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1.
Int J Public Health ; 66: 634000, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34526874

RESUMO

Objectives: Understanding treatment seeking for severe febrile illness (SFI) is methodologically challenging. In this scoping review, we investigate definitions of severe febrile illness in treatment seeking studies on children under 5 years of age in low and middle income countries. We analyze the association of SFI definitions with different concepts of treatment seeking and identify related research gaps. Methods: We searched Pubmed, Scopus and WHOLIS, and screened references of included publications for eligibility. Results: Definitions of SFI had either a biomedical perspective (predominantly in quantitative studies) or a caregiver perspective (predominantly in qualitative studies). In quantitative analyses of treatment seeking, severity was more often conceptualized as a determinant rather than an outcome of a treatment seeking process. The majority of quantitative analyses only included surviving children or did not explicitly mention dead children. Conclusion: Different research questions lead to diverse definitions and concepts of severity and treatment seeking outcomes, which limits the comparability of the available evidence. Systematic exclusion of dead children is likely to bias inferences on the association of treatment seeking and health outcomes of children with SFI in low and middle income countries.


Assuntos
Países em Desenvolvimento , Febre , Aceitação pelo Paciente de Cuidados de Saúde , Índice de Gravidade de Doença , Pré-Escolar , Febre/terapia , Humanos , Lactente , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos
2.
Emerg Med Clin North Am ; 39(3): 627-639, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34215406

RESUMO

Pediatric fever is a common complaint in children. The most common cause is self-limited viral infection. However, neonates and young infants are evaluated and treated differently than older, vaccinated, and clinically evaluable children. Neonates should be admitted to the hospital, young infants in the second month of life may be risk stratified, and those deemed low risk on testing may be sent home with close follow-up. Children older than 2 months may be evaluated clinically for signs of bacterial infection that require intervention. Urinary tract infections cause more than 90% of serious bacterial illness in children, and younger children have a higher incidence of infection.


Assuntos
Febre/etiologia , Febre/terapia , Medicina de Emergência Pediátrica , Algoritmos , Anemia Falciforme/complicações , Antibacterianos/uso terapêutico , Antipiréticos/uso terapêutico , Biomarcadores/sangue , Proteína C-Reativa/análise , Criança , Febre/diagnóstico , Humanos , Incidência , Doenças do Prematuro/diagnóstico , Infecções/diagnóstico , Infecções/tratamento farmacológico , Neutropenia/complicações , Pró-Calcitonina/sangue , Medição de Risco
3.
BMC Public Health ; 21(1): 1075, 2021 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-34090402

RESUMO

BACKGROUND: Febrile diseases in Sub-Saharan Africa cause acute and chronic illness. Co-infections are common and these diseases have a complex etiology that includes zoonoses. For the implementation of appropriate treatment and control strategies, determinants of lay treatment-seeking behavior by the affected communities need to be understood. The objective of this study was to explore, using the socio-ecological model, the determinants of treatment-seeking actions among self-identified febrile illness cases in the Kilombero District of Tanzania. METHODS: Thirty-nine in-depth interviews were conducted with 28 men and 11 women in three villages in Kilombero district. These villages were purposively selected due to malaria endemicity in the area, animal husbandry practices, and proximity to livestock-wildlife interaction, all risk factors for contracting febrile zoonotic infections. Thematic analysis was conducted on the interviews to identify the key determinants of treatment-seeking actions. RESULTS: Study participants attributed febrile illnesses to malaria, typhoid and urinary tract infections. Treatment-seeking behavior was an iterative process, influenced by individual, socio-cultural, ecological and policy factors. Age, expendable income, previous history with a febrile illness, perceptions on disease severity, seasonal livelihood activities and access to timely healthcare were some of the determinants. Self-treatment with pharmaceutical drugs and herbs was usually the initial course of action. Formal healthcare was sought only when self-treatment failed and traditional healers were consulted after the perceived failure of conventional treatment. Delays in seeking appropriate health care and the consultation of medically unqualified individuals was very common. CONCLUSION: The results imply that treatment-seeking behavior is shaped by multiple factors across all levels of the socio-ecological model. Public policy efforts need to focus on facilitating prompt health care seeking through community education on the complicated etiology of febrile illnesses. Improved access to timely treatment and better differential diagnostics by health professionals are essential to ensure correct and appropriate treatment and to reduce reliance of patients on unqualified persons.


