教学课程资源库 更多>>

关键词： Traumatic brain injury   Hospitals   Paediatric   Skull fractures   Neurosurgery   Falls   Traffic injuries  

摘要： Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children with a broad injury spectrum and associated continuum in the level of care required. A dearth of data exists regarding children requiring inpatient neurosurgical admission following TBI. A retrospective study of children 016 years-old admitted to the neurosurgical unit of a level-1 paediatric trauma hospital in Queensland, Australia following TBI was conducted focusing on the demographics, clinical characteristics, and management of these patients to guide those involved in their management, and identify areas for improvement in injury prevention and trauma system management. Over 48 months, 671 patients were identified (62.6% male) with median age 5.0 years, the majority transferred from peripheral centres. Falls (47.2%) and traffic accidents (21.5%) were the most common mechanisms. Non-displaced skull fracture was the most common injury. Moderate or severe TBI (GCS 3-12) was seen in 14.8% of whom were more likely to require surgery, intensive care, or suffer polytrauma. Clinically significant TBI, defined as moderate/severe TBI, polytrauma, death, requiring neurosurgery, intensive care admission, intubation, or admission three or more nights was detected in 57.97% with higher rates in transferred patients (62.9%) versus primary presentations (50.6%). Mechanisms involving low kinetic forces especially low-height falls and children with non-surgical pathology were less likely to meet criteria for clinically significant TBI. Opportunity exists to optimise triage and transfer practices within the trauma network to minimise the economic and social implications of over-triage with many children requiring only brief observation. Crown Copyright (C) 2019 Published by Elsevier Ltd. All rights reserved.

摘要： Pneumonia is a leading killer of children younger than 5 years despite high vaccination coverage, improved nutrition, and widespread implementation of the Integrated Management of Childhood Illnesses algorithm. Assessing the effect of interventions on childhood pneumonia is challenging because the choice of case definition and surveillance approach can affect the identification of pneumonia substantially. In anticipation of an intervention trial aimed to reduce childhood pneumonia by lowering household air pollution, we created a working group to provide recommendations regarding study design and implementation. We suggest to, first, select a standard case definition that combines acute (<= 14 days) respiratory symptoms and signs and general danger signs with ancillary tests (such as chest imaging and pulse oximetry) to improve pneumonia identification;second, to prioritise active hospital-based pneumonia surveillance over passive case finding or home-based surveillance to reduce the risk of non-differential misclassification of pneumonia and, as a result, a reduced effect size in a randomised trial;and, lastly, to consider longitudinal follow-up of children younger than 1 year, as this age group has the highest incidence of severe pneumonia.

关键词： adult   complications   database   incidence   morbidity   mortality   paediatric   registries   spinal surgery  

摘要： Spinal surgery procedures are growing rapidly in number and complexity due to an increasingly aging population, high patient expectations and continuous improvements in both surgical techniques and quality of instrumentation. National health services have to finance the rising costs of an increasing number of medico-legal claims against spinal surgeons, often arising from significantly life-changing complications. The most common complications specific to spinal surgery are implant failure, neurological deficit (nerve root, cauda equina or spinal cord injury), and dural tear. General complications include visual impairment, blood loss, thromboembolic events, infection and mortality. Instrumentation failure occurs most commonly due to misplacement, which is more frequent in deformity surgery. Kyphosis correction is associated with the highest risk of neurological injury and visual loss. Thromboembolic events are more frequent in patients undergoing treatment for metastatic spinal disease. Underlying conditions such as neuromuscular scoliosis increase significantly the risk of infection, as well as major systemic morbidity and mortality. Reliable national registries and international databases with accurate recording of information on procedures and corresponding complications help better understand, address, and reduce complications related to spinal surgery with the aim to improve patient care and achieve optimum outcomes. © 2019 Elsevier Ltd

关键词： Cone beam computed tomography   Radiation dosage   Child   Head   X-rays  

摘要： Objectives To provide an indication-based and scanner-specific radiation dose and risk guide for paediatric patients undergoing dental and maxillofacial cone beam computed tomography (CBCT) examinations. Methods Five commercially available scanners were simulated in EGSnrc Monte Carlo (MC) code. Dedicated, in-house built, head and neck voxel models, each consisting of 22 segmented organs, were used in the study. Organ doses and life attributable risk (LAR) for cancer incidence were assessed for males and females, aged 5 to 14 years old, for every clinically available protocol: central upper and lower incisors, upper and lower premolars, upper and lower jaws, cleft palate, temporal bone, sinus, dentomaxillofacial complex, and face and skull imaging. Dose results were normalised to the x-ray tube load (mAs) and logarithmic curves were fit to organ dose and risk versus age data. Results Females demonstrated higher LAR values in all cases. A well-established dose decreasing pattern with increasing age-at-exposure was observed. Central upper incisor protocols were those with the lowest risk, contrary to skull protocols which provided the highest LAR values. Salivary glands and oral mucosa were the highest irradiated organs in all cases, followed by extrathoracic tissue (ET) in protocols where the entire nasal cavity was inside the primary field. The dose to thyroid was considerably high for younger patients. Conclusions This work provides an extensive dose assessment guide for 5 dental CBCTs, enabling detailed dose assessment for every paediatric patient. Key Points Radiation dose concerns due to the growing use of paediatric dental and maxillofacial CBCT underline the need for justification that should in part be based on radiation exposure in radiology. Patient-specific dose calculations based on Monte Carlo simulations and head-neck paediatric voxel models overcome the limitations of conventional thermoluminescent dosimeter (TLD) dosimetry and provide proper guidance

