The cumulative radiation dose paradigm in pediatric imaging

2021 ◽  
pp. 20210478
Author(s):  
Donald Frush
Keyword(s):  
Effective Dose ◽  
Adult Population ◽  
Pediatric Care ◽  
Quality And Safety ◽  
Medical Settings ◽  
Relative Percentage ◽  
Dose Monitoring ◽  
Cumulative Radiation Dose ◽  
Adults And Children ◽  
Pediatric Populations

Medical imaging professionals have an accountability for both quality and safety in the care of patients that have unexpected or anticipated repeated imaging examinations that use ionizing radiation. One measure in the safety realm for repeated imaging is cumulative effective dose (CED). CED has been increasingly scrutinized in patient populations, including adults and children. Recognizing the challenges with effective dose, including the cumulative nature, effective dose is still the most prevalent exposure currency for recurrent imaging examinations. While the responsibility for dose monitoring incorporates an element of tracking an individual patient cumulative radiation record, a more complex aspect is what should be done with this information. This challenge also differs between the pediatric and adult population, including the fact that high cumulative doses (e.g.,>100 mSv) are reported to occur much less frequently in children than in the adult population. It is worthwhile, then, to review the general construct of CED, including the comparison between the relative percentage occurrence in adult and pediatric populations, the relevant pediatric medical settings in which high CED occurs, the advances in medical care that may affect CED determinations in the future, and offer proposals for the application of the CED paradigm, considering the unique aspects of pediatric care.

Pediatric care coordination and risk tiering: Moving beyond claims data

2021 ◽  
pp. 1-9
Author(s):  
Hillary E. Swann-Thomsen ◽  
Jared Vineyard ◽  
John Hanks ◽  
Rylon Hofacer ◽  
Claire Sitts ◽  
...  
Keyword(s):  
Care Coordination ◽  
Chronic Conditions ◽  
Pediatric Patients ◽  
Classification Model ◽  
Pediatric Care ◽  
Care Needs ◽  
Accurate Identification ◽  
Special Health Care ◽  
Pediatric Populations ◽  
Mean Differences

PURPOSE: The goal of this study was to evaluate the performance of a pediatric stratification tool that incorporates health and non-medical determinants to identify children and youth with special health care needs (CYSHCN) patients according to increasing levels of complexity and compare this method to existing tools for pediatric populations. METHODS: This retrospective cohort study examined pediatric patients aged 0 to 21 years who received care at our institution between 2012 and 2015. We used the St. Luke’s Children’s Acuity Tool (SLCAT) to evaluate mean differences in dollars billed, number of encounters, and number of problems on the problem list and compared the SLCAT to the Pediatric Chronic Conditions Classification System version2 (CCCv2). RESULTS: Results indicate that the SLCAT assigned pediatric patients into levels reflective of resource utilization and found that children with highly complex chronic conditions had significantly higher utilization than those with mild and/or moderate complex conditions. The SLCAT found 515 patients not identified by the CCCv2. Nearly half of those patients had a mental/behavioral health diagnosis. CONCLUSIONS: The findings of this study provide evidence that a tiered classification model that incorporates all aspects of a child’s care may result in more accurate identification of CYSHCN. This would allow for primary care provider and care coordination teams to match patients and families with the appropriate amount and type of care coordination services.

scholarly journals Remoção de órgãos sólidos para transplante: protocolo para a enfermagem

2019 ◽  
Vol 13 ◽  
Author(s):  
Edna Andréa Pereira de Carvalho ◽  
Shirlei Moreira da Costa Faria ◽  
Natália Ribeiro Ramos ◽  
Karla Rona da Silva
Keyword(s):  
Nursing Care ◽  
Professional Competence ◽  
Descriptive Study ◽  
Quality And Safety ◽  
Clinical Protocols ◽  
Structured Interviews ◽  
Validity Index ◽  
Organ Removal ◽  
Qualitative Descriptive ◽  
Adults And Children