Assuntos
Malária , Animais , Feminino , Febre/epidemiologia , Febre/etiologia , Febre/terapia , Humanos , Malária/tratamento farmacológico , Malária/epidemiologia , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Autorrelato , Tanzânia/epidemiologia
4.
Artigo em Inglês | MEDLINE | ID: mdl-34068916

RESUMO

OBJECTIVE: Fever alone can lead to rare serious complications in children, such as febrile seizures. The aim of this study is to assess the knowledge, beliefs, and behavior of parents toward fever and its management. METHODS: A cross-sectional study using an online questionnaire was applied over a period of 3 months, from January to March 2018, to parents who were living in Saudi Arabia. The inclusion criteria were a parent who is a resident of Saudi Arabia, with at least one child aged 6 years or less, while incomplete questionnaires, having a child aged more than 6 years, or parents who were not living in Saudi Arabia were excluded. RESULTS: A total of 656 parents completed the questionnaire. More than two-thirds of the subjects were female, the majority of whom were aged between 25-33 years old. The best-reported place to measure the temperature of children was the armpit (46%), followed by the ear (28%) and the mouth (10.7%). More than half of the parents considered their children feverish at a temperature of 38 °C. The majority of parents (79.7%) reported that the most serious side effects of fever were seizure, brain damage (39.3%), coma (29.9%), dehydration (29.7%), and death (25%). The most common method used to measure a child's temperature was an electronic thermometer (62.3%). The most common antipyretic was paracetamol (84.5%). CONCLUSIONS: Our study demonstrates the good knowledge of parents in identifying a feverish temperature using the recommended route and tools for measuring body temperature.


Assuntos
Antipiréticos , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Antipiréticos/uso terapêutico , Criança , Estudos Transversais , Feminino , Febre/epidemiologia , Febre/terapia , Humanos , Masculino , Arábia Saudita/epidemiologia , Inquéritos e Questionários
5.
N Engl J Med ; 384(24): 2283-2294, 2021 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-34133859

RESUMO

BACKGROUND: Targeted temperature management is recommended for patients after cardiac arrest, but the supporting evidence is of low certainty. METHODS: In an open-label trial with blinded assessment of outcomes, we randomly assigned 1900 adults with coma who had had an out-of-hospital cardiac arrest of presumed cardiac or unknown cause to undergo targeted hypothermia at 33°C, followed by controlled rewarming, or targeted normothermia with early treatment of fever (body temperature, ≥37.8°C). The primary outcome was death from any cause at 6 months. Secondary outcomes included functional outcome at 6 months as assessed with the modified Rankin scale. Prespecified subgroups were defined according to sex, age, initial cardiac rhythm, time to return of spontaneous circulation, and presence or absence of shock on admission. Prespecified adverse events were pneumonia, sepsis, bleeding, arrhythmia resulting in hemodynamic compromise, and skin complications related to the temperature management device. RESULTS: A total of 1850 patients were evaluated for the primary outcome. At 6 months, 465 of 925 patients (50%) in the hypothermia group had died, as compared with 446 of 925 (48%) in the normothermia group (relative risk with hypothermia, 1.04; 95% confidence interval [CI], 0.94 to 1.14; P = 0.37). Of the 1747 patients in whom the functional outcome was assessed, 488 of 881 (55%) in the hypothermia group had moderately severe disability or worse (modified Rankin scale score ≥4), as compared with 479 of 866 (55%) in the normothermia group (relative risk with hypothermia, 1.00; 95% CI, 0.92 to 1.09). Outcomes were consistent in the prespecified subgroups. Arrhythmia resulting in hemodynamic compromise was more common in the hypothermia group than in the normothermia group (24% vs. 17%, P<0.001). The incidence of other adverse events did not differ significantly between the two groups. CONCLUSIONS: In patients with coma after out-of-hospital cardiac arrest, targeted hypothermia did not lead to a lower incidence of death by 6 months than targeted normothermia. (Funded by the Swedish Research Council and others; TTM2 ClinicalTrials.gov number, NCT02908308.).


Assuntos
Febre/terapia , Hipotermia Induzida , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Temperatura Corporal , Reanimação Cardiopulmonar/métodos , Coma/etiologia , Coma/terapia , Feminino , Febre/etiologia , Humanos , Hipotermia Induzida/efeitos adversos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/complicações , Parada Cardíaca Extra-Hospitalar/mortalidade , Método Simples-Cego , Resultado do Tratamento
6.
Medicine (Baltimore) ; 100(21): e25645, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032692

RESUMO

ABSTRACT: Since December 2019, pneumonia caused by a novel coronavirus (SARS-CoV-2), namely 2019 novel coronavirus disease (COVID-19), has rapidly spread from Wuhan city to other cities across China. The present study was designed to describe the epidemiology, clinical characteristics, treatment, and prognosis of 74 hospitalized patients with COVID-19.Clinical data of 74 COVID-19 patients were collected to analyze the epidemiological, demographic, laboratory, radiological, and treatment data. Thirty-two patients were followed up and tested for the presence of the viral nucleic acid and by pulmonary computed tomography (CT) scan at 7 and 14 days after they were discharged.Among all COVID-19 patients, the median incubation period for patients and the median period from symptom onset to admission was all 6 days; the median length of hospitalization was 13 days. Fever symptoms were presented in 83.78% of the patients, and the second most common symptom was cough (74.32%), followed by fatigue and expectoration (27.03%). Inflammatory indicators, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) of the intensive care unit (ICU) patients were significantly higher than that of the non-ICU patients (P < .05). However, 50.00% of the ICU patients had their the ratio of T helper cells to cytotoxic T cells (CD4/CD8) ratio lower than 1.1, whose proportion is much higher than that in non-ICU patients (P < .01).Compared with patients in Wuhan, COVID-19 patients in Anhui Province seemed to have milder symptoms of infection, suggesting that there may be some regional differences in the transmission of SARS-CoV-2 between different cities.


Assuntos
Antivirais/uso terapêutico , COVID-19/diagnóstico , Tosse/epidemiologia , Febre/epidemiologia , Oxigenação Hiperbárica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Antibioticoprofilaxia/estatística & dados numéricos , Sedimentação Sanguínea , Proteína C-Reativa/análise , COVID-19/complicações , COVID-19/epidemiologia , COVID-19/terapia , Teste de Ácido Nucleico para COVID-19 , Criança , Pré-Escolar , China/epidemiologia , Cidades/epidemiologia , Tosse/sangue , Tosse/terapia , Tosse/virologia , Feminino , Febre/sangue , Febre/terapia , Febre/virologia , Seguimentos , Geografia , Humanos , Tempo de Internação/estatística & dados numéricos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , RNA Viral/isolamento & purificação , Estudos Retrospectivos , SARS-CoV-2/genética , SARS-CoV-2/isolamento & purificação , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Adulto Jovem
7.
BMJ Open ; 11(3): e041952, 2021 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-33692177

RESUMO

OBJECTIVE: To explore parent and staff views on the acceptability of a randomised controlled trial investigating temperature thresholds for antipyretic intervention in critically ill children with fever and infection (the FEVER trial) during a multi-phase pilot study. DESIGN: Mixed methods study with data collected at three time points: (1) before, (2) during and (3) after a pilot trial. SETTING: English, Paediatric Intensive Care Units (PICUs). PARTICIPANTS: (1) Pre-pilot trial focus groups with pilot site staff (n=56) and interviews with parents (n=25) whose child had been admitted to PICU in the last 3 years with a fever and suspected infection, (2) Questionnaires with parents of randomised children following pilot trial recruitment (n=48 from 47 families) and (3) post-pilot trial interviews with parents (n=19), focus groups (n=50) and a survey (n=48) with site staff. Analysis drew on Sekhon et al's theoretical framework of acceptability. RESULTS: There was initial support for the trial, yet some held concerns regarding the proposed temperature thresholds and not using paracetamol for pain or discomfort. Pre-trial findings informed protocol changes and training, which influenced views on trial acceptability. Staff trained by the FEVER team found the trial more acceptable than those trained by colleagues. Parents and staff found the trial acceptable. Some concerns about pain or discomfort during weaning from ventilation remained. CONCLUSIONS: Pre-trial findings and pilot trial experience influenced acceptability, providing insight into how challenges may be overcome. We present an adapted theoretical framework of acceptability to inform future trial feasibility studies. TRIAL REGISTRATION NUMBERS: ISRCTN16022198 and NCT03028818.


