Over a 21-month period, a cluster of 13 safety events was observed in a perioperative service area that met criteria as either serious safety events per the health care performance improvement safety event classification system or Joint Commission sentinel events. This cluster of events served as the impetus to deploy high reliability organization (HRO) interventions to reduce potential future harm. To increase safety awareness and improve clinical safety across perioperative services, 3 interventions were iteratively implemented over a 6-month period: (1) surgical safety stand-downs; (2) error prevention training; and (3) establishment of a safety coach program. Simultaneously, analyses were conducted to address systemic causes leading to and preventing additional safety events from occurring. The impacts of these interventions were then monitored for over 2 years post-implementation to assess the outcome. Following the deployment of 3 interventions, we observed an increase in cases between events from a baseline mean of 2977 cases to a period of 39 654 cases (over 585 days) without a safety event triggering analysis. This occurred with a concurrent increased trend in safety reports. As a balancing metric, we did not observe decreased case volumes; in fact, cases increased throughout the observed period. Department-wide HRO-based interventions contributed to a significant decrease in serious safety and sentinel events and should be considered to improve patient care. Attention to departmental safety trends can drive systemic improvements leading to higher-quality perioperative care.
Background/Objectives: Inborn errors of immunity (IEI) are rare and complex pediatric disorders that create significant information gaps for families and non-specialist healthcare professionals. Large language models (LLMs) such as ChatGPT are increasingly used as on-demand health information resources; however, evidence on their performance in rare pediatric diseases remains limited. This study aimed to evaluate the reliability, quality, readability, understandability, reproducibility, and safety-related concerns of ChatGPT-4o responses to frequently searched questions about pediatric IEI posed by healthcare professionals and patients/caregivers. Methods: This cross-sectional evaluation used the publicly accessible ChatGPT-4o interface to generate responses to 20 frequently searched questions about pediatric IEI, equally distributed between healthcare professional (n = 10) and patient/caregiver queries (n = 10). Three pediatric allergy-immunology specialists independently evaluated response quality using the modified DISCERN (mDISCERN) and Global Quality Scale (GQS) tools, supplemented by a structured expert-based assessment of misinformation, safety-related concerns, suspected factual issues, missing disclaimers, and clinically meaningful inter-iteration inconsistency. Text readability was assessed using four validated indices (ARI, FRES, FKGL, GFR), comprehensibility using the Patient Education Materials Assessment Tool (PEMAT), and reproducibility using natural language processing methods. Results: ChatGPT-4o demonstrated strong overall performance, with median mDISCERN and GQS scores of 4 (IQR: 3-5) for both query types. Readability scores substantially exceeded recommended thresholds, with FKGL scores of 12.96 ± 0.69 and 10.83 ± 0.67 for professional and patient/caregiver queries, respectively. Mean PEMAT understandability scores were 71.80 ± 5.75% for professional queries and 80.80 ± 4.73% for patient/caregiver queries (p = 0.001). Reproducibility was high, with semantic similarity rates of 86.10 ± 3.84% and 87.30 ± 3.68%, respectively. Suspected factual issues were identified in 4 of 20 responses (20%), safety-related concerns in 3 (15%), clinically meaningful inter-iteration inconsistencies in 3 (15%), and missing medical disclaimers in all 20 responses (100%). Conclusions: ChatGPT-4o showed strong performance across validated quality metrics for pediatric IEI information support; however, its high reading level, universal absence of medical disclaimers, and occasional clinically meaningful inconsistencies limit its suitability as a standalone source for clinically sensitive guidance. These findings underscore the need for AI-driven patient education tools with improved readability, adaptive complexity adjustment, and safety-oriented communication.
Background Accurate and complete clinical documentation is essential for ensuring patient safety, continuity of care, and effective clinical decision-making. In many resource-limited settings, documentation practices remain inconsistent due to the absence of standardized tools, leading to gaps in care delivery. Objective This study aimed to evaluate and improve the completeness of pediatric follow-up documentation through the implementation of a structured follow-up card. Methods This was a closed-loop quality improvement project conducted at the pediatric outpatient department of Almanagil Teaching Hospital, Sudan. Two audit cycles were performed. The first cycle involved a retrospective review of 50 pediatric follow-up records over a two-week period in August 2025 to assess baseline documentation practices. Following this, a one-month intervention was implemented, introducing a structured pediatric follow-up card alongside brief staff orientation. The second cycle was conducted prospectively over two months (October-November 2025), including 50 follow-up records. Documentation completeness was assessed using predefined criteria, and comparisons between cycles were performed using the chi-square test, with a p-value <0.05 considered statistically significant. Results At baseline, documentation across all assessed variables was absent (0%). Following the intervention, significant improvements were observed across nearly all variables. Core documentation elements, including patient identification details, diagnosis, and treatment plan, reached 100% compliance (n = 50). Clinical variables such as chronic disease status and medication-related documentation improved to 74.0% (n = 37) and 68.0% (n = 34), respectively, while medication frequency and nutritional documentation exceeded 98.0% (n = 49). All improvements were statistically significant (p < 0.001), except for medical file number documentation, which remained unchanged. Conclusion The introduction of a structured pediatric follow-up card significantly improved documentation completeness. This study highlights the effectiveness of simple, low-cost interventions in addressing system-level documentation gaps and improving the quality of care in resource-limited settings.
Tranexamic acid (TXA) is a widely used antifibrinolytic agent in surgical and trauma settings in adults. This study aimed to evaluate the efficacy and safety of TXA in pediatric trauma patients across various clinical outcomes. A comprehensive literature search was conducted across 4 databases. We included clinical trials and observational studies that reported the use of TXA in pediatric trauma patients (aged ≤18 years). Data extraction and risk-of-bias assessment were performed by independent reviewers. Meta-analyses were conducted with RStudio software. A total of 12 studies (2 randomized controlled trials [RCTs] and 10 observational) involving 66,398 pediatric trauma patients were included. Tranexamic acid was not significantly associated with reduction in hospital mortality (OR = 1.06; 95% CI, 0.32-3.45) but was associated with significantly shorter hospital stays (mean difference [MD] = -1.49; 95% CI, -2.43 to -0.56). The need for emergency mechanical ventilation was higher among the TXA group (OR = 4.29; 95% CI, 2.52-7.31), whereas the need for mechanical ventilation at discharge was lower (OR = 0.23; 95% CI, 0.08-0.64). Tranexamic acid use did not significantly alter the risk of thromboembolic events (OR = 0.72; 95% CI, 0.19-2.79) or poor neurological outcomes (OR = 2.51; 95% CI, 0.86-7.35). Tranexamic acid may reduce hospital length of stay in pediatric trauma patients, with inconsistent effects on mortality and adverse events. Its use should be individualized based on injury severity and resource availability. Further high-quality research is needed to confirm these findings and clarify the role of TXA in pediatric trauma care.
The daily safety brief (DSB) is a structured approach to enhancing patient safety and readiness, widely used in free-standing children's hospitals. This observational study examines the implementation and feasibility of a DSB within a children's hospital embedded in an adult healthcare system-a unique challenge requiring adaptation to an infrastructure primarily designed for adult care. Using a descriptive, observational design, we tracked safety concerns reported during DSBs over a 12-month period across inpatient units and the pediatric emergency department. Safety concerns were categorized using a predefined taxonomy and reviewed by the implementation team. The implementation process confirmed the feasibility of integrating pediatric safety efforts within an adult system. While qualitative feedback suggested improved communication and situational awareness, this study did not measure direct improvements in patient safety outcomes, and the single-center design limits generalizability. The reduction in reported safety concerns over time should be interpreted cautiously, as changes in reporting may reflect cultural or behavioral factors rather than true safety improvements. This initiative highlights the potential for embedding pediatric safety practices within broader hospital operations, warranting further investigation using controlled designs with objective patient safety outcome measures.
