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PubMed2005

Increasing general dentists' provision of care to child patients through changes in the undergraduate pediatric dentistry program.

Reduced caries rates and an increased percentage of children with dental insurance have made it more difficult for dental schools to provide undergraduates with sufficient numbers of pediatric dental patients requiring restorative procedures. This may result in graduates who are not competent and are reluctant to treat children after graduation. To ensure the quality of the undergraduate clinical training program, the Division of Pediatric Dentistry at the University of Manitoba changed from a comprehensive-based clinic to a block system in 1998-99. Specific communities with limited access to dental care (neighboring core area schools and Hutterite colonies) were specifically targeted as potential sources for child patients. This format increased the exposure of students to patient management as well as to complex pediatric dentistry procedures. To assess the learning experiences before and after the changes to the clinical pediatric dentistry program, sixty general dentists who had graduated from the University of Manitoba were randomly selected using the Manitoba Dental Association Directory. Surveys were sent to twenty general dentists who graduated in each of the following years: 1993, 2000, and 2002. Forty-five dentists responded, fifteen from each of the three surveyed classes. Dentists who graduated after the changes to the program (2000, 2002) reported that they performed a greater number of complex pediatric dentistry procedures and treated more toddler and preschool children than the group that graduated before the changes (1993). Referrals to pediatric dentistry specialists were higher in the 1993 group than in the 2000 and 2002 groups. In conclusion, an adequate pool of pediatric patients is critical to provide dental students with sufficient learning experiences. The dentists who graduated from the program after the changes were implemented are providing more comprehensive treatment to younger children.

Child↗
PubMed2005

Bloodstream infections in pediatric patients.

OBJECTIVE: Blood stream infection (BSI) is the leading cause of morbidity and mortality in pediatric patients. This study aims to describe the clinical, microbiological characteristics and outcome of BSI in pediatric patients. METHODS: We collected the clinical data from all pediatric patients with positive blood cultures. We identified all isolates from these patients from January 2004 to December 2004 at King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia, and determined antimicrobial susceptibilities by MicroScan Walk Away 96 (Dade Behring Inc., West Sacramento, CA95691, USA). RESULTS: Two hundred and twenty pediatric patients had BSI, of whom 147 (67%) were males and 71 (32.2%) were from intensive care units (ICUs). Two hundred and ten (95.4%) had single blood culture isolate. One hundred and seventy-three (78.6%) of the isolates were Gram positive bacteria and included the following: Staphylococcus epidermidis (55.4%), Staphylococcus aureus (9.5%) of which 14% were methicillin resistant, Streptococcus pneumoniae (S. pneumoniae) (4.5%), 40% of which were resistant to penicillin and Enterococcus faecalis (4%). Gram negative bacteria were 44 (20%) and included Escherichia coli and Klebsiella pneumoniae (K.pneumoniae) (3.6% each). Three isolates (1.3%) were Candida glabrata. None of the Gram positive isolates were vancomycin resistant. Three K.pneumoniae and one Pseudomonas spp. isolates were multiresistant. One hundred and ninety-four (88%) of BSI isolates were hospital acquired. Fever was the most common presentation of pediatric patients (26%) with positive blood culture with no apparent focus of infection. Respiratory tract infections 26 (12%) were the next most common. We seen sepsis in (7.7%) children between 8 days and 6 months of age. Bone and joint infections, cardiac, renal, gastrointestinal diseases, malignancy and surgical cases were other associated clinical diagnoses of BSI in pediatric patients. Patients with immuno- suppressive disorders with BSI had isolates such as Salmonella spp., S. pneumoniae and Pseudomonas spp. Overall mortality was 13 (6%) (p<0.005) and those patients had underlying serious medical conditions with associated risk factors such as prolonged hospital stay, intensive care unit (ICU) admission, indwelling catheterization, mechanical ventilation and prior antimicrobial use. CONCLUSION: Bloodstream infection is an important cause of morbidity and mortality in pediatric patients. Risk factors for hospital acquired infection include: prematurity, prolonged hospitalization, ICU admission, indwelling catheterization, mechanical ventilation and prior antimicrobial therapy.

Adolescent↗
PubMed2005

[Bibliometric analysis of Chinese Journal of Pediatrics].

