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目的:调查儿科ICU护士对危重症患儿早期活动的认知、态度和实践现状,分析危重症患儿早期活动实施的障碍因素。方法:采用问卷调查法对187名儿科ICU护士进行调查。结果:儿科ICU护士对危重症患儿早期活动的认知、态度、行为得分分别为(3.55±1.40)分、(29.40±3.97)分、(17.87±4.89)分。多元线性回归结果显示,所在科室、是否接受早期活动相关培训是认知得分的影响因素(P<0.05),是否接受早期活动相关培训是态度得分的影响因素(P<0.05),是否为儿科危重症专科护士、是否接受早期活动相关培训是行为得分的影响因素(P<0.05)。结论:儿科ICU护士对早期活动态度积极,但实施行为较欠缺,相关知识不足,危重症患儿早期活动实施障碍较多。未来应积极开展多学科合作,加强对ICU护士实施危重症患儿早期活动的规范化、专业化培训,提高其对早期活动的认知、实践水平。  相似文献   
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BackgroundThe Coronavirus Disease 2019 pandemic provided a natural experiment to study the effect of social distancing on the risk of developing Hirschsprung's Associated Enterocolitis (HAEC).MethodsUsing the Pediatric Health Information System (PHIS), a retrospective cohort study of children (<18 years) with Hirschsprung's Disease (HSCR) across 47 United States children's hospitals was performed. The primary outcome was HAEC admissions per 10,000 patient-days. The exposure (COVID-19) was defined as April 2020–December 2021. The unexposed (historical control) period was April 2018–December 2019. Secondary outcomes included sepsis, bowel perforation, intensive care unit (ICU) admission, mortality, and length of stay.ResultsOverall, we included 5707 patients with HSCR during the study period. There were 984 and 834 HAEC admissions during the pre-pandemic and pandemic periods, respectively (2.6 vs. 1.9 HAEC admissions per 10,000 patient-days, incident rate ratio [95% confidence interval]: 0.74 [0.67, 0.81], p < 0.001). Compared to pre-pandemic, those with HAEC during the pandemic were younger (median [IQR]: 566 [162, 1430] days pandemic vs. 746 [259, 1609] days pre-pandemic, p < 0.001) and more likely to live in the lowest quartile of median household income zip codes (24% pandemic vs. 19% pre-pandemic, p = 0.02). There were no significant differences in rates of sepsis (6.1% pandemic vs. 6.1% pre-pandemic, p > 0.9), bowel perforation (1.3% pandemic vs. 1.2% pre-pandemic, p = 0.8), ICU admissions (9.6% pandemic vs. 12% pre-pandemic, p = 0.2), mortality (0.5% pandemic vs. 0.6% pre-pandemic, p = 0.8), or length of stay (median [interquartile range]: 4 [(Pastor et al., 2009; Gosain and Brinkman, 2015) 2,112,11 days pandemic vs. 5 [(Pastor et al., 2009; Tang et al., 2020) 2,102,10 days pre-pandemic, p = 0.4).ConclusionsThe COVID-19 pandemic was associated with significantly decreased incidence of HAEC admissions across US children's hospitals. Possible etiologies such as social distancing should be explored.Level of evidenceII.  相似文献   
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Background and aimChildhood obesity is an emerging problem often leading to earlier onset of non-communicable diseases in later life. Biomarkers to identify individual risk scores are insufficient in routine clinical practice, which is related to the need for easily sampled, non-invasive survey methods in children. We aimed to investigate and strengthen possible pro-inflammatory markers and epigenetic risk factors in saliva of obese children compared to lean controls.Methods and results19 overweight/obese (OC, 10.1 ± 1.9 years, BMI 27.7 ± 3.2 kg/m2) and 19 lean control children (CC, 9.7 ± 2.5 years, BMI 16.4 ± 1.8 kg/m2) participated in this explorative pilot study. Anthropometric measures, saliva and cheek swab samples were taken. Saliva profiles were examined for acute phase proteins (CRP and neopterin) and pro-inflammatory cytokines (IL-17a/IL-1β/IL-6). Cheek swabs were analyzed to investigate DNA methylation differences with subsequent hierarchical cluster and principal component analyses (PCA). Saliva analysis showed significant increased CRP concentrations in OC compared to CC (p < 0.001). There were no significant differences, but high intra-individual values in neopterin, IL-17a, IL-1β and IL-6. An unsupervised PCA of CpG loci with high variance (σ/σmax > 0.2) clearly separated OC and CC according to their methylation pattern. Furthermore, a supervised approach revealed 7125 significantly differentially methylated loci, whose corresponding genes were significantly enriched for genes playing roles in e.g., cellular signalling, cytoskeleton organization and cell motility.ConclusionsCRP and methylation status determinations in saliva are suitable as non-invasive methods for early detection of risks for non-communicable diseases in children/adolescents and might be a useful supplementary approach in the routine clinical practice/monitoring.  相似文献   
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马赞 《中国校医》2022,36(3):200
目的 探讨腰硬联合麻醉(CSEA)与全麻对老年腹部手术患者术后认知功能的影响。方法 选取本院2018年5月—2019年5月收治的82例老年腹部手术患者,按随机数表法分为观察组和对照组,各41例。观察组应用CSEA,对照组则采用全身麻醉。比较两组的麻醉相关指标,术后6 h、12 h、24 h的精神功能状态以及患者术后短期认知功能障碍的发生率。结果 观察组麻醉起效时间(min)、完全清醒时间(min)分别为(8.19±1.04)、(28.67±5.60)与对照组的(10.17±2.12)、(37.25±6.12)比较差异有统计学意义(P<0.05);观察组视觉模拟评分(VAS)(3.51±1.12)与对照组的(4.27±1.15)比较差异有统计学意义(P<0.05);观察组患者术后6 h、12 h、24 h时的MMSE评分分别为(22.27±1.46)、(26.23±1.26)、(28.19±1.24),均高于对照组的(21.46±1.35)、(24.68±1.23)、(26.37±1.19)(P<0.05);观察组短期内POCD的发生率为4.88%,低于对照组的24.39%,差异有统计学意义(P<0.05)。结论 对老年腹部手术患者采用CSEA,不仅能缩短麻醉起效时间和完全清醒的时间,减轻疼痛,而且对患者精神功能的影响小,可有效减少短期内认知功能障碍发生率。  相似文献   
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《Radiography》2022,28(4):964-972
