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关键词： Shunt outcome   Secondary endoscopic third ventriculostomy   Shunt removal   Overdrainage  

摘要： Purpose Shunt independence remains a matter of debate for neurosurgeons, and little information on this subject is available in the literature. The aims of the study were to analyse the incidence of shunt removal in a series of paediatric patients and to describe our experience with attempts at shunt removal. Methods Thirty of 212 paediatric patients shunted between 2000 and 2016 at our institution were studied for shunt independence. Variables related to hydrocephalus aetiology, shunt complications, independence trial peculiarities and follow-up were recorded and a descriptive analysis of the data was performed. Results Two patients (0.94%) refused to be included in a shunt independence trial and were analysed separately. In the other 28 patients, 29 shunt independence trials were performed, of which 19 (65.52%) were successful, giving a global rate of shunt independence of 8.96% (19/212) in our population. Secondary endoscopic third ventriculostomy was the most frequent type of independence trial and achieved the highest success rate (75%). Spontaneous independence was achieved in just 4/7 cases (57.14%). Planned removal of the shunt in overdrainage cases had a 50% success rate, with transient measures to control intracranial pressure frequently required. Conclusions Shunt independence trials should be considered for selected patients in a closely monitored setting. Secondary endoscopic third ventriculostomy at the time of shunt malfunction has the highest success rate whereas planned removal of the shunt in overdrainage is an invasive procedure with more likelihood of failure. Shunt independence should not be presumed.

关键词： concept analysis   cultural sensitivity   family-centred care   Iran   paediatric nursing  

摘要： Background Cultural sensitivity is a core concept to establish awareness and knowledge about various ethnicities, cultures, genders and additional diversity characteristics to understand individual's requests and respond appropriately to them. A need for further development of the concept is warranted, especially in the context of paediatric nursing. Aims The purpose of this paper was to determine the main elements of cultural sensitivity in the context of paediatric nursing in Iran. Methods The Hybrid method was implemented consisting of three phases: theoretical, fieldwork and final analysis. In the theoretical phase, articles from 2007 to 2017 were reviewed for relevance. In the phase of fieldwork, 25 nurses and nine parents were interviewed to explore the aspects of cultural sensitivity in paediatric nursing. The interviews were transcribed, and content analysis was conducted. In the final phase, an overall analysis of the two previous phases was performed. Results In the theoretical phase, the following attributes were determined: cultural encounter and awareness, acceptance of cultural diversity and designing programmes in accordance with family culture. The fieldwork phase explored three themes of intercultural encounters, intercultural communication and adapting the care plan with family culture. The final synthesis yielded that sensitivity to family requests and beliefs, effective intercultural communication and integration of family culture with the care plan are the main elements of cultural sensitivity in Iranian paediatric nursing. Conclusion With a deeper understanding of the term cultural sensitivity, nurses will have a foundation to improve paediatric nursing care and align the care plan with the patient's culture to provide trust, child/parent participation, secure care, effective communication and satisfaction. Since the concepts are the building blocks that underpin theory, the present concepts identified can help to serve as the foundation for th

关键词： type 1 diabetes   adolescents   young adults   transition to adult care  

摘要： Aim The aim of the present study was to explore how young adults with type 1 diabetes (T1D) experienced the transition from paediatric to adult health care services. Design A qualitative, explorative design was used. Methods Eleven young adults with T1D receiving adult diabetes care at a hospital in western Norway participated in semi-structured interviews. Data were analysed using Interpretive Description, an inductive approach inspired by grounded theory, ethnography and phenomenology, and specifically designed to explore phenomena in clinical practice aiming to generate new knowledge and skills. Results Four main themes regarding the adolescents' experiences of the transfer from paediatric to adult care emerged: (i) limited information about the transition;(ii) transition from frequent, thorough and personal follow-up to a less comprehensive and less personal follow-up;(iii) the importance of being seen as a whole person;(iv) limited expectations of how the health care services were organised. Conclusions The study showed that the existing routines for transfer between paediatric and adult care are not optimal. The participants expressed that they were not prepared for the dissimilarities in follow-up and were predominantly less pleased with the adult care follow-up. Relevance to clinical practice The findings support a need for structured transition programmes, that is programmes that contribute to young adults with T1D receiving a safe and positive transition at an otherwise demanding life phase. Young peoples' individual needs for the transition to and follow-up in adult care may be promoted by an approach based on person-centred care.

