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European Annals of Otorhinolaryngology,... Mar 2021Nasal irrigation is a grade A recommendation treatment, which is essential in many pathological conditions. Very heterogeneous practices are observed in paediatrics as a...
Nasal irrigation is a grade A recommendation treatment, which is essential in many pathological conditions. Very heterogeneous practices are observed in paediatrics as a result of poor instruction in this technique. We propose to describe the nasal irrigation technique developed by a team of respiratory physiotherapists in Lille for the management of cystic fibrosis and bronchiolitis. This technique is intended for children over the age of 6 months, as it requires an oral breathing reflex and cough reflex that are not systematically acquired before this age. Nasal irrigation is performed on a 30° upward inclined plane on a calm and cooperative child, away from meals. The child is maintained gently, without pressure, in the fencing position with the head turned away from the practitioner. Using a continuous flow spray, the practitioner grasps the top of the upper nostril and irrigates the nostril for an average of 3 s (6mL per nostril). These steps are then repeated until satisfactory patency is achieved in both nostrils. This technique constitutes a practical tool to help healthcare professionals and parents perform nasal irrigation in young children over the age of 6 months.
Topics: Child; Child, Preschool; Cystic Fibrosis; Humans; Infant; Nasal Lavage; Nose; Pediatrics
PubMed: 32891588
DOI: 10.1016/j.anorl.2020.08.004 -
Frontiers in Endocrinology 2021
Topics: Autoimmune Diseases; Child; Graves Disease; Hashimoto Disease; Humans; Pediatrics; Prognosis; Thyroid Gland
PubMed: 33613458
DOI: 10.3389/fendo.2021.645278 -
BMC Emergency Medicine Mar 2023The practice of paediatric emergency medicine in Nigeria is still evolving, and laden with enormous challenges which contribute to adverse outcomes of childhood... (Review)
Review
The practice of paediatric emergency medicine in Nigeria is still evolving, and laden with enormous challenges which contribute to adverse outcomes of childhood illnesses in emergency settings. Deaths from childhood illnesses presenting as emergencies contribute to overall child mortality rates in Nigeria. This narrative review discusses existing structures, organization, and practice of paediatric emergency in Nigeria. It highlights some of the challenges and suggests ways of surmounting them in order to reduce deaths in the children emergency units in Nigerian hospitals. Important aspects of this review include current capacity and need for capacity development, equipment needs for emergency care, quality of service in the context of inadequate healthcare funding and the need for improvement.
Topics: Child; Humans; Nigeria; Pediatric Emergency Medicine; Emergency Medical Services; Emergency Service, Hospital; Emergency Treatment
PubMed: 36927266
DOI: 10.1186/s12873-023-00790-1 -
JAMA Network Open Oct 2021The published evidence in support of probiotic use is conflicting, which may be a result of selective publication of probiotic trials. (Review)
Review
IMPORTANCE
The published evidence in support of probiotic use is conflicting, which may be a result of selective publication of probiotic trials.
OBJECTIVES
To compare the proportion of registered trials that evaluate pediatric probiotics vs those that evaluate antibiotics that are published and to identify study-related factors associated with publication status.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study evaluated eligible trials registered in ClinicalTrials.gov, an online clinical trials registry, from July 1, 2005, to June 30, 2016. Eligible studies included participants younger than 18 years, evaluated a probiotic or 1 of the 5 most commonly prescribed antibiotics in children and adolescents, and randomized study participants. All searches were updated and finalized as of September 9, 2020.
EXPOSURES
Probiotic or antibiotic.
MAIN OUTCOMES AND MEASURES
The primary outcome was study publication status. In addition, exposure status (probiotic vs antibiotic), trial result, and funding source were assessed for independent association with publication status. Whether study design elements, publication journal impact factor, and the interval from study completion to publication differed by exposure status were also evaluated.
RESULTS
A total of 401 unique trials (265 probiotic and 136 antibiotic) met eligibility criteria. A greater proportion of antibiotic compared with probiotic studies were published (83 [61.0%] vs 119 [44.9%]; difference, 16.1% [95% CI, 5.8%-25.9%]). After adjustment for funding source, blinding, and purpose, studies evaluating an antibiotic were more likely to be published (odds ratio, 2.1 [95% CI, 1.3-3.4]). No other covariates included in the model were independently associated with publication status. Antibiotic trials, compared with probiotic trials, were more likely to have a therapeutic purpose (114 [83.8%] vs 117 [44.2%]; difference, 39.6% [95% CI, 31.1%-48.3%]) and to be multicenter (46 [33.8%] vs 46 [17.4%]; difference, 16.5% [95% CI, 7.5%-25.7%]). The median impact factor of the journals in which the studies were published was higher for the antibiotic trials (7.2 [IQR, 2.8-20.5] vs 3.0 [IQR, 2.3-4.2]; P < .001). The median number of days to publication did not differ between the probiotic and antibiotic trials (683 [IQR, 441-1036] vs 801 [IQR, 550-1183]; P = .24).
CONCLUSIONS AND RELEVANCE
The findings of this cross-sectional study suggest that probiotic studies are less likely to be published than antibiotic trials. No other study characteristics were associated with publication status. This finding raises concerns regarding the results of meta-analyses of probiotic trials.