The management of facial fractures in the pediatric population represents a unique challenge in facial fracture care, where fixation must strike a balance between stability and interference with growth and the need for secondary implant removal procedures. Bioresorbable fixation systems have been increasingly applied in this population; however, their pooled safety and performance data and clinical advantages over titanium fixation in the pediatric population are not well described. This systematic review and meta-analysis aimed to comprehensively assess the clinical outcomes and complication rates associated with the use of resorbable fixation systems in the management of pediatric facial fractures. The PubMed, Cochrane Library, Scopus, Web of Science, and ScienceDirect databases were searched for articles published until March 2025. The selection criteria were as follows: randomized controlled trials (RCTs), cohort studies, and comparative clinical studies of patients aged ≤18 years who received resorbable fixation systems for any facial fracture. The primary outcomes were infection, malocclusion, implant palpability, and plate removals. Study quality was assessed using the ROBINS-I risk of bias tool. A meta-analysis was conducted using a random-effects model and reported as log OR and logit event rate with 95% CI. Twenty-six studies reporting on nearly 620 patients were included in this review. The pooled infection rate was 3.2% (95% CI: 0.63-7.5%; I2 = 0%), malocclusion rate was 8.7% (95% CI: 1.88-15.7%; I2 = 0%), and implant palpability was observed in 11.8% of patients (95% CI: 6.42-17.2%; I2 = 0%). Compared with titanium fixation, resorbable systems were associated with a 96% reduction in the odds of plate removal (log OR: -3.287; 95% CI: -4.968 to -1.607; p = 0.00013). Statistical heterogeneity was low for all outcomes (I2 < 20%). No evidence of a significant publication bias was found. Resorbable fixation systems are safe, functionally effective, and growth-accommodating alternatives to titanium plates for managing facial fractures in children and adolescents. The greatly reduced risk of requiring secondary implant removal and low complication rates support their use as a first-line fixation strategy for facial fractures in the pediatric population.
Articaine is known to be safe in children; however, it is not suggested for children under the age of four. Various studies have been performed that show articaine as a superior local anesthetic (LA) agent when compared with lignocaine. This study aimed to systematically review the safety of lignocaine and articaine as LA agents in pediatric dental patients. An electronic search of randomized controlled trials (RCTs) reporting on adverse reactions of lignocaine and articaine in children between 4 and 13 years of age was conducted. The databases searched included PubMed, Cochrane Library, CBM, Embase, Web of Science, and CNKI. A thorough electronic search was conducted for studies published up to May 2024. Seven articles were included in the systematic review. For each of the included studies, the methodological quality and risk of bias (RoB) were assessed. Relative risk (RR) and standard deviations were used to summarize the data from each of the studies, and meta-analyses were conducted with studies of limited heterogeneity. Based on the available evidence, lignocaine and articaine appear to have similar safety profiles when used as LA agents in pediatric dental patients. Meta-analysis showed a nonsignificant statistical difference in favor of soft tissue injury [RR = 0.47, 95% confidence interval (CI) (0.17, 1.28), p = 0.14], postoperative pain (RR = 1.68, 95% CI (0.56, 5.08), p = 0.36), and edema (RR = 1.78, 95% CI (0.17, 18.81), p = 0.63). Overall adverse events were also nonsignificant (RR = 1.26, 95% CI (0.62, 2.54), p = 0.52). Buccal infiltration with 4% articaine was equally safe as inferior alveolar nerve block (IANB) with 2% lignocaine for primary tooth extraction and endodontic procedures. More clinical trials should be conducted that measure the effects of lignocaine and articaine on blood pressure, pulse rate, and tissue rehabilitation. Babhulgaonkar PB, Dahake PT, Dadpe MV, et al. Safety Evaluation of Articaine and Lignocaine as Local Anesthetic Agents in Pediatric Dental Patients: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2026;19(5):648-654.
Appendicitis serves as a model for pathway-driven quality improvement (QI) in pediatric surgical care. The high case volume, predictable clinical trajectory, and measurable outcomes associated with acute appendicitis care facilitate identification of unwarranted practice variation and allow standardization to be feasible at scale. Starting in the mid-2010s, several QI initiatives transformed appendicitis management in children. This review highlights four QI efforts in pediatric appendicitis management including the shift of diagnostic imaging from routine computed tomography to ultrasound-first strategies, improved opioid stewardship, de-implementation of low-value practices such as routine total parenteral nutrition utilization, and generation of severity-guided clinical practice guidelines that decreased postoperative antibiotic durations. Across these domains, improvement followed a consistent progression through phases of documented variation, evidence consolidation, structured local implementation, guideline alignment, and eventually sustained monitoring of guideline-based practices. Continued progress will require ongoing development of pediatric-specific evidence, dissemination of evidence-based practices into broader practice settings, and focused efforts to ensure equitable implementation across populations. QI efforts for appendicitis serve as a transferable blueprint for value-based and safety-focused pediatric care, demonstrating that unwarranted variation can be reduced when evidence-based practices are embedded into structured clinical guidelines, process metrics and outcomes are measured transparently, and principles are reinforced through coordinated dissemination.
