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Faulkner, Bethany, and M. Begoña Delgado-Charro. "Cardiovascular Paediatric Medicines Development: Have Paediatric Investigation Plans Lost Heart?" Pharmaceutics 12, no. 12 (December 2, 2020): 1176. http://dx.doi.org/10.3390/pharmaceutics12121176.
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This work aimed to establish whether paediatric needs in cardiovascular diseases have been met by paediatric investigation plans (PIPs) produced since the development of the European Union Paediatric Regulation in 2007. The European Medicines Agency repository was searched for patterns in the development of paediatric medicines in general. Next, positive PIPs related to cardiovascular diseases were scrutinized for outcomes and compared to specific paediatric cardiovascular needs. In total, 1866 PIPs were identified with 12% corresponding to decisions taken for cardiovascular medicines. However, despite this therapeutic area having the greatest number of overall PIPs, only 14% of established needs in paediatric cardiovascular diseases were addressed by PIPs with positive decisions. Further, 71.9% of PIPs with decisions in cardiovascular disease corresponded to full waivers, so the product would not be studied in paediatrics. Despite the progress found in overall numbers of PIPs published, cardiovascular products are still commonly used off-label in paediatrics. Particularly, there is a need to develop products to treat heart failure and hypertension, two areas with clear unmet clinical needs in paediatrics. A case study on valsartan showed that industry, regulators, health technology assessment bodies, and prescribers should work together to reduce off-label use of paediatric cardiovascular diseases (CVD).
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Sewell, Jillian R. "Paediatrics and paediatric surgery." Medical Journal of Australia 176, no. 1 (January 2002): 32. http://dx.doi.org/10.5694/j.1326-5377.2002.tb04265.x.
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Bell, R. A. F. "Bailliere's Clinical Paediatrics: Paediatric Gastroenterology." Archives of Disease in Childhood 74, no. 3 (March 1, 1996): 275. http://dx.doi.org/10.1136/adc.74.3.275-b.
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Lim, Andrew, Pradeep Sharma, Oleg Stepanov, and Venkatesh Pilla Reddy. "Application of Modelling and Simulation Approaches to Predict Pharmacokinetics of Therapeutic Monoclonal Antibodies in Pediatric Population." Pharmaceutics 15, no. 5 (May 20, 2023): 1552. http://dx.doi.org/10.3390/pharmaceutics15051552.
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Ethical regulations and limited paediatric participants are key challenges that contribute to a median delay of 6 years in paediatric mAb approval. To overcome these barriers, modelling and simulation methodologies have been adopted to design optimized paediatric clinical studies and reduce patient burden. The classical modelling approach in paediatric pharmacokinetic studies for regulatory submissions is to apply body weight-based or body surface area-based allometric scaling to adult PK parameters derived from a popPK model to inform the paediatric dosing regimen. However, this approach is limited in its ability to account for the rapidly changing physiology in paediatrics, especially in younger infants. To overcome this limitation, PBPK modelling, which accounts for the ontogeny of key physiological processes in paediatrics, is emerging as an alternative modelling strategy. While only a few mAb PBPK models have been published, PBPK modelling shows great promise demonstrating a similar prediction accuracy to popPK modelling in an Infliximab paediatric case study. To facilitate future PBPK studies, this review consolidated comprehensive data on the ontogeny of key physiological processes in paediatric mAb disposition. To conclude, this review discussed different use-cases for pop-PK and PBPK modelling and how they can complement each other to increase confidence in pharmacokinetic predictions.
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Završnik, Jernej, Peter Kokol, Stefano del Torso, and Helena Blažun Vošner. "Citation context and impact of ‘sleeping beauties’ in paediatric research." Journal of International Medical Research 44, no. 6 (November 11, 2016): 1212–21. http://dx.doi.org/10.1177/0300060516672129.
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Objectives ‘Sleeping beauties’, i.e. publications that are not cited for a long while, present interesting findings in science. This study analysed the citation trends of sleeping beauties in paediatric research. Methods The study used bibliometric software to analyse the papers citing sleeping beauties in paediatric research, to understand the context in which paediatric sleeping beauties were finally cited and the impact of these sleeping beauties on paediatric research. Results Two paediatric sleeping beauties, addressing medical homes and the transition from paediatric to adult health care, respectively, awakened in response to organizational needs. Both presented novel concepts of paediatric service organization that became important because of an increased need for optimization of services. Conclusion All sleeping beauties bring new knowledge that becomes important only after several years. Paediatric sleeping beauties exhibited unique characteristics; however, their presence in paediatric research shows that knowledge acquisition in paediatrics resembles that in other disciplines.
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Kinsella, Anna. "4 Development of a workbook to guide pre-registration pharmacists through paediatric pharmacy training." Archives of Disease in Childhood 103, no. 2 (January 19, 2018): e2.34-e2. http://dx.doi.org/10.1136/archdischild-2017-314585.4.
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AimTo improve pre-registration pharmacist training and enthuse students in the area of paediatrics, within a teaching hospital.BackgroundThe pre-registration pharmacist training programme within the hospital allocates each student two weeks within paediatrics, which in the past has been poorly structured. During this time, the pre-registration pharmacist spent time shadowing pharmacists and accompanying them on ward visits. On occasions it was not always possible for the pre-registration pharmacist to accompany a pharmacist. In addition, some key paediatric medical conditions did not always present during their two weeks.MethodTo facilitate a more comprehensive training package a workbook, specific to paediatric clinical pharmacy was created. The booklet also contains brief introductory information about the wards and paediatric pharmacists, aims and objectives, and a reading list. The workbook is intended to be used as a ‘self-directed learning tool’, identifying clinical areas that the pre-registration student is expected to have a basic knowledge about, to help them prepare them for their exam and to give a good basic grounding in paediatrics. Different learning methods are used throughout the booklet to aid learning.The workbook includes, all with a paediatric perspective, common illnesses, immunisation, drug history taking, counselling children/parents, role of different members of the multi-disciplinary team, paediatric reference sources, calculations, renal function, pharmacokinetics in children, fluid prescriptions, use of unlicensed medicines in children, suitability of formulations, neonatal pharmacy and total parenteral nutrition.The students were briefed about the booklet at the start of their two weeks in paediatrics, and a discussion about progress at midway and at the end.Feedback was requested from each student (n=15), with a view to improving the booklet and enhancing their time spent within paediatric pharmacy.During the two weeks the students spent time in ‘general paediatrics’ and with specialist pharmacists, in tertiary paediatric services, experiencing the more complex pharmaceutical needs of these patients and the role of the specialist pharmacist.ResultsFeedback was received from eight students (53%). All of them had enjoyed the placement, found the booklet helpful in directing their learning and using their time productively, when they were unable to accompany a pharmacist. Of those who responded, all commented that the booklet was a novel idea not used within other clinical areas within the Trust, and that it should be considered to enhance training. In addition, the paediatric pharmacists agreed unanimously that the booklet has been an asset in assisting the training of the students.ConclusionThe development of a workbook, to enhance the training of pre-registration pharmacists in the clinical area of paediatrics, has been very well received by the students and pharmacists. In response to feedback, it is being further developed and may be used as template for use in other clinical areas within the Trust.
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Redman, Melody Grace, Davide Carzedda, Nicola Jay, Simon J. Clark, and Marie Rogers. "Searching for the true attrition rate of UK paediatric trainees." Archives of Disease in Childhood 106, no. 9 (February 12, 2021): 903–5. http://dx.doi.org/10.1136/archdischild-2020-321415.
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ObjectiveTo quantitatively analyse the number of doctors leaving the paediatric specialty training (ST) programme in the UK, to assist with evidence-based workforce planning.DesignData were sought on those leaving the UK paediatrics training programme between 2014 and 2019 from Heads of Schools of Paediatrics and Freedom of Information Act requests.SettingRetrospective data analysis.Outcome measuresOverall attrition rate, attrition rate across level of training, attrition rate across geographical area, recorded reason for leaving.ResultsAll results must be interpreted with caution due to limitations in record keeping and analysis. The annual attrition rate across all ST levels between 2014 and 2019 is estimated at 3.7%–4.2% (ie, 749–845 trainees may have left the paediatric training programme over 2014–2019). No reason for leaving was recorded for three-quarters of individuals, around 630 doctors. Of those leaving paediatrics, significantly more (χ², p=0.015) did so at ST3 (20.3%) versus the next highest training year, ST2 (13.6%).ConclusionsThis project seems to demonstrate worryingly poor record-keeping of the true attrition rate of paediatric trainees by organisations responsible for workforce planning, including Health Education England, the Royal College of Paediatrics and Child Health and individual paediatric schools across the UK. To allow evidence-based workforce planning for the benefit of UK children, it is vital that accurate records on trainees who leave the training programme are kept and shared across the UK.
