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PubMed2006

Children with chronic conditions in a paediatric emergency department.

AIM: To describe the use of a paediatric emergency department by children with chronic conditions. MATERIAL AND METHODS: We prospectively indexed all the children seen in our emergency department during 1 y to describe the population of children with chronic conditions, and to compare it with the general paediatric population. RESULTS: There were 11,483 patient visits, of which 11% were by chronically ill children. Six subspeciality areas accounted for the vast majority of the chronic conditions seen: neurology (30%), cardiology (18%), pulmonology (18%), nephro-urology (16%), haemato-oncology (9%) and endocrinology (4%). Admission rate to the hospital was significantly higher for chronically ill patients (38% vs 23%). Among chief complaints, fever, respiratory distress, headache and seizures were overrepresented in chronically ill children. The chief complaint was related to the child's chronic condition in 51% of the visits. In both chronically and non-chronically ill patients, the majority of final diagnoses were related to infection (57% and 65%, respectively). Among diagnoses, bacterial infections, seizures, vasovagal syncopes and asthma were overrepresented in chronically ill children. CONCLUSION: From the analysis of our data, we conclude that children with chronic conditions account for a tenth of all visits to a paediatric emergency department. The paediatric emergency physicians provide an important service to both the children with chronic conditions and the subspecialists who care for them.

Child↗

PubMed2006

Childhood death auditing to improve paediatric care.

AIM: Field-testing a paediatric mortality audit system at eight sites in South Africa to assess its feasibility, to collect local data on common causes of death in children under 5 y, and to determine health system failure, missed opportunities of intervention and substandard care (modifiable factors). METHODS: The study tested the Under-5 Healthcare Problem Identification Programme (U5PIP). The sites represent different levels of paediatric healthcare. STUDY PERIOD: 1 September 2003-31 August 2004. STUDY POPULATION: Under-5 patients admitted to study hospitals. CASES: Under-5 patients who died in study hospitals. RESULTS: In total, 1532 under-5 deaths occurred, representing a case-fatality rate of 7.8%. Main causes of death were lower respiratory tract infections (33%), gastroenteritis (15%) and septicaemia (12%). Sixty per cent of the deaths were HIV/AIDS related. Sixty-nine per cent of children who died were underweight. Administrative modifiable factors were present in 31% of deaths. Clinical personnel-related modifiable factors were detected in 26% at the clinic level and in 33-37% at the hospital level. CONCLUSION: The U5PIP is feasible for ongoing mortality reviews by paediatric teams as part of routine work. Information on common causes of death and modifiable factors in this study focus on the impact of HIV/AIDS, malnutrition and resource allocation, and can be used for interventions to improve paediatric healthcare.

Cause of Death↗

PubMed2004

Transition from paediatric to adult services: experiences of HIV-positive adolescents.

In this small, preliminary study, semi-structured interviews were conducted with seven adolescents to explore their experiences of transition between paediatric and adult HIV care services. In general, the transition process established between the two health care units was considered by most participants to be beneficial, particularly the introduction of adult service providers early on in the transition preparation period. Four of the participants found the transition 'easy', whereas three had concerns that possibly delayed their transition, including coordination of haemophiliac and HIV care and fear of an adult environment. Individuals who had experienced little input into their care decisions during their paediatric appointments were more positive and ready for transition than those who had been more involved. Confidence and attachment with paediatric staff generally involved those who had been more involved in their care decision making. On transition, some of the participants were not prepared for the predominantly gay male population and were disappointed in not seeing other adolescents. The benefits of transition included the sense of independence, the shift in responsibility to the individual and general satisfaction in being treated as an adult. For those with strong paediatric staff rapport, a sense of loss in these relationships was expressed. Participants were forthcoming in suggesting recommendations for future transitions that are discussed.

Adolescent↗

PubMed1994

'We just want to be a normal family...'. Paediatric HIV/AIDS services at an inner-London teaching hospital.

The nature of the HIV epidemic in the UK is changing with the increasing number of infected women and children. This recent onset means that there are few data about the specific problems of HIV in families. This study examines current issues in service provision to HIV infected children and their families at an inner-London teaching hospital. A sample of ten families were interviewed, from a caseload of approximately 100 HIV-positive children. Of the ten children, seven were under the age of 5 years. All the children were vertical transmissions and six of the mothers were from Sub-Saharan Africa. Only three of the ten children were identified antenatally. In terms of service provision, families were very satisfied with the care provided by the study hospital's paediatric HIV team but felt that the hospital's paediatric and adult HIV services were poorly co-ordinated and impractically located over different sites. Families did not have confidence in GP and community services, preferring to use hospital services which they felt to have more expertise in paediatric HIV. Future policy developments will have to confront the hospital-centred nature of paediatric HIV services and develop primary and community care services.

Acquired Immunodeficiency Syndrome↗

PubMed2001

Paediatric rehabilitation.

More and more researchers are questioning the theoretical and scientific foundations as well as the efficacy and effects of many physiotherapy interventions. The same applies for many of the neurophysiological based interventions that are being used in paediatric rehabilitation. Opinions and views regarding the development of motor behaviour of infants and children are significantly changing. Paediatric interventionists should consider bringing their interventions and focus of treatment into agreement with changed scientific knowledge. Moreover, for almost all other medical problems in childhood, paediatric rehabilitation has little to offer but mostly miniaturized forms of adult treatment. It not only means that we have to make a paradigm shift, but also are in the need of a broader view on paediatric rehabilitation as a specialized professional activity.

Child↗

PubMed2004

Experiences of adolescents with cystic fibrosis during their transition from paediatric to adult health care: a qualitative study of young Australian adults.

PURPOSE: Exploring the experiences of Australian adolescents with Cystic Fibrosis (CF) as they made the transition from paediatric to adult care. This often traumatic change of care was examined from the perspective of the two types of care, paediatric and adult, elements of a transition programme if available and psychosocial factors that may affect the transition. METHOD: Focused-in-depth interviews were conducted with six young adults with CF (19-34 years), asking them to describe their experiences during the transition period. RESULTS: Thematic analysis of the transcribed interviews indicated that the four main areas that affected the transition experiences of the participants were paediatric and adult health care, the elements included in the transition programme, and psychosocial factors. CONCLUSIONS: The relationship of the patient with their paediatric doctor, the doctor's attitude towards the transition and the delivery of age-appropriate care appeared to influence the experiences of adolescents as they changed to adult care. Successful elements of a transition programme, if it was offered, were the orientation tours, the provision of information and the presence of a familiar face at adult clinics. Transition experiences of individuals had potential effects on their psychological and physical well-being so that, in order to maximize quality of care, health professionals must be aware of factors which may improve transition experiences.

Adaptation, Psychological↗

PubMed2000

Sedation and monitoring of paediatric patients undergoing open low-field MRI.

UNLABELLED: The purpose of this study was to determine the need, effectiveness and safety of sedation and monitoring in infants and children in a paediatric open low-field MRI system. Of 274 patients (median age 9 y) examined, only 74 children (median age 25 mo) needed sedation. Sedation was achieved by intravenous administration of midazolam (0.2 mg/kg) and etomidate (0.2 mg/kg). Mean total doses required were 0.28 and 0.27 mgl/kg, respectively. With the exception of eight primarily ventilated patients, all children breathed spontaneously. O2 saturation, arterial blood pressure and ECG were monitored. The low resonance frequency of the MRI system required a specially designed high frequency (HF) shielding of the monitor system to avoid HF artifacts. The overall sedation rate was markedly lower (74/274 = 27%) compared to a control group previously examined in a closed high-field MRI system (52/111 = 47%). This was due to a significant lower need for sedation in patients aged up to 10 y (p < or = 0.0001) in the open MRI unit. General anaesthesia could be avoided in all patients. No significant movement artifacts occurred in any of the MRI examinations and no serious side effects were observed. CONCLUSIONS: MRI of children is easier in an open MRI system and with fewer sedations, as in closed high-field systems. Sedation by a combination of midazolam and etomidate is highly effective and safe. Monitoring devices for high-field systems may have to be modified for low-field systems. An in-house paediatric MRI unit with an open and special paediatric design is of major advantage for imaging paediatric patients.