IgA vasculitis nephritis (IgAVN) is an important cause of secondary glomerulonephritis and long-term renal morbidity in children. Traditional Chinese medicine (TCM) interventions are widely used for pediatric IgAVN, either alone or combined with Western medicine, but their efficacy and safety remain uncertain. This study evaluated the efficacy and safety of TCM interventions in children with IgAVN. Eight databases were searched from inception to March 7, 2025, for randomized controlled trials comparing TCM interventions with Western medicine alone in children with IgAVN. The primary outcome was the overall clinical effective rate. Secondary outcomes included 24-hour urinary protein excretion, urinary red blood cell count, β2-microglobulin, D-dimer, and adverse events. Meta-analyses were performed using RevMan 5.4. Risk of bias was assessed using the Cochrane risk-of-bias tool, and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. Nineteen randomized controlled trials involving 1764 children were included. Compared with Western medicine alone, TCM interventions improved the overall clinical effective rate (risk ratio = 1.20, 95% confidence interval [CI] = [1.15-1.25], P < .00001) and reduced 24-hour urinary protein excretion (standardized mean difference = -0.83, 95% CI = [-1.12 to -0.54], P < .00001) and β2-microglobulin levels (standardized mean difference = -0.54, 95% CI = [-0.70 to -0.38], P < .00001). Sensitivity analyses suggested possible reductions in urinary red blood cell count and D-dimer levels after excluding heterogeneous trials. The incidence of adverse events did not differ significantly between groups (risk ratio = 0.92, 95% CI = [0.60-1.40], P = .70). The certainty of evidence ranged from moderate to very low. The TCM interventions included in this review may provide short-term benefits in clinical response and selected renal-related laboratory outcomes in children with IgAVN, without increasing the observed incidence of adverse events. High-quality randomized trials with standardized outcomes, structured safety monitoring, and longer follow-up are needed.
Preventable harm in pediatric care requires coordinated, cross-institutional learning. The Child Health Patient Safety Organization established weekly safety huddles to enhance situational awareness and strengthen a protected learning network under the Patient Safety and Quality Improvement Act. This iterative time-series quality improvement study examined weekly huddle content, assessed targeted interventions to increase participation, and evaluated engagement trends over time. The primary outcome was composite engagement, defined as ≥80% annual attendance and ≥5 submitted reports. Secondary measures included attendance, quarterly reporting, and categorization of reported safety events. Frequently reported events involved medication issues, diagnostic errors, and device malfunctions. Targeted interventions increased composite engagement from 21% to 71.4%, alongside improvements in weekly attendance and quarterly reporting. Organizations also reported using huddle insights to guide internal risk assessments and escalate concerns. Child Health Patient Safety Organization safety huddles improved participation, supported shared learning, and strengthened safety culture consistent with learning-organization and high-reliability principles.
Romiplostim, a thrombopoietin receptor agonist, is a second-line therapy for primary immune thrombocytopenia (ITP). This real-world observational study evaluated romiplostim safety and efficacy in 52 children with persistent/chronic ITP. Baseline and follow-up data were retrospectively collected from patients' files. Primary endpoints: platelet response rate and time to first response. Secondary endpoints: durable response rate, safety, and health-related quality of life (HRQoL) using (PedsQL 4.0). Romiplostim decreased significant bleeding frequency (from 76.9% to 34.6%, P=0.003), hospital admission rate (from 69.2% to 7.7%, P<0.001), and rescue medication use (from 65.4% to 11.5%, P<0.001). In all, 92.3% of patients achieved platelet response in a median of 1 month, and 80.8% achieved a durable response. The most frequent adverse events were headache and joint pain; no serious adverse events occurred. Platelet count was positively correlated with HRQoL in parent-proxy reports (P<0.05). In linear regression univariate analysis, platelet count ≥100×109/L was associated with better parent-proxy HRQoL (P=0.004) but not after multivariate adjustment, while joint pain remained independently associated with lower parent-proxy HRQoL. Beyond confirming the efficacy and safety of romiplostim, this study supports the sequential use of thrombopoietin receptor agonists, as romiplostim was still effective in patients who did not respond to previous treatment with eltrombopag.
The objective is to determine the prevalence and types of drug-related problems (DRPs), identify associated factors, and evaluate the impact of a structured pharmacist-led intervention on prescribing quality in pediatric outpatient care in a resource-limited health system with limited advanced prescribing decision-support. A pre-post intervention study was conducted from July 2023 to June 2024 at a secondary-level hospital in a lower-middle-income country setting (Vietnam). Two independent cross-sectional prescription samples were obtained using systematic random sampling (323 prescriptions preintervention and 323 postintervention). DRPs were identified using national prescribing frameworks and mapped to the Pharmaceutical Care Network Europe DRP Classification (v9.1). The intervention comprised pharmacist-led educational sessions and the dissemination of drug information bulletins, with ongoing reminders, targeting the most frequent baseline DRPs. Factors associated with DRP occurrence (≥1 DRP per prescription) were examined using logistic regression; pre-post comparisons used Chi-square tests. At baseline, 57.9% of prescriptions contained at least one DRP, predominantly dosage regimen-related problems, with incorrect timing of administration being the most frequent (32.20%). In multivariable analysis, prescriptions issued by male prescribers had higher odds of DRPs (odds ratio 2.51, 95% confidence interval 1.51-4.18), whereas prescriptions for children aged 2-6 years and 6-12 years had lower odds than those for children aged ≤2 years. Following the intervention, DRP prevalence decreased significantly to 40.2% (P < 0.001), with marked reductions in timing- and dosing-related DRPs. A structured, low-cost pharmacist-led intervention integrated into routine outpatient practice was associated with a clinically meaningful reduction in DRPs. Strengthening clinical pharmacy services is a feasible and scalable strategy to improve pediatric prescribing safety in resource-limited settings where systematic medication review and electronic decision support are constrained.
Quantify post-traumatic stress disorder (PTSD) prevalence rates in pediatric nurses; identify the strength, direction, and predictive relationship between PTSD and psychological capital (PsyCap), psychological safety, coworker support, and supervisor support; and explore nurses' perceptions and coping strategies for dealing with work-related trauma. A convergent mixed-methods cross-sectional, correlational-predictive online research study design utilizing the Conservation of Resources theoretical framework. Convenience sample of pediatric nurses working in direct patient care in the United States. Post-Traumatic Checklist for DSM-5 (PCL-5), Psychological Capital Questionnaire (PCQ), Psychological Safety tool, Coworker Support Scale (CSS), and Supervisor Support Scale (SSS). Qualitative questions were content analyzed. Descriptive and inferential statistics, including hierarchical regression models, were used. One-hundred and seventy-one participants were included in the analysis; 56.7% met the cut-point for full PTSD criteria. PTSD symptoms were inversely related to nurses' Psychological Capital and PsyCap scores. Additionally, Psychological Safety and PsyCap were independent predictors of PTSD when entered in the hierarchical regression analysis model. A joint display table was developed to integrate qualitative and quantitative findings. PTSD is a concern for direct-care pediatric nurses. Results from the hierarchical regression analysis lend important insight into workforce factors (Psychological Safety) and intrapersonal qualities (PsyCap) affecting PTSD symptomology in pediatric nurses. Qualitative comments support the importance of coworker, leader, and organizational support for individuals. Implication to Practice This study highlights potential predictive and protective intrapersonal, interpersonal, and organizational factors on pediatric nurses' PTSD symptomology.
Parents of children with pediatric orthopaedic conditions frequently have questions after their clinic visit, and a reliable postconsultation resource to address these enquiries is lacking. Online resources are variable in quality, and general purpose artificial intelligence (AI) models have demonstrated safety limitations, including unprompted treatment recommendations and citation inaccuracies. A purpose-built, supervised generative AI solution may offer a safer and more reliable alternative. A generative AI chatbot was developed using retrieval-augmented generation and trained on OrthoKids educational materials covering 5 common pediatric orthopaedic conditions: in-toeing, flatfoot, scoliosis, bow legs, and knock knees. After iterative refinement by 2 fellowship-trained pediatric orthopaedic surgeons, the chatbot was evaluated by 18 multidisciplinary clinicians using a structured 12-item 5-point Likert scale survey assessing accuracy, safety, usability, and clinical acceptability. Mean scores exceeded 4.0 of 5.0 on 11 of 12 domains. Clarity of explanation achieved unanimous positive endorsement (100%), while protocol alignment received the highest mean score (4.50 ± 0.62). Citation accuracy was the lowest-rated domain (4.00 ± 0.77). No hallucinations were identified, and 88.9% of evaluators confirmed the absence of unprompted treatment recommendations. The reverse-scored safety item (Q8) demonstrated the greatest inter-rater variability (mean 3.11 ± 1.57), with orthopaedic specialists rating perceived harm substantially lower (mean 1.33) than nurses (mean 4.40). A purpose-built gen AI chatbot demonstrated high clinical accuracy and acceptability among multidisciplinary evaluators, with effective avoidance of unprompted treatment recommendations. These pilot findings support feasibility for use as a parental education adjunct in pediatric orthopaedic practice. Level III. See Instructions for Authors for a complete description of levels of evidence.
