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1.
Pediatr Neurol ; 116: 62-67, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33486423

RESUMO

BACKGROUND: The past decades have seen a transformational shift in the understanding and treatment for neurological diseases affecting infants and children. These advances have been driven in part by the pediatric neurology physician-scientist workforce and its efforts. However, pediatric neurology research faces substantial challenges from internal and external forces including work-life balance demands, COVID-19 pandemic effects, and research funding. Understanding the impact of these challenges on the perceptions, planning, and careers of pediatric neurology physician-scientists is needed to guide the research mission. METHODS: Our objective was to survey the research challenges, goals, and priorities of pediatric neurologists. In 2020 we conducted a cross-sectional, 28-question survey emailed to 1,775 members of the Child Neurology Society. RESULTS: One hundred fifty-one individuals responded to the survey. Most respondents were grant investigators (52%) and conducted clinical research (69%). Research areas included epilepsy (23%), neurodevelopmental and autism (16%), neurocritical care and stroke (11%), neurogenetics and neurometabolics (9%), neonatal neurology (8%), and others. The most common funding source was the National Institutes of Health (37%). Shared major research concerns were funding, utilization of remote technology, overcoming disparities, natural history and multicenter studies, global neurology, and diversification of the research portfolio. Commitment to continuing and increasing research efforts was evident. CONCLUSIONS: Our survey demonstrates obstacles for physician-scientist researchers in pediatric neurology, but it also shows optimism about continued opportunity. Creative approaches to address challenges will benefit the research mission, maximize the current and future pool of researchers, and help improve the lives of children with neurological disorders.


Assuntos
Pesquisa Biomédica/estatística & dados numéricos , Neurologistas/estatística & dados numéricos , Pediatras/estatística & dados numéricos , Pesquisadores/estatística & dados numéricos , Estudos Transversais , Humanos , Otimismo , Sociedades Médicas/estatística & dados numéricos , Inquéritos e Questionários , Recursos Humanos
2.
Isr J Health Policy Res ; 9(1): 53, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-33081834

RESUMO

BACKGROUND: Facing the global health crisis of COVID-19, health systems are increasingly supporting the use of telemedicine in ambulatory care settings. It is not clear whether the increased use of telemedicine will persist after the pandemic has resolved. The aims of this study were to assess the use of telemedicine by Israeli pediatricians before and during the first lockdown phase of the pandemic, and to elucidate how they foresee telemedicine as a medium of medical practice in the post-pandemic era. METHODS: A web-based survey was distributed among Israeli pediatricians in May 2020, soon after the end of first lockdown was announced. The survey assessed the frequency of telemedicine use as well as its influence on clinical decision making before and during the first COVID-19 lockdown, using two hypothetical clinical scenarios. The same scenarios were also used to assess how the pediatricians foresaw telemedicine in the post-pandemic period. In addition, administrative data from Maccabi on telemedicine use before, during and after the first lockdown were retrieved and analyzed. RESULTS: One hundred and sixty-nine pediatricians responded to the survey (response rate = 40%). The percentage of respondents who reported daily use of text messages, pictures and videoconferencing increased from 24, 15 and 1% before COVID-19 to 40, 40 and 12% during the lockdown, respectively (p < 0.05). After the pandemic, projected use of text messages and pictures/videoclips was expected to decrease to 27 and 26% of respondents, respectively (p < 0.05), but pictures/videoclips were expected to increase from 15% of respondents before to 26% of respondents after (p < 0.05). The reported high likelihood of treating suspected pneumonia or prescribing antibiotics for suspected otitis media via telemedicine was expected to decrease from 20% of respondents during the COVID-19 lockdown to 6%% of respondents after (p < 0.05), and from 14% of respondents during the lockdown to 3% of respondents after, respectively. (p < 0.05). Maccabi administrative data indicated that during the lockdown, there was an increase in phone visits and a decrease in in-person visits compared to the pre-lockdown levels of use. One month after the end of the first lock-down there was a partial return to baseline levels of in-person visits and a sustained increase in phone visits. Phone visits accounted for 0% of pediatrician visits before the first lockdown, 17% of them during the lockdown, and 19% of them 1 month after the lockdown relaxation. CONCLUSIONS: The study indicates that use of telemedicine technologies by primary care pediatricians increased substantially during the first COVID-19 lockdown. The study also found that pediatricians expected that use levels will recede after the pandemic. As the pandemic continues and evolves, it will be important to continue to monitor the level of telemedicine use as well as expectations regarding post-pandemic use levels.