Child↗

PubMed2006

Age-dependent organ and effective dose coefficients for external photons: a comparison of stylized and voxel-based paediatric phantoms.

This present study investigates the anatomical realism of conventional stylized models of children by comparing organ dose conversion coefficients for the ORNL paediatric phantom series with those determined in the UF (University of Florida) voxel paediatric phantoms. The latter includes whole-body models of a 9 month male, 4 year female, 8 year female, 11 year male and a 14 year male. Of these phantoms, the 1 year, 5 year and 10 year ORNL phantoms, and 9 month male, 4 year female and 11 year male UF voxel phantoms were selected for side-by-side comparisons under idealized external photon irradiation. Organ absorbed dose per unit air kerma (Gy/Gy) for various radiosensitive organs and tissues were calculated for monoenergetic photons over the energy range of 15 keV to 10 MeV and for six irradiation geometries: anterior-posterior (AP), posterior-anterior (PA), right lateral (RLAT), left lateral (LLAT), rotational (ROT) and isotropic (ISO). Differences in organ dose conversion coefficients for the gonads, bone marrow, colon, lung and stomach, to which prominent tissue weighting factors are assigned, were depicted and analysed. Two major causes of observed differences were suggested: differences in organ shape and position and the differences in tissue shielding by overlying tissue regions within the phantoms. Significant discrepancies caused by anatomical differences between the two types of phantoms are also reported for several organs, and in particular, the thyroid and urinary bladder. The results of this study suggest that the paediatric series of ORNL phantoms also have less realistic internal organ and body anatomy and that dose conversion coefficients from these stylized phantoms should be re-evaluated using paediatric voxel phantoms.

Adolescent↗

PubMed2000

Publications on paediatric anaesthesia: a quantitative analysis of publication activity and international recognition.

A comprehensive compilation of the current international literature on paediatric anaesthesia is lacking. The aim of this study was to identify all articles on clinical practice in paediatric anaesthesia, to name the respective journals, and to assess the publication activity and international recognition of selected countries for a 6-yr period (1993-1998). The search comprised an article-to-article evaluation ('hand search') of 12 peer-reviewed anaesthesia journals, as well as an Internet-based ('SilverPlatter') Medline-search (3,900 medical journals, US National Library of Medicine), both limited to original articles, case reports, reviews and editorials. Selected physical characteristics, for example the number of infants and children aged 0-14 yr old, the number of anaesthetists (specialists) and current impact factors (Science Citation Index) served to assess publication activity and international recognition. During the time period studied, 2259 articles (377/yr) were published on paediatric anaesthesia in 295 medical journals. The articles were primarily written in English (85.1%) and the majority originated from the USA (35.4%) and the UK (12.6%). The largest number of publications (77.7%) appeared in 29 anaesthesia journals, all referenced in Medline, with 46% being published by only five journals. Most authors published in journals of their home country/region. Authors from the UK ranked highest in publication activity, followed by those from Canada, Switzerland, Sweden and Denmark. The highest impact factor was achieved by US and UK authors. We conclude that publications on paediatric anaesthesia are clustered in a small number of journals and are written predominantly by authors from English-speaking countries, who achieved the highest international recognition.

Anesthesia↗

PubMed2005

Effect of three different anaesthetic agents on the postoperative production of cardiac troponin T in paediatric cardiac surgery.