OBJECTIVE: To evaluate the quality of articles and the popularity of Chinese Journal of Pediatrics. METHODS: With the database of Chinese Science & Technology Journal Citation Reports 2000-2003, the six indicators, including impact factor (IF), total cited numbers, immediate index, ratio of cited numbers by other journals to total cited numbers, number of citing journals, and cited half-life were evaluated and compared with other Chinese periodicals in pediatrics and related subjects. The cited numbers, distribution of cited areas, and cited institutions of published articles in Chinese Journal of Pediatrics 2000-2003 were analyzed. RESULTS: From 2000 to 2003, the impact factor of the Journal was 0.937, 1.025, 1.052, 1.252, total cited number was 1378, 1468, 1863 and 2396. Immediate index, citing journals, and cited half-life rose steadily, and the ratio of cited numbers by other journals to total cited numbers remained above 0.9. The average cited number of articles was 3.3. The cited authors were from 26 provinces or cities. CONCLUSION: The Chinese Journal of Pediatrics ranked at the top of Chinese pediatric journals with its highest IF and total cited numbers, which indicates that the journal has explicit editorial aims, stable continuity, and the increased influence in Chinese pediatric research. The stable growth of immediate index, number of citing journals and cited half-life show that the Journal has a high rate of reflection, the articles published in the Journal were paid more attention and have influenced researchers for longer periods and widely. The higher rate of citation by others and lower self-cited rate indicate that the Journal has been rigorous and realistic in editorial practice. The Journal is demonstrated to be one of the main medical core periodicals and one of the most important information sources in the field of pediatrics in China.

Bibliometrics↗
PubMed1986

A needs assessment of advanced life support and emergency medical services in the pediatric patient: state of the art.

The outcome from cardiopulmonary arrest in children in the prehospital and hospital setting is generally poor. The event that compromises the cardiac status is often respiratory embarrassment, and the presenting rhythms are often bradyarrhythmias and asystole. Emergency medical services (EMS) systems have primarily an adult focus and may not be organized to manage optimally the critically ill and injured child. Data from a survey of training programs demonstrate that paramedic and EMT education in pediatric emergencies may be inadequate. Forty-one percent of the programs surveyed had less than 10 hr of pediatric training. Data suggest that EMS providers may not be equipped to manage children effectively. The Los Angeles EMS System for children is described. There are two levels of receiving facilities: Emergency Departments Approved for Pediatrics and Pediatric Critical Care Centers. The system is voluntary and has 85% of the hospitals in compliance with the guidelines. Early recognition of the prearrest state, improved training, and equipping of prehospital care personnel, development of EMS services for children, dissemination of an advanced pediatric life support course, as well as research in pediatric CPR may improve the outcome of resuscitation in the pediatric population.

Adolescent↗
PubMed1995

Clinicolegal aspects of practice guidelines for pediatric eye and vision examination.

BACKGROUND: The American Optometric Association (AOA) recently joined a growing trend in the health care professions by adopting clinical practice guidelines. The goals of practice guidelines are to improve quality of care and to provide a more objective measure of standard of care for the legal system and the health insurance industry. Practice guidelines may eventually reduce the number and cost of malpractice actions. Historically, the standard of care for pediatric eye and vision examination has been the subject of controversy. Issues of disagreement include the amount of ocular health testing that should be performed and the determination of appropriate emphasis on functional vision. This paper summarizes the precedents that have established a legal standard of care for pediatric eye and vision examination. METHODS: A review of malpractice claims relevant to pediatric optometry was conducted. Public health policy, legal, and malpractice literature was also consulted for current views on practice guidelines. The recent AOA Optometric Clinical Practice Guidelines for Pediatric Eye and Vision Examination were compared to this review. RESULTS: Standards of care for pediatric eye examination should minimally include assessment of visual acuity, refractive error, binocular vision, functional vision, and eye health assessment including dilated funds examination with a binocular indirect ophthalmoscope. These standards are commensurate with the AOA Guidelines. CONCLUSIONS: The AOA Optometric Clinical Practice Guidelines for Pediatric Eye and Vision Examination is compared to the current standard of care for pediatric optometry. It is concluded that the Guidelines are appropriate. Optometrists should integrate these practices into patient care, and the optometric profession should seek to obtain wide spread acceptance of the Guidelines.

