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1.
Ann R Coll Surg Engl ; 102(1): 49-53, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31755741

RESUMO

INTRODUCTION: Testicular torsion treatment rests on the horns of a dilemma, with widespread national variation in whether the responsible surgical specialty is general surgery or urology, even in hospitals with both general surgery and urology emergency service assets. This study aimed to quantify higher surgical trainee operative experience and confidence in managing suspected testicular torsion in a single UK deanery (Wales). MATERIALS AND METHODS: Anonymised logbook data were obtained via the Intercollegiate Surgical Curriculum Programme version 10 using the head of school report function for all general surgery (n=53) and urology (n=15) higher surgical trainees, which were combined with the distribution of an electronic self-administered questionnaire. RESULTS: Median operative scrotal explorations recorded for all general surgery higher surgical trainees and senior general surgery higher surgical trainees (ST7+) was 7 (range 1-22) and 10 (range 1-22), compared with 21 (range 9-64, p=0.00104) and 24 (19-64, p<0.001) for urology higher surgical trainees. The questionnaire response rate was 64.6% (general surgery 31/50, urology 11/15). Confidence levels in assessing adult and paediatric patients were lower in general surgery when compared with urology higher surgical trainees: median adult confidence rate 7/10 compared with 9/10, and paediatric confidence rate 7/10 compared with 8/10 (p<0.001 and p=0.053, respectively). All higher surgical trainees preferred urology as the accountable hospital specialty when both assets were available. DISCUSSION AND CONCLUSION: General surgery higher surgical trainees receive less than 50% of the operative exposure of urology higher surgical trainees in emergency scrotal surgery, which has important implications for curriculum competence development and patient safety.


Assuntos
Cirurgia Geral/educação , Torção do Cordão Espermático/cirurgia , Urologia/educação , Adulto , Atitude do Pessoal de Saúde , Criança , Competência Clínica/normas , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Cirurgia Geral/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Humanos , Masculino , Pediatria/educação , Pediatria/estatística & dados numéricos , Inquéritos e Questionários , Urologistas/educação , Urologistas/normas , Urologia/estatística & dados numéricos , País de Gales
2.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31562252

RESUMO

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


Assuntos
Transtorno do Espectro Autista/diagnóstico , Lista de Checagem , Programas de Rastreamento/normas , Pediatria/normas , Fatores Etários , Transtorno do Espectro Autista/epidemiologia , Pré-Escolar , Registros Eletrônicos de Saúde , Feminino , Seguimentos , Hospitais Pediátricos , Humanos , Lactente , Masculino , Programas de Rastreamento/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Philadelphia/epidemiologia , Valor Preditivo dos Testes , Prevalência , Sensibilidade e Especificidade , Fatores Sexuais , Fatores Socioeconômicos
3.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31515298

RESUMO

OBJECTIVES: To examine screening practices for autism spectrum disorder (ASD), subsequent referrals, and diagnostic outcomes within a large network of primary pediatric care practices. METHODS: Rates of ASD screening with the Modified Checklist for Autism in Toddlers (M-CHAT) