Bakgrund: Barn som vårdas på sjukhus är ofta i behov av någon form av venaccess. På flera platser i Sverige finns enbart perifiera venkatetrar att tillgå när en central infart ej är aktuellt. För barn med långvarigt behov av intravenösa läkemedel kan detta orsaka upprepade stick och kateterbyten. Midline är en perifer venaccsess med längre hållbarhet som nyligen börjat användas inom pediatrisk vård. Syfte: Studiens syfte är att undersöka sjuksköterskors erfarenheter av att vårda barn med Midline. Metod: Studien genomfördes med kvalitativ metod genom semistrukturerade intervjuer.Därefter utfördes en innehållsanalys för att besvara studiens syfte. Deltagarna var nio sjuksköterskor vid fyra olika sjukhus i mellersta och södra Sverige. Resultat: Analysen resulterade i kategorierna: En ny typ av infart, En vårdupplevelse med barnet i fokus samt Att företräda barnen. Tillgång till en infart som var säker och hade längre hållbarhet än andra perifiera venkatetrar uppskattades av deltagarna. Tydliga instruktioner och rutiner ansågs viktiga. En stor fördel med Midline ur ett barnperspektiv var färre stick i samband med långvarigt behov av venaccsess. Samt vikten av det interprofessionella samarbetet som krävs för att få inläggning av katetern att bli så bra som möjligt. Slutsats: Deltagarna såg Midline som ett bra alternativ till andra perifiera infarter i vården av barn med behov av långvarig venaccess. Detta då det minskade lidandet för barnen samt att det gav en möjlighet till lek och vistelse utanför sjukhus som annars hade varit svårt att tillgodose. / Background: Children in hospital care may need venous access. In many places in Sweden the only type of access available is peripheral venous catheter or central lines. For children with a long need of intravenous treatment this can cause repeated procedures and pain.Midline is a peripheral venousacsess with longer durability that recently has been introduced in pediatric care. Aim: To explore nurses experience of using Midline in paediatric care. Method: The method used was a qualitative design with a content analysis. Semistructured interviews were conducted with nine nurses from four different hospitals in the middle and southern parts of Sweden. Results: The participants’ experiences were categorized in three main categories: A new type of venous access, A care experience with the child in focus and To represent the child. To have a secure access with a longer durability compared to a regular venous catheter was highly appreciated by the participants. Instructions and routines where essential for the catheter to work properly. Fewer painful procedures was seen as an advantage with the Midline catheter through the children's perspective. Conclusion: The participants saw the Midline catheter as a good alternative to the regular peripheral venous catheter in the paediatric care. It was seen to decrease childrens suffering and gave a better opportunity to play and spend time outside of the hospital.

