Tool For Children Research Articles

Cost-effectiveness of whole-exome sequencing in progressive neurological disorders of children.

To clarify the diagnostic utility and the cost-effectiveness of whole-exome sequencing (WES) as a routine early-diagnostic tool in children with progressive neurological disorders. Patients with infantile-onset severe neurological diseases or childhood-onset progressive neurological disorders were prospectively recruited to this WES study, in the pediatric neurology clinic at Helsinki University Hospital during 2016-2018. A total of 48 patients underwent a singleton WES. A control group of 49 children underwent traditional diagnostic examinations and were retrospectively collected from the hospital records. Their use of health care services, related to the diagnostic process, was gathered. Incremental cost-effectiveness ratio (ICER) per additional diagnosis was calculated from the health care provider perspective. Bootstrapping methods were used to estimate the uncertainty of cost-effectiveness outcomes. WES provided a better diagnostic yield (38%) than diagnostic pathway that did not prioritize WES in early diagnosis (25%). WES outperformed other diagnostic paths especially when made early, within one year of first admission (44%). Cost-effectiveness in our results are conservative, affected by WES costs during 2016-18. WES is an efficient and cost-effective diagnostic tool that should be prioritized in early diagnostic path of children with progressive neurological disorders. The progressively decreasing price of the test improves cost-effectiveness further.

Возможности реализации скрининговых методов оценки нутритивного риска у детей с неврологической патологией

Objective. Comparative evaluation and study of the effectiveness of using different nutritional risk screening tools in children with neurological pathology. Patients and methods. This study included 105 children with neurological pathology (epilepsy, cerebral palsy, congenital anomalies of the nervous system), among whom were 50 (47.6%) boys and 55 (52.4%) girls aged 1 to 17 years (7.8 ± 4.9 years). Anthropometric indices were assessed and questionnaires using nutritional risk screening tools were conducted, followed by calculation of their sensitivity and specificity. STRONGkids (Screening Tool Risk on Nutritional Status and Growth), PYMS (Pediatric Yorkhill Malnutrition Score), and STAMP (Screening Tool for the Assessment of Malnutrition in Paediatrics) were used. Results. Assessment of anthropometric indices (weight-for-height, BMI-for-age, and height-for-age Z-scores) indicated malnutrition in 5 to 15 children (4.8-14.3%), depending on the evaluation criteria. According to the screening results, all patients were classified as high and medium risk of malnutrition, and 94 (89.5%) children required nutritional care according to STRONGkids, 38 (36.2%) children – according to PYMS, and 104 (99%) children – according to STAMP. The most sensitive screening tool was STAMP with a sensitivity score of 89.5% as compared with STRONGkids and PYMS (21.1% and 31.6%, respectively). Conclusion. The results of this work demonstrate the advantages of the STAMP tool in assessing the nutritional status of children with neurological pathology, given its higher efficacy in this group of patients, and the need for further research to develop practical recommendations. Key words: children, nutrient deficiency, nutritional risk screening tools

ĐỀ XUẤT CÁC TIÊU CHÍ CƠ BẢN TRONG XÂY DỰNG BỘ CÔNG CỤ GIAO TIẾP BỔ TRỢ VÀ THAY THẾ CHO TRẺ RỐI LOẠN PHỔ TỰ KỈ

Augmentative Alternative Communication (AAC) is a system or approach used to facilitate communication skills for individuals who are nonverbal, minimally verbal or have unintelligible speech productions. For individuals with Autism Spectrum Disorders (ASD), AAC is often associated with images, photos and pictures. The article reviews the use of the AAC for children with ASD, including common types of the AAC used for this population. Based on the review, the article suggests the essential criteria for creating the AAC toolkit for Vietnamese children with ASD alignment with illustrations. These criteria are developed based on both the international standards of the AAC tools for children with ASD and the Vietnamese people's cultural and communication characteristics.

Use of the Snoring, Trouble Breathing, Un-Refreshed questionnaire to predict perioperative respiratory adverse events in children.