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Haylı, Çiğdem Müge, Dilek Demir Kösem, and Neşe Ataman Bor. "Investigation of the impact of paediatric hospices on the quality of care of paediatric nurses." International Journal of Palliative Nursing 30, no. 1 (January 2, 2024): 20–26. http://dx.doi.org/10.12968/ijpn.2024.30.1.20.
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Background: The establishment of paediatric hospices improves the quality of care of paediatric nurses. Aim: To examine the effect of establishing paediatric hospices on the quality of care of paediatric nurses. Methods: Data was collected between 22 October 2022 and 25 February 2023. An online survey method was used to collect sociodemographic data and paediatric hospice data for paediatric nurses and a scale was used to determine the opinions of nurses working in the field of paediatrics. A total of 300 paediatric nurses who voluntarily participated in the collection of the research data were selected with the convenience sampling method, with written consent. SPSS 26.0 data analysis programme was used in the statistical analysis of the data obtained in the study, and Independent Sample t-test and ANOVA analysis were used in the analysis of the data. Findings: Of the participating paediatric nurses, 60.9% were women, 39.1% were men, 41.1% were married, 65.9% were between the ages of 22–33, and 71.6% worked at a paediatric hospice. There was no significant difference in paediatric hospice scale scores according to sociodemographic variables such as gender, age, marital status, education level and the health institution worked by paediatric nurses (p>.05). There was a significant difference in paediatric hospice scale scores according to hospice information. It was determined that the establishment of paediatric hospices had an effect on the quality of care (p<.01). Conclusion: Paediatric nurses felt that the establishment of paediatric hospices would improve the quality of care of children at the end of life. It is recommended that applications and studies on the establishment and structuring of paediatric hospices should be carried out by expanding the samples, not only in the field of paediatric nursing, but also in all nursing fields.
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ElBeltagi, Mohamed N., Verna Wall, and Laure Marignol. "Planning target volume (PTV) margin practice patterns in adults and paediatrics among the Paediatric Radiation Oncology Society (PROS) members: an international survey." Journal of Radiotherapy in Practice 17, no. 4 (June 21, 2018): 368–72. http://dx.doi.org/10.1017/s1460396918000146.
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AbstractAimEvolving data are showing the need of considering smaller planning target volume (PTV) margin in paediatrics compared with adults treated for the same body site. This study proposed to evaluate the current patterns of practice regarding the PTV margin in paediatric patients compared with adult patients through an international survey.Materials and methodsA four-item questionnaire was created to address the PTV margins for paediatrics and adults as part of a comprehensive survey. International Paediatric Radiation Oncology Society (PROS) members were selected to partake and were contacted via email.ResultsIn total, 43 responded to the survey. The majority of the responders have written guidelines for PTV margin while the majority of those who have guidelines do not have separate guidelines for paediatrics. The implemented PTV margin for paediatric patients was in the majority 3–5 mm for the head region and 5–10 mm for the torso region and the difference from the PTV margin implemented in adults was not statistically significant.ConclusionThe majority of responders employ a series of site-specific PTV margin protocols that are applied to both adults and paediatrics, and do not take into consideration patient age or size. These results highlight the need of a separate policy for PTV margin in adults and paediatrics in every institution.
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Salah, Samer, Yat Hang To, Taleb Ismaeel, Omar Khzouz, Iyad Yasin Sultan, Sameer Yaser, Anoud Zaid Alnsour, et al. "Salvage chemotherapy using irinotecan and temozolamide in pediatric and adult populations with relapsed Ewing sarcoma." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e22500-e22500. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e22500.
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e22500 Background: Irinotecan and temozolomide (IT) is a widely used regimen for relapsed Ewing Sarcoma (ES), although studies are largely limited to the paediatric population. We aimed to compare the tolerability and efficacy of IT between paediatric and adult patients. Methods: We retrospectively reviewed paediatric (< 18 years) and adult patients treated with salvage IT chemotherapy at two institutions from March, 2010 to June, 2018. Toxicities were graded according to common terminology criteria of adverse events (CTCAE v. 4.03) and compared using the Chi Square test. Responses were interpreted by Response Evaluation Criteria in Solid Tumors (RECIST). The Kaplan-Meyer method was used to estimate progression free survival (PFS); survival comparisons were carried out by the Log-rank test. Results: Fifty-three patients were included ( n= 16 paediatric; n= 37 adult). Median age was 20 (range, 5 – 45 years). A total 236 IT cycles were delivered (median = 4, range:1-7). IT was given as second-line ( n= 34; 64%) or ≥third-line ( n= 19; 36%). There was no difference in ≥grade 3/4 haematologic toxicity between paediatric and adult patients (31% vs. 35% respectively; p= 0.76), whilst febrile neutropenia was observed in two (4%) patients (one adults and one paediatric). The frequency of diarrhoea of any grade was similar (38% in each group). Of 43 patients assessable for response, 12 (28%) had objective response (1 CR, 11 PR), 19 (44%) had disease progression and 12 (28%) had stable disease. Objective response rate did not differ between the two groups (36% in paediatrics vs. 25% in adults; p = 0.47). Median PFS was superior in paediatrics vs. adults (7.4 vs. 2.1 months, p = 0.001). Superior PFS for the paediatric population was observed in both, the second-line (6.2 vs. 2.2 months; p= 0.060) and ≥third-line setting (7.4 vs. 1.2 months, p= 0.014). Conclusions: IT is an effective salvage regimen for ES, with favourable toxicity and equally observed objective responses in paediatric and adult populations. The observed superior PFS for the paediatric cohort requires further confirmation in a larger prospective study.
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Morgan, Kate. "P37 A model for reducing paediatric prescribing errors in secondary care." Archives of Disease in Childhood 105, no. 9 (August 19, 2020): e26.1-e26. http://dx.doi.org/10.1136/archdischild-2020-nppg.46.
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BackgroundA prescribing error is a preventable error that may lead to inappropriate medication use and patient harm(1). Prescribing errors are particularly important in paediatrics where dose calculations are complicated and small errors can result in significant morbidity and mortality.1 In 2017 pharmacy data showed that paediatric prescribing errors were an issue at our Hospital regarding the severity and high numbers of errors, especially for antibiotics and analgesia.ObjectivesTo achieve a zero prescribing error rate for paediatric within the hospital.MethodForm the Paediatric Medication Errors Prevention (PMEP) group consisting of the Paediatric Consultant, Paediatric Pharmacist, Children’s Assessment Unit Sister and Practice Education Senior Nurse.Paediatric Pharmacist to record and feedback all paediatric prescribing errors weekly at Doctors’ handover.Paediatric Pharmacist/Nurses to DATIX report all significant medication prescribing errorsPaediatric Pharmacist to produce and communicate monthly pharmacy prescribing newsletter.Paediatric Pharmacist to produce quick reference charts for the drugs with the most common prescribing errors e.g. antibiotics and analgesiaPaediatric Doctors to request a second check from another Doctor or Ward Sister when prescribing any medication on the drug chart of take home prescription.Paediatric Pharmacist to target Doctors’ induction to improve prescribing and implement a prescribing test.Doctors to complete reflections for errors with their educationsal supervisors.This study did not require ethics approval.ResultsFollowing implementation of the above strategies, there was a 33% reduction in the number of prescribing errors recorded by the Paediatric Pharmacist daily intervention log from 2017/2018 to 2018/2019. There were 163 prescribing errors for 2017/2018 compared to 110 for 2018/2019.ConclusionThe formation of the PMEP group and implementation of strategies to reduce paediatric prescribing errors has positively impacted on reducing the error rate at the hospital. It has also raised awareness of the necessity to report all errors and actively find ways to prevent these from re-occurring. Further work is required to reduce these errors to zero including targeting non paediatric teams prescribing on paediatrics and implementing Pharmacists prescribing on consultant ward rounds. Future work would also include replicating this model in other specialities e.g. neonatal intensive care to achieve the same success rate in reducing medication errors.ReferenceDavis T. Paediatric prescribing errors. Arch Dis Child. 2011;96:489–91. Accessed via http://adc.bmj.com on 2/4/19.
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Mullen, Stephen, Michael D. Shields, and Dara O'Donoghue. "Exposure and attitudes to adolescent health amongst Paediatric trainees in Northern Ireland: a mixed-methods study." BMJ Paediatrics Open 4, no. 1 (March 2020): e000563. http://dx.doi.org/10.1136/bmjpo-2019-000563.
