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Paediatric Emergency

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https://www.readbyqxmd.com/read/28641582/a-multicentre-randomised-controlled-trial-of-levetiracetam-versus-phenytoin-for-convulsive-status-epilepticus-in-children-protocol-convulsive-status-epilepticus-paediatric-trial-consept-a-predict-study
#1
Stuart R Dalziel, Jeremy Furyk, Megan Bonisch, Ed Oakley, Meredith Borland, Jocelyn Neutze, Susan Donath, Cynthia Sharpe, Simon Harvey, Andrew Davidson, Simon Craig, Natalie Phillips, Shane George, Arjun Rao, Nicholas Cheng, Michael Zhang, Kam Sinn, Amit Kochar, Christine Brabyn, Franz E Babl
BACKGROUND: Convulsive status epilepticus (CSE) is the most common life-threatening childhood neurological emergency. Despite this, there is a lack of high quality evidence supporting medication use after first line benzodiazepines, with current treatment protocols based solely on non-experimental evidence and expert opinion. The current standard of care, phenytoin, is only 60% effective, and associated with considerable adverse effects. A newer anti-convulsant, levetiracetam, can be given faster, is potentially more efficacious, with a more tolerable side effect profile...
June 22, 2017: BMC Pediatrics
https://www.readbyqxmd.com/read/28637642/emergency-department-attendance-following-4-component-meningococcal-b-vaccination-in-infants
#2
Sarah Kapur, Thomas Bourke, Julie-Ann Maney, Paul Moriarty
INTRODUCTION: In September 2015, the UK became the first country in the world to introduce the 4-component meningococcal B vaccine(4CMenB) into the routine vaccine schedule for infants. 4CMenB is known to cause fever in infants. Infants presenting with fever, particularly those under 3 months, have a significant risk of serious bacterial infection(SBI). METHOD: Between September 2015 and January 2016, we performed a prospective audit of management of infants between 30 and 180 days attending the regional paediatric emergency department(ED) in Northern Ireland, within 4 days of receiving 4CMenB...
June 21, 2017: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/28631089/targeted-temperature-management-in-the-icu-guidelines-from-a-french-expert-panel
#3
REVIEW
Alain Cariou, Jean-François Payen, Karim Asehnoune, Gerard Audibert, Astrid Botte, Olivier Brissaud, Guillaume Debaty, Sandrine Deltour, Nicolas Deye, Nicolas Engrand, Gilles Francony, Stéphane Legriel, Bruno Levy, Philippe Meyer, Jean-Christophe Orban, Sylvain Renolleau, Bernard Vigue, Laure De Saint Blanquat, Cyrille Mathien, Lionel Velly
Over the recent period, the use of induced hypothermia has gained an increasing interest for critically ill patients, in particular in brain-injured patients. The term "targeted temperature management" (TTM) has now emerged as the most appropriate when referring to interventions used to reach and maintain a specific level temperature for each individual. TTM may be used to prevent fever, to maintain normothermia, or to lower core temperature. This treatment is widely used in intensive care units, mostly as a primary neuroprotective method...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28629473/emergency-treatment-with-levetiracetam-or-phenytoin-in-status-epilepticus-in-children-the-eclipse-study-study-protocol-for-a-randomised-controlled-trial
#4
Mark D Lyttle, Carrol Gamble, Shrouk Messahel, Helen Hickey, Anand Iyer, Kerry Woolfall, Amy Humphreys, Naomi E A Bacon, Louise Roper, Franz E Babl, Stuart R Dalziel, Mary Ryan, Richard E Appleton
BACKGROUND: Convulsive status epilepticus (CSE) is the most common life-threatening neurological emergency in childhood. These children are also at risk of significant morbidity, with acute and chronic impact on the family and the health and social care systems. The current recommended first-choice, second-line treatment in children aged 6 months and above is intravenous phenytoin (fosphenytoin in the USA), although there is a lack of evidence for its use and it is associated with significant side effects...