BACKGROUND: Paediatric cardiac surgery is associated with some degree of myocardial injury. Ischaemic preconditioning (IP) has been investigated widely in the adult population. Volatile agents have been shown to simulate IP providing extra protection to the myocardium during adult cardiopulmonary bypass (CPB) while propofol seems to act through different mechanisms. IP has not been investigated in the paediatric population to the same extent. Cardiac troponin T (cTnT) is a reliable marker of myocardial injury in neonates and children. We have investigated the relationship between three anaesthetic agents, midazolam, propofol, and sevoflurane, and postoperative production of cTnT. METHODS: Ninety patients undergoing repair of congenital heart defect with CPB were investigated in a prospective randomized study. cTnT was measured four times during the first 24 h following admission to the paediatric intensive care unit. Other variables measured included arterial blood gases, lactate, fluid balance, use of inotropic drugs, PaO2/FiO2 ratio and ventilator hours. RESULTS: cTnT was elevated in all three groups throughout the study period. The differences between the three groups were not statistically significant. Eight hours after admission to the intensive care unit cTnT concentrations tended to be higher in the midazolam group [mean (95% confidence intervals)]; 2.7 (1.9-3.5) ng ml(-1). Patients receiving a propofol-based anaesthesia had similar concentrations 2.6 (1.7-3.5) ng ml(-1) while those receiving sevoflurane tended to have a lower cTnT production 1.7 (1.3-2.2) ng ml(-1). CONCLUSIONS: Midazolam, propofol, and sevoflurane appear to provide equal myocardial protection in paediatric cardiac surgery when using cTnT as a marker of myocardial damage.

Anesthetics, Inhalation↗

PubMed2005

Randomized single versus double embryo transfer: obstetric and paediatric outcome and a cost-effectiveness analysis.

BACKGROUND: Transfer of several embryos after IVF results in a high multiple birth rate associated with increased morbidity and high costs for the neonatal care. In a previous randomized trial we demonstrated that a single embryo transfer (SET) strategy, including one fresh single embryo transfer and, if no live birth, one additional frozen-thawed SET, resulted in a live-birth rate that was not substantially lower than after double embryo transfer (DET) but markedly reduced the multiple birth rate. METHODS: We compared costs for maternal health care and productivity losses and paediatric costs for the SET and DET strategies. In addition, maternal and paediatric outcomes between the two groups were compared. RESULTS: The SET strategy resulted in lower average total costs from treatment until 6 months after delivery. There were a few more deliveries with at least one live-born child in the DET group. The incremental cost per extra delivery in the DET alternative was high, 71 940. The rates of prematurely born and low birthweight children were significantly lower with the SET strategy. There were also markedly fewer maternal and paediatric complications in the SET group. CONCLUSIONS: The SET strategy is superior to the DET strategy, when number of deliveries with at least one live-born child, incremental cost-effectiveness ratio and maternal and paediatric complications are taken into consideration. The findings do not support continuing transfers of two embryos in this group of patients.

Adult↗

PubMed2025

Population pharmacokinetics and dosing optimization of cefoselis in paediatric patients with haematological malignancies.

BACKGROUND: Cefoselis is a fourth-generation cephalosporin primarily indicated for infections caused by susceptible bacteria. The pharmacokinetic (PK) characteristics, efficacy and safety of cefoselis in paediatric patients with haematological malignancies remain unclear, posing a risk of suboptimal exposure and associated therapeutic failure or toxicity. Therefore, we studied cefoselis pharmacokinetics (PK) to optimize dosing in paediatric patients with haematological malignancies. METHODS: Blood samples were collected from paediatric patients with haematological malignancies. A population PK (PopPK) analysis was performed using NONMEM (v7.4). Monte Carlo simulations were used to evaluate current dosing regimens by calculating the PTA. Pharmacodynamic target was defined as unbound plasma concentrations above the MIC throughout the entire dosing interval. Clinical efficacy and safety data were collected. RESULTS: A total of 96 samples from 53 patients were collected. A two-compartment model with zero-order input and first-order elimination best described the PK of cefoselis after IV administration. Weight was the only covariate that affected PK. Monte Carlo simulations showed that the PTA was more than 96.7% for susceptible pathogens (MIC = 0.25 mg/L) at 40 mg/kg, and less than 30.5% for Pseudomonas aeruginosa (MIC = 32 mg/L) at 80 mg/kg. A total of 39 patients had body temperatures below 37.3°C after 3 ± 1 days of cefoselis treatment (with a median baseline temperature of 38.5°C). There were no adverse events leading to discontinuation. CONCLUSIONS: A PopPK model of cefoselis in paediatric patients with haematological malignancies was established and the dosing regimens were evaluated.