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AimsTo determine the exposure and attitudes of paediatric trainees towards adolescent medicine.MethodsAll paediatric trainees in the Northern Ireland deanery (n=107) were invited to participate in an online survey in March 2016. The questionnaire was based on the ‘Modified Perceptions of Adolescent Issues and Resources: Care of Adolescents’ questionnaire. The questions included a 5-point Likert scale (1-strongly disagree, 5-strongly agree) as well as open questions. All paediatric trainees were invited to attend focus groups to expand on themes generated from the questionnaire.ResultsThe response rate for the paediatric survey was 62% (n=66). Trainees identified adolescence as an area of importance similar to paediatrics and neonates; however, knowledge, confidence, skills and previous teaching in adolescent medicine were lower than for neonatal medicine and general paediatrics. Trainees who saw ≥6 adolescent patients per week were more likely to rate the importance of adolescent medicine higher. Trainees’ perceived confidence, knowledge, self-rated skills and prior teaching in adolescent medicine were strongly correlated. Most (70%) respondents stated that they had not attended an adolescent transition clinic during their postgraduate training. Undergraduate and postgraduate teaching for adolescent health was rated poorly.ConclusionsThis project identified a paediatric trainee population that are aware of the importance of adolescent health but with low perceived knowledge, skills and confidence to manage them. Education is required to enhance learning and improve outcomes for adolescent patients.
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Tan, Jacqueline CL, Peck Har Ang, Shu-Ling Chong, Khai Pin Lee, Gene YK Ong, Nur Diana Binte Zakaria, and Jen Heng Pek. "Differences in Utilisation of the General and Paediatric Emergency Departments by Paediatric Patients." Annals of the Academy of Medicine, Singapore 49, no. 12 (January 31, 2020): 948–54. http://dx.doi.org/10.47102/annals-acadmedsg.2020327.
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Abstract Introduction: Paediatric patients presenting to the general emergency departments (EDs) differ from those presenting to paediatric EDs. General EDs vary in preparedness to manage paediatric patients, which may affect delivery of emergency care with varying clinical outcomes. We aimed to elucidate the differences in utilisation patterns of paediatric and general EDs by paediatric patients. Methods: This study was conducted in a public healthcare cluster in Singapore consisting of 4 hospitals. A retrospective review of the medical records of paediatric patients, defined as age younger than 16 years old, who attended the EDs from 1 January 2015 to 31 December 2018, was performed. Data were collected using a standardised form and analysed. Results: Of the 704,582 attendances, 686,546 (97.4%) were seen at the paediatric ED. General EDs saw greater number of paediatric patients in the emergent (P1) category (921 [5.1%] versus 14,829 [2.2%]; P<0.01) and those with trauma-related presentations (6,669 [37.0%] vs 108,822 [15.9%]; P<0.01). The mortality of paediatric patients was low overall but significantly higher in general EDs (39 [0.2%] vs 32 [0.005%]; P<0.01). Seizure, asthma/bronchitis/bronchiolitis, allergic reaction, cardiac arrest and burns were the top 5 diagnoses that accounted for 517 (56.1%) of all emergent (P1) cases seen at general EDs. Conclusion: General EDs need to build their capabilities and enhance their preparedness according to the paediatric population they serve so that optimal paediatric emergency care can be delivered, especially for critically ill patients who are most in need of life-saving and timely treatment. 3 Keywords: Attendance, emergency, epidemiology, health services, paediatrics
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Frederick, Tarryn Miranda, Desiree Varatharajullu, and Maureen Nokuthula Sibiya. "Perceptions of New Graduate Chiropractors in Their Management of Paediatric Patients in the eThekwini Municipality." Global Journal of Health Science 12, no. 3 (February 15, 2020): 32. http://dx.doi.org/10.5539/gjhs.v12n3p32.
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The aim of the study was to assess the perceptions of new graduate chiropractors in their management of paediatric patients in the eThekwini Municipality. A qualitative, explorative, descriptive research design was utilised for this study. A purposive sample of 10 new graduate chiropractors in the eThekwini Municipality were interviewed. Data was collected utilising semi-structured interviews. The collected data was then stored electronically and transcribed. The transcripts were then coded and analysed by the researcher to identify categories and subcategories. The coded data was thereafter interpreted, using the themes and sub-themes identified. Four main themes were identified in the study, namely self-perception of confidence, knowledge and skill in paediatric patient management; exposure and training received in the chiropractic course; challenges encountered in paediatric patient management; and further enhancement of paediatric patient management. New graduate chiropractors expressed a lack of confidence and competence with regards to their management of the paediatric population, which was found to correlate with their lack of exposure to paediatric patients during the chiropractic paediatric curriculum in the course. Participants stated that their lack of exposure to this patient group negatively impacted on their diagnostic ability, orthopaedic assessment and treatment of paediatric patients. Participants identified areas of improvement in the chiropractic paediatric curriculum. Methods to enhance paediatric assessment and management were then discussed further. The findings of this study indicate that lack of exposure to paediatric patients prior to private practice was a key factor that negatively impacted on a new graduate’s confidence to assess, treat and manage paediatrics.
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Holland, Andrew J. A., Daniel T. Cass, and John Pitkin. "Updates in medicine: paediatrics and paediatric surgery." Medical Journal of Australia 176, no. 7 (April 2002): 352–53. http://dx.doi.org/10.5694/j.1326-5377.2002.tb04442.x.
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Sewell, Jillian R. "Updates in medicine: paediatrics and paediatric surgery." Medical Journal of Australia 176, no. 7 (April 2002): 352–53. http://dx.doi.org/10.5694/j.1326-5377.2002.tb04443.x.
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Oranje, Arnold P. "Paediatric Dermatology. Oxford Specialist Handbook in Paediatrics." Acta Paediatrica 99, no. 11 (September 14, 2010): 1751. http://dx.doi.org/10.1111/j.1651-2227.2010.01997.x.
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Zhu, H., A. Q. A. Teo, M. E. Allan, K. Hallett, and W. Kelsall. "Paediatric societies: increasing student engagement in paediatrics." Archives of Disease in Childhood 96, no. 12 (October 28, 2011): 1206–7. http://dx.doi.org/10.1136/archdischild-2011-301131.
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Procopis, Peter G. "Examination Paediatrics; A Guide to Paediatric Training." Journal of Paediatrics and Child Health 43, no. 4 (April 2007): 322. http://dx.doi.org/10.1111/j.1440-1754.2007.01072.x.
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Shahidullah, H. "Paediatric Dermatology (Oxford Specialist Handbooks in Paediatrics)." British Journal of Dermatology 164, no. 3 (March 2011): 682. http://dx.doi.org/10.1111/j.1365-2133.2011.10261.x.
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Li, Danning, Movin Abeywickrema, Sharvari Vadeyar, Abigail Ward, Thomas Abberton, and Justina Rweyemamu. "Improving paediatric flow in an UK Paediatric Assessment Unit." BMJ Open Quality 11, no. 1 (January 2022): e001561. http://dx.doi.org/10.1136/bmjoq-2021-001561.
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The 2010 Royal College of Paediatrics and Child Health (RCPCH) guidelines for acute paediatric services set standards for time to senior review for paediatric medical admissions in the UK as tier two doctor (registrar) review within 4 hours and consultant review within 14 hours. Our aim was to implement these standards in our unit through increasing proportions of reviews within these timeframes and measuring the impact on patient flow. Four quality improvement cycles were completed between March 2018 and March 2020 capturing data from 288 patient data sets. Recommendations included the extension of consultant on-site availability out of routine working hours (after cycle 1), highlighting patients awaiting consultant review during team handover (after cycle 2), and improving tier two doctor rostering (after cycle 3). After highlighting patients for consultant priority review, the proportion of patients seen within 14 hours improved from 53.3% (cycle 2) to 95% (cycle 3, p=0.005). Improved tier two doctor cover increased the proportion meeting registrar review within 4 hours from 82.9% (cycle 3) to 96.2% (cycle 4, p=0.028). A large proportion of paediatric patients were managed and discharged at tier two doctor level (65.6% over cycles 1–4). An inverse correlation was seen (R=−0.587) between time to discharge and the number of tier two doctors on shift (cycle 4). The interventions conducted demonstrated significant improvement in proportions of paediatric patients seen within the RCPCH timeframes. Adequate tier two doctor staffing is a priority for prompt review and discharge of acute paediatric patients. Future work aims to consider factors such as nursing rostering, bed management and the impact of COVID-19 on paediatric flow.
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Tegegne, Biresaw Ayen, Girmay Fitiwi Lema, Demeke Yilkal Fentie, and Yosef Belay Bizuneh. "The preparedness of preoperative anesthesia equipment’s and monitors for pediatric patients." Annals of Medicine & Surgery 85, no. 7 (June 12, 2023): 3423–27. http://dx.doi.org/10.1097/ms9.0000000000000958.
