Off-hours admission and mortality in two pediatric intensive care units without 24-h in-house senior staff attendance

To compare risk-adjusted mortality of children non-electively admitted during off-hours with risk-adjusted mortality of children admitted during office hours to two pediatric intensive care units (PICUs) without 24-h in-house attendance of senior staff. Prospective observational study, performed between January 2003 and December 2007, in two PICUs without 24-h in-house attendance of senior staff, located in tertiary referral children's hospitals in the Netherlands. Standardized mortality rates (SMRs) of patients admitted during off-hours were compared to SMRs of patients admitted during office hours using Pediatric Index of Mortality (PIM1) and Pediatric Risk of Mortality (PRISM2) scores. Office hours were defined as week days between 8:00 a.m. and 6:00 p.m., with in-house attendance of senior staff, and off-hours as week days between 6:00 p.m. and 8:00 a.m., Saturdays, Sundays and public holidays, with one resident covering the PICU and senior staff directly available on-call. Of 3,212 non-elective patients admitted to the PICUs, 2,122 (66%) were admitted during off-hours. SMRs calculated according to PIM1 and PRISM2 did not show a significant difference with those of patients admitted during office hours. There was no significant effect of admission time on mortality in multivariate logistic regression with odds ratios of death in off-hours of 0.95 (PIM1, 95% CI 0.71-1.27, p = 0.73) and 1.03 (PRISM2, 95% CI 0.76-1.39, p = 0.82). Off-hours admission to our PICUs without 24-h in-house attendance of senior staff was not associated with higher SMRs than admission during office hours when senior staff were available in-house

Gastrointestinal motility disorders in children; etiology and associated behaviors

Genetisch koppelingsonderzoek en het bestuderen van niet-geïsoleerde motiliteitsstoornissen (problemen met de motoriek van darmen of maag) bevestigen de klinische en genetische heterogeniteit van deze aandoeningen. Behalve omgevingsfactoren blijken ook gedragingen van het kind en karakteristieken van ouders geassocieerd met motiliteitsstoornissen op de kinderleeftijd. In haar proefschrift ontrafelt Babette Peeters de rol van genetische factoren, omgevingsfactoren en gedrag in de ontstaanswijze van de meest voorkomende motiliteitsstoornissen bij kinderen. Problemen met de motoriek van darmen of maag (de motiliteit) worden gezien bij kinderen van alle leeftijden. De meest voorkomende stoornissen op kinderleeftijd zijn reflux, afsluiting van de maaguitgang en problemen met de stoelgang. Er is weinig bekend over het ontstaan van deze stoornissen

Toilet training in children with a functional defecation disorder and concomitant symptoms of autism spectrum disorder

The purpose of this study was to determine the association between the presence of symptoms of Autism Spectrum Disorder (ASD) and the time of completion of toilet training in pediatric patients with a Functional Defecation Disorder (FDD). Consecutive children (4-12 yrs) presenting with FDD according to the ROME III criteria were screened for symptoms of ASD by two validated questionnaires; the Social Responsiveness Scale (SRS) and the Social Communication Questionnaire-Lifetime (SCQ-L). Children were defined as having symptoms of ASD when they scored at or above the cut-off value on one or two questionnaires (SRS ≥ 51; SCQ ≥ 15). This study included 96 age-matched controls from the general population and 242 pediatric patients with FDD of which 70 had symptoms of ASD. Significantly less children with FDD and ASD symptoms were toilet trained for stools and urine during daytime before the age of 4 yrs (41% and 58% respectively) than children with FDD only (56% and 72%), whereas almost all controls had completed toilet training daytime before this age (95% and 98%). Children with FDD and ASD symptoms completed toilet training both for stools and urine during daytime at a significantly later age than children with FDD only and controls.publisher: Elsevier articletitle: Toilet training in children with a functional defecation disorder and concomitant symptoms of autism spectrum disorder journaltitle: Research in Autism Spectrum Disorders articlelink: http://dx.doi.org/10.1016/j.rasd.2016.02.009 content_type: article copyright: Copyright © 2016 Elsevier Ltd. All rights reserved.status: publishe

Toilet training in children with a functional defecation disorder and concomitant symptoms of autism spectrum disorder

