BACKGROUND Knowledge-based systems(KBS)are software applications based on a knowledge database and an inference engine.Various experimental KBS for computerassisted medical diagnosis and treatment were started to be u...BACKGROUND Knowledge-based systems(KBS)are software applications based on a knowledge database and an inference engine.Various experimental KBS for computerassisted medical diagnosis and treatment were started to be used since 70s(VisualDx,GIDEON,DXPlain,CADUCEUS,Internist-I,Mycin etc.).AIM To present in detail the“Electronic Pediatrician(EPed)”,a medical non-machine learning artificial intelligence(nml-AI)KBS in its prototype version created by the corresponding author(with database written in Romanian)that offers a physiopathology-based differential and positive diagnosis and treatment of ill children.METHODS EPed specifically focuses on the physiopathological reasoning of pediatric clinical cases.EPed has currently reached its prototype version 2.0,being able to diagnose 302 physiopathological macro-links(briefly named“clusters”)and 269 pediatric diseases:Some examples of diagnosis and a previous testing of EPed on a group of 34 patients are also presented in this paper.RESULTS The prototype EPed can currently diagnose 269 pediatric infectious and noninfectious diseases(based on 302 clusters),including the most frequent respiratory/digestive/renal/central nervous system infections,but also many other noninfectious pediatric diseases like autoimmune,oncological,genetical diseases and even intoxications,plus some important surgical pathologies.CONCLUSION EPed is the first and only physiopathology-based nml-AI KBS focused on general pediatrics and is the first and only pediatric Romanian KBS addressed to medical professionals.Furthermore,EPed is the first and only nml-AI KBS that offers not only both a physiopathology-based differential and positive disease diagnosis,but also identifies possible physiopathological“clusters”that may explain the signs and symptoms of any child-patient and may help treating that patient physiopathologically(until a final diagnosis is found),thus encouraging and developing the physiopathological reasoning of any clinician.展开更多
Objective: To assess current practices, attitudes, and perceived barriers toward pediatric vision screening. Patients and Methods: A link to a 9-question survey was electronically distributed to a national sample of 6...Objective: To assess current practices, attitudes, and perceived barriers toward pediatric vision screening. Patients and Methods: A link to a 9-question survey was electronically distributed to a national sample of 6000 pediatricians through Medical Marketing Services Inc. Data were collected using Survey Monkey. Results: Email open rate was 11%;37% of those who opened the email responded (225 respondents). Over ninety percent of respondents perform some type of vision screening at least yearly, although age at which screening began varied, with two thirds of respondents instituting formal vision screening after three years. Fifty eight percent of respondents were either extremely unsatisfied, unsatisfied or only somewhat satisfied with their current screening method. Preferred methods of screening and confidence of pediatricians in their ability to detect pathology varied for children under versus over age three. The least frequently used methods for all age groups were autorefraction and photoscreening. The most commonly reported barriers to screening were inadequate training (48%), time required for exam (42%), and inadequate reimbursement (32%). Conclusions: Perceived barriers to vision screening in the pediatrician office have been previously identified, and photoscreening and autorefraction have been identified as a possible means to circumvent them. In spite of the addition of new procedural codes, pediatricians continue to report similar barriers to screening.展开更多
Background: The inappropriate, irrational use or misuse of antibiotics is observed in all health systems and in all patients’ groups worldwide, especially for children, where antibiotics continue to be the drugs most...Background: The inappropriate, irrational use or misuse of antibiotics is observed in all health systems and in all patients’ groups worldwide, especially for children, where antibiotics continue to be the drugs most commonly prescribed. Methods: A cross-sectional study was conducted in all public pediatric clinics in the Republic of Cyprus, from April to May 2015. A questionnaire was distributed to pediatricians in order to identify the antibiotic prescription practices in common childhood diseases and attitudes towards Pharmacovigilance. The SPSS 19.0 was used for the statistical analysis. In total 42 pediatricians and pediatric residents filled out the questionnaire. Results: A significant percentage of the respondents administered empirical therapy for possible group A streptococcus infection (59.5%), they implemented the “watchful waiting” tactic in acute otitis media (66.7%), whereas 11.9% of them administered antibiotics for the prevention of secondary respiratory tract infections. The majority of physicians did not feel diagnostic uncertainty leading to antibiotics prescribing (90.2%) and their prescribing habits were not influenced by parental demand (80.5%). Although 23.1% of physicians observed often/very often Adverse Drug Reactions (ADRs) after antibiotic administration during their clinical practice, however, 47.6% of the pediatricians declared that they did not report them. Conclusion: Health professionals’ continuing education on the use of therapeutic guidelines and protocols and the development of Pharmacovigilance programs could significantly contribute to the avoidance of the misuse of antibiotics in hospital care as well as to health professionals’ awareness on rational prescribing.展开更多
