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1.
Public Health Res Pract ; 30(1)2020 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-32152619

RESUMO

OBJECTIVE: Hospital falls are a major cause of costly harm. This descriptive epidemiological study reports the results of a data linkage and medical record review to examine the relative utility of these methods for identifying paediatric in-hospital falls. Type of program or service: The study was conducted across two tertiary and quaternary specialist paediatric hospitals in New South Wales (NSW), Australia. METHODS: A retrospective audit was conducted of paediatric falls occurring in hospital between 1 July 2015 and 30 June 2016. Falls were identified using two systems: the Incident Information Management System (IIMS) and medical records coded data (MRCD). These data were linked, and falls were verified using medical record review. RESULTS: Of the 146 in-hospital falls identified, only 28 (19%percnt;) were included in both systems. The IIMS identified 137 falls, with five excluded. The MRCD identified 63 admissions in which falls occurred, with 27 excluded, and screening of clinical notes found 42 falls in the remaining 36 admissions. LESSONS LEARNT: There was a discrepancy in the number of falls identified in the two administrative datasets due to different inclusion criteria. The medical record review provided additional practice-relevant information that was unavailable within the two datasets. This descriptive epidemiological study highlights the value of combining data linkage with medical record review, but also the need for more critical reflection on the methods used to collect and report falls data in Australian hospitals, so that comprehensive and accurate data can be used to inform quality and safety interventions. This analysis will inform improvements to data capture methods and provide data to advise paediatric falls prevention strategies within the NSW paediatric hospital context.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Hospitalização , Hospitais Pediátricos , Acidentes por Quedas/prevenção & controle , Adolescente , Criança , Pré-Escolar , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Armazenamento e Recuperação da Informação , Masculino , New South Wales , Estudos Retrospectivos
2.
BMC Infect Dis ; 20(1): 132, 2020 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-32050912

RESUMO

BACKGROUND: Community-acquired pneumonia (CAP) is one of the leading worldwide causes of childhood morbidity and mortality. Its disease burden varies by age and etiology and is time dependent. We aimed to investigate the annual and seasonal patterns in etiologies of pediatric CAP requiring hospitalization. METHODS: We conducted a retrospective study in 30,994 children (aged 0-18 years) with CAP between 2010 and 2015 at 23 nationwide hospitals in South Korea. Mycoplasma pneumoniae (MP) pneumonia was clinically classified as macrolide-sensitive MP, macrolide-less effective MP (MLEP), and macrolide-refractory MP (MRMP) based on fever duration after initiation of macrolide treatment, regardless of the results of in vitro macrolide sensitivity tests. RESULTS: MP and respiratory syncytial virus (RSV) were the two most commonly identified pathogens of CAP. With the two epidemics of MP pneumonia (2011 and 2015), the rates of clinical MLEP and MRMP pneumonia showed increasing trends of 36.4% of the total MP pneumonia. In children < 2 years of age, RSV (34.0%) was the most common cause of CAP, followed by MP (9.4%); however, MP was the most common cause of CAP in children aged 2-18 years of age (45.3%). Systemic corticosteroid was most commonly administered for MP pneumonia. The rate of hospitalization in intensive care units was the highest for RSV pneumonia, and ventilator care was most commonly needed in cases of adenovirus pneumonia. CONCLUSIONS: The present study provides fundamental data to establish public health policies to decrease the disease burden due to CAP and improve pediatric health.


