Search Results (220)

School-based neuromuscular training interventions have the potential to mitigate dynapenia in the paediatric population and enhance movement skill outcomes; however, translating research into practice in primary school settings has been slow due to the expertise and professional learning required for implementation. This review describes the new teacher-supported intervention ‘Kids Innovative Neuromuscular Enhancement & Teacher-supported Instructional Coaching with AI’ (Kinetic AI) and presents evidence supporting its use in primary school settings. The Scale for the Assessment of Narrative Review Articles (SANRA) was used to guide the narrative and conceptual review methodology employed to synthesise peer-reviewed literature on paediatric dynapenia, school-based neuromuscular training, and AI technology-supported instructional models. This synthesis informed the development of a conceptual approach to neuromuscular training delivery in primary schools. The newly developed Kinetic AI conceptual model provides a pathway to embed neuromuscular training within active class breaks, offering adaptive feedback and targeted teacher support to facilitate implementation. This approach has the potential to bridge gaps between research, access, and practice. The Kinetic AI application is designed to support children’s muscular fitness and movement skills through school-based neuromuscular training, while addressing barriers to research translation and teacher expertise. When applied during school breaks, this approach has the potential to reduce the risk of dynapenia and contribute to scalable improvements in paediatric health and wellbeing. Full article

Background/Aim: Although large language models (LLMs) achieve >90% accuracy on medical multiple-choice questions, their actual diagnostic utility remains unproven. This study compared four approaches to general medical diagnostics using real clinical data and LLMs: standalone LLM, LLM with Retrieval-Augmented Generation (RAG), LLM with expert system, and full integration of LLM, RAG, and expert system. Methods: Twenty LLMs were tested on 1655 unpublished clinical cases (paediatrics and internal medicine) in Polish and English, yielding 264,800 diagnostic evaluations. TOP-1, TOP-3, and grouped International Classification of Diseases, 10th Revision (ICD-10) accuracy were measured. Results: Standalone LLMs achieved only 16–20% TOP-1 accuracy. RAG added minimal benefit (+2–5 percentage points). The expert system improved performance 2.5-fold (55% paediatrics, 39% internal medicine). Unexpectedly, combining all components reduced results compared to the expert system alone, revealing an “integration paradox”. Conclusions: LLMs alone are insufficient for clinical diagnostics in practical applications with incomplete data. Developers of clinical decision support systems should not treat LLMs as standalone diagnostic engines. Expert systems based on machine learning algorithms provide better support and should serve as the primary component in hybrid architectures. Combining LLM, RAG, and expert systems without deliberate output weighting paradoxically reduces performance. Hybrid systems should implement dynamic source selection or prediction weighting mechanisms rather than simple integration. Full article

Background: A paediatric cancer diagnosis is a profound stressor for the entire family system. Although coping strategies are well-studied, their link to the quality of the parent–child attachment relationship remains less explored. In this study, we investigated whether dyadic attachment dynamics—specifically closeness and conflict between parent and child—are associated with the use of adaptive or maladaptive coping strategies in caregivers of children undergoing active treatment for oncohaematological diseases. Methods: We conducted a multicentre, cross-sectional study across three Italian paediatric oncohaematology centres. A total of 165 caregivers of 91 paediatric patients aged 3–17 years completed self-report measures assessing parent–child relationship quality (Child–Parent Relationship Scale-CPRS), coping strategies (COPE-NVI), perceived social support (MSPSS), and resilience (RS-14). We tested whether the quality of the parent–child attachment relationship is associated with caregivers’ coping strategies. We hypothesised that Attachment Closeness would be associated with adaptive coping (Positive Attitude, Social Support, Problem Orientation), whereas Attachment Conflict would be associated with maladaptive coping (Avoidance). We conducted multiple linear regression models, adjusted for key covariates and with robust standard errors clustered at the family level, to test these hypotheses. Results: Higher levels of emotional closeness (CPRS) were significantly associated with greater use of adaptive coping strategies, specifically Positive Attitude (β = 0.20, p = 0.049) and Problem Orientation (β = 0.26, p = 0.002), even after controlling for sociodemographic factors, social support, and resilience. Conversely, higher levels of relational conflict were significantly associated with greater use of the maladaptive Avoidance strategy (β = 0.14, p = 0.015). The hypothesis linking closeness to Social Support seeking was not supported. Conclusions: The findings suggest that the parent–child attachment relationship is a significant correlate of caregiver coping strategies in caregivers of children with cancer. Interventions aimed at supporting the caregiver–child dyad by fostering emotional closeness and reducing conflict may promote more adaptive parental coping mechanisms, thereby enhancing family resilience and psychological adjustment throughout the treatment journey. Full article

