Recomendaciones de “no hacer” en la consulta de Atención Primaria / Recommendations for “not to do” in primary care practice

Introducción: en los últimos años se ha observado un exceso de prácticas clínicas innecesarias en Pediatría que carecen de suficiente evidencia científica y generan costos significativos, además de resultar molestas para el paciente y no aportar beneficios adicionales. Por ello, diversas sociedades e instituciones científicas han propuesto recomendaciones para evitar estas intervenciones ineficaces y científicamente injustificadas. Material y métodos: el proyecto fue coordinado por el grupo de trabajo PrevInfad de la Asociación Española de Pediatría de Atención Primaria (AEPap). Se desarrolló en dos fases a través del intercambio de correos electrónicos. En la primera, se solicitó a los coordinadores que divulgaran el proyecto y recopilaran propuestas de intervenciones innecesarias. En la segunda, se realizó la selección de las recomendaciones mediante el método Delphi y dos rondas de votación. Resultados: en la primera fase se obtuvieron 40 propuestas de recomendaciones de “no hacer”. En la primera ronda de la segunda fase se aceptaron 7 propuestas. Cinco recomendaciones fueron rechazadas y 28 fueron consideradas dudosas y pasaron a una segunda valoración. En la segunda ronda se aceptó una recomendación adicional. En total, se aprobaron 8 recomendaciones de “no hacer”. Conclusiones: la AEPap elaboró una lista de recomendaciones de “no hacer” en Pediatría en colaboración con sus grupos de trabajo y asociaciones federadas utilizando la metodología Delphi para el consenso entre expertos. Estas recomendaciones buscan mejorar la calidad asistencial y promover la utilización adecuada de recursos en la Atención Primaria pediátrica (AU)

Introduction: in recent years, there has been an excess of unnecessary clinical practices in pediatrics that lack sufficient scientific evidence and generate significant costs, in addition to being bothersome and not providing additional benefits. For this reason, various scientific societies and institutions have proposed recommendations to avoid these ineffective and scientifically unjustified interventions.Material and methods: the project was coordinated by the PrevInfad working group of the Spanish Association of Primary Care Pediatrics (AEPap). It was developed in two phases through the exchange of e-mails. In the first phase, the coordinators were asked to disseminate the project and to collect proposals for unnecessary interventions. In the second phase, the recommendations were selected using the Delphi method and two rounds of voting.Results: in the first phase, 40 proposals for 'do not do' recommendations were obtained. In the first round of the second phase, seven proposals were accepted. Five recommendations were rejected and 28 were considered doubtful and passed to a second assessment. One additional recommendation was accepted in the second round. In total, 8 'do not do' recommendations were approved.Conclusions: the AEPap developed a list of 'do not do' recommendations in pediatrics in collaboration with its working groups and federated associations using the Delphi methodology for consensus among experts. These recommendations aim to improve the quality of care and promote the appropriate use of resources in pediatric primary care. (AU)

Recomendaciones de no hacer en distintos ámbitos de la atención pediátrica / Do not do recommendations in different paediatric care settings

Introducción: Muchas son las iniciativas encaminadas a eliminar intervenciones clínicas de poco valor en la asistencia sanitaria. Desde el Comité de Calidad Asistencial y Seguridad del Paciente de la Asociación Española de Pediatría, se ha propuesto la elaboración de recomendaciones de «no hacer» (RNH) con el objetivo de señalar una serie de prácticas evitables en la atención del paciente pediátrico en atención primaria, urgencias, hospitalización y domicilio. Material y métodos: Este trabajo se desarrolló en 2fases: una primera en la que se propusieron posibles RNH y una segunda en la que se consensuaron las recomendaciones finales mediante el método Delphi. Tanto las propuestas como las evaluaciones partieron de miembros de los grupos y sociedades pediátricas a los que se les realizó la propuesta, coordinados por miembros del Comité de Calidad Asistencial y Seguridad del Paciente. Resultados: Fueron propuestas un total de 164 RNH por la Sociedad Española de Neonatología, la Asociación Española de Pediatría de Atención Primaria, la Sociedad Española de Urgencias de Pediatría, la Sociedad Española de Pediatría Interna Hospitalaria y el Comité de Medicamentos de la Asociación Española de Pediatría con el Grupo Español de Farmacia Pediátrica de la Sociedad Española de Farmacia Hospitalaria. Se logró reducir el conjunto inicial a 42 RNH y en sucesivas fases se llegó a la selección final de 25 RNH, 5 RNH por cada grupo o sociedad. Conclusiones: Este proyecto ha permitido seleccionar y consensuar una serie de recomendaciones para evitar prácticas inseguras, ineficientes o de escaso valor en distintos ámbitos de la atención pediátrica, lo que podría resultar útil para mejorar la seguridad y la calidad de nuestra actividad asistencial. (AU)

