Assessment Of Pediatric Patients Research Articles

Feasibility of tumor-informed circulating tumor DNA (ctDNA) for molecular residual disease (MRD) assessment in pediatric patients with solid tumors.

10058 Background: Circulating Tumor DNA (ctDNA) is a noninvasive biomarker which has been validated as a prognostic tool in multiple adult cancers. There is evolving evidence that ctDNA may be prognostic in pediatric solid tumors, but experience with commercially available assays in pediatric patients is scarce. Signatera is a ctDNA assay which utilizes whole exome sequencing of tumor and whole blood to identify 16 tumor-specific, clonal, somatic variants. These variants are then monitored in plasma as a molecular residual disease (MRD) assessment. Methods: From November 2021 through August 2023, 30 patients were enrolled on a single center study evaluating the feasibility and utility of Signatera MRD monitoring in pediatric patients with solid tumors. Patients 6 months to 25 years of age with any malignant extracranial solid tumor including lymphoma were eligible. Peripheral blood has been collected every 3 weeks to 3 months while on therapy and every 3 to 6 months while off therapy for up to 2 years. A minimum of 22mL of blood was required for the first draw, and 16mL for subsequent draws. Timing of blood draws was aligned with standard of care blood draws when possible. Results of ctDNA MRD were compared with imaging obtained for disease response and surveillance as standard of care. Results: The cohort consisted of 6 cases of neuroblastoma, 6 osteosarcomas, 4 Wilms tumors, 4 carcinomas, 3 soft tissue sarcomas, 2 Ewing sarcomas, 2 germ cell tumors, 2 lymphomas, and one hepatoblastoma. Of 30 patients enrolled, a tumor-informed ctDNA assay was successfully created for 27 (90%). Of 25 patients who had radiographic evidence of disease at any time of monitoring, 23 (92%) had simultaneous detectable ctDNA. Seven patients have had disease recurrence, of whom all seven had detectable ctDNA at or preceding time of recurrence. Conclusions: Signatera tumor-informed ctDNA assay is a feasible noninvasive tool which may be utilized in parallel with standard of care imaging to monitor for disease recurrence in pediatric patients with extracranial solid tumors. Additional analysis of a larger patient cohort is needed to identify tumor types and clinical scenarios for which its application is most useful.

Wireless handheld ultrasound for internal jugular vein assessment in pediatric patients.

Rapid evolution of ultrasound technology has allowed widespread use of handheld ultrasound devices (HHUDs) for many possible applications. Along with the adult population, the use of HHUDs for Point of Care Ultrasound (POCUS) in pediatric medicine has been increasing over the last few years. However, pediatric-specific literature is still scarce on mobile vascular ultrasound. To evaluate diagnostic capabilities of Vscan Air™ in comparison with high-end ultrasound for the assessment of the internal jugular vein in children and adolescents. 42 Internal Jugular Veins (IJVs) of 21 pediatric patients were scanned by an experienced examiner using a WLAN-supported handheld ultrasound device (Vscan Air™) and high-end cart-based ultrasound (LOGIQ E9) as reference. B-Mode and Color-coded Doppler (CCDS) were performed and compared. Image quality was assessed using a score of 0 to 5 and statistically analyzed. Results were interpreted independently by two readers in consensus. 21 patients (2-17 years; mean 11,00±4,5 years; female n = 11, male n = 10) were examined. The rating score never dropped below 3 for both devices. The median score evaluation of B-Mode and CCDS for the high-end device was 5.00, of Vscan Air™ 5.00 for B-Mode and 4.00 for CCDS. A significant difference was shown between the two devices in the evaluation of CCDS. Vscan Air™ ultrasound device allows sufficient assessability of the IJV in pediatric patients, opening up new possibilities for fast and mobile POCUS of cervical veins and potential guidance of central venous catheter placement.

Skeletal Muscle Mass Assessment in Pediatric Patients: Development of a Normative Equation and Assessment of Factors Associated With a Low Skeletal Muscle Mass in PICU Patients.

