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1.
Euro Surveill ; 25(3)2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31992389

RESUMO

Recognition of measles is crucial to prevent transmissions in the hospital settings. Little is known about the level of recognition of measles and possible causes of not recognising the disease by physicians in the post-vaccine era. We report on a measles outbreak in a paediatric hospital in Austria in January to February 2017 with strikingly high numbers of not recognised cases. The extent and course of the outbreak were assessed via retrospective case finding. Thirteen confirmed measles cases were identified, two with atypical clinical picture. Of eight cases with no known epidemiological link, only one was diagnosed immediately; four were recognised with delay and three only retrospectively. Eleven typical measles cases had four 'unrecognised visits' to the outpatient clinic and 28 on the ward. Two atypical cases had two 'unrecognised visits' to the outpatient clinic and 19 on the ward.Thirteen clinicians did not recognise typical measles (atypical cases not included). Twelve of 23 physicians involved had never encountered a patient with measles before. The direct and indirect costs related to the outbreak were calculated to be over EUR 80,000. Our findings suggest the need to establish regular training programmes about measles, including diagnostic pitfalls in paediatric hospitals.


Assuntos
Surtos de Doenças/estatística & dados numéricos , Vírus do Sarampo/genética , Vírus do Sarampo/imunologia , Sarampo/epidemiologia , Adolescente , Adulto , Áustria/epidemiologia , Criança , Pré-Escolar , Ensaio de Imunoadsorção Enzimática , Feminino , Hospitais Pediátricos , Hospitais Universitários , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Lactente , Masculino , Vírus do Sarampo/isolamento & purificação , RNA Viral/análise , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
2.
Medicine (Baltimore) ; 99(2): e18714, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914082

RESUMO

To investigate the situation of antibiotic consumption and to assess the inappropriate use on pediatric inpatients of different types hospitals in Sichuan, China.A cross-sectional survey of antibiotic prescriptions among hospitalized children aged 1month -14years were conducted from April 2018 to June 2018 in southwestern China. Antibiotic prescriptions were extracted from electronic records during hospitalization of each inpatient in five different types hospitals.In this study, the antibiotic prescription rate of hospitalized children was 66.9% (1176/1758). Compared with tertiary children hospital (TC) (46.1%), general hospitals and non-tertiary children hospitals has higher rate of antibiotic prescription (almost 85%) (P < .001). 93.4% of inpatients received parenteral antibiotic. Overall, the most common antibiotics were Cefoperazone and enzyme inhibitor, Cefixime and Azithromycin. Lower respiratory tract infection (LRTI) was the leading reason for antibiotic consumption in pediatric wards (56.8%), followed by upper respiratory tract infection (URTI) (22.2%). For children with LRTI, Cephalosporins were heavy prescribed, especially broad-spectrum third-generation Cephalosporins (60.3%). The antibiotic prescription proportion of URTI in general hospitals and non-tertiary children hospitals (more than 18%) was higher than TC (8.1%) (P < .001).There was inappropriate use of antibiotic in hospitalized children including overuse of parenteral administration, overprescribing of antibiotic on URTI and misuse of third-generation Cephalosporins in pediatric inpatients with LRTI. Compared with tertiary freestanding children hospital, the irrational antibiotic prescription of general hospitals and non-tertiary children hospitals were more serious. Management strategy should be implementer on quality improvement of antibiotic use.


