251 research outputs found
Childhood leukaemia in the Netherlands : a register based epidemiologic study
Leukaemia, literally "white blood", is the most common type of
malignancy in childhood (Birch et al., 1980). The clinical features are
caused by abnormal proliferation of one or more of the blood-forming
cellular elements. The immature malignant cells usually disturb
normal haematopoiesis and often invade other organs or tissues.
Since the 'seventies the survival of children with leukaemia,
especially acute lymphocytic leukaemia (ALL), has improved and cure
can be obtained in approximately 50% of the paediatric patients with
ALL (Finkel, 1976; van der Does-van den Berg, 1980). Therefore
morbidity rather than mortality data are needed for epidemiological
studies on aetiological factors of childhood leukaemia.
The impetus for this study was a suggestion originating in
Germany, that childhood leukaemia occurs more frequently in
children who lived near nuclear plants. In the Dutch Parliament
questions were asked about the possible relation between proximity to
nuclear plants and the development of leukaemia. In The Netherlands
there are three such nuclear plants. The Dutch Childhood Leukaemia
Study Group (DCLSG), in a letter to the Minister of Public Health and
Environmental Hygiene, offered to initiate a study on environmental
factors in childhood leukaemia, since this group maintains a morbidity
register of childhood leukaemia from 1972 onwards. Subsequently the
Ministry established a grant for this study (Persbericht Ministerie van
Volksgezondheid en Milieuhygiene, 1979). In view of the specific nature of the study, the Institute of
Epide~iology of the Erasmus University Rotterdam, was asked to
cooperate
The proxy problem anatomized: child-parent disagreement in health related quality of life reports of chronically ill adolescents
<p>Abstract</p> <p>Background</p> <p>Discrepancy between self-reports and parent-proxy reports of adolescent health-related quality of life (HRQoL) has been repeatedly acknowledged in the literature as the proxy problem. However, little is known about the extent and direction of this discrepancy. The purpose of this study is to explore to what extent and in what direction HRQoL self-reports of adolescents with chronic conditions and those of their parents differ.</p> <p>Methods</p> <p>A cross-sectional survey was conducted among adolescents suffering from chronic conditions and their parents. Socio-demographic and disease-related characteristics were collected and information about consequences of the chronic condition was assessed. HRQoL was measured with KIDSCREEN-10 and DISABKIDS condition generic measure (DCGM-10). Agreement was analysed through defining a threshold of agreement based on half of the standard deviation of the HRQoL score with the highest variance. Agreement occurred if the difference between adolescent and parent scores was less than or equal to half of the standard deviation. Intra-class correlation coefficients and Bland-Altman plots were also computed. The characteristics associated with direction of disagreement were statistically tested with one-way ANOVA and Chi-square tests.</p> <p>Results</p> <p>584 paired HRQoL scores were obtained. Ratings from both adolescents and parents were high, compared to European norm data. Differences between adolescents and parents were statistically significant, yet relatively small. Disagreement existed in both directions: in 24.5% (KIDSCREEN-10) and 16.8% (DCGM-10) of the cases adolescents rated their HRQoL lower than did their parent, while in 32.2% (KIDSCREEN-10) and 31.7% (DCGM-10) of the cases the opposite was true. Adolescent's age, educational level and type of education, parent's educational level, number of hospital admissions and several other disease-related factors influenced direction of disagreement.</p> <p>Conclusions</p> <p>In a reasonable proportion of cases the adolescent and parent agreed on the adolescent's HRQoL (43-51% of the cases) and most disagreement tended to be minor. Thus, the proxy problem may be smaller than presented in the literature and its extent may differ per population. As adolescents are expected to become partners in their own health care, it is recommended to focus on adolescents' own perceptions of HRQoL.</p
Association between hypotension and serious illness in the emergency department: an observational study
Background The value of routine blood pressure
measurement in the emergency department (ED) is
unclear.
Objective To determine the association between
hypotension in addition to tachycardia and the Shock
Index for serious illness.
Design Observational study.
Setting University ED (2009ā2016).
Participants, methods and main outcomes Routine
data collected from consecutive children <16 years.
