Modification and Assessment of the Bedside Pediatric Early Warning Score in the Pediatric Allogeneic Hematopoietic Cell Transplant Population

OBJECTIVES: To determine the validity of the Bedside Pediatric Early Warning Score system in the hematopoietic cell transplant population, and to determine if the addition of weight gain further strengthens the association with need for PICU admission. DESIGN: Retrospective cohort study of pediatric allogeneic hematopoietic cell transplant patients from 2009 to 2016. Daily Pediatric Early Warning Score and weights were collected during hospitalization. Logistic regression was used to identify associations between maximum Pediatric Early Warning Score or Pediatric Early Warning Score plus weight gain and the need for PICU intervention. The primary outcome was need for PICU intervention; secondary outcomes included mortality and intubation. SETTING: A large quaternary free-standing children's hospital. PATIENTS: One-hundred two pediatric allogeneic hematopoietic cell transplant recipients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of the 102 hematopoietic cell transplant patients included in the study, 29 were admitted to the PICU. The median peak Pediatric Early Warning Score was 11 (interquartile range, 8-13) in the PICU admission cohort, compared with 4 (interquartile range, 3-5) in the cohort without a PICU admission (p < 0.0001). Pediatric Early Warning Score greater than or equal to 8 had a sensitivity of 76% and a specificity of 90%. The area under the receiver operating characteristics curve was 0.83. There was a high negative predictive value at this Pediatric Early Warning Score of 90%. When Pediatric Early Warning Score greater than or equal to 8 and weight gain greater than or equal to 7% were compared together, the area under the receiver operating characteristic curve increased to 0.88. CONCLUSIONS: In this study, a Pediatric Early Warning Score greater than or equal to 8 was associated with PICU admission, having a moderately high sensitivity and high specificity. This study adds to literature supporting Pediatric Early Warning Score monitoring for hematopoietic cell transplant patients. Combining weight gain with Pediatric Early Warning Score improved the discriminative ability of the model to predict the need for critical care, suggesting that incorporation of weight gain into Pediatric Early Warning Score may be beneficial for monitoring of hematopoietic cell transplant patients

The Use of a Kinetic Therapy Rotational Bed in Pediatric Acute Respiratory Distress Syndrome: A Case Series

Patients with acute respiratory distress syndrome (ARDS) commonly have dependent atelectasis and heterogeneous lung disease. Due to the heterogenous lung volumes seen, the application of positive end expiratory pressure (PEEP) can have both beneficial and deleterious effects. Alternating supine and prone positioning may be beneficial in ARDS by providing more homogenous distribution of PEEP and decreasing intrapulmonary shunt. In pediatrics, the pediatric acute lung injury and consensus conference (PALICC) recommended to consider it in severe pediatric ARDS (PARDS). Manually prone positioning patients can be burdensome in larger patients. In adults, the use of rotational beds has eased care of these patients. There is little published data about rotational bed therapy in children. Therefore, we sought to describe the use of a rotational bed in children with PARDS. We performed a retrospective case series of children who utilized a rotational bed as an adjunctive therapy for their PARDS. Patient data were collected and analyzed. Descriptive statistical analyses were performed and reported. Oxygenation indices (OI) pre- and post-prone positioning were analyzed. Twelve patients with PARDS were treated with a rotational bed with minimal adverse events. There were no complications noted. Three patients had malfunctioning of their arterial line while on the rotational bed. Oxygenation indices improved over time in 11 of the 12 patients included in the study while on the rotational bed. Rotational beds can be safely utilized in pediatric patients. In larger children with PARDS, where it may be more difficult to perform a manual prone position, use of a rotational bed can be considered a safe alternative

Design and in vitro studies of a needle-type glucose sensor for subcutaneous monitoring

International audienceA new miniaturized glucose oxidase based needle-type glu¬ cose mlcrosensor has been developed for subcutaneous glu¬ cose monitoring. The sensor Is equivalent In shape and size to a 26-gauge needle (0.45-mm o.d.) and can be Implanted with ease without any Incision. The novel configuration greatly facilitates the deposition of enzyme and polymer films so that sensors with characteristics suitable for In vivo use (upper limit of linear range > 15 mM, response time 60%). The sensor response is largely Independent of ox¬ ygen tension In the normal physiological range. It also ex¬ hibits good selectivity against common interferences except for the exogenous drug acetaminophen