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Background: In resource-limited settings, providing anaesthesia services to paediatric patients at the operation theatre needs to be considered and optimal utilization of national resources available for the provision of services should be undertaken. Therefore, optimal perioperative care of infants and children requires the availability of monitors and contemporary equipment designed specifically for this purpose. Objective: This study aimed to determine the practice of preoperative anaesthesia equipment and monitor preparation for paediatric patients. Method: A cross-sectional study was employed among 150 consecutively selected paediatrics from April to June 2020. Data were collected by semi-structured questionnaire. Data entry and analysis were done using Epi Data and Stata version 14.0. Descriptive statistics were employed. Result: A total of 150 patients who undergo surgery under anaesthesia were observed in surgical and ophthalmic operation rooms. From those procedures, only stethoscope and small-sized syringes achieved 100% of the standards. But paediatric stylet, paediatric defibrillator and paediatric folly catheter had achieved 0%. The remaining were between 10 and 97% according to standards. Conclusion: Even though some paediatric anaesthesia equipments and monitoring preparation have fulfilled the standards, this study showed practice gaps in majority of cases in the preparation of appropriately sized paediatric equipments and monitors.
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Jones, Catherine, Jennifer Fraser, and Sue Randall. "An evaluation of training to prepare nurses in a home-based service to care for children and families." Journal of Child Health Care 24, no. 4 (October 15, 2019): 589–602. http://dx.doi.org/10.1177/1367493519881572.
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Evaluation of training was conducted for a paediatric hospital-in-the-home service in Sydney, Australia. Community nurses with no paediatric training or experience were employed and undertook a training program. The aim was to assess the degree to which the training had prepared them to care for children and families in their homes. A mixed-methods design was employed. Overall, the following aspects of the training were well received by the community nurses: paediatric resuscitation, growth and development, clinical deterioration and child protection. Each topic provided basic knowledge and skills in the speciality. The participating nurses generally reached a ‘competent’ level of practice as defined by Benner (2000). Further training and development is recommended. Where paediatric nursing practice is isolated from acute paediatrics services, opportunities must be provided to improve safe levels of practice for children of all ages.
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Bruyne, Pauline De, Kevin Meesters, and Johan Vande Walle. "SAFE-PEDRUG: A NEW STRATEGY FOR PAEDIATRIC DRUG RESEARCH." Archives of Disease in Childhood 101, no. 1 (December 14, 2015): e1.29-e1. http://dx.doi.org/10.1136/archdischild-2015-310148.35.
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BackgroundDrug evaluation in children is stimulated by initiatives of the Regulatory Authorities; in Europe by the ‘Paediatric Regulation'. As stated in this Regulation, Paediatric Investigational Plans must be submitted to the Paediatric Committee around the end of Phase I adult trials. However, the proposed paediatric trials tend to be amended frequently and postponed to the end of the drug evaluation process, as they are largely based on extrapolations of results of adult trials.Materials and methodsExperts in paediatrics, pharmaceutical sciences, veterinary medicine and ethics (of three Belgian universities) collaborated to develop a research consortium that will focus mainly on generating paediatric pharmacokinetic and pharmacodynamic (PK/PD) knowledge before the actual human trials are performed. National and international stakeholders (including Industry, Regulatory Authorities, and Patient Organisations) support this consortium in the valorisation of results.ResultsThe above-mentioned networking resulted in the SAFE-PEDRUG project, funded by the Agency for Innovation by Science and Technology (Flanders). This program will explore the value of the porcine juvenile animal model and PK modelling (physiologically-based pharmacokinetic modelling) in providing prior paediatric PK/PD-knowledge. For the evaluation of this approach, three case compounds were selected: desmopressin, lisinopril, and fluoroquinolones. The results of the models are plotted against human paediatric data. Furthermore, PK/PD in neonates and critically ill children will also be explored.ConclusionA close collaboration of experts and stakeholders is mandatory for the future of paediatric pharmacology. Exchange of ideas and knowledge can help to tailor paediatric clinical trials to the PK/PD-characteristics and needs of children.
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Peng, Wan-Sheng, Lian Wang, Hui Zhang, Zhen Zhang, Yu-Meng Wu, Xu Sang, Rui Zhou, Jia-Li Xu, and Xin Chen. "Application of virtual scenario simulation combined with problem-based learning for paediatric medical students." Journal of International Medical Research 49, no. 2 (February 2021): 030006052097921. http://dx.doi.org/10.1177/0300060520979210.
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Objectives To examine the application and effects of virtual scenario simulation combined with problem-based learning (PBL) in teaching paediatric medical students. Methods Participants were 300 paediatric medical students randomly divided into a study group and control group. Students in the study group were taught using virtual scenario simulation combined with PBL; students in the control group were taught using conventional teaching methods. Academic performance, knowledge of paediatrics, self-evaluation of comprehensive ability and degree of learning satisfaction were evaluated. Results Students in the study group showed considerably higher academic performance and noticeably higher classroom performance. Paediatric knowledge, comprising initiating communication, collecting information, giving information, understanding the paediatric patient and concluding communication, was higher for students in the study group. The degree of learning satisfaction was higher for students in the study group. Conclusion Virtual scenario simulation combined with PBL can effectively improve students’ academic performance, mastery of paediatric knowledge, comprehensive ability evaluation and learning satisfaction. The broader application of this approach should be explored for medical student education.
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Angelico, Roberta, M. Thamara P. R. Perera, Tommaso Maria Manzia, Alessandro Parente, Chiara Grimaldi, and Marco Spada. "Donation after Circulatory Death in Paediatric Liver Transplantation: Current Status and Future Perspectives in the Machine Perfusion Era." BioMed Research International 2018 (2018): 1–8. http://dx.doi.org/10.1155/2018/1756069.
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Efforts have been made by the transplant community to expand the deceased donor pool in paediatric liver transplantation (LT). The growing experience on donation after circulatory death (DCD) for adult LT has encouraged its use also in children, albeit in selective cases, opening new perspectives for paediatric patients. Even though there has recently been a slight increase in the number of DCD livers transplanted in children, with satisfactory graft and patient outcomes, the use of DCD grafts in paediatric recipients is still controversial due to morbid outcomes associated with DCD grafts. In this context, recent advances in the optimization of donor support by extracorporeal membrane oxygenation and in the graft preservation by liver machine perfusion could find application in order to expand the donor pool in paediatric LT. In the present study we review the current literature on DCD liver grafts transplanted in children and on the use of extracorporeal donor support and liver perfusion machines in paediatrics, with the aim of defining the current status and future perspectives of paediatric LT.
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Muhammad, F. I., D. C. Ugwuanyi, M. Sidi, A. Ya’u, and A. T. Aliyu. "Ultrasonographic evaluation of common findings in acute abdomen amongst paediatric age group in Kano Metropolis, Nigeria." Dutse Journal of Pure and Applied Sciences 9, no. 3b (November 1, 2023): 28–35. http://dx.doi.org/10.4314/dujopas.v9i3b.4.
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Acute abdomen is very common complaint for paediatric patients presenting to the paediatric emergency departments and outpatient clinics and its management is time consuming. Ultrasound is reliable for the diagnosis of acute abdomen. This study was aimed at evaluating the commonest ultrasonographic findings in paediatric age group presented with acute abdomen in Kano metropolis, Nigeria. This was rospective, cross sectional study conducted from September, 2020 to December, 2022. A convenience sampling method was employed and a sample size of 170 paediatric patients with ages ranging between 0 and 18 years. Paediatrics presenting with non-traumatic acute abdomen were included in the study, while those with traumatic acute abdomen were excluded. GE LOGIQ F6 US machine with transducer frequency of 3.5 MHz-8 MHz was used as an instrument for data collection. The selected patients were scanned in supine position. Data generated was analyzed using SPSS version 22.0. Results generated indicate that the commonest symptoms of acute abdomen among paediatric in Kano metropolis besides abdominal pain were vomiting (63.5%) and running fever (55.8%). The commonest ultrasonographic findings of acute abdomen were gastroenteritis (17.1%), acute appendicitis (12.9%), nonspecific abdominal pain (10.0%) mesenteric adenitis (7.6%) and acute cholecystitis (7.1%). Intussusception, intestinal obstruction and intestinal perforation accounted for 5.9% each. Pyelonephritis, and cystitis accounted for 4.1% and 4.7% respectively. There was 2.9% for each acute hepatitis, renal calculus and pelvic inflammatory disease (PID). Midgut malrotation and volvulus and acute peritonitis accounted for 1.8% each. The common findings in acute abdomen among paediatrics in Kano metropolis, Nigeria were gastroenteritis, acute appendicitis, nonspecific abdominal pain and mesenteric adenitis.
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Felisi, Mariagrazia, Fedele Bonifazi, Maddalena Toma, Claudia Pansieri, Rebecca Leary, Victoria Hedley, Ronald Cornet, et al. "Mapping of Data-Sharing Repositories for Paediatric Clinical Research—A Rapid Review." Data 9, no. 4 (April 20, 2024): 59. http://dx.doi.org/10.3390/data9040059.
