ObjectiveTo investigate the demand of pediatric health service, the current situation of resource allocation and the equity of health service, so as to provide guidelines for optimizing the resource allocation of pediatric health service in Sichuan province.MethodsA questionnaire of all healthcare institutions with legal capability from a total of 183 prefectures in Sichuan province was performed in 2015. We described the demand of pediatric health service by two-week hospital visit rate, the proportion of no-visit rate within two-weeks, hospital admission rate, and the patient required hospitalization rate. We assessed current situation of resource allocation, equity and accessibility by analyzing Gini coefficient, Lorenz curve and thermodynamic diagram.ResultsThe demand of pediatric health service in Sichuan province was huge and the current resource allocation can be shown a " inverted triangle” form. According to population distribution, the Gini coefficients of physician, bed and equipment were 0.47, 0.40 and 0.49, respectively, which represented inequality in resource allocation. By location, the Gini coefficients of physician, bed and equipment were 0.82, 0.77 and 0.81, respectively, which indicated an absolutely unfair situation.ConclusionsThe health resources of pediatric in Sichuan province are limited, the distribution is unbalanced, and the supply of pediatric healthcare is not compatible with demand. The lack of resources and waste coexist simultaneously. Furthermore, the fairness of distribution in terms of geographical areas is far less than that in terms of population. The accessibility of superior health resources is low.
With the development of surgical technology and the need of clinical, transesophageal echocardiography is more and more favored by clinicians. Although the transesophageal echocardiography has developed more than 20 years, yet it has not been widely used in operation at present in domestic. In addition, its application in surgery of children is more rare. It has been confirmed that intraoperative use of transesophageal echocardiography has good safety and wide range of application. We will summarize indications, complications, and the progress of the current technology from the scope of transesophageal echocardiography in pediatric surgery.
Objective To determine the extent of off-label drug use in pediatric outpatients of West China Second University Hospital in 2010, and to analyze its possible risk factors, so as to provide baseline data for getting acquainted with the extent of off-label drug use in pediatrics in China and developing policy of off-label drug use. Methods The stratified random sampling was conducted to select prescriptions of children aged 0 to 18 years in pediatric outpatients of the West China Second University Hospital in 2010. According to drug instructions, off-label drug use of prescriptions of all selected children was analyzed in the following aspects, the category of off-label drug use, age, category of drugs. In addition, an analysis was conducted to check the relationship between off-label use and following possible risk factors: age, sex, essential medicines and over-the-counter drugs. Results A total of 2 640 prescriptions with 8 588 medical advices involving 329 drugs were extracted and analyzed, with incidence rates of off-label drug use accounting for 76.59%, 40.88% and 83.89%, respectively. The main categories of off-label drug use were no pediatric information (35.57%), indication (25.44%), and dosage (25.31%). The top 2 age groups with highest incidence rate of off-label drug were neonates (54.35%) and adolescents (49.64%). The top 4 drugs with highest incidence rate of off-label drug were respiratory system medicines (48.12%), Chinese patent medicines (48.12%), digestive and metabolic system medicines (33.36%), and systemic anti-infectives (16.27%). The off-label use risks in all age groups in the hospital were indifferent, and the essential medicines and prescription medicines were likely to present higher risks of drug off-label. Conclusion Off-label drug use in pediatric outpatients is common with growth trend in pediatric outpatients of the West China Second University Hospital. On the one hand, drug instructions lack pediatric information, and on the other hand, it’s badly in need of developing relevant legislation, regulations or guidelines to regulate off-label drug use, providing more evidence by conducting clinical trials on pediatric drugs, encouraging the development and production of the applicable drugs and dosage forms for children, and establishing the children essential medicine list, so as to avoid doctor’s professional risk and ensure the safety of pediatric drug use.