Assuntos
Atitude do Pessoal de Saúde , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pediatras/psicologia , Pneumonia Viral/prevenção & controle , Atenção Primária à Saúde/organização & administração , Telemedicina/tendências , Adulto , Idoso , Criança , Infecções por Coronavirus/epidemiologia , Feminino , Previsões , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Pediatras/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Política Pública , Quarentena
3.
Ital J Pediatr ; 46(1): 146, 2020 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-33023616

RESUMO

BACKGROUND: There is ample evidence that COVID-19 is significantly less severe in children than in adults and asthma and allergy, the most common chronic disorders in children, are not included in the top 10 comorbidities related to COVID-19 fatalities. Nevertheless, concerns about asthma and allergy are still high.. In order to evaluate the impact of paediatric COVID-19 among Italian paediatricians, we sent a 20-questions anonymous internet-based survey to 250 Italian paediatricians with particular address to allergic symptoms and those affecting the upper airways. METHODS: The questionnaire was conceived and pretested in April 2020, by a working group of experts of the Italian Paediatric Society for Allergy and Immunology (SIAIP), and structured into different sections of 20 categorized and multiple choice questions. The first part included questions about epidemiological data follows by a second part assessing the way to manage a suspected COVID-19 infection and personal experiences about that. The third part concerned questions about patients' clinical characteristics and clinical manifestations. The survey was emailed once between April and mid-May 2020. RESULTS: A total 99 participants had participated in our survey and provided responses to our electronic questionnaire. The distribution of patients reported per month varies significantly according to the geographical area (P = 0.02). Data confirmed that in the North part of Italy the rate of patients referred is higher than in the rest of Italy. Almost all respondents (98%) reported caring for up to a maximum of 10 infected children and the last 2% more than twenty. Among these patients, according to the 75% of responders, a maximum rate of 20% were affected by allergic rhino-conjunctivitis and in particular in the North of Italy while in the Centre and in the South there was a higher incidence (P = 0.09). Almost the same applies for asthma, 83% of responders declared that up to a maximum of 20% of affected children were asthmatic, from 20 to 40% for the 13,5% of responders and from 40 to 60% for the last 3,5%. As for the allergic conjunctivitis also for asthma, we found a higher incidence in the Centre and in South than in the North (P = 0.03). CONCLUSIONS: This study is the first to provide a comprehensive review of COVID-19 knowledge and impact among paediatricians in Italy about allergic asthma and upper airway involvement. From our point of view, it provides important information clearly useful for improving a good practice.


Assuntos
Conjuntivite Alérgica/epidemiologia , Infecções por Coronavirus/epidemiologia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Rinite Alérgica/epidemiologia , Inquéritos e Questionários , Adolescente , Distribuição por Idade , Causalidade , Criança , Conjuntivite Alérgica/diagnóstico , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Feminino , Humanos , Incidência , Itália/epidemiologia , Masculino , Pandemias/prevenção & controle , Pediatras/estatística & dados numéricos , Pediatria/normas , Pneumonia Viral/prevenção & controle , Rinite Alérgica/diagnóstico , Medição de Risco , Distribuição por Sexo , Sociedades Médicas
4.
Cir. pediátr ; 33(4): 188-192, oct. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-195130

RESUMO

OBJETIVO: Analizar parámetros sociolaborales y sociodemográficos para conocer la situación de los cirujanos pediátricos en España. MATERIAL Y MÉTODOS: Se realizó una encuesta de elaboración propia inspirada en modelos de satisfacción laboral. Es un estudio observacional, descriptivo y transversal, realizado online a los cirujanos pediátricos pertenecientes a la Sociedad Española de Cirugía Pediátrica (SECIPE). RESULTADOS: De los 290 cirujanos pediátricos de la SECIPE, 133 contestaron a la encuesta (tasa de respuesta del 45,8%). De estos, el 49,6% tienen entre 30-39 años, habiendo casi igualdad entre hombres y mujeres. El 69% de los encuestados dedican entre el 75 y el 100% de su tiempo de trabajo a la asistencia, el 89,4% dedica entre 0-25% a la investigación y el 80% entre 0 y 25 % a la docencia. Los resultados mostraron satisfacción laboral, tanto en relación con el equipo de trabajo como con la calidad asistencial, las posibilidades de desarrollo profesional o la consideración social. Sin embargo, los encuestados mostraron su disconformidad con respecto al sueldo, al tiempo dedicado a la investigación y a la docencia, y a la relación con la dirección. CONCLUSIÓN: Este estudio permite conocer la situación laboral de los profesionales en España, lo que puede ayudar a identificar medidas de mejora. La encuesta señala un descontento generalizado con el escaso tiempo dedicado a la investigación y poca satisfacción en el trabajo docente. La mayor parte del tiempo se dedica a la práctica clínica, existiendo baja satisfacción salarial, circunstancias que pueden contribuir a la insatisfacción en el desarrollo de la actividad asistencial


