Lancet Child & Adolescent Health最新文献

{"title":"International benchmarking of stage at diagnosis for six childhood solid tumours (the BENCHISTA project): a population-based, retrospective cohort study","authors":"Laura Botta MSc , Fabio Didonè MSc , Angela Lopez-Cortes MSc , Adela Cañete Nieto PhD , Emmanuel Desandes MD , Lisa L Hjalgrim PhD , Zsuzsanna Jakab MD , Charles A Stiller MSc , Bernward Zeller MD , Gemma Gatta MD , Prof Kathy Pritchard-Jones PhD","doi":"10.1016/S2352-4642(24)00302-X","DOIUrl":"10.1016/S2352-4642(24)00302-X","url":null,"abstract":"<div><h3>Background</h3><div>International variation in childhood cancer survival might be explained by differences in stage at diagnosis, among other factors. As part of the BENCHISTA project, we aimed to assess geographical variation in tumour stage at diagnosis through the application, by population-based cancer registries working with clinicians, of the international consensus Toronto Childhood Cancer Stage Guidelines.</div></div><div><h3>Methods</h3><div>This population-based, retrospective cohort study involved 67 cancer registries from 23 European countries, Australia, Brazil, Japan, and Canada. Participating cancer registries applied the Toronto Guidelines to stage all incident cases of six childhood solid tumours—neuroblastoma, medulloblastoma, and Wilms tumour (age 0–14 years) and Ewing sarcoma, rhabdomyosarcoma, and osteosarcoma (age ≤19 years)—diagnosed between Jan 1, 2014, and Dec 31, 2017. Eligible cancer registries were those able to assign stage according to the Toronto Guidelines; information on the staging investigations conducted was collected where available. European countries were grouped by geographical area and non-European countries were considered individually. We used χ<sup>2</sup> tests to compare stage distribution across these geographical areas and multivariable logistic models to estimate odds ratios (ORs) for metastatic stage at diagnosis, using central Europe (Austria, Belgium, France, Germany, the Netherlands, and Switzerland) as the comparison. Sensitivity analyses were conducted to overcome potential bias from non-random missing stage information for some geographical areas and cancer types.</div></div><div><h3>Findings</h3><div>Data from 10 937 patients with cancer (6031 [55·1%] male and 4906 [44·9%] female) were analysed. Tumour staging was complete for 93·1% (10 180 of 10 937) of patients, ranging from 88·7% (1347 of 1518 patients) with medulloblastoma to 96·5% (1083 of 1122 patients) with Ewing sarcoma. Stage distribution differed statistically by geographical area for neuroblastoma, Wilms tumour, osteosarcoma, and rhabdomyosarcoma, but not for Ewing sarcoma or medulloblastoma. After excluding patients with missing stage information and, for the sarcomas, patients aged 18–19 years, the proportions of patients with metastases detected at diagnosis were 50·3% with neuroblastoma (1435 of 2852 patients; including 1159 [40·6%] stage M and 276 [9·7%] stage MS), 35·1% with medulloblastoma (473 of 1347 patients; stages M1–M4), 32·6% with Ewing sarcoma (335 of 1028 patients), 29·0% with rhabdomyosarcoma (368 of 1267 patients), 25·5% with osteosarcoma (345 of 1353 patients), and 18·2% with Wilms tumour (384 of 2114 patients). After adjusting by age group, significant differences in the proportions of patients with metastases detected at diagnosis were found between geographical areas for neuroblastoma, Wilms tumour, osteosarcoma, and rhabdomyosarcoma.</div></div><div><h3>Interpretation</h3><div>Assessed at a populat","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 2","pages":"Pages 89-99"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Procalcitonin-guided duration of antibiotic treatment in children hospitalised with confirmed or suspected bacterial infection in the UK (BATCH): a pragmatic, multicentre, open-label, two-arm, individually randomised, controlled trial","authors":"Cherry-Ann Waldron PhD , Philip Pallmann PhD , Simon Schoenbuchner PhD , Debbie Harris PhD , Lucy Brookes-Howell PhD , Prof Céu Mateus PhD , Jolanta Bernatoniene FRCPCH PhD , Katrina Cathie FRCPCH MD , Prof Saul N Faust FRCPCH PhD , Lucy Hinds FRCPCH MBBS , Prof Kerenza Hood PhD , Chao Huang PhD , Sarah