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1.
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
2.
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
3.
Pediatrics ; 144(6)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31690710

RESUMO

BACKGROUND AND OBJECTIVES: The American Board of Pediatrics (ABP) certifies that general and subspecialty pediatricians meet standards of excellence established by their peers, immediately after training and over the course of their careers (ie, Maintenance of Certification [MOC]). In 2015-2016, the ABP developed the Maintenance of Certification Assessment for Pediatrics (MOCA-Peds) as an alternative assessment to the current proctored, closed-book general pediatrics (GP) MOC examination. This article is 1 of a 2-part series examining results from the MOCA-Peds pilot in 2017. METHODS: We conducted quantitative and qualitative analyses with 5081 eligible pediatricians who registered to participate in the 2017 pilot; 81.4% (n = 4016) completed a quarter 4 survey and/or end-of-year survey (January 2018) and comprise the analytic sample. RESULTS: The majority of pediatricians considered the MOCA-Peds to be feasible and acceptable as an alternative to the proctored MOC GP examination. More than 90% of respondents indicated they would participate in the proposed MOCA-Peds model instead of the examination. Participants also offered recommendations to improve the MOCA-Peds (eg, enhanced focus of questions on outpatient GP, references provided before taking questions); the ABP is carefully considering these as the MOCA-Peds is further refined. CONCLUSIONS: Pilot participant feedback in 2017 suggested that the MOCA-Peds could be implemented for GP starting in January 2019, with all 15 subspecialties launched by 2022. Current and future evaluations will continue to explore feasibility, acceptability, and learning and practice change as well as sustainability of participation.


Assuntos
Atitude do Pessoal de Saúde , Certificação/normas , Competência Clínica/normas , Pediatras/psicologia , Pediatras/normas , Inquéritos e Questionários , Adulto , Idoso , Certificação/métodos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
4.
Pediatrics ; 144(6)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31690712

RESUMO

BACKGROUND AND OBJECTIVES: This article is the second of a 2-part series examining results regarding self-reported learning and practice change from the American Board of Pediatrics 2017 pilot of an alternative to the proctored, continuing certification examination, termed the Maintenance of Certification Assessment for Pediatrics (MOCA-Peds). Because of its design, MOCA-Peds has several learning advantages compared with the proctored examination. METHODS: Quantitative and qualitative analyses with 5081 eligible pediatricians who registered to participate in the 2017 pilot; 81.4% (n = 4016) completed a quarter 4 survey and/or the end-of-year survey (January 2018) and compose the analytic sample. RESULTS: Nearly all (97.6%) participating pediatricians said they had learned, refreshed, or enhanced their medical knowledge, and of those, 62.0% had made a practice change related to pilot participation. Differences were noted on the basis of subspecialty status, with 68.9% of general pediatricians having made a practice change compared with 41.4% of subspecialists. Within the 1456 open-ended responses about participants' most significant practice change, responses ranged widely, including both medical care content (eg, "care for corneal abrasions altered," "better inform patients about. . .flu vaccine") and nonspecific content (eg, providing better patient education, using evidence-based medicine, increased use of resources in regular practice). CONCLUSIONS: As a proctored examination alternative, MOCA-Peds positively influenced self-reported learning and practice change. In future evaluation of MOCA-Peds and other medical longitudinal assessments, researchers should study ways to further encourage learning and practice change and sustainability.