June 19, 2017: Trials
https://www.readbyqxmd.com/read/28627014/review-article-paediatric-status-epilepticus-in-the-pre-hospital-setting-an-update
#5
REVIEW
Jeremy Furyk, Kerriane Watt, Theophilus I Emeto, Stuart Dalziel, Daniel Bodnar, Kate Riney, Franz E Babl
Paediatric status epilepticus (SE) is a medical emergency and a common critical condition confronting pre-hospital providers. Management in the pre-hospital environment is challenging but considered extremely important as a potentially modifiable factor on outcome. Recent data from multicentre clinical trials, quality observational studies and consensus documents have influenced management in this area, and is important to both pre-hospital providers and emergency physicians. The objective of this review was to: (i) present an overview of the available evidence relevant to pre-hospital care of paediatric SE; and (ii) assess the current pre-hospital practice guidelines in Australia and New Zealand...
June 18, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28620921/consistency-of-total-body-surface-area-assessment-in-severe-burns-implications-for-practice
#6
Stephen Face, Sarah Dalton
BACKGROUND: Paediatric burn injury is common and often serious. Injuries occur across New South Wales (NSW), with specialised treatment provided in a centralised burns unit. Early management prior to transfer is essential but variation is seen. OBJECTIVES: To determine if differences exist between referring hospital estimates of the total body surface area (TBSA) of burns, and estimates for the same burns by the Burns Unit. To consider if differences in estimations influence initial and ongoing management, and decisions regarding transfer/retrieval...
June 15, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28618012/metabolomic-signature-of-brain-cancer
#7
Renu Pandey, Laura Caflisch, Alessia Lodi, Andrew J Brenner, Stefano Tiziani
Despite advances in surgery and adjuvant therapy, brain tumours represent one of the leading causes of cancer-related mortality and morbidity in both adults and children. Gliomas constitute about 60% of all cerebral tumours, showing varying degrees of malignancy. They are difficult to treat due to dismal prognosis and limited therapeutics. Metabolomics is the untargeted and targeted analyses of endogenous and exogenous small molecules, which characterizes the phenotype of an individual. This emerging "omics" science provides functional readouts of cellular activity that contribute greatly to the understanding of cancer biology including brain tumour biology...
June 15, 2017: Molecular Carcinogenesis
https://www.readbyqxmd.com/read/28617125/-emergency-nursing-is-the-best-job-you-ll-ever-have
#8
Layla Haidrani
What is your job? I am a clinical development specialist at Hasbro Children's Hospital, the paediatric division of Rhode Island Hospital in Providence, US. I educate and mentor new graduate nurses from the paediatric emergency department (ED) and inpatient areas.
June 15, 2017: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
https://www.readbyqxmd.com/read/28614019/eosinophilic-oesophagitis-an-otolaryngologist-s-perspective
#9
T Gnanasekaran, S Gnanasekaran, J M Wood, P Friedland
Eosinophilic oesophagitis is a diagnosis that is being made more frequently in the assessment of dysphagia in both adults and children. It is unclear whether this is a result of increased prevalence or improved diagnostic methods. Children present commonly to paediatric institutions with foreign body impaction. Research indicates that food impaction may predispose to eosinophilic oesophagitis. This article presents eosinophilic oesophagitis from an otolaryngologist's point of view. It details the clinical features present in the disease as well as how it is diagnosed and managed...
June 2, 2017: British Journal of Hospital Medicine
https://www.readbyqxmd.com/read/28613141/completely-genomic-and-evolutionary-characteristics-of-human-dominant-g9p-8-group-a-rotavirus-strains-in-yunnan-china
#10
Ziqin Dian, Binghui Wang, Mao Fan, Shuwei Dong, Yue Feng, A-Mei Zhang, Li Liu, Hua Niu, Yuanyue Li, Xueshan Xia
G9P[8] rotavirus A (RVA) has been identified as the predominant genotype circulating in Yunnan, China. To elucidate the molecular characteristics of its genetic composition at the whole-genome level, the genomes of 12 strains isolated from paediatric patients with diarrhoea were fully sequenced and characterized. Eleven of the 12 strains were genotyped as G9-P[8]-I1-R1-C1-M1-A1-N1-T1-E1-H1, which is closely related to the Wa-like genotype 1 constellation. In contrast, one strain was genotyped as G9-P[8]-I1-R1-C1-M1-A1-N2-T1-E1-H1, with the NSP2 gene characterized as a DS-1 like genotype...