Behavioral health concerns are surging in pediatric practices.Fortunately,integrated behavioral/medical health clinics are growing and child psychiatrists/psychologists are increasingly embedded in these care settings...Behavioral health concerns are surging in pediatric practices.Fortunately,integrated behavioral/medical health clinics are growing and child psychiatrists/psychologists are increasingly embedded in these care settings to help shoulder the clinical load.Routine screening of behavioral health problems in primary care facilities enables early identification and treatment.However,deciding on sound,efficient,and scalable screening measures is sometimes arduous.Accordingly,this article presents a clinician-friendly review of three common instruments useful in screening pediatric behavioral health concerns including anxiety,depression,and conduct problems.Psychometric findings and clinical applications of the Pediatric Symptom Checklist-17(PSC-17),the Patient Health Questionnaire-9(PHQ-9),and the Screen for Child Anxiety Related Emotional Disorders(SCARED)are delineated.Finally,clinical implications and recommendations for practicing pediatricians and child psychiatrists are offered.展开更多
Marfan syndrome (MFS)(OMIM 154700) is a relatively common autosomal dominant genetic disease that causes skeletal, ocular, and cardiovascular defects and was first described by a French pediatrician in 1896 (Bitterman...Marfan syndrome (MFS)(OMIM 154700) is a relatively common autosomal dominant genetic disease that causes skeletal, ocular, and cardiovascular defects and was first described by a French pediatrician in 1896 (Bitterman and Sponseller, 2017). Its prevalence rate is 1/3000—1/5000, and more than 25% of cases are sporadic (Chiu et al., 2014). Studies have shown that about 90% of MFS is caused by variants in the fibrillin-1 gene (FBN1, OMIM 134797). FBN1, located on chromosome 15q21.1, encodes a macromolecular glycoprotein-fibrin 1, which aggregates to form microfibers in the extracellular matrix and distributes in various human connective tissues, such as periosteum, vessel wall, and crystal suspensor ligament. Variants in FNB1 have been reported in 65 exons, but the relationship between genotype and phenotype remains rather unclear (Sakai et al., 2016). Studies have also shown that patients with MFS and similar diseases may have variants in other related genes such as members of the transforming growth factor beta receptor (TGFBR) family (Mizuguchi et al., 2004;Sakai et al., 2006;Bolar et al., 2012;De Cario et al., 2018). For better prevention and treatment of MFS as well as for suspected MFS patients, there is a strong need for efficient genetic testing for early diagnosis and differential diagnoses of patients with related phenotypes (Aubart et al., 2018).展开更多
文摘BACKGROUND Knowledge-based systems(KBS)are software applications based on a knowledge database and an inference engine.Various experimental KBS for computerassisted medical diagnosis and treatment were started to be used since 70s(VisualDx,GIDEON,DXPlain,CADUCEUS,Internist-I,Mycin etc.).AIM To present in detail the“Electronic Pediatrician(EPed)”,a medical non-machine learning artificial intelligence(nml-AI)KBS in its prototype version created by the corresponding author(with database written in Romanian)that offers a physiopathology-based differential and positive diagnosis and treatment of ill children.METHODS EPed specifically focuses on the physiopathological reasoning of pediatric clinical cases.EPed has currently reached its prototype version 2.0,being able to diagnose 302 physiopathological macro-links(briefly named“clusters”)and 269 pediatric diseases:Some examples of diagnosis and a previous testing of EPed on a group of 34 patients are also presented in this paper.RESULTS The prototype EPed can currently diagnose 269 pediatric infectious and noninfectious diseases(based on 302 clusters),including the most frequent respiratory/digestive/renal/central nervous system infections,but also many other noninfectious pediatric diseases like autoimmune,oncological,genetical diseases and even intoxications,plus some important surgical pathologies.CONCLUSION EPed is the first and only physiopathology-based nml-AI KBS focused on general pediatrics and is the first and only pediatric Romanian KBS addressed to medical professionals.Furthermore,EPed is the first and only nml-AI KBS that offers not only both a physiopathology-based differential and positive disease diagnosis,but also identifies possible physiopathological“clusters”that may explain the signs and symptoms of any child-patient and may help treating that patient physiopathologically(until a final diagnosis is found),thus encouraging and developing the physiopathological reasoning of any clinician.
