Your browser doesn't support javascript.
loading
: 20 | 50 | 100
1 - 20 de 60.529
1.
Washington, D.C.; OPS; 2022-01-03.
Es | PAHOIRIS | ID: phr-55125

En la actualidad, las guías basadas en la evidencia constituyen una de las herramientas más útiles para mejorar la salud pública y la práctica clínica. Su finalidad es formular intervenciones con sólidas pruebas de eficacia, evitar riesgos innecesarios, utilizar los recursos de forma eficiente, disminuir la variabilidad clínica y, en esencia, mejorar la salud y garantizar una atención de calidad, razón de ser de los sistemas y servicios de salud. Las presentes directrices se elaboraron siguiendo la metodología GRADE con el apoyo de un panel de expertos clínicos de distintos países, todos ellos convocados por la Organización Panamericana de la Salud. Por medio de la respuesta a doce preguntas clave sobre el diagnóstico clínico y el tratamiento del dengue, el chikunguña y el zika, se formulan recomendaciones basadas en evidencia para pacientes pediátricos, jóvenes, adultos, personas mayores y embarazadas expuestos a estas enfermedades o con sospecha o diagnóstico confirmado de infección. La finalidad de las directrices es evitar la progresión a las formas graves y a los eventos mortales que puedan causar. Las recomendaciones están dirigidas a profesionales de la salud, incluidos el personal médico general, residente y especialista; y los profesionales de enfermería, así como a estudiantes de medicina y enfermería, quienes de una u otra forma participan en la atención de pacientes con sospecha de dengue, chikunguña o zika. También se dirige a los administradores de las unidades de salud y a los equipos directivos de los programas nacionales de prevención y control de enfermedades arbovirales, quienes tienen la responsabilidad de facilitar el proceso de aplicación de estas directrices. Esperamos que esta publicación beneficie no solo al personal de salud, que dispondrá de información científica actualizada y de la mejor calidad posible, sino a los menores, los adultos, las embarazadas, las personas mayores y la población en general, quienes recibirán una mejor atención de salud prestada por personal médico debidamente capacitado.


Chikungunya virus , Dengue Virus , Communicable Diseases , Clinical Diagnosis , Dengue , Zika Virus , Arboviruses , Pregnant Women , Child , Pediatrics , Aged , Communicable Disease Control
2.
BMC Health Serv Res ; 22(1): 9, 2022 Jan 02.
Article En | MEDLINE | ID: mdl-34974841

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.


Apoptosis Regulatory Proteins , Pediatrics , Child , Hospitalization , Hospitals , Humans , Intensive Care Units, Pediatric
3.
Pediatr Clin North Am ; 69(1): 153-170, 2022 02.
Article En | MEDLINE | ID: mdl-34794672

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.


Child, Adopted , Communicable Diseases/diagnosis , Communicable Diseases/therapy , Emigrants and Immigrants , Refugees , Adolescent , COVID-19/diagnosis , Child , Child, Preschool , Communicable Disease Control/methods , Female , HIV Infections/diagnosis , Hepatitis, Viral, Human/diagnosis , Humans , Immunization/methods , Infant , Male , Mass Screening/methods , Parasitic Diseases/diagnosis , Pediatrics/methods , Practice Guidelines as Topic , Syphilis/diagnosis , Tuberculosis/diagnosis
6.
J Public Health Manag Pract ; 28(1): E1-E8, 2022.
Article En | MEDLINE | ID: mdl-34797247

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.


COVID-19 , Pediatrics , Child , Humans , Pandemics , Prospective Studies , Public Health , Retrospective Studies , SARS-CoV-2 , United States
8.
Pediatr Pulmonol ; 57(1): 100-108, 2022 01.
Article En | MEDLINE | ID: mdl-34672435

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.


Asthma , Patient Portals , Pediatrics , Asthma/diagnosis , Asthma/therapy , Caregivers , Child , Child, Preschool , Humans , Parents , Surveys and Questionnaires
10.
Article Es | PAHOIRIS | ID: phr2-55467

“Andar la salud” es un boletín elaborado en la Oficina de la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS) en Cuba. Su propósito fundamental es compartir lo más relevante de la cooperación técnica de esta Representación con el Ministerio de Salud Pública (MINSAP) y otras instituciones y organismos en el país. Desde que comenzó la pandemia provocada por el SARS-CoV-2 en la isla, esta publicación se ha dedicado a compilar y dar a conocer aspectos destacados de la respuesta en el territorio nacional. Con la colaboración del personal de OPS, autoridades y especialistas de Salud Pública, así como de otras ramas de la ciencia, se han elaborado artículos sobre la situación epidemiológica; los protocolos para el diagnóstico y la atención; los productos biotecnológicos utilizados; el papel desempeñado por diferentes instituciones, entre otros temas. En este número se desea resaltar lo relacionado con el comportamiento de la COVID-19 y los resultados de la inmunización durante los últimos cuatro meses, hasta el 30 de octubre de 2021. Teniendo en cuenta que se ha avanzado en el control de la epidemia, también se ofrecen detalles de la flexibilización de algunas medidas de prevención. Además, se recogen trabajos dedicados al proceso de precalificación de las vacunas cubanas; la incidencia de la enfermedad en edades pediátricas; la ejecución de un proyecto de cooperación con la Unión Europea, y la labor del Centro para el Control Estatal de Medicamentos, Equipos y Dispositivos Médicos (CECMED). Asimismo, se realizan análisis desde el enfoque de género y se habla sobre los esfuerzos de OPS por proteger la población de las Américas.


