Clinical decision support systems in child and adolescent psychiatry: a systematic review.
Eur Child Adolesc Psychiatry. 2017 Apr 28;:
Authors: Koposov R, Fossum S, Frodl T, Nytrø Ø, Leventhal B, Sourander A, Quaglini S, Molteni M, de la Iglesia Vayá M, Prokosch HU, Barbarini N, Milham MP, Castellanos FX, Skokauskas N
Psychiatric disorders are amongst the most prevalent and impairing conditions in childhood and adolescence. Unfortunately, it is well known that general practitioners (GPs) and other frontline health providers (i.e., child protection workers, public health nurses, and pediatricians) are not adequately trained to address these ubiquitous problems (Braddick et al. Child and Adolescent mental health in Europe: infrastructures, policy and programmes, European Communities, 2009; Levav et al. Eur Child Adolesc Psychiatry 13:395-401, 2004). Advances in technology may offer a solution to this problem with clinical decision support systems (CDSS) that are designed to help professionals make sound clinical decisions in real time. This paper offers a systematic review of currently available CDSS for child and adolescent mental health disorders prepared according to the PRISMA-Protocols (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols). Applying strict eligibility criteria, the identified studies (n = 5048) were screened. Ten studies, describing eight original clinical decision support systems for child and adolescent psychiatric disorders, fulfilled inclusion criteria. Based on this systematic review, there appears to be a need for a new, readily available CDSS for child neuropsychiatric disorder which promotes evidence-based, best practices, while enabling consideration of national variation in practices by leveraging data-reuse to generate predictions regarding treatment outcome, addressing a broader cluster of clinical disorders, and targeting frontline practice environments.
PMID: 28455596 [PubMed - as supplied by publisher]
Understanding the linkages between social safety nets and childhood violence: a review of the evidence from low- and middle-income countries.
Health Policy Plan. 2017 Apr 22;:
Authors: Peterman A, Neijhoft AN, Cook S, Palermo TM
As many as one billion children experience violence every year, and household- and community-level poverty are among the risk factors for child protection violations. Social safety nets (SSNs) are a main policy tool to address poverty and vulnerability, and there is substantial evidence demonstrating positive effects on children's health and human capital. This paper reviews evidence and develops a framework to understand linkages between non-contributory SSNs and the experience of childhood emotional, physical and sexual violence in low- and middle-income countries. We catalogue 14 rigorous impact evaluations, 11 of which are completed, analysing 57 unique impacts on diverse violence indicators. Among these impacts, approximately one in five represent statistically significant protective effects on childhood violence. Promising evidence relates to sexual violence among female adolescents in Africa, while there is less clear evidence of significant impacts in other parts of the developing world, and on young child measures, including violent discipline. Further, few studies are set up to meaningfully unpack mechanisms between SSNs and childhood violence; however, those most commonly hypothesized operate at the household level (through increases in economic security and reductions in poverty-related stress), the interpersonal level (improved parental behaviours, caregiving practices, improved psychosocial well-being) and at the child-level (protective education and decreases in problem or risky behaviours). It is important to emphasize that traditional SSNs are never designed with violence prevention as primary objectives, and thus should not be considered as standalone interventions to reduce risks for childhood violence. However, SSNs, particularly within integrated protection systems, appear to have potential to reduce violence risk. Linkages between SSNs and childhood violence are understudied, and investments should be made to close this evidence gap.
PMID: 28444197 [PubMed - as supplied by publisher]
Persistent Pneumonia: Time to Take a Closer Look.
Pediatr Emerg Care. 2017 Jan;33(1):31-33
Authors: Ruttan T, Vezzetti R, Scalo J
Primary pulmonary tumors are rare in pediatrics. When they are encountered, they are usually carcinoid tumors or mucoepidermoid carcinomas. We present a patient who presented to both his primary care physician and the pediatric emergency department with recurrent bouts of wheezing and pneumonia, none of which ever completely resolved despite appropriate treatment. The patient had multiple chest films, which demonstrated the persistence of what appeared to be a right-sided infiltrate/atelectasis. Ultimately, the patient underwent a diagnostic workup that included a computed tomography scan and bronchoscopy. These studies revealed the presence of a bronchial mucoepidermoid carcinoma. The patient was successfully treated with photoablation of the lesion through the involvement of multiple subspecialists, including pediatric pulmonology, pediatric surgery, pediatric otolaryngology, and pediatric oncology. We discuss the incidence and epidemiology of pediatric bronchial tumors in general and mucoepidermoid carcinoma in particular as well as diagnosis, treatment options, and prognosis. Emergency physicians must maintain a high index of suspicion for alternate diagnoses in patients whose disease fails to respond to traditionally accepted therapy.
PMID: 26414631 [PubMed - indexed for MEDLINE]
Do Adolescents With Higher Knowledge of HIV Have Lower Sexual Risk Behaviors?
Pediatr Emerg Care. 2016 Dec;32(12):846-850
Authors: Hoehn EF, FitzGerald MR, Bhatt SR, Robinson VM, Lippe JE, Reed JL
OBJECTIVES: Human immunodeficiency virus (HIV) remains a leading cause of morbidity and mortality in the United States, and adolescents account for a disproportionate number of new cases. We aimed to assess knowledge of HIV in relation to sexual risk behaviors among adolescents seeking care in our pediatric emergency department and to assess sources of HIV knowledge among this population.
METHODS: Adolescents aged 14 to 21 years who presented to the pediatric emergency department participated in a questionnaire assessing HIV knowledge, sexual risk behaviors, and sources of HIV knowledge. For purposes of statistical analysis, patients were divided into a high-score (greater than or equal to the median score) or low-score (less than the median score) group based on the HIV-Knowledge Questionnaire 18 portion of the survey.
RESULTS: A total of 240 adolescents were enrolled. Of those, 112 patients scored higher than or equal to the median HIV-Knowledge Questionnaire 18 score of 11. High-scoring knowledge was independently associated with patients 18 years or older (P = 0.001), any lifetime sexual activity (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.30-3.67; P = 0.003), previous testing for HIV (OR, 2.40; 95% CI, 1.40-4.11; P = 0.002), and an "expert" source (school-based or medical professionals) as their primary source of knowledge (OR, 1.88; 95% CI, 1.05-3.41; P = 0.034). Age of first sexual encounter, number of partners, and condom use were not significantly associated with knowledge score.
CONCLUSIONS: Education from "expert" sources is important in providing adolescents with accurate information. However, education alone is unlikely to change sexual practices. A more comprehensive approach to HIV prevention is needed to decrease HIV transmission among this patient population.
PMID: 26760829 [PubMed - indexed for MEDLINE]
Context matters! sources of variability in weekend physical activity among families: a repeated measures study.
BMC Public Health. 2017 Apr 18;17(1):330
Authors: Noonan RJ, Fairclough SJ, Knowles ZR, Boddy LM
BACKGROUND: Family involvement is an essential component of effective physical activity (PA) interventions in children. However, little is known about the PA levels and characteristics of PA among families. This study used a repeated measures design and multiple data sources to explore the variability and characteristics of weekend PA among families.
METHODS: Families (including a 'target' child aged 9-11 years, their primary caregiver(s) and siblings aged 6-8 years) were recruited through primary schools in Liverpool, UK. Participants completed a paper-based PA diary and wore an ActiGraph GT9X accelerometer on their left wrist for up to 16 weekend days. ActiGraph.csv files were analysed using the R-package GGIR version 1.1-4. Mean minutes of moderate-to-vigorous PA (MVPA) for each weekend of measurement were calculated using linear mixed models, and variance components were estimated for participant (inter-individual), weekend of measurement, and residual error (intra-individual). Intraclass correlation coefficients (ICC) were calculated from the proportion of total variance accounted for by inter-individual sources, and used as a measure of reliability. Diary responses were summed to produce frequency counts. To offer contextual insight into weekend PA among family units, demographic, accelerometer, and diary data were combined to form two case studies representative of low and high active families.
RESULTS: Twenty-five participants from 7 families participated, including 7 'target' children (mean age 9.3 ± 1.1 years, 4 boys), 6 siblings (mean age 7.2 ± 0.7 years; 4 boys) and 12 adults (7 mothers and 5 fathers). There was a high degree of variability in target children's (ICC = 0.55), siblings (ICC = 0.38), and mothers' MVPA (ICC = 0.58), but not in fathers' MVPA (ICC = 0.83). Children's weekend PA was mostly unstructured in nature and undertaken with friends, whereas a greater proportion of parents' weekend PA was undertaken alone in structured settings. The family case studies demonstrated that in the selected cases MVPA levels and variability across weekends were contingent on mode of PA participation.
CONCLUSIONS: These novel findings enhance understanding of the variability and characteristics of weekend PA among family units. The study demonstrates the utility of PA diaries in conjunction with accelerometers to provide understanding of the mode and contexts of out-of-school and family-based PA.
PMID: 28420363 [PubMed - indexed for MEDLINE]
Clinical Status of Adolescents with Perinatal HIV at Transfer to Adult Care in the UK/Ireland.
Clin Infect Dis. 2017 Apr 15;64(8):1105-1112
Authors: Collins IJ, Foster C, Tostevin A, Tookey P, Riordan A, Dunn D, Gibb DM, Judd A, Collaborative HIV Paediatric Study (CHIPS) Steering Committee
Background.: Increasing numbers of children infected perinatally with human immunodeficiency virus (HIV) are surviving to adolescence and transitioning to adult care, yet there are scarce data on their clinical status at transfer.
Methods.: We analyzed prospective cohort data from the UK/Ireland national Collaborative HIV Pediatric Study (CHIPS). Clinical status at last pediatric clinic visit prior to transfer was described. Factors associated with higher CD4 cell count and viral load (VL) suppression<400 c/mL among patients on antiretroviral therapy (ART) at transfer were assessed using linear and logistic regression, respectively. Data were matched with the UK HIV Drug Resistance Database (UKHIVDRB) to assess cumulative resistance profiles at transfer.
Results.: Of 1,907 children followed in CHIPS from 1996 to November 2014, 644 (34%) transferred to adult care: 53% were female, 62% born outside the UK/Ireland, 75% black African. At last pediatric follow-up, median age was 17.4 years [interquartile range 16.5,18.1], 27% had previous AIDS diagnosis, CD4 was 444 cells/mm3 [280, 643], 76% were on ART, 13% off-ART, and 11% ART-naive. Among patients on ART, 74% had VL<400 c/mL. In multivariable analysis, higher CD4 at transfer was associated with younger age, higher CD4 at ART initiation and lower VL at transfer (P ≤ .001). Predictors of viral suppression include no AIDS diagnosis and later year of transfer (P ≤ .05). Of 291 patients with resistance data, 82% had resistance to ≥1 drug class, 56% to ≥2 classes and 12% had triple-class resistance.
Conclusion.: Three-quarters of adolescents were on stable ART at transfer, of whom 74% were virologically suppressed. The prevalence of triple-class resistance was relatively low at 12%.
PMID: 28329212 [PubMed - indexed for MEDLINE]
The Diagnosis of Urinary Tract Infection in Young Children (DUTY) Study Clinical Rule: Economic Evaluation.
Value Health. 2017 Apr;20(4):556-566
Authors: Hollingworth W, Busby J, Butler CC, O'Brien K, Sterne JA, Hood K, Little P, Lawton M, Birnie K, Thomas-Jones E, Harman K, Hay AD, DUTY Study Team
OBJECTIVE: To estimate the cost-effectiveness of a two-step clinical rule using symptoms, signs and dipstick testing to guide the diagnosis and antibiotic treatment of urinary tract infection (UTI) in acutely unwell young children presenting to primary care.
METHODS: Decision analytic model synthesising data from a multicentre, prospective cohort study (DUTY) and the wider literature to estimate the short-term and lifetime costs and healthcare outcomes (symptomatic days, recurrent UTI, quality adjusted life years) of eight diagnostic strategies. We compared GP clinical judgement with three strategies based on a 'coefficient score' combining seven symptoms and signs independently associated with UTI and four strategies based on weighted scores according to the presence/absence of five symptoms and signs. We compared dipstick testing versus laboratory culture in children at intermediate risk of UTI.
RESULTS: Sampling, culture and antibiotic costs were lowest in high-specificity DUTY strategies (£1.22 and £1.08) compared to clinical judgement (£1.99). These strategies also approximately halved urine sampling (4.8% versus 9.1% in clinical judgement) without reducing sensitivity (58.2% versus 56.4%). Outcomes were very similar across all diagnostic strategies. High-specificity DUTY strategies were more cost-effective than clinical judgement in the short- (iNMB = £0.78 and £0.84) and long-term (iNMB =£2.31 and £2.50). Dipstick tests had poorer cost-effectiveness than laboratory culture in children at intermediate risk of UTI (iNMB = £-1.41).
CONCLUSIONS: Compared to GPs' clinical judgement, high specificity clinical rules from the DUTY study could substantially reduce urine sampling, achieving lower costs and equivalent patient outcomes. Dipstick testing children for UTI is not cost-effective.
PMID: 28407997 [PubMed - indexed for MEDLINE]
Is the infant car seat challenge useful? A pilot study in a simulated moving vehicle.
Arch Dis Child Fetal Neonatal Ed. 2017 Mar;102(2):F136-F141
Authors: Arya R, Williams G, Kilonback A, Toward M, Griffin M, Blair PS, Fleming P
BACKGROUND AND OBJECTIVE: The American Academy of Pediatrics recommends that preterm infants complete a predischarge 'car seat challenge' observation for cardiorespiratory compromise while in a car seat. This static challenge does not consider the more upright position in a car or the vibration of the seat when the car is moving. This pilot study was designed to assess the cardiorespiratory effects of vibration, mimicking the effect of being in a moving car, on preterm and term infants.
METHODS: A simulator was designed to reproduce vertical vibration similar to that in a rear-facing car seat at 30 mph. 19 healthy newborn term and 21 preterm infants, ready for hospital discharge, underwent cardiorespiratory measurements while lying flat in a cot (baseline), static in the seat (30°), simulator (40°) and during motion (vibration 40°).