Adolescent↗
PubMed1994

Impact of quality-of-care factors on pediatric intensive care unit mortality.

OBJECTIVE: To determine the importance of the following care factors previously associated with hospital quality on survival from pediatric intensive care: size of the intensive care unit (ICU), medical school teaching status of the hospital housing the ICU, specialist status (pediatric intensivist), and unit coordination. DESIGN: After a national survey, consecutive case series were collected at 16 sites randomly selected to represent unique combinations of quality-of-care factors. SETTING: Pediatric ICUs. PATIENTS: Consecutive admissions to each site. MAIN OUTCOME MEASURE: Patient mortality adjusted for physiologic status, diagnosis, and other mortality risk factors. RESULTS: There were 5415 pediatric ICU admissions and 248 ICU deaths. The ICUs differed significantly with respect to descriptive variables, including mortality (range, 2.2% to 16.4%). Analysis of risk-adjusted mortality indicated that the hospital teaching status and the presence of a pediatric intensivist were significantly associated with a patient's chance of survival. The probability of patient survival after hospitalization in an ICU located in a teaching hospital was decreased (relative odds of dying, 1.79; 95% confidence interval [CI], 1.23 to 2.61; P = .002). In contrast, the probability of patient survival after hospitalization in an ICU with a pediatric intensivist was improved (relative odds of dying, 0.65; 95% CI, 0.44 to 0.95; P = .027). Post hoc analysis indicated that the higher severity-adjusted mortality in teaching hospitals may be explained by the presence of residents caring for ICU patients. CONCLUSION: Characteristics indicative of the best overall hospital quality may not be associated, or may be negatively associated, with quality of care in specialized care areas, including the pediatric ICU.

Child↗
PubMed1993

Behavioral pediatrics: its past and its future.

What can one predict about the future of behavioral pediatrics? How can its present academic status be enhanced? What anticipatory guidance can be offered to behavioral pediatrics fellows? The evolution of ambulatory pediatrics and adolescent medicine as academic disciplines offers a historical perspective that helps answer these questions. The similarities between these sister disciplines and behavioral pediatrics are identified along with the principles that guided their development. Likewise, promoting factors and potential future initiatives for behavioral pediatrics are presented. A checklist of career success predictors is included. The establishment of Sections of Personal Health Promotion in departments of pediatrics is suggested as a means to augment the creativity, resources, and critical mass available to Sections of Behavioral Pediatrics.

Behavioral Medicine↗
PubMed1993

Management of cardiopulmonary and trauma resuscitation in the pediatric emergency department.

The etiology and management of critical illness and injury in a pediatric emergency department were reviewed to survey the use of cardiopulmonary and trauma resuscitation and to compare these data with the educational content of Pediatric Advanced Life Support (PALS) courses. The emergency department records of 183 patients treated in the cardiopulmonary/trauma resuscitation room of a pediatric emergency department over a 17-month period were reviewed for data on diagnosis, morbidity, presence of apnea or pulselessness, and utilization of several resuscitation skills: intubation, cardioversion, tibial interosseous line placement, and other resuscitation techniques. Apneic and pulseless pediatric patients had poor survival (10.3%), but apneic patients had excellent survival (96.9%). Endotracheal intubation (57.9%), bag-valve-mask ventilation (63.9%), and medications for rapid-sequence induction of anesthesia prior to endotracheal intubation (25.7%) were used frequently. Inasmuch as asystole was the most common rhythm in pulseless patients, cardioversion and defibrillation were rarely used (2.2%). Specialized vascular access techniques, tibial interosseous lines (24.0%), and femoral intravenous lines (19.7%), were used frequently in pediatric patients. The frequent use of airway management skills and the excellent survival of apneic pediatric patients supports the current emphasis on airway management in PALS courses. Cardioversion/defibrillation should receive less emphasis in PALS courses. The frequent use of rapid-sequence induction of anesthesia prior to endotracheal intubation indicates that these techniques might warrant increased emphasis in the training of pediatric emergency department personnel and in PALS courses.

Apnea↗
PubMed1999

The role of serial radiographs in the management of pediatric torus fractures.

