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Entrance surface dose measurements in pediatric radiological examinations

Ribeiro, Livia Alves; Yoshimura, Elisabeth Mateus
Fonte: PERGAMON-ELSEVIER SCIENCE LTD Publicador: PERGAMON-ELSEVIER SCIENCE LTD
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
36.65%
A survey of pediatric radiological examinations was carried out in a reference pediatric hospital of the city of Sao Paulo. in order to investigate the doses to children undergoing conventional X-ray examinations. The results showed that the majority of pediatric patients are below 4 years, and that about 80% of the examinations correspond to chest projections. Doses to typical radiological examinations were measured in vivo with thermoluminescent dosimeters (LiF: Mg, Ti and LiF: Mg, Cu, P) attached to the skin of the children to determine entrance surface dose (ESD). Also homogeneous phantoms were used to obtain ESD to younger children, because the technique uses a so small kVp that the dosimeters would produce an artifact image in the patient radiograph. Four kinds of pediatric examinations were investigated: three conventional examinations (chest, skull and abdomen) and a fluoroscopic procedure (barium swallow). Relevant information about kVp and mAs values used in the examinations was collected, and we discuss how these parameters can affect the ESD. The ESD values measured in this work are compared to reference levels published by the European Commission for pediatric patients. The results obtained (third-quartile of the ESD distribution) for chest AP examinations in three age groups were: 0.056 mGy (2-4 years old); 0...

Construção de instrumento para identificação da carga de trabalho da equipe de enfermagem em unidades pediátricas.; Building an instrument for the identification of nursing staff workload in pediatric units.

Santos, Nanci Cristiano
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 13/09/2006 PT
Relevância na Pesquisa
36.6%
A pesquisa teve por objetivo construir um instrumento para identificação da carga de trabalho da equipe de enfermagem em unidades pediátricas e realizar a validação aparente do instrumento construído. O instrumento para identificação da carga de trabalho da equipe, na área de pediatria, foi elaborado a partir da eleição de um sistema padronizado de linguagem, com a finalidade de comunicar um significado comum aos diversos locais de atendimento. Dentre as classificações analisadas, optou-se por utilizar a Classificação das Intervenções de Enfermagem (NIC). Para compor o instrumento foram selecionadas, na NIC, as intervenções e as atividades consideradas relevantes para a assistência de enfermagem pediátrica. Essas intervenções e atividades foram distribuídas em domínios classes, conservando-se a estrutura taxonômica da NIC. A seguir foram descritas em diferentes níveis, de acordo com a natureza das ações e o tempo estimado para a sua realização. Para a validação aparente do instrumento foram convidadas enfermeiras com conhecimento em cada um dos temas envolvidos na sua construção: Assistência de Enfermagem Pediátrica; Sistema de Classificação de Pacientes e Classificação das Intervenções de Enfermagem. A análise dessas enfermeiras considerou que as intervenções e atividades selecionadas...

Aplicação do Pediatric Risk of Mortality escore (PRISM) e determinação dos fatores de prognóstico para óbito em uma unidade de terapia intensiva pediátrica terciária; Application of the Pediatric Risk of Mortality score (PRISM) and determination of mortality prognostic factors in a tertiary pediatric intensive care unit

Costa, Graziela de Araujo
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 27/09/2011 PT
Relevância na Pesquisa
36.63%
O avanço tecnológico nas unidades de terapia intensiva pediátricas (UTIPs) tornou-as aptas ao atendimento de casos de alta complexidade e elevado custo. Porém, a tecnologia disponível nem sempre tem conseguido melhorar a qualidade de atendimento aos pacientes e a própria capacidade de prolongar o tempo de vida torna-se um instrumento que potencializa a dor e o sofrimento. Sendo assim, tornou-se necessário caracterizar o estágio de gravidade da doença, que reflete a magnitude das comorbidades e distúrbios fisiológicos, no momento da internação. Esse procedimento pode ser realizado através dos escores prognósticos de mortalidade que quantificam a gravidade da doença, estimando a probabilidade de óbito de acordo com seu estágio clínico. Atualmente os escores prognósticos fazem parte das metodologias de controle de qualidade e de pesquisa. O Pediatric Risk of Mortality escore (PRISM) é um dos escores mais utilizados na unidade de terapia intensiva pediátrica (UTIP). O objetivo desse estudo foi avaliar a utilização do PRISM quanto a sua capacidade de discriminação entre sobreviventes e não-sobreviventes e determinar os fatores de prognóstico para óbito em uma UTIP terciária. Foi realizado um estudo retrospectivo na UTIP do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo...