Authentic, situated learning experiences which mirror the collaborative nature of healthcare practice are essential in preparing students for their future professions. Feedback literacy may be thought of as the understanding, capacity, and disposition needed to make sense of information and use it to enhance work or learning strategies. This study explored how feedback literacy can be developed through situated, interprofessional peer-to-peer feedback within a community-based paediatric health screening programme. Using an exploratory Action Research qualitative design, the planning activities stage explored current practice, gathering student insights via interviews, reflections, and a workshop to co-design an Interprofessional Feedback Conversation Guide (IPFCG). The IPFCG was piloted, integrating structured feedback tools and protected time for peer exchange, within the community screening activity. Feedback regarding use of the IPFCG contributed to the gathering data stage, which was followed by the evaluation and reflection stage. Evaluation revealed four key themes: value, engagement, optimising relationships, and structuring conversations. Students valued receiving feedback from peers outside their discipline, actively engaged with the process, emphasised the importance of building rapport, and utilised structured dialogue. These findings highlight how authentic, field-based learning can foster feedback literacy, enhancing the development of professional identity. The interprofessional nature of the program reflects the complexity of modern healthcare and demonstrates how curriculum-integrated models of authentic learning can enhance student engagement and workplace readiness. This study contributes to the evolving conversation about embedding authenticity in higher education and offers a practical model for building collaborative communication within situated learning experiences at scale. Full article

Background: Preoperative differentiation between uncomplicated and complicated paediatric appendicitis remains challenging. This study aimed to evaluate the diagnostic performance of routine admission biomarkers and blood cell count-derived inflammatory indices for severity stratification and to determine whether fibrinogen provides additional predictive value beyond commonly used markers. Methods: We conducted a retrospective single-centre study (2018–2025) using electronically recorded clinical data. Patients with suspected appendicitis were identified through appendicitis-related ICD-10 codes and diagnostically validated. The final analytical cohort required complete admission laboratory data, including C-reactive protein (CRP), fibrinogen, and complete blood count parameters. Derived inflammatory indices included the neutrophil-to-lymphocyte ratio (NLR) and the systemic immune-inflammation index (SII). Diagnostic discrimination and multivariable prediction models were evaluated to assess the ability of these markers to distinguish complicated from uncomplicated appendicitis. Results: Of 1518 screened records, 1132 patients met inclusion criteria (620 complicated; 512 uncomplicated). Complicated appendicitis was associated with higher inflammatory markers and longer hospital stay (all p < 0.001). CRP demonstrated the strongest univariable discrimination (area under the curve [AUC] 0.785), while fibrinogen showed lower performance (AUC 0.744). A combined model including CRP, NLR, and SII achieved good discrimination (AUC 0.812), with minimal improvement after adding fibrinogen (AUC 0.813). In multivariable analysis, log-transformed CRP and SII remained independently associated with complicated appendicitis (both p < 0.001). A rule-out probability threshold of 0.303 achieved 90% sensitivity (negative predictive value 0.803), whereas a CRP cut-off ≥92.24 mg/L showed high specificity (0.943) and positive predictive value (0.900). Conclusions: Routine admission biomarkers and inflammatory indices derived from complete blood counts can support severity stratification in paediatric appendicitis. CRP and SII provide meaningful predictive information, whereas fibrinogen contributes little additional discriminatory value beyond CRP-based models. These findings suggest that a small set of routinely available laboratory markers may assist early risk stratification, although external validation is required before clinical implementation. Full article

Multi-class and multi-label classification of medical dialogues remains a challenging task due to high linguistic variability and transcription noise. This study proposes an ensemble approach based on three fine-tuned Polish T5 (Text-to-Text Transfer Transformer) models trained on partially overlapping clinical dialogue datasets. The models are evaluated exclusively on low-quality, highly noisy, automatically transcribed conversations to assess real-world robustness. The results demonstrate that the ensemble of models improves classification stability and outperforms the best single model, increasing the F1-score by 21.8% for internal medicine dialogues and by 44.9% for paediatric interviews. The proposed method shows potential for practical deployment in clinical decision support and automated medical documentation systems. Full article