The purpose of this study was to determine the association between the presence of symptoms of Autism Spectrum Disorder (ASD) and the time of completion of toilet training in pediatric patients with a Functional Defecation Disorder (FDD). Consecutive children (4-12 yrs) presenting with FDD according to the ROME III criteria were screened for symptoms of ASD by two validated questionnaires; the Social Responsiveness Scale (SRS) and the Social Communication Questionnaire-Lifetime (SCQ-L). Children were defined as having symptoms of ASD when they scored at or above the cut-off value on one or two questionnaires (SRS >= 51; SCQ >= 15). This study included 96 age-matched controls from the general population and 242 pediatric patients with FDD of which 70 had symptoms of ASD. Significantly less children with FDD and ASD symptoms were toilet trained for stools and urine during daytime before the age of 4 yrs (41% and 58% respectively) than children with FDD only (56% and 72%), whereas almost all controls had completed toilet training daytime before this age (95% and 98%). Children with FDD and ASD symptoms completed toilet training both for stools and urine during daytime at a significantly later age than children with FDD only and controls. (C) 2016 Elsevier Ltd. All rights reserve

Laparoscopic pyloromyotomy, the tail of the learning curve

The debate whether laparoscopic pyloromyotomy (LP) is superior to open pyloromyotomy (OP) remains actual. A recent review showed no benefit between the LP or OP, but in the studied randomized, controlled trials the learning curve was not addressed. Comparing LP including the learning curve with OP after the learning curve is questionable. In previous research, the learning curve of LP was analyzed. It was concluded that the plateau was reached after 35 procedures with a steep decrease in complications when comparing before and after 35 procedures. This study was designed to retrospectively analyze the results obtained in HPS patients after the learning curve in LP has been reached. The results will be compared with results of OP in HPS patients in the same period. A retrospective analysis in 106 OP and 57 LP was performed from September 2008 to June 2012. The overall complication rate in the OP group was significantly higher than in the LP group (18% vs. 3.5%, p = 0.012). Also there was a higher major complication rate in the OP group (10.4% vs. 1.7%, p = 0.045). The median time to operate was with 28.5 min in OP and 30.0 min in LP (not significant), whereas the LOS was 2 days in both groups (not significant). In this study, a further decline in overall and major complications after the learning curve is seen in the LP group, the tail of the learning curve. The debate whether LP is superior to OP is not finished as long as it is not clear whether the minimally invasive operation is beyond the initial or tail of the learning curv

Sacral Neuromodulation Therapy: A Promising Treatment for Adolescents With Refractory Functional Constipation

BACKGROUND: Sacral neuromodulation therapy has been successfully applied in adult patients with urinary and fecal incontinence and in adults with constipation not responding to intensive conservative treatment. No data, however, are available on sacral neuromodulation therapy as a treatment option in adolescents with refractory functional constipation. OBJECTIVES: This study aimed to describe the short-term results of sacral neuromodulation in adolescents with chronic functional constipation refractory to intensive conservative treatment. DESIGN: This is a retrospective review. SETTING: This study took place at the Department of Surgery, Maastricht University Medical Centre, The Netherlands. PATIENTS: Thirteen patients (all girls, age 10-18 years) with functional constipation according to the ROME III criteria not responding to intensive oral and rectal laxative treatment were assigned for sacral neuromodulation. MAIN OUTCOME MEASURES: When improvement of symptoms was observed during the testing phase, a permanent stimulator was implanted. Patients were prospectively followed up to at least 6 months after implantation of the permanent stimulator by interviews, bowel diaries, and Cleveland Clinic constipation score. Improvement was defined as spontaneous defecation >= 2 times a week. RESULTS: At presentation, none of the patients had spontaneous defecation or felt the urge to defecate. All patients had severe abdominal pain. Regular school absenteeism was present in 10 patients. After the testing phase, all but 2 patients had spontaneous defecation >= 2 times a week with a reduction in abdominal pain. After implantation, 11 (of 12) had a normal spontaneous defecation pattern of >= 2 times a week without medication, felt the urge to defecate, and perceived less abdominal pain without relapse of symptoms until 6 months after implantation. The average Cleveland Clinic constipation score decreased from 20.9 to 8.4. One lead revision and 2 pacemaker relocations were necessary. LIMITATIONS: This study is limited by its small sample size, single-institution bias, and retrospective nature. CONCLUSION: Sacral neuromodulation appears to be a promising new treatment option in adolescents with refractory functional constipation not responding to intensive conservative therapy. Larger randomized studies with long-term follow-up are require