Assuntos
Infecções Comunitárias Adquiridas/etiologia , Pneumonia por Mycoplasma/epidemiologia , Pneumonia Viral/epidemiologia , Infecções por Vírus Respiratório Sincicial/epidemiologia , Infecções por Adenoviridae/tratamento farmacológico , Infecções por Adenoviridae/epidemiologia , Infecções por Adenoviridae/etiologia , Adolescente , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Macrolídeos/uso terapêutico , Masculino , Pneumonia por Mycoplasma/tratamento farmacológico , Pneumonia por Mycoplasma/etiologia , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/etiologia , República da Coreia/epidemiologia , Infecções por Vírus Respiratório Sincicial/tratamento farmacológico , Infecções por Vírus Respiratório Sincicial/etiologia , Vírus Sincicial Respiratório Humano/patogenicidade , Estudos Retrospectivos , Estações do Ano
3.
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.
Ann R Coll Surg Engl ; 102(4): 271-276, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31918560

RESUMO

INTRODUCTION: There has been regular dialogue regarding the importance of developing clinical networks to compensate for the steady decline in general paediatric surgery performed by adult surgeons. Despite this dialogue, there are no contemporary published data to quantify the issue. This report documents patterns in delivery of general paediatric surgery in England and shows what is being performed where and by whom. MATERIALS AND METHODS: Using the Surgical Workload Outcome Database, we compared hospital-level data between 2009 and 2017. Inclusion criteria were children under 18 years admitted to NHS hospitals in England for elective general paediatric surgery. Data were analysed with an online statistical package performing paired t-tests. RESULTS: There was no real change in the overall number of elective general paediatric surgical marker cases, but the type mix has changed. The number of marker cases performed by adult surgeons fell by 34% (4699 vs 3090 p < 0.05). The number of marker cases performed by specialist paediatric surgeons increased by 21% (8184 vs 9862 p < 0.05). This increase in workload occurred in both tertiary (21% increase) and peripheral (18% increase) centres. When analysing data by operation type it was apparent that 78% of the increased workload was attributable to an increase in orchidopexy rate. CONCLUSION: Best practice is to treat children close to home by staff with the right skills. This study shows significant shifts in the general paediatric surgical workload. It is important to monitor these trends for successful succession planning as well as configuration of services.


Assuntos
Procedimentos Cirúrgicos Eletivos/tendências , Hospitais Gerais/tendências , Hospitais Pediátricos/tendências , Centro Cirúrgico Hospitalar/tendências , Carga de Trabalho/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Inglaterra , Feminino , Planejamento Hospitalar/organização & administração , Hospitais Gerais/estatística & dados numéricos , Hospitais Pediátricos/organização & administração , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Especialização/estatística & dados numéricos , Especialização/tendências , Medicina Estatal/organização & administração , Medicina Estatal/estatística & dados numéricos , Medicina Estatal/tendências , Cirurgiões/estatística & dados numéricos , Cirurgiões/tendências , Centro Cirúrgico Hospitalar/estatística & dados numéricos
5.
BMC Health Serv Res ; 20(1): 28, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914990

RESUMO

BACKGROUND: Moderate and deep sedation are well-established techniques in many developed countries, and several guidelines have been published. However, they have received attention in China only in recent years. The aim of this study is to investigate current paediatric sedation practices in tertiary children's hospitals and tertiary maternity and children hospitals in China. METHODS: All tertiary children's hospitals and tertiary maternity and children hospitals registered with the National Health Commission of the People's Republic of China were invited to participate in an electronic survey, which included information on the sedation caseload, facility availability, staff structure, clinical skill requirements for sedation providers, fasting guidelines, patient-monitoring practices, and choice of sedatives. RESULTS: Fifty-eight of the 63 hospitals that completed the survey (92.1%) provided moderate and deep sedation. Dedicated sedation rooms and post-sedation recovery rooms were found in 14 (24.1%) and 19 (32.8%) hospitals, respectively. Sedation for non-invasive procedures was primarily performed by anaesthesiologists (69.0%); however, 75.9% of the sedation providers had not received paediatric basic or advanced life-support training. Children were asked to fast from clear liquids for at least 2 h in 44.8% of hospitals and up to 6 h in 5.2% of hospitals; they were asked to fast from solid food/milk for at least 4 h in 27.6% of hospitals and more than 8 h in 1.7% of hospitals. The most commonly used sedative in all groups was chloral hydrate. For rescue, propofol was the most widely used sedative, particularly for children older than 4 years. CONCLUSIONS: Moderate and deep sedation practices vary widely in tertiary children's hospitals and tertiary maternity and children hospitals in China. Optimised practices should be established to improve the quality of moderate and deep sedation.