Using logistic regression, we assessed the association
between hypotension (adjusted for tachycardia) and
Shock Index (ratio heart rate/blood pressure [BP]) for
serious illness. The predictive accuracy (sensitivity,
specificity) for hypotension and Shock Index was
determined for serious illness, defined as intensive care
unit (ICU) and hospital admissions.
Results We included 10 698 children with measured
BP. According to three age-adjusted clinical cut-offs
(Advanced Paediatric Life Support, Paediatric Advanced
Life Support and Paediatric Early Warning Score),
hypotension was significantly associated with ICU
admission when adjusted for tachycardia (range OR
2.6ā5.3). Hypotension showed low sensitivity (rang
G protein variation in respiratory syncytial virus group A does not correlate with clinical severity
Respiratory syncytial virus group A strain variations of 28 isolates from
The Netherlands collected during three consecutive seasons were studied by
ana
Randomized, controlled trial of ibuprofen syrup administered during febrile illnesses to prevent febrile seizure recurrences
OBJECTIVES: Febrile seizures recur frequently. Factors increasing the risk
of febrile seizure recurrence include young age at onset, family history
of febrile seizures, previous recurrent febrile seizures, time lapse since
previous seizure <6 months, relative low temperature at the initial
seizure, multiple type initial seizure, and frequent febrile illnesses.
Prevention of seizure recurrences serves two useful purposes: meeting
parental fear of recurrent febrile seizures in general and reducing the
(small) risk of a long-lasting and eventually injurious recurrent seizure.
In daily practice, children with febrile seizures often are treated with
antipyretics during fever to prevent febrile seizure recurrences. Thus
far, no randomized placebo-controlled trial has been performed to assess
the efficacy of intermittent antipyretic treatment in the prevention of
seizure recurrence. METHODS: We performed a randomized, double-blind,
placebo-controlled trial. Children 1 to 4 years of age who had had at
least one risk factor for febrile seizure recurrence were enrolled. They
were randomly assigned to either ibuprofen syrup, 20 mg/mL, 0.25 mL (= 5
mg) per kilogram of body weight per dose, or matching placebo, to be
administered every 6 hours during fever (temperature, >/=38.5 degrees C).
Parents were instructed to take the child's rectal temperature immediately
when the child seemed ill or feverish and to promptly administer the study
medication when the temperature was >/=38.5 degrees C. Doses were to be
administered every 6 hours until the child was afebrile for 24 hours. The
parents were instructed not to administer any other antipyretic drug to
the child. For measuring rectal temperature, a Philips HP5316 digital
thermometer (Philips, Eindhoven, The Netherlands) was distributed. During
subsequent treatment of the fever episode, parents had to call the
investigator at least once each day to notify the investigator in case of
febrile seizure recurrence. The investigator could be contacted by parents
24 hours per day. The primary outcome was the first recurrence of a
febrile seizure. Kaplan-Meier curves and Cox regression were used for the
statistical analysis. The treatment effect on the course of the
temperature was assessed using analysis of covariance, with temperature at
fever onset as covariate. Two analyses were performed. In an
intention-to-treat analysis, all first recurrences were considered
regardless of study medication compliance. A per-protocol analysis was
limited to those recurrences that occurred in the context of study
medication compliance. RESULTS: Between October 1, 1994, and April 1,
1996, 230 children were randomly assigned to ibuprofen syrup (111
children) or placebo (119 children). Median follow-up time was 1.04 years
(25th-75th percentiles; 0.7-1.8 years) in the ibuprofen group and 0.98
years (0.7-1.6 years) in the placebo group. Of all children, 67 had a
first febrile seizure recurrence, with 31 in the ibuprofen group and 36 in
the placebo group. The 2-year recurrence probabilities were 32% and 39%,
Screening for child abuse at emergency departments: a systematic review
Introduction: Child abuse is a serious problem worldwide and can be difficult to detect. Although children who experience the consequences of abuse will probably be treated at an emergency department, detection rates of child abuse at emergency departments remain low. OBJECTIVE: To identify effective interventions applied at emergency departments that significantly increase the detection rate of confirmed cases of child abuse. DESIGN: This review was carried out according to the Cochrane Handbook. Two reviewers individually searched Pubmed, The Cochrane Library, EMBASE, Web of Science, and CINAHL for papers that met the inclusion criteria. RESULTS: Fifteen papers describing interventions were selected and reviewed; four of these were finally included and assessed for quality. In these studies the intervention consisted of a checklist of indicators of risk for child abuse. After implementation, the rate of detected cases of suspected child abuse increased by 180% (weighted mean in 3 studies). The number of confirmed cases of child abuse, reported in two out of four studies, showed no significant increase. CONCLUSIONS: Interventions at emergency departments to increase the detection rate of cases of confirmed child abuse are scarce in the literature. Past study numbers and methodology have been inadequate to show conclusive evidence on effectiveness