Assuntos
Antibacterianos/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Prescrição Inadequada/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Antibacterianos/administração & dosagem , Criança , Criança Hospitalizada , Pré-Escolar , China , Estudos Transversais , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Masculino , Infecções Respiratórias/tratamento farmacológico
4.
BMC Infect Dis ; 19(1): 1012, 2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31783806

RESUMO

BACKGROUND: Influenza is the most frequent cause of acute upper respiratory tract infections during winter season. Although rare, neurological manifestations are known to occur during influenza infection and approximatively three-quarters of cases are in children. In this study, we aimed to characterize the burden and clinical spectrum of influenza-associated encephalopathy and encephalitis in children admitted at a tertiary pediatric hospital in Italy over two influenza seasons (2017-2019). METHODS: We retrospectively analyzed clinical, laboratory, instrumental data and outcome of patients discharged with ICD9-CM 487.0 code. RESULTS: Fifteen children (13.1% of those discharged with a diagnosis of influenza infection in the study period), had influenza-associated central nervous system (CNS) manifestations. Eight patients (53.3%) were diagnosed as influenza encephalitis, 7 (46.7%) as influenza encephalopathy. Median age was 27 months. In children under 2 years of age (40% of all cases) altered consciousness was the most frequent neurological manifestation while respiratory symptoms were present at admission in all cases. Younger children also required intensive care support more frequently. Five subjects (33.3%) presented comorbidity. None of the patients had received seasonal influenza vaccination. The median time from onset of respiratory signs to onset of neurological manifestations was 24 h. Cerebrospinal fluid (CSF) analysis was normal in most patients and polymerase chain reaction for influenza virus RNA on CSF, when performed, was negative in all samples. Neuroradiological investigations, performed in 5 children, reported cortical and subcortical white matter signal alterations. Oseltamivir was administered only in 2 cases. Fourteen patients recovered without sequelae, and only a 2-year-old girl had minimal impairment in fine motor skills at discharge. CONCLUSIONS: All children presenting acute neurological features during influenza season should be evaluated for influenza-associated CNS complications even if the respiratory involvement is mild. Absence of underlying diseases or other risk factors are not protective factors against CNS influenza-associated complications. The lack of CSF pleocytosis does not exclude CNS involvement. Children under 2 years of age are at higher risk of requiring intensive care support.


Assuntos
Encefalite/diagnóstico , Influenza Humana/patologia , Criança , Pré-Escolar , Encefalite/etiologia , Feminino , Hospitais Pediátricos , Humanos , Lactente , Influenza Humana/complicações , Influenza Humana/virologia , Itália , Masculino , Orthomyxoviridae/genética , Orthomyxoviridae/isolamento & purificação , RNA Viral/líquido cefalorraquidiano , Estudos Retrospectivos , Estações do Ano , Centros de Atenção Terciária
5.
Health Serv Res ; 54(6): 1203-1213, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31742687

RESUMO

OBJECTIVE: To evaluate the impact of TEAM UP-an initiative that fully integrates behavioral health services into pediatric primary care in three Boston-area Community Health Centers (CHCs)-on health care utilization and costs. DATA SOURCES: 2014-2017 claims data on continuously enrolled children from a Massachusetts Medicaid managed care plan. STUDY DESIGN: We used a difference-in-difference approach with inverse probability of treatment weights to compare outcomes in children receiving primary care at TEAM UP CHCs versus comparison site CHCs, in the pre (2014-2016q2)- versus post (2016q3-2017)-intervention periods. Utilization outcomes included emergency department visits, inpatient admissions, primary care visits, and outpatient/professional visits (all cause and those with mental health (MH) diagnoses). Cost outcomes included total cost of care (inpatient, outpatient, professional, pharmacy). We further assessed differential effects by baseline MH diagnosis. PRINCIPAL FINDINGS: After 1.5 years, TEAM UP was associated with a relative increase in the rate of primary care visits (IRR = 1.15, 95% CI 1.04-1.27, or 115 additional visits/1000 patients/quarter), driven by children with a MH diagnosis at baseline. There was no significant change in avoidable health care utilization or cost. CONCLUSIONS: Expanding the TEAM UP behavioral health integration model to other sites has the potential to improve primary care engagement in low-income children with MH needs.