Assuntos
Antipiréticos , Antipiréticos/uso terapêutico , Criança , Cuidados Críticos , Febre/terapia , Humanos , Unidades de Terapia Intensiva Pediátrica , Projetos Piloto
8.
Cochrane Database Syst Rev ; 2: CD012882, 2021 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-33565123

RESUMO

BACKGROUND: The leading causes of mortality globally in children younger than five years of age (under-fives), and particularly in the regions of sub-Saharan Africa (SSA) and Southern Asia, in 2018 were infectious diseases, including pneumonia (15%), diarrhoea (8%), malaria (5%) and newborn sepsis (7%) (UNICEF 2019). Nutrition-related factors contributed to 45% of under-five deaths (UNICEF 2019). World Health Organization (WHO) and United Nations Children's Fund (UNICEF), in collaboration with other development partners, have developed an approach - now known as integrated community case management (iCCM) - to bring treatment services for children 'closer to home'. The iCCM approach provides integrated case management services for two or more illnesses - including diarrhoea, pneumonia, malaria, severe acute malnutrition or neonatal sepsis - among under-fives at community level (i.e. outside of healthcare facilities) by lay health workers where there is limited access to health facility-based case management services (WHO/UNICEF 2012). OBJECTIVES: To assess the effects of the integrated community case management (iCCM) strategy on coverage of appropriate treatment for childhood illness by an appropriate provider, quality of care, case load or severity of illness at health facilities, mortality, adverse events and coverage of careseeking for children younger than five years of age in low- and middle-income countries. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase and CINAHL on 7 November 2019, Virtual Health Library on 8 November 2019, and Popline on 5 December 2018, three other databases on 22 March 2019 and two trial registers on 8 November 2019. We performed reference checking, and citation searching, and contacted study authors to identify additional studies. SELECTION CRITERIA: Randomized controlled trials (RCTs), cluster-RCTs, controlled before-after studies (CBAs), interrupted time series (ITS) studies and repeated measures studies comparing generic WHO/UNICEF iCCM (or local adaptation thereof) for at least two iCCM diseases with usual facility services (facility treatment services) with or without single disease community case management (CCM). We included studies reporting on coverage of appropriate treatment for childhood illness by an appropriate provider, quality of care, case load or severity of illness at health facilities, mortality, adverse events and coverage of careseeking for under-fives in low- and middle-income countries. DATA COLLECTION AND ANALYSIS: At least two review authors independently screened abstracts, screened full texts and extracted data using a standardised data collection form adapted from the EPOC Good Practice Data Collection Form. We resolved any disagreements through discussion or, if required, we consulted a third review author not involved in the original screening. We contacted study authors for clarification or additional details when necessary. We reported risk ratios (RR) for dichotomous outcomes and hazard ratios (HR) for time to event outcomes, with 95% confidence intervals (CI), adjusted for clustering, where possible. We used estimates of effect from the primary analysis reported by the investigators, where possible. We analysed the effects of randomized trials and other study types separately. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS: We included seven studies, of which three were cluster RCTs and four were CBAs. Six of the seven studies were in SSA and one study was in Southern Asia. The iCCM components and inputs were fairly consistent across the seven studies with notable variation for the training and deployment component (e.g. on payment of iCCM providers) and the system component (e.g. on improving information systems). When compared to usual facility services, we are uncertain of the effect of iCCM on coverage of appropriate treatment from an appropriate provider for any iCCM illness (RR 0.96, 95% CI 0.77 to 1.19; 2 CBA studies, 5898 children; very low-certainty evidence). iCCM may have little to no effect on neonatal mortality (HR 1.01, 95% 0.73 to 1.28; 2 trials, 65,209 children; low-certainty evidence). We are uncertain of the effect of iCCM on infant mortality (HR 1.02, 95% CI 0.83 to 1.26; 2 trials, 60,480 children; very low-certainty evidence) and under-five mortality (HR 1.18, 95% CI 1.01 to 1.37; 1 trial, 4729 children; very low-certainty evidence). iCCM probably increases coverage of careseeking to an appropriate provider for any iCCM illness by 68% (RR 1.68, 95% CI 1.24 to 2.27; 2 trials, 9853 children; moderate-certainty evidence). None of the studies reported quality of care, severity of illness or adverse events for this comparison. When compared to usual facility services plus CCM for malaria, we are uncertain of the effect of iCCM on coverage of appropriate treatment from an appropriate provider for any iCCM illness (very low-certainty evidence) and iCCM may have little or no effect on careseeking to an appropriate provider for any iCCM illness (RR 1.06, 95% CI 0.97 to 1.17; 1 trial, 811 children; low-certainty evidence). None of the studies reported quality of care, case load or severity of illness at health facilities, mortality or adverse events for this comparison. AUTHORS' CONCLUSIONS: iCCM probably increases coverage of careseeking to an appropriate provider for any iCCM illness. However, the evidence presented here underscores the importance of moving beyond training and deployment to valuing iCCM providers, strengthening health systems and engaging community systems.