Background: Oral malignancies in the paediatric population are rare, but if left untreated, the patient’s prognosis may be altered. The current literature is varied in its findings regarding common sites and types of tumours found in the paediatric population. Our goal was to describe the distribution of paediatric head and neck cancers, test associations, quantify temporal trends and perform survival analyses. We then compared our results with the current literature. Methods: Approval for the study was given by the Hadassah Medical Organization Helsinki Committee (HMO0792-20). We obtained data from the Israel National Cancer Registry, for the years 1970–2017, regarding head and neck malignancies, including oral malignancies, diagnosed in Israel in individuals under the age of 19. We performed a comprehensive statistical analysis, including annual incidence analysis, Kaplan–Meier survival curves to estimate 5-year survival, and a multivariable Cox proportional hazards model to evaluate the association between demographic and tumor-related variables and overall survival. Results: Our study consisted of 393 cases. The most common cancer location was the nasopharynx, and the most common cancer histology was of epithelial origin. Regarding gender, there were significantly more males diagnosed with cancer. Over 40% of the diagnosed cases were in the 15–18 age group. There was no evidence of a notable change in the average incidence rate over time. The lowest survival rates were observed in cancers originating in the oropharynx and in hematologic malignancies when stratified by tumor location and histology, respectively. Conclusions: The importance of this research is significant, as it adds to the current pool of information and touches on aspects that have not been commonly analysed. Full article

Background/Objectives: Children and young people with intellectual disability/developmental disorder (ID/DD) face inequities in hospital care, including poor communication, limited reasonable adjustments, and fragmented coordination. This study examined the presence of care coordination elements within staff and caregiver experiences and explored how these practices were influenced by a locally delivered staff training program implemented in a tertiary paediatric emergency department (ED) in New South Wales, Australia (Motivated for Change). Methods: A qualitative pre–post design was used, incorporating staff and caregiver interviews and ED observations to evaluate the program. This study included 22 observations (10 baseline, 12 post-intervention) and 15 interviews (six baseline, nine post-intervention) with staff and caregivers. The intervention included three one-hour training sessions and practical tools such as the digital Top 5 Tile This study represents a secondary use of existing data, applying a previously established care coordination framework and its associated definitions. Data were analysed using the framework method by five members of the research team. Results: Post-intervention, staff more consistently engaged parents and caregivers, made tailored adjustments, and used the Top 5 Tile to support information continuity. Child life therapists played a pivotal role in advocating for families and modelling inclusive practices. The findings mapped strongly to the framework domains of communication, proactive care planning, and aligning resources to needs, though systemic constraints remained. Conclusions: Targeted training and structured tools can strengthen care coordination for children and young people with ID/DD in EDs, improving safety and quality of care. Broader implementation across other departments and evaluation of sustainability are warranted. Full article

Background/Objectives: Preclinical models that accurately reflect Ewing sarcoma (ES) will enable the prioritisation of clinically active targeted agents from bench to clinic. To expedite this process, we have established and characterised patient-derived ES cultures (PDES) in vitro. Methods: Fluorescence in situ hybridisation, RT-PCR and western blotting were used to examine expression of the pathognomonic EWSR1 fusions. Activation or repression of EWSR1 fusion downstream targets and proliferation was examined by immunofluorescence and immunohistochemistry. Using next-generation sequencing, the DNA and transcriptomic profiles of PDES and cell lines were compared. The response of PDES and cell lines to standard-of-care chemotherapeutics, ionising radiation and investigational drugs was examined. Results: All PDES contain EWSR1 fusion DNA, consistent with a diagnosis of ES. EWSR1 fusion gene RNA and protein were detected in 70% and 21% of PDES, respectively. Markers of proliferation and expression of EWSR1 fusion target genes were consistent with the tumours from which PDES were derived (R² = 0.74, p < 0.0001) and the paediatric mesenchymal lineage (SBS5 and SBS1, ID1 and ID2). In contrast, the transcriptome of PDES was significantly different from that of cell lines. PDES had a significantly increased doubling time (p < 0.00001), decreased expression of Ki67 (p < 0.0001) and increased migration (p < 0.02) compared to cell lines. Consistent with the longer doubling time, PDES were more resistant to doxorubicin, etoposide and vincristine and ionising radiation (p < 0.0001) than cell lines. PDES were sensitive to mTKIs (cabozantinib, lenvatinib, and regorafenib), and trabectedin. The response of PDES to drugs in vitro reflects the clinical experience of patients. Conclusions: Models incorporating PDES cells may positively contribute to the preclinical pipeline. Full article

