Prevalence of pain in the departments of surgery and oncohematology of a paediatric hospital that has joined the project "Towards pain free hospital"

Background. Among hospitalized adults and children pain is undertreated. This study wants to assess the effectiveness of pain therapy in two departments of a large children's hospital. Materials and Methods. During a single day work three committees, administering a questionnaire to patients or parents, have evaluated the adherence to international recommendations (JCI and WHO) in the management of analgesic therapy. Patient demographics, prevalence and intensity (moderate and/or severe) of pain (during hospitalization, 24 hours before and at the time of the interview), analgesia (type, route, duration and frequency of administration) and Pain Management Index (=analgesic score-pain score) were recorded. Results. 75 patients participated in the study (age: 2 months up to 24 years, mean 7.8 ± 6). During hospitalization 43 children (57%) had no pain while 32 (43%) have experienced pain. 22 children (29 %) had pain 24 hours before and 12 (16%) at the time of the interview. The average value of the PMI was -0.8±1.3 with a minimum of -3 and a maximum of +2: 60% (19) of the children had a PMI less than 0 (undertreated pain) while 40% (13) had a value=or > 0. Out of 32 patients who needed an analgesic therapy 14 (44%) received an around-the-clock dosing, 8 (25%) an intermittent therapy and 10 (31%) no treatment.17 (77 %) were the single drug therapy and 5 (23%) the multimodal ones. Conclusion. The prevalence of pain in the two departments is high. The main cause is that knowledge is not still well translated into clinical practice

Extraction of video features for real-time detection of neonatal seizures

This paper presents a novel approach to the extraction of video features for real-time detection of neonatal seizures. In particular, after identification of a proper Region Of Interest (ROI) within the video frame, the broadening factor and the maximum distance between consecutive pairs of zeros of a properly extracted average differential luminosity signal are shown to be relevant features for a diagnosis. The ROI is selected by defining an area around the point where the maximum amplitude of the optical flow vector of that video frame sequence is observed. The located point is then tracked by an algorithm based on template matching and optical flow. The proposed approach allows to differentiate pathological movements (e.g., clonic and myoclonic seizures) from random ones. © 2011 IEEE

Video processing-based detection of neonatal seizures by trajectory features clustering

In this paper, we present a novel approach to early diagnosis, through a video processing-based approach, of the presence of neonatal seizures. In particular, image processing and gesture recognition techniques are first used to characterize typical gestures of neonatal seizures. More precisely, gesture trajectories are characterized by extracting some relevant features. In particular, selecting the point with the maximum amplitude of the optical flow vector of the video frame sequence, during a newborn movement, is selected and then tracked through an algorithm based on template matching and optical flow. The observed features are then clustered using the Density-Based Spatial Clustering of Applications with Noise (DBSCAN) algorithm. The proposed approach allows to efficiently differentiate pathological repetitive movements (e.g., clonic and subtle seizures) from random ones

Video processing-based detection of neonatal seizures by trajectory features clustering

In this paper, we present a novel approach to early diagnosis, through a video processing-based approach, of the presence of neonatal seizures. In particular, image processing and gesture recognition techniques are first used to characterize typical gestures of neonatal seizures. More precisely, gesture trajectories are characterized by extracting some relevant features. In particular, selecting the point with the maximum amplitude of the optical flow vector of the video frame sequence, during a newborn movement, is selected and then tracked through an algorithm based on template matching and optical flow. The observed features are then clustered using the Density-Based Spatial Clustering of Applications with Noise (DBSCAN) algorithm. The proposed approach allows to efficiently differentiate pathological repetitive movements (e.g., clonic and subtle seizures) from random ones. © 2012 IEEE

Maximum-likelihood detection of neonatal clonic seizures by video image processing

In this paper we consider the use of a well-known statistical method, namely Maximum-Likelihood Detection (MLD), to early diagnose, through a wire-free low-cost video processing-based approach, the presence of neonatal clonic seizures. Since clonic seizures are characterized by periodic movements of parts of the body (e.g., hands, legs), by evaluating the periodicity of the extracted signals it is possible to detect the presence of a clonic seizure. The proposed approach allows to differentiate clonic seizure-related movements from random ones. While we first consider a single-camera scenario, we then extend our approach to encompass the use of multiple sensors, such as several cameras or the Microsoft Kinect RBG-Depth sensor. In these cases, data fusion principles are considered to aggregate signals from multiple sensors. © 2014 IEEE

