Protocol For Children Research Articles

Determination of relative dose of ionizing radiation in the thyroid gland using a panoramic device with different protocols.

The use of panoramic radiography (PR) is a complementary examination to aid in the diagnosis of cases in paediatric dentistry. The lack of specific protocols for these devices, however, can result in high doses of radiation, affecting critical organs such as the thyroid. To evaluate the discrepancies in ionizing radiation received by the thyroid during PR examinations using anthropomorphic paediatric simulators built from computed tomography images. Two anthropomorphic paediatric phantoms were printed and used, representing children aged 6 and 11 years, with an opening in the thyroid region for the insertion of dosimetric radiographic films. The simulators were subjected to different pre-existing protocols in the PR devices. The radiographic films were processed and analysed using a luxmeter. The radiation dose to the thyroid was higher in the 6-year-old phantom than in the 11-year-old phantom, for given exposure factors. In addition, there was an increase in dose in children's protocols compared with small adult protocols. Therefore, companies that develop PR equipment must develop child protocols for separate age groups that will consequently reduce the radiation dose in children, especially in their critical organs.

Paediatric Organ and Tissue Donation: Developing a Comprehensive Protocol for Effective Donation Procedures in the Netherlands

The waiting list for children needing organ and tissue transplantation increases yearly; some die while waiting for a suitable transplant. Most of them need small organs or tissues from paediatric donors. Paediatric donation is a unique and extremely sensitive process that requires specific knowledge and competencies. Because paediatric donation is relatively rare and complex, gaining knowledge and experience in this field is difficult. This article describes essential facts about donation and transplantation concerning children in the Netherlands and summarises studies reporting on the various factors influencing paediatric donation. The methodology used combines various research methods, including literature review, online survey, face-to-face interviews, and retrospective study, to evaluate the organ and tissue donation protocols for the paediatric population in Dutch Paediatric Intensive Care Units and Neonatal Intensive Care Units. The studies provide insights into the current process and limitations of paediatric donation and offer recommendations for the development of a paediatric donation protocol. Recurrent themes that emphasise the importance of a robust paediatric donation process were identified and later used to form the groundwork for a paediatric donation protocol. Healthcare professionals lack knowledge and experience with donation procedures. Work experience at the Paediatric Intensive Care Unit or Neonatal Intensive Care Unit is not related to the gained experience in the organ or tissue donation procedure. Paediatric Intensive Care nurses had significantly less experience than Paediatric Intensivists. The survey respondents confirmed needing more guidance on the paediatric donation process. They further agreed there was a need for an easily accessible and clear guidelines document for paediatrics known as “the children's protocol” to cover all types of paediatric donation procedures (Donation after Brain Death, Donation after Circulatory Death and tissue donation). Neonatal Intensive Care Unit donation potential is limited. A new donation protocol for paediatrics was designed using the results of all the above studies. The comprehensive protocol for paediatric organ donation in the Netherlands aims to assist healthcare professionals in identifying potential donors and referring them to an Organ Procurement Organization in a timely manner. Additionally, the protocol will support healthcare professionals in conducting sensitive yet necessary discussions with the family regarding the possibility of organ and tissue donation. Finally, while using the protocol, healthcare professionals provide the appropriate state-of-the-art support to the parents during a challenging and emotional time.

The Effects of a Direct Discharge Protocol in Children with a Bicycle Spoke Injury

The Effects of a Direct Discharge Protocol in Children with a Bicycle Spoke Injury

785-P: Comparison of Six Months Experience on Hybrid Closed Loop MiniMed 670G System and Advanced Hybrid Closed Loop MiniMed 780G System Using a Structured Initiation Protocol in Children and Adolescents with Type 1 Diabetes

