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Navigating the path to equitable rheumatologic care for underserved children with quality improvement. 通过提高质量,为医疗服务不足的儿童提供公平的风湿病治疗。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-15 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1426588
Sheetal S Vora, Sarah C Mabus, Talia L Buitrago-Mogollon

Objective: The aim of this quality improvement project is to identify children with rheumatologic conditions to prevent delayed or missed diagnosis in underserved pediatric populations. Our focus is on prompt and accurate identification and subsequent treatment of rheumatologic symptoms in pediatric patients referred from Atrium Health safety-net primary care clinics that deliver care to families without private insurance, including those lacking insurance entirely.

Methods: We collaborated with providers at one safety-net clinic to improve the processes of identification and subspecialty referral, resulting in an increase in the number of identified pediatric patients and referrals for these patients with potential rheumatologic disease. We used the Model for Improvement framework with rapid Plan-Do-Study-Act cycles and evaluated improvement with run and statistical process control charts.

Results: We achieved improvement, with zero referrals in the previous 5 years for the targeted population increasing to 15 patient referrals within 1 year of project initiation. Despite this increase in referrals, the rheumatology clinic was able to see all priority patients within 20 business days from referral.

Conclusion: An awareness of concerning rheumatologic symptoms in safety-net primary care clinics, combined with the use of both visual and decision aids, allows care teams to efficiently recognize and accurately refer patients needing specialty care.

目标:本质量改进项目旨在识别患有风湿病的儿童,以防止在服务不足的儿科人群中出现延误或漏诊。我们的重点是对 Atrium Health 安全网初级保健诊所转诊的儿科患者的风湿病症状进行及时准确的识别和后续治疗,这些诊所为没有私人保险的家庭(包括完全没有保险的家庭)提供医疗服务:我们与一家安全网诊所的医疗服务提供者合作,改进了识别和亚专科转诊流程,从而增加了识别出的儿科患者人数,并为这些可能患有风湿病的患者转诊。我们采用了 "改进模式 "框架和 "计划-实施-研究-行动 "快速周期,并通过运行和统计过程控制图对改进情况进行了评估:结果:我们取得了改善,在项目启动后的一年内,目标人群的转诊量从过去 5 年的零增加到 15 例。尽管转诊人数有所增加,但风湿病诊所仍能在转诊后的 20 个工作日内为所有重点病人看病:结论:安全网初级保健诊所对相关风湿病症状的认识,结合视觉和决策辅助工具的使用,可使护理团队有效识别并准确转诊需要专科护理的患者。
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引用次数: 0
Corrigendum: Significance of detecting cardiac troponin I and creatine kinase MB in critically Ill children without primary cardiac illness. 更正:在无原发性心脏病的重症儿童中检测心肌肌钙蛋白 I 和肌酸激酶 MB 的意义。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-14 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1495374
Yangyang Zhang, Yinyin Cao, Yi Xin, Yongming Liu

[This corrects the article DOI: 10.3389/fped.2024.1445651.].

[This corrects the article DOI: 10.3389/fped.2024.1445651.].
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引用次数: 0
Emerging innovations in neonatal monitoring: a comprehensive review of progress and potential for non-contact technologies. 新生儿监护领域的新兴创新:非接触式技术的进展与潜力综合评述。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-14 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1442753
Brooke A Krbec, Xiang Zhang, Inbar Chityat, Alexandria Brady-Mine, Evan Linton, Daniel Copeland, Brian W Anthony, Elazer R Edelman, Jonathan M Davis

Continuous monitoring of high-risk neonates is essential for the timely management of medical conditions. However, the current reliance on wearable or contact sensor technologies for vital sign monitoring often leads to complications including discomfort, skin damage, and infections which can impede medical management, nursing care, and parental bonding. Moreover, the dependence on multiple devices is problematic since they are not interconnected or time-synchronized, use a variety of different wires and probes/sensors, and are designed based on adult specifications. Therefore, there is an urgent unmet need to enable development of wireless, non- or minimal-contact, and non-adhesive technologies capable of integrating multiple signals into a single platform, specifically designed for neonates. This paper summarizes the limitations of existing wearable devices for neonates, discusses advancements in non-contact sensor technologies, and proposes directions for future research and development.