RESULTS: Median test age was 13 days (range 1-65 days) and median weight was 2.5 kg (IQR: 2.1-3.1 kg).Compared with baseline observations, only the total number of desaturations was significantly increased when infants were placed at 30° (p=0.03). At 40°, or with vibration, respiratory and heart rates increased and oxygen saturation decreased significantly. Profound desaturations <85% significantly increased during motion, regardless of gestational age.
CONCLUSIONS: This is the first study to assess the effect of motion on infants seated in a car safety seat. Term and preterm infants showed significant signs of potentially adverse cardiorespiratory effects in the upright position at 40°, particularly with simulated motion, not identified in the standard challenge. A larger study is required to investigate the significance of these results.
PMID: 27694399 [PubMed - indexed for MEDLINE]
Risk of Pertussis in Relation to Degree of Prematurity in Children Less Than 2 Years of Age.
Pediatr Infect Dis J. 2017 May;36(5):e151-e156
Authors: Riise ØR, Laake I, Vestrheim D, Flem E, Moster D, Riise Bergsaker MA, Storsæter J
BACKGROUND: A few previous studies reported increased risk of pertussis in children with birth weight less than 2500 g. The risk of pertussis by degree of prematurity has not been determined in a cohort study. The vaccine effectiveness (VE) against reported pertussis in preterm infants is unknown.
METHODS: Data were obtained from the Medical Birth Registry of Norway (1998-2010) and linked to other national registries. In total, 713,166 children were included in our study and followed until 2 years of age. Incidence rate ratios (IRRs) and confidence intervals (CIs) were estimated with Poisson regression.
RESULTS: We identified 999 reported cases of pertussis. We observed a higher rate of reported pertussis in preterm than in full-term infants, IRR = 1.65 (95% CI: 1.32-2.07). Compared to full-term infants, the risk of reported pertussis in infants born at gestational age (GA) 35-36, 32-34 and 23-27 weeks were higher [IRRs = 1.49 (95% CI: 1.11-2.01), 1.63 (95% CI: 1.06-2.51) and 4.49 (95% CI: 2.33-8.67), respectively]. Moreover, preterm infants had a higher rate of pertussis-related hospitalization than full-term infants [IRR = 1.99 (95% CI: 1.47-2.71)]. The VE against reported pertussis for the third dose was 88.8% (95% CI: 84.3-92.0) in full-term infants and 93.0% (95% CI: 85.8-96.5) in preterm infants.
CONCLUSIONS: In this cohort study, preterm infants including those born at GA 35 and 36 weeks had increased risk of reported pertussis. The VE was similar in preterm and full-term infants.
PMID: 28403056 [PubMed - indexed for MEDLINE]
Home uterine monitoring for detecting preterm labour.
Cochrane Database Syst Rev. 2017 02 15;2:CD006172
Authors: Urquhart C, Currell R, Harlow F, Callow L
BACKGROUND: To reduce the morbidity and mortality associated with preterm birth, home uterine activity monitoring aims for early detection of increased contraction frequency, and early intervention with tocolytic drugs to inhibit labour and prolong pregnancy. However, the effectiveness of such monitoring is disputed.
OBJECTIVES: To determine whether home uterine activity monitoring is effective in improving the outcomes for women and their infants considered to be at high risk of preterm birth, when compared with care that does not include home uterine activity monitoring.
SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2016), CENTRAL (Cochrane Library 2016, Issue 5), MEDLINE (1966 to 28 June 2016), Embase (1974 to 28 June 2016), CINAHL (1982 to 28 June 2016), and scanned reference lists of retrieved studies.
SELECTION CRITERIA: Randomised control trials of home uterine activity monitoring, with or without patient education programmes, for women at risk of preterm birth, compared with care that does not include home uterine activity monitoring.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risks of bias, extracted data and checked them for accuracy. We did not attempt to contact authors to resolve queries. We assessed the evidence using the GRADE approach.
MAIN RESULTS: There were 15 included studies (6008 enrolled participants); 13 studies contributed data. Women using home uterine monitoring were less likely to experience preterm birth at less than 34 weeks (risk ratio (RR) 0.78, 95% confidence interval (CI) 0.62 to 0.99; three studies, 1596 women; fixed-effect analysis) (GRADE high). This difference was not evident when we carried out a sensitivity analysis, restricting the analysis to studies at low risk of bias based on study quality (RR 0.75, 95% CI 0.57 to 1.00; one study, 1292 women). There was no difference in the rate of perinatal mortality (RR 1.22, 95% CI 0.86 to 1.72; two studies, 2589 babies) (GRADE low).There was no difference in the number of preterm births at less than 37 weeks (average RR 0.85, CI 0.72 to 1.01; eight studies, 4834 women; random-effects, Tau(2) = 0.03, I(2) = 68%) (GRADE very low). Infants born to women using home uterine monitoring were less likely to be admitted to neonatal intensive care unit (average RR 0.77, 95% CI 0.62 to 0.96; five studies, 2367 babies; random-effects, Tau(2) = 0.02, I(2) = 32%) (GRADE moderate). This difference was not maintained when we restricted the analysis to studies at low risk of bias (RR 0.86, 95% CI 0.74 to 1.01; one study, 1292 babies). Women using home uterine monitoring made more unscheduled antenatal visits (mean difference (MD) 0.48, 95% CI 0.31 to 0.64; two studies, 1994 women) (GRADE moderate). Women using home uterine monitoring were also more likely to have prophylactic tocolytic drug therapy (average RR 1.21, 95% CI 1.01 to 1.45; seven studies, 4316 women; random-effects, Tau(2) = 0.03, I(2) = 62%), but this difference was no longer evident when we restricted the analysis to studies at low risk of bias (average RR 1.22, 95% CI 0.90 to 1.65; three studies, 3749 women; random-effects, Tau(2) = 0.05, I(2) = 76%) (GRADE low). The number of antenatal hospital admissions did not differ between home groups (RR 0.91, 95% CI 0.74 to 1.11; three studies, 1494 women (GRADE low)). We found no data on maternal anxiety or acceptability.
AUTHORS' CONCLUSIONS: Home uterine monitoring may result in fewer admissions to a neonatal intensive care unit but in more unscheduled antenatal visits and tocolytic treatment; the level of evidence is generally low to moderate. Important group differences were not evident when we undertook sensitivity analysis using only trials at low risk of bias. There is no impact on maternal and perinatal outcomes such as perinatal mortality or incidence of preterm birth.
PMID: 28205207 [PubMed - indexed for MEDLINE]
Eliciting Preferences for Information Provision in Newborn Bloodspot Screening Programs.
Value Health. 2017 Apr;20(4):651-661
Authors: Wright SJ, Ulph F, Dharni N, Payne K
BACKGROUND: The national newborn bloodspot screening programs (NBSPs) are continually expanding to screen for more conditions.
OBJECTIVES: To quantify parents' preferences for information and the way in which this is provided in example NBSPs.
METHODS: A hybrid choice experiment, combining a conjoint analysis and a discrete choice experiment, was designed. A sample of current and future parents between the ages of 18 and 45 years was identified via an Internet panel. Respondents completed one of two survey versions (9 conditions and 20 conditions) comprising a validated measure of attitudes toward involvement in decision making, 6 CA questions (11 information attributes), 10 DCE questions (4 attributes: 3 process and the ability to make an informed decision), and demographic questions.
RESULTS: Of the 702 respondents who completed the survey, 58% were women, 48% were between 25 and 34 years old, and 48% were current parents. All types of information were identified to statistically significantly improve parents' ability to make a decision. Participants preferred taking an "active" role in decision making. Respondents to the 9-condition survey preferred information before 20 weeks (willingness to pay [WTP] £11.88; CI £5.56 to £19.53) and the 20-condition group after 20 weeks (WTP £15.91; CI £10.64 to £21.63). All respondents disliked receiving information 3 days after birth, with the 20-condition group also being averse to receiving it on day 5 (WTP -£11.20; CI -£18.40 to 5.72). Respondents in both groups preferred to receive their information in an individual discussion.
CONCLUSIONS: This study suggests that parents' preferences for receiving NBS information differ from how this information is given in current UK practice.
PMID: 28408008 [PubMed - indexed for MEDLINE]
Models of midwifery care for Indigenous women and babies: A meta-synthesis.
Women Birth. 2017 Feb;30(1):77-86
Authors: Corcoran PM, Catling C, Homer CS
ISSUE: Indigenous women in many countries experience a lack of access to culturally appropriate midwifery services. A number of models of care have been established to provide services to women. Research has examined some services, but there has not been a synthesis of qualitative studies of the models of care to help guide practice development and innovations.
AIM: To undertake a review of qualitative studies of midwifery models of care for Indigenous women and babies evaluating the different types of services available and the experiences of women and midwives.
METHODS: A meta-synthesis was undertaken to examine all relevant qualitative studies. The literature search was limited to English-language published literature from 2000-2014. Nine qualitative studies met the inclusion criteria and literature appraisal - six from Australia and three from Canada. These articles were analysed for coding and theme development.
FINDINGS: The major themes were valuing continuity of care, managing structural issues, having negative experiences with mainstream services and recognising success.
DISCUSSION: The most positive experiences for women were found with the services that provided continuity of care, had strong community links and were controlled by Indigenous communities. Overall, the experience of the midwifery services for Indigenous women was valuable. Despite this, there were still barriers preventing the provision of intrapartum midwifery care in remote areas.
CONCLUSION: The expansion of midwifery models of care for Indigenous women and babies could be beneficial in order to improve cultural safety, experiences and outcomes in relation to pregnancy and birth.
PMID: 27612623 [PubMed - indexed for MEDLINE]
Non-surgical management of obstructive sleep apnoea: a review.
Paediatr Int Child Health. 2017 Feb;37(1):1-5
Authors: Whitla L, Lennon P
BACKGROUND: Obstructive sleep apnoea is common in children and, if untreated, can lead to multiple medical sequelae. The Childhood Adenotonsillectomy Trial demonstrated benefit from early surgical intervention, but rapid access to such treatment is not always available.
AIMS: To examine the recent literature on non-surgical aspects of the management of paediatric obstructive sleep apnoea (OSA).
METHODS: The English language literature was searched for articles on the conservative management of OSA.
RESULTS: In mild cases of OSA, intra-nasal steroids and other anti-inflammatory medications may give relief in mild cases of OSA, but the long-term safety of these treatments has not been established. Weight loss in obese children has been shown to be effective in selected patients but is limited in practice. Non-invasive ventilation may be effective but compliance can be a major obstacle. Oral appliances are effective by stenting the pharyngeal airway, but research in this area is limited.
CONCLUSIONS: There are number of potential, if not proven, alternative management strategies for children with OSA, which could be considered in the absence of early surgical intervention.
PMID: 27077480 [PubMed - indexed for MEDLINE]
Randomised controlled trial of silk therapeutic garments for the management of atopic eczema in children: the CLOTHES trial.
Health Technol Assess. 2017 Apr;21(16):1-260
Authors: Thomas KS, Bradshaw LE, Sach TH, Cowdell F, Batchelor JM, Lawton S, Harrison EF, Haines RH, Ahmed A, Dean T, Burrows NP, Pollock I, Buckley HK, Williams HC, Llewellyn J, Crang C, Grundy JD, Guiness J, Gribbin A, Wake EV, Mitchell EJ, Brown SJ, Montgomery AA
BACKGROUND: Atopic eczema (AE) is a chronic, itchy, inflammatory skin condition that affects the quality of life of children and their families. The role of specialist clothing in the management of AE is poorly understood.
OBJECTIVES: To assess the effectiveness and cost-effectiveness of silk garments for the management of AE in children with moderate to severe disease.
DESIGN: Parallel-group, observer-blind, randomised controlled trial of 6 months' duration, followed by a 2-month observational period. A nested qualitative study evaluated the beliefs of trial participants, health-care professionals and health-care commissioners about the use of silk garments for AE.
SETTING: Secondary care and the community in five UK centres.
PARTICIPANTS: Children aged 1-15 years with moderate or severe AE.
INTERVENTIONS: Participants were randomised (1 : 1 using online randomisation) to standard care or standard care plus 100% silk garments made from antimicrobially protected knitted sericin-free silk [DermaSilk(TM) (AlPreTec Srl, San Donà di Piave, Italy) or DreamSkin(TM) (DreamSkin Health Ltd, Hatfield, UK)]. Three sets of garments were supplied per participant, to be worn for up to 6 months (day and night). At 6 months the standard care group received the garments to use for the remaining 2-month observational period.
MAIN OUTCOME MEASURES: Primary outcome - AE severity using the Eczema Area and Severity Index (EASI) assessed at 2, 4 and 6 months, by nurses blinded to treatment allocation. EASI scores were log-transformed for analysis. Secondary outcomes - patient-reported eczema symptoms (Patient Oriented Eczema Measure); global assessment of severity (Investigator Global Assessment); quality of life of the child (Atopic Dermatitis Quality of Life, Child Health Utility - 9 Dimensions), family (Dermatitis Family Impact Questionnaire) and main carer (EuroQoL-5 Dimensions-3 Levels); use of standard eczema treatments (e.g. emollients, topical corticosteroids); and cost-effectiveness. The acceptability and durability of the clothing, and adherence to wearing the garments, were assessed by parental/carer self-report. Safety outcomes - number of skin infections and hospitalisations for AE.
RESULTS: A total of 300 children were randomised (26 November 2013 to 5 May 2015): 42% female, 79% white, mean age 5 years. The primary analysis included 282 out of 300 (94%) children (n = 141 in each group). Garments were worn for at least 50% of the time by 82% of participants. Geometric mean EASI scores at baseline, 2, 4 and 6 months were 8.4, 6.6, 6.0, 5.4 for standard care and 9.2, 6.4, 5.8, 5.4 for silk clothing, respectively. There was no evidence of difference between the groups in EASI score averaged over all follow-up visits adjusted for baseline EASI score, age and centre (ratio of geometric means 0.95, 95% confidence interval 0.85 to 1.07; p = 0.43). This confidence interval is equivalent to a difference of -1.5 to 0.5 in the original EASI scale units. Skin infections occurred in 39 out of 141 (28%) and 36 out of 142 (25%) participants for standard care and silk clothing groups, respectively. The incremental cost per QALY of silk garments for children with moderate to severe eczema was £56,811 from a NHS perspective in the base case. Sensitivity analyses supported the finding that silk garments do not appear to be cost-effective within currently accepted thresholds.