Background/Objectives: Hydroxyurea is currently the standard disease-modifying therapy for reducing sickle cell disease (SCD) complications; however, drug labels currently advise discontinuation of breastfeeding during hydroxyurea therapy due to limited human data on the risk of hydroxyurea exposure in breastfed neonates. Methods: A physiologically based pharmacokinetic (PBPK) model for hydroxyurea was built and verified with data from non-lactating adult patients with SCD. The model was then extended to predict hydroxyurea in nursing and in paediatric populations. Predictions were compared to the observed data. Results: The PBPK model predictions for hydroxyurea pharmacokinetics described the observed data in both adult and paediatric subjects with SCD. Observed concentration profiles were within the 5th–95th prediction intervals, and predicted PK parameters were within 2-fold of the observed values. The predicted milk-to-plasma ratio was 0.8. Neonatal exposure to hydroxyurea via breast milk as a percentage of maternal exposure increased from 0.6% at 1 day to 10% at the 4th week postpartum before declining to 5%, 3%, and 2% at 6, 9, and 12 months postpartum, respectively. Conclusions: About 56% of total milk hydroxyurea exposure is within the first 3 h of post-maternal dose. Disposal of this early milk would reduce the exposure of breastfed children. The reduction in exposure is especially pronounced around the first 1 month postpartum. Lactation PBPK models offer a physiological approach to assess real-life scenarios that are difficult to investigate in clinical studies and provide useful results for future clinical study design and clinical recommendations. This was exemplified with hydroxyurea in the current work. Full article

Children with rare tumours and malformations may benefit from innovative imaging, including patient-specific 3D models that can enhance communication and surgical planning. The primary aim was to evaluate the impact of patient-specific 3D models on communication with families. The secondary aims were to assess their influence on medical management and to establish an efficient post-processing workflow. From 2021 to 2024, we prospectively included patients aged 3 months to 18 years with rare tumours or malformations. Families completed questionnaires before and after the presentation of a 3D model generated from MRI sequences, including peripheral nerve tractography. Treating physicians completed a separate questionnaire before surgical planning. Analyses were performed in R. Among 21 patients, diagnoses included 11 tumours, 8 malformations, 1 trauma, and 1 pancreatic pseudo-cyst. Likert scale responses showed improved family understanding after viewing the 3D model (mean score 3.94 to 4.67) and a high overall evaluation (mean 4.61). Physicians also rated the models positively. An efficient image post-processing workflow was defined. Although manual 3D reconstruction remains time-consuming, these preliminary results show that colourful, patient-specific 3D models substantially improve family communication and support clinical decision-making. They also highlight the need for supporting the development of MRI-based automated segmentation softwares using deep neural networks, which are clinically approved and usable in routine practice. Full article

Background: Postnatal growth failure in very preterm infants remains a major concern in neonatal care and clinical management is complicated by the lack of a standardized definition. This study aims to identify risk factors for growth faltering (GF) and undernutrition (UN) at hospital discharge, defined according to the latest consensus definitions established by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Methods: We conducted a retrospective observational study of 416 preterm infants (gestational age < 32 weeks and/or birth weight < 1500 g). Growth was monitored using the Intergrowth 21st standards. In line with ESPGHAN criteria, GF was defined longitudinally as a weight for age (WFA) z-score decline ≥ 1 SD from birth, while UN was defined cross-sectionally as a WFA or length for age z-score < −2 SD at discharge. Logistic regression models were used to determine independent predictors for both growth phenotypes. Results: At discharge, the prevalence of GF and UN was 45.3% and 33.1%, respectively. In infants born without growth restriction (GR), UN was almost entirely driven by GF (89.7%). In contrast, 85.5% of infants born with GR remained undernourished at discharge. Multivariate analysis identified bronchopulmonary dysplasia and higher maximal postnatal weight loss as major independent risk factors for GF, while female sex and human milk feeding at discharge were associated with a lower risk of GF. For infants born with adequate weight, maternal hypertension, extremely low birth weight, and the co-occurrence of GF were the strongest predictors of UN. Conclusions: Nearly half of very preterm infants experience significant growth impairment before discharge. By assessing the dynamic process of GF and the static endpoint of UN, we identified distinct clinical trajectories. Standardized ESPGHAN criteria allow for the identification of high-risk “phenotypes”—particularly those with GR at birth or severe neonatal morbidity—enabling more targeted and intensive nutritional management during the critical developmental window. Full article