对高危新生儿进行持续监测对于及时控制病情至关重要。然而,目前依赖可穿戴或接触式传感器技术进行生命体征监测往往会导致不适、皮肤损伤和感染等并发症,从而妨碍医疗管理、护理和父母亲情。此外,对多种设备的依赖也是一个问题,因为这些设备不能相互连接或时间同步,使用各种不同的电线和探头/传感器,而且是根据成人规格设计的。因此,目前急需开发能将多种信号集成到一个平台的无线、非接触或最小接触、非粘附性技术,这些技术是专为新生儿设计的。本文总结了现有新生儿可穿戴设备的局限性,讨论了非接触式传感器技术的进展,并提出了未来的研发方向。
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引用次数: 0
A young child formula supplemented with a synbiotic mixture of scGOS/lcFOS and Bifidobacterium breve M-16V improves the gut microbiota and iron status in healthy toddlers. 添加了scGOS/lcFOS和乳双歧杆菌M-16V合成益生菌混合物的幼儿配方奶粉可改善健康幼儿的肠道微生物群和铁状况。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-14 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1193027
Charmaine Chew, Misa Matsuyama, Peter S W Davies, Rebecca J Hill, Mark Morrison, Rocio Martin, Francisco M Codoñer, Jan Knol, Guus Roeselers

Early-life gut microbiota development depends on a highly synchronized microbial colonization process in which diet is a key regulator. Microbiota transition toward a more adult-like state in toddlerhood goes hand in hand with the transition from a milk-based diet to a family diet. Microbiota development during the first year of life has been extensively researched; however, studies during toddlerhood remain sparse. Young children's requirement for micronutrients, such as dietary iron, is higher than adults. However, their intake is usually sub-optimal based on regular dietary consumption. The Child Health and Residence Microbes (CHaRM) study, conducted as an adjunct to the GUMLi (Growing Up Milk "Lite") trial, was a double-blind randomized controlled trial to investigate the effects on body composition of toddler milk compared to unfortified standard cow's milk in healthy children between 1 and 2 years of age in Brisbane (Australia). In this trial, fortified milk with reduced protein content and added synbiotics [Bifidobacterium breve M-16V, short-chain galactooligosaccharides, and long-chain fructooligosaccharides (ratio 9:1)] and micronutrients were compared to standard unfortified cow's milk. In the present study, the effects of the intervention on the gut microbiota and its relationship with iron status in toddlers were investigated in a subset of 29 children (18 in the Active group and 11 in the Control group) who completed the CHaRM study. The toddler microbiota consisted mainly of members of the phyla Firmicutes, Bacteroidota, and Actinobacteriota. The abundance of the B. breve species was quantified and was found to be lower in the Control group than in the Active group. Analysis of blood iron markers showed an improved iron status in the Active group. We observed a positive correlation between Bifidobacterium abundance and blood iron status. PICRUSt, a predictive functionality algorithm based on 16S ribosomal gene sequencing, was used to correlate potential microbial functions with iron status measurements. This analysis showed that the abundance of predicted genes encoding for enterobactin, a class of siderophores specific to Enterobacteriaceae, is inversely correlated with the relative abundance of members of the genus Bifidobacterium. These findings suggest that healthy children who consume a young child formula fortified with synbiotics as part of a healthy diet have improved iron availability and absorption in the gut and an increased abundance of Bifidobacterium in their gut microbiome.

生命早期肠道微生物群的发育取决于高度同步的微生物定植过程,而饮食是其中的关键调节因素。在幼儿期,微生物群向更像成人的状态过渡,这与从以牛奶为基础的饮食向家庭饮食过渡是同步的。出生后第一年的微生物群发育已得到广泛研究,但幼儿期的研究仍然很少。幼儿对膳食铁等微量营养素的需求高于成人。然而,根据常规膳食摄入量,他们的摄入量通常达不到最佳水平。儿童健康与居住地微生物(CHaRM)研究是一项双盲随机对照试验,旨在调查幼儿牛奶与未强化的标准牛奶相比对身体组成的影响,该研究是作为 GUMLi("轻型 "成长牛奶)试验的辅助项目在澳大利亚布里斯班进行的。在这项试验中,将蛋白质含量较低、添加了合生元[乳双歧杆菌 M-16V、短链半乳寡糖和长链果寡糖(比例为 9:1)]和微量营养素的强化牛奶与未强化的标准牛奶进行了比较。在本研究中,我们对完成 CHaRM 研究的 29 名儿童(积极组 18 名,对照组 11 名)进行了调查,以了解干预措施对幼儿肠道微生物群的影响及其与铁状况的关系。幼儿微生物群主要由固醇菌门、类杆菌门和放线菌门的成员组成。通过量化研究发现,对照组的布氏杆菌数量低于活跃组。对血液中铁标记物的分析表明,活跃组的铁状况有所改善。我们观察到双歧杆菌的丰度与血液中铁的状况呈正相关。PICRUSt 是一种基于 16S 核糖体基因测序的预测功能算法,用于将潜在的微生物功能与铁状态测量值联系起来。该分析表明,编码肠杆菌素(肠杆菌科特有的一类嗜苷酸盐)的预测基因的丰度与双歧杆菌属成员的相对丰度成反比。这些研究结果表明,作为健康饮食的一部分,食用添加了合生元的幼儿配方奶粉的健康儿童的肠道对铁的可用性和吸收得到了改善,肠道微生物组中双歧杆菌的数量也有所增加。
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引用次数: 0
Clinical characteristics and factors associated with mucus plugs under bronchoscopy in children hospitalized for acute asthma attack. 因哮喘急性发作住院治疗的儿童支气管镜下粘液栓的临床特征及相关因素。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-14 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1382680
Peng Han, Anxia Jiao, Ju Yin, Huimin Zou, Yuliang Liu, Zheng Li, Quan Wang, Jie Wu, Kunling Shen

Objective: To describe clinical characteristics of hospitalized children with acute asthma attacks complicated with mucus plugs and to investigate the factors associated with mucus plugs in asthma children.

Methods: This retrospective study analyzed hospitalized children and adolescents with acute asthma attacks from January 2016 to December 2021. The demographic information and characteristics were collected. Subjects were categorized into the mucus plug group and the control group based on the bronchoalveolar lavage results. The Logistic regression analyses were utilized to assess the relative factors associated with mucus plugs. All data were analyzed using SPSS 22.0.

Results: This study included 242 individuals. Out of the 151 subjects who underwent bronchoscopy, 62.9% were classified in the mucus plug group and 37.1% in the control group. The subjects with dyspnea had a higher proportion in the mucus plug group (52.6% vs. 26.8%). The serum total IgE level of the mucus plug group was lower than the control group. The proportion of subjects who were diagnosed with asthma for the first time during hospitalization (87.4% vs. 76.8%) and combined with respiratory infection (91.6% vs. 82.1%) in the mucus plug group might be higher than that in the control group. More subjects in the mucus plug group were administered systemic glucocorticoid, magnesium sulfate, aminophylline, and mucolytic drugs after hospitalization. In multivariable analysis, diagnosed with asthma for the first time during hospitalization (OR = 4.404; 1.101-17.614), dyspnea (OR = 4.039; 1.306-12.496), and cesarean (OR = 0.274; 0.092-0.812) might be associated with mucus plug in children hospitalized for an acute asthma attack.

Suggests: While our retrospective study suggests that some clinical features of children hospitalized with asthma who have mucus plugs differ from those without, further studies are required.

目的描述急性哮喘发作并发粘液栓的住院患儿的临床特征,并研究与哮喘患儿粘液栓相关的因素:这项回顾性研究分析了 2016 年 1 月至 2021 年 12 月期间哮喘急性发作的住院儿童和青少年。研究收集了人口统计学信息和特征。根据支气管肺泡灌洗结果将受试者分为粘液栓塞组和对照组。利用逻辑回归分析评估与粘液栓相关的相对因素。所有数据均使用 SPSS 22.0 进行分析:本研究共纳入 242 人。在接受支气管镜检查的 151 名受试者中,62.9% 属于粘液栓组,37.1% 属于对照组。有呼吸困难的受试者在粘液栓组中所占比例较高(52.6% 对 26.8%)。粘液栓组的血清总 IgE 水平低于对照组。粘液栓组在住院期间首次诊断为哮喘(87.4% 对 76.8%)和合并呼吸道感染(91.6% 对 82.1%)的受试者比例可能高于对照组。粘液栓组有更多的患者在住院后全身使用糖皮质激素、硫酸镁、氨茶碱和粘液溶解药物。在多变量分析中,住院期间首次诊断为哮喘(OR = 4.404; 1.101-17.614)、呼吸困难(OR = 4.039; 1.306-12.496)和剖腹产(OR = 0.274; 0.092-0.812)可能与哮喘急性发作住院患儿的粘液栓有关:建议:虽然我们的回顾性研究表明,哮喘住院患儿的某些临床特征与无粘液栓的患儿有所不同,但仍需进一步研究。
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引用次数: 0
The cardiopulmonary benefits of physiologically based cord clamping persist for at least 8 hours in lambs with a diaphragmatic hernia. 对患有膈疝的羔羊来说,基于生理学的脐带钳夹术对心肺功能的益处可持续至少 8 小时。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-11 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1451497
Paige J Riddington, Philip L J DeKoninck, Marta Thio, Calum T Roberts, Risha Bhatia, Janneke Dekker, Aidan J Kashyap, Benjamin J Amberg, Karyn A Rodgers, Alison M Thiel, Ilias Nitsos, Valerie A Zahra, Ryan J Hodges, Stuart B Hooper, Kelly J Crossley

