Does the pediatric advanced life support course improve knowledge of pediatric resuscitation?

OBJECTIVE: To determine whether the pediatric advanced life support (PALS) course contributes to the knowledge required by health care providers for pediatric resuscitation and whether differences in achievement exist between professional groups. METHODS: Physicians, nurses, and paramedics from across Israel who registered for PALS were administered a standardized test both before and on completion of the course. Pretest and posttest results were compared by statistical analysis. A score of 80 or higher was considered a passing grade. RESULTS: Paired pretest and posttest results were available for 370 participants (72.5%): 128 physicians, 158 nurses, and 84 paramedics. The percentage of participants who passed the course was 83.5% for the entire cohort, 85.9% for physicians, 78.5% for nurses, and 89.3% for paramedics. Physicians and paramedics had higher pretest and posttest scores than nurses. There was a significant improvement in mean posttest scores compared with pretest scores for the entire group (86.6 +/- 9.8 vs 78.0 +/- 12.7, P < 0.001) and when results were stratified by profession. A significantly greater proportion of participants passed the posttest than the pretest both for the entire cohort (83.5% vs 61.9%, P < 0.0001) and by profession. CONCLUSIONS: The pediatric advanced life support course significantly increases immediate short-term knowledge of pediatric resuscitation for all professional groups. This finding supports the use of PALS as an educational tool. Further studies are required to determine the effect of PALS on actual performance and outcome of resuscitation.     

Do pediatric nurse practitioners recognize sexual abuse?

INTRODUCTION: This study was undertaken to describe pediatric nurse practitioners' (PNPs') knowledge of genital anatomy and their ability to recognize sexual abuse. METHOD: A 33-item questionnaire developed by Ladson, Johnson, and Doty (1987) was revised, and PNPs were asked questions about demographics, their knowledge of normal and abnormal prepubescent genital anatomy, and their recognition of the association between sexually transmitted diseases and sexual abuse in prepubescent girls. The questionnaire was mailed to 213 PNPs within the state of Ohio, all of whom were members of the Ohio Chapter of NAPNAP. RESULTS: No statistically significant correlation was noted between any demographic characteristics and correct responses to questionnaire items. Two anatomical parts--hymen and vaginal opening--were correctly identified by less than 60% of the participants. Only 67.1% of the PNPs stated that a child can have a normal genital examination after penile penetration of the vagina. CONCLUSIONS: PNPs need to increase their knowledge of normal prepubescent genital anatomy and physical findings of sexual abuse and report these findings if abuse is suspected.     

Inflammation: What role in pediatric cancer?

There is growing evidence for the importance of chronic inflammation in the pathogenesis of adult cancers and for an ongoing role of the inflammatory response in tumor growth and metastasis. Here, we examine how these processes relate to pediatric malignancies. While it is unlikely that chronic inflammation plays a significant role in driving malignant progression in childhood tumors that typically have developmental origins, the inflammatory response does appear to play an important role in the development and progression of many types of childhood cancer. An enhanced understanding of these processes will be of critical importance in developing novel therapeutic strategies.     

Can pediatric vasovagal syncope be individually managed?

In children and adolescents,syncope is common and accounts for a considerable proportion of emergency visits.The underlying diseases of pediatric syncope mainly include neurally mediated syncope(NMS)and cardiogenic conditions.NMS accounts for 70–80%of pediatric syncopal cases,and one of the most common forms is vasovagal syncope(VVS)[1–3].In children with VVS,owing to the impairment of the barorefex integrity,the sympathetic system usually becomes overexcited after the change in position,leading to forceful contractions of a relatively empty ventricle and fnally causing a sympathetic withdrawal and an increased vagal activity.A relatively insufcient central volume,excessive vasodilation of peripheral vessel,autonomic nervous dysfunction,and neurohormonal disturbance may be aggravating factors.However,the efectiveness of previously unselected treatments for VVS has not been satisfactory.As such,a comprehensive assessment of the clinical characteristics,pathogenesis,and biochemical markers is needed to select the corresponding therapy.Since individualized treatment for VVS was proposed,several improvements have been made in the feld.     

What is new in pediatric cardiac imaging?