LIMITATIONS: Knowledge of treatment allocation may have affected behaviour and outcome reporting for some of the patient-reported outcomes.
CONCLUSIONS: The addition of silk garments to standard AE care is unlikely to improve AE severity, or to be cost-effective compared with standard care alone, for children with moderate or severe AE. This trial adds to the evidence base to guide clinical decision-making.
FUTURE WORK: Non-pharmacological interventions for the management of AE remain a research priority among patients.
TRIAL REGISTRATION: Current Controlled Trials ISRCTN77261365.
FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 16. See the NIHR Journals Library website for further project information.
PMID: 28409557 [PubMed - in process]
Preparing the Family and Children for Surgery.
Crit Care Nurs Q. 2017 Apr/Jun;40(2):99-107
Authors: Yahya Al-Sagarat A, Al-Oran HM, Obeidat H, Hamlan AM, Moxham L
The focus of this literature analysis is the concept of preparing the family and children for surgery. As posited in the literature, surgery causes stress and anxiety that have a negative impact on both parents and their children. Therefore, the need for health care professionals to facilitate positive preparation for surgery to minimize anxiety and enhance postoperative recovery is important. Preparing the family and children for surgery is discussed in depth under the following themes: Preoperative Anxiety in Children, the Impact of Preoperative Anxiety on the Pediatric Patients and Parents, Preoperative Psychological Preparation for Children and Parents, and the Role of Nurse Practitioners in Preoperative Preparation. Through reviewing the literature, it would appear that some areas of preparation for parents are not as sufficient as they could be, particularly with regard to adequate preoperative education programs. The majority of studies reported that therapeutic play and clown interventions used for psychological preparation of parents and their children have been effective in minimizing and decreasing anxiety levels.
PMID: 28240692 [PubMed - indexed for MEDLINE]
Newborn vitamin K prophylaxis: an analysis of information resources for parents and professionals.
N Z Med J. 2016 Dec 02;129(1446):44-52
Authors: Miller H, Wheeler B, Kerruish N
AIMS: Vitamin K prophylaxis represents one of the first healthcare decisions families make for their newborn. Information resources are an important component of this process. This study aimed to identify and analyse written information about vitamin K.
METHODS: Resources concerning vitamin K prophylaxis for both parents and health professionals were accessed through tertiary hospitals in New Zealand and Australia, midwives associated with Queen Mary Maternity Centre (Dunedin, New Zealand), antenatal class providers in the Dunedin, New Zealand area, and an online search of Australian and New Zealand government and hospital websites, as well as the Centre for Disease Control (CDC) in the US. These materials were assessed with regard to coverage of information relevant to vitamin K prophylaxis, whether a statement of the recommended option was included, and information concerning parental choice.
RESULTS: In Australia, the majority of centres use the Australian Government National Health and Medical Research Council (NHMRC) resource. In New Zealand, eight different resources are in use. There was variation between resources in all aspects, including use of different incidence rates for vitamin K deficiency bleeding (VKDB). No New Zealand resources were available in languages other than English. The resources for health professionals also varied, and the two available New Zealand consensus statements (Ministry of Health and College of Midwives) differed in terms of their main recommendation.
CONCLUSIONS: Many different information resources are available regarding vitamin K prophylaxis in New Zealand. Standardisation of such information would be more equitable and would facilitate easier review of content and translation into multiple languages.
PMID: 27906918 [PubMed - indexed for MEDLINE]
Less reduction of psychosocial problems among adolescents with unmet communication needs.
Eur Child Adolesc Psychiatry. 2017 Apr;26(4):403-412
Authors: Jager M, Reijneveld SA, Almansa J, Metselaar J, Knorth EJ, De Winter AF
Patient-professional communication has been suggested to be a major determinant of treatment outcomes in psychosocial care for children and adolescents. However, the mechanisms involved are largely unknown and no longitudinal studies have been performed. Our aim was, therefore, to assess over the course of 1 year, the impact of patient-centered communication on psychosocial problems of adolescents in psychosocial care, including the routes mediating this impact. We obtained data on 315 adolescents, aged 12-18 years, enrolled in child and adolescent social or mental health care. We assessed patient-centered communication by comparing the needs and experiences of adolescents with regard to three aspects of communication: affective quality, information provision, and shared decision-making. Changes in psychosocial problems comprised those reported by adolescents and their parents between baseline and 1 year thereafter. Potential mediators were treatment adherence, improvement of understanding, and improvement in self-confidence. We found a relationship between unmet needs for affective quality, information provision, and shared decision-making and less reduction of psychosocial problems. The association between the unmet need to share in decision-making and less reduction of psychosocial problems were partially mediated by less improvement in self-confidence (30 %). We found no mediators regarding affective quality and information provision.
Our findings confirm that patient-centered communication is a major determinant of treatment outcomes in psychosocial care for adolescents. Professionals should be aware that tailoring their communication to individual patients' needs is vital to the effectiveness of psychosocial care.
PMID: 27623817 [PubMed - indexed for MEDLINE]
Maternal warmth and toddler development: support for transactional models in disadvantaged families.
Eur Child Adolesc Psychiatry. 2017 Apr;26(4):497-507
Authors: Girard LC, Doyle O, Tremblay RE
Studies support cognitive and social domains of development as entwined in childhood, however, there is a paucity of investigation into the nature of the mother-child relationship within an interdependence framework. Furthermore, the focus on these processes within families from impoverished communities using frequent assessments in early childhood has been limited.
Our objectives were to identify (1) the directional associations between toddler's communication ability and social competence, (2) to establish whether the association between toddler's communication ability and social competence is mediated by maternal warmth, and (3) to establish support for transactional models between toddlers' outcomes and maternal warmth in disadvantaged communities in Ireland. Participants included 173 toddlers and their families enrolled in a prenatally commencing prevention programme. Toddler's communication and social competence were assessed at 12, 18, 24 and 36 months and maternal warmth at 6 and 24 months. Cross-lagged models were estimated examining multiple paths of associations simultaneously. Direct and indirect paths of maternal warmth were also examined. Bi-directional associations were found between communication ability and social competence from 12 to 24 months but not thereafter. Maternal warmth did not significantly mediate these associations, however, support of a transactional model was found with social competence.
The results support early positive associations between better communication ability and social competence in the first 2 years, however, they suggest that these associations are no longer present by the third year. The role of maternal warmth in fostering social competencies is important for toddlers and equally important is toddler's level of social competence in eliciting increased maternal warmth.
PMID: 27771763 [PubMed - indexed for MEDLINE]
Social disadvantage and developmental diagnosis in pre-schoolers.
J Paediatr Child Health. 2017 Apr 11;:
Authors: Kayrouz N, Milne SL, McDonald JL
AIM: To explore the association between social disadvantage and developmental diagnoses in pre-school children.
METHODS: Between 2012 and 2015, 845 pre-school children were assessed by the Child Assessment Team at Campbelltown Hospital. A social worker interviewed 469 families and these children were eligible for inclusion in the study. Autism spectrum disorder (ASD) was confirmed in 290 children. Of those without ASD, 72 did not have global developmental delay (GDD) and were excluded from the study. The remaining 107 children with GDD were used as the comparison group. Social risk factors in the two groups were compared using χ (2) tests. Variables with statistical significance were then entered into a logistic regression.
RESULTS: After logistic regression, children with ASD were more likely to be male (odds ratio (OR) 3.1, 95% CI 0.195-0.529; P < 0.001) and their parents were more likely to have a clinically significant stress score (OR 1.3, 95% CI 0.334-0.992; P = 0.047). Children with GDD were more likely to live in a disadvantaged suburb (OR 1.7, 95% CI 1.042-2.940; P = 0.034), more likely to have a sole parent (OR 1.8, 95% CI 1.062-3.082; P = 0.029) and much more likely to have had involvement with child protection services (OR 3.9, 95% CI 2.044-7.416; P < 0.001).
CONCLUSIONS: Children with GDD without autism were more likely to be disadvantaged and to have had contact with child protection services than children with ASD. This has implications for the assessment, early intervention and support services for children with disabilities and their families.
PMID: 28398695 [PubMed - as supplied by publisher]
Supporting Caregivers of Children With Acute Lymphoblastic Leukemia via a Smartphone App: A Pilot Study of Usability and Effectiveness.
Comput Inform Nurs. 2016 Nov;34(11):520-527
Authors: Wang J, Yao N, Shen M, Zhang X, Wang Y, Liu Y, Geng Z, Yuan C
Smartphone applications are widely used for self-help interventions in adult cancer survivors. However, applications for parents of pediatric cancer patients are limited. We developed an applications to assist parents of children with acute lymphoblastic leukemia. The aim of this study is to evaluate the app's usability and effectiveness in a preliminary way. A stepwise approach and mixed methods were used. The application was initially tested by healthcare providers, and their comments and suggestions were used to develop an updated version. This version was tested by parents of children with acute lymphoblastic leukemia. Comments and nonverbal expressions of parents were recorded during a 2-week pilot test. The qualitative study was followed by a quantitative study using audit log data from the administration portal to understand how parents use the application. Six healthcare providers and 15 parents participated.
Parents gained a greater knowledge of leukemia, confidence in caregiving, social support, and information on how to reduce stress. Over usability was rated as stable, useful, simple, and self-explanatory. No software failure occurred. Applications have the potential to support caregivers of pediatric cancer patients. We plan to address limitations and perform an empirical interventional study to examine its clinical effectiveness.
PMID: 27385540 [PubMed - indexed for MEDLINE]
Delivering Knowledge of Stroke to Parents Through Their Children Using a Manga for Stroke Education in Elementary School.
J Stroke Cerebrovasc Dis. 2017 Feb;26(2):431-437
Authors: Ishigami A, Yokota C, Nishimura K, Ohyama S, Tomari S, Hino T, Arimizu T, Wada S, Toyoda K, Minematsu K
BACKGROUND: School-based intervention would be promising to spread stroke knowledge widely. This study aimed to clarify the effectiveness of our new educational aids that were developed for elementary school children to impart information about stroke to children and their parents in 2 different ways: with or without stroke lessons by a neurologist.
METHODS: We enrolled 562 children (aged 11 to 12 years) and their parents (n = 485). The students were divided into 2 groups: 323 received a lesson on stroke by a stroke neurologist without watching an animated cartoon (Group I), and 239 watched an animated cartoon without the lesson (Group II). All of the children took the manga home, and talked about stroke with their parents. Questionnaires on stroke knowledge were administered at baseline (BL), immediately after the lesson (IL), and 3 months (3M) after the lesson.
RESULTS: There were significant increases in the adjusted mean scores for risk factors as well as stroke symptoms at 3M in both groups compared with BL scores, although the children in Group I scored significantly better than those in Group II at IL and 3M (P < .05). In both children and parents, the correct answer rates of the FAST mnemonic at 3M were around 90%, with no significant differences between groups.
CONCLUSIONS: Stroke education for elementary school children using our educational aids provided knowledge of stroke symptoms to the children as well as their parents even without lessons on stroke, although a better understanding of stroke was obtained from lessons led by stroke neurologists.
PMID: 27838177 [PubMed - indexed for MEDLINE]
Where are the opportunities for an earlier diagnosis of primary intracranial tumours in children and young adults?
Eur J Paediatr Neurol. 2017 Mar;21(2):388-395
Authors: Chu TP, Shah A, Walker D, Coleman MP
BACKGROUND: Childhood brain tumours have some of the longest time to diagnosis. A timely diagnosis may have a role in reducing anxiety in waiting for a diagnosis and subsequent morbidity and mortality. We investigated where the opportunities for an earlier diagnosis were, and for which anatomical locations this strategy will most likely to be effective.
METHODS: A record-linkage cohort study of patients diagnosed aged 0-24 years with a primary intracranial tumour between 1989 and 2006 in England, using records from the National Cancer Registry linked to hospital admission records from Hospital Episode Statistics (HES, 1997-2006) and primary care consultation records from Clinical Practice Research Datalink (CPRD, 1989-2006). Relevant neurological presentations were extracted from HES and CPRD. Temporal changes in presentation rates were estimated in generalised additive models.
RESULTS: Frequency of presentation began to increase six months before diagnosis in primary care and three months before diagnosis in hospital. Supratentorial and midline tumours had the longest presentation history before diagnosis. Peri-ventricular tumours presented frequently in hospital (rate ratio = 1.29 vs supratentorial tumours; 95% CI = 1.12-1.48) or as an emergency (1.24; 1.01-1.51), and in primary care (1.12; 0.62-1.85).
CONCLUSIONS: Opportunities for an earlier diagnosis are greater in supratentorial, midline or cranial nerve tumours, which have a longer presentation history than peri-ventricular, cerebellar or brainstem tumours. Common features before diagnosis include headache, convulsions, and growth or endocrine disorders. Focal neurological deficits are uncommon and emerge late in the pre-diagnosis period.
PMID: 27840025 [PubMed - indexed for MEDLINE]
Do developmental milestones at 4, 8, 12 and 24 months predict IQ at 5-6 years old? Results of the EDEN mother-child cohort.
Eur J Paediatr Neurol. 2017 Mar;21(2):272-279
Authors: Peyre H, Charkaluk ML, Forhan A, Heude B, Ramus F, EDEN Mother–Child Cohort Study Group
RATIONALE: The present study aims: (i) to determine how well developmental milestones at 4, 8, 12 and 24 months may predict IQ at 5-6 years old, (ii) to identify cognitive domains during the first two years that best predict later IQ and (iii) to determine whether children with IQ in the normal range at 5-6 years old may differ from disabled (IQ < 70) and gifted children (IQ > 130) with regard to their early cognitive development.
