A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / The objective of this project was to review skeletal survey reports and examine the differences in reporting of non-accidental trauma in patients with similar radiological findings. The overall purpose of this project is to develop a standardized reporting system for radiological findings suspicious for non-accidental trauma. Ten years’ worth of skeletal survey reports were obtained on over 1,500 pediatric patients. These reports were individually reviewed and their findings were categorized in a table separating findings suspicious for non-accidental trauma. After data collection, analysis was completed to inspect the consistency of reports amongst studies with similar fractures specifying non-accidental trauma. The comparison was made between reports containing long bone fractures, metaphyseal corner fractures, rib fractures, or any combination of these. It was concluded that there are inconsistencies in reporting of non-accidental trauma in reports with similar patterns of these fractures. We propose a Skeletal Survey – Reporting and Data System (SS-RADS) score which will help radiologist standardize their reporting methods for more consistent interpretations and clinical outcomes.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / CT abdomen and pelvis is a widely-used imaging modality used in the evaluation of appendicitis but it carries risks of radiation. A recent retrospective review localizes all appendices (both normal and abnormal) below the level of the L1 vertebral body, obviating the need to scan superior to that level. This study is a retrospective review of prospectively-collected data from 171 consecutive pediatric patients presenting with clinical suspicion of acute appendicitis and undergoing “low FOV CT.” The low FOV CT uses the L1 vertebral body as the superior aspect of the exam instead of the of the dome of the diaphragm as in standard CT.

Introduction : Dans la population pédiatrique, la prescription des antipsychotiques (AP) connait une hausse majeure ces quinze dernières années malgré une Autorisation de Mise sur le Marché (AMM) française limitée à quelques molécules AP avec des indications réduites. Cela conduit à un taux de prescription hors AMM important avec des modalités de prescription dépendantes du prescripteur en l’absence de recommandations de prescription et de surveillance. De plus, la littérature relève un nombre inquiétant d’événements indésirables (EI) associé à un manque de données sur les conséquences à moyen et long terme. Méthode : L’étude ETAPE nationale, multicentrique, prospective a été financée par l’Agence Nationale de Sécurité du Médicament et des produits dérivés. L’objectif principal était de déterminer le taux d’incidence des EI au cours d’un suivi de 12 mois chez des enfants et des adolescents de 6 à 18 ans exposés pour la première fois à un AP quel que soit le motif de la prescription. Le suivi proposé était de 12 mois avec 5 visites (à l’inclusion, puis à 3, 6, 9 et 12 mois). Une recherche exhaustive des EI a été réalisée à chaque visite grâce à la passation d’échelles cliniques, un examen physique et des bilans complémentaires. Résultats : L’étude a débuté en Avril 2013, la période d’inclusion s’est étendue sur deux ans et le suivi s’est terminé en Avril 2016. Au total, 200 patients ont été inclus. Les données de 190 patients ont été analysées. L’âge moyen était de 12 ± 2,99 ans, avec une proportion de 75% de garçons. A l’inclusion, 91% des patients ont reçu un AP en monothérapie et 9% au moins deux psychotropes. Rispéridone et aripiprazole étaient les AP les plus prescrits. Parmi les prescriptions d’AP, 20,5% répondaient à une AMM. Parmi les EI potentiellement attribuables à l’AP : 15,4% étaient neuromoteurs, 14,8% gastroentérologiques, 12,2% métaboliques et 11,8% étaient des symptômes généraux. Le taux d’incidence des EI était de 11,52 EI par personne-année (IC 95% [9,83 ; 13,20]). Chez les 108 patients avec un suivi complet de 12 mois, 52,7% des EI sont apparus au cours du premier trimestre d’exposition (représentés principalement par les EI généraux et hormonaux). Néanmoins, l’apparition des EI était observée pendant toute la durée du suivi. Parmi ces patients, 25,8 % ont présenté au moins un EI sévère ou extrêmement sévère. De plus, la présence des EI s’est révélée stable au cours des 12 mois. Conclusion : Ce travail a contribué à mettre en évidence dans une population naïve pédiatrique nationale un fort taux d’incidence d’EI et un taux d’apparition et de présence des EI stable sur 12 mois. La présence d’EI sévères a touché un quart de la population ayant complété le suivi. Perspectives : Sur un échantillon de 55 patients niçois nous chercherons l’impact du polymorphisme génétique des cytochromes dans le métabolisme des AP et sur l’apparition des EI. L’ensemble de ces travaux a pour objectif de contribuer à la mise en place de recommandations de prescription et de surveillance des paramètres cliniques, biologiques et électrocardiographiques lors de l’introduction d’un AP en population pédiatrique pour améliorer la balance bénéfice/risque. / Background In France, as in the rest of the world, the off-label prescription of antipsychotics is on the rise in the pediatric population. In the literature, we noticed a significant lack of data on drug safety and adverse events in the naïve pediatric population treated by antipsychotic in the short as well as in the long term. In addition, studies independent of pharmaceutical laboratories are lacking. Method ETAPE Study was a naturalistic prospective multicenter study conducted between April 2013 and May 2016. Type of AP, concomitant treatment, clinical evaluation and AEs were registered at inclusion and 3-, 6-, 9- and 12-months follow up. This trial is registered with ClinicalTrials.gov, number NCT02007928. The main objective was to determine the incidence rate of adverse events (AEs) in the antipsychotic-naïve pediatric population treated by antipsychotic (AP) during a 12-months. Outcomes A total of 190 patients were analyzed. The mean age was 12 ± 2.99 years, with 75% being males. At baseline, 91% of patients received AP monotherapy and 9% received at least two psychotropic drugs. Risperidone and aripiprazole were the most frequently prescribed AP. 20.5% of prescriptions were in label. Among the AEs potentially attributable to AP, 15.4% were neuromotor, 14.8% gastroenterological, 12.2% metabolic and 11.8% general symptoms. The overall incidence rate was 11.52 AE per person-years (IC 95% [9.83; 13.20]). In patients completing completed FU (n=108), 52.7% of AEs appeared during the first 3 months, but onset of AE was noted during the 12-months FU. 25.8 % of patients have been exposed to at least one severe or extreme severity AE. The persistence of AEs was stable during the 12-months FU.Interpretation The high incidence rate of AEs, the severity and the persistence of AEs justify the necessity of clinical and biological follow-up of AEs during at least 12-months of AP treatment.

Submitted by Erika Demachki (erikademachki@gmail.com) on 2016-08-09T20:37:17Z No. of bitstreams: 2 Dissertação - Anniely Carvalho Rebouças Oliveira - 2016.pdf: 1878998 bytes, checksum: 1afecfd5948d2abb2a5374cbeb9ff005 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Erika Demachki (erikademachki@gmail.com) on 2016-08-09T20:41:31Z (GMT) No. of bitstreams: 2 Dissertação - Anniely Carvalho Rebouças Oliveira - 2016.pdf: 1878998 bytes, checksum: 1afecfd5948d2abb2a5374cbeb9ff005 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-08-09T20:41:32Z (GMT). No. of bitstreams: 2 Dissertação - Anniely Carvalho Rebouças Oliveira - 2016.pdf: 1878998 bytes, checksum: 1afecfd5948d2abb2a5374cbeb9ff005 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-04-08 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The acute respiratory infections (ARIs) are an important cause of morbidity and mortality worldwide. Viruses have an important role in the etiology of the respiratory infections. Children less than five years of age have about four to six ARIs per year and this is a common cause of hospitalization, mainly in developing countries. In Brazil, particularly in the West-Central region, studies that evaluated the circulation of respiratory viruses in the pediatric population are scarce. Thus, this study aimed to investigate the occurrence of respiratory viruses in the pediatric population, from Goiânia-Goiás. Between May/2014 and May/2015, samples of nasal swabs were collected from children from zero to six years of age presenting or not respiratory symptoms, attended at the Materno Infantil hospital in Goiânia. For the molecular screening, 16 viruses were investiged using three Multiplex Nested-PCR protocols. It two hundred and fifty one samples were collected, of wich 90 (35,9%) were positive for at least one respiratory agent, being rhinovirus (31%), respiratory syncytial virus (27,4%) and parainfluenza virus (13,3%) the most prevalent. Children under two years of age had greater overall positive, although not statistically significant. Similar detection rate was observed among the groups symptomatic (37%) and asymptomatic (34,5%). For the symptomatic group, children whose samples were collected during the dry period (p<0,05) and those with up to two years of age were most affected (p<0,05). In the asymptomatic group no statistical difference was observed. It was observed rate of co-detection of 6,4% (16/251), mostly in samples of symptomatic patients (13/16) (p<0,05). The