Cystic fibrosis (CF) is an autosomal recessive genetic disorder involving a mutation in the CF transmembrane conductance regulator protein (CFTR), which causes dysfunctional transport of chloride ions across cell membranes. CF affects multiple body systems and a few of its symptoms include chronic cough, difficulty breathing, obstructive airway disease, bacterial pulmonary infections, maldigestion, malabsorption, pancreatitis, and male infertility. Until recently, treatment options have been limited to alleviating symptoms, but a new classification of drugs, CFTR modulators, provide an opportunity to slow the progression of the disease and improve clinical outcomes. The effect of CFTR modulators may be attributed to the reduction of persistently colonizing bacteria in CF lungs. Though, the effects of modulators on microbial communities colonizing the CF lung remains unknown, specifically with common respiratory pathogens such as Pseudomonas aeruginosa and Staphylococcus aureus. Particularly, previous CF studies have been limited in scope due to focusing on only one type of modulator and by using low-yield sequencing techniques. To address this gap, we seek to study the changes in CF respiratory pathogens of patients initiating CFTR modulator therapy at Nemours Hospital using long-read metagenomic sequencing (Oxford Nanopore) of longitudinally collected respiratory samples. We have optimized a protocol for host DNA depletion and microbial metagenomic sequencing to characterize the respiratory microbiome. This study focuses on utilizing these sequencing data to compare the microbiome among two healthy controls to pre-CFTR-treatment microbial communities of two recruited pediatric CF patients.

Rhinoviruses (RVs) constitute a substantial public health burden. To evaluate their abundance and genetic diversity in pediatric patients, RV RNA in respiratory samples was assessed using real-time RT-PCR and partial nucleic acid sequencing of viral genomes. Additionally, clinical data were retrieved from patient charts to determine the clinical significance of pediatric RV infections. In total, the respiratory specimens of 776 patients (<18 years), collected from 2013 to 2017, were analyzed. Infections occurred throughout the entire year, with peaks occurring in fall and winter, and showed remarkably high intra- and interseasonal diversity for RV genotypes. RV species were detected in the following frequencies: 49.1% RV-A, 5.9% RV-B, and 43.6% RV-C. RV-C was found to be more frequently associated with asthma (p = 0.04) and bronchiolitis (p < 0.001), while RV-A was more frequently associated with fever (p = 0.001) and pneumonia (p = 0.002). Additionally, 35.3% of the patients had co-infections with other pathogens, which were associated with a longer hospital stay (p < 0.001), need for ventilation (p < 0.001), and pneumonia (p < 0.001). Taken together, this study shows pronounced RV genetic diversity in pediatric patients and indicates differences in RV-associated pathologies, as well as an important role for co-infections.

Der Ernährungsstatus ist ein wichtiger Einflussfaktor auf den Gesundheitszustand von Kindern und Jugendlichen. Sowohl Unter- als auch Übergewicht können den Krankheitsverlauf beeinflussen und stellen einen Risikofaktor für die Entwicklung weiterer Erkrankungen dar. Über die Prävalenz von Über- und Untergewicht bei hospitalisierten Kindern und Jugendlichen in Deutschland ist wenig bekannt. In der vorliegenden Arbeit werden die Daten von 906 Patienten zwischen 0 und 17 Jahren, die auf eine allgemein-pädiatrische Station mit neuropädiatrischem Schwerpunkt der Universitätsmedizin Göttingen im Jahr 2012 aufgenommen wurden, erhoben. Die Prävalenz und der Zusammenhang zwischen Über- und Untergewicht, eingeteilt nach BMI-Perzentilen und sozialen Faktoren, individuellen Faktoren und Erkrankung wurden untersucht und mit einem gesunden Referenzkollektiv aus der KiGGS-Studie des Robert Koch-Instituts verglichen. Von den 906 Patienten sind 458 männlich und 448 weiblich. 15,45% der Patienten sind mit einem BMI unter der 10. Perzentile untergewichtig, davon ist etwa die Hälfte (8,72%) mit einem BMI unter der 3. Perzentile stark untergewichtig. Übergewichtig (BMI >90. Perzentile) sind 16,56% der Kinder und Jugendlichen, davon 6,91% mit einem BMI über der 97. Perzentile adipös. Die am häufigsten von Untergewicht betroffene Altersgruppe ist die von 0-2 Jahren (25,34%, OR: 2,29-3,65), Übergewicht und Adipositas treten am häufigsten in der Altersgruppe zwischen 14 und 17 Jahren auf (21,15%). Kinder mit niedrigem Geburtsgewicht und Frühgeborene sind auch später häufiger untergewichtig (32,79%, p=0,013 und 22,7%, p=0,082). Mentale Retardierung und schwere körperliche Beeinträchtigung sind signifikant häufiger mit Untergewicht assoziiert (OR=2,1 und OR=3,6) ebenso wie infektiöse und parasitäre Erkrankungen (OR=6,27), Entwicklungsstörungen allgemein (OR=5,4), zerebrale Lähmungen und sonstige Lähmungssyndrome (OR=5,26) und Verletzungen des Kopfes (OR=2,59). Dagegen sind Kinder und Jugendliche mit Multipler Sklerose häufiger von Übergewicht betroffen (OR=2,14). Erkrankungsgruppen mit vermehrtem Vorkommen von sowohl Unter- als auch Übergewicht sind Neubildungen (OR=5,12 und OR=3,32) und angeborene Fehlbildungen, Deformitäten und Chromosomenanomalien (OR=3,76 und OR=1,49). Im Gesamtvergleich zwischen hospitalisierten Kindern und Jugendlichen und der gesunden Referenzgruppen zeigt sich kein signifikanter Unterschied in der Prävalenz von Unter- und Übergewicht. Einzelne Erkrankungsgruppen sind jedoch besonders häufig mit Unter- oder Übergewicht assoziiert. Um eine optimale Versorgung dieser betroffenen Kinder und Jugendlichen sicherzustellen, muss die Identifikation und Betreuung von akut und chronisch kranken Kindern und Jugendlichen mit Ernährungsstörungen verbessert und zu einem integralen Bestandteil im klinischen Alltag werden.