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The reuse of paediatric individual patient data (IPD) from clinical trials (CTs) is essential to overcome specific ethical, regulatory, methodological, and economic issues that hinder the progress of paediatric research. Sharing data through repositories enables the aggregation and dissemination of clinical information, fosters collaboration between researchers, and promotes transparency. This work aims to identify and describe existing data-sharing repositories (DSRs) developed to store, share, and reuse paediatric IPD from CTs. A rapid review of platforms providing access to electronic DSRs was conducted. A two-stage process was used to characterize DSRs: a first step of identification, followed by a second step of analysis using a set of eight purpose-built indicators. From an initial set of forty-five publicly available DSRs, twenty-one DSRs were identified as meeting the eligibility criteria. Only two DSRs were found to be totally focused on the paediatric population. Despite an increased awareness of the importance of data sharing, the results of this study show that paediatrics remains an area in which targeted efforts are still needed. Promoting initiatives to raise awareness of these DSRs and creating ad hoc measures and common standards for the sharing of paediatric CT data could help to bridge this gap in paediatric research.
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Nieber, Karen, Esther Raskopf, Johanna Möller, Olaf Kelber, Robert Fürst, Kija Shah-Hosseini, Jaswinder Singh, Karin Kraft, and Ralph Mösgens. "Pharmaco-epidemiological research on herbal medicinal products in the paediatric population: data from the PhytoVIS study." European Journal of Pediatrics 179, no. 3 (December 11, 2019): 507–12. http://dx.doi.org/10.1007/s00431-019-03532-3.
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AbstractIn paediatrics, clinical study data are limited, especially on herbal medicinal products. To address this gap, 2063 datasets from the paediatric population were evaluated in the PhytoVIS data base. By screening for paediatric data, information on indication, gender, treatment, co-medication and tolerability were evaluated. The majority of patients was treated because of common cold, fever, digestive complaints, skin diseases, sleep disturbances and anxiety. The perceived effect of the therapy was rated in 84% of the patients as very good or good without adverse events. The data shed light on a still neglected field of phyto-pharmacotherapy by giving information on the use of herbal medicines in an unselected cohort of paediatric patients. The results confirm the good clinical effects and safety of herbal medicinal products in this patient population and show that they are widely used in Germany.What is Known:• In Germany, about 85% of children receive one or more herbal medicinal products per year.• Despite international initiatives to promote clinical research in paediatrics, there are still many gaps of knowledge in the use of drugs in paediatrics.What is New:• The PhytoVIS project evaluated 2063 data sets from the paediatric population using herbal medicinal products.• The majority of patients was treated because of common cold, fever, digestive complaints, skin diseases, sleep disturbances and anxiety, and 84% of the patients rated the therapy as very good or good without adverse events.
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Mukattash, Tareq L., Anan S. Jarab, Rana K. Abu-Farha, Eman Alefeishat, and James C. McElnay. "Pharmaceutical Care in Children: Self-reported knowledge, attitudes and competency of final-year pharmacy students in Jordan." Sultan Qaboos University Medical Journal [SQUMJ] 18, no. 4 (March 28, 2019): 468. http://dx.doi.org/10.18295/squmj.2018.18.04.007.
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Objectives: Pharmacists require a baseline level of knowledge in paediatric pharmaceutical care in order to be able to adequately care for paediatric patients and counsel their families. This study aimed to explore the self-reported knowledge, attitudes and competency of final-year pharmacy students in Jordan regarding paediatric pharmaceutical care. Methods: This study took place in Jordan between November 2016 and May 2017. A 28-item questionnaire was designed and administered to 400 students from all pharmacy programmes in Jordan during their final year of training. Results: A total of 354 students agreed to take part in the study (response rate: 88.5%). Most respondents (95.2%) were aware of the term ‘paediatrics’. However, almost one-third of the respondents (30.5%) reported never having taken paediatric dose calculation courses and more than half (55.6%) were unfamiliar with the term ‘off-label medicines’. Moreover, most respondents (65.1%) had low knowledge scores (≤2 out of 5) when presented with realistic paediatric case scenarios. There were no significant differences in knowledge and attitudes between undergraduate and doctoral students or between those from public or private universities (P >0.05). Conclusion: The findings of this study highlight an alarming deficiency in paediatric pharmaceutical knowledge among final-year pharmacy students in Jordan. As such, paediatric-related content should be emphasised in the pharmacy curricula of Jordanian universities so that pharmacy students receive more formalised education and more extensive training in this area.Keywords: Pharmaceutical Care; Pediatrics; Pharmacy Students; Knowledge; Attitudes; Competency-Based Education; Jordan.
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Bernardini, Roberto, Gaia Toschi Toschi Vespasiani, and Arianna Giannetti. "An Overview of Off-Label Use of Humanized Monoclonal Antibodies in Paediatrics." Medicina 58, no. 5 (April 29, 2022): 625. http://dx.doi.org/10.3390/medicina58050625.
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In recent years, off-label and unlicensed drug use has extensively developed in the paediatric population. For a long time, clinical trials in the paediatric population were considered complicated to perform because of ethical problems, causing frequent off-label use. Off-label drug use remains an important public health issue, especially for children with rare conditions or with diseases not responsive to conventional treatments. The present paper is a narrative review of the literature of off-label drug use in children. The aim of our study is to summarize the main works dealing with the off-label use of biological drugs in paediatrics. Further studies analyzing their efficacy, safety, and cost–benefit ratios are needed to extend the use of biological therapies to the paediatric population.
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Khan, Dilawar, Daniel Kirby, Simon Bryson, Maryam Shah, and Mohammed Afzal. "P23 Accelerating and de-risking the production of paediatric oral formulations." Archives of Disease in Childhood 105, no. 9 (August 19, 2020): e18.1-e18. http://dx.doi.org/10.1136/archdischild-2020-nppg.32.
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Background & AimAs part of the EU paediatric regulation, the paediatric use marketing authorisation (PUMA) was introduced, with an aim to stimulate research in existing compounds that are off-patent and/or to help transform known off-label use into authorised use.1 However, success has been limited, with only a few products gaining a PUMA, such as Sialanar 320 micrograms/mL glycopyrronium (equivalent to 400 micrograms/mL glycopyrronium bromide). A distinct challenge to overcome in this area is the development of more ‘age appropriate formulations’, particularly with an excipient composition and load that is suitable for paediatric patients. This project aims to establish an excipient screening platform, supplemented with analytical characterisation of materials, which will act as a decision making tool to accelerate and de-risk the production of age appropriate paediatric medicines.MethodTo develop this excipient screening platform, a list of drugs that require an age appropriate formulation was produced using the ‘needs for paediatric medicines’ documents provided by the European medicines agency (EMA),2whilst common problematic excipients in paediatrics were identified using an EMA reflection paper.3 Literature and prescribing data were also reviewed to ensure drugs selected would benefit from an age appropriate formulation. Differential scanning calorimetry (DSC) to determine compatibility of selected drugs with widely used excipients was carried out using a TA DSCQ200 instrument (TA Instruments, New Castle, DE) with TA Instruments Universal Analysis 2000 software. Data was collected under nitrogen atmosphere (50 mL min−1) using pierced flat-bottomed TZero aluminium pans (sample mass about 2 mg) and heating rate of 10 °C min−1 in the range from 50 to 400°C. For samples containing both the drug and an excipient, 1 mg of each was measured out and gently mixed with a spatula for one minute.ResultsThe most common class of drugs identified as requiring age appropriate formulations were related to cardiovascular disorders and neurology, whilst the majority of drugs identified also exhibit poor aqueous solubilities. Some identified problematic excipients include ethanol, sodium benzoate and sorbitol; however, these excipients may still be used in paediatric formulations, as long as they are below certain concentrations (for example, ethanol concentration should not exceed 0.5% w/v for under 6 years old). Two drugs identified through the initial screening, carvedilol and nifedipine, were analysed by DSC, alone and then alongside starch from corn and starch 1500; the resulting DSC curves showed no changes in peak size, position (peak onset temperatures for nifedipine and carvedilol were observed at 173.2°C and 117.3°C, respectively) and shape, as well as no additional peaks, therefore suggesting compatibility between the tested samples.ConclusionThis first phase of the development of an excipient screening platform will continue to scan several different excipients with selected active pharmaceutical ingredients (APIs) in order to create compatibility profiles. The excipient screening platform generated will accelerate and de-risk the production of age appropriate formulations, as it would allow screening for potential incompatibilities and acceptability, alongside informing formulation of appropriate oral paediatric dosage forms.ReferencesEuropean Commission. State of Paediatric Medicines in the EU. 10 years of the EU Paediatric Regulation. COM (2017) 626. Available at: https://ec.europa.eu/health/sites/health/files/files/paediatrics/docs/2017_childrensmedicines_report_en.pdfNeeds for paediatric medicines - European Medicines Agency [Internet]. 2019 [cited 28 June 2019]. Available from: https://www.ema.europa.eu/en/human-regulatory/research-development/paediatric-medicines/needs-paediatric-medicinesReflection paper: formulations of choice for the paediatric population [Internet]. European Medicines Agency. 2019 [cited 28 June 2019]. Available from: https://www.ema.europa.eu/en/documents/scientific-guideline/reflection-paper-formulations-choice-paediatric-population_en.pdf
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Aurich, B., V. Elie, and E. Jacqz-Aigrain. "P11 Neonatal and paediatric protocol development and drug safety: points to consider for risk management and safety data collection." Archives of Disease in Childhood 104, no. 6 (May 17, 2019): e21.2-e22. http://dx.doi.org/10.1136/archdischild-2019-esdppp.50.
