Current Issue : January - March Volume : 2012 Issue Number : 1 Articles : 5 Articles
Background: Adverse drug reactions in children are an important public health problem. We have undertaken a systematic\r\nreview of observational studies in children in three settings: causing admission to hospital, occurring during hospital stay\r\nand occurring in the community. We were particularly interested in understanding how ADRs might be better detected,\r\nassessed and avoided.\r\nMethods and Findings: We searched nineteen electronic databases using a comprehensive search strategy. In total, 102\r\nstudies were included. The primary outcome was any clinical event described as an adverse drug reaction to one or more\r\ndrugs. Additional information relating to the ADR was collected: associated drug classification; clinical presentation;\r\nassociated risk factors; methods used for assessing causality, severity, and avoidability. Seventy one percent (72/102) of\r\nstudies assessed causality, and thirty four percent (34/102) performed a severity assessment. Only nineteen studies (19%)\r\nassessed avoidability. Incidence rates for ADRs causing hospital admission ranged from 0.4% to 10.3% of all children (pooled\r\nestimate of 2.9% (2.6%, 3.1%)) and from 0.6% to 16.8% of all children exposed to a drug during hospital stay. Anti-infectives\r\nand anti-epileptics were the most frequently reported therapeutic class associated with ADRs in children admitted to\r\nhospital (17 studies; 12 studies respectively) and children in hospital (24 studies; 14 studies respectively), while antiinfectives\r\nand non-steroidal anti-inflammatory drugs (NSAIDs) were frequently reported as associated with ADRs in\r\noutpatient children (13 studies; 6 studies respectively). Fourteen studies reported rates ranging from 7%ââ?¬â??98% of ADRs being\r\neither definitely/possibly avoidable.\r\nConclusions: There is extensive literature which investigates ADRs in children. Although these studies provide estimates of\r\nincidence in different settings and some indication of the therapeutic classes most frequently associated with ADRs, further\r\nwork is needed to address how such ADRs may be prevented....
Background: Fathers are increasingly providing substantial amounts of technical and nursing care to growing\r\nnumbers of children with complex healthcare needs. This exploratory study reports some of the first in-depth\r\nevidence of fathers� experiences and presents a research agenda in this critically under-researched area.\r\nMethods: We conducted in-depth qualitative interviews with 8 fathers who provided a substantial amount of\r\ncomplex technical and nursing care for their child at home. The aim was to describe their experiences of fathering,\r\nparenting and caring. Interviews were recorded, transcribed and analysed using Burnard�s approach, which has\r\ncommonalities with phenomenological and content analysis.\r\nResults and Discussion: Fathers enjoyed their caring role and found it rewarding and at times stressful. They\r\ninstituted structured regimes, which focused on the father/child/family. Performing intimate care posed specific\r\nchallenges for which there is no guidance. Children�s community nursing was highly valued. Fathers generally\r\nrejected the need for specific father-focussed services, as such provision would induce guilt feelings. Fathers\r\nreported positive relationships with their children and partners.\r\nConclusions: Key areas for future exploration include gaining a better understanding of fathers� motivations and\r\nstyles of caring, developing interventions to support fathers� caring role, developing guidance on intimate care, and\r\ndelivering tailored services to fathers in a family context. There is little understanding of fathering and caring by\r\nnon-resident, teenage and step-fathers. Finally, knowing more about resilience and coping of fathers in strong\r\nrelationships with partners and children may help inform interventions to support fathers who do not feel able to\r\nstay with their family....
Background : Pain in infancy is poorly understood, and medical staff often have difficulty assessing\r\nwhether an infant is in pain. Current pain assessment tools rely on behavioural and\r\nphysiological measures, such as change in facial expression, which may not accurately reflect\r\npain experience. Our ability to measure cortical pain responses in young infants gives us the\r\nfirst opportunity to evaluate pain assessment tools with respect to the sensory input and\r\nestablish whether the resultant pain scores reflect cortical pain processing.\r\nMethods and Findings : Cortical haemodynamic activity was measured in infants, aged 25ââ?¬â??43 wk postmenstrual,\r\nusing near-infrared spectroscopy following a clinically required heel lance and compared to the\r\nmagnitude of the premature infant pain profile (PIPP) score in the same infant to the same\r\nstimulus (nÃ?¼12, 33 test occasions). Overall, there was good correlation between the PIPP score\r\nand the level of cortical activity (regression coefficientÃ?¼0.72, 95% confidence interval [CI] limits\r\n0.32ââ?¬â??1.11, p Ã?¼ 0.001; correlation coefficient Ã?¼ 0.57). Of the different PIPP components, facial\r\nexpression correlated best with cortical activity (regression coefficient Ã?¼ 1.26, 95% CI limits\r\n0.84ââ?¬â??1.67, p , 0.0001; correlation coefficient Ã?¼ 0.74) (n Ã?¼ 12, 33 test occasions). Cortical pain\r\nresponses were still recorded in some infants who did not display a change in facial expression.\r\nConclusions : While painful stimulation generally evokes parallel cortical and behavioural responses in\r\ninfants, pain may be processed at the cortical level without producing detectable behavioural\r\nchanges. As a result, an infant with a low pain score based on behavioural assessment tools\r\nalone may not be pain free....
