Pediatric Emergency Care Applied Research Network head injuryprediction rules: on the basis of cost and effectiveness

Gökharman, Fatma Dilek; Aydın, Sonay; Fatihoğlu, Erdem; Koşar, Pınar Nercis

doi:10.3906/sag-1703-206

Cited by 8 publications

(10 citation statements)

References 17 publications

(26 reference statements)

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“…High level insulin-like growth factor-1 (IGF-1) can enhance the activity of cytochrome P450c17 enzyme, stimulate the follicular membrane to synthesize excessive androgens, and aggravate hyperandrogenemia (Chen et al, 2017, Zhong et al, 2018). Pregnancy rate is related to endometrial receptivity and endometrial thickness, and endometrial dysplasia leads to a reduction in pregnancy rate (Zeng et al, 2018, Azemi et al, 2018, Lungu et al, 2017, Kumar and Kumar, 2017, Gokharman et al, 2017, Gao et al, 2017, Xu et al, 2018). The results showed that total flavonoids of dodder could reduce serum LH/FSH ratio, PRL and INS levels and increase serum P levels, decrease the levels of TNF-α and IGF-1 proteins in ovarian tissue.…”

Section: Discussmentioning

confidence: 99%

Effects of dodder total flavone on polycystic ovary syndrome rat models induced by DHEA combined HCG

Miao

Peng

Zhu

et al. 2019

Saudi Journal of Biological Sciences

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Aims Explore the effects of dodder total flavone on polycystic ovary syndrome (PCOS) rat models induced by dehydroepiandrosterone (DHEA) combined human chorionic gonadotropin (HCG). Methods Except the blank group, the rest of the rats were injected with DHEA 6 mg/100 g on the back of the neck and 1.5 IU HCG each day, for 21 consecutive days. On the 16th day of modeling, vaginal smear was performed to select the model rats, which were randomly divided into model group, dacin-35 group, large, middle and small dose dodder total flavonoids groups, and given the medicine for three weeks. At the end of the last administration, take samples, so as to calculate the ovaries and uterus indexes, measure serum LH/FSH ratio, P, PRL and INS levels, fixed the uterus and pancreas in 10% formalin solution and stained with HE to observe the morphological changes of the organs. And measure the expression of TNF-α and IGF-l proteins in ovaries by immunohistochemistry. Results Compared with the blank group, ovarian and uterine indexes, serum LH/FSH ratio, serum PRL and INS levels, ovary TNF-α and IGF-l protein expression were significantly increased, and significant pathological changes were observed in the uterine and pancreatic tissues in model group ( P < 0.01). While the serum P level decreased significantly ( P < 0.01), Compared with the model group, the ovarian and uterine indexes, serum LH/FSH ratio, serum P, PRL and INS levels, ovary TNF-α protein expression were significantly decreased in large, middle and small dose dodder total flavonoids groups ( P < 0.01); The expression of IGF-1 protein was decreased and uterus pathological changes were improved in different extents ( P < 0.01 or P < 0.05), pancreas pathological changes were improved significantly ( P < 0.01). Conclusion PCOS rat models was successfully replicated. Dodder total flavone can protect PCOS rats induced by DHEA combined HCG by different action pathways.

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Section: Discussmentioning

confidence: 99%

Effects of dodder total flavone on polycystic ovary syndrome rat models induced by DHEA combined HCG

Miao

Peng

Zhu

et al. 2019

Saudi Journal of Biological Sciences

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“…14 Thus, the conclusion is that North-American physicians, in comparison to Canadian physicians, perform excessive procedures, which results in major increase in hospital expenses. 14 A similar fact was identified in a retrospective study carried out in Turkey, 12 which stated that the improper use of imaging examinations causes major economic losses for hospital UEs. Imaging examinations, when performed without necessity, generate an approximate cost of US$ 20 billion; the non-performance of improper imaging examinations, regardless of the type, could generate an annual saving of US$ 81 billion.…”

Section: Nd Category -The Relation Between Ionization and Possible Mmentioning

confidence: 66%

“…10 It was estimated that 1.5-2% of malignant neoplasms in the USA may have been caused by radiation from CTs. 12 Besides, it is assumed that CTs in the pediatric population may be related to 5,000 future annual cases of cancer. 11 A study carried out in the Netherlands 13 showed that the performance of a head CT increases the risk of developing a future brain tumor.…”

Section: Nd Category -The Relation Between Ionization and Possible Mmentioning

confidence: 99%

“…14 5th category -instruments used to reduce the exposure to ionizing agents in pediatric emergency patients Several instruments are used to guide health professionals as to the use of imaging examinations, in order to reduce the unnecessary exposure to ionizing agents in pediatric UE patients. 1,2,[7][8][9][10][11][12] The Alvarado Score is used for abdominal CT. 2 For head CT, the following instruments were reported: Pediatric Emergency Care Applied Research Network (PECARN), 1,2,7,12 National Emergency X-Radiography Utilization Study (NEXUS), 1,7 Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) 1 and Canadian Assessment of Tomography for Childhood Head Injury (CATCH). 1,7 The last two, however, were considered little reliable for clinical use due to their low sensitivity.…”

Section: Reviewmentioning

confidence: 99%

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Exposure of Pediatric Emergency Patients to Imaging Exams, Nowadays and in Times of Covid-19: An Integrative Review

Floriani¹,

Borgmann²,

Barreto³

et al. 2022

Rev. paul. pediatr.