Introduction: There are many initiatives aimed at eliminating health care interventions of limited utility in clinical practice. The Committee on Care Quality and Patient Safety of the Spanish Association of Pediatrics has proposed the development of «do not do» recommendations (DNDRs) to establish a series of practices to be avoided in the care of paediatric patients in primary, emergency, inpatient and home-based care. Material and methods: The project was carried out in 2 phases: a first phase in which possible DNDRs were proposed, and a second in which the final recommendations were established by consensus using the Delphi method. Recommendations were proposed and evaluated by members of the professional groups and paediatrics societies invited to participate in the project under the coordination of members of the Committee on Care Quality and Patient Safety. Results: A total of 164 DNDRs were proposed by the Spanish Society of Neonatology, the Spanish Association of Primary Care Paediatrics, the Spanish Society of Paediatric Emergency Medicine, the Spanish Society of Internal Hospital Paediatrics and the Medicines Committee of the Spanish Association of Pediatrics and the Spanish Group of Paediatric Pharmacy of the Spanish Society of Hospital Pharmacy. The initial set was limited to 42 DNDRs, and the selection over successive rounds yielded a final set of 25 DNDRs, with 5 DNDRs for each paediatrics group or society. Conclusions: This project allowed the selection and establishment by consensus of a series of recommendations to avoid unsafe, inefficient or low-value practices in different areas of paediatric care, which may contribute to improving the safety and quality of paediatric clinical practice. (AU)

Do not do recommendations in different paediatric care settings.

INTRODUCTION: There are many initiatives aimed at eliminating health care interventions of limited utility in clinical practice. The Committee on Care Quality and Patient Safety of the Spanish Association of Pediatrics (AEP) has proposed the development of "DO NOT DO" recommendations (DNDRs) to establish a series of practices to be avoided in the care of paediatric patients in primary, emergency, inpatient and home-based care. MATERIAL AND METHODS: The project was carried out in 2 phases: a first phase in which possible DNDRs were proposed, and a second in which the final recommendations were established by consensus using the Delphi method. Recommendations were proposed and evaluated by members of the professional groups and paediatrics societies invited to participate in the project under the coordination of members of the Committee on Care Quality and Patient Safety. RESULTS: A total of 164 DNDRs were proposed by the Spanish Society of Neonatology, the Spanish Association of Primary Care Paediatrics, the Spanish Society of Paediatric Emergency Medicine, the Spanish Society of Internal Hospital Paediatrics and the Medicines Committee of the AEP and the Spanish Group of Paediatric Pharmacy of the Spanish Society of Hospital Pharmacy. The initial set was limited to 42 DNDRs, and the selection over successive rounds yielded a final set of 25 DNDRs, with 5 DNDRs for each paediatrics group or society. CONCLUSIONS: This project allowed the selection and establishment by consensus of a series of recommendations to avoid unsafe, inefficient or low-value practices in different areas of paediatric care, which may contribute to improving the safety and quality of paediatric clinical practice.

[Summary PAPPS Childhood and Adolescence 2022]. / Resumen PAPPS Infancia y Adolescencia 2022.

Two important topics about children and adolescents in our primary care activity are presented in this update document: tobacco smoking prevention in adolescence and prophylaxis with vitamin K to prevent the hemorrhagic disease of the newborn.

Uso profiláctico de la vitamina K para prevenir la enfermedad hemorrágica del recién nacido / Prophylactic use of vitamin K to prevent hemorrhagic disease of the newborn

El déficit de vitamina K al nacimiento supone un factor de riesgo para desarrollar la enfermedad hemorrágica del recién nacido (EHRN). Este estado pro hemorrágico puede producir sangrados graves principalmente a nivel cutáneo, gastrointestinal y cerebral. Hay buena evidencia de que la administración de vitamina K en el recién nacido (RN) es segura y eficaz, los daños potenciales son leves, por lo que está claro el beneficio neto a favor de la administración. El grupo PrevInfad recomienda administrar a todos los recién nacidos 1 mg de vitamina K de forma profiláctica por vía intramuscular para prevenir la EHRN. En el documento, se hacen consideraciones especiales para prematuros y para niños cuyos padres rechazan la profilaxis intramuscular. Asimismo, se presenta una propuesta operativa e información para padres (AU)

