1551
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Batchelor HK, Kendall R, Desset-Brethes S, Alex R, Ernest TB. Application of in vitro biopharmaceutical methods in development of immediate release oral dosage forms intended for paediatric patients. Eur J Pharm Biopharm 2013; 85:833-42. [PMID: 23665448 DOI: 10.1016/j.ejpb.2013.04.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 03/18/2013] [Accepted: 04/15/2013] [Indexed: 01/19/2023]
Abstract
Biopharmaceutics is routinely used in the design and development of medicines to generate science based evidence to predict in vivo performance; the application of this knowledge specifically to paediatric medicines development is yet to be explored. The aim of this review is to present the current status of available biopharmaceutical tools and tests including solubility, permeability and dissolution that may be appropriate for use in the development of immediate release oral paediatric medicines. The existing tools used in adults are discussed together with any limitations for their use within paediatric populations. The results of this review highlight several knowledge gaps in current methodologies in paediatric biopharmaceutics. The authors provide recommendations based on existing knowledge to adapt tests to better represent paediatric patient populations and also provide suggestions for future research that may lead to better tools to evaluate paediatric medicines.
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Affiliation(s)
- Hannah K Batchelor
- Pharmacy, Pharmacology and Therapeutics Section, University of Birmingham, Birmingham, UK.
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1552
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Valenzuela J, Araneda P, Cruces P. Weaning from mechanical ventilation in paediatrics. State of the art. Arch Bronconeumol 2013; 50:105-12. [PMID: 23542044 DOI: 10.1016/j.arbres.2013.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 01/09/2013] [Accepted: 02/04/2013] [Indexed: 11/19/2022]
Abstract
Weaning from mechanical ventilation is one of the greatest volume and strength issues in evidence-based medicine in critically ill adults. In these patients, weaning protocols and daily interruption of sedation have been implemented, reducing the duration of mechanical ventilation and associated morbidity. In paediatrics, the information reported is less consistent, so that as yet there are no reliable criteria for weaning and extubation in this patient group. Several indices have been developed to predict the outcome of weaning. However, these have failed to replace clinical judgement, although some additional measurements could facilitate this decision.
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Affiliation(s)
- Jorge Valenzuela
- Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; Área de Cuidados Críticos, Hospital Padre Hurtado, Santiago, Chile.
| | - Patricio Araneda
- Área de Cuidados Críticos, Hospital Padre Hurtado, Santiago, Chile
| | - Pablo Cruces
- Área de Cuidados Críticos, Hospital Padre Hurtado, Santiago, Chile; Centro de Investigación de Medicina Veterinaria, Escuela de Medicina Veterinaria, Facultad de Ecología y Recursos Naturales, Universidad Andres Bello, Santiago, Chile
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1553
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Abstract
AIMS We sought to determine whether velocity vector imaging (VVI)-derived left ventricular (LV) myocardial deformation indices could detect subtle myocardial abnormalities in acute Kawasaki disease (KD). METHODS AND RESULTS The study cohort of children with KD was divided by coronary artery dilation (CAD, Z-score >2.5) and/or uncomplicated vs. treatment-resistant (persistent/recrudescent fever) cases and compared with age-matched controls. Peak systolic LV myocardial strain (ε) and strain rate (SR) were obtained using VVI on pre-treatment echocardiograms. Comparisons were made between controls and (i) the entire KD group, (ii) KD group subdivided by CAD, and (iii) KD group subdivided by treatment resistance. The KD group consisted of 32 children (66% male, 24 ± 20 months). Of these, 17 had CAD and 14 had resistant KD. The control group consisted of 22 children (55% male, 20 ± 17 months). Routine echo indices of LV systolic function were normal for both groups. Compared with controls, KD patients had lower global longitudinal ε (-15.29 vs. -12.94, P = 0.04) and SR (-1.12 vs. -0.87, P = 0.003). On subgroup analysis compared with controls, KD patients with CAD (n = 17) had lower longitudinal ε (-15.29 vs. -11.87, P = 0.02) and SR (-1.12 vs. -0.86, P = 0.005). Subdivided by treatment resistance, compared with controls, those with resistant KD had lower longitudinal ε (-15.29 vs. -11.8, P = 0.01) and SR (-1.12 vs. -0.82, P = 0.003). CONCLUSION Despite normal LV systolic function by routine echocardiographic measurements, KD patients have reduced longitudinal LV ε and SR, which may be more sensitive indicators of myocardial inflammation and may provide supportive criteria to avoid delayed diagnosis of KD.
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Affiliation(s)
- Rachel T McCandless
- Division of Cardiology, Department of Pediatrics, Primary Children's Medical Center and the University of Utah, 100 N. Mario Capecchi Drive, Salt Lake City, UT, USA
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1554
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Abstract
BACKGROUND The surgical management of paediatric bladder/prostate rhabdomyosarcoma (B/P RMS) continues to develop, with the goal of maximising organ preservation while achieving successful cancer control. The timing of radiotherapy and surgical excision to improve event-free survival (EFS) and overall survival (OS) remains controversial. METHODS Previous reports in English on B/P RMS over the past 15 years were identified and reviewed, focusing on studies comparing the effects of radiotherapy and surgery for local control, the effect of local control on OS, and improved means of diagnosing viable tumour after chemotherapy. RESULTS The concept of lowering the 'cost of cure' drives current protocols. Bladder-sparing surgery is possible for 80% of patients after initial chemotherapy, with a mean 5-year OS of 85%. Overall, half of the patients are continent of urine, and adding radiotherapy might increase the risk of incontinence. Previous studies suggesting that early radiotherapy achieved better EFS than delayed radiotherapy did not control for stage and size of the tumour, which are the primary determinants of EFS. Improved local control does not automatically translate into improved OS. CONCLUSIONS The current role for the surgical management in B/P RMS is to achieve local control of tumours that do not respond to chemotherapy and radiotherapy. An improved means of detecting viable tumour after initial chemotherapy would improve the ability to decide when local therapy is necessary. The continuing challenge for urologists managing these children is knowing when bladder-sparing surgery would be the best therapy.