Assuntos
Prestação Integrada de Cuidados de Saúde/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitais Pediátricos/economia , Medicaid/economia , Medicaid/estatística & dados numéricos , Serviços de Saúde Mental/economia , Atenção Primária à Saúde/economia , Adolescente , Boston , Criança , Pré-Escolar , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Serviços de Saúde Mental/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
6.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med ; 27(Special Issue): 587-593, 2019 Aug.
Artigo em Russo | MEDLINE | ID: mdl-31747150

RESUMO

Currently, the development of day care hospitals is determined by the need to improve medical, social and economic efficiency of medical institutions, and high demand among population for this type of medical service. Our foreign colleagues' experiance shows that the volume of planned surgical care in such structural units reaches 80%. The article analyzes the results of the Surgical Short Stay Unit at the Moscow Morozov children's hospital. From February 2017 to December 2018, 5684 surgical interventions were performed in the Department, 1073 of them were performed via the laparoscopic method in patients with inguinal hernias, varicocele, and non-palpable testicular syndrome. The length of patients' stay at the hospital averaged 6-8 hours. A unique algorithm of anesthetic support using 2-lumen laryngeal masks without muscle relaxants and narcotic anesthetics was performed. Only 1 patient needed to be transferred to a 24-hour hospital from the Unit. There were no surgical complications. The organization of the short stay unit in Morozov Moscow Children's Hospital allowed to radically improve the availability of minimally invasive modern medical care for children, to free highly specialized round-the-clock surgical beds, and to increase economic benefits for the medical institution.


Assuntos
Hospitais Pediátricos , Tempo de Internação , Algoritmos , Criança , Hospitais Urbanos , Humanos , Masculino , Moscou
7.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med ; 27(Special Issue): 653-666, 2019 Aug.
Artigo em Russo | MEDLINE | ID: mdl-31747158

RESUMO

Stroke is in the top ten causes of children death, ahead of brain tumors. Х-ray diagnostics development has significantly improved the detectability of pediatric stroke. The average incidence of cerebrovascular diseases in children was 13 per 100,000 children annually. The main feature of children's stroke is its multifactorial character, which complicates diagnostic process and requires involvement of doctors of different specialties to determine the leading etiological factors and choose optimal therapy and management tactics. The Center for the Treatment of Cerebrovascular Pathology in Children and Adolescents was established on the basis of Morozov Children City Clinical Hospital by Moscow Healthcare Department, Order No. 169, dated February 27, 2014. The main task was to create a pediatric stroke center on the basis of multidisciplinary Morozov Children City Clinical Hospital, which met the main international requirements of the primary center for pediatric stroke. It was done to improve early diagnostic process, refine the algorithm for maintaining patient data in acute periods, develop preventive measures, maintain city pediatric stroke register, introduce family consultations, coordinate medical care for children with cerebrovascular pathology at various levels in Moscow, and improve medical care quality for children with cerebrovascular pathology and their families. Since April 2014 more than 800 children have undergone inpatient treatment and more than 420 have been treated in outpatient departments of Morozov Children City Clinical Hospital.


Assuntos
Transtornos Cerebrovasculares , Hospitais Pediátricos , Acidente Vascular Cerebral , Adolescente , Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/terapia , Criança , Hospitais Urbanos , Humanos , Moscou , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia
8.
J Nurs Adm ; 49(11): 561-568, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31651617

RESUMO

BACKGROUND: Institutional objectives for clinical ladder program (CLP) implementation often focus on improving job satisfaction, retention rates, and patient outcomes. Local inconsistency in CLP implementation seemed to be contributing to decreased job satisfaction and nurse retention rates. PURPOSE: The aim of this study was to use current evidence and prevailing perceptions of bedside nurses and nurse managers to refine an existing CLP. METHODS: Pretest/posttest design was used to evaluate differences in perceptions of existing CLP (baseline) and perceptions 6 months after CLP refinements were initiated (post). RESULTS: Baseline perceptions of CLP implementation were significantly different for bedside nurses and managers. Bedside nurses were more dissatisfied than nurse managers. Perceptions became more similar across groups as initiatives were implemented to improve CLP understanding and as CLP implementation became more consistent across the organization. CONCLUSIONS: Targeted strategies tailored to increase understanding and consistent CLP implementation can be effective in improving CLP satisfaction and increasing bedside nurse professional behaviors.


