Assembling a global database of child pneumonia studies to inform WHO pneumonia management algorithm: Methodology and applications

Background

The existing World Health Organization (WHO) pneumonia case management guidelines rely on clinical symptoms and signs for identifying, classifying, and treating pneumonia in children up to 5 years old. We aimed to collate an individual patient-level data set from large, high-quality pre-existing studies on pneumonia in children to identify a set of signs and symptoms with greater validity in the diagnosis, prognosis, and possible treatment of childhood pneumonia for the improvement of current pneumonia case management guidelines.

Methods

Using data from a published systematic review and expert knowledge, we identified studies meeting our eligibility criteria and invited investigators to share individual-level patient data. We collected data on demographic information, general medical history, and current illness episode, including history, clinical presentation, chest radiograph findings when available, treatment, and outcome. Data were gathered separately from hospital-based and community-based cases. We performed a narrative synthesis to describe the final data set.

Results

Forty-one separate data sets were included in the Pneumonia Research Partnership to Assess WHO Recommendations (PREPARE) database, 26 of which were hospital-based and 15 were community-based. The PREPARE database includes 285 839 children with pneumonia (244 323 in the hospital and 41 516 in the community), with detailed descriptions of clinical presentation, clinical progression, and outcome. Of 9185 pneumonia-related deaths, 6836 (74%) occurred in children <1 year of age and 1317 (14%) in children aged 1-2 years. Of the 285 839 episodes, 280 998 occurred in children 0-59 months old, of which 129 584 (46%) were 2-11 months of age and 152 730 (54%) were males.

Conclusions

This data set could identify an improved specific, sensitive set of criteria for diagnosing clinical pneumonia and help identify sick children in need of referral to a higher level of care or a change of therapy. Field studies could be designed based on insights from PREPARE analyses to validate a potential revised pneumonia algorithm. The PREPARE methodology can also act as a model for disease database assembly.

Ergebnisse der Pars-plana-Lentektomie bei kindlicher Katarakt

BACKGROUND

Pars plana lensectomy with subsequent fitting of contact lenses is the standard procedure for cataracts occurring within the first 2 years of life. We wanted to assess the outcome and complication rate of this procedure.

METHODS

Pars plana lensectomy was performed on 29 eyes of 15 children with bilateral as well as 12 eyes with unilateral cataracts. All children were reexamined at an age of at least 3 years.

RESULTS

In bilateral cases the mean age at the time of surgery was 4.0 months and mean resulting visual acuity 0.32. After exclusion of three eyes with complications or bad postoperative compliance, we found a statistically significant correlation between age at surgery and visual acuity (r(2)=0.432, p<0.05). Some form of binocular vision was achieved by 40% of the children; 17% developed ocular hypertension and 7% a secondary cataract. In the unilateral cases the mean age at surgery was 3.9 months and the mean resulting visual acuity 0.14. There was no significant correlation between age and visual acuity; 17% gained binocular function and 5% had ocular hypertension.

CONCLUSION

Visual function after lensectomy is better in eyes with bilateral cataracts compared to unilateral cataracts. Early surgery as well as adequate orthoptic therapy and compliance with wearing the contact lens are necessary for good outcome.

Developing Collaborative Partnerships in Continuing Nursing Education: Walking the Talk

The purpose of this article is to describe and analyze a reciprocal partnership developed among four university-based continuing education providers in Wisconsin. Members of this partnership collaborated in developing a statewide program to address the educational needs of nurses moving from acute or long-term care into community nursing. Components of the reciprocal partnership model were applied in developing this program. The partners identified that, despite the initial time investment, the collaborative approach was an advantage. The collaborative approach enhanced the quality of the program developed and reached a wider audience. Continuing nursing educators may want to consider partnership arrangements for program development and implementation.

[Dextrose and vigilance: the effect of dextrose on the spectro-analytic parameters of pharmaco-EEG]

In a randomized single-blind cross-over-design the effect of 15 g dextrose was investigated against placebo with 48 healthy subjects at two different days each. The quantitative pharmaco-EEG was recorded occipitocentral at the left side (O1-Cz) under vigilance controlled conditions and then under resting conditions (three minutes each). Having measured its baseline it was repeated six times every 20 minutes starting 10 minutes after the application of the substance. After the administration of dextrose a stabilization of vigilance could be seen in the EEG by the following differences of statistical significance (p < = 0.05) between dextrose and placebo under resting recording conditions: In the first control (14.-16. minute post) there was a significant decrease of the relative power in the delta and in the theta range combined with an increase of alpha 2. In the second control (34.-36. minute post) there was a significant decrease of relative power in the theta range and significant increase in the alpha 1 range. In the third control (54.-56. minute post) and later on no effects of dextrose were left in the pharmaco-EEG. The significant differences in the first and second control have to be interpreted as follows: After the administration of dextrose the level of vigilance was increased compared to the placebo group.

[Studies on the effect of Harmonicum Much on sleep using polygraphic EEG recordings]

The effects of 60 and 120 mg valerian (1 resp. 2 capsules Harmonicum Much) have been investigated by computer analysis of sleep stages (sleep profiles) and psychometric methods ( questionnaires ). EOG, EMG of cervical muscles, ECG and EEG (two-sided: centro-occipital and fronto-central - have been recorded from 6 male and 5 (3) female healthy volunteers. Amplified signals have been analysed on-line (power spectral analysis) and the sleep profiles have been calculated accordingly. After one night for adaptation, each subject took orally placebo, 60 and 120 mg valerian (1 resp. 2 capsules Harmonicum Much) according to a randomized double-blind repeated measures-design. The sleep investigations have been carried out by distance of a week for each condition (dosage per subject). In the morning following this night, the subjects completed a mood scale. Both dosages showed a decrease of sleep stage 4 and a slight reduction of REM-sleep. Contrary, a slight increase of sleep stage awake, 1 and 2 could be observed. A further increase of sleep stage 3 could be identified. After application of 120 mg valerian , the frequency of REM-phases (in %) declined during the first half of the night, whereas during the second part of the night, a surplus appeared. Changes or the Beta-intensity of the EEG during REM-sleep show a stronger hypnotic effect for the 120 mg dosage than for 60 mg. Maximum effect was observed between 2 and 3 hours post medicationem . Results of the mood scale are indifferent between the experimental conditions, which indicate no negative (side-) effects neither by drug nor by testing methods.