Jones BSc Hons , Sarah Kotecha PhD , Helen M Nabwera FRCPCH PhD , Sanjay Patel MRCPCH MA , Stéphane C Paulus FRCPCH MD , Prof Colin V E Powell FRCPCH MD , Jenny Preston BA Hons , Huasheng Xiang PhD , Erika Rojas-Jimenz","doi":"10.1016/S2352-4642(24)00306-7","DOIUrl":"10.1016/S2352-4642(24)00306-7","url":null,"abstract":"<div><h3>Background</h3><div>Procalcitonin is a rapid response biomarker specific for bacterial infection, which is not routinely used in the UK National Health Service. We aimed to assess whether using a procalcitonin-guided algorithm would safely reduce the duration of antibiotic therapy compared with usual care, in which C-reactive protein is the commonly used biomarker.</div></div><div><h3>Methods</h3><div>The BATCH trial was a pragmatic, multicentre, open-label, parallel, two-arm, individually randomised, controlled trial conducted in 15 hospitals in England and Wales. Children aged 72 h to 18 years who were admitted to hospital and were being treated with intravenous antibiotics for suspected or confirmed bacterial infection and who were expected to remain on intravenous antibiotics for more than 48 h were enrolled. Participants were randomly assigned (1:1) to receive either current clinical management alone (usual care group) or clinical management with the addition of a procalcitonin test guided algorithm (procalcitonin group). Participants were randomly assigned by minimisation, with site and age group (0–6 months, 6 months to 2 years, 2–5 years, and older than 5 years) as minimisation factors and a random element to reduce predictability. Participants were randomly assigned remotely using a secure 24 h web-based randomisation programme. The coprimary outcomes were duration of intravenous antibiotic use, assessed for superiority, and a composite safety measure, assessed for non-inferiority (non-inferiority margin 5%). The primary analysis sample for each coprimary endpoint included all randomly assigned participants with available outcome data. This trial is registered with the International Standard Randomised Controlled Trial Number registry, ISRCTN11369832.</div></div><div><h3>Findings</h3><div>Between June 11, 2018, and Oct 12, 2022, 15 282 children were screened for eligibility, 1949 of whom were randomly assigned to receive procalcitonin-guided antibiotic therapy (n=977) or usual care (n=972). The median intravenous antibiotic duration was 96·0 h (IQR 59·5–155·5) in the procalcitonin group and 99·7 h (61·2–153·8) in the usual care group (hazard ratio 0·96 [95% CI 0·87–1·05]). 78 (9%) of 917 participants in the procalcitonin group and 85 (9%) of 904 participants in the usual care group had at least one event covered by the composite safety outcome measure (estimated adjusted risk difference –0·81% [95% CI upper bound 1·11]).</div></div><div><h3>Interpretation</h3><div>In children with suspected or confirmed bacterial infection admitted to hospitals in England and Wales for intravenous antibiotic treatment of at least 48 h, the introduction of a procalcitonin-guided algorithm did not reduce duration of intravenous antibiotics treatment and is non-inferior to usual care for safety outcomes. Therefore, evidence does not support the use of procalcitonin-guided algorithms where robust effective paediatric antibiotic stewardship programme","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 2","pages":"Pages 121-130"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Children and young people with mental health concerns admitted to medical wards","authors":"Josephine Holland","doi":"10.1016/S2352-4642(24)00355-9","DOIUrl":"10.1016/S2352-4642(24)00355-9","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 2","pages":"Pages 79-80"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to Lancet Child Adolesc Health 2025; 9: 10–14","authors":"","doi":"10.1016/S2352-4642(25)00007-0","DOIUrl":"10.1016/S2352-4642(25)00007-0","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 2","pages":"Page e3"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to Lancet Child Adolesc Health 2025; 9: 37–46","authors":"","doi":"10.1016/S2352-4642(25)00006-9","DOIUrl":"10.1016/S2352-4642(25)00006-9","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 