The Snoring, Trouble Breathing, Un-Refreshed (STBUR) screening questionnaire has been validated in identifying pediatric surgical patients with symptoms of sleep-disordered breathing who may be at risk of perioperative respiratory adverse events. We sought to assess the performance of the STBUR questionnaire when adjusting for potential confounders such as patient comorbidities or surgical service. This was a retrospective cohort study of children aged 2-18 years undergoing elective procedures under general anesthesia over a 3-month period. Procedure specialties included general surgery, urology, orthopedic surgery, neurosurgery, plastic surgery, otolaryngology, dentistry, and gastroenterology. Preoperative STBUR questionnaire responses and perioperative respiratory adverse events were documented prospectively. Multivariate logistic regression was used to quantify associations between preoperative questionnaire responses, other potential risk factors (including age, sex, surgical specialty, comorbidities), and risk of perioperative respiratory adverse events. Of 555 children, 17% had a positive STBUR screen. The prevalence of perioperative respiratory adverse events with a positive questionnaire screen was significantly greater than with a negative screen (29% vs 9%, respectively; P < .001). A positive questionnaire screen was associated with a significantly increased risk of a perioperative respiratory adverse event (adjusted odds ratio 3.47 [95% confidence interval 1.53-7.84], P = .003). A positive screen on the STBUR questionnaire was associated with a 3.5-fold increased risk of perioperative respiratory adverse events in pediatric surgical patients. The STBUR questionnaire should be considered as a routine preoperative screening tool in children undergoing elective procedures. Huerta J, Taleu H, Norton R, Gries H, Yun P, Lam D. Use of the Snoring, Trouble Breathing, Un-Refreshed questionnaire to predict perioperative respiratory adverse events in children. J Clin Sleep Med. 2022;18(3):695-701.

Validation of the Lusaka Formula: A Novel Formula for Weight Estimation in Children Presenting for Surgery in Zambia.

In children, the use of actual weight or predicted weight from various estimation methods is essential to reduce harm associated with dosing errors. This study aimed to validate the new locally derived Lusaka formula on an independent cohort of children undergoing surgery at the University Teaching Hospital in Lusaka, Zambia, to compare the Lusaka formula's performance to commonly used weight prediction tools and to assess the nutritional status of this population. The Lusaka formula (weight = [age in months/2] + 3.5 if under 1 year; weight = 2×[age in years] + 7 if older than 1 year) was derived from a previously published data set. We aimed to validate this formula in a new data set. Weights, heights, and ages of 330 children up to 14 years were measured before surgery. Accuracy was examined by comparing the (1) mean percentage error and (2) the percentage of actual weights that fell between 10% and 20% of the estimated weight for the Lusaka formula, and for other existing tools. World Health Organization (WHO) growth charts, mid upper arm circumference (MUAC), and body mass index (BMI) were used to assess nutritional status. The Lusaka formula had similar precision to the Broselow tape: 160 (48.5%) vs 158 (51.6%) children were within 10% of the estimated weight, 241 (73.0%) vs 245 (79.5%) children were within 20% of the estimated weight. The Lusaka formula slightly underestimated weight (mean bias, -0.5 kg) in contrast to all other predictive tools, which overestimated on average. Twenty-two percent of children had moderate or severe chronic malnutrition (stunting) and 4.7% of children had moderate or severe acute malnutrition (wasting). The Lusaka formula is comparable to, or better than, other age-based weight prediction tools in children presenting for surgery at the University Teaching Hospital in Lusaka, Zambia, and has the advantage that it covers a wider age range than tools with comparable accuracy. In this population, commonly used aged-based prediction tools significantly overestimate weights.

QLF-D: A Contemporary Plaque Control Tool in Children.

Background and objectivesThe main causative factors for maximum periodontal diseases are dental plaque and oral biofilms. This study was done to check the impact of quantitative light-induced fluorescence-digital (QLF-D) as a motivational tool for plaque control among children from various schools situated in Dehradun district along with education using audiovisual aids.Materials and methodsA total sample of 800 school-going children including both males and females aged 6 to 12 years from various schools situated in Dehradun district of Uttarakhand were surveyed. A pro forma was prepared and the demographics of the students were noted. All the students were first examined for the Oral Hygiene Index-Simplified (OHI-S) and then the random division was done into two groups, group A (Q-scan) and group B (basic diagnostic aids) for examination of plaque index.ResultsThe results of the study revealed that good OHI-S scores increased significantly from 1st visit to 3rd visit. The plaque scores for the control group, when examined with basic diagnostic aids of all three visits, were significantly good which increased subsequently from 1st visit to 3rd visit. Good plaque index score increased significantly for the test group from 1st to 3rd visit when examined with QLF-D.ConclusionWe found in our study that QLF technology is of paramount importance in epidemiological surveys and plays a pivotal role in evaluating masses in maintaining oral health care.How to cite this articleSolanki R, Tuli A, Dhawan P, et al. QLF-D: A Contemporary Plaque Control Tool in Children. Int J Clin Pediatr Dent 2021;14(4):502–505.