METHOD: The main developmental milestones were collected through self-administered questionnaires rated by parents at 4, 8, 12 and 24 months and through parental questionnaires administered by a trained interviewer and questionnaires completed following a medical examination at 12 months. These questionnaires were derived from the Brunet-Lézine Psychomotor Development Scale and they addressed several cognitive domains (gross and fine motor skills, language and socialization).
RESULTS: (i) Developmental milestones predict a substantial part of the later IQ variance from 24 months (R(2) ∼ 20%). (ii) Early language skills more strongly predict later IQ than the other cognitive domains. (iii) Several cognitive domains, but particularly language skills, predict disabled children at 5-6 years old (from the age of 8 months) and gifted children (from the age of 12 months).
DISCUSSION: The present study provides valuable information for early developmental assessment and could contribute to a better understanding of intellectual development.
PMID: 27889381 [PubMed - indexed for MEDLINE]
Reliability and validity of DS-ADHD: A decision support system on attention deficit hyperactivity disorders.
Comput Methods Programs Biomed. 2017 Mar;140:241-248
Authors: Chu KC, Huang YS, Tseng CF, Huang HJ, Wang CH, Tai HY
BACKGROUND AND OBJECTIVES: The purpose of this study is to examine the reliability of the clinical use of the self-built decision support system, diagnosis-supported attention deficit hyperactivity disorder (DS-ADHD), in an effort to develop the DS-ADHD system, by probing into the development of indicating patterns of past screening support systems for ADHD.
METHODS: The study collected data based on 107 subjects, who were divided into two groups, non-ADHD and ADHD, based on the doctor's determination, using the DSM-IV diagnostic standards. The two groups then underwent Test of Variables of Attention (TOVA) and DS-ADHD testing. The survey and testing results underwent one-way ANOVA and split-half method statistical analysis, in order to further understand whether there were any differences between the DS-ADHD and the identification tools used in today's clinical trials.
RESULTS: The results of the study are as follows: 1) The ROC area between the TOVA and the clinical identification rate is 0.787 (95% confidence interval: 0.701-0.872); 2) The ROC area between the DS-ADHD and the clinical identification rate is 0.867 (95% confidence interval: 0.801-0.933).
CONCLUSIONS: The study results show that DS-ADHD has the characteristics of screening for ADHD, based on its reliability and validity. It does not display any statistical differences when compared with TOVA systems that are currently on the market. However, the system is more effective and the accuracy rate is better than TOVA. It is a good tool to screen ADHD not only in Chinese children, but also in western countries.
PMID: 28254080 [PubMed - indexed for MEDLINE]
Ethical considerations for children's participation in data collection activities during humanitarian emergencies: A Delphi review.
Confl Health. 2017;11:5
Authors: Bennouna C, Mansourian H, Stark L
BACKGROUND: Children's right to participate in data collection during emergencies has been widely recognized by humanitarian actors. However, participation in such activities can expose children to risk. Tensions have been noted between the right to participate and other principles, such as the imperative to 'do no harm.' With little evidence to inform guidance on addressing this tension, our study sought to identify expert consensus on whether and how children participate in emergency-related data collection activities.
METHODS: We employed a three-round Delphi technique with a purposive sample of 52 child protection specialists. Respondents answered two open-ended questions in round one. A thematic analysis of responses generated a set of unique statements addressing the study questions. In the second round, respondents rated each statement on a five-point scale. In the final round, respondents reviewed the group's average ratings for each statement with the option to revise their own ratings. A statement was said to have reached clear consensus when at least 90% of respondents agreed or strongly agreed with the statement.
RESULTS: A total of 124 statements and 14 themes emerged from the thematic analysis, with 46.0% of statements reaching clear consensus in the third round. Respondents strongly supported children's right to participate in data collection in humanitarian settings, while also recognizing that protecting children from harm may "over-ride" the participation principle in some contexts. Respondents identified capacity and contextual considerations as important factors influencing participation decisions, though they sometimes disagreed about how these factors should determine participation. Respondents also considered the role of individual child factors and the presence of caregivers in selecting child participants, and proposed best practice approaches for securing children's safe and meaningful participation.
CONCLUSIONS: With almost half of statements reaching clear consensus, these findings reflect broad agreement within the sector about engaging children in data collection in emergencies. At the same time, points of ongoing debate around how to factor different risks into child participation decisions may indicate discordant practice. Further reflection is needed around how factors such as the phase of emergency, the existence of basic services, and cultural beliefs should influence whether and how children participate.
PMID: 28352291 [PubMed - in process]
Universal Mandatory Reporting Policies and the Odds of Identifying Child Physical Abuse.
Am J Public Health. 2017 Mar 21;:e1-e8
Authors: Ho GW, Gross DA, Bettencourt A
OBJECTIVES: To examine the relationships between universal mandatory reporting (UMR), child physical abuse reporting, and the moderating effect of UMR on physical abuse report outcomes by report source.
METHODS: We used a national data set of 204 414 children reported for physical abuse in 2013 to compare rates of total and confirmed reports by states or territories with and without UMR. We estimated odds and predicted probabilities of confirming a physical abuse report made by professional versus nonprofessional reporters, accounting for the moderating effect of UMR and individual-level characteristics.
RESULTS: Rates of total and confirmed physical abuse reports did not differ by UMR status. Nonprofessionals were more likely to make reports in UMR states compared with states without UMR. Probability of making a confirmed report was significantly lower under UMR; this effect almost doubled for nonprofessionals compared with professional reporters.
CONCLUSIONS: Universal mandatory reporting may not be the answer for strengthening the protection of children victimized by physical abuse. Implementation of child protection policies must be exercised according to evidence to exert the fullest impact and benefit of these laws. (Am J Public Health. Published online ahead of print March 21, 2017: e1-e8. doi:10.2105/AJPH.2017.303667).
PMID: 28323475 [PubMed - as supplied by publisher]
Redrawing the line: An exploration of how lay people construct child neglect.
Child Abuse Negl. 2017 Apr 05;68:11-24
Authors: Williams SE
While there has been an increasing professional and political focus on the prevalence and harmfulness of child neglect, little has been done to explore what child neglect means outside child protection circles. This qualitative study explores lay constructions of child neglect by thematically analyzing focus group discussions between 46 self-defined 'lay' people in England. Participants viewed neglect as extremely damaging for children and as arising when children's physical, emotional, training and supervisory needs were unmet due to abnormal parental behavior. Children with unmet needs were positioned as deprived, unloved, uncontrolled and escaping. They were only positioned as neglected when failure to meet their needs was attributable to a lack of parental knowledge and skill (clueless parents), a lack of appropriate parental disposition (underinvested parents) or both (unsuitable parents). 'Normal' parents - those with the appropriate parental disposition, skills and knowledge - who failed to meet their children's needs were not seen as neglectful but rather as overburdened. As 'normal parenting' has fragmented in late modernity, society wide consensus on child neglect was felt by participants to have retreated to child protection definitions, alienating lay understandings. If child neglect really is 'everybody's business', then it is important that lay people are included in forging new definitions of and responses to meeting the needs of children.
PMID: 28391074 [PubMed - as supplied by publisher]
Screening for early-onset invasive group B Streptococcal disease in neonates in an Irish hospital (2001-2014): a retrospective audit.
Infect Dis (Lond). 2017 Jun;49(6):466-470
Authors: Nielsen M, Sheikh N, Fitzgerald E, Meehan M, LeBlanc D, Eogan M, El-Khuffash A, Drew RJ
Group B Streptococcus (GBS) is the most common cause of early-onset neonatal sepsis and meningitis. In babies with no clinical suspicion of infection, who are at risk of early-onset invasive disease based on maternal risk factors, blood cultures are taken to detect bacteraemia. In our institution, lumbar punctures are performed in infants with clinical signs of sepsis but not in infants who are well at the time of screening. Between 2001 and 2014, there were 112,361 live births weighing >500 g, of whom 13,959 (12.4%) infants had a blood culture taken on the first or second day of life, and 1971 (14.1%) of these infants had lumbar punctures on these first two days of life. Fifty-three cases of early-onset GBS disease were identified. Only three patients with invasive GBS disease had no clinical suspicion for sepsis at the time of testing. Thus, the number of blood cultures taken to detect one case of GBS bacteraemia in an infant who is well at the time of testing was 3996.
PMID: 28276804 [PubMed - indexed for MEDLINE]
Mental Health Visits: Examining Socio-demographic and Diagnosis Trends in the Emergency Department by the Pediatric Population.
Child Psychiatry Hum Dev. 2017 Mar 17;:
Authors: Holder SM, Rogers K, Peterson E, Ochonma C
The emergency department (ED) is increasingly being used for mental health visits by children and adolescents. It is estimated that 21-23% of youth have a diagnosable psychiatric or substance use disorder. Using data from the ED of a tertiary medical center, we examined trends in mental health diagnoses over a 5-year period. In school age children the most prevalent diagnoses were anxiety disorders (28.4%); disorders first usually diagnosed in infancy, childhood, or adolescence (26.5%), and mood disorders (18.6%). High school students were more likely to visit the ED for anxiety disorders (30%). Females (34.5%) presented more for anxiety disorders compared to males (22.7%). Mental health visits and diagnoses were higher during school months (September-May) and lower in the summer months (June-August). The diagnosis trends identified in this study have clinical implications that can contribute to evidence-based restructuring of mental health resources and screenings.
PMID: 28315109 [PubMed - as supplied by publisher]
Explaining culturally and linguistically diverse (CALD) parents' access of healthcare services for developmental surveillance and anticipatory guidance: qualitative findings from the 'Watch Me Grow' study.
BMC Health Serv Res. 2017 Mar 22;17(1):228
Authors: Garg P, Ha MT, Eastwood J, Harvey S, Woolfenden S, Murphy E, Dissanayake C, Jalaludin B, Williams K, McKenzie A, Einfeld S, Silove N, Short K, Eapen V
BACKGROUND: Regular health visits for parents with young children provide an opportunity for developmental surveillance and anticipatory guidance regarding common childhood problems and help to achieve optimal developmental progress prior to school entry. However, there are few published reports from Australian culturally and linguistically diverse (CALD) communities exploring parents' experiences for accessing child health surveillance programs. This paper aims to describe and explain parental experiences for accessing developmental surveillance and anticipatory guidance for children.
METHODS: Qualitative data was obtained from 6 focus groups (33 parents) and seven in-depth interviews of CALD parents recruited from an area of relative disadvantage in Sydney. Thematic analysis of data was conducted using an ecological framework.
RESULTS: An overarching theme of "awareness-beliefs-choices" was found to explain parents' experiences of accessing primary health care services for children. "Awareness" situated within the meso-and macro-systems explained parents knowledge of where and what primary health services were available to access for their children. Opportunities for families to obtain this information existed at the time of birth in Australian hospitals, but for newly arrived immigrants with young children, community linkages with family and friends, and general practitioner (GPs) were most important. "Beliefs" situated within the microsystems included parents' understanding of their children's development, in particular what they considered to be "normal" or "abnormal". Parental "choices", situated within meso-systems and chronosystems, related to their choices of service providers, which were based on the proximity, continuity, purpose of visit, language spoken by the provider and past experience of a service.
CONCLUSIONS: CALD parents have diverse experiences with primary health care providers which are influenced by their awareness of available services in the context of their duration of stay in Australia. The role of the general practitioner, with language concordance, suggests the importance of diversity within the primary care health workforce in this region. There is a need for ongoing cultural competence training of health professionals and provisions need to be made to support frequent use of interpreters at general practices in Australia.
PMID: 28330490 [PubMed - in process]
Construct validity and responsiveness of Movakic: An instrument for the evaluation of motor abilities in children with severe multiple disabilities.
Res Dev Disabil. 2016 Dec;59:194-201
Authors: Mensch SM, Echteld MA, Evenhuis HM, Rameckers EA
Movakic is a newly developed instrument for measurement of motor abilities in children with severe multiple disabilities, with a satisfactory feasibility and content validity and good inter-observer and test-retest reliability. The objective of this study was to investigate its construct validity and responsiveness to change. Sixty children with severe multiple disabilities (mean age 7.7 years, range 2-16) were measured using Movakic six times during 18 months. Construct validity was assessed by correlating Movakic scores with expert judgment. In order to assess responsiveness, scores during 3-months intervals were compared (mean score-changes and intraclass correlations) during which some children experienced meaningful events influencing motor abilities and during which others experienced no such event. Forty-five percent of children had a lower cognitive development level than 6-month, 52% had Gross Motor Function Classification System level V and 37% had level IV. For 27 children all measurements were completed, six children dropped out. Construct validity was good (r=0.50-0.71). Responsiveness was demonstrated by significantly larger score changes after events than when such events did not occur. Movakic is a valid instrument for measuring motor abilities in children with severe multiple disabilities. Results suggest responsiveness to change in motor abilities after meaningful events.
PMID: 27627682 [PubMed - indexed for MEDLINE]
The Role of Teen Mothers' Support Relationships in Maintenance of Contraceptive Use.
J Pediatr Adolesc Gynecol. 2017 Feb;30(1):35-40
Authors: Quinn DA, Mitchell SJ, Lewin A
STUDY OBJECTIVE: To explore interpersonal factors associated with maintaining contraceptive use over time among urban, African American teen mothers.
DESIGN: Longitudinal study, 2011-2015.
SETTING: Six pediatric primary care sites in the same city, all of which primarily serve urban, low-income, African American families.
PARTICIPANTS: Teen mothers accessing health services for their child at one of the six study sites.
INTERVENTIONS: The current study was a secondary data analysis of data that were collected as part of a patient-centered medical home model intervention, that compared a group of teen mothers and their children who were participants in the intervention with mother-child dyads who were enrolled in standard community-based pediatric primary care. Structured interviews were conducted with teen mothers at baseline/enrollment, when their children were, on average, 3 months old, and again 12 months later.