Introduction: Infants with congenital diaphragmatic hernia can suffer severe respiratory insufficiency and pulmonary hypertension after birth. Aerating the lungs before removing placental support (physiologically based cord clamping, PBCC) increases pulmonary blood flow (PBF) and reduces pulmonary vascular resistance (PVR) in lambs with a diaphragmatic hernia (DH). We hypothesized that these benefits of PBCC persist for at least 8 h after birth.

Methods: At ∼138 days of gestation age (dGA), 21 lambs with a surgically induced left-sided DH (∼86 dGA) were delivered via cesarean section. The umbilical cord was clamped either before ventilation onset (immediate cord clamping, ICC, n = 9) or after achieving a tidal volume of 4 ml/kg, with a maximum delay of 10 min (PBCC, n = 12). The lambs were ventilated for 8 h, initially with conventional mechanical ventilation, but were switched to high-frequency oscillatory ventilation after 30 min if required. Ventilatory parameters, cardiopulmonary physiology, and arterial blood gases were measured throughout the study.

Results: PBF increased after ventilation onset in both groups and was higher in the PBCC DH lambs than the ICC DH lambs at 8 h (5.2 ± 1.2 vs. 1.9 ± 0.3 ml/min/g; p < 0.05). Measured over the entire 8-h ventilation period, PBF was significantly greater (p = 0.003) and PVR was significantly lower (p = 0.0002) in the PBCC DH lambs compared to the ICC DH lambs. A high incidence of pneumothoraces in both the PBCC (58%) and ICC (55%) lambs contributed to a reduced sample size at 8 h (ICC n = 4 and PBCC n = 4).

Conclusion: Compared with ICC, PBCC increased PBF and reduced PVR in DH lambs and the effects were sustained for at least 8 h after ventilation onset.

导言患有先天性膈疝的婴儿出生后会出现严重的呼吸功能不全和肺动脉高压。在去除胎盘支持前给肺部通气(生理脐带夹闭,PBCC)可增加膈疝(DH)羔羊的肺血流量(PBF)并降低肺血管阻力(PVR)。我们假设,PBCC 的这些益处至少会在出生后 8 小时内持续存在:方法:21 只妊娠 138 天(dGA)的左侧膈疝(86 dGA)羔羊通过剖腹产分娩。脐带在通气开始前夹闭(立即夹闭脐带,ICC,n = 9)或在潮气量达到 4 毫升/千克后夹闭,最长延迟 10 分钟(PBCC,n = 12)。羔羊通气时间为 8 小时,最初使用常规机械通气,但在 30 分钟后根据需要改用高频振荡通气。在整个研究过程中测量了通气参数、心肺生理学和动脉血气:结果:通气开始后,两组羔羊的 PBF 都有所增加,8 h 时,PBCC DH 组羔羊的 PBF 高于 ICC DH 组羔羊(5.2 ± 1.2 vs. 1.9 ± 0.3 ml/min/g;p p = 0.003),PBCC DH 组羔羊的 PVR 显著低于 ICC DH 组羔羊(p = 0.0002)。PBCC(58%)和ICC(55%)羔羊的气胸发生率都很高,导致8小时的样本量减少(ICC n = 4,PBCC n = 4):结论:与 ICC 相比,PBCC 可增加 DH 羔羊的 PBF 并降低 PVR,其效果在通气开始后至少持续 8 小时。
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引用次数: 0
Case Report: Esophageal squamous cell carcinoma in a 13-year-old boy with a history of esophageal atresia with tracheoesophageal fistula. 病例报告:食管闭锁伴气管食管瘘病史的 13 岁男孩患食管鳞状细胞癌。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-11 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1438242
B Bernar, C Mayerhofer, T Fuchs, G Schweigmann, E Gassner, R Crazzolara, B Hetzer, U Klingkowski, A Zschocke, G Cortina

