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关键词： Anorectal malformation   Hirschsprung disease   sub-Saharan Africa   paediatric surgery   global surgery  

摘要： In sub-Saharan Africa, there is a high burden of paediatric surgical conditions and a paucity of data regarding outcomes of congenital colorectal anomalies. A retrospective, descriptive analysis utilizing the Kamuzu Central Hospital (Lilongwe, Malawi) paediatric acute care surgery database (age <= 18 years) over 44 months was performed. Of the 133 children presenting, 82 had Hirschsprung disease (HD) (2.4 +/- 2.7 years) and 51 had anorectal malformations (ARM) (1.8 +/- 2.4 years). Of the latter, 51.0% underwent surgery, mainly exploratory laparotomy (n = 15, 57.7%) and posterior sagittal anorectoplasty (n = 7, 26.9%). Of those with HD, 50.0% underwent operative intervention (77.3% boys), including exploratory laparotomy (n = 17, 41.5%) and definitive pull-through (n = 8, 19.5%). A dearth of expert paediatric surgeons and limited exposure to paediatric conditions in general surgeons limits definitive surgery. An emphasis on paediatric surgical training and improvement of referral networks for definitive therapy will improve patient outcomes.

关键词： Acute lymphoblastic leukemia   Methotrexate   Leucovorin   Oral mucositis  

摘要： Introduction: This study aimed to determine the efficacy of different Leucovorin regimens to reduce oral mucositis in children with acute lymphoblastic leukemia after high-dose Methotrexate (HD-MTX). Methods: Twelve articles were included in a systematic literature review. Articles were categorized into low/medium/high risk of bias. Results: As no randomized controlled trial assessing the effect of Leucovorin has been performed, the efficacy of Leucovorin to reduce oral mucositis remains unknown. Leucovorin was initiated at 24, 36 or 42 h after HD-MTX at a dose of 15 or 30 mg/m(2). No meta-analysis could be performed as treatment regimens differed. When comparing studies with similar HD-MTX doses, we observed lower oral mucositis rates in regimens with higher cumulative doses of Leucovorin and early initiation of Leucovorin after MTX. Conclusion: Even though future studies are necessary, higher cumulative Leucovorin doses and early initiation of Leucovorin after start of MTX seem to reduce oral mucositis.

关键词： Professional development   Paediatric oncology nursing   Qualitative research   Longitudinal diary study  

摘要： Purpose: There is a limited amount of studies with results on professional development of paediatric oncology nurses. This study seeks to increase the understanding of the factors associated with the professional development of paediatric oncology nurses through the continuous education programme from the paediatric nurses' perspective. Method: The descriptive, qualitative study used the text of participants' electronic diaries as data during a two-year continuing professional education programme in 2016-2018. The sample consisted of 17 paediatric oncology nurses who were working in three different university hospitals. The data were analysed with the inductive content analysis method. Results: Professional development is linked with a strong knowledge base in nursing, which involves the use of nursing methods and up-to-date nursing practices. Professional development is also linked with the use of medical knowledge, which manifests as a deep understanding of cancers and their treatment. Conclusions: Research results show that a strong knowledge base in nursing alone is not sufficient for the professional development of paediatric oncology nurses. They also need to use their medical knowledge in order to gain an adequately deep understanding of children's cancers and their treatment. Nursing must be organised so that nurses have the opportunity to compare, share, question and argue for the methods they use with their colleagues in their own unit and other hospitals. Further research is needed on the professional development of paediatric oncology nurses and factors affecting it in order for a career development model to be created for this specific yet demanding area of nursing.

关键词： Paediatric   stabbing   penetrating trauma   socioeconomic  

摘要： Introduction Paediatric stabbings are on the increase across the United Kingdom, especially in large urban centres. Many London trauma centres are reporting a significant annual rise in the cases of penetrating trauma. Studies have shown victims with a lower socioeconomic status have an increased risk of paediatric penetrating trauma. This study aims to determine whether high depravity of an area increases the risk of paediatric stabbings in West London. We hypothesise that more deprived areas are likely to have a higher incidence of paediatric stabbings. Methods A retrospective review of data from the emergency department at a major trauma centre in West London was conducted using patient <18 years with a stabbing injury between March 2015 and July 2017. Gender, age, incident postcode and home postcode were collected. Socioeconomic status was measured using the 2015 English index of multiple deprivation. Incident postcode and home postcode were matched to an index of multiple deprivation decile, with 1 being the most deprived. Data were analysed using SPSS (c) Statistics 24. Results One hundred seventy-four cases were included;97.7% of the cases were male and the mean age was 16 years. The location of the stabbings had a median index of multiple deprivation score of 3 (interquartile range = 3) with 61% of the cases occurring in areas with an index of multiple deprivation decile of 3 or less. Index of multiple deprivation decile from incident location and frequency of stabbing were strongly negatively associated (r = -0.85, p = 0.002). The victim's home location had a median index of multiple deprivation score of 3 (interquartile range = 3) and 59.3% of victims living in areas with an index of multiple deprivation decile of less than 3. Again, they were strongly negatively associated (r = -0.85, p = 0.002). Conclusion The location of paediatric stabbings is associated with areas of high depravity and with victims from a more deprived background. To prevent paediatri

关键词： Telehealth   telepractice   paediatric   feeding   dysphagia   human-centred design  

