e-POCT: improving health outcomes of febrile children in Tanzania through innovative point-of-care technologies at the primary care level

Febrile illnesses are the leading cause for pediatric outpatient consultations in low-resource settings. Only a small percentage of children require antibiotic treatment or inpatient care. The key challenge for clinicians is to identify this minority with serious presentations among the large number of children with self-limiting infections. Health workers tend to prescribe antibiotics in the vast majority of cases, “to be on the safe side”, given the lack of adequate diagnostic tools. To address these challenges electronic clinical decision algorithms, based on the World Health Organization Integrated Management of Childhood Illnesses (IMCI) guidelines, had been developed by Swiss TPH. However, opportunities for improvement remain, especially related to the identification of children with serious infections. Host biomarkers, that can help identify children with bacterial infections, had not been considered within the IMCI strategy. In addition, point-of-care tests (POCTs) are available that may help detect children with severe presentations where clinical signs lack diagnostic accuracy, e.g. hemoglobin testing for identifying children with severe anemia. The aim of this project was to improve the clinical outcome and rational antimicrobial prescription among children with acute febrile illnesses through the development and evaluation of a novel electronic disease management tool (ePOCT). The project had two major components: i) development of a novel, evidence-based electronic algorithm, ePOCT, that integrates clinical signs with point-of-care biomarkers, and ii) evaluation of ePOCT through a controlled, randomized, non-inferiority trial in Tanzania

Performance characteristics of a rapid immunochromatographic assay for detection of pandemic influenza A (H1N1) virus in children

Rapid tests for diagnosis of influenza are valuable assets in the management of influenza in pediatric patients. However, test performance fluctuates with virus subtypes. We assessed the test characteristics of Influenzatop®, a rapid immunochromatographic influenza A and B test, in detecting pandemic 2009 influenza A (H1N1) in children up to 18years of age, using reverse transcriptase polymerase chain reaction (RT-PCR) as the gold standard. Three hundred and one pediatric outpatients with influenza-like illness were included into the study. Overall sensitivity of Influenzatop® was 64% (95% confidence interval (CI) 56-71%) but increased to 92% (95% CI, 80-97%) when performed between 24 and 48h after onset of symptoms. Positive Influenzatop® results among RT-PCR-positive patients were associated with higher viral load. No significant variation in test performance could be detected when analyzed by age and high versus low prevalence period. Overall test specificity was 99% (95% CI, 95-100%); positive and negative predictive values were 98% (95% CI, 93-99%) and 70% (95% CI, 63-76%), respectively. Conclusion: Influenzatop® rapid influenza test is a sound tool in the diagnosis of H1N1 in pediatric patients when employed 24-48h after onset of symptom

Performance characteristics of a rapid immunochromatographic assay for detection of pandemic influenza A (H1N1) virus in children.

UNLABELLED Rapid tests for diagnosis of influenza are valuable assets in the management of influenza in pediatric patients. However, test performance fluctuates with virus subtypes. We assessed the test characteristics of Influenzatop®, a rapid immunochromatographic influenza A and B test, in detecting pandemic 2009 influenza A (H1N1) in children up to 18 years of age, using reverse transcriptase polymerase chain reaction (RT-PCR) as the gold standard. Three hundred and one pediatric outpatients with influenza-like illness were included into the study. Overall sensitivity of Influenzatop® was 64% (95% confidence interval (CI) 56-71%) but increased to 92% (95% CI, 80-97%) when performed between 24 and 48 h after onset of symptoms. Positive Influenzatop® results among RT-PCR-positive patients were associated with higher viral load. No significant variation in test performance could be detected when analyzed by age and high versus low prevalence period. Overall test specificity was 99% (95% CI, 95-100%); positive and negative predictive values were 98% (95% CI, 93-99%) and 70% (95% CI, 63-76%), respectively. CONCLUSION Influenzatop® rapid influenza test is a sound tool in the diagnosis of H1N1 in pediatric patients when employed 24-48 h after onset of symptoms

Lorentz meets Fano spectral line shapes: A universal phase and its laser control

Symmetric Lorentzian and asymmetric Fano line shapes are fundamental spectroscopic signatures that quantify the structural and dynamical properties of nuclei, atoms, molecules, and solids. This study introduces a universal temporal-phase formalism, mapping the Fano asymmetry parameter q to a phase {\phi} of the time-dependent dipole-response function. The formalism is confirmed experimentally by laser-transforming Fano absorption lines of autoionizing helium into Lorentzian lines after attosecond-pulsed excitation. We also prove the inverse, the transformation of a naturally Lorentzian line into a Fano profile. A further application of this formalism amplifies resonantly interacting extreme-ultraviolet light by quantum-phase control. The quantum phase of excited states and its response to interactions can thus be extracted from line-shape analysis, with scientific applications in many branches of spectroscopy.Comment: 11 pages, 4 figure

The Utility of a Pediatric COVID-19 Online Forward Triage Tool in Switzerland.

Background To offset the burden on the health system, hospitals set up telehealth interventions, such as online forward triage tools (OFTT). The website www.coronabambini.ch was developed to specifically address the needs of children and their families in Switzerland and to facilitate the decision to test, isolate, attend school, or access the health care system. Methods Video interviews were held with key informants (n = 20) from a population of parents, teachers, guardians, as well as doctors who had used the child-specific COVID-19 OFTT and had consented to a further study. Convenience and quota sampling were done to include a variety of key informants. Interviews were recorded, transcribed verbatim, and analyzed for themes. Results Three main themes emerged: i) the usefulness of the OFTT to the users, ii) expectation management and importance of stakeholder involvement in OFTT development, and iii) OFTT limitations. Conclusion Our study highlights opportunities, limitations, and lessons to consider when developing a pediatric COVID-19 OFTT. The involvement of stakeholders, parents, teachers, and health care providers in the design, set up, implementation, and evaluation of telehealth interventions is critical as this can help with expectation management and enhance OFTT utility

Minor head trauma in infants - how accurate is cranial ultrasound performed by trained radiologists?

