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Dundaru-Bandi D, Antel R, Ingelmo P. Advances in pediatric perioperative care using artificial intelligence. Curr Opin Anaesthesiol 2024; 37:251-258. [PMID: 38441085 DOI: 10.1097/aco.0000000000001368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE OF THIS REVIEW This article explores how artificial intelligence (AI) can be used to evaluate risks in pediatric perioperative care. It will also describe potential future applications of AI, such as models for airway device selection, controlling anesthetic depth and nociception during surgery, and contributing to the training of pediatric anesthesia providers. RECENT FINDINGS The use of AI in healthcare has increased in recent years, largely due to the accessibility of large datasets, such as those gathered from electronic health records. Although there has been less focus on pediatric anesthesia compared to adult anesthesia, research is on- going, especially for applications focused on risk factor identification for adverse perioperative events. Despite these advances, the lack of formal external validation or feasibility testing results in uncertainty surrounding the clinical applicability of these tools. SUMMARY The goal of using AI in pediatric anesthesia is to assist clinicians in providing safe and efficient care. Given that children are a vulnerable population, it is crucial to ensure that both clinicians and families have confidence in the clinical tools used to inform medical decision- making. While not yet a reality, the eventual incorporation of AI-based tools holds great potential to contribute to the safe and efficient care of our patients.
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Affiliation(s)
| | - Ryan Antel
- Department of Anesthesia, McGill University
| | - Pablo Ingelmo
- Department of Anesthesia, McGill University
- Division of Pediatric Anesthesia
- Edwards Family Interdisciplinary Center for Complex Pain. Montreal Children's Hospital
- Research Institute, McGill University Health Center
- Alan Edwards for Research on Pain. McGill University, Montreal, Quebec, Canada
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Barry HC. Ultrasonography Is Accurate for Diagnosing Upper Extremity Fractures in Children. Am Fam Physician 2021; 104:Online. [PMID: 34913666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Weber C. Solving Unmet Needs With Innovative Pediatric Medical Devices. IEEE Pulse 2021; 12:24-27. [PMID: 33606620 DOI: 10.1109/mpuls.2021.3053755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In the last decade, only 24% of class III life-saving devices approved by the U.S. Food and Drug Administration (FDA) were for pediatric use-and most of those were for children over 12. Of these, less than 4% were labeled for pediatric patients ages 0-2 years old and the number of approved devices is even lower for neonatal patients. For these young patients, adult medical devices are often manipulated by pediatric specialists in order to provide stop-gap solutions. However, these repurposed devices are not always able to fulfill the unique needs of children's biology and growth patterns.
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Crulli B, Kawaguchi A, Praud JP, Petrof BJ, Harrington K, Emeriaud G. Evolution of inspiratory muscle function in children during mechanical ventilation. Crit Care 2021; 25:229. [PMID: 34193216 PMCID: PMC8243304 DOI: 10.1186/s13054-021-03647-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is no universally accepted method to assess the pressure-generating capacity of inspiratory muscles in children on mechanical ventilation (MV), and no study describing its evolution over time in this population. METHODS In this prospective observational study, we have assessed the function of the inspiratory muscles in children on various modes of MV. During brief airway occlusion maneuvers, we simultaneously recorded airway pressure depression at the endotracheal tube (ΔPaw, force generation) and electrical activity of the diaphragm (EAdi, central respiratory drive) over five consecutive inspiratory efforts. The neuro-mechanical efficiency ratio (NME, ΔPaw/EAdimax) was also computed. The evolution over time of these indices in a group of children in the pediatric intensive care unit (PICU) was primarily described. As a secondary objective, we compared these values to those measured in a group of children in the operating room (OR). RESULTS In the PICU group, although median NMEoccl decreased over time during MV (regression coefficient - 0.016, p = 0.03), maximum ΔPawmax remained unchanged (regression coefficient 0.109, p = 0.50). Median NMEoccl at the first measurement in the PICU group (after 21 h of MV) was significantly lower than at the only measurement in the OR group (1.8 cmH2O/µV, Q1-Q3 1.3-2.4 vs. 3.7 cmH2O/µV, Q1-Q3 3.5-4.2; p = 0.015). Maximum ΔPawmax in the PICU group was, however, not significantly different from the OR group (35.1 cmH2O, Q1-Q3 21-58 vs. 31.3 cmH2O, Q1-Q3 28.5-35.5; p = 0.982). CONCLUSIONS The function of inspiratory muscles can be monitored at the bedside of children on MV using brief airway occlusions. Inspiratory muscle efficiency was significantly lower in critically ill children than in children undergoing elective surgery, and it decreased over time during MV in critically ill children. This suggests that both critical illness and MV may have an impact on inspiratory muscle efficiency.
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Affiliation(s)
- Benjamin Crulli
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Université de Montréal, 3175 chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Atsushi Kawaguchi
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Université de Montréal, 3175 chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
- Pediatric Intensive Care Unit, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
- Department of Intensive Care Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Jean-Paul Praud
- Neonatal Respiratory Research Unit, Departments of Pediatrics and Pharmacology-Physiology, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Basil J Petrof
- Meakins-Christie Laboratories and Translational Research in Respiratory Diseases Program, McGill University Health Centre and Research Institute, 1001 Boulevard Décarie, Montreal, QC, H4A 3J1, Canada
| | - Karen Harrington
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Université de Montréal, 3175 chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Guillaume Emeriaud
- Pediatric Intensive Care Unit, CHU Sainte-Justine, Université de Montréal, 3175 chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada.
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Hilty DM, Zalpuri I, Torous J, Nelson EL. Child and adolescent asynchronous technology competencies for clinical care and training: Scoping review. Fam Syst Health 2021; 39:121-152. [PMID: 33151726 DOI: 10.1037/fsh0000536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Objective: Asynchronous technologies such as mobile health, e-mail, e-consult, and social media are being added to in-person and synchronous service delivery. To ensure quality care, clinicians need skills, knowledge, and attitudes related to technology that can be measured. This study sought out competencies for asynchronous technologies and/or an approach to define them. Methods: This 6-stage scoping review of Pubmed/Medline, APA PsycNET, PsycINFO and other databases was based on a broad research question, "What skills are needed for clinicians and trainees to provide quality care using asynchronous technologies for children and adolescents, and how can they be made measurable to implement, teach and evaluate?" The search focused on key words in 4 concept areas: (a) competencies; (b) asynchronous technology; (c) synchronous telepsychiatry, telebehavioral or telemental health; and (d) clinical. The screeners reviewed the full-text articles based on inclusion (mesh of the key words) and exclusion criteria. Results: From a total of 5,877 potential references, 2 authors found 509 eligible for full text review and found 110 articles directly relevant to the concepts. Clinical studies discuss clinical, technical and administrative workflow rather than competencies, though behavioral health professions' position statements advise on adapting care and training. Existing technology competencies for video, social media, mobile health, and other asynchronous technologies were used to build a framework. Training, faculty development, and organizational suggestions are suggested. Conclusions: Research is needed on how to implement and evaluate asynchronous competencies to ensure quality clinical care and training, which is a paradigm shift for participants. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Donald M Hilty
- Northern California Veterans Administration Health Care System
| | - Isheeta Zalpuri
- Department of Psychiatry, Pediatric Mood Disorders Clinic, Stanford University Medical Center
| | - John Torous
- Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Eve-Lynn Nelson
- Department of Pediatrics, Kansas City Medical Center, University of Kansas School of Medicine, University of Kansas
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De Luca D, Cogo P, Kneyber MC, Biban P, Semple MG, Perez-Gil J, Conti G, Tissieres P, Rimensberger PC. Surfactant therapies for pediatric and neonatal ARDS: ESPNIC expert consensus opinion for future research steps. Crit Care 2021; 25:75. [PMID: 33618742 PMCID: PMC7898495 DOI: 10.1186/s13054-021-03489-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/04/2021] [Indexed: 12/14/2022] Open
Abstract
Pediatric (PARDS) and neonatal (NARDS) acute respiratory distress syndrome have different age-specific characteristics and definitions. Trials on surfactant for ARDS in children and neonates have been performed well before the PARDS and NARDS definitions and yielded conflicting results. This is mainly due to heterogeneity in study design reflecting historic lack of pathobiology knowledge. We reviewed the available clinical and preclinical data to create an expert consensus aiming to inform future research steps and advance the knowledge in this area. Eight trials investigated the use of surfactant for ARDS in children and ten in neonates, respectively. There were improvements in oxygenation (7/8 trials in children, 7/10 in neonates) and mortality (3/8 trials in children, 1/10 in neonates) improved. Trials were heterogeneous for patients' characteristics, surfactant type and administration strategy. Key pathobiological concepts were missed in study design. Consensus with strong agreement was reached on four statements: 1. There are sufficient preclinical and clinical data to support targeted research on surfactant therapies for PARDS and NARDS. Studies should be performed according to the currently available definitions and considering recent pathobiology knowledge. 2. PARDS and NARDS should be considered as syndromes and should be pre-clinically studied according to key characteristics, such as direct or indirect (primary or secondary) nature, clinical severity, infectious or non-infectious origin or patients' age. 3. Explanatory should be preferred over pragmatic design for future trials on PARDS and NARDS. 4. Different clinical outcomes need to be chosen for PARDS and NARDS, according to the trial phase and design, trigger type, severity class and/or surfactant treatment policy. We advocate for further well-designed preclinical and clinical studies to investigate the use of surfactant for PARDS and NARDS following these principles.
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Affiliation(s)
- Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, 157 Rue de la Porte de Trivaux, 92140, Clamart (Paris-IDF), France.
- Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France.
| | - Paola Cogo
- Department of Pediatrics, University of Udine, Udine, Italy
| | - Martin C Kneyber
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Beatrix Children's Hospital Groningen, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Critical Care, Anesthesiology, Peri-Operative and Emergency Medicine (CAPE), University of Groningen, Groningen, The Netherlands
| | - Paolo Biban
- Department of Neonatal and Pediatric Critical Care, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Malcolm Grace Semple
- Health Protection Research Unit in Emerging and Zoonotic Infections, Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - Jesus Perez-Gil
- Department of Biochemistry and Molecular Biology and Research Institute "Hospital 12 de Octubre", Complutense University, Madrid, Spain
| | - Giorgio Conti
- Department of Anesthesiology and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy
| | - Pierre Tissieres
- Division of Pediatric Critical Care and Neonatal Medicine, "Kremlin-Bicetre" Medical Center, Paris Saclay University Hospitals, APHP, Paris, France
- Integrative Cellular Biology Institute-UMR 9198, Host-Pathogen Interactions Team, Paris Saclay University, Paris, France
| | - Peter C Rimensberger
- Division of Neonatology and Pediatric Critical Care, Department of Pediatrics, University Hospital of Geneva, University of Geneva, Geneva, Switzerland
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Hochart A, Momal R, Garrigue-Huet D, Drumez E, Susen S, Bijok B. Prothrombin Time ratio can predict mortality in severe pediatric trauma: Study in a French trauma center level 1. Am J Emerg Med 2020; 38:2041-2044. [PMID: 33142171 DOI: 10.1016/j.ajem.2020.06.075] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/16/2020] [Accepted: 06/24/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Injury results in more deaths in children than all other causes combined, but there is little data regarding the association of early coagulopathy on outcomes in pediatric patients with traumatic injuries. The aim of this study was to determine the optimal cut-off value for the Prothrombin Time ratio (PTr) and to show the diagnostic characteristics of the PTr to predict mortality. METHODS We retrospectively included during 4 years all patients less than 16 years old referred to our trauma center for traumatic injury with ISS ≥9. RESULTS A total of 272 children were included. Mean age was 9.4 ± 4.8 years and median ISS was 17 [interquartile range, 12 to 26]. Day 28 mortality was 6.7%. The optimal cut-off value in our population for predicting day 28 mortality was 1.24. Using this value, the sensitivity of PTr was 84%, specificity was 82%, positive likelihood ratio was 4.7, and negative likelihood ratio was 0.19. Early mortality (i.e., mortality at 24 h) was also well-predicted (1.0% versus 16.4%, p < .0001), as the need for massive transfuion. Similarly, patients with PTr ≥1.24 at admission presented with a higher rate of severe thoracic and abdominal trauma, higher ISS, higher likelihood of admission to an intensive care unit, longer hospitalization, and higher rate of significant procedure (e.g., surgery or embolization). CONCLUSIONS Trauma-induced coagulopathy defined only by a PTr ≥1.24 could be used as a severity predictive marker and as a sensitive, specific, quick, and easy to use tool for admission triage of pediatric patients.
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Affiliation(s)
- Audrey Hochart
- CHU Lille, Institut d'Hématologie et de Transfusion, F-59000 Lille, France.
| | - Romain Momal
- CHU de Lille, Pôle d'anesthésie-réanimation, Lille F-59000, France.
| | - Delphine Garrigue-Huet
- CHU de Lille, Pôle d'anesthésie-réanimation, Lille F-59000, France; CHU Lille, Pôle de l'Urgence, Lille F-59000, France.
| | - Elodie Drumez
- Univ. Lille, CHU Lille, Unité de biostatistiques, EA 2694, F-59000 Lille, France.
| | - Sophie Susen
- CHU Lille, Institut d'Hématologie et de Transfusion, F-59000 Lille, France.
| | - Benjamin Bijok
- CHU de Lille, Pôle d'anesthésie-réanimation, Lille F-59000, France; CHU Lille, Pôle de l'Urgence, Lille F-59000, France.
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Takahashi S, Iwasaki K, Shirato H, Ho M, Umezu M. Comparison of supportive regulatory measures for pediatric medical device development in Japan and the United States. J Artif Organs 2020; 24:90-101. [PMID: 33079285 PMCID: PMC7889561 DOI: 10.1007/s10047-020-01216-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/09/2020] [Indexed: 11/26/2022]
Abstract
Further development of medical devices for children is required in Japan, but the development of such devices is delayed compared to that of medical devices for adults. Herein, we investigated policies for advancing the development of pediatric medical devices in Japan and the United States. Considering the achievements of each policy, we proposed a strategy to promote further development of pediatric medical devices in Japan. We investigated policies for supporting the development of pediatric medical devices and approved cases in Japan and the United States by searching contents of websites of regulatory bodies and other related administrations, and scientific papers. We found the main six policies in Japan and nine main policies in the United States for the development of pediatric medical devices. In the United States, various measures have initiated mainly in the 2000s, while in Japan, the main measures have been in place since 2013. Similarities were found in both countries, such as subsidies for application fees and research and development expenses, exemption of requirements for regulatory approval, and priority review and consultation by the regulatory body. Our study revealed that there are similarities in initiatives by both countries. To promote further development of pediatric medical devices in the future, improvements to expediting the review process to approval by the regulatory body, global development, and implementation of alternative measures to ensure the efficacy and safety of the device instead of large-scale clinical trials should be anticipated through cooperation among industry, government, and academia.
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Affiliation(s)
- Sara Takahashi
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Waseda University, 2-2 Wakamatsucho, Shinjuku, Tokyo, 1628480, Japan.
- Office of Medical Devices I, Pharmaceuticals and Medical Devices Agency, Shin-Kasumigaseki Building, 3-3-2, Kasumigaseki, Chiyoda-ku, Tokyo, 100-0013, Japan.
| | - Kiyotaka Iwasaki
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Waseda University, 2-2 Wakamatsucho, Shinjuku, Tokyo, 1628480, Japan.
- Department of Modern Mechanical Engineering, Graduate School of Creative Science and Engineering, Waseda University, 2-2 Wakamatsucho, Shinjuku, Tokyo, 1628480, Japan.
- Department of Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University, 2-2 Wakamatsucho, Shinjuku, Tokyo, 1628480, Japan.
| | - Haruki Shirato
- Office of Medical Devices I, Pharmaceuticals and Medical Devices Agency, Shin-Kasumigaseki Building, 3-3-2, Kasumigaseki, Chiyoda-ku, Tokyo, 100-0013, Japan
| | - Mami Ho
- Office of Medical Devices I, Pharmaceuticals and Medical Devices Agency, Shin-Kasumigaseki Building, 3-3-2, Kasumigaseki, Chiyoda-ku, Tokyo, 100-0013, Japan
| | - Mitsuo Umezu
- Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Waseda University, 2-2 Wakamatsucho, Shinjuku, Tokyo, 1628480, Japan
- Department of Modern Mechanical Engineering, Graduate School of Creative Science and Engineering, Waseda University, 2-2 Wakamatsucho, Shinjuku, Tokyo, 1628480, Japan
- Department of Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University, 2-2 Wakamatsucho, Shinjuku, Tokyo, 1628480, Japan
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Zhang M, Fan Y, Tian C, Xie Y, Huang Y, Yang S, Zhang Q. The efficacy and safety of Chinese herbal compound in pediatric patients with allergic rhinitis: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e21643. [PMID: 32769932 PMCID: PMC7592995 DOI: 10.1097/md.0000000000021643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND We design this study to assess the efficacy and safety of Chinese herbal compound for allergic rhinitis in children. METHODS PubMed, EMbase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang, the Chongqing VIP Chinese Science and Technology Periodical Database, and China biomedical literature database (CBM) will be searched from the establishment of each database to July 2020. Randomized controlled trials of Chinese herbal compound for the treatment of allergic rhinitis in children will be included. Two researchers will screen the literature, extract data, and assess the risk of bias independently. Statistical analysis will be performed in RevMan 5.3. RESULTS This study will summarize high quality evidence of randomized controlled trials on exploring the efficacy and safety of Chinese herbal compound for allergic rhinitis in children. CONCLUSIONS The findings of study will provide scientific evidence of the efficacy and safety of Chinese herbal compound for allergic rhinitis in children for clinician and further studies. ETHICS AND DISSEMINATION The private information from individuals will not be published. This systematic review also will not involve endangering participant rights. Ethical approval is not required. The results may be published in a peer-reviewed journal or disseminated in relevant conferences. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/Q5TRZ.
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Affiliation(s)
- Mengni Zhang
- Chengdu University of Traditional Chinese Medicine
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan province
| | - Yihua Fan
- Tianjin University of Traditional Chinese Medicine, Tianjin
| | - Chunying Tian
- Tianjin University of Traditional Chinese Medicine, Tianjin
| | - Yue Xie
- Tianjin University of Traditional Chinese Medicine, Tianjin
| | - Yao Huang
- Chengdu University of Traditional Chinese Medicine
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan province
| | - Shasha Yang
- First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou province
| | - Qinxiu Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan province
- School of Medical and Life Sciences/Reproductive & Women-Children Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Abstract
CONTEXT Endotracheal intubation of pediatric patients is challenging, especially in the pre-hospital emergency setting and if performed by less experienced providers. Securing an airway should be achieved with a single intubation attempt, as each intubation attempt contributes to morbidity and mortality. A new airway device, the VieScope, was recently introduced into clinical market, but efficacy to reduced intubation attempts remains unclear thus far. OBJECTIVE We aimed to compare endotracheal intubation by paramedics using the Vie Scope in different pediatric airway simulation conditions. METHODS We conducted a randomized, cross-over simulation study. Following a theoretical and practical training session, paramedics performed endotracheal intubation in 3 different pediatric emergency scenarios: normal airway; tongue edema; cardiopulmonary resuscitation using the VieScope. Overall intubation success rate was the primary outcome. Secondary outcomes included number of intubation attempts, time to intubation, Cormack-Lehane grade, POGO score, and ease of use (using 1-100 scale). RESULTS Fifty-five paramedics with at least 2 years of clinical experience and without any previous experience with the VieScope participated in this study. The overall intubation success rate was 100% in all 3 scenarios. The median intubation time was 27 (24-34) versus 27 (25-37) versus 29 (25-40) s for scenarios A, B, and C, respectively. In scenario A, all paramedics performed successful intubation with 1 single intubation attempt, whereas 2% of the paramedics had to perform 2 intubation attempts in scenario B and 9% in scenario C. CONCLUSIONS Results of this simulation study indicate preliminary evidence, that the VieScope enables adequate endotracheal intubation in the pediatric setting. Further clinical studies are needed to confirm these results.