Vitamin K deficiency at birth is a risk factor for Haemorrhagic disease of the newborn. This bleeding prone situation can produce severe hemorrhages mainly in the skin, gastrointestinal tract and brain.There is strong evidence that the administration of vitamin K to the newborn is safe and effective, potential side effects are mild, so there is a clear benefit of its administration.PrevInfad workgroup recommends the prophylactic administration of 1 mg intramuscular Vitamin K to prevent the Haemorrhagic disease of the newborn.Some special considerations for preterm newborns and for children whose parents reject intramuscular prophylaxis are explained in the document. Moreover, an operative proposal and information for parents are presented. (AU)

Evaluation of atopy schools for parents

Introduction Atopic dermatitis is a highly prevalent chronic disorder. Therapeutic education in diseases of this kind is essential in order to improve patient management and prognosis. A study was conducted regarding parent satisfaction following educational sessions in an Atopy School organized by a multidisciplinary team. Material and methods E-mail surveys with variables scored by means of a Likert scale were administered among the parents participating in the workshops organized by the Atopy School. The educational program comprised four sessions with a duration of 4 hours. Results Ninety-five percent of the parents were satisfied after participating in the workshops, and were of the opinion that the therapeutic education received was useful for improving control of the illness of their children. Likewise, 85% were satisfied or very satisfied with the help received in the sessions for control of the disease during flare-ups, and 90% considered the data and advice received in the sessions to be of use in improving quality of life of both the children and the family as a whole. Conclusions The Atopy School afforded caregiver empowerment, and the parents were satisfied and felt more secure in dealing with the disease of their children—thereby improving the prognosis and quality of life (AU)

Evaluation of atopy schools for parents.

INTRODUCTION: Atopic dermatitis is a highly prevalent chronic disorder. Therapeutic education in diseases of this kind is essential in order to improve patient management and prognosis. A study was conducted regarding parent satisfaction following educational sessions in an Atopy School organized by a multidisciplinary team. MATERIAL AND METHODS: E-mail surveys with variables scored by means of a Likert scale were administered among the parents participating in the workshops organized by the Atopy School. The educational program comprised four sessions with a duration of 4 hours. RESULTS: Ninety-five percent of the parents were satisfied after participating in the workshops, and were of the opinion that the therapeutic education received was useful for improving control of the illness of their children. Likewise, 85% were satisfied or very satisfied with the help received in the sessions for control of the disease during flare-ups, and 90% considered the data and advice received in the sessions to be of use in improving quality of life of both the children and the family as a whole. CONCLUSIONS: The Atopy School afforded caregiver empowerment, and the parents were satisfied and felt more secure in dealing with the disease of their children-thereby improving the prognosis and quality of life.

Análisis de menús sin gluten de comedores escolares en granada capital y área metropolitana: ¿son equilibrados? / Analysis of the gluten-free menus served in school canteens: are they balanced?

Introducción y objetivos: analizar el perfil alimentario y el valor nutricional de los menús adaptados para celiacos ofertados en los comedores de los centros escolares de Granada capital y área metropolitana. Material y métodos: estudio descriptivo en el que se han analizado los menús adaptados para niños celiacos de 41 centros escolares, cinco con cocina propia y 36 abastecidos por catering. La participación de los centros fue voluntaria, una vez fueron informados de las características y objetivos del estudio. Se recogió información a través de las fichas técnicas de los platos elaborados con la cantidad de cada alimento, además de las marcas de los productos sin gluten utilizados. Se analizaron menús de cuatro semanas en cuanto a distribución de raciones, energía, macro y micronutrientes para el grupo de 10 a 12 años, obteniendo valores medios y desviación estándar de 31 parámetros. Se utilizaron el programa Odimet y la base de datos CeliacBase. Se usó el programa estadístico IBM SPSS 22.0. Resultados: la pasta sin gluten fue la base del primer plato en el 31,7% de los menús analizados. En el segundo plato, la carne fue el constituyente principal. En todos los menús se ofertaba, al menos, una ración diaria de verdura. El 80% de los menús no alcanzaron la ingesta energética recomendada, aunque la distribución de macronutrientes fue adecuada. La cantidad media de fibra y de hidratos de carbono totales fue superior a lo recomendado. La cantidad de calcio y vitamina D no alcanzó la ingesta recomendada. Destaca un elevado consumo de sodio, que duplica la cantidad recomendada para la comida del mediodía. Conclusiones: los menús escolares adaptados para niños celiacos se ajustan a las recomendaciones, aunque deberían limitar la ingesta semanal de carne y presentan exceso de azúcares totales y sal