Införandet av en mobil intensivvårdsgrupp (MIG) har visat sig ha goda resultat utomlands med minskade andningsstopp och mortalitet inom pediatrisk vård. Vid Astrid Lindgrens Barnsjukhus i Solna, Sverige (ALB) finns långt framskridna planer på att starta en MIG-verksamhet. Syftet med denna studie var att beskriva pediatriska patienter som faller in under potentiella MIG-kriterier innan inläggning på barnintensivvårdsavdelningen/barnintermediäravdelningen (BIVA/BIMA) på ALB. Studien gjordes retrospektivt genom journalgranskning av inskrivna pediatriska patienter på BIVA/BIMA under 2009. Totalt inkluderades 148 pediatriska patienter i åldern 0-18 år i studien. Resultat visade att Andningsbesvär var den vanligaste inskrivningsorsaken och att Andning var den vanligast förekommande kontaktorsaken. Provtagning var den mest förekommande åtgärden som utfördes på akutmottagningen/vårdavdelningen innan förflyttning till BIVA/BIMA. Slutsatsen blev att det skulle kunna finnas cirka 300 pediatriska patienter per år på ALB som skulle kunna vara aktuella för MIG-uppdrag. Det är en klar indikation för att starta en MIG-verksamhet på ALB för att minska inläggningar på BIVA/BIMA samt identifiera dessa pediatriska patienter i ett tidigt skede innan akut försämring. / The implementation of Pediatric Medical Emergency Team (PMET) has proven to reduce respiratory arrest and mortality in Pediatric hospitals worldwide. At Astrid Lindgrens Barnsjukhus in Solna, Sweden (ALB) there are advanced plans to start a PMET. The aim of this study was to describe pediatric patients that met potential PMET-criteria before being admitted to pediatric intensive care unit/high demand unit (PICU/HDU) at ALB. The study was a retrospective chart review of admitted pediatric patients at PICU/HDU during 2009. Totally 148 pediatric patients between the age of 0 to 18 years were included in the study. The result showed that respiratory problems were the most common reason for being admitted to the hospital and problems with breathing was the most frequent PMET-criteria. Before the patient moved to the PICU/HDU the most common intervention performed in the emergency department/wards was sample-taking. The conclusion was that around 300 pediatric patients a year could benefit from a PMET at ALB. That is a clear indication that a PMET should be started at ALB to reduce admitted patients to PICU/HDU and identify the patients at risk for acute worsening.