Humans↗

PubMed2006

Treatment with caspofungin in immunocompromised paediatric patients: a multicentre survey.

OBJECTIVES: Although a paediatric dosage has not been established, caspofungin is occasionally used in paediatric patients. We conducted a multicentre retrospective survey to obtain data on immunocompromised paediatric patients considered to require caspofungin therapy. METHODS: The survey identified 64 patients (median age: 11.5 years; 25 females, 39 males) with haematological malignancies (48), marrow failure (9), solid tumours (3), haematological disorders (2) and congenital immunodeficiency (2) who received caspofungin for proven (17), probable (14) and possible (17) invasive fungal infections or empirically (16). Caspofungin was administered until intolerance or maximum efficacy at dosages individually determined by the responsible physician for refractory infection (38), intolerance of other agents (10) or as best therapeutic option (16). RESULTS: The 64 patients received caspofungin for a median of 37 days (range 3-218) as single agent (20) or in combination (44). The median daily maintenance dosage was 1.07 mg/kg (95% CI 1.09-1.35; range 0.40-2.92) or 34.3 mg/m2 (95% CI 32.3-37.3; range 16.3-57.5). In none of the patients was therapy discontinued due to adverse events (AEs). Clinical AEs were mild to moderate and observed in 34 patients (53.1%). While mean glutamate pyruvate transaminase and glutamate oxalate transaminase values were slightly (P < 0.005) higher at the end of treatment (EOT), serum bilirubin, alkaline phosphatase and creatinine values were not different from baseline. Complete responses, partial responses or stabilization were observed in 5/7/3 of 17 patients with proven, in 3/4/3 of 14 patients with probable and in 7/6/1 of 15 evaluable patients with possible invasive infections. Thirteen of 16 patients on empirical therapy completed without breakthrough infection. Overall survival was 75% at the EOT and 70% at 3 months post-EOT, respectively. CONCLUSIONS: Caspofungin displayed favourable safety and tolerance and may have useful antifungal efficacy in severely immunocompromised paediatric patients.

Adolescent↗

PubMed2001

Arterial changes in paediatric haemodialysis patients undergoing renal transplantation.

BACKGROUND: The relationship between primary renal disease and arterial wall changes in paediatric haemodialysis patients has been little studied. The aim of the present work was to determine the influence of primary renal disease on arterial wall pathology in uraemic paediatric patients. METHODS: Twelve paediatric haemodialysis patients (seven girls, five boys) aged 11-17 years were included in the study. The primary renal diseases were urinary malformations in six patients (uropathy group) and acquired glomerular diseases (glomerulopathy group) in six patients. Age, sex distribution, duration of chronic renal failure, duration of haemodialysis, blood pressure, serum glucose, triglycerides, cholesterol, fibrinogen, calcium, phosphorus and parathyroid hormone levels were compared. Internal iliac artery samples were obtained at the time of related-donor renal transplantation. Artery samples were fixed in formaldehyde and sections were stained separately with haematoxylin and eosin, Orcein, Verhoef-van Gieson, and Masson trichrome. RESULTS: Five arteries had fibrous or fibroelastic intimal thickening, medial mucoid ground substance and disruption of the internal elastic lamella. Two of these had microcalcification in the intimal layer; another two demonstrated atheromatous plaques; the remaining five were normal. These pathological changes were found in the arteries of all six patients with uropathy, whereas of the six patients with glomerulopathy only one had arterial changes (P<0.001). The duration of chronic renal failure was 4.8+/-1.9 years in the uropathy group and 2.2+/-1.2 in the glomerulopathy group (P<0.05). The two groups were comparable in terms of serum glucose, triglycerides, cholesterol, fibrinogen, calcium, and parathyroid hormone levels, presence of hypertension, sex distribution, and duration of haemodialysis. Plasma phosphorus and the calcium x phosphate product were higher in the uropathy group than in the glomerulopathy group (P<0.05). CONCLUSIONS: This study demonstrated that pathological changes are common in the arteries of uraemic paediatric patients, and that calcification and atherosclerosis are integral to this disease process. In our study, these alterations were more common in the patients with uropathy. We speculate that the patients with uropathy are more prone to these alterations due to slower progression and a longer duration of renal insufficiency.