Carga de trabalho de enfermagem em Unidade de Pediatria; The nursing staff workload at a Pediatric

Rogenski, Karin Emilia
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 23/10/2014 PT
Relevância na Pesquisa
36.6%
Introdução: A carga de trabalho dos profissionais de enfermagem, referida como a principal variável dos métodos de dimensionamento, não tem sido objeto de investigação na área de pediatria, evidenciando-se, consequentemente, a ausência de parâmetros específicos para atendimento dos pacientes assistidos em unidades pediátricas. Objetivo: Mensurar a carga de trabalho da equipe de enfermagem em Unidade de Pediatria. Método: Estudo descritivo, observacional, transversal de natureza quantitativa, realizado na Clínica Pediátrica (Cl.Ped.) do Hospital Universitário da Universidade de São Paulo (HU-USP). Participaram da pesquisa todos os profissionais de enfermagem que trabalharam na Cl.Ped. no período de 30 de setembro a seis de outubro de 2013. A pesquisa foi desenvolvida em quatro etapas: identificação das atividades de enfermagem realizadas na assistência ao paciente pediátrico (prontuário e observação em campo); mapeamento das atividades em intervenções, segundo a Nursing Intervention Classification (NIC); validação do mapeamento das atividades em intervenções da NIC (Oficinas de Trabalho); mensuração da carga de trabalho da equipe de enfermagem (Técnica de Amostragem do Trabalho, em intervalos de 10 minutos). Resultados: Foram coletados 8.387 amostras de intervenções e atividades realizadas pelos profissionais de enfermagem. Verificou-se que as intervenções que mais demandaram tempo de trabalho da equipe foram: DOCUMENTAÇÃO (16...

The impact of admission to a pediatric intensive care unit assessed by means of global and cognitive performance scales; Impacto da internação em unidades de terapia intensiva pediátrica : avaliação por meio de escalas de desempenho cognitivo global

Alievi, Patrícia Tollens; Carvalho, Paulo Roberto Antonacci; Trotta, Eliana de Andrade; Mombelli Filho, Ricardo
Fonte: Universidade Federal do Rio Grande do Sul Publicador: Universidade Federal do Rio Grande do Sul
Tipo: Artigo de Revista Científica Formato: application/pdf
POR
Relevância na Pesquisa
36.65%
Objetivo: Avaliar o impacto da internação sobre os desempenhos cognitivo e global em crianças admitidas na unidade de tratamento intensivo (UTI) pediátrica do Hospital de Clínicas de Porto Alegre. Métodos: Estudo longitudinal, observacional de amostra seqüencial de crianças gravemente doentes. Foram utilizados os indicadores Pediatric Index of Mortality (PIM), para gravidade e risco de morte na admissão, Pediatric Cerebral Performance Category (PCPC), para morbidade cognitiva, e Pediatric Overall Performance Category (POPC), para morbidade global, na admissão e na alta. Para morbidade relacionada à UTI, foi utilizada a diferença entre as classificações de alta e de admissão (escores delta). Foi empregado o teste de Kruskal-Wallis. Resultados: Foram avaliados 443 pacientes, sendo 54% do sexo masculino, com mediana de idade de 12 meses (IQ 4-45), e mediana de permanência na UTI de 4,24 dias (IQ 2,4-8). A taxa de mortalidade foi de 6,3%. A mediana do PIM foi de 2,36% (IQ 1-7). Na admissão, 46% dos pacientes tinham algum grau de morbidade cognitiva e 66% de morbidade global. Na alta, 60% de morbidade cognitiva e 86% de morbidade global. Na avaliação de morbidade relacionada à UTI, 25% dos pacientes mostraram variação na área cognitiva...

The Brazilian pediatric myelodysplastic cooperative group strategies: are they relevant to improve educational approach and correct diagnosis?

