Paediatric tracheostomy tubes: recent developments and our current practice

2018 ◽  
Vol 132 (11) ◽  
pp. 961-968 ◽  
Author(s):  
D J Tweedie ◽  
J Cooke ◽  
K A Stephenson ◽  
S L Gupta ◽  
C M Pepper ◽  
...  
Keyword(s):  
Tracheostomy Tube ◽  
Current Practice ◽  
Small Range ◽  
Street Hospital ◽  
Children's Hospital ◽  
Great Ormond Street Hospital ◽  
Design Changes ◽  
Children’S Hospital ◽  
Recent Developments ◽  
Tracheostomy Tubes

AbstractObjectiveA variety of paediatric tracheostomy tubes are available. This article reviews the tubes in current use at Great Ormond Street Hospital for Children and Evelina London Children's Hospital.MethodsThis paper outlines our current preferences, and the particular indications for different tracheostomy tubes, speaking valves and other attachments.ResultsOur preferred types of tubes have undergone significant design changes. This paper also reports further experience with certain tubes that may be useful in particular circumstances. An updated sizing chart is included for reference purposes.ConclusionThe choice of a paediatric tracheostomy tube remains largely determined by individual clinical requirements. Although we still favour a small range of tubes for use in the majority of our patients, there are circumstances in which other varieties are indicated.

Choosing a paediatric tracheostomy tube: an update on current practice

2007 ◽  
Vol 122 (2) ◽  
pp. 161-169 ◽  
Author(s):  
D J Tweedie ◽  
C J Skilbeck ◽  
L A Cochrane ◽  
J Cooke ◽  
M E Wyatt
Keyword(s):  
Tracheostomy Tube ◽  
Current Practice ◽  
Small Range ◽  
Street Hospital ◽  
Great Ormond Street Hospital ◽  
Tracheostomy Tubes

AbstractObjectives:A variety of paediatric tracheostomy tubes are available. This article reviews those in current use at Great Ormond Street Hospital.Methods:We outline our preferences and the particular indications for the different tubes, speaking valves and other attachments.Results:Practice has changed significantly in recent years. One product has been re-sized by its manufacturer; others are no longer commonly used. An updated sizing chart is included for reference purposes, together with manufacturers' contact details.Conclusions:The choice of paediatric tracheostomy tube is driven by clinical requirements. A small range of tubes are suitable for the majority of children, but some will require other varieties in specific circumstances.

Passy-Muir Speaking Valve Use in a Children's Hospital: An Interdisciplinary Approach

2008 ◽  
Vol 18 (2) ◽  
pp. 76-86 ◽  
Author(s):  
Lauren Hofmann ◽  
Joseph Bolton ◽  
Susan Ferry
Keyword(s):  
Tracheostomy Tube ◽  
Pediatric Population ◽  
Interdisciplinary Approach ◽  
Extended Period ◽  
Speech Development ◽  
Tube Placement ◽  
Background Information ◽  
Speaking Valve ◽  
Children's Hospital ◽  
Children’S Hospital

Abstract At The Children's Hospital of Philadelphia (CHOP) we treat many children requiring tracheostomy tube placement. With potential for a tracheostomy tube to be in place for an extended period of time, these children may be at risk for long-term disruption to normal speech development. As such, speaking valves that restore more normal phonation are often key tools in the effort to restore speech and promote more typical language development in this population. However, successful use of speaking valves is frequently more challenging with infant and pediatric patients than with adult patients. The purpose of this article is to review background information related to speaking valves, the indications for one-way valve use, criteria for candidacy, and the benefits of using speaking valves in the pediatric population. This review will emphasize the importance of interdisciplinary collaboration from the perspectives of speech-language pathology and respiratory therapy. Along with the background information, we will present current practices and a case study to illustrate a safe and systematic approach to speaking valve implementation based upon our experiences.

Recent Developments in Health Law: Civil Procedure: First Circuit Holds it Unreasonable to Hale Hospitals into Foreign Forums Simply for Accepting Out-of-State Patients — Harlow v. Children's Hospital

2006 ◽  
Vol 34 (2) ◽  
pp. 467-469
Author(s):  
Ashley Clare Hague
Keyword(s):  
United States ◽  
The United States ◽  
District Court ◽  
State Court ◽  
Medical Procedure ◽  
Court Of Appeals ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Recent Developments ◽  
Behavioral Impairments

