中西医治疗婴幼儿腹泻病47例疗效观察

目的：观察婴幼儿腹泻病中西医结合治疗的临床疗效。方法我院2011年1月—2012年12月收治98例腹泻病患儿,随机分为西医组和中西结合2组,均以液体疗法为基础,西医组配合止泻、抗病毒、助消化药物治疗,中西结合组配以推拿捏脊、艾灸神阙穴、中药穴位外敷治疗,对2组的治疗结果进行对比分析。结果患儿住院3 d~8 d,平均4.5 d,均痊愈出院。2组治疗48 h内的总有效率比较差异有统计学意义（P<0.05）。结论以液体疗法为基础,配以推拿捏脊、艾灸神阙穴、中药穴位外敷治疗婴幼儿腹泻,疗效优于西药治疗。     

重庆市农村留守儿童接种率现状及其监护人预防接种知信行研究

目的：了解重庆农村地区留守／非留守儿童监护人的预防接种知识、态度、行为现状和知识需求情况,探索相应干预模式。方法对3个项目县的1岁组留守／非留守儿童监护人进行问卷调查并查验儿童接种证获取信息,完成有效问卷1441份。结果留守儿童监护人文化水平低于非留守儿童监护人,留守儿童监护人对预防接种知识知晓率与预防接种行为依从性比例低于非留守儿童监护人。村医对基层预防接种工作开展起主要推动作用。结论建议引入同伴教育的宣传方式深入农村留守儿童家庭中开展宣传教育;针对留守儿童预防接种干预工作的重点是调动村级预防接种人员积极性,加强对农村留守儿童预防接种工作的投入与关心。     

Reliability and sources of variation of the ABILHAND-Kids questionnaire in children with cerebral palsy

Purpose: To determine reliability of the ABILHAND-Kids, explore sources of variation associated with these measurement results, and generate repeatability coefficients.

Method: A reliability study with a repeated measures design was performed in an ambulatory rehabilitation care department from a rehabilitation center, and a center for special education. A physician, an occupational therapist, and parents of 27 children with spastic cerebral palsy independently rated the children’s manual capacity when performing 21 standardized tasks of the ABILHAND-Kids from video recordings twice with a three week time interval (27 first-, and 25?second video recordings available). Parents additionally rated their children’s performance based on their own perception of their child's ability to perform manual activities in everyday life, resulting in eight ratings per child.

Results: ABILHAND-Kids ratings were systematically different between observers, sessions, and rating method. Participant?×?observer interaction (66%) and residual variance (20%) contributed the most to error variance (9%). Test–retest reliability was 0.92. Repeatability coefficients (between 0.81 and 1.82 logit points) were largest for the parents’ performance-based ratings.

Conclusion: ABILHAND-Kids scores can be reliably used as a performance- and capacity-based rating method across different raters. Parents’ performance-based ratings are less reliable than their capacity-based ratings. Resulting repeatability coefficients can be used to interpret ABILHAND-Kids ratings with more confidence.

• Implications for Rehabilitation

• The ABILHAND-Kids is a valuable tool to assess a child's unimanual and bimanual upper limb activities.

• The reliability of the ABILHANDS-Kids is good across different observers as a performance- and capacity-based rating method.

• Parents' performance-based ratings are less reliable than their capacity-based ones.

• This study has generated repeatability coefficients for clinical decision making.

     

Moving research tools into practice: the successes and challenges in promoting uptake of classification tools

Purpose: In this paper, we present our experiences – both successes and challenges – in implementing evidence-based classification tools into clinical practice. We also make recommendations for others wanting to promote the uptake and application of new research-based assessment tools.

Method: We first describe classification systems and the benefits of using them in both research and practice. We then present a theoretical framework from Implementation Science to report strategies we have used to implement two research-based classification tools into practice. We also illustrate some of the challenges we have encountered by reporting results from an online survey investigating 58 Speech-language Pathologists’ knowledge and use of the Communication Function Classification System (CFCS), a new tool to classify children’s functional communication skills.

Result and conclusions: We offer recommendations for researchers wanting to promote the uptake of new tools in clinical practice. Specifically, we identify structural, organizational, innovation, practitioner, and patient-related factors that we recommend researchers address in the design of implementation interventions. Roles and responsibilities of both researchers and clinicians in making implementations science a success are presented.