OBJECTIVE: To analyze work, demographic, and social parameters in order to learn about the working status of pediatric surgeons in Spain. MATERIALS AND METHODS: A survey inspired in job satisfaction models and designed by the authors was performed. It was an observational, descriptive, cross-border online survey intended for pediatric surgeons from the Spanish Society of Pediatric Surgery (SECIPE). RESULTS: Of the 290 SECIPE pediatric surgeons, 133 responded to the survey (45.8% response rate), of whom 49.6% were 30-39 years old. The number of male and female respondents was virtually the same. 69% of respondents devoted 75-100% of their working hours to healthcare, 89.4% devoted 0-25% to research, and 80% devoted 0-25% to teaching. The survey demonstrated job satisfaction in terms of colleagues, healthcare role, professional development expectations, and social consideration. However, respondents showed disconformity with their pay, the time devoted to research and teaching, and their relationship with the executive board. CONCLUSION: This study sheds light on the Spanish professionals' working status, which can help identify measures for improvement. The survey shows widespread disconformity with the short time devoted to research, and little satisfaction with teaching. Most of the working hours are devoted to clinical practice, with poor pay satisfaction, which can contribute to dissatisfaction in the development of healthcare activity


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Pediatria/organização & administração , Satisfação no Emprego , Qualidade da Assistência à Saúde , Pediatras/organização & administração , Pediatras/estatística & dados numéricos , Sociedades Médicas/organização & administração , Estudos Transversais
5.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32747473

RESUMO

BACKGROUND: One-third of outpatient antibiotic prescriptions for pediatric acute respiratory tract infections (ARTIs) are inappropriate. We evaluated a distance learning program's effectiveness for reducing outpatient antibiotic prescribing for ARTI visits. METHODS: In this stepped-wedge clinical trial run from November 2015 to June 2018, we randomly assigned 19 pediatric practices belonging to the Pediatric Research in Office Settings Network or the NorthShore University HealthSystem to 4 wedges. Visits for acute otitis media, bronchitis, pharyngitis, sinusitis, and upper respiratory infection for children 6 months to <11 years old without recent antibiotic use were included. Clinicians received the intervention as 3 program modules containing online tutorials and webinars on evidence-based communication strategies and antibioti c prescribing, booster video vignettes, and individualized antibiotic prescribing feedback reports over 11 months. The primary outcome was overall antibiotic prescribing rates for all ARTI visits. Mixed-effects logistic regression compared prescribing rates during each program module and a postintervention period to a baseline control period. Odds ratios were converted to adjusted rate ratios (aRRs) for interpretability. RESULTS: Among 72 723 ARTI visits by 29 762 patients, intention-to-treat analyses revealed a 7% decrease in the probability of antibiotic prescribing for ARTI overall between the baseline and postintervention periods (aRR 0.93; 95% confidence interval [CI], 0.90-0.96). Second-line antibiotic prescribing decreased for streptococcal pharyngitis (aRR 0.66; 95% CI, 0.50-0.87) and sinusitis (aRR 0.59; 95% CI, 0.44-0.77) but not for acute otitis media (aRR 0.93; 95% CI, 0.83-1.03). Any antibiotic prescribing decreased for viral ARTIs (aRR 0.60; 95% CI, 0.51-0.70). CONCLUSIONS: This program reduced antibiotic prescribing during outpatient ARTI visits; broader dissemination may be beneficial.


Assuntos
Antibacterianos/uso terapêutico , Educação a Distância/organização & administração , Prescrição Inadequada/prevenção & controle , Atenção Primária à Saúde , Infecções Respiratórias/tratamento farmacológico , Doença Aguda , Bronquite/tratamento farmacológico , Bronquite/virologia , Chicago , Criança , Pré-Escolar , Comunicação , Intervalos de Confiança , Educação a Distância/métodos , Feminino , Humanos , Lactente , Análise de Intenção de Tratamento , Modelos Logísticos , Masculino , Razão de Chances , Otite Média/tratamento farmacológico , Pacientes Ambulatoriais , Enfermagem Pediátrica/educação , Enfermagem Pediátrica/estatística & dados numéricos , Pediatras/educação , Pediatras/estatística & dados numéricos , Faringite/tratamento farmacológico , Faringite/microbiologia , Faringite/virologia , Desenvolvimento de Programas , Melhoria de Qualidade , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/virologia , Sinusite/tratamento farmacológico , Infecções Estreptocócicas/tratamento farmacológico
6.
J Prev Med Hyg ; 61(2): E125-E129, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32802994