Assuntos
Atitude do Pessoal de Saúde , Certificação/normas , Competência Clínica/normas , Educação Médica Continuada/normas , Aprendizagem , Pediatras/normas , Adulto , Certificação/métodos , Educação Médica Continuada/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pediatras/psicologia , Projetos Piloto , Padrões de Prática Médica/normas , Inquéritos e Questionários
5.
S D Med ; 72(8): 349-353, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31465639

RESUMO

INTRODUCTION: Safe sleep recommendations for infants have been evolving over the past three decades. It has been shown that physicians' recommendations strongly influence parents' choice of infant sleep position. However, the proportion of physicians and/or nurses giving infant sleep advice to parents is reportedly low. METHODS: A survey was conducted in South Dakota to evaluate pediatricians' and family practitioners' knowledge of safe sleep recommendations for infants. Survey questions assessed their beliefs regarding risk factors for sudden infant death syndrome (SIDS) and their recommendations for safe sleep environments provided to parents/caregivers. RESULTS: Among the respondents, 98 percent felt that it is important to discuss SIDS with every parent and 80 percent of them indicated a need within their profession to have further information on the topic of SIDS. However, 31 percent of physicians with 16 years or more since training and 64.5 percent of those with less than 16 years since training did provide safe sleep advice to parents and caregivers. CONCLUSIONS: Despite the knowledge of SIDS risk factors, gaps were seen in dissemination of information regarding all risk factors to parents. While sleep position, postnatal exposures and breast feeding were more likely to be addressed, other elements of a safe sleep environment such as bedding surface, bed sharing, pacifier use and room ventilation were less likely to be covered. These findings indicate the need for improved health care provider education/communication in South Dakota.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pediatras/psicologia , Guias de Prática Clínica como Assunto , Morte Súbita do Lactente , Leitos , Humanos , Lactente , Pediatras/normas , Fatores de Risco , Sono , South Dakota , Decúbito Dorsal
6.
Eur J Pediatr ; 178(8): 1219-1227, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31177289

RESUMO

This study compares the performance of pediatricians and anesthetists in neonatal and pediatric endotracheal intubations (ETI) during simulated settings. Participants completed a questionnaire and performed an ETI scenario on a neonatal and a child manikin. The procedures were recorded with head cameras and cameras attached to standard laryngoscope blades. The outcomes were successful intubation, time to successful intubation, number of attempts, complications, total performance score, end-assessment rating, and an assessment whether the participant was sufficiently able to perform an ETI. Fifty-two pediatricians and 52 anesthetists were included. For the neonatal ETI, the rate of successful intubation was in favor of anesthetists although not significant. Anesthetists performed significantly better in all other outcomes. Of the pediatricians, 65% was rated sufficiently adept to perform a neonatal ETI vs 100% of the anesthetists. Pediatricians (29%) overestimated while anesthetists (33%) underestimated their performance in neonatal ETI. For the pediatric ETI, all outcomes were significantly better for anesthetists. Only 15% of all pediatricians were considered sufficiently able to perform pediatric ETI vs 94% of the anesthetists.Conclusion: Anesthetists are far more adept in performing ETI in neonates and children compared with pediatricians in a simulated setting. Complications are expected to occur less frequently and less seriously when anesthetists perform ETI. What is Known: • Endotracheal intubation (ETI) performed by inexperienced care providers can lead to unsuccessful and/or prolonged intubation attempts. This can cause complications such as hypoxemia, trauma to the oropharynx and larynx, and prolonged interruption of resuscitation, which results in a high morbidity/mortality. • Fifty to 60 real-life ETI procedures are needed before ETI can be performed with a 90% success rate. Despite this, 18% of providers still require some assistance even after performing 80 intubations. Skill fade will occur if there is too little exposure. What is New: • This study shows that, on both neonatal and child manikins, anesthetists perform better in ETI compared with pediatricians. Besides this, complications are expected to occur less frequently and less seriously when anesthetists are performing the ETIs on neonates and children. • In those countries where there are no clear interprofessional agreements made in general hospitals on who will perform ETI on neonates and children in acute care settings, these agreements are urgently necessary.


Assuntos
Anestesistas/normas , Competência Clínica/estatística & dados numéricos , Intubação Intratraqueal , Pediatras/normas , Adulto , Criança , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Intubação Intratraqueal/normas , Laringoscópios , Masculino , Manequins , Pessoa de Meia-Idade , Autoeficácia , Método Simples-Cego , Gravação em Vídeo
8.
Indian J Ophthalmol ; 67(6): 928-931, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31124517

RESUMO

Purpose: To explore the knowledge of retinopathy of prematurity (ROP) and habilitation services for children with visual loss from ROP, among health care professionals (HCPs) involved in care of preterm children and to explore their attitudes and practices in relation to referral for habilitation. Methods: A modified knowledge, attitude and practice questionnaire were administered to ophthalmologists and paediatricians associated with ROP care. Data were collected about their knowledge, beliefs and practices of ROP and referral to rehabilitation facilities. Data were analysed to establish level of knowledge, type of attitude and practices and its association with speciality. Results: Response rate was 78% (25/32). Most (14/25, 56%) were ophthalmologists. All (100%) participants knew that ROP can cause blindness. Knowledge about Indian ROP screening criteria was poor among a third (8/25, 32%), more so in paediatricians (5/11, 45.5%). Most (21/25, 84%) did not have knowledge of what a habilitation service entails and where such facilities are located. More than two-thirds (18/25, 72%) believed that special education should be preferred over inclusive education. Overall, 10/25 (40%) of the HCPs had never referred a child for rehabilitation. More than a half (13/25, 52%) were not confident of counselling parents of blind children. All agreed that rehabilitation services are not part of but should be included in medical curriculum. Conclusion: Indian guidelines for ROP screening are not universally known among HCPs. Educating medical undergraduates, providing counselling training to professionals and integration of rehabilitation into the health system will ensure continuity of care for children with visual loss and their families.


Assuntos
Cegueira/reabilitação , Conhecimentos, Atitudes e Prática em Saúde , Triagem Neonatal/métodos , Pediatras/normas , Retinopatia da Prematuridade/reabilitação , Acuidade Visual , Adolescente , Adulto , Distribuição por Idade , Cegueira/epidemiologia , Cegueira/etiologia , Criança , Pré-Escolar , Feminino , Idade Gestacional , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Retinopatia da Prematuridade/complicações , Retinopatia da Prematuridade/fisiopatologia , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
9.
Pediatr Int ; 61(7): 658-663, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31102485

RESUMO

BACKGROUND: A child's death affects not only family members but also the health-care professionals involved in patient care. The education system for bereavement care in Japan, however, is not set up in a systematic way, and the care provided is based on the individual experience of the health-care professional. The aim of this study was to investigate pediatrician awareness of and actual circumstances involved in bereavement care in Japan. METHODS: A qualitative descriptive study was conducted at four facilities in Japan. Data collected using semi-structured interviews of 11 pediatricians were assessed using inductive qualitative analysis. RESULTS: Pediatrician recognition of the elements of bereavement care was categorized as follows: (i) developing relationships with families before a child's death is important in bereavement care; (ii) after the child dies, family involvement is left to the doctor's discretion; (iii) coping with a child's death myself through past experience is essential; (iv) doctors involved in a child's death also experience mental burden; and (v) a system for the family's bereavement care must be established. Two categories were established according to actual circumstances involved in bereavement care: (i) attention must be given to the emotions of the families who lost a child; and (ii) doctor involvement with bereaved families depends on doctor awareness and expertise. CONCLUSION: Japanese pediatricians provided bereavement care to families who lost their children in a non-systematic manner. This is necessitates improvement of the self-care of health-care professionals with regard to grief by improving bereavement care-related education. Additionally, health-care professionals must be trained, and a national-level provision system must be established to provide high-quality bereavement care to families who lose a child.