Background: The objective of this study was to evaluate glycemic outcomes using a structured initiation protocol for Hybrid Closed Loop (HCL) MiniMed 670G and Advanced Hybrid Closed Loop (AHCL) Minimed 780G system in children and adolescents with Type 1 Diabetes (T1D) previously treated with Multiple Daily Injections. Methods: The data from two separate (HCL and AHCL system) investigations were analyzed in individuals (aged 7-18 years) with T1D on MDI therapy, both followed a structured initiation protocol. Time in Ranges, HbA1c and system characteristics were analyzed between two systems at 3 and 6 months of Automated Insulin Delivery (AID) . Results: 30 children (age 10.24 ± 2.6 years, HbA1c 8.2±1.4% (66±15.3 mmol/mol)) with HCL system and 34 children (12.5 ± 3.7 years, 8.6±1.7% (70±18.6 mmol/mol)) with AHCL system completed the planned 12 weeks of AID. TIR (70-180mg/dl) of 73.4±8.9% with HCL and 78.2±4.3% with AHCL (p=0.01) was achieved at 6 months of AID. No episodes of severe hypoglycemia or DKA were reported using both systems. Conclusion: Individuals using AHCL MiniMed 780G system had more stringent system settings, spent more time in AID with less exits, which possibly lead to further improvements of glycemic control compared to HCL MiniMed 670G system using the same structured protocol. Disclosure G.Petrovski: None. J.Campbell: Advisory Panel; Medtronic. F.Alkhalaf: None. K.Hussain: None.

Safety of Modified Sesame Desensitization Protocols in Children in Real-World Clinical Practice

A major limitation of current oral immunotherapy (OIT) protocols is the risk of anaphylaxis. We aim to explore modified OIT protocols that promote a safer approach to sesame desensitization, without compromising effectiveness.

Exploring the Feasibility of a Virtual, Home-Based MusicGlove® Protocol for Children with Hemiparetic Cerebral Palsy

Background: The MusicGlove® as an occupational therapy intervention has been shown to improve upper limb function and satisfaction over conventional therapies for adults who have had a stroke, however, its effectiveness with children who have cerebral palsy has not been examined. The purpose of this research was to explore the feasibility of a virtual, home-based MusicGlove® protocol to increase upper extremity function, quality of life, and internal motivation in children with hemiparetic cerebral palsy. Method: Three participants, ages 6 to 16, diagnosed with hemiparetic cerebral palsy participated in 23 guided sessions using the home-based MusicGlove protocol over 5 weeks. Functional outcomes, quality of life, and intrinsic motivation were measured using the ABILHAND-Kids, Cerebral Palsy Quality of Life, and Intrinsic Motivation Inventory. Results: Two participants had an increase in percentages of notes hit (13%­­–20%) following the MusicGlove® intervention. All three participants rated the MusicGlove® as being of value/usefulness and two reported interest/enjoyment in using the MusicGlove®. All three participants and their caregivers reported an increase in quality of life and decrease in perceived difficulty of daily activities. Conclusion: The virtual, home-based MusicGlove® protocol may be a feasible intervention to improve hand function for children diagnosed with cerebral palsy.

Impact of a Standardized Emergency Department Pain Protocol for Children with Sickle Cell Disease

