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At least 199 records · Page 11Linked to original sources

PubMed1995

Paediatric out-of-hospital cardiac arrests--epidemiology and outcome.

OBJECTIVE: To determine the epidemiology and aetiology of out-of-hospital paediatric cardiac arrest and the outcome of resuscitation and to apply the Utstein template for the paediatric cardiac arrest population. DESIGN: Retrospective cohort study. SETTING: A middle-sized urban city (population 516,000) served by a single emergency medical services (EMS) system. PATIENTS: 79 consecutive paediatric (age under 16 years) prehospital cardiac arrest patients between January 1, 1985 and December 31, 1994. No patient was excluded. INTERVENTION: Advanced paediatric life support according to the recommendations of American Heart Association. MAIN OUTCOME MEASURES: Survival from cardiac arrest to discharge and factors associated with favourable outcome defined as alive 1 year after discharge with Bloom category I or II. RESULTS: 79 patients had cardiac arrest. The incidence of paediatric out-of-hospital cardiac arrest and sudden unexpected out-of-hospital death was 9.8 and 8.9/100,000/inhabitants aged under 16, respectively. The mean age was 2.9 years, 72.2% were under 18 months. SIDS was the leading cause of cardiac arrest followed by trauma, airway related cardiac arrest and (near)drowning. Fifty-two patients were considered for resuscitation in whom asystole was the most common initial rhythm (78.9%) followed by pulseless electrical activity (13.5%) and ventricular fibrillation (3.8%). Resuscitation was attempted in 34 patients. The overall survival rate was 9.6%, for attempted resuscitation 14.7%, for attempted resuscitation when cardiac arrest was witnessed 25.0% and for attempted resuscitation with witnessed arrest of cardiac origin 0%. Favourable outcome was registered in four of five survivors. Factors associated with favourable outcome were collapse in a public place, the near-drowning aetiology of arrest, bystander initiated CPR and short duration of resuscitation. Multivariate regression analysis showed no factor related to favourable outcome, but MICU time interval < 10 min was related with survival. Due to the retrospective nature of this study all core times could not be obtained. In spite of this, the Utstein template was applicable also in our paediatric cardiac arrest population. CONCLUSIONS: Survival from paediatric cardiac arrest has remained low. The overall survival rate was 9.6%, survival after attempted resuscitation 14.7% and 0% when resuscitation was attempted in witnessed arrest of cardiac origin. Asystole was the most common initial rhythm and the four leading causes for cardiac arrest were SIDS, trauma, airway related arrest and (near)drowning. The Utstein template adopted for adult out-of-hospital cardiac arrests was was found applicable also in paediatric cardiac arrests.

Adolescent↗

PubMed2005

The utilisation of intraosseous infusion in the resuscitation of paediatric major trauma patients.

Intraosseous lines are a reliable and rapid tool for obtaining vascular access in emergency situations, particularly in children. Their use is recommended when intravenous access cannot be easily secured and there is a need for fluid or pharmacological resuscitation. Training in this technique is included in the Advanced Trauma Life Support (ATLS) and Advanced Paediatric Life Support course (APLS) provider courses. The objective of this study is to analyse the national use of intraosseous lines in paediatric trauma in England and Wales. Data has been collected from the Trauma Audit and Research Network (TARN) group longitudinally over 14 years from 1988 to 2002. From 23,489 paediatric trauma cases, intraosseous lines were used in only 129 patients. Compared with the remainder of the paediatric data, we found that these were the younger (1-6 years), more severely injured patients (higher ISS, lower GCS, higher head, thorax, and abdominal AIS). The mortality of these patients was high at 64% compared with 4% overall. IO line use was greater in general than in Paediatric hospitals, perhaps due to good intravenous access skills in paediatric centres. We recommend that intraosseous line use should be a skill available to everybody involved in paediatric trauma resuscitation, particularly those who may not have refined paediatric intravenous cannulation skills.

Age Distribution↗

PubMed2005

Paediatric fever management: continuing education for clinical nurses.