OBJECTIVES: To assess the utility of radiographs taken immediately after the application of a cast in the management of pediatric torus (or buckle) fractures and to determine the need for serial radiographs taken at follow-up visits. DESIGN: Retrospective medical record review; survey questionnaire of a panel of experts. SETTING: The pediatric emergency department (PED) and the pediatric orthopedic clinic at an urban, tertiary care hospital. PATIENTS: All children with torus fractures referred to the pediatric orthopedic clinic for follow-up visits between February 1995 and February 1997. MAIN OUTCOME MEASURES: The number of patients whose postcast studies was obtained in the PED; number of follow-up visits and studies conducted at the pediatric orthopedic clinic; usual regional practices as extracted from a panel of experts by survey questionnaire. RESULTS: Of 70 patients, 46 (66%) were evaluated by a single, precast study in the PED, and 24 (34%) were evaluated by both precast and postcast studies in the PED. The time range of the first follow-up study was the first to fifth week after the patient's injury. The range of the number of follow-up studies for each patient was 0 to 5. Our cohort's total radiology charges for 70 patients were $27251. Regional directors of pediatric orthopedic surgery unanimously agreed that postcast studies in the PED are unnecessary. The range of the number of follow-up studies they obtained is 0 to 3 per patient. CONCLUSIONS: Postcast studies of torus fractures are unnecessary. Multiple radiographs taken during follow-up visits, especially early in the healing process, do not change fracture management. Relying on the clinical examination, perhaps combined with a single follow-up study, is a more appropriate regimen for the management of pediatric torus fractures and translates into a cost savings of over $ 10000 for our 70 patients.

Boston↗
PubMed2001

Removing the pediatric cervical collar: current practice patterns.

OBJECTIVES: To identify the current practice patterns of emergency medicine practitioners and the typical criteria used in discontinuing cervical spine immobilization (CSI) in the pediatric patient. DESIGN: Mail-in survey. PARTICIPANTS: All physicians on the mailing list of the American Academy of Pediatrics Section of Emergency Medicine and an equal number of randomly chosen members of the American College of Emergency Physicians. The total number of participants was 1360. METHODS: The survey consisted of a case scenario describing a 3-year-old child brought to the emergency department with CSI. The approach to such a scenario was assessed. Surveys were mailed with self-addressed stamped envelopes; repeat mailings were sent at 4 and 8 weeks after the first mailing. Those not currently in active practice or not involved in the decision to discontinue CSI were excluded from the study. RESULTS: The response rate was 55%. Most respondents were younger than 44 years (71%), in practice less than 10 years (56%), and practiced in an urban setting (68%). Nearly two thirds (62.6%) had completed residency training in pediatrics, 24% in emergency medicine and 36% a pediatric emergency medicine fellowship. Most (63%) would discontinue CSI without obtaining radiographs. Factors associated with removal were residency training in pediatrics and being in practice for less than 10 years. The most common criteria for discontinuing CSI were normal neurological (96%) and cervical spine (98%) examinations, normal mental status (92%), and absence of neck pain (93%). CONCLUSIONS: Discontinuing CSI without obtaining radiographs is common, especially among those with residency training in pediatrics and those in practice for less than 10 years. Knowledge of current practice is essential to future development of guidelines for managing pediatric trauma patients for whom cervical spine injury is a consideration.

Adult↗
PubMed2006

Racial and ethnic disparities in pediatric tuberculosis in North Carolina.

OBJECTIVES: To investigate an increase in active pediatric tuberculosis (TB) cases in North Carolina from 9 cases in 2001 to 32 cases in 2002, and to pilot test a screening tool for detection of latent TB infection in children. DESIGN: Retrospective cohort and cross-sectional study. SETTING: State of North Carolina and a county public health department pediatric clinic. PARTICIPANTS: Children younger than 15 years with TB in North Carolina from January 1, 1994, to December 31, 2002, and children younger than 21 years initially seen in a primary care public health department pediatric clinic from July 16, 2004, to December 8, 2004. INTERVENTIONS: We reviewed medical records for 180 children (<15 years) with active TB reported in North Carolina. We subsequently initiated a screening project at a county public health department pediatric clinic. MAIN OUTCOME MEASURES: Incidence of TB and prevalence of latent TB infection. RESULTS: One hundred eighty pediatric TB cases were reported from 1994 to 2002. Compared with 0.2 case per 100 000 non-Hispanic white children, the incidence rates were 3.0 cases per 100 000 non-Hispanic black children (P = .003) and 4.5 cases per 100 000 Hispanic children (P = .01); 88.3% of pediatric patients with TB were nonwhite. The screening project detected 2 cases of latent TB infection among 864 US-born children of foreign-born parents. CONCLUSIONS: The burden of pediatric TB is almost entirely borne by black and Hispanic children in North Carolina. Tuberculin skin testing of US-born children of foreign-born parents is of low yield; more efficient screening strategies are necessary.

Adolescent↗
PubMed2000

Mapping of a gene for severe pediatric gastroesophageal reflux to chromosome 13q14.

CONTEXT: Gastroesophageal reflux (GER) has not previously been widely regarded as a hereditary disease. A few reports have suggested, however, that a genetic component may contribute to the incidence of GER, especially in its severe or chronic forms. OBJECTIVE: To identify a genetic locus that cosegregates with a severe pediatric GER phenotype in families with multiple affected members. DESIGN: A genome-wide scan of families affected by severe pediatric GER using polymorphic microsatellite markers spaced at an average of 8 centimorgans (cM), followed by haplotyping and by pairwise and multipoint linkage analyses. SETTING: General US community, with research performed in a university tertiary care hospital. SUBJECTS: Affected and unaffected family members from 5 families having multiple individuals affected by severe pediatric GER, identified through a patient support group. MAIN OUTCOME MEASURES: Determination of inheritance patterns and linkage of a genetic locus with the severe pediatric GER phenotype by logarithm-of-odds (lod) score analysis, considering a lod score of 3 or greater as evidence of linkage. RESULTS: In these families, severe pediatric GER followed an autosomal dominant hereditary pattern with high penetrance. A gene for severe pediatric GER was mapped to a 13-cM region on chromosome 13q between microsatellite markers D13S171 and D13S263. A maximum multifamily 2-point lod score of 5.58 and a maximum multifamily multipoint lod score of 7.15 were obtained for marker D13S1253 at map position 35 cM when presumptively affected persons were modeled as unknown (a maximum multipoint score of 4.88 was obtained when presumptively affected persons were modeled as unaffected). CONCLUSION: These data suggest that a gene for severe pediatric GER maps to chromosome 13q14. JAMA. 2000;284:325-334

Child↗
PubMed2001

Epstein-Barr virus (EBV) in Chinese pediatric Hodgkin disease: Hodgkin disease in young children is an EBV-related lymphoma.

BACKGROUND: The Epstein-Barr virus (EBV) is thought to be involved in the pathogenesis of some Hodgkin disease (HD) cases. EBV may be associated particularly with childhood HD, a disease rare in the West compared with developing countries. In this study, a large series of Chinese pediatric HD cases has been examined to determine the age-specific prevalence of EBV. METHODS: Paraffin sections from 104 pediatric and 52 adult Chinese HD cases were examined for EBV-RNA (EBERs) and EBV latent membrane protein-1. RESULTS: Most pediatric cases arose in boys and showed an histology of mixed cellularity. Prominent interfollicular involvement was seen frequently in the childhood cases. EBV was identified in tumor cells in 113 of 156 (72%) HD cases but was more frequent in pediatric cases (93 of 104; 89%) compared with adult cases (20 of 52; 38%) (P < 0.01; chi-square test). EBV was found in 86 out of 91 (95%) cases in children aged 3-10 years and in 7 out of 13 (54%) cases in children aged 11-14 years (P < 0.01; chi-square test). The virus was less frequent in cases in young adults than in old adults, although this trend was not significant (P > 0.05; chi-square test). Pediatric HD was associated with EBV irrespective of histologic subtype. In adults, EBV was associated more frequently with mixed cellularity than with other subtypes. CONCLUSION: To the authors' knowledge, this is to date the largest series of pediatric HD cases studied for EBV. Study findings provided further evidence that HD is etiologically heterogeneous. The authors believe that pediatric HD now should be regarded as a distinctive EBV-related lymphoma.

Adolescent↗
PubMed1993

Pharmacokinetics of the new antiasthma and antiallergy drug, azelastine, in pediatric and adult beagle dogs.

The plasma concentrations and relative bioavailability of azelastine hydrochloride (AZ) and its desmethyl metabolite (DAZ) after a single and 10 once-a-day oral doses of 2.5 mg kg-1 AZ were determined in adult male and female and pediatric male and female beagle dogs. The pediatric and adult dogs were 4-6 weeks and 1-2 years of age, respectively. An analysis of variance (ANOVA) was performed on the bioavailability parameters among all groups and between the first and last doses. No statistically significant (p < 0.05) sex-related differences in the bioavailability parameters were observed. The peak concentration (Cmax) of AZ, especially after the first dose, was significantly higher in pediatric dogs than that in adult dogs, whereas following the multiple AZ administrations, the bioavailability parameters for the last dose were similar in the two age groups. The apparent volume of distribution (Vss) of AZ suggested that the drug was extensively distributed into tissue in adult as well as in pediatric dogs. The Vss was considerably smaller in pediatric dogs, which may explain the higher Cmax in this age group. The bioavailability of the metabolite in adult dogs after multiple administration of AZ was higher than that in pediatric dogs. Although some differences in the parameters among the groups are statistically significant, they do not appear to have any biological significance. Therefore, similar AZ dosages may be required in pediatric and in adult populations to achieve optimum therapeutic drug levels.

Animals↗
PubMed2003

Aberrant DNA methylation in pediatric patients with acute lymphocytic leukemia.

BACKGROUND: Aberrant methylation of promoter-associated cystosine-guanine (CpG) islands is an epigenetic modification of DNA frequently observed in adult patients with acute lymphocytic leukemia (ALL). This epigenetic modification has been associated with gene silencing, malignant transformation, and aging. It is not known whether there are epigenetic differences between pediatric patients and adult patients with ALL. METHODS: To investigate the methylation characteristics of pediatric patients with ALL and to determine whether DNA methylation can explain prognostic or biologic differences between pediatric and adult patients, the authors analyzed the methylation status of 7 promoter-associated CpG islands in 16 pediatric patients with ALL and compared them with the methylation characteristics of a cohort of adult patients with ALL. The genes analyzed included the estrogen receptor gene (ER), multidrug resistance gene 1 (MDR1), p15, C-ABL, CD10, p16, and p73. RESULTS: The mean methylation densities of ER, MDR1, CD10, p15, and C-ABL were 25.4%, 16.4%, 5.23%, 4.24%, and 4%, respectively. P16 was methylated in 11.7% of patients, and p73 was methylated in 17.6% of patients. One patient (6.2%) had methylation of 0 genes, 15 patients (93.7%) had methylation of >/= 1 gene, and 4 patients (25%) had methylation of 3-4 genes. Methylation of all these genes was < 2% (or methylation specific polymerase chain reaction negative) in nonneoplastic tissues. A significant inverse correlation was observed between methylation of CD10 and CD10 expression. No differences were observed between the methylation characteristics of pediatric patients and adult patients. CONCLUSIONS: The results indicate that DNA methylation is common in pediatric patients with ALL and that methylation of the genes studied does not account for prognostic differences between pediatric patients and adult patients with ALL.

Adolescent↗
PubMed2005

Psychosocial treatment of pediatric posttraumatic stress disorder: the neglected field of single-incident trauma.

Despite the prevalence of childhood trauma, studies regarding psychotherapy for children suffering from posttraumatic stress disorder (PTSD) are scarce, especially regarding the treatment for pediatric PTSD following single-incident trauma. Treatment practices for this population rely mainly on the paradigms of therapy for adult PTSD and pediatric PTSD following sexual abuse. This review outlines the studies published in the last 10 years pertaining to the treatment of pediatric PTSD following single-incident trauma. This is done in the context of available literature on the paradigms mentioned above. Of 742 articles dealing with treatment of pediatric trauma, 10 were found relevant to the treatment of pediatric PTSD following single-incident trauma. The modalities of treatment most frequently reported in this context were cognitive-behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), and play therapy. As a whole, CBT studies were methodologically more rigorous, used manualized, reproducible treatment, and were group, school-based therapies. EMDR treatments were usually short and individual. Most studies showed statistically significant improvement but were still methodologically lacking. We conclude that research on the subject of treatment for pediatric PTSD following single-incident trauma constitutes a neglected part of the study of pediatric PTSD. This stands in contrast to the obvious prevalence of this type of trauma. We encourage future research that will address issues such as clarifying the role of pharmacotherapy, comparing different modes of treatment, dismantling treatment "packages," researching developmentally sensitive treatments, conducting long-term follow-up, and comparing different PTSD populations.