文摘Objective: To assess current practices, attitudes, and perceived barriers toward pediatric vision screening. Patients and Methods: A link to a 9-question survey was electronically distributed to a national sample of 6000 pediatricians through Medical Marketing Services Inc. Data were collected using Survey Monkey. Results: Email open rate was 11%;37% of those who opened the email responded (225 respondents). Over ninety percent of respondents perform some type of vision screening at least yearly, although age at which screening began varied, with two thirds of respondents instituting formal vision screening after three years. Fifty eight percent of respondents were either extremely unsatisfied, unsatisfied or only somewhat satisfied with their current screening method. Preferred methods of screening and confidence of pediatricians in their ability to detect pathology varied for children under versus over age three. The least frequently used methods for all age groups were autorefraction and photoscreening. The most commonly reported barriers to screening were inadequate training (48%), time required for exam (42%), and inadequate reimbursement (32%). Conclusions: Perceived barriers to vision screening in the pediatrician office have been previously identified, and photoscreening and autorefraction have been identified as a possible means to circumvent them. In spite of the addition of new procedural codes, pediatricians continue to report similar barriers to screening.
文摘Background: The inappropriate, irrational use or misuse of antibiotics is observed in all health systems and in all patients’ groups worldwide, especially for children, where antibiotics continue to be the drugs most commonly prescribed. Methods: A cross-sectional study was conducted in all public pediatric clinics in the Republic of Cyprus, from April to May 2015. A questionnaire was distributed to pediatricians in order to identify the antibiotic prescription practices in common childhood diseases and attitudes towards Pharmacovigilance. The SPSS 19.0 was used for the statistical analysis. In total 42 pediatricians and pediatric residents filled out the questionnaire. Results: A significant percentage of the respondents administered empirical therapy for possible group A streptococcus infection (59.5%), they implemented the “watchful waiting” tactic in acute otitis media (66.7%), whereas 11.9% of them administered antibiotics for the prevention of secondary respiratory tract infections. The majority of physicians did not feel diagnostic uncertainty leading to antibiotics prescribing (90.2%) and their prescribing habits were not influenced by parental demand (80.5%). Although 23.1% of physicians observed often/very often Adverse Drug Reactions (ADRs) after antibiotic administration during their clinical practice, however, 47.6% of the pediatricians declared that they did not report them. Conclusion: Health professionals’ continuing education on the use of therapeutic guidelines and protocols and the development of Pharmacovigilance programs could significantly contribute to the avoidance of the misuse of antibiotics in hospital care as well as to health professionals’ awareness on rational prescribing.
文摘Behavioral health concerns are surging in pediatric practices.Fortunately,integrated behavioral/medical health clinics are growing and child psychiatrists/psychologists are increasingly embedded in these care settings to help shoulder the clinical load.Routine screening of behavioral health problems in primary care facilities enables early identification and treatment.However,deciding on sound,efficient,and scalable screening measures is sometimes arduous.Accordingly,this article presents a clinician-friendly review of three common instruments useful in screening pediatric behavioral health concerns including anxiety,depression,and conduct problems.Psychometric findings and clinical applications of the Pediatric Symptom Checklist-17(PSC-17),the Patient Health Questionnaire-9(PHQ-9),and the Screen for Child Anxiety Related Emotional Disorders(SCARED)are delineated.Finally,clinical implications and recommendations for practicing pediatricians and child psychiatrists are offered.
基金supported by the National Key R&D Program of China (2018YFC1002302, 2016YFC0900103)National Natural Science Foundation of China (81671458)+1 种基金Beijing Lab for Cardiovascular Precision Medicine (PXM2018_014226_000013)supported by the Reproduction Center Biobank at Peking University Third Hospital
文摘Marfan syndrome (MFS)(OMIM 154700) is a relatively common autosomal dominant genetic disease that causes skeletal, ocular, and cardiovascular defects and was first described by a French pediatrician in 1896 (Bitterman and Sponseller, 2017). Its prevalence rate is 1/3000—1/5000, and more than 25% of cases are sporadic (Chiu et al., 2014). Studies have shown that about 90% of MFS is caused by variants in the fibrillin-1 gene (FBN1, OMIM 134797). FBN1, located on chromosome 15q21.1, encodes a macromolecular glycoprotein-fibrin 1, which aggregates to form microfibers in the extracellular matrix and distributes in various human connective tissues, such as periosteum, vessel wall, and crystal suspensor ligament. Variants in FNB1 have been reported in 65 exons, but the relationship between genotype and phenotype remains rather unclear (Sakai et al., 2016). Studies have also shown that patients with MFS and similar diseases may have variants in other related genes such as members of the transforming growth factor beta receptor (TGFBR) family (Mizuguchi et al., 2004;Sakai et al., 2006;Bolar et al., 2012;De Cario et al., 2018). For better prevention and treatment of MFS as well as for suspected MFS patients, there is a strong need for efficient genetic testing for early diagnosis and differential diagnoses of patients with related phenotypes (Aubart et al., 2018).
