Articles: child.
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Postoperative pain assessment in children with cognitive impairment poses major challenges to healthcare professionals. Children with moderate to severe cognitive impairment are generally unable to communicate effectively and to self-report the level of pain. Difficulties assessing pain have led to their exclusion from clinical trials and rendered them vulnerable to insufficient treatment of pain. ⋯ Scales based on a child's own perception of pain and its severity play a limited role in this vulnerable population and pain assessment tools which rely on observing pain behavior are essential. The r-FLACC, which is reliable and valid, includes specific behavioral descriptors and can be used simply and effectively postoperatively in clinical practice. Our task has to be assessing pain as a routine procedure in cognitively impaired children as a keystone for an improved and successful pain management in this very sensitive patient population.
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Invasive candidiasis is associated with high morbidity and mortality in neonates and children. The incidence of invasive candidiasis is greater in children than in adults and is particularly high in neonates. Main risk factors are multiple antibiotics, central venous catheters, parenteral nutrition, immunodepression, low birth weight, fungal colonization, and necrotizing enterocolitis. Successful management of IFIs relies on early recognition and rapid initiation of effective treatment.
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The aim of this study was to review literature on unaccompanied hospitalized children and report the incidence at a pediatric hospital over 2 weeks. The philosophical model of most pediatric hospitals is family-centered care (FCC) and reducing separation effects. ⋯ Children and parents express that they want to be together, but many parents have obstacles to participation including increased expectations. The incidence study found that about one third of children were sometimes unaccompanied.
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Intensive care medicine · Apr 2010
ReviewSystematic review of paediatric alert criteria for identifying hospitalised children at risk of critical deterioration.
Unrecognised or untreated clinical deterioration can lead to serious adverse events, including cardiopulmonary arrest and unexpected death. Paediatric alert criteria aim to identify children with early signs of physiological instability that precede clinical deterioration so that experienced clinicians can intervene with the aim of reducing serious adverse events and improving outcome. ⋯ Evidence supporting the validity, reliability and utility of paediatric alert criteria is weak. Studies are needed to determine which physiological parameters or combinations of parameters, best predict serious adverse events. Prospective evaluation of validity, reliability and utility is then needed before widespread adoption into clinical practice can be recommended.
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Arch Pediatr Adolesc Med · Apr 2010
ReviewPsychiatric morbidity in pediatric critical illness survivors: a comprehensive review of the literature.
To review the prevalence of psychiatric syndromes in pediatric critical illness survivors as well as to summarize data on vulnerabilities and pediatric intensive care unit exposures that may increase risk of developing these syndromes. ⋯ Psychiatric morbidity appears to be a substantial problem for pediatric critical illness survivors. Future research should include more in-depth assessment of post-critical illness depressive, anxiety, and psychotic symptoms, validate existing psychiatric instruments, and clarify how vulnerability factors, pediatric intensive care unit service-delivery characteristics, and severity of critical illnesses are associated with subsequent psychopathology.