Olsson, S. Föräldrars upplevelse av egenvård och egenvårdsråd vid förstoppning hos barn: En intervjustudie. Examensarbete i omvårdnad 15 högskolepoäng. Avancerad nivå – Magister. Malmö Universitet: Hälsa och samhälle, Institutionen för vårdvetenskap, 2018. Bakgrund: Trots att förstoppningsproblematik hos barn förekommer hos upp till 30 procent av befolkningen är många barn underbehandlade. Vården består i huvudsak av egenvård som ges av föräldrar till barn i hemmet. Vikten av att rätt egenvård initieras i rätt tid påverkar prognosen för om förstoppningsproblematiken utvecklas till att bli mer svårbehandlad eller inte. Föräldrars upplevelse av egenvård och egenvårdsråd torde kunna ge en fingervisning kring om den evidens som finns kommer ut till de barn som är drabbade och vilken roll specialistsjuksköterskan kan spela för att hjälpa föräldrar till barn med förstoppning.Syfte: Att belysa föräldrars upplevelse av egenvård och egenvårdsråd vid förstoppning hos barn.Metod: Kvalitativa semistrukturerade intervjuer genomfördes med nio föräldrar till barn med förstoppningsproblematik. Intervjuernas innehåll analyserades enligt innehållsanalys med induktiv ansats.Resultat: Tre teman framkom i resultatet: innebörden av egenvård och egenvårdsråd, påverkan på det sociala livet och en känsla av utsatthet. Dessa teman reflekterade hur föräldrar till barn med förstoppningsproblematik kunde uppleva svårigheter att definiera hur, när och varför egenvård kunde behöva ges eller förändras till det egna barnet.Slutsats: Resultatet indikerar att relevant kunskap om egenvård vid förstoppning inte når ut till de familjer som behöver den i behandlingen av det förstoppade barnet. Den specialistutbildade sjuksköterskan torde kunna spela en avgörande roll för föräldrar till barn med förstoppningsproblematik i deras upplevelse och behandling av problematiken.Nyckelord: Egenvård, Funktionell förstoppning, Innehållsanalys, Omvårdnad, Pediatrisk vård / Olsson, S. Parents’ experiences of self-care and advice on self-care when handling childhood constipation: an interview study. Degree project, 15 Credit Points One-year Master, Malmö University: Health and society, Department of Care Science, 2018. Background: Despite a prevalence of up to 30 percent many children with childhood constipation are undertreated. Large part of the treatment for constipation consists of self-care administrated to the child by its parents. The importance of proper self-care initiated in time affects the prognosis of whether the constipation will become treatment resistant or not. Parents' perception of self-care and advice on self-care may be an indicator to whether the evidence-based care is offered to the affected children. It could also indicate what role the nurse specialized in pediatric care can play to help parents and their children with constipation. Aim: This study aimed to highlight parents’ perception of self-care and advice on self-care when having a child with constipation.Method: Qualitative semi structured interviews were conducted with 9 parents of constipated children. The interview material was analysed using content analysis.Results: Three themes were identified; meaning of self-care and self-care advice, impact on social life and a sense of vulnerability. These themes reflected how Parents of children with functional constipation experienced difficulties in defining how, when and why self-care might be needed for their child.Conclusion: The studies result implies that relevant knowledge about self-care does not reach the families who need it the most. A nurse specialised in paediatric care could therefore play a crucial role for parents of children with functional constipation in their experience and treatment of the problem.Keywords: Content analysis, Functional Constipation, Nursing, Paediatric care, Self-care.

Objective:Iatrogenic acute limb ischaemia in paediatric patients is a well-recognised complication of vascular access. This retrospective review of a paediatric intensive care unit identified patients who developed iatrogenic acute limb ischaemia between January 2008 and July 2013. Methods: The medical records of inpatients diagnosed with acute limb ischaemia during the study period were reviewed. Patients with other causes of acute limb ischaemia were excluded. A descriptive analysis of demographics, primary diagnosis, type of vascular access used, affected anatomical region, clinical presentation, type of therapy, type of block, response to intervention used and outcomes was conducted. Results:A total of 28 patients presented with signs of acute limb ischaemia, of whom 28.6% were aged <30 days, 46.4 % were between one and 12 months and 25% were between one and five years old; 78.6% of the affected limbs were lower limbs. Four patients had resolution of ischaemia upon removal of the vascular access devices. 23 patients received various forms of pharmacological sympathectomy, in addition to conservative therapy. One patient had missing data on the type of sympathectomy that was done. The response to the sympathectomies was: 60.9% good, 8.7% moderate, 8.7% poor and in 21.7% no responses. Documented tissue loss related to the ischaemia occurred in six (21.4%) of the 28 patients. Conclusions: Iatrogenic acute limb ischaemia in children are usually managed without surgical intervention. Pharmacological sympathectomies lead to increased blood flow to the affected limb via vasodilatation of collateral vessels, with an added advantage of reducing ischemic pain. The improved blood flow is postulated to avoid and/or minimise the amount of tissue loss. Pharmacological sympathectomies may, thus, have a role to play in th e management of iatrogenic acute limb ischaemia in the paediatric population.

Introduction: Diabetes management in very young children remains challenging. Glycaemic targets are achieved at the expense of high parental diabetes management burden and frequent hypoglycaemia, impacting quality of life for the whole family. Our objective is to assess whether automated insulin delivery can improve glycaemic control and alleviate the burden of diabetes management in this particular age group. Methods and analysis: The study adopts an open-label, multinational, multicentre, randomised, crossover design and aims to randomise 72 children aged 1-7 years with type 1 diabetes on insulin pump therapy. Following screening, participants will receive training on study insulin pump and study continuous glucose monitoring devices. Participants will be randomised to 16-week use of the hybrid closed-loop system (intervention period) or to 16-week use of sensor-augmented pump therapy (control period) with 1-4 weeks washout period before crossing over to the other arm. The order of the two study periods will be random. The primary endpoint is the between-group difference in time spent in the target glucose range from 3.9 to 10.0 mmol/L based on sensor glucose readings during the 16-week study periods. Analyses will be conducted on an intention-to-treat basis. Key secondary endpoints are between group differences in time spent above and below target glucose range, glycated haemoglobin and average sensor glucose. Participants' and caregivers' experiences will be evaluated using questionnaires and qualitative interviews, and sleep quality will be assessed. A health economic analysis will be performed. Ethics and dissemination: Ethics approval has been obtained from Cambridge East Research Ethics Committee (UK), Ethics Committees of the University of Innsbruck, the University of Vienna and the University of Graz (Austria), Ethics Committee of the Medical Faculty of the University of Leipzig (Germany) and Comité National d'Ethique de Recherche (Luxembourg). The results will be disseminated by peer-reviewed publications and conference presentations.