In adults, esophageal cancers are a global health concern. Esophageal squamous cell carcinoma (ESCC) accounts for approximately 90% of esophageal carcinomas. The prognosis of esophageal cancers remains dismal, with a five-year survival rate below 20%. It typically affects older patients, and for now, ESCC after esophageal atresia has not been reported in patients younger than 18 years. We present an exceptional case of an ESCC in a 13-year-old boy with a history of esophageal atresia and corrective surgery in infancy. After the surgery the patient was lost to surgical follow up for over ten years and then presented to our emergency department with respiratory distress requiring antibiotic therapy and supplemental oxygen. Radiologic imaging revealed a volume reduction of the right lung with bronchiectasis, as well as esophageal stenosis at the level of the previous anastomosis, with an adjacent abscess in the right lung. These changes may have arisen due to a chronic fistula from the esophagus to the right lung. Initial interventional therapy with a stent implantation had no lasting success and, in an effort to prevent further aspiration into the right lung, a cervical esophagus stoma was established, and the patient received prolonged antibiotic treatment. However, a thoracic CT scan performed 4 months later revealed a large, retrospectively progressive prevertebral mass originating from the distal portion of the esophagus below the stenosis, compressing the trachea and the right main bronchus. The patient's condition rapidly worsened and he developed respiratory failure, requiring veno-venous extracorporeal membrane oxygenation. Unfortunately, an endoscopic biopsy revealed an advanced ESCC. With no rational treatment options available, we changed the goals of care to a palliative setting. The key message of this case is that in adolescents with chronic infections, an abscess can potentially mask a malignant transformation. Therefore, in adolescents, with an history of corrective surgery for esophageal atresia and chronic complications, consideration should also be given to the possibility of squamous cell carcinoma of the esophagus.

成人食管癌是全球关注的健康问题。食管鳞状细胞癌(ESCC)约占食管癌的 90%。食管癌的预后仍然不容乐观,五年生存率低于 20%。食管癌通常发生在年龄较大的患者身上,目前还没有关于 18 岁以下患者食管闭锁后发生 ESCC 的报道。我们介绍了一例特殊的 ESCC 病例,患者是一名 13 岁男孩,曾患食道闭锁,并在婴儿期接受过矫正手术。手术后,患者失去了十多年的手术随访机会,随后因呼吸困难到我们的急诊科就诊,需要抗生素治疗和补充氧气。放射成像显示,患者右肺体积缩小并伴有支气管扩张,之前吻合处的食管狭窄,右肺邻近有脓肿。这些变化可能是由于食管到右肺的慢性瘘管造成的。最初植入支架的介入治疗没有取得持久的成功,为了防止进一步吸入右肺,患者接受了颈部食管造口术,并长期接受抗生素治疗。然而,4 个月后进行的胸部 CT 扫描显示,一个巨大的、呈进行性发展的椎管前肿块源自狭窄处下方的食管远端,压迫气管和右主支气管。患者病情迅速恶化,出现呼吸衰竭,需要静脉体外膜肺氧合。不幸的是,内窥镜活检发现了晚期 ESCC。由于没有合理的治疗方案,我们将治疗目标改为姑息治疗。本病例的关键信息是,在患有慢性感染的青少年中,脓肿有可能掩盖恶性转化。因此,对于有食道闭锁矫正手术史和慢性并发症的青少年,还应考虑食道鳞状细胞癌的可能性。
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引用次数: 0
Feasibility of clinical EEG for music recognition in children aged 1-12 years. 临床脑电图对 1-12 岁儿童进行音乐识别的可行性。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-11 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1427118
Janeen Bower, Sebastian John Corlette, Mengmeng Wang, Wendy L Magee, Cathy Catroppa, Felicity Anne Baker

Introduction: Musicality is an innate capability and the fundamental architectures necessary for music processing are present from birth. However, there is a notable gap in pediatric specific music neuroscience research and research that employs ecologically valid musical stimuli.

Methods: This pragmatic feasibility study aimed to assess the utility of EEG collected via pre-existing clinical monitoring to describe the processing of familiar song as an ecologically valid stimulus, in the underrepresented pediatric population. Three comparative auditory conditions (song, speech, and noise) were utilized to assess the changes in EEG across these conditions compared to a baseline silence.

Results: Analysis of EEG data from a pilot sample of four children revealed distinct changes in the underlying frequency components of the EEG during the song condition that were not observed in either the speech or noise conditions. To extend this analysis, a uniquely hypothesis-driven, multivariate statistical analysis method (generalized eigendecomposition [GED]) was employed, however in this study we did not isolate a consistent source responsible for the observed changes in the frequency components of the EEG during the song condition.

Discussion: The study is limited by the small sample size but nevertheless demonstrated feasibility of collecting EEG data in the imperfect auditory environment of an acute clinical setting to describe a response to an ecologically valid stimulus in the underrepresented pediatric population. Further research with a more restrictive study design and greater participant numbers is needed to extend these preliminary findings.