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Key Words
- B/P, bladder/prostate
- Bladder
- COG, Children’s Oncology Group
- EFS, event-free survival
- FDG-PET, F-18 fluorodeoxyglucose positron-emission tomography
- IRSG, Intergroup Rhabdomyosarcoma Study Group
- IVA, ifosfomide
- OS, overall survival
- Paediatric
- Prostate
- RMS, rhabdomyosarcoma
- Rhabdomyosarcoma
- SIOP, International Society of Paediatric Oncology
- VAC, vincristine, dactinomycin and cyclophosphamide
- VAIA, IVA with or without an anthracycline
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Affiliation(s)
- Hsi-Yang Wu
- Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, S-287, Stanford, CA 94305, USA
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1555
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Sam J, Pierse M, Al-Qahtani A, Cheng A. Implementation and evaluation of a simulation curriculum for paediatric residency programs including just-in-time in situ mock codes. Paediatr Child Health 2013; 17:e16-20. [PMID: 23372405 DOI: 10.1093/pch/17.2.e16] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2011] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To develop, implement and evaluate a simulation-based acute care curriculum in a paediatric residency program using an integrated and longitudinal approach. DESIGN Curriculum framework consisting of three modular, year-specific courses and longitudinal just-in-time, in situ mock codes. SETTING Paediatric residency program at BC Children's Hospital, Vancouver, British Columbia. INTERVENTIONS The three year-specific courses focused on the critical first 5 min, complex medical management and crisis resource management, respectively. The just-in-time in situ mock codes simulated the acute deterioration of an existing ward patient, prepared the actual multidisciplinary code team, and primed the surrounding crisis support systems. Each curriculum component was evaluated with surveys using a five-point Likert scale. RESULTS A total of 40 resident surveys were completed after each of the modular courses, and an additional 28 surveys were completed for the overall simulation curriculum. The highest Likert scores were for hands-on skill stations, immersive simulation environment and crisis resource management teaching. Survey results also suggested that just-in-time mock codes were realistic, reinforced learning, and prepared ward teams for patient deterioration. CONCLUSIONS A simulation-based acute care curriculum was successfully integrated into a paediatric residency program. It provides a model for integrating simulation-based learning into other training programs, as well as a model for any hospital that wishes to improve paediatric resuscitation outcomes using just-in-time in situ mock codes.
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Affiliation(s)
- Jonathan Sam
- Department of General Pediatrics, BC Children's Hospital, Vancouver, British Columbia
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1556
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Leon SL, Cappelli M, Ali S, Craig W, Curran J, Gokiert R, Klassen T, Osmond M, Scott SD, Newton AS. The current state of mental health services in Canada's paediatric emergency departments. Paediatr Child Health 2013; 18:81-5. [PMID: 24421661 PMCID: PMC3567901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2012] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE To describe emergency mental health services in major paediatric centres across Canada. METHODS A cross-sectional study of mental health services in emergency departments (EDs) from all 15 Canadian tertiary care paediatric centres was conducted. RESULTS Fifteen individuals participated and were either a paediatric emergency physician with administrative responsibilities (60%) or an emergency mental health care provider (40%). Four participants reported that their ED used an evidence-based guideline, tool or policy, and one participant reported their ED based its services on published research evidence. Reported ED-based mental health resources included a crisis intervention team (five EDs), a mental health nurse (six EDs) and a social worker (five EDs). Thirteen participants reported on-site consultation with child psychiatry and six reported urgent follow-up as an adjunct service to ED care. CONCLUSIONS There is a wide variety of mental health care practices in Canadian paediatric EDs. Consideration of which resources are required to ensure evidence-based, effective services are provided to children and youth is necessary.
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Affiliation(s)
- Stephanie L Leon
- Department of Psychology, University of Ottawa & Research Institute, Children’s Hospital of Eastern Ontario, Ottawa, Ontario
| | - Mario Cappelli
- Department of Psychology, University of Ottawa & Research Institute, Children’s Hospital of Eastern Ontario, Ottawa, Ontario
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta
| | - William Craig
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta
| | - Janet Curran
- Department of Pediatrics, Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia
| | - Rebecca Gokiert
- Faculty of Extension, University of Alberta, Edmonton, Alberta
| | - Terry Klassen
- Manitoba Institute of Child Health & Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba
| | - Martin Osmond
- Department of Psychology, University of Ottawa & Research Institute, Children’s Hospital of Eastern Ontario, Ottawa, Ontario
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta
| | - Amanda S Newton
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta
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1557
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Watson HJ, McCormack J, Hoiles KJ, Forbes D, Potts J. The HOPE (Helping to Outline Paediatric Eating Disorders) Project: development and debut of a paediatric clinical eating disorder registry. J Eat Disord 2013; 1:30. [PMID: 24999409 PMCID: PMC4081767 DOI: 10.1186/2050-2974-1-30] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 05/31/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The HOPE (Helping to Outline Paediatric Eating Disorders) Project is an ongoing registry study made up of a sequential cross-sectional sample prospectively recruited over 17 years, and is designed to answer empirical questions about paediatric eating disorders. This paper introduces the HOPE Project, describes the registry sample to-date, and discusses future directions and challenges and accomplishments. The project and clinical service were established in a tertiary academic hospital in Western Australia in 1996 with a service development grant. Research processes were inbuilt into the initial protocols and data collection was maintained in the following years. Recognisable progress with the research agenda accelerated only when dedicated research resources were obtained. The registry sample consists of consecutive children and adolescents assessed at the eating disorder program from 1996 onward. Standardised multidisciplinary data collected from family intake interview, parent and child clinical interviews, medical review, parent, child and teacher psychometric assessments, and inpatient admission records populate the HOPE Project database. RESULTS The registry database to-date contains 941 assessments, of whom 685 met DSM-IV diagnostic criteria for an eating disorder at admission. The majority of the sample were females (91%) from metropolitan Perth (83%). The cases with eating disorders consist of eating disorders not otherwise specified (68%), anorexia nervosa (25%) and bulimia nervosa (7%). Among those with eating disorders, a history of weight loss since illness onset was almost universal (96%) with fear of weight gain (71%) common, and the median duration of illness was 8 months. CONCLUSIONS Over the next five years and more, we expect that the HOPE Project will make a strong scientific contribution to paediatric eating disorders research and will have important real-world applications to clinical practice and policy as the research unfolds.
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Affiliation(s)
- Hunna J Watson
- Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Australia ; Centre for Clinical Interventions, Perth, Australia ; School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia ; School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Julie McCormack
- Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Australia
| | - Kimberley J Hoiles
- Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Australia ; School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - David Forbes
- Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Australia ; School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
| | - Julie Potts
- Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Australia
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1558
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Bhattacharyya AK, Ghosh S. Paediatric facial paralysis. Current opinion in evaluation and management. Indian J Otolaryngol Head Neck Surg 2012; 51:21-7. [PMID: 23119539 DOI: 10.1007/bf02996523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Facial palsy in the paediatric age group is less common than in adults, but poses its own problems because clinical diagnosis and investigations are more difficul. i' perform. In recent years, electroneuronography (EnoG) has proved to be useful for prognosis, and in many endemic areas, neuroborreliosis (Lyme'sDisease) has proved to be the commonest cause of this condition in children. Fortunately the prognosis in children appears to be better than in adults.
