Fosterchu9190

Registered nurses were faster to defibrillate in Ebola PPE and slower when wearing chemical PPE (median difference, -3.5 vs 2 seconds, respectively; P less then 0.01). Registered nurse IV placement took longer in Ebola and chemical PPE (5.5 vs 42 seconds, respectively; P less then 0.01). After the PPE session, participants were significantly less likely to indicate that full-body PPE interfered with procedures, was claustrophobic, or slowed them down. CONCLUSIONS Personal protective equipment did not affect procedure timeliness or success on a simulated child, with the exception of IV placement. Further study is needed to investigate PPE's impact on procedures performed in a clinical care context.STUDY OBJECTIVE The aim of this study was to examine the impact of the ACEP (American College of Emergency Physicians) clinical policy regarding diagnosis of suspected appendicitis on changing practice in the pediatric emergency department (ED) in the absence of a formal departmental protocol. METHODS This was a retrospective chart review in a pediatric ED in which patients aged 2 to 18 years were evaluated for appendicitis via ultrasound, computed tomography (CT), or both, over a 7-year study period. We compared rates of CT utilization in the period before the release of the ACEP clinical policy regarding diagnosis and treatment of appendicitis (2008-2009) and the period after (2010-2014). Other metrics of interest were ultrasound results and physician response to results, as well as surrogate markers for quality of care. RESULTS Seven hundred pediatric ED visits were included, with 200 prepolicy release and 500 postrelease. Computed tomography utilization decreased significantly postpolicy release from 43.5% (95% confidence interval [CI], 36.6%-50.3%) to 22.2% (95% CI, 18.5%-25.8%). The proportion of ultrasounds with indeterminate results also decreased, with 71.5% (95% CI, 65.1%-77.9%) and 55.1% (95% CI, 50.7%-59.5%) in the pre and post groups, respectively. Physicians ordered fewer CTs after indeterminate ultrasounds, decreasing from 63.7% (95% CI, 56.9%-70.5%) to 48.3%% (95% CI, 43.9%-52.7%). CONCLUSIONS After the release of the clinical policy, CT utilization decreased significantly suggesting possible effectiveness of the policy in bringing about change in practice. Subsequently, there was an increase in the definitiveness in the ultrasound results. Physicians also evolved in their response to indeterminate ultrasound results, with fewer CTs ordered reflexively after indeterminate results.OBJECTIVES Our primary objective was to describe emergency department (ED) presentation, treatment, and outcomes for children after hematopoietic cell transplantation (HCT). Our secondary objective was to identify factors associated with serious infection in this population. METHODS This is a retrospective review of HCT patients who presented to our university children's hospital ED from January 1, 2011, to June 30, 2013. Emergency department presentation, treatment, and outcomes were described. Descriptive statistics were used to compare children with definite serious infection with those without serious infection. Multiple binary logistic regression was performed for risk factors associated with definite serious infection. RESULTS Fifty-four HCT patients (132 encounters) presented to our ED. Most were transplanted for a malignant (46%) or metabolic (36%) diagnosis and were recipients of bone marrow (51%) or umbilical cord blood (45%). Fever was the most common complaint (25%). Emergency department laboratory (64%) or imaging (58%) studies were frequently obtained. Admission was common (n = 70/132, 53%), with 79% (n = 55) of admissions to intensive care or bone marrow transplant units. Thirty-five encounters had definite serious infection, 5 had probable serious infection, and 92 had no serious infection. Fever (P less then 0.001) and high-risk white blood cell (WBC) count of less than 5 or greater than 15 k/μL (P less then 0.001) were associated with definite serious infection. Fever (odds ratio = 8.84, 95% confidence interval = 2.92-26.73) and high-risk WBC (odds ratio = 6.67, 95% confidence interval = 2.24-19.89) remained significantly associated with definite serious infection in our regression model. CONCLUSIONS Children presenting to the ED after HCT require extensive support and resources, with more than half requiring admission. Fever and high-risk WBC are associated with serious infection.OBJECTIVES The rate of negative appendectomy in children is 7%. The value of imaging depends on the institution. In addition, imaging errors can lead to an appendectomy in children who do not have appendicitis. It is the hypothesis that children with short onset of symptoms who undergo negative appendectomy often have erroneous imaging findings. METHODS A retrospective study of patients' records over a 30-month period was carried out. A search by histologic diagnosis in the department of pathology was used to identify the cases of all patients who did not have a diseased appendix with the preoperative diagnosis of appendicitis. In addition, the imaging report was reviewed for the radiologic diagnosis of each patient, and the operative note was reviewed to document the clinical indication for surgery. RESULTS A total of 1377 patients who underwent appendectomy with the preoperative diagnosis of appendicitis were reviewed. Sixty-eight of these children did not have an abnormal pathologic diagnosis; hence, there was a negative appendectomy rate of 4.8%. All 68 had imaging before surgery consistent with appendicitis. Thirty-six of these patients had symptoms less than 3 days. In 30 (84%) of these 36 patients, the note identifies imaging as the indication for surgery. CONCLUSIONS Children who had an appendectomy and found to have a normal appendix shared 2 characteristics. (1) Their symptoms were less than 3 days, and (2) the imaging was considered the indication by the surgical team. In the situation of an unclear diagnosis and a short onset of symptoms, observation or further evaluation should be considered.OBJECTIVES Solitary rectal ulcer syndrome (SRUS) is said to be rare in children (largest series so-far; 55 in children, 116 in adults). We analysed our experience to look at its clinical presentations, endoscopic appearance and treatment outcome in a large cohort of children. METHODS Clinical and endoscopic data were collected between 2000 to 2018. Children (≤18 years) diagnosed to have SRUS on colonoscopy and confirmed by histopathology were included. All children with SRUS were treated with behavioural modification, bulk laxative. Most with ulcer received steroid enema and some sulfasalazine or sucralfate enema. RESULTS The median age of 140 children was 12 (IQR 10-14) years, 79% were males. The median symptom duration was 21 (IQR 9-36) months. Rectal bleeding was the presenting feature in 131(93.6%), constipation in 38 (27%); and small, frequent stools in 79 (56%). Most children had features of dyssynergic defecation such as prolonged sitting in the toilet (131, 93.6%), excessive straining (138, 98.6%), a feeling of incomplete evacuation (130, 92.8%) and rectal digitation (71, 50.7%). Rectal prolapse was noted in 24 (17%) cases. Colonoscopy documented rectal ulcer in 101 (72%) [Single 84]. Over a median follow-up of 6 (IQR 4-18) months, 27 patients were lost to follow-up and of the remaining 113 cases, 71 (62.8%) showed clinical improvement (healing of ulcer documented in 36/82, 44%). CONCLUSIONS The majority of cases of SRUS presented in second decade with rectal bleeding and features of dyssynergic defecation. Ulcer was noted in three-fourths of cases. The outcome of medical treatment with behavioural modification and local therapy was modest.OBJECTIVES Assessment of adherence to gluten-free-diet (GFD) in celiac disease (CD) is generally recommended. Few data are available about consequences of transition from the referral center to the general pediatrician (GP) once remission is achieved. METHODS Adherence was assessed in patients referred to the GP for an annual basis follow-up, called back for re-evaluation. IgA anti-tTG antibodies and the Biagi Score (BS) were determined at last follow-up at the referral Center (V1), and at re-evaluation (V2). Patients were classified as adherent (BS 3-4, IgA anti-tTG  = 7). Scores of adherence were correlated with personal and clinical data. RESULTS We evaluated 200 patients. Overall, we found good adherence rates in 94,95% of patients at V1 and 83,5% at V2. IgA anti-tTG were negative in 100% at V1 and 96,97% at V2. BS is 3-4 in 94,5% at V1 and 84% at V2. Adherence at V2 was significantly worse than V1 (p  less then  0.001). No significant associations were found between scores of adherence and sex, symptoms and age at diagnosis, family history of CD, comorbidity, diagnosis by endoscopy. Age ≥13 years old represents a risk factor for lack of compliance at V1 (p = 0,02) and V2 (p = 0,04), as well as foreign nationality at V2 (p = 0,001). CONCLUSIONS The BS, serology, and a clinical interview, integrated, are reliable tools for assessing pediatric adherence to GFD. We argue that referring patients to the GP after remission of CD is important, but the process must be improved and recommendations are required.OBJECTIVES To assess differences in the diagnosis and management of Eosinophilic Esophagitis (EoE) by European pediatric (PG) and adult gastroenterologists (AG), and their self-reported adherence to guidelines. METHODS A multiple-choice questionnaire gauged the diagnostic and management strategies of gastroenterologists treating children or adults in 14 European countries and the United Arab Emirates (UAE). RESULTS Questionnaires were completed by 465 PG and 743 AG. PG were significantly more likely to take biopsies in patients with symptoms of esophageal dysfunction (86.2% PG vs. 75.4% AG, p  less then  0.001) and to perform endoscopic follow-up (86.3% PG vs. 80.6% AG, p  less then  0.001). After failure of proton-pump inhibitors, topical steroids were the preferred second line therapy, however PG opted more frequently for elimination diets (47.5% PG vs. 13.7% AG, p  less then  0.001). More PG than AG indicated having read recent guidelines (89.4% PG vs. 58.2% AG, p  less then  0.001). Geographic differences in practice were reported, with respondents from the United Kingdom, Portugal and Spain more often adhering to recommended biopsy protocols. Physicians in the UAE, France, Lithuania and Poland tended to opt for steroid therapy or elimination diets as first line therapy, in contrast to most other countries. CONCLUSIONS Significant differences in general practice between PG and AG were demonstrated with notable divergence from consensus guidelines. International practice variations are also apparent. Among other strategies, educational activities to highlight current recommendations may help harmonize and optimize clinical practice.OBJECTIVES Current pediatric guidelines allow non-invasive diagnosis of celiac disease in selected children. We investigated in a large cohort study whether the severity of villous atrophy at diagnosis is associated with clinical characteristics or long-term health outcomes, thus having a prognostic significance. METHODS Comprehensive medical data on 906 children with celiac disease were analyzed. Long-term health outcomes of 503 adult patients diagnosed in childhood were moreover assessed with a specific study questionnaire and validated Gastrointestinal Symptom Rating Scale (GSRS) and Psychological General Well-Being (PGWB) questionnaires. Patients were classified into three groups according to severity of villous atrophy at diagnosis and all variables were compared. RESULTS Altogether 34% of the patients had partial, 40% subtotal, and 26% total villous atrophy. Children with milder lesions were diagnosed more recently (median year 2007 vs. 2006 vs. 2001 respectively, p  less then  0.001), more often by screening (30% vs.