Bakgrund: Barn i alla åldrar kan känna smärta vid nålstick vilket är starkt sammankopplat med rädsla. Det kan generera stress och negativa minnen inför framtida vårdtillfällen, med risk för individ, vård och ökade samhällskostnader. Adekvat smärtlindring är en mänsklig rättighet för individen, men även sett från ett medicinskt, etiskt och juridiskt perspektiv. Trots detta är icke-farmakologisk smärtlindring, som avledning, underutnyttjade i den pediatriska vården. Eftersom barnvaccinationsprogrammet innebär flera nålstick under barnets uppväxt är kunskap om avledning av stor vikt.  Syfte: Syftet med denna litteraturstudie var att beskriva effekter av avledning som icke-farmakologisk metod för reducerad smärtupplevelse hos barn vid nålstick. Metod: En litteraturstudie utfördes med deskriptiv design och kvantitativ ansats. Studiens resultat har baserats på 16 randomiserade originalartiklar som hämtades från databaserna Cinahl och PubMed. Artiklarna kvalitetsgranskades enligt Caldwell et al. (2011) och resultatanalysen utfördes enligt Popenoe et al. (2021). Huvudresultat: Avledning men hjälp av virtual reality, avledningskort, verbal interaktion med vårdnadshavare, träleksak, leksaksarmband och kalejdoskop hade smärtreducerande effekter för barn vid nålstick. Avledning med såpbubblor visade endast en smärtreducerande effekt hos mindre barn (3–6 år). Vibrerande instrument med kylkudde hade ingen smärtreducerande effekt hos barn som redan var smärtpåverkade. Studien fann motstridiga resultat för effekten av surfplatta och inga signifikanta effekter för leksaksrobot och aromaterapi.  Slutsats: Resultatets påvisande av avledningsmetoders smärtreducerande effekter på barn vid nålstick, föranleder en rekommendation om att dessa implementeras inom hälso- och sjukvård (primärvård, slutenvård, barnhälsovård och elevhälsovård). / Background: Children of all ages feel pain during needlesticks, which is strongly linked to fear. Associated stress and negative memories could affect future healthcare visits. This could imply an increased risk and cost for society. Adequate pain management is, from a medical, ethical and judicial standpoint, a human right. Despite this, pain management, such as distraction, remains underutilized in paediatric care. The childhood vaccination programme involves several needlesticks during the child’s upbringing, understanding the impact of distraction is of great importance. Aim: The aim of this literature review was to describe the effects of distraction as a non-pharmacological method for reducing the pain experience in children during needlesticks. Methods: This literature review was carried out using a descriptive design and a quantitative approach. The results have been based on 16 randomized original studies which were found through the Cinahl and PubMed databases. Article quality was assessed in accordance with Caldwell et al. (2011) and the data analysis was carried out in accordance with Popenoe et al. (2021). Main results: Virtual reality, distraction cards, verbal parent interaction, wooden toy, toy bracelet and kaleidoscope were found to have pain reducing effects for children during needlesticks. Distraction using soap bubbles showed effect only on younger children (3-6 years). Vibrating tool with cold patch showed no effect on children already in pain. There were contradictory results regarding the pain reducing effects of a smart tablet and no significant pain reducing effects of a toy robot and aromatherapy. Conclusion: The demonstrated pain reducing effect of distraction in children warrants a recommendation of implementation of these distraction methods in primary care, inpatient care, child health care and student healthcare.

