Adolescents with Rett syndrome at critical care pathway junctures: Examining clinicians' decision to initiate invasive long-term ventilation.

Background: The initiation of invasive long-term ventilation (I-LTV) for an adolescent with Rett Syndrome (RTT) involves many serious bioethical considerations. In moving towards a more inclusive model of patient participation, transparency surrounding the main influencing factors around this decision is important.

Objective: We aimed to identify the main drivers influencing a clinician's decision to support initiation of I-LTV for an adolescent with RTT.

The factorial survey as an approach to investigate clinical decision-making: examining influences on a clinician's decision to initiate life-sustaining clinical technology for a child with spinal muscular atrophy type 1.

Background: Spinal Muscular Atrophy (SMA) type 1 is a debilitating condition with a poor prognosis, though therapeutic advances are promising. Long-term ventilation is a common management strategy as respiratory function deteriorates. Without consensus on best practice respiratory management, the decision to initiate invasive LTV (I-LTV) for this group of young children involves many ethical considerations.

Impact of adapting paediatric intensive care units for adult care during the COVID-19 pandemic: a scoping review.

Objectives: The objectives were to categorise the evidence, map out the existing studies and explore what was known about the organisation of paediatric intensive care units (PICUs) during the first 18 months of the COVID-19 pandemic. Additionally, this review set out to identify any knowledge gaps in the literature and recommend areas for future research.

Design: Scoping review.

Technology solutionism in paediatric intensive care: clinicians' perspectives of bioethical considerations.

Background: The use of long-term life-sustaining technology for children improves survival rates in paediatric intensive care units (PICUs), but it may also increase long-term morbidity. One example of this is children who are dependent on invasive long-term ventilation. Clinicians caring for these children navigate an increasing array of ethical complexities.

An Evaluation of the Use of Low-Fidelity and High-Fidelity Mannequins in Clinical Simulations in a Module Preparing Final Year Children's and General Nursing Students for Internship Placement.

Internationally, the use of simulation-learning environments in nursing education has escalated over the last number of years. Simulations have been recognized as providing clinical opportunities for student nurses to gain experience in a safe and controlled learning environment. A module specifically preparing fourth year children's and general nursing students for internship was developed.

Integrated care for children living with complex care needs: an evolutionary concept analysis.

Children with complex care needs (CCNs) are in need of improved access to healthcare services, communication, and support from healthcare professionals to ensure high-quality care is delivered to meet their needs. Integrated care is viewed as a key component of care delivery for children with CCNs, as it promotes the integration of healthcare systems to provide family and child-centred care across the entire health spectrum. There are many definitions and frameworks that support integrated care, but there is a lack of conceptual clarity around the term.

Organisation of care in paediatric intensive care units during the first 18 months of the COVID-19 pandemic: a scoping review protocol.

Introduction: The emergence of COVID-19 has had a significant impact on hospital services, particularly care delivered to those in intensive care units (ICUs) and paediatric ICUs (PICUs) across the world. Although much has been written about healthcare delivery and the healthcare setting since COVID-19 began, to the authors' knowledge, this is the first scoping review to investigate the organisation of care and changes implemented in PICUs during the COVID-19 pandemic. The aim is to conduct a scoping review of the literature to map out the existing studies about care delivery in PICUs during the COVID-19 pandemic and the changes made to the organisation of care in these units during the first 18 months of the pandemic.

Virtual reality device to improve the tolerability of lumbar puncture.

Background: Virtual reality is increasingly being used as an adjunct or replacement to pharmacological analgesia and sedation during medical procedures.

Methods And Results: We report the successful use of a virtual reality device in a highly anxious patient undergoing lumbar puncture.

Conclusion: The case demonstrates how virtual reality technology may benefit patients undergoing invasive procedures such as lumbar puncture.

The Meaning Given to Bioethics as a Source of Support by Physicians Who Care for Children Who Require Long-Term Ventilation.

The role and potential of bioethics input when a child requires the initiation of technology dependence to sustain life is relatively unknown. In particular, little is understood about the meaning physicians give to bioethics as a source of support during the care of children in pediatric intensive care who require long-term ventilation (LTV). We used a hermeneutic phenomenological approach to underpin the collection and analysis of data.

Respite Care for Children with Complex Care Needs: A Literature Review.

Children with complex care needs form a diverse population with a variety of health and social care requisites in the presence of a range of complex symptoms and diagnoses. An exploratory literature review with a systematic search of the current qualitative literature was undertaken to explore parents' perceptions and evaluation of respite care services for children with complex needs. A systematic search was undertaken using a pre-defined search strategy in six databases; CINAHL, EMBASE, PsycINFO, Applied Social Sciences Index & abstracts and Web of Science.

Enhancing care of children with complex healthcare needs: an improvement project in a community health organisation in Ireland.

Background: Integration of care for children with complex care needs is developing slowly internationally. There remains wide variation in the governance of, and access to, care for these children and their families.

Local Problem: There was a need to develop a service that would have a specific remit for organising the overall management and governance of the care of these children in the community.

The effects of COVID-19 on IBD prescribing and service provision in a UK tertiary centre.

Background: To quantify the effects of COVID-19 on our inflammatory bowel disease (IBD) unit, including service provision, prescribing practices and use of therapeutic drug monitoring (TDM).

Methods: We performed a single centre retrospective observational cohort study. Data was extracted from our IBD database, electronic patient records and radiology/endoscopy reporting systems between 16/3/20-17/4/20 and the corresponding period in 2019.