Analysis of buccal mucosa as a prognostic tool in children with arrhythmogenic cardiomyopathy

BackgroundThe diagnosis of arrhythmogenic cardiomyopathy (ACM) is challenging especially in children at risk of adverse events. Analysis of cardiac myocyte junctional protein distribution may have diagnostic and prognostic implications, but its utility is limited by the need for a myocardial sample. We previously reported that buccal mucosa cells show junctional protein redistribution similar to that seen in cardiac myocytes of adult patients with ACM. ObjectivesWe aimed to determine when junctional protein distribution abnormalities first occur in children with ACM variants and whether they correlate with progression of clinically apparent disease. MethodsWe analyzed buccal mucosa samples of children and adolescents with a family history of ACM (n = 13) and age-matched controls (n = 13). Samples were immunostained for plakoglobin, desmoplakin, plakophilin-1 and connexin43 and analyzed by confocal microscopy. All participants were swabbed at least twice with an average interval of 12–18 months between samplings. ResultsJunctional protein re-localization in buccal mucosa cells did not correlate with the presence of ACM-causing variants but instead occurred with clinical onset of disease. No changes in protein distribution were seen unless and until there was clinical evidence of disease. In addition, progressive shifts in the distribution of key proteins correlated with worsening of the disease phenotype. Finally, we observed restoration of junctional signal for Cx43 in patient with a favorable response to anti-arrhythmic therapy. ConclusionsDue to ethical concerns about obtaining heart biopsies in children with no apparent disease, it has not been possible to analyze molecular changes in cardiac myocytes with the onset/progression of clinical disease. Using buccal smears as a surrogate for the myocardium may facilitate future studies of mechanisms and pathophysiological consequences of junctional protein redistribution in ACM. Buccal cells may also be a safe and inexpensive tool for risk stratification and potentially monitoring response to treatment in children bearing ACM variants.

Fostering Children\u2019s Participation in Disaster Risk Reduction Through Play: A Case Study of LEGO and Minecraft

This article focuses on children’s participation in disaster risk reduction. It draws on a 2018 study done in New Zealand with 33 school children who conducted participatory mapping with LEGO and the video game Minecraft to assess disaster risk in their locality and identify ways to be more prepared. The research involved participatory activities with the children actively involved in the co-design, implementation, and evaluation of the initiative. A focus group discussion was also conducted to assess the project from the viewpoint of the schoolteachers. The results indicate that LEGO and Minecraft are playful tools for children to participate in disaster risk reduction. The research identifies four key elements of genuine children’s participation, including the Participants, Play, the Process, and Power (4 Ps). This framework emphasizes that fostering children’s participation in disaster risk reduction requires focusing on the process through which children gain power to influence decisions that matter to them. The process, through play, is child-centered and fosters ownership. The article concludes that Play is essential to ground participation within children’s worldviews and their networks of friends and relatives.

Comparative analysis of major incident triage tools in children: a UK population-based analysis

IntroductionTriage is a key principle in the effective management of major incidents. There is currently a paucity of evidence to guide the triage of children. The aim of this study...

Pre- and Postnatal Damage to the Retro-Geniculate Visual Pathways Cause Retinal Degeneration Predictive for Visual Function.

To increase the understanding of the relationship between structure and function in individuals with damage to the brain from different stages of maturation of the visual system, we examined 16 teenagers and young adults. We used diffusion-weighted magnetic resonance imaging (MRI) and fiber tractography of the optic radiation (OR) and optical coherence tomography (OCT) of the peripapillary retinal nerve fiber layer (pRNFL) and the ganglion cell layer + inner plexiform layer (GC+IPL) in the macula. Visual field (VF) function was assessed with the Humphrey Field Analyzer (HFA). Injuries to the immature OR were associated with thinning of the pRNFL and GC+IPL, and corresponding VF defects irrespectively of timing of the lesion. However, in cases with bilateral white-matter damage of immaturity (WMDI) we noticed a well preserved central VF despite a very thin GC+IPL. We speculate that this is due to plasticity in the immature visual system. Similar results were not noticed among cases with unilateral damage, acquired pre- or postnatally, in which the central VF was affected in most cases. OCT has proved to be a valuable targeted tool in children with damage to the retro-geniculate visual pathways, and that focal thinning of the GC+IPL predicts VF defects. This brief research report includes a review of four previously published papers. In addition, we present one new case and apply a recently developed classification system for CVI. The classification was applied on cases with bilateral WMDI to investigate its relation to retinal structure.

Suicide Risk Screening in Pediatric Outpatient Neurodevelopmental Disabilities Clinics.

The purpose of this study was to describe the implementation of universal suicide risk screening in pediatric neurodevelopmental disabilities (NDD) medical clinics, analyze demographic and clinical characteristics of eligible patients, describe outcomes of positive screenings, and describe factors that influenced participation in screenings. A suicide risk screening protocol was developed and implemented for medical clinic patients aged 8 to 18 years. Registered nurses screened patients using the "Ask Suicide-Screening Questions" tool during triage. Positive screenings were referred for further assessment and mental health management. Demographics and clinical data were extracted from medical records using retrospective chart reviews. During the 6-month study period, 2961 individual patients presented for 5260 screening eligible patient visits. In total, 3854 (73.3%) screenings were completed with 261 (6.8%) positive screenings noted. Screenings were declined in 1406 (26.7%) visits. Parents of children with cognitive impairments were more likely to decline screening. Clinics serving children with autism spectrum disorder had higher rates of positive screenings compared with all other clinic attendees. Seventy-two of 187 children (38.5%) with positive screenings were identified and referred to outpatient mental health referrals. Seven (2.5%) of these children required acute psychiatric treatment. Routine screening, identification of increased suicide risk, and referral to mental health care among children with NDD are feasible. It remains unclear whether variation in rates among youth with and without NDD may indicate true differences in suicide risk or cognitive impairments or reflect psychiatric comorbidities. High rates of declined participation may have influenced identification of children with NDD and suicide risk. Preliminary findings identified groups of children with NDD at heightened risk for suicidal ideation and behavior. Further research is needed to assess the validity of suicide risk screening tools in children with neurodevelopmental disorders.

BERMAIN KONSTRUKTIF UNTUK MENINGKATKAN KEMAMPUAN BERBICARA PADA ANAK USIA 4-5 TAHUN

Constructive play is an imaginative and fun game. This is important for children's development, one of which is the ability to speak as a communication tool for children to express all ideas and feelings when playing constructively, children can explore with their imaginations, learn to find and pour new ideas, do problem solving and recognize rules. The research method used is descriptive qualitative research. The purpose of this study was to see the meaning and benefits of constructive play. Constructive play activities emphasize the nature of building and creating something that can stimulate children's speaking skills. Qualitative data analysis using the model from Miles and Huberman through triangulation: (1) data reduction, (2) data display, (3) verification, through observation, interviews and documentation during the action. The results showed that through constructive play based on peer groups can develop children's speaking skills. Through the experience of playing, creating and interacting with peer groups, children can improve all aspects of their speaking ability.

The Paediatric Evaluation of Emotions, Relationships, and Socialisation Questionnaire (PEERS-Q): development and validation of a parent-report questionnaire of social skills for children

ABSTRACT Background To assess social skills, professionals require a tool that is grounded in science, age-appropriate and sensitive to deviations from normal expectations. The Paediatric Evaluation of Emotions, Relationships and Socialisation Questionnaire (PEERS-Q) was developed to address this gap. This study aimed to detail the psychometric properties of PEERS-Q. Method 571 parents of children aged 5-15 years completed questionnaires about their child’s social competence (PEERS-Q, Social Skills Improvement System (SSIS), Strengths and Difficulties Questionnaire (SDQ)). Children completed a measure of estimated IQ. Confirmatory factor analysis explored reliability and validity of PEERS-Q. Age- and sex-adjusted T-scores were derived and relationships between these and validation instruments were explored. Results Six subscales were derived; Relationships, Participation, Social Rules, Social Communication, Social Cognition and Behaviour. PEERS-Q has good to very good internal consistency (α = 0.89, subscales 0.78-0.95); good convergent validity with the SSIS and the SDQ (r = 0.76, subscales 0.47 to 0.59), and good discriminant validity using Matrix Reasoning (r = – 0.11, subscales – 0.08 to – 0.11). Conclusions PEERS-Q is a useful tool for measuring domains of social competence in children/adolescents. PEERS-Q may improve a clinician’s ability to identify a young person’s social difficulties and hence guide intervention. Further research in clinical populations is required to determine these benefits. KEY POINTS What is already known about this topic: (1) There is currently a lack of robust and developmentally appropriate social skills assessment tools for children and adolescents. (2) Exisiting measures either fail to assess the complexity of social function, or are included as smaller sub-scales of broader outcome measures. (3) Without valid and reliable measures that target the specific subdomains of social skills, interventions cannot be targeted to specific social skills strengths and weaknesses. What this topic adds: (1) The PEERS-Q is a new tool for measuring social skills in children, grounded in developmental neuroscience. (2) PEERS-Q is a valid and reliable measure. (3) PEERS-Q may improve a clinician’s ability to identify a young person’s social difficulties and tailor the type of intervention required.

