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关键词： Paediatric Intensive Care   Questionnaire survey   Sedation   Ventilation  

摘要： Nurses play a key role in administering sedation to mechanically ventilated children, which impacts children's psychological, physiological and cognitive changes in the paediatric intensive care unit. This study aimed to survey the sedation practices of paediatric intensive care unit nurses on mechanically ventilated children in China and explored the influencing factors. A cross-sectional survey was conducted based on electronic questionnaires comprised of the Nurse Sedation Practices Scale (Chinese version) in 14 different types of paediatric intensive care units of 11 academic hospitals in China from 15 February to 15 April 2017. A convenience sample of 495 nurses [73 center dot 4% response rate, (674)] completed the survey. Seven units applied Ramsay Sedation Scale as a sedative assessment tool. The majority of the nurses used observed behaviours and physiological changes of the ventilated children as indicators to assess the sedation level, and they had a positive attitude and intention, which may influence practice positively, whereas high clinical workload and the lack of communication between the nurses and families might hinder practice. The practice of sedation varied greatly in different regions, and the respondents of the northwest region scored lower. Paediatric nurses in China rarely used a validated paediatric instrument to assess sedation, and most nurses relied on physiological and behavioural cues. The quality of sedation training, nursing workload and regional economic disparity affected the sedation practice. The restricted visiting policy and lack of clearly defined nursing responsibilities around sedation may hinder effective sedation assessment and management. This study found that there was no paediatric-validated tool popularized in paediatric intensive care units in China and explored influencing factors. We suggest that a validated tool, high-quality training and hospital's policy, such as visiting regulation, should be promoted to improve

关键词： caries   Hall Technique   preformed metal crowns   primary molars  

摘要： Background The Hall Technique is a less invasive caries management technique for treating carious primary molars. It has become a routine treatment at specialists' practices. Aim To retrospectively evaluate the clinical success and survival rates of preformed metal crowns placed on primary molars using the Hall Technique in a Paediatric Dentistry Setting. Design Patient records of children receiving Hall crowns (with or without proximal slicing) between 2011 and 2017 were reviewed. Teeth with no clinical or radiographic evidence of pulp involvement at baseline and at least six months' follow-up were included. Kaplan-Meier survival analyses and Mantel-Cox statistics were carried out. Results In total, 181 Hall crowns performed in 2- to 10-year-olds with a mean follow-up period of 22 months were included for analysis. Mean d(3)mft/D3MFT was 6.55 +/- 3.48/0.18 +/- 0.66. The majority of crowns were successful (92.3%;n = 167), four presented at least one minor failure (2.2%;reversible pulpitis, crown lost, or secondary caries) and ten were major failures (5.5%;irreversible pulpitis or abscess). When comparing crowns performed with no tooth preparation to crowns performed with proximal slicing, no differences were observed (P = 0.70, CI = 0.68-0.83). Conclusion The survival rate and clinical efficacy of Hall crowns were high in a secondary care-based setting. The HT is an effective and less invasive management option for asymptomatic carious primary molars.

关键词： Ian H McDonald   paediatric anaesthesia   Royal Children's Hospital Melbourne   prolonged intubation   SPANZA   Nuffield Department of Anaesthesia Oxford   Robert R Macintosh  

摘要： Dr Ian Hamilton McDonald (1923-2019) was a pioneer of paediatric anaesthesia and intensive care at the Royal Children's Hospital, Melbourne. He first started working at the hospital in the 1940s, later doing further training from 1953-1955 at the Nuffield Department of Anaesthesia in Oxford under Sir Robert Macintosh. McDonald returned to Melbourne as assistant director supporting Dr Margaret (Gretta) McClelland as the director of anaesthesia, together pioneering the development of a major paediatric anaesthesia department. McDonald, along with Dr John Stocks (1930-1974), was intimately involved in pioneering prolonged nasotracheal intubation in children, following on from earlier work by Dr Bernard Brandstater (an Australian working in Beirut), and Drs Tom Allen and Ian Steven in Adelaide. Ian McDonald was an influential, highly respected and greatly loved paediatric anaesthetist who had a profound influence on the early days of paediatric anaesthesia in Australia.