No

No / The purpose was to determine if an age based, local diagnostic reference level for paediatric skeletal surveys could be established using retrospective data. Methods: All children below two years of age referred for a primary skeletal survey as a result of suspected physical abuse during 2017 or 2018 (n ¼ 45) were retrospectively included from a large Danish university hospital. The skeletal survey protocol included a total of 33 images. Dose Area Product (DAP) and acquisition parameters for all images were recorded from the Picture Archival and Communication System (PACS) and effective dose was estimated. The 75th percentile for DAP was considered as the diagnostic reference level (DRL). Results: The 75th percentile for DAP was 314 mGy*cm2 , 520 mGy*cm2 and 779 mGy*cm2 for children <1 month, 1e11 months and 12 < 24 months of age respectively. However, only the age group 1e11 months had a sufficient number of children (n ¼ 27) to establish a local DRL. Thus, for the other groups the DAP result must be interpreted with caution. Effective dose was 0.19, 0.26 and 0.18 mSv for children <1, 1e11 months and 12 < 24 months of age respectively. Conclusion: For children between 1 and 11 months of age, a local diagnostic reference level of 520 mGy*cm2 was determined. This may be used as an initial benchmark for primary skeletal surveys as a result of suspected physical abuse for comparison and future discussion. Implications for practice: While the data presented reflects the results of a single department, the suggested diagnostic reference level may be used as a benchmark for other departments when auditing skeletal survey radiation dose.

This thesis focuses on service utilisation among children with mild ID and their families, their needs for support and their experiences of support. Aims The overall aim of the thesis was to explore and describe service utilisation patterns among families of children with mild ID from a systems perspective. Methods A cross-sectional, descriptive and comparative quantitative design was used to describe the extent of service utilisation among 84 children with mild ID and their families (paper I and II). The types and number of services utilised were investigated in relation to the child’s age, gender and school setting. Data concerning the services utilised were collected from the organisational records of social services and paediatric habilitation units. In paper III, a descriptive questionnaire design was used to describe the support needs of families of 38 children with mild ID. A confirmatory design was used to examine the relation between family needs for support and (a) parental self-efficacy and (b) parents’ control over services. A confirmatory design was also used to examine the relation between parents’ experiences of the helpfulness of the support and (a) parental self-efficacy and (b) parents’ control over services. In paper IV a longitudinal, comparative and confirmatory design was used to investigate whether social service utilisation patterns differ over time when children with mild ID in self-contained classes are compared with those integrated into mainstream classes (n=405). Results In total, 60% of the families utilised paediatric habilitation services, and 40% of the families used disability-related services provided by social services. The most commonly utilised services were services concerned support outside of the home, such as respite care and services to improve children’s participation in society. Approximately 25% of the families utilised social problems-related services provided by social services. The most commonly utilised services concerned those to support parents in their parenting roles and financial assistance. In contrast to older children, younger children were more likely to utilise paediatric habilitation services. Older children utilised a higher number of disability-related service types provided by social services. Few differences were found between males and females. The majority of families did not utilise such services that are provided by social services. It was rare for families to use both disability-related services and those that address social problems during the same year. Commonly reported family needs concerned information about what services are available for their child, their child's impairment, how to respond to their child's behaviour and how to teach their child skills. Other common needs included access to parent support networks, to find suitable leisure activities for the child, and more alone time for parents. In contrast to families with mothers who did not participate in paid work, families with mothers who were employed expressed a lower requirement for support such as counselling, contact with other parents of children with impairments, more friends and more alone time for parents. Similar results werefound for families with mothers with higher levels of education. Parents with higher levels of perceived self-efficacy reported a lower need for information, as did also parents with higher levels of control over services. Parents with higher levels of control over services experienced the support as being more helpful. Children with mild ID who attended self-contained classes were more likely to utilise paediatric habilitation services than children integrated in mainstream classes. The same pattern was found for utilisation of disability-related services provided by social services. Integrated children who changed school setting to attend self-contained classes were more likely to begin to utilise disability-related services in comparison with those children who continued to be integrated. The former also had a higher likelihood of increasing the number of disability-related service types utilised. Conclusions In addition to disability-related problems, families of children with mild ID may also be at a higher risk of experiencing social problems when compared with the general population. Furthermore, very few families utilised both disability-related services and services addressing social problems. This implies that collaboration flaws exist between those professionals concerned with child welfare services and those concerned with disability-related services. A strong predictor of service utilisation was the type of school setting: children attending self-contained classes had a higher rate of service utilisation than those attending mainstream classes. This indicates that service systems outside of school are designed to collaborate with groups of pupils in special classes rather than individual children in mainstream classes. The strong need for information by families indicates that an ecological framework should be used to identify those factors that affect information availability and effectiveness. To increase parents’ perceived level of control over services, HSO professionals need to work in a capacity building manner with the explicit goal to enhance parental self-efficacy.