Assuntos
Atitude do Pessoal de Saúde , Luto , Competência Clínica , Cuidados Paliativos na Terminalidade da Vida/psicologia , Pediatras/psicologia , Padrões de Prática Médica , Relações Profissional-Família , Adulto , Conscientização , Criança , Família/psicologia , Feminino , Cuidados Paliativos na Terminalidade da Vida/normas , Humanos , Entrevistas como Assunto , Japão , Masculino , Pessoa de Meia-Idade , Pediatras/educação , Pediatras/normas , Pediatria/educação , Pediatria/normas , Padrões de Prática Médica/normas , Pesquisa Qualitativa
10.
Rev Chil Pediatr ; 90(1): 44-51, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31095218

RESUMO

INTRODUCTION: Anaphylaxis is an emergency condition. According to the latest international guide lines, early recognition and treatment with intramuscular epinephrine are associated with increased survival. OBJECTIVE: To determine the level of knowledge of pediatricians in a tertiary Pediatric Hos pital about the diagnostic criteria and treatment of anaphylaxis. MATERIAL AND METHOD: A cross-sec tional descriptive study was conducted, designing, applying, and validating an anonymous survey to physicians with complete residency in pediatrics who are on call at a third level hospital. The statisti cal analysis was made using the SPSS v.21 software, presenting measures of central tendency (median, range, and frequency table) and Chi-square test for comparison. A value of p < 0.05 was considered significant. RESULTS: 71 physicians completed the survey with a median of three years after the end of residency.35% of them identified all clinical criteria, 99% (70) indicated epinephrine, 73% chose the intramuscular route, and 55% indicated the correct dose. Only 48% of responders chose the dose and administration route correctly. In general, 21% recognized anaphylaxis and used epinephrine correctly. Physicians with less than five years of experience performed better in the intramuscular administration of epinephrine (83% vs 52% p = 0.005) and in the detection of gastrointestinal symp toms (60% vs 35% p = 0.043). CONCLUSIONS: There are difficulties in the identification and proper management of anaphylaxis by pediatricians of a tertiary Pediatric Hospital in a theoretical clinical setting. Although most of pediatricians chose epinephrine as a first-line drug, half of them did not indicate it correctly, and only one-third recognized anaphylaxis in all scenarios.


Assuntos
Anafilaxia/diagnóstico , Anafilaxia/tratamento farmacológico , Competência Clínica/estatística & dados numéricos , Epinefrina/uso terapêutico , Fidelidade a Diretrizes/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Simpatomiméticos/uso terapêutico , Argentina , Criança , Estudos Transversais , Emergências , Pesquisas sobre Serviços de Saúde , Hospitais Pediátricos , Humanos , Injeções Intramusculares , Pediatras/normas , Pediatras/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas
11.
Clin Pediatr (Phila) ; 58(5): 547-554, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30788982

RESUMO

The preparticipation sports examination (PPE) is required for US high school athletes. We queried members of the Illinois Chapter of the American Academy of Pediatrics (ICAAP) about what they actually include in a PPE, allotted PPE time, and counseling about full contact sports participation. Of 2300 ICAAP members contacted electronically, 228 (10%) responded, yielding 205 usable surveys. When performing a PPE, 34 (25%) always complete all of 6 selected AAP-recommended PPE components and 102 (74%) always get a concussion history. In contrast, 29 (21%) always complete all of the 6 selected AAP PPE components and 70 (49%) always get a concussion history as part of well-child checkup. Main interferences with clinician proficiency are lack of time and training cited by 49% and 37%, respectively. Pediatricians were evenly divided about whether or not to counsel against full contact sports, but were more likely to do so after the athlete sustained a first concussion.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Anamnese/métodos , Pediatras/estatística & dados numéricos , Exame Físico/métodos , Padrões de Prática Médica/estatística & dados numéricos , Esportes Juvenis , Adolescente , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/etiologia , Traumatismos em Atletas/prevenção & controle , Atitude do Pessoal de Saúde , Concussão Encefálica/diagnóstico , Concussão Encefálica/etiologia , Concussão Encefálica/prevenção & controle , Criança , Aconselhamento Diretivo/estatística & dados numéricos , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Illinois , Masculino , Anamnese/normas , Anamnese/estatística & dados numéricos , Pediatras/normas , Exame Físico/normas , Exame Físico/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Medição de Risco , Esportes Juvenis/lesões
12.
Matern Child Health J ; 23(1): 61-71, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30030742

RESUMO

Objectives Calls for pediatricians to tend to children's psychosocial concerns have existed for decades because they are known to negatively impact child health. Children with chronic illnesses frequently have child- and family-level psychosocial concerns that complicate the care provided by their pediatric subspecialists. This study compares pediatricians who exclusively practice general pediatrics with subspecialists regarding their inquiring/screening and referring for psychosocial concerns. Physician and practice characteristics associated with these behaviors were examined. Methods We conducted a cross-sectional study using the 2013 American Academy of Pediatrics Periodic Survey of Fellows. Respondents included 304 pediatricians who exclusively practice general pediatrics and 147 subspecialists. The primary analysis compared the current practices of generalists vs. subspecialists with regard to inquiring/screening and referring children with 10 different psychosocial concerns. Covariates included socio-demographics, practice characteristics, and training experiences. Weighted univariate, bivariate and multivariable analyses were performed. Results Less than half of all pediatricians in the sample reported routinely inquiring/screening for most psychosocial concerns, and 2/3 of subspecialists failed to routinely inquire/screen for most of these conditions. Pediatricians who practice general pediatrics exclusively were more likely to inquire/screen (incident rate ratio (IRR) 1.41, p < .05) and refer (IRR 1.59, p < .001) for a greater number of psychosocial concerns than subspecialists, after adjusting for provider and practice characteristics. Having attended a child or adolescent mental health (MH) lecture/conference in the past 2 years was also related to inquiring/screening (IRR 1.24, p < .05). Conclusions Pediatricians infrequently inquire/screen and refer psychosocial concerns, with subspecialists addressing these concerns even less frequently.


Assuntos
Transtornos Mentais/diagnóstico , Pediatras/normas , Encaminhamento e Consulta/normas , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Pediatras/estatística & dados numéricos , Médicos/normas , Médicos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos
13.
Am J Intellect Dev Disabil ; 123(5): 387-398, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30198765

RESUMO

The American Academy of Pediatrics's guideline on health supervision for children with Down syndrome (DS) offers pediatricians guidance to improve detection of comorbid conditions. Pediatrician adherence has not yet been comprehensively evaluated. Medical records of 31 children with DS who received primary care at two urban academic clinic sites from 2008-2012 were reviewed. Data was extracted on adherence to age-specific individual guideline components for each subject by year-of-life (total 84 years-of-life). Overall adherence across all components was 83% (2001 guideline) and 67% (2011 guideline). Adherence to thyroid, hearing, vision, and developmental components was >85%, and anticipatory guidance regarding atlantoaxial instability and sexuality was <35%. Overall adherence was higher when a subject was younger and when a provider was an attending-level pediatrician.


Assuntos
Síndrome de Down , Fidelidade a Diretrizes/normas , Pediatras/normas , Pediatria/normas , Atenção Primária à Saúde/normas , Adolescente , Criança , Pré-Escolar , Comorbidade , Síndrome de Down/diagnóstico , Síndrome de Down/epidemiologia , Síndrome de Down/terapia , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Hospitais Pediátricos , Humanos , Lactente , Masculino , Pediatras/estatística & dados numéricos , Guias de Prática Clínica como Assunto/normas , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Sociedades Médicas/normas
14.
BMC Ophthalmol ; 18(1): 195, 2018 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-30103708