In Vivo Analysis of Tissue S-Nitrosothiols in Pediatric Sepsis

S-nitrosothiols are endogenous, bioactive molecules. S-nitrosothiols are implicated in many diseases, including sepsis. It is currently cumbersome to measure S-nitrosothiols clinically. We have previously developed an instrument to measure tissue S-nitrosothiols non-invasively using ultraviolet light. We have performed a prospective case control study of controls and children with sepsis admitted to the PICU. We hypothesized that tissue S-nitrosothiols would be higher in septic patients than controls. Controls were patients with no cardiopulmonary instability. Cases were patients with septic shock. We measured S-nitrosothiols, both at diagnosis and after resolution of shock. A total of 44 patients were enrolled: 21 controls and 23 with sepsis. At baseline, the controls were younger [median age 5 years (IQR 0, 9) versus 11 years (IQR: 6, 16), p-value = 0.012], had fewer comorbidities [7 (33.3%) vs. 20 (87.0%), p-value < 0.001], and had lower PELOD scores [0 (IQR: 0, 0) vs. 12 (IQR: 11, 21), p-value < 0.001]. S-nitrosothiol levels were higher in sepsis cohort (1.1 ppb vs. 0.8 ppb, p = 0.004). Five patients with sepsis had longitudinal measures and had a downtrend after resolution of shock (1.3 ppb vs. 0.9 ppb, p = 0.04). We dichotomized patients based on S-nitrosothiol levels and found an association with worse clinical outcomes, but further work will be needed to validate these findings

Justifications, strategies, and critical success factors in successful ITIL implementations in U.S. and Australian companies: an exploratory study

A growing number of organizations are implementing the ITIL (IT Infrastructure Library) 'best practice' framework in an attempt to improve their IT service management processes. However, not all ITIL implementations are successful and some companies have been disappointed with the outcomes. This exploratory research reports on four case studies of 'successful' implementations of IT service management using the process-based ITIL V2 framework. Two companies are located in the U.S. and two in Australia. The cases demonstrate a mix of implementation justifications and strategies. Critical success factors (CSFs) suggested in the literature are compared against those attributed to these successful ITIL implementations. Some CSFs, including executive management support, interdepartmental communication and collaboration, use of consultants, training and careful software selection are confirmed. Three new CSFs are identified: creating an ITIL-friendly culture, process as a priority, and customer-focused metrics. Practitioner guidelines, to assist IT managers, who are contemplating adopting ITIL for process improvement and organisational transformation, are also provided together with some challenges encountered and their associated resolutions

Perspectives of Healthcare Professionals on the use of Immersive Virtual Reality in Teenage and Young Adult Oncology:A Qualitative Interview Study

Background:Applications of Virtual Reality (VR) in healthcare continue to grow at a rapid pace, yet the challenges and opportunities associated with VR from the perspective of clinicians and healthcare staff remain underexplored, particularly in the context of Teenage and Young Adult (TYA) oncology. This study aims to bridge this knowledge gap by interviewing clinicians and staff regarding the use of VR in TYA cancer care.Method:Fourteen semi-structured qualitative interviews were conducted with a diverse range of healthcare professionals working in TYA oncology within the United Kingdom including oncologists, hematologists, clinical nurse specialists, clinical psychologists, radiographers, play specialists, clinical social workers and youth support coordinators. Data were analysed thematically with three themes and ten sub-themes developed.Results:The findings reveal that TYA healthcare professionals are optimistic and enthusiastic about the potential of using VR to enhance cancer care for teenagers and young adults. However, they also expressed notable concerns related to the practical implementation of VR in clinical settings. These concerns included infection and safety risks, privacy and security concerns, cost implications, storage requirements and staff burden. Clinicians and staff proposed valuable applications for VR in TYA oncology specifically in patient distraction, physiotherapy, procedure preparation, and the delivery of psychotherapy, including acceptance and commitment therapy. Conclusions:This research has demonstrated that despite an enthusiasm to adopt VR in TYA oncology there are still many challenges, both practical and ethical, that must be addressed to enable the successful implementation of VR in hospitals within the UK. Further research into applications of VR for TYA oncology is warranted, particularly in areas of psychology, physiotherapy, and procedure preparation

