One-Month Therapy with Simvastatin Restores Endothelial Function in Hypercholesterolemic Children and Adolescents

Simvastatin has been shown to restore endothelial function in children with familial hypercolesterolemia after 28 weeks of treatment. The aim of this study was to evaluate 1-month simvastatin treatment effect on endothelial function in hypercholesterolemic children and adolescents. Eighteen hypercholesterolemic patients (HC group) and 18 healthy controls, aged 6–18 years, were studied with medical history, physical examination, full lipid profile, serum apolipoprotein B (apo B), fibrinogen, hepatic transaminases, and creatine kinase concentrations. Flow-mediated dilatation (FMD) was performed by high-resolution ultrasound of the brachial artery. The HC group received simvastatin 10 mg/day for 1 month. Arterial diameter was measured by two experienced sonographers who were unaware of subjects’ conditions. At baseline, FMD was impaired in the HC group (mean, 5.27 ± 4.67%) compared to controls (mean, 15.05 ± 5.97%) (p < 0.001). After treatment, we observed a significant reduction in total cholesterol (TC) (29%), low-density lipoprotein cholesterol (LDL-C); (37%), apo B concentrations (36%) and FMD restoration (mean, 12.94 ± 7.66%), with an absolute increase of 7.66 ± 8.58 (p = 0.001). These results show that children and adolescents with hypercholesterolemia present endothelial dysfunction, and simvastatin, in addition to significantly reducing TC, LDL-C, and apo B concentrations, restores endothelial function with 1-month treatment.     

中国儿童超说明书用药管理现状及认知度的横断面调查

目的：调查中国儿童超说明书用药的管理现状及医务人员的认知度,为规范儿童超说明书用药提供依据。方法：以横断面研究设计,在中国大陆每个省至少选择一家具备儿科资质的医疗单位;调查人群：儿科医生、药师、护士和医务科行政人员;由儿科临床专家、药学专家、流行病学专家和药事管理专家组成的工作小组自制《中国儿童超说明书用药调查表》,包括基本信息维度6个条目,所在医院超说明书用药的现状及管理维度11个条目,超说明书用药及其管理的认知和《中国儿科超说明书用药专家共识》知晓情况维度33个条目,行网络问卷调查。结果：全国31省436家医院参与调查,其中儿童专科医院36家,妇幼保健院50家,综合性医院350家;一级医院20家,二级医院185家,三级医院231家。收集到有效问卷2116份,其中医生621名、药师755名、护士531名和医务科行政人员209名;初级职称712名、中级职称894名、高级职称510名。63.8%的医生有开具超说明书用药处方经历,职称越高,超说明书用药的现象越多;18.8%的医生经常超说明书用药,职称越高经常超说明书用药发生概率越大;19.4%的医生超说明书用药时都没有得到药师或护士提醒。药师发现过医生超说明书用药的情况是普遍存在的,不论药师职称的高与低（87.1%~98.3%）,不论医院级别（82.1%~94.2%）,6.9%~8.8%的护士面对医生超说明书用药拒绝执行医嘱。60.6%的被调查医院针对超说明书用药有统一制度流程,其中三级医院的比例高于一、二级医院,儿童专科医院的比例高于综合医院和妇幼保健院。70%的被调查者认为超说明书用药并不违法,但是80%以上的被调查者肯定超说明书用药存在风险。在医生、药师、护士和医务科行政人员中,2016年中华医学会儿科学分会临床药理学组提出的《中国儿科超说明书用药专家共识》知晓率分别为51.2%、56.8%、35.8%和45.4%。结论：中国大陆儿童超说明书用药现象普遍存在,急需统一有效的管理模式,需要制定出适合中国大陆的超说明书用药流程,加强医务人员培训,推进儿童规范化超说明书用药。     

A survey of the management of neonatal opiate withdrawal in England and Wales

Abstract This report details the results of a survey of 213 maternity units in England and Wales concerning the use of neonatal opiate withdrawal (NOW) charts and the drug therapy management of babies born to drug using mothers. There was a response rate of 89.6%. NOW charts were used in 36.6% of units. There were eight different charts in use in which over 35 different signs of NOW were recorded, ranging from 10 to 22 on individual charts. Nine different drugs were used to manage NOW, with chlorpromazine most commonly used.Conclusion Drug misuse is increasing in women of childbearing age and the management of the drug affected neonate varies widely, with inconsistent policies on determining the presence of NOW and how to treat it.     

上海市二级以上公立医院儿科急诊现状调查

目的:了解目前上海市儿科急诊的现状及存在的问题,为儿科急诊的建设与管理提供依据。方法:采用调查问卷的方式,对上海市二级以上公立医院的儿科急诊进行现状调查。结果:共发放调查问卷28份,有效问卷28份。28家医院中6家无行政上独立的儿科急诊或者无独立的儿科急诊区域。22家医院中,除了1家二级医院缺少儿科急诊专科医生,其余医...     