To develop an equation for defining a low skeletal muscle mass (SMM) in children and to investigate risk factors and outcomes associated with low SMM in critically ill pediatric patients. Single-center retrospective pediatric cohorts, 2011-2018. Tertiary Emergency and Critical Care Center of Kyushu University Hospital in Japan. We studied two cohorts of pediatric patients 1-15 years old who underwent abdominal CT at the level of the third lumbar vertebra (L3). First a cohort of trauma patients presented to the emergency department in whom we developed an SMM regression equation. Second, a cohort of patients who had undergone abdominal CT within 3 days of PICU admission. None. The equation for estimating normal SMM used sex, age, and weight. Low SMM was defined as less than 80% of normal. In the 112 patients in the PICU cohort, median (range) age was 68 (13-191) months, and 83 (74.1%) had underlying disease. There was low SMM in 54 patients (48.2%). Regarding associations, using odds ratio (OR) and 95% CI, we found that low dietary intake (OR 4.33 [95% CI, 1.37-13.70]; p = 0.013) and the presence of underlying disease (OR 7.44 [95% CI, 2.10-26.30]; p = 0.002) were independently associated with greater odds of low SMM. Low SMM, compared with normal SMM, was also associated with longer hospital stays (42.5 d vs. 20.5 d; p = 0.007; β, 1.59; 95% CI, 1.09-2.33; p = 0.016). In this retrospective PICU cohort from a single center in Japan, we found that low SMM at PICU admission was present in almost half the cases. Low SMM, as defined by being less than 80% of the normal, was associated with greater odds of low dietary intake and underlying chronic disease. Furthermore, low SMM was associated with longer hospital stays.

A Case of a Pediatric Finger Tendon Rupture Diagnosed by Point-of-Care Ultrasound

BackgroundPediatric tendon injuries to the finger are rare, and their diagnosis can be challenging due to the difficulty in sensorimotor assessment in pediatric patients. Point-of-care ultrasound (POCUS) has currently been used for identifying tendon injury in adult acute care, but reports of its use in pediatric emergency departments are scarce. Case reportA previously healthy 14-year-old male patient visited our emergency department due to a finger laceration that occurred when he was cutting sausages using a knife. Physical examination revealed a 1.5 cm laceration over the palmer surface of the left fifth proximal phalanx. Tendon exposure was unremarkable, and the peripheral perfusion and sensation of the injured finger were intact. Flexion of the proximal and distal interphalangeal joints was limited due to pain. POCUS showed the disruption of the tendon structure over the laceration site, suggesting the flexor tendon rupture. Wound exploration by the orthopedic team revealed a transected flexor digitorum superficialis and flexor digitorum profundus and a tendon repair was performed. The patient was discharged with immobilization of the injured hand. Why Should an Emergency Physician Be Aware of This?Pediatric tendon injuries to the finger are rare, and their diagnosis can be challenging to diagnose due to the difficulty in sensorimotor assessment in pediatric patients. POCUS can directly visualize a tendon structure without procedural sedation or radiation exposure, empowering physicians to diagnose tendon injuries and optimize patient care.

Morphometric and clinical comparison of MRI-based synthetic CT to conventional CT of the hip in children.

