Outcome analysis of functional endoscopie sinonasal surgery for paediatric rhinosinusitis using the Lund-Mackay-Kennedy scoring system

There are very few indications for surgical management of chronic rhinosinusitis in children. This has been partly due to the fact that the definition of what qualifies as racalcitrant sinusitis in children is still obscure. There is also significant evidence in literature that surgery, especially radical surgery, on the nose and sinuses in children would result in some interference with the growth of the facio-maxillary skeleton. The advent of Functional Endoscopie sino-nasal Surgery ( F. E. S. S. ) in recent years has changed the philosophy of surgery for paediatric rhinosinusitis and has proven to be an effective choice of management in difficult cases. We persent here our experience and preliminary results with the use of FESS in nine children with sinonasal disorders including cystic fibrosis. The usefulness of the recently described Lund- mackay and Kennedy Scoring System for chronic rhinosinusitis in terms of symptom score, radiological score, endoscopie score and surgical score has been demonstrated.     

Improved growth and clinical, nutritional, and respiratory changes in response to nutritional therapy in cystic fibrosis

To investigate the role of nutritional factors in growth and in the clinical, nurtitional, and respiratory status in cystic fibrosis, we studied 12 problem CF patients from six months before to six months after a period of supplemental parenteral nutrition. During the initial six months' observation period on appropriate conventional therapy, the patients (aged 0.5 to 11 years) had inadequate growth and weight gain, a total of 21 active pulmonary infections, and, despite dietary supplements, inadequate ad libitum nutrient intakes. After nutritional therapy, providing a balanced consistent hypercaloric intake for 21 days, catch-up weight gain occurred by one month and continued at six months; catch-up in linear growth was observed by three months and continued at six months. In addition, significantly fewer pulmonary infections were observed in the six months' post-therapy (n = 3), sustained and significant improvements were noted in clinical score and plumonary function, and there was a marked improvement in well-being and ad libitum nutrient intake. We conclude that adequate nutritional support can favorably affect growth, clinical status, and the course of chronic pulmonary disease in problem cases of CF.     

The aetiology of paediatric inflammatory vulvovaginitis

Vulvovaginitis is the most common gynaecological problem in prepubertal girls and clear-cut data on the microbial aetiology of moderate to severe infections are lacking. Many microorganisms have been reported in several studies, but frequently the paediatrician does not know the pathogenic significance of an isolate reported in vaginal specimens of girls with vulvovaginitis. A multicentre study was performed, selecting 74 girls aged 2 to 12 years old with a clinical picture of vulvovaginitis and inflammatory cells on Gram stain. All the specimens were cultured following standard microbiological techniques and the paediatricians completed a questionnaire to highlight risk factors after interviewing the parents or tutors. The data were compared with those obtained in a control group of 11 girls without vulvovaginitis attending a clinic. Streptococcus pyogenes and Haemophilus spp.were isolated in 47 and 12 cases, respectively. Upper respiratory infection in the previous month ( P <0.001) and vulvovaginitis in the previous year ( P <0.05) were identified as significant risk factors. Foreign bodies, sexual abuse, poor hygiene and bad socioeconomic situation were not identified as risk factors for the infection. Conclusion: Paediatric inflammatory vulvovaginitis is mainly caused by pathogens of the upper respiratory tract and the most common risk factor for this infection is to have suffered an upper respiratory tract infection in the previous month.Abbreviations HI Haemophilus influenzae - PIV paediatric inflammatory vulvovaginitis - SP Streptococcus pyogenes On behalf of the Spanish Study Group for Primary Care Infection     

Caustic ingestion in children—A review

Various domestic or industrial chemicals may cause significant upper aerodigestive tract burns. Preventive measures should be up-scaled, especially in the developing world, to reduce the epidemic of accidental victims, largely unsupervised preschool children. External signs do not predict degree of injury. Non-invasive diagnostic screening includes radio-nuclear imaging, but early oesophago-gastroduodenoscopy remains the standard to predict stricture formation from circumferential submucosal scarring. Serial dilation is the mainstay of oesophageal stricture therapy, with oesophageal replacement reserved for severe refractory strictures. Intra-lesional steroid or mitomycin C may decrease the dilatations required for severe strictures, although long-term effects are unknown. Risk of secondary oesophageal carcinoma mandates long-term surveillance.     