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1559
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Mohiy HA, Sim J, Seeram E, Annabell N, Geso M, Mandarano G, Davidson R. A dose comparison survey in CT departments of dedicated paediatric hospitals in Australia and Saudi Arabia. World J Radiol 2012; 4:431-8. [PMID: 23150767 PMCID: PMC3495990 DOI: 10.4329/wjr.v4.i10.431] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 09/17/2012] [Accepted: 09/24/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To measure and compare computed tomography (CT) radiation doses delivered to patients in public paediatric hospitals in Australia and Saudi Arabia.
METHODS: Doses were measured for routine CT scans of the head, chest and abdomen/pelvis for children aged 3-6 years in all dedicated public paediatric hospitals in Australia and Saudi Arabia using a CT phantom measurement cylinder.
RESULTS: CT doses, using the departments’ protocols for 3-6 year old, varied considerably between hospitals. Measured head doses varied from 137.6 to 528.0 mGy·cm, chest doses from 21.9 to 92.5 mGy·cm, and abdomen/pelvis doses from 24.9 to 118.0 mGy·cm. Mean head and abdomen/pelvis doses delivered in Saudi Arabian paediatric CT departments were significantly higher than those in their Australian equivalents.
CONCLUSION: CT dose varies substantially across Australian and Saudi Arabian paediatric hospitals. Therefore, diagnostic reference levels should be established for major anatomical regions to standardise dose.
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1560
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Abstract
The administration of intravenous (IV) therapy at home is an alternative to hospitalization for treatment of infection and a number of other conditions, and has been demonstrated to be effective and safe, to reduce cost and to improve quality of life. While home IV therapy has many advantages for children, it is not uniformly available and access may be limited by age, geographical location and ability to pay. Physicians caring for children need to be aware of the indications for home IV therapy, its requirements and limitations, as well as whether this option is available for children in their care. Where access is limited, physicians should advocate for home IV therapy for children when it is medically indicated.
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1561
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Lee BE, Joffe AR, Vaudry W. Hantavirus pulmonary syndrome: Report of the first Canadian paediatric case. Can J Infect Dis 1998; 9:319-21. [PMID: 22346552 DOI: 10.1155/1998/597549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/1998] [Accepted: 01/21/1998] [Indexed: 11/18/2022] Open
Abstract
Hantavirus pulmonary syndrome (HPS) was first recognized as a severe respiratory illness transmitted through rodent excreta in the southwestern United States in 1993. As of November 1997, 175 cases have been reported in the United States. The mortality rate of this disease has been reported to be as high as 52% in the United States, and the majority of the cases (94%) involved adults. Twenty-one cases have been recognized in Canada. This paper describes the first Canadian paediatric case and discusses some of the clinical features of this disease.
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1562
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Toye JM, Lemire EG, Baerg KL. Perinatal and childhood morbidity and mortality in congenital analbuminemia. Paediatr Child Health 2012; 17:e20-e23. [PMID: 23730173 PMCID: PMC3380755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2012] [Indexed: 06/02/2023] Open
Abstract
Albumin, a serum transport protein, provides 80% of colloid osmotic pressure. Congenital analbuminemia (CAA) is an autosomal recessive disorder characterized by absence of serum albumin. Fifty cases of CAA have been reported throughout the world; however, little is known about its clinical impact. Most reported cases have few clinical signs and symptoms. Twelve local cases from the northwestern central plains region in Saskatchewan were identified and reviewed to ascertain morbidity and mortality related with CAA. All the cases are from two remote First Nations communities. Cases had frequent hospital admissions and recurrent respiratory tract infections. Placental abnormalities included hydropic placentas, placental infarcts and microcalcifications. One-half of the cases were born preterm and one-quarter were small for their gestational age. There were three mortalities in the case series. The present case series suggests increased morbidity and mortality during infancy in patients with CAA. The long-term risks of CAA in this population are unknown and a longitudinal study is recommended.
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Affiliation(s)
- Jennifer M Toye
- Department of Pediatrics, Division of Neonatology, University of Alberta, Edmonton, Alberta
| | - Edmond G Lemire
- Department of Pediatrics, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan
| | - Krista L Baerg
- Department of Pediatrics, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan
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1563
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Hidas G, Watts B, Khoury AE. The evolving role of laparoscopic surgery in paediatric urology. Arab J Urol 2012; 10:74-80. [PMID: 26558007 PMCID: PMC4442882 DOI: 10.1016/j.aju.2011.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 12/01/2011] [Accepted: 12/03/2011] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We review the various applications of laparoscopic and robotic-assisted laparoscopy in paediatric urology, as the laparoscopic and robotic approach in this population is gradually being recognised. METHODS We searched PubMed for human studies in English that were published between 1990 and the present, focusing on laparoscopic nephrectomies and partial nephrectomies, laparoscopic and robotic pyeloplasties and ureteric reimplantation, laparoscopic orchidopexy and varicocelectomy. We also reviewed robotic-assisted laparoscopic urological major reconstructions. Key articles were reviewed, extracting the indications, techniques, and the advantages and disadvantages. RESULTS AND CONCLUSIONS Laparoscopy has a defined place in modern paediatric urological surgery. Laparoscopic nephrectomies, pyeloplasties and abdominal exploration for the evaluation and management of impalpable undescended testicles have become the standard of care. Robotic-assisted laparoscopic surgery is developing as a safe and effective option even for infant patients.
