Patient experience assessment in pediatric hospitals in Argentina.

OBJECTIVE: To create a hospital pediatric inpatient experience survey based on the Consumer Assessment of Healthcare Providers and Systems Hospital Survey (CAHPS® Hospital Survey). DESIGN: Survey development based on: (i) Translation and back translation, (ii) Review by experts, (iii) Cultural adaptation: qualitative evaluation of dimensions with reformulation and adaptation of items, (iv) Local cognitive evaluation and (v) Final measurement of its psychometric properties. Inspection, content validity and reliability assessment through internal consistency (Cronbach's alpha coefficient) and inter-item correlation. Factor analysis matrix: extraction, selection and rotation. SETTING: Two pediatric hospitals in Buenos Aires, Argentina: Hospital de Pediatría 'Garrahan' (HG) and Hospital de Niños 'Ricardo Gutiérrez' (HRG). PARTICIPANTS: Parents or caregivers of pediatric patients hospitalized for at least 24 h. RESULTS: A feasible and easy to administer 21-item instrument was developed. One thousand and thirty-two surveys were analyzed, 630 (61%) in HG and 402 (39%) in HRG. Population: mothers of admitted children were interviewed 85% of the time, 61% (625) had completed minor schooling to high school education; 365 families (35%) had unsatisfied basic needs and 51% (529) did not have health insurance. Reliability: adequate Cronbach's alpha scores were found with correlation 0.7 or higher in most domains. Validity: a direct correlation was observed between overall positive opinion and quality of care perceived with the survey, and an indirect correlation (perceived low quality) with higher level of schooling and health insurance ownership. CONCLUSION: An instrument with adequate psychometric properties was adapted to evaluate patients and families' perceptions of quality of care received during children's hospitalization.

[Lymphatic malformations: percutaneus treatment with bleomycin]. / Malformaciones linfáticas: tratamiento percutáneo con bleomicina.

Lymphatic malformations are developmental abnormalities of the lymphatic system, which tend to complicate during their evolution. In the last decade, therapy with sclerosing agents has gained popularity over surgery due to its effectiveness, fewer complications, and excellent cosmetic results. We present a series of 24 patients treated with percutaneous bleomycin injection. Results were excellent (volume reduction ≥ 95%, without symptoms) in 12 patients, good (volume reduction between 50% and 95%, without symptoms) in 5 patients, fair (volume reduction <50%, without symptoms) in 4 patients, and poor (no change in volume from baseline and persistence of symptoms) in 3 patients. These results were directly related to the type of lymphatic malformation. The complications found had little clinical relevance. Sclerotherapy with bleomycin is an effective and safe treatment for patients with unicystic or macrocystic lymphatic malformations. It could also be used in patients with microcystic or cavernous lymphatic malformation undergoing surgery to reduce both the malformation size and postoperative lymphorrhea, and in postoperative symptomatic patients whose malformation could not be totally resected.

Malformaciones linfáticas: tratamiento percutáneo con bleomicina / Lymphatic malformations: percutaneus treatment with bleomycin

Las malformaciones linfáticas son anomalías del desarrollo del sistema linfático que tienden a sufrir complicaciones en su evolución. En la última década, la terapia con agentes esclerosantes ha ido ganando popularidad sobre la cirugía, por su eficacia, sus menores complicaciones y sus excelentes resultados estéticos. Presentamos una serie de 24 pacientes tratados mediante esclerosis percutánea con bleomicina. Los resultados fueron excelentes (reducción de volumen ≥ 95% y asintomáticos) en 12 pacientes, buenos (reducción de volumen entre 50% y 95% y asintomáticos) en 5 pacientes, regulares (reducción de volumen < 50% y asintomáticos) en 4 pacientes, y malos (sin cambios de volumen respecto al inicio o sin desaparición de síntomas iniciales) en 3 pacientes. Estos resultados estuvieron directamente relacionados con el tipo de malformación. Las complicaciones observadas fueron de escasa relevancia clínica. La escleroterapia con bleomicina es un método eficaz y seguro en el tratamiento de pacientes con malformación linfática uniquística o macroquística. Su indicación también podría extenderse a pacientes con malformación linfática microquística o cavernosa que serán sometidos a cirugía, para obtener una reducción de su tamaño y menor linforragia postoperatoria, y a pacientes postquirúrgicos sintomáticos, en quienes no fue posible la resección total de la malformación.

Lymphatic malformations are developmental abnormalities of the lymphatic system, which tend to complicate during their evolution. In the last decade, therapy with sclerosing agents has gained popularity over surgery due to its effectiveness, fewer complications, and excellent cosmetic results. We present a series of 24 patients treated with percutaneous bleomycin injection. Results were excellent (volume reduction ≥ 95%, without symptoms) in 12 patients, good (volume reduction between 50% and 95%, without symptoms) in 5 patients, fair (volume reduction <50%, without symptoms) in 4 patients, and poor (no change in volume from baseline and persistence of symptoms) in 3 patients. These results were directly related to the type of lymphatic malformation. The complications found had little clinical relevance. Sclerotherapy with bleomycin is an effective and safe treatment for patients with unicystic or macrocystic lymphatic malformations. It could also be used in patients with microcystic or cavernous lymphatic malformation undergoing surgery to reduce both the malformation size and postoperative lymphorrhea, and in postoperative symptomatic patients whose malformation could not be totally resected.

Enteropatía autoinmune en la infancia / Enteropathy autoimmune in children

Se presenta una paciente de 5 años de edad, que en el período de convalecencia de una varicela comienza con diarrea. A los 10 dias de evolución presenta una peritonitis biliar secundaria a ruptura espontánea del conducto cístico y efracción de la vesícula biliar. Luego de un postoperatorio sin complicaciones continúa con diarrea grave. Es dependiente de Nutricómn Parenteral Total por un período mayor de un año, al cabo del cual fallece por sépsis por catéter. Durante este período, luego de descartar etiologías infecciosas y expresiones de patologías no infecciosas, se estudia el probable origen autoinmune de la diarrea, confirmandose por la presencia de anticuerpos antienterocitos.

Enteropatía autoinmune en la infancia / Enteropathy autoimmune in children

Se presenta una paciente de 5 años de edad, que en el período de convalecencia de una varicela comienza con diarrea. A los 10 dias de evolución presenta una peritonitis biliar secundaria a ruptura espontánea del conducto cístico y efracción de la vesícula biliar. Luego de un postoperatorio sin complicaciones continúa con diarrea grave. Es dependiente de Nutricómn Parenteral Total por un período mayor de un año, al cabo del cual fallece por sépsis por catéter. Durante este período, luego de descartar etiologías infecciosas y expresiones de patologías no infecciosas, se estudia el probable origen autoinmune de la diarrea, confirmandose por la presencia de anticuerpos antienterocitos. (AU)