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2.
Rev. neurol. (Ed. impr.) ; 78(8): 229-235, Ene-Jun, 2024.
Artigo em Espanhol | IBECS | ID: ibc-232510

RESUMO

La alteración aguda del estado mental en pediatría se refiere a un cambio repentino y significativo en la función cerebral y el nivel de conciencia de un niño. Puede manifestarse como confusión, desorientación, agitación, letargo o incluso pérdida de la conciencia. Esta condición es una emergencia médica, y requiere una evaluación y una atención inmediatas. Existen diversas causas de alteración aguda del estado mental en niños, algunas de las cuales incluyen infecciones del sistema nervioso central, como la meningitis o la encefalitis, los traumatismos craneoencefálicos, los trastornos metabólicos, las convulsiones o las intoxicaciones, entre otras. Este estudio tuvo como objetivo analizar, preparar y calificar la bibliografía actual para determinar las mejores recomendaciones sobre el tratamiento ante casos de alteración aguda del estado mental en pediatría de diferentes causas. El estudio se basó en la calificación de expertos en el campo para poder determinar la calificación de las recomendaciones, además de ser sometido a la revisión por parte del comité científico de la Academia Iberoamericana de Neurología Pediátrica. Nuestra guía representa una ayuda para el tratamiento de este síntoma inespecífico desde un enfoque básico y avanzado, aplicable por cualquier neurólogo pediatra.(AU)


In pediatric patients, an acute altered mental status refers to a sudden and significant change in a child’s brain function and level of consciousness. It may manifest as confusion, disorientation, agitation, lethargy or even a loss of consciousness. This condition is a medical emergency, and requires immediate evaluation and attention. There are several causes of acute altered mental status in children, including infections of the central nervous system such as meningitis or encephalitis, traumatic brain injury, metabolic disorders, seizures and poisoning, among others. The aim of this study was to analyse, prepare and classify the current literature in order to determine the best recommendations for the treatment of cases of acute altered mental status with various causes in pediatric patients. The study was based on opinions from experts in the field in order to classify the recommendations, and was submitted to the scientific committee of the Iberoamerican Academy of Pediatric Neurology for review. Our guide is an aid for the treatment of this non-specific symptom based on a basic and advanced approach, which can be applied by any pediatric neurologist.(AU)


Assuntos
Humanos , Masculino , Feminino , Saúde da Criança , Consciência , Confusão , Fadiga Mental , Disfunção Cognitiva , Pediatria , Neurologia , Doenças do Sistema Nervoso
3.
Pediatr Radiol ; 54(Suppl 2): 169-288, 2024 06.
Artigo em Inglês | MEDLINE | ID: mdl-38822865
5.
BMJ Paediatr Open ; 8(1)2024 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-38823801

RESUMO

INTRODUCTION: In paediatric oncology, 'breaking bad news'-BBN-like cancer diagnosis is perceived as particularly challenging. Enabling a trialogue between children with their relatives and health professionals requires profound communication skills. Lacking the skills, experience or adequate support tools might result in negative consequences for both paediatric oncologists as BBN transmitters and BBN receivers as children with cancer and their relatives.In contrast to oncology for adults, multiperspective studies that explore BBN experience and specific support needs are rare, especially in Germany. Systematically developed and practically piloted support instruments, which address the specific needs of paediatric oncology, are missing. OBJECTIVE: To systematically design and mature in practice an orientation compass for preparing, delivering and following up on BBN conversations in paediatric oncology-so-called Orientierungskompass zur Übermittlung schwerwiegender Nachrichten in der Kinderonkologie (OKRA). METHODS AND ANALYSIS: OKRA is based on a QUAL-quant mixed study design, comprising two phases. Four groups will contribute (1) experts through personal experience (representatives for children receiving BBN and their parents), (2) medical care providers and representatives of national medical societies, (3) ambulant psychosocial/psychological support providers and (4) researchers. In phase 1, multiperspective knowledge is generated through a participatory group Delphi that involves in-depth interviews, focus group discussions and questionnaires. This process culminates in formulating theses for a high-quality BBN process (output phase 1). In phase 2, based on the theses, a pilot orientation compass is designed. Through iterative cycles with the participatory action research method, this instrument will be piloted in three paediatric oncological settings and consequently optimised. ETHICS AND DISSEMINATION: OKRA was approved on 19 September 2023 by the ethics committee of the Medical Faculty of the University of Cologne (No. 23-1187). After project completion, the OKRA compass will be distributed to multidisciplinary paediatric oncology teams throughout Germany. TRIAL REGISTRATION NUMBER: DRKS00031691.