PURPOSE: This study examined the influence of level of practice, additional paediatric education and length of paediatric and current experience on nurses' knowledge of and beliefs about fever and fever management. METHOD: Fifty-one nurses from medical wards in an Australian metropolitan paediatric hospital completed a self-report descriptive survey. RESULTS: Knowledge of fever management was mediocre (Mean 12.4, SD 2.18 on 20 items). Nurses practicing at a higher level and those with between one and four years paediatric or current experience were more knowledgeable than novices or more experienced nurses. Negative beliefs that would impact nursing practice were identified. Interestingly, beliefs about fever, antipyretic use in fever management and febrile seizures were similar; they were not influenced by nurses' knowledge, experience, education or level of practice. CONCLUSIONS: Paediatric nurses are not expert fever managers. Knowledge deficits and negative attitudes influence their practice irrespective of additional paediatric education, paediatric or current experience or level of practice. Continuing education is therefore needed for all paediatric nurses to ensure the latest clear evidence available in the literature for best practice in fever management is applied.

Analgesics, Non-Narcotic↗

PubMed1997

Should paediatric intensive care be centralised? Trent versus Victoria.

BACKGROUND: The mortality rate is lower among children admitted to specialist paediatric intensive care units (ICUs) than among those admitted to mixed adult and paediatric units in non-tertiary hospitals. In the UK, however, few children receive intensive care in specialist paediatric units. We compared the ICU mortality rate in children from the area the Trent Health Authority, UK, with the rate in children from Victoria, Australia, where paediatric intensive care is highly centralised. METHODS: We studied all children under 16 years of age from Trent and Victoria who received intensive care between April 1, 1994, and March 31, 1995. Children younger than 1 month were excluded unless they had cardiac disorders. We developed a logistic regression model that used information gathered at the time of admission to ICU to adjust for risk of mortality. FINDINGS: The rates of admission of children to intensive care were similar for Trent and Victoria (1.22 and 1.18 per 1000 children per year), but the mean duration of an ICU stay was 3.93 days for Trent children compared with 2.14 days for children from Victoria. 74 (7.3%) of the 1014 children from Trent died, compared with 60 (5.0%) of the 1194 children from Victoria. With adjustment for severity of illness at the time of admission to ICU, the odds ratio for the risk of death for Trent versus Victoria was 2.09 (95% CI 1.37-3.19, p < 0.0005). There were 31.7 (14.0-50.4) excess deaths in Trent children, which is equivalent to 42.8% of the deaths in ICU, and 11.1% of all deaths in children between the ages of 1 month and 16 years in Trent. INTERPRETATION: If Trent is representative of the whole country, there are 453 (200-720) excess deaths a year in the UK that are probably due to suboptimal results from paediatric intensive care. If the ratio of paediatric ICUs to children were the same in the UK as in Victoria, there would be only 12 paediatric ICUs in the country. Our findings suggest that substantial reductions in mortality could be achieved if every UK child who needed endotracheal intubation for more than 12-24 h were admitted to one of 12 large specialist paediatric ICUs.

Adolescent↗

PubMed2003

Use of unlicensed and off-label medications in paediatric gastroenterology with a review of the commonly used formularies in the UK.

BACKGROUND: Use of unlicensed and off-label medications is common in hospital based paediatric practice. Whilst inpatient prescription can be closely monitored within the hospital setting, it is subspecialties like paediatric gastroenterology, caring for chronically ill children on an outpatient basis that require administration of regular medications in the community. Local practitioners rely on available paediatric formularies or information provided by the tertiary unit for monitoring and dispensing further prescriptions. AIM: To assess the proportion of unlicensed and off-label medications prescribed in a paediatric gastroenterology unit to children discharged to the community and assess adequacy of information about these medications in commonly used British formularies. METHODS: All prescriptions prescribed over a six-month period (Jan-Jul 2002) either in the paediatric gastroenterology outpatient department or for children discharged home after an inpatient stay, were retrieved from the pharmacy database. The main outcome measures were to assess the proportion of medications prescribed for unlicensed or off-label use. RESULTS: 308 patients received 777 prescriptions of which 384 (49%) were for unlicensed or off-label use. Of these 291 (76%) were off-label; 208 in relation to indication and 83 to child's age. 93 of the prescribed medications were unlicensed; 37 were due to manipulation of formulation. Of the commonly used formularies in the UK, only 'Medication for Children(R)' contained dosage information on more than half (9/13) of the most often prescribed off-label/unlicensed medications in paediatric gastroenterology. CONCLUSIONS: Use of unlicensed and off-label medications remains a problem in paediatric practice. Until licensing laws change and more drugs are licensed in children, paediatric gastroenterologists remain responsible for provision of information to families, local practitioners, nurses and pharmacists. Of the commonly used formularies, 'Medicines for Children' is the most detailed and comprehensive, and should be available to all general practitioners and pharmacists in the UK. Clear communication between specialist units and local practitioners is imperative to ensure safe and effective prescribing to children.