June 14, 2017: Journal of General Virology
https://www.readbyqxmd.com/read/28607037/international-comparison-of-emergency-hospital-use-for-infants-data-linkage-cohort-study-in-canada-and-england
#11
Katie Harron, Ruth Gilbert, David Cromwell, Sam Oddie, Astrid Guttmann, Jan van der Meulen
OBJECTIVES: To compare emergency hospital use for infants in Ontario (Canada) and England. METHODS: We conducted a population-based data linkage study in infants born ≥34 weeks' gestation between 2010 and 2013 in Ontario (n=253 930) and England (n=1 361 128). Outcomes within 12 months of postnatal discharge were captured in hospital records. The primary outcome was all-cause unplanned admissions. Secondary outcomes included emergency department (ED) visits, any unplanned hospital contact (either ED or admission) and mortality...
June 12, 2017: BMJ Quality & Safety
https://www.readbyqxmd.com/read/28606907/first-line-support-for-assistance-in-breathing-in-children-first-abc-protocol-for-a-multicentre-randomised-feasibility-trial-of-non-invasive-respiratory-support-in-critically-ill-children
#12
Padmanabhan Ramnarayan, Paula Lister, Troy Dominguez, Parviz Habibi, Naomi Edmonds, Ruth Canter, Paul Mouncey, Mark J Peters
INTRODUCTION: Over 18 000 children are admitted annually to UK paediatric intensive care units (PICUs), of whom nearly 75% receive respiratory support (invasive and/or non-invasive). Continuous positive airway pressure (CPAP) has traditionally been used to provide first-line non-invasive respiratory support (NRS) in PICUs; however, high-flow nasal cannula therapy (HFNC), a novel mode of NRS, has recently gained popularity despite the lack of high-quality trial evidence to support its effectiveness...
June 12, 2017: BMJ Open
https://www.readbyqxmd.com/read/28606747/hot-tea-and-tiny-tots-don-t-mix-a-cross-sectional-survey-on-hot-beverage-scalds
#13
J D Burgess, R M Kimble, K A Watt, C M Cameron
OBJECTIVE: Hot beverage scalds are a leading cause of burns in young children. The aim of this study was to look at the circumstances surrounding these injuries in terms of setting, mechanism, supervision and first aid to inform a prevention campaign. METHODS: A cross-sectional study was delivered via iPad to parents and caregivers presenting with a child aged 0-36 months with a hot beverage scald at a major paediatric burns centre. RESULTS: Of the 101 children aged 0-36 months that presented with a hot beverage scald over a 12-month period, 54 participants were included...
June 9, 2017: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/28605441/aortopexy-offers-surgical-options-for-a-variety-of-pathological-tracheal-conditions-in-paediatric-patients
#14
Anna Gruszka, Joerg S Sachweh, Heike Schnoering, Klaus Tenbrock, Eberhard G Muehler, Michael Laschat, Jaime F Vazquez-Jimenez
OBJECTIVES: Aortopexy is widely used; however, many surgeons still regard it with suspicion. To date, there are only a few large series and minimal long-term data. Against this background, our goal was to report our experience, particularly with regard to the recent expansion of indications and modification of diagnostic routine and surgical strategy. METHODS: Between 1994 and 2012, 53 patients (mean age: 1.1 years; 5 weeks-10.2 years) were operated on. Tracheomalacia after the operation for oesophageal atresia was the main indication for aortopexy (74%), followed by tracheal compression by the innominate artery (17%) and other selected indications (9%)...