Assuntos
Revelação da Verdade , Humanos , Criança , Alemanha , Neoplasias/terapia , Neoplasias/psicologia , Oncologia/métodos , Pediatria/métodos , Comunicação , Relações Médico-Paciente , Pais/psicologia , Relações Profissional-Família
6.
Appl Clin Inform ; 15(3): 437-445, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38839064

RESUMO

BACKGROUND: Clinical informatics (CI) has reshaped how medical information is shared, evaluated, and utilized in health care delivery. The widespread integration of electronic health records (EHRs) mandates proficiency among physicians and practitioners, yet medical trainees face a scarcity of opportunities for CI education. OBJECTIVES: We developed a CI rotation at a tertiary pediatric care center to teach categorical pediatric, pediatric-neurology, and medicine-pediatric residents foundational CI knowledge and applicable EHR skills. METHODS: Created in 2017 and redesigned in 2020, a CI rotation aimed to provide foundational CI knowledge, promote longitudinal learning, and encourage real-world application of CI skills/tools. Led by a team of five physician informaticist faculty, the curriculum offers personalized rotation schedules and individual sessions with faculty for each trainee. Trainees were tasked with completing an informatics project, knowledge assessment, and self-efficacy perception survey before and after rotation. Paired t-test analyses were used to compare pre- and postcurriculum perception survey. RESULTS: Thirty-one residents have completed the elective with their projects contributing to diverse areas such as medical education, division-specific initiatives, documentation improvement, regulatory compliance, and operating plan goals. The mean knowledge assessment percentage score increased from 77% (11.6) to 92% (10.6; p ≤ 0.05). Residents' perception surveys demonstrated improved understanding and confidence across various informatics concepts and tools (p ≤ 0.05). CONCLUSION: Medical trainees are increasingly interested in CI education and find it valuable. Our medical education curriculum was successful at increasing residents' understanding, self-efficacy, and confidence in utilizing CI concepts and EHR tools. Future data are needed to assess the impact such curricula have on graduates' proficiency and efficiency in the use of CI tools in the clinical workplace.


Assuntos
Currículo , Informática Médica , Pediatria , Informática Médica/educação , Humanos , Pediatria/educação , Pessoal de Saúde/educação , Registros Eletrônicos de Saúde , Internato e Residência
7.
Pediatr Rheumatol Online J ; 22(1): 60, 2024 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-38840147

RESUMO

BACKGROUND: Many children with rheumatic and musculoskeletal diseases are unrecognized. Identifying these children requires health care provider awareness, knowledge, and skills to recognize disease features and how (and when) to refer to specialist care. The aim of this paper is to highlight the need for better access to health care, review the essential role that education and virtual care play to address unmet need in low resource areas and especially to expand workforce capacity. Using collaborative partnerships, virtual platforms, and innovative assessment methods, musculoskeletal care and education can be delivered to reach a greater audience than ever before. Increased awareness through multiple initiatives and readily available resources are imperative to improve global rheumatology care. CONCLUSION: The needs of children with rheumatic diseases and musculoskeletal conditions are vastly underserved around the world resulting in preventable morbidity and mortality. Expanded implementation of virtual education and e-health care platforms provides an opportunity to increase access to care for children globally.