Objetivos: elaborar um instrumento na modalidade de protocolo que permita a uniformidade das ações de Enfermagem em remoção de órgãos sólidos para transplantes. Método: trata-se de estudo qualitativo, descritivo, com foco na construção de um instrumento tecnológico do tipo protocolo, respeitando-se as seguintes etapas: revisão integrativa; coleta de dados por meio de entrevistas semiestruturadas; apreciação dos dados por meio da Análise de Conteúdo; elaboração da proposta de protocolo e utilização do Índice de Validade do Conteúdo para a validação.  Resultados esperados: espera-se disponibilizar, para os centros transplantadores, um protocolo que auxilie o enfermeiro na sistematização das ações de Enfermagem em cirurgias de remoção de órgãos para transplantes, contribuindo para a qualidade e segurança da assistência prestada a adultos e crianças submetidos a transplantes. Descritores: Protocolos Clínicos; Cuidados de Enfermagem; Transplante de Órgãos; Aloenxerto; Competência Profissional; Fluxo de Trabalho. ABSTRACT Objectives: to elaborate an instrument in the protocol modality that allows uniformity of Nursing actions in the removal of solid organs for transplants. Method: this is a qualitative, descriptive study, focusing on the construction of a protocol-type technological instrument, respecting the following steps: integrative review; data collection through semi-structured interviews; data appreciation through Content Analysis; elaboration of the protocol proposal and use of the Content Validity Index for validation. Expected results: It is expected to make available to transplantation centers a protocol that assists nurses in the systematization of Nursing actions in transplantation organ removal surgeries, contributing to the quality and safety of care provided to adults and children undergoing transplantation. Descriptors: Clinical Protocols; Nursing Care; Organ Transplantation; Allografts; Professional Competence; Workflow.RESUMEN Objetivos: elaborar un instrumento en la modalidad de protocolo que permita la uniformidad de las acciones de enfermería en la extracción de órganos sólidos para trasplante. Método: se trata de un estudio cualitativo, descriptivo, centrado en la construcción de un instrumento tecnológico de tipo protocolo, respetando los siguientes pasos: revisión integradora; recopilación de datos a través de entrevistas semiestructuradas; apreciación de datos a través del Análisis de Contenido; elaboración de la propuesta de protocolo y uso del índice de validez de contenido para la validación. Resultados esperados: se espera que se ponga a disposición para los centros de trasplante, un protocolo que ayude el enfermero en la sistematización de las acciones de Enfermería en cirugías de extracción de órganos de trasplante, contribuyendo para la calidad y seguridad de la atención prestada en adultos y niños sometidos a trasplantes. Descriptores: Protocolos Clínicos; Atención de Enfermería; Transplante de Órganos; Aloinjertos; Competencia Profesional; Flujo de Trabajo. 

Common Foot and Ankle Disorders in Adults and Children

2015 ◽  
Vol 19 (2) ◽  
pp. 54-65 ◽  
Author(s):  
Ganesan Balasankar ◽  
Luximon Ameersing
Keyword(s):  
Soft Tissues ◽  
Adult Population ◽  
Complex Structure ◽  
Whole Body ◽  
Clinical Aspects ◽  
Foot Deformities ◽  
Foot And Ankle ◽  
Human Foot ◽  
Flat Feet ◽  
Adults And Children

The human foot is a complex structure, which includes bones, joints, muscles, ligaments, soft tissues, nerves and veins. It supports the weight of the whole body and helps one to walk, run, and jump. Ankle and foot biomechanical functions that are interrupted by various pathological deformities lead to pain or other deformities, and result in difficulties during mobility. Foot problems are very common in children and adults. In this article, attempts are made to explore the clinical aspects of the most common foot and ankle deformities and their management by children and adults. Foot deformities may be congenital or acquired, and may involve arthritis conditions, such as rheumatoid arthritis and osteoarthritis. In children, congenital clubfoot, cavus, and flat feet are the most common disorders and can be treated by non-operative means or surgical management. Hallux valgus and rigidus, lesser toe deformities, and arthritis are mostly present with or without pain in the adult population.

Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery

2011 ◽  
Vol 31 (5) ◽  
pp. E5 ◽  
Author(s):  
Geoffrey Appelboom ◽  
Stephen D. Zoller ◽  
Matthew A. Piazza ◽  
Caroline Szpalski ◽  
Samuel S. Bruce ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Adult Population ◽  
Pediatric Trauma ◽  
Anatomical Variations ◽  
Decompressive Surgery ◽  
Pediatric Populations ◽  
The Impact