The Use of Interactive Panels in the Classroom and Health of Schoolchildren

Background: In contemporary conditions of digital transformation of education, the medical community, teachers, and parents are concerned about health effects of electronic learning tools in children. The emergence of new types of digital tools necessitates studies of related fatigue of schoolchildren in the dynamics of learning. A questionnaire-based survey of pupils aimed to establish their main complaints attributed to the use interactive panels, the most common type of educational boards in the classroom, helps identify and analyze weaknesses from the point of view of health maintenance in organization of the educational process. Objective: To study specific health effects of interactive panels used in the classroom in fifth-year pupils. Materials and methods: We conducted a questionnaire-based survey of 130 schoolchildren aged 11 years to establish their self-rated health, visual functions, risk factors and educational experience related to the use of interactive displays. Data processing was carried out using nonparametric methods of statistical analysis; relative risk values were established according to the rules of evidence-based medicine. Results: Some pupils, especially those with vision impairment, had complaints indicative of general and visual fatigue following the exposure to interactive panels. Inappropriate or excessive use of the interactive display in the classroom increased the frequency of such complaints. Conclusion: The reported adverse factors including bright light from the display, small and fuzzy image, rising temperature in the classroom, etc., defined preventive measures to be implemented for ensuring safe learning conditions.

Pengaruh Penggunaan Aplikasi “Si Pesek” (Stop Tindakan Pelecehan Seksual) Terhadap Pengetahuan Tentang Personal Safety Skill Pada Anak Usia Prasekolah di TK Manba’ul Huda Bekasi

Sexual child abuse is involving, persuading, or forcing a child to take part in sexual activities or encouraging the child to behave inappropriate sexual contact, and this is a frequent phenomenon. The purpose of this study was to identify the effect of using the application “si pesek” on personal safety skill knowledge in preschool children at Manba’ul Huda, Bekasi, West Java. The research design used was the equations experimental non equivalent control grop design with 30 respondents divided into two groups, intervention dan control. The result showed that the ads were the effect of giving the application “si pesek” on personal knowledge of safety skill with a p value 0.000 (0.05). There is an effect of confounding factors on children knowledge, namely age with p value 0.04 (0.05), environment with p value 0.04 (0.05), socio cultural with p value 0.04 (0.05) and information is the most significant with p value 0.02 (0.05). Based on the research results the application “si pesek” can be recommended as an educational tool in child nursing services to prevent sexual violence in preschoolersKeywords: Preschool children, sexual education, sexual abuse

Scientific reviews. Principles of diagnosis and treatment of iron deficiency anemia in children