Assuntos
Pediatria , Reumatologia , Humanos , Reumatologia/educação , Criança , Pediatria/educação , Pediatria/métodos , Acessibilidade aos Serviços de Saúde , Doenças Reumáticas/terapia , Doenças Musculoesqueléticas/terapia , Telemedicina
8.
BMC Med Educ ; 24(1): 645, 2024 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-38851725

RESUMO

BACKGROUND: Interprofessional education is vital in oral healthcare education and should be integrated into both theoretical and work-based education. Little research addresses interprofessional education in dental hands-on training in authentic oral healthcare settings. The aim of the study was to examine the readiness and attitudes of dental and oral hygiene students towards interprofessional education during joint paediatric outreach training. METHODS: In the spring of 2022, a cross-sectional study was done involving dental and oral hygiene students using the Readiness for Interprofessional Learning Scale (RIPLS) during joint paediatric outreach training. The 19-item tool was answered on a five-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, and 5 = strongly agree). Means, standard deviations, minimums, maximums, and medians were calculated for each subscale and overall score. Students grouped according to their categorical variables were compared for statistically significant differences. The Mann-Whitney U-test was used for groups of two and the Kruskal-Wallis one-way analysis for groups of three or more. The internal consistency of the scale was measured with Cronbach's alpha. Statistical level was set at 0.05. RESULTS: The survey included 111 participants, consisting of 51 oral hygiene students and 60 dental students, with a response rate of 93%. The questionnaire yielded a high overall mean score of 4.2. Both oral hygiene (4.3) and dental students (4.2) displayed strong readiness for interprofessional education measured by the RIPLS. The subscale of teamwork and collaboration achieved the highest score of 4.5. Students lacking prior healthcare education or work experience obtained higher RIPLS scores. Oral hygiene students rated overall items (p = 0.019) and the subscales of positive professional identity (p = < 0.001) and roles and responsibilities (p = 0.038) higher than dental students. The Cronbach's alpha represented high internal consistency for overall RIPLS scores on the scale (0.812). CONCLUSIONS: Both oral hygiene and dental students perceived shared learning as beneficial and showcased high readiness for interprofessional education, as evident in their RIPLS scores. Integrating interprofessional learning into oral hygiene and dental curricula is important. Studying together can form a good basis for future working life collaboration.


Assuntos
Atitude do Pessoal de Saúde , Relações Interprofissionais , Estudantes de Odontologia , Humanos , Estudos Transversais , Masculino , Feminino , Estudantes de Odontologia/psicologia , Educação Interprofissional , Higiene Bucal/educação , Inquéritos e Questionários , Educação em Odontologia/métodos , Pediatria/educação , Higienistas Dentários/educação , Adulto
9.
Pediatr Ann ; 53(6): e202-e207, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38852083

RESUMO

For more than 4 decades, pediatricians have sought the best practices for effectively managing well-appearing young febrile infants. In 2021, the American Academy of Pediatrics released a clinical practice guideline for the management of well-appearing febrile infants aged 8 to 60 days. The guideline incorporates advancements in testing, such as biomarkers and diagnostic testing in the setting of changing epidemiology, to help risk stratify infants in the newly formed group age 22 to 28 days as well as the group age 29 to 60 days. The new guideline uses inflammatory markers (procalcitonin, C-reactive protein, absolute neutrophil count, and a temperature >38.4°C) to identify infants at low risk for invasive bacterial infection who can potentially avoid the invasive procedures of lumbar puncture, hospitalization, and broad-spectrum antimicrobials. Because of continued ambiguity, incorporating shared decision-making with families in the care of these infants will be important, as will ongoing clinical research to better inform future practice. [Pediatr Ann. 2024;53(6):e202-e207.].