RESUMO

BACKGROUND: Retinopathy of prematurity (ROP) is a disorder of the developing retina of preterm infants due to defective vasculogenesis. The aim of the study was to analyze the level of awareness, knowledge, attitude and practice of pediatricians about ROP in the West Bank, Palestine. METHODS: A questionnaire was designed on the knowledge, attitude, and practice (KAP) pattern. The questionnaire included questions about pediatrician's educational and practicing profile, knowledge of screening guidelines, risk factors for ROP, referral facilities and barriers for referral. The questionnaire was given to70 practicing specialists and residents in hospitals having neonatal intensive care units in the West Bank, Palestine. It was a self-administered questionnaire, collected between November 2016 and February 2017. RESULTS: A total of 70 pediatricians from 11 different hospitals without ROP screening service participated in the study. The mean age of the participants was 33.04 ± 7.74. Of which, 62.9% were males and 37.1% were females. Fifty-nine (84.3%) answered that ROP is preventable, while 11 (15.7%) responded that ROP is not preventable. Nine (12.9%) pediatricians had no idea as to which part of the eye is affected in ROP. Among the participants, 29 (41.4%) did not know when ROP screening should be started. Sixty-three (90%) pediatricians were sure that ROP is treatable. Regarding barriers for ROP screening, 'ophthalmologist not available' reason was expressed by 37.1% (26/70), 'discharge person not writing' by 20% (14/70) and 'parents not agreeing' by 18.6% (13/70) of the participants. Knowledge on the use of laser as a treatment modality of ROP was shown by 39 (55.7%) participants, and the use of anti-VEGF was shown by 6 (8.6%) participants, whereas 25 (35.7%) of the participants didn't know about the treatment modalities. CONCLUSION: The study findings suggest that a large majority of pediatricians were aware of ROP as a preventable disease, but had less information about ROP screening guidelines and service delivery. The study suggests the need to increase the awareness of pediatricians by dissemination of information about ROP and creating a close coordination between them and ophthalmologists to address barriers for service delivery in Palestine.


Assuntos
Conscientização , Competência Clínica , Programas de Rastreamento , Pediatras/psicologia , Retinopatia da Prematuridade/psicologia , Adulto , Estudos Transversais , Feminino , Seguimentos , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Oriente Médio/epidemiologia , Pediatras/normas , Retinopatia da Prematuridade/diagnóstico , Retinopatia da Prematuridade/epidemiologia , Estudos Retrospectivos , Inquéritos e Questionários
17.
Am J Ophthalmol ; 191: 7-13, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29621506

RESUMO

PURPOSE: Retinopathy of prematurity (ROP) may cause visual impairment in infants with very low birth weight. Lack of parent knowledge may contribute to gaps in screening and treatment. We studied parents' knowledge and education of ROP. DESIGN: Cross-sectional study. METHODS: Setting: Four high-acuity neonatal intensive care units in California (40-84 beds). PARTICIPANTS: Total of 194 English- and Spanish-speaking parents of very low birth weight (<1500 grams) infants recruited from September 2013 to April 2015. MAIN OUTCOME MEASURES: We asked parents what they knew about ROP, how they were educated about ROP, and their experiences obtaining outpatient eye care. We used multivariate analysis to assess whether parent knowledge was associated with level of English proficiency and literacy, education modality (verbal, written, online, video), and hospital transfer status. RESULTS: Of the 194 participants, 131 (68%) completed surveys: 18% had both limited English proficiency and low literacy while overall 26% had limited English proficiency and 37% had low literacy; 17% did not know that ROP is an eye disease, and 38% did not know that very low birth weight and prematurity are both risk factors for ROP. Parents reported receiving verbal (62%) or written (56%) information; few used online resources (12%) or videos (3%). Half reported receiving information about infants' retinopathy status at discharge. No education modality was associated with higher knowledge. Limited English proficiency and low literacy were associated with lower knowledge (vs English-proficient, literate). CONCLUSIONS: Parents of infants with very low birth weight, particularly those with limited English proficiency and low health literacy, lack knowledge about ROP.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Unidades de Terapia Intensiva Neonatal , Pais , Pediatras/normas , Retinopatia da Prematuridade/psicologia , California/epidemiologia , Estudos Transversais , Escolaridade , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Prevalência , Retinopatia da Prematuridade/epidemiologia , Fatores de Risco
18.
Arch Dis Child ; 103(10): 952-956, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29618485