2","pages":"Page e3"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating care quality and appropriateness when promoting health-care seeking for children – Authors' reply","authors":"Myrthe van den Broek , Mark J D Jordans","doi":"10.1016/S2352-4642(24)00325-0","DOIUrl":"10.1016/S2352-4642(24)00325-0","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 2","pages":"Page e2"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building global collaborative research networks in paediatric critical care: a roadmap","authors":"Prof Luregn J Schlapbach PhD ,&nbsp;Prof Padmanabhan Ramnarayan FRCPCH ,&nbsp;Prof Kristen S Gibbons PhD ,&nbsp;Brenda M Morrow PhD ,&nbsp;Natalie Napolitano PhD ,&nbsp;Lyvonne N Tume RN PhD ,&nbsp;Andrew C Argent MD ,&nbsp;Prof Akash Deep MD ,&nbsp;Jan Hau Lee MBBS ,&nbsp;Prof Mark J Peters PhD ,&nbsp;Michael S D Agus MD ,&nbsp;John Adabie Appiah FWACP ,&nbsp;Jennifer Armstrong MSc ,&nbsp;Tigist Bacha MPH ,&nbsp;Warwick Butt FCICM ,&nbsp;Daniela Carla de Souza PhD ,&nbsp;Jaime Fernández-Sarmiento PhD ,&nbsp;Heidi R Flori MD ,&nbsp;Patricia Fontela PhD ,&nbsp;Ben Gelbart PhD ,&nbsp;Kusum Menon MSc","doi":"10.1016/S2352-4642(24)00303-1","DOIUrl":"10.1016/S2352-4642(24)00303-1","url":null,"abstract":"<div><div>Paediatric critical care units are designed for children at a vulnerable stage of development, yet the evidence base for practice and policy in paediatric critical care remains scarce. In this Health Policy, we present a roadmap providing strategic guidance for international paediatric critical care trials. We convened a multidisciplinary group of 32 paediatric critical care experts from six continents representing paediatric critical care research networks and groups. The group identified key challenges to paediatric critical care research, including lower patient numbers than for adult critical care, heterogeneity related to cognitive development, comorbidities and illness or injury, consent challenges, disproportionately little research funding for paediatric critical care, and poor infrastructure in resource-limited settings. A seven-point roadmap was proposed: (1) formation of an international paediatric critical care research network; (2) development of a web-based toolkit library to support paediatric critical care trials; (3) establishment of a global paediatric critical care trial repository, including systematic prioritisation of topics and populations for interventional trials; (4) development of a harmonised trial minimum set of trial data elements and data dictionary; (5) building of infrastructure and capability to support platform trials; (6) funder advocacy; and (7) development of a collaborative implementation programme. Implementation of this roadmap will contribute to the successful design and conduct of trials that match the needs of globally diverse paediatric populations.</div></div>","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 2","pages":"Pages 138-150"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142884009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building policy around the built environment for adolescent mental health","authors":"Amy Mizen ,&nbsp;Richard Fry ,&nbsp;Susan Williams ,&nbsp;Ann John","doi":"10.1016/S2352-4642(24)00259-1","DOIUrl":"10.1016/S2352-4642(24)00259-1","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 2","pages":"Pages 81-82"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timeliness and value of individual participant data meta-analyses in paediatric tuberculosis research","authors":"Ben J Marais ,&nbsp;Mikaela Coleman ,&nbsp;Leyla Larsson ,&nbsp;Katharina Kranzer","doi":"10.1016/S2352-4642(24)00357-2","DOIUrl":"10.1016/S2352-4642(24)00357-2","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 2","pages":"Pages 78-79"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating care quality and appropriateness when promoting health-care seeking for children","authors":"Man Lui Chan ,&nbsp;Kwok Ying Chan ,&nbsp;Anthea Wan Hung Chan","doi":"10.1016/S2352-4642(24)00327-4","DOIUrl":"10.1016/S2352-4642(24)00327-4","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 2","pages":"Page e1"},"PeriodicalIF":19.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}