<p>Despite major advances in our understanding of the biology of childhood acute myeloid leukemia (AML) and the development of new cytotoxic drugs, the prognosis of long-term survival is still only 60-65 %.</p><p>In the present research, we studied the pharmacokinetics of drugs used in the induction therapy of childhood AML and performed in vitro drug sensitivity testing of leukemic cells from children with AML.</p><p>The aims of the studies were to correlate the results of the analysis to biological and clinical parameters and to identify subgroups of AML with specific drug sensitivity profiles in order to better understand why treatment fails in some patients and how therapy may be improved.</p><p>Blood samples were analysed to study the pharmacokinetics of doxorubicin (n=41), etoposide (n=45) and 6-thioguanine (n=50). Doxorubicin plasma concentration and total body clearance were correlated to the effect of induction therapy, and doxorubicin plasma concentration was an independent factor for complete remission, both in univariate and multivariate analysis including sex, age, and white blood cell count at diagnosis. For etoposide and 6-thioguanine no correlation was found between pharmacokinetics and clinical effect. Children with Down syndrome (DS) tended to reach higher blood concentrations of etoposide and thioguanine nucleotides, indicating that dose reduction may be reasonable to reach the same drug exposure as in children without DS.</p><p>Leukemic cells from 201 children with newly diagnosed AML, 15 of whom had DS, were successfully analysed for in vitro drug sensitivity by the fluorometric microculture cytotoxicity assay (FMCA). We found that samples from children with DS were highly sensitive to most drugs used in AML treatment. In non-DS children, the t(9;11) samples were significantly more sensitive to cytarabine (p=0.03) and doxorubicin (p=0.035) than other samples. The findings might explain the very favorable outcome reported in children with DS and t(9;11)-positive AML. A specific drug resistance profile was found for several other genetic subgroups as well. A detailed study of MLL-rearranged leukemia showed that cellular drug sensitivity is correlated both to partner genes and cell lineage, findings that support the strategy of contemporary protocols to include high-dose cytarabine in the treatment of patients with MLL-rearrangement, both in AML and acute lymphoblastic leukemia (ALL).</p><p>Our results indicate that drug resistance and pharmacokinetic studies may yield important information regarding drug response in different sub-groups of childhood AML, helping us to optimize future chemotherapy in childhood AML.</p>

Childhood cancer is a life-threatening disease with a profound impact on the family. Treatment side-effects and accompanied dietary difficulties are for example severe stressors, as appropriate nutrition is important for the treatment success and quality of life. In addition, (unhealthy) dietary patterns established in childhood tend to maintain in survivors. Parents are key players in feeding and establishing these pat-terns, though, systematic research on how parents experience these dietary difficulties is limited. This study aimed at exploring parental experiences of children’s dietary changes and difficulties during cancer treatment and after completion: what feelings do parents experience regarding their child’s dietary changes and difficulties, what feeding strategies to they apply to handle these difficulties, and how did they experience professional support and what are parental support needs. A systematic literature review was conducted and resulted in 21 suitable articles. The children were 0-21 years old, had various types of cancer, and received various types of therapy. Findings showed that parents reported many dietary changes (e.g. increase or decrease in food intake) and associated symptoms (e.g. nausea, changed tastes) during and after the cancer treatment course. Parents reported mainly negative feelings towards these dietary difficulties (e.g. distress and anxiety) and applied a wide range of behavioural feeding strategies, both negative (e.g. pressure to eat) and positive (e.g. provide healthy food) strategies. Parents also used complementary and alternative medicine. A high need for informational support regarding eating and feeding was expressed by parents during treatment, a need for emotional and practical support to a lower extent. These results showed how frequent and profound eating and feeding difficulties are in the childhood cancer and survivor population, and their (negative) impact on parents. Parents consequently need more support: they need oral and written information to set realistic expectations and install appropriate feeding strategies. This is important for the child’s nutritional status and general health both during and after cancer.