Assuntos
Administração de Caso/organização & administração , Serviços de Saúde da Criança/organização & administração , Agentes Comunitários de Saúde , Países em Desenvolvimento , África ao Sul do Saara , Ásia , Viés , Pré-Escolar , Agentes Comunitários de Saúde/economia , Agentes Comunitários de Saúde/educação , Agentes Comunitários de Saúde/organização & administração , Estudos Controlados Antes e Depois , Diarreia/terapia , Febre/terapia , Humanos , Lactente , Mortalidade Infantil , Transtornos da Nutrição do Lactente/terapia , Recém-Nascido , Malária/terapia , Sepse Neonatal/terapia , Pneumonia/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Salários e Benefícios , Nações Unidas
9.
Epidemiol Infect ; 149: e61, 2021 02 24.
Artigo em Inglês | MEDLINE | ID: mdl-33622421

RESUMO

A fever clinic within a hospital plays a vital role in pandemic control because it serves as an outpost for pandemic discovery, monitoring and handling. As the outbreak of coronavirus disease 2019 (COVID-19) in Wuhan was gradually brought under control, the fever clinic in the West Campus of Wuhan Union Hospital introduced a new model for construction and management of temporary mobile isolation wards. A traditional battlefield hospital model was combined with pandemic control regulations, to build a complex of mobile isolation wards that used adaptive design and construction for medical operational, medical waste management and water drainage systems. The mobile isolation wards allowed for the sharing of medical resources with the fever clinic. This increased the capacity and efficiency of receiving, screening, triaging and isolation and observation of patients with fever. The innovative mobile isolation wards also controlled new sudden outbreaks of COVID-19. We document the adaptive design and construction model of the novel complex of mobile isolation wards and explain its characteristics, functions and use.


Assuntos
Febre/terapia , Modelos Organizacionais , Isolamento de Pacientes/métodos , COVID-19/complicações , COVID-19/epidemiologia , China/epidemiologia , Febre/epidemiologia , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Isolamento de Pacientes/tendências
10.
Cien Saude Colet ; 26(2): 445-454, 2021 Feb.
Artigo em Português, Inglês | MEDLINE | ID: mdl-33605322

RESUMO

The study analyses the understanding of parents or guardians of children aged zero to five years old about fever, the conduct and care for this condition, carried out in the urgent and emergency service. The qualitative research, which used the thematic analysis technique, was carried out through interviews with 14 parents or guardians who sought an urgent and emergency Pediatric Service in a municipality in the countryside of São Paulo for this reason. The experiences of parents who seek these services are associated to three main topics: fear of fever; care for a febrile child; and the experience of care at the urgent and emergency services. It was identified that an exaggerated fear of fever predominates and that parents / guardians feel safe regarding the existing technology found in urgent and emergency services. The adopted precautions, however, are not always those recommended for the existing situation.


Assuntos
Serviços Médicos de Emergência , Pais , Brasil , Criança , Pré-Escolar , Febre/epidemiologia , Febre/terapia , Humanos , Lactente , Recém-Nascido , Pesquisa Qualitativa
11.
J Psychiatr Pract ; 27(1): 75-80, 2021 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-33438871

RESUMO

This case report details the multidisciplinary management of a frequent attender in his early 50s with no fixed abode who presented with pyrexia of unknown origin, complicated by his noncooperation with intervention and treatment because of the development of psychotic symptoms. The case required the involvement of liaison psychiatry, anesthesia, cardiology, radiology, gastroenterology, rheumatology, respiratory, hematology, and social services, highlighting not just multidisciplinary intervention but the benefits of working with a multispeciality team. The patient had previously presented to the emergency department 47 times over an 18-month period. The management during his most recent inpatient stay resulted in the patient living independently and presenting to the hospital only once over the ensuing 7 months.


