Lung Ultrasound As A Diagnostic Tool for Radiographically-Confirmed Pneumonia in Low Resource Settings

Background Pneumonia is a leading cause of morbidity and mortality in children worldwide; however, its diagnosis can be challenging, especially in settings where skilled clinicians or standard imaging are unavailable. We sought to determine the diagnostic accuracy of lung ultrasound when compared to radiographically-confirmed clinical pediatric pneumonia. Methods Between January 2012 and September 2013, we consecutively enrolled children aged 2–59 months with primary respiratory complaints at the outpatient clinics, emergency department, and inpatient wards of the Instituto Nacional de Salud del Niño in Lima, Peru. All participants underwent clinical evaluation by a pediatrician and lung ultrasonography by one of three general practitioners. We also consecutively enrolled children without respiratory symptoms. Children with respiratory symptoms had a chest radiograph. We obtained ancillary laboratory testing in a subset. Results Final clinical diagnoses included 453 children with pneumonia, 133 with asthma, 103 with bronchiolitis, and 143 with upper respiratory infections. In total, CXR confirmed the diagnosis in 191 (42%) of 453 children with clinical pneumonia. A consolidation on lung ultrasound, which is our primary endpoint for pneumonia, had a sensitivity of 88.5%, specificity of 100%, and an area under-the-curve of 0.94 (95% CI 0.92–0.97) when compared to radiographically-confirmed clinical pneumonia. When any abnormality on lung ultrasound was compared to radiographically-confirmed clinical pneumonia the sensitivity increased to 92.2% and the specificity decreased to 95.2%, with an area under-the-curve of 0.94 (95% CI 0.91–0.96). Conclusions Lung ultrasound had high diagnostic accuracy for the diagnosis of radiographically-confirmed pneumonia. Added benefits of lung ultrasound include rapid testing and high inter-rater agreement. Lung ultrasound may serve as an alternative tool for the diagnosis of pediatric pneumonia

Benign external hydrocephalus: a review, with emphasis on management

Benign external hydrocephalus in infants, characterized by macrocephaly and typical neuroimaging findings, is considered as a self-limiting condition and is therefore rarely treated. This review concerns all aspects of this condition: etiology, neuroimaging, symptoms and clinical findings, treatment, and outcome, with emphasis on management. The review is based on a systematic search in the Pubmed and Web of Science databases. The search covered various forms of hydrocephalus, extracerebral fluid, and macrocephaly. Studies reporting small children with idiopathic external hydrocephalus were included, mostly focusing on the studies reporting a long-term outcome. A total of 147 studies are included, the majority however with a limited methodological quality. Several theories regarding pathophysiology and various symptoms, signs, and clinical findings underscore the heterogeneity of the condition. Neuroimaging is important in the differentiation between external hydrocephalus and similar conditions. A transient delay of psychomotor development is commonly seen during childhood. A long-term outcome is scarcely reported, and the results are varying. Although most children with external hydrocephalus seem to do well both initially and in the long term, a substantial number of patients show temporary or permanent psychomotor delay. To verify that this truly is a benign condition, we suggest that future research on external hydrocephalus should focus on the long-term effects of surgical treatment as opposed to conservative management

How to elicit and cease herding behaviour? On the effectiveness of a warning message as a debiasing decision support system

Behavioural economics has been argued to be a productive basis for decision support system (DSS) research. Whereas traditional economics assumes that individuals make decisions independently of others, behavioural economists have shown that humans tend to follow the crowd in their decisions (i.e., exhibit herding bias). However, the literature is silent on how convincing the information on the decisions of the crowd needs to be to elicit herding bias and on whether herding can be reduced (i.e., debiased) by presenting a warning message. This paper addresses both questions in the contexts of financial decisions that were guided by two DSSs in the form of simulation tools. In particular, we conduct a randomised controlled trial with 768 respondents randomly assigned to peer information. The results indicate that the intervention successfully elicited herding bias and that herding occurs when respondents are informed that at least 50% of other people made a particular decision. The results further show that a DSS in the form of a warning message is not sufficient to debias herding. In conclusion, these findings showed that individuals are easily influenced by erroneous peer information and that this effect is robust against debiasing using a warning message. Hence, DSS developers need to consider more intense debiasing strategies to overcome herding

How to elicit and cease herding behaviour? On the effectiveness of a warning message as a debiasing decision support system

Behavioural economics has been argued to be a productive basis for decision support system (DSS) research. Whereas traditional economics assumes that individuals make decisions independently of others, behavioural economists have shown that humans tend to follow the crowd in their decisions (i.e., exhibit herding bias). However, the literature is silent on how convincing the information on the decisions of the crowd needs to be to elicit herding bias and on whether herding can be reduced (i.e., debiased) by presenting a warning message. This paper addresses both questions in the contexts of financial decisions that were guided by two DSSs in the form of simulation tools. In particular, we conduct a randomised controlled trial with 768 respondents randomly assigned to peer information. The results indicate that the intervention successfully elicited herding bias and that herding occurs when respondents are informed that at least 50% of other people made a particular decision. The results further show that a DSS in the form of a warning message is not sufficient to debias herding. In conclusion, these findings showed that individuals are easily influenced by erroneous peer information and that this effect is robust against debiasing using a warning message. Hence, DSS developers need to consider more intense debiasing strategies to overcome herding

RCT naar mindfulness-based cognitieve therapie voor psychische klachten bij oncologische patiënten [RCT about mindfulness-based cognitive therapy for psychological distress in cancer patients]

BACKGROUND: Cancer patients may experience psychological distress, like anxiety and depressive symptoms. Mindfulness-based cognitive therapy (MBCT) has been shown to alleviate this psychological distress. However, patients experience barriers in participating in face-to-face MBCT. Individual internet-based MBCT (eMBCT) could be an alternative. AIM: To compare MBCT and eMBCT to treatment as usual (TAU) for psychological distress in cancer patients. METHOD: 245 cancer patients with psychological distress were randomly allocated to MBCT (n = 77), eMBCT (n = 90) or TAU (n = 78). Patients completed baseline (T0) and post-intervention (T1) assessments. The primary outcome was psychological distress on the Hospital Anxiety and Depression Scale. Outcomes were analyzed using linear mixed modeling on the intention-to-treat sample. Since both interventions were compared to TAU, the type I error rate was set to p RESULTS: Compared to TAU, patients reported significantly less psychological distress after both MBCT (Cohen's d = 0.43, p CONCLUSION: Compared to TAU, MBCT and eMBCT were similarly effective in reducing psychological distress in a sample of distressed heterogeneous cancer patients