MRI-based synthetic CT (sCT) generates CT-like images from MRI data. To evaluate equivalence, inter- and intraobserver reliability, and image quality of sCT compared to conventional (cCT) for assessing hip morphology and maturity in pediatric patients. We prospectively enrolled patients <21 years old with cCT and 3T MRI of the hips/pelvis. A dual-echo gradient-echo sequence was used to generate sCT via a commercially available post-processing software (BoneMRI v1.5 research version, MRIguidance BV, Utrecht, NL). Two pediatric musculoskeletal radiologists measured seven morphologic hip parameters. 3D surface distances between cCT and sCT were computed. Physeal status was established at seven locations with cCT as reference standard. Images were qualitatively scored on a 5-point Likert scale regarding diagnostic quality, signal-to-noise ratio, clarity of bony margin, corticomedullary differentiation, and presence and severity of artifacts. Quantitative evaluation of Hounsfield units (HU) was performed in bone, muscle, and fat tissue.Inter- and intraobserver reliability were measured by intraclass correlation coefficients. The cCT-to-sCT intermodal agreement was assessed via Bland-Altman analysis. The equivalence between modalities was tested using paired two one-sided tests. The quality parameter scores of each imaging modality were compared via Wilcoxon signed-rank test. For tissue-specific HU measurements, mean absolute error and mean percentage error values were calculated using the cCT as the reference standard. Thirty-eight hips in 19 patients were included (16.6 ± 3 years, range 9.9-20.9; male = 5). cCT- and sCT-based morphologic measurements demonstrated good to excellent inter- and intraobserver correlation (0.77<ICC<0.98). Measurements were statistically equivalent (P< 0.05), with average intermodal differences <2°. Mean surface distance between cCT and sCT was 0.23 ± 0.18mm. Accuracy to determine physeal maturity status by sCT was 98.4% (242/246, 95% CI 96.0-99.6). No significant differences were found on overall diagnostic quality, bony margin clarity, corticomedullary differentiation, and artifacts between sCT and cCT; signal-to-noise ratio was higher on sCT (P< 0.001). HU were within reference values on both sCT and cCT. sCT is equivalent to cCT for the assessment of hip morphology, physeal status, and radiodensity assessment in pediatric patients.

Autonomic activity and cardiovascular system risk assessment in pediatric patients with hemolytic uremic syndrome.

In pediatric patients with hemolytic uremic syndrome (HUS), cardiac involvement and autonomic nervous system function can be evaluated by a non-invasive method called heart rate variability (HRV). This study aims to evaluate heart rate variability and electrocardiography findings in patients with HUS by comparing a healthy group. Patients who are diagnosed with HUS at a university hospital from December 2020 to June 2022 are screened by electrocardiography (ECG), echocardiography, and 24-h Holter ECG. A healthy control group, compatible in age and gender with the patient group, was selected from healthy subjects. HRV parameters, laboratory values, and ECG findings were analyzed and compared with the healthy group and each other. There were 25 patients with HUS and 51 participants in the healthy control group. Statistically significant differences were found in some HRV parameters: standard deviation of normal to normal intervals, the mean of the 5-min RR interval standard deviations, the standard deviation of 5-min RR interval means, the triangular interpolation of normal to normal interval, and very-low-frequency power. HUS patients had impaired and declined HRV values compared to the healthy group. There was a significant decrease in the PR distance, while a significant increase in the corrected QT and QT dispersion values was detected in the electrocardiographic findings of the patient group. HRV values impaired as renal failure parameters increased. Conclusion: Patients with HUS may have autonomic nervous system dysfunction. HRV measurement is a non-invasive method that can evaluate this. It can be thought that there may be an increased risk of cardiovascular events and arrhythmias in some patients with HUS. ECG should be also considered to detect arrhythmia. What is Known: • Hemolytic uremic syndrome (HUS) primarily effects the hematologic parameters and kidney. • Secondary cardiomyopathy with hypertension and renal failure could be observed in these patients. • Rhythm problems are not expected primarily in these patients. • There is very limited data in evaluating autonomic function and arrhythmia risk for these patients. What is New: • Patients with HUS may have autonomic nervous system dysfunction. • HRV measurement is a non-invasive method that can evaluate this. • Cardiovascular events and arrhythmias due to the deterioration of the balance between the sympathetic and parasympathetic systems could manifest in patients with HUS. • An ECG and screening patients for cardiac events, and monitoring them closely should be considered.

The Diagnostic Utility of Contrast-Enhanced FLAIR Imaging in the Diagnosis of Pediatric Uveitis

The Diagnostic Utility of Contrast-Enhanced FLAIR Imaging in the Diagnosis of Pediatric Uveitis

Effects of White Noise Sound on the Severity of Muscle Vaccination Pain in Children Under Two Years.