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BackgroundProtocol development for neonatal or paediatric clinical trials needs to take into account the age group specifics of the study population (e.g. pharmacokinetics, reference values for laboratory data and vital signs). Drug safety and risk management for neonatal/paediatric trials require an understanding of how these change throughout childhood. We were interested in reviewing and summarising the literature to identify publications which provide researchers with practical information of how the neonatal/paediatric drug safety profile informs age group specific safety data collection and risk management in the protocol.MethodsPubmed, Embase and regulatory authority (RA) websites were searched for publications up to 31/12/2018 for children (0–18 years). In addition, the bibliography of included publications was reviewed to identify additional publications.ResultsRA websites provided general and disease specific guidance on neonatal/paediatric clinical trials with sections relating to drug safety. No publication was identified describing the practicalities of how the neonatal/paediatric drug safety profile can be included throughout the various sections of a clinical trial protocol. The existing literature was summarised providing an overview of how the neonatal/paediatric drug safety profile supports the development of the various protocol sections. For example laboratory values in the exclusion criteria and safety monitoring sections need to be adjusted for age. Vital sign and psychomotor assessment should be done at least at baseline, trial completion and follow-up. Monitoring of adverse events of interest requires consideration of how these may present in neonatal/paediatric patients.ConclusionsIn order to support the protocol development with regards to neonatal/paediatric drug safety a dual competence in both paediatrics and drug safety is required. This review provides an overview of the practical aspects related to neonatal/paediatric drug safety during protocol development.Disclosure(s)Nothing to disclose
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A., Jyothi, and Subramanya N. K. "Severe generalized dystonia in paediatric onset wilsons disease." International Journal of Contemporary Pediatrics 6, no. 6 (October 21, 2019): 2720. http://dx.doi.org/10.18203/2349-3291.ijcp20194762.
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Wilson disease (WD) is a rare autosomal recessive disorder with defect in copper transport mechanism with varied clinical manifestation predominantly hepatic, neurological, ophthalmological and multi-systemic involvement. WD in paediatrics age group manifest differently from the adults. In this case report, Authors have described the first case report presenting with neurological involvement in the form of severe generalized dystonia in a paediatric onset WD. This case report is of greater significance in detecting the most often undetected paediatric WD presenting with a usual hepatic manifestation occurring early in the course.
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Janet, Sophie, Neal Russell, Nikola Morton, Daniel Martinez, Mona Tamannai, Nadia Lafferty, Harriet Roggeveen, et al. "MSF Paediatric Days: a step forward in operationalising ‘Humanitarian Paediatrics’." BMJ Paediatrics Open 5, no. 1 (September 2021): e001156. http://dx.doi.org/10.1136/bmjpo-2021-001156.
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Around the world, one in four children live in a country affected by conflict, political insecurity and disaster. Healthcare in humanitarian and fragile settings is challenging and complex to provide, particularly for children. Furthermore, there is a distinct lack of medical literature from humanitarian settings to guide best practice in such specific and resource-limited contexts. In light of these challenges, Médecins Sans Frontières (MSF), an international medical humanitarian organisation, created the MSF Paediatric Days with the aim of uniting field staff, policymakers and academia to exchange ideas, align efforts, inspire and share frontline research and experiences to advance humanitarian paediatric and neonatal care. This 2-day event takes place regularly since 2016. The fourth edition of the MSF Paediatric Days in April 2021 covered five main topics: essential newborn care, community-based models of care, paediatric tuberculosis, antimicrobial resistance in neonatal and paediatric care and the collateral damage of COVID-19 on child health. In addition, eight virtual stands from internal MSF initiatives and external MSF collaborating partners were available, and 49 poster communications and five inspiring short talks referred to as ‘PAEDTalks’ were presented. In conclusion, the MSF Paediatric Days serves as a unique forum to advance knowledge on humanitarian paediatrics and creates opportunities for individual and collective learning, as well as networking spaces for interaction and exchange of ideas.
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Brännström, Inger. "Publishing ethics in paediatric research: A cross-cultural comparative review." Nursing Ethics 19, no. 2 (March 2012): 268–78. http://dx.doi.org/10.1177/0969733011419242.
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The present article aims to scrutinize publishing ethics in the fields of paediatrics and paediatric nursing. Full-text readings of all original research articles in paediatrics from a high-income economy, i.e. Sweden, and from all low-income economies in Sub-Saharan Africa, were reviewed as they were indexed and stored in Web of Science for the search period from 1 January 2007 to 7 October 2009. The application of quantitative and qualitative content analysis revealed a marked discrepancy in publishing frequencies between the two contrasting economies. Authors from 16 low-income economies in Sub-Saharan Africa, with at least one article stored, were obviously closely linked to co-authorships and foreign funding sources, predominantly from Europe and the USA. Statements concerning conflicts of interest were frequently missing (both regions), even when multiple financial sources, including companies, were involved. It is necessary to be aware of possible systematic bias when using electronic databases to search for certain topics and regions. Further research regarding publishing ethics in paediatrics and paediatric nursing is emphasized.
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McColgan, Martin, Rachel Winch, Simon J. Clark, Carol Ewing, Neena Modi, and Anne Greenough. "The changing UK paediatric consultant workforce: report from the Royal College of Paediatrics and Child Health." Archives of Disease in Childhood 102, no. 2 (October 27, 2016): 170–73. http://dx.doi.org/10.1136/archdischild-2016-312055.
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ObjectivesTo determine if there had been changes in the size of the UK paediatric workforce and working patterns between 1999 and 2013.DesignAnalysis of prospectively collected datasets.SettingUK consultant paediatricians.InterventionsData from the Royal College of Paediatrics and Child Health's workforce census from 1999 to 2013 and the annual surveys of new paediatric Certificate of Completion of Training (CCT) and Certificate of Equivalence of Specialist Registration (CESR) holders between 2010 and 2013.Main outcome measuresPaediatric consultant numbers, programmed activities (PAs) and resident shift working.ResultsThe UK paediatric consultant workforce grew from 1933 in 1999 to 3718 in 2013. Over the same time period, there was a decline in the number of consultants with a primary academic contract from 210 to 143. There was an increase in the proportion of consultants who were female (40% in 1999 to 50% in 2013, p<0.01). The median number of PAs declined from 11 in 2009 to 10 in 2013 (p<0.001) as did the median number of PAs for supporting professional activities (2.5–2.3, p<0.001). In 2013, 38% of new consultants in general paediatrics or neonatology were working resident shifts. Between 2009 and 2013, the proportion of less than full-time working consultants rose from 18% to 22%, which was more common among female consultants (35% vs 9%).ConclusionThe paediatric consultant workforce has doubled since 1999, but more are working less than full time. The decline in those with a primary academic contract is of concern.
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van der Heijden, Joyce, Jolien Freriksen, Marika de Hoop-Sommen, Rick Greupink, and Saskia de Wildt. "13 Feasibility of the pragmatic PBPK modelling approach – towards model-informed dosing in paediatric clinical care." Archives of Disease in Childhood 108, no. 6 (May 18, 2023): A4.3—A5. http://dx.doi.org/10.1136/archdischild-2023-esdppp.13.
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IntroductionMore than half of all drugs are still prescribed off-label to children. To support off-label dosing, pharmacokinetic (PK) data are needed. Physiologically-based pharmacokinetic (PBPK) models are increasingly used to study PK and guide dosing decisions. We hypothesize that combining existing compound models with a paediatric population model can be used to pragmatically predict paediatric exposure.MethodsSeven drugs, with various pharmacokinetic characteristics, were selected (i.e. meropenem, ceftazidime, azithromycin, propofol, midazolam, lorazepam, and caffeine). Simcyp v20 was used to predict exposure in adults, paediatrics and preterm neonates by combining an existing compound file with various virtual populations. Predictive performance was evaluated by calculating the ratio of predicted-to-observed PK parameter values (0.5 to 2-fold acceptance range) and by a visual predictive check.ResultsOverall, model predictions in adults were able to capture clinical observed PK data and confidence in PBPK model performance for predicting PK in this population was therefore considered high. However, predictive performance decreased when predicting PK in the paediatric population, even more so in preterm neonates.ConclusionsPragmatic PBPK modelling in paediatrics is feasible, though the approach is not straight forward as limitations, such as inadequate parameterization with respect to paediatric-specific ADME properties, have been observed. A thorough understanding of the models assumptions and limitations is required, before dose recommendations can be generated for use in clinical practice.This abstract is based on research funded by the Bill & Melinda Gates Foundation.