Assuntos
Atitude do Pessoal de Saúde , Mobilidade Ocupacional , Enfermeiras Administradoras/psicologia , Recursos Humanos de Enfermagem no Hospital/psicologia , Desenvolvimento de Pessoal/organização & administração , Adulto , Estudos de Coortes , Connecticut , Feminino , Hospitais Pediátricos , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
9.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31519793

RESUMO

OBJECTIVES: We assessed racial differences in sepsis recognition in a pediatric emergency department (ED) with an established electronic sepsis alert system. METHODS: Quality-improvement data from June 1, 2016 to May 31, 2017 was used in this retrospective cohort study. All ED visits were included for non-Hispanic black (NHB) and non-Hispanic white (NHW) patients. The sepsis pathway was activated through the alert, 2 stages and a huddle, or outside of the alert using clinician judgment alone. We evaluated racial differences in the frequency of alerts and sepsis pathway activation within and outside of the alert. Multivariable regression adjusted for high-risk condition, sex, age, and insurance. RESULTS: There were 97 338 ED visits: 56 863 (58.4%) and 23 008 (23.6%) from NHBs and NHWs, respectively. NHWs were more likely than NHBs to have a positive second alert (adjusted odds ratio [aOR] 2.4; 95% confidence interval [CI] 2.1-2.8). NHWs were more likely than NHBs to have the sepsis pathway activated (aOR 1.4; 95% CI 1.02-2.1). Of those treated within the alert, there was no difference in pathway activation (aOR 0.93; 95% CI 0.62-1.4). Of those recognized by clinicians when the alert did not fire, NHWs were more likely than NHBs to be treated (aOR 3.4; 95% CI 1.8-6.4). CONCLUSIONS: NHWs were more likely than NHBs to be treated for sepsis, although this difference was specifically identified in the subset of patients treated for sepsis outside of the alert. This suggests that an electronic alert reduces racial differences compared with clinician judgment alone.


Assuntos
Afro-Americanos/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Hipotensão/diagnóstico , Sepse/diagnóstico , Taquicardia/diagnóstico , Adolescente , Criança , Pré-Escolar , Intervalos de Confiança , Diagnóstico Precoce , Feminino , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Masculino , Razão de Chances , Philadelphia , Melhoria de Qualidade , Qualidade da Assistência à Saúde , Análise de Regressão , Estudos Retrospectivos , Sepse/etnologia , Sepse/terapia
10.
Soins Pediatr Pueric ; 40(310): 45-48, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31543235

RESUMO

Paediatric palliative care has been set up after extensive discussion and observations regarding the need to provide different support to children with a serious and incurable disease as well as their families. The mobile palliative care team support children and their family in this specific process and train caregivers in the palliative approach.


Assuntos
Hospitais Pediátricos/organização & administração , Unidades Móveis de Saúde/organização & administração , Cuidados Paliativos/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Criança , Humanos
11.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31562252