Cardiac imaging has had significant influence on the science and practice of pediatric cardiology. Especially the development and improvements made in noninasive imaging techniques, like echocardiography and cardiac magnetic resonance imaging (MRI), have been extremely important. Technical advancements in the field of medical imaging are quickly being made. This review will focus on some of the important evolutions in pediatric cardiac imaging. Techniques such as intracardiac echocardiography, 3D echocardiography, and tissue Doppler imaging are relatively new echocardiographic techniques, which further optimize the anatomical and functional aspects of congenital heart disease. Also, the current standing of cardiac MRI and cardiac computerized tomography will be discussed. Finally, the recent European efforts to organize training and accreditation in pediatric echocardiography are highlighted.     

PET imaging in pediatric Hodgkin’s lymphoma

Advances in diagnostic imaging technology, especially functional imaging modalities like positron emission tomography (PET), have significantly influenced the staging and treatment approaches used for pediatric Hodgkins lymphoma. Today, the majority of children and adolescents diagnosed with Hodgkins lymphoma will be cured following treatment with non-cross-resistant combination chemotherapy alone or in combination with low-dose, involved-field radiation. This success produced a greater appreciation of long-term complications related to radiation, chemotherapy, and surgical staging that prompted significant changes in staging and treatment protocols for children and adolescents with Hodgkins lymphoma. Contemporary treatment for pediatric Hodgkins lymphoma uses a risk-adapted approach that reduces the number of combination chemotherapy cycles and radiation treatment fields and doses for patients with localized favorable disease presentation. Advances in diagnostic imaging technology have played a critical role in the development of these risk-adapted treatment regimens. The introduction of computed tomography (CT) provided an accurate and non-invasive modality to define nodal involvement below the diaphragm that motivated the change from surgical to clinical staging. The introduction of functional imaging modalities, like positron emission tomography (PET) scanning, provided the means to correlate tumor activity with anatomic features generated by CT and modify treatment based on tumor response. For centers with access to this modality, PET imaging plays an important role in staging, evaluating tumor response, planning radiation treatment fields, and monitoring after completion of therapy for pediatric Hodgkins lymphoma. This trend will likely increase in the future as a result of PETs superior sensitivity in correlating sites of tumor activity compared to other available functional imaging modalities. Ongoing prospective studies of PET in pediatric patients will increase understanding about the optimal use of this modality in children with cancer and define the characteristics of FDG-avid nonmalignant conditions that may be problematic in the interpretation of tumor activity.Supported in part by grants Cancer Center Support (CORE) Grant CA-21765, P01 CA-20180 from the National Cancer Institute from the National Institutes of Health, a Center of Excellence grant from the state of Tennessee, and by the American Lebanese Syrian Associated Charities (ALSAC)CME activity Please find the CME information and questions at the end of this issueThe author(s) have no financial interest, arrangement, or affiliation to disclose in the context of this CME activity. There is nothing to disclose regarding investigational or off-label use of medical devices or other products, or any pharmaceutical agents     

Chest CT findings in pediatric Wegener’s granulomatosis

Background Although pulmonary involvement occurs in the majority of children and adolescents with Wegener’s granulomatosis (WG), relatively little has been published regarding the CT imaging manifestations in this group of patients. Objective To determine the frequency and types of chest CT abnormalities in active pediatric WG (pWG). Materials and methods The study was a retrospective examination of 29 chest CT examinations performed at diagnosis (n=14) and during disease flares (n=15) in 18 children. Results The most common abnormalities were nodules (seen in 90% of examinations), ground-glass opacification (52%), and air-space opacification (45%). Of examinations with nodules, 73% demonstrated nodules >5 mm in diameter and 69% demonstrated more than five nodules; 17% had cavitary lesions. The only abnormality with a significant difference in prevalence between diagnosis and disease flares was air-space opacification, present in 71% and 20%, respectively (P < 0.01). Conclusions In accordance with the findings of published adult studies and at variance with those of prior pediatric studies, our findings indicate that chest CT abnormalities in active pWG are frequent, most commonly comprising nodules and ground-glass opacification, which may be difficult to detect on plain radiography. We therefore advocate the routine use of chest CT for all affected patients, both at the time of presentation and during disease flares.