June 9, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28601795/the-role-of-nurses-clinical-impression-in-the-first-assessment-of-children-at-the-emergency-department
#15
Joany M Zachariasse, Dominique van der Lee, Nienke Seiger, Evelien de Vos-Kerkhof, Rianne Oostenbrink, Henriëtte A Moll
OBJECTIVE: To assess the diagnostic value and determinants of nurses' clinical impression for the recognition of children with a serious illness on presentation to the emergency department (ED). DESIGN: Secondary analysis of a prospective cohort. SETTING AND PATIENTS: 6390 consecutive children <16 years of age presenting to a paediatric ED with a non-surgical chief complaint and complete data available. MAIN OUTCOME MEASURES: Diagnostic accuracy of nurses' clinical impression for the prediction of serious illness, defined by intensive care unit (ICU) and hospital admission...
June 10, 2017: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/28601216/usefulness-of-ct-value-in-acute-respiratory-infections-caused-by-respiratory-syncytial-virus-a-and-b-and-influenza-virus-a-h1n1-pdm09-a-h3n2-and-b
#16
Jordi Reina, Carmen Morales, María Busquets, Cristina Norte
INTRODUCTION: Acute respiratory infections of viral cause are very frequent entities. The difficulty in evaluating the detection of a virus in these entities could be solved by determining the viral load. METHODS: A prospective study on the mean Ct value (cycle threshold value) detected against RSV-A, RSV-B and influenza A (H1N1)pdm09, A (H3N2) and B viruses in patients of different origin and age was performed. Detection was performed using a commercial molecular amplification (RT-PCR) technique...
June 7, 2017: Enfermedades Infecciosas y Microbiología Clínica
https://www.readbyqxmd.com/read/28600630/arterial-versus-venous-lactate-a-measure-of-sepsis-in-children
#17
Sahan Asela Samaraweera, Berwyck Gibbons, Anami Gour, Philip Sedgwick
This study assessed the agreement between arterial and venous blood lactate and pH levels in children with sepsis. This retrospective, three-year study involved 60 PICU patients, with data collected from electronic or paper patient records. The inclusion criteria comprised of children (≤17 years old) with sepsis and those who had a venous blood gas taken first with an arterial blood gas taken after within one hour. The lactate and pH values measured through each method were analysed. There is close agreement between venous and arterial lactate up to 2 mmol/L...
June 10, 2017: European Journal of Pediatrics
https://www.readbyqxmd.com/read/28595614/a-multicentre-randomised-intervention-study-of-the-paediatric-early-warning-score-study-protocol-for-a-randomised-controlled-trial
#18
Claus Sixtus Jensen, Hanne Aagaard, Hanne Vebert Olesen, Hans Kirkegaard
BACKGROUND: Patients' evolving critical illness can be predicted and prevented. However, failure to identify the signs of critical illness and subsequent lack of appropriate action for patients developing acute and critical illness remain a problem. Challenges in assessing whether a child is critically ill may be due to children's often uncharacteristic symptoms of serious illness. Children may seem relatively unaffected until shortly before circulatory and respiratory failure and cardiac arrest...
June 8, 2017: Trials
https://www.readbyqxmd.com/read/28595529/development-and-optimization-by-quality-by-design-strategies-of-frovatriptan-orally-disintegrating-tablets-for-migraine-management
#19
Natascia Mennini, Serena Orlandini, Sandra Furlanetto, Benedetta Pasquini, Paola Mura
BACKGROUND: Frovatriptan is a potent anti-migraine agent with unfavourable slow onset of action, available on the market as film-coated tablets. OBJECTIVE: optimization, by Quality by Designs strategies, of an orally disintegrating tablet (ODT) formulation of frovatriptan aimed to make its oral administration easier and its dissolution faster than the commercial tablets, thus improving its effectiveness in migraine management. METHOD: A screening D-optimal design was applied to investigate the effects of different levels of kind and amount of ODT special excipient and disintegrant agents (identified as the critical variables) on disintegration time (DT) and % drug dissolved at 30 s (%Diss), selected as the responses to optimize...
June 5, 2017: Current Drug Delivery
https://www.readbyqxmd.com/read/28588977/determinants-of-morbidity-and-mortality-following-emergency-abdominal-surgery-in-children-in-low-income-and-middle-income-countries
#20
(no author information available yet)
BACKGROUND: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally. METHODS: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014...
November 2016: BMJ Global Health
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