Adolescent↗

PubMed2005

Decision making concerning life-sustaining treatment in paediatric nephrology: professionals' experiences and values.

BACKGROUND: In a previous article, we studied decisions to withhold or withdraw life-sustaining treatment (LST) taken between 1995 and 2001 in 31 French-speaking paediatric nephrology centres. Files were available for 18 of the 31 centres. A grid was used to analyse the criteria on which decisions were based, and the results were enriched by an analysis of interviews with the doctors at these centres (31 interviews with doctors from the 18 centres). The goal was to describe in detail and to specify the criteria on which decisions to withhold or withdraw LST were based, in cases extracted from the files. The second paper deals exclusively with the interviews with doctors and analyses their lifetime's experience and perception. METHODS: We carried out semi-directed interviews with nephrologists from all the paediatric nephrology centres in France and the French-speaking regions of Switzerland and Belgium. RESULTS: We interviewed 46 paediatric nephrologists. Most were aware that decisions relating to LST are necessary and based on the assessment of the child's quality of life. According to them, decisions are not based on scientific criteria, but on the capacity to accept handicap, the family's past experiences and the doctor's own projections. They report that their task is particularly difficult when their action may contribute to death (withdrawal of treatment or acceleration of the process). They feel that their duty is to help the families in the acceptance of the doctors' decision rather than to encourage their participation in the decision-making process (DMP). CONCLUSIONS: This article shows that paediatric nephrologists differ in their opinions, mostly due to their own ethical convictions. This observation highlights the need to establish common rules taking into account the views held by doctors. This is the only way to establish an ethical code shared by professionals.

Adult↗

PubMed2006

Post-transplantation anaemia in adult and paediatric renal allograft recipients-Guy's Hospital experience.

BACKGROUND: The commonest cause of renal transplant loss is death with a functioning graft, usually from an excess of cardiovascular disease (CVD). Anaemia is becoming increasingly recognized as a reversible risk factor for the development of CVD. The purpose of this study was to estimate the prevalence of post-transplantation anaemia (PTA) in a large population of stable adult and paediatric renal transplants in one centre and to correlate the estimated glomerular filtration rate (eGFR), iron indices and the use of immunosuppressants with the prevalence of anaemia. METHODS: Every adult and paediatric patient with a functioning renal transplant and more than 3 months post-engraftment at Guy's hospital, London, as of 31 December 2004 and who had a valid creatinine and haemoglobin, in the period 1 September-31 December 2004 inclusive, was identified. A large database of clinical and biochemical indices was built up on the basis of medical notes and electronic patient records. Results were analysed for the prevalence of anaemia and risk factors for its development. Anaemia was defined according to the WHO criteria. All patients on treatment with an erythropoiesis stimulating agent were classified as anaemic, irrespective of haemoglobin. RESULTS: A total of 878 adults and 73 children were identified. Mean haemoglobin in adults was 12.9 +/- 1.6 g/dl and 11.8 +/- 1.4 g/dl in the children. Mean eGFR was 49.3 +/- 20.1 ml/min in adults and 65.7 +/- 18.8 ml/min in the paediatric cohort. Haemoglobin correlated positively with the eGFR in both cohorts (R = 0.33 and 0.29 in adults and children, respectively (P < 0.0001 for both)). We identified anaemia in 45.3% of adults and 22% in children. Ferritin levels were lower in children than in adults (79 +/- 93 vs 204 +/- 353 mg/l), but were higher in both cohorts among the non-anaemic populations than in those with anaemia. 58% of adults taking mycophenolate mofetil (MMF) were anaemic compared with 22% of children. One child, and 68 adults, were on recombinant erythropoietin. Multiple regression analyses identified age, female gender, eGFR and serum ferritin levels as independent predictors of haemoglobin in adult subjects. CONCLUSIONS: The prevalence of PTA was high in both adult and paediatric cohorts while comparatively few patients were being treated with erythropoiesis stimulating agents. The strongest predictors of haemoglobin in this cohort of patients were age, female sex and graft function. Immunosuppression including MMF or sirolimus was associated with a higher prevalence of anaemia, but this was likely to be the result of poorer graft function in these subjects. Iron deficiency did not seem to be a causative factor for anaemia in this population.