Lopes, L. F.; Lorand-Metze, I; Niero-Melo, L.; Tone, L. G.; Velloso, E.; Campanaro, C. M.; Latorre, M. D.
Fonte: Elsevier B.V. Publicador: Elsevier B.V.
Tipo: Artigo de Revista Científica Formato: 637-642
ENG
Relevância na Pesquisa
36.66%
Brazil is a wide country with huge contrasts. Its peculiarities can highlight environmental factors that could influence the frequencies of different cancers. The standard treatment and results achieved from several different areas of the country may not be found in others. The establishment of a national cooperative group has the potential to improve outcomes. The The Brazilian Cooperative Group on Pediatric Patients with Myelodysplastic Syndrome (BCG-MDS-PED) was first organized in January 1997 as a working group of hematologists, pediatric oncologists, pediatric-hematologists, molecular biologists and other professionals in order to study pediatric (age < 18 years) MDS. Six distinct subcommittees constituted with members from several universities: cytology, histopathology, clinical, cytogenetics, molecular biology and epidemiology. The goals of the BCG-MDS-PED were: (i) to offer support for diagnosis and orientation for treatment; (ii) educational Support for the colleagues all over the country and (iii) research on pathogenesis and new approaches for pediatric MDS patients. There are socio-economical differences among the five regions of the country. The BCG-MDS-PED believes that it is absolutely necessary to Study the clinical...

The Role of the Pediatric Pharmacist in Personalized Medicine and Clinical Pharmacogenomics for Children: Pediatric Pharmacogenomics Working Group

Kennedy, Mary Jayne; Phan, Hanna; Benavides, Sandra; Potts, Amy; Sorensen, Susan
Fonte: Pediatric Pharmacy Advocacy Group Publicador: Pediatric Pharmacy Advocacy Group
Tipo: Artigo de Revista Científica
Publicado em //2011 EN
Relevância na Pesquisa
46.66%
With the initiatives by the National Institutes of Health and the Food and Drug Administration, pharmacogenomics has now moved from the laboratory to the patient bedside. Over 100 drug-products now contain pharmacogenomic information as part of their labeling. Many of these are commonly used in the pediatric population. Direct-to-consumer genetic test kits also require intervention and guidance from healthcare professionals. This increased trend towards personalized medicine mandates that healthcare professionals develop a working knowledge about pharmacogenomics and its application towards patient care. Because pharmacogenomic testing can provide patient-specific predictors for response to and safety of medications, pharmacists are positioned to play an active role in pharmacogenomic testing, clinical interpretation of results, and recommendations for individualization of drug therapy. Opportunities for pharmacists exist in both inpatient and outpatient settings, such as pharmacist-managed clinical pharmacogenomics consultation services and educating patients and families about pharmacogenomic testing. In addition to clinical roles, pharmacists may also be involved in genetically-influenced drug discovery and development. Given the potential for genetic and age-dependent factors to influence drug selection and dosing...

Regionalization of pediatric emergency care in Korea

Kim, Do Kyun
Fonte: The Korean Pediatric Society Publicador: The Korean Pediatric Society
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
36.6%
In order to care for an ill or injured child, it is crucial that every emergency department (ED) has a minimum set of personnel and resources because the majority of children are brought to the geographically nearest ED. In addition to adequate preparation for basic pediatric emergency care, a comprehensive, specialized healthcare system should be in place for a critically-ill or injured victim. Regionalization of healthcare means a system providing high-quality and cost-effective care for victims who present with alow frequency, but critical condition, such as multiple trauma or cardiac arrest. Within the pediatric field, neonatal intensive care and pediatric trauma care are good examples of regionalization. For successful regionalized pediatric emergency care, all aspects of a pediatric emergency system, from pre-hospital field to hospital care, should be categorized and coordinated. Efforts to set up the pediatric emergency care regionalization program based on a nationwide healthcare system are urgently needed in Korea.