Ambulatory Care↗

PubMed2003

Paediatric emergency department design: Does it affect staff, patient and community satisfaction?

OBJECTIVES: To assess the change in perception of the standard of paediatric care following the opening of a dedicated paediatric emergency area in an established tertiary hospital emergency department on patients and families, hospital staff and the general practitioners of the local community. METHODS: A questionnaire was circulated to the relevant parties prior to and 6 months after the opening of the paediatric department. The surveys were circulated to the families/custodians of the paediatric attendees, general practitioners who refer paediatric patients and the medical and nursing staff both within the emergency department and the inpatient paediatric ward. The questions related to the physical environment, perceived level of care and the overall satisfaction with treatment. RESULTS: The most striking change was in the patient family group who showed an increase in their level of satisfaction with the physical environment and their overall care. The general practitioner group showed only a slight improvement, while the inpatient staff showed no notable changes. The emergency department staff developed a higher level of confidence and satisfaction when dealing with this population group. CONCLUSION: The change in the physical environment in which we treat our paediatric emergencies seemed to enhance the level of satisfaction of our attendees. Staff appear to be more confident when dealing with these patients in a dedicated paediatric area. The effect has not yet flowed on to the inpatient staff and general practitioners, perhaps reflecting a small exposure of these individuals to the survey subject matter.

Attitude of Health Personnel↗

PubMed2001

New avenues in treatment of paediatric migraine: a review of the literature.

BACKGROUND: Headaches are a common problem in paediatric practice. Recurrent headaches can be a significant source of stress for patient and parents, and disruptive regarding school obligations and parental work responsibilities. Most treatment interventions are developed from research data extrapolated from adult studies, with resultant concerns of safety and efficacy when utilizing these therapeutic conclusions in children. METHODS: This paper incorporates current treatment strategies in paediatric migraine utilizing a Medline search of English language studies from January 1988 to December 1999, with a literature search referencing the terms of paediatrics, migraines, headaches, therapy and treatment. Reference sections of the articles were reviewed for pertinent information prior to January 1988. Articles were evaluated systematically to formulate concise terms for diagnosis of paediatric migraine and applicability to clinical treatment studies. Particular emphasis was placed on newer options with relevance in adult treatment such as triptans and anti-epileptic drugs, and their benefit in therapy of paediatric migraine. Non-pharmacological options were also subjected to organized review to determine relevance in treatment of paediatric migraine. RESULTS: The review of the literature indicates that although migraine in childhood and adolescence appears to be increasing in prevalence, few clinical studies are available, with most current treatment recommendations utilizing data from adult studies. CONCLUSION: Further headache treatment studies in the paediatric population are necessary in order to ascertain safety and efficacy of pharmaco-therapeutics in these children. Also, much current interest in treatment in adults with recurrent headaches involves non-pharmacological areas-dietary modification and stress management. Application of these avenues especially warrants further clarification with regard to relevance in paediatric migraine treatment.

Adolescent↗

PubMedDate not supplied

Long-term outcomes of single paediatric vs. ideal adult renal allograft transplants in adult recipients.

AIM: To compare the outcomes of single paediatric vs. adult kidneys transplanted into adult recipients. METHODS: A retrospective single-centre review of 38 single cadaver kidney transplants from donors less than five yr of age to wait-listed patients of low body mass index (BMI). Survival of grafts and quality of renal function were compared with 121 similarly low BMI recipients of grafts from donors 18-45 yr of age that were transplanted during the same period. Immunosuppression consisted of sirolimus, minimal-dose cyclosporine and prednisone. The mean age of the paediatric vs. adult donors was 2.8+/-1.0 and 31.1+/-9.2 yr, respectively (p<0.01) and of the recipients, 42.0+/-12.4 and 45.7+/-14.8 yr, respectively (p=NS). The mean BMI of paediatric vs. adult donor kidney recipients was 21.8+/-2.9 and 22.4+/-2.0 kg/m2 (p=NS). Sixty-six per cent of paediatric donor recipients were women compared with 44% of adult donor recipients (p=0.03). RESULTS: Death censored actuarial graft survivals at one and five yr for recipients of paediatric vs. adult donor grafts were 93 and 84% compared with 93 and 85% (p=NS). There were no graft losses because of technical complications in the paediatric kidney donor group. At one and five yr post-transplantation, the mean estimated creatinine clearances of the paediatric donor graft recipients were 52.9+/-19.6 and 54.0+/-17.8 mL/min, respectively, compared with 56.4+/-19.8 and 49.1+/-21.7 mL/min for recipients of adult donor grafts at the same times (p=NS). CONCLUSION: Transplantation of single paediatric donor kidneys into low BMI adult recipients provided equivalent outcomes to those of grafts from adult donors between the ages of 18 and 45 yr.

Adolescent↗

PubMed2004

Facilities and equipment in district general hospitals in the Netherlands: are we prepared for the critically ill paediatric patients?

OBJECTIVE: To evaluate the inventory for initial treatment of critically ill children. DESIGN: Prospective study. SETTING: Paediatric emergency settings in 15 major district general hospitals. METHODS: Using an "expert opinion" created by paediatric intensivists, all hospitals were visited twice to check the inventory. Firstly, to examine the initial site of emergency care for children coming from outside the hospital. Secondly, to visit other emergency sites. A total score below 75% of the optimum was considered as not optimally equipped. MAIN RESULTS: Equipment to meet "respiratory problems" was considered by the experts as most essential. Seventy five per cent of all emergency sites scored below 75% (4 of 11 paediatric departments, 1 of 15 emergency rooms. The emergency room was in all aspects significantly better equipped than the paediatric department. Major differences and variations in the inventory were identified between all hospitals. CONCLUSIONS: Emergency rooms are better equipped to meet the needs of critically ill paediatric patients coming from outside the hospital than the paediatric departments. Paediatricians involved in the treatment of children who become critically ill during their stay in the hospital (the "indoor" patients), have less equipment and medication on the paediatric department at their disposal than on their emergency room. Obviously, emergency care on the paediatric wards should be equipped at the same level as in the emergency room because for both locations the "golden hour" is critically important in final outcome.

Child↗

PubMed2002

Paediatric regional anaesthesia, a survey of practice in the United Kingdom.

BACKGROUND: A variety of techniques and drugs, many unlicensed, is used in paediatric regional anaesthesia. This study is the first to survey paediatric anaesthetists about the techniques and drugs used in paediatric regional anaesthesia. The aim is to provide a record and benchmark of UK practice. METHODS: A postal questionnaire was sent to all members of the Association of Paediatric Anaesthetists residing in the UK. Information was requested on the type of hospital worked in, years of practice, paediatric anaesthesia workload, regional anaesthesia techniques used, and drugs used in regional anaesthesia. RESULTS: A total of 220 responses from 264 questionnaires (83.3%) were received. Of these respondents, 155 (70%) practised paediatric anaesthesia as more than 50% of their workload, and 10 had retired or returned blank forms. Two hundred and two of 210 (96%) use caudal anaesthesia and 151 (72%) use caudal, epidural and peripheral block. One hundred and ninety-two of 210 (91%) have no lower age limit for using caudal anaesthesia. One hundred and twenty-three of 210 anaesthetists (58%) used adjuvants with local anaesthetics in caudal block, the most common being fentanyl [44/210 (21%)], clonidine [55/210 (26%)], diamorphine [27/210 (13%)] and ketamine [67/210 (32%)]. Those working in specialist centres or teaching hospitals or who had a greater paediatric anaesthesia workload were more likely to use a greater variety of regional anaesthesia techniques. CONCLUSIONS: Caudal anaesthesia is widely used for patients of all ages by almost all practitioners. Most anaesthetists at all hospital types and experience levels use adjuvants with local anaesthetics when performing caudal anaesthesia. Those with more experience in paediatric anaesthesia and those in specialist centres commonly use other neuraxial and peripheral block techniques.