Adult↗

PubMed2004

Acute and chronic paediatric intensive care patients: current trends and perspectives on resource utilization.

BACKGROUND: Advances in paediatric critical care have resulted in increased survival of critically ill patients, many of whom require long-term ventilation as a means of life support. AIM: To determine current trends in resource utilization, and problems in the care of acute and chronic paediatric intensive care patients. DESIGN: Open observational study. METHODS: We evaluated consecutive admissions (n = 1629) to a 10-bed paediatric intensive care unit (PICU) over a 5-year period. Three previously defined criteria for resource utilization were used: mean length of stay (LOS); length of mechanical ventilation (LOMV); and LOMV/LOS ratio. RESULTS: A total of 10 310 patient bed days and 5223 ventilator days were used. Mean LOS increased from 5.3 +/- 12 days in 1998 to 8.7 +/- 27 days in 2001 (p < 0.05). Although LOMV/LOS ratio (50.7%) was significantly correlated with Paediatric Risk of Mortality score (p < 0.0001), there was no significant change in mortality rate (12.6% vs. 12%). Patients hospitalized for >2 weeks (n = 320, 20%) used 55% of LOS and 57% of LOMV, in contrast to the 1298 (80%) hospitalized for <7 days, who used only 29% of LOS and 20% of LOMV. Patients hospitalized for >3 months (11, 0.7%) consumed 17% of LOS and 23% of LOMV. Five of these (45%) were eventually discharged home, two on ventilators. CONCLUSION: The increasing trend of occupation of PICU bed and ventilator days by critically ill children may be related to the increasing trend for hospitalization of chronic care patients. Severity scoring systems were predictive of resource consumption, but not of the overall trend in mortality rate.

Acute Disease↗

PubMed2000

Audit of rheumatology services for adolescents and young adults in the UK. British Paediatric Rheumatology Group.

BACKGROUND: Juvenile idiopathic arthritis (JIA) is associated with significant morbidity in adulthood with at least one third of children continuing to have active inflammatory disease into their adult years and up to 60% of all patients continuing to have some limitation of their activities of daily living. A survey of service provision for these young people in the transition from paediatric to adult rheumatology care was therefore undertaken. METHODS: A postal questionnaire was sent to all 92 members of the British Paediatric Rheumatology Group, representing 61 units providing a paediatric rheumatology service in the UK and Eire. RESULTS: Fifty-five replies were received representing a 60% completion rate of doctors and 84% of units on the mailing list. The majority of respondents were adult rheumatologists (n = 36, 65%) with 42% of respondents based in teaching hospitals. A median of 24 patients (new and follow-up, range 1-225) were seen in a median of two paediatric rheumatology clinics (range 0-15) per month. Eighteen per cent of units had a dedicated adolescent clinic (n = 9) with a median of one clinic per month and a median number of new patients per month of two (range 0-24) and 10 review patients (4-32). All the adolescent clinics involved an adult rheumatologist with five having a paediatrician in clinic and four having access to a paediatrician. The majority of clinics involved a specialist registrar (n = 6), a nurse specialist (n = 6), an occupational therapist (n = 6) and a physiotherapist (n = 5). The majority of clinics had flexible entry and exit criteria. In seven clinics there was a standardized process of transfer, first discussed at a median age of 13 yr (range 12-16) but no unit provided literature or organized pre-visits for this process. A demand for patient information resources (e.g. disease and drug information, careers) specifically aimed at adolescents with rheumatic diseases was identified. Generic health issues were only addressed by two clinics. Obstacles to current service provision and ideas for future developments were identified. CONCLUSIONS: This survey identifies a heterogeneity of provision of healthcare for adolescents with rheumatic disease and highlights the potential for further research and development.

Adolescent↗