Perspectives of Healthcare Professionals on the use of Immersive Virtual Reality in Teenage and Young Adult Oncology:A Qualitative Interview Study

Background:Applications of Virtual Reality (VR) in healthcare continue to grow at a rapid pace, yet the challenges and opportunities associated with VR from the perspective of clinicians and healthcare staff remain underexplored, particularly in the context of Teenage and Young Adult (TYA) oncology. This study aims to bridge this knowledge gap by interviewing clinicians and staff regarding the use of VR in TYA cancer care.Method:Fourteen semi-structured qualitative interviews were conducted with a diverse range of healthcare professionals working in TYA oncology within the United Kingdom including oncologists, hematologists, clinical nurse specialists, clinical psychologists, radiographers, play specialists, clinical social workers and youth support coordinators. Data were analysed thematically with three themes and ten sub-themes developed.Results:The findings reveal that TYA healthcare professionals are optimistic and enthusiastic about the potential of using VR to enhance cancer care for teenagers and young adults. However, they also expressed notable concerns related to the practical implementation of VR in clinical settings. These concerns included infection and safety risks, privacy and security concerns, cost implications, storage requirements and staff burden. Clinicians and staff proposed valuable applications for VR in TYA oncology specifically in patient distraction, physiotherapy, procedure preparation, and the delivery of psychotherapy, including acceptance and commitment therapy. Conclusions:This research has demonstrated that despite an enthusiasm to adopt VR in TYA oncology there are still many challenges, both practical and ethical, that must be addressed to enable the successful implementation of VR in hospitals within the UK. Further research into applications of VR for TYA oncology is warranted, particularly in areas of psychology, physiotherapy, and procedure preparation

Modification and Assessment of the Bedside Pediatric Early Warning Score in the Pediatric Allogeneic Hematopoietic Cell Transplant Population

OBJECTIVES: To determine the validity of the Bedside Pediatric Early Warning Score system in the hematopoietic cell transplant population, and to determine if the addition of weight gain further strengthens the association with need for PICU admission. DESIGN: Retrospective cohort study of pediatric allogeneic hematopoietic cell transplant patients from 2009 to 2016. Daily Pediatric Early Warning Score and weights were collected during hospitalization. Logistic regression was used to identify associations between maximum Pediatric Early Warning Score or Pediatric Early Warning Score plus weight gain and the need for PICU intervention. The primary outcome was need for PICU intervention; secondary outcomes included mortality and intubation. SETTING: A large quaternary free-standing children's hospital. PATIENTS: One-hundred two pediatric allogeneic hematopoietic cell transplant recipients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of the 102 hematopoietic cell transplant patients included in the study, 29 were admitted to the PICU. The median peak Pediatric Early Warning Score was 11 (interquartile range, 8-13) in the PICU admission cohort, compared with 4 (interquartile range, 3-5) in the cohort without a PICU admission (p < 0.0001). Pediatric Early Warning Score greater than or equal to 8 had a sensitivity of 76% and a specificity of 90%. The area under the receiver operating characteristics curve was 0.83. There was a high negative predictive value at this Pediatric Early Warning Score of 90%. When Pediatric Early Warning Score greater than or equal to 8 and weight gain greater than or equal to 7% were compared together, the area under the receiver operating characteristic curve increased to 0.88. CONCLUSIONS: In this study, a Pediatric Early Warning Score greater than or equal to 8 was associated with PICU admission, having a moderately high sensitivity and high specificity. This study adds to literature supporting Pediatric Early Warning Score monitoring for hematopoietic cell transplant patients. Combining weight gain with Pediatric Early Warning Score improved the discriminative ability of the model to predict the need for critical care, suggesting that incorporation of weight gain into Pediatric Early Warning Score may be beneficial for monitoring of hematopoietic cell transplant patients