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Affiliation(s)
- Guy Hidas
- Department of Paediatric Urology, UC Irvine and Children's Hospital of Orange County, Orange, CA, USA
| | - Blake Watts
- Department of Paediatric Urology, UC Irvine and Children's Hospital of Orange County, Orange, CA, USA
| | - Antoine E Khoury
- Department of Paediatric Urology, UC Irvine and Children's Hospital of Orange County, Orange, CA, USA
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1564
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Sonnega RJA, van der Sluijs JA, Wainwright AM, Roposch A, Hefti F. Management of slipped capital femoral epiphysis: results of a survey of the members of the European Paediatric Orthopaedic Society. J Child Orthop 2011; 5:433-8. [PMID: 22184504 PMCID: PMC3221762 DOI: 10.1007/s11832-011-0375-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 10/19/2011] [Indexed: 02/03/2023] Open
Abstract
AIM To determine current practice recommendations for the treatment of slipped capital femoral epiphysis (SCFE) among members of the European Paediatric Orthopaedic Society (EPOS). MATERIALS AND METHODS A questionnaire with 4 case vignettes of a 12-year-old boy presenting with a stable and unstable SCFE. Each, stable and unstable slips, was of mild (20° epiphyseal-shaft angle) and of severe (60° epiphyseal-shaft angle) degree was sent to all members of EPOS in 2009 in order to ascertain their views on the best management of SCFE. Specifically, respondents were asked about the role of reduction, methods of fixation, prophylactic fixation of the non-affected hip, postoperative management and their view on the anticipated need for secondary surgery. RESULTS The response rate was 25% (72/287). The participating surgeons' average workload was 76% in paediatric orthopaedics, with mean 16 years of experience. Surgeons were most consistent in their advice for stable slips, where around 90% of the respondents did not recommend a reduction of the slip regardless of severity of slip. Seventy per cent of the respondents recommended the use of only one screw for fixation of a stable slip and for mild unstable slips. For severe unstable slips, 46% of surgeons recommended reduction only by positioning of the hip on the fracture table, 35% by manipulation and 11% advised open reduction. Responders were less consistent in their advice on the anticipated need for secondary osteotomies (in mild slips about 40% and about 60% in severe slips would advise an osteotomy) and on treatment of the contralateral hip (with 32% of surgeons recommending prophylactic fixation of the contralateral hip). CONCLUSION Within members of EPOS, there is controversy on several aspects of the management of SCFE particularly on aspects of the treatment of unstable SCFE. SIGNIFICANCE Members of EPOS predominantly use traditional means of treatment for patients with SCFE. In contrast, the more modern treatment concepts, such as open reduction via surgical dislocation, are rarely used.
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Affiliation(s)
- R. J. A. Sonnega
- Department of Orthopaedic Surgery, VU Medical Center, Boelelaan, 1007 MB Amsterdam, The Netherlands
| | - J. A. van der Sluijs
- Department of Orthopaedic Surgery, VU Medical Center, Boelelaan, 1007 MB Amsterdam, The Netherlands
| | | | - A. Roposch
- Great Ormond Street Hospital for Children, Institute of Child Health, University College London, London, UK
| | - F. Hefti
- Department of Paediatric Orthopaedic Surgery, University Children’s Hospital Basel (UKBB), Basel, Switzerland
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1565
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Abstract
AIM To describe the neonatal symptoms, developmental problems and chronic multisystem medical morbidities of congenital myotonic dystrophy (CDM) patients registered in the United States National Registry of Myotonic Dystrophy - a disease-specific, self-report program maintained since 2002. Comparisons with the Canadian Paediatric Surveillance Program for CDM are highlighted. METHODS Genetically confirmed cases of CDM demonstrating symptoms in the first four weeks of life are described. Patients (or their caregivers) and physicians completed survey information at baseline and annually thereafter. RESULTS Twenty-one patients were included (13 male and eight female), ranging from three to 24 years of age. The CTG trinucleotide repeat number ranged from 940 to 2100. Gastrointestinal, pneumonia and cardiac morbidities were most common. No deaths were noted. CONCLUSIONS The United States Registry is a valuable resource for clinical research on patients with CDM; however, in contrast with the Canadian Paediatric Surveillance Program, some limitations are identified.
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1566
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Chibuk T, Cohen E, Robinson J, Mahant S, Hartfield D. Paediatric complicated pneumonia: Diagnosis and management of empyema. Paediatr Child Health 2011; 16:425-429. [PMID: 22851899 PMCID: PMC3200394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Pneumonia can be complicated by an empyema, progressing from an exudative effusion, to a fibrinopurulent stage with loculations, and then organized with a thick fibrinous peel. The predominant causative organisms are Streptococcus pneumoniae, Staphyloccocus aureus (including methicillin-resistant S aureus) and Streptococcus pyogenes. Recently, an increased incidence of paediatric complicated pneumonia has been reported. For diagnostic imaging, a chest radiograph followed by a chest ultrasound is preferred. Computed tomography chest scans, with associated radiation, should not be routinely used. Antibiotic coverage should treat the most common causative organisms. Additional invasive or surgical management is recommended to reduce the duration of illness in cases not promptly responding to antibiotics or with significant respiratory compromise. Choice of management should be guided by best evidence and local expertise. Video-assisted thorascopic surgery or insertion of a small-bore percutaneous chest tube with instillation of fibrinolytics are the best current options.
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1567
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McMurtry CM. Needle and dread: Is it just a little poke? A call for implementation of evidence-based policies for the management of needle pain in clinical settings. Paediatr Child Health 2011; 12:101-2. [PMID: 19030347 DOI: 10.1093/pch/12.2.101] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2006] [Indexed: 11/14/2022] Open
Abstract
The present commentary calls for the implementation of evidence-based policies to manage paediatric needle pain in clinical settings. While there have been fundamental advances in the treatment of needle pain over the past three decades, relevant techniques are often not used in clinical practice. Evidence indicates that needle procedures do hurt, are frequently cited as the most painful experience by children and a subset of children are terrified of them. Pain and distress from needle procedures can and must be addressed because needle procedures are frequently performed on both healthy (eg, immunizations) and ill (eg, bone marrow aspirations, lumbar punctures) children. An essential step in translating research knowledge into practice is the creation of evidence-based policies. Policy statements regarding the management of needle pain must be incorporated at the hospital, clinic and individual office levels to reduce the amount of pain and distress children suffer from needle procedures. Specific suggestions for policies to be incorporated in clinical settings are provided.
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Affiliation(s)
- C Meghan McMurtry
- Department of Psychology, Dalhousie University, Centre for Research in Family Health, IWK Health Centre, Halifax, Nova Scotia
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1568
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Abstract
OBJECTIVE To determine the outcome of paediatric oncology patients with positive blood cultures. DESIGN Retrospective chart review. SETTING Tertiary care hospital. POPULATION STUDIED Oncology patients up to 17 years of age with positive blood cultures from January 1, 1994 to March 31, 1999. MAIN RESULTS There were 121 episodes of positive blood cultures in 76 patients. Seventeen episodes were excluded because blood cultures were contaminated. Of the organisms grown from the remaining episodes, 63% were Gram-positive organisms, 23% were Gram-negative organisms, 3% were fungal and 11% were mixed. There were 13 episodes with pure or mixed isolates of Staphylococcus aureus, of which nine occurred within 14 days of the placement of a new central venous tunnelled catheter. Central venous tunnelled catheters were retained in 76 of the 102 episodes when they were present. There were two relapses, and four children were admitted to the intensive care unit with septic shock, but all survived. CONCLUSIONS The outcome was excellent with the current management of possible bacteremia in paediatric oncology patients, but the high incidence of S aureus bacteremia suggests that empirical antibiotics should be altered if sepsis is suspected within 14 days of the placement of a central venous catheter.