The United States Court of Appeals for the First Circuit recently upheld a United States District Court for the District of Maine Judge's decision to dismiss a Maine plaintiff's medical malpractice claim against a Massachusetts hospital defendant for want of personal jurisdiction over the hospital. The Court of Appeals found it unreasonable to hale hospitals into an out-of-state court merely because they accept out-of-state patients.Plaintiff Danielle Harlow is a Maine resident who suffered a stroke at the age of six while undergoing a medical procedure at Children's Hospital of Boston, Massachusetts (“Children's Hospital”). The stroke, allegedly caused by the Hospital's negligence, led to brain damage resulting in partial paralysis and cognitive and behavioral impairments. The procedure was supposed to treat Harlow's rapid heartbeat, a condition related to her Wolff-Parkinson-White Syndrome. Harlow's pediatrician in Maine recommended that she visit Children's Hospital in Boston to treat her arrhythmia.

scholarly journals The need for tumor surveillance of children and adolescents with cancer predisposition syndromes: a retrospective cohort study in a tertiary-care children’s hospital

2021 ◽  
Author(s):  
Simon Huber ◽  
Mareike Schimmel ◽  
Désirée Dunstheimer ◽  
Karolina Nemes ◽  
Markus Richter ◽  
...  
Keyword(s):  
Cancer Risk ◽  
Children And Adolescents ◽  
Current Practice ◽  
Tertiary Care ◽  
Cancer Predisposition ◽  
Tumor Surveillance ◽  
Children's Hospital ◽  
Consensus Recommendations ◽  
Children’S Hospital ◽  
Expert Recommendations

AbstractExpert recommendations for the management of tumor surveillance in children with a variety of cancer predisposition syndromes (CPS) are available. We aimed (1) at identifying and characterizing children who are affected by a CPS and (2) at comparing current practice and consensus recommendations of the American Association for Cancer Research workshop in 2016. We performed a database search in the hospital information system of the University Children’s Hospital for CPS in children, adolescents, and young adults and complemented this by review of electronic patients’ charts. Between January 1, 2017, and December 3, 2019, 272 patients with 41 different CPS entities were identified in 20 departments (144 [52.9%] male, 128 [47.1%] female, median age 9.1 years, range, 0.4–27.8). Three (1.1%) patients died of non-malignancy-associated complications of the CPS; 49 (18.0%) patients were diagnosed with malignancy and received regular follow-up. For 209 (95.0%) of the remaining 220 patients, surveillance recommendations were available: 30/220 (13.6%) patients received CPS consultations according to existing consensus recommendations, 22/220 (10.0%) institutional surveillance approaches were not complying with recommendations, 84/220 (38.2%) patients were seen for other reasons, and 84/220 (38.2%) were not routinely cared for. Adherence to recommendations differed extensively among CPS entities.Conclusion: The spectrum of CPS patients at our tertiary-care children’s hospital is manifold. For most patients, awareness of cancer risk has to be enhanced and current practice needs to be adapted to consensus recommendations. Offering specialized CPS consultations and establishing education programs for patients, relatives, and physicians may increase adherence to recommendations. What is Known: • A wide spectrum of rare syndromes manifesting in childhood is associated with an increased cancer risk. • For many of these syndromes, expert recommendations for management and tumor surveillance are available, although based on limited evidence. What is New: • Evaluating current practice, our data attest significant shortcomings in tumor surveillance of children and adolescents with CPS even in a tertiary-care children’s hospital. • We clearly advocate a systematic and consistent integration of tumor surveillance into daily practice.

P19 Development of a guideline on management of medicines for patients on a ketogenic diet

2018 ◽  
Vol 103 (2) ◽  
pp. e2.21-e2
Author(s):  
Anneka Sareen
Keyword(s):  
Ketogenic Diet ◽  
Carbohydrate Content ◽  
List Type ◽  
Street Hospital ◽  
Practical Advice ◽  
Diagnosis And Management ◽  
Children's Hospital ◽  
Ketogenic Diets ◽  
Children’S Hospital ◽  
Carbohydrate Contents