Vaccination , SARS-CoV-2 , Epidemiology , Protocols , COVID-19 , Pediatrics , Epidemics , Pandemics , European Union , Impacts on Health , Leadership , Coronavirus
11.
Washington, D.C.; OPS; 2021-12-01. (OPS/NMH/NV/cvn7/21-0040).
Es | PAHOIRIS | ID: phr-55238

El objetivo de los cuidados paliativos en pacientes pediátricos con cáncer es mejorar el bienestar del paciente y su familia a lo largo de toda la enfermedad, así como también reducir el sufrimiento físico, emocional y espiritual. En el marco de la Iniciativa Mundial contra el Cáncer Infantil, la OPS ofrece una serie de módulos sobre cuidados paliativos pediátricos para madres, padres y cuidadores. Cada uno contiene información esencial para poder proveer los mejores cuidados y satisfacer las necesidades derivadas de la enfermedad que afectan tanto al paciente como a sus seres queridos. En este módulo se aborda el tema de la espiritualidad: ¿qué es?, ¿en qué consiste su desarrollo?, ¿cómo desarrollarla con el menor?, ¿por qué es importante realizar prácticas espirituales? o ¿cómo se pueden realizar prácticas espirituales con los menores?


Child , Cancer Pain , Neoplasms , Pediatrics , Child Health , Child Health Services , Spirituality , Palliative Care
12.
Washington, D.C.; OPS; 2021-12-01. (OPS/NMH/NV/cvn8/21-0040).
Es | PAHOIRIS | ID: phr-55237

El objetivo de los cuidados paliativos en pacientes pediátricos con cáncer es mejorar el bienestar del paciente y su familia a lo largo de toda la enfermedad, así como también reducir el sufrimiento físico, emocional y espiritual. En el marco de la Iniciativa Mundial contra el Cáncer Infantil, la OPS ofrece una serie de módulos sobre cuidados paliativos pediátricos para madres, padres y cuidadores. Cada uno contiene información esencial para poder proveer los mejores cuidados y satisfacer las necesidades derivadas de la enfermedad que afectan tanto al paciente como a sus seres queridos. En este módulo se abordan los cuidados del final de la vida. Se ofrecen herramientas para mitigar el sufrimiento de los pacientes cuando la muerte es inevitable y se brinda apoyo a madres y padres. Algunos signos pueden indicar el final de la vida y, en cuanto aparecen, es fundamental procurar un ambiente familiar, tranquilo y privado para el menor.


Pediatrics , Patient Care , Palliative Care , Neoplasms , Child Health , Hospice Care
14.
Am Fam Physician ; 104(6): 618-625, 2021 12 01.
Article En | MEDLINE | ID: mdl-34913645

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.


Pneumonia/diagnosis , Pneumonia/therapy , Community-Acquired Infections/diagnosis , Community-Acquired Infections/physiopathology , Community-Acquired Infections/therapy , Humans , Pediatrics/methods , Pediatrics/trends , Pneumonia/physiopathology , United States
17.
J Pediatric Infect Dis Soc ; 10(Supplement_4): S71-S77, 2021 Dec 24.
Article En | MEDLINE | ID: mdl-34951466

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.


Communicable Diseases , Pediatrics , Child , Communicable Diseases/diagnosis , High-Throughput Nucleotide Sequencing , Humans , Metagenomics , Retrospective Studies , Sensitivity and Specificity
18.
J Med Internet Res ; 23(12): e26684, 2021 12 24.
Article En | MEDLINE | ID: mdl-34951592

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.


Health Literacy , Pediatrics , Adolescent , Aged , Child , Communication , Genomics , Humans , Parents
19.
Nutrients ; 13(12)2021 Nov 23.
Article En | MEDLINE | ID: mdl-34959753

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.


Infant Food/standards , Infant Nutritional Physiological Phenomena , Iron/blood , Nutrition Policy , Pediatrics/standards , Anemia, Iron-Deficiency/prevention & control , Child, Preschool , Consensus , Female , Humans , Infant , Male , Nutritional Status , Societies, Medical
20.
Harefuah ; 160(12): 780-785, 2021 Dec.
Article He | MEDLINE | ID: mdl-34957711

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.


Acute Kidney Injury , COVID-19 , Nephrology , Pediatrics , Acute Kidney Injury/virology , COVID-19/complications , Child , Humans , Systemic Inflammatory Response Syndrome
...