Topics: Anti-Bacterial Agents; Cross-Sectional Studies; Humans; Pediatrics; Periodicals as Topic; Probiotics; Publishing
PubMed: 34623409
DOI: 10.1001/jamanetworkopen.2021.25236 -
Genes May 2021With limited access to trained clinical geneticists and/or genetic counselors in the majority of healthcare systems globally, and the expanding use of genetic testing in... (Review)
Review
With limited access to trained clinical geneticists and/or genetic counselors in the majority of healthcare systems globally, and the expanding use of genetic testing in all specialties of medicine, many healthcare providers do not receive the relevant support to order the most appropriate genetic test for their patients. Therefore, it is essential to educate all healthcare providers about the basic concepts of genetic testing and how to properly utilize this testing for each patient. Here, we review the various genetic testing strategies and their utilization based on different clinical scenarios, and test characteristics, such as the types of genetic variation identified by each test, turnaround time, and diagnostic yield for different clinical indications. Additional considerations such as test cost, insurance reimbursement, and interpretation of variants of uncertain significance are also discussed. The goal of this review is to aid healthcare providers in utilizing the most appropriate, fastest, and most cost-effective genetic test for their patients, thereby increasing the likelihood of a timely diagnosis and reducing the financial burden on the healthcare system by eliminating unnecessary and redundant testing.
Topics: Genetic Testing; Humans; Pediatrics; Practice Guidelines as Topic; Precision Medicine; Whole Genome Sequencing
PubMed: 34071827
DOI: 10.3390/genes12060818 -
International Journal of Environmental... Apr 2021Since December 2019, coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread, becoming the first... (Review)
Review
Since December 2019, coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread, becoming the first pandemic of the 21st century by number of deaths (over 2,000,000 worldwide). Many aspects of SARS-CoV-2 infection in children and adolescents remain unclear, and optimal treatment has not yet been defined. Therefore, our goal was to develop a consensus document, practically synthesizing the accumulated data and clinical experience of our expert group. Literature research was carried out using the keywords "COVID-19" or "SARS-CoV-2" and "children" or "pediatrics" and "prevention" or "diagnosis" or "MIS-C" or "treatment" in electronic databases (MEDLINE, PUBMED), existing guidelines and gray literature. The fact that the majority of the problems posed by SARS-CoV-2 infection in pediatric age do not need hospital care and that, therefore, infected children and adolescents can be managed at home highlights the need for a strengthening of territorial pediatric structures. The sharing of hospitalization and therapeutic management criteria for severe cases between professionals is essential to ensure a fair approach based on the best available knowledge. Moreover, the activity of social and health professionals must also include the description, management and limitation of psychophysical-relational damage resulting from the SARS-CoV-2 pandemic on the health of children and adolescents, whether or not affected by COVID-19. Due to the characteristics of COVID-19 pathology in pediatric age, the importance of strengthening the network between hospital and territorial pediatrics, school, educational, social and family personnel both for strictly clinical management and for the reduction in discomfort, with priority in children of more frail families, represents a priority.
Topics: Adolescent; COVID-19; Child; Consensus; Humans; Italy; Pediatrics; SARS-CoV-2
PubMed: 33917940
DOI: 10.3390/ijerph18083919 -
European Journal of Hospital Pharmacy :... Jul 2022This systematic review (SR) was undertaken to identify and summarise any factors which influence the implementation of paediatric clinical pharmacy service (CPS) from... (Review)
Review
OBJECTIVES
This systematic review (SR) was undertaken to identify and summarise any factors which influence the implementation of paediatric clinical pharmacy service (CPS) from service users' perspectives in hospital settings.
METHODS
Literature search from EMBASE, MEDLINE, Web of Science (Core Collection), Cochrane Library, Scopus and CINAHL databases were performed in order to identify any relevant peer-reviewed quantitative and qualitative studies from inception until October 2019 by following the inclusion criteria. Boolean search operators were used which consisted of service, patient subgroup and attribute domains. Studies were screened independently and included studies were quality assessed using Mixed Methods Appraisal Tool. The study was reported against the 'Enhancing Transparency in Reporting the Synthesis of Qualitative Research' statement.
RESULTS
4199 citations were screened by title and abstract and 6 of 32 full publications screened were included. There were two studies that were graded as 'high' in quality, with four graded as 'moderate'. The analysis has led to the identification of seven factors categorised in five predetermined overarching themes. These were: other healthcare professionals' attitudes and acceptance; availability of clinical pharmacist on ward or outpatient settings; using drug-related knowledge to perform clinical activities; resources for service provision and coverage; involvement in a multidisciplinary team; training in the highly specialised areas and development of communication skills.
CONCLUSION
Evidence for paediatric CPS was sparse in comparison to a similar SR conducted in the adult population. An extensive knowledge gap within this area of practice has therefore been identified. Nevertheless, majority of the factors identified were viewed as facilitators which enabled a successful implementation of CPS in paediatrics. Further research is needed to identify more factors and exploration of these would be necessary in order to provide a strong foundation for strategic planning for paediatric CPS implementation and development.
