ObjectivesTo understand the current situation of the nosocomial infection management system in maternal and child health care institutions at all levels in Sichuan province, and provide a feasible policy basis for strengthening the nosocomial infection management.MethodsThe expert group members of Sichuan Maternal and Child Health Association Academy Association designed a unified questionnaire, and distributed the questionnaire through “Questionnaire Star” to carry out on-site online survey.ResultsA total of 159 maternal and child health care institutions participated in the survey. Most secondary and below maternal and child health care institutions had not set up professional hospital infection monitoring system. A few secondary and below maternal and child health care institutions did not independently set up a hospital infection management committee, hospital infection management department, full-time hospital infection department head, the inspection team of infection control, monitoring system, and nosocomial infection management system and special supervision had not been established in special departments. There were statistical differences in some jobs in the construction of nosocomial infection management system in different levels of maternal and child health care institutions (P<0.05).ConclusionsThe organizational system construction of hospital infection managemen are at a low level in the second level and below maternal and child health care institutions in Sichuan province. The tertiary maternal and child health care institutions should give full play to the leading role in promoting the standard construction of nosocomial infection management system of maternal and child health care institutions in Sichuan province, and carry out nosocomial infection management of maternal and child health care institutions orderly.
PURPOSE:To evaluate the B sean ultrasonic examination in diagnosis and prognosis of infectious endophthalmitis in children. METHODS:The hospital records of 44 children with infectious endophthalmitis were retrospectively analysed. The correlation between the initial B scan eehographic findings and the initial vision and the vision at discharge were analysed by t-test. RESULTS :The average visual, acuity was hand moving on admission,and 0.04 at discharge. Both the final vision and the initial vision were associated with the severity of vitreous opacity. The ultrasonic findings including retinal detachment and choroidal detachment were associated with poor vision outcomes. CONCLUSION :The ocular B scan ultrasonic examination was effective to predict the final vision in infectious endophthalmitis in children. （Chin J Ocul Fundus Dis,1997,13: 134-135）
ObjectiveTo analyze the perdictive value of Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) for malnutrition or postoperative complications in children with critical congenital heart disease (CHD).MethodsA total of 875 children with critical CHD who were hospitalized in West China Hospital, Sichuan University form August 2019 to February 2021, including 442 males and 433 females with a median age of 30 (12, 48) months, were assessed by STAMP in Health Information System. Clinical data of postoperative complications were collected.Results(1) Based on World Health Organization Z-score as gold standard, 24.5% had malnutrition risk, and 34.3% were diagnosed with malnutrition. According to STAMP, the children were with medium malnutrition risk of 37.9% and high malnutrition risk of 62.1%. There was a statistical difference of incidence rate of malnutrition and detection rate of STAMP malnutrition risk in gender, age, ICU stay or length of mechanical ventilation (P<0.05); (2) with the optimal cut-off point of 5.5 in STAMP for malnutrition, the sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC) were 68.3%, 84.3%, 48.1%, 88.3% and 0.82, respectively; (3) 12.0% of the children were with postoperative complications; (4) with the optimal cut-off point of 5.5 in STAMP for postoperative complications, the sensitivity, specificity, positive predictive value, negative predictive value and AUC were 83.8%, 73.1%, 18.8%, 99.1% and 0.85, respectively.ConclusionChildren with critical CHD have a higher incidence of malnutrition risk and postoperative complications. STAMP has a good perdictive value for malnutrition or postoperative complications, however, the sensitivity and specificity of STAMP are affected by the gold standard or the cut-off point.
Objective To compare the short-term outcomes of small thoracotomy and thoracoscopic approach for pediatric lobectomy. Methods From June 2011 to June 2016, 42 patients with lung diseases undertook lobectomy in Xinhua Hospital. There were 24 males and 18 females with an average age of 7.13±5.00 years, ranging from 4 months to 16 years. According to different operation methods, they were divided into a thoracoscopy group (n=22) and a small incision group (n=20). Duration of operation, intraoperative blood loss, duration of postoperative drainage, and postoperative hospital stay and complications between the two groups were recorded and compared. Results There was no significant difference in the age, body weight between the two groups (8.44±4.99 yearsvs. 5.68±4.69 years,t=1.84,P=0.07; 34.18±16.52 kgvs. 25.03±18.06 kg,t=1.72,P=0.09). Two patients (9%) undergoing thoracoscopy required conversion to small thoracotomy. Perioperative outcomes, including operation time (151.64±74.59 minvs. 136.40±50.36 min,t=0.77,P=0.45), intraoperative blood loss (43.41±45.91 mlvs. 79.50±131.00 ml,t=–1.21,P=0.23), drainage duration (5.00±1.79 dvs. 4.90±2.36 d,t=0.23,P=0.82), length of hospital stay (8.41±3.11 dvs. 8.65±2.66 d,t=–0.27,P=0.79) showed no significant differences between the two groups. One patient suffered pneumonia in thoracoscopy group after operation and the rest patients recovered well without severe complications such as atelectasis, active bleeding and bronchopleural fistula. Conclusion Lobectomy via small thoracotomy and thoracoscopic approach is effective and safe for pediatric patients with equivalent short-term outcomes. While thoracoscopic surgery with relatively small incision achieves good cosmetic outcome.