Bakgrund: Ambulanssjukvården är en viktig del av vårdkedjan med avancerade bedömningar och behandlingar till svårt sjuka och skadade personer. Ambulanssjuksköterskan behöver kunna ta snabba och ibland livsavgörande beslut utanför sjukhus där den drabbade befinner sig. Varje år drabbas cirka 80 barn av hjärtstopp utanför sjukhus, vilket motsvarar cirka 1-2% av alla prehospitala hjärtstopp i Sverige. Att vårda svårt sjuka barn uppfattas som stressande, krävande och kan vara en stor utmaning i vårdutförandet.  Motiv: Genom en ökad kunskap om ambulanssjuksköterskors upplevelse av att vårda barn med hjärtstopp kan studien bidra till en ökad förståelse för vad som orsakar stressen och hur stresshanteringen kan förbättras. Syfte: Att beskriva ambulanssjuksköterskors upplevelse av att vårda barn prehospitalt där HLR förekommit.Metod: Individuella semistrukturerade intervjuer genomfördes med ambulanssjuksköterskor på tre olika ambulansstationer i Region Sörmland, Region Västernorrland samt Region Östergötland. Insamlat data analyserades med kvalitativ innehållsanalys. Resultat: Analysen resulterade i fyra kategorier “Att inte vara förberedd”, “Att tvingas hantera larmet”, “Att vilja överlämna ansvaret” och “Att trots allt lära sig av larmet”. Kategorierna fördes samman i temat: Barn HLR larm skapar stress och ångest.  Konklusion: Barnlarm ger ett ökat stress- och adrenalinpåslag. Otillräcklig information, svårigheten med närvarande föräldrar och anhöriga och att mötas av ett tyst barn skapar känslor av frustration, att inte räcka till och overklighet. För att ambulanssjuksköterskor ska kunna bibehålla en god hälsa efter svåra barnlarm ses ett behov av kollegialt stöd men även stöd från arbetsgivaren. Ambulanssjuksköterskor behöver känna att deras upplevelse och känslor bekräftas efter ett svårt larm, genom att exempelvis inte behöva ta sig an nya larm direkt. Arbetsgivaren har en viktig roll att tillgodose möjligheter för ambulanssjuksköterskor att bearbeta larmet utifrån att de är individer med olika behov. / Background: Ambulance care is an important part of the medical chain with advanced assessments and treatments for seriously ill and injured people. The ambulance nurse needs to be able to make quick and sometimes life-changing decisions outside the hospital where the victim is. Every year, approximately 80 children suffer cardiac arrest outside the hospital, which corresponds to approximately 1-2% of all pre-hospital cardiac arrests in Sweden. Caring for seriously ill children is perceived as stressful, demanding and can be a major challenge in the care delivery.Motive: Through an increased knowledge of ambulance nurses' experience of caring for children with cardiac arrest, the study can contribute to an increased understanding of what causes stress and how stress management can be improved. Purpose: To describe ambulance nurses' experience of caring for children pre-hospital where CPR has occurred.Method: Individual semi-structured interviews were conducted with ambulance nurses at three different ambulance stations located in Region Sörmland, Region Västernorrland and Region Östergötland. The collected data was analyzed using qualitative content analysis. Results: The analysis resulted in four categories: "Not being prepared", "Forced to handle the call", "Wanting to hand over the responsibility" and "Despite learning from the alarm". The categories were brought together in the theme: Child CPR alarms create stress, and anxiety. Conclusion: Pediatric calls provide an increased stress and adrenaline boost. Inadequate information, the difficulty of having parents and relatives present and being met by a silent child create feelings of frustration, inadequacy and unreality. In order for ambulance nurses to be able to maintain good health after severe pediatric calls, there is a need for collegial support but also support from the employer. Ambulance nurses need to feel that their experience and feelings are confirmed after a difficult mission, by, for example, not having to deal with new calls immediately. The employer has an important role in providing opportunities for ambulance nurses to process the alarm based on the fact that they are individuals with different needs.

The topic of my diploma thesis is the issue of nursing care in pediatric pati- ents before consumption of organs at the resuscitation department. I consider this topic socially very topical because the number of transplant candidates on transplantation lists is constantly increasing. Since child transplant can- didates are the most vulnerable group, I have focused on child organ donors. The theoretical part criticizes the concept of death and threat, including examination methods that lead to brain death. I present the activities of the Coordination Center of the Transplant and Coordinated Coordinator in a donor program that seeks to proliferate the transplant program. An important component is legal legislation and ethical aspects, which are an integral part of the donor system in the Czech Republic. Study materials I searched in the databases NLK, SVKKL, Medvik, Embase, PubMed, Wiley Online Library, Medscape. The research was conducted from the National Medical Library and from the Central Bohemian Library in Kladno. I got statistical data from web sources, especially from KST. Methodology: The choice of the case study best fulfills the requirements necessary to map the key moments of nursing care, which may play a role in the timely indication of a potential organ donor, as well as in considering...