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1569
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Beck CE, Khambalia A, Parkin PC, Raina P, Macarthur C. Day of discharge and hospital readmission rates within 30 days in children: A population-based study. Paediatr Child Health 2011; 11:409-12. [PMID: 19030310 DOI: 10.1093/pch/11.7.409] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Adults discharged from hospital on a Friday are more likely to be readmitted within 30 days than are adults discharged midweek. No study has examined readmission rates for children by day of discharge. OBJECTIVE To determine the risk of readmission within 30 days by day of discharge in the paediatric population. METHODS The Canadian Institute for Health Information provided data on children 29 days to 18 years of age who were discharged from hospitals in Ontario between January 1996 and December 2000. Two groups of children (those who were readmitted within 30 days and those who were not) were compared on demographic and clinical characteristics. Multivariable modelling was used to account for potential confounding variables: age, sex, length of hospital stay, number of diagnoses, in-hospital operative procedure, in-hospital complication and hospital admission in the previous six months. RESULTS A total of 506,035 hospitalizations (involving 334,959 children) occurred over the study period. Of these children, 3.4% were readmitted within 30 days of discharge. In total, 3.6% of children discharged on a Friday were readmitted within 30 days compared with 3.3% of children discharged on a Wednesday. After adjusting for patient and hospital factors, Friday discharge was not associated with readmission within 30 days (adjusted RR 1.07, 95% CI 0.99 to 1.15). More significant predictors of readmission included number of diagnoses, in-hospital complications and hospital admission in the six months previous to the index admission date. CONCLUSION Risk of readmission within 30 days is not significantly increased for children discharged on a Friday compared with children discharged midweek. Significant risk factors for hospital readmission are patient complexity and disease severity.
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Affiliation(s)
- Carolyn E Beck
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team, The Hospital for Sick Children and the University of Toronto, Toronto
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1570
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Abstract
Gynecological problems are common in children but training in this subject is rare during paediatric postgraduate education. Knowledge in this area is important for providing comprehensive health care to children. The article explores the gynecological examination of the child and common gynecological disorders in the paediatric and adolescent age groups. Routine examination of the external genitalia as part of a well-child physical normalizes the examination for the child and helps to inform the physician about the large variations in normal genitals. Many complaints can be dealt with by reassurance, while most others respond to medical therapy and can be dealt with easily by paediatricians. Both young children and adolescents respond positively when allowed to have control over the tempo of the interview and the examination. A positive experience associated with a genital examination will help to open lines of trust. This along with nonjudgmental, open communication, will create educational opportunities to enhance a responsible transition from child to young adult.
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Affiliation(s)
- Victoria Jane Davis
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario
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1571
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Abstract
BACKGROUND The current objectives for teaching paediatric cardiology to paediatric residents have not been validated and may not be relevant to current paediatric practice. OBJECTIVES To validate the cardiology component of the Royal College of Physician and Surgeons of Canada's objectives for training paediatricians. METHODS A questionnaire was sent to practising paediatricians in Atlantic Canada. The questions were based on the Royal College of Physician and Surgeons of Canada's training objectives. The frequency of problems seen, confidence in assessment and management of problems, and reasons for referral were identified. Clinical vignettes were followed by short questions. The outpatient referrals were reviewed to validate the questionnaire responses. RESULTS One hundred fifty-one questionnaires were mailed and the response rate was 60%. Murmurs were the most common problem encountered (92%). Syncope (9%), Kawasaki disease (8%) and chest pain (6%) were less frequently encountered. Paediatricians were confident in assessing and managing problems despite the low frequency of encounters. Less confidence was expressed regarding physical examination skills and interpretation of electrocardiograms. Uncertainty of the diagnosis was the most common reason for patient referral, with parental anxiety and medicolegal concerns accounting for 24% and 7% of referrals, respectively. Syncope with exercise was relatively poorly recognized as a worrisome symptom. CONCLUSIONS Most cardiology objectives for general paediatric training remain relevant and appropriate to clinical practice. Physical examination skills, electrocardiogram interpretation and the assessment of syncope need to be emphasized.
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Affiliation(s)
- Kenny K Wong
- Division of Cardiology, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia
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1572
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Reebye SC, Blair GK, Rogers PC, Jamieson D, Skarsgard ED. An audit of cancer diagnosis in a Canadian children's hospital: Quality, timing and efficiency. Paediatr Child Health 2011; 11:143-7. [PMID: 19030269 DOI: 10.1093/pch/11.3.143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The diagnosis of paediatric cancer requires multidisciplinary cooperation to achieve both a timely diagnosis and efficient resource use. The authors undertook a 12-month audit of paediatric cancer cases to assess BC's Children's Hospital's (Vancouver, British Columbia) diagnostic process from the perspective of quality (timing and accuracy of diagnosis) and procedural efficiency, with an emphasis on the impact on resource use in the departments of radiology, pathology, anesthesia and surgery. METHODS Malignancies (excluding brain and cortical bone primary tumours, for which the preoperative diagnostic workup is often completed before admission) diagnosed between January 1 to December 31, 2003, were reviewed. Data collected included total outpatient versus inpatient procedures, number and timing of diagnostic procedures, general anesthesia (GA) requirements, and lag times from admission to biopsy to diagnosis during the initial hospitalization. RESULTS Fifty-four patients were identified. Only 10 patients (19%) had an outpatient diagnostic procedure. One hundred seventeen inpatient diagnostic procedures were performed, with only 50% occurring within regular working hours. Thirty-one per cent of patients required two or more procedural GAs during their initial hospital admission. The mean lag time to biopsy was 2.6 days and to a pathological diagnosis was 1.2 days. CONCLUSIONS Despite timeliness, the process of cancer diagnosis at BC Children's Hospital requires hospital admission and a significant consumption of resources outside of regular working hours. Opportunities for improvement include maximizing outpatient workup, allocating oncology operating room time to increase the percentage of weekday procedures and improving interdisciplinary procedural coordination to reduce the GA requirements per patient.
