Elbow flexion contractures in neonatal brachial plexus palsy: A one-year comparison of dynamic orthosis and serial casting.

Objective: Elbow flexion contractures are common complications of neonatal brachial plexus palsy, but evidence on how to treat these contractures is weak. This study compared the treatment of elbow flexion contractures using a dynamic orthosis or serial circular casting.

Methods: A randomized controlled trial was conducted with one-year follow-up.

Effect of saline inhalation on vocal fold epithelial morphology evaluated by optical coherence tomography.

Objectives/hypothesis: Examination of tissue structures by optical coherence tomography (OCT) has been shown to be useful on mucous membranes of the vocal folds, but so far its application to the human larynx has been limited because it is technically cumbersome and usually needs to be performed with sedation. Here a newly developed, noninvasive combined laryngoscopy and OCT procedure is described and its suitability for ambulatory OCT studies evaluated. Because inhalation therapies utilizing saline solutions are commonly used as a treatment option for disorders of the airways, and vocal fold epithelium is most likely to be affected due to its superficial positioning, epithelial thickness was chosen as a relevant test parameter and evaluated before and after saline inhalation.

Automated working distance adjustment enables optical coherence tomography of the human larynx in awake patients.

Optical coherence tomography (OCT) provides structural information of laryngeal tissue which is comparable to histopathological analysis of biopsies taken under general anesthesia. In awake patients, movements impede clinically useful OCT acquisition. Therefore, an automatic compensation of movements was implemented into a swept source OCT-laryngoscope.

Effects of cavitation bubble interaction with temporally separated fs-laser pulses.

We present a time-resolved photographic analysis of the pulse-to-pulse interaction. In particular, we studied the influence of the cavitation bubble induced by a fs-pulse on the optical focusing of the consecutive pulse and its cavitation bubble dynamics in dependence on temporal pulse separation in water. As a first result, by decreasing the temporal separation of laser pulses, there is a diminishment of the laser-induced optical breakdown (LIOB) efficiency in terms of energy conversion, caused by disturbed focusing into persisting gas bubbles at the focal volume.

Socio-demographic and lifestyle determinants of 'Western-like' and 'Health conscious' dietary patterns in toddlers.

Determinants of a child's diet shortly after weaning and lactation have been relatively understudied. The aim of the present study was hence to identify common dietary patterns in toddlers and to explore parental and child indicators of these dietary patterns. The study was a population-based, prospective birth-cohort study in Rotterdam, the Netherlands.

Relation between regional and global systolic function in patients with ischemic cardiomyopathy after beta-blocker therapy or revascularization.

Background: To assess the relationship between improved regional and global myocardial function in patients with ischemic cardiomyopathy in response to beta-blocker therapy or revascularization.

Materials And Methods: Cardiovascular magnetic resonance (CMR) was performed in 32 patients with ischemic cardiomyopathy before and 8 +/- 2 months after therapy. Patients were assigned clinically to beta-blocker therapy (n = 20) or revascularization (n = 12).

Polytomous regression did not outperform dichotomous logistic regression in diagnosing serious bacterial infections in febrile children.

Objective: To compare polytomous and dichotomous logistic regression analyses in diagnosing serious bacterial infections (SBIs) in children with fever without apparent source (FWS).

Study Design And Setting: We analyzed data of 595 children aged 1-36 months, who attended the emergency department with fever without source. Outcome categories were SBI, subdivided in pneumonia and other-SBI (OSBI), and non-SBI.

Food questionnaire for assessment of infant gluten consumption.

Background: In light of the possibly preventive role of timing and amount of gluten in celiac disease, it would be helpful to have a questionnaire to assess the gluten intake in infants.

Aims: Development and validation of a food questionnaire to assess gluten consumption in healthy infants aged 0-12 months (FQ-gluten).

Methods: A food frequency questionnaire, previously developed for the Generation R study, was adapted for the assessment of gluten intake.

Validating and updating a prediction rule for serious bacterial infection in patients with fever without source.

Aim: To externally validate and update a previously developed rule for predicting the presence of serious bacterial infections in children with fever without apparent source.

Methods: Patients, 1-36 mo, presenting with fever without source, were prospectively enrolled. Serious bacterial infection included bacterial meningitis, sepsis, bacteraemia, pneumonia, urinary tract infection, bacterial gastroenteritis, osteomyelitis/ethmoiditis.

Structured data entry for narrative data in a broad specialty: patient history and physical examination in pediatrics.

Background: Whereas an electronic medical record (EMR) system can partly address the limitations, of paper-based documentation, such as fragmentation of patient data, physical paper records missing and poor legibility, structured data entry (SDE, i.e. data entry based on selection of predefined medical concepts) is essential for uniformity of data, easier reporting, decision support, quality assessment, and patient-oriented clinical research.

Paper versus computer: feasibility of an electronic medical record in general pediatrics.

Background: Implementation of electronic medical record systems promises significant advances in patient care, because such systems enhance readability, availability, and data quality. Structured data entry (SDE) applications can prompt for completeness, provide greater accuracy and better ordering for searching and retrieval, and permit validity checks for data quality monitoring, research, and especially decision support. A generic SDE application (OpenSDE) to support documentation of patient history and physical examination findings was developed and tailored for the domain of general pediatrics.

External validation is necessary in prediction research: a clinical example.

Background And Objectives: Prediction models tend to perform better on data on which the model was constructed than on new data. This difference in performance is an indication of the optimism in the apparent performance in the derivation set. For internal model validation, bootstrapping methods are recommended to provide bias-corrected estimates of model performance.

Diagnostic research on routine care data: prospects and problems.

A diagnosis in practice is a sequential process starting with a patient with a particular set of signs and symptoms. To serve practice, diagnostic research should aim to quantify the added value of a test to clinical information that is commonly available before the test will be applied. Routine care databases commonly include all documented patient information, and therefore seem to be suitable to quantify a tests' added value to prior information.

Internal and external validation of predictive models: a simulation study of bias and precision in small samples.

We performed a simulation study to investigate the accuracy of bootstrap estimates of optimism (internal validation) and the precision of performance estimates in independent validation samples (external validation). We combined two data sets containing children presenting with fever without source (n=376+179=555; 120 bacterial infections). Random samples were drawn from this combined data set for the development (n=376) and validation (n=179) of logistic regression models.

Predicting serious bacterial infection in young children with fever without apparent source.

Unlabelled: The aim of this study was to design a clinical rule to predict the presence of a serious bacterial infection in children with fever without apparent source. Information was collected from the records of children aged 1-36 mo who attended the paediatric emergency department because of fever without source (temperature > or = 38 degrees C and no apparent source found after evaluation by a general practitioner or history by a paediatrician). Serious bacterial infection included bacterial meningitis, sepsis, bacteraemia, pneumonia, urinary tract infection, bacterial gastroenteritis, osteomyelitis and ethmoiditis.

[Young child with fever of unknown origin in the 'post Haemophilus influenzae era'].

A 2.5-year-old boy and a 2-month-old girl presented with fever without an apparent source. Additional laboratory tests were requested due to alarming signs for the presence of a serious bacterial infection.

[Acute respiratory insufficiency in children].

Acute respiratory distress in children is often a consequence of asthma. Other causes are subglottic laryngitis, epiglottitis, aspiration of a foreign body, acute bacterial pneumonia or pneumothorax. History and physical examination should differentiate between the various diseases.