Pain and its control is a significant health problem worldwide. The present study aimed to determine the effects of white noise (bird sound) on the severity of muscle vaccination pain in children under two years old. This study was a case-control study conducted in 2021. The samples included seventy children under two years old referred to the health centers in Ramsar City, Iran. The samples were selected using the convenient sampling method and divided into experimental and control groups. The data were collected using the demographic characteristics questionnaire, facial expression, and pain assessment in pediatric patients (FLACC). They were then analyzed by SPSS16 using an independent t-test and analysis of covariance (P<0.05). A significant difference was observed between the severity of muscle vaccination pain in children in the two groups (p=0.042); the pain intensity mean in the experimental group (6.45±2.01) was lower than the control group (8.94±1.28). This method can be a harmless and inexpensive intervention to reduce pain intensity and behavioral pain responses in infants during painful procedures, especially vaccination.

Multispectral optoacoustic tomography enables assessment of disease activity in paediatric inflammatory bowel disease

Multispectral optoacoustic tomography (MSOT) allows non-invasive molecular disease activity assessment in adults with inflammatory bowel disease (IBD). In this prospective pilot-study, we investigated, whether increased levels of MSOT haemoglobin parameters corresponded to inflammatory activity in paediatric IBD patients, too. 23 children with suspected IBD underwent MSOT of the terminal ileum and sigmoid colon with standard validation (e.g. endoscopy). In Crohn`s disease (CD) and ulcerative colitis (UC) patients with endoscopically confirmed disease activity, MSOT total haemoglobin (HbT) signals were increased in the terminal ileum of CD (72.1 ± 13.0 a.u. vs. 32.9 ± 15.4 a.u., p = 0.0049) and in the sigmoid colon of UC patients (62.9 ± 13.8 a.u. vs. 35.1 ± 16.3 a.u., p = 0.0311) as compared to controls, respectively. Furthermore, MSOT haemoglobin parameters correlated well with standard disease activity assessment (e.g. SES-CD and MSOT HbT (rs =0.69, p = 0.0075). Summarizing, MSOT is a novel technology for non-invasive molecular disease activity assessment in paediatric patients with inflammatory bowel disease.

A National Assessment of EMS Performance at the Response and Agency Level

Background In 2019, the National EMS Quality Alliance (NEMSQA) established a suite of 11 evidence-based EMS quality measures, yet little is known regarding EMS performance on a national level. Our objective was to describe EMS performance at a response and agency level using the National EMS Information System (NEMSIS) dataset. Methods The 2019 NEMSIS research dataset of all EMS 9-1-1 responses in the United States was utilized to calculate 10 of 11 NEMSQA quality measures. Measure criteria and pseudocode was implemented to calculate the proportion meeting measure criteria and 95% confidence intervals across all encounters and for each anonymized agency. We omitted Pediatrics-03b because the NEMSIS national dataset does not report patient weight. Agency level analysis was subsequently stratified by call volume and urbanicity. Results Records from 9,679 agencies responding to 26,502,968 9-1-1 events were analyzed. Run-level average performance ranged from 12% for Safety-01 (encounter documented as initial response without the use of lights and siren to 82% for Pediatrics-02 (documented respiratory assessment in pediatric patients with respiratory distress) At the agency level, significant variation in measure performance existed by agency size and by urbanicity. At the individual agency performance analysis, Trauma-04 (trauma patients transported to trauma center) had the lowest agency-level performance with 47% of agencies reporting 0% of eligible runs with documented transport to a trauma center. Conclusion There is a wide range of performance in key EMS quality measures across the United States that demonstrate a need to identify strategies to improve quality and equity of care in the prehospital environment, system performance and data collection.

Multicenter study. Nursing professionals’ perception of training needs in pain assessment in pediatric patients with cognitive dysfunction

IntroductionPediatric patients with cognitive dysfunction are at greater risk of pain than typically developing children. Pain assessment in these patients is complex and could generate uncertainty in health professionals about what the key aspects are. AimTo determine the training needs perceived by nursing professionals regarding acute pain assessment in pediatric patients with cognitive dysfunction. MethodsA descriptive, cross-sectional, and multicenter study was performed using a survey addressed to nursing professionals who work in pediatrics during the months of August and September 2022. Results163 responses were obtained. Most of the professionals who responded were female (92.6%, n = 151), with a mean age of 38.98 ± 10.40 years. The most frequent work unit was the pediatric intensive care unit (PICU), in 36% (n = 58). Most of the participants reported not having previously received training on pain assessment in pediatric patients with cognitive disabilities (85.9%, n = 139). However, 70.4% (n = 114) considered it “very necessary” for the development of their work to receive specific training on this topic. Knowing how to assess acute pain in this population (85.3%, n = 139) and knowing the clinical and behavioral manifestations of pain in this type of patient (84.7%, n = 138) were the aspects that obtained higher scores. ConclusionThis research notes more than 90% of participants consider “quite necessary” and “strong necessary” to be training in pediatric cognitive dysfunction patients pain assessment. Furthermore, work experience, academic education and to be pediatric specialist obtain statistical significance data.