Adjuvants, Anesthesia↗

PubMed1986

Paediatric developmental screening: a survey of general practitioners.

A questionnaire survey of 293 general practitioner trainers in England to investigate paediatric screening yielded a response rate of 86%. Paediatric screening sessions were being held by a practice member in the practices of 54% of respondents. In one-third of these practices the practice member was acting in the capacity of clinical medical officer. Of responding trainers 28% held sessions personally and these doctors did not differ significantly from the remainder in terms of sex, seniority, hospital paediatric experience or membership of the Royal College of General Practitioners. About one-third of the doctors holding sessions had spent six months or more working in hospital paediatric departments. First-hand experience of paediatric screening was gained by 60% of the current trainees.Sixty-one per cent of trainers agreed with the view that developmental screening is an appropriate task for all general practitioners, while 71% saw it as an appropriate task for themselves. Eight-six per cent of trainers agreed that doctors should be paid for this service if trained for it, and 56% that they should be paid regardless of training.Comparative figures were determined from a parallel survey of 333 non-training general practitioners of whom 225 (68%) replied. Paediatric screening sessions were held in the practices of 34% of respondents and personally by 21%.It is concluded that there is a high level of interest in paediatric screening among general practitioners, but that there is a need for further expansion in postgraduate paediatric training.

Attitude of Health Personnel↗

PubMed2003

Identification of an autosomal recessive mode of inheritance in paediatric Behçet's families by segregation analysis.

We have conducted a segregation analysis in order to characterise the transmission of Behçet Disease (BD), a multifactorial condition with a strong genetic component. Complete information about BD status and pedigree was obtained on 104 probands from our database. We used the criteria of the International Study Group for BD (ISBD) to delineate the clinical status of the sibs: possible BD (patients meeting two criteria), or ascertained BD (patients meeting at least three criteria). A proband was defined as "paediatric" when he/she completed ISBD criteria before/by the age of 16 years. Families were distinguished as paediatric (n = 67) (ascertained through a paediatric proband), and non-paediatric (n = 37) ones. An Expectation Maximization (EM) algorithm was used to estimate the Mendelian segregation ratio P in nuclear families (two parents and their offspring). The maximum likelihood estimate: Pcirc; = 0.248, calculated in the paediatric data set, was consistent with the theoretical value of P = (1/4) for autosomal recessive inheritance, whereas the Pcirc; value was 0.08 when using the non-paediatric data set. Our work provides the first evidence of genetic heterogeneity in BD, and of the existence of a Mendelian entity in the paediatric BD subgroup. Previous studies failed to show any simple mode of inheritance in BD, probably because they were performed on the whole BD population.

Behcet Syndrome↗

PubMed2004

Psychiatric outcome following paediatric intensive care unit (PICU) admission: a cohort study.

OBJECTIVE: To determine whether paediatric intensive care unit (PICU) admission is associated with greater psychiatric morbidity in children and parents as compared with general paediatric ward admissions. DESIGN: Retrospective cohort study. SETTING: Paediatric intensive care unit and two general paediatric wards of a London teaching hospital. PARTICIPANTS: Children aged 5-18 years discharged from PICU (exposed cohort) and general paediatric wards (unexposed cohort) 6-12 months previously, together with their parents. MEASUREMENTS AND RESULTS: Children: the Clinician Administered Post Traumatic Stress Disorder (PTSD) Scale for Children (CAPS-C), the Impact of Event Scale (IES), Strengths and Difficulties Questionnaire, Birleson Depression Scale, Revised Children's Manifest Anxiety Scale, Child Somatization Inventory. Parents: IES, General Health Questionnaire, Beck Depression Inventory, Hospital Anxiety and Depression Scale. Thirty-five of 46 (76%) PICU-discharged families and 33 of 41 (80%) from general paediatric wards participated. Valid CAPS-C data were obtained for 19 PICU-admitted children and 27 children admitted only to the general paediatric ward; 4/19 (21%) of PICU-discharged children developed PTSD (compared with none of 27 ward admissions), p=0.02. PICU children had significantly more PTSD features of irritability and persistent avoidance of reminders of the admission. Parents of PICU children were more likely to screen positive for PTSD (9/33 (27%) compared with 2/29 (7%) parents of ward-admitted children), p=0.04. There were no significant differences between the groups for other measures of psychopathology. CONCLUSION: Post traumatic stress disorder diagnosis and symptomatology is significantly more common in families where a child has been admitted to the PICU. Consideration should be given to providing psychological support for children and parents after PICU admission.