Biofeedback, Psychology↗
PubMedDate not supplied

Respiratory function monitoring during mechanical ventilation in pediatric intensive care unit.

Noninvasive monitoring of lung function during mechanical ventilation has been used to study disease processes causing respiratory failure. Pediatric pulmonary function monitoring during mechanical ventilation in the pediatric intensive care unit in patient with respiratory failure is becoming more common in western countries. The article describes a review of principles and methods of respiratory function monitoring in the pediatric age group. It attempts to incorporate experience from original articles previously published as well as the experience in monitoring pulmonary mechanics at our institution. Routine monitoring of pulmonary mechanics in patients being mechanically ventilated may have significant impact on morbidity and/or mortality of pediatric patients with respiratory failure. Key articles pertaining to lung function testing in pediatric age group from past 15 years were used as well as clinical experience encountered by attending pediatric intensivists at Henrico Doctors' Hospital was incorporated. Over the past ten years the use of monitoring of gas exchange and bedside pulmonary mechanics monitoring as a part of respiratory function monitoring has become more common. With better clinical information to precisely document the status of lung function, it may lead to improved methods of ventilator management which may prevent complications and may significantly impact on morbidity and/or mortality of mechanically ventilated pediatric patients.

Child↗
PubMed2002

[Pediatric prehospital trauma care. A retrospective comparison of air and ground transportation].

OBJECTIVE: In contrast to prehospital care of adult trauma victims, prehospital care providers have only limited clinical experience of pediatric trauma cases as these are relatively infrequent. Literature reports on prehospital pediatric trauma care given by paramedics are frequently found in the literature, but there are few publications analyzing the quality of prehospital trauma care provided by emergency physicians in the care of injured children. It was the goal of this study to analyze the prehospital care of the pediatric trauma victims transported to a trauma center by physician-staffed ambulances and helicopters. METHODS: The study took the form of a retrospective 5-year review of pediatric trauma patients admitted to a trauma center. The inclusion criteria were age younger than 13 years and a NACA score higher than 3. In all, 104 patients were included, and these were divided into two groups, those transported to hospital by helicopter (RTH, n=87) and those taken to hospital by road ambulance (NEF, n=17). RESULTS: With a mean NACA score of 4.6 and a mean ISS of 15, no significant differences were found between the two groups in either severity of injury or length of hospital stay. The mortality of the total patient population was 15.4%, with no evidence of preventable deaths in patients who were admitted to the trauma center with vital signs. Analysis of prehospital therapy showed no differences in the volume of intravenous fluids administered (RTH 636 ml vs NEF 476 ml) or in the proportion of children with a GCS<9 in whom endotracheal intubation was implemented (RTH 39/44 vs NEF 7/7). Placement of more than one i.v. line and endotracheal intubation were associated with longer times at the scene of the accident before patients were taken to hospital (>one i.v. corresponded to 9 min longer, and endotracheal intubation, to 10 min longer). CONCLUSIONS: Prehospital pediatric trauma care delivered by physician-staffed ambulances or rescue helicopters is associated with a high rate of i.v. line placement (92%) and high intubation rates (90%) in patients with an altered level of consciousness (GCS<9). The prehospital care provided by helicopter or ground ambulance personnel was not different and was not associated with longer stays in the intensive care unit or longer overall stays in hospital. Scene times became longer with increasing number of i.v. line placements and with endotracheal intubation, but was not prolonged by a greater severity of injury as determined by the ISS. Preventable deaths were not observed in the patient population. In summary, owing to the the local infrastructure, pediatric trauma patients are more frequently transported to the trauma center by air (87 by air vs. 17 by road per 5-year time period). However, despite being less frequently involved in the case of pediatric trauma, the quality of care provided by road ambulance staff is similar to that in air ambulances.

Air Ambulances↗