Estudio multicéntrico. Percepción de los profesionales de enfermería sobre las necesidades formativas de valoración del dolor en pacientes pediátricos con disfunción cognitiva

IntroductionPediatric patients with cognitive dysfunction are at greater risk of pain than typically developing children. Pain assessment in these patients is complex and could generate uncertainty in health professionals about what the key aspects are. AimTo determine the training needs perceived by nursing professionals regarding acute pain assessment in pediatric patients with cognitive dysfunction. MethodsA descriptive, cross-sectional, and multicenter study was performed using a survey addressed to nursing professionals who work in pediatrics during the months of August and September 2022. Results163 responses were obtained. Most of the professionals who responded were female (92.6%, n=151), with a mean age of 38.98±10.40 years. The most frequent work unit was the pediatric intensive care unit (PICU), in 36% (n=58). Most of the participants reported not having previously received training on pain assessment in pediatric patients with cognitive disabilities (85.9%, n=139). However, 70.4% (n=114) considered it “very necessary” for the development of their work to receive specific training on this topic. Knowing how to assess acute pain in this population (85.3%, n=139) and knowing the clinical and behavioral manifestations of pain in this type of patient (84.7%, n=138) were the aspects that obtained higher scores. ConclusionThis research notes more than 90% of participants consider “quite necessary” and “strong necessary” to be training in pediatric cognitive dysfunction patients pain assessment. Furthermore, work experience, academic education and to be pediatric specialist obtain statistical significance data.

Free-Breathing Compressed Sensing Cine Cardiac MRI for Assessment of Left Ventricular Strain by Feature Tracking in Children.

Cardiac MRI feature-tracking (FT) with breath-holding (BH) cine balanced steady state free precession (bSSFP) imaging is well established. It is unclear whether FT-strain measurements can be reliably derived from free-breathing (FB) compressed sensing (CS) bSSFP imaging. To compare left ventricular (LV) strain analysis and image quality of an FB CS bSSFP cine sequence with that of a conventional BH bSSFP sequence in children. Prospective. 40 children able to perform BHs (cohort 1 [12.1 ± 2.2 years]) and 17 children unable to perform BHs (cohort 2 [5.2 ± 1.8 years]). 3T, bSSFP sequence with and without CS. Acquisition times and image quality were assessed. LV myocardial deformation parameters were compared between BH cine and FB CS cine studies in cohort 1. Strain indices and image quality of FB CS cine studies were also assessed in cohort 2. Intraobserver and interobserver variability of strain parameters was determined. Paired t-test, Wilcoxon signed-rank test, intraclass correlation coefficient (ICC), and Bland-Altman analysis. A P-value <0.05 was considered statistically significant. In cohort 1, the mean acquisition time of the FB CS cine study was significantly lower than for conventional BH cine study (15.6 s vs. 209.4 s). No significant difference were found in global circumferential strain rate (P = 0.089), global longitudinal strain rate (P = 0.366) and EuroCMR image quality scores (P = 0.128) between BH and FB sequences in cohort 1. The overall image quality score of FB CS cine in cohort 2 was 3.5 ± 0.5 with acquisition time of 14.7 ± 2.1 s. Interobserver and intraobserver variabilities were good to excellent (ICC = 0.810 to 0.943). FB CS cine imaging may be a promising alternative technique for strain assessment in pediatric patients with poor BH ability. 1 TECHNICAL EFFICACY: Stage 1.

IMU-based protocol for gait performance assessment in paediatric patients with rare neurological diseases

IMU-based protocol for gait performance assessment in paediatric patients with rare neurological diseases

Effect of Multidisciplinary Assessment on Paediatric Patients with Monosymptomatic Nocturnal Enuresis.