Objective To analyze the complaint characteristics of emergency department of women and children’s specialized hospital, and to provide a basis for improving medical service quality, enhancing hospital management, increasing satisfaction, and reducing complaint rates in specialized hospitals. Methods Using the Healthcare Complaint Analysis Tool classification framework, a retrospective analysis was conducted on complaints from the Emergency Department of West China Second University Hospital of Sichuan University. Results The total number of complaints from 2020 to 2022 was 525, and the number of complaints had been increasing year by year. There were 196 complaints against personnel and 329 complaints against regions. There were 320 complaints related to management issues (61.0%), 143 complaints related to doctor-patient relationship issues (27.2%), and 62 complaints related to clinical issues (11.8%). The complained areas were mainly fever clinics (193 cases), and the complained personnel were mainly nurses (82 cases). Conclusion The emergency department of women and children’s specialized hospitals is different from comprehensive hospitals, and active optimization should be carried out to address the main issues. While continuously improving the level of medical technology, it is also necessary to strengthen information technology construction, optimize medical procedures, improve environmental facilities, and provide psychological support for patients and their caregivers.
ObjectiveTo analyze the effectiveness of external fixator combined with Kirschner wire (EF-KW) fixation in the treatment of oblique and comminuted distal humeral metaphyseal-diaphyseal junction (DHMDJ) fractures in children. Methods A clinical data of 22 children with DHMDJ fractures who met the selection criteria between April 2021 and December 2023 was retrospectively analyzed. All patients were treated with EF-KW fixation. There were 14 boys and 8 girls with an average age of 6.8 years (range, 1.5-12.0 years). The time from injury to operation was 14-38 hours (mean, 24.2 hours). There were 18 cases of comminuted fractures and 4 cases of oblique fractures; and 1 case of median nerve injury and 1 case of radial nerve injury before operation. The occurrence of postoperative complications was recorded. At last follow-up, the function of the affected elbow joint was evaluated according to the Mayo elbow joint function score, and the Baumann’s angle (BA) and humero-capitellar angle (HCA) of the affected and healthy sides were recorded and compared. ResultsAll fractures were successfully treated with closed reduction and no complications such as nerve injury occurred. Superficial infection occurred in 4 cases after operation and healed after symptomatic treatment. The incisions of other patients healed by first intention. All patients were followed up 9-24 months (mean, 13.8 months). At last follow-up, according to the Mayo elbow joint function score, the elbow joint function was rated as excellent in 15 cases, good in 6 cases, and fair in 1 case, with an excellent and good rate of 95.5%. The neurologic injury before operation recovered gradually. X-ray films reexamination showed that all fractures healed, and the healing time of fractures ranged from 29 to 61 days, with an average of 35.6 days. At last follow-up, there was no significant difference in BA and HCA between the healthy side and the affected side (P>0.05). During follow-up, 1 case developed mild cubitus varus, while the other patients had no serious complications. ConclusionEF-KW fixation for oblique and comminuted DHMDJ fractures in children has the advantages of less trauma, simple operation, easy reduction, good stability after reduction, low incidence of serious complications, and good elbow functional recovery.