Artificial Intelligence Applied to Pancreatic Imaging: A Narrative Review

The diagnosis, evaluation, and treatment planning of pancreatic pathologies usually require the combined use of different imaging modalities, mainly, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). Artificial intelligence (AI) has the potential to transform the clinical practice of medical imaging and has been applied to various radiological techniques for different purposes, such as segmentation, lesion detection, characterization, risk stratification, or prediction of response to treatments. The aim of the present narrative review is to assess the available literature on the role of AI applied to pancreatic imaging. Up to now, the use of computer-aided diagnosis (CAD) and radiomics in pancreatic imaging has proven to be useful for both non-oncological and oncological purposes and represents a promising tool for personalized approaches to patients. Although great developments have occurred in recent years, it is important to address the obstacles that still need to be overcome before these technologies can be implemented into our clinical routine, mainly considering the heterogeneity among studies

An approach to evaluate the quality of radiological reports in Head and Neck cancer loco-regional staging: experience of two Academic Hospitals

OBJECTIVES: To evaluate the quality of the reports of loco-regional staging computed tomography (CT) or magnetic resonance imaging (MRI) in head and neck (H&N) cancer. METHODS: Consecutive reports of staging CT and MRI of all H&N cancer cases from 2018 to 2020 were collected. We created lists of quality indicators for tumor (T) for each district and for node (N). We marked these as 0 or 1 in the report calculating a report score (RS) and a maximum sum (MS) of each list. Two radiologists and two otolaryngologists in consensus classified reports as low quality (LQ) if the RS fell in the percentage range 0-59% of MS and as high quality (HQ) if it fell in the range 60-100%, annotating technique and district. We evaluated the distribution of reports in these categories. RESULTS: Two hundred thirty-seven reports (97 CT and 140 MRI) of 95 oral cavity, 52 laryngeal, 47 oropharyngeal, 19 hypo-pharyngeal, 14 parotid, and 10 nasopharyngeal cancers were included. Sixty-six percent of all the reports were LQ for T, 66% out of all the MRI reports, and 65% out of all CT reports were LQ. Eight-five percent of reports were HQ for N, 85% out of all the MRI reports, and 82% out of all CT reports were HQ. Reports of oral cavity, oro-nasopharynx, and parotid were LQ, respectively, in 76%, 73%, 100% and 92 out of cases. CONCLUSION: Reports of staging CT/MRI in H&N cancer were LQ for T description and HQ for N description

Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe

Background Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Findings Between April 1, 2014, and Jan 31, 2015, 31â127 anaesthetic procedures in 30â874 children with a mean age of 6·35 years (SD 4·50) were included. The incidence of perioperative severe critical events was 5·2% (95% CI 5·0â5·5) with an incidence of respiratory critical events of 3·1% (2·9â3·3). Cardiovascular instability occurred in 1·9% (1·7â2·1), with an immediate poor outcome in 5·4% (3·7â7·5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10â000. This was independent of type of anaesthesia. Age (relative risk 0·88, 95% CI 0·86â0·90; p<0·0001), medical history, and physical condition (1·60, 1·40â1·82; p<0·0001) were the major risk factors for a serious critical event. Multivariate analysis revealed evidence for the beneficial effect of years of experience of the most senior anaesthesia team member (0·99, 0·981â0·997; p<0·0048 for respiratory critical events, and 0·98, 0·97â0·99; p=0·0039 for cardiovascular critical events), rather than the type of health institution or providers. Interpretation This study highlights a relatively high rate of severe critical events during the anaesthesia management of children for surgical or diagnostic procedures in Europe, and a large variability in the practice of paediatric anaesthesia. These findings are substantial enough to warrant attention from national, regional, and specialist societies to target education of anaesthesiologists and their teams and implement strategies for quality improvement in paediatric anaesthesia. Funding European Society of Anaesthesiology