Willingness to vaccinate children against COVID-19 declined during the pandemic.

OBJECTIVES: To document the level of vaccine hesitancy in caregivers' of children younger than 12 years of age over the course of the pandemic in Pediatric Emergency Departments (ED). Study design Ongoing multicenter, cross-sectional survey of caregivers presenting to 19 pediatric EDs in the USA, Canada, Israel, and Switzerland during first months of the pandemic (phase1), when vaccines were approved for adults (phase2) and most recently when vaccines were approved for children (phase3). RESULTS: Willingness to vaccinate rate declined over the study period (59.7%, 56.1% and 52.1% in the three phases). Caregivers who are fully vaccinated, who have higher education, and those worried their child had COVID-19 upon arrival to the ED, were more likely to plan to vaccinate in all three phases. Mothers were less likely to vaccinate early in the pandemic, but this hesitancy attenuated in later phases. Older caregivers were more willing to vaccinate, and caregivers of older children were less likely to vaccinate their children in phase 3. During the last phase, willingness to vaccinate was lowest in those who had a primary care provider but did not rely on their advice for medical decisions (34%). Those with no primary care provider and those who do and rely on their medical advice, had similar rates of willingness to vaccinate (55.1% and 52.1%, respectively). CONCLUSIONS: COVID-19 vaccine hesitancy is widespread and growing over time, and public health measures should further try to leverage identified factors associated with hesitancy in order to enhance vaccination rates among children.

Safety of nurse-directed triage intranasal fentanyl protocol for acute pain management in a European pediatric emergency department: A retrospective observational analysis.

Background: Nurse-directed pain protocols for intranasal fentanyl administration are not widely implemented in European (EU) pediatric emergency departments (PED). Barriers include perceived safety concerns for intranasal (IN) fentanyl. The aim of this study is to describe our experience with a nurse-directed triage IN fentanyl protocol with a focus on safety in a tertiary EU PED. Methods: We conducted a retrospective analysis of patient records of children aged 0-16 years who received nurse-directed IN fentanyl between January 2019 and December 2021 at the PED of the University Children's Hospital of Bern, Switzerland. Extracted data points included demographics, presenting complaint, pain score, IN fentanyl dosage, concomitant pain medication use, and adverse events. Results: A total of 314 patients were identified with ages ranging from 9 months to 15 years. The main indication for nurse-directed fentanyl administration was musculoskeletal pain due to trauma (n = 284, 90%). Mild adverse events (vertigo) were reported in two patients (0.6%), without a correlation to concomitant pain medication or protocol violation. The only reported severe adverse event of syncope and hypoxia in a 14-year-old adolescent occurred in a setting where the institutional nurse-directed protocol was violated. Conclusion: In accordance with previous studies outside of Europe, our data support the case that when appropriately used, nurse-directed IN fentanyl is a safe potent opioid analgesic for pediatric acute pain management. We strongly encourage the introduction of nurse-directed triage fentanyl protocols Europe-wide in order to provide effective and adequate acute pain management in children.

Observed costs and health care use of children in a prospective cohort study on community-acquired pneumonia in Geneva, Switzerland.

QUESTIONS UNDER STUDY: Despite various efforts to estimate cost-effectiveness of pneumococcal conjugate vaccines, only scarce information on the cost burden of paediatric community acquired pneumonia (CAP) exists. The objective of this study was to prospectively calculate direct and indirect costs associated with treatment of CAP from a society perspective in children between 2 months and 16 years of age seeking care at a tertiary hospital in Geneva, Switzerland between December 2008 and May 2010. METHODS: This cost of illness study population comprised children aged from 2 months to 16 years of age seeking care for CAP at the University Children's Hospital Geneva from January 2008 through May 2010 (a subset of patients taken from a larger multicentre prospective cohort). Hospital-associated costs for episodes of pneumonia were computed according to the REKOLE® system. Non-hospital costs were estimated by parental interviews at baseline and follow-up on day 14. RESULTS: The overall cost for one episode of CAP was 11'258 CHF; 23'872 CHF for inpatient treatment and 1009 CHF for outpatient treatment. Severe pneumonia cases per World Health Organisation (WHO) definition used significantly more hospital resources than non-severe cases: 21'842 CHF versus 3'479 CHF (p <0.0001). CONCLUSION: Childhood CAP results in a significant medical cost burden that may have been underestimated in previous cost-effectiveness analyses of pneumococcal vaccine strategies.

[Frequency and pathogenis of thrombocytopenia in cardiac failure]. / Häufigkeit und Pathogenese einer Thrombozytopenie bei Herzinsuffizienz

In 395 consecutively investigated patients with cardiac failure of varying aetiologythe platelet ocurt in venous blood was less than 100 000/mm(3) in 5.3% and below the 2s devaition (less than 136 000/mm (3)) in 19.2. The average platelet count of the whole group was 197 500 +/- 70 800/mm (3) which was significantly lower (P less than 0.001) than in normal controls (n = 128). In 6 patients a (51)Cr study of platelet kinetics was performed; the results support the conclusion that the faculatative thrombocytopenia in cardiac failure is mainly,but not exclusively, due to an increased uptake of platelets in the congested spleen.