Medication safety in pediatrics should remain high on the agenda: Child stays sometimes longer in hospital due to damage after medication error
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In Nederland streven het ministerie van VWS en het ZonMw ondersteuningsprogramma Gezonde Slagkracht bij overgewichtpreventie op lokaal niveau naar een samenhangend en integraal beleid, bij voorkeur volgens de beginselen van de EPODE aanpak. In dit onderzoek is gekeken hoe de EPODE aanpak zich verhoudt tot de praktijk, met als voorbeeld de via Gezonde Slagkracht gesubsidieerde gemeente Raalte. De EPODE aanpak is gestoeld op vier pijlers: politiek draagvlak, stevige wetenschappelijke steun, sociale marketing en publiek-privaat partnerschap. De gemeente Raalte heeft, met de ondersteuning van GGD IJsselland, een goede stap gezet om aansluiting te vinden bij EPODE. De pijlers bestuurlijk draagvlak en publiek-privaat partnerschap blijken relatief eenvoudig ingevuld te kunnen worden. De gemeente is bewust van het belang van deze pijlers en heeft er concrete ideeën voor. De moeilijkste pijlers om te realiseren, blijken wetenschappelijke steun en sociale marketing. Daar heeft de gemeente dan ook extra ondersteuning nodig. De EPODE aanpak biedt via de vier pijlers een nuttig framework om initiatieven te ordenen en mogelijkheden te signaleren. Maar om de aanpak ten volle te kunnen benutten, is een betere en concretere beschrijving van de pijlers nodig, en meer ondersteuning bij de praktische invulling. Voor de ontwikkeling van een succesvolle, lokale, integrale aanpak en het daarvoor benodigde ondersteuningsaanbod is het waardevol om meer te weten over de ontwikkelingen in verschillende gemeenten die met de EPODE aanpak (of de Nederlandse variant: JOGG) bezig gaan met het bevorderen van een gezonde leefstijl.
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The purpose of this study was to examine the feasibility and validity of an Athletic Skills Track (AST) to assess fundamental movement skills among 6- to 12-year-old children in a physical education setting. 463 Dutch children (211 girls, 252 boys) completed three tests: the Körperkoordination-Test für Kinder (KTK) and two Athletic Skills Tracks (AST-1, AST-2). The validity of AST-1 and AST-2 was examined by correlating the time (sec) needed to complete the tracks and the KTK Motor Quotient (KTK MQ). Overall, there was a small correlation between AST-1 and the KTK MQ (r = - 0.474 (p = 0.01)) and a medium correlation between AST-2 and the KTK MQ (r = - 0.502 (p = 0.01)). When split up by age group the associations between the Athletic Skills Tracks and the KTK MQ were large for 12-year old children (AST-1: r = - 0.767; AST-2: r = - 0.727) and smallest for 8-year olds with a medium association (AST-1: r = - 0.501; AST-2: r = - 0.469). The results suggest that children’s motor skills can be assessed with a quick, convenient, and low-cost motor competence test in a physical education setting, i.e. an Athletic Skills Track. This is an Accepted Manuscript of an article published by Taylor & Francis in "Journal of Sports Sciences" on 3 March 2016, available online: https://doi.org/10.1080/02640414.2016.1151920
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Introduction: The purpose of this review is to gather and analyse current research publications to evaluate Sinogram-Affirmed Iterative Reconstruction (SAFIRE). The aim of this review is to investigate whether this algorithm is capable of reducing the dose delivered during CT imaging while maintainingimage quality. Recent research shows that children have a greater risk per unit dose due to increased radiosensitivity and longer life expectancies, which means it is particularly important to reduce the radiation dose received by children.Discussion: Recent publications suggest that SAFIRE is capable of reducing image noise in CT images, thereby enabling the potential to reduce dose. Some publications suggest a decrease in dose, by up to 64% compared to filtered back projection, can be accomplished without a change in image quality.However, literature suggests that using a higher SAFIRE strength may alter the image texture, creating an overly ‘smoothed’ image that lacks contrast. Some literature reports SAFIRE gives decreased low contrast detectability as well as spatial resolution. Publications tend to agree that SAFIRE strength threeis optimal for an acceptable level of visual image quality, but more research is required. The importance of creating a balance between dose reduction and image quality is stressed. In this literature review most of the publications were completed using adults or phantoms, and a distinct lack of literature forpaediatric patients is noted.Conclusion: It is necessary to find an optimal way to balance dose reduction and image quality. More research relating to SAFIRE and paediatric patients is required to fully investigate dose reduction potential in this population, for a range of different SAFIRE strengths.