关键词： Concurrent engineering   design for assembly   design for manufacture   design for manufacture and assembly   paediatric prosthetic knee   product development  

摘要： Design for manufacture and assembly is a critical step in the product design life cycle. In this study, design for manufacture and assembly theory was applied to the design of a polycentric paediatric prosthetic knee to resolve assembly and manufacture issues prior to product prototyping. Assembly time and efficiency prior and subsequent to design for assembly analysis was calculated. By combining redundant parts and improving the ease of alignment, orientation, and insertion of various parts through modification of part features, a 10.1% increase in assembly efficiency was achieved. Design for manufacture analysis was then performed for die casting of the component. Undercut features were removed and replaced with the use of standard components, reducing the assembly time of the component by reducing the complexity of parts. Proposed design changes were verified using finite element analysis to simulate the loading conditions of a polycentric prosthetic knee as per the ISO10328:2006 standard for methods of testing prostheses. An overall improvement of 13.6% in assembly efficiency was achieved after the design for manufacture and assembly analysis. The improvement is due to the decrease in assembly insertion time and eliminating small parts and parts in areas that were difficult to access. The reduction in assembly time will directly reduce the labour cost for assembly of the manufactured product. This case study illustrates how design for manufacture and assembly theory can be applied to the design of biomedical equipment to reduce the need for prototype re-work and the consequent costs.

关键词： radiation dose   optimisation   CTDIvol   DLP  

摘要： This study aimed to investigate the current status of Diagnostic Reference Levels (DRLs) in paediatric CT across Jordan. The dose data for four main CT examinations (brain, chest, abdominopelvic, and chest, abdomen and pelvis (CAP)) in hospitals and imaging centres (n;=;4) were measured. The volume CT dose index (CTDIvol) and Dose Length Product (DLP) values were compared within the different hospitals and age groups (<1 year, 1?4 years, 5?10 years and 11?18 years). DRLs in Jordan were compared to international DRLs. The paediatric population consisted of 1818 children;61.4% of them were male. There were significant variations between the DRLs for each CT scanner with an up to four-fold difference in dose between hospitals. There were apparent significant differences between Jordan and other countries with the DLPs in Jordan being relatively high. However, for CTDIvol, the values in Jordan were close to those of other countries. This study confirmed variations in the CTDIvol and DLP values of paediatric CT scans in Jordan. These variations were attributed to the different protocols and equipment used. There is a need to optimise paediatric CT examinations doses in Jordan.

关键词： Heart clinical   Complications-heart clinical   Paediatric transplantation  

摘要： We sought to better define the demographics and characteristics of post-transplant lymphoproliferative disorders (PTLD) in a cohort of paediatric OHT patients from a developing country. Data were collected from the Heart Institute, Sao Paulo, for all paediatric OHT recipients from October 1992 to October 2018. Group differences between the PTLD and non-PTLD cohorts were assessed by Fisher exact and Mann-Whitney U tests. Kaplan-Meier curves analysed the survival in each group. Data were reviewed for 202 paediatric OHT recipients. Overall 1-, 5- and 10-year survival for the entire cohort was 76.5%, 68.3% and 62.9%;24 patients (11.9%) developed PTLD at a median 3.1 years (IQR 0.8-9.0) after OHT. Cases were evenly spread over the follow-up period, with PTLD diagnosed in 9.8% (n = 137) of patients who were alive at 3 years, 15.3% (n = 78) of patients who were alive at 5 years and 29.3% (n = 41) of patients who were alive at 10 years. The commonest form of PTLD was diffuse large B cell lymphoma (n = 9), and most patients received rituximab with immunosuppression and chemotherapy as treatment (n = 15). We identified no increased risk in mortality amongst the PTLD vs. non-PTLD cohorts in multivariate analysis (P = 0.365). PTLD after paediatric OHT had acceptable outcomes. However, risk factors for PTLD were not identified and warrant further investigation.

关键词： Health occupations   Paediatrics