Time-varying coefficient of determination to quantify the explanatory power of biomarkers on longitudinal GFR among children with chronic kidney disease

Purpose

Coefficients of determination (R²) for continuous longitudinal data are typically reported as time constant, if they are reported at all. The widely used mixed model with random intercepts and slopes yields the total outcome variance as a time-varying function. We propose a generalized and intuitive approach based on this variance function to estimate the time-varying predictive power (R²) of a variable on outcome levels and changes.

Acceptability of children's testing for HIV infection during routine care activities in the Pediatrics Department of Sourô Sanou Teaching Hospital in Bobo-Dioulasso (Burkina Faso)

Background

In order to contribute to the fight against the pediatric HIV infection, we have assessed, through a study in which we have systematically proposed to carry out children's testing, the rate of acceptability and the feasibility of children's HIV testing during the routine activities of the department. We have also analyzed the reasons for the acceptability or the refusal of the child's HIV testing by the accompanying person.

Perspectives on transitions: rethinking services for children and youth with developmental disabilities

Transition to adulthood for youth with developmental disabilities has become an important concern internationally of service providers working with these young people. Reflecting on the useful review by Binks and colleagues in this issue of the Archives, we argue as developmentalists that this is an ideal time to step back from our traditional preoccupation with "treatment" of childhood disability and to reconsider broadly what our goals for intervention ought to be. We invoke the concepts of the International Classification of Functioning, Health and Disability framework and draw on research that taps the voices of young people with disabilities-voices we believe have a lot to tell us about what has and has not worked for them. We suggest that there are unparalleled opportunities to enhance transition to adulthood for young people with developmental disabilities, in part by a feed-forward of the best of childhood services, and to work to prevent many of the difficulties faced by the current generation making this challenging transition.     

对儿科归档病历中护理记录存在的质量问题分析及对策

目的:找出儿科归档病历中护理记录存在主要共同问题,针对问题提出应对方法,进一步提高护理质量。方法:随机抽取儿科归档护理记录200份,将所存在问题合并归类,然后就问题共性进行分析。结果:在200份护理记录中发现问题316处,占抽查病历的93%。结论:严格护理记录书写规范是保证护理记录真实有效的必要手段。     

Propofol‐cetamina versus dexmedetomidina‐cetamina para sedação durante endoscopia digestiva alta em pacientes pediátricos: estudo clínico randomizado

Background and objectivesDay‐case pediatric sedation is challenging. Dexmedetomidine is a sedative analgesic that does not induce respiratory depression. We compared dexmedetomidine to propofol when it was added to ketamine for sedation during pediatric endoscopy, regarding recovery time and hemodynamic changes.MethodsWe enrolled 120 patients (2−7 years in age) and randomly assigned them into two groups. Each patient received intravenous (IV) ketamine at a dose of 1 mg.kg^‐1 in addition to either propofol (1 mg.kg^‐1) or dexmedetomidine (0.5 μg.kg^‐1). The recovery time was compared. Hemodynamics, oxygen saturation, need for additional doses, postoperative complications and endoscopist satisfaction were monitored.ResultsThere was no significant difference in hemodynamics between the groups. The Propofol‐Ketamine (P‐K) group showed significantly shorter recovery times than the Dexmedetomidine‐Ketamine (D‐K) group (21.25 and 29.75 minutes respectively, p < 0.001). The P‐K group showed more oxygen desaturation. Eleven and six patients experienced SpO₂ < 92% in groups P‐K and D‐K, respectively. A significant difference was noted regarding the need for additional doses; 10% of patients in the D‐K group needed one extra dose, and 5% needed two extra doses, compared to 25% and 20% in the P‐K group, respectively (p = 0.001). The P‐K group showed less post‐procedure nausea and vomiting. No statistically significant difference between both groups regarding endoscopist satisfaction.ConclusionsThe P‐K combination was associated with a shorter recovery time in pediatric upper gastrointestinal endoscopy, while the D‐K combination showed less need for additional doses.Registration numberClinical trials.gov (NCT02863861).     

我院儿科住院患者抗菌药物应用分析

目的：全面了解我院儿科住院患者抗菌药物应用情况,促进我院抗菌药物的合理使用。方法：通过医院HIS系统,对我院2013年7月至2014年6月儿科2362份住院病历进行分析。结果：2362份住院病历中,应用抗菌药物的病历有2176份,其中合理使用抗菌药物的有1963份,不合理应用抗菌药物的有213份。不合理应用的病例有：越级应用抗菌药物的有83份（39%）,无指征应用抗菌药物的有45份（21%）,无指征更换抗菌药物的有57份（27%）,无指征联合应用抗菌药物的有28份（13%）。结论：我院儿科总体用药较为合理,但尚存在一些不合理应用抗菌药物的现象,需进一步加强抗菌药物合理应用的管理,提高抗菌药物合理应用水平。     

Pediatric urinary incontinence: Classification,evaluation, and management

ObjectiveTo review the classification, evaluation, and management of pediatric urinary incontinence.MethodsAn examination of texts and peer-reviewed literature was performed to identify subject matter relevant to the stated objectives, with the experience of the senior author used in cases where the literature failed to provide guidance.ResultsOn the basis of our review, we identified the International Children's Continence Society's (ICCS) statement standardizing the terminology for lower urinary tract function in children and present a logical classification scheme for incontinence. After an epidemiology review, we discuss the appropriate evaluation of the incontinent child, of which the cornerstones are a detailed history and thorough physical exam. Finally, a concise discussion of the management of daytime incontinence, nocturnal enuresis, and neurogenic and anatomic incontinence is presented, with deference to evidence-based approaches where available. Depending on the type of incontinence, the management strategies can include behavioral, pharmacologic, and/or surgical approaches.ConclusionPediatric urinary incontinence is a common condition which, after appropriate evaluation, can be successfully treated.     

儿科门诊输液处方合理性调查

目的：评价医院儿科门诊输液处方的合理性,促进儿科合理用药。方法随机抽查医院2013年6月输液药房中儿科门诊输液处方500张,对联合用药处方、应用糖皮质激素的处方和不合理用药处方进行分类和统计分析。结果联合用药处方、应用激素处方、不合理用药处方分别占调查处方的91.6％、28.2％、2.6％。不合理用药情况有：药物选择不合理、用量不合理、溶媒选择不合理、联合用药不合理等。结论进行儿科门诊输液处方不合理用药调查,将信息及时反馈给医师,护士,可减少不良反应的发生。有助于加强医师、药师、护士合作,促进儿科合理用药。