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1573
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Abstract
BACKGROUND Essential oils, such as camphorated and eucalyptus oils, are volatile oils that can be absorbed by mouth and through the skin; if ingested orally by children, they can be harmful, even life-threatening. OBJECTIVE To determine the frequency of essential oil ingestion among children in Toronto, Ontario. METHODS Charts from December 1995 through March 1997 at the Ontario Regional Poison Information Centre, The Hospital for Sick Children, Toronto were reviewed to collect information on calls about essential oil ingestion, and a search of MEDLINE articles from 1966 to 1998 was conducted using the key words: 'camphor', 'eucalyptus', 'paediatric', and 'poisoning'. RESULTS Callers to the Poison Information Centre reported that 251 children had ingested an essential oil or product: eucalyptus oil 50 children; camphorated oil 18 children; VapAir (Drug Trading, Canada) vaporizing liquid 93 children; and Vicks VaporRub (Procter & Gamble, Canada) 90 children. The most common symptoms were cough, vomiting and cough associated with vomiting. Two children had seizures but recovered. The MEDLINE search found 18 reports of paediatric ingestion of the oils or oil products. The main symptoms were vomiting, lethargy, coma and seizures. One child died. CONCLUSION Although widely used by health care consumers, essential oils and the products that contain them can be harmful when ingested by children. Further education for parents and other caregivers about the risks involved in exposure to these products is required.
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Affiliation(s)
- Z Flaman
- Ontario Regional Poison Information Centre and
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1574
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Bulut T, Yilmazlar A, Yavascaoglu B, Sarisozen B. The effect of local anaesthetic on post-operative pain with wound instillation via a catheter for paediatric orthopaedic extremity surgery. J Child Orthop 2011; 5:179-85. [PMID: 22654979 PMCID: PMC3100459 DOI: 10.1007/s11832-011-0337-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Accepted: 03/06/2011] [Indexed: 02/03/2023] Open
Abstract
PURPOSE We aimed to investigate the effects on post-operative pain of local anaesthetic administration via a catheter placed into the operation site in patients who were undergoing upper and lower extremity paediatric orthopaedic surgery. METHODS In this randomised, double-blind and placebo study, 40 ASA I-II patients aged between 1 and 12 years were randomly allocated into two groups: study group (Group S: 0.2 ml/kg, 0.5% bupivacaine, n = 20) and control group (Group C: 0.2 ml/kg, serum physiologic, n = 20). Before the fascia was closed by the surgical team, the solution previously prepared by the chief nurse was injected into the subfascial soft tissue with the syringe as the "injected dose" of serum physiologic or bupivacaine. After the closure, 0.2 ml/kg (1 mg/kg) bupivacaine or saline was instillated as the "first instillated dose" into the surgical area via the catheter. Pain scores were recorded at 0, 1, 2, 4, 8, 12, 24 and 48 h post-operatively. Patients were administered 0.75 mg/kg meperidine intramuscularly post-operatively to equalise the pain scores. RESULTS No statistically significant difference was found between Group S and Group C in terms of demographic and other data and pain scores in the post-anaesthesia care unit, while a statistically significant decrease was found at 2, 4, 8, 12, 24 and 48 h in Group S and at 1, 2 and 4 h in Group C based on pain scores in the post-anaesthesia care unit (P < 0.05). A statistically significant decreasing pain score was found at 4, 8, 12, 24 and 48 h in Group S (P < 0.05). CONCLUSION The local anaesthetic administered via a catheter implanted in the surgical field may provide long-term and efficient post-operative analgesia.
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Affiliation(s)
- T. Bulut
- Department of Anesthesiology, Uludag University, Medical School, Görükle, Bursa, Turkey
| | - A. Yilmazlar
- Department of Anesthesiology, Uludag University, Medical School, Görükle, Bursa, Turkey
| | - B. Yavascaoglu
- Department of Anesthesiology, Uludag University, Medical School, Görükle, Bursa, Turkey
| | - B. Sarisozen
- Department of Orthopaedia and Traumatology, Uludag University, Bursa, Turkey
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1575
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Varghese AM, Mathew J, Alexander A, Thenmozhi K, Evangelin GL, Kurien M. Bilateral simultaneous cochlear implantation in children: report of a case and review of literature. Indian J Otolaryngol Head Neck Surg 2011; 64:95-6. [PMID: 23449284 DOI: 10.1007/s12070-011-0219-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2009] [Accepted: 03/27/2009] [Indexed: 11/26/2022] Open
Abstract
The benefits of bilateral cochlear implant in adults are well established. Auditory ability in children is also substantially improved by binaural hearing. We report the first case of bilateral simultaneous paediatric cochlear implant in India and discuss the merits of bilateral implant.
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1576
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Abstract
Chronic and recurrent benign pain complaints are common among children and adolescents. Although many young persons with chronic pain adapt well, a small, but significant, proportion experience marked functional deficits. Pain can produce life disruptions, e.g. impeding activities and maturation, and interferes with family functioning. Conventional medically-based approaches have been inadequate in addressing chronic pain and its sequelae. Instead, effective management requires an interdisciplinary approach involving paediatricians and mental health practitioners working collaboratively to treat psychiatric comorbidities, enhance the patient's functional adaptation, restore the child or adolescent's maturational and social capabilities and reduce family disruptions.
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Affiliation(s)
- Raphael J Leo
- Department of Psychiatry, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Erie County Medical Center, 462 Grider Street, Buffalo, New York 14215, USA. E-mail:
| | - Shiva Prakash Srinivasan
- Department of Psychiatry, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Erie County Medical Center, 462 Grider Street, Buffalo, New York 14215, USA. E-mail:
| | - Shrenik Parekh
- Department of Psychiatry, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Erie County Medical Center, 462 Grider Street, Buffalo, New York 14215, USA. E-mail:
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1577
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Cheng A. Emergency treatment of anaphylaxis in infants and children. Paediatr Child Health 2011; 16:35-40. [PMID: 22211074 PMCID: PMC3043023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Anaphylaxis is a severe, acute and potentially life-threatening condition, often in response to an allergen. Patients experiencing anaphylaxis can present with cutaneous, respiratory, cardiovascular or gastrointestinal manifestations. Epinephrine given intramuscularly remains the mainstay of treatment for this condition. Other second-line therapies, such as inhaled beta-2 agonists, H1 and H2 receptor antagonists and corticosteroids, may play a role in resolving respiratory and cutaneous signs and symptoms. Biphasic reactions may occur during the resolution phase of symptoms and, thus, all patients should be observed for a minimum of 4 h to 6 h before discharge from hospital. On discharge, all patients should be prescribed epinephrine autoinjectors, and referred to an allergist or immunologist for further evaluation and education.
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Affiliation(s)
- A Cheng
- Canadian Paediatric Society, Acute Care Committee
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1578
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Al-Salam S, Al Ashari M. Epithelioid sarcoma in a child presenting as a submandibular mass. Afr Health Sci 2010; 10:400-404. [PMID: 21416044 PMCID: PMC3052803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Affiliation(s)
- S Al-Salam
- Pathology Department, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE.