evaluation of the temporal profile showed a higher detection rate during the dry season, less rainfall, relative humidity and cooler temperatures. The results reinforce the importance of respiratory viruses in children and contribute to further understanding of the epidemiological and temporal factors associated with different pathogens in our region. Thus, they open the way to new studies in the state of Goiás, also providing information to assist in the construction of control measures and more effective prevention of these infections. / As infecções do trato respiratório (ITRs) representam importante causa de morbimortalidade em todo o mundo, sendo os vírus importantes agentes etiológicos. Estima-se que grande parte das crianças menores de cinco anos de idade tenha a cada ano de quatro a seis ITRs, sendo esta causa comum de hospitalização, especialmente em países em desenvolvimento. No Brasil, em particular na Região Centro-Oeste, estudos que avaliem a circulação de vírus respiratórios em população pediátrica são escassos. Neste contexto, o presente estudo teve como objetivo investigar a ocorrência de diferentes vírus respiratórios em população pediátrica de Goiânia-Goiás, apresentando ou não quadro sintomático respiratório. Durante o período de maio/2014 a maio/2015, foram coletadas amostras de swab respiratório de crianças entre zero e seis anos de idade, apresentando quadro de infecção respiratória ou assintomáticas para a mesma, atendidas no Hospital Materno Infantil, em Goiânia. As amostras foram submetidas à triagem molecular para 16 vírus respiratórios por meio de três protocolos de multiplex nested-PCR. No total, 251 amostras foram coletadas, das quais 90 (35,9%) apresentaram positividade para pelo menos um agente respiratório, sendo rinovírus (31%), vírus sincicial respiratório (27,4%) e parainfluenza (13,3%) os mais frequentes. Crianças com até dois anos de idade apresentaram maior positividade global, contudo sem diferença estatística. Índice de detecção semelhante foi observado entre os grupos sintomático (37%) e assintomático (34,5%). Para as crianças do grupo sintomático, foram mais afetadas aquelas cujas amostras foram coletadas durante período de seca (p<0,05) e aquelas com até dois anos de idade (p<0,05). No grupo assintomático, nenhuma diferença estatística foi observada. Foi observado índice de co-detecção de 6,4% (16/251), sendo a maioria de indivíduos sintomáticos (13/16) (p<0,05). A avaliação do perfil temporal demonstrou maior índice de detecção nos meses de seca, com menor precipitação pluviométrica, umidade relativa do ar e temperaturas mais frias. Os resultados obtidos no presente estudo reforçam a importância dos vírus respiratórios na população pediátrica, auxiliando na compreensão dos fatores epidemiológicos e temporais associados aos diferentes patógenos em nossa região. Desta forma, abrem caminhos para novos estudos no estado de Goiás, fornecendo ainda informações que auxiliem na construção de medidas de controle e prevenção mais eficazes contra estas infecções.

No description available.

The purpose of this body of work was to address medication errors and safe medication administration practices in relation to practicing nurses and nursing students via several different approaches. These different approaches will be presented as three separate papers but interrelated themes. The specific purpose for each paper and the corresponding research questions were addressed individually in each chapter. The approach used in the first paper was a systematic literature search of medication administration errors and the pediatric population; five themes emerged including the incidence rate of medication administration errors, specific medications involved in medication administration errors and classification of the errors, why medication administration errors occur, medication error reporting, and interventions to reduce medication errors. The approach used in the second paper included a systematic literature review and implementation of a survey, both focusing on the assessment strategies for safe medication administration with practicing nurses and nursing students. Results of both the review and the survey indicated a lack of a comprehensive assessment of safe medication administration. The approach used in the third paper was a research study to conduct a psychometric evaluation of the Safe Medication Administration (SAM) Scale with baccalaureate nursing students. Results provided evidence of the validity and reliability of the SAM Scale. This body of work exposed a gap in nursing and demonstrates the importance of having a standardized assessment of safe medication administration with evidence of validity and reliability to demonstrate competency in this area.

The Wide Range Assessment of Memory and Learning (WRAML) is a relatively new instrument used in the assessment of memory in children. The purpose of this study was to examine the validity of the WRAML by comparing the performance of children on both the WRAML and the Woodcock-Johnson Tests of Cognitive Ability- Revised (WJTCA-R). Subjects for the study were children in treatment for a brain tumor at a regional children's medical center. Fifty children participated in the study ranging from ages 6 to 17. A multiple regression analysis was conducted to determine which of four selected clusters from the WJTCA-R would have the highest correlation with the Verbal Memory Index (VERI) from the WRAML. The Short-Term Memory (GSM) cluster had the highest correlation ( r = .82) as predicted. A Pearson's product-moment correlational analysis was conducted between the Visual Processing (GV) cluster from the WJTCA-R and the Visual Memory Index (VISI) from the WRAML. GV was found to have a high positive correlation ( r = .63) with VISI. A similar analysis was conducted between the Long-Term Retrieval (GLR) cluster from the WJTCA-R and the Learning Index (LRNI) from the WRAML. GLR was found to have a high positive correlation ( r = .81) with LRNI. Finally, a correlational analysis was conducted between the Broad Cognitive Ability (BCA) scale from the WJTCA-R and the General Memory Index (GENI) from the WRAML. A high positive correlation ( r = .87) was found between these most global measures from the two batteries. The observed correlation between BCA and GENI was much higher than anticipated. The author concluded that neurological impairment had affected subject memory and intellectual functioning in similar ways. The results do not generalize to children who have not had similar decrements in cognitive functioning. Future research should establish a baseline correlation between the two instruments with a non-impaired population.

No description available.

Les études de séroprévalence portant sur les infections au SRAS-CoV-2 doivent souvent composer avec des échantillons non-aléatoires et non-représentatifs, limitant ainsi parfois la validité externe de leurs résultats lorsque ceux-ci sont appliqués à la population générale. Dans le cadre de ce mémoire, il s’agit d’investiguer la représentativité d’une cohorte pédiatrique d’une étude longitudinale de séroprévalence (Enfants et COVID-19 : Étude de séroprévalence) et d’évaluer dans quelle mesure ses estimations de séroprévalence peuvent s’appliquer à la population pédiatrique montréalaise en général. 1 632 enfants ont fourni au point de départ un échantillon sanguin afin de déterminer leur séropositivité aux anticorps contre le SRAS-CoV-2. À l’aide d’une modélisation par régression logistique et d’un procédé de « standardisation marginale », une pondération post-stratification calculée à partir des données du recensement canadien de 2016 a été appliquée à la population d’étude. Les variations dans les estimations de séroprévalence ont finalement été évaluées. D’importantes différences dans la distribution de certaines caractéristiques sociodémographiques peuvent être observées lorsqu’on compare la population d’étude et la population générale en se basant sur les données du recensement canadien de 2016. En comparaison des estimations non-pondérées, les estimations de séroprévalence générées à partir du procédé de « standardisation marginale » montrent une variation de plusieurs points de pourcentage, allant de -0,4% à +3,2%. La pondération n’a pas induit de changement dans l’estimation de mesures relatives comme les ratios de séroprévalence. Lorsque la population d’étude est non-représentative de la population-cible, il est nécessaire de pondérer les caractéristiques sociodémographiques associées à l’issue si l’on veut appliquer les résultats plus généralement. / Prevalence studies on SARS-CoV-2 infections have often based on study populations with non-random and non-representative samples, which limits the external validity of their results when applied to the general population. The aim of this thesis was to investigate the representativeness of a pediatric cohort of a longitudinal seroprevalence study (Children and COVID-19: Seroprevalence study) and to assess to what extent its baseline estimates of seroprevalence can be applied to the Montreal pediatric population. There were 1 632 children participants who provided a blood sample at baseline, which was used to determine their seropositivity to SARS-CoV-2 antibodies. Using logistic regression modeling and a "marginal standardization" method, post-stratification weights calculated from 2016 Canadian census data were applied to the study population. Variations in seroprevalence estimates were then assessed. Significant differences in the distribution of certain sociodemographic characteristics were observed when comparing the study population and the target population based on 2016 Canadian census data. Seroprevalence estimates were generated from the “marginal standardization” approach which differed to that of the non-standardized estimates, and the differences ranges from -0,4% to +3,2%. Weighting did not change relative measures estimates, such as seroprevalence ratios. When the study population is not representative of the target population, it is necessary to weight the sociodemographic characteristics associated with the prevalence estimates, if the results will be applied more broadly.