Key Performance Indicators for the Assessment of Pediatric Pharmacotherapeutic Guidance

Barrett, Jeffrey S.; Patel, Dimple; Jayaraman, Bhuvana; Narayan, Mahesh; Zuppa, Athena
Fonte: Pediatric Pharmacy Advocacy Group Publicador: Pediatric Pharmacy Advocacy Group
Tipo: Artigo de Revista Científica
Publicado em //2008 EN
Relevância na Pesquisa
36.6%
Given the paucity of actual guidance provided for managing pediatric drug therapy, prescribing caregivers must be able to draw on the limited published information in pediatrics and/or guidance provided in adults with some account for expected pediatric response. Guidance for managing drug therapy in children is clearly desirable. Our objectives were to construct key performance indicators (KPIs) for pediatric pharmacotherapy guidance to identify drugs where pharmacotherapy guidance would be most beneficial. A pilot survey to assess variation in caregiver appreciation for pediatric dosing guidance has also been constructed to provide a complementary subjective assessment. Three KPI categories, drug utilization (based on hospital admission and billing data collected from 2001 through 2006), medical need, and guidance outcome value along with a KPI composite score have been proposed. Low scores are favored with respect to prioritization for pharmacotherapy guidance. The pilot survey consisted of 15 questions to assess 1) physician knowledge regarding dosing guidance, 2) attitudes toward dose modification and patient individualization, 3) the accessibility, ease of use and appropriateness of existing data stores, and 4) frequency of dosing modification...

New Antiretroviral Therapies for Pediatric HIV Infection

Morris, Jennifer L.; Kraus, Donna M.
Fonte: Pediatric Pharmacy Advocacy Group Publicador: Pediatric Pharmacy Advocacy Group
Tipo: Artigo de Revista Científica
Publicado em //2005 EN
Relevância na Pesquisa
36.6%
Human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome affect millions of children worldwide. The development of antiretroviral therapy has significantly improved the morbidity and mortality of pediatric patients infected with HIV. Currently, 4 classes of antiretroviral agents exist: nucleoside / nucleotide reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, and entry inhibitors. A total of 21 single-entity antiretroviral agents and 4 co-formulated antiretroviral products hold Food and Drug Administration (FDA) approval for treatment of HIV-1 infection. However, not all of these agents are indicated for use in patients less than 18 years of age. Since the year 2000, 7 new antiretroviral agents (atazanavir, emtricitabine, enfuvirtide, fosamprenavir, lopinavir/ritonavir, tenofovir, and tipranavir) have been approved by the FDA for use in adult patients as part of combination therapy for the treatment of HIV-1 infection. Although only 3 of these newer agents (emtricitabine, enfuvirtide, and lopinavir/ritonavir) are currently FDA approved for use in pediatric patients, pediatric clinical studies of the other 4 new agents are currently underway. The purpose of this article is to review these 7 new antiretroviral agents and describe their roles in the treatment of pediatric HIV infection. For each drug...

Pre–hospital care of pediatric patients with trauma

Seid, Terrence; Ramaiah, Ramesh; Grabinsky, Andreas
Fonte: Medknow Publications & Media Pvt Ltd Publicador: Medknow Publications & Media Pvt Ltd
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
Relevância na Pesquisa
36.6%
Prehospital pediatric care is an important component in the treatment of the injured child, as the prehospital responders are the first medical providers performing life saving and directed medical care. Traumatic injuries are the leading cause of morbidity and mortality in the pediatric patient population. Nevertheless, for most prehospital provider it is a rare event to treat pediatric trauma patients and there is a still existing gap between the quality of care for pediatric patients compared to adults. To improve pediatric prehospital trauma care more provider need to be trained in identifying the specific differences between adult and pediatric patients.

Utilization of a Mobile Medical Van for Delivering Pediatric Care in the Bateys of the Dominican Republic

Crouse, Heather L.; Macias, Charles G.; Cruz, Andrea T.; Torrey, Susan B.; Wilson, Kim Alyson
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
36.6%
Background Bateys are impoverished areas of housing for migrant Haitian sugar cane workers in the Dominican Republic (DR). In these regions, preventative health care is almost non-existent, public service accessibility is limited, and geographic isolation prevents utilization of care even by those families with resources. Consequently, the development of a viable mobile system is vital to the delivery of acute and preventative health care in this region. Aims This study evaluated an existing mobile medical system. The primary goal was to describe the population served, diseases treated, and resources utilized. A secondary goal was to determine qualitatively an optimal infrastructure for sustainable health care delivery within the bateys. Methods Information on basic demographic data, diagnosis, chronicity of disease, and medications dispensed was collected on all pediatric patients seen in conjunction with an existing mobile medical system over a 3-month period in the DR. Health statistics for the region were collected and interviews were conducted with health care workers (HCWs) and community members on existing and optimal health care infrastructure. Results Five hundred eighty-four pediatric patients were evaluated and treated. Median age was 5 years (range 2 weeks to 20 years)...