肿瘤患儿疼痛管理现状的单中心调查

目的了解目前血液肿瘤患儿疼痛管理现状及存在的阻碍。方法以2018年1月8日—2018年1月26日期间血液肿瘤科实体瘤及淋巴瘤病房住院患儿、家长及医生为研究对象,对年龄大于4岁的住院患儿进行连续地疼痛评估,对23名医生及28名患儿家长进行问卷调查。结果有97名患儿接受了多次疼痛评估,其中20人发生中重度疼痛(20.6%)。共计评估367人次,67人次为中重度疼痛(占18.3%),其中70.2%的疼痛未向医生报告,予以镇痛治疗的仅占17.9%,其中阿片类药物占8.3%。针对家长和医师的问卷调查显示:有5/23的医生选择偶尔或从不对患儿评估疼痛,21/28的家长选择医生偶尔或从不评估患儿疼痛,差异具有显著性。当被问及开具镇痛药物依据时,有11/23的医生选择依据疼痛评分;当被问及最有助于缓解晚期癌症患儿中到重度疼痛方法时,有17/23的医生选择阿片类药物;而当被问及实际推荐首选药物时仅6/23的选择阿片类药物,差异具有显著性。结论肿瘤患儿的镇痛治疗尚未被充分重视,甚至中重度疼痛都仍被忽视。疼痛评估不足、家长及医生缺失疼痛相关知识是目前疼痛管理关键阻碍。完善疼痛评估是开展儿童癌痛管理的关键。     

Perception and management of cancer predisposition in pediatric cancer centers: A European-wide questionnaire-based survey

The European Union-funded COST Action (LEukaemia GENe Discovery by data sharing, mining, and collaboration) LEGEND was an international and multidisciplinary collaboration between clinicians and researchers that covered a range of aspects of genetic predisposition in childhood leukemia. Within this framework, we explored the perception and handling of genetic predisposition in the daily practice of European treatment centers. Herein, we present the results of our questionnaire-based survey. We found that the overall awareness is quite high, and respondents remarked that identification and treatment of the most common predisposition syndromes were present. Nevertheless, high demand for continuous education and routinely updated resources remains.     

National survey on current management of ovarian tumors in pediatric age group

Aim of the study

To investigate the current management of ovarian tumors in children by the Egyptian pediatric surgical association (EPSA) consultants who are dealing with approximately 80% of these cases in our country.

A survey of pediatric intensive care services in Turkey

The aim of this study was to describe and assess the structure, organization, and staffing of pediatric intensive care services in Turkey. A survey was sent to major university and government hospitals. Out of the 40 hospitals stating to provide pediatric intensive care, 34 responded to the survey (85% response rate). In the majority (81.2%) of hospitals, pediatric intensive care was provided in single room units or within the pediatric ward. Unit size ranged from 1-16 beds with an average of 6.8 +/- 4.2 operational beds per unit. Much of the equipment and a sufficient number of specialists for pediatric intensive care unit (PICU) care were present in the surveyed hospitals. However, only 12 units had a pediatric intensivist on staff and few had special PICU nurses. Many hospitals in Turkey already have various equipment and specialists needed to support pediatric intensive care. Expansion of services and improved care could be achieved if more pediatric intensivists and nurses could be provided and services concentrated in fully equipped tertiary centers.     

A survey of pediatric hematology/oncology specialists regarding management of central line associated venous thrombosis

Central venous catheters (CVCs) account for the largest proportion of thrombotic events in pediatric patients. Questions remain regarding adequate treatment and prevention methods. We surveyed pediatric hematology/oncology specialists, using hypothetical cases to assess management strategies for acute CVC thrombosis and secondary prevention. Survey respondents varied in the use of the thrombophilia evaluation (33.3%, 41/123) and duration of treatment (6 weeks: 54.1%, 66/122). Secondary CVC prophylaxis was utilized by 36.6% (45/123) of respondents and by 24.4% (30/123) but only if there was a documented thrombophilia. This heterogeneity highlights the need for clinical studies to address these important clinical questions.     

A training needs survey of doctors' breastfeeding support skills in England

The study examined the training needs of paediatricians and general practitioners (GPs). Respondents rated their competence on 23 breastfeeding support skills, importance of update in the next 2 years, actual and potential helpfulness of different forms of professional updates, and accessibility in the next 2 years. The perception of organizational barriers to breastfeeding support and practitioners' knowledge of policies and guidance on breastfeeding were also examined. The sample comprised 120 paediatricians and 57 GPs. Response rates were estimated as between 4% and 29%, depending upon the method of recruitment. Although both groups rated themselves as fairly competent in most of the skill areas, they welcomed training in key areas of practice. Paediatricians identified more areas for update than GPs ( t  = 3.44; d.f. = 178; P  < 0.00001). Those who believed that they were less competent in clinical skills were least likely to seek update ( r  = 0.35; P  < 0.00001). Practical forms of training were most often welcomed. Only 47% of GPs and 62.5% of paediatricians had access to a local breastfeeding policy. There were evident gaps in knowledge on key aspects of public health policy, which could influence local practice; for example, 50.8% of GPs and 47.5% of paediatricians identified a younger age for introducing solids than the minimum according to current government guidance. Organizational barriers to breastfeeding support were experienced by all respondents. Recommendations include purposively targeting training to those least likely to seek training, and developing effective self-study and observational methods of learning. All training should be evaluated and implemented alongside breastfeeding policies and clinical leadership to improve the practice of all healthcare practitioners.