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1.
BMC Health Serv Res ; 22(1): 9, 2022 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-34974841

RESUMO

BACKGROUND: Paediatric mortality rates in the United Kingdom are amongst the highest in Europe. Clinically missed deterioration is a contributory factor. Evidence to support any single intervention to address this problem is limited, but a cumulative body of research highlights the need for a systems approach. METHODS: An evidence-based, theoretically informed, paediatric early warning system improvement programme (PUMA Programme) was developed and implemented in two general hospitals (no onsite Paediatric Intensive Care Unit) and two tertiary hospitals (with onsite Paediatric Intensive Care Unit) in the United Kingdom. Designed to harness local expertise to implement contextually appropriate improvement initiatives, the PUMA Programme includes a propositional model of a paediatric early warning system, system assessment tools, guidance to support improvement initiatives and structured facilitation and support. Each hospital was evaluated using interrupted time series and qualitative case studies. The primary quantitative outcome was a composite metric (adverse events), representing the number of children monthly that experienced one of the following: mortality, cardiac arrest, respiratory arrest, unplanned admission to Paediatric Intensive Care Unit, or unplanned admission to Higher Dependency Unit. System changes were assessed qualitatively through observations of clinical practice and interviews with staff and parents. A qualitative evaluation of implementation processes was undertaken. RESULTS: All sites assessed their paediatric early warning systems and identified areas for improvement. All made contextually appropriate system changes, despite implementation challenges. There was a decline in the adverse event rate trend in three sites; in one site where system wide changes were organisationally supported, the decline was significant (ß = -0.09 (95% CI: - 0.15, - 0.05); p = < 0.001). Changes in trends coincided with implementation of site-specific changes. CONCLUSIONS: System level change to improve paediatric early warning systems can bring about positive impacts on clinical outcomes, but in paediatric practice, where the patient population is smaller and clinical outcomes event rates are low, alternative outcome measures are required to support research and quality improvement beyond large specialist centres, and methodological work on rare events is indicated. With investment in the development of alternative outcome measures and methodologies, programmes like PUMA could improve mortality and morbidity in paediatrics and other patient populations.


Assuntos
Proteínas Reguladoras de Apoptose , Pediatria , Criança , Hospitalização , Hospitais , Humanos , Unidades de Terapia Intensiva Pediátrica
2.
Pediatr Clin North Am ; 69(1): 153-170, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34794672

RESUMO

Immigrant children are a diverse group and include refugees, asylees, and internationally adopted children. They have various infectious disease risk factors, depending on conditions within their country of origin, journey, and current living conditions. Infectious disease screening should take place within the framework of a comprehensive medical evaluation in the medical home. Some screening is recommended for all immigrant children including hepatitis B, syphilis, HIV, tuberculosis, and intestinal parasites; other diseases can be tested for based on individual risks. Although guidelines and resources are available, there is limited evidence supporting much of the care of immigrant children and youth.


Assuntos
Criança Adotada , Doenças Transmissíveis/diagnóstico , Doenças Transmissíveis/terapia , Emigrantes e Imigrantes , Refugiados , Adolescente , COVID-19/diagnóstico , Criança , Pré-Escolar , Controle de Doenças Transmissíveis/métodos , Feminino , Infecções por HIV/diagnóstico , Hepatite Viral Humana/diagnóstico , Humanos , Imunização/métodos , Lactente , Masculino , Programas de Rastreamento/métodos , Doenças Parasitárias/diagnóstico , Pediatria/métodos , Guias de Prática Clínica como Assunto , Sífilis/diagnóstico , Tuberculose/diagnóstico
5.
J Public Health Manag Pract ; 28(1): E1-E8, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34797247