Traumatic brain injury (TBI) is the current leading cause of death in children over 1 year of age. Adequate management and care of pediatric patients is critical to ensure the best functional outcome in this population. In their controversial trial, Cooper et al. concluded that decompressive craniectomy following TBI did not improve clinical outcome of the analyzed adult population. While the study did not target pediatric populations, the results do raise important and timely clinical questions regarding the effectiveness of decompressive surgery in pediatric patients. There is still a paucity of evidence regarding the effectiveness of this therapy in a pediatric population, and there is an especially noticeable knowledge gap surrounding age-stratified interventions in pediatric trauma. The purposes of this review are to first explore the anatomical variations between pediatric and adult populations in the setting of TBI. Second, the authors assess how these differences between adult and pediatric populations could translate into differences in the impact of decompressive surgery following TBI.

scholarly journals Comparative Costs of Treating Adults and Children within Selected Diagnosis-related Groups

2002 ◽  
Vol 48 (1) ◽  
pp. 150-160
Author(s):  
Donald S Young ◽  
Bruce S Sachais ◽  
Leigh C Jefferies
Keyword(s):  
Large Scale ◽  
Diagnosis Related Groups ◽  
Hospital Costs ◽  
University Hospitals ◽  
Patient Admissions ◽  
Nominal Condition ◽  
Adults And Children ◽  
Pediatric Populations ◽  
The University ◽  
Effect Of Age

Abstract Background: There have been no large-scale analyses of resource utilization comparing the overall costs to treat pediatric patients vs adult patients. Likewise, there have been no studies evaluating the costs of the various components of hospitalization (e.g., accommodation, laboratory, radiology, and drugs) among adult and pediatric populations. Methods: To study the effect of age on the costs of treating patients, we have evaluated 43 conditions with matching diagnosis-related groups (DRGs) for children and adults. Using a database developed by the University HealthSystems Consortium, we examined the major non-physician components of hospital costs, including accommodation, surgery, pharmacy, radiology, and laboratory for 1 346 028 patient admissions to 60 University hospitals. These costs were derived from the ratio of costs to charges based on the Centers for Medicare and Medicaid Services PPS UB-2 cost reports. Results: The total non-physician cost of treating adults was generally greater than that for children within paired DRGs. Some of this difference may be attributable to the overall longer stay of adults in hospital. For conditions that were nominally the same, radiology, laboratory, and drug costs, especially tended to be higher for adults than for children. This was most marked when the costs were evaluated on a per diem basis. There tended to be greater variability in the costs of treating children than adults within the paired DRGs, as evidenced by greater differences between the median and mean costs. Conclusions: Among University hospitals, the costs of managing children are typically less than for adults with the same nominal condition. In these hospitals, there tends to be less use of laboratory, radiology, and pharmacy services for children than for adults.

Transmission of Measles Virus in Healthcare Settings During a Communitywide Outbreak

1999 ◽  
Vol 20 (2) ◽  
pp. 115-119 ◽  
Author(s):  
Karen R. Steingart ◽  
Ann R. Thomas ◽  
Clare A. Dykewicz ◽  
Stephen C. Redd
Keyword(s):  
Measles Virus ◽  
Adult Population ◽  
Health Maintenance Organization ◽  
Health Maintenance ◽  
Medical Settings ◽  
Immunization Policy ◽  
Clark County ◽  
Healthcare Settings ◽  
Medical Facilities ◽  
Multispecialty Group

AbstractObjective:To describe the epidemiology of measles in medical settings and to evaluate the implementation and effectiveness of the 1989 Advisory Committee on Immunization Practices (ACIP) guidelines for measles immunization in healthcare workers (HCWs).Design:Confirmed cases of measles reported in Clark County, Washington, from March 14 to June 2,1996, were analyzed for characteristics of cases occurring in medical settings. A questionnaire was used to assess employee immunization (95% response rate).Setting and Participants:Reported measles cases and HCWs at community hospitals, primary-care medical facilities, a health-maintenance organization, and a multispecialty group practice.Results:Of 31 cases of measles, 8 (26%) occurred in HCWs, and 5 (16%) occurred in patients or visitors to medical facilities. Cases of measles occurred in HCWs who were not required to have proof of measles immunity as defined by the 1989 ACIP guidelines. The relative risk of measles in HCWs compared to Clark County adults was 18.6 (95% confidence interval, 7.4-45.8;P<.001).A survey of medical facilities revealed that 47% had an employee measles immunization policy; only 21% met ACIP recommendations and enforced their policies.Conclusions:HCWs were at higher risk of measles than the adult population. Transmission of measles in medical settings was related to both deficiencies in, and lack of implementation of, the ACIP guidelines.