Implementation and evaluation of a simulation curriculum for paediatric residency programs including just-in-time in situ mock codes

OBJECTIVE:

To develop, implement and evaluate a simulation-based acute care curriculum in a paediatric residency program using an integrated and longitudinal approach.

DESIGN:

Curriculum framework consisting of three modular, year-specific courses and longitudinal just-in-time, in situ mock codes.

SETTING:

Paediatric residency program at BC Children’s Hospital, Vancouver, British Columbia.

INTERVENTIONS:

The three year-specific courses focused on the critical first 5 min, complex medical management and crisis resource management, respectively. The just-in-time in situ mock codes simulated the acute deterioration of an existing ward patient, prepared the actual multidisciplinary code team, and primed the surrounding crisis support systems. Each curriculum component was evaluated with surveys using a five-point Likert scale.

RESULTS:

A total of 40 resident surveys were completed after each of the modular courses, and an additional 28 surveys were completed for the overall simulation curriculum. The highest Likert scores were for hands-on skill stations, immersive simulation environment and crisis resource management teaching. Survey results also suggested that just-in-time mock codes were realistic, reinforced learning, and prepared ward teams for patient deterioration.

CONCLUSIONS:

A simulation-based acute care curriculum was successfully integrated into a paediatric residency program. It provides a model for integrating simulation-based learning into other training programs, as well as a model for any hospital that wishes to improve paediatric resuscitation outcomes using just-in-time in situ mock codes.     

Socio-economic and clinical factors predictive of paediatric quality of life post burn

Burns represent the second most common cause of non-intentional death in children under the age of five. Burns are amongst the most traumatic injuries and may impose significant psychological, educational, social and future occupational limitations to the young child.This cross-sectional study aimed to determine the socio-economic and clinical factors which predict quality of life in children with burn in a burns unit in South Africa.The Paediatric Quality of Life Inventory (PedsQL) and the Household Economic and Social Status Index (HESSI) questionnaires were administered to children and their caregivers one week and three months post discharge from the Johnson and Johnson Paediatric Burns Unit, Chris Hani Baragwanath Hospital, Soweto.The improvement in the PedsQL scores suggests that the quality of life for children three months after discharge is good despite being burnt. The severity of the burn was found to be a significant predictor of quality of life (p = 0.00). Poor socio-economic status was clearly evident in demographic data of the subjects.The findings from this study are particularly important in identifying areas for further research that would be beneficial to developing countries. Furthermore, the results are important in the move towards more holistic care for paediatric burn survivors.     

Psychiatric outcomes amongst adult survivors of childhood burns

Background

Research on the adult psychiatric outcomes of childhood burns is limited.

Aims

To examine the rates of DSM-IV psychiatric disorder amongst adult survivors of paediatric burns, and to explore factors likely to contribute to variation in outcomes. In line with Meyer and colleagues [1], it was expected that high levels of psychopathology would be found.

Method

Participants were 272 adults hospitalised for burns during childhood between the years 1980 and 1990. Structured interviews and self-report questionnaires were used to assess psychiatric symptoms.

Results

Lifetime prevalence of any DSM-IV disorder was 42%, 30% for depressive disorders, and 28% for anxiety disorders. Eleven percent had made a suicide attempt. Female gender, single relationship status, higher level of disfigurement, longer hospital stays and higher number of burn-related surgeries were associated with adverse psychiatric outcomes.

Conclusions

High rates of suicidality and depression were concerning in adults with a history of childhood burns. Factors found to predict psychiatric outcomes could be used to direct interventions and further research is needed to establish how this could best be done.     

Health service costs of paediatric cochlear implantation: influence of the scale and scope of activity

The health service cost of paediatric cochlear implantation (CI) varies among hospitals in the UK. The purpose of this study was to determine whether the variation is associated with differences in the scale and scope of activity in CI programmes. The health service cost of CI was estimated for 908 children implanted in 12 hospitals between 1989 and 1998. Annual levels of activity in implanting children and adults were monitored in the same hospitals. Costs of paediatric CI were lower in hospitals implanting larger numbers of children and adults, thereby benefiting from economies of scale and scope, respectively. These economies arose from lower per-child staff costs in larger programmes, and were estimated to be exhausted when a hospital implanted more than nine children and more than 20 adults each year. Accommodating increased numbers of children in an existing programme is predicted to cost less than setting up a new programme.