Increasing general dentists’ provision of care to child patients through changes in the undergraduate pediatric dentistry program

Lekic, P.C.; Sanche, N.; Odlum, O.; de Vries, J.; Wiltshire, W.
Fonte: American Association of Dental Schools Publicador: American Association of Dental Schools
Tipo: Artigo de Revista Científica
Publicado em //2005 EN
Relevância na Pesquisa
36.63%
Reduced caries rates and an increased percentage of children with dental insurance have made it more difficult for dental schools to provide undergraduates with sufficient numbers of pediatric dental patients requiring restorative procedures. This may result in graduates who are not competent and are reluctant to treat children after graduation. To ensure the quality of the undergraduate clinical training program, the Division of Pediatric Dentistry at the University of Manitoba changed from a comprehensive-based clinic to a block system in 1998–99. Specific communities with limited access to dental care (neighboring core area schools and Hutterite colonies) were specifically targeted as potential sources for child patients. This format increased the exposure of students to patient management as well as to complex pediatric dentistry procedures. To assess the learning experiences before and after the changes to the clinical pediatric dentistry program, sixty general dentists who had graduated from the University of Manitoba were randomly selected using the Manitoba Dental Association Directory. Surveys were sent to twenty general dentists who graduated in each of the following years: 1993, 2000, and 2002. Forty-five dentists responded...

Clinical and Molecular Comparison of Pediatric and Adult Reverse Remodeling With Ventricular Assist Devices

Weia, Benjamin C.; Adachi, Iki; Jacot, Jeffrey G.
Fonte: Universidade Rice Publicador: Universidade Rice
Tipo: Journal article; Text; post-print
ENG
Relevância na Pesquisa
36.65%
Ventricular assist device (VAD) support induces reverse remodeling of failing myocardium that leads to occasional functional recovery of the adult heart. While there have been numerous clinical reports in adult patients with end-stage cardiomyopathy, little is known about reverse remodeling in children, which has increasing clinical potential with the recent expansion of pediatric VADs in the setting of static organ supply for heart transplantation. Pediatric myocardium also promises theoretical advantages for recovery over adult myocardium due to its greater abundance of cardiac progenitor cells. To identify potential targets of future studies, we conducted a literature review with two aims: (i) to summarize clinical cases of pediatric patients who exhibited cardiac recovery following VAD support; and (ii) to analyze genetic changes in pediatric myocardium induced by VAD support compared with those observed in adult patients. Several clinical series of pediatric VAD cases report that small proportions of their cohorts were weaned off from device support, but a lack of information about the etiology and support duration of these patients limits the ability to determine whether they represent reverse remodeling of myocardial structure or just recovery from acute illness. A comparison of pediatric and adult gene expression changes with VAD support reveals approximately 40% of genes to be oppositely regulated...

Recommendations for Meeting the Pediatric Patient's Need for a Clinical Pharmacist: A Joint Opinion of the Pediatrics Practice and Research Network of the American College of Clinical Pharmacy and the Pediatric Pharmacy Advocacy Group