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Affiliation(s)
- Maciej Maslanka
- Medical Institute of Maria Sklodowska-Curie
- Department of Medical Emergency Assistance Service, Masovian Province Council
| | - Lukasz Szarpak
- Comprehensive Cancer Center in Bialystok, Bialystok, Poland
| | - Sanchit Ahuja
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, MI
| | - Kurt Ruetzler
- Departments of Outcomes Research and General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
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Nakashima EN, Sutton CX, Yamamoto LG, Len KA. Wellness Curriculum in the Pediatric Clerkship. Hawaii J Health Soc Welf 2020; 79:50-54. [PMID: 32490386 PMCID: PMC7260878] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Psychological distress leading to burnout is an important issue during medical school. While studies have researched interventions in the pre-clerkship years, very few have targeted the clerkship years. To improve the wellness of third year medical students, the following interventions were implemented: (1) prompted students to identify two wellness goals in the areas of personal and physical well-being and (2) encouraged students to participate in meditation and chair yoga sessions during their pediatrics clerkship. Students completed pre- and post-clerkship wellness surveys. The interventions led to a small but significant improvement in the wellness of students, particularly in mental, physical, emotional, social, and spiritual well-being.Further expansion of a wellness curriculum to all clerkships during the entire third and fourth years may result in reduced burnout and sustained improvements in wellness during post graduate training and practice.
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Affiliation(s)
| | | | | | - Kyra A. Len
- Correspondence to: Kyra A. Len MD, 1319 Punahou Street, Honolulu, HI 96826;
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Winter BK, Carlton E. BET 1: Efficacy of different techniques using a metered-dose inhaler with Spacer to relieve symptoms in children with acute asthma. Emerg Med J 2020; 36:697-698. [PMID: 31641042 DOI: 10.1136/emermed-2019-209162.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A shortcut review was carried out to establish which inhaler with spacer technique provides the greatest improvement in symptoms in children with acute asthma. Four relevant papers were identified for inclusion using the reported search strategy. The author, date and country of publication; group studied; study type; relevant outcomes; results and study weaknesses of these papers are tabulated. It is concluded that a 'tidal breathing' technique, with a minimum of three breaths per inhaler activation, is likely equivalent in efficacy to a 'single breath and hold technique', and easier for a breathless child to perform.
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Wong JJM, Liu S, Dang H, Anantasit N, Phan PH, Phumeetham S, Qian S, Ong JSM, Gan CS, Chor YK, Samransamruajkit R, Loh TF, Feng M, Lee JH. The impact of high frequency oscillatory ventilation on mortality in paediatric acute respiratory distress syndrome. Crit Care 2020; 24:31. [PMID: 32005285 PMCID: PMC6995130 DOI: 10.1186/s13054-020-2741-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/14/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND High-frequency oscillatory ventilation (HFOV) use was associated with greater mortality in adult acute respiratory distress syndrome (ARDS). Nevertheless, HFOV is still frequently used as rescue therapy in paediatric acute respiratory distress syndrome (PARDS). In view of the limited evidence for HFOV in PARDS and evidence demonstrating harm in adult patients with ARDS, we hypothesized that HFOV use compared to other modes of mechanical ventilation is associated with increased mortality in PARDS. METHODS Patients with PARDS from 10 paediatric intensive care units across Asia from 2009 to 2015 were identified. Data on epidemiology and clinical outcomes were collected. Patients on HFOV were compared to patients on other modes of ventilation. The primary outcome was 28-day mortality and secondary outcomes were 28-day ventilator- (VFD) and intensive care unit- (IFD) free days. Genetic matching (GM) method was used to analyse the association between HFOV treatment with the primary outcome. Additionally, we performed a sensitivity analysis, including propensity score (PS) matching, inverse probability of treatment weighting (IPTW) and marginal structural modelling (MSM) to estimate the treatment effect. RESULTS A total of 328 patients were included. In the first 7 days of PARDS, 122/328 (37.2%) patients were supported with HFOV. There were significant differences in baseline oxygenation index (OI) between the HFOV and non-HFOV groups (18.8 [12.0, 30.2] vs. 7.7 [5.1, 13.1] respectively; p < 0.001). A total of 118 pairs were matched in the GM method which found a significant association between HFOV with 28-day mortality in PARDS [odds ratio 2.3, 95% confidence interval (CI) 1.3, 4.4, p value 0.01]. VFD was indifferent between the HFOV and non-HFOV group [mean difference - 1.3 (95%CI - 3.4, 0.9); p = 0.29] but IFD was significantly lower in the HFOV group [- 2.5 (95%CI - 4.9, - 0.5); p = 0.03]. From the sensitivity analysis, PS matching, IPTW and MSM all showed consistent direction of HFOV treatment effect in PARDS. CONCLUSION The use of HFOV was associated with increased 28-day mortality in PARDS. This study suggests caution but does not eliminate equivocality and a randomized controlled trial is justified to examine the true association.
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Affiliation(s)
- Judith Ju-Ming Wong
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
| | - Siqi Liu
- Saw Swee Hock School of Public Health, National University Health System, NUS Graduate School for Integrative Science and Engineering, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore
| | - Hongxing Dang
- Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, 136 Zhongshan 2nd Rd, Yuzhong district, Chongqing, 400041, China
| | - Nattachai Anantasit
- Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Phuc Huu Phan
- National Children's Hospital, 18/879 La Thành, Láng Thượng, Đống Đa, Hanoi, Vietnam
| | - Suwannee Phumeetham
- Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road Bangkoknoi, Bangkok, 10700, Thailand
| | - Suyun Qian
- Beijing Children's Hospital, Capital Medical University, 56 Nanlishi Rd, Xicheng District, Beijing, 100045, China
| | - Jacqueline Soo May Ong
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Chin Seng Gan
- Department of Pediatrics, University of Malaya. Jalan Universiti, 50603, Wilayah Persekutuan, Kuala Lumpur, Malaysia
| | - Yek Kee Chor
- Sarawak General Hospital, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia
| | - Rujipat Samransamruajkit
- Critical Care Excellence Center, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University Bangkok, Bangkok, 10330, Thailand
| | - Tsee Foong Loh
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Mengling Feng
- Saw Swee Hock School of Public Health, National University Health System, NUS Graduate School for Integrative Science and Engineering, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore
| | - Jan Hau Lee
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
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14
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Dagdanpurev S, Tsogzolmaa U, Sun G, Choimaa L, Abe S, Matsui T. Development of a low-cost, portable, pediatric infection screening system using simultaneous measurement of multiple vital signs. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:7181-7184. [PMID: 31947491 DOI: 10.1109/embc.2019.8857689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The primary cause of death among children under age 5 years is acute respiratory infection, such as pneumonia. Detection of infection at the earliest point of contagion is necessary, to reduce morbidity and prevent infectious disease epidemics; therefore, identifying abnormal vital signs is essential. For early detection of pediatric infections, we developed a low-cost, portable, rapid screening system of pediatric infection. The system simultaneously measures three vital signs: heart rate (HR), respiration rate (RR), and body temperature (Temp) within 10 seconds using a pulse sensor, Doppler radar, and an infrared thermopile. Vital sign signal processing and computation are conducted using an Arduino Nano microprocessor, enabling the small, lightweight, and portable design of this system. Moreover, the cost-effectiveness of the system facilitates system applications in developing countries, which have the highest levels of pediatric mortality. We conducted trial measurement in Bayangol Health Center, Ulaanbaatar, Mongolia in 2019. A total of 50 children (age 1-14 years, 26 boys/24 girls) were enrolled in this study. Bland-Altman plot and Pearson correlation methods were used to evaluate the accuracy of the proposed system. The correlation coefficients were calculated as HR: r=0.92, RR: r=0.8, and Temp: r=0.82, with p<; 0.01. The system appears promising for rapid and convenient detection of infection in children.
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15
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Carrillo L, Skibber M, Kumar A, George M, Aziz S, Harting MT, Moore LJ, Cox CS. Morphometric and Physiologic Modeling Study for Endovascular Occlusion in Pediatric Trauma Patients. ASAIO J 2020; 66:97-104. [PMID: 30913102 PMCID: PMC6856426 DOI: 10.1097/mat.0000000000000961] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The use of the resuscitative endovascular balloon occlusion of the aorta (REBOA) device is expanding in adult trauma. Reports of its use in pediatric patients have been published, but no guidelines currently exist nor has it been Food and Drug Administration approved in pediatrics. This project develops a model to determine appropriate balloon inflation volumes in pediatric patients to guide potential use. Artificial aortas were three-dimensional (3D) printed using synthetic polymers. Segments were created based on aortic diameters from 289 pediatric trauma patients' computer tomography (CT) scans. These aortic segments were inserted into a circulatory system model featuring two branches to simulate abdominal and upper body perfusion (cerebral, cardiac, and upper extremities). Sonographic flow meters and pressure transducers were placed along the circuit, and measurements were recorded as a REBOA device was inflated in the aortic segment. A negative sigmoidal relationship was observed between device inflation and aortic flow occlusion, with the initial 50% of inflation causing a 10% reduction in flow, followed by a steep decline. With increasing inflation, distal aortic flow and pressure were found to have an inverse relationship with the upper body branch metrics. In conclusion, pediatric patients present with a range of vessel diameters that occlude at various REBOA balloon inflation volumes. This study provides a basis to establish initial inflation volumes for safe REBOA deployment in appropriate pediatric trauma patients.