关键词： HCV   Children   Treatment   DAAs  

摘要： Hepatitis C virus (HCV) infection is a major cause of chronic liver disease in the world. It is a challenging medico-social problem in the paediatric population. High HCV infection rates are reported in low and middle incomes countries. From the health economic point of view treatment of hepatitis C virus (HCV) with subsequent virus eradication is very effective as it eliminates the long-term sequelae of untreated or maltreated HCV In this review we summarize the updates and highlight the historical approach of treatment of chronic HCV infection in children in the new era of directly acting antiviral (DAA) agents. (C) 2019 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.

关键词： Autoimmune Hepatitis   Diagnosis   STILL   Pediatrics  

摘要： The article informs on a study conducted for examining diagnosis of autoimmune hepatitis in paediatric patients. It mentions in children and adolescents, the overlap syndrome between autoimmune hepatitis and sclerosing cholangitis is often termed autoimmune sclerosing cholangitis. It also informs on the investigation of the efficiency of standard therapy for autoimmune hepatitis score and interleukin 2 measured at baseline.

关键词： Anaesthesia and developing brain   neuromuscular junction pharmacology   paediatric anaesthesia   paediatric pharmacokinetics   paediatric pharmacology  

摘要： A child is not a mini adult. They differ from adults in terms of weight, shape, anatomical size and major body systems such as cardiovascular and respiratory as well as psychologically. Each organ system is immature in paediatric age group and their growth and development can dramatically affect the pharmacokinetics of different drugs. Children differ in every way from an adult thus mandating to have a basic knowledge of the pharmacokinetic and pharmacodynamic principles in paediatric population to prevent under dosing or toxicity of drugs. This review article aims to simplify the basic principles of pharmacokinetics and pharmacodynamics in paediatric population. It also highlights physiological and pharmacological differences between adults and paediatric age. We performed a PUBMED search for English language articles using keywords including pharmacology, child, paediatric anaesthesia. We also hand searched references from relevant review articles and text book chapters. We have also discussed drug interaction in anaesthesia, pharmacology pertaining to neuromuscular junction and effects of anaesthesia over the developing brain.

关键词： Vulnerable children   Southern countries   Paediatric palliative care access   Advocacy  

摘要： In a global context where inequality of access to health is current and where access to opiates and palliative care remains largely non-existent, health professionals are committed to improving access to paediatric palliative care. Solicited by partners and having strong expertise on the subject of paediatric palliative care through its collaborators, the non-governmental organization Medecins du monde-Suisse started at the end of 2014 a program to promote access in four contexts: in Kinshasa, Democratic Republic of Congo, Yaounde, Cameroon, Lome, Togo and Managua, Nicaragua. The aims of this project are to reinforce local initiatives in paediatric palliative care, help to perpetuate the offers of health care and promote exchanges within a network of professionals from both north and south while involving hospital and ministerial institutions. (C) 2019 Elsevier Masson SAS. All rights reserved.

关键词： Anti-Mullerian hormone   paediatrics   assay   reference range  

摘要： Background Autoanalyser methods for the measurement of anti-Mullerian hormone have been introduced into clinical laboratories but few reports of paediatric reference intervals using these new assays have been published. Methods After prior evaluation of the Roche Elecsys anti-Mullerian hormone assay against the Beckman Coulter modified second generation anti-Mullerian Hormone enzyme-linked immunosorbent assay using samples from adult females, a cohort of paediatric samples which had previously been assessed using the Beckman Coulter Access anti-Mullerian hormone assay was analysed using the Roche Elecsys anti-Mullerian hormone assay. Results The Roche Elecsys anti-Mullerian hormone assay measured significantly lower than the Beckman Coulter modified second generation anti-Mullerian Hormone enzyme-linked immunosorbent assay. In the paediatric cohort measured with the Roche Elecsys assay, male levels are very high from birth to puberty after which they fall towards postpubertal female levels. Male results were similar to those previously obtained using the Beckman Coulter Access anti-Mullerian hormone assay on the same cohort. Roche Elecsys anti-Mullerian hormone in the females was very low in the neonatal and prepubertal years and the postpubertal trend, with a steady rise from 15 years, was smoother than previously modelled using the Beckman Coulter Access anti-Mullerian hormone assay. Conclusion Anti-Mullerian hormone levels measured with the Roche Elecsys assay were significantly lower than the Beckman Coulter modified second generation enzyme-linked immunosorbent assay suggesting the need for new reference ranges. In the paediatric cohort, Roche Elecsys anti-Mullerian hormone levels between boys and girls showed good prepubertal delineation and small but statistically significant differences to previously measured levels using the Beckman Coulter Access anti-Mullerian hormone assay on the same sample cohort.