This study aims to comprehensively evaluate the clinical efficacy, impact on immune function, and safety of thymosin combined with anticancer therapy for esophageal cancer (EC) patients. We systematically searched Chinese and English databases to identify randomized controlled trials (RCTs) evaluating thymosin combined with standard anticancer therapy for EC. Meta-analysis was performed using Review Manager 5.4. Sensitivity analysis and publication bias assessment were conducted using Stata 18.0. TSA was further employed to validate the reliability of primary outcomes. Evidence quality was assessed using GRADE system. A total of 18 RCTs (1,272 patients) were included. Meta-analysis demonstrated that compared with standard anticancer therapy alone, combined thymosin therapy significantly improved Objective Response Rate (ORR) (RR = 1.27, 95% CI: 1.17-1.39) and Disease Control Rate (DCR) (RR = 1.13, 95% CI: 1.07-1.19), and improved 1-year survival rate (RR = 1.36, 95% CI: 1.19-1.56), 2-year survival rate (RR = 1.47, 95% CI: 1.12-1.92), and 3-year survival rate (RR = 1.42, 95% CI: 1.07-1.90). Regarding immune function, the treatment group exhibited a higher CD3+ T lymphocyte ratio (CD3+%) (MD = 17.56, 95% CI: 13.63-21.50), CD4+ T lymphocyte ratio (CD4+%) (MD = 12.81, 95% CI: 10.76-14.87), CD4+/CD8+ ratio (MD = 0.71, 95% CI: 0.61 - 0.81), and natural killer (NK) cell level (MD = 4.02, 95% CI: 3.06-4.97) were significantly elevated. Regarding safety, combination therapy significantly reduced incidence of treatment-related adverse effects, including gastrointestinal reactions (nausea and vomiting) (RR = 0.69, 95% CI: 0.60-0.79), leukopenia (RR = 0.52, 95% CI: 0.43-0.63), radiation esophagitis (RR = 0.63, 95% CI: 0.44-0.90), and radiation pneumonitis (RR = 0.37, 95% CI: 0.22-0.62). However, methodological quality of included RCTs was limited, and a comprehensive safety assessment is limited by lack of data on thymosin-specific side effects. GRADE assessment indicates that the quality of evidence for most outcomes ranges from "very low" to "low." Current evidence suggests that combination of thymosin with anticancer therapy for EC may enhance antitumor efficacy, improve patients' immune function, and reduce toxicity associated with conventional treatments. However, given limited quality of RCTs and presence of publication bias, these conclusions require validation through additional large-scale, high-quality prospective research. https://www.crd.york.ac.uk/prospero/, identifier PROSPERO CRD420261282381.
The anesthesiological care of children places particular demands on the knowledge and skills of the anesthetist providing care. There is currently no structured further training in this field in Germany. A curriculum for a fellowship program in pediatric anesthesiology was developed through a consensus procedure. Building on specialist anesthesiology training this program aims to impart specific knowledge and skills for the care of children. The defined final skills were divided into basic and advanced skills. Basic skills are taught at all fellowship sites, while the teaching of advanced skills depends on the structural requirements of the centers. In addition to the acquisition of clinical competencies, the fellowship comprises mandatory supplementary components, such as a quality improvement project, continuing professional development, certified pediatric emergency courses and webinars. The fellows' progress in competencies is monitored through regular, standardized evaluation interviews and documented as part of a structured evaluation. The "Pediatric Anesthesiology Fellowship" is a competency-based, curriculum-structured training program. Building on specialist anesthesiology training it aims to contribute to the sustainable improvement of patient safety and the quality of care in pediatric anesthesiology. EINLEITUNG: Die anästhesiologische Versorgung von Kindern stellt besondere Anforderungen an die Kenntnisse und Kompetenzen der betreuenden Anästhesist:innen. In Deutschland existiert derzeit keine strukturierte Weiterbildung in diesem Bereich. Im Rahmen eines Konsensusverfahrens wurde ein Curriculum für ein Fellowship-Programm in der Kinderanästhesiologie entwickelt. Aufbauend auf der anästhesiologischen Facharztweiterbildung soll dieses Programm spezifische Kenntnisse und Kompetenzen für die Versorgung von Kindern vermitteln. Die definierten Abschlussfertigkeiten wurden in Basis- und erweiterte Fertigkeiten unterteilt. Basisfertigkeiten werden an allen Fellowship-Standorten vermittelt, während die Vermittlung der erweiterten Fertigkeiten von den strukturellen Voraussetzungen der Zentren abhängt. Ergänzend zum klinischen Kompetenzerwerb umfasst das Fellowship verpflichtende Zusatzbausteine wie eine qualitätsverbessernde Projektarbeit, Fortbildungen, zertifizierte Kindernotfallkurse und Webinare. Der Kompetenzfortschritt der Fellows wird durch regelmäßige, standardisierte Evaluationsgespräche begleitet und im Rahmen einer strukturierten Evaluation dokumentiert. Das „Fellowship Kinderanästhesiologie“ ist ein kompetenzbasiertes, curricular aufgebautes Weiterbildungsprogramm. Aufbauend auf der anästhesiologischen Facharztweiterbildung soll es dazu beitragen, die Patientensicherheit und Versorgungsqualität in der anästhesiologischen Versorgung von Kindern nachhaltig zu verbessern.