Assuntos
Febre/complicações , Febre/terapia , Equipe de Assistência ao Paciente , Transtornos Psicóticos/complicações , Transtornos Psicóticos/terapia , Serviço Hospitalar de Emergência , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/psicologia
12.
J Pediatr ; 232: 237-242, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33508277

RESUMO

OBJECTIVE: To determine the frequency and predictors of temperature measurement at well-child visits in the US and report rates of interventions associated with visits at which temperature is measured and fever is detected. STUDY DESIGN: In this cross-sectional study, we analyzed 22 518 sampled well-child visits from the National Ambulatory Medical Care Survey between 2003 and 2015. We estimated the frequency of temperature measurement and performed multivariable regression to identify patient, provider/clinic, and seasonal factors associated with the practice. We described rates of interventions (complete blood count, radiograph, urinalysis, antibiotic prescription, and emergency department/hospital referral) by measurement and fever (temperature ≥100.4 °F, ≥38.0 °C) status. RESULTS: Temperature was measured in 48.5% (95% CI 45.6-51.4) of well-child visits. Measurement was more common during visits by nonpediatric providers (aOR 2.0, 95% CI 1.6-2.5; reference: pediatricians), in Hispanic (aOR 1.9, 95% CI 1.6-2.3) and Black (aOR 1.5, 95% CI 1.2-1.9; reference: non-Hispanic White) patients, and in patients with government (aOR 2.0, 95% CI 1.7-2.4; reference: private) insurance. Interventions were more commonly pursued when temperature was measured (aOR 1.3, 95% CI 1.1-1.6) and fever was detected (aOR 3.8, 95% CI 1.5-9.4). CONCLUSIONS: Temperature was measured in nearly one-half of all well-child visits. Interventions were more common when temperature was measured and fever was detected. The value of routine temperature measurement during well-child visits warrants further evaluation.


Assuntos
Temperatura Corporal , Febre/diagnóstico , Padrões de Prática Médica/estatística & dados numéricos , Serviços Preventivos de Saúde/métodos , Atenção Primária à Saúde/métodos , Termografia/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Febre/etiologia , Febre/terapia , Pesquisas sobre Serviços de Saúde , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Análise Multivariada , Serviços Preventivos de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Termografia/métodos , Estados Unidos
13.
Nurse Educ Today ; 97: 104731, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33385941

RESUMO

BACKGROUND: Fever phobia, the unfounded fear regarding the potential harms of fever in children, has been internationally documented among parents. This fear causes anxiety in parents and health professionals are regularly consulted for advice. OBJECTIVES: This study aimed to investigate the knowledge, beliefs and recommended treatments among Australian nurses, pharmacists, general practitioners and paediatricians in the management of febrile children. DESIGN, SETTING AND PARTICIPANTS: This was an online cross-sectional survey of Australian nurses, pharmacists, general practitioners and paediatricians designed to evaluate the knowledge and preferred recommendations in the management of febrile children. METHODS: The health professionals were recruited via Facebook. Demographic information, knowledge, beliefs and preferred treatments were collected through the online survey, and responses were compared across professions. RESULTS: Of the 839 health professionals who completed the survey, 52.0% correctly identified a fever as 38 °C or above. Overall, 23.6% underestimated the temperature that constitutes a fever. Respondents reported concerns leaving fever untreated in children, with dehydration (65.1%), seizures (65.2%), serious illness (34.4%) and brain damage (29.9%) the most common concerns. Pharmacists were more likely to hold these concerns. The beliefs that reducing a child's fever with medication will reduce the risk of harm (34.7%) and prevent febrile convulsions (51.1%) were prevalent among respondents. These beliefs were more common among pharmacists. Pharmacists were also more likely to recommend parents monitor a child's temperature (48.5%) and give medication to reduce fever (64.6%). CONCLUSIONS: Australian nurses, pharmacists, general practitioners and paediatricians reported many misconceptions surrounding the definition of fever, the potential harms of fever and its management, which may perpetuate parental fears. These misconceptions were most common among pharmacists. Continuing professional development is essential to ease unfounded concerns and ensure the safe and judicious care of febrile children.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Enfermeiras e Enfermeiros , Austrália , Criança , Estudos Transversais , Febre/terapia , Humanos , Pais , Inquéritos e Questionários
14.
Acad Emerg Med ; 28(1): 46-59, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32648270

RESUMO

OBJECTIVES: We aimed to develop and test a tool to engage parents of febrile infants ≤ 60 days of age evaluated in the emergency department (ED). The tool was designed to improve communication for all parents and to support shared decision-making (SDM) about whether to perform a lumbar puncture (LP) for infants 29 to 60 days of age. METHODS: We conducted a multiphase development and testing process: 1) individual, semistructured interviews with parents and clinicians (pediatric and general emergency medicine [EM] physicians and pediatric EM nurses) to learn their preferences for a communication and SDM tool; 2) design of a "storyboard" of the tool with design impression testing; 3) development of a software application (i.e., app) prototype, called e-Care; and 4) usability testing of e-Care, using qualitative assessment and the system usability scale (SUS). RESULTS: We interviewed 27 parents and 23 clinicians. Interviews revealed several themes, including that a communication tool should augment but not replace verbal communication; a Web-based format was preferred; and information about infections and testing, including the rationales for specific tests, would be valuable. We then developed separate versions of e-Care for infants ≤ 28 days and 29 to 60 days of age, in both English and Spanish. The e-Care app includes four sections: 1) homepage; 2) why testing is done; 3) what tests are done; and 4) what happens after testing, including a table for parents of infants 29 to 60 days of age to compare the risks/benefits of LP in preparation for an SDM conversation. Parents and clinicians reported that e-Care was understandable and helpful. The mean SUS score was 90.3 (95% confidence interval = 84 to 96.6), representing "excellent" usability. CONCLUSIONS: The e-Care app is a useable and understandable tool to support communication and SDM with parents of febrile infants ≤ 60 days of age in the ED.


Assuntos
Comunicação , Tomada de Decisão Compartilhada , Aplicativos Móveis , Pais , Serviço Hospitalar de Emergência , Feminino , Febre/diagnóstico , Febre/terapia , Humanos , Lactente , Cuidado do Lactente , Recém-Nascido , Masculino , Medição de Risco
15.
Hum Antibodies ; 29(1): 49-54, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32986663

RESUMO

Coronavirus disease 2019 (COVID-19) has caused a global pandemic in early 2020. This infectious disorder has a heterogeneous course ranging from asymptomatic disorder to a critical situation needing intensive cares. In the current study, we present a report of affected patients admitted in a single hospital in Iran. Eighty-two hospitalized patients with COVID-19 were assessed. Demographic, clinical, and paraclinical parameters were gathered and statistically analyzed. The median age (IQR) of the patients was 57.32 (45.75, 70) years. At primary evaluation, fever was present in 45.12% of the affected individuals. The most common clinical symptoms were dyspnea (81.71%) and cough (65.85%). Totally, 12 (14.63%) and 14 (17.07%) of patients had low and high WBC counts, respectively. Lymphopenia was detected in 36 (43.9%) of patients, while 6 (7.32%) of patients had lymphocytosis. High levels of Il-6 were detected in 4 (4.88%) of patients. CRP levels were elevated in 69 (84.1%) of patients. The median (IQR) of hospitalization was 7 (5, 9) days. Totally, 26 patients (31%) were hospitalized in ICU. All patients were discharged with good health conditions except for one patient who died. The current study shows the heterogeneous clinical manifestations and paraclinical parameters of COVID-19 patients.


Assuntos
COVID-19/fisiopatologia , Tosse/fisiopatologia , Dispneia/fisiopatologia , Febre/fisiopatologia , Linfocitose/fisiopatologia , Linfopenia/fisiopatologia , Idoso , Proteína C-Reativa/metabolismo , COVID-19/mortalidade , COVID-19/terapia , COVID-19/virologia , Tosse/mortalidade , Tosse/terapia , Tosse/virologia , Diabetes Mellitus/mortalidade , Diabetes Mellitus/fisiopatologia , Diabetes Mellitus/terapia , Diabetes Mellitus/virologia , Dispneia/mortalidade , Dispneia/terapia , Dispneia/virologia , Feminino , Febre/mortalidade , Febre/terapia , Febre/virologia , Hospitais , Humanos , Hipertensão/mortalidade , Hipertensão/fisiopatologia , Hipertensão/terapia , Hipertensão/virologia , Irã (Geográfico) , Contagem de Leucócitos , Linfocitose/mortalidade , Linfocitose/terapia , Linfocitose/virologia , Linfopenia/mortalidade , Linfopenia/terapia , Linfopenia/virologia , Masculino , Pessoa de Meia-Idade , Obesidade/mortalidade , Obesidade/fisiopatologia , Obesidade/terapia , Obesidade/virologia , Oxigênio/uso terapêutico , Respiração Artificial/métodos , Estudos Retrospectivos , SARS-CoV-2/patogenicidade , Índice de Gravidade de Doença , Análise de Sobrevida
16.
Acta Paediatr ; 110(3): 1046-1055, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33000491

RESUMO

AIM: To evaluate the frequency and predictors of poor outcome in febrile children presenting to the Emergency Department. METHODS: Retrospective observational study from the Emergency Department of The Royal Children's Hospital, Melbourne, Australia. All children with presenting complaint of fever or triage temperature >38°C over a 6-month period were included. Poor outcome was defined as: new organ dysfunction or the requirement for organ support therapy (inotrope infusion, mechanical ventilation, renal replacement therapy and extra-corporeal life support). Predictors evaluated were as follows: initial vital signs, blood tests and clinical scores. Odds ratio, sensitivity, specificity and area under the receiver-operating characteristics curve were calculated for each predictor variable. RESULTS: Between Jan-June 2019, 6217 children met inclusion criteria. Twenty-seven (0.4%) developed new organ dysfunction, 10 (0.2%) required organ support therapy (inotrope infusion in 5, mechanical ventilation in 6, renal replacement therapy in 1, extra-corporeal life support in 1). Odds of new organ dysfunction, requirement for inotropic support and mechanical ventilation were higher with abnormal initial vital signs, blood tests and clinical scores, though overall test characteristics were poor due to infrequency. CONCLUSION: Poor outcomes were uncommon among febrile children presenting to the Emergency Department. Vital signs, blood tests and clinical scores were poor predictors.


Assuntos
Serviço Hospitalar de Emergência , Febre , Austrália , Criança , Febre/epidemiologia , Febre/etiologia , Febre/terapia , Humanos , Estudos Retrospectivos , Triagem
18.
CNS Neurol Disord Drug Targets ; 20(2): 101-104, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33222680

RESUMO

COVID-19 is one of the most disastrous respiratory diseases (after the 1918 influenza outbreak) spreading in the community. So far, it has killed 7,37,417 individuals. High variability in the viral genome and its greater ability to spread in the human community are badly affecting the comorbid individuals. Although infected individuals mainly possess respiratory issues, neurological manifestations in these individuals cannot be overlooked. The literature search is based on the recent development in the concerned field. We searched databases like PubMed, Google Scholar, and ScienceDirect using the keywords "COVID-19", "neurological manifestations", "CNS", and "PNS". The major neurological complications observed in these patients are encephalitis, necrotising haemorrhagic encephalopathy, Guillain-Barré Syndrome, smell/taste impairment, epileptic seizures, and abnormal states of consciousness. COVID-19 infection is just more than a cough, fever, and respiratory illness; it can cause indirect neurological complications in infected patients. It is therefore advised to treat and have a careful observation of the COVID-19 patients for neurological manifestations.


Assuntos
COVID-19/epidemiologia , Tosse/epidemiologia , Surtos de Doenças , Febre/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , COVID-19/diagnóstico , COVID-19/terapia , Tosse/diagnóstico , Tosse/terapia , Surtos de Doenças/prevenção & controle , Encefalite/diagnóstico , Encefalite/epidemiologia , Encefalite/terapia , Febre/diagnóstico , Febre/terapia , Humanos , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/terapia
20.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334767

RESUMO

An 83-year-old man with a history of chronic myelogenous leukaemia in remission maintained with bosutinib presented with new-onset fevers. He denied pain and had no other focal symptoms. Ultrasound imaging revealed mild gallbladder wall thickening. Non-contrasted CT revealed right upper quadrant inflammation of indeterminate source. The diagnosis of acalculous cholecystitis was made on the third day when a CT with oral contrast demonstrated a remarkably inflamed biliary tree. The gallbladder was surgically removed and found to be necrotic. The case highlights an unusual presentation for a well-known condition. Both ultrasound and CT have limited diagnostic sensitivity for acalculous cystitis. This case adds to existing literature to support development of acalculous cholecystitis in non-critically ill patients. Clinicians should maintain awareness of this condition among patients presenting to the hospital or clinic with abdominal pain. Careful discussion with radiology and surgery is indicated to guide diagnostic testing when initial imaging results are indeterminate.


Assuntos
Colecistite Acalculosa/diagnóstico , Escherichia coli/isolamento & purificação , Febre/microbiologia , Vesícula Biliar/patologia , Colecistite Acalculosa/complicações , Colecistite Acalculosa/microbiologia , Colecistite Acalculosa/terapia , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Colecistectomia , Quimioterapia Combinada , Febre/sangue , Febre/imunologia , Febre/terapia , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/microbiologia , Vesícula Biliar/cirurgia , Humanos , Masculino , Necrose/complicações , Necrose/diagnóstico , Necrose/microbiologia , Necrose/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia
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