1,720,964 research outputs found
Efficacy of physiotherapy treatments in children and adolescents with somatic symptom disorder and other related disorders: systematic review of the literature
Full text linkAccording to the latest version of the Diagnostic and Statistical Manual of Mental Disorders, somatic symptom and related disorders (SSRDs) are defined as psychopathological manifestations characterized by physical signs not attributable to organic pathology. Their incidence has grown dramatically over the past few decades, and treatment is challenging. Besides other interventions on the child and the family, physiotherapy is considered an integral part of the treatment, although there is no evidence for its efficacy. The study aimed to review the available proof on the effectiveness of physiotherapy in children and adolescents with SSRDs. A systematic literature search was conducted on MEDLINE/PubMed, CINAHL, Cochrane Library, PsycINFO, and PEDro, including 1999 to 2021. The methodological quality of the publications was assessed by applying the guidelines proposed by the Equator network, according to the different study designs. The scientific bibliography on the subject was minimal and had poor methodological quality. The choice of outcome indicators and the scales to measure them varied from study to study and were not standardized, making comparison and meta-analysis challenging. Conclusion: According to the available evidence, it is impossible to answer the review question regarding the effectiveness of physiotherapy in children and adolescents with SSRDs. It is necessary to improve the methodological quality of the studies. Definition of standard rehabilitation treatments, identification of appropriate result indicators, and adoption of standardized evaluation scales are needed
Ketorolac use in the emergency department in children: a systematic review and meta-analysis
Full text linkAcute pain is a frequent reason for pediatric patients visiting the emergency department (ED). Non-steroidal anti-inflammatory drugs (NSAIDs) and opioids are often used to manage pain in this setting. This systematic review and meta-analysis evaluates the effectiveness of ketorolac, a NSAIDs, in managing acute pain in children in the ED, comparing its efficacy and potential advantages over other pain management options. The search was conducted in PubMed and Web of Science, for English-language articles published from 1991 to February 2023. Only randomized controlled trials (RCTs) evaluating the analgesic effect of ketorolac in commonly painful conditions such as migraine, traumatic and non-traumatic musculoskeletal pain, abdominal pain, and renal colic treated in the ED were included. Pediatric studies were specifically selected. A meta-analysis was subsequently conducted to compare efficacy of ketorolac with other analgesic medications. Eight RCTs have investigated the efficacy of ketorolac for acute pain in children in the ED, reflecting limited pediatric evidence. Ketorolac showed variable effectiveness for conditions such as migraine, musculoskeletal trauma, acute abdominal pain, renal colic, and vaso-occlusive crisis in sickle cell disease. The meta-analysis revealed no significant differences in analgesic performance between ketorolac and other drugs, including opioids and other NSAIDs. The risk of bias across the studies was evaluated. However, the evidence remains insufficient to confidently recommend a specific intervention, highlighting the need for further research to guide clinical decision-making. Conclusion: Despite its limitations, the systematic review highlights that ketorolac seems effective for managing acute pain in pediatric ED patients, but not superior to other analgesic drugs. It emphasizes the necessity for further research to define optimal dosing, administration methods, and its comparative effectiveness with other analgesics across various clinical scenarios
Nonpharmacological treatment of rumination syndrome in childhood: A systematic review of the literature
Full text linkRumination syndrome (RS) is a complex functional disorder characterized by recurrent, repetitive regurgitation of recently swallowed food. RS may have medical and psychosocial implications, compromising the quality of life and causing high rates of school absenteeism. Pediatric RS has been poorly studied and little evidence regarding its treatment is available. This systematic review aims to evaluate the literature on the nonpharmacological treatment of RS in childhood. A systematic literature search was conducted on MEDLINE/PubMed, CINAHL, Cochrane Library, PsycINFO, and PEDro, from 2000 to 2023. The methodological quality of the publications was assessed by applying the guidelines proposed by the Equator network, according to the different designs of study, and the risk of bias was evaluated with the Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I). Five hundred ninety-six studies were screened, and 7 studies were included in the review. Diaphragmatic breathing was the most used nonpharmacological treatment, and it was always combined with other therapeutic strategies. The vast heterogeneity of the physical or mental comorbidities and the methodology adopted in the publications did not allow a comparative analysis of the different treatments. Regardless of the type of treatment, high-intensity therapeutic programs and specific operators' training emerged as the most influencing factors for patients' outcomes. According to the available evidence, there is not enough high-quality evidence to suggest a defined therapeutic strategy. Large observational studies on selected patients accounting for possible confounders, with adequate follow-up times, and with clearly defined treatment regimens are needed to identify the best therapeutic approach