RESUMO

CONTEXT: Pediatric providers across the United States have sought guidance on how to care for the nation's children during the uncertain historic times of the COVID-19 pandemic. The health care community has been challenged by the unprecedented burden of caring for patients when they have evolving guidelines and limited information about the effects of the virus on children. PROGRAM: In response, the American Academy of Pediatrics (AAP) rapidly launched a national initiative to increase child health professionals' knowledge, skills, and self-efficacy. This COVID-19 ECHO (Extension for Community Healthcare Outcomes) program created communities of learners among child health professionals and subject matter expert faculty using didactic and case-based presentations that foster an "all-teach, all-learn" approach. IMPLEMENTATION: The initial AAP COVID-19 ECHO program hosted more than 900 participants in 127 individual virtual sessions, with approximately 25 participants per session. The evolving nature of the pandemic necessitated dynamic and continuous bidirectional flow of concerns and information relevant to participants. Session topics were selected in a "just-in-time" fashion based on participant feedback from the prospective postsession surveys and faculty recommendations; speakers brought data and expert recommendations. EVALUATION: To assess impact, the AAP used a mixed-methods approach to evaluate the program's effectiveness in meeting its educational objectives. The 2-phase evaluation collected quantitative and qualitative data through an integrated feedback structure that utilized prospective postsession and retrospective postprogram surveys, along with postprogram focus groups. DISCUSSION: As the COVID-19 pandemic surges and another influenza season is upon us, the ECHO model is an effective strategy for facilitating bidirectional communication and education to build child health professionals' knowledge, skills, and self-efficacy during an unprecedented and ongoing public health emergency. KEY POINTS: The ECHO model is an effective strategy for health care organizations to facilitate bidirectional communication and education in building health professionals' clinical knowledge, skills, and self-efficacy during the unprecedented and ongoing public health emergency of the COVID-19 pandemic.


Assuntos
COVID-19 , Pediatria , Criança , Humanos , Pandemias , Estudos Prospectivos , Saúde Pública , Estudos Retrospectivos , SARS-CoV-2 , Estados Unidos
7.
Pediatr Pulmonol ; 57(1): 100-108, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34672435

RESUMO

BACKGROUND: Collection of patient-reported data has been demonstrated to improve asthma outcomes. One method to collect information is through the electronic patient portal. In practice, patient portal use in pediatrics and, specifically for asthma management, has had low uptake. OBJECTIVE: To understand parental/caregiver experience of pediatric asthma care management, and perceptions of the use of patient portal questionnaires before the clinic visit. METHODS: We conducted semi-structured interviews with caregivers of children 5-11 years old with asthma in the University of California, Los Angeles (UCLA) Health System. We included patient portal "users" (n = 20) and "non-users" (n = 5). Interview questions were developed based on clinic visit workflow with a focus on perceived usefulness and ease of use to complete pediatric asthma questionnaires in the patient portal before the visit. Interviews were audio-recorded, transcribed, and codes were generated from themes using constant comparative analysis. RESULTS: We identified eight themes related to caregiver-physician communication, perception of portal questionnaires, facilitators, and barriers to portal questionnaire use. A salient finding was that caregivers considered the portal questionnaire as a tool to be integrated into the visit to facilitate a conversation about their child's asthma. Caregiver portal-based questionnaire use was more likely if the ongoing data entered was accessible to caregivers to track and update, and if caregivers were reassured the clinicians would use questionnaire responses during the visit. CONCLUSION: Caregivers of children with asthma are more likely to complete a patient portal intake questionnaire before the visit if they trust their responses will be used during the visit to inform care.


Assuntos
Asma , Portais do Paciente , Pediatria , Asma/diagnóstico , Asma/terapia , Cuidadores , Criança , Pré-Escolar , Humanos , Pais , Inquéritos e Questionários
8.
9.
Braz. J. Biol. ; 81(4): 887-898, Oct.-Dec. 2021. tab
Artigo em Inglês | VETINDEX | ID: vti-762600

RESUMO

This study aimed to describe the use of medicinal plants for the relief and treatment of pediatrics pathologies performed by parents of children registered in a Basic Health Unit. This is a cross-sectional, observational and analytical study that occurred from March until May 2016, with the participation of 176 individuals, using a semi-structured questionnaire as a research instrument. Descriptive statistics were applied for data analysis, using frequency distribution and chi-square test. Among all 177 indications of medicinal use of plants in childhood, considering the plant part and administration method, 61.6% converged with scientific data, 21.5% differed and 16.9% were new indications without a similar record in the literature. These results support the popular use of medicinal plants and show to need for greater awareness about the rational use of phytotherapy and stimulate scientific research, as they bring new elements about the therapeutic potential of different species.(AU)


O objetivo deste estudo foi descrever o uso de plantas medicinais para alívio e tratamento de patologias em pediatria realizado por pais de crianças cadastradas em uma Unidade Básica de Saúde. Trata-se de um estudo transversal, observacional e analítico, que ocorreu nos meses de março a maio de 2016, com a participação de 176 indivíduos, utilizando como instrumento de investigação um questionário semiestruturado. Para análise dos dados aplicou-se a estatística descritiva, com uso da distribuição de frequências e o teste do qui-quadrado. Das 177 indicações de uso medicinal de plantas na infância, considerando a parte da planta utilizada e sua forma de uso, 61,6% convergiram com os dados científicos, 21,5% divergiram e 16,9% foram novas indicações, sem registro semelhante na literatura. Esses resultados, ao mesmo tempo em que respaldam o uso popular de plantas medicinais, apontam a necessidade de maior conscientização sobre o uso racional da fitoterapia e estimulam a investigação científica, pois trazem novos elementos sobre o potencial terapêutico de diferentes espécies.(AU)


Assuntos
Humanos , Plantas Medicinais , Pediatria , Medicamentos Fitoterápicos , Fitoterapia
11.
Am Fam Physician ; 104(6): 618-625, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34913645

RESUMO

In the United States, pneumonia is the most common cause of hospitalization in children. Even in hospitalized children, community-acquired pneumonia is most likely of viral etiology, with respiratory syncytial virus being the most common pathogen, especially in children younger than two years. Typical presenting signs and symptoms include tachypnea, cough, fever, and anorexia. Findings most strongly associated with an infiltrate on chest radiography in children with clinically suspected pneumonia are grunting, history of fever, retractions, crackles, tachypnea, and the overall clinical impression. Chest radiography should be ordered if the diagnosis is uncertain, if patients have hypoxemia or significant respiratory distress, or if patients fail to show clinical improvement within 48 to 72 hours after initiation of antibiotic therapy. Outpatient management of community-acquired pneumonia is appropriate in patients without respiratory distress who can tolerate oral antibiotics. Amoxicillin is the first-line antibiotic with coverage for Streptococcus pneumoniae for school-aged children, and treatment should not exceed seven days. Patients requiring hospitalization and empiric parenteral therapy should be transitioned to oral antibiotics once they are clinically improving and able to tolerate oral intake. Childhood and maternal immunizations against S. pneumoniae, Haemophilus influenzae type b, Bordetella pertussis, and influenza virus are the key to prevention.


Assuntos
Pneumonia/diagnóstico , Pneumonia/terapia , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/fisiopatologia , Infecções Comunitárias Adquiridas/terapia , Humanos , Pediatria/métodos , Pediatria/tendências , Pneumonia/fisiopatologia , Estados Unidos
14.
J Pediatric Infect Dis Soc ; 10(Supplement_4): S71-S77, 2021 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-34951466

RESUMO

Metagenomic next-generation sequencing (mNGS) is a novel tool for identifying microbial DNA and/or RNA in blood and other clinical specimens. In the face of increasingly complex patients and an ever-growing list of known potential pathogens, mNGS has been proposed as a breakthrough tool for unbiased pathogen identification. Studies have begun to explore the clinical applicability of mNGS in a variety of settings, including endocarditis, pneumonia, febrile neutropenia, osteoarticular infections, and returning travelers. The real-world impact of mNGS has also been assessed through retrospective studies, documenting varying degrees of success and limitations. In this review, we will explore current highlights of the clinical mNGS literature, with a focus on pediatric data where available. We aim to provide the reader with a deeper understanding of the strengths and weaknesses of mNGS and to provide direction toward areas requiring further research.