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Affiliation(s)
- Louis Carrillo
- From the Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas
| | - Max Skibber
- From the Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas
| | - Akshita Kumar
- From the Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas
| | - Mitchell George
- From the Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas
| | - Shahroz Aziz
- Department of Radiology, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas
| | - Matthew T Harting
- From the Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas
| | - Laura J Moore
- Texas Trauma Institute, The University of Texas Health Science Center, Houston, Texas
| | - Charles S Cox
- From the Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas
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16
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Abstract
Regular self-monitoring of blood glucose levels, and ketones when indicated, is an essential component of type 1 diabetes (T1D) management. Although fingerstick blood glucose monitoring has been the standard of care for decades, ongoing rapid technological developments have resulted in increasingly widespread use of continuous glucose monitoring (CGM). This article reviews recommendations for self-monitoring of glucose and ketones in pediatric T1D with particular emphasis on CGM and factors that impact the accuracy and real-world use of this technology.
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Affiliation(s)
- Brynn E. Marks
- Division of Endocrinology and Diabetes, Children's National Hospital, Washington, DC, United States
- *Correspondence: Brynn E. Marks
| | - Joseph I. Wolfsdorf
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, United States
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17
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Affiliation(s)
- Justin Chan
- Paul G Allen School of Computer Science & Engineering, University of Washington, Seattle, WA 98195, USA.
| | - Sharat C Raju
- Department of Otolaryngology-Head And Neck Surgery, University of Washington, Seattle, WA 98195, USA
| | - Eric Topol
- Scripps Research Translational Institute, La Jolla, CA, USA
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18
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Cui X, Liang L, Wei X, Liao X, Li Y, Cheng H, Xie Y, Cheng Y, Du Y, Liu G, Zhang H, Wang S, Liu J, Wang Z, Zhang Y, Tian Y. The efficacy, safety, and cost benefits of splints for fractures of the distal radius in children: A systematic review and meta-analysis protocol. Medicine (Baltimore) 2019; 98:e16562. [PMID: 31374022 PMCID: PMC6709099 DOI: 10.1097/md.0000000000016562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Distal radius fractures (DRFs) is one of the most common bone injuries in children, which may lead to deformity and other complications if the treatment is not prompt or appropriate. Splints external fixation is a common conservative treatment for such fractures. Therefore, we conducted a systematic review and meta-analysis to explore the efficacy, safety and cost benefits of splints in the treatment of DRFs in children. METHODS PubMed, Web of Science, Embase, Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov, Chinese National Knowledge Infrastructure Database (CNKI), Wanfang Database, and VIP Database were searched for eligible randomized controlled trials (RCTs). The methodological quality of the included studies and the level of evidence for results were assessed, respectively, using the risk bias assessment tool of Cochrane and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. Statistical analysis was conducted with Revman 5.3. RESULTS This study will analyze and integrate the existing evidence for effectiveness, safety and cost benefits of splints on DRFs in children. CONCLUSION The conclusion of this study will provide evidence to effectiveness, safety and cost benefits of splints on DRFs in children, which can further guide the selection of appropriate interventions. PROSPERO REGISTRATION NUMBER CRD42019123429.
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Affiliation(s)
| | | | | | - Xing Liao
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing
| | | | | | - Yanming Xie
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing
| | | | | | | | - Hongyan Zhang
- Guangzhou University of Traditional Chinese Medicine, Guangzhou
| | - Shiheng Wang
- China Institute for History of Medicine and Medical Literature
| | - Jiani Liu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing
| | - Zhibo Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing
| | - Yue Zhang
- Longhua Hospital, Shanghai University of Traditional, Chinese Medicine, Shanghai, China
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19
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Sachdev A, Chhawchharia R. Flexible Fiberoptic Bronchoscopy in Pediatric Practice. Indian Pediatr 2019; 56:587-593. [PMID: 31333214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Flexible fiberoptic bronchoscopy a vital diagnostic and therapeutic procedure for assessing the airway. Its logistics, clinical indications and utility need to be elucidated in pediatric context. Pediatric flexible fibreoptic bronchoscopy is useful for diagnosis of airway anomalies, bronchoalveolar lavage for diagnostic and therapeutic purposes, and interventions like foreign body removal. Newer ultra-thin bronchoscopes can be used to perform this procedure in children of all ages. Pediatric flexible bronchoscopy is a valuable diagnostic and therapeutic tool in the hands of skilled personnel when used judiciously.
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Affiliation(s)
- Anil Sachdev
- Department of Pediatrics, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India. Correspondence to: Dr Anil Sachdev, Department of Pediatrics, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India.
| | - Ritika Chhawchharia
- Department of Pediatrics, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
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20
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Invited Editorials Biomaterials science and engineering research in India Sunita P. Victor and Chandra P. Sharma State of the art-Artificial liver in China Yimin Zhang and Lanjuan Li Abstracts from the 15th International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion. Artif Organs 2019; 43:E53-75. [PMID: 30950078 DOI: 10.1111/aor.13451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Shahjouei S, Vafaei Sadr A, Khorasani S, Nejat F, Habibi Z, Akbari Sari A. Utility Measures in Pediatric Temporary Health States: Comparison of Prone Positioning Valuation Through 5 Assessment Tools. Value Health Reg Issues 2019; 18:97-105. [PMID: 30897544 DOI: 10.1016/j.vhri.2019.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 06/21/2018] [Revised: 12/03/2018] [Accepted: 01/04/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Assessment of health-related quality of life (HRQOL or utility) is a complex issue especially in children with temporary health states. OBJECTIVES To assess the utility of prone positioning as a prophylactic postsurgical approach with the aid of 5 frequently used general instruments. METHODS Visual analogue scale (VAS), time trade-off (TTO), modified TTO (m-TTO), standard gamble (SG), and chain of gambles (ChGs) instruments and interview with the parent caregivers were used to measure the HRQOL (utility value) of patients who were admitted in the surgical wards of Children's Medical Center Hospital between July and November 2015. RESULTS A total of 74 parent caregivers with a mean age of 30.48 ± 6.66 years were enrolled. On the basis of the Gaussian model of the repeated VAS measures, we classified the behavior of the participants into 4 clusters. Cumulative study of all these clusters demonstrated that TTO has the highest utility measure for prone positioning (0.682 ± 0.359), whereas the lowest utility value was measured by VAS2 (0.132 ± 0.569). In addition, all VAS measures underestimated the preferences. Overall, values of TTO, m-TTO, and ChGs remained consistent through each of these 4 clusters (intracluster consistency) and within each cluster (intercluster consistency). The adopted utility value of prone positioning based on these 3 instruments was estimated as 0.68 ± 0.21. CONCLUSIONS We recommended a model for assessment of HRQOL in children with temporary health states to overcome the challenges of each isolated instrument and used this model to measure the utility value of prone positioning in pediatric patients.
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Affiliation(s)
- Shima Shahjouei
- Department of Neurosurgery, Children's Hospital Medical Centre, Tehran University of Medical Sciences, Tehran, Iran; Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Universal Scientific Education and Research Network, Tehran, Iran
| | - Alireza Vafaei Sadr
- Department of Physics, Shahid Beheshti University, Tehran, Iran; Department of Theoretical Physics and Center for Astroparticle Physics, University of Geneva, Geneva, Switzerland
| | - Soheila Khorasani
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Nejat
- Department of Neurosurgery, Children's Hospital Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Habibi
- Department of Neurosurgery, Children's Hospital Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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22
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Wong JC, Izadi Z, Schroeder S, Nader M, Min J, Neinstein AB, Adi S. A Pilot Study of Use of a Software Platform for the Collection, Integration, and Visualization of Diabetes Device Data by Health Care Providers in a Multidisciplinary Pediatric Setting. Diabetes Technol Ther 2018; 20:806-816. [PMID: 30461307 PMCID: PMC6299845 DOI: 10.1089/dia.2018.0251] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Diabetes devices provide data for health care providers (HCPs) and people with type 1 diabetes to make management decisions. Extracting and viewing the data require separate, proprietary software applications for each device. In this pilot study, we examined the feasibility of using a single software platform (Tidepool) that integrates data from multiple devices. MATERIALS AND METHODS Participating HCPs (n = 15) used the software with compatible devices in all patient visits for 6 months. Samples of registration desk activity and office visits were observed before and after introducing the software, and HCPs provided feedback by survey and focus groups. RESULTS The time required to upload data and the length of the office visit did not change. However, the number of times the HCP referred to the device data with patients increased from a mean of 2.8 (±1.2) to 6.1 (±3.1) times per visit (P = 0.0002). A significantly larger proportion of children looked at the device data with the new application (baseline: 61% vs. study end: 94%, P = 0.015). HCPs liked the web-based user interface, integration of the data from multiple devices, the ability to remotely access data, and use of the application to initiate patient education. Challenges included the need for automated data upload and integration with electronic medical records. CONCLUSIONS The software did not add to the time needed to upload data or the length of clinic visits and promoted discussions with patients about data. Future studies of HCP use of the application will evaluate clinical outcomes and effects on patient engagement and self-management.