Frequency of fever episodes related to febrile seizure recurrence
The aim of this study was to assess the number of fever episodes as a risk factor for febrile seizure recurrence during the first 6 months after the last previous febrile seizure. In a 6-month follow-up study of 155 children, aged 3 months to 5 y, with a first or a recurrent febrile seizure, the occurrence of fever episodes and febrile seizure recurrences was prospectively documented. Using logistic regression analysis the association between the baseline characteristics and the number of fever episodes and the outcome, a febrile seizure recurrence, was studied. In total, 260 fever episodes were registered; 29 children experienced 1 or more febrile seizure recurrence during follow-up. Two factors were associated with febrile seizure recurrence: the number of fever episodes [odds ratio (OR)= 1.8; 95% confidence interval (CI): 1.4-2.4)] and age at study entry (OR=0.6; 95% CI: 0.3-1.1). In a multivariable model, only the number of fever episodes remained significant. In conclusion, the number of fever episodes increases the risk of a febrile seizure recurrence with a factor of 1.8 per fever episode in the first 6 months after a febrile seizure
A comparison of clinical paediatric guidelines for hypotension with population-based lower centiles: A systematic review
Background: Different definitions exist for hypotension in children. In this study, we aim to identify evidence-based reference values for low blood pressure and to compare these with existing definitions for systolic hypotension. Me
Why are structured data different? Relating differences in data representation to the rationale of OpenSDE
OpenSDE is an application that supports clinicians with structured recording of narrative patient data to enable use of data in both clinical practice and research. OpenSDE is based on a rationale and requirements for structured data entry. In this study, we analyse the impact of the rationale and the requirements on data representation using OpenSDE. Three paediatricians transcribed 20 paper patient records using OpenSDE. The transcribed records were compared; the findings that were the same in content but differed in representation (e.g. recorded as free text instead of in a structured manner) were categorized in one of three categories of difference in representation. The transcribed records contained 1764 findings in total. The medical content of 302 of these findings was represented differently by at least one clinician and was thus included in this study. In OpenSDE, clinicians are free to determine the degree of detail at which patient data are described. This flexibility accounts for 87% of the differences in data representation. Thirteen per cent of the differences are due to clinicians interpreting and translating phrases from the source text and transcribing these to (different) concepts in OpenSDE. The differences in data representation largely result from initial design decisions for OpenSDE
Implementation of clinical decision support in young children with acute gastroenteritis: a randomized controlled trial at the emergency department
textabstractAcute gastroenteritis (AGE) is one of the most frequent reasons for young children to visit emergency departments (EDs). We aimed to evaluate (1) feasibility of a nurse-guided clinical decision support system for rehydration treatment in children with AGE and (2) the impact on diagnostics, treatment, and costs compared with usual care by attending physician. A randomized controlled trial was performed in 222 children, aged 1 month to 5 years at the ED of the Erasmus MC-Sophia Childrenās hospital in The Netherlands ( 2010ā2012). Outcome included (1) feasibility, measured by compliance of the nurses, and (2) length of stay (LOS) at the ED, the number of diagnostic tests, treatment, follow-up, and costs. Due to failure of post-ED weight measurement, we could not evaluate weight difference as measure for dehydration. Patient characteristics were comparable between the intervention (N = 113) and the usual care group (N = 109). Implementation of the clinical decision support system proved a high compliance rate. The standardized use of oral ORS (oral rehydration solution) significantly increased from 52 to 65%(RR2.2, 95%CI 1.09ā4.31 p < 0.05). We observed no differences in other outcome measures. Conclusion: Implementation of nurse-guided clinical decision support system on rehydration treatment in children with AGE showed high compliance and increase standardized use of ORS, without differences in other outcome measures.(Table presented.
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