Adolescent↗

PubMed2002

Unlicensed and off-label drug use in a paediatric ward of a general hospital in the Netherlands.

OBJECTIVES: Many drugs used in paediatric care are not licensed for that use or are prescribed outside the terms of the product license (off-label). Studies in the UK and Europe showed a large number of unlicensed and off-label drug prescription in specialised paediatric health care centres. We determined the extent and nature of use of unlicensed drugs and off-label prescriptions in children in a general hospital in the Netherlands. METHODS: We conducted a longitudinal prospective cohort study in a dynamic population consisting of patients admitted to the paediatric ward and the neonatology unit of a general hospital during a 19-week period. Drug-licensing status of all prescriptions given to these patients was determined. RESULTS: A total of 1017 prescriptions was administered to 293 paediatric patients for 114 different drugs. The median number of prescriptions per patient was three (interquartile range 2-5). The most commonly administered drugs were acetaminophen (14%), cefotaxime (8%), amoxicillin (7%), caffeine (4%) and prednisolone (4%). Four hundred and forty-three (44%) prescriptions were off-label, and 285 (28%) were for unlicensed drugs. Ninety-two percent of patients received one or more unlicensed or off-label prescriptions, and this proportion was significantly higher in children below 6 months of age than in older children. CONCLUSIONS: This study shows that the extent of unlicensed and off-label drug prescription in a paediatric ward and neonatology unit of a general hospital is large and not smaller than in an academic paediatric setting. Lack of paediatric drug labelling is therefore not solely a problem with drugs used in university hospitals, but also in general hospitals. Efforts must be taken to change the current situation.

Adolescent↗

PubMed2005

Off label and unlicensed drugs use in paediatric cardiology.

OBJECTIVES: The use of drugs in an off label or unlicensed manner to treat children is a widespread phenomenon in Europe and the United States. The incidence of unlicensed and off label prescribing in paediatric cardiology practice has not been studied to date. This study was designed to assess the extent and nature of off label and unlicensed drug use in paediatric cardiology inpatients. METHODS: In a prospective study, drug prescriptions in a paediatric cardiology ward were reviewed during a 2-year period. Data were collected and analyzed by special software created for this purpose. RESULTS: The children (n = 544) studied varied in age from 4 h to 18 years. One or more off label and unlicensed prescriptions were given to 414 (76%) patients. Of the 2,130 prescriptions given during the 2-year period, more than one-half were unlicensed (11%) or off label (47%). While children aged 2-11 years received most of the unlicensed drug prescriptions (17%), neonates, who did not receive unlicensed drugs, led (64%) in the use of off label drugs. CONCLUSIONS. This study showed that the problem of off label and unlicensed drug use also exists in paediatric cardiology. The findings imply that the phenomenon of off label and unlicensed use of drugs in children can be correlated with the deficiency of paediatric drug formulations on the global market and insufficient data from clinical studies which must be performed to confirm the efficacy and safety of drugs in the paediatric population. Therefore, efforts to improve paediatric labelling are important and need the full support of all involved.

Adolescent↗

PubMed2004

German-language paediatric websites.

BACKGROUND: Among medical subspecialties, paediatrics is relatively well represented on the Internet, as evidenced by the number of topical pages retrieved with different search engine queries. We sought to identify the kind of information that is readily available and to evaluate those resources for the quality of patient education from the consumer's perspective. METHODS: A review was conducted of paediatric material found on German-language websites. In November 2002, we used a popular method of searching information on the Internet to locate German-language websites identified by the search string "kinderarzt". The first 200 websites listed in the most popular search engine 'Google' were recorded in a database and compared with one another. RESULTS: A search of the Internet identified 40.900 potential paediatric sites. The most common features of the reviewed websites included information about a specific paediatric practice (71%); general health-care information (52%); and a description of vaccinations (30%). E-mail consulting was offered by 44% of the sites. Only a few sites conform to the code of the Health On the Net (HON) Foundation, clearly state authorship, or exactly identify the most recent material update. CONCLUSIONS: The Internet is a tool capable of providing an unprecedented amount of information to patients interested in paediatric health topics. Our assessment of the status of German-language paediatric information on the Internet indicates that many colleagues use the Internet only to promote their private practice. Our findings indicate that Internet-based information regarding paediatric health care is extensive at present, but is also poorly organised and hard to find.

Austria↗

PubMed2006

Molecular characterisation of Canadian paediatric multidrug-resistant Streptococcus pneumoniae from 1998-2004.

Multidrug-resistant (MDR) Streptococcus pneumoniae (i.e. resistant to three different antimicrobial classes) is a global concern. The molecular epidemiology of MDR S. pneumoniae has not been characterised in Canadian paediatric isolates. Paediatric MDR S. pneumoniae were obtained from a national surveillance study. Susceptibility testing was performed by the methods of the Clinical and Laboratory Standards Institute. Phenotypic and genotypic relatedness were assessed by serotyping and pulsed-field gel electrophoresis (PFGE). Penicillin resistance was assessed with polymerase chain reaction (PCR) followed by DNA sequencing of penicillin-binding proteins (PBPs) 1A, 2B and 2X. Macrolide resistance was assessed by PCR-based detection of mef(E) and erm(B). PCR and sequencing of the dihydrofolate reductase (DHFR) gene was performed to assess resistance to trimethoprim/sulphamethoxazole (T/S). Seventy (98.6%) of 71 MDR paediatric isolates were concomitantly resistant to penicillin, erythromycin and T/S. Resistance genes mef(E) (66.2%) or erm(B) (22.5%) or both mef(E) and erm(B) (8.5%) were associated with macrolide resistance, and the prevalence of erm(B) increased significantly (P=0.0001) over time. Penicillin resistance was associated with amino acid substitutions in PBPs 1A, 2B and 2X. Resistance to T/S was associated with amino acid substitutions in the DHFR gene; in particular, Ile100-->Leu was detected in all isolates analysed. PFGE revealed three clusters of isolates that were genetically related and associated with specific serotypes (Taiwan(19F), Spain(23F), Spain(14) and France(9V)), suggesting clonal expansion as the primary means of paediatric MDR S. pneumoniae dissemination in Canada. The heptavalent pneumococcal vaccine Prevnar, currently approved in Canada for use in children < or =2 years of age, provided excellent coverage (90.2%) of paediatric MDR S. pneumoniae. In conclusion, paediatric MDR S. pneumoniae simultaneously resistant to penicillin, erythromycin and T/S are genetically similar and disseminating across Canada. Prevnar provides excellent coverage of paediatric MDR S. pneumoniae.

Adolescent↗

PubMed2002

Paediatric training for family doctors: principals and practice.

BACKGROUND: There is controversy as to how best to train general practitioners for the paediatric challenges they will meet in practice, in particular what should be included in training, what should be left out and how long should it last? SUBJECTS AND METHODS: All 615 general practice principals referring to 6 hospitals were surveyed (40% response rate). SETTING: West Midlands region of England. STUDY DESIGN: Postal questionnaire. STATISTICS: Quantitative and qualitative assessment of responses. Quantitative responses were analysed by hospital, decade of qualification, and duration of paediatric training. Qualitative responses were analysed using grounded theory. RESULTS: Satisfaction with training was directly related to its duration, with low levels of satisfaction for less than 6 months paediatrics, moderate levels for 6-11 months, and high levels with 12 months or more. The most important item of training was recognition of the sick child. Acute and chronic paediatrics was generally well covered. Psychosocial aspects, public health and immunisation were poorly addressed. Neonatal resuscitation and first day checks were seen as relevant, but neonatal intensive care was not. CONCLUSIONS: At least 6 months of paediatrics is necessary for GPs in training, but longer paediatric exposure further increases their satisfaction with training. GPs have a biopsychosocial rather than biomedical approach to their child patients, suggesting potential benefits from a greater emphasis on psychosocial and public health aspects at the expense of neonatal intensive care. Recognition of the sick child is essential, and acute and chronic organic illness should be covered in breadth. Possible future models for GP training in paediatrics are discussed.

Education, Medical↗