To evaluate the introduction of locally configured standard concentration (StdC) intravenous drug infusions in critically ill children. This two-year quality improvement retrospective cohort study (2018-20) examined post-implementation of 47 StdC drugs configured across three weight bands: <5 kg, 5-20 kg and >20 kg in a 26-bed, multispecialty paediatric intensive care unit. The main outcome measures were (1) adherence to StdC use (non-adherence defined as using a bespoke drug concentration), (2) attempts at dosing above the pre-set infusion rates, known as hard limit events (HLEs), (3) incidents related to infusions and (4) percentage of total fluid allowance available for nutrition. In total, 33 224 infusions were administered, with morphine, clonidine and milrinone representing 61%. Most of them (83.6%) were initiated in children in the lower weight bands. Adherence to StdCs was 96% and was similar across weight bands. A total of 204 498 pump programming events were examined, with 418 (0.2%) being HLEs. Only 21 HLEs (0.01%) were considered potentially clinically significant (defined as programming >2.5 times the maximum dose). Following investigation, 20/21 were found likely to be related to training episodes, rather than true errors. Twenty clinical incidents linked to StdC infusions were reported but none caused harm. The mean fluid allowance available for nutrition after accounting for StdC volumes was 38.8% in the <5 kg weight band, and 71% and 67.4% in the other two bands, respectively. Configured StdCs are effective and safe across all weight bands and allow for partial provision of nutritional needs in fluid-restricted patients. The high adherence rate facilitated pharmacy supplying infusions as Ready-To-Administer (RTA).
Orthognathic surgery is a definitive treatment for dentofacial deformities, yet comprehensive synthesis of clinical outcomes, complications, and quality of life impacts remains limited. This systematic review critically evaluates contemporary evidence on orthognathic surgery effectiveness and safety. A systematic search of PubMed/MEDLINE, Embase, Cochrane CENTRAL, Web of Science, and Scopus was conducted through December 2024. Studies reporting clinical outcomes, complications, or quality of life following orthognathic surgery in patients with dentofacial deformities were included. Quality assessment employed the Cochrane Risk of Bias tool and Newcastle-Ottawa Scale. Meta-analysis with random-effects models was performed where appropriate. Sixty-five studies encompassing 6,482 patients were included. Mean ANB angle improvements were 6.8° (95% CI: 6.2-7.4°) for class III and 5.4° (95% CI: 4.9-5.9°) for class II corrections, with 87.3% maintaining skeletal stability at ≥1-year follow-up. Overall complication rate was 32.4% (95% CI: 28.7-36.1%), predominantly minor and self-limiting. Neurosensory disturbances occurred in 52.8% of cases, with 92.6% recovering by 12 months and permanent alterations in 3.4%. Relapse (>2mm) occurred in 18.7% of cases. Quality of life demonstrated substantial improvements with standardized mean difference of -1.84 (95% CI: -2.12 to -1.56, p < 0.001) for OQLQ total scores. Patient satisfaction reached 87.6% (95% CI: 84.2-91.0%), with higher ratings for aesthetic vs. functional outcomes.Conclusion: Orthognathic surgery effectively corrects dentofacial deformities with significant clinical and quality of life improvements. However, moderate complication rates and relapse risk necessitate careful patient selection, informed consent, and long-term follow-up.Keywords: orthognathic surgery; dentofacial deformities; systematic review; quality of life; complications; patient satisfaction; skeletal stability; neurosensory disturbances.