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1579
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Lloyd JM, Craik J, Harvey A. Proximal humerus fracture with a pink, pulseless arm in a teenage boy and literature review. Eur J Trauma Emerg Surg 2010; 36:593-5. [PMID: 26816316 DOI: 10.1007/s00068-010-0036-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 06/22/2010] [Indexed: 10/19/2022]
Abstract
Proximal humeral fractures associated with vascular compromise are extremely rare in children. We describe the presentation, diagnosis and management of one such injury in a child.
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1580
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Dinning PG, Benninga MA, Southwell BR, Scott SM. Paediatric and adult colonic manometry: A tool to help unravel the pathophysiology of constipation. World J Gastroenterol 2010; 16:5162-72. [PMID: 21049550 PMCID: PMC2975087 DOI: 10.3748/wjg.v16.i41.5162] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Colonic motility subserves large bowel functions, including absorption, storage, propulsion and defaecation. Colonic motor dysfunction remains the leading hypothesis to explain symptom generation in chronic constipation, a heterogeneous condition which is extremely prevalent in the general population, and has huge socioeconomic impact and individual suffering. Physiological testing plays a crucial role in patient management, as it is now accepted that symptom-based assessment, although important, is unsatisfactory as the sole means of directing therapy. Colonic manometry provides a direct method for studying motor activities of the large bowel, and this review provides a contemporary understanding of how this technique has enhanced our knowledge of normal colonic motor physiology, as well as helping to elucidate pathophysiological mechanisms underlying constipation. Methodological approaches, including available catheter types, placement technique and recording protocols, are covered, along with a detailed description of recorded colonic motor activities. This review also critically examines the role of colonic manometry in current clinical practice, and how manometric assessment may aid diagnosis, classification and guide therapeutic intervention in the constipated individual. Most importantly, this review considers both adult and paediatric patients. Limitations of the procedure and a look to the future are also addressed.
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1581
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Jauquier N, Doerfler M, Haecker FM, Hasler C, Zambelli PY, Lutz N. Immediate hip spica is as effective as, but more efficient than, flexible intramedullary nailing for femoral shaft fractures in pre-school children. J Child Orthop 2010; 4:461-5. [PMID: 21966311 PMCID: PMC2946524 DOI: 10.1007/s11832-010-0279-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 07/13/2010] [Indexed: 02/03/2023] Open
Abstract
UNLABELLED Flexible intramedullary nailing (FIN) is the gold standard treatment for femur fracture in school-aged children. It has been performed successfully in younger children, although Spica cast immobilisation (SCI) has been the most widely used strategy to date. METHOD A retrospective analysis was performed between two comparable groups of children aged 1-4 years with a femoral shaft fracture. Two University hospitals, each using specific treatment guidelines, participated in the study: SCI in Group I (Basel, Switzerland) and FIN in Group II (Lausanne, Switzerland). RESULTS Group I included 19 children with a median age of 26 months (range 12-46 months). Median hospital stay was 1 day (range 0-5 days) and casts were retained for a median duration of 21 days (range 12-29 days). General anaesthesia was used in six children and sedation in four. Skin breakdown secondary to cast irritation occurred in two children (10.5%). The median follow-up was 114 months (range 37-171 months). No significant malunion was noted. Group II included 27 children with a median age of 38.4 months (range 18.7-46.7 months). Median hospital stay was 4 days (range 1-13 days). All children required general anaesthesia for insertion and removal of the nails. Free mobilisation and full weight bearing were allowed at a median of 2 days (range 1-10 days) and 7 days (range 1-30 days), respectively, postoperatively. Nail exteriorisation was noted in three children (11%). The median follow-up was 16.5 months (range 8-172 months). No significant malunion was reported. CONCLUSIONS Young children with a femoral shaft fracture treated by SCI or FIN had similarly favourable outcomes and complication rates. FIN allowed earlier mobilisation and full weight bearing. Compared to SCI, a greater number of children required general anaesthesia. In a pre-school child with a femoral shaft fracture, immediate SCI applied by a paediatric orthopaedic team following specific guidelines allowed early discharge from hospital with few complications.
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Affiliation(s)
- Nicolas Jauquier
- />Paediatric Orthopaedic and Traumatology Unit, Children’s Hospital, Lausanne, Switzerland
| | - Martina Doerfler
- />Department of Paediatric Surgery, University Children’s Hospital, Basel, Switzerland
| | - Frank-Martin Haecker
- />Department of Paediatric Surgery, University Children’s Hospital, Basel, Switzerland
| | - Carol Hasler
- />Orthopaedic Department, University Children’s Hospital, Basel, Switzerland
| | - Pierre-Yves Zambelli
- />Paediatric Orthopaedic and Traumatology Unit, Children’s Hospital, Lausanne, Switzerland
| | - Nicolas Lutz
- />Paediatric Orthopaedic and Traumatology Unit, Children’s Hospital, Lausanne, Switzerland
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1582
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Al-Binali AM, Shabana M, Al-Fifi S, Dawood S, Shehri AA, Al-Barki A. Cantharidin Poisoning due to Blister Beetle Ingestion in Children: Two case reports and a review of clinical presentations. Sultan Qaboos Univ Med J 2010; 10:258-261. [PMID: 21509239 PMCID: PMC3074703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 02/07/2010] [Accepted: 03/22/2010] [Indexed: 05/30/2023] Open
Abstract
Cantharidin is an intoxicant found in beetles in the Meloidae (Coleoptera) family. Ingestion may result in haematemesis, impaired level of consciousness, electrolyte disturbance, haematurea and renal impairment. Here, we report two paediatric cases of meloid beetle ingestion resulting in cantharidin poisoning and the clinical presentation of the ensuing intoxication.
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Affiliation(s)
- Ali M. Al-Binali
- Department of Child Health, College of Medicine, King Khalid University, Saudi Arabia
| | - Medhat Shabana
- Department of Child Health, College of Medicine, King Khalid University, Saudi Arabia
| | - Suliman Al-Fifi
- Department of Child Health, College of Medicine, King Khalid University, Saudi Arabia
| | - Sami Dawood
- Department of Pediatrics, Aseer Central Hospital, Abha, Saudi Arabia
| | - Amer A. Shehri
- Department of Pediatrics, Aseer Central Hospital, Abha, Saudi Arabia
| | - Ahmed Al-Barki
- Department of Pediatrics, Aseer Central Hospital, Abha, Saudi Arabia
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1583
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PA S, Jacob R, Sahajanandan R, Joselyn AS. Paediatric Auto Renal transplantation-Anaesthetic Challenge. Indian J Anaesth 2009; 53:489-91. [PMID: 20640215 PMCID: PMC2894490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2009] [Indexed: 11/03/2022] Open
Abstract
SUMMARY Takayasu's arteritis is described to be the single most important cause of renovascular hypertension. Anaesthetising a child with Takayasu's arteritis for auto renal transplantation is a challenge as it is complicated by severe uncontrolled hypertension, end-organ dysfunction resulting from hypertension, stenosis of major blood vessels affecting regional circulation, and difficulties encountered in monitoring arterial blood pressure. A balanced anaesthetic technique, maintenance of stable haemodynamics with monitoring is required for a successful outcome. We describe the anaesthetic management of a child with Takayasu's arteritis and severe hypertension refractory to medical treatment requiring auto renal transplantation.