Well siblings' experiences of living with a child following a traumatic brain injury: a systematic review protocol.

Background: The aim of this systematic review is to synthesize the available evidence identified through a systematic search on well siblings' experiences of living with a child following a traumatic brain injury (TBI). Brain injuries in children have been referred to as the "silent epidemic" of current times. Brain injuries in children are also recognized as a global public health concern, with the impact on children, effects on family life, and caregiving markedly misunderstood and underestimated.

Deriving a water quality guideline for protection of aquatic communities exposed to triclosan in the Canadian environment.

Triclosan is an antibacterial and antifungal chemical used in a variety of consumer products, including soaps, detergents, moisturizers, and cosmetics. Aquatic ecosystems may be exposed to triclosan following the release of remaining residues in wastewater effluents and biosolids. In December 2017, Environment and Climate Change Canada (ECCC) released a federal environmental quality guideline (FEQG) report that contained a federal water quality guideline (FWQG) for triclosan.

Organophosphate triesters and selected metabolites enhance binding of thyroxine to human transthyretin in vitro.

The toxicological properties of organophosphate (OP) triesters that are used as flame retardants and plasticizers are currently not well understood, though increasing evidence suggests they can affect the thyroid system. Perturbation of thyroid hormone (TH) transport is one mechanism of action that may affect thyroid function. The present study applied an in vitro competitive protein binding assay with thyroxine (T4) and human transthyretin (hTTR) transport protein to determine the potential for the OP triesters, TDCIPP (tris(1,3-dichloro-2-propyl) phosphate), TBOEP (tris(butoxyethyl) phosphate), TEP (triethyl phosphate), TPHP (triphenyl phosphate), p-OH-TPHP (para-hydroxy triphenyl phosphate), and the OP diester DPHP (diphenyl phosphate), to competitively displace T4 from hTTR.

In Vitro and in Silico Competitive Binding of Brominated Polyphenyl Ether Contaminants with Human and Gull Thyroid Hormone Transport Proteins.

Tetradecabromo-1,4-diphenoxybenzene (TeDB-DiPhOBz) is a highly brominated additive flame retardant (FR). Debrominated photodegradates of TeDB-DiPhOBz are hydroxylated in vitro in liver microsomal assays based on herring gulls (Larus argentatus), including one metabolite identified as 4″-OH-2,2',2″,4-tetrabromo-DiPhOBz. Chemically related methoxylated tetra- to hexabromo-DiPhOBzs are known contaminants in herring gulls.

Optimization of an assay methodology for competitive binding of thyroidogenic xenobiotics with thyroxine on human transthyretin and albumin.

Thyroid hormones (THs) are involved in the regulation of many physiological processes in vertebrates. Competition for TH binding sites on serum transport proteins can interfere with delivery of THs to target tissues, and this is a potential mechanism of action of exogenous thyroidogenic substances. To date, detailed accounts of methods for competitive binding with THs on TH transport proteins (human or wildlife) are sparse.

A refined ecological risk assessment for California red-legged frog, Delta smelt, and California tiger salamander exposed to malathion.

The California red-legged frog (CRLF), Delta smelt (DS), and California tiger salamander (CTS) are 3 species listed under the United States Federal Endangered Species Act (ESA), all of which inhabit aquatic ecosystems in California. The US Environmental Protection Agency (USEPA) has conducted deterministic screening-level risk assessments for these species potentially exposed to malathion, an organophosphorus insecticide and acaricide. Results from our screening-level analyses identified potential risk of direct effects to DS as well as indirect effects to all 3 species via reduction in prey.

Respite services for children with life-limiting conditions and their families in Ireland.

Appropriate respite care for children with life-limiting conditions (LLC) and their families is the cornerstone of high quality paediatric care. The effect of caring for children with LLC on families, including parental needs, cannot be underestimated and respite can give families support while caring for their children. There are many different types of respite care available in Ireland, including specialist respite, inhome respite or out-of-home respite; the wishes of the family should be sought when arranging care.

Medical therapy for acquired urinary incontinence in dogs.

The objective of this case report was to review acquired canine urethral incontinence in a case of a 2-year-old beagle that presented for inappropriate urination. Commercially available medications, as well as compounded medical therapeutic options, were reviewed. Diagnostic results revealed cystitis, which responded to the prescribed antibiotics.

Palliative care nursing for children in the UK and Ireland.

Currently, there are many changes taking place in the area of paediatric palliative care. These include the role of the nurse, development of national policies, and recommendations for the future of paediatric palliative care. This article discusses palliative care for children with life-limiting conditions in the UK and Ireland, highlights national and international developments in this area, describes current services, and makes recommendations for future developments.

Cochlear implants for children with significant residual hearing.

Background: Previous research suggests that children with pure-tone averages of greater than 90 dB hearing level and/or open-set sentence perception of less than 30% may derive significant benefit from cochlear implantation.

Objective: To evaluate postoperative speech perception benefit and bilateral-bimodal benefit for 16 children whose preimplant speech perception scores exceeded conservative candidacy guidelines.

Study Design: Preimplant and postimplant repeated-measure design.

Speech perception outcomes in older children who use multichannel cochlear implants: older is not always poorer.

Speech perception outcomes for early-deafened children who undergo implantation as teenagers or young adults are generally reported to be poorer than results for young children. It is important to provide appropriate expectations when counseling adolescents and their families to help them make an informed choice regarding cochlear implant surgery. The considerable variation of results in this group makes this process more difficult.