MAIN OUTCOME MEASURES: Maintenance of contraceptive use over time.
RESULTS: Teen mothers who perceived any tangible support from their own mothers were significantly less likely to maintain contraceptive use over time (adjusted odds ratio [AOR] = .27). However, teens who perceived any emotional support from their own mothers were nearly four times more likely to maintain contraceptive use (AOR = 3.74). Teens who lived with their own mothers were more than 5 times more likely to maintain contraceptive use over time (AOR = 5.49).
CONCLUSION: To better understand contraceptive discontinuation and thus to prevent repeat pregnancies among teen mothers, it might be necessary to further examine the role of support relationships in teen mothers' contraceptive decision-making. Secondary pregnancy prevention programs should include key support persons.
PMID: 27565409 [PubMed - indexed for MEDLINE]
Topical administration of hyaluronic acid in children with recurrent or chronic middle ear inflammations.
Int J Immunopathol Pharmacol. 2016 Sep;29(3):438-42
Authors: Torretta S, Marchisio P, Rinaldi V, Gaffuri M, Pascariello C, Drago L, Baggi E, Pignataro L
Hyaluronic acid (HA) treatment has been successfully performed in patients with recurrent upper airway infections or rhinitis. The aim of this study was to assess the efficacy and safety of the topical nasal administration of an HA-based compound by investigating its effects in children with recurrent or chronic middle ear inflammations and chronic adenoiditis. A prospective, single-blind, 1:1 randomised controlled study was performed to compare otoscopy, tympanometry and pure-tone audiometry in children which received the daily topical administration of normal 0.9% sodium chloride saline solution (control group) or 9 mg of sodium hyaluronate in 3 mL of a 0.9% sodium saline solution. The final analysis was based on 116 children (49.1% boys; mean age, 62.9 ± 17.9 months): 58 in the control group and 58 in the study group. At the end of follow-up, the prevalence of patients with impaired otoscopy was significantly lower in the study group (P value = 0.024) compared to baseline but not in the control group. In comparison with baseline, the prevalence of patients with impaired tympanometry at the end of the follow-up period was significantly lower in the study group (P value = 0.047) but not in the control group. The reduction in the prevalence of patients with conductive hearing loss (CHL) (P value = 0.008) and those with moderate CHL (P value = 0.048) was significant in the study group, but not in the control group. The mean auditory threshold had also significantly improved by the end of treatment in the study group (P value = 0.004) but not in the control group.
Our findings confirm the safety of intermittent treatment with a topical nasal sodium hyaluronate solution and are the first to document its beneficial effect on clinical and audiological outcomes in children with recurrent or chronic middle ear inflammations associated with chronic adenoiditis.
PMID: 27481884 [PubMed - indexed for MEDLINE]
Late effects of chemotherapeutic agents on renal function in childhood cancer survivors: a review of the literature.
Ir J Med Sci. 2017 Feb;186(1):49-55
Authors: O'Sullivan D
BACKGROUND: Survival outcomes for childhood cancers have significantly improved. As more children are now surviving into adulthood, knowledge of the long-term effects of childhood cancer treatments has become the focus of research.
AIM: To determine what is known about the incidence of renal function impairment in childhood cancer survivors and to determine what is known about risk factors for developing renal function impairment following childhood cancer treatment.
METHODS: A comprehensive literature search was preformed to identify studies that investigated renal dysfunction in patients who were diagnosed with childhood cancer and treated with potentially nephrotoxic chemotherapeutic agents. Potentially nephrotoxic chemotherapeutic agents identified in the selection criteria include ifosfamide, cisplatin, carboplatin and methotrexate.
RESULTS: 15 papers met the inclusion criteria. Renal function impairment was reported in 15 of 15 studies included in this literature review. The incidence of ifosfamide induced nephrotoxicity varied from 1 to 50 %. This variation may be due to the heterogeneity of reported outcome measurements. Treatment with cisplatin and carboplatin was associated with hypomagnesemia. The prevalence of hypomagnesemia varied from 7 to 29 %. This variation may be due to diversity of treatment protocols. The incidence of renal dysfunction following treatment with methotrexate was reported as 1.8 % and completely reversible.
CONCLUSION: As more childhood cancer survivors are reaching adulthood, a new niche of cancer research has emerged. Researchers are now investigating the late effects due to cytotoxic treatments. Renal function impairment is a potential late effect of treatment with nephrotoxic chemotherapeutic agents including ifosfamide, cisplatin, carboplatin and methotrexate.
PMID: 27339643 [PubMed - indexed for MEDLINE]
Outcome of pregnancy in women diagnosed with idiopathic polyhydramnios.
Aust N Z J Obstet Gynaecol. 2017 Feb;57(1):57-62
Authors: Khan S, Donnelly J
INTRODUCTION: Polyhydramnios is present in approximately 2% of pregnancies and it has been associated with a variety of adverse pregnancy outcomes.
OBJECTIVES: The aim of our study was to evaluate the association between polyhydramnios and adverse pregnancy outcomes.
METHODS: This was a retrospective case control study of 288 singleton pregnancies delivered in the Rotunda Hospital, Dublin, between 2013 and 2014. Polyhydramnios was defined as: (i) amniotic fluid index (AFI) ≥ 25 cm; (ii) maximal vertical pocket (MVP) of ≥8 cm; and (iii) a gestational age-specific threshold for AFI. Demographic information, obstetric and neonatal outcomes were obtained by review of hospital databases. Exclusion criteria included gestational or pre-existing diabetes, multiple pregnancy, carrying a fetus with structural or chromosomal abnormalities, Rhesus factor isoimmunisation, and TORCH screen positive. Outcomes were compared with outcomes of those without polyhydramnios.
RESULTS: A total of 8798 deliveries occurred during the study period. The frequency of polyhydramnios was 1.6%. One hundred and forty-four women were selected in each group. There was no significant difference in preterm deliveries, low birth weight, low Apgar score at one minute and five minutes and perinatal mortality. However, increase in caesarean delivery rate (43.1% vs 21.5%), number of fetal distresses (17.4% vs 6.9%) and number of neonatal intensive care unit (NICU) admissions (17.4% vs 4.9%) were observed in our study.
CONCLUSION: In conclusion, idiopathic polyhydramnios is associated with specific adverse outcomes, such as higher rate of caesarean delivery, fetal distress and NICU admissions. Therefore, close surveillance of these pregnancies is required, especially near term.
PMID: 28251633 [PubMed - indexed for MEDLINE]
Where to from here? The treatment of impetigo in children as resistance to fusidic acid emerges.
N Z Med J. 2016 Oct 14;129(1443):77-83
Authors: Vogel A, Lennon D, Best E, Leversha A
Admissions for skin and soft-tissue infections have been increasing steadily in children and in the general population. Concerns have been raised recently about the increasing widespread use of topical fusidic acid and concurrent increase of fusidic acid-resistant Staphylococcus aureus. Fusidic acid resistance and methicillin resistant Staphylococcus aureus (MRSA) are both more prevalent in youngest age group (<5 year-olds) and particularly in the North island. In New Zealand, fusidic acid is recommended for treatment of minor impetigo and is the only fully-funded topical antibiotic. The evidence base for alternative treatment strategies for mild impetigo is limited. Most children with impetigo in the current Counties Manukau skin and sore throat schools programme received care with wound management with only a few requiring escalation. An upcoming randomised controlled trial comparing topical hydrogen peroxide cream, topical fusidic acid and wound management only (clean and cover) will help provide evidence about the effectiveness of alternative treatments in the New Zealand setting.
PMID: 27736855 [PubMed - indexed for MEDLINE]
Pregnancy and epilepsy; meeting the challenges over the last 25 years: The rise of the pregnancy registries.
Seizure. 2017 Jan;44:162-168
Authors: Kinney MO, Craig JJ
PURPOSE: Women with epilepsy (WWE), of all ages, have much to consider if their care is to be optimised and they are not to be denied the choices open to those without epilepsy. At no time is this more critical than during their child-bearing years when treatment decisions are complex.
METHODS: In this article we will provide a personal commentary and review of the pertinent literature on how the management of WWE of childbearing years has changed over the last 25 years. As well as reflecting on the state of knowledge at the start of the 1990s and the approach to managing WWE at this time, we will demonstrate that in addition to much more information now being available that there has also been an attempt to standardise how WWE should be managed.
RESULTS: As a means of achieving this increase in knowledge and standardisation of care, we argue that the various pregnancy registries have played a significant part in these positive developments. As vehicles for collecting clinically relevant data, they have provided information that has helped empower women and their health care providers to make sound clinical decisions, as well as highlighting the difficulties and unknowns.
CONCLUSIONS: Still being active the pregnancy registries maintain a continued focus on the relevant issues relating to WWE.
PMID: 27839978 [PubMed - indexed for MEDLINE]
The impact of preterm birth <37 weeks on parents and families: a cross-sectional study in the 2 years after discharge from the neonatal intensive care unit.
Health Qual Life Outcomes. 2017 Feb 16;15(1):38
Authors: Lakshmanan A, Agni M, Lieu T, Fleegler E, Kipke M, Friedlich PS, McCormick MC, Belfort MB
BACKGROUND: Little is known about the quality of life of parents and families of preterm infants after discharge from the neonatal intensive care unit (NICU). Our aims were (1) to describe the impact of preterm birth on parents and families and (2) and to identify potentially modifiable determinants of parent and family impact.
METHODS: We surveyed 196 parents of preterm infants <24 months corrected age in 3 specialty clinics (82% response rate). Primary outcomes were: (1) the Impact on Family Scale total score; and (2) the Infant Toddler Quality of Life parent emotion and (3) time limitations scores. Potentially modifiable factors were use of community-based services, financial burdens, and health-related social problems. We estimated associations of potentially modifiable factors with outcomes, adjusting for socio-demographic and infant characteristics using linear regression.
RESULTS: Median (inter-quartile range) infant gestational age was 28 (26-31) weeks. Higher Impact on Family scores (indicating worse effects on family functioning) were associated with taking ≥3 unpaid hours/week off from work, increased debt, financial worry, unsafe home environment and social isolation. Lower parent emotion scores (indicating greater impact on the parent) were also associated with social isolation and unpaid time off from work. Lower parent time limitations scores were associated with social isolation, unpaid time off from work, financial worry, and an unsafe home environment. In contrast, higher parent time limitations scores (indicating less impact) were associated with enrollment in early intervention and Medicaid.
CONCLUSIONS: Interventions to reduce social isolation, lessen financial burden, improve home safety, and increase enrollment in early intervention and Medicaid all have the potential to lessen the impact of preterm birth on parents and families.
PMID: 28209168 [PubMed - indexed for MEDLINE]
Determining rates of overweight and obese status in children using electronic medical records: Cross-sectional study.
Can Fam Physician. 2017 Feb;63(2):e114-e122
Authors: Birken CS, Tu K, Oud W, Carsley S, Hanna M, Lebovic G, Guttmann A
OBJECTIVE: To determine the prevalence of overweight and obese status in children by age, sex, and visit type, using data from EMRALD(®) (Electronic Medical Record Administrative data Linked Database).
DESIGN: Heights and weights were abstracted for children 0 to 19 years of age who had at least one well-child visit from January 2010 to December 2011. Using the most recent visit, the proportions and 95% CIs of patients defined as overweight and obese were compared by age group, sex, and visit type using the World Health Organization growth reference standards.
PARTICIPANTS: Children 0 to 19 years of age who were rostered to a primary care physician participating in EMRALD and had at least one well-child visit from January 2010 to December 2011.
MAIN OUTCOME MEASURES: Proportion and 95% CI of children with overweight and obese status by age group; proportion of children with overweight and obese status by sex (with male sex as the referent) within each age group; and proportion of children with overweight and obese status at the most recent well-child visit type compared with other visit types by age group.
RESULTS: There were 28 083 well-child visits during this period. For children who attended well-child visits, 84.7% of visits had both a height and weight documented. Obesity rates were significantly higher in 1- to 4-year-olds compared with children younger than 1 (6.1% vs 2.3%; P < .001), and in 10- to 14-year-olds compared with 5- to 9-year-olds (12.0% vs 9.0%; P < .05). Both 1- to 4-year-old boys (7.2% vs 4.9%; P < .01) and 10- to 14-year-old boys (14.5% vs 9.6%; P < .05) had higher obesity rates compared with girls. Rates of overweight and obese status were lower using data from well-child visits compared with other visits.
CONCLUSION: Electronic medical records might be useful to conduct population-based surveillance of overweight or obese status in children. Methodologic standards, however, should be developed.
PMID: 28209703 [PubMed - indexed for MEDLINE]
Autism Spectrum Disorder: Primary Care Principles.
Am Fam Physician. 2016 Dec 15;94(12):972-979
Authors: Sanchack KE, Thomas CA
Autism spectrum disorder is characterized by difficulty with social communication and restricted, repetitive patterns of behavior, interest, or activities. The Diagnostic and Statistical Manual of Mental Disorders, 5th ed., created an umbrella diagnosis that includes several previously separate conditions: autistic disorder, Asperger syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified. There is insufficient evidence to recommend screening for autism spectrum disorder in children 18 to 30 months of age in whom the disorder is not suspected; however, there is a growing body of evidence that early intensive behavioral intervention based on applied behavior analysis improves cognitive ability, language, and adaptive skills. Therefore, early identification of autism spectrum disorder is important, and experts recommend the use of a validated screening tool at 18- and 24-month well-child visits. Medications can be used as adjunctive treatment for maladaptive behaviors and comorbid psychiatric conditions, but there is no single medical therapy that is effective for all symptoms of autism spectrum disorder. Prognosis is heavily affected by the severity of diagnosis and the presence of intellectual disability. Children with optimal outcomes receive earlier, more intensive behavioral interventions and less pharmacologic treatment.
PMID: 28075089 [PubMed - indexed for MEDLINE]
Growth and nutritional risk in children with developmental delay.
Ir J Med Sci. 2016 Nov;185(4):839-846
Authors: Malone C, Sharif F, Glennon-Slattery C
INTRODUCTION: Nutritional risk impacts outcome in developmental delay. The main objectives were to identify the incidence and factors contributing to growth faltering.
METHODS: Clinical data review was completed for 500 patients with developmental delay accepted to an Early Intervention service. Data was collected using the standardised parent nutrition screening checklist prior to and at time of initial dietary assessment. Data was compared to nutritional assessment data, GOSH and FSAI dietary guidelines. Weight category was determined using RCPCH growth and BMI charts. Statistical analysis was conducted using Statistical Package for the Social Sciences version 20 (IBM Statistics 20.0).
RESULTS: Nutritional risk was identified in 48.6 %. Weight categories were growth faltering (13.5 %), underweight (7.7 %), overweight (8.4 %) and obesity (4.3 %) at initial assessment. Growth faltering was correlated with age <1 year (p = 0.000) and with gestational age (p = 0.017) with highest rates identified in those born 32-36 weeks (3.6 %). Weight category was associated with introduction of solids pre 17 weeks recommendation (10.1 %), ANOVA demonstrating significance (P = 0.013). There was poor parental recognition of nutritional risk in 22.7 % of those assessed. Nutritional difficulties were common: 4.2 % were enterally fed, 7.7 % were on prescribed nutritional supplements, 29.1 % (n = 121) had feeding difficulties and 13.9 % (n = 58) had behavioural feeding difficulties. Iron intake did not meet the recommended intake in 20.9 % (n = 87), calcium in 4.5 % (n = 19). The prevalence of constipation was 21.6, 11.8 % of whom required medical management.
CONCLUSIONS: Developmental delay predisposes to nutritional deficits which influence outcome. Screening, assessment and timely interventions are warranted to prevent poorer developmental outcomes.
PMID: 26573207 [PubMed - indexed for MEDLINE]
Preparing young people for future decision-making about cancer risk in families affected or at risk from hereditary breast cancer: A qualitative interview study.
Eur J Oncol Nurs. 2016 Dec;25:9-15
Authors: Rowland E, Plumridge G, Considine AM, Metcalfe A
PURPOSE: Women carrying the mutated BRCA gene, have approximately an 80% life-time risk of developing breast cancer with 50% risk of their children inheriting the gene mutation. Many parents find it difficult to know when and how to disclose this information to their children and how such disclosure might affect their child's future decision-making.
METHOD: This study explored the communication of genetic risk information in families using qualitative semi-structured interviews conducted with parents, children (7-11years) and young people (12-18years) affected or at risk from a BRCA gene mutation. Thematic analysis was applied to coded transcripts producing four themes; family communication, perception of cancer risks, risk management strategies and impact of genetic risk communication in children and young people's decision making.
RESULTS: Twenty-seven individuals from 11 families took part, recruited through purposive sampling techniques. Cancer risk caused by a BRCA gene mutation induced a sense of fear in parents about their children's future. As a result, parents with hereditary breast cancer disclosed limited information about the risks associated with prophylactic surgery and/or the psychological and emotional impacts of surgery on body image. This had implications to children and young people's perceptions of prophylactic procedures, which were already influenced by cultural understandings of the 'desirable body' and increasing acceptance and proliferation cosmetic surgery.
CONCLUSION: Lack of risk management information and the acculturation of cosmetic surgery combined to limit children and young people's understanding of the impact of hereditary breast cancer; reducing their ability to actualise the physiological, psychological and emotional consequences of surgery.
PMID: 27865258 [PubMed - indexed for MEDLINE]
Environmental and individual attributes associated with child maltreatment resulting in hospitalization or death.
Child Abuse Negl. 2017 Mar 02;67:119-136
Authors: Thurston H, Freisthler B, Bell J, Tancredi D, Romano PS, Miyamoto S, Joseph JG
Maltreatment continues to be a leading cause of death for young children. Researchers are beginning to uncover which neighborhood attributes may be associated with maltreatment outcomes. However, few studies have been able to explore these influences while controlling for individual family attributes, and none have been able to parse out the most severe outcomes-injuries resulting in hospitalization or death. This study utilizes a retrospective, case-control design on a dataset containing both individual and environmental level attributes of children who have been hospitalized or died due to maltreatment to explore the relative influence of attributes inside and outside the household walls. Binary conditional logistic regression was used to model the outcome as a function of the individual and environmental level predictors. Separate analyses also separated the outcome by manner of maltreatment: abuse or neglect. Finally, a sub-analysis included protective predictors representing access to supportive resources.
Findings indicate that neighborhood attributes were similar for both cases and controls, except in the neglect only model, wherein impoverishment was associated with higher odds of serious maltreatment. Dense housing increased risk in all models except the neglect only model. In a sub-analysis, distance to Family Resource Centers was inversely related to serious maltreatment. In all models, variables representing more extreme intervention and/or removal of the victim and/or perpetrator from the home (foster care or criminal court involvement) were negatively associated with the risk of becoming a case. Medi-Cal insurance eligibility of a child was also negatively associated with becoming a case. Government interventions may be playing a critical role in child protection. More research is needed to ascertain how these interventions assert their influence.
PMID: 28254689 [PubMed - as supplied by publisher]
Defining reasonable force: Does it advance child protection?
Child Abuse Negl. 2017 Feb 28;:
Authors: Durrant JE, Fallon B, Lefebvre R, Allan K
Fifty-two countries have abolished all physical punishment of children, yet Canada has retained its criminal defense to 'reasonable' corrective force. In 2004, Canada's Supreme Court attempted to set limits on punitive acts that can be considered reasonable under the law. In the present study, we examined the validity of these limits. If the court's limits provide adequate protection to children, most substantiated child maltreatment cases should exceed those limits. We operationalized each limit and applied it to a provincially representative sample of substantiated child physical maltreatment cases. We found that the majority of substantiated physical abuse cases fell within each of the court's limits. In more than one in four substantiated physical abuse cases, not even one of the court's limits was exceeded. The best predictor of whether a report was substantiated was whether spanking was typical in the child's home.
The findings suggest that: abolition of physical punishment would provide greater protection to children than attempts to set limits on its use.
PMID: 28258758 [PubMed - as supplied by publisher]
Training on domestic violence and child safeguarding in general practice: a mixed method evaluation of a pilot intervention.
BMC Fam Pract. 2017 Mar 04;18(1):33
Authors: Lewis NV, Larkins C, Stanley N, Szilassy E, Turner W, Drinkwater J, Feder GS
BACKGROUND: Children's exposure to domestic violence is a type of child maltreatment, yet many general practice clinicians remain uncertain of their child safeguarding responsibilities in the context of domestic violence. We developed an evidence-based pilot training on domestic violence and child safeguarding for general practice teams. The aim of this study was to test and evaluate its feasibility, acceptability and the direction of change in short-term outcome measures.
METHODS: We used a mixed method design which included a pre-post questionnaire survey, qualitative analysis of free-text comments, training observations, and post-training interviews with trainers and participants. The questionnaire survey used a validated scale to measure participants' knowledge, confidence/ self-efficacy, and beliefs/ attitudes towards domestic violence and child safeguarding in the context of domestic violence.
RESULTS: Eleven UK general practices were recruited (response rate 55%) and 88 clinicians attended the pilot training. Thirty-seven participants (42%) completed all pre-post questionnaires and nine were interviewed. All training sessions were observed. All six trainers were interviewed. General practice clinicians valued the training materials and teaching styles, opportunities for reflection and delivery by local trainers from both health and children's social services. The training elicited positive changes in total outcome score and knowledge and confidence/ self-efficacy sub scores which remained at 3-month follow up. However, the mean sub score of beliefs and attitudes did not change and the qualitative results were mixed. Two interviewees described changes in their clinical practice. Participants' suggestions for improving the training included incorporating more ethnic and class diversity in the material, using cases with multiple socio economic disadvantages, and addressing multi-agency collaboration in the context of changing and under-resourced services for children.
CONCLUSIONS: The pilot training for general practice on child safeguarding in the context of domestic violence was feasible and acceptable. It elicited positive changes in clinicians' knowledge and confidence/ self-esteem. The extent to which clinical behaviour changed is unclear, but there are indications of changes in practice by some clinicians. The pilot training requires further refinement and evaluation before implementation.
PMID: 28259143 [PubMed - in process]
Screening for Child Sexual Exploitation in Online Sexual Health Services: An Exploratory Study of Expert Views.
J Med Internet Res. 2017 Feb 14;19(2):e30
Authors: Spencer-Hughes V, Syred J, Allison A, Holdsworth G, Baraitser P
BACKGROUND: Sexual health services routinely screen for child sexual exploitation (CSE). Although sexual health services are increasingly provided online, there has been no research on the translation of the safeguarding function to online services. We studied expert practitioner views on safeguarding in this context.
OBJECTIVE: The aim was to document expert practitioner views on safeguarding in the context of an online sexual health service.
METHODS: We conducted semistructured interviews with lead professionals purposively sampled from local, regional, or national organizations with a direct influence over CSE protocols, child protection policies, and sexual health services. Interviews were analyzed by three researchers using a matrix-based analytic method.
RESULTS: Our respondents described two different approaches to safeguarding. The "information-providing" approach considers that young people experiencing CSE will ask for help when they are ready from someone they trust. The primary function of the service is to provide information, provoke reflection, generate trust, and respond reliably to disclosure. The approach values online services as an anonymous space to test out disclosure without commitment. The "information-gathering" approach considers that young people may withhold information about exploitation. Therefore, services should seek out information to assess risk and initiate disclosure. This approach values face-to-face opportunities for individualized questioning and immediate referral.
CONCLUSIONS: The information-providing approach is associated with confidential telephone support lines and the information-gathering approach with clinical services. The approach adopted online will depend on ethos and the range of services provided. Effective transition from online to clinic services after disclosure is an essential element of this process and further research is needed to understand and support this transition.
PMID: 28196790 [PubMed - in process]
Child sexual abuse and exploitation-A global glimpse.
Child Abuse Negl. 2017 Feb 22;:
Authors: Dubowitz H
The view of what constitutes child abuse and neglect is dependent on the laws, cultural context, local thresholds and the availability. Since 1982, the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) has conducted surveillance of child maltreatment and child protection every two years, published in World Perspectives on Child Abuse. It is hoped that up to date information will inform the development of laws, policies and programs to better address child abuse and neglect. This article is based on data on child sexual abuse and exploitation from 73 countries gathered online in 2015-16 for the 12 edition of World Perspectives. Respondents were key informants who were knowledgeable professionals in the child protection field. They were encouraged to consult with colleagues so as to provide accurate information. Countries were grouped into different regions of the world and into income level categories. The findings focus on definitions of abuse and neglect, laws, policies and programs to address and prevent maltreatment and barriers to prevention. It is evident that there is considerable variability across regions and country income categories, and that programs and services need to be considerably strengthened, even in high income countries.
PMID: 28237191 [PubMed - as supplied by publisher]
Maltreatment Risk Among Children With Disabilities.
Pediatrics. 2017 Mar 06;:
Authors: Maclean MJ, Sims S, Bower C, Leonard H, Stanley FJ, O'Donnell M
BACKGROUND: Children with disabilities are at increased risk of child maltreatment; however, there is a gap in the evidence about whether all disabilities are at equal risk and whether risk factors vary according to the type of disability.
METHODS: A population-based record-linkage study of all children born in Western Australia between 1990 and 2010. Children with disabilities were identified by using population-based registers and risk of maltreatment determined by allegations reported to the Department for Child Protection and Family Support.
RESULTS: Although children with disabilities make up 10.4% of the population, they represent 25.9% of children with a maltreatment allegation and 29.0% of those with a substantiated allegation; however, increased risk of maltreatment was not consistent across all disability types. Children with intellectual disability, mental/behavioral problems, and conduct disorder continued to have increased risk of an allegation and substantiated allegation after adjusting for child, family, and neighborhood risk factors. In contrast, adjusting for these factors resulted in children with autism having a lower risk, and children with Down syndrome and birth defects/cerebral palsy having the same risk as children without disability.
CONCLUSIONS: The prevalence of disabilities in the child protection system suggests a need for awareness of the scope of issues faced by these children and the need for interagency collaboration to ensure children's complex needs are met. Supports are needed for families with children with disabilities to assist in meeting the child's health and developmental needs, but also to support the parents in managing the often more complex parenting environment.
PMID: 28264988 [PubMed - as supplied by publisher]
An evidence-based resource for the management of comorbidities associated with childhood overweight and obesity.
J Am Assoc Nurse Pract. 2016 Oct;28(10):559-570
Authors: Thompson N, Mansfield B, Stringer M, Stewart B, Potter J, Fernengel K
PURPOSE: Overweight and obesity in children and adolescents is often accompanied by obesity-related comorbidities. An integrative review of the literature was performed to create a comprehensive algorithm to help primary care providers manage the common comorbidities associated with childhood overweight and obesity.
DATA SOURCES: The Cumulative Index to Nursing and Allied Health Literature, ProQuest Nursing and Allied Health Source, and PubMed databases were searched. Evidence from 2002 to present was reviewed. Guidelines and algorithms from the American Academy of Pediatrics, National Association of Pediatric Nurse Practitioners, American Heart Association, American Diabetes Association, Centers for Disease Control and Prevention, National Heart, Lung, and Blood Institute, Agency for Healthcare and Research Quality, U.S. Department of Health and Human Services, and the International Diabetes Federation were also reviewed.
CONCLUSIONS: Key information was extracted and data sources ranked according to the Polit and Beck evidence hierarchy. Highest level evidence guided the selection and development of recommendations to formulate a comprehensive resource for the recognition and management of pediatric hypertension, sleep apnea, vitamin D deficiency, nonalcoholic fatty liver disease, dyslipidemia, thyroid disease, diabetes mellitus, insulin resistance, metabolic syndrome, and polycystic ovarian syndrome.
IMPLICATIONS FOR PRACTICE: The Childhood Overweight and Obesity Comorbidities Resource provides a consistent, convenient point-of-care reference to help primary care providers improve pediatric health outcomes.