ObjectiveTo analyze the short- and long-term therapeutic effects of heart transplantation in children. MethodsA retrospective study was conducted on recipients and donors who underwent heart transplantation at the 7th People’s Hospital of Zhengzhou from May 2018 to August 2023, analyzing their clinical characteristics, surgical data, postoperative complications, and survival rates. ResultsA total of 22 children underwent heart transplantation, including 14 males and 8 females, with a median age of 13.5 (10.0, 15.0) years and a median weight of 41.9 (30.5, 55.4) kg. The primary diseases included: dilated cardiomyopathy in 16 patients, hypertrophic cardiomyopathy in 1 patient, myocardial dysplasia in 3 patients, right ventricular dysplasia in 1 patient, and congenital heart disease with abnormal coronary artery origin in 1 patient. The median age of the donors was 21.0 (13.0, 29.0) years, and the median weight was 50.5 (47.3, 75.0) kg. The blood types of the donors and recipients were the same, with type A in 10 patients, type B in 5 patients, type O in 5 patients, and type AB in 2 patients. Before transplantation, all children had a New York Heart Association cardiac function grade Ⅳ, with 1 patient assisted by intra-aortic balloon pump (IABP), 3 patients assisted by extracorporeal membrane oxygenation (ECMO), 2 patients assisted by continuous renal replacement therapy (CRRT), and 2 patients on mechanical ventilation. Nine patients met the criteria for emergency child status allocation, and the panel reactive antibody level in the patients was<10%. The median cold ischemic time of the donor heart was 355.0 (262.0, 395.5) min, the median aortic cross-clamping time was 45.0 (38.3, 51.3) min, the median mechanical ventilation time was 22.5 (16.8, 52.5) h, the median postoperative hospital stay was 29.5 (20.0, 43.0) d, and the median intensive care unit stay was 6.0 (5.0, 8.3) d. After surgery, 4 patients were assisted by ECMO, 2 patients by CRRT, and 7 patients developed complications, including lung fungal infection in 6 patients, liver and kidney dysfunction in 1 patient, local wound non-union and mediastinal infection in 1 patient, and multiple organ failure in 1 patient. Kaplan-Meier curve analysis showed that the survival rates of children after surgery were 91.3% at 1 year and 3 years; the survival rates of adult heart transplant recipients at our center were 86.7% and 73.8% at 1 year and 3 years, respectively, indicating that the survival rate of children with heart transplantation was higher than that of adult patients. ConclusionHeart transplantation is an effective treatment for end-stage heart failure in children, and the short- and long-term survival rates of children with heart transplantation are superior to those of adults. There are still many difficulties to be solved in pediatric heart transplantation, requiring joint efforts from society and the medical community.
Objective To explore the application of the Handbook for the Training Nurses in the standardized training for nurses in pediatric surgery. Methods Twenty-four training nurses trained under the instruction of the Handbook for the Training Nurses in Department of Pediatric Surgery from July 2014 to December 2015 were included as the observation group. Their training effects were compared historically with those of twenty-four training nurses who were trained without the help of the handbook from January 2013 to June 2014 (the control group). Results After the completion of the half-year training, theoretical score of training nurses in the observation group was better than that in the control group, and the difference was significant (87.16±4.18 vs. 83.71±5.46; t=2.492, P=0.016). Meanwhile, the specialist practical skill examination of training nurses in the observation group, such as femoral vein blood collection, replacement of drainage bag and indwelling needle infusion in children, and emergency practical skill examination such as cardiopulmonary resuscitation and the use of simple respirator were higher than those in the control group; and the working performance scores of training nurses in the observation group, such as the ability to adapt to the environment, patient satisfaction, nursing document writing, work efficiency and morning questions were better than those in the control group; the differences were significant (P< 0.05). Conclusion The Handbook for the Training Nurses can help the training nurses to adjust their working environment, master the practical skills and nursing knowledge in pediatric surgery.