Background/Objective: Sickle cell disease (SCD) is a common heritable red blood cell disorder that transcends the lifespan. Abnormal sickle-shaped erythrocytes interfere with blood flow in small vessels resulting in vaso-occlusion. This vaso-occlusion leads to tissue ischemia and inflammation which causes severe pain and is commonly referred to as a vaso-occlusive crisis (VOC). VOC is the most common complication seen in SCD and accounts for the majority of Emergency Department (ED) visits and hospitalizations. The primary objective of this study was to evaluate if pain management of SCD in pediatric patients at our institution was in accordance with national and institutional pain management guidelines before and after implementation of a standardized pain management algorithm.
 Methods: We retrospectively analyzed electronic medical record (EMR) data at Riley Hospital for Children between June 2015-May 2018, as well as from January 2019-December 2019 from for all pediatric patients (0-21 years old) who presented to the Riley ED with a confirmed diagnosis of SCD and uncomplicated VOC. These timeframes represented pre and post implementation of a standardized pain management algorithm, which has been described separately. The data collected included time to first dose of analgesia, type and dose of analgesia, change in pain score, length of stay in the ED, and disposition (discharge or admission). Univariate analyses were used to compare data between encounters.
 Results: Prior to implementation, 186 patients were seen for a total of 504 encounters, the majority of whom were male (59%, p<0.001) and had Hb SS disease (67%, p<0.001). The mean length of an ER visit was approximately 5 hours (+/-113 minutes). The median pain score at presentation was 9 (0-10 scale), with an average of 23 minutes from check in to first documented pain score. However, 19% of patients had no initial pain score documented, which occurred more often if the patient’s initial analgesic was given orally (p<0.001). The mean time from ED check in to first dose of analgesia (PO, IV, IN) was 76 minutes. The mean time between pain scores and medication administration increased between subsequent doses. 70% of these encounters resulted in hospitalization, with an average LOS of 4.1 days. Analysis of data following implementation of a standardized pain management algorithm is ongoing.
 Conclusion: Acute pain episodes are the leading cause of ED visits and hospitalizations for those with SCD. Thus, to properly meet the needs of patients with SCD and improve their outcomes, there needs to be collaborative, standardized and SCD- specific clinical guidelines for ED providers to utilize. Pre-implementation of a standardized acute pain management algorithm, our institution was not meeting national guidelines for administration of analgesia and assessment of pain. Post-implementation results are currently under analysis.
 Impact and Implications: Patients with SCD experience longer wait times in the ED and significant bias and mistrust regarding pain concerns. Standardized clinical guidelines have the potential to improve care and decrease variation in care delivery. The results from our study can inform institutional and national policy makers on gaps that exist in pediatric SCD, so that research funding can be appropriately allocated.

Commentary on "Effectiveness of Different Physiotherapy Protocols in Children in the Intensive Care Unit: A Randomized Clinical Trial".

Commentary on "Effectiveness of Different Physiotherapy Protocols in Children in the Intensive Care Unit: A Randomized Clinical Trial".

Comparing the Transfer Effects of Three Neurocognitive Training Protocols in Children With Attention-Deficit/Hyperactivity Disorder: A Single-Case Experimental Design

AbstractThe current study used behavioural and electroencephalograph measures to compare the transferability of three home-based interventions — cognitive training (CT), neurofeedback training (NFT), and CT combined with NFT — for reducing symptoms in children with attention-deficit/hyperactivity disorder (AD/HD). Following a multiple-baseline single-case experimental design, twelve children were randomised to a training condition. Each child completed a baseline phase, followed by an intervention phase. The intervention phase consisted of 20 sessions of at-home training. Tau-U analysis and standardised visual analysis were adopted to detect effects. Results showed that CT improved inhibitory function and NFT improved alpha EEG activity and working memory. The combined condition, which was a reduced ‘dose’ of CT and NFT, did not show any improvements. The three conditions did not alleviate AD/HD symptoms. While CT and NFT may have transfer effects on executive functions, considering the lack of improvement in symptoms, this study does not support CT and NFT on their own as a treatment for children with AD/HD.

Evaluation of Sedentary Behavior and Physical Activity Levels Using Different Accelerometry Protocols in Children from the GENOBOX Study