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Aim: Optimise a set of exposure factors, with the lowest effective dose, to delineate spinal curvature with the modified Cobb method in a full spine using computed radiography (CR) for a 5-year-old paediatric anthropomorphic phantom.Methods: Images were acquired by varying a set of parameters: positions (antero-posterior (AP), posteroanterior (PA) and lateral), kilo-voltage peak (kVp) (66-90), source-to-image distance (SID) (150 to 200cm), broad focus and the use of a grid (grid in/out) to analyse the impact on E and image quality(IQ). IQ was analysed applying two approaches: objective [contrast-to-noise-ratio/(CNR] and perceptual, using 5 observers. Monte-Carlo modelling was used for dose estimation. Cohen’s Kappa coefficient was used to calculate inter-observer-variability. The angle was measured using Cobb’s method on lateralprojections under different imaging conditions.Results: PA promoted the lowest effective dose (0.013 mSv) compared to AP (0.048 mSv) and lateral (0.025 mSv). The exposure parameters that allowed lower dose were 200cm SID, 90 kVp, broad focus and grid out for paediatrics using an Agfa CR system. Thirty-seven images were assessed for IQ andthirty-two were classified adequate. Cobb angle measurements varied between 16°±2.9 and 19.9°±0.9.Conclusion: Cobb angle measurements can be performed using the lowest dose with a low contrast-tonoise ratio. The variation on measurements for this was ±2.9° and this is within the range of acceptable clinical error without impact on clinical diagnosis. Further work is recommended on improvement tothe sample size and a more robust perceptual IQ assessment protocol for observers.
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Niet alle pasgeborenen hebben een goede start, bijvoorbeeld omdat hun ouders in een moeilijke situatie zitten. Een prenataal huisbezoek (PHB) is bedoeld om te inventariseren wat zij nodig hebben en hen waar nodig te helpen. In dit onderzoek zagen we dat de partijen in Delft het kleinschalige weten te benutten. Professionals kennen elkaar, hebben onderling vertrouwen opgebouwd en kunnen gemakkelijk contact zoeken om af te stemmen. Tussen praktijk en beleid bestaan eveneens korte lijntjes. De aansturing vanuit de gemeente biedt professionals ruimte om te zoeken wat het beste werkt voor aanstaande ouders en activiteiten op elkaar af te stemmen. Ouders kunnen van de kleinschaligheid profiteren, bijvoorbeeld omdat de JGZ-verpleegkundigen zowel prenatale huisbezoeken doen, als de mogelijkheid hebben om vervolghulp te bieden waardoor continuïteit in de zorg en ondersteuning kan worden gerealiseerd. Ouders hebben dan te maken met een vertrouwd gezicht. Juist in deze omgeving van kleinschaligheid is het mogelijk om prenatale zorg en ondersteuning voor ouders steeds verder te ontwikkelen en de samenhang erin te verbeteren. Partijen waren hier al enkele jaren mee bezig, dit onderzoek heeft hieraan verder een bijdrage willen leveren en we hopen dat partijen hier na het onderzoek ook weer mee verder gaan.
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This review aims to identify strategies to optimise radiography practice using digital technologies, for full spine studies on paediatrics focusing particularly on methods used to diagnose and measure severity of spinal curvatures. The literature search was performed on different databases (PubMed, Google Scholar and ScienceDirect) and relevant websites (e.g., American College of Radiology and International Commission on Radiological Protection) to identify guidelines and recent studies focused on dose optimisation in paediatrics using digital technologies. Plain radiography was identified as the most accurate method. The American College of Radiology (ACR) and European Commission (EC) provided two guidelines that were identified as the most relevant to the subject. The ACR guidelines were updated in 2014; however these guidelines do not provide detailed guidance on technical exposure parameters. The EC guidelines are more complete but are dedicated to screen film systems. Other studies provided reviews on the several exposure parameters that should be included for optimisation, such as tube current, tube voltage and source-to-image distance; however, only explored few of these parameters and not all of them together. One publication explored all parameters together but this was for adults only. Due to lack of literature on exposure parameters for paediatrics, more research is required to guide and harmonise practice
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Ingezonden artikel in MEMO RAD: dit artikel is een samenvatting van afstudeeronderzoek dat de eerste auteur heeft uitgevoerd ter afronding van de bachelor opleiding Medisch Beeldvorming en Radiotherapeutische Technieken aan de hogeschool Inholland.
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Background: Computed tomography (CT) is one of the most used modalities for diagnostics in paediatric populations, which is a concern as it also delivers a high patient dose. Research has focused on developing computer algorithms that provide better image quality at lower dose. The iterative reconstruction algorithm Sinogram-Affirmed Iterative Reconstruction (SAFIRE) was introduced as a new technique that reduces noise to increase image quality.Purpose: The aim of this study is to compare SAFIRE with the current gold standard, Filtered Back Projection (FBP), and assess whether SAFIRE alone permits a reduction in dose while maintaining image quality in paediatric head CT.Methods: Images were collected using a paediatric head phantom using a SIEMENS SOMATOMPERSPECTIVE 128 modulated acquisition. 54 images were reconstructed using FBP and 5 different strengths of SAFIRE. Objective measures of image quality were determined by measuring SNR and CNR. Visual measures of image quality were determined by 17 observers with different radiographic experiences. Images were randomized and displayed using 2AFC; observers scored the images answering 5 questions using a Likert scale.Results: At different dose levels, SAFIRE significantly increased SNR (up to 54%) in the acquired images compared to FBP at 80kVp (5.2-8.4), 110kVp (8.2-12.3), 130kVp (8.8-13.1). Visual image quality was higher with increasing SAFIRE strength. The highest image quality was scored with SAFIRE level 3and higher.Conclusion: The SAFIRE algorithm is suitable for image noise reduction in paediatric head CT. Our data demonstrates that SAFIRE enhances SNR while reducing noise with a possible reduction of dose of 68%.
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