Assuntos
Febre , Pediatria , Guias de Prática Clínica como Assunto , Humanos , Lactente , Febre/etiologia , Febre/diagnóstico , Recém-Nascido , Pediatria/métodos , Pediatria/normas , Estados Unidos , Antibacterianos/uso terapêutico , Sociedades Médicas , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/tratamento farmacológico , Biomarcadores/sangue
11.
Pediatr Ann ; 53(6): e208-e216, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38852082

RESUMO

Neonatal hyperbilirubinemia is one of the most common conditions managed by pediatricians. Although many infants are affected, most will experience complete resolution without complication. Acute bilirubin encephalopathy and kernicterus are rare yet debilitating sequelae of severe hyperbilirubinemia that can be avoided through careful monitoring and treatment with phototherapy. Appropriate management of neonatal hyperbilirubinemia must balance the risks of these severe conditions with the effects of overtreatment. Released in 2022, the American Academy of Pediatrics revised the clinical practice guideline for the management of hyperbilirubinemia, which aims to provide that balance through updates to the previous guideline. This article will provide the reader with (1) an evidence-based harm and benefit analysis of the guideline, (2) an overview of key changes and clarifications made in the new guideline, and (3) a practical summary of guideline updates. [Pediatr Ann. 2024;53(6):e208-e216.].


Assuntos
Hiperbilirrubinemia Neonatal , Kernicterus , Fototerapia , Humanos , Hiperbilirrubinemia Neonatal/terapia , Hiperbilirrubinemia Neonatal/diagnóstico , Recém-Nascido , Estados Unidos , Fototerapia/métodos , Kernicterus/terapia , Kernicterus/prevenção & controle , Kernicterus/etiologia , Kernicterus/diagnóstico , Guias de Prática Clínica como Assunto , Pediatria/normas , Pediatria/métodos , Sociedades Médicas
12.
Perspect Biol Med ; 67(2): 209-226, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38828600

RESUMO

Recently published consensus recommendations on pediatric decision-making by Salter and colleagues (2023) did not address neonatal decision-making, due to the unique complexities of neonatal care. This essay explores three areas that impact neonatal decision-making: legal and policy considerations, rapid technological advancement, and the unique emotional burdens faced by parents and clinicians during the medical care of neonates. The authors evaluate the six consensus recommendations related to these considerations and conclude that the consensus recommendations apply to neonates.


Assuntos
Tomada de Decisões , Humanos , Recém-Nascido , Tomada de Decisões/ética , Pais/psicologia , Pediatria/ética , Tomada de Decisão Clínica/ética
14.
Perspect Biol Med ; 67(2): 186-196, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38828598

RESUMO

This article describes the process engaged by 17 expert scholars in the development of a set of six consensus recommendations about the normative foundations of pediatric decision-making. The process began with a robust pre-reading assignment, followed by three days of in-person symposium discussions that resulted in a publication in Pediatrics entitled "Pediatric Decision-Making: Consensus Recommendations" (Salter et al. 2023). This article next compares the six recommendations to existing statements about pediatric decision-making (specifically those developed by the American Academy of Pediatrics), highlighting similarities and differences. Finally, the article discusses the value of finding consensus in the field of pediatric bioethics.


Assuntos
Consenso , Pediatria , Humanos , Pediatria/ética , Pediatria/normas , Criança , Tomada de Decisões
15.
Perspect Biol Med ; 67(2): 277-289, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38828604

RESUMO

Pediatric intervention principles help clinicians and health-care institutions determine appropriate responses when parents' medical decisions place children at risk. Several intervention principles have been proposed and defended in the pediatric ethics literature. These principles may appear to provide conflicting guidance, but much of that conflict is superficial. First, seemingly different pediatric intervention principles sometimes converge on the same guidance. Second, these principles often aim to solve different problems in pediatrics or to operate in different background conditions. The potential for convergence between intervention principles-or at least an absence of conflict between them-matters for both the theory and practice of pediatric ethics. This article builds on the recent work of a diverse group of pediatric ethicists tasked with identifying consensus guidelines for pediatric decision-making.