关键词： Children   Distraction methods   Intravenous access   Nuclear medicine   Pain  

摘要： Background In paediatric nuclear medicine, the majority of the scans require intravenous (IV) access to deliver the radiotracers. Children and parents often cite procedural pain as the most distressing part of their child's hospitalization. In our department, various pain management strategies including physical and psychological distraction methods and pharmacological intervention have been implemented to reduce procedural pain. Objective The purpose of this study was to evaluate and compare different pain reduction strategies used in our paediatric nuclear medicine department. Materials and methods The charts of 196 children (114 female) were reviewed retrospectively (median age: 8 months;interquartile range [IQR]: 33.1). Children were categorized into five groups: (1) Maxilene (topical liposomal lidocaine;n=50), (2) Pain Ease (vapocoolant;n=69), (3) oral sucrose (n=48), (4) Maxilene and Pain Ease combined (n=10), and (5) no pharmacological/adjuvant intervention (n=19). Physical and psychological distraction were used in all patients. Therefore, Group 5 only received physical and psychological strategies. Physical methods included supportive positioning, deep breathing, temperature considerations, massage pressure or vibration and neonatal development strategies (e.g., non-nutritive sucking, facilitated tucking, swaddling, rocking). Psychological strategies included education, distraction with movies, books or storytelling, and relaxation techniques. The pain perceived by the children after the IV access was compared in these five groups. Two types of pain assessment were used in this study: self-reporting pain scale and behavioural observational pain rating scale. Pain was reported on a scale of 1 to 10. The average pain score was also compared between patients who had one or two attempts for IV access and those who had more than two attempts. Results The average pain score was 2.8 (mean +/- standard error [SE]=0.4) in Maxilene, 2.1 (SE=0.3) in Pain Ease, 2.7 (SE

关键词： central venous catheter   children   intestinal failure   liver disease   parenteral nutrition   short bowel syndrome  

摘要： Background and Aims: The aim of the study was to aid decisions on prognosis and transplantation;this study describes the outcome of children with intestinal failure managed by the multidisciplinary intestinal rehabilitation program at the Royal Children's Hospital, Melbourne. Methods: Retrospective review of children requiring parenteral nutrition (PN) for >3 months who were assessed for home PN between 1991 and 2011. Results: A total of 51 children were included. Forty-two (82%) had short bowel syndrome (SBS), 5 (10%) had chronic intestinal pseudo-obstruction syndrome, and 4 (8%) had congenital enteropathies. Median small bowel length for patients with SBS was 45 cm (interquartile range 30-80) or 23.9% of the expected length for age (interquartile range 17.0%-40.6%). Overall survival rate was 84% (43/51). Mortality in children (n = 7) occurred after a median of 13.2 months (range 6.2-29.2) with intestinal failure-associated liver disease (IFALD) being the only predictor (P = 0.001). Out of 50 children 21 (42%) had IFALD. Children who were premature (P = 0.013), had SBS (P = 0.038), and/or frequent sepsis (P = 0.014) were more likely to develop IFALD. PN weaning occurred in 27 of 35 (77%) SBS survivors, after a median of 10.8 months (up to 8.2 years), with longer residual small bowel (P = 0.025), preservation of the ileocecal valve (P = 0.013) and colon (P = 0.011) being predictors. None of 5 (0%) patients with chronic intestinal pseudo-obstruction syndrome and 2 of 4 (50%) patients with congenital enteropathies weaned off PN. Overall sepsis rate was 7.3 episodes/1000 line days. Frequency of sepsis and longevity of central lines improved with time as patients grew older (both P < 0.001). Conclusions: Long-term PN with intestinal rehabilitation was effective in treating most children with intestinal failure. Children with severe refractory IFALD may have benefited from intestinal transplantation.