PMID: 27193136 [PubMed - indexed for MEDLINE]
The Five S's: A Communication Tool for Child Psychiatric Access Projects.
Curr Probl Pediatr Adolesc Health Care. 2016 Dec;46(12):411-419
Authors: Harrison J, Wasserman K, Steinberg J, Platt R, Coble K, Bower K
Given the gap in child psychiatric services available to meet existing pediatric behavioral health needs, children and families are increasingly seeking behavioral health services from their primary care clinicians (PCCs). However, many pediatricians report not feeling adequately trained to meet these needs. As a result, child psychiatric access projects (CPAPs) are being developed around the country to support the integration of care for children. Despite the promise and success of these programs, there are barriers, including the challenge of effective communication between PCCs and child psychiatrists. Consultants from the Maryland CPAP, the Behavioral Health Integration in Pediatric Primary Care (BHIPP) project, have developed a framework called the Five S's. The Five S's are Safety, Specific Behaviors, Setting, Scary Things, and Screening/Services. It is a tool that can be used to help PCCs and child psychiatrists communicate and collaborate to formulate pediatric behavioral health cases for consultation or referral requests. Each of these components and its importance to the case consultation are described. Two case studies are presented that illustrate how the Five S's tool can be used in clinical consultation between PCC and child psychiatrist. We also describe the utility of the tool beyond its use in behavioral health consultation.
PMID: 27919566 [PubMed - indexed for MEDLINE]
Comparison of the primary cesarean hysterotomy scars after single- and double-layer interrupted closure.
Acta Obstet Gynecol Scand. 2016 Dec;95(12):1352-1358
Authors: Kataoka S, Tanuma F, Iwaki Y, Iwaki K, Fujii T, Fujimoto T
INTRODUCTION: It is unclear whether hysterotomy closure techniques can affect niche development. Therefore, this study aimed to analyze the effect of single-layer and double-layer interrupted closures of hysterotomy incisions during primary cesarean section on the formation of uterine niches.
MATERIAL AND METHODS: A prospective cohort study of women undergoing primary cesarean section was performed between June 2011 and July 2014. Saline contrast sonohysterography was used to measure the niche depth and residual myometrium. The ratio of the niche depth to the sum of the niche depth and residual myometrium thickness (niche ratio) was calculated.
RESULTS: Niches were identified in 14/58 (24.1%) women with single-layer sutures and 55/209 (26.3%) women with double-layer sutures (p = 0.74). Single-layer closure was associated with more than a five-fold increase in the odds of a niche ratio ≥0.4 (odds ratio 5.59; 95% CI 1.71-18.28).
CONCLUSION: Single-layer closure may be associated with an increased risk of larger niches (niche ratio ≥0.4), although it may not increase the overall frequency of niche formation.
PMID: 27617416 [PubMed - indexed for MEDLINE]
Thirty-days readmissions in pediatric surgery: The first U.K. experience.
J Pediatr Surg. 2016 Nov;51(11):1877-1880
Authors: Sinha CK, Decker E, Rex D, Mukhtar Z, Murphy F, Nicholls E, Okoye B, Giuliani S
INTRODUCTION: The aim of this study was to investigate readmissions within 30days of operation (ReAd) in the setting of a tertiary pediatric surgical practice in the UK.
METHODS: Using Hospital Episode Statistics, cases that were readmitted within 30days of primary operation were identified retrospectively. Demographics including age, gender, preexisting comorbidities, diagnosis on primary admission and the treatment, length of stay, and diagnosis on readmission with treatment, including further surgical intervention, were collected from discharge summaries and hospital notes. Neonates were excluded from this study. Comorbidities, involving one or more systems, were also identified for each case of readmission. ReAds were classified into emergency and elective cohort depending on the nature of the primary operation. Outcomes were compared between these two groups. Data were quoted as median (range) unless indicated otherwise. Data were analyzed using SPSS software Desktop 22.0, using Mann-Whitney U and Chi-Squared tests, with a consideration that a P≤0.05 was significant.
RESULTS: A total of 2378 procedures were performed during the study period. Elective cases, including day cases, accounted for 77% (n=1837) of all cases. The remaining 23% (n=541) were emergency cases. Total unplanned readmission rate within 30days (ReAd) was 2%. Further surgical procedures were required in 38%. Having excluded neonates, the most common primary procedure leading to readmission within 30days was appendicectomy (26%). Overall, the most common cause for readmission within 30days was postoperative infection (30%). The ReAd in emergency cohort was 3.5% in comparison to 1.5% in elective, which was significantly different (P value=0.007).
CONCLUSION: Readmission within thirty days of primary procedure in pediatric surgery has little published data. An efficient discharge planning may play a vital role in preventing unwanted readmission. Elective operations had a significantly lower readmission rate than emergency operations. Having excluded neonates, appendicectomy was found to be the most common operation associated with readmission in the pediatric surgical practice. Although widely used as quality care indicator in adults, more studies are required to validate readmission rate as a quality of care indicator in pediatric surgery practice.
PMID: 27430864 [PubMed - indexed for MEDLINE]
Validation of hospital discharge diagnoses for hypertensive disorders of pregnancy.
Acta Obstet Gynecol Scand. 2016 Nov;95(11):1288-1294
Authors: Luef BM, Andersen LB, Renäult KM, Nohr EA, Jørgensen JS, Christesen HT
INTRODUCTION: A correct diagnosis of preeclampsia and gestational hypertension is important for treatment and epidemiological studies. Changes in diagnostic criteria and underreporting in certain subsets of patients may hamper validity of the diagnoses.
MATERIALS AND METHODS: We validated the discharge diagnoses of preeclampsia and gestational hypertension, which are reported to the Danish National Patient Registry, in a cohort of 2163 pregnant women by retrospective evaluation of electronic hospital data.
RESULTS: A preeclampsia discharge diagnosis was found in 113 (5.2%) of the participants. After validation, significantly more patients fulfilled criteria for diagnosis of preeclampsia (n = 163, 7.5%, p = 0.002); more had severe preeclampsia, 14 (0.6%) vs. 70 (3.2%), p < 0.001 and gestational hypertension, 62 (2.9%) vs. 46 (2.1%), p = 0.12. The diagnostic sensitivity for preeclampsia by discharge diagnosis was 55.8%; severe preeclampsia 18.6%; gestational hypertension 39.1%. Corresponding positive predictive values were 80.5, 92.9 and 29.0%. Misclassification occurred in 4.3, 2.7 and 3.3%, respectively. Misclassification was more prevalent in obese compared to lean women (10% vs. 3.6%, p < 0.0001).
CONCLUSIONS: Discharge diagnoses substantially underestimated the prevalence of preeclampsia, especially severe preeclampsia. Misclassification was most common in obese preeclamptic women. These findings depict the limitations associated with the direct use of discharge diagnoses of hypertensive disorders in pregnancy for research purposes.
PMID: 27562930 [PubMed - indexed for MEDLINE]
The Effectiveness of a Mobile Clinic in Improving Follow-up Eye Care for At-Risk Children.
J Pediatr Ophthalmol Strabismus. 2016 Nov 01;53(6):344-348
Authors: Diao W, Patel J, Snitzer M, Pond M, Rabinowitz MP, Ceron G, Bagley K, Dennis K, Weiner R, Martinez-Helfman S, Maria KS, Burke B, Aultman WB, Levin AV
PURPOSE: To investigate the potential of a mobile ophthalmic unit in the schoolyard to improve the follow-up rate for children who have failed an optometric in-school screening program. Previously, the optometric program made referrals to the center and only 53% of students attended the desired ophthalmology consultation.
METHODS: This was a cohort study of students conducted in elementary school lots in socioeconomically disadvantaged communities. The mobile ophthalmic unit visited schools where students with parental consent who needed examination had been identified by an in-school optometric vision care program.
RESULTS: A total of 132 students were referred by the optometric program, of whom 95 (72%) had complete signed consent forms. Eighty-two patients (62%, confidence interval: 54% to 70%) were successfully seen by the mobile unit. Compared to the historical rate of successful completion of ophthalmology consultation (53%), a statistically significant improvement in follow-up was noted (P = .036). On a Likert scale of 1 to 5, the mean school nurse satisfaction rating was 4.8.
CONCLUSIONS: The findings demonstrate the potential impact of mobile eye clinics at schools in connecting children with ophthalmic care. [J Pediatr Ophthalmol Strabismus. 2016;53(6):344-348.].
PMID: 27486729 [PubMed - indexed for MEDLINE]
Associations between birth weight and colon and rectal cancer risk in adulthood.
Cancer Epidemiol. 2016 06;42:181-5
Authors: Smith NR, Jensen BW, Zimmermann E, Gamborg M, Sørensen TI, Baker JL
BACKGROUND: Birth weight has inconsistent associations with colorectal cancer, possibly due to different anatomic features of the colon versus the rectum. The aim of this study was to investigate the association between birth weight and colon and rectal cancers separately.
METHODS: 193,306 children, born from 1936 to 1972, from the Copenhagen School Health Record Register were followed prospectively in Danish health registers. Colon and rectal cancer cases were defined using the International Classification of Disease version 10 (colon: C18.0-18.9, rectal: 19.9 and 20.9). Only cancers classified as adenocarcinomas were included in the analyses. Cox regressions were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Analyses were stratified by birth cohort and sex.
RESULTS: During 3.8 million person-years of follow-up, 1465 colon and 961 rectal adenocarcinomas were identified. No significant sex differences were observed; therefore combined results are presented. Birth weight was positively associated with colon cancers with a HR of 1.14 (95% CI, 1.04-1.26) per kilogram of birth weight. For rectal cancer a significant association was not observed for birth weights below 3.5kg. Above 3.5kg an inverse association was observed (at 4.5kg, HR=0.77 [95% CI, 0.61-0.96]). Further, the associations between birth weight and colon and rectal cancer differed significantly from each other (p=0.006).
CONCLUSIONS: Birth weight is positively associated with the risk of adult colon cancer, whereas the results for rectal cancer were inverse only above values of 3.5kg. The results underline the importance of investigating colon and rectal cancer as two different entities.
PMID: 27203465 [PubMed - indexed for MEDLINE]
Health disparities and impact on outcomes in children with primary central nervous system solid tumors.
J Neurosurg Pediatr. 2016 Nov;18(5):585-593
Authors: Austin MT, Hamilton E, Zebda D, Nguyen H, Eberth JM, Chang Y, Elting LS, Sandberg DI
OBJECTIVE Health disparities in access to care, early detection, and survival exist among adult patients with cancer. However, there have been few reports assessing how health disparities impact pediatric patients with malignancies. The objective in this study was to examine the impact of racial/ethnic and social factors on disease presentation and outcome for children with primary CNS solid tumors. METHODS The authors examined all children (age ≤ 18 years) in whom CNS solid tumors were diagnosed and who were enrolled in the Texas Cancer Registry between 1995 and 2009 (n = 2421). Geocoded information was used to calculate the driving distance between a patient's home and the nearest pediatric cancer treatment center. Socioeconomic status (SES) was determined using the Agency for Healthcare Research and Quality formula and 2007-2011 US Census block group data. Logistic regression was used to determine factors associated with advanced-stage disease. Survival probability and hazard ratios were calculated using life table methods and Cox regression. RESULTS Children with advanced-stage CNS solid tumors were more likely to be < 1 year old, Hispanic, and in the lowest SES quartile (all p < 0.05). The adjusted odds ratios of presenting with advanced-stage disease were higher in children < 1 year old compared with children > 10 years old (OR 1.71, 95% CI 1.06-2.75), and in Hispanic patients compared with non-Hispanic white patients (OR 1.56, 95% CI 1.19-2.04). Distance to treatment and SES did not impact disease stage at presentation in the adjusted analysis. Furthermore, 1- and 5-year survival probability were worst in children 1-10 years old, Hispanic patients, non-Hispanic black patients, and those in the lowest SES quartile (p < 0.05). In the adjusted survival model, only advanced disease and malignant behavior were predictive of mortality. CONCLUSIONS Racial/ethnic disparities are associated with advanced-stage disease presentation for children with CNS solid tumors. Disease stage at presentation and tumor behavior are the most important predictors of survival.
PMID: 27540957 [PubMed - indexed for MEDLINE]
Unscheduled Pediatric Intensive Care Unit Admissions in Patients With Cardiovascular Disease: Clinical Features and Outcomes.
World J Pediatr Congenit Heart Surg. 2016 07;7(4):454-9
Authors: Coro MD, Spaeder MC, Penk JS, Levin AB, Futterman C
BACKGROUND: An unscheduled readmission to the intensive care unit (ICU) is associated with increased morbidity and mortality in children. There is a paucity of data examining the impact of unscheduled admissions on outcomes in children with specific disease processes such as cardiovascular disease. We investigated the impact of scheduled versus unscheduled ICU admission on clinical outcomes and differences in patient characteristics in children with cardiovascular disease.
METHODS: This was a retrospective analysis of contemporaneously collected clinical data using the Virtual PICU Systems database. All consecutive admissions at 102 participating pediatric ICUs in patients with cardiovascular disease were collected from October 2010 to September 2012.
RESULTS: There were 48,653 admissions included in the analysis (44% scheduled and 56% unscheduled). The median patient age was 31 months. Unscheduled admissions were associated with longer ICU length of stay and increased mortality (both P < .001). Adjusting for age, weight, and primary ICU admission diagnosis (cardiovascular vs noncardiovascular), patients with unscheduled admissions had an increased odds of mortality (odds ratio = 4.8, P < .001).
CONCLUSIONS: Unscheduled ICU admissions were associated with worse clinical outcomes including increased mortality. Efforts targeted at reducing unscheduled admissions in at-risk patients are warranted.
PMID: 27358300 [PubMed - indexed for MEDLINE]
Management of giant omphaloceles: A systematic review of methods of staged surgical vs. nonoperative delayed closure.