Correct management of infants after minor head trauma is crucial to minimize the risk to miss clinically important traumatic brain injury (ciTBI). Current practices typically involve CT or in-hospital surveillance. Cranial ultrasound (CUS) provides a radiation-free and fast alternative. This study examines the accuracy of radiologist-performed CUS to detect skull fracture (SF) and/or intracranial hemorrhage (ICH). An inconspicuous CUS followed by an uneventful clinical course would allow exclusion of ciTBI with a great certainty. This monocentric, retrospective, observational study analyzed CUS in infants (< 12 months) after minor head trauma at Bern University Children's Hospital, between 7/2013 and 8/2020. The primary outcome was the sensitivity and specificity of CUS in detecting SF and/or ICH by comparison to the clinical course and to additional neuroimaging. Out of a total of 325 patients, 73% (n = 241) had a normal CUS, 17% (n = 54) were found with SF, and ICH was diagnosed in 2.2% patients (n = 7). Two patients needed neurosurgery and three patients deteriorated clinically during surveillance. Additional imaging was performed in 35 patients. The sensitivity of CUS was 93% ([0.83, 0.97] 95% CI) and the specificity 98% ([0.95, 0.99] 95% CI). All false-negative cases originated in missed SF without clinical deterioration; no ICH was missed.  Conclusion: This study shows high accuracy of CUS in exclusion of SF and ICH, which can cause ciTBI. Therefore, CUS offers a reliable method of neuroimaging in infants after minor head trauma and gives reassurance to reduce the duration of in-hospital surveillance. What is Known: • Minor head trauma can cause clinically important traumatic brain injury in infants, and the management of these cases is a challenge for the treating physician. • Cranial ultrasound (CUS) is regularly used in neonatology, but its accuracy after head trauma in infants is controversial. What is New: • CUS performed by a trained radiologist can exclude findings related to clinically important traumatic brain injury (ciTBI) with high sensitivity and specificity. It therefore offers reassurance in the management of infants after minor head trauma

The use of intercultural interpreter services at a pediatric emergency department in Switzerland.

The aim of our study was to analyze the use of interpreter services and improve communication during health encounters with families with limited language proficiency (LLP) at the pediatric emergency department (ED) of the University Hospital of Bern.This study is a pre- and post-intervention study analyzing the use of interpreter services for LLP families. All families originating from a country with a native language other than German, English or French presenting to the ED were eligible to participate in the study. If they agreed to participate, the language proficiency of the caregiver present during the health encounter was systematically assessed during a phone interview within a few days after the consultation, using a standardized screening tool. If screened positive (relevant LLP), a second phone interview with an interpreter was conducted. Further variables were extracted including nationality, age, gender and date of visit using administrative health records. To increase the use of interpreter services, a package of interventions was implemented at the department during 3 months. It consisted of: i) in person and online transcultural teaching ii) awareness raising through the regular information channels and iii) the introduction of a pathway to systematically identify and manage LLP families.The proportion of LLP families who received an interpreter was 11.0% (14/127) in the pre-intervention period compared to 14.8% (20/135) in the post-intervention period. The interpreter use was therefore increased by 3.8% (95% CI - 0.43 to 0.21; p = 0.36).The assessed level of language proficiency of caregivers differed from the self-reported level of language proficiency. Of the study participants in the interview whose language proficiency was screened as limited, 77.1% estimated their language proficiency level as intermediate. More than half of the LLP families who did not receive an interpreter and participated in the interview reported, that they would have liked an interpreter during the consultation.Conclusions: Interpreter services are largely underused during health encounters with LLP families. Relying on caregivers´ self-assessed language proficiency and their active request for an interpreter is not sufficient to ensure safe communication during health encounters. Systematic screening of language proficiency and standardized management of LLP families is feasible and needed at health care facilities to ensure equitable care. Further studies are needed to analyze personal and institutional barriers to interpreter use and find interventions to sustainably increase the use of interpreter services for LLP families

Public health communication: Attitudes, experiences, and lessons learned from users of a COVID-19 digital triage tool for children

Background: The pandemic has made public health communication even more daunting because acceptance and implementation of official guidelines and recommendations hinge on this. The situation becomes even more precarious when children are involved. Our child-specific COVID-19 online forward triage tool (OFTT) revealed some of the public health communication challenges. We aimed to explore attitudes, experiences, and challenges faced by OFTT users and their families, in regard to public health recommendations. Methods: We selected key informants (n = 20) from a population of parents, teachers, guardians, as well as doctors who had used the child-specific COVID-19 OFTT and had consented to a further study. Videos rather than face-face interviews were held. Convenience and quota sampling were performed to include a variety of key informants. Interviews were recorded, transcribed verbatim, and analyzed for themes. Results: Several themes emerged, namely; (1) definition and expectations of high-risk persons, (2) quarantine instructions and challenges, (3) blurred division of responsibility between authorities and parents, (4) a novel condition and the evolution of knowledge, (5) definition and implications of socioeconomic status, (6) new normal and societal divisions, and (7) the interconnectedness of these factors-systems thinking. Conclusion: As the virus is evolving and circumstances are changing rapidly, the communication of public health to the different interest groups becomes, both an art and science, even more so when using a new technological communication channel: an OFTT. A myriad of interconnected factors seems to influence attitudes toward public health recommendations, which calls for systems thinking in public health communication