Assuntos
Sedação Consciente/estatística & dados numéricos , Sedação Profunda/estatística & dados numéricos , Maternidades/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Criança , Pré-Escolar , China , Pesquisas sobre Serviços de Saúde , Humanos , Lactente
6.
J Surg Res ; 246: 93-99, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31562991

RESUMO

BACKGROUND: Ninety-four percent of congenital anomalies occur in low- and middle-income countries. In Uganda, only three pediatric surgeons and three pediatric anesthesiologists serve more than 20 million children. This study estimates burden, outcomes, coverage, and economic benefit of neonatal surgical conditions in Uganda. METHODS: A prospectively collected database was reviewed for neonatal surgical admissions from January 1, 2012, to December 31, 2017, at the only two sites with specialist pediatric surgical coverage. Outcomes were compared with high-income countries. Met and unmet need were estimated using disability-adjusted life years. Economic benefit was estimated using a value of statistical life-year approach. RESULTS: For 1313 neonatal admissions, the median age of presentation was 3 d, overall mortality was 36%, and median distance traveled was 40 km. Anorectal malformations were most common (18%). Postoperative mortality was 24%. Mortality was significantly associated with surgical intervention (P < 0.0001). Met need was 4181 disability-adjusted life years per year, which corresponds to a $3.5 million net economic benefit to Uganda, with a potential additional benefit of $153 million if unmet need were fully addressed. Approximately 2% of the total need is met by the health care system. CONCLUSIONS: Neonatal surgery is associated with improved survival for most conditions. Despite increases in workforce and infrastructure, a limited proportion of the need for neonatal surgery is currently being met. This is multifactorial, including lack of access to surgical care and severe shortages of workforce and infrastructure. Current and potential economic benefit to Uganda appears substantial.


Assuntos
Efeitos Psicossociais da Doença , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Doenças do Recém-Nascido/cirurgia , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Análise Custo-Benefício , Feminino , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/economia , Mão de Obra em Saúde/economia , Mão de Obra em Saúde/estatística & dados numéricos , Mortalidade Hospitalar , Hospitais Pediátricos/economia , Humanos , Recém-Nascido , Doenças do Recém-Nascido/economia , Doenças do Recém-Nascido/epidemiologia , Masculino , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Procedimentos Cirúrgicos Operatórios/economia , Taxa de Sobrevida , Uganda/epidemiologia
7.
Neurosciences (Riyadh) ; 24(4): 257-263, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31872803

RESUMO

OBJECTIVE: To review the experience of 2 tertiary centers in Saudi Arabia with intracranial hypertension (IH) in the pediatric population. METHODS: We retrospectively reviewed and analyzed pediatric patients diagnosed with IH from June 2002 to May 2017 in 2 institutes. RESULTS: We identified 53 patients (30 females and 23 males) with a mean age of 7 years at the time of presentation. Among them, 41 patients were younger than 12 years, and 12 were older. Obese and overweight patients constituted 27.00% (n = 14) of all cases, 8 (66.7%) of whom were older than 12 years. The most common presenting feature was papilledema followed by headache. Vitamin D deficiency, which constituted the most common associated condition, was identified in 12 (22.6%) patients. Acetazolamide was the treatment option in 98.11% of patients, and only 5.7% underwent surgical interventions. The length of follow-up ranged from 6 months to 8 years. CONCLUSION: Intracranial hypertension is rare in children and commonly seen in overweight females older than 12 years similar to adults. Patients younger than 12 years tend to develop secondary IH. More studies are needed to characterize the clinical presentation and guide the management plan.


