Antoine Tran

Factorial Validity of the ADHD Adult Symptom Rating Scale in a French Community Sample Results From the ChiP-ARD Study

Objective: Recent publications reported that a bifactor model better represented the underlying structure of ADHD than classical models, at least in youth. The Adult ADHD Symptoms Rating Scale (ASRS) has been translated into many languages, but a single study compared its structure in adults across Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) and International Classification of Diseases (ICD-10) classifications. Method: We investigated the factor structure, reliability, and measurement invariance of the ASRS among a community sample of 1,171 adults. Results: Results support a bifactor model, including one general ADHD factor and three specific Inattention, Hyperactivity, and Impulsivity factors corresponding to ICD-10, albeit the Impulsivity specific factor was weakly defined. Results also support the complete measurement invariance of this model across gender and age groups, and that men have higher scores than women on the ADHD G-factor but lower scores on all three S-factors. Conclusion: Results suggest that a total ASRS-ADHD score is meaningful, reliable, and valid in adults. (J. of Att. Dis. 2016; 20(6) 530-541)

Prevalence and correlates of attention deficit hyperactivity disorder in adults from a French community sample.

Abstract Validated tools are lacking in languages such as French to diagnose attention deficit hyperactivity disorder (ADHD) in adults. The Adult ADHD Symptoms Self-Report (ASRS) was filled out by 1171 parents of 900 school-aged youths in the context of the Children and Parents With ADHD and Related Disorders study. Prevalence estimates based on three scoring methods are compared (6-item screener, all 18 items, or the screener followed by the 12 remaining items). On the basis of the recommended and more conservative scoring method, the overall prevalence of ADHD symptoms is estimated to be 2.99%, without significant group differences between sexes or between younger and older adults. Potential correlates of ADHD symptoms were also examined in their relatives (children, brothers/sisters, uncles/aunts, and parents) as follows: birth order, level of education, body mass index categories, enuresis, suicide attempts, depression, and learning disabilities. Adults can be screened for ADHD symptoms using the ASRS; negative long-term outcomes should be assessed in patients’ relatives too.

Exploring sources of construct‐relevant multidimensionality in psychiatric measurement: A tutorial and illustration using the Composite Scale of Morningness

This paper illustrates a psychometric approach of broad relevance to psychiatric research instruments. Many instruments include indicators related to more than one source of true‐score variance due to the: (1) assessment of conceptually adjacent constructs; (2) the presence of a global construct underlying answers to items designed to assess multiple dimensions. Exploratory structural equation modelling (ESEM) is naturally suited to the investigation of the first source, whereas bifactor models are particularly suited to the investigation of the second source. When both sources are present, bifactor‐ESEM becomes the model of choice. To illustrate this framework, we use the responses of 1159 adults [655 female, 504 male, mean age (Mage) = 41.84] who completed the French Version of the Composite Scale of Morningness (CSM). We investigate the factor structure of the CSM, test the relations between CSM factors and body mass index, and verify the measurement invariance of the model across gender and age groups. Copyright

Teacher Ratings of the ADHD-RS IV in a Community Sample Results From the ChiP-ARD Study

Objective: Validated instruments to assess ADHD are still unavailable in many languages other than English for teachers, which constitutes a clear obstacle to screening, diagnosis, and treatment of ADHD in many European countries. Method: Teachers rated 892 youths using the ADHD Rating Scale (ADHD-RS). We investigated the factor structure, reliability, and measurement invariance based on confirmatory factor analyses. Results: Results support a bifactor model, including one general ADHD factor and two specific Inattention and Hyperactivity-Impulsivity factors. But the latter is improperly defined calling into question the existence of a Predominantly Hyperactivity-Impulsivity subtype. The measurement invariance is fully supported across gender, age groups, and Gender × Age Groups. Conclusion: Results support the multiple-pathways hypothesis and suggest that a total ADHD score is meaningful, reliable, and valid, as well as specific assessments of Inattention. Some youths—especially older ones—may present a profile of ADHD particularly marked by Inattention symptoms. (J. of Att. Dis. 2016; 20(5) 434-444)

Ecthyma gangrenosum, a skin manifestation of Pseudomonas aeruginosa sepsis in a previously healthy child: A case report

Rationale: Ecthyma gangrenosum (Eg) is a necrotic lesion that is mostly seen in immunocompromised patients. It reflects a severe sepsis, possibly caused by Pseudomonas aeruginosa (Pa). Patient concerns: A healthy 3-year-old girl admitted to the Pediatric Emergency Department presented a sepsis-associated purpura with neurological and respiratory distress. Interventions: An empiric antibiotherapy (anti-meningococcal) was prescribed. Diagnoses: Forty-eight hours after admission, blood and wound cultures were positive for Pa. As a result, the decision was made to change the antibiotic therapy. Unfortunately, on day 3, the patient died. Exhaustive immunologic tests are presently being carried out. Outcomes: Eg caused by Pa is uncommon in healthy children, and purpura sepsis is usually caused by Neisseria meningitides infection. Lessons: Eg should be recognized rapidly so that the appropriate treatment can be prescribed as quickly as possible.

Evaluation of the Bladder Stimulation Technique to Collect Midstream Urine in Infants in a Pediatric Emergency Department

Objective Midstream clean-catch urine is an accepted method to diagnose urinary tract infection but is impracticable in infants before potty training. We tested the bladder stimulation technique to obtain a clean-catch urine sample in infants. Materials and methods We included 142 infants under walking age who required a urine sample in a cross- sectional study carried out during a 3-months period, from September to November 2014, in the emergency department of the University Children’s Hospital of Nice (France). A technique based on bladder stimulation and lumbar stimulation maneuvers, with at least two attempts, was tested by four trained physicians. The success rate and time to obtain urine sample within 3 minutes were evaluated. Discomfort (EVENDOL score ≥4/15) was measured. We estimated the risk factors in the failure of the technique. Chi-square test or Fisher’s exact test were used to compare frequencies. T-test and Wilcoxon test were used to compare quantitative data according to the normality of the distribution. Risk factors for failure of the technique were evaluated using a multivariate logistic regression model. Results We obtained midstream clean-catch urine in 55.6% of infants with a median time of 52.0 s (10.0; 110.0). The success rate decreased with age from 88.9% (newborn) to 28.6% (>1 y) (p = 0.0001) and with weight, from 85.7% (<4kg) to 28.6% (>10kg) (p = 0.0004). The success rate was 60.8% for infants without discomfort (p<0.0001). Heavy weight and discomfort were associated with failure, with adjusted ORs of 1.47 [1.04–2.31] and 6.65 [2.85–15.54], respectively. Conclusion Bladder stimulation seems to be efficient in obtaining midstream urine with a moderate success rate in our study sample. This could be an alternative technique for infants before potty training but further randomized multicenter studies are needed to validate this procedure.

Terrorist attack in Nice: the central role of a children's hospital

www.thelancet.com Vol 389 March 11, 2017 1007 2 Aylwin CJ, König TC, Brennan NW, et al. Reduction in critical mortality in urban mass casualty incidents. Lancet 2006; 368: 2219–25. 3 Gregory TM, Bihel T, Guigui P, et al. Terrorist attacks in Paris: surgical trauma experience in a referral center. Injury 2016; 47: 2122–26. 4 Tobert D, von Keudell A, Rodriguez EK. Lessons from the Boston Marathon bombing: an orthopaedic perspective on preparing for high-volume trauma in an urban academic center. J Orthop Trauma 2015; 29 (suppl 10): S7–10. 5 Weil YA, Peleg K, Givon A, Israeli Trauma Group, Mosheiff R. Musculoskeletal injuries in terrorist attacks—a comparison between the injuries sustained and those related to motor vehicle accidents, based on a national registry database. Injury 2008; 39: 1359–64. order to keep reserve staff at home was given, resulting in strong feelings of frustration among those people. 44 patients were admitted in 2 h (appendix). Of these, 12 were adults: five were in critical condition, of whom four died quickly. The remaining 32 patients were children: eight were in critical condition, of whom two died later. The trauma leader assigned the patients to the operating room, resuscitation room, or for a CT scan. The CT scanner was made immediately available, performing 15 scans during the night. Six patients needed surgery during the first 24 h. All elective surgeries scheduled for July 15, 2016, were postponed, and team rotations were reorganised to allow rest. Injuries were typical of road crashes, differing from those caused by bomb or bullets, but similar to injuries observed in Israel. Cause of death was mainly haemorrhagic shock after multiple traumas including pelvic disjunction, head trauma, and trunk crush. During the night, child psychiatrists took care of victims, parents, witnesses, and staff. Stress disorder and dissociative symptomatology were observed—more prominently in adults than in children— and resulted in two transfers to the psychiatric emergency department at Pasteur Hospital and in disorganisation and sick leave for affected hospital staff. Multiple debriefing meetings, both technical and psychological, were necessary and profitable for all hospital staff. Our experience confirms that every hospital, regardless of level and specialty, should be prepared to receive patients of all ages, with all types of severities and lesions.

A prospective study into the benefits of simulation training in teaching obstetric vaginal examination

To assess the benefits of incorporating simulations in obstetric vaginal‐examination training.

Development of Reliable and Validated Tools to Evaluate Technical Resuscitation Skills in a Pediatric Simulation Setting: Resuscitation and Emergency Simulation Checklist for Assessment in Pediatrics

Objectives To develop a reliable and validated tool to evaluate technical resuscitation skills in a pediatric simulation setting. Study design Four Resuscitation and Emergency Simulation Checklist for Assessment in Pediatrics (RESCAPE) evaluation tools were created, following international guidelines: intraosseous needle insertion, bag mask ventilation, endotracheal intubation, and cardiac massage. We applied a modified Delphi methodology evaluation to binary rating items. Reliability was assessed comparing the ratings of 2 observers (1 in real time and 1 after a video‐recorded review). The tools were assessed for content, construct, and criterion validity, and for sensitivity to change. Results Inter‐rater reliability, evaluated with Cohen kappa coefficients, was perfect or near‐perfect (>0.8) for 92.5% of items and each Cronbach alpha coefficient was ≥0.91. Principal component analyses showed that all 4 tools were unidimensional. Significant increases in median scores with increasing levels of medical expertise were demonstrated for RESCAPE‐intraosseous needle insertion (P = .0002), RESCAPE‐bag mask ventilation (P = .0002), RESCAPE‐endotracheal intubation (P = .0001), and RESCAPE‐cardiac massage (P = .0037). Significantly increased median scores over time were also demonstrated during a simulation‐based educational program. Conclusions RESCAPE tools are reliable and validated tools for the evaluation of technical resuscitation skills in pediatric settings during simulation‐based educational programs. They might also be used for medical practice performance evaluations.

Eosinophilic granulomatosis with polyangiitis in children: Data from the French RespiRare® cohort

To describe the characteristics of pediatric cases of eosinophilic granulomatosis with polyangiitis (EGPA), a systemic necrotizing vasculitis rarely diagnosed in children, retrieved from the French Reference Center for rare pediatric lung diseases and compared with adult cases included in the French Vasculitis Study Group cohort.