关键词： anti-epileptic drugs   monotherapy   paediatrics   polytherapy   utilization  

摘要： Objectives To evaluate the utilization pattern of anti-epileptic drugs (AEDs) in Indian paediatric patients and compare it with the global usage data. Methods Paediatric patients (<= 18 years) with a confirmed diagnosis of epilepsy and prescribed with at least one AED were included in the study from a child neurology clinic in Pune, Maharashtra, India. The data pertaining to the type of epilepsy, and drug therapy was obtained retrospectively. The prescribing pattern of AEDs was identified and compared with the drug utilization pattern of the Asian and European countries from a systemic literature review. Key findings Out of the 343 paediatric patients enrolled in the study, 55.6% were males. Thirty-four per cent of the patients were under the age group of 2-6 years. More than half (60.5%) of the patients were diagnosed with generalized seizures, with tonic-clonic seizures (48%) being the most common among them. Out of the 37.9% of patients diagnosed with partial epilepsy, simple partial seizure was the most common type. The most commonly prescribed drug was sodium valproate for both generalized and partial seizures. Levetiracetam was found to be the preferred newer AED for management of generalized epilepsy. Similar prescribing pattern was seen in Asian countries where sodium valproate was the most preferred AED followed by levetiracetam and oxcarbazepine. Sodium valproate was also highly prescribed in European countries while levetiracetam and oxcarbazepine were underused. Two hundred and seven patients (60%) were managed on monotherapy. Conclusions Older generation AEDs are still used in majority of patients as mono and dual therapy. Among the newer generation AEDs, there is an increase in the utilization of levetiracetam. Prescription of AEDs in our study goes in line with Asian countries but differs with the European counterparts due to various reasons.

关键词： Lens diseases   Risk factors  

摘要： Purpose To assess the outcomes of intra-lenticular lens aspiration (ILLA) in paediatric cases with anterior dislocation of lens. Methods A retrospective review of medical records of cases with anterior dislocation of the lens in children (age < 16 years) that underwent ILLA between June 2017 and May 2018 was performed. Corrected distance visual acuity (CDVA), intraocular pressure (TOP), and anterior segment findings were noted at presentation and follow-up. Surgical notes were reviewed for all cases. Post-operative central corneal thickness (CCT) and central macular thickness (CMT) were recorded. Results Eleven eyes of eight patients with a median age of ten years underwent ILLA. There were four males and four females. The median duration of symptoms was 2 months, CDVA was 1.77 logMAR, and TOP was 16 mm of Hg. Ten eyes had corneo-lenticular touch with corneal oedema, and two had raised IOP at presentation. Homocystinuria (n = 2/8), Microspherophakia (n = 2/8), Marfan syndrome (n = 1/8), Buphthalmos (n = 1/8) and Ectopia lentis et pupillae (n = 1/8) were the identifiable causes for anterior dislocation. There were no intra-operative complications in any case. Immediate post-operative corneal oedema and raised IOP was observed in nine and three cases respectively and was treated with medical therapy. The median post-operative CDVA and TOP at 6-months was 1 logMAR and 15 mm of Hg respectively. The median CCT and CMT were 516 and 248 mu m respectively. Five eyes developed a central corneal descemet scar. Conclusions ILLA is a safe and effective technique for surgical removal of an anteriorly dislocated lens in paediatric cases.

关键词： 儿科学   内科学   急救   护理   研究  

ISBN: (纸本)9787557625252

摘要： 本书主要介绍儿科急诊，急救的治疗方法和监护技术，共分三部分二十七章，从临床实用性出发，立足于培养新生儿科重症监护治疗策略专科护士的专业发展核心能力，内容包括急诊医学总论、新生儿急救护理、儿童急危重症护理及技术。