RESUMO

OBJECTIVE: We investigated whether ultrasound guidance was advantageous over the anatomical landmark technique when performed by inexperienced paediatricians. DESIGN: Randomised controlled trial. SETTING: A paediatric intensive care unit of a teaching hospital. PATIENTS: 80 children (aged 28 days to <14 years). INTERVENTIONS: Internal jugular vein cannulation with ultrasound guidance in real time or the anatomical landmark technique. MAIN OUTCOME MEASURES: Success rate, success rate on the first attempt, success rate within three attempts, puncture time, number of attempts required for success and occurrence of complications. RESULTS: We found a higher success rate in the ultrasound guidance than in the control group (95% vs 61%, respectively; p<0.001; relative risk (RR)=0.64, 95% CI (CI) 0.50 to 0.83). Success on the first attempt was seen in 95% and 34% of venous punctures in the US guidance and control groups, respectively (p<0.001; RR=0.35, 95% CI 0.23 to 0.54). Fewer than three attempts were required to achieve success in 95% of patients in the US guidance group but only 44% in the control group (p<0.001; RR=0.46, 95% CI 0.32 to 0.66). Haematomas, inadvertent arterial punctures, the number of attempts and the puncture time were all significantly lower in the ultrasound guidance than in the control group (p<0.015 for all). CONCLUSIONS: Critically ill children may benefit from the ultrasound guidance for internal jugular cannulation, even when the procedure is performed by operators with limited experience. TRIAL REGISTRATION NUMBER: RBR-4t35tk.


Assuntos
Cateterismo , Veias Jugulares/cirurgia , Complicações Pós-Operatórias , Ultrassonografia de Intervenção/métodos , Adolescente , Cateterismo/efeitos adversos , Cateterismo/métodos , Cateterismo/normas , Criança , Pré-Escolar , Competência Clínica , Feminino , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Masculino , Pediatras/normas , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia
19.
Anesth Analg ; 127(1): 217-223, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29677057

RESUMO

BACKGROUND: Birth asphyxia is a leading cause of early neonatal death. In 2013, 32% of neonatal deaths in Zambia were attributable to birth asphyxia and trauma. Basic, timely interventions are key to improving outcomes. However, data from the World Health Organization suggest that resuscitation is often not initiated, or is conducted suboptimally. Currently, there are little data on the quality of newborn resuscitation in the context of a tertiary center in a lower-middle income country. We aimed to measure the competencies of clinical practitioners responsible for newborn resuscitation. METHODS: This observational study was conducted over 5 months in Zambia. Health care professionals were recruited from anesthesia, pediatrics, and midwifery. Newborn skills and knowledge were examined using the following: (1) multiple-choice questions; (2) a ventilation skills test; and (3) 2 low-medium fidelity simulation scenarios. Participant demographics including previous resuscitation training and a self-efficacy rating score were noted. The primary outcome examined performance scores in a simulated scenario, which assessed the care of a newborn that failed to respond to basic interventions. Secondary outcome measures included apnea times after delivery and performance in the other assessments. RESULTS: Seventy-eight participants were enrolled into the study (13 physician anesthesiology residents, 13 pediatric residents, and 52 midwives). A significant difference in interprofessional performance was observed when examining checklist scores for the unresponsive newborn simulated scenario (P = .006). The median (quartiles) checklist score (out of 18) was 14.0 (13.0-14.75) for the anesthesiologists, 11.0 (8.5-12.3) for the pediatricians, and 10.8 (8.3-13.9) for the midwives. A score of 14 or more was required to pass the scenario. There was no significant difference in performance between participants with and without previous newborn resuscitation training (P = .246). The median (quartiles) apnea time after delivery was significantly different between all groups (P = .01) with anesthetic and pediatric residents performing similarly, 61 (37-97) and 63 (42.5-97.5) seconds, respectively. The midwifery participants displayed a significantly longer apnea time, 93.5 (66.3-129) seconds. Self-efficacy rating scores displayed no correlation between confidence level and the primary outcome, Spearman coefficient 0.06 (P = .55). CONCLUSIONS: Newborn resuscitation skills among health care professionals are varied. Midwives lead the majority of deliveries with anesthesiologists and pediatricians only being present at operative or high-risk births. It is therefore common that midwifery practitioners will initiate resuscitation. Despite this, midwives perform poorly when compared to anesthesia and pediatric residents. To address this discrepancy, a multidisciplinary, simulation-based newborn resuscitation program should be considered with continual clinical reenforcement of best practice.