Assuntos
Tomada de Decisão Clínica , Pais , Pediatria , Humanos , Pais/psicologia , Pediatria/ética , Criança , Tomada de Decisão Clínica/ética , Tomada de Decisões/ética
16.
Perspect Biol Med ; 67(2): 290-304, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38828605

RESUMO

In summer 2022, six points of consensus emerged from a symposium addressing the question, "In the context of U.S. pediatric care, what moral precepts ought to guide parents and clinicians in medical decision making for children?" (Salter et al. 2023). The authors of this statement wrote, however, that the points of consensus may require modification or may not apply in their entirety to children in state custody. This article addresses the consensus recommendations in the context of the thousands of children removed annually from the custody of their parents. While the consensus statements developed at the symposium provide a good starting point for decision-making in the context of these children, some alterations and nuance must be applied to attend to the specific needs of this population. The article works through what special considerations and changes ought to be made to expand the reach of the original points of consensus without neglecting the particular conditions of children in state custody, as well as their parents and caregivers.


Assuntos
Custódia da Criança , Humanos , Custódia da Criança/legislação & jurisprudência , Criança , Tomada de Decisões , Pais/psicologia , Pediatria/ética , Estados Unidos , Consenso
17.
BMC Med Educ ; 24(1): 607, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38824537

RESUMO

BACKGROUND: Healthcare systems worldwide face challenges related to patient safety, quality of care, and interprofessional collaboration. Simulation-based team training has emerged as a promising approach to address some of these challenges by providing healthcare professionals with a controlled and safe environment to enhance their teamwork and communication skills. The purpose of this study protocol is to describe an intervention using simulation-based team training in pediatric departments. METHODS: Using a parallel-group, non-randomized controlled trial design, a simulation-based team training intervention will be implemented across four pediatric departments in Denmark. Another four pediatric departments will serve as controls. The intervention implies that healthcare professionals engage in simulation-based team training at a higher quantity and frequency than they did previously. Development of the intervention occurred from April 2022 to April 2023. Implementation of the intervention occurs from April 2023 to April 2024. Evaluation of the intervention is planned from April 2024 to April 2025. All simulation activity both before and during the intervention will be registered, making it possible to compare outcomes across time periods (before versus after) and across groups (intervention versus control). To evaluate the effects of the intervention, we will conduct four analyses. Analysis 1 investigates if simulation-based team training is related to sick leave among healthcare professionals. Analysis 2 explores if the simulation intervention has an impact on patient safety culture. Analysis 3 examines if simulation-based team training is associated with the treatment of critically ill newborns. Finally, Analysis 4 conducts a cost-benefit analysis, highlighting the potential return on investment. DISCUSSION: The implemented simulation-based team training intervention can be defined as a complex intervention. Following the Medical Research Council framework and guidelines, the intervention in this project encompasses feasibility assessment, planning of intervention, implementation of intervention, and rigorous data analysis. Furthermore, the project emphasizes practical considerations such as stakeholder collaboration, facilitator training, and equipment management. TRIAL REGISTRATION: Registered as a clinical trial on clinicaltrials.gov, with the identifier NCT06064045.


Assuntos
Equipe de Assistência ao Paciente , Treinamento por Simulação , Humanos , Dinamarca , Pediatria/educação , Pessoal de Saúde/educação , Ensaios Clínicos Controlados não Aleatórios como Assunto , Segurança do Paciente
18.
Can Med Educ J ; 15(2): 88-90, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38827899

RESUMO

A Transition to Foundations (TTF) curriculum that includes didactic and simulation components prepares first-year pediatric residents for increased roles and responsibilities in the Foundations of Discipline stage of Competency Based Medical Education, including junior night float rotations. Simulations of acute presentations improve resident comfort before overnight on-call experiences.


Un programme de transition vers les fondements de la discipline (TTF) comportant des volets didactique et de simulation prépare les résidents de première année en pédiatrie à des rôles et des responsabilités accrus à l'étape des fondements de la discipline dans le cadre d'une approche par compétences, notamment aux stages de nuit des résidents juniors. Les simulations de présentations aiguës améliorent le confort des résidents avant les gardes de nuit.


Assuntos
Educação Baseada em Competências , Currículo , Internato e Residência , Pediatria , Humanos , Pediatria/educação , Educação Baseada em Competências/métodos , Competência Clínica , Avaliação de Programas e Projetos de Saúde
19.
Pediatr Transplant ; 28(5): e14790, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38837638

RESUMO

BACKGROUND: Probiotics are living microorganisms that may confer health benefits to their host if administered in sufficient quantities. However, data on the use of probiotics in transplant recipients are scarce. METHOD: This multi-center survey of pediatric nephrologists aimed to examine variations in practice regarding the use of probiotics in pediatric kidney transplant recipients. The survey was conducted via a 10-item questionnaire (developed in Survey Monkey) administered to pediatric nephrologists participating in the Pediatric Nephrology Research Consortium meeting in April 2023. RESULTS: Sixty-four pediatric nephrologists completed the survey. Twenty-seven (42.2%) respondents reported having prescribed probiotics to pediatric kidney transplant recipients. The primary reason for probiotic use was the treatment of antibiotic-associated diarrhea (n = 20), with other reasons including recurrent Clostridium difficile infection (n = 15), general gut health promotion (n = 12), recurrent urinary tract infections (n = 8), and parental request (n = 1). Of those who prescribed probiotics, 48.1% held them during periods of neutropenia and 14.8% during central venous line use. Of the 64 respondents, 20 reported the lack of safety data as a concern for using probiotics in kidney transplant recipients. CONCLUSION: Pediatric nephrologists are increasingly prescribing probiotics to pediatric kidney transplant recipients; nevertheless, substantial practice variations exist. The paucity of safety data is a significant deterrent to probiotic use in this population.


Assuntos
Transplante de Rim , Padrões de Prática Médica , Probióticos , Humanos , Probióticos/uso terapêutico , Criança , Nefrologia/métodos , Medicina Baseada em Evidências , Masculino , Feminino , Inquéritos e Questionários , Complicações Pós-Operatórias/prevenção & controle , Transplantados , Pediatria , Adolescente
20.
BMJ Open ; 14(6): e081541, 2024 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-38839390

RESUMO

INTRODUCTION: The development of paediatric medical devices continues to lag adult medical devices and contributes to issues of inequity, safety, quality and patient outcomes. New legislation and funding mechanisms have been introduced over the past two decades, but the gap remains. Clinical trials have been identified as a pain point, but components of effective clinical research infrastructure are poorly understood. As part of a multimodal research strategy, the Pediatric Device Consortia (PDC) will conduct a scoping review to better understand infrastructural barriers to and facilitators of paediatric medical device clinical research identified in the health sciences literature. METHODS AND ANALYSIS: The following databases will be included for this review: Medline, Embase, Cochrane CENTRAL, Web of Science and IEEE Xplore. Additional grey literature will be sought out through Google Scholar and reviewing the citations of included studies. Included studies will discuss medical devices according to the U.S. Food and Drug Administration classification, focus on the paediatric population (ages 0-21 years) and involve human premarket or postmarket research. All study types that were published in 2007-present in English, Spanish, French or Italian will be included. Using Covidence web-based software, two independent reviewers will screen the resulting titles, abstracts and the full text of potential studies. Conflicts will be resolved by the primary investigator during both phases. REDCap will be used for quantitative and qualitative data charting, generating data tables and narrative synthesis. ETHICS AND DISSEMINATION: This research did not require research ethics board consideration as it does not involve human participants and all data will be collected from published literature. We will share our findings through peer-reviewed manuscripts, clinical and research conference presentations and professional networks available to the PDC. STUDY REGISTRATION: Open Science Framework (https://osf.io/k72bn).


Assuntos
Equipamentos e Provisões , Humanos , Criança , Pediatria , Projetos de Pesquisa , Adolescente , Invenções , Literatura de Revisão como Assunto
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