摘要： Introduction Telepractice systems should be acceptable to users and meet end-user needs. Whilst the system requirements to conduct adult dysphagia assessments via telepractice are established, key differences exist between adult and paediatric swallowing assessments. This study was conducted to develop the system architecture required to conduct paediatric feeding assessments in patient homes via telepractice. Methods The study used a four-phase iterative design, informed by human-centred design principles. In Phase 1, two telepractice researchers and two paediatric feeding clinicians identified assessment tasks and explored potential system design solutions. Initial system testing was completed using clinical simulations (Phase 2). Live trials with 10 typically developing children were then conducted (Phase 3). Phase 4 involved user-centred feedback from clinicians and parents. Feedback from the development team, clinicians and parents was used to continuously refine the model. Results A combination of synchronous and asynchronous methods enabled all assessment components to be successfully completed. Clinician and parent feedback established the optimal technology (e.g. phone, tablet) and key camera positions necessary to optimise visual/auditory information for the online clinician. End-user feedback identified greater time efficiencies could be achieved through collecting some data (e.g. intra-oral pictures) via asynchronous methods prior to the session. Information sheets were deemed necessary to enhance the user experience. Clinicians and parents responded positively to the final system design. Discussion Modifications to standard videoconferencing were necessary to develop a clinically viable process for conducting paediatric feeding assessments in the home via telepractice. End-user feedback was integral to the design of the final model.

关键词： Chiari I malformation   Suboccipital decompression  

摘要： Purpose The natural history of Chiari I malformation (C1M) in the paediatric population is poorly understood. There are conflicting reports with regards to surgical indications, operative techniques and peri-operative prognostic indicators. In this paper, we report our institutional experience in the management of paediatric C1M. Methods The workflow process which includes preferred imaging modalities, surgical techniques and indications for intervention is discussed. In particular, we describe one of our current projects-an in-house designed Seow Operative Score (SOS) as a feasibility scoring system for neurosurgical intervention in our local cohort of paediatric C1M patients. Results In our series, we have 2 groups: 10 non-operated patients versus 19 operated patients. In the non-operated group, the majority of patients had a SOS of 0 to 1. One patient had a score of 2.5 and was kept under close surveillance. Follow-up imaging demonstrated resolution of the cerebellar herniation and intraspinal syrinx. In the operated group, 17 patients had a SOS of 3 or more. Two patients had a SOS of 2. For these 2, 1 developed progressive symptoms, and the other had an extensive cervico-thoracic syrinx. Decision was made for surgery after a period of surveillance. Conclusions In this paper, we report our institutional experience in managing paediatric C1M and, at the same time, highlight salient points of our practices. Meanwhile, we advocate collective global efforts and in-depth research for better disease understanding of this challenging condition.

关键词： Coping   Adaptation   Nursing   Paediatric Intensive Care Unit  

摘要： The death of a child in the Paediatric Intensive Care Unit (PICU) is difficult, the toss generates feelings of sadness and pain;this study highlights the different coping strategies used by nurses to manage this situation and find the strength to provide care at the end of life. Objective: Explore the strategies used by nurses in the PICU in coping with death. Methods: Study conducted in the city of Manizales, Colombia, during the months of October, November and December. A qualitative, hermeneutical phenomenological approach was used. The method of intentional sampling for the selection of participating nurses (n =10) working in PICU, in-depth interviews were conducted for the construction of the information and the data were analyzed according to the procedures proposed by Cohen, Kahn and Steeves. Results: Nurses use coping strategies focused on emotions: they inhibit their feelings towards the patient and their family;they use communication and prayer with the patient, as well as accompaniment to alleviate the suffering of the family. Conclusion: UCIP nurses develop coping strategies for end-of-life care using spiritual resources and communication with the family who require ongoing support, reflecting on death and accompanying the child in its transcendence. (C) 2018 Sociedad Espanola de Enfermeria Intensiva y Unidades Coronarias (SEEIUC). Published by Elsevier Espana, S.L.U. All rights reserved.

关键词： Technical standards   Sleep Apnea Syndromes   Oximetry   Pediatrics   Sleep Apnea, Obstructive  

摘要： Objective: To map research based pain management interventions used in the paediatric intensive care unit. Methodology: A scoping review of research literature has been conducted. Five databases were searched from their inception to end 2015 (CINAHL, EMBASE, MEDLINE, PsychINFO, and ProQuest Dissertations & Theses Global). Reference lists from the screened full text articles were reviewed. Results: 7046 articles were identified, 100 underwent full text screening and 27 were included in the scoping review. Seventeen (63%) were non-experimental, and 10 (37%) were experimental, of which 8 (30%) were randomised controlled trials. The majority of the articles focused on pharmacological interventions (n = 21, 78%), one on physical, and one on psychological interventions. Four studies included more than one category of interventions. The majority of the studies focused on post-operative pain management (n = 18, 67%), three (11%) on analgesia and sedation management and six (22%) on other pain management for different conditions. Discussion: Most studies included in this scoping review focused on medications and post-operative pain management and most were non clinical trials. More research, including clinical trials, is warranted to determine the effectiveness of pharmacological and non-pharmacological interventions for pain management in the paediatric intensive care unit. (C) 2019 Elsevier Ltd. All rights reserved.