Assuntos
Cefaleia/epidemiologia , Hipertensão Intracraniana/complicações , Obesidade/epidemiologia , Papiledema/epidemiologia , Deficiência de Vitamina D/epidemiologia , Acetazolamida/uso terapêutico , Criança , Pré-Escolar , Diuréticos/uso terapêutico , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Hipertensão Intracraniana/tratamento farmacológico , Hipertensão Intracraniana/epidemiologia , Hipertensão Intracraniana/patologia , Masculino , Arábia Saudita , Centros de Atenção Terciária/estatística & dados numéricos
8.
PLoS One ; 14(12): e0225607, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31869341

RESUMO

BACKGROUND: Pediatric patients undergoing invasive operations bear extra risk of developing nosocomial infections (NIs). However, epidemiological evidence of the underlying risk factors, which is needed for early prevention, remains limited. METHODS: Using data from the electronic medical records and the NI reporting system of a tertiary pediatric hospital, we conducted a retrospective analysis to identify preoperative and operation-related risk factors for postoperative NIs. Multivariable accelerated failure time models were fitted to select independent risk factors. The performance of these factors in risk stratification was examined by comparing the empirical risks between the model-defined low- and high-risk groups. RESULTS: A total of 18,314 children undergoing invasive operations were included for analysis. After a follow-up period of 154,700 patient-days, 847 postoperative NIs were diagnosed. The highest postoperative NI rate was observed for operations on hemic and lymphatic system. Surgical site infections were the NI type showing the highest overall risk; however, patients were more likely to develop urinary tract infections in the first postoperative week. Older age, higher weight-for-height z-score, longer preoperative ICU stay, preoperative enteral nutrition, same-day antibiotic prophylaxis, and higher hemoglobin level were associated with delayed occurrence of postoperative NIs, while longer preoperative hospitalization, longer operative duration, and higher American Society of Anesthesiologists score showed acceleration effects. Risk stratification based on these factors in an independent patient population was moderate, resulting in a high-risk group in which 72% of the postoperative NIs were included. CONCLUSIONS: Our findings suggest that pediatric patients undergoing invasive operations and at high risk of developing postoperative NIs are likely to be identified using basic preoperative and operation-related risk factors, which together might lead to moderately accurate risk stratification but still provide valuable information to guide early and judicious prevention.


Assuntos
Infecção Hospitalar/epidemiologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Infecções Urinárias/epidemiologia , Pré-Escolar , China/epidemiologia , Infecção Hospitalar/etiologia , Feminino , Seguimentos , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Masculino , Modelos Biológicos , Período Pré-Operatório , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Infecção da Ferida Cirúrgica/etiologia , Centros de Atenção Terciária/estatística & dados numéricos , Infecções Urinárias/etiologia
9.
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
10.
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
11.
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
12.
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
13.
Pharm. pract. (Granada, Internet) ; 17(3): 0-0, jul.-sept. 2019. graf
Artigo em Inglês | IBECS | ID: ibc-188114

RESUMO

Background: Drug utilisation studies from paediatric hospitals that do not have access to patient level data on medication use are limited by a lack of standardised units of measures that reflect the varying daily dosage requirements among patients. The World Health Organization's defined daily dose is frequently used in adult hospitals for benchmarking and longitudinal analysis but is not endorsed for use in paediatric populations. Objective: Explore agreement between standard adult-based defined daily doses (DDD) and paediatric estimates of daily injectable antibiotic use in a Paediatric Intensive Care Unit that does not have access to individual patient-level data. Methods: Hospital pharmacy antibiotic use reports and age-specific occupied bed-day data from 1 January 2010 to 31 May 2016 were extracted. Paediatric reference dosages and frequencies for antibiotics were defined and applied to three paediatric units of measure. Measures were applied to extracted data, measured in the adult DDD and each of the paediatric measures was assessed visually via Bland-Altman plots and linear regression for each antibiotic. Results: Thirty one different antibiotics were used throughout the study period. Despite varying daily dosages in grams, the daily use of vials was unchanged from birth to 18 years for thirteen antibiotics. Agreement between DDD and vial-based measures was closer than the total recommended daily dose that did not account for wastage during preparation and administration. Vial-based measures were unaffected by vial size changes due to drug shortage. Conclusions: Agreement between the DDD and vial-based measures of use supports the use of DDD for select antibiotics that may be targeted by antimicrobial stewardship programs. Vial based measures should be further explored in hospitals with single vial policies; detailed understanding of hospital practice is needed before inter-hospital comparisons are made


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Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Prescrições de Medicamentos/estatística & dados numéricos , Antibacterianos/uso terapêutico , Controle de Doenças Transmissíveis/métodos , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Estudos Retrospectivos , Atenção Terciária à Saúde/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Padrões de Referência , Qualidade da Assistência à Saúde
14.
Pediatrics ; 144(3)2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31420369

RESUMO

BACKGROUND: The 13-valent pneumococcal conjugate vaccine (PCV13) was licensed in the United States in 2010. We describe invasive pneumococcal disease (IPD) in children at 8 children's hospitals in the US from 2014 to 2017. METHODS: Children with IPD occurring from 2014 to 2017 were identified from a prospective study. Demographic and clinical data, including results of any immune evaluation along with the number and dates of previous pneumococcal conjugate vaccines administered, were recorded on case report forms. Isolate serotypes were determined in a central laboratory. Pneumococcal conjugate vaccine doses were counted if IPD occurred ≥2 weeks after a dose. RESULTS: PCV13 serotypes accounted for 23.9% (115 out of 482) of IPD isolates from 2014 to 2017. Serotypes 3, 19A, and 19F accounted for 91% of PCV13 serotypes. The most common non-PCV13 serotypes were 35B, 23B, 33F, and 22F. An underlying condition was significantly (P < .0001) more common in children with IPD due to non-PCV13 serotypes (200 out of 367, 54.5%) than for children with PCV13 serotypes (27 out of 115, 23.5%). An immune evaluation was undertaken in 28 children who received ≥2 PCV13 doses before IPD caused by a PCV13 serotype. Only 1 was found to have an immunodeficiency. CONCLUSIONS: PCV13 serotypes (especially serotypes 3, 19A, and 19F) continue to account for nearly a quarter of IPD in US children 4 to 7 years after PCV13 was introduced. Underlying conditions are more common in children with non-PCV13 serotype IPD. Immune evaluations in otherwise healthy children with PCV13 serotype IPD despite receiving ≥2 PCV13 doses did not identify an immunodeficiency.


Assuntos
Infecção Hospitalar/epidemiologia , Hospitais Pediátricos/estatística & dados numéricos , Infecções Pneumocócicas/epidemiologia , Antibacterianos/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/imunologia , Infecção Hospitalar/virologia , Suscetibilidade a Doenças/virologia , Humanos , Esquemas de Imunização , Hospedeiro Imunocomprometido , Testes de Sensibilidade Microbiana , Infecções Pneumocócicas/tratamento farmacológico , Infecções Pneumocócicas/imunologia , Infecções Pneumocócicas/virologia , Vacinas Pneumocócicas/classificação , Estudos Retrospectivos , Sorogrupo , Estados Unidos/epidemiologia , Vacinas Conjugadas/classificação
15.
Health Serv Res ; 54(5): 1007-1015, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31388994

RESUMO

OBJECTIVE: To examine the impact of a Medicaid-serving pediatric accountable care organization (ACO) on health service use by children who qualify for Medicaid by virtue of a disability under the "aged, blind, and disabled" (ABD) eligibility criteria. DATA SOURCES/STUDY SETTING: We evaluated a 2013 Ohio policy change that effectively moved ABD Medicaid children into an ACO model of care using Ohio Medicaid administrative claims data for years 2011-2016. STUDY DESIGN: We used a difference-in-difference design to examine changes in patterns of health care service use by ABD-enrolled children before and after enrolling in an ACO compared with ABD-enrolled children enrolled in non-ACO managed care plans. DATA COLLECTION/EXTRACTION METHODS: We identified 17 356 children who resided in 34 of 88 counties as the ACO "intervention" group and 47 026 ABD-enrolled children who resided outside of the ACO region as non-ACO controls. PRINCIPAL FINDINGS: Being part of the ACO increased adolescent preventative service and decreased use of ADHD medications as compared to similar children in non-ACO capitated managed care plans. Relative home health service use decreased for children in the ACO. CONCLUSIONS: Our overall results indicate that being part of an ACO may improve quality in certain areas, such as adolescent well-child visits, though there may be room for improvement in other areas considered important by patients and their families such as home health service.


Assuntos
Organizações de Assistência Responsáveis/normas , Crianças com Deficiência/reabilitação , Hospitais Pediátricos/estatística & dados numéricos , Hospitais Pediátricos/normas , Programas de Assistência Gerenciada/normas , Medicaid/normas , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Organizações de Assistência Responsáveis/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Crianças com Deficiência/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Programas de Assistência Gerenciada/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Ohio , Estados Unidos
16.
Surgery ; 166(5): 854-860, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31402130

RESUMO

BACKGROUND: Conjoined twins are rare developmental anomalies. There is a paucity of literature other than case reports and small case series. The aim of this study was to examine national outcomes and identify predictors of mortality in newborn conjoined twins. METHODS: We reviewed data on newborn conjoined twins from the Kids' Inpatient Database (1997-2012). RESULTS: A total of 240 patients were identified for a nationally weighted incidence of 1 per 100,000 live births. The majority of conjoined twins were female (n = 190 [81%]). The most commonly associated anomalies were cardiac (n = 87 [36%]), gastrointestinal (n = 41 [17%]), and abdominal wall (n = 32 [13%]) defects. Fifty-six (23%) patients underwent operative procedures, including 28 (12%) neonatal separation surgeries. The overall mortality rate was 61%; most deaths occurred within 24 hours (99 of 146 [68%]) to 48 hours (129 of 146 [88%]) after birth. Mortality was higher in female compared with male children (66% vs 38%, P = .025), premature compared with full-term children (72% vs 44%, P = .007), and in children with extremely low birth weight (95% vs 59%, P = .002). Congenital diaphragmatic hernias were seen in 15 (6%) patients and were uniformly fatal (100% vs 58%, P = .029). Mortality was highest in hospitals not designated as children's hospitals (72%) compared with children's hospitals (44%) (P = .007). CONCLUSION: Conjoined twins are rare anomalies who are susceptible to extremely high perinatal mortality, especially in female children, those who are premature, or those who have low birth weight. These data support caring for these complex patients at hospitals equipped to care for this fragile population.


Assuntos
Anormalidades Múltiplas/mortalidade , Mortalidade Hospitalar , Hospitais Pediátricos/estatística & dados numéricos , Gêmeos Unidos , Feminino , Idade Gestacional , Humanos , Incidência , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Estados Unidos/epidemiologia
17.
Am J Health Syst Pharm ; 76(11): 815-819, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31361813

RESUMO

PURPOSE: The study analyzes the effectiveness and safety of a higher than standard enoxaparin dosing protocol implemented for pediatric patients requiring initiation of therapeutic anticoagulation. METHODS: A retrospective review of 2 enoxaparin dosing and monitoring protocols was performed. The standard protocol used 1.5 mg/kg/dose (in patients <3 months of age) and 1 mg/kg/dose (in patients ≥3 months of age) with anti-Xa monitoring following the first dose. The high-dose protocol was implemented at 1.7 mg/kg/dose (in patients <3 months of age), 1.5 mg/kg/dose (in patients 3 through 11 months of age), 1.2 mg/kg/dose (in patients 1 through 4 years of age), and 1.1 mg/kg/dose (in patients 5 through 17 years of age), with anti-Xa monitoring after the second dose. Primary outcomes were number of dosing changes prior to and time to first target anti-Xa level. Secondary outcomes included percentage of patients with anti-Xa levels above target level. RESULTS: The median number of dose changes required to achieve a target anti-Xa level was 1 (interquartile range [IQR], 0-1.5) and 0 (IQR, 0-1) for the standard-dose (n = 87) and high-dose groups (n = 132) (p = 0.17), respectively. The median number of dose adjustments to achieve target anti-Xa levels in the 3 through 11 months of age subgroup declined from 2 (IQR, 1-3.25) to 0 (IQR, 0-1) in the standard- versus high-dose groups, respectively (p < 0.01). No difference was seen in other age subgroups. Patients with above-target levels did not differ statistically between groups. CONCLUSION: Initiating enoxaparin at higher doses in pediatric patients may result in fewer dosing changes than standard dosing. Benefit was demonstrated for the 3-11 months of age high-dose subgroup. Across all groups, the high-dose strategy was safe and did not result in a statistically significant increase in above-target levels.


Assuntos
Monitoramento de Medicamentos/métodos , Enoxaparina/administração & dosagem , Inibidores do Fator Xa/administração & dosagem , Adolescente , Coagulação Sanguínea/efeitos dos fármacos , Criança , Pré-Escolar , Relação Dose-Resposta a Droga , Enoxaparina/efeitos adversos , Enoxaparina/sangue , Inibidores do Fator Xa/efeitos adversos , Inibidores do Fator Xa/sangue , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Masculino , Estudos Retrospectivos
18.
Emerg Med J ; 36(9): 529-534, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31326954

RESUMO

BACKGROUND: Trauma team activation criteria have a variable performance in the paediatric population. We aimed to identify predictors for high-level resource utilisation during trauma resuscitation in the ED. METHODS: A retrospective study was conducted in the ED of a tertiary paediatric hospital. Patient data were collected from trauma surveillance registry and analysis was performed to identify significant predictors. We then assessed the sensitivity and specificity of proposed models with respect to observed patient outcomes. RESULTS: Among 11 282 cases, the mean age was 6.1±4.9 (SD) years old. Fall was the most common mechanism of injury in 7364 (65.3%) patients. Eighty-eight (0.8%) patients required at least one high-level resource. Significant predictors for high-resource utilisation were overall GCS of <14 (relative risk (RR) 38.841, 95% CI 21.328 to 70.739, p<0.001), high-risk mechanisms of fall from height and motor vehicle collision (RR 7.863, 95% CI 4.687 to 13.192, p<0.001), as well as age-specific tachycardia (RR 1.796, 95% CI 1.145 to 2.817, p=0.0108). A model consisting of GCS and high-risk mechanism would under-triage 21 (0.2%) patients and over-triage 681 (6.0%) patients. When age-specific tachycardia was added, 8 (0.1%) less patients would be under-triaged but an additional 3251 (28.9%) patients would be over-triaged. CONCLUSION: As utilisation of high-level resources in paediatric trauma was rare, it was difficult to find an appropriate balance between under-triage and over-triage. Between the two, minimising the proportion of under-triage is more important as patient safety is paramount in paediatric trauma care.


Assuntos
Utilização de Instalações e Serviços/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Ressuscitação/estatística & dados numéricos , Ferimentos e Lesões/terapia , Criança , Pré-Escolar , Utilização de Instalações e Serviços/organização & administração , Utilização de Instalações e Serviços/normas , Feminino , Escala de Coma de Glasgow/estatística & dados numéricos , Hospitais Pediátricos/organização & administração , Hospitais Pediátricos/normas , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Masculino , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Sistema de Registros/estatística & dados numéricos , Ressuscitação/normas , Estudos Retrospectivos , Singapura , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/normas , Centros de Atenção Terciária/estatística & dados numéricos , Centros de Traumatologia/organização & administração , Centros de Traumatologia/normas , Centros de Traumatologia/estatística & dados numéricos , Triagem/organização & administração , Triagem/normas , Triagem/estatística & dados numéricos , Ferimentos e Lesões/diagnóstico
19.
PLoS One ; 14(7): e0219514, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31291345

RESUMO

OBJECTIVES: The main purpose of this paper was to model the process by which patients enter the ED, are seen by physicians, and discharged from the Emergency Department at Nationwide Children's Hospital, as well as identify modifiable factors that are associated with ED lengths of stay through use of multistate modeling. METHODS: In this study, 75,591 patients admitted to the ED from March 1st, 2016 to February 28th, 2017 were analyzed using a multistate model of the ED process. Cox proportional hazards models with transition-specific covariates were used to model each transition in the multistate model and the Aalen-Johansen estimator was used to obtain transition probabilities and state occupation probabilities in the ED process. RESULTS: Acuity level, season, time of day and number of ED physicians had significant and varying associations with the six transitions in the multistate model. Race and ethnicity were significantly associated with transition to left without being seen, but not with the other transitions. Conversely, age and gender were significantly associated with registration to room and subsequent transitions in the model, though the magnitude of association was not strong. CONCLUSIONS: The multistate model presented in this paper decomposes the overall ED length of stay into constituent transitions for modeling covariate-specific effects on each transition. This allows physicians to understand the ED process and identify which potentially modifiable covariates would have the greatest impact on reducing the waiting times in each state in the model.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Admissão do Paciente/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores Sexuais , Fatores de Tempo
20.
Artigo em Inglês | MEDLINE | ID: mdl-31262051

RESUMO

Rotavirus is a leading cause of acute diarrhea in children worldwide. Costa Rica recently started universal rotavirus vaccinations for infants with a two-dose schedule in February 2019. We aimed to study the seasonality of rotavirus during the pre-vaccination era. We retrospectively studied a six-year period of hospital admissions due to rotavirus gastroenteritis. We estimated seasonal peak timing and relative intensities using trend-adjusted negative binomial regression models with the δ-method. We assessed the relationship between rotavirus cases and weather characteristics and estimated their effects for the current month, one-month prior and two months prior, by using Pearson correlation coefficients. A total of 798 cases were analyzed. Rotavirus cases predominated in the first five months of the year. On average, the peak of admissions occurred between late-February and early-March. During the seasonal peaks, the monthly count tended to increase 2.5-2.75 times above the seasonal nadir. We found the strongest negative association of monthly hospitalizations and joint percentiles of precipitation and minimal temperature at a lag of two months (R = -0.265, p = 0.027) and we detected correlations of -0.218, -0.223, and -0.226 (p < 0.05 for all three estimates) between monthly cases and the percentile of precipitation at lags 0, 1, and 2 months. In the warm tropical climate of Costa Rica, the increase in rotavirus hospitalizations coincided with dry and cold weather conditions with a two-month lag. The findings serve as the base for predictive modeling and estimation of the impact of a nation-wide vaccination campaign on pediatric rotaviral infection morbidity.


Assuntos
Hospitais Pediátricos/estatística & dados numéricos , Infecções por Rotavirus/epidemiologia , Rotavirus , Estações do Ano , Criança , Pré-Escolar , Temperatura Baixa , Costa Rica/epidemiologia , Diarreia , Feminino , Febre , Hospitalização , Humanos , Programas de Imunização , Lactente , Masculino , Morbidade , Estudos Retrospectivos , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/imunologia , Clima Tropical , Vacinação , Tempo (Meteorologia)
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