Background : An outbreak of chikungunya virus affected over one-third of the population of La ReÃ?´union\nIsland between March 2005 and December 2006. In June 2005, we identified the first case of\nmother-to-child chikungunya virus transmission at the Groupe Hospitalier Sud-ReÃ?´union level-3\nmaternity department. The goal of this prospective study was to characterize the\nepidemiological, clinical, biological, and radiological features and outcomes of all the cases\nof vertically transmitted chikungunya infections recorded at our institution during this\noutbreak.\nMethods and Findings : Over 22 mo, 7,504 women delivered 7,629 viable neonates; 678 (9.0%) of these parturient\nwomen were infected (positive RT-PCR or IgM serology) during antepartum, and 61 (0.8%) in\npre- or intrapartum. With the exception of three early fetal deaths, vertical transmission was\nexclusively observed in near-term deliveries (median duration of gestation: 38 wk, range 35ââ?¬â??40\nwk) in the context of intrapartum viremia (19 cases of vertical transmission out of 39 women\nwith intrapartum viremia, prevalence rate 0.25%, vertical transmission rate 48.7%). Cesarean\nsection had no protective effect on transmission. All infected neonates were asymptomatic at\nbirth, and median onset of neonatal disease was 4 d (range 3ââ?¬â??7 d). Pain, prostration, and fever\nwere present in 100% of cases and thrombocytopenia in 89%. Severe illness was observed in\nten cases (52.6%) and mainly consisted of encephalopathy (nÃ?¼9; 90%). These nine children had\npathologic MRI findings (brain swelling, n Ã?¼ 9; cerebral hemorrhages, n Ã?¼ 2), and four evolved\ntowards persistent disabilities.\nConclusions: Mother-to-child chikungunya virus transmission is frequent in the context of intrapartum\nmaternal viremia, and often leads to severe neonatal infection. Chikungunya represents a\nsubstantial risk for neonates born to viremic parturients that should be taken into account by\nclinicians and public health authorities in the event of a chikungunya outbreak....
Background : Proteomic analysis of amniotic fluid shows the presence of biomarkers characteristic of\nintrauterine inflammation. We sought to validate prospectively the clinical utility of one such\nproteomic profile, the Mass Restricted (MR) score.\nMethods and Findings: We enrolled 169 consecutive women with singleton pregnancies admitted with preterm\nlabor or preterm premature rupture of membranes. All women had a clinically indicated\namniocentesis to rule out intra-amniotic infection. A proteomic fingerprint (MR score) was\ngenerated from fresh samples of amniotic fluid using surface-enhanced laser desorption\nionization (SELDI) mass spectrometry. Presence or absence of the biomarkers of the MR score\nwas interpreted in relationship to the amniocentesis-to-delivery interval, placental inflammation,\nand early-onset neonatal sepsis for all neonates admitted to the Newborn Special Care\nUnit (n Ã?¼ 104). Women with ââ?¬Ë?ââ?¬Ë?severeââ?¬â?¢Ã¢â?¬â?¢ amniotic fluid inflammation (MR score of 3 or 4) had\nshorter amniocentesis-to-delivery intervals than women with ââ?¬Ë?ââ?¬Ë?noââ?¬â?¢Ã¢â?¬â?¢ (MR score of 0)\ninflammation or even ââ?¬Ë?ââ?¬Ë?minimalââ?¬â?¢Ã¢â?¬â?¢ (MR score of 1 or 2) inflammation (median [range] MR 3ââ?¬â??4:\n0.4 d [0.0ââ?¬â??49.6 d] versus MR 1ââ?¬â??2: 3.8 d [0.0ââ?¬â??151.2 d] versus MR 0: 17.0 d [0.1ââ?¬â??94.3 d], p , 0.001).\nNonetheless, a ââ?¬Ë?ââ?¬Ë?minimalââ?¬â?¢Ã¢â?¬â?¢ degree of inflammation was also associated with preterm birth\nregardless of membrane status. There was a significant association between the MR score and\nseverity of histological chorioamnionitis (r Ã?¼ 0.599, p , 0.001). Furthermore, neonatal\nhematological indices and early-onset sepsis significantly correlated with the MR score even\nafter adjusting for gestational age at birth (OR for MR 3ââ?¬â??4: 3.3 [95% CI, 1.1 to 9.2], p Ã?¼ 0.03).\nWhen compared with other laboratory tests routinely used to diagnose amniotic fluid\ninflammation and infection, the MR score had the highest accuracy to detect inflammation\n(white blood cell count . 100 cells/mm3), whereas the combination of Gram stain and MR\nscore was best for rapid prediction of intra-amniotic infection (positive amniotic fluid culture).\nConclusions: High MR scores are associated with preterm delivery, histological chorioamnionitis, and earlyonset\nneonatal sepsis. In this study, proteomic analysis of amniotic fluid was shown to be the\nmost accurate test for diagnosis of intra-amniotic inflammation, whereas addition of the MR\nscore to the Gram stain provides the best combination of tests to rapidly predict infection....
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