RESUMO

BACKGROUND: Universal screening is recommended to reduce the age of diagnosis for autism spectrum disorder (ASD). However, there are insufficient data on children who screen negative and no study of outcomes from truly universal screening. With this study, we filled these gaps by examining the accuracy of universal screening with systematic follow-up through 4 to 8 years. METHODS: Universal, primary care-based screening was conducted using the Modified Checklist for Autism in Toddlers with Follow-Up (M-CHAT/F) and supported by electronic administration and integration into electronic health records. All children with a well-child visit (1) between 16 and 26 months, (2) at a Children's Hospital of Philadelphia site after universal electronic screening was initiated, and (3) between January 2011 and July 2015 were included (N = 25 999). RESULTS: Nearly universal screening was achieved (91%), and ASD prevalence was 2.2%. Overall, the M-CHAT/F's sensitivity was 38.8%, and its positive predictive value (PPV) was 14.6%. Sensitivity was higher in older toddlers and with repeated screenings, whereas PPV was lower in girls. Finally, the M-CHAT/F's specificity and PPV were lower in children of color and those from lower-income households. CONCLUSIONS: Universal screening in primary care is possible when supported by electronic administration. In this "real-world" cohort that was systematically followed, the M-CHAT/F was less accurate in detecting ASD than in previous studies. Disparities in screening rates and accuracy were evident in traditionally underrepresented groups. Future research should focus on the development of new methods that detect a greater proportion of children with ASD and reduce disparities in the screening process.


Assuntos
Transtorno do Espectro Autista/diagnóstico , Lista de Checagem , Programas de Rastreamento/normas , Pediatria/normas , Fatores Etários , Transtorno do Espectro Autista/epidemiologia , Pré-Escolar , Registros Eletrônicos de Saúde , Feminino , Seguimentos , Hospitais Pediátricos , Humanos , Lactente , Masculino , Programas de Rastreamento/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Philadelphia/epidemiologia , Valor Preditivo dos Testes , Prevalência , Sensibilidade e Especificidade , Fatores Sexuais , Fatores Socioeconômicos
12.
J Laparoendosc Adv Surg Tech A ; 29(10): 1383-1387, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31536444

RESUMO

Introduction: Minimally invasive surgery (MIS) in pediatric surgery is now the standard of care for various surgical conditions. We have seen an increase in MIS with some of the procedures requiring intraoperative conversion to open surgery. Materials and Methods: This is a single-institution retrospective study of patients who underwent MIS between 2009 and 2017 requiring conversion to open surgery. Preoperative characteristics, cause of conversion, and postoperative factors were recorded. Results: A total of 154 patients had converted to MIS, 89.6% underwent laparoscopic procedures. Mean age was 8.5 years, 53.9% were male. Primary cause leading to surgery was not oncologic (89.6%), dirty contaminated wound was found in 49.35%, inflammatory response markers were altered, and 38.9% of our patients were American Society of Anesthesiologists physical status classification 3. Principal causes of conversion were failure in progression (53.25%) and loss of anatomic reference (24.5%). A total of 44.16% of the patients required postoperative pediatric intensive care unit admission, 29.2% required reintervention, and mortality rate was 0.65%. We detailed data regarding thoracoscopic, appendectomy, and laparoscopic procedures. Conclusion: Conversion to MIS is a decision the surgeon must make in different scenarios. This study allowed us to characterize our population regarding converted MIS procedures. Male gender, age group, altered inflammatory markers, not oncologic pathology, and dirty wound were frequently found, but we cannot establish any of them as risk factors. Main cause for conversion to open surgery was failure in the progression of the procedure in our study according to reported literature. We intend to develop further studies to determine risk factors.


Assuntos
Conversão para Cirurgia Aberta/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Laparoscopia/estatística & dados numéricos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Retrospectivos
13.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31515299