Objective To explore the use of ChatGPT (Chat Generative Pre-trained Transformer) in pediatric diagnosis, treatment and doctor-patient communication, evaluate the professionalism and accuracy of the medical advice provided, and assess its ability to provide psychological support. Methods The knowledge databases of ChatGPT 3.5 and 4.0 versions as of April 2023 were selected. A total of 30 diagnosis and treatment questions and 10 doctor-patient communication questions regarding the pediatric urinary system were submitted to ChatGPT versions 3.5 and 4.0, and the answers to ChatGPT were evaluated. Results The answers to the 40 questions answered by ChatGPT versions 3.5 and 4.0 all reached the qualified level. The answers to 30 diagnostic and treatment questions in ChatGPT 4.0 version were superior to those in ChatGPT 3.5 version (P=0.024). There was no statistically significant difference in the answers to the 10 doctor-patient communication questions answered by ChatGPT 3.5 and 4.0 versions (P=0.727). For prevention, single symptom, and disease diagnosis and treatment questions, ChatGPT’s answer scores were relatively high. For questions related to the diagnosis and treatment of complex medical conditions, ChatGPT’s answer scores were relatively low. Conclusion ChatGPT has certain value in assisting pediatric diagnosis, treatment and doctor-patient communication, but the medical advice provided by ChatGPT cannot completely replace the professional judgment and personal care of doctors.
The developing status of pediatric day-care surgery is comprehensively analyzed based on SWOT model from the following four dimensions: strength (S), weakness (W), opportunities (O) and threats (T). Day-care surgery strategy is in line with the characteristics of pediatric diseases, which can improve medical efficiency and reduce medical costs. However, it is limited by both the particularity of pediatric patients and the complexity of postoperative management. In terms of external environment at present, there are many opportunities for its development of day-care surgery such as national policy support, medical technology innovation, and regional medical center construction. Nevertheless, some threats cannot yet be ignored such as medical safety risks, unfair resource allocation, traditional habit of medical treatment and medical insurance payment policies. In order to promote the high-quality development of pediatric day-care surgery in the future, it is recommended to innovate medical service models, improve medical quality management systems, train medical qualified personnel, and enhance national policy support.
Accurate segmentation of pediatric echocardiograms is a challenging task, because significant heart-size changes with age and faster heart rate lead to more blurred boundaries on cardiac ultrasound images compared with adults. To address these problems, a dual decoder network model combining channel attention and scale attention is proposed in this paper. Firstly, an attention-guided decoder with deep supervision strategy is used to obtain attention maps for the ventricular regions. Then, the generated ventricular attention is fed back to multiple layers of the network through skip connections to adjust the feature weights generated by the encoder and highlight the left and right ventricular areas. Finally, a scale attention module and a channel attention module are utilized to enhance the edge features of the left and right ventricles. The experimental results demonstrate that the proposed method in this paper achieves an average Dice coefficient of 90.63% in acquired bilateral ventricular segmentation dataset, which is better than some conventional and state-of-the-art methods in the field of medical image segmentation. More importantly, the method has a more accurate effect in segmenting the edge of the ventricle. The results of this paper can provide a new solution for pediatric echocardiographic bilateral ventricular segmentation and subsequent auxiliary diagnosis of congenital heart disease.