简介音乐性是一种与生俱来的能力,音乐处理所需的基本架构从出生时就已存在。然而,儿科音乐神经科学研究和采用生态学上有效的音乐刺激的研究还存在明显差距:这项实用的可行性研究旨在评估通过已有的临床监测收集的脑电图的效用,以描述代表性不足的儿科人群对熟悉的歌曲作为生态有效刺激的处理过程。研究采用了三种比较听觉条件(歌曲、语音和噪音),以评估与基线静默相比,这些条件下的脑电图变化:结果:对四名试点样本儿童的脑电图数据进行分析后发现,在歌曲条件下,脑电图的基本频率成分发生了明显变化,而在语音或噪音条件下均未观察到这种变化。为了扩展这一分析,我们采用了一种独特的假设驱动型多元统计分析方法(广义多重分解法 [GED]),但在这项研究中,我们并未分离出导致在歌曲条件下观察到的脑电图频率成分变化的一致来源:讨论:这项研究因样本量较小而受到限制,但还是证明了在急性期临床环境不完善的听觉环境中收集脑电图数据的可行性,以描述代表性不足的儿科人群对生态有效刺激的反应。要扩展这些初步研究结果,还需要进行更严格的研究设计和更多的参与者。
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引用次数: 0
A systematic review of the effect of sandplay therapy on social communication deficits in children with autism spectrum disorder. 沙盘游戏疗法对自闭症谱系障碍儿童社交沟通障碍影响的系统性综述。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-11 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1454710
Ren Yuxi, Jia Shuqi, Liu Cong, Li Shufan, Long Yueyu

Objective: To explore the efficacy of sandplay therapy in intervening social communication deficits in children with autism spectrum disorders (ASD), and whether this efficacy is influenced by the age of the children and the dosage of sandplay therapy intervention.

Methods: Following the PICOS principle, randomized controlled trials (RCTs) related to sandplay therapy for social communication deficits in ASD children were retrieved from seven databases: PubMed, WOS, The Cochrane Library, Embase, CNKI, Wanfang, and VIP, from the inception of each database to November 10, 2023. Two experimenters independently conducted study screening and excluded studies with concomitant diseases, incomplete data, unextractable data, and non-randomized controlled trials. The PEDro scale was used for methodological quality assessment, and the GRADEprofiler method was employed to evaluate the quality of evidence. Stata17 software was used for meta-analysis, subgroup analysis, sensitivity analysis, and publication bias testing. The standardized mean difference (SMD) and 95% confidence interval (CI) were used as the effect statistics.

Results: A total of 12 RCTs (791 cases) were included. Sandplay therapy had a positive impact on the social communication deficits of ASD children [SMD = -1.42, 95%CI (-1.79, -1.04), P < 0.001]. Subgroup analysis revealed that sandplay therapy administered during the early school age (449 cases, SMD = -1.44, P < 0.05), for a duration of 22-28 weeks (208 cases, SMD = 1.69, P < 0.05), and with a frequency of once per week (218 cases, SMD = -1.67, P < 0.05) was most effective in improving on social communication deficits of ASD children.

Discussion: The quality of evidence in this study was rated as high, with good methodological quality, including 12 studies with better quality and no detection of bias risk. The study had high heterogeneity, which was attributed to the measurement tools and intervention duration through subgroup analysis, with no inconsistency found. Additionally, no downgrade factors related to imprecision, publication bias, or indirectness were identified. In conclusion, sandplay therapy is an effective measure to improve social communication deficits in children with ASD, and current evidence recommends early intervention using an individual sandplay therapy or integrated sandplay therapy intervention program once a week for 22-28 weeks, which can serve as evidence-based clinical guidance.

Systematic review registration: www.crd.york.ac.uk, identifier (CRD420234821750).