RESUMO

BACKGROUND: Diagnostic delays in the pediatric emergency department (ED) can lead to unnecessary interventions and prolonged ED length of stay (LOS), especially in patients with diabetes mellitus evaluated for diabetic ketoacidosis (DKA). At our institution, baseline DKA determination time (arrival to diagnosis) was 86 minutes, and 61% of patients did not meet DKA criteria. Subsequently, intravenous (IV) placement occurred in 85% of patients without DKA. We aimed to use point-of-care (POC) testing to reduce DKA determination time from 86 to 30 minutes and to reduce IV placements in patients without DKA from 85% to 20% over 18 months. METHODS: Four key interventions (POC tests, order panels, provider guidelines, and nursing guidelines) were tested by using plan-do-study-act cycles. DKA determination time was our primary outcome, and secondary outcomes included the percentage of patients receiving IV placement and ED LOS. Process measures included the rate of use of POC testing and order panels. All measures were analyzed on statistical process control charts. RESULTS: Between January 2015 and July 2018, 783 patients with diabetes mellitus were evaluated for DKA. After all 4 interventions, DKA determination time decreased from 86 to 26 minutes (P < .001). In patients without DKA, IV placement decreased from 85% to 36% (P < .001). ED LOS decreased from 206 to 186 minutes (P = .009) in patients discharged from the hospital after DKA evaluation. POC testing and order panel use increased from 0% to 98% and 90%, respectively. CONCLUSIONS: Using quality-improvement methodology, we achieved a meaningful reduction in DKA determination time, the percentage of IV placements, and ED LOS.


Assuntos
Cetoacidose Diabética/diagnóstico , Cetoacidose Diabética/terapia , Serviço Hospitalar de Emergência/organização & administração , Testes Imediatos , Melhoria de Qualidade , Tempo para o Tratamento , Adolescente , Glicemia/análise , Criança , Pré-Escolar , Diagnóstico Tardio/prevenção & controle , Diabetes Mellitus Tipo 1/complicações , Feminino , Hidratação , Guias como Assunto , Hospitais Pediátricos , Humanos , Hipoglicemiantes/uso terapêutico , Lactente , Insulina/uso terapêutico , Tempo de Internação , Masculino , Equipe de Assistência ao Paciente , Wisconsin , Adulto Jovem
14.
Acta Trop ; 200: 105176, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31526777

RESUMO

BACKGROUND: Introduced in June 2017 by the World Health Organization (WHO) as a Neglected Tropical Diseases, snakebite envenoming is a global health problem. In Costa Rica, an incidence of 15 per 100,000 inhabitants and a mortality rate of 0.15 per 100,000 inhabitants per year were reported from 2005-2012. Children are also affected and prone to complications. METHODS: Retrospective descriptive 14-year study of children with envenomings by Viperidae snakebites managed at the tertiary pediatric hospital in Costa Rica. FINDINGS: 80 patients (pts) were included and classified as having mild (17 pts, 29.3%), moderate (58 pts, 72.5%) or severe (5 pts, 6.2%) envenoming. 52/80 (65%) patients received treatment within the first four hours, three (3.75%) between 5-8 h, three between 9-12 h, four (4%) between 13-16 h, two (2.5%) between 17-20 h, and seven (8.75%) after 20 h. Edema was documented in 76/80 (95%), pain in 58 (72.5%), local bleeding in 23 (28.8%), emesis in 10 (12.5%), bullae formation in 8 (10%), and tissue necrosis in three (3.8%) pts. Complications presented according with degree of envenoming, being more common in severe cases: wound infection occurred in 14/58 (24.1%) with moderate envenoming and 5/5 pts with severe envenoming (p < 0.0001), bleeding presented in 3/58 (5.2%) with moderate cases, and 2/5 (40%) in pts with severe envenoming (p = 0.004); and compartmental syndrome occurred in 3/17 (17.6%) pts with mild envenoming, in 33/58 (56.9%), and 5/5 of moderate and severe envenomed pts, respectively (p = 0.0014). Sequelae were documented 25/80 (31%).


Assuntos
Antivenenos/uso terapêutico , Hospitais Pediátricos/estatística & dados numéricos , Doenças Negligenciadas/terapia , Mordeduras de Serpentes/tratamento farmacológico , Mordeduras de Serpentes/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Viperidae , Adolescente , Animais , Criança , Pré-Escolar , Costa Rica/epidemiologia , Feminino , Humanos , Incidência , Lactente , Masculino , Estudos Retrospectivos
15.
Klin Padiatr ; 231(6): 313-319, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31525782

RESUMO

BACKGROUND: Pediatrics are often regarded as a "victim" of the German Diagnosis related Groups (G-DRG) system because the economic situation of many pediatric hospitals has deteriorated since the introduction of the G-DRG system in 2004. This is often attributed to an insufficient case mix of pediatric diagnoses. It is unknown if revenues are lost due to an insufficient qualification of coding staff. METHODS: All members of the German Society of Pediatric Hospitals and Departments (GKinD) were invited to an online survey by e-mail. RESULTS: 177 (52%) of the 340 german children's hospitals delivered complete questionnaires. 52% of the hospitals employed codings staff that had no additional clinical duties. Coding staff had no specific professional training and did not undergo specific ongoing education in 47 and 32% of the hospitals, respectively. During absence, 35% of coding staff a no substitute or a non-pediatric substitute. 2,8% of the senior physicians judged the established structures as "bad" or "very bad". DISCUSSION: In many german children's hospitals, diagnoses are documented by coding staff with an insufficient qualification. This is associated with the risk of inaccurate or incomplete coding and can threaten the economic success of the hospital. The senior physicians are satisfied with the established coding structures, thus they might be unaware of the great economic potenzial of improvements of the coding quality. CONCLUSION: The economic situation of german children's hospitals could be significantly improved by recruitment of qualified, full-time coding staff.


Assuntos
Grupos Diagnósticos Relacionados/economia , Grupos Diagnósticos Relacionados/estatística & dados numéricos , Administração Hospitalar/economia , Administração Hospitalar/estatística & dados numéricos , Hospitais Pediátricos , Médicos/economia , Criança , Alemanha , Humanos , Mecanismo de Reembolso , Inquéritos e Questionários
17.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31484676

RESUMO

More than 21 million low-income children rely on free or reduced-price meals during the school year. The US Department of Agriculture Summer Food Service Program (SFSP) provides meals to children during the summer months, but these programs are underused. The emergency department (ED) of urban medical centers is 1 of the few establishments that children access during the summer months, and as such, it may be a prime point of entry for such programs. This advocacy case study describes the implementation and evaluation of situating an SFSP in the pediatric ED and explores the impact on participant intention to connect with community resources after the ED visit. In this 7-week pilot, we partnered with a community agency to provide free lunch to all children ages 2 to 18 during their ED visit at an urban, freestanding children's hospital. After patient rooming and clarification of nil per os status, boxed meals were delivered to patients and siblings along with information regarding the SFSP and how to access community program sites. Parents completed a survey about the experience with the meal program in the ED, previous knowledge of the SFSP, and intention to use community SFSP sites in the future. This case study demonstrates that situating the SFSP in the acute-care clinical setting is acceptable and has strong potential to improve the historically poor connection between families and critical community resources. Additionally, this project highlights the potential of community-clinical partnerships to improve family resources and enhance the reach of established programs.


Assuntos
Serviço Hospitalar de Emergência , Serviços de Alimentação , Abastecimento de Alimentos , Refeições , Adolescente , Criança , Pré-Escolar , Hospitais Pediátricos , Hospitais Urbanos , Humanos , Projetos Piloto , Pobreza , Avaliação de Programas e Projetos de Saúde , Estações do Ano , Estados Unidos , United States Department of Agriculture , População Urbana
18.
BMC Infect Dis ; 19(1): 757, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31470805

RESUMO

BACKGROUND: Human metapneumovirus (HMPV) is an important respiratory pathogen that causes seasonal epidemics of acute respiratory illness and contributes significantly to childhood pneumonia. Current knowledge and understanding on its patterns of spread, prevalence and persistence in communities in low resource settings is limited. METHODS: We present findings of a molecular-epidemiological analysis of nasal samples from children < 5 years of age admitted with syndromic pneumonia between 2007 and 2016 to Kilifi County Hospital, coastal Kenya. HMPV infection was detected using real-time RT-PCR and positives sequenced in the fusion (F) and attachment (G) genes followed by phylogenetic analysis. The association between disease severity and HMPV subgroup was assessed using Fisher's exact test. RESULTS: Over 10 years, 274/6756 (4.1%) samples screened were HMPV positive. Annual prevalence fluctuated between years ranging 1.2 to 8.7% and lowest in the recent years (2014-2016). HMPV detections were most frequent between October of one year to April of the following year. Genotyping was successful for 205/274 (74.8%) positives revealing clades A2b (41.0%) and A2c (10.7%), and subgroups B1 (23.4%) and B2 (24.9%). The dominance patterns were: clade A2b between 2007 and 11, subgroup B1 between 2012 and 14, and clade A2c in more recent epidemics. Subgroup B2 viruses were present in all the years. Temporal phylogenetic clustering within the subgroups for both local and global sequence data was seen. Subgroups occurring in each epidemic season were comprised of multiple variants. Pneumonia severity did not vary by subgroup (p = 0.264). In both the F and G gene, the sequenced regions were found to be predominantly under purifying selection. CONCLUSION: Subgroup patterns from this rural African setting temporally map with global strain distribution, suggesting a well-mixed global virus transmission pool of HMPV. Persistence in the local community is characterized by repeated introductions of HMPV variants from the global pool. The factors underlying the declining prevalence of HMPV in this population should be investigated.


Assuntos
Metapneumovirus/classificação , Metapneumovirus/isolamento & purificação , Infecções por Paramyxoviridae , Pneumonia , Idade de Início , Pré-Escolar , Epidemias , Feminino , Genótipo , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Quênia/epidemiologia , Masculino , Metapneumovirus/genética , Infecções por Paramyxoviridae/epidemiologia , Infecções por Paramyxoviridae/virologia , Admissão do Paciente/estatística & dados numéricos , Filogenia , Pneumonia/epidemiologia , Pneumonia/virologia , Vigilância da População , Prevalência , Reação em Cadeia da Polimerase em Tempo Real , Estações do Ano
20.
N Z Med J ; 132(1500): 59-69, 2019 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-31415500

RESUMO

AIM: Child restraint practices among New Zealand children have fallen short of best practice recommendations. In 2013, New Zealand child restraint legislation was amended. The aim of the present study was to determine the child restraint practices of a cohort of children admitted to hospital and how practices have changed since the amendment in child restraint legislation. METHODS: We conducted interviews with the parents of 300 paediatric inpatients aged 0-13 years. Data were recorded on their child's usual child restraint use, the restraint used during their trip to hospital, and parental knowledge of child restraint law and best practice recommendations. We compared their responses with those of our survey published in 2013, which was performed before the amendment in child restraint legislation. RESULTS: The median age of the 300 children was three years: 181 (60%) were aged 0-4 years, 65 (22%) 5-9 years and 54 (18%) 10-13 years. One hundred and thirty-six (45%) were girls. Of children <5 years of age, 97% always used a child restraint. Of children 5-9 years of age, 60% always used a child restraint, 12% sometimes and 28% never. A significantly greater proportion of 5-9 year-old children used a child restraint at least some of the time in the present study compared to the 2013 study (47/65 versus 27/53, OR 2.49 [95%CI 1.09-5.81]). Child restraint use declined in children <6 years of age. On their journey to hospital, five children used no restraint, four of whom were held in the arms of a caregiver. Parental knowledge of child restraint recommendations correlated inversely with their compliance with the recommendations (OR 0.33 [95%CI 0.11-0.91]). CONCLUSIONS: Consideration should be given to extending child restraint legislation to children older than seven years of age. Further studies could explore the barriers parents face to the use of child restraints and the potential effect of extending child restraint laws to older children.


Assuntos
Sistemas de Proteção para Crianças/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Pais , Automóveis , Criança , Pré-Escolar , Feminino , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Masculino , Nova Zelândia/epidemiologia , Inquéritos e Questionários
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