IntroductionThe British Institute of Radiology (BIR) and American Association of Physicists in Medicine (AAPM) have recommended that gonad shielding is no longer used during pelvic X-ray examinations. The BIR guidance states that shielding may still be considered for use on males, but should not be used on females. This paper aimed to evaluate if this decision was supported by evidence from practice, by comparing the accuracy of gonad shield placement in paediatric males and females.MethodsA systematic review of databases including EMBASE, MEDLINE and PubMed was performed in February 2021. Studies were considered eligible if they provided data on the use of gonad shielding during pelvic X-ray examinations on male and female patients under the age of 18. Nine studies met the inclusion criteria and data extraction was performed. Quality appraisal was undertaken, and a meta-analysis of shielding accuracy was performed on seven studies.ResultsThe results from the meta-analysis (2187 total radiographs) demonstrated that female patients were significantly more likely (OR 1.38, 95% CI 0.88–1.87) than males to have gonad shields placed inaccurately (p value < 0.001).ConclusionGonad shield placement on paediatric female patients is significantly less accurate than on males, and so the results support the AAPM and BIR guidance to stop the practice for females. Shield application may also be frequently inaccurate for males, but the review does not provide clear evidence for or against continuing the practice for males.Implications for practiceDiscontinuing the use of gonad shields in paediatric pelvic radiography on female patients is supported. Any continued use on male patients, or for reasons such as psychological reassurance, should be subject to enhanced training and audit to ensure benefits outweigh any risks.  相似文献   
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AIM: To describe prevalence and different clinical signs and management of cases with penetrating eye injuries during loco-regional anesthesia for ophthalmic surgery. METHODS: A retrospective review of clinical records was carried out, identifying cases of globe penetration secondary to peribulbar anesthesia injection during 5y activity in Centro de Oftalmología Barraquer. RESULTS: A total of 17 460 needle-based ocular anesthesia procedures were performed in our centre and 4 cases of globe penetration were recorded with an estimated prevalence of 0.024%. Globe penetrations were always detected in the first 24h after surgery. Vitreous haemorrhage was found in all the cases. Two eyes presented retinal detachment and two eyes choroidal detachment (CD). The initial surgical approach was performed within the first 48h. Silicone oil was used as tamponade in three eyes and the fourth case remained only with air. Detachments were solved successfully in all the cases. Functional results varied among cases, depending on ocular remarkable antecedent and globe penetration with or without retinal or CD. CONCLUSION: Prevalence of globe penetration during loco-regional anesthesia is low in our centre. Physicians should consider the possibility of globe penetration in eyes with postoperative atypical appearance after loco-regional anesthesia. Immediate B-scan ultrasonography is recommended in suspicious cases with a dense vitreous haemorrhage. An early vitrectomy surgery in conjunction with laser or cryotherapy at the penetration sites is essential for good anatomical and functional results.  相似文献   
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Age estimation is a mandatory procedure when the chronological age is unknown or uncertain. Dental development is the preferred characteristic for estimating a child's age. There are many methods for dental age estimation, but their reliability can differ between populations. This study compared the accuracy of three of these methods—the London Atlas (LA), Haavikko's method (HM), and Cameriere's European formula (CF)—in Turkish children living in northwestern Turkey. Panoramic radiographs of 980 children from northwestern Turkey aged between 6.00 and 14.99 years were examined for the whole study group and separately for different ages and sexes by all three methods. Statistical differences between chronological age and dental age were tested using the paired sample t-test and the Wilcoxon signed-rank test. The LA, HM, and CF accuracies were determined based on the mean absolute error. Spearman's rank correlation coefficient showed that the correlation between chronological age and dental age for both sexes was linear for all methods. The LA overestimated the chronological age by 0.09 years, while HM and CF underestimated it by 0.49 and 0.11 years, respectively. The difference between dental age and chronological age was significant in all samples, for all methods, except for the LA in boys. When boys, girls, and the total sample were evaluated, values with the lowest mean absolute error were obtained by HM and were statistically significant in all three groups. Therefore, HM is more accurate than the LA and CF for dental age estimation in Turkish children living in northwestern Turkey.  相似文献   
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