ObjectiveTo systematically review the diagnostic accuracy of MRI in preschool children with autism spectrum disorder. MethodsDatabases including Web of Science, PubMed, The Cochrane Library, EMbase, CBM, CNKI, WanFang Data, and VIP were electronically searched for studies on MRI in diagnosis of preschool children with autism spectrum disorder from inception to January 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias the included studies. Then, meta-analysis was performed using Meta-Disc, RevMan 5.4 and Stata 16.0 software. ResultsA total of 17 studies were finally included. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnosis odds ratio and area under the curve of SROC were 0.78 (95%CI 0.76 to 0.81), 0.77 (95%CI 0.75 to 0.79), 3.92 (95%CI 2.83 to 5.41), 0.28 (95%CI 0.23 to 0.35), 14.8 (95%CI 9.31 to 23.52) and 0.86, respectively. Subgroup analysis revealed that the source of patients, age, prediction methods and analysis features were potential sources of heterogeneity. Heterogeneity in the subgroup of 1-3 years old was small, and the pooled sensitivity, specificity and area under the curve of SROC were 0.81 (95%CI 0.76 to 0.85), 0.82 (95%CI 0.78 to 0.86) and 0.87, respectively. The pooled sensitivity, specificity and area under the curve of SROC for non-site studies were 0.80 (95%CI 0.75 to 0.84), 0.80 (95%CI 0.76 to 0.85) and 0.86, respectively. ConclusionMRI has a high accuracy in the diagnosis of preschool children with autism spectrum disorder; however, the possibility of misdiagnosis and missed diagnosis should be considered. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective To assess the global situation of off-label drug use in hospitalized children. Methods The databases such as PubMed, EMbase, CBM, CNKI and VIP were searched to collect studies on off-label drug use in hospitalized children at age of 0 to 18 years old. The publication language was limited to English and Chinese. The quality assessment was based on Crombie Criteria for cross-sectional studies. The incidence of off-label drug use was described in different wards and age groups, and the proportion of different off-label used drugs was analyzed. Results The total 29 cross-sectional studies were included, involving 8 560 children and 41 655 prescriptions. a) Median (IQR) of off-label use incidence: Neonatal ICU 52.5% (23.0% to 44.8%), Pediatric ICU 43.5% (34.5% to 60%), General pediatric ward 35.5% (23.8% to 43.3%), Pediatric surgical ward 27.5% (23.0% to 44.8%); b) The results of off-label incidence in different age groups were inconsistent among different studies; and c) The off-label drug use for “no pediatric information” had the largest proportion, followed by dose and age. Conclusion a) Off-label drug use exists widely around the world, but the incidence varies a lot in different countries and different types of wards; b) The incidence of off-label drug use may be higher in ICU than in non-ICU, and higher in the neonatal ward than the pediatric ward; c) The off-label drug use for no pediatric information is the commonest type, and further clinical studies should focus on areas in which high quality evidence is totally absent; and d) The multi-center studies with unified design on off-label drug use in hospitalized children in China are urgently needed to provide evidence for policy-making.
The integral and individual-scale wavelet entropy of electroencephalogram (EEG) were employed to investigate the information complexity in EEG and to explore the dynamic mechanism of child absence epilepsy (CAE). The digital EEG signals were collected from patients with CAE and normal controls. Time-frequency features were extracted by continuous wavelet transformation. Individual scale power spectrum characteristics were represented by wavelet-transform. The integral and individual-scale wavelet entropy of EEG were computed on the basis of individual scale power spectrum. The evolutions of wavelet entropy across ictal EEG of CAE were investigated and compared with normal controls. The integral wavelet entropy of ictal EEG is lower than inter-ictal EEG for CAE, and it also lower than normal controls. The individual-scale wavelet entropies of 12th scale (centered at 3 Hz) of ictal EEG in CAE was significantly higher than normal controls. The individual-scale wavelet entropies for α band (centered at 10 Hz) of ictal EEG in CAE were much lower than normal controls. The integral wavelet entropy of EEG can be considered as a quantitative parameter of complexity for EEG signals. The complexity of ictal EEG for CAE is obviously declined in CAE. The wavelet entropies declined could become quantitative electrophysiological parameters for epileptic seizures, and it also could provide a theoretical basis for the study of neuromodulation techniques in epileptic seizures.
ObjectiveTo investigate the effectiveness of rotationplasty in treating osteosarcoma of distal femur in children.MethodsA clinical data of 10 children with osteosarcoma of distal femur treated with rotationplasty between March 2014 and June 2016 was retrospectively analyzed. There were 7 boys and 3 girls with an average age of 6.7 years (range, 4-10 years). There were 4 cases of osteoblastic osteosarcoma, 4 cases of mixed osteosarcoma, and 2 cases of chondroblastic osteosarcoma. All children were staged as Enneking stage ⅡB. The disease duration ranged from 3.5 to 6.0 months (mean, 4.6 months). The lower limb functional scoring system of 1993 Musculoskeletal Tumor Society (MSTS93), Toronto Extremity Salvage Score (TESS), and knee mobility were used to evaluate postoperative function. Tumor recurrence and metastases were monitored by radiograph.ResultsPoor superficial incision healing occurred in 1 patient, and healed after dressing change. The other incisions healed by first intention. All children were followed up 24-72 months (mean, 52.6 months). No local recurrence was observed during follow-up. Three of the ten patients suffered from metastases including 1 dying of multiple organ dysfunction syndrome, 1 alive with tumor, and 1 tumor free survival. Painful callosities and ulcers which related to prosthetic wear occurred in 2 patients and turned up after optimizing prosthetic fit and physiotherapy. The fracture healing time was 2.5-5.0 months (mean, 3.5 months). All children could walk independently at 4 months postoperatively. At last follow-up, the MSTS93 score was 19-25 (mean, 22) and the TESS score was 87-93 (mean, 90). The extension of knee joint mobility with artificial limbs was 0°-10° (mean, 5°), and the flexion of knee joint mobility with artificial limbs was 85°-95° (mean, 90.5°).ConclusionRotationplasty in treating osteosarcoma of distal femur in children with limb salvage difficulties can effectively preserve the limb function and improve the quality of life, and it can be used as an alternative to amputation.