J Pediatr Surg. 2016 Oct;51(10):1725-30
Authors: Bauman B, Stephens D, Gershone H, Bongiorno C, Osterholm E, Acton R, Hess D, Saltzman D, Segura B
PURPOSE: Despite the numerous methods of closure for giant omphaloceles, uncertainty persists regarding the most effective option. Our purpose was to review the literature to clarify the current methods being used and to determine superiority of either staged surgical procedures or nonoperative delayed closure in order to recommend a standard of care for the management of the giant omphalocele.
METHODS: Our initial database search resulted in 378 articles. After de-duplification and review, we requested 32 articles relevant to our topic that partially met our inclusion criteria. We found that 14 articles met our criteria; these 14 studies were included in our analysis. 10 studies met the inclusion criteria for nonoperative delayed closure, and 4 studies met the inclusion criteria for staged surgical management.
RESULTS: Numerous methods for managing giant omphaloceles have been described. Many studies use topical therapy secondarily to failed surgical management. Primary nonoperative delayed management had a cumulative mortality of 21.8% vs. 23.4% in the staged surgical group. Time to initiation of full enteric feedings was lower in the nonoperative delayed group at 14.6days vs 23.5days.
CONCLUSION: Despite advances in medical and surgical therapies, giant omphaloceles are still associated with a high mortality rate and numerous morbidities. In our analysis, we found that nonoperative delayed management with silver therapy was associated with lower mortality and shorter duration to full enteric feeding. We recommend that nonoperative delayed management be utilized as the primary therapy for the newborn with a giant omphalocele.
PMID: 27570242 [PubMed - indexed for MEDLINE]
Comparing 2 Adhesive Methods on Skin Integrity in the High-Risk Neonate.
Adv Neonatal Care. 2016 Dec;16(6):449-454
Authors: Boswell N, Waker CL
BACKGROUND: Nurses have a primary role in promoting neonatal skin integrity and skin care management of the critically ill neonate. Adhesive products are essential to secure needed medical devices but can be a significant factor contributing to skin breakdown. Current literature does not offer a definitive answer regarding which products most safely and effectively work to secure needed devices in the high-risk neonatal population.
PURPOSE: To determine which adhesive method is best practice to safely and effectively secure lines/tubes in the high-risk neonate population.
FINDINGS/RESULTS: The only main effect that was significant was age group with mean skin scores. Subjects in the younger group (24-28 weeks) had higher skin scores than in the older group (28-34 weeks), validating that younger gestations are at higher risk of breakdown with the use of adhesives.
IMPLICATIONS FOR PRACTICE: The findings did not clearly identify which product was superior to secure tubes and lines, or was the least injurious to skin of the high-risk neonate. Neither a transparent dressing only or transparent dressing over hydrocolloid method clearly demonstrated an advantage in the high-risk, preterm neonate. Anecdotal comments suggested staff preferred the transparent dressing over hydrocolloid method as providing better adhesive while protecting skin integrity. The findings validated that younger gestations are at higher risk of breakdown with the use of adhesives and therefore require close vigilance to maintain skin integrity.
PMID: 27649300 [PubMed - indexed for MEDLINE]
Infants With Technology Dependence: Facilitating the Road to Home.
Adv Neonatal Care. 2016 Dec;16(6):424-429
Authors: Bowles JD, Jnah AJ, Newberry DM, Hubbard CA, Roberston T
BACKGROUND: The incidence of premature infants with complex medical needs, dependent upon medical technology at discharge, is on the rise in the United States.
PURPOSE: Preparing the family for the hospital-to-home transition can be challenging due to the complex medical and emotional needs of the vulnerable infant and the volume of subspecialty services and equipment required.
METHODS/SEARCH STRATEGY: Relevant articles from PubMed, Google Scholar, CINAHLFINDINGS/RESULTS:: There is an increasing incidence of technology dependent infants discharged from neonatal intensive care units in the United States. Transition from hospital to home requires lengthy preparation, multidisciplinary-open communication, and family centered care.
IMPLICATIONS FOR PRACTICE: Early assimilation of the parents into the ongoing care of their infant, the provision of comprehendible parental education by neonatal nurses and other members of the healthcare team, the provision of adequate rooming-in experiences prior to discharge, and the collaborative coordination of outpatient community services are crucial elements of the discharge process. Neonatal nurses possess population-specific education, training, commitment, and expertise that make them the ideal experts to implement and evaluate a discharge planning framework, in collaboration with the medical team and the family.
IMPLICATIONS FOR RESEARCH: Methods to prevent readmission and ensure successful discharge from hospital to home is indicated. Standardization of a discharge process of infants of technology dependence combining medical team, family, outpatient coordinators, and primary care providers.
PMID: 27906716 [PubMed - indexed for MEDLINE]
Student Outcomes of School-Based Physical Therapy as Measured by Goal Attainment Scaling.
Pediatr Phys Ther. 2016;28(3):277-84
Authors: Chiarello LA, Effgen SK, Jeffries L, McCoy SW, Bush H
PURPOSE: The main purposes were to describe individualized outcomes of students receiving school-based physical therapy and determine if goal attainment differed by gross motor ability and age.
METHODS: One hundred nine physical therapists and 296 students participated. At the beginning of the school year, therapists translated students' Individualized Education Program goals into subgoals using Goal Attainment Scaling and determined students' Gross Motor Functional Classification System level. Researchers categorized goals (posture/mobility, recreation/fitness, self-care, or academics), and therapists identified students' primary goal. At the end of the school year, therapists scored the goals. Descriptive statistics and 2-way analyses of variance were conducted.
RESULTS: Students exceeded their expected goal level for primary goals and goals categorized as posture/mobility, recreation/fitness, and self-care and made progress on academic goals. No differences were found by gross motor ability. Younger students had higher goal attainment for primary and recreation goals.
CONCLUSION: Students achieve individualized outcomes addressed by school-based physical therapy.
PMID: 27341574 [PubMed - indexed for MEDLINE]
A standardized approach for the assessment and treatment of internationally adopted children with a previously repaired anorectal malformation (ARM).
J Pediatr Surg. 2016 Nov;51(11):1864-1870
Authors: Lane VA, Skerritt C, Wood RJ, Reck C, Hewitt GD, McCracken KA, Jayanthi VR, DaJusta D, Ching C, Deans KJ, Minneci PC, Levitt MA
INTRODUCTION: A significant number of internationally adopted children have congenital birth defects. As a specialist center for colorectal diagnoses, we evaluate such children with an anorectal malformation (ARM) and have found that a significant number need a reoperation. Knowledge of the common complications following ARM surgery has led us to develop treatment algorithms for patients with unknown past medical and surgical history, a situation typically encountered in the adopted population.
METHODS: The results of investigations, indications, and rate of reoperation were assessed for adopted children with an ARM evaluated between 2014 and 2016.
RESULTS: 56 patients (28 males) were identified. 76.8% required reoperative surgery. Mislocation of the anus outside the sphincter complex was seen in 50% of males and 39.3% of females. Anal stricture, rectal prolapse, retained vaginal septum, and a strictured vaginal introitus were also common.
CONCLUSION: The reoperative surgery rate in the internationally adopted child with an ARM is high. Complete, systematic evaluation of these children is required to identify complications following initial repair. Development of mechanisms to improve the primary surgical care these children receive is needed.
PMID: 27554917 [PubMed - indexed for MEDLINE]
Voiding postponement in children-a systematic review.
Eur Child Adolesc Psychiatry. 2016 Aug;25(8):809-20
Authors: von Gontard A, Niemczyk J, Wagner C, Equit M
Voiding postponement (VP) has been defined as a habitual postponement of micturition using holding maneuvers. VP can represent both a symptom, as well as a condition. As divergent definitions are used internationally, the aim was to review the current state of knowledge on VP and provide recommendations for assessment, diagnosis and treatment. A Scopus and a Pubmed search was conducted, entering the terms 'voiding postponement' without any restrictions or specifications. Other publications relevant to the topic were added. VP can represent a symptom in healthy children. As a condition, VP in combination with nocturnal enuresis (NE) is a subtype of non-monosymptomatic NE. Most studies have focused on daytime urinary incontinence (DUI) with VP, or more aptly termed voiding postponement incontinence (VPI). It is a behaviorally defined syndrome, i.e., by the habitual deferral of micturition and DUI. VPI is associated with a low micturition frequency, urgency and behavioral problems. The most common comorbid disorder is oppositional defiant disorder (ODD). VP as a symptom and VPI as a condition should be differentiated. VPI is a common disorder with many associated problems and disorders. Urotherapy and timed voiding are the main treatment approaches. Due to the high rate of comorbid ODD, other forms of treatment, especially cognitive behavioral therapy, are often needed.
PMID: 26781489 [PubMed - indexed for MEDLINE]
Paracetamol (acetaminophen) or non-steroidal anti-inflammatory drugs, alone or combined, for pain relief in acute otitis media in children.
Cochrane Database Syst Rev. 2016 12 15;12:CD011534
Authors: Sjoukes A, Venekamp RP, van de Pol AC, Hay AD, Little P, Schilder AG, Damoiseaux RA
BACKGROUND: Acute otitis media (AOM) is one of the most common childhood infectious diseases and a significant reason for antibiotic prescriptions in children worldwide. Pain from middle ear infection and pressure behind the eardrum is the key symptom of AOM. Ear pain is central to children's and parents' experience of the illness. Because antibiotics provide only marginal benefits, analgesic treatment including paracetamol (acetaminophen) and non-steroidal anti-inflammatory drugs (NSAIDs) is regarded as the cornerstone of AOM management in children.
OBJECTIVES: Our primary objective was to assess the effectiveness of paracetamol (acetaminophen) or NSAIDs, alone or combined, compared with placebo or no treatment in relieving pain in children with AOM. Our secondary objective was to assess the effectiveness of NSAIDs compared with paracetamol in children with AOM.
SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Issue 7, July 2016; MEDLINE (Ovid, from 1946 to August 2016), Embase (from 1947 to August 2016), CINAHL (from 1981 to August 2016), LILACS (from 1982 to August 2016) and Web of Science (from 1955 to August 2016) for published trials. We screened reference lists of included studies and relevant systematic reviews for additional trials. We searched WHO ICTRP, ClinicalTrials.gov, and the Netherlands Trial Registry (NTR) for completed and ongoing trials (search date 19 August 2016).
SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing the effectiveness of paracetamol or NSAIDs, alone or combined, for pain relief in children with AOM. We also included trials of paracetamol or NSAIDs, alone or combined, for children with fever or upper respiratory tract infections (URTIs) if we were able to extract subgroup data on pain relief in children with AOM either directly or after obtaining additional data from study authors.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed methodological quality of the included trials and extracted data. We used the GRADE approach to rate the overall quality of evidence for each outcome of interest.
MAIN RESULTS: We included three RCTs (327 children) which were assessed at low to moderate risk of bias.One RCT included 219 children with AOM, and used a three-arm, parallel group, double-blind design to compare paracetamol versus ibuprofen versus placebo. All children also received antibiotics and those with fever > 39 °C could have received paracetamol (30 mg to 60 mg) additionally to the studied treatments.Another RCT involved 156 febrile children (26 of whom had AOM). The study design was a three-arm, parallel group, double-blind design and compared paracetamol versus ibuprofen versus ibuprofen plus paracetamol.The third RCT included 889 children with respiratory tract infections (82 of whom had AOM). This study applied a 3 x 2 x 2 factorial, open-label design and compared paracetamol versus ibuprofen versus ibuprofen plus paracetamol. Study participants were randomised to one of the three treatment groups as well as two dosing groups (regular versus as required) and two steam inhalation groups (steam versus no steam).Authors of two RCTs provided crude subgroup data on children with AOM. We used data from the remaining trial to inform comparison of paracetamol versus placebo (148 children) and ibuprofen versus placebo (146 children) assessments. Data from all included RCTs informed comparison of ibuprofen versus paracetamol (183 children); data from the two RCTs informed comparison of ibuprofen plus paracetamol versus paracetamol alone (71 children).We found evidence, albeit of low quality, that both paracetamol and ibuprofen as monotherapies were more effective than placebo in relieving pain at 48 hours (paracetamol versus placebo: proportion of children with pain 10% versus 25%, RR 0.38, 95% CI 0.17 to 0.85; number needed to treat to benefit (NNTB) 7; ibuprofen versus placebo: proportion of children with pain 7% versus 25%, RR 0.28, 95% CI 0.11 to 0.70; NNTB 6). Very low quality evidence suggested that adverse events did not significantly differ between children treated with either paracetamol, ibuprofen or placebo.We found insufficient evidence of a difference between ibuprofen and paracetamol in relieving ear pain at 24 hours (2 RCTs, 39 children; RR 0.83, 95% CI 0.59 to 1.18; very low quality evidence), 48 to 72 hours (3 RCTs, 183 children; RR 0.91, 95% CI 0.54 to 1.54; low quality evidence) and four to seven days (2 RCTs, 38 children; RR 0.74, 95% CI 0.17 to 3.23; very low quality evidence).Data on the effectiveness of ibuprofen plus paracetamol versus paracetamol alone came from two RCTs that provided crude subgroup data for 71 children with AOM. The small sample provided imprecise effect estimates and we were consequently unable to draw any firm conclusions (very low quality evidence).
AUTHORS' CONCLUSIONS: Despite explicit guideline recommendations on its use, current evidence on the effectiveness of paracetamol or NSAIDs, alone or combined, in relieving pain in children with AOM is limited. Low quality evidence indicates that both paracetamol and ibuprofen as monotherapies are more effective than placebo in relieving short-term ear pain in children with AOM. There is insufficient evidence of a difference between ibuprofen and paracetamol in relieving short-term ear pain in children with AOM, whereas data on the effectiveness of ibuprofen plus paracetamol versus paracetamol alone were insufficient to draw any firm conclusions. Further research is needed to provide insights into the role of ibuprofen as adjunct to paracetamol, and other analgesics such as anaesthetic eardrops, for children with AOM.
PMID: 27977844 [PubMed - indexed for MEDLINE]