Annotation.In Europe, the overall prevalence of iron deficiency anemia is 2-4%, with two peaks: young children (2.3-15%) and adolescents (3.5-13% – in boys, 11-33% – in girls). Iron deficiency occurs earlier than anemia, which is characterized by a decrease in the size and iron saturation of erythrocytes, and they become microcytic and hypochromic. Therefore, anemia can be prevented by early diagnosis and treatment of latent iron deficiency. The aim of the work was to analyze and systematize the main problematic issues of diagnosis and treatment of iron deficiency anemia in children. To conduct the study, we analyzed databases PubMed, Cochrane Library, Google Scholar, etc., referring to the vast majority of publications from the last five years (2016-2021), in addition to three articles published in 2012 and 2014. The main criteria for selecting sources were: the availability of the latest methods for the diagnosis of anemia, modern methods of treatment of iron deficiency anemia in children. Analysis of the identified literature sources showed that iron deficiency in the laboratory and clinically can manifest itself at different stages. Negative iron balance, which persists after a decrease in iron stores, is manifested by a decrease in hemoglobin and the development of anemia. A decrease in the number of erythrocytes or the level of hemoglobin (Hb) by 5 percentile below the normal value of hemoglobin, determined for a given age in healthy people, is called anemia. Routine screening for iron deficiency should be performed in children aged 6 to 24 months. Screening consists of identifying risk factors and laboratory testing if available. Determination of serum ferritin during the first screening is the main diagnostic tool in children with risk factors for iron deficiency and signs of anemia. Ferritin levels should always be carefully evaluated, as ferritin is nonspecifically elevated in a variety of inflammatory conditions. Other screening tests, such as reticulocyte levels, iron transferrin saturation, and serum iron-binding capacity, are performed to confirm the diagnosis. The choice and route of administration of iron requires consideration of the cause that led to its deficiency, the severity of symptoms and condition of the patient, the probable and desired rate of hematological response, risks and complications of treatment, availability of resources and preferences of the patient. Oral iron remains a priority for the treatment of children with iron deficiency anemia, but it is necessary to consider situations where first-line therapy will be administered by intravenous means. Thus, based on the analysis of the literature, we can conclude that iron deficiency anemia remains an urgent medical and social problem today. Children with iron deficiency anemia develop cognitive impairment that does not fully recover even after treatment. Therefore, further research aimed at improving methods of prevention, early diagnosis and treatment of iron deficiency anemia in different age groups of children should be promising.

Informatization of education: medical and social problems, technologies for hygienic safety students training

Introduction. The digitalization of education in the Russian Federation accompanied by the intensive use of digital tools in children and adolescents’ education and leisure activities actualizes the problems of preserving the health of the younger generation. The aim of the study was to assess the current medical and social problems of informatization of education and the formation of approaches to the hygienic regulation of the main risk factors for the health of students, to determine the technologies for ensuring their hygienic safety in the digital environment. Materials and methods. The expert and analytical research were carried out using scientific publications, Internet resources, normative and methodological documents showing the features of the organization of educational activities of students in the digital environment, the technology of ensuring their hygienic safety. Results. It shows the high degree of development of the digital environment in the Russian education system; a diverse arsenal of digital educational resources and services that are most in demand by participants in the educational process; prospects for the modernization and development of education in the course of the introduction of the digital educational environment (DEE). The new digital environment can negatively impact the lifestyle and behavior of children and adolescents and contribute to the formation of additional risk factors for their health. In the context of the increased informatization of the educational process and the active use of electronic learning tools (ESE), there is an increase in the information load and psychoemotional overstrain in children and adolescents, an increase in various forms of information dependence, borderline mental disorders and behavioural disorders, the prevalence of school-related conditions and diseases. Conclusion. Among the measures related to the safety of the use of digital technologies and means of their provision in the educational and leisure activities of children, the implementation of technologies aimed at assessing the main risk factors for children’s health in the developing digital environment and the prospects for the development of hygienic rationing; compliance with hygiene regulations and rules of work when using ESO; training and education of children, parents and teachers; expertise of educational programs and technologies; monitoring the effectiveness of the implementation of DEE.

A patient safety and quality improvement curriculum for child and adolescent psychiatry fellows using the Learning from Defect Tool

The purpose of this article is to describe the development and evaluation of an 11-session patient safety and quality improvement curriculum for first-year child and adolescent psychiatry fellows. The curriculum uses the Learning from Defects tool which teaches fellows how to conduct an analysis of a safety event they have encountered in their clinical work. The Learning from Defects tool provides a structured approach to address adverse clinical events and identify system failures by providing a framework to determine what happened, examine why it happened, implement interventions to reduce the probability that a similar event will recur, and evaluate whether the interventions were effective. Six fellows participated in the curriculum during their protected didactics time. Curriculum evaluation included an assessment of fellows’ knowledge, skills, and attitudes toward patient safety and quality improvement before and immediately after the curriculum, and 6-months later. Immediately upon completion of the curriculum, fellows reported more confidence and comfort with patient safety and quality improvement-related tasks in their clinical practice. Fellows reported a positive perception of the curriculum related to their learning objectives and utility in the future career. At the 6-month follow-up, the majority of fellows continued to work on their Learning from Defects project and endorsed the intention to participate in patient safety and quality improvement work in the future. This study provides preliminary support for implementing this patient safety and quality improvement curriculum utilizing the Learning from Defects tool in child and adolescent psychiatry fellowship programs. The Learning from Defects tool offers a practical way to teach patient safety and quality improvement skills that potentially can be generalized to future clinical work.