RESUMO

Introduction: The global COVID-19 pandemic is placing a heavy burden on health services. One result could be a general reduction in routine vaccination activities. In Tuscany (Central Italy), paediatricians (in agreement with the regional health service) administer and register paediatric vaccinations of their patients. The aim of the present study was to evaluate the impact of the COVID-19 epidemic on paediatric vaccinations administered by Tuscan paediatricians, as a proxy of adherence to vaccinations during this epidemic period. Methods: Four hundred members of the Tuscany section of the Italian Federation of Paediatricians (FIMP) were invited to participate in a semi-structured online survey. Results: During the COVID-19 pandemic, almost all (98.2%) of the 223 respondents reported a general decline in outpatient paediatric visits; 65.8% reported a more than 60% reduction (144 answers) in comparison with the situation before the COVID-19 pandemic. A total of 208 paediatricians (93.3%) continued to vaccinate in the period considered: 66/208 (31.7%) reported a reduction in parents' compliance with mandatory vaccination (hexavalent and MMRV vaccines), and 88/208 (42.3%) reported a reduction in compliance with non-mandatory vaccinations. Almost all paediatricians declared having taken preventive actions to counter the spread of SARS-CoV-2. Discussion and conclusions: Although the majority of Tuscan paediatricians continued to vaccinate during the lock-down, some parents decided to postpone their children's scheduled vaccinations, mainly owing to fears concerning the safety of access to health services. When Italian immunization coverage data on the first months of 2020 become available, it will be possible to assess the real impact of the COVID-19 pandemic on paediatric vaccinations. It is crucial to continue vaccinating against preventable infectious diseases in order to avoid other possible epidemic outbreaks. The pandemic must not be seen as an obstacle to compliance with the vaccination schedule, but rather as an excellent opportunity to underline the importance of all recommended vaccinations.


Assuntos
Atitude do Pessoal de Saúde , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Esquemas de Imunização , Pneumonia Viral/epidemiologia , Padrões de Prática Médica/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Criança , Feminino , Humanos , Itália , Masculino , Pandemias , Pediatras/estatística & dados numéricos , Inquéritos e Questionários
7.
Pediatr Surg Int ; 36(7): 809-815, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32488401

RESUMO

BACKGROUND/PURPOSE: The purpose of this study was to characterize current practices to prevent venous thromboembolism (VTE) in children and measure adherence to recent joint consensus guidelines from the Pediatric Trauma Society and Eastern Association for the Surgery of Trauma (PTS/EAST). METHODS: An 18-question survey was sent to the membership of PTS and the Trauma Center Association of American. Responses were compared with Chi-square test. RESULTS: One hundred twenty-nine members completed the survey. Most respondents were from academic (84.5%), Level 1 pediatric (62.0%) trauma centers. Criteria for VTE prophylaxis varied between hospitals with freestanding pediatric trauma centers significantly more likely to stratify children by risk factors than adult trauma centers (p = 0.020). While awareness of PTS/EAST guidelines (58.7% overall) was not statistically different between hospital types (44% freestanding adult, 52% freestanding pediatric, 71% combined adult pediatric, p = 0.131), self-reported adherence to these guidelines was uniformly low at 37.2% for all respondents. Lastly, in three clinical scenarios, respondents chose VTE screening and prophylaxis plans in accordance with a prospective application of PTS/EAST guidelines 55.0% correctly. CONCLUSION: Currently no consensus regarding the prevention of VTE in pediatric trauma exists. Prospective application of PTS/EAST guidelines has been limited, likely due to poor quality of evidence and a reliance on post-injury metrics. Results of this survey suggest that further investigation is needed to more clearly define the risk of VTE in children, evaluate, and prospectively validate alternative scoring systems for VTE prevention in injured children. LEVEL OF EVIDENCE: N/A-Survey.


Assuntos
Pesquisas sobre Serviços de Saúde/métodos , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Tromboembolia Venosa/prevenção & controle , Ferimentos e Lesões/complicações , Adulto , Criança , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Masculino , Pediatras/estatística & dados numéricos , Fatores de Risco , Sociedades Médicas , Estados Unidos , Tromboembolia Venosa/etiologia
8.
J Surg Res ; 255: 181-187, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32563758

RESUMO

BACKGROUND: Pediatric thyroid cancer rates are rising. The aim of this study was to determine the state of current practice and outcomes for pediatric thyroidectomies using the pediatric National Surgical Quality Improvement Program (NSQIP-P) with specific attention to differences based on surgeon type/specialty. METHODS: All cases of pediatric thyroidectomies and neck dissections within the NSQIP-P database were identified from 2015 to 2017. Patient, disease, and treatment-related factors affecting 30-day outcomes were analyzed using univariate and multivariate analyses. RESULTS: A total of 1300 cases were identified. Mean age at time of surgery was 14.0 (SD 3.5) years. The majority of patients were female (78%) and Caucasian (72%). Pediatric general surgeons performed the largest proportion of cases (42%) followed by pediatric otolaryngologists (33%). Malignancies were present in 29% of cases. The overall rate of complications was 3.0%. On multivariate analysis, non-pediatric surgeons were more likely to operate on Caucasian children, malignant pathology, and perform modified radical neck dissections. Pediatric surgeons were more likely to have longer operative times, have specialized in otolaryngology, and operate on sicker children (ASA>2). There were no differences in length of stay or overall complications rates. CONCLUSIONS: This study shows that pediatric surgeons currently perform the majority of thyroid surgeries in children. While unable to assess surgeon volume, our data show that thyroid surgery is being safely performed at NSQIP-affiliated hospitals by both non-pediatric and pediatric surgeons. Further studies are needed to determine if there are differences in specific procedure-related complications and long-term outcomes between surgeon types.