Assuntos
Doenças Transmissíveis , Pediatria , Criança , Doenças Transmissíveis/diagnóstico , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Metagenômica , Estudos Retrospectivos , Sensibilidade e Especificidade
15.
J Med Internet Res ; 23(12): e26684, 2021 12 24.
Artigo em Inglês | MEDLINE | ID: mdl-34951592

RESUMO

BACKGROUND: The emergence of genetic and genomic sequencing approaches for pediatric patients has raised questions about the genomic health literacy levels, attitudes toward receiving genomic information, and use of this information to inform treatment decisions by pediatric patients and their parents. However, the methods to educate pediatric patients and their parents about genomic concepts through digital health interventions have not been well-established. OBJECTIVE: The primary objective of this scoping review is to investigate the current levels of genomic health literacy and the attitudes toward receiving genomic information among pediatric patients and their parents. The secondary aim is to investigate patient education interventions that aim to measure and increase genomic health literacy among pediatric patients and their parents. The findings from this review will be used to inform future digital health interventions for patient education. METHODS: A scoping review using PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines and protocols was completed using the following databases: MEDLINE, Embase, CINAHL, and Scopus. Our search strategy included genomic information inclusive of all genetic and genomic terms, pediatrics, and patient education. Inclusion criteria included the following: the study included genetic, genomic, or a combination of genetic and genomic information; the study population was pediatric (children and adolescents <18 years) and parents of patients with pediatric illnesses or only parents of patients with pediatric illnesses; the study included an assessment of the knowledge, attitudes, and intervention regarding genomic information; the study was conducted in the last 12 years between 2008 and 2020; and the study was in the English language. Descriptive data regarding study design, methodology, disease population, and key findings were extracted. All the findings were collated, categorized, and reported thematically. RESULTS: Of the 4618 studies, 14 studies (n=6, 43% qualitative, n=6, 43% mixed methods, and n=2, 14% quantitative) were included. Key findings were based on the following 6 themes: knowledge of genomic concepts, use of the internet and social media for genomic information, use of genomic information for decision-making, hopes and attitudes toward receiving genomic information, experiences with genetic counseling, and interventions to improve genomic knowledge. CONCLUSIONS: This review identified that older age is related to the capacity of understanding genomic concepts, increased genomic health literacy levels, and the perceived ability to participate in decision-making related to genomic information. In addition, internet-searching plays a major role in obtaining genomic information and filling gaps in communication with health care providers. However, little is known about the capacity of pediatric patients and their parents to understand genomic information and make informed decisions based on the genomic information obtained. More research is required to inform digital health interventions and to leverage the leading best practices to educate these genomic concepts.


Assuntos
Letramento em Saúde , Pediatria , Adolescente , Idoso , Criança , Comunicação , Genômica , Humanos , Pais
16.
Nutrients ; 13(12)2021 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-34959753

RESUMO

The complementary feeding (CF) period that takes place between 6 and 24 months of age is of key importance for nutritional and developmental reasons during the transition from exclusively feeding on milk to family meals. In 2021, a multidisciplinary panel of experts from four Italian scientific pediatric societies elaborated a consensus document on CF, focusing in particular on healthy term infants. The aim was to provide healthcare providers with useful guidelines for clinical practice. Complementary feeding is also the time window when iron deficiency (ID) and iron deficiency anemia (IDA) are most prevalent. Thus, it is appropriate to address the problem of iron deficiency through nutritional interventions. Adequate iron intake during the first two years is critical since rapid growth in that period increases iron requirements per kilogram more than at any other developmental stage. Complementary foods should be introduced at around six months of age, taking into account infant iron status.


Assuntos
Alimentos Infantis/normas , Fenômenos Fisiológicos da Nutrição do Lactente , Ferro/sangue , Política Nutricional , Pediatria/normas , Anemia Ferropriva/prevenção & controle , Pré-Escolar , Consenso , Feminino , Humanos , Lactente , Masculino , Estado Nutricional , Sociedades Médicas
17.
Harefuah ; 160(12): 780-785, 2021 Dec.
Artigo em Hebraico | MEDLINE | ID: mdl-34957711

RESUMO

INTRODUCTION: Symptomatic coronavirus 2019 (COVID-19) infection usually presents with upper airway symptoms, but may lead to complications, such as pneumonia and involvement of other organs, or even death. Children often have a mild clinical course or may be asymptomatic, however, a severe complication of multisystem inflammatory syndrome has been described in rare cases. In severe COVID-19 infection, acute kidney injury may manifest even in children without comorbidities. The aim of this review is to present available data on renal involvement in pediatric COVID-19, and disease manifestations in children with underlying chronic kidney disease (CKD) or children receiving immunosuppressive medications due to kidney transplantation or glomerular disease. Although it could be assumed that children with CKD, including immunosuppressed patients, might be a high risk group for infection and severity of COVID-19 disease, this is not supported by current available data.


Assuntos
Injúria Renal Aguda , COVID-19 , Nefrologia , Pediatria , Injúria Renal Aguda/virologia , COVID-19/complicações , Criança , Humanos , Síndrome de Resposta Inflamatória Sistêmica
18.
Ital J Pediatr ; 47(1): 239, 2021 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-34922600

RESUMO

Pediatrics and society are closely related. This link is as old as the history of Pediatrics, and dates to the second half of the eighteenth century. The vocation of the first European pediatric schools, indeed, was clinical and scientific, as well as social. The founding fathers of Pediatrics were scientists of great talent, and many of them benefactors and philanthropists. They spent their lives assisting the suffering childhood, and became promoters and organizers of social securities for the poorest and most vulnerable categories. The attention to the problems of abandonment was closely linked to study, prevention, and treatment of pathologies (especially infectious, deficiency and neurological ones). The profile and activity of pediatricians grew in the following decades after the birth of the first pediatric schools. The University institutions contributed to provide a further impulse to childcare as well as cultural authority, also thanks to the foundation of the first chairs and scientific journals of Pediatrics. The relevance and prestige of the studies performed rapidly spread throughout Europe, and also reached our country, contributing to a progressive and relevant improvement in the quality of children's care, and in the meantime to the decrease of neonatal and infant mortality rates.Today's pediatricians, as in the past, must spend his efforts to face the needs of children and their families, be their social receptor, interpreter if necessary, and credible and authoritative interlocutor beside institutions. The current coronavirus pandemic dramatically exposed social inequalities and inequities. In this new scenario, the pediatrician's role of defender of all children becomes even more necessary and indispensable. Here we trace the historical steps which led to the birth and development of pediatrics, as independent medical discipline with ethical and social vocation. Its rise within the University institutions is analyzed, as well as the contribution of the greatest European and Italian masters. Finally, the role of today's pediatrician is described, his responsibilities also in dealing with new health critical issues, related to the biological, cultural, and psychological changes of the patients of present days. He must have holistic competences, to effectively take care of all children. In addition, he must socially act to guarantee the best possible context for the well-being of the child.