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Affiliation(s)
- Jenise C. Wong
- Division of Endocrinology, Department of Pediatrics, The Madison Clinic for Pediatric Diabetes, University of California San Francisco, San Francisco, California
- Address correspondence to: Jenise C. Wong, MD, PhD, Division of Endocrinology, Department of Pediatrics, The Madison Clinic for Pediatric Diabetes, University of California San Francisco, 1500 Owens Street, Suite 300, San Francisco, CA 94158
| | - Zara Izadi
- Division of Endocrinology, Department of Pediatrics, The Madison Clinic for Pediatric Diabetes, University of California San Francisco, San Francisco, California
| | - Shannon Schroeder
- Division of Endocrinology, Department of Pediatrics, The Madison Clinic for Pediatric Diabetes, University of California San Francisco, San Francisco, California
| | - Marie Nader
- Division of Endocrinology, Department of Pediatrics, The Madison Clinic for Pediatric Diabetes, University of California San Francisco, San Francisco, California
| | - Jennifer Min
- Division of Endocrinology, Department of Pediatrics, The Madison Clinic for Pediatric Diabetes, University of California San Francisco, San Francisco, California
| | - Aaron B. Neinstein
- Division of Endocrinology and Metabolism, Department of Medicine, Center for Digital Health Innovation, University of California San Francisco, San Francisco, California
| | - Saleh Adi
- Division of Endocrinology, Department of Pediatrics, The Madison Clinic for Pediatric Diabetes, University of California San Francisco, San Francisco, California
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Sack BS, Elizondo RA, Huang GO, Janzen N, Espinoza J, Sanz-Cortes M, Dietrich JE, Hakim J, Richardson ES, Oden M, Hanks J, Haridas B, Hury JF, Koh CJ. Pediatric medical device development by surgeons via capstone engineering design programs. J Pediatr Surg 2018; 53:493-498. [PMID: 28196661 PMCID: PMC5545169 DOI: 10.1016/j.jpedsurg.2017.01.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 01/27/2017] [Accepted: 01/28/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is a need for pediatric medical devices that accommodate the unique physiology and anatomy of pediatric patients that is increasingly receiving more attention. However, there is limited literature on the programs within children's hospitals and academia that can support pediatric device development. We describe our experience with pediatric device design utilizing collaborations between a children's hospital and two engineering schools. METHODS Utilizing the academic year as a timeline, unmet pediatric device needs were identified by surgical faculty and matched with an engineering mentor and a team of students within the Capstone Engineering Design programs at two universities. The final prototypes were showcased at the end of the academic year and if appropriate, provisional patent applications were filed. RESULTS All twelve teams successfully developed device prototypes, and five teams obtained provisional patents. The prototypes that obtained provisional patents included a non-operative ureteral stent removal system, an evacuation device for small kidney stone fragments, a mechanical leech, an anchoring system of the chorio-amniotic membranes during fetal surgery, and a fetal oxygenation monitor during fetoscopic procedures. CONCLUSIONS Capstone Engineering Design programs in partnership with surgical faculty at children's hospitals can play an effective role in the prototype development of novel pediatric medical devices. LEVELS OF EVIDENCE N/A - No clinical subjects or human testing was performed.
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Affiliation(s)
- Bryan S Sack
- Department of Pediatric Urology, Boston Children's Hospital/Harvard Medical School, Boston, MA
| | - Rodolfo A Elizondo
- Division of Pediatric Urology, Department of Surgery, and the Scott Department of Urology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Gene O Huang
- Division of Pediatric Urology, Department of Surgery, and the Scott Department of Urology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Nicolette Janzen
- Division of Pediatric Urology, Department of Surgery, and the Scott Department of Urology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Jimmy Espinoza
- Department of Obstetrics and Gynecology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Magdalena Sanz-Cortes
- Department of Obstetrics and Gynecology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Jennifer E Dietrich
- Department of Obstetrics and Gynecology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Julie Hakim
- Division of Pediatric and Adolescent Gynecology, Departments of Surgery and Obstetrics and Gynecology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Eric S Richardson
- Division of Pediatric and Adolescent Gynecology, Departments of Surgery and Obstetrics and Gynecology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Maria Oden
- Oshman Engineering Design Kitchen, Department of Bioengineering, Brown School of Engineering, Rice University, Houston, TX
| | - John Hanks
- Department of Biomedical Engineering, Dwight Look College of Engineering, Texas A&M University, College Station, TX
| | - Balakrishna Haridas
- Department of Biomedical Engineering, Dwight Look College of Engineering, Texas A&M University, College Station, TX
| | - James F Hury
- Business Development and Planning Department, Texas Children's Hospital, Houston, TX
| | - Chester J Koh
- Division of Pediatric Urology, Department of Surgery, and the Scott Department of Urology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX.
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Amiral J, Seghatchian J. Blood derived products in pediatrics: New laboratory tools for optimizing potency assignment and reducing side effects. Transfus Apher Sci 2017; 56:107-117. [PMID: 28343935 DOI: 10.1016/j.transci.2017.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Neonates and children can develop rare bleeding disorders due to congenital/acquired coagulation Factor deficiencies, or allo-immune/autoimmune complications, or can undergo surgeries at high haemorrhagic risk. They then need specialized transfusion of blood components/products, or purified blood extracted products or recombinant proteins. Blood-derived therapies conventionally used for management of affected infants with genetic/acquired deficiencies, bleeding problems (coagulation Factor reduced or missing) or thrombotic disorders (reduced or missing anticoagulant proteins) pose some additional risks. These remedial therapies can cause tolerance when used very early in life and, sometimes needed, repeatedly. The introduction of recombinant proteins has allowed manufacturers to produce large amounts of the proteins usually present at very low concentration in blood. This has also changed the risk pattern of plasma-extracted products, especially in terms of continual reduction of viral transmission. Many efforts have been made over these past decades to reduce the risks associated with the use of all these products in terms of viral and bacterial safety, as well as immune disorders but they are not the objective of this article. Other associated side effects are the presence of undesired activities in blood products, which can produce thrombotic events or adverse reactions. The progressive introduction of blood derived products has greatly improved the prognosis and quality of life of affected patients. This concerns whole blood, but also blood cell concentrates, mainly platelets and red blood cells, plasma, while the blood extracted products are increasingly replaced by recombinant proteins. All these therapeutic products, i.e. blood extracted drugs, improve health and quality of life for hemophiliac's A or B, or patients with auto/allo-immune thrombocytopenias or with rare bleeding disorders, and those with thrombotic events occurring in childhood, which are mainly due to Protein C or Protein S deficiencies (congenital or acquired). Progress in analytical methods and biotechnology allow better control of the manufacturing processes for all blood derived or plasma extracted products and recombinant proteins, and contribute to improved manufacturing processes to minimize the occurrence of side effects. These adverse events can be due to the aging of the blood cell concentrate with release of their granule content, and generation of EVs, which can produce anaphylactic reactions and risk of thrombosis, but also to the presence of activated coagulation Factors in purified products, such as Factor Xia as recently identified in immunoglobulin concentrates. Characterization and measurement of contaminant products is of special usefulness during product preparation and for optimization of manufacturing processes for purified extracted products, but also for recombinant proteins. The pharmaceutical industry introduces these new methods for validating manufacturing processes, or for quality control assessments. The objective is first to warrant the full quality and safety of the lots produced, and assure the highest efficacy with the lowest risks when used in patients. For cell concentrates and fresh blood, storage conditions are critical and measurement of analytes such as EVs or Annexin V allows evaluation of quality of each individual transfused pouch. In addition to all the rules around viral and bacterial transmission risk, and immune tolerance, our available laboratory methods contribute to reducing the side effects of blood cell concentrates and derived plasma products, as well as those of the therapeutic recombinant proteins.
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Affiliation(s)
- Jean Amiral
- SH-Consulting, Andrésy, France; Scientific and Technical Advisor for Hyphen BioMed, Sysmex Group, Neuville sur Oise, France.
| | - Jerard Seghatchian
- International Consultancy in Blood Components Quality/Safety Improvement, Audit/Inspection and DDR Strategies, London, UK.
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De Somer F, De Wachter D, Verdonck P, Van Nooten G, Ebels T. Evaluation of different paediatric venous cannulae using gravity drainage and VAVD: an in vitro study. Perfusion 2016; 17:321-6. [PMID: 12243434 DOI: 10.1191/0267659102pf593oa] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Six different commercially available paediatric venous cannulae, together with a specially constructed cannula, were tested in vitro for their pressure-flow relationship. With the cannulae placed in an open reservoir, flow increased with larger diameters and higher pressures. At a pressure of 30 cm H2O, flows were 219± 20, 285± 13, 422± 11 and 728± 4 ml/min for the 12, 13.2, 14 and 16 French, respectively. No differences were found between angled and straight cannulae. When the cannulae were tested in a latex model simulating the right atrium and vena cavae, the highest flow obtained by gravity was 164 ml/min using an angled 14-French cannula. When vacuum was applied to augment venous return, a maximum flow of 179 ml/min was measured using an angled 14-French cannula. Collapse can occur when the pressure difference becomes too high in the test system. This is important, since most children are selectively cannulated in both major veins. Monitoring of the intravascular pressure might help to prevent collapse. A larger-diameter venous cannula does not always produce the highest flow when placed in a vein. This is most obvious when augmenting venous return. The design of the cannula tip, in combination with VAVD, can affect the venous return.
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Affiliation(s)
- F De Somer
- Institute of Biomedical Technology, University of Ghent, Belgium.