目的探讨沙盘游戏疗法在干预自闭症谱系障碍(ASD)儿童社交沟通障碍方面的疗效,以及这种疗效是否受儿童年龄和沙盘游戏疗法干预剂量的影响:按照 PICOS 原则,从七个数据库中检索了与沙盘游戏疗法治疗 ASD 儿童社交沟通障碍相关的随机对照试验(RCT):PubMed、WOS、The Cochrane Library、Embase、CNKI、万方和VIP,检索时间从各数据库建立之初至2023年11月10日。两名实验员独立进行研究筛选,排除了伴有疾病、数据不完整、无法提取数据和非随机对照试验的研究。方法学质量评估采用 PEDro 量表,证据质量评估采用 GRADEprofiler 方法。Stata17软件用于荟萃分析、亚组分析、敏感性分析和发表偏倚测试。采用标准化平均差(SMD)和95%置信区间(CI)作为效应统计:结果:共纳入了 12 项 RCT(791 个病例)。沙盘游戏疗法对 ASD 儿童的社交沟通障碍有积极影响[SMD = -1.42, 95%CI (-1.79, -1.04), P P P P 讨论:本研究的证据质量被评为高,具有良好的方法学质量,其中包括 12 项质量较好且无检测偏倚风险的研究。该研究的异质性较高,通过亚组分析可归因于测量工具和干预持续时间,未发现不一致性。此外,没有发现与不精确、发表偏倚或间接性有关的降级因素。总之,沙盘游戏疗法是改善ASD儿童社会交往障碍的有效措施,目前的证据建议采用个体沙盘游戏疗法或综合沙盘游戏疗法干预方案进行早期干预,每周一次,持续22-28周,可作为循证临床指导。系统综述注册:www.crd.york.ac.uk,标识符(CRD420234821750)。
{"title":"A systematic review of the effect of sandplay therapy on social communication deficits in children with autism spectrum disorder.","authors":"Ren Yuxi, Jia Shuqi, Liu Cong, Li Shufan, Long Yueyu","doi":"10.3389/fped.2024.1454710","DOIUrl":"10.3389/fped.2024.1454710","url":null,"abstract":"<p><strong>Objective: </strong>To explore the efficacy of sandplay therapy in intervening social communication deficits in children with autism spectrum disorders (ASD), and whether this efficacy is influenced by the age of the children and the dosage of sandplay therapy intervention.</p><p><strong>Methods: </strong>Following the PICOS principle, randomized controlled trials (RCTs) related to sandplay therapy for social communication deficits in ASD children were retrieved from seven databases: PubMed, WOS, The Cochrane Library, Embase, CNKI, Wanfang, and VIP, from the inception of each database to November 10, 2023. Two experimenters independently conducted study screening and excluded studies with concomitant diseases, incomplete data, unextractable data, and non-randomized controlled trials. The PEDro scale was used for methodological quality assessment, and the GRADEprofiler method was employed to evaluate the quality of evidence. Stata17 software was used for meta-analysis, subgroup analysis, sensitivity analysis, and publication bias testing. The standardized mean difference (SMD) and 95% confidence interval (CI) were used as the effect statistics.</p><p><strong>Results: </strong>A total of 12 RCTs (791 cases) were included. Sandplay therapy had a positive impact on the social communication deficits of ASD children [SMD = -1.42, 95%CI (-1.79, -1.04), <i>P</i> < 0.001]. Subgroup analysis revealed that sandplay therapy administered during the early school age (449 cases, SMD = -1.44, <i>P</i> < 0.05), for a duration of 22-28 weeks (208 cases, SMD = 1.69, <i>P</i> < 0.05), and with a frequency of once per week (218 cases, SMD = -1.67, <i>P</i> < 0.05) was most effective in improving on social communication deficits of ASD children.</p><p><strong>Discussion: </strong>The quality of evidence in this study was rated as high, with good methodological quality, including 12 studies with better quality and no detection of bias risk. The study had high heterogeneity, which was attributed to the measurement tools and intervention duration through subgroup analysis, with no inconsistency found. Additionally, no downgrade factors related to imprecision, publication bias, or indirectness were identified. In conclusion, sandplay therapy is an effective measure to improve social communication deficits in children with ASD, and current evidence recommends early intervention using an individual sandplay therapy or integrated sandplay therapy intervention program once a week for 22-28 weeks, which can serve as evidence-based clinical guidance.</p><p><strong>Systematic review registration: </strong>www.crd.york.ac.uk, identifier (CRD420234821750).</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"12 ","pages":"1454710"},"PeriodicalIF":2.1,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142498919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Measurements of enteral feeding intolerance in critically ill children: a scoping review. 重症儿童肠内喂养不耐受的测量方法:范围综述。
IF 2.1 3区 医学 Q2 PEDIATRICS Pub Date : 2024-10-10 eCollection Date: 2024-01-01 DOI: 10.3389/fped.2024.1441171
Yan Li, Cong-Hui Fu, Min-Jie Ju, Ji Liu, Xiao-Ya Yang, Ting-Ting Xu

Objective: To examine the measurements on enteral feeding intolerance (EFI) in critically ill children.

Methods: The Joanna Briggs Institute methods for conducting a scoping review were followed. Articles published since 2004 which assessed EFI in critically ill children were identified. A full search strategy was executed in seven English databases (MEDLINE, EMBASE, PubMed, Web of Science, Cochrane Central Register of Controlled Trials, JBI EBP, CINAHL) and four Chinese databases (CNKI, VIP, Wanfang, Sinomed). Two reviewers screened records according to our inclusion and exclusion criteria, and conducted a full-text review of selected articles. The reference lists of all studied selected were screened for additional sources. Relevant data was extracted using a researcher-developed tool.

Results: Of the 627 articles identified, 32 were included in this scoping review. Most articles focused on the measurement of high gastric residual volume (n = 22), followed by diarrhea (n = 20), and vomiting (n = 9). Most of the studies were of observational-analytic design (13/32) and experimental design (8/32).

Conclusion: This scoping review addressed the complexity and diversity of EFI measurements. Given the importance of adequacy of enteral nutrient intake, we highlighted the necessary to develop individual measurements of EFI, taking the age of children and disease condition into consideration. Further studies can also investigate accurate and objective physiological measurements of EFI to advance EN and improve outcomes in critically ill children.

目的:研究危重症儿童肠内喂养不耐受(EFI)的测量方法:研究重症儿童肠内喂养不耐受(EFI)的测量方法:采用乔安娜-布里格斯研究所(Joanna Briggs Institute)的方法进行范围审查。确定了自 2004 年以来发表的评估危重症儿童肠内喂养不耐受的文章。我们在七个英文数据库(MEDLINE、EMBASE、PubMed、Web of Science、Cochrane Central Register of Controlled Trials、JBI EBP、CINAHL)和四个中文数据库(CNKI、VIP、万方、中国医药网)中执行了全面检索策略。两名审稿人根据纳入和排除标准筛选记录,并对所选文章进行全文审阅。对所有入选研究的参考文献目录进行了筛选,以寻找更多来源。使用研究人员开发的工具提取相关数据:在确定的 627 篇文章中,有 32 篇被纳入此次范围界定综述。大多数文章侧重于高胃剩余容积的测量(22 篇),其次是腹泻(20 篇)和呕吐(9 篇)。大多数研究采用观察-分析设计(13/32)和实验设计(8/32):本次范围界定综述探讨了 EFI 测量的复杂性和多样性。鉴于肠内营养摄入充足性的重要性,我们强调有必要在考虑儿童年龄和疾病状况的基础上,制定个性化的肠内营养摄入量(EFI)测量方法。进一步的研究还可以对 EFI 进行准确、客观的生理学测量,以促进肠内营养的摄入并改善危重症儿童的预后。
{"title":"Measurements of enteral feeding intolerance in critically ill children: a scoping review.","authors":"Yan Li, Cong-Hui Fu, Min-Jie Ju, Ji Liu, Xiao-Ya Yang, Ting-Ting Xu","doi":"10.3389/fped.2024.1441171","DOIUrl":"https://doi.org/10.3389/fped.2024.1441171","url":null,"abstract":"<p><strong>Objective: </strong>To examine the measurements on enteral feeding intolerance (EFI) in critically ill children.</p><p><strong>Methods: </strong>The Joanna Briggs Institute methods for conducting a scoping review were followed. Articles published since 2004 which assessed EFI in critically ill children were identified. A full search strategy was executed in seven English databases (MEDLINE, EMBASE, PubMed, Web of Science, Cochrane Central Register of Controlled Trials, JBI EBP, CINAHL) and four Chinese databases (CNKI, VIP, Wanfang, Sinomed). Two reviewers screened records according to our inclusion and exclusion criteria, and conducted a full-text review of selected articles. The reference lists of all studied selected were screened for additional sources. Relevant data was extracted using a researcher-developed tool.</p><p><strong>Results: </strong>Of the 627 articles identified, 32 were included in this scoping review. Most articles focused on the measurement of high gastric residual volume (<i>n</i> = 22), followed by diarrhea (<i>n</i> = 20), and vomiting (<i>n</i> = 9). Most of the studies were of observational-analytic design (13/32) and experimental design (8/32).</p><p><strong>Conclusion: </strong>This scoping review addressed the complexity and diversity of EFI measurements. Given the importance of adequacy of enteral nutrient intake, we highlighted the necessary to develop individual measurements of EFI, taking the age of children and disease condition into consideration. Further studies can also investigate accurate and objective physiological measurements of EFI to advance EN and improve outcomes in critically ill children.</p>","PeriodicalId":12637,"journal":{"name":"Frontiers in Pediatrics","volume":"12 ","pages":"1441171"},"PeriodicalIF":2.1,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11499133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142498940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Frontiers in Pediatrics
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