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Siddiqui, Md Tosadeque Hossain, Shoheli Alam, and Zeba Ahmed. "Spina Bifida and Hydrocephalus in children: Role of a Paediatric Surgeon." Journal of Paediatric Surgeons of Bangladesh 3, no. 1 (June 29, 2015): 37–46. http://dx.doi.org/10.3329/jpsb.v3i1.23907.
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Spina bifida and Hydrocephalus is one of the most common malformations in Paediatric Surgery. Though the two diseases has their own way of presentation but Spina bifida is accompanied by hydrocephalus in 80 to 90% of cases and treatment protocol is interrelated. As a general paediatric surgeon of the third world country we are facing the challenging job in our day to day practice. The etiology, pathophysiology, diagnosis, treatment and prognosis is not well understood and gratifying. We dont have so much interest on the most vital but neglected birth defect. My aim of discussing this two entity at a time to show light on this malformation and make all paediatric surgeon a bit conscious about the disease process and treatment modalities. So that only referring the patient to a tertiary hospital is not the job of a paediatric surgeon rather we must come forward to prevent and treat this major morbid diseases with ourselves. As a paediatric surgeon our role is not to become a good general paediatric surgeon, also acquire proficiency on other speciality like urology, neurosurgery, orthopaedics, reconstructive & oncology.J. Paediatr. Surg. Bangladesh 3(1): 37-46, 2012 (January)
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Barbour, Emma, and Maeve Murray. "P22 Implementing GREATix: learning from excellence in paediatric services." Archives of Disease in Childhood 108, no. 5 (April 19, 2023): 12.2–13. http://dx.doi.org/10.1136/archdischild-2023-nppg.21.
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AimThe paediatric service is extremely good at reporting incidents through Datix system. These incidents are reviewed, learning is identified and then information disseminated, or even a change in practice takes place, all with the aim to improve things and prevent errors happening. A regular bulletin is prepared for the multidisciplinary paediatric team with the paediatric pharmacist involved in the medication section of this bulletin. There is no system within the Trust for reporting all the good things that are happening and it was felt that the department were missing out on learning from these. Learning from Excellence1is not new and numerous areas, both locally and nationally have introduced it in some form.The aim of this project is to identify and learn from everyday excellence as we currently learn from error via Datix, and to also improve staff morale. We wanted to have an anonymised way to let a colleague know they have done a great job. The ultimate goal would be to also interrogate and report findings.MethodA paediatric multidisciplinary oversight group was set up by the paediatric pharmacist and paediatric practice educator. A questionnaire was issued to paediatric staff, examining morale. Resources were developed to support reporting, data collection and nominee feedback. Following some meetings and discussions with the Trust IQI team, a GREATix reporting system was introduced into paediatrics. A pilot was initially carried out in one small area of paediatrics, a few changes were made and it was then introduced throughout the trust in paediatrics.Nominees are issued with a certificate and a letter from head of service and clinical director.ResultsOver the past 20 months there have been a total of 130 nominations to date. 20 themes have been coded including evidence of good teamwork and communication, putting the child and family at the centre of care and staff acting to positively affect patient safety or preserve further harm when an incident had occurred. There has been some feedback from nominees saying how delighted they were receiving the award, how it had made their day, and how grateful they are.ConclusionFor those staff who have received a nomination there has been some evidence of an increase in morale. There have been areas within paediatrics who have embraced this new system more than other areas. As an oversight group we need to highlight the process more. The plan would be to generate a bi-annual report for the paediatric service and present the learning Trust wide. We have supported other areas in the Trust to implement GREATix, including introducing it into the clinical pharmacy team. Our IQI team in the Trust are meeting with the small number of areas within the Trust who have implemented this and plan to look at the way forward as to how we can collaborate to introduce this further within the Trust.ReferenceKelly N, Blake S, Plunkett A. Learning from excellence in healthcare: a new approach in incident reporting.Arch of Dis Child2016;101:788–791.
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Meng, Min, Bin Ge, Wenjuan Lei, Yuqiong Wu, Min Tian, Yali Lu, Tingji Shao, et al. "Paediatric off-label use of drugs in Gansu, China: a multicentre cross-sectional study." BMJ Open 14, no. 5 (May 2024): e078126. http://dx.doi.org/10.1136/bmjopen-2023-078126.
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ObjectiveTo examine the current prevalence and cost of paediatric off-label drug prescriptions in Gansu, China, and the potential influencing factors.DesignThe prevalence of off-label prescriptions in paediatrics was evaluated according to the National Medical Products Administration drug instructions in the China Pharmaceutical Reference (China Pharmaceutical Reference, MCDEX) database. The evidence of the prescription was determined by existing clinical practice guidelines and the Thomson Grade in the Micromedex 2021 compendium. We used logistic regression to investigate the characteristics that influence paediatric off-label drug use after single-factor regression analysis.SettingA multicentre cross-sectional study of outpatient paediatric prescriptions in 196 secondary and tertiary hospitals in Gansu Province, China, in March and September 2020.ResultsWe retrieved 104 029 paediatric prescriptions, of which 39 480 (38.0%) contained off-label use. The most common diseases treated by off-label drugs were respiratory system diseases (n=15 831, 40.1%). A quarter of off-label prescriptions had adequate evidence basis (n=10 130, 25.6%). Unapproved indications were the most common type of off-label drug use (n=25 891, 65.6%). A total of 1177 different drugs were prescribed off-label, with multienzyme tablets being the most common drug (n=1790, 3.5%). The total cost of the prescribed off-label drugs was ¥106 116/day. Off-label prescriptions were less frequent in tertiary than in secondary hospitals. Topical preparations were more commonly prescribed off-label than other types of drugs. Senior-level clinicians prescribed drugs off-label more often than intermediate and junior clinicians.ConclusionOff-label drug use is widespread in paediatric practice in China. Three-quarters of the prescriptions may potentially include inappropriate medication use, resulting in a daily economic burden of about ¥81 000 in 2020 in Gansu Province with 25 million inhabitants. The management of off-label drug use in paediatrics in China needs improvement.
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Yeung, W. L., G. Wong, T. F. Fok, J. Griffith, J. C. Y. Cheng, M. Hjelm, C. Hall, and D. Shaw. "Telemedicine conference on a 13-year-old Chinese girl with an unusual skeletal condition." Journal of Telemedicine and Telecare 4, no. 2 (June 1, 1998): 120–21. http://dx.doi.org/10.1258/1357633981931957.
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Departments of Paediatrics, Diagnostic Radiology, Orthopaedics and Traumatology and Chemical Pathology, Prince of Wales Hospital, Shatin, Hong Kong, China; Department of Paediatric Radiology, Hospital for Sick Children, Great Ormond Street Hospital, London, UK
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Dehneh, Younes, Mohammed Alamine Elfarissi, Mohammed Khoulali, Nourredine Oulali, and Faycal Moufid. "Paediatric midbrain abscess: A case report and literature review." Karnataka Paediatric Journal 38 (December 9, 2023): 135–39. http://dx.doi.org/10.25259/kpj_54_2023.
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Midbrain abscess is an uncommon pathology, especially in paediatric patients. Establishing a guideline for managing brain-stem abscesses is not yet well described, as few paediatrics patients have been treated for this central nervous system infection type. A 3-year-old boy was admitted for facial paralysis. A brain magnetic resonance imaging showed a brain-stem abscess. He was put on Teicoplanin and cephalosporin third generation for four weeks, with favourable evolution. The prognosis in paediatric brain-stem abscesses is generally favourable. Most patients recover with minor neurologic deficits or improve ultimately.
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Jansen, Danielle, and Károly Illy. "Paediatric Care in The Netherlands: State of Affairs, Challenges and Prospects." International Journal of Environmental Research and Public Health 19, no. 3 (January 18, 2022): 1037. http://dx.doi.org/10.3390/ijerph19031037.
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There are many societal developments in The Netherlands, such as a rising and changing demand for care and support and a paradigm shift from curation to prevention, that currently—and in the near future—will have an impact on paediatric care. These developments both reveal potential risks in paediatric care and affect practices that require future improvement. In this viewpoint, we first present the most pressing developments for paediatrics, and we demonstrate why and how Dutch paediatricians have renewed their vision on paediatric care in order to cope with a changing society. It is a vision towards the year 2030 that gives children and paediatric care the right place in the Dutch healthcare landscape to guarantee accessible, high-quality, and effective care for every child at the right time. Realising this renewed vision requires however not only an adjustment from paediatricians and paediatricians in training, but also from professionals who work with them and from the Government that can facilitate or accelerate the implementation of the renewed vision in various ways.