Background and Objectives: Predicting postoperative refractive development after paediatric intraocular lens (IOL) implantation remains challenging due to continued ocular growth and interindividual variability. This scoping review maps current evidence on demographic, biometric, and surgical factors influencing postoperative myopic shift in children undergoing cataract surgery with IOL implantation. Methods and Materials: A systematic literature search was conducted in PubMed and Scopus from the last ten years through October 2025. Eligible studies included children (≤18 years) with congenital or developmental cataract undergoing primary or secondary IOL implantation that reported postoperative refractive change and its predictors. Titles, abstracts, and full texts were screened according to PRISMA-ScR guidelines. Data were charted on study design, age at surgery, follow-up duration, refractive and biometric outcomes, and associated predictors. Results: Twelve studies met the inclusion criteria. Younger age at surgery, shorter preoperative axial length, and unilateral cataract consistently predicted greater postoperative myopic shift. Reported myopic change ranged from approximately −1.8 D after 2 years to −11.6 D after 15 years of follow-up, correlating with the rate of axial elongation. Optical biometry and modern formulas (e.g., Holladay 1) showed lower absolute prediction error than manual A-scan or SRK-II calculations. Postoperative complications, especially glaucoma and visual axis opacification, were associated with greater refractive change. Conclusions: Postoperative myopic shift is a predictable, age-dependent feature of paediatric pseudophakia driven primarily by ocular growth dynamics. Standardised biometry, age-stratified refractive targeting, and integration of longitudinal growth models into IOL calculation algorithms may improve refractive predictability and visual outcomes in children. Full article

Background: Vesicoureteral reflux (VUR) contributes significantly to recurrent childhood urinary tract infections and renal scarring, yet predicting which patients will develop adverse outcomes or benefit from specific investigations or treatments remains challenging. Numerous prognostic tools have been proposed, but none have achieved widespread adoption. Methods: A comprehensive search of the literature available on MEDLINE, PUBMED, Embase, Emcare, CINAHL, and Google Scholar was performed to identify combinations of factors, scoring systems, ratios, models, and tools relating to VUR. This included predicting the spontaneous resolution of established vesicoureteral reflux, the risk of breakthrough urinary tract infections (UTIs), and guiding clinical decision making regarding the need for VCUG in patients with UTIs, continuous antibiotic prophylaxis (CAP), or surgical intervention in patients with confirmed VUR. Articles were included if they either described or validated a predictive tool that was designed to aid clinical decision making in patients with either suspected or confirmed VUR with regards to investigation or management strategies. All the studies included were then analysed, and the predictive tools have been summarised in a narrative format. Results: Seventeen predictive tools developed over thirty-nine years were identified: six predicting spontaneous resolution, four predicting breakthrough urinary tract infection (BTUTI) on CAP, two determining which children benefit from CAP, and five estimating the probability of VUR or high-grade VUR after a first febrile UTI. Approaches ranged from radiological ratios to multifactorial clinical–radiological scores and machine-learning models. Only five tools had any external validation, and none demonstrated sufficient reliability for universal clinical use. Significant heterogeneity in design, imaging interpretation, inclusion criteria, and outcome definitions limited comparison and wider applicability. Conclusions: This atlas provides the first consolidated overview of prognostic tools in paediatric VUR. Future development should prioritise multicentre, prospectively validated models that integrate established clinical and radiological predictors with transparent computational methods to create practical, generalisable risk-stratification frameworks for routine care. Full article

Background/Objectives: Incidence of malnutrition varies greatly among gastrointestinal (GI) cancer patients and has a major impact on prognosis. We performed a meta-analysis to identify risk factors for malnutrition risk, malnutrition diagnosis, and cachexia in patients with GI cancer. Methods: A systematic search was performed on 31 October 2025 on the PubMed (Medline), Embase, and Cochrane Library databases. Eligible studies reported on risk factors for malnutrition risk, malnutrition diagnosis, malnutrition-related complication risk and cachexia in adult patients with GI cancer. Articles on neuroendocrine tumours, primary cancer outside the GI tract, and the paediatric population were excluded. The random-effects model yielded the pooled odds ratios (ORs) and 95% confidence intervals (CIs) for the investigated risk factors. Results: A total of 37,624 records were identified. Data from 262,525 patients from 578 articles were included in the analysis. Older age (≥65) was associated with higher odds for malnutrition risk across all GI cancers. In gastric cancer, males had a lower odds for malnutrition risk (OR 0.84; 95% CI 0.75–0.95); however, the sex difference across other cancer types was heterogeneous, and mostly not significant. Tumour location influenced the odds for malnutrition-related complication risk in pancreatic ductal adenocarcinoma (head vs. body/tail—OR 1.48; 95% CI 0.98–2.23) and colorectal cancer (colon vs. rectal—OR 1.39; 95% CI 1.07–1.81; right-sided vs. left-sided—OR 1.54; 95% CI 1.34–1.77). Increased C-reactive protein alone indicated higher odds for malnutrition risk at baseline. Conclusions: Inflammatory biomarkers and tumour characteristics may indicate malnutrition risk in GI cancer at baseline. There is a great need for standardised and harmonised approaches in nutritional status assessment in GI cancer. Full article