教学课程资源库 更多>>

关键词： general anesthesia   paediatric   preoperative fasting   ultrasound  

摘要： Background A light breakfast has been found to empty from the stomach within 4 hours in healthy volunteers. Aim The aim of this study was to investigate whether a light breakfast of yoghurt or gruel empties from the stomach within 4 hours, in children scheduled for general anaesthesia. Method In this observational cohort study, children aged 1-6 years scheduled for elective general anaesthesia were prescribed free intake of yoghurt or gruel 4 hours prior to induction. They were subsequently examined with gastric ultrasound within 4 hours of ingestion. In case of gastric contents, the gastric antral area was measured, and gastric content volume (GCV) was calculated. Results Twenty children were included in the study and the ingested amount of gruel or yoghurt ranged 2.5-25 mL kg(-1). In 15 cases, the stomach was empty with juxtaposed walls and no further measurements were made. In four cases, there was fluid present in the stomach, but the calculated gastric contents were <0.5 mL kg(-1). One patient had solids in the stomach, and GCV in this patient was calculated to 2.1 mL kg(-1). The patient with solids present had ingested 25 mL kg(-1) of gruel 4 hours prior to assessment. The planned procedure was therefore delayed 1 hour. There were no cases of pulmonary aspiration or vomiting. Conclusion A light breakfast 4 hours prior to induction may be considered, but there is need for further studies on safe limits for the volume ingested.

摘要： The article presents an online survey on collaborative networking between regional child mental health, paediatric and educational services in Gippsland, Australia. Topic include recruiting health professionals, specialists in mental health; and approval was obtained from the administration through the Institutional Ethics Review Committee of the Latrobe Regional Hospital.

关键词： consultants   fatigue   on-call   sleep   wellbeing  

摘要： The tragic death of an anaesthetic trainee driving home after a series of night shifts prompted a national survey of fatigue in trainee anaesthetists. This indicated that fatigue was widespread, with significant impact on trainees' health and well-being. Consultants deliver an increasing proportion of patient care resulting in long periods of continuous daytime duty and overnight on-call work, so we wished to investigate their experience of out-of-hours working and the causes and impact of work-related fatigue. We conducted a national survey of consultant anaesthetists and paediatric intensivists in the UK and Ireland between 25 June and 6 August 2018. The response rate was 46% (94% of hospitals were represented): 84% of respondents (95%CI 83.1-84.9%) contribute to a night on-call rota with 32% (30.9-33.1%) working 1:8 or more frequently. Sleep disturbance on-call is common: 47% (45.6-48.4%) typically receive two to three phone calls overnight, and 48% (46.6-49.4%) take 30 min or more to fall back to sleep. Only 15% (14.0-16.0%) reported always achieving 11 h of rest between their on-call and their next clinical duty, as stipulated by the European Working Time Directive. Moreover, 24% (22.8-25.2%) stated that there is no departmental arrangement for covering scheduled clinical duties following a night on-call if they have been in the hospital overnight. Overall, 91% (90.3-91.7%) reported work-related fatigue with over half reporting a moderate or significantly negative impact on health, well-being and home life. We discuss potential explanations for these results and ways to mitigate the effects of fatigue among consultants.

关键词： acute scrotum   epididymo-orchitis   paediatric   testicular appendage   testicular torsion  

摘要： Background: Acute scrotal pain is a common paediatric surgical presentation. Delays in treatment can result in testicular loss from torsion. It is unclear where delays occur. We aimed to investigate presentations with an acute scrotum to identify any potential areas of delay. Methods: We conducted a prospective study (April 2017-November 2018) of paediatric patients (<18 years) presenting with acute scrotal pain. Data collected included: patient demographics, history/examination findings, mode of presentation, clinical timeline details and outcomes. Results: A total of 107 acute scrotum presentations were identified: 58 (54.2%) testicular appendage torsion, 23 (21.5%) testicular torsion, 6 (5.6%) epididymo-orchidits and 20 (18.7%) other diagnoses. Median age at presentation was 11 years (4 months-16 years). Fifty-seven (53.3%) underwent emergency surgery, of whom 23 (40.4%) had testicular torsion, with 2 requiring orchidectomy. Median time from onset of symptoms to seeking medical opinion was 5.5 (0-135) h. Once assessed by a medical professional, the route to paediatric surgical review via general practitioner (GP) and local emergency department (ED) to paediatric ED was 4.84 (1.67-24.5) h;via GP to paediatric ED was 2.58 (0.75-25.5) h;via local ED to paediatric ED was 2.25 (1-7.75) h;and directly to paediatric ED was 0.45 (0-1.42) h. Conclusion: Delays in assessment and treatment of acute scrotal pain occur from the time parents are aware of symptoms to seeking medical opinion. Education to increase awareness may reduce time delays. GPs should refer patients directly to a paediatric ED. Local EDs should manage paediatric cases as per the local surgeons' skill base.