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Griffiths SE, Boleat E, Goodwin A, Sheikh A, Goonasekera C. Efficacy of paediatric anaesthetic trolleys: A call for a basic standard and layout. Int J Risk Saf Med 2016; 27:201-7. [PMID: 26756893 DOI: 10.3233/jrs-150661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Providing safe anaesthesia to children especially in emergency situations goes hand in hand with instant availability of appropriately sized equipment and monitoring. This is best achieved using a designated paediatric anaesthetic trolley containing essential equipment. Guidance for the contents of such trolleys is neither explicit nor standard. We used a survey and a qualitative enquiry to develop a checklist suitable for standardisation of contents and layout of paediatric anaesthetic trolleys. METHODS We conducted an observational study of our current practice and paediatric anaesthetic trolleys in a tertiary care hospital. We also performed a qualitative enquiry from experienced paediatric anaesthetists and operating department practitioners.We developed an empirical checklist to ensure the minimum 'essential' equipment is available on these trolleys and implemented a standard layout to facilitate its use. RESULTS We identified 11 areas in our hospital where anaesthesia is provided to children, each with a designated paediatric anaesthetic trolley. There were considerable deficiencies of items in all areas with no standard pattern or layout. Different types of trolleys contributed to the confusion. In addition, overstocking of inappropriate items hindered its efficient use. CONCLUSION Standardising the contents and layout of the paediatric anaesthetic trolley is an essential pre-requisite for safer paediatric anaesthetic practice.
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Schmucker M, Yildirim K, Igel C, Haag M. Wearable Technology in Medicine: Machine-to-Machine (M2M) Communication in Distributed Systems. Stud Health Technol Inform 2016; 228:225-229. [PMID: 27577376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Smart wearables are capable of supporting physicians during various processes in medical emergencies. Nevertheless, it is almost impossible to operate several computers without neglecting a patient's treatment. Thus, it is necessary to set up a distributed network consisting of two or more computers to exchange data or initiate remote procedure calls (RPC). If it is not possible to create flawless connections between those devices, it is not possible to transfer medically relevant data to the most suitable device, as well as to control a device with another one. This paper shows how wearables can be paired and what problems occur when trying to pair several wearables. Furthermore, it is described as to what interesting scenarios are possible in the context of emergency medicine/paramedicine.
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Abstract
BACKGROUND Optimization of factors affecting aerosol delivery during mechanical ventilation in the pediatric population is important. We hypothesized that increasing the tidal volume (V(T)), using a vibrating mesh nebulizer, and placing the nebulizer at the ventilator would increase lung dose/delivery efficiency. METHODS Continuous-output jet and vibrating mesh nebulizers loaded with albuterol (2.5 mg/3 mL) were compared when placed before the Y-piece and at the ventilator. The model consisted of a ventilator operated in pressure-regulated volume control ventilation mode at a breathing frequency of 20 breaths/min, PEEP of 5 cm H2O, FIO2 of 0.4, inspiratory time of 0.75 s, and bias flow of 0.5 L/min with a humidifier (37 ± 1.5°C) and an adult heated-wired circuit. V(T) values of 100, 150, 200, and 300 mL were studied. The circuit was connected in series to a 5.5-mm inner diameter endotracheal tube with a filter (lung dose) interposed between them. Delivery efficiency was calculated as a percentage of the nominal dose captured on the filter. Albuterol content was analyzed by spectrophotometry (276 nm). RESULTS No differences in lung dose/delivery efficiency were found at different V(T) values for the jet nebulizer (both positions) and the vibrating mesh nebulizer (ventilator). Lung dose/delivery efficiency was higher (P < .02) at a VT of 100 mL compared with the other volumes tested. The vibrating mesh nebulizer had higher lung dose/delivery efficiency compared with the jet nebulizer only when placed before the Y-piece. Moving the nebulizers from before the Y-piece to the ventilator increased lung dose/delivery efficiency for all conditions tested except the vibrating mesh nebulizer at a V(T) of 100 mL (P = .36). CONCLUSIONS Optimization of inhaled drug delivery during pediatric mechanical ventilation should include careful selection of the type of delivery device and its placement in the ventilator circuit. Increasing V(T) during nebulization did not increase lung dose/delivery efficiency.
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Affiliation(s)
- Ariel Berlinski
- Arkansas Children's Hospital, Little Rock, Arkansas. Pulmonology Section, Department of Pediatrics, University of Arkansas for Medical Sciences, and the Pediatric Aerosol Research Laboratory, Arkansas Children's Hospital Research Institute, Little Rock, Arkansas.
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Ubeda C, Vano E, Miranda P, Aguirre D, Riquelme N, Guarda E. Comparison of two angiographic systems in paediatric interventional cardiology. Radiat Prot Dosimetry 2015; 165:250-253. [PMID: 25843951 DOI: 10.1093/rpd/ncv035] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of this work was to analyse the radiation dose for patients and staff between X-ray systems, a new biplane with flat-panel detectors (FDs) and a conventional system equipped with image intensifier (II). Entrance surface air kerma (ESAK) and scatter doses were measured on polymethyl methacrylate (PMMA) phantoms of different thicknesses (from 4 to 16 cm). The ESAK values for the different acquisition modes and PMMA thicknesses were higher for the II in comparison with FDs. For the II, the scatter dose rates ranged from 0.67 to 12.2 mSv h(-1) at the eye position of the cardiologist during fluoroscopy and cine modes. At the lower extremities, these values were 1.11 and 24.24 mSv h(-1). In the case of the FDs, these values ranged from 0.24 to 0.67 mSv h(-1) for eye lens and from 0.73 to 2.01 mSv h(-1) for the position of cardiologist's ankle. The newly installed X-ray system showed an average reduction factor of up to 9.7 times for ESAK values. For the staff with an average reduction factor of 15.9 times at the eye position during fluoroscopy and cine modes, no protective tools are used. At the lower extremities, this value was 7.6 times.
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Affiliation(s)
- C Ubeda
- Medical Technology Department, Study Center in Radiological Sciences (CECRAD), Health Sciences Faculty, Tarapaca University, Arica, Chile
| | - E Vano
- Radiology Department, Faculty of Medicine, Complutense University and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid 28040, Spain
| | - P Miranda
- Hemodynamic Department, Cardiovascular Service, Luis Calvo Mackenna Hospital, Santiago, Chile
| | - D Aguirre
- Hemodynamic Department, Cardiovascular Service, Roberto del Rio Hospital, Santiago, Chile
| | - N Riquelme
- Hemodynamic Department, Cardiovascular Service, Roberto del Rio Hospital, Santiago, Chile
| | - E Guarda
- Centro de Diagnóstico y Terapia Endovascular, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Ubeda C, Vano E, Miranda P, Valenzuela E, Vergara F, Guarda E. Entrance surface air kerma in X-ray systems for paediatric interventional cardiology: a national survey. Radiat Prot Dosimetry 2015; 165:107-110. [PMID: 25805885 DOI: 10.1093/rpd/ncv045] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aims of this work were to report the results of a national survey on entrance surface air kerma (ESAK) values for different phantom thicknesses and operation modes in paediatric interventional cardiology (IC) systems and to compare them with previous values. The national survey also offers suggested investigation levels (ILs) for ESAK in paediatric cardiac procedures. ESAK was measured on phantoms of 4-16 cm thickness of polymethyl methacrylate slabs. For low fluoroscopy mode (FM), ESAK rates ranged from 0.11 to 33.1 mGy min(-1) and for high FM from 0.34 to 61.0 mGy min(-1). For cine mode, values of ESAK per frame were from 1.9 to 78.2 µGy fr(-1). The ILs were suggested as the third quartile of the values measured. This research showed lower ESAK values than in previous research, particularly for ESAK values in cine modes. This work represents a first step towards launching a national programme in paediatric dosimetry for IC procedures.
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Affiliation(s)
- C Ubeda
- Department of Medical Technology, Study Center in Radiological Sciences (CECRAD), Health Sciences Faculty, Tarapaca University, Arica, Chile
| | - E Vano
- Department of Radiology, Faculty of Medicine, Complutense University and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid 28040, Spain
| | - P Miranda
- Department of Hemodynamic, Cardiovascular Service, Luis Calvo Mackenna Hospital, Santiago, Chile
| | - E Valenzuela
- Centro de Diagnóstico y Terapia Endovascular, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - F Vergara
- Centro de Diagnóstico y Terapia Endovascular, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - E Guarda
- Centro de Diagnóstico y Terapia Endovascular, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Theerapongpakdee S, Sathitkamrnmanee T, Tribuddharat S, Rojanapithayakorn N, Uppan K, Thongrong C, Bunsangcharoen P. Comparison of minimal fresh gas requirements of baby enclosed afferent reservoir and Jackson Rees anesthetic circuit for general anesthesia in spontaneously breathing children. J Med Assoc Thai 2014; 97:1171-1176. [PMID: 25675682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The authors compared the baby enclosed afferent reservoir (Baby EAR) with the Jackson-Rees (JR) anesthesia circuit for the minimal fresh gas flow (FGF) requirement with no and clinically acceptable rebreathing in spontaneous breathing anesthesia among pediatric patients. MATERIAL AND METHOD The present study was a randomized crossover study. Twenty patients, weighing 5 to 20 kg with ASA physical status I-II were enrolled. They were allocated to group 1 (EAR-JR) starting with Baby EAR then switching to JR or group 2 (JR-EAR), reversedpattern. After induction and intubation, anesthesia was maintainedwith a N2O/O2 combination with sevoflurane 1 to 3% and fentanyl. Starting with the first circuit, all patients were spontaneously ventilated with FGF 500 mL/kg/min for 10 minutes, and then gradually decreased by 50 mL/kg/min every five minutes. End-tidal CO2 (ETCO) and inspired minimum CO2 (imCO) were recorded until rebreathing (imCO2 >2 mmHg) occurred and continued until rebreathing was not clinically acceptable (imCO2 >6 mmHg). The anesthesia breathing circuit was switched and the procedure repeated. RESULTS The minimal FGF at no rebreathing of Baby EAR and JR were 192.5±76.6 and 347.5±108.2 mL/kg/min; p<0.001. At acceptable rebreathing, the values were 117.5±46.7 and 227.6±90.6 mL/kg/min; p< 0. 001. CONCLUSION Baby EAR can be used safely, effectively, and requires less FGF than JR in pediatric anesthesia in patients weighing 5 to 20 kg.