Assuntos
Asfixia Neonatal/terapia , Competência Clínica/normas , Países em Desenvolvimento , Corpo Clínico Hospitalar/normas , Recursos Humanos de Enfermagem no Hospital/normas , Ressuscitação/normas , Centros de Atenção Terciária/normas , Organização Mundial da Saúde , Anestesiologistas/educação , Anestesiologistas/normas , Asfixia Neonatal/diagnóstico , Asfixia Neonatal/mortalidade , Lista de Checagem/normas , Estudos Transversais , Disparidades em Assistência à Saúde/normas , Humanos , Recém-Nascido , Internato e Residência/normas , Corpo Clínico Hospitalar/educação , Tocologia/educação , Tocologia/normas , Recursos Humanos de Enfermagem no Hospital/educação , Pediatras/educação , Pediatras/normas , Ressuscitação/efeitos adversos , Ressuscitação/mortalidade , Análise e Desempenho de Tarefas , Fatores de Tempo , Resultado do Tratamento , Zâmbia
20.
Respir Med ; 137: 201-205, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29605205

RESUMO

OBJECTIVES: Guidelines recommend that healthcare providers adjust the dose of inhaled corticosteroids (ICS) in asthma patients based on the degree of symptom severity and control. Symptom-based, intermittent ICS therapy (use of ICS together with short acting bronchodilators- symptom-based adjustment: SBA) has been demonstrated to be comparable to guideline-based management by providers in controlled clinical trials. We sought input from African American caregivers and pediatricians on the acceptability and barriers for this alternative management strategy. METHODS: Focus group interviews of caregivers and individual interviews with community providers of African-American children ages 6-17 years with mild-moderate persistent asthma were conducted by trained facilitators to assess perceptions of how asthma affects children and their caregivers, and of SBA as a management strategy. Interview data were transcribed and analyzed using inductive thematic based coding. RESULTS: Twenty-six parents participated in six focus groups. Fourteen pediatricians were interviewed. Caregivers reported facing financial burden and difficulty with tracking medications. Caregivers and pediatricians were favorable about SBA, citing its potential for decreased use of medications and cost and similarity to actual care provided. Some caregivers voiced concern that SBA would not be as effective as daily ICS. Caregivers suggested that education on symptom recognition and close communication between physician and patient would facilitate the implementation of SBA. CONCLUSIONS: SBA was generally viewed favorably by caregivers and providers of African American children. However, concerns regarding effectiveness of SBA were voiced by both caregivers and providers. Patient education and provider-patient communication is important in implementing this alternative asthma management strategy.


Assuntos
Corticosteroides/uso terapêutico , Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Broncodilatadores/uso terapêutico , Administração por Inalação , Adolescente , Corticosteroides/administração & dosagem , Afro-Americanos/etnologia , Antiasmáticos/administração & dosagem , Asma/economia , Asma/psicologia , Broncodilatadores/administração & dosagem , Cuidadores/psicologia , Criança , Comunicação , Grupos Focais/métodos , Fidelidade a Diretrizes , Humanos , Assistência Centrada no Paciente/métodos , Pediatras/normas , Índice de Gravidade de Doença
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