AimThe National Institute for Health and Care Excellence (NICE) states that initiation of a ketogenic diet should be considered for children and young people whose epilepsy has not responded to anti-epileptic drug therapy.1 At present, no guideline exists within the Trust about ketogenic diets and so it was agreed that some guidance would be appropriate to guide doctors, nursing staff and pharmacists about how to manage medication for paediatric patients on a ketogenic diet.MethodA literature search was conducted using Embase and Medline with the search terms ‘ketogenic diet’ and ‘epilepsy.’ The only filters included in the search were to ensure information was in English and that human subjects were the focus. Guidance used within other Trusts and recommendations from the International Ketogenic Diet Study group were also considered.There is a paediatric ketogenic dietician within the Trust and so she was consulted for her advice throughout guideline development.ResultsA guideline has been produced that addresses how medicines should be managed for patients on a ketogenic diet. If any new medicines are initiated within hospital, practical advice is given on how to ensure the carbohydrate content is minimal, and the importance of ensuring ketone levels are monitored.The guideline also briefly considers the acute and chronic effects of the ketogenic diet and how these may result in other medicines and supplements being prescribed. Given that there is no nationally recognised resource available for identifying the carbohydrate contents of medicines, all oral anti-epileptic medication, analgesics and antibiotics that could be used within the Children’s Hospital were considered and the carbohydrate contents confirmed with the relevant manufacturers, with the aim of guiding prescribing decisions about the management of pain, infections and epilepsy.Despite many liquid medicinal preparations stating that they are ‘sugar free,’ they will often contain large amounts of sorbitol and other ingredients that are sources of carbohydrate, which will be problematic for ketogenic diet patients.2 Given that liquid preparations are largely used within the Children’s Hospital, the guideline gives practical advice about key sources of carbohydrate that may be found in liquid medicines and hence ingredients that should be avoided where possible.ConclusionThe research conducted to develop this guideline has shown that ketogenic diets can be a very effective method for reducing seizure activity.2 Considering that the carbohydrate content of medication can affect whether a patient is in a state of ketosis, it is important for healthcare professionals to acknowledge how to manage any changes to a patient’s medication. It is hoped that by providing the carbohydrate content of certain medicines within the guideline, patients will be treated in hospital without ketone levels being compromised.ReferencesNational Institute for Health and Care Excellence. Epilepsies: Diagnosis and management (CG137). Available from: https://www.nice.org.uk/guidance/cg137/resources/epilepsies-diagnosis-and-management-35109515407813 [Accessed: 4th July 2016].Great Ormond Street Hospital NHS Trust for Children. Ketogenic diet. Available from: http://www.gosh.nhs.uk/health-professionals/clinical-guidelines/ketogenic-diet [Accessed: 5th July 2016].

Designing for Patient Safety and Efficiency: Simulation-Based Hospital Design Testing

2020 ◽  
Vol 13 (4) ◽  
pp. 68-80 ◽  
Author(s):  
Nora Colman ◽  
Mary Bond Edmond ◽  
Ashley Dalpiaz ◽  
Sarah Walter ◽  
David C. Miller ◽  
...  
Keyword(s):  
Bivariate Analysis ◽  
Effect Analysis ◽  
Healthcare Facilities ◽  
Children's Hospital ◽  
Hospital Design ◽  
Design Changes ◽  
Simulation Based ◽  
Children’S Hospital ◽  
Design Planning ◽  
Schematic Design

Objective: In the schematic design phase of a new freestanding children’s hospital, Simulation-based Hospital Design Testing (SbHDT) was used to evaluate the proposed design of 11 clinical areas. The purpose of this article is to describe the SbHDT process and how it can help identify and mitigate safety concerns during the facility design process. Background: In the design of new healthcare facilities, the ability to mitigate risk in the preconstruction period is imperative. SbHDT in a full-scale cardboard mock-up can be used to proactively test the complex interface between people and the built environment. Method: This study was a prospective investigation of SbHDT in the schematic design planning phase for a 400-bed freestanding children’s hospital where frontline staff simulated episodes of care. Latent conditions related to design were identified through structured debriefing. Failure mode and effect analysis was used to categorize and prioritize simulation findings and was used by the architect team to inform design solutions. A second round of testing was conducted in order to validate design changes. Results: A statistically significant reduction in criticality scores between Round 1 ( n = 201, median = 16.14, SD = 5.8) and Round 2 ( n = 201, median score of 7.68, SD = 5.26, p < .001) was identified. Bivariate analysis also demonstrated a statistically significant reduction in very high/high criticality scores between Round 1 and Round 2. Conclusions: SbHDT in the schematic phase of design planning was effective in mitigating risk related to design prototypes through effective identification of latent conditions and validation of design changes.

INPATIENT STATISTICS AT THE HOPITAL DES ENFANTS MALADES IN PARIS FOR THE YEAR 1822

PEDIATRICS ◽  
1982 ◽  
Vol 70 (6) ◽  
pp. 940-940
Author(s):  
T. E. C.
Keyword(s):  
Hospital Stay ◽  
Current Practice ◽  
Surgical Patients ◽  
Average Hospital Stay ◽  
Children's Hospitals ◽  
Average Hospital ◽  
Children's Hospital ◽  
Children’S Hospitals ◽  
Children’S Hospital ◽  
Overall Mortality

The HÔpital des Enfants Malades, the world's first children's hospital, was founded in Paris in 1802. Twenty years later it contained 560 beds, 491 for medical and 69 for surgical patients. In 1822, 2,641 patients were admitted; their diagnoses were as follows: [SEE TABLE IN SOURCE PDF.] The overall mortality among inpatients was about 27 percent. The mortality for smallpox was 47 percent, and for measles 35 percent. Contrary to current practice in our children's hospitals, inpatients at the Hôpital des Enfants Malades, at least in 1822, were hospitalized for exceedingly long periods. For example, patients with scabies spent between 21 and 69 days in the hospital; for tinea the average hospital stay was 156 days; and for scrofula 288 days.

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