BackgroundPhysical activity (PA) has acquired a significant relevance due to the health benefits associated with its practice. Accelerometers are an effective tool to assess PA; however, the diversity of cut-off points used to define different PA intensities through accelerometry could interfere in the interpretation of the findings among studies.ObjectivesThe present study aimed to examine the sedentary behavior (SB) and physical activity (PA) levels in children using six selected accelerometry protocols based on diverse cut-off points.MethodsClinical examination, anthropometric measurements, and PA evaluation by accelerometry were assessed in 543 selected children (10 ± 2.4 years old) from the Spanish GENOBOX study. The ActiLife data scoring program was used to determine daily min spent in SB, and light, moderate, vigorous and moderate-vigorous PA using six validated accelerometry protocols differing in their cut-off points.ResultsVery different estimations for SB and PA intensity levels were found in children, independently of the non-wear-time algorithm selected, and considering puberty stages, age and body mass index. The time spent in daily SB varied from 471 to 663.7 min, PA ranged from 141 to 301.6 min, and the moderate-vigorous PA was reported between 20.7 and 180.2 min.ConclusionThe choice of a particular accelerometry protocol considering these factors is important to evaluate SB or PA intensities to suit the characteristics of the sample researched. It seems necessary to establish future lines of research that include different analytical approaches to measure SB and PA by accelerometry based on standardized and validated methodology.

Preventing Hospital-Acquired Pressure Injuries by Using a Tiered Protocol in Children Receiving ECMO in the Pediatric Intensive Care Unit.

Preventing Hospital-Acquired Pressure Injuries by Using a Tiered Protocol in Children Receiving ECMO in the Pediatric Intensive Care Unit.

Postoperative Pain Protocol in Children after Selective Dorsal Rhizotomy

Introduction: Selective dorsal rhizotomy (SDR) provides lasting relief of spasticity for children suffering from cerebral palsy, although controlling postoperative pain is challenging. Postoperatively, escalation of therapies to include a patient-controlled analgesia (PCA) pump and intensive care unit (ICU) admission is common. Objectives: We developed a multimodal pain management protocol that included intraoperative placement of an epidural catheter with continuous opioid administration. We present the 3-year results of protocol implementation. Methods: With institutional review board approval, all patients who were subjected to SDR at our institution were identified for review. Hourly pain scores were recorded. Adverse effects of medication, including desaturation, nausea/vomiting, and pruritus, were also noted. Comparisons were made between patients treated with PCA and those treated with multimodal pain control using t and χ² tests as appropriate. Results: Thirty-nine patients undergoing the procedure with protocolized pain control (average age 6.8 years, 57% male) were compared to 7 PCA-treated controls (average age 6.6 years, 54% male). Pain control was satisfactory in both groups, with average pain scores of 1.5 in both groups on postoperative day 0, decreasing by postoperative day 3 to 1.1 in the PCA group and 0.5 in the protocol group. No patients under the protocol required ICU admission; all patients with PCA spent at least 1 day in the ICU. Desaturations were seen in 16 patients in the protocol group (41%), but none required ICU transfer. Treatment for pruritis was given to 57% of PCA patients and 15% of protocol patients. Treatment for nausea and vomiting was given to 100% of PCA patients and 51% of protocol patients. Medication requirements for the hospitalization were decreased from 1.1 to 0.28 doses per patient for pruritis, and from 3 to 1.1 doses per patient for nausea. Conclusions: Multimodal analgesia is an excellent alternative to PCA for postoperative pain after SDR. Actual analgesia is comparative to that of controls without the need for intensive care monitoring. Side effects of high-dose opiates were less frequent and required less medication. With the protocol, patients were safely treated outside the ICU.

Spectacle utilisation rate and reasons for non-compliance with wearing of spectacles amongst primary school children in Onitsha, Anambra state, Nigeria

Background: Uncorrected refractive errors (REs) are becoming very common in children in developing countries, yet the use of spectacles and compliance to wear are not well documented in African children. Aim: To determine spectacle utilisation rate and reasons for non-compliance with spectacle wear amongst primary school children. Setting: Primary schools in Onitsha, Anambra state, Nigeria. Methods: A stratified random cluster sampling procedure was used to select children aged 5–15 years in 17 primary schools. A total of 1020 were enumerated – 998 (97.8%) were examined, and 97 (9.7%) had RE (uncorrected visual acuity of 20/40 or worse in both eyes). A questionnaire interview using items derived from the revised Refractive Error Study in Children protocol was used to get information regarding reasons for spectacle wear non-compliance. Results: Of the 97 children with RE, 20 wore their spectacles during the time of study, yielding a spectacle utilisation rate of 20.6%. Eleven (55%) of those wearing spectacles were females, 13 (65%) were myopic and the highest number (50%) of spectacle wearers was in the 8–10 years age category. Age, gender and type of RE were significantly associated with spectacle wear ( p < 0.05 was considered statistically significant). The major reasons for non-compliance with spectacles wear were parental disapproval for using spectacles and misconceptions about wearing spectacles. Conclusion: Spectacle utilisation amongst primary school children in Onitsha was low. These findings suggest the need for public awareness about the importance and benefits of wearing spectacles.