Bhatt-Mehta, Varsha; Buck, Marcia L.; Chung, Allison M.; Farrington, Elizabeth Anne; Hagemann, Tracy M.; Hoff, David S.; LaRochelle, Joseph M.; Pettit, Rebecca S.; Phan, Hanna; Potts, Amy L.; Smith, Katherine P.; Parrish, Richard H.
Fonte: Pediatric Pharmacy Advocacy Group Publicador: Pediatric Pharmacy Advocacy Group
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
Relevância na Pesquisa
36.68%
Children warrant access to care from clinical pharmacists trained in pediatrics. The American College of Clinical Pharmacy Pediatrics Practice and Research Network (ACCP Pediatrics PRN) released an opinion paper in 2005 with recommendations for improving the quality and quantity of pediatric pharmacy education in colleges of pharmacy, residency programs, and fellowships. While progress has been made in increasing the availability of pediatric residencies, there is still much to be done to meet the direct care needs of pediatric patients. The purpose of this Joint Opinion paper is to outline strategies and recommendations for expanding the quality and capacity of pediatric clinical pharmacy practitioners by 1) elevating the minimum expectations for pharmacists entering practice to provide pediatric care; 2) standardizing pediatric pharmacy education; 3) expanding the current number of pediatric clinical pharmacists; and 4) creating an infrastructure for development of pediatric clinical pharmacists and clinical scientists. These recommendations may be used to provide both a conceptual framework and action items for schools of pharmacy, health care systems, and policymakers to work together to increase the quality and quantity of pediatric training...

Second Annual Meeting of the International Society of Pediatric Wound Care

Keswani, Sundeep G.
Fonte: Mary Ann Liebert, Inc. Publicador: Mary Ann Liebert, Inc.
Tipo: Artigo de Revista Científica
Publicado em 01/10/2015 EN
Relevância na Pesquisa
36.65%
The overarching goals of the International Society of Pediatric Wound Care (ISPeW) are to (1) set global standards for the assessment and treatment of pediatric wounds of varying etiologies; (2) provide a forum for international interprofessional collaboration among healthcare professionals, researchers, educators, and industry leaders dedicated to the care of pediatric wounds; (3) promote and support clinical research focused on the prevention, assessment, and treatment of pediatric wounds; (4) collaborate with wound care organizations worldwide on pediatric wound care issues; and (5) provide evidence-based pediatric wound care education to healthcare professionals, parents, and lay caregivers. This edition of Advances in Wound Care includes some of the work that was presented at the 2014 ISPeW meeting in Rome. The first article by Dr. Romanelli, is an in-depth description of the progression of skin physiology throughout its maturational stages and clinical implication. A cutting edge article by Dr. Timothy King then follows, with regard to scar prevention in postnatal tissues. This is followed by a comprehensive look at debridement techniques in pediatric trauma by Dr. Ankush Gosain. Next, is a cautionary article by Dr. Luca Spazzapan that examines the prevalence of diabetic foot ulcers in children and the potential for an epidemic. The last article in this series is from the keynote speaker...

Pediatric Head and Neck Dynamic Response: A Computational Study

Dibb, Alan Thomas
Fonte: Universidade Duke Publicador: Universidade Duke
Tipo: Dissertação
Publicado em //2011
Relevância na Pesquisa
36.72%

Traumatic injuries are the leading cause of death to children between the ages of one to nineteen years in the United States. The primary source of these traumatic injuries is motor vehicle traffic, with the head being the primary region of the body to suffer injury. While the pediatric neck is also prone to injury, it is particularly notable since it governs head excursion and acceleration, thus influencing head impacts and injuries. Pediatric fatalities can be prevented through safety improvements to vehicle compartments and child restraints by way of advanced biofidelic pediatric anthropomorphic testing devices (ATDs) and a more complete understanding of pediatric biomechanics. Computer models of the pediatric head and neck provide a valuable tool to combine results from pediatric postmortem human specimen (PMHS), radiological, and human volunteer studies to investigate the dynamics of the pediatric head and neck. The current study produced the first validated computer model of the pediatric head and neck which were created using the framework of a validated adult model. Radiology studies were conducted to determine pediatric cervical muscle cross sectional areas, vertebral anthropometry, and vertebral inertial properties. The results of these studies were combined with available pediatric PMHS properties to create the six and ten year old models. The models were validated against pediatric volunteer low speed frontal impacts and were then used to simulate higher rate and injurious inducing loading scenarios. The six and ten year old flexion bending stiffnesses were found to be 36% and 45% of the adult bending stiffness...