• Implications for rehabilitation

• Promoting uptake of new and evidence-based tools into clinical practice is challenging.

• Implementation science can help researchers to close the knowledge-to-practice gap.

• Using concrete examples, we discuss our experiences in implementing evidence-based classification tools into practice within a theoretical framework.

• Recommendations are provided for researchers wanting to implement new tools in clinical practice. Implications for researchers and clinicians are presented.

     

Spectrum of ocular firework injuries in children: A 5-year retrospective study during a festive season in Southern India

Purpose:

Ocular trauma is a major cause of acquired monocular blindness in children. Firework injuries account for 20% of ocular trauma. The purpose of our study was to document the profile of ocular firework injuries in children during the festive season of Diwali and to determine the prevalence of unilateral blindness in them.

Materials and Methods:

A retrospective chart analysis of ocular firework injury in children during the festival of Diwali from 2009 to 2013, conducted in a tertiary care eye center in Tamil Nadu, Southern India. Children below 18 years of age with ocular firework injuries who presented to the emergency department for 3 consecutive days - the day of Diwali, 1 day before, and 1 day after Diwali - were included in this study.

Results:

Eighty-four children presented with firework-related ocular injuries during the study period. Male to female ratio was 4:1 with mean age 9.48 ± 4 years. Forty-four percentage required hospitalization. The prevalence of unilateral blindness in children due to fireworks was found to be 8% (95% confidence interval - 2–13%).

Conclusion:

Vision 2020 gives high priority to avoidable blindness, especially in children. In our study, for every 12 children who presented with firecracker injury, one resulted in unilateral blindness. This is an avoidable cause of blindness. Awareness needs to be created, and changes in policy regarding sales and handling of firecrackers including mandatory use of protective eyewear should be considered.     

印度成人对于儿童眼保健的认识及贫困因素对其的影响

目的：探讨印度金奈地区成人对于儿童视力筛查的认识以及贫困因素对其的影响。
　　方法：此研究采用为期4wk的现况研究方法,于2012－12在印度金奈市及周边社会经济发展水平较低的地区,随机选取参加拓展营的个体作为研究对象。在接受了免费的视力筛查之后,与他们进行了一个简短的半结构性面谈。每隔两位选取一位受访者在一开始就被问及是否有儿童居住在他们住宅区,回答肯定者则纳入此项研究。
　　结果：本研究共纳入120人,其中38％（95％CI：30～47）的人指出在他们住宅区内至少有一名儿童先前接受过眼部检查（组1）,62％（95％CI：53～70）的参与者表示无儿童曾经接受过眼科检查（组2）。采用简单贫困记分卡方法测量两组贫困比分并无统计学差异。
　　结论：据不到半数的参与者回忆,他们的孩子之前曾接受过眼部检查。在贫困比分上,确认之前曾接受过眼部检查的参与者与没有接受过眼科检查的参与者之间无统计学差异。与孩子从未接受过眼科检查的参与者相比,那些孩子接受过眼部检查的参与者对该检查抱有更积极的态度。研究表明,成人对于孩子接受眼部检查重要性的认识不受贫困程度的影响,提高成人对于儿童接受眼部检查的认识可能需要更多的干预措施而不是扶贫。     

儿童外伤性眼内炎的临床疗效分析

目的:探讨儿童外伤性眼内炎的治疗效果.方法:回顾性研究2 ～11岁儿童确诊为外伤性眼内炎24例24眼的治疗方法及结果.所有患儿入院后立即行患眼的玻璃体腔内注药(万古霉素1mg/0.1mL+头孢他啶2.25mg/0.1mL+地塞米松0.4 mg/0.1 mL),第2d,23例重症者行玻璃体切除+晶状体切除术,充填硅油者10例、无菌空气者8例、C3F8者3例、灌注液者2例.1例轻症者72h后再次注射.结果:术后随访6 ～ 78mo,所有病例炎症控制,4例眼球萎缩(3例硅油眼).7例硅油眼已取出硅油并植入IOL.BCVA:＜0.02者12例,0.02～0.1者4例,0.15 ～0.3者4例,0.5 ～1.0者4例.16例(70％)较入院视力提高,4例(17％)不变,3例(13％)下降,1例不配合.结论:及时行玻璃体腔内注射广谱抗生素、玻璃体切除术能改善儿童外伤性眼内炎的预后.