This study aimed to investigate the effect of multidisciplinary assessment in paediatric patients with monosymptomatic nocturnal enuresis (MNE). From July 2018 to June 2021, 242 patients with enuresis who received diagnosis and treatment in our hospital were retrospectively enrolled. They were divided into the multidisciplinary assessment group (n = 130) and routine assessment group (n = 112). Multidisciplinary assessments were completed by a multidisciplinary team, and the data included structured medical history, physical and neurological examinations, bladder and bowel diaries, sleep diaries, questionnaires, psychological assessments, urinary ultrasonography, blood and urine laboratory tests, polysomnography and balance assessments. A higher proportion of patients with enuresis associated with other conditions was identified in the multidisciplinary assessment group than in the routine assessment group (27.7% vs 15.2%, p = 0.019). With regard to treatment response to the enuresis alarm, the treatment response rate was 52.9% (17/33) in the conventional assessment group, whereas such a response was significantly higher in the multidisciplinary assessment group (82.1%, 32/39; p = 0.028). Compared with the routine assessment group, the multidisciplinary assessment group had a significantly higher treatment response rate for desmopressin (83.3% vs 52.0%; p = 0.022) and alarms combined with desmopressin (74.2% vs 44.4%; p = 0.045). After treatment, the Pediatric Quality of Life Inventory version 4.0 (PedsQL 4.0) score in the multidisciplinary assessment group was significantly higher than that in the routine assessment group (91.9 ± 6.3 vs 87.1 ± 7.3; p < 0.001). Multidisciplinary evaluation can identify more children with enuresis caused by other diseases, which promotes the differential diagnosis of MNE. In addition, multidisciplinary assessment can determine the appropriate treatment response in children with MNE.

Feasibility and Effectiveness Assessment of the New Triage System Adopted by the Disaster Medicine Service of Regione Piemonte: Results of a Controlled Randomized Study

Introduction:Validation of the new MCI Triage protocol of Regione Piemonte by comparing it with the already published and internationally used START/Jump START protocol. Compare its accuracy, execution time, over and under triage indices and the influence of any rescuer characteristics in reference to adult and pediatric victims when in use in a simulated multi-casualties event setting.Method:We conducted a randomized controlled experimental study in a simulation setting. A group of 35 people involved in an incident (volunteer participants) was assessed by a population of trained and untrained healthcare professionals (nursing students and nurses). The participants were randomly divided into two homogenous groups to which the two protocols were explained separately and carried out the simulation in single-blind. Evaluation data were collected and statistically processed. The resulting items were used to compare the accuracy, over- and under-triage rates and any items related to rescuer characteristics for each triage system.Results:74 subjects were included in the study. Of these, 56.7% were healthcare professionals in training and 43.4% were trained nurses. Compared to standard criterion definitions, the MCI triage protocol showed a higher accuracy rate than START (88.4% vs 80.4%, p&lt;0.01). MCI triage had a significant lower rate of underestimation compared to START (8.9 vs 13.6%, p&lt; 0.01) as well as overestimation (3.2% vs. 6.8%, p&lt; 0.01). Time is only correlated with the performance of MCI triage, influencing its accuracy. There were no significant differences in the accuracy of diagnosis in pediatric patients.Conclusion:We found that MCI method triaged adult patients more often correctly than START method. Underestimation and overestimation were lower than in the control method, although there tended to be a significant overestimation of white codes which were not present in the START system. In the assessment of pediatric patients, the protocols are equivalent.