Radiation Dose and Diagnostic Accuracy in Pediatric Computed Tomography

Li, Xiang
Fonte: Universidade Duke Publicador: Universidade Duke
Tipo: Dissertação Formato: 10742762 bytes; application/pdf
Publicado em //2010 EN_US
Relevância na Pesquisa
36.66%

Since its inception in the 1970's, computed tomography (CT) has revolutionized the practice of medicine and evolved into an essential tool for diagnosing numerous diseases not only in adults but also in children. The clinical utility of CT examinations has led to a rapid expansion in CT use and a corresponding increase in the radiation burden to patients. CT radiation is of particular concern to children, whose rapidly growing tissues are more susceptible to radiation-induced cancer and who have longer life spans during which cancerous changes might occur. In recent years, the increasing awareness of CT radiation risk to children has brought about growing efforts to reduce CT dose to the pediatric population. The key element of all dose reduction efforts is to reduce radiation dose while maintaining diagnostic accuracy. Substantiating the tradeoff between the two is the motivation behind this dissertation work.

The first part of this dissertation involved the development of an accurate method for estimating patient-specific radiation dose and potential cancer risk from CT examinations. A Monte Carlo program was developed and validated for dose simulation in a state-of-the-art CT system. Combined with realistic computer models of patients created from clinical CT data...

Barriers to palliative care for children: Perceptions of pediatric health care providers

Davies, B.; Sehring, S.A.; Patridge, J.C.; Cooper, B.A.; Hughes, Ann Maree; Philp, J.C.; Amidi-Nouri, A.; Kramer, R.F.
Fonte: American Academy of Pediatrics Publicador: American Academy of Pediatrics
Tipo: Artigo de Revista Científica
Relevância na Pesquisa
36.63%
OBJECTIVE. The goal was to explore barriers to palliative care experienced by pediatric health care providers caring for seriously ill children. METHODS. This study explored pediatric provider perceptions of end-of-life care in an academic children's hospital, with the goal of describing perceived barriers to end-of-life care for children and their families. The report focuses on the responses of nurses (n = 117) and physicians (n = 81). RESULTS. Approximately one half of the respondents reported 4 of 26 barriers listed in the study questionnaire as frequently or almost always occurring, that is, uncertain prognosis (55%), family not ready to acknowledge incurable condition (51%), language barriers (47%), and time constraints (47%). Approximately one third of respondents cited another 8 barriers frequently arising from problems with communication and from insufficient education in pain and palliative care. Fourteen barriers were perceived by >75% of staff members as occasionally or never interfering with pediatric end-of-life care. Comparisons between physicians and nurses and between ICU and non-ICU staff members revealed several significant differences between these groups. CONCLUSIONS. Perceived barriers to pediatric end-of-life care differed from those impeding adult end-of-life care. The most-commonly perceived factors that interfered with optimal pediatric end-of-life care involved uncertainties in prognosis and discrepancies in treatment goals between staff members and family members...

Validation of the Script Concordance Test as an instrument to assess clinical reasoning of residents in pediatric emergency medicine in Mexico

Zavaleta-Hernández,Sergio; Cerón-Rodríguez,Magdalena; Olivar-López,Víctor; Espinoza-Montero,Rubén; Rizzoli-Córdoba,Antonio
Fonte: Instituto Nacional de Salud, Hospital Infantil de México Federico Gómez Publicador: Instituto Nacional de Salud, Hospital Infantil de México Federico Gómez
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/2011 EN
Relevância na Pesquisa
36.65%
Background. Clinical reasoning is a crucial skill to be acquired during a residency training program. In pediatric emergency medicine, physicians are challenged by diagnostic, investigative, and treatment uncertainties. The Script Concordance Test (SCT) uses authentic clinical scenarios to compare trainee’s judgement skills with those of experts. The purpose of this study was to evaluate the clinical reasoning using a pediatric emergency medicine SCT and to determine if it would be able to differentiate between different levels of residency training, validating it in Mexico. Methods. A SCT containing 58 questions nested in 14 cases was administered to pediatric and senior residents at one academic institution. Fourteen experienced emergency medicine pediatricians were part of a reference panel to establish the basis for the scoring process. Results. Ninety six residents consented to participate. Thirteen residents were fellows of pediatric intensive care medicine or pediatric emergency medicine, and there were 83 pediatric residents. Overall, there was a significant difference in performance across levels of training. The difference between all levels was significant. Conclusions. This pediatric emergency medicine Script Concordance Test was useful to assess the progression of clinical reasoning during residency training in Mexico.