High-risk medications are used commonly in pediatric dentistry. Yet evidence on medication safety is focused on medical clinics and hospitals, with limited research on dental settings. The authors aimed to assess adverse outcomes associated with pediatric dental sedation. The authors analyzed MarketScan data for patients younger than 18 years who underwent dental sedation from 2014 through 2019. Composite outcomes included emergency department or urgent care visits and hospitalization within 7 days of sedation. Attributable outcomes included sedation-related adverse outcomes. Multivariable generalized estimating equations modeled the association between characteristics and outcomes. Four percent of all sedations were associated with a composite outcome. Children aged 12 through 17 years (odds ratio [OR], 2.42) and from 6 through 11 years (OR, 1.75) and children with noncomplex chronic conditions (OR, 2.28), complex chronic conditions (OR, 1.87), Medicaid coverage (OR, 1.88), and prior medical visits (OR, 7.60) were more likely to experience a composite outcome; 0.18% of all sedations were associated with a sedation-related adverse outcome. Children with Medicaid coverage (OR, 1.49) and those with complex chronic conditions (OR, 2.54) were more likely to experience a sedation-related outcome. Sedations in hospital or ambulatory surgery settings were nearly 3 times more likely than those in outpatient clinics settings to be associated with a sedation-related outcome (OR, 2.55). For every 27 dental sedation visits, 1 is associated with an adverse outcome. Targeted risk-mitigation strategies are necessary to enhance patient safety among high-risk populations. Improving the safety of pediatric dental sedation requires thorough presedation assessment, vigilant patient monitoring, ongoing provider training, and adherence to clinical guidelines.
Introduction: Advances in pediatric oncology have transformed cancer into a condition with chronic and long-term developmental consequences. While survival rates have improved significantly, the literature on psychosocial outcomes remains fragmented and inconsistent, with a notable lack of person-centered analyses that account for the heterogeneity of adaptive trajectories. Current evidence fails to explain why survivors with similar clinical profiles exhibit divergent psychological phenotypes, particularly regarding the late effects of multimodal treatments. The aim of this study was to identify heterogeneous psychosocial profiles among adolescent cancer survivors and to examine their associations with treatment complexity and quality of life. Materials and Methods: This cross-sectional study included 165 adolescents aged 12-18 years (mean age: 14.64 years) who were in clinical remission following oncological treatment. Standardized assessment tools were used: the Children's Depression Inventory 2 (CDI-2™) to measure depressive symptoms, the KIDSCREEN-10 index to assess health-related quality of life (HRQoL), and a scale evaluating satisfaction across 14 life domains. Adaptive profiles were identified using a Two-Stage Cluster Procedure, and risk factors were examined using multinomial logistic regression. Results: Four clusters were identified in the study population: a depressive-dysphoric profile, an anhedonic-withdrawn profile, a highly adaptive profile, and a mixed (struggling) profile. Treatment complexity was identified as a significant independent predictor of membership in the high-distress (depressive) cluster. While each additional therapeutic modality beyond standard chemotherapy was associated with a markedly increased risk (OR = 8.91; p < 0.001), the relatively wide confidence interval (95% CI: 3.27-24.31) suggests that the exact magnitude of this effect should be interpreted with caution. The high lower bound of the interval (3.27), however, strongly supports the directional association of cumulative iatrogenic burden with psychological adaptation. Subjective quality of life functioned as a protective factor against depressive symptoms (OR = 0.57); however, paradoxically, higher self-reported quality of life increased the likelihood of classification into the anhedonic group (OR = 1.81). This divergence between high self-reported HRQoL and social withdrawal potentially suggests a 'well-being paradox'. It is hypothesized that standard HRQoL instruments may primarily capture physical remission and relief from acute somatic symptoms, potentially masking underlying social-emotional deficits. This suggests that HRQoL scores in survivors should be interpreted with caution and complemented by specific affective screenings. Conclusions: The absence of a uniform pattern of psychological response to cancer among adolescent survivors supports the validity of a patient-centered approach. The burden associated with intensive multimodal treatment significantly increases the likelihood of full-syndrome depression during adolescence. Moreover, the identification of a cluster suggestive of anhedonic and socially withdrawn features highlights the limitations of standard screening tools focused solely on the detection of overt sadness. This heterogeneity underscores the need for personalized psycho-oncological care and the implementation of intensified monitoring for patients at high medical risk.