Triponderal mass index and markers of metabolic risk in children and adolescents with obesity

Background and objectiveTriponderal mass index (TMI) would estimate excess adiposity better than body mass index (BMI), maintaining stable values during childhood. This work aims to determine the correlation between TMI and markers of metabolic risk as well as set values of TMI that are related to an increase of metabolic risk. Material and methodsMulticenter, observational, cross-sectional and prospective study in children under 14 years of age with obesity. Variables: age, sex, pubertal stage, weight, height, abdominal circumference, BMI, TMI, basal glucose and insulin, HOMA index, blood pressure, lipoprotein profile, transaminases and uric acid. BMI and TMI were expressed according to the values of the Barcelona Longitudinal Study. Statistical analysis was performed with the SPSS® program. Results199 patients (50.3% male), age 11.08 (2.48) years, TMI 19.68 (2.36) kg/m3. Correlation between TMI and abdominal circumference (r 0.571; p 0), insulin (r 0.198; p 0.005), HOMA index (r 0.189; p 0.008) and HDL-c (r −0.188; p 0.008) was observed. IMT>20.15kg/m3 was associated with insulin ≥15 mIU/mL (p 0.029) and IMT>20.36kg/m3 with HDL-c <40mg/dl (p 0.023). ConclusionsTMI was correlated with increase of abdominal circumference, insulin and HOMA index and decrease of HDL-c. IMT>20kg/m3 can be associated with increased insulin and decreased HDL-c. Therefore, the IMT seems to be a useful parameter in the assessment of pediatric patients with obesity.

Pain Assessment in Pediatric Patients with Primary Bone Cancer in a Single Site Cohort

Introduction: Pain is the main symptom described in cancer patients. Objective: To assess pain classification and management in pediatric patients with primary bone cancer over time: admission, during treatment and follow-up, and to investigate factors associated with pain classification at the last assessment. Method: Retrospective cohort study of osteosarcoma and Ewing's sarcoma cases in individuals &lt;19 years old treated at a single cancer referral site and followed up by a multidisciplinary team. The primary endpoint was pain score at the last assessment. Secondary outcome: evolution of pharmacological treatment. Results: 142 patients were included. The frequency of pain assessment increased during the study period from 53.5% at admission to 68.3% during treatment and 85.9% in follow-up. Of the patients who had pain assessed, 65.8% had pain at admission and 26.2% at the end of the study. There was an increase in the use of strong opioids and antidepressants. In the last evaluation, 56 patients (39.4%) were at the end-of-life and this was not associated with more pain (p=0.68). Meanwhile, those who had more pain used strong opioids (p=0.01) or steroids (p=0.03). Conclusion: Pain management during treatment resulted in increased use of strong opioids and antidepressants with pain reduction, revealing that pain control is possible. In the last assessment, end-of-life patients no longer had pain and patients with pain were the ones who used strong opioids and steroids at the most, showing the difficulty of pain control in some patients.

Evaluation of pain in the paediatric patient admitted to sub-intensive care: a scoping review protocol.

pain is considered as the 5th vital sign thus it's paramount that healthcare professionals are equipped with validated tools for his correct assessment. There are different paediatric pain assessment scales that take into account patients' age. Actually, the "Face, Legs, Activity, Cry, Consolability" (FLACC), Wong-Baker and NRS scales are regarded as the gold standard in low intensity clinical areas, while the COMFORT-Behavior (COMFORT-B) and Behavioral Pain Scale (BPS) ones are used for high intensity clinical areas where paediatric patients are sedated/intubated. It's unclear which pain assessment scale should be used in sub-intensive areas such as Sub-Paediatric Intensive Care Unit (Sub-PICU) e Sub-Neonatal Intensive Care Unit (Sub-NICU). The aim of this protocol is to map the literature in order to identify what evidences are available regarding the assessment of pain in the paediatric sub-intensive clinical areas. "What is the literature available on pain assessment in paediatric patients in sub-intensive clinical areas such as Sub-PICU and sub-NICU?". literature search will be performed through the following databases: PubMed, Scopus, CINAHL, Cochrane Library, Open Dissertations (EBSCO) and DOAJ. Furthermore, Cochrane CENTRAL and ClinicalTrials.gov will also be included. this scoping review will be conducted in accordance to the Joanna Briggs Institute guidelines and the results presented through a PRISMA flowchart. Open Science Framework https://doi.org/10.17605/OSF.IO/8KBRQ.

Integrated lung and inferior vena cava ultrasonography for dry weight assessment in pediatric patients on regular hemodialysis: A single center study

Integrated lung and inferior vena cava ultrasonography for dry weight assessment in pediatric patients on regular hemodialysis: A single center study