A Systematic Review and Pooled Prevalence of Delirium in Critically Ill Children.

Pediatric delirium is a neuropsychiatric disorder with disrupted cerebral functioning due to underlying disease and/or critical care treatment. Pediatric delirium can be classified as hypoactive, hyperactive, and mixed. This systematic review was conducted to estimate the pooled prevalence of pediatric delirium using validated assessment tools in children (Cornell Assessment of Pediatric Delirium, Pediatric Confusion Assessment Method for the ICU, PreSchool Confusion Assessment Method for the ICU, Pediatric Confusion Assessment Method for the ICU Severity Scale, and Sophia Observation Withdrawal Symptoms Pediatric Delirium scale), identify modifiable and nonmodifiable risk factors, and explore the association of pediatric delirium with clinical outcomes. A systematic search of PubMed, EMBASE, and CINAHL databases was undertaken for full articles pertaining to pediatric delirium prevalence. No language or date barriers were set. Studies were included where the following eligibility criteria were met: study design aimed to estimate pediatric delirium prevalence arising from treatment in the intensive care setting, using a validated tool. Only randomized controlled trials, cross-sectional studies, or cohort studies allowing an estimate of the prevalence of pediatric delirium were included. Data were extracted by the primary researcher (D.S.) and accuracy checked by coauthors. A narrative synthesis and pooled prevalence meta-analysis were undertaken. Pediatric delirium, as determined by the Cornell Assessment of Pediatric Delirium score, is estimated to occur in 34% of critical care admissions. Eight of 11 studies reporting on subtype identified hypoactive delirium as most prevalent (46-81%) with each of the three remaining reporting either hyperactive (44%), mixed (57%), or equal percentages of hypoactive and mixed delirium (43%) as most prevalent. The development of pediatric delirium is associated with cumulative doses of benzodiazepines, opioids, the number of sedative classes used, deep sedation, and cardiothoracic surgery. Increased time mechanically ventilated, length of stay, mortality, healthcare costs, and associations with decreased quality of life after discharge were also found. Multi-institutional and longitudinal studies are required to better determine the natural history, true prevalence, long-term outcomes, management strategies, and financial implications of pediatric delirium.

Utility Of A Pediatric Computerized Cognitive Tool In Children Aged 5-9 Following Concussion

PURPOSE: Computerized neurocognitive testing is commonly used as part of a comprehensive evaluation of sport-related concussion (SRC) in adolescents and adults. However, these tools are not designed for use in children. There is a need for a valid, computerized tool to assess cognitive function in pediatric athletes following SRC. The aim is to evaluate a pediatric version of the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) neurocognitive battery by examining the measure’s clinical utility in the evaluation and management of concussion in a pediatric population. METHODS: A total of 63 children (female-42.2%) aged 5-9 years (7.5 ± 1.0 years) were enrolled within 30 (8.5 ± 5.9) days of concussion upon presentation to a sports medicine concussion specialty clinic. Participants were administered the ImPACT Pediatric at all clinic visits. ImPACT Pediatric is a brief (25 min) computerized neurocognitive test with composite scores for sequential memory, word memory, visual memory, and rapid processing. An omnibus F-test was used to evaluate ImPACT Pediatric performance from initial clinic visit (V1) to medical clearance visit. Paired t-tests were used to compare ImPACT Pediatric composite and subtest scores at V1 and clearance with statistical significance set at p < .05. RESULTS: On average, participants recovered in 34.1 ± 23.5 days. Participants demonstrated improved performance on all ImPACT Pediatric composite scores from V1 to clearance (p = .001, ηp2 = .152), with particular improvement in speeded domains (rapid processing: p = .008, d = .29). At both V1 and clearance, older participants demonstrated faster performance (rapid processing: p = .021, d = .58) and higher accuracy scores on subtests measuring word learning/memory (word learning correct: p = .008, d = .67) and working memory (memory touch sequences correct: p = .005, d = .72). CONCLUSIONS: The findings indicate that ImPACT Pediatric composites and subtests, particularly speeded domains, are able to detect changes in cognitive function from initial to medical clearance visits following concussion. This study suggests that the ImPACT Pediatric tool can be used by sports medicine professionals as one component of a comprehensive assessment to evaluate injury, monitor recovery, and inform return-to-play decisions following SRC.