Les antipsychotiques de seconde génération (ASG) peuvent induire des effets métaboliques tels qu’une prise de poids, des troubles cardio-métaboliques, des effets endocriniens et dans de très rares cas une mort soudaine d’origine cardiaque. Les effets indésirables métaboliques potentiels des ASG doivent être surveillés. L’Alliance canadienne pour la surveillance de l’efficacité et de l’innocuité des antipsychotiques (CAMESA) propose des lignes directrices à cet effet. Les objectifs de cette étude rétrospective sont d’évaluer, à long terme, les taux d’enfants et d’adolescents recevant pour la première fois un ASG bénéficiant d’un monitoring dans les cliniques de santé mentale et de documenter les facteurs qui peuvent les influencer. À cet effet, les dossiers médicaux de 180 enfants et adolescents (âge moyen 13,3 ± 3,1 ans, 54,4 % garçons), traités pour la première fois par ASG entre janvier 2016 et juin 2018, ont été examinés. Les périodes de monitoring ont été divisées en baseline, de 1 à 6 et de 9 à 24 mois. La population étudiée a été stratifiée en enfants (4- 12 ans) vs adolescents (13-18 ans). Les caractéristiques sociodémographiques, le diagnostic psychiatrique et les comorbidités, les types d’ASG et les comédications prescrites, les mesures anthropométriques (MA), la pression artérielle (PA), les bilans sanguins (BS), l’électrocardiogramme (ECG) et les années de pratique du psychiatre ont été collectés. Des tableaux croisés ont été utilisés pour présenter les taux de monitoring. Les catégories ont été comparées par analyse de co-variable. Les taux de patients monitorés ont été comparés à travers les catégories de monitoring, en ayant recours au test exact de Fisher. Nos résultats démontrent des taux de monitoring pour MA, BS et PA de : 55 %, 47,8 % et 46,7 % au baseline ; 50 %, 41,7 % et 45,2 % à 1-6 mois ; et 47,2 %, 41,5 % et 40,6 % à 9-24 mois, respectivement. Des taux de monitoring plus élevés étaient associés de manière significative au statut d’adolescent (MA, BS et PA au baseline ; MA et PA à 1-6 mois), à un diagnostic de trouble psychotique et / ou affectif (MA, BS et PA au baseline ; MA et PA à 1-6 mois; BS à 9-24 mois), avoir ≤ 1 comorbidités psychiatriques (BS à 1-6 mois), et à l’expérience du clinicien (BS et ECG à 1-6 mois). En conclusion, cinq ans après les recommandations de CAMESA, le monitoring métabolique est effectué chez moins de la moitié des patients et diminue tout au long de la durée du traitement. Dans notre échantillon, les catégories d’âge, de diagnostic, de comorbidités psychiatriques et d’expérience du clinicien ont influencé les taux de monitoring. Toutefois, des progrès importants doivent encore être réalisés pour parvenir à un taux de monitoring satisfaisant. / Second generation antipsychotics (SGA) can induce metabolic effects such as weight gain, cardiometabolic disorders, endocrine effects and in very rare cases sudden cardiac death. The potential metabolic side effects of second generation antipsychotics need to be monitored. The Canadian Alliance for Monitoring the Efficacy and Safety of Antipsychotics (CAMESA) offers guidelines for this purpose. The objectives of this retrospective study are to evaluate, the long-term rates of youths receiving monitoring in mental health clinics and document the factors that may influence them. To this end, the charts of 180 children and adolescents (average age 13.3 ± 3.1 years, 54.4 % males) receiving SGA treatment for the first time between January 2016 and June 2018 were reviewed. Monitoring was divided into baseline and 1 to 6 and 9 to 24-month periods. The population under study was stratified into children (4-12 years) vs adolescents (13-18 years). Sociodemographic characteristics, psychiatric diagnosis and comorbidities, prescribed SGAs and comedications, anthropometric measurements (AM), blood pressure (BP), blood tests (BT), electrocardiogram (ECG) and the psychiatrist’s years of practice were collected. Cross tables were used to present the monitoring rates. Categories were compared by covariate analysis. Rates of patients monitored across categories were compared using Fisher’s exact test. Our results show that monitoring rates for AM, BT, and BP were: 55 %, 47.8 %, and 46.7 % at baseline, 50 %, 41.7 %, and 45.2 % at 1 to 6 months, and 47.2 %, 41.5 %, and 40.6 % at 9 to 24 months, respectively. Higher monitoring rates were significantly associated with adolescent status vs child (baseline AM, BT, and BP; 1-6-month AM and BP), a diagnosis of psychotic and/or affective disorder (baseline AM, BT, and BP; 1-6-month AM and BP; 9-24-month BT), having ≤ 1 psychiatric comorbidities (1-6-month BT), and clinician’s experience (1-6-month BT and ECG). In conclusion, five years after publication of the CAMESA guidelines, metabolic monitoring is conducted for less than half of patients and decreases over time. In our sample, age, diagnostic category, psychiatric comorbidities, and clinician’s experience influenced the monitoring rates. Major progress still needs to be made before reaching a satisfactory level of monitoring.