Shoulder Rotation Function Following the Sup-ER Protocol in Children with Brachial Plexus Injuries.

Background: Our group previously developed an upper extremity repositioning (Sup-ER) protocol for brachial plexus birth injuries (BPBIs) that may improve supination and external rotation (ER) at 2 years of age. Questions were raised about the potential for the protocol to cause internal rotation (IR) deficits. The goal of this study was to explore the longer-term outcomes of the Sup-ER protocol and investigate IR/ER function. Methods: This prospective cross-sectional cohort study examined 16 children older than 4 years of age with significant enough BPBI to be treated with the Sup-ER protocol. Total shoulder and elbow function were assessed, including passive and active ranges of motion and strength of IR and ER. Results: Range of motion (ROM) for most active movements was decreased in the affected compared to unaffected arm. Notably, IR passive ROM was similar in the affected (78.7°) and unaffected arm (82.8°). External rotation strength of the affected arm was weaker (42.8 N) compared to the unaffected arm (57.9 N). IR strength had a greater deficit in the affected (43.2 N) arm compared to the unaffected arm (72.2 N), but both ER and IR showed less deficit than described in the literature. Conclusions: Despite differences in ranges of motion between the affected and unaffected arms, ROMs for the affected arm were comparable to the functional limits as reported in the literature. The Sup-ER protocol shows potential to optimize long-term shoulder rotation function in children with BPBI without compromising IR.

Safety of a Modified Environmental Rush Immunotherapy Protocol in Children

Safety of a Modified Environmental Rush Immunotherapy Protocol in Children

Implementation of a Nurse-Empowered Renal Anemia Protocol in Children

A high proportion of patients on hemodialysis persist with low hemoglobin levels despite receiving treatment with erythropoiesis-stimulating agents. A registered nurse-driven renal anemia protocol was designed and implemented by a team in a pediatric hemodialysis unit. We compared proportion of patients achieving the target hemoglobin (Hgb) and transferrin saturation (TSAT) before and after the implementation of the protocol. There was an increase in patients achieving the target Hgb and TSAT range, with an increase in the Hgb concentration. There were no differences in the proportion of patients with left ventricular hypertrophy, erythropoiesis-stimulating agents or intravenous iron dose, transfusion rates, or hospitalization rates. The implementation of a nurse-driven anemia protocol in a pediatric hemodialysis unit increased the proportion of patients achieving target Hgb and TSAT range without a rise in medication doses.

Evaluating Adherence to Return to School and Activity Protocols in Children After Concussion.

The need to have a pediatric-specific concussion management protocol on Return to School (RTS) and Return to Activity (RTA) after concussion has been recognized internationally. The first step to evaluate the protocol effectiveness is to establish whether children and youth are adhering to these recommendations. The objective of this study was to explore the prevalence and predictors of adherence to RTS and RTA concussion management protocols for children/youth. A prospective cohort of children/youth with concussion. Childhood Disability Research Centre. One hundred thirty-nine children/youth aged 5 to 18 years, diagnosed with concussion and symptomatic upon enrollment, were followed for up to 6 months. Primary recruitment occurred from a Children's Hospital Emergency Department. Provision of RTS/RTA guidelines. Measurement of adherence came from multiple sources, including the child's and parent's knowledge of protocols, research personnel evaluations, and self-reported stages of RTS/RTA and Post-Concussion Symptom Scale (PCSS) scores. Spearman correlations and logistic regression were used, investigating the relationship between PCSS and progression of protocols and determining predictors of adherence. Significant negative associations between total PCSS score and stage of RTS/RTA protocols were found. Fifty-three percent and 56% of the participants adhered to the RTS and RTA protocols, respectively. Children's knowledge of protocols and total PCSS scores significantly predicted adherence to RTS/RTA and may be the most important factors in predicting adherence during recovery from concussion.