摘要： AIM: To determine local departmental adherence to the paediatric post-mortem magnetic resonance imaging (MRI) protocols, using a customised automated computational approach. MATERIALS AND METHODS: A retrospective review of 460 whole-body post-mortem MRI examinations performed at Great Ormond Street Hospital for Children over a 5.5-year period was assessed for adherence to a full or abbreviated imaging sequence protocol. A simple computer program was developed to batch process DICOM (digital imaging and communications in medicine) files, extracting imaging sequence details, followed by natural language processing (NLP) of authorised reports to automate information extraction of diagnostic image quality. RESULTS: The program was able to extract study parameters from the entire dataset (approximately 80 GB of data) in a few hours, and retrieve information on diagnostic image quality using NLP with an overall diagnostic accuracy for data extraction of 96.7% (445/460, 95% confidence interval [CI]: 94.7-98%). The full imaging protocol was adhered to in 305/460 (66.3%) cases, and an abbreviated protocol in 140/460 (30.4%) cases. Overall, 423/460 (91.9%) of studies were of diagnostic quality. These included 298/305 (97.7%) of the full protocol, 111/140 (79.3%) of the abbreviated protocol. In only five cases were the examinations non-diagnostic for all body systems, all of whom weighed <100 g (24.7-72 g) and imaged using the abbreviated protocol. CONCLUSION: The present study demonstrated a successful application of an automated approach for data collection for audit and quality assessment purposes using paediatric postmortem imaging as a specific example. Re-audit of these data following change implementation will be straightforward now that the automated workflow is clearly established. (C) 2019 Published by Elsevier Ltd on behalf of The Royal College of Radiologists.

关键词： diffusion tensor imaging   FIM scale   neurobehavioral sequelae   paediatric brain injury   traumatic brain injury  

摘要： Background In patients with moderate and severe paediatric traumatic brain injury (TBI), we investigated the presence and severity of white matter (WM) tract damage, cortical lobar and deep grey matter (GM) atrophies, their interplay and their correlation with outcome rating scales. Methods Diffusion tensor (DT) and 3D T1-weighted MRI scans were obtained from 22 TBI children (13 boys;mean age at insult = 11.6 years;72.7% in chronic condition) and 31 age-matched healthy children. Patients were tested with outcome rating scales and the Wechsler Intelligence Scale for Children (WISC). DT MRI indices were obtained from several supra- and infra-tentorial WM tracts. Cortical lobar and deep GM volumes were derived. Comparisons between patients and controls, and between patients in acute (<6 months from the event) vs. chronic (>= 6 months) condition were performed. Results Patients showed a widespread pattern of decreased WM FA and GM atrophy. Compared to acute, chronic patients showed severer atrophy in the right frontal lobe and reduced FA in the left inferior longitudinal fasciculus and corpus callosum (CC). Decreased axial diffusivity was observed in acute patients versus controls in the inferior fronto-occipital fasciculus and CC. Chronic patients showed increased axial diffusivity in the same structures. Uncinate fasciculus DT MRI abnormalities correlated with atrophy in the frontal and temporal lobes. Hippocampal atrophy correlated with reduced WISC scores, whereas putamen atrophy correlated with lower functional independence measure scores. Conclusions The study isolated a distributed fronto-temporal network of structures particularly vulnerable to axonal damage and atrophy that may contribute to cognitive deficits following TBI.