Short Oral Antibiotic Therapy for Pediatric Febrile Urinary Tract Infections: A Randomized Trial
Full text linkBackground and objectives: Febrile urinary tract infection (fUTI) in well-appearing children is conventionally treated with a standard 10-day course of oral antibiotic. The objective of this study is to determine the noninferiority (5% threshold) of a 5-day amoxicillin-clavulanate course compared with a 10-day regimen to treat fUTIs. Methods: This is a multicenter, investigator-initiated, parallel-group, randomized, controlled trial. We randomly assigned children aged 3 months to 5 years with a noncomplicated fUTI to receive amoxicillin-clavulanate 50 + 7.12 mg/kg/day orally in 3 divided doses for 5 or 10 days. The primary end point was the recurrence of a urinary tract infection within 30 days after the completion of therapy. Secondary end points were the difference in prevalence of clinical recovery, adverse drug-related events, and resistance to amoxicillin-clavulanic acid and/or to other antibiotics when a recurrent infection occurred. Results: From May 2020 through September 2022, 175 children were assessed for eligibility and 142 underwent randomization. The recurrence rate within 30 days of the end of therapy was 2.8% (2/72) in the short group and 14.3% (10/70) in the standard group. The difference between the 2 groups was -11.51% (95% confidence interval, -20.54 to -2.47). The recurrence rate of fUTI within 30 days from the end of therapy was 1.4% (1/72) in the short group and 5.7% (4/70) in the standard group (95% confidence interval, -10.4 to 1.75). Conclusions: This study demonstrates that a 5-day course is noninferior to a 10-day course of oral amoxicillin-clavulanate
Ketorolac analgesia in the emergency department in adults: systematic review and meta-analysis
No full textBackground and objective: Acute painful conditions are a common reason to emergency department (ED) referral, and a broad variety of analgesic drugs may be used. Among them, ketorolac is a Non-Steroidal Anti-Inflammatory Drug (NSAID) increasingly used in the last two decades. In order to clarify the available evidence about the use of ketorolac in the ED setting, a systematic review and meta-analysis was performed. Databases and data treatment: A search was performed in PubMed for English written articles updated to February 2023. Only randomized controlled trials regarding adult patients with acute painful conditions treated in the ED were selected. A meta-analysis was performed to evaluate the effectiveness of ketorolac in different pain conditions. Results: : Forty randomized controlled trials were selected including studies focused on acute renal colic, headache, traumatic and non-traumatic musculoskeletal pain, and biliary colic. In these studies, ketorolac was mainly compared to opioids and in general showed a similar analgesic efficacy. On the other hand, when compared to other NSAIDs, ketorolac does not seem to have a stronger analgesic effect. Conclusion: s: This systematic review indicates that ketorolac is a valuable option, alternative to opioids, to induce analgesia in adult ED patients, as our meta-analysis showed no significant difference in efficacy compared to opioids or other NSAIDs. Nevertheless, the evidence regarding its efficacy compared to other commonly NSAIDs is still limited and should be further explored in future studies
Anomalous aortic origin of coronary artery: For a challenging diagnosis, a transthoracic echocardiogram is recommended
Full text linkAnomalous aortic origin of a coronary artery (AAOCA), especially the interarterial course of the right or left coronary artery, predisposes paediatric patients to myocardial ischaemia. This rare condition is a leading cause of sudden cardiac death. General paediatricians face challenges when diagnosing this anomaly, and they should pay particular attention to the recurrence of exercise‐related syncope without prodromal symptoms, chest pain and dyspnoea. An accurate transthoracic echocardiogram with Doppler colour flow mapping is the best method to use to identify AAOCA. CONCLUSION: Identifying an AAOCA is challenging, and we provide advice on clinical red flags and diagnostic approaches for general paediatricians
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
SBI is uncommon in the absence of paediatricians' gut feeling and abnormal respiratory pattern
Full text linkAIM: According to the Italian national statistical institute, severe bacterial infections (SBI) in Italy are responsible for 1.7% of mortality under 5 years of age and their recognition is often challenging, especially in the first stages of the disease. We tried to estimate the prevalence of SBI in our target population and to identify signs and symptoms that could guide in the initial evaluation of a child with a possible SBI. METHODS: We designed a prospective, multicentre study and enrolled patients aged 0–14 years at the first evaluation to the emergency department with an acute illness lasting a maximum of 5 days. The presence of variables suggestive of SBI was collected for every enrolled patient. One week after the enrolment, every patient was followed up by telephone. RESULTS: SBI is more likely to be detected with the ‘gut feeling’ in both univariate and multivariate models (univariate OR: 7.16, 95% CI: 4.08–12.56; multivariate OR: 5.34, 95% CI: 2.78–10.25), while abnormal breathing pattern resulted significative only in univariate model (OR 3.83, 95% CI: 1.98–7.40). Nevertheless, their associated sensitivity is low. CONCLUSION: SBI is uncommon in the absence of paediatricians' gut feeling and abnormal respiratory pattern
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