Assuntos
Pediatras/tendências , Pediatria/tendências , Sociedades Médicas , Criança , Europa (Continente) , Humanos , Fatores Socioeconômicos
19.
CMAJ Open ; 9(4): E1149-E1158, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34906990

RESUMO

BACKGROUND: There were large disruptions to health care services after the onset of the COVID-19 pandemic. We sought to describe the extent to which pandemic-related changes in service delivery and access affected use of primary care for children overall and by equity strata in the 9 months after pandemic onset in Manitoba and Ontario. METHODS: We performed a population-based study of children aged 17 years or less with provincial health insurance in Ontario or Manitoba before and during the COVID-19 pandemic (Jan. 1, 2017-Nov. 28, 2020). We calculated the weekly rates of in-person and virtual primary care well-child and sick visits, overall and by age group, neighbourhood material deprivation level, rurality and immigrant status, and assessed changes in visit rates after COVID-19 restrictions were imposed compared to expected baseline rates calculated for the 3 years before pandemic onset. RESULTS: Among almost 3 million children in Ontario and more than 300 000 children in Manitoba, primary care visit rates declined to 0.80 (95% confidence interval [CI] 0.77-0.82) of expected in Ontario and 0.82 (95% CI 0.79-0.84) of expected in Manitoba in the 9 months after the onset of the pandemic. Virtual visits accounted for 53% and 29% of visits in Ontario and Manitoba, respectively. The largest monthly decreases in visits occurred in April 2020. Although visit rates increased slowly after April 2020, they had not returned to prerestriction levels by November 2020 in either province. Children aged more than 1 year to 12 years experienced the greatest decrease in visits, especially for well-child care. Compared to prepandemic levels, visit rates were lowest among rural Manitobans, urban Ontarians and Ontarians in low-income neighbourhoods. INTERPRETATION: During the study period, the pandemic contributed to rapid, immediate and inequitable decreases in primary care use, with some recovery and a substantial shift to virtual care. Postpandemic planning must consider the need for catch-up visits, and the long-term impacts warrant further study.


Assuntos
COVID-19/epidemiologia , Pediatria/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adolescente , Distribuição por Idade , Assistência Ambulatorial/estatística & dados numéricos , COVID-19/virologia , Criança , Pré-Escolar , Estudos Transversais , Bases de Dados Factuais , Emigrantes e Imigrantes , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Manitoba/epidemiologia , Ontário/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Pandemias , Vigilância da População , População Rural
20.
Bol Med Hosp Infant Mex ; 78(6): 636-641, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34934213

RESUMO

BACKGROUND: Cerebral aneurysms in pediatrics represent < 4% of the total of this condition, and their rupture represents 10-23% mortality. Aneurysms have been associated with infections, head injuries, sickle cell anemia, cardiovascular diseases, autoimmune diseases, immunodeficiencies, and connective tissue diseases. Their clinical presentation includes severe headache, seizures, motor-sensory deficits, and death due to subarachnoid and intraparenchymal hemorrhage. CASE REPORT: We describe the case of a 12-year-old female patient who presented with a sudden intense headache; after 72 hours, generalized tonic-clonic seizures were observed. At the hospital, she was stabilized with antiepileptic drugs and analgesics. A simple head computed tomography scan showed intraparenchymal hemorrhage in the right frontal lobe and subarachnoid hemorrhage. The study was complemented with a cerebral angiotomography, which revealed an aneurysm of the anterior communicating artery. The pediatric neurosurgeon evaluated the case, and management in the pediatric intensive care unit was decided. Two weeks after the stroke, the aneurysm was clipped and excluded. The patient developed adequate clinical evolution and resolution of initial symptoms, resuming her daily activities. CONCLUSIONS: Pediatric cerebral aneurysms differ from their adult counterparts, mainly in their etiology and evolution. In addition, pediatric patients have a longer life expectancy. Aneurysm clipping and neurological endovascular therapy have shown similar results.


Assuntos
Aneurisma Intracraniano , Pediatria , Hemorragia Subaracnóidea , Criança , Feminino , Cefaleia/etiologia , Humanos , Aneurisma Intracraniano/diagnóstico , Aneurisma Intracraniano/cirurgia , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/etiologia , Tomografia Computadorizada por Raios X
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