关键词： Consent   Paediatric   Capacity  

摘要： Introduction Consenting paediatric patients for surgical procedures remains inherently unique in that it is underpinned by principles such as parental responsibility, assessment of the child's capacity to consent, and adherence to national/legal guidelines. Quality record keeping is an important objective evidence to demonstrate the highest standards of medical care provided to our patients. The consent form is a crucial medical record encapsulating the attainment of informed consent from a parent/guardian for performing a procedure on their child. We aimed to prospectively evaluate the consenting process in our department to assess adequacy of documentation and parental perspectives. Methods A prospective study using qualitative descriptive design was conducted with parents of 50 children requiring neurosurgical procedures over a 3-month period. Results All patients understood the primary diagnosis and type of surgery. Procedure-specific risks were understood by 98% and 84% could remember the mentioning of general risks of surgery. Only a minority of parents (24%) could recollect that alternative options of management including no treatment were discussed. In cases where relevant, laterality was only documented in 56% of consent forms. All patients felt that an informed decision regarding consent to surgery was made. However, 12% suggested areas where further improvement could be made in the timing of consent and the way information could be better provided. Discussion Consent is more than a signature on a form. It provides objective evidence of a shared decision-making process between the surgeon, patient, and their parent/guardian. Our initial study highlights multiple areas for improvement.

关键词： avascular necrosis   deformity   mal-reduction   paediatric   slipped upper femoral epiphysis   supracondylar fracture  

摘要： Paediatric orthopaedic surgery can be an unfamiliar and challenging field with the potential for devastating consequences. This article discusses late deformity associated with humeral supracondylar fractures and slipped capital femoral epiphysis (SCFE). Common complications include loss of fixation, mal-reduction, avascular necrosis and growth disturbance. Many cases result in reoperation and revision surgery associated with significant morbidity. We discuss the risk factors, aetiology, tips to avoid them and management options based on current evidence. © 2019

关键词： clinical trial   long-term adalimumab   methotrexate   pediatrics   psoriasis  

摘要： Background Adalimumab (ADA) (Humira (R), AbbVie Inc., U.S.A.) is approved by the European Medicines Agency for children aged >= 4 years with severe plaque psoriasis. Objectives To evaluate the long-term efficacy and safety of ADA in children with severe plaque psoriasis. Methods Results are presented from the 52-week long-term extension (LTE) of the randomized, double-blind, double-dummy, phase III trial, in children with severe plaque psoriasis (results from prior periods have been published). Patients aged >= 4 and < 18 years were randomized 1 : 1 : 1 to ADA 0.8 mg kg(-1) (40 mg maximum) or 0.4 mg kg(-1) (20 mg maximum) every other week or to methotrexate (MTX) 0.1-0.4 mg kg(-1) (25 mg maximum) weekly. The 16-week initial treatment (IT) period was followed by a 36-week withdrawal period and a 16-week retreatment period. Patients could enter the LTE at prespecified time points to receive ADA 0.8 mg kg(-1) (blinded or open label) or ADA 0.4 mg kg(-1) (blinded), or to remain off treatment. Efficacy is reported for patient groups according to doses received in the IT and LTE periods. Results Of the 114 patients randomized in the IT period, 108 entered the LTE (n = 36 in each group);93 received ADA 0.8 mg kg(-1). Efficacy (>= 75% improvement from baseline in Psoriasis Area and Severity Index) was maintained or improved from entry to the end of the LTE: MTX(IT)/ADA 0.8(LTE) 31-86% of patients;ADA 0.4(IT)/0.4 or 0.8(LTE) 28-47%;ADA 0.8(IT)/0.8(LTE) 50-72%. No serious infections occurred in the LTE. Conclusions After 52 weeks of long-term ADA treatment in children aged 4-18 years with severe plaque psoriasis, disease severity was reduced and maintained or further improved, as demonstrated by efficacy outcomes. No new safety risks were identified.