scholarly journals Vitamin D status in adults and children in Transcarpathia, Ukrainein 2019

2020 ◽  
Author(s):  
Khrystyna Shchubelka
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Adult Population ◽  
Winter Season ◽  
Epidemiological Data ◽  
Adult Women ◽  
Vitamin D Levels ◽  
Significant Difference ◽  
Adults And Children ◽  
The Mean

Abstract Background: Vitamin D deficiency is a global health problem, it is assessed by measuring serum 25-hydroxivitamin D (25(OH) D), nevertheless epidemiological data for many countries remains underreported.Objectives:To study the prevalence of vitamin D deficiency throughout the calendar year in a large cohort recruited ina multiethnic Transcarpathian region of Ukraine.Methods: In this retrospective study 25(OH)D serum concentration was measured during all 12 months of the year 2019 by electrochemoluminescent assay on the automatic analyzer Cobas e411 in 1,823 subjects, including both children and adults (1551 females (85.03%) and 273 males (14.97%)). ResultsThe mean 25(OH) D concentration in adults demonstrates significantly lower levels compared to children (22.67±8.63 ng/ml vs. 26.00±10.72 ng/ml respectively, p<0.001). Adult women expressed significantly lower mean annual serum 25 (OH) D concentrations in comparison to men (22.29±8.46 ng/ml vs. 25.75±9.38 ng/ml respectively, p< 0.001). In contrast, children did not show a significant difference between sexes (girls 24.98±10.38 ng/ml vs. boys 27.01±11.01 ng/ml, p=0.2003). In the winter months, 25(OH)D levels fell below 20 ng/ml in 51,74 % of adult population of Thranscarpathia, and in 12.91%, - below 12 ng/ml.ConclusionsThe results of this study contradict the previously reported evaluations of the vitamin D levels in Ukraine which were assessed by measuring serum 25(OH) D. Specifically, only approximately half of the studied population is vitamin D deficient during winter season. This study features the most representative sample size in Ukraine to date.

scholarly journals The Challenges of Crizotinib Treatment in a Child With Anaplastic Large Cell Lymphoma

2021 ◽  
Vol 26 (6) ◽  
pp. 647-654
Author(s):  
Liesbeth Vanheeswijck ◽  
Joris Verlooy ◽  
Els Van de Vijver ◽  
An Bervoets ◽  
Katleen Balliauw ◽  
...  
Keyword(s):  
Side Effects ◽  
Anaplastic Large Cell Lymphoma ◽  
Targeted Therapies ◽  
Cell Lymphoma ◽  
Large Cell ◽  
Pediatric Care ◽  
Anaplastic Lymphoma ◽  
Pediatric Populations ◽  
Large Cell Lymphoma ◽  
Alk Positive

Survival in cases involving childhood malignancy is reaching nearly 80% in high-income countries, yet cancer remains one of the leading disease-related causes of death in children. In adult oncology the role of targeted therapies is established, but information regarding the use of these therapies in children is limited, largely because targeted therapies were developed in the context of adult pathologies. The few pediatric reports regarding crizotinib, an anaplastic lymphoma kinase (ALK) inhibitor, seem promising. This case of an 8-year-old male with an ALK-positive anaplastic large cell lymphoma highlights the challenges of treating children with crizotinib. Our experience with crizotinib was more challenging than described in the limited pediatric reports. Not only was the tumor response poorer than described in the reports, but a substantial amount of side-effects and practical difficulties, such as the method of administration and dosing, made management challenging. Many challenges for the use of targeted therapy in pediatric care currently persist. The limited research in pediatric populations leaves uncertainty regarding efficacy and short- and long-term side effects as well as practical difficulties. Despite a clear underlying biological rationale for certain targeted therapies, their contribution toward improving the outcome of childhood cancer remains largely unclear.

SU-C-217A-02: An Effective Dose Monitoring Program for Computed Radiography

2012 ◽  
Vol 39 (6Part2) ◽  
pp. 3607-3607
Author(s):  
J Johnson ◽  
E Samei ◽  
O Christianson ◽  
D Bower
Keyword(s):  
Effective Dose ◽  
Computed Radiography ◽  
Monitoring Program ◽  
Dose Monitoring
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