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Affiliation(s)
- Saravanan PA
- Asst Professor, Department of Anaesthesia and critical care, Christian Medical College & Hospital, Vellore, India-632004,Correspondence to: Saravanan PA, Department of Anaesthesia and critical care, Christian Medical College & Hospital, Vellore, India-632004, E-mail:
| | - Rebecca Jacob
- Professor, Department of Anaesthesia and critical care, Christian Medical College & Hospital, Vellore, India-632004
| | - Raj Sahajanandan
- Asst Professor, Department of Anaesthesia and critical care, Christian Medical College & Hospital, Vellore, India-632004
| | - Anita Shirley Joselyn
- Asst Professor, Department of Anaesthesia and critical care, Christian Medical College & Hospital, Vellore, India-632004
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1584
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Mukhida K. Loving your child to death: Considerations of the care of chronically ill children and euthanasia in Emil Sher's Mourning Dove. Paediatr Child Health 2008; 12:859-65. [PMID: 19043501 DOI: 10.1093/pch/12.10.859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2007] [Indexed: 11/14/2022] Open
Abstract
How do parents cope when their child is ill or dying, and when he or she is experiencing constant pain or suffering? What do parents think of the contributions that medical professionals make to the care of their chronically or terminally ill child? Is it possible for a parent to love a child so much that they wish their child to be dead? The purpose of the present paper is to explore these questions and aspects of the care of chronically or terminally ill children using Mourning Dove's portrayal of one family's attempt to care for their ill daughter. Mourning Dove, a play written by Canadian playwright Emil Sher, was inspired by the case of Saskatchewan wheat farmer Robert Latimer who killed his 12-year-old daughter, Tracy, who suffered with cerebral palsy and had begun to experience tremendous pain. Rather than focusing on the medical or legal aspects of the care of a chronically ill child, the play offers a glimpse into how a family copes with the care of such a child and the effect the child's illness has on the family. The reading and examination of nonmedical literature, such as Mourning Dove, serves as a useful means for medical professionals to better understand how illness affects and is responded to by patients and their families. This understanding is a prerequisite for them to be able to provide complete care of children with chronic or terminal illnesses and their families.
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Affiliation(s)
- Karim Mukhida
- Division of Neurosurgery, University of Toronto, Toronto, Ontario
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1585
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Brophy J, Yau Y, Cox P, Katz K, Bitnun A. A sentinel fatal paediatric case of community-associated methicillin-resistant Staphylococcus aureus in Canada. Paediatr Child Health 2007; 12:319-322. [PMID: 19030381 PMCID: PMC2528684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2006] [Indexed: 05/27/2023] Open
Abstract
Community-associated methicillin-resistant Staphylococcus aureus is an established pathogen in many centres in the United States, but has yet to establish a firm foothold in Canada. In the present article, the authors report, to their knowledge, Canada's first fatal paediatric case of invasive disease due to community-associated methicillin-resistant S aureus and review its pathogenesis, epidemiology and treatment.
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Affiliation(s)
- Jason Brophy
- Division of Infectious Diseases, Department of Paediatrics
| | - Yvonne Yau
- Department of Paediatric Laboratory Medicine
| | - Peter Cox
- Department of Critical Care, The Hospital for Sick Children, University of Toronto
| | - Kevin Katz
- Department of Infection Prevention and Control, North York General Hospital, Toronto, Ontario
| | - Ari Bitnun
- Division of Infectious Diseases, Department of Paediatrics
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1586
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Varshney S. Hypopharayngeal carcinoma in a child: Case report. Indian J Otolaryngol Head Neck Surg 2006; 58:320-1. [PMID: 23120334 DOI: 10.1007/bf03050861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
A 15 years old boy with keratinizing squamous cell carcinoma of the Hypopharynx is being presented because of its rarity. The patient presented with pain in throat and difficulty in swallowing since 15 days. Barium swallow and direct Laryngoscopy revealed a mass in Hypopharynx. Tobacco smoking since early childhood can be the aetological factor. The patient did not consent for surgery and could not afford radiotherapy. Hence, Tracheostomy and feeding gastrosomy were done. Patient died at home two months after the diagnosis.
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Affiliation(s)
- Saurabh Varshney
- Dept. of E.N.T., Himalayan Institute of Medical Sciences, Swami Ram Nagar, Doiwala, 248140 Jollygrant Dehradun (U.A.), India
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1587
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Abstract
BACKGROUND Although psychiatric morbidity is common amongst paediatric patients, little is known about the availability of CAMH paediatric liaison services. METHOD We surveyed all Trusts with specialist CAMH services and paediatric units in Greater London, enquiring about the nature of liaison that CAMHS provide. RESULTS We found that although liaison paediatric work was common, dedicated paediatric liaison services were provided by only a minority of specialist multidisciplinary CAMHS. Their work involved most aspects of child psychopathology, and included emergencies and children with joint physical and psychiatric problems. About 2/3 of paediatricians were satisfied with CAMHS liaison services, but virtually all desired to see them developed further. There were few indications of co-ordination between specialist multidisciplinary CAMHS and other paediatric psychosocial support services.
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Affiliation(s)
- Mark Woodgate
- Child and Family Consultation Service, Erme House, Mount Gould Hospital, Mount Gould, Plymouth PL4 7QD, UK. E-mail:
| | - M Elena Garralda
- Academic Unit of Child and Adolescent Psychiatry, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK
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1588
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Abstract
Complementary and alternative medicine (CAM) use, including paediatric use, is common. The Hospital for Sick Children Foundation organized a priority-setting forum regarding paediatrics and the use of CAM/natural health products in November 2001. Four priority areas were identified: the creation of a national paediatric research network and/or centre of excellence in CAM; support for experiential learning, education, and training; completion of a needs/use assessment; and facilitation of knowledge transfer. These priority areas are discussed in the context of research, education, knowledge transfer and health systems. The present article represents a call for action for Canadian funding agencies to support the development of an evidence base in paediatric CAM.
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