of 746 children who had cardiac surgery during this period. The patients' age range was from 1 day to 20.33 years, with a median age of 6.5 months. Median weight was 5 kg (range from 2 to 53 kg). Twenty patients were successfully decannulated (66.67%), and 12 patients (40%) were survived to hospital discharge. Patients with biventricular repair tended to have better survival rate compared with those with single ventricle palliation (55.55 versus 16.66%, p-value 0.058). During the first 24 hours of extracorporeal membrane oxygenation support, the flow rate was significantly reduced after 4 hours of extracorporeal membrane oxygenation connection in successfully decannulated patients. Conclusion: Survival to hospital discharge in patients requiring extracorporeal membrane oxygenation support after paediatric cardiac surgery was better in those who underwent biventricular repair than in those who had univentricular palliation. Capillary leak on extracorporeal membrane oxygenation could be a risk of mortality in patients after paediatric cardiac surgery.

关键词： Medical imaging   peadiatric radiography   radiographers' knowledge   quaility assessment  

摘要： Introduction Digital radiography (DR) systems enable radiographers to reduce the radiation dose to patients while maintaining optimised image quality. However, concerns still exist about paediatric patients who may be exposed to an increased level of radiation dose which is not needed for clinical practice. The purpose of this study was to evaluate the knowledge, awareness and attitudes, in terms of image quality optimisation of radiographers undertaking paediatric DR in Australia and Saudi Arabia. Methods A survey-based study was devised and distributed to radiographers from Australia and Saudi Arabia. Questions focused on Australian and Saudi Arabian radiographers' knowledge and attitude of paediatric DR examinations. Results There were 376 participants who responded to the survey from both countries. A major finding showed that most participants lack knowledge in the area of paediatric DR examinations. Most participants from Australia had received no formal training in paediatric digital radiography (79%), whereas nearly half of the participants from Saudi Arabia received no training (45%). Approximately three out of four radiographers from both countries believed that when using DR they did not need to change the way they collimate the beam as DR images can be cropped using post-processing methods. Conclusion The finding of this study demonstrates that radiographers from both countries should improve their understanding and clinical use of DR in paediatric imaging. More education and training for both students and clinicians is needed to enhance radiographer performance in digital radiography and improve their clinical practices.

关键词： children   emergency   weight estimation  

摘要： Objectives: To determine the accuracy of using parental estimate of a child's weight compared to actual weight in a paediatric emergency setting. Methods: Prospective, observational study. Age, weight and height data were collected from children aged 1 month up to 11 years with an Australian Triage score of 3 or higher. This was compared with a parent weight estimate. Analysis is descriptive. Results: A total of 450 children were studied with a mean age of 4 years 4 months. A total of 85.3% of parents were willing to provide a weight estimate (n = 384). The mean difference between the parent estimate (where provided) and the actual weight was 0.33 kg (measured weight > estimated;95% confidence interval [CI] -6.9 kg to +7.6 kg). There was 75% agreement within 10% of the measured weight (95% CI 71-79%) and 92% agreement within 20% of the measured weight (95% CI 89-95%). Weight was more commonly underestimated than overestimated. Children of Polynesian/Pacific ethnicity were less likely to have an accurate parental weight estimation. Conclusions: Parent estimate is an accurate weight estimation method when parents are willing to give an estimate. There is ethnic variation in accuracy that should be taken into account when applying this method.