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Abstract
BACKGROUND A number of articles addressing various aspects of health-related quality of life (HRQoL) were published in the Health and Quality of Life Outcomes (HQLO) journal in 2012 and 2013. This review provides a summary of studies describing recent methodological advances and innovations in HRQoL felt to be of relevance to clinicians and researchers. METHODS Scoping review of original research articles, reviews and short reports published in the HQLO journal in 2012 and 2013. Publications describing methodological advances and innovations in HRQoL were reviewed in detail, summarized and grouped into thematic categories. RESULTS 358 titles and abstracts were screened initially, and 16 were considered relevant and incorporated in this review. Two studies discussed development and interpretation of HRQoL outcomes; two described pediatric HRQoL measurement; four involved incorporation of HRQoL in economic evaluations; and eight described methodological issues and innovations in HRQoL measures. CONCLUSIONS Several studies describing important advancements and innovations in HRQoL, such as the development of the PROMIS pediatric proxy-item bank and guidelines for constructing patient-reported outcome (PRO) instruments, were published in the HQLO journal in 2012 and 2013. Proposed future directions for the majority of these studies include extension and further validation of the research across a diverse range of health conditions.
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Affiliation(s)
- Kristofer Bandayrel
- />Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario Canada
- />Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario Canada
- />Peter Gilgan Centre for Research and Learning, Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9848, Toronto, ON M5G 0A4 Canada
| | - Bradley C Johnston
- />Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario Canada
- />Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario Canada
- />Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario Canada
- />Peter Gilgan Centre for Research and Learning, Hospital for Sick Children Research Institute, 686 Bay Street, Room 11.9848, Toronto, ON M5G 0A4 Canada
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Chandler C. Neurosurgery of paediatric brain tumours. Trans Med Soc Lond 2014; 127:84-91. [PMID: 24941646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
Over the past two decades the EEG has technically improved from the use of analog to digital machines and more recently to video-EEG systems. Despite these advances, recording a technically acceptable EEG in an electrically hostile environment such as the emergency department (ED) remains a challenge, particularly with infants or young children. In 1996, a meeting of French experts established a set of guidelines for performing an EEG in the ED based on a review of the available literature. The authors highlighted the most suitable indications for an emergency EEG including clinical suspicion of cerebral death, convulsive and myoclonic status epilepticus, focal or generalized relapsing convulsive seizures as well as follow-up of known convulsive patients. They further recommended emergency EEG in the presence of doubt regarding the epileptic nature of the presentation as well as during the initiation or modification of sedation following brain injury. Subsequently, proposals for expanding the use of EEG in emergency patients have been advocated including trauma, vascular and anoxic-ischemic injury due to cardiorespiratory arrest, postinfective encephalopathy and nonconvulsive status epilepticus. The aim of this review is to show the diagnostic importance of video-EEG, as well as highlighting the predictive prognostic factors for positive and negative outcomes, when utilized in the pediatric ED for seizures as well as other neurological presentations.
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Affiliation(s)
- Raffaele Falsaperla
- Pediatric Acute and Emergency Operative Unit and Department, Policlinico-Vittorio Emanuele University Hospital, University of Catania, Via Plebiscito 628, 95124 Catania, Italy
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Food and Drug Administration, HHS. Medical devices; pediatric uses of devices; requirement for submission of information on pediatric subpopulations that suffer from a disease or condition that a device is intended to treat, diagnose, or cure. Final rule. Fed Regist 2014; 79:1735-41. [PMID: 24409553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The Food and Drug Administration (FDA) is issuing a final rule amending the regulations on premarket approval of medical devices to include requirements relating to the submission of information on pediatric subpopulations that suffer from the disease or condition that a device is intended to treat, diagnose, or cure.
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Abstract
This article reviews recent developments and core topics in the use and design of pediatric cuffed tracheal tubes. A concept for an appropriate pediatric cuffed tracheal tube is introduced. The main points in this concept are evidence-based tracheal tube size recommendation, continuous cuff pressure monitoring and a pediatric tracheal tube with an anatomically-based intubation depth mark and a short distally placed high-volume-low pressure cuff made from an ultra-thin polyurethane membrane with markedly improved tracheal sealing performance. The main points in proper handling of cuffed tracheal tubes in children are highlighted. Finally, an outlook on future developments in the design of pediatric cuffed tracheal tubes and an overview of tasks to be performed in evaluating them is given.
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Affiliation(s)
- Markus Weiss
- University Children's Hospital, Steinwiesstrasse 75, CH 8032 Zurich, Switzerland.
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Abstract
Computed tomography plays a central and increasingly important role in medical imaging. From the very beginning more than 30 years ago, computed tomography technology has continued to develop and provide a wide variety of applications for evaluation of disorders of virtually any organ system in both children and adults. The benefits are particularly evident with the newer, fast, high-resolution multidetector scanners. However, these benefits must be carefully weighed against the potential risks, which include a relatively high radiation dose. Current research efforts are directed at both further improvements in the diagnostic potential with computed tomography, as well as managing radiation dose.
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Affiliation(s)
- Donald P Frush
- Division of Pediatric Radiology, Duke University Medical Center, 1905 McGovern-Davison Children's Health Center, Box 3808, Department of Radiology, Durham, NC 27710, USA.
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Fiadjoe JE, Kovatsis P. Videolaryngoscopes in pediatric anesthesia: what's new? Minerva Anestesiol 2014; 80:76-82. [PMID: 24002465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Anesthesiologists are increasingly turning to videolaryngoscopes (VLs) for normal and difficult endotracheal intubations. As children grow the airway is in constant transition. This means that a device that works well in an older child may fail in an infant. Are VLs ideal in all children? What are the pitfalls and strengths of these devices? When are they indicated? How should their efficacy be assessed? Can they play a role in teaching standard laryngoscopy? This article explores these questions and reviews the literature relating to VLs use in children.
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Affiliation(s)
- J E Fiadjoe
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA -
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Kern D, Larcher C, Cottron N, Ait Aissa D, Fesseau R, Alacoque X, Delort F, Masquère P, Agnès E, Visnadi G, Fourcade O. [The choice of a pediatric anesthesia ventilator]. Ann Fr Anesth Reanim 2013; 32:e199-e203. [PMID: 24209991 DOI: 10.1016/j.annfar.2013.10.011] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The technology of anesthesia ventilators has substantially progressed during last years. The choice of a pediatric anesthesia ventilator needs to be led by multiple parameters: requirement, technical (pneumatic performance, velocity of halogenated or oxygen delivery), cost (purchase, in operation, preventive and curative maintenance), reliability, ergonomy, upgradability, and compatibility. The demonstration of the interest of pressure support mode during maintenance of spontaneous ventilation anesthesia makes this mode essential in pediatrics. In contrast, the financial impact of target controlled inhalation of halogenated has not be studied in pediatrics. Paradoxically, complex and various available technologies had not been much prospectively studied. Anesthesia ventilators performances in pediatrics need to be clarified in further clinical and bench test studies.
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Affiliation(s)
- D Kern
- EA 4564 MATN, IFR 150, département d'anesthésie et de réanimation, CHRU Toulouse Purpan, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France.
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Abstract
Three different devices are available for inhaled medications in children: the pressurized metered dose inhalers (pMDIs, breath-actuator synchronized pMDI, and valved holding spacers), the dry powder inhalers, and the nebulizers. To choose the better device for a particular patient, a perfect knowledge of the available devices, of their mode of use, of their advantages and inconvenient is required. The use of a pMDI coupled to a valved holding spacer is the first mode of delivery to propose in children aged less than 6 years. After 6 years old, the DPIs may be proposed depending on the child's competences. At last, the nebulizations are indicated in some particular and severe indications, but new indications are appearing because of recent progresses.
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Affiliation(s)
- A Sapet
- Unité de pneumologie pédiatrique, hôpital de la Timone, CHU Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
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Hodge AB, Yeager CJ, Preston TJ, Savage AJ, Butts RJ, Kavarana MN. The Thoratec CentriMag for pediatric right ventricular failure. J Extra Corpor Technol 2013; 45:133-135. [PMID: 23930384 PMCID: PMC4557580] [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] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 05/08/2013] [Indexed: 06/02/2023]
Abstract
Acute right ventricular failure post heart transplantation in the pediatric population has not been well documented. Treatment using medical therapies including inotropes and nitric oxide are often inefficient for pediatric patients. Extracorporeal membrane oxygenation has been traditionally used in children until a long-term decision can be made. As a result of the emergence of smaller assist devices, pediatric practitioners now have more options available to treat this patient population. We describe the successful use of the Thoratec CentriMag in a pediatric patient posttransplantation with acute right ventricular failure.
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Affiliation(s)
- Ashley B Hodge
- The Heart Center at Nationwide Children's Hospital Columbus, Ohio 43205, USA.