The topic of my diploma thesis is the issue of nursing care in pediatric patients before consumption of organs at the resuscitation department. I consider this topic socially very topical because the number of transplant candidates on transplantation lists is constantly increasing. Since child transplant candidates are the most vulnerable group, I have focused on child organ donors. The theoretical part criticizes the concept of death and threat, including examination methods that lead to brain death. I present the activities of the Coordination Center of the Transplant and Coordi- nated Coordinator in a donor program that seeks to proliferate the transplant program. An important component is legal legislation and ethical aspects, which are an integral part of the donor system in the Czech Republic. Study materials I searched in the databases NLK, SVKKL, Medvik, Embase, PubMed, Wiley Online Library, Medscape. The research was conducted from the National Medical Library and from the Central Bohemian Library in Kladno. I got statistical data from web sources, especially from KST. Methodology: The choice of the case study best fulfills the requirements necessary to map the key moments of nursing care, which may play a role in the timely indication of a potential organ donor, as well as in considering...

Syfte: Syftet var att beskriva den prehospitala användningen av supraglottiska hjälpmedel hos barn. Metod: En litteraturstudie på magisternivå baserad på 11 orginal artiklar hämtade från CINAHL och PubMed. Resultat: Supraglottiska hjälpmedel placerades främst hos äldre barn &lt;12 år med antingen hjärtstopp, trauma, respiratorisk instabilitet eller kramper. Flertalet olika supraglottiska hjälpmedel används internationellt och studierna beskriver att hjälpmedlen är tidseffektiva att placera, medför få komplikationer samt att den neurologiska funktionen är likvärdig med de som erhåller luftvägshantering med hjälp av endotrakeal intubation eller ventilation med mask och blåsa. Slutsats: Supraglottiska hjälpmedel används internationnelt hos pediatriska patienter i den prehospitala miljön, där placeringen av hjälpmedlet avgörs av kompetens och utbildningsnivå hos den prehospitala personalen. Vidare forskning krävs för att fasställa hurvida supraglottiska hjälpmedel hos den pediatriska populationen kan etableras prehospitalt och i synnerlighet hos barn under 12 år.

El presente estudio de caso tuvo como objetivo describir, analizar y comprender las experiencias de las enfermeras en la canalización de vías endovenosas en pacientes pediátricos en un hospital 2019, con un enfoque cualitativo. La muestra estuvo conformada por doce enfermeras que laboran en el servicio de pediatría del Hospital Regional, se determinó por saturación y redundancia incluyendo los criterios de inclusión y exclusión, se utilizó la técnica de recolección de datos, entrevista semiestructurada a profundidad, para el procesamiento de la información se empleó el método del análisis temático. En todo momento se cumplió con los criterios éticos y el rigor científico de la investigación. Entre los resultados se obtuvo que las enfermeras reconocen la expresión de sentimientos positivos a través de gratas experiencias vividas en su quehacer diario durante la canalización endovenosa, lo cual les genera no solo satisfacción profesional y personal sino el bienestar que logra en el paciente haciendo menos daño con menos venopunciones. Se encontró que las enfermeras viven experiencias difíciles y complicadas, les permite generar habilidades como el autocontrol, el entusiasmo, la automotivación, la empatía y dotarlas de defensas para la reacción positiva a la tensión y al estrés; y entre sus experiencias difíciles recurren a la ayuda espiritual como es Dios buscando fe y fortaleza; en la familia del paciente pediátrico buscan el soporte para generar un ambiente de confianza al momento de realizar la canalización y que sea más rápida y menos dolorosa para el paciente. / The objective of this case study was to describe, analyze and understand the experiences of nurses in the cannulation of intravenous lines in pediatric patients in a hospital in 2019, with a qualitative approach. The sample was made up of twelve nurses who work in the pediatric service of the Regional Hospital, it was determined by saturation and redundancy including theinclusion and exclusion criteria, the data collection technique, semi-structured in-depth interview, was used for the processing of The thematic analysis method was used to collect the information. The ethical criteria and scientific rigor of the research were met at all times. Amongthe results, it was obtained that nurses recognize the expression of positive feelings through pleasant experiences in their daily work during intravenous cannulation, which generates not only professional and personal satisfaction but also the well-being that it achieves in the patient,doing less harm. with fewer venipunctures. It was found that nurses live difficult and complicated experiences, allowing them to generate skills such as self-control, enthusiasm, self-motivation, empathy and providing them with defenses for a positive reaction to tension and stress; and among their difficult experiences they turn to spiritual help such as God seeking faithand strength; The family of the pediatric patient seeks support to generate an environment of trust when performing the canalization and to make it faster and less painful for the patient.

No description available.