Papel de los padres en las urgencias pediátricas: ¿tradición, conflicto o mejoría? / Role of parents in paediatric emergencies: Tradition, conflict or improvement

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¿Ha aumentado la presencia de los padres durante los procedimientos invasivos en urgencias en los últimos años? / Has the presence of parents during invasive procedures in the emergency department increased in the last few years?

INTRODUCCIÓN: En los últimos años los padres están adquiriendo un protagonismo cada vez mayor en los servicios de urgencias pediátricos (SUP), manifestando su deseo de presenciar los procedimientos invasivos (PI) realizados a sus hijos. OBJETIVOS: 1) Comparar la presencia de los padres durante los PI en SUP españoles entre 2008 y 2012; 2) comparar los argumentos para restringir la presencia y los problemas derivados; y. 3) conocer si ha cambiado la opinión del personal sanitario. METODOLOGÍA: Estudio descriptivo multicéntrico comparativo. En 2008 y 2012 se envían 42 encuestas vía correo electrónico a los responsables de SUP españoles, incluyéndose en el estudio los que responden en ambos periodos. RESULTADOS: Veintidós hospitales participan en el estudio. La presencia de los padres en los SUP espa˜noles aumenta entre 2008 y 2012 para todos los PI, significativamente en la analítica sanguínea y en el sondaje vesical. En 2012 los responsables argumentan menos frecuentemente el nerviosismo de los niños, la ansiedad de los padres y el temor del personal a un peor rendimiento para restringir la presencia. En ambos periodos los problemas son ocasionales, disminuyendo el peor comportamiento de los niños. Según los responsables el acuerdo del personal sanitario no ha cambiado en estos años. CONCLUSIONES: La presencia de los padres durante los PI en los SUP ha aumentado en los últimos 4 a˜nos, aunque es aún escasa durante los procedimientos más invasivos. Los responsables argumentan menos problemas conductuales, aunque el grado de acuerdo del personal no ha cambiado, siendo necesario continuar trabajando en el tema

INTRODUCTION: In the recent years, parents are playing an important role in Pediatric Emergency Department (PED), and wish to be present when invasive procedures (IP) are performed. OBJECTIVES: 1) To compare the presence of parents during IP in PED in Spain between 2008 and 2012. 2) To compare the arguments to restrict the presence and problems arising from this, and 3) To determine whether the views of health personnel have changed on this subject. METHODOLOGY: A descriptive multicenter comparative study was conducted in 2008 and 2012. A total of 42 questionaires were sent by email to PED managers, with the responding hospitals being included in the 2 periods of the study. RESULTS: A total of 22 hospitals participated in the study. The presence of parents in the PED increased between 2008 and 2012 for all IP, significantly in the blood test and urine catheterization. In 2012, managers state that children are not so nervous, and anxiety of the parents and staff fear of a poorer performance, as an argument to restrict family presence. There were few problems during the 2 periods, with the poor behavior of the children decreasing. According to managers, the opinion of health personnel has not changed in the last four years. CONCLUSIONS: The presence of parents during the IP in the PED has increased in the last four years, although the presence is low for more invasive procedures. Managers argue the presence of fewer behavior problems to restrict family presence. The opinion of the staff has not changed in the last four years, although more studies are required on this issue

Nurse practitioners and physician assistants employed by general and subspecialty pediatricians.

OBJECTIVE: There is little nationally representative information describing the current manner in which nurse practitioners (NPs) and physician assistants (PAs) work in pediatric practices and their professional activities. To understand better the current NP and PA workforce in pediatric primary and subspecialty care, we conducted a national survey of pediatricians. METHODS: A survey study of a random national sample of 498 pediatric generalists and 1696 subspecialists in the United States was performed by using a structured questionnaire administered by mail. The survey focused on practice settings, employment, and scope of work of NPs and PAs. RESULTS: Response rates were 72% for generalists and 77% for subspecialists. More than one-half (55%) of generalists reported that they do not currently work with NPs or PAs, compared with only one-third of subspecialists who do not. Many generalists and subspecialists intend to increase the number of NPs and PAs in their practices in the next 5 years. More generalist and subspecialty practices work with NPs than with PAs. There was great variability between generalists and subspecialists and among different subspecialties in the proportions that worked with NPs and PAs. The scope of work of NPs and PAs also varied between generalists and subspecialists. CONCLUSIONS: Planned increases in the number of NPs hired and expansion of their scope of work might put subspecialists and general pediatricians in competition with regard to recruitment and hiring of a limited pool of new pediatric NPs. Similar issues might arise with PAs.

Quemaduras en pediatría Hospital Materno Infantil Germán Urquidi / Burns in the pediatric service of the Obstetric Hospital German Urquidi

El presente trabajo es una evalaución restrospectica de 493 pacientes con quemaduras admitidos en el servicio de Quemados del Depto. de pediatria del H.M.I.G.U., durante el periódo de Enero de 1989 a Diciembre de 1993. No se observa un cambio significativo en la incidencia anual, los meses con mayores ingresos fueron Mayo, Junio, Julio y Diciembre. Se observa un predominio del sexo masculino, siendo el preescolar el mas afectado. Existe ligera predominancia de pacientes provenientes del area sub urbana. La causa mas frecuente fue líquidos calientes, ocurriendo el accidente en el hogar casi en la totalidad. En cuanto a superficie quemada del 6 al 15 por ciento correspondía a la mayoría, predominando la quemadura A-AB. El 69.9 por ciento de los pacientes solo requirió curaciones con un tiempo de internación menor de 15 días en la mayoría. La mortalidad encontrada fue de 2.4 por ciento debido a complicaciones.

PA utilization on a pediatric bone marrow transplant unit.

Operating without residents or fellows in continuous attendance, The University of Iowa Hospitals and Clinics Pediatric Bone Marrow Transplant Unit utilizes PAs to assume primary responsibility for patients and to assure continuity of care. Major tasks assigned to the PAs include evaluation and assessment, writing notes and orders, and clinic follow-up. Basic PA training in pharmacology, physiology, and pathology has proved to be a sufficient background, supplemented by extensive on-the-job training; a knowledge of hematology is helpful. Severity of illnesses being treated contributes to burnout, which is addressed by staff support groups. This PA utilization model is strongly recommended for other such wards.

Quality assessment of a telephone care system utilizing non-physician personnel.

An approach to providing medical care by telephone is described and its content and quality assessed by means of an outcome study. Pediatric health assistants have been trained to evaluate, triage and offer home management advice in lieu of an office visit for medical problems presented by parents via telephone. During a four-week study period, data were collected on all calls (N = 2520) using a telephone encounter form. Fifty-nine per cent of all calls involved requests for care of illness, 30 per cent of which were independently handled by the health assistant. Quality of care was evaluated for those cases who received advice in home management by means of a seven day follow-up interview with parents (N = 247). Access, parent satisfaction, residual symptoms, and the need for further care were ascertained. Greater than 90 per cent of parents expressed satisfaction and 92 per cent of problems had resolved. Results indicate that this telephone care system can effectively sort out and advise parents in home management for the many minor problems which occur in a pediatric practice, thereby increasing time for direct contact with patients.

A successful new primary health care provider in the newborn nursery.

The mothers' acceptance of the Child Health Associate ("CHA") as a qualified health professional and the documentation of CHA's clinical abilities to provide broad-based health care for normal infants attest to their capabilities to function as primary health care providers in a newborn nursery. In "low-risk" nursery settings, where other capable health professionals may not be available, the CHA can assume primary and direct responsibility for the care of the normal newborn infant.