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Nurul Fadhlina Ismail and Rineswary A/P Rajasagaran. "Computed Tomography Dose Estimation Using Dose Length Product Conversion Coefficients In Paediatric Patients From University Of Malaya Medical Centre." Malaysian Journal of Applied Sciences 7, no. 2 (October 31, 2022): 60–63. http://dx.doi.org/10.37231/myjas.2022.7.2.334.
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The increasing use of computed tomography (CT) procedures provides a greater risk for paediatrics in developing radiation-induced cancer than adults. Therefore, a feasible method is required to quantify the received radiation dose. This study aims to estimate the effective dose (ED-estimated) received from CT Brain among paediatric patient of four age groups using published age-and-region specific dose length products (DLP) as ED conversion coefficients. A retrospective study was conducted over 2 months at the University of Malaya Medical Centre. Paediatric patients of four age groups: 0, 1, 5, and 10 years old who went through CT Brain scan was selected for this study. The DLP data that was obtained from the CT console was multiplied with age and region-specific conversion coefficient to estimate the ED. Over the 2 months of the study, there were numerous data of paediatric patients who went through CT Brain scan in the past 3 years from the date of 16 February 2020 that were kept by the hospital in their system. The estimated ED for the four age groups decreases as the age of paediatric patients increases. An inverse relationship will be observed between the age and effective dose of paediatric patients who went through CT Brain.
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Krishnan, Ashida M., Deepthi Raj M.L, Priya V.S, and Arya R.S. "Clinical and Morphological Profile of Immune Thrombocytopenic Purpura in Children - A Five Year Study in a Paediatric Tertiary Health Care Centre of South India." Journal of Evidence Based Medicine and Healthcare 7, no. 46 (November 16, 2020): 2724–29. http://dx.doi.org/10.18410/jebmh/2020/560.
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BACKGROUND Immune Thrombocytopenic Purpura (ITP) is one of the most commonly encountered disease in paediatric practice. Thorough clinical and morphological study of peripheral blood and bone marrow is required for confirming ITP. Clinicomorphological aspects of paediatric ITP is a less studied topic especially in developing countries like India. The objective was to study the clinical and morphological profile of paediatric cases of ITP. METHODS This is a 5-year record based retrospective study conducted in a paediatric tertiary health care centre in Kerala, South India. Data of all paediatric cases diagnosed as ITP including clinical presentation, clinical findings, blood counts, peripheral blood morphology, bone marrow morphology, and treatment response was collected and entered in SPSS software version 16.0 and analysed. For assessing correlation, chi-square test was used. RESULTS The age of children ranged from 3 months to 15 years. H/o viral fever was noted in 53 % cases. Cases which had moderate and severe thrombocytopenia were 74 % and 21 % respectively. Isolated thrombocytopenia was the most common peripheral blood picture observed with few cases showing coexisting eosinophilia and anaemia. All cases showed megakaryocyte proliferation in marrow with 9 % cases showing coexisting iron deficiency anaemia. Majority of cases showed rapid response to steroid / IVIG therapy and the response had no correlation with grade of thrombocytopenia (p value < 0.05). CONCLUSIONS Paediatric cases of ITP usually present following viral infections or vaccination, with worrisome bleeding episodes, petechiae, ecchymosis or purpura. KEYWORDS ITP, Paediatrics, Platelet Count, Thrombocytopenia, Vaccination
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Bax, Martin, and Keith Brown. "Paediatric Neurology and Paediatric Neurologists." Developmental Medicine & Child Neurology 36, no. 2 (November 12, 2008): 95–96. http://dx.doi.org/10.1111/j.1469-8749.1994.tb11817.x.
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Aldriwesh, Marwh, Hessa Albass, Shog Alzaben, Reem Alangari, Lama Alajroush, Mohammed Almutairi, and Khamisa Almokali. "Tuberculous Peritonitis in a Peritoneal Dialysis Paediatric Patient: A Case Report." Clinical Medicine Insights: Case Reports 15 (January 2022): 117954762210870. http://dx.doi.org/10.1177/11795476221087056.
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Mycobacterium tuberculosis is known to cause infection primarily in the lungs, which may spread to other parts of the body causing extrapulmonary tuberculosis. Few studies in the literature identify M. tuberculosis as a cause of peritoneal dialysis (PD)-associated peritonitis among paediatric patients who have no history of pulmonary tuberculosis. PD is the most used renal replacement therapy for paediatric patients with end-stage renal disease. However, despite continuous improvements in the PD connecting system, peritonitis remains the Achilles’ heel of dialysis procedures and prophylaxis for PD. Here, we report a case of M. tuberculosis peritonitis in a paediatric patient receiving PD and the infection was managed successfully with appropriate anti-tuberculous treatment. This case emphasises the importance of considering tuberculous peritonitis in PD paediatrics patients who have no history of pulmonary tuberculosis and whose PD routine cultures produce negative results.
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Pritchard-Wiart, Lesley, Sandra Thompson-Hodgetts, and Ashley B. McKillop. "A review of goal setting theories relevant to goal setting in paediatric rehabilitation." Clinical Rehabilitation 33, no. 9 (May 9, 2019): 1515–26. http://dx.doi.org/10.1177/0269215519846220.
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Background: Goal setting in paediatric rehabilitation is influenced by shifting parent, sibling, caregiver, and child roles over time and evolving child developmental capacity for participation in the process. A theoretical and evidence-informed approach to goal setting, specific to paediatrics, would provide a framework for goal setting in practice and facilitate systematic evaluation of the effects of goal-setting processes on child and family outcomes. Objective: To provide an overview of relevant goal-setting theories and their implications for paediatric rehabilitation. Methods: Prevalent theories were identified from relevant rehabilitation, motivation, behaviour change, and goal-setting literature. Implications for goal setting in paediatrics are summarized according to goal-setting and action-planning phases: (1) preparation, (2) formulation of goals, (3) formulation of action plan, (4) coping planning, and (5) follow up. Results: Social cognitive theory, self-determination theory, Health Action Process Approach, Mastery Motivation, and goal-setting theory are reviewed. Examples of implications for goal setting include, sharing information with families about the purpose of goal setting; identifying goals that are specific, proximal, challenging, and important to the child; and addressing self-efficacy. Conclusion: The theories reviewed have clear implications for paediatric rehabilitation research and practice. They address considerations not typically discussed in adult rehabilitation such as observing children to obtain information about meaningful goals when they are unable to communicate them directly and the importance of establishing flexible processes that will accommodate changing family roles over time. Research is needed to evaluate the effects of goal-setting processes and strategies on outcomes in paediatric rehabilitation.
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Krishnatry, Rahul, Maya Prasad, Girish Chinnaswamy, Abhisheik Chaterjee, Jayant Goda, Epari Sridhar, Aliasgar Moiyadi, et al. "LINC-12. COMBINED ADULT AND PAEDIATRIC NEURO-ONCOLOGY LONG-TERM SURVIVOR CLINIC EXPERIENCE FROM A TERTIARY CANCER CENTRE IN A LOW-MIDDLE-INCOME COUNTRY." Neuro-Oncology 22, Supplement_3 (December 1, 2020): iii380. http://dx.doi.org/10.1093/neuonc/noaa222.447.
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Abstract NeuroOncology survivor clinics (NOS) is uncommon in low-middle-income countries. We started combined (paediatric and adult) NOS clinic in our tertiary a cancer centre (Jan-2017) and review here the demographic, clinical-pathological and treatment spectrum for our paediatric (0-18years) and adult (>18years) survivors (>5years since their initial diagnosis) till date. Of total 312 patients registered, 198 (63.5%) were adults while 114 (36.5%) were paediatric at-diagnosis with median age (IQR) at presentation: 34 (23–41) and 9(6 – 13) years respectively. In both groups, only 33% were females. The median (IQR) time since diagnosis was 9 (9–14) and 8 (6–12) years respectively with 60% of paediatric turning into adult survivors. The commonest paediatric tumours were glioma (52, 45.6%), embryonal (34, 29.8%), and ependymoma (12, 10.5%) versus gliomas (114, 57.6%) and benign tumours (42, 21.2%) in adults. The low-grade-glioma comprised 90.4% of all pediatric gliomas and intermediate-grade (90%) in adults. The primary treatment consisted of radiotherapy and chemotherapy in 95% and 43% versus 99% and 36% in adults versus paediatric patients respectively. Temozolomide and multi-drug combinations were the commonest chemotherapy used in adults and paediatrics respectively. Relapse and retreatments were seen in 16.6 and 14% of adults and paediatric patients. There were two deaths each in each group since registration (median 12 months). Although the baseline diagnosis/treatment characteristics are different, survivors of both group had a similar number of retreatments and deaths. Combined survivor clinics may present an interesting and unique opportunity to learn and provide challenging service in this part of the world.