Topics: Adult; Attitude of Health Personnel; Child; Hospitals; Humans; Patient Care; Pediatrics; Pharmacy Service, Hospital
PubMed: 33472818
DOI: 10.1136/ejhpharm-2020-002520 -
Pediatric Rheumatology Online Journal Jun 2024Many children with rheumatic and musculoskeletal diseases are unrecognized. Identifying these children requires health care provider awareness, knowledge, and skills to... (Review)
Review
BACKGROUND
Many children with rheumatic and musculoskeletal diseases are unrecognized. Identifying these children requires health care provider awareness, knowledge, and skills to recognize disease features and how (and when) to refer to specialist care. The aim of this paper is to highlight the need for better access to health care, review the essential role that education and virtual care play to address unmet need in low resource areas and especially to expand workforce capacity. Using collaborative partnerships, virtual platforms, and innovative assessment methods, musculoskeletal care and education can be delivered to reach a greater audience than ever before. Increased awareness through multiple initiatives and readily available resources are imperative to improve global rheumatology care.
CONCLUSION
The needs of children with rheumatic diseases and musculoskeletal conditions are vastly underserved around the world resulting in preventable morbidity and mortality. Expanded implementation of virtual education and e-health care platforms provides an opportunity to increase access to care for children globally.
Topics: Humans; Rheumatology; Child; Pediatrics; Health Services Accessibility; Rheumatic Diseases; Musculoskeletal Diseases; Telemedicine
PubMed: 38840147
DOI: 10.1186/s12969-024-00978-0 -
The Pediatric Infectious Disease Journal Mar 2022The growth of antimicrobial resistance worldwide has led to increased focus on antimicrobial stewardship (AMS) and infection prevention and control (IPC) measures,... (Comparative Study)
Comparative Study
BACKGROUND
The growth of antimicrobial resistance worldwide has led to increased focus on antimicrobial stewardship (AMS) and infection prevention and control (IPC) measures, although primarily in high-income countries (HIC). We aimed to compare pediatric AMS and IPC resources/activities between low- and middle-income countries (LMIC) and HIC and to determine the barriers and priorities for AMS and IPC in LMIC as assessed by clinicians in those settings.
METHODS
An online questionnaire was distributed to clinicians working in HIC and LMIC healthcare facilities in 2020.
RESULTS
Participants were from 135 healthcare settings in 39 LMIC and 27 HIC. Formal AMS and IPC programs were less frequent in LMIC than HIC settings (AMS 42% versus 76% and IPC 58% versus 89%). Only 47% of LMIC facilities conducted audits of antibiotic use for pediatric patients, with less reliable availability of World Health Organization Access list antibiotics (29% of LMIC facilities). Hand hygiene promotion was the most common IPC intervention in both LMIC and HIC settings (82% versus 91%), although LMIC hospitals had more limited access to reliable water supply for handwashing and antiseptic hand rub. The greatest perceived barrier to pediatric AMS and IPC in both LMIC and HIC was lack of education: only 17% of LMIC settings had regular/required education on antimicrobial prescribing and only 25% on IPC.
CONCLUSIONS
Marked differences exist in availability of AMS and IPC resources in LMIC as compared with HIC. A collaborative international approach is urgently needed to combat antimicrobial resistance, using targeted strategies that address the imbalance in global AMS and IPC resource availability and activities.
Topics: Antimicrobial Stewardship; Developed Countries; Developing Countries; Health Facilities; Health Knowledge, Attitudes, Practice; Health Resources; Humans; Infection Control; Pediatrics; Surveys and Questionnaires
PubMed: 35134034
DOI: 10.1097/INF.0000000000003318 -
Danish Medical Journal Jun 2023Co-regulated learning (CRL) is a process in which the learner's regulation of learning is guided by social transactions. The change in learning techniques during the...
INTRODUCTION
Co-regulated learning (CRL) is a process in which the learner's regulation of learning is guided by social transactions. The change in learning techniques during the transition from university to workplace learning and the rapidly changing learning environment make awareness of CRL extremely relevant. This study examined CRL among medical students and residents and identified the factors affecting CRL.
METHODS
We applied an explorative approach using direct observation and semi-structured focus group discussions (FGD). The first author made direct observations that produced explorative data about actual behaviour. However, this was not sufficiently sensitive to capture the participants' full perceptions of CRL. Therefore, we conducted semi-structured FGD that involved interactions and reflections among the participants.
RESULTS
This study suggests that CRL occurred in multiple situations and was affected by many factors. The stimulating factors identified were a supportive learning environment, feedback based on observations and questioning by a supervisor, dyad work and interactive, bimodal presentation of emergency cases at the morning conference. Time pressure, heavy workload and shortage of specialists were inhibiting factors.
CONCLUSION
We identified several factors affecting CRL. A focus on the augmentation of stimulating factors and reduction of inhibiting factors may help medical students and residents develop CRL.
FUNDING
None.
TRIAL REGISTRATION
Not relevant.
Topics: Humans; Focus Groups; Learning; Pediatrics; Students, Medical
PubMed: 37381865
DOI: No ID Found