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Objective: To analyze literature data about unnecessary exposure of pediatric emergency patients to ionizing agents from imaging examinations, nowadays and during times of COVID-19. Data sources: Between April and July 2020, articles were selected using the databases: Virtual Health Library, PubMed and Scientific Electronic Library Online. The following descriptors were used: [(pediatrics) AND (emergencies) AND (diagnostic imaging) AND (medical overuse)] and [(Coronavirus infections) OR (COVID-19) AND (pediatrics) AND (emergencies) AND (diagnostic imaging)]. Inclusion criteria were articles available in full, in Portuguese or English, published from 2016 to 2020 or from 2019 to 2020, and articles that covered the theme. Articles without adherence to the theme and duplicate texts in the databases were excluded. Data synthesis: 61 publications were identified, of which 17 were comprised in this review. Some imaging tests used in pediatric emergency departments increase the possibility of developing future malignancies in patients, since they emit ionizing radiation. There are clinical decision instruments that allow reducing unnecessary exam requests, avoiding over-medicalization, and hospital expenses. Moreover, with the COVID-19 pandemic, there was a growing concern about the overuse of imaging exams in the pediatric population, which highlights the problems pointed out by this review. Conclusions: It is necessary to improve hospital staff training, use clinical decision instruments and develop guidelines to reduce the number of exams required, allowing hospital cost savings; and reducing children’s exposure to ionizing agents.

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“…This qualifies the PECARN rule for grade C1. Four economic analysis studies discussed the positive potential effects of using the PECARN rule on lowering healthcare costs, decreasing the frequency of using CT scans and minimising the exposure of children to harmful ionising radiation [62, 68, 69, 75]. This qualifies the PECARN rule for grade B2.…”

Section: Resultsmentioning

confidence: 99%

Grading and assessment of clinical predictive tools for paediatric head injury: a new evidence-based approach

Khalifa

Gallego

2019

BMC Emerg Med

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Background Many clinical predictive tools have been developed to diagnose traumatic brain injury among children and guide the use of computed tomography in the emergency department. It is not always feasible to compare tools due to the diversity of their development methodologies, clinical variables, target populations, and predictive performances. The objectives of this study are to grade and assess paediatric head injury predictive tools, using a new evidence-based approach, and to provide emergency clinicians with standardised objective information on predictive tools to support their search for and selection of effective tools. Methods Paediatric head injury predictive tools were identified through a focused review of literature. Based on the critical appraisal of published evidence about predictive performance, usability, potential effect, and post-implementation impact, tools were evaluated using a new framework for grading and assessment of predictive tools (GRASP). A comprehensive analysis was conducted to explain why certain tools were more successful. Results Fourteen tools were identified and evaluated. The highest-grade tool is PECARN; the only tool evaluated in post-implementation impact studies. PECARN and CHALICE were evaluated for their potential effect on healthcare, while the remaining 12 tools were only evaluated for predictive performance. Three tools; CATCH, NEXUS II, and Palchak, were externally validated. Three tools; Haydel, Atabaki, and Buchanich, were only internally validated. The remaining six tools; Da Dalt, Greenes, Klemetti, Quayle, Dietrich, and Güzel did not show sufficient internal validity for use in clinical practice. Conclusions The GRASP framework provides clinicians with a high-level, evidence-based, comprehensive, yet simple and feasible approach to grade, compare, and select effective predictive tools. Comparing the three main tools which were assigned the highest grades; PECARN, CHALICE and CATCH, to the remaining 11, we find that the quality of tools’ development studies, the experience and credibility of their authors, and the support by well-funded research programs were correlated with the tools’ evidence-based assigned grades, and were more influential, than the sole high predictive performance, on the wide acceptance and successful implementation of the tools. Tools’ simplicity and feasibility, in terms of resources needed, technical requirements, and training, are also crucial factors for their success. Electronic supplementary material The online version of this article (10.1186/s12873-019-0249-y) contains supplementary material, which is available to authorized users.

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Pediatric Emergency Care Applied Research Network head injuryprediction rules: on the basis of cost and effectiveness

Cited by 8 publications

References 17 publications

Effects of dodder total flavone on polycystic ovary syndrome rat models induced by DHEA combined HCG

Effects of dodder total flavone on polycystic ovary syndrome rat models induced by DHEA combined HCG

Exposure of Pediatric Emergency Patients to Imaging Exams, Nowadays and in Times of Covid-19: An Integrative Review

Grading and assessment of clinical predictive tools for paediatric head injury: a new evidence-based approach

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