International Cooperative Treatment Protocol for Children and Adolescents With Lymphoblastic Lymphoma

International Cooperative Treatment Protocol for Children and Adolescents With Lymphoblastic Lymphoma

Safety and Efficacy of a Propofol and Ketamine Based Procedural Sedation Protocol in Children with Cerebral Palsy Undergoing Botulinum Toxin A Injections.

Pediatric patients with cerebral palsy often undergo intramuscular botulinum toxin (BoNT-A) injections. These injections can be painful and may require procedural sedation. An ideal sedation protocol has yet to be elucidated. To investigate the safety and efficacy of a propofol and ketamine based sedation protocol in pediatric patients with cerebral palsy requiring BoNT-A injections. Retrospective chart review. The sedations took place in a procedural sedation suite at a tertiary children's hospital from February 2013 through September 2017. 164 patients with diagnoses of cerebral palsy undergoing propofol and ketamine based sedation for injections with botulinum toxin A. An initial bolus of 0.5 mg/kg ketamine followed by a 2 mg/kg bolus of propofol was administered with supplemental boluses of propofol as needed to achieve deep sedation during the intramuscular BoNT-A injections. Propofol dosages, adverse events, serious adverse events, and sedation time parameters were reviewed. 345 sedations were successfully performed on 164 patients. The median total dose of propofol was 4.7 mg/kg (interquartile range [IQR]: 3.5, 6.3). Adverse events were encountered in 10.1% of procedures including hypoxemia responsive to supplemental oxygen (9.6%) and transient apnea (1.4%). The mean procedure time, recovery time, and total sedation time were 10, 11 and 33 minutes, respectively. With regard to patient variables, including age, weight, dose of propofol, sedation time, and Gross Motor Function Classification System classification, there was no association with increased incidence of adverse events. Our sedation protocol of propofol and ketamine is safe and effective in children with cerebral palsy undergoing procedural sedation for intramuscular injections with BoNT-A. The adverse events encountered appeared to be related to airway and respiratory complications secondary to musculoskeletal deformities, emphasizing the importance of airway monitoring and management in these patients. IV.

EMDR Intervention for a 17-Month-Old Child to Treat Attachment Trauma: Clinical Case Presentation

This article explores the effectiveness of treating a 17-month-old male diagnosed with posttraumatic stress disorder (PTSD) and a disrupted secure attachment utilizing eye movement desensitization reprocessing (EMDR) and an integrative family therapy approach. The child experienced a life-threatening choking incident requiring hospitalization. Pretreatment, the child was inconsolable by his parents when distressed and could not tolerate anything touching his throat. Posttreatment, the child accepts comfort from his parents and allows his mother to kiss his throat. Results demonstrate a reduction or elimination of PTSD symptoms and a return to a secure attachment. This case study underscores Shapiro’s Adaptive Information Processing (AIP) model (2001). Application and customization of the eight phases of EMDR therapy are highlighted along with the Integrative Attachment Trauma Protocol for Children (IATP-C). Treatment consisted of five sessions. Customization included caregiver psychoeducation; EMDR resource development, focused on strengthening attachment and regulating emotion; and facilitating caregiver co-regulation throughout EMDR. The use of EMDR therapy with customization through the IATP-C protocol shows promise as an effective intervention for treating posttraumatic stress symptoms and repairing attachment in very young children.