Objective To systematically review the risk factors of tic disorder (TD) in children. Methods Databases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, CBM, VIP, and WanFang Data were electronically searched to collect observational studies on children with TD from inception to June 29th 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 32 studies involving 556 560 children were included. The results of meta-analysis showed that the risk factors for TD were as follows: male (OR=2.23, 95%CI 1.08 to 4.61, P=0.03), premature delivery (OR=1.66, 95%CI 1.04 to 2.64, P=0.03), low birth weight (OR=1.27, 95%CI 1.07 to 1.50, P=0.005), history of neonatal jaundice (OR=7.46, 95%CI 1.15 to 48.42, P=0.04), other adverse factors in the perinatal period (OR=2.74, 95%CI 1.89 to 3.98, P<0.000 01), poor eating habits (OR=2.11, 95%CI 1.52 to 2.93, P<0.000 01), long-term viewing of electronic products (OR=2.22, 95%CI 1.31 to 3.75, P=0.003), history of febrile convulsions (OR=2.43, 95%CI 1.21 to 4.86, P=0.01), recurrent respiratory infection (OR=2.63, 95%CI 1.49 to 4.64, P=0.000 8), chronic tonsillitis (OR=2.01, 95%CI 1.31 to 3.09, P=0.001), rhinopathy (OR=1.77, 95%CI 1.35 to 2.31, P<0.000 1), attention deficit hyperactivity disorder (ADHD) (OR=5.32, 95%CI 3.77 to 7.51, P<0.000 01), decreased blood iron content (OR=3.68, 95%CI 1.56 to 8.67, P=0.003), family history of TD (OR=6.33, 95%CI 3.20 to 12.53, P<0.000 01), family history of mental illness (OR=2.39, 95%CI 2.03 to 2.83, P<0.000 01), maternal mental disorder during pregnancy (OR=2.49, 95%CI 1.99 to 3.11, P<0.000 01), alcohol drinking during pregnancy (OR=1.40, 95%CI 1.09 to1.79, P=0.007), smoking or passive smoking during pregnancy (OR=1.84, 95%CI 1.68 to 2.01, P<0.000 01), and corporal punishment (OR=3.57, 95%CI 1.52 to 8.34, P=0.003). Parity (second birth and above) (OR=0.41, 95%CI 0.25 to 0.68, P=0.000 6) was a protective factor for tic disorder. Conclusions Current evidence shows that the incidence of TD is related to gender, family history of mental illness, maternal life habits during pregnancy, perinatal history, chronic respiratory diseases, abnormal trace elements, and strict education methods, etc. Moreover, parity is a protective factor for the occurrence of TD. Due to the limited quantity and quality of included studies, more high-quality studies are required to verify the above conclusions.
Objective To determine the extent of off-label drug use in Pediatric Wards of West China Second University Hospital in 2010 and analyze its risk factors, so as to provide baseline data for getting acquainted with the extent of off-label drug use in pediatrics in China, and for making policies of off-label drug use. Methods The proportionate stratified random sampling was conducted to select medical advice and discharge medication for hospitalized children in Pediatric Wards in 2010. According to drug instructions, the off-label drug use of prescriptions of all selected children was analyzed in the following aspects, the category of off-label drug use, age, category of drugs and wards. In addition, a logistic regression was done that modeled the odds of receiving an off-label prescription as a function of the following possible risk factors: age, sex and the rank of doctors. Results The total 749 children were selected, and 14 374 prescriptions involving 385 drugs were analyzed. The rate of off-label drug use was 98.00%, 78.96% and 88.05% in children, prescriptions and drug categories, respectively. The main categories of off-label drug use were no pediatric information (29.41%), indication (18.35%), dosage (17.61%) and dosage range (±20%) (13.52%). The top 2 age groups of off-label drug use were adolescents (83.56%) and children (80.58%). The top 4 drugs of off-label use were those for alimentary tract and metabolism (82.28%), anti-infectives for systemic use (75.06%), blood and blood forming organs (79.27%) and respiratory (58.27%). The top 2 wards of off-label drug use were Pediatric Hematology (88.27%) and Neonates (79.12%). In hospital, children, adolescents and male patients had higher risk factors of off-label drug use, and doctors with senior rank prescribed more off-label prescriptions than those with intermediate rank. Conclusion The off-label drug use in Pediatric Wards is common in West China Second University Hospital. On the one hand, drug instructions lack the pediatric information, and, on the other hand, it’s badly in need of developing relevant legislations, regulations or guidelines to regulate off-label drug use, in order to avoid doctor’s professional risks and ensure the safety of pediatric drug use.