Introduction and objectives: the alimentary profile and the nutritional value of the menus adapted for coeliacs in the dining halls of the schools of Granada capital and Metropolitan Area. Material and methods: descriptive study in which we analyzed the menus adapted for children from 41 schools, 5 with their own kitchen and 36 supplied by catering. The information is recognized through the technical sheets of the dishes made with the quantity of each food, in addition to the brands of the gluten-free products. The four-week menus will be analyzed in terms of the distribution of rations, energy, macro and micronutrients for the age group of 10 to 12 years, obtaining average values and standard deviation of 31 parameters. The Odimet program and the CeliacBase database are used. The data will be analyzed using the IBM SPSS 22.0 statistical program. Results: gluten-free pasta was the basis of the first course in 31.7% of the menus analyzed. In the second dish, the meat was the main constituent. In all the menus, at least one daily vegetable ration was offered. 80% of the menus did not reach the recommended energy intake, although the distribution of macronutrients was adequate. The average amount of fiber and total carbohydrates was higher than recommended. The amount of calcium and vitamin has not been recommended. It emphasizes a high consumption of sodium, which doubles the amount recommended for the midday meal. Conclusions: school menus adapted for children conform to the recommendations, although they should be limited to intake

[Analysis of the gluten-free menus served in school canteens: are they balanced?] / Análisis de menús sin gluten de comedores escolares en granada capital y área metropolitana: ¿son equilibrados?

INTRODUCTION: Introduction and objectives: the alimentary profile and the nutritional value of the menus adapted for coeliacs in the dining halls of the schools of Granada capital and Metropolitan Area. Material and methods: descriptive study in which we analyzed the menus adapted for children from 41 schools, 5 with their own kitchen and 36 supplied by catering. The information is recognized through the technical sheets of the dishes made with the quantity of each food, in addition to the brands of the gluten-free products. The four-week menus will be analyzed in terms of the distribution of rations, energy, macro and micronutrients for the age group of 10 to 12 years, obtaining average values and standard deviation of 31 parameters. The Odimet program and the CeliacBase database are used. The data will be analyzed using the IBM SPSS 22.0 statistical program. Results: gluten-free pasta was the basis of the first course in 31.7% of the menus analyzed. In the second dish, the meat was the main constituent. In all the menus, at least one daily vegetable ration was offered. 80% of the menus did not reach the recommended energy intake, although the distribution of macronutrients was adequate. The average amount of fiber and total carbohydrates was higher than recommended. The amount of calcium and vitamin has not been recommended. It emphasizes a high consumption of sodium, which doubles the amount recommended for the midday meal. Conclusions: school menus adapted for children conform to the recommendations, although they should be limited to intake.

INTRODUCCIÓN: Introducción y objetivos: analizar el perfil alimentario y el valor nutricional de los menús adaptados para celiacos ofertados en los comedores de los centros escolares de Granada capital y área metropolitana. Material y métodos: estudio descriptivo en el que se han analizado los menús adaptados para niños celiacos de 41 centros escolares, cinco con cocina propia y 36 abastecidos por catering. La participación de los centros fue voluntaria, una vez fueron informados de las características y objetivos del estudio. Se recogió información a través de las fichas técnicas de los platos elaborados con la cantidad de cada alimento, además de las marcas de los productos sin gluten utilizados. Se analizaron menús de cuatro semanas en cuanto a distribución de raciones, energía, macro y micronutrientes para el grupo de 10 a 12 años, obteniendo valores medios y desviación estándar de 31 parámetros. Se utilizaron el programa Odimet y la base de datos CeliacBase. Se usó el programa estadístico IBM SPSS 22.0. Resultados: la pasta sin gluten fue la base del primer plato en el 31,7% de los menús analizados. En el segundo plato, la carne fue el constituyente principal. En todos los menús se ofertaba, al menos, una ración diaria de verdura. El 80% de los menús no alcanzaron la ingesta energética recomendada, aunque la distribución de macronutrientes fue adecuada. La cantidad media de fibra y de hidratos de carbono totales fue superior a lo recomendado. La cantidad de calcio y vitamina D no alcanzó la ingesta recomendada. Destaca un elevado consumo de sodio, que duplica la cantidad recomendada para la comida del mediodía. Conclusiones: los menús escolares adaptados para niños celiacos se ajustan a las recomendaciones, aunque deberían limitar la ingesta semanal de carne y presentan exceso de azúcares totales y sal.