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Ginther RM, Gorney R, Forbess JM. Use of del Nido cardioplegia solution and a low-prime recirculating cardioplegia circuit in pediatrics. J Extra Corpor Technol 2013; 45:46-50. [PMID: 23691784 PMCID: PMC4557463] [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] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 02/05/2013] [Indexed: 06/02/2023]
Abstract
The evolution of myocardial protection techniques has been both the source of milestone advancements and controversial debate in cardiac surgery. Our institution has modified a low-prime cardioplegia system (CPS) and adopted a single-dose cardioplegia solution (del Nido cardioplegia) for our congenital heart disease population. The goal of this article is to describe our CPS and outline our myocardial protection protocol. These techniques have allowed us to minimize circuit surface area, operate uninterrupted, and safely protect the myocardium during extended ischemic periods.
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Affiliation(s)
- Richard M Ginther
- Division of Pediatric Cardiothoracic Surgery, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas 75235, USA.
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Undar A, Wang S, Krawiec C. Impact of a unique international conference on pediatric mechanical circulatory support and pediatric cardiopulmonary perfusion research. Artif Organs 2012; 36:943-50. [PMID: 23121202 DOI: 10.1111/j.1525-1594.2012.01563.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is no question that the International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion is a unique event that has had a significant impact on the treatment of neonatal, infantile, and pediatric cardiopulmonary patients around the globe since 2005. This annual event will continue as long as there is a need to fill the gap for underserved patient population. It will also continue to recognize promising young investigators based on their full manuscripts for young investigator awards.
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Kawasaki T, Aoyama T, Yamauchi-Kawaura C, Fujii K, Koyama S. Organ dose and effective dose estimation in paediatric chest radiographic examinations by using pin silicon photodiode dosemeters. Radiat Prot Dosimetry 2012; 154:314-319. [PMID: 23019596 DOI: 10.1093/rpd/ncs251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Organ and effective doses during paediatric chest radiographic examination were investigated for various tube voltages between 60 and 110 kV at a constant milliampere-second value and focus-to-film distance by using an in-phantom dose measuring system and a Monte Carlo (MC) simulation software (PCXMC), where the former was composed of 32 photodiode dosemeters embedded in various tissue and organ sites within a 6-y-old child anthropomorphic phantom. Lung doses obtained ranged from 0.010 to 0.066 mGy and effective doses from 0.004 to 0.025 mSv, where these doses varied by a factor of 6 with the change in the tube voltage. Effective doses obtained using the MC simulation software agreed with those obtained using the dose measuring system within 23 %, revealing the usefulness of PCXMC software for evaluating effective doses. The present study would provide helpful dose data for the selection of technical parameters in paediatric chest radiography in Japan.
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Affiliation(s)
- Toshio Kawasaki
- Department of Radiological Technology, Kanagawa Children's Medical Center, Mutsukawa 2-138-4, Minami-ku, Yokohama 232-8555, Japan.
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Khan MA, Vakhova EL. [The health improving technologies in pediatrics]. Vopr Kurortol Fizioter Lech Fiz Kult 2012:53-56. [PMID: 22994067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The development of prophylactic treatment is one of most challenging and socially significant aspects of modern pediatrics. Today, a great variety of natural and artificial physical factors are employed to protect and/or restore the health of the children and to improve it. The broad scope of non-medicamentous technologies used for the purpose makes it possible to elaborate prophylactic programs adapted to the specific requirements of individual patients at all levels of medical care including therapeutic and prophylactic, spa and resort institutions, educational institutions, health improvement and recreational camps of different types, and home care.
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Barth BA, Banerjee S, Bhat YM, Desilets DJ, Gottlieb KT, Maple JT, Pfau PR, Pleskow DK, Siddiqui UD, Tokar JL, Wang A, Song LMWK, Rodriguez SA. Equipment for pediatric endoscopy. Gastrointest Endosc 2012; 76:8-17. [PMID: 22579260 DOI: 10.1016/j.gie.2012.02.023] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 02/17/2012] [Indexed: 02/07/2023]
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Kalechstein S, Permual A, Cameron BM, Pemberton J, Hollaar G, Duffy D, Cameron BH. Evaluation of a new pediatric intraosseous needle insertion device for low-resource settings. J Pediatr Surg 2012; 47:974-9. [PMID: 22595584 DOI: 10.1016/j.jpedsurg.2012.01.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 01/26/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE The Near Needle Holder (NNH) (Near Manufacturing, Camrose, Alberta, Canada) is a reusable tool to introduce a standard hollow needle for pediatric intraosseous (IO) infusion. We compared the NNH to the Cook Dieckmann (Cook Critical Care, Bloomington, IN) manual IO needle in a simulation setting. METHODS Study subjects were 32 physicians, nurses, and medical students participating in a trauma course in Guyana. After watching a training video and practicing under supervision, subjects were observed inserting each device into a pediatric leg model using a randomized crossover design. Outcome measures were time to successful insertion, technical complications, ease of use, and safety of each device. RESULTS The mean time for IO insertion (32 ± 13 seconds) was similar for both devices (P = .92). Subjects rated the NNH device equivalent in ease of use to the Cook IO needle but slightly lower in perceived safety to the user. CONCLUSIONS After training, all subjects successfully inserted the NNH IO device in a simulation environment, and most rated it as easy to use and safe. The NNH is a significant advance because IO needles are often not available in emergency departments in developing countries. Further studies are needed to evaluate clinical effectiveness of the NNH.
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Bendo CB, Paiva SM, Viegas CM, Vale MP, Varni JW. The PedsQL™ Oral Health Scale: feasibility, reliability and validity of the Brazilian Portuguese version. Health Qual Life Outcomes 2012; 10:42. [PMID: 22531004 PMCID: PMC3425333 DOI: 10.1186/1477-7525-10-42] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 04/24/2012] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Oral and orofacial problems may cause a profound impact on children's oral health-related quality of life (OHRQoL) because of symptoms associated with these conditions that may influence the physical, psychological and social aspects of their daily life. The OHRQoL questionnaires found in the literature are very specific and are not able to measure the impact of oral health on general health domains. Consequently, the objective of this study was to evaluate the psychometric properties of the Portuguese version for Brazilian translation of the Pediatric Quality of Life Inventory™ (PedsQL™) Oral Health Scale in combination with the PedsQL™ 4.0 Generic Core Scales. METHODS The PedsQL™ Oral Health Scale was forward-backward translated and cross-culturally adapted for the Brazilian Portuguese language. In order to assess the feasibility, reliability and validity of the Brazilian version of the instrument, a study was carried out in Belo Horizonte with 208 children and adolescents between 2 and 18 years-of-age and their parents. Clinical evaluation of dental caries, socioeconomic information and the Brazilian versions of the PedsQL™ Oral Health Scale, PedsQL™ 4.0 Generic Core Scales, Child Perceptions Questionnaire (CPQ11-14 and CPQ8-10) and Parental-Caregiver Perception Questionnaire (P-CPQ) were administered. Statistical analysis included feasibility (missing values), confirmatory factor analysis (CFA), internal consistency reliability, and test-retest intraclass correlation coefficients (ICC) of the PedsQL™ Oral Health Scale. RESULTS There were no missing data for both child self-report and parent proxy-report on the Brazilian version of the PedsQL™ Oral Health Scale. The CFA showed that the five items of child self-report and parent proxy-report loaded on a single construct. The Cronbach's alpha coefficients for child/adolescent and parent oral health instruments were 0.65 and 0.59, respectively. The test-retest reliability (ICC) for child self-report and parent proxy-report were 0.90 [95% confidence interval (CI) = 0.86-0.93] and 0.86 (95%CI = 0.81-0.90), respectively. The PedsQL™ Oral Health Scale demonstrated acceptable construct validity, convergent validity and discriminant validity. CONCLUSIONS These results supported the feasibility, reliability and validity of the Brazilian version of the PedsQL™ Oral Health Scale for child self-report for ages 5-18 years-old and parent proxy-report for ages 2-18 years-old children.
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Affiliation(s)
- Cristiane B Bendo
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Federal University of Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, MG, 31270-901, Brazil
| | - Saul M Paiva
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Federal University of Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, MG, 31270-901, Brazil
| | - Claudia M Viegas
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Federal University of Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, MG, 31270-901, Brazil
| | - Miriam P Vale
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Federal University of Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, MG, 31270-901, Brazil
| | - James W Varni
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, 3137 TAMU, College Station, TX, 77843-3137, USA
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Schappert SM, Bhuiya F. Availability of pediatric services and equipment in emergency departments: United States, 2006. Natl Health Stat Report 2012:1-21. [PMID: 22690535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES This report presents data on the availability of pediatric services, expertise, and supplies for treating pediatric emergencies in U.S. hospitals. METHODS Data in this report are from the Emergency Pediatric Services and Equipment Supplement (EPSES), a self-administered questionnaire added to the 2006 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS samples nonfederal short-stay and general hospitals in the United States. Sample data were weighted to produce annual estimates of pediatric services, expertise, and equipment availability in hospital emergency departments (EDs). RESULTS In 2006, only 7.2 percent of hospital EDs had all recommended pediatric emergency supplies, and 45.6 percent had at least 85.0 percent of recommended supplies. EDs in children's hospitals and hospitals with pediatric intensive care units (PICUs) were more likely to meet guidelines for pediatric emergency department services, expertise, and supplies. About 74.0 percent of these facilities had at least 85.0 percent of recommended supplies, compared with 42.4 percent of other facilities. Among children's hospitals and hospitals with PICUs, 66.0 percent had 24 hours a day, 7 days a week access to a board-certified pediatric emergency medicine attending physician; such access was uncommon in other types of hospitals. In general, little change was noted in the availability of emergency pediatric supplies between 2002-2003, when the initial EPSES was conducted, and 2006.
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Affiliation(s)
- Susan M Schappert
- Center for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD 20782, USA
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