Assuntos
Esvaziamento Cervical/estatística & dados numéricos , Tireoidectomia/estatística & dados numéricos , Adolescente , Criança , Feminino , Humanos , Masculino , Otolaringologia/estatística & dados numéricos , Pediatras/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Melhoria de Qualidade , Estudos Retrospectivos , Cirurgiões/estatística & dados numéricos , Estados Unidos/epidemiologia
9.
Pediatrics ; 145(5)2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32350023

RESUMO

OBJECTIVES: Standing orders are an effective way to increase vaccination rates, yet little is known about how pediatricians use this strategy for childhood immunizations. We assessed current use of, barriers to using, and factors associated with use of standing orders for vaccination among pediatricians. METHODS: Internet and mail survey from June 2017 to September 2017 among a nationally representative sample of pediatricians. In the principal component analysis of barrier items, we identified 2 factors: physician responsibility and concerns about office processes. A multivariable analysis that included barrier scales and physician and/or practice characteristics was used to identify factors associated with use of standing orders. RESULTS: The response rate was 79% (372 of 471); 59% of respondents reported using standing orders. The most commonly identified barriers among nonusers were concern that patients may mistakenly receive the wrong vaccine (68%), concern that patients prefer to speak with the physician about a vaccine before receiving it (62%), and belief that it is important for the physician to be the person who recommends a vaccine to patients (57%). These 3 items also made up the physician responsibility barrier factor. Respondents with higher physician responsibility scores were less likely to use standing orders (risk ratio: 0.59 [95% confidence interval: 0.53-0.66] per point increase). System-level decision-making about vaccines, suburban or rural location, and lower concerns about office processes scores were each associated with use of standing orders in the bivariate, but not the multivariable, analysis. CONCLUSIONS: Among pediatricians, use of standing orders for vaccination is far from universal. Interventions to increase use of standing orders should address physicians' attitudinal barriers as well as organizational factors.


Assuntos
Pediatras/tendências , Prescrições Permanentes , Vacinação/tendências , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pediatras/estatística & dados numéricos , Vacinação/estatística & dados numéricos
11.
Pediatrics ; 145(4)2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32213648

RESUMO

BACKGROUND: Pediatricians are less frequently sued than other physicians. When suits are successful, however, the average payout is higher. Little is known about changes in the risk of litigation over time. We sought to characterize malpractice lawsuit trends for pediatricians over time. METHODS: The Periodic Survey is a national random sample survey of American Academy of Pediatrics members. Seven surveys between 1987 and 2015 asked questions regarding malpractice (n = 5731). Bivariate and multivariable analyses examined trends and factors associated with risk and outcome of malpractice claims and lawsuits. Descriptive analyses examined potential change in indemnity amount over time. RESULTS: In 2015, 21% of pediatricians reported ever having been the subject of any claim or lawsuit, down from a peak of 33% in 1990. Report of successful outcomes in the most-recent suit trended upward between 1987 and 2015, greatest in 2015 at 58%. Median indemnity was unchanged, averaging $128 000 in 2018 dollars. In multivariate analysis, male sex, hospital-based subspecialty (neonatology, pediatric critical care, pediatric emergency medicine, and hospital medicine), longer career, and more work hours were associated with a greater risk of malpractice claim. CONCLUSIONS: From 1987 to 2015, the proportion of pediatricians sued has decreased and median indemnity has remained unchanged. Male pediatricians and hospital-based subspecialists were more likely to have been sued. Greater knowledge of the epidemiology of malpractice claims against pediatricians is valuable because it can impact practice arrangements, advise risk-management decisions, influence quality and safety projects, and provide data to guide advocacy for appropriate tort reform and future research.


Assuntos
Imperícia/tendências , Pediatria/tendências , Adulto , Análise de Variância , Competência Clínica/estatística & dados numéricos , Feminino , Humanos , Masculino , Imperícia/economia , Imperícia/legislação & jurisprudência , Imperícia/estatística & dados numéricos , Pessoa de Meia-Idade , Pediatras/estatística & dados numéricos , Pediatras/tendências , Pediatria/economia , Pediatria/estatística & dados numéricos , Área de Atuação Profissional/estatística & dados numéricos , Risco , Viés de Seleção , Fatores Sexuais , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos
12.
Pediatrics ; 145(4)2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32123018

RESUMO

BACKGROUND: Current guidelines from the American Academy of Pediatrics recommend screening children for developmental problems by using a standardized screening tool and referring at-risk patients to early intervention (EI) or subspecialists. Adoption of guidelines has been gradual, with research showing many children still not being screened and referred. METHODS: We analyzed American Academy of Pediatrics Periodic Survey data from 2002 (response rate = 58%; N = 562), 2009 (response rate = 57%; N = 532), and 2016 (response rate = 47%, N = 469). Surveys included items on pediatricians' knowledge, attitudes, and practices regarding screening and referring children for developmental problems. We used descriptive statistics and a multivariable logistic regression model to examine trends in screening and referral practices and attitudes. RESULTS: Pediatricians' reported use of developmental screening tools increased from 21% in 2002 to 63% in 2016 (P < .001). In 2016, on average pediatricians reported referring 59% of their at-risk patients to EI, up from 41% in 2002 (P < .001), and pediatricians in 2016 were more likely than in 2002 to report being "very likely" to refer a patient with global developmental delay, milestone loss, language delay, sensory impairment, motor delays, and family concern to EI. CONCLUSIONS: Pediatricians' reported use of a standardized developmental screening tool has tripled from 2002 to 2016, and more pediatricians are self-reporting making referrals for children with concerns in developmental screening. To sustain this progress, additional efforts are needed to enhance referral systems, improve EI programs, and provide better tracking of child outcomes.


Assuntos
Deficiências do Desenvolvimento/diagnóstico , Fidelidade a Diretrizes/tendências , Programas de Rastreamento/tendências , Pediatria/tendências , Adulto , Criança , Intervenção Médica Precoce/estatística & dados numéricos , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Pediatras/estatística & dados numéricos , Pediatria/normas , Encaminhamento e Consulta/estatística & dados numéricos , Sociedades Médicas/normas
13.
PLoS One ; 15(2): e0228377, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32012194

RESUMO

AIM: To identify subgroups regarding paediatricians' awareness, attitude, practice and satisfaction about management of Sleep-Disordered Breathing (SDB) in Italy using Latent Class Analysis (LCA). METHODS: A cross-sectional study was conducted on a large sample of Italian paediatricians. Using a self-administered questionnaire, the study collected information on 420 Paediatric Hospital Paediatricians (PHPs) and 594 Family Care Paediatricians (FCPs). LCA was used to discover underlying response patterns, thus allowing identification of respondent groups with similar awareness, attitude, practice and satisfaction. A logistic regression model was used to investigate which independent variables influenced latent class membership. Analyses were performed using R 3.5.2 software. A p-value<0.05 was considered statistically significant. RESULTS: Two classes were identified: Class 1 (n = 368, 36.29%) "Untrained and poorly satisfied" and Class 2 (n = 646, 63.71%) "Trained and satisfied." Involving paediatric pneumologists or otorhinolaryngologists in clinical practice was associated with an increased probability of Class 2 membership (OR = 5.88, 95%CI [2.94-13.19]; OR = 15.95, 95% CI [10.92-23.81] respectively). Examining more than 20 children with SDB during the last month decreased the probability of Class 2 membership (OR = 0.29, 95% CI [0.14-0.61]). FCPs showed a higher probability of Class 2 membership than PHPs (OR = 4.64, 95% CI [3.31-6.55]). CONCLUSIONS: These findings suggest that the LCA approach can provide important information on how education and training could be tailored for different subgroups of paediatricians. In Italy standardized educational interventions improving paediatricians' screening of SDB are needed in order to guarantee efficient management of children with SDB and reduce the burden of disease.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Hospitais Pediátricos/normas , Pediatras/psicologia , Pediatria/educação , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Síndromes da Apneia do Sono/terapia , Criança , Estudos Transversais , Humanos , Itália , Análise de Classes Latentes , Pediatras/normas , Pediatras/estatística & dados numéricos , Pediatria/normas , Satisfação Pessoal , Projetos Piloto , Inquéritos e Questionários
15.
PLoS One ; 15(2): e0229356, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32092100

RESUMO

Food allergy is an emerging clinical condition in pediatrics, so recommendations on its management have been widely published. Studying pediatricians' adherence to these clinical practice guidelines (CPG) and understanding the reasons for their non-compliance can help to promote better management of this condition. A cross-sectional study was conducted by a survey among Brazilian pediatricians, randomly selected during the 38th Brazilian Congress of Pediatrics, which took place in October, 2017. A validated questionnaire with 16 questions addressing knowledge and practice on food allergy, as well as self-reported adherence to international guidelines was applied. Of the total of 415 pediatricians from all regions of the country who were surveyed, only 69 (16.7%) had a satisfactory adherence rate (≥80%). Adequate adherence to the guidelines was associated with the variables: 'evaluating more than 10 children with suspected cow's milk allergy (CMA) per month'; 'having read the Brazilian consensus'; or 'being aware of any international food allergy guideline'. In 8 of the 10 questions that assessed conscious adherence, a minority of those surveyed (20.3-42.3% variation) stated that they knew that their response was in line with the guidelines. This finding was statistically significant (p<0.05) in 7 of these 8 questions. The self-reported adherence of Brazilian pediatricians to international food allergy guidelines was low. Pediatricians who evaluated a higher number of children with suspected CMA or who were aware of the recommendations, had a higher rate of adherence. The results of the survey found that lack of resource was the major reported barrier to guideline adherence but lack of awareness must be a relevant non perceived barrier. This study shows the pediatricians´ self-reported adherence to food allergy guidelines in a widely overview for the first time in Brazil. More studies are necessary to investigate adherence to guidelines by pediatricians in other countries and to develop strategies to improve adherence.


Assuntos
Hipersensibilidade Alimentar/terapia , Fidelidade a Diretrizes/estatística & dados numéricos , Pediatras/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Conscientização , Brasil/epidemiologia , Estudos Transversais , Feminino , Hipersensibilidade Alimentar/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Hipersensibilidade a Leite/epidemiologia , Hipersensibilidade a Leite/terapia , Pediatras/normas , Padrões de Prática Médica/normas , Inquéritos e Questionários
16.
J Pediatr Surg ; 55(5): 908-912, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32063366

RESUMO

PURPOSE: Canada is the second largest country in the world, with most of the population located in the southern-most portion of its geography. We sought to define the relative distribution of pediatric surgeons to potential pediatric patients using data from the Canadian census. METHODS: The 2011 Canadian Census and a convenience sample of current Canadian pediatric surgeons were used to calculate straight-line distances between pediatric surgeon postal code centroids and census dissemination block centroids. RESULTS: Currently, there are 74 practicing pediatric surgeons in Canada; 493,345 populated census blocks were identified, and 7,752,075 children were enumerated. The median (IQR) kilometers to the closest pediatric surgeon was 27.99 (11.35, 85.47) kilometers, and 22.7% of Canadian children lived more than 100 km from care. Nearly 13% of children lived greater than 200 km from the nearest pediatric surgeon. CONCLUSION: More than 1.7 million Canadian children, nearly one quarter of all Canadian children, live greater than 100 km from the closest pediatric surgeon. This identifies a disparate group of patients who do not have an equal access-to-care as compared to others in the country. LEVEL OF EVIDENCE: Level IV.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios , Viagem , Canadá , Criança , Estudos Transversais , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Pediatras/estatística & dados numéricos , Pediatria , Cirurgiões/estatística & dados numéricos
17.
Rev Paul Pediatr ; 38: e2018189, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31939511

RESUMO

OBJECTIVE: To develop, implement and evaluate an online virtual learning environment (VLE) on pediatric rheumatology, aimed at pediatric residents, analyzing its effectiveness and satisfaction rates. METHODS: A total of 92 first and second year pediatric residents at two pediatric reference centers were invited to participate in the study. Residents were randomized into a case group (that answered the pre-course test, attended the six virtual pediatric rheumatology modules, and then responded to the post-course test and a satisfaction questionnaire) and a control group (that only answered the pre-course test and, after 4 weeks, the post-course test). RESULTS: Forty-seven residents (51%) completed their participation. In the case group (n=24), the mean percentage of correct answers was 14% higher on the post-course test (p<0.001). The number of correct answers was larger in the case group than in the control one (n=23) in the post-course test (p=0.045). In the assessment of satisfaction with VLE use, residents considered the site easy to navigate (91%), suitable as a learning tool (91%), and attractive in design (79%). They reported poor prior knowledge in pediatric rheumatology (91%) and agreed that there was good learning with the methodology (75%). CONCLUSIONS: The virtual learning environment in pediatric rheumatology proved to be an effective teaching tool with high satisfaction rates, providing pediatrician residents with adequate knowledge regarding the initial assessment and management of children with rheumatic diseases.


Assuntos
Pediatras/educação , Reumatologia/educação , Ensino/estatística & dados numéricos , Interface Usuário-Computador , Estudos de Casos e Controles , Humanos , Internato e Residência/organização & administração , Conhecimento , Aprendizagem , Pediatras/estatística & dados numéricos , Satisfação Pessoal , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Inquéritos e Questionários
18.
Einstein (Sao Paulo) ; 18: eAO5168, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31994609

RESUMO

OBJECTIVE: To understand the use of tools, protocols and comfort measures related to sedation/analgesia, and to screen the occurrence of delirium in pediatric intensive care units. METHODS: A survey with 14 questions was distributed by e-mail to Brazilian critical care pediatricians. Eight questions addressed physician and hospital demographics, and six inquired practices to assess sedation, analgesia, and delirium in pediatric intensive care units. RESULTS: Of 373 questionnaires sent, 61 were answered (16.3%). The majority of physicians were practicing in the Southeast region (57.2%). Of these, 46.5% worked at public hospitals, 28.6% of which under direct state administration. Of respondents, 57.1% used formal protocols for sedation and analgesia, and the Ramsay scale was the most frequently employed (52.5%). Delirium screening scores were not used by 48.2% of physicians. The Cornell Assessment of Pediatric Delirium was the score most often used (23.2%). The majority (85.7%) of physicians did not practice daily sedation interruption, and only 23.2% used non-pharmacological measures for patient comfort frequently, with varied participation of parents in the process. CONCLUSION: This study highlights the heterogeneity of practices for assessment of sedation/analgesia and lack of detection of delirium among critical care pediatricians in Brazil.


Assuntos
Analgesia/métodos , Sedação Profunda/métodos , Delírio/diagnóstico , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Pediatras/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Analgesia/efeitos adversos , Analgesia/estatística & dados numéricos , Brasil , Sedação Profunda/efeitos adversos , Sedação Profunda/estatística & dados numéricos , Delírio/etiologia , Humanos , Respiração Artificial/métodos , Respiração Artificial/estatística & dados numéricos , Inquéritos e Questionários
19.
Clin Pediatr (Phila) ; 59(1): 21-30, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31609128

RESUMO

Pediatric antibiotic prescriptions originate from an increasingly broad range of ambulatory settings. In this retrospective study, pharyngitis, otitis media, sinusitis, pneumonia, and upper respiratory infection cases, at 11 primary care offices, 2 independent urgent care centers (UCCs), and a pediatric emergency department in Western New York, were analyzed relative to medical society practice guidelines and antibiotic utilization. Of 2358 eligible visits across all sites, 25% were for study diagnoses, with 38% at UCC (P < .01). Across all sites, 26% of pharyngitis cases given antibiotics did not have diagnostic evidence of bacterial infection. At primary care offices and UCCs, guideline recommended first-line agents for pharyngitis and otitis media were used in only 58% and 63% of treated cases, respectively. Overall, an estimated 9855 to 12 045 avoidable antibiotic and 8030 non-guideline antibiotic courses annually are represented by the 14 sites studied. These and other study findings highlight numerous opportunities for outpatient pediatric antibiotic stewardship.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos , Fidelidade a Diretrizes , Prescrição Inadequada/estatística & dados numéricos , Pediatras/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Instituições de Assistência Ambulatorial , Criança , Serviço Hospitalar de Emergência , Humanos , New York , Estudos Retrospectivos
20.
J Clin Res Pediatr Endocrinol ; 12(1): 95-103, 2020 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-31486330

RESUMO

Objective: Turner syndrome (TS) is one of the most common chromosomal abnormalities and an important cause of short stature and infertility due to ovarian failure in females. The aim was to evaluate the knowledge of TS among physicians and parents of children with TS and to enhance awareness about this subject. Methods: One hundred and forty physicians were included in the study. The study population comprised 37 pediatricians (26.4%), 15 gynecologists (10.7%), 88 family physicians (62.9%) and 30 parents who had daughters with a diagnosis of TS. Two separate questionnaires were administered to evaluate TS knowledge of physicians and parents. Results: According to the self-reports of physicians, 49% had insufficient knowledge of TS, while 15.7% indicated that they had no knowledge of TS. The mean percentage of correct answers was 50.71±16.17% for all physicians. When the entire group of physicians was considered, 67.1% of them did not know the approximate incidence of TS, while 14.3% of them incorrectly indicated that TS was a condition that was seen in boys. The mean percentage of correct answers among parents was 68±15%, and there was no difference between the mothers' and fathers' correct answer rates (p=0.063). The majority of parents was not aware of TS-associated diseases and increased malignancy risk in TS. Conclusion: Physician knowledge of TS was poor and that there is a need for continued education about TS at the medical faculty and post-graduate levels.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pais , Médicos/estatística & dados numéricos , Síndrome de Turner , Adulto , Criança , Feminino , Ginecologia/estatística & dados numéricos , Humanos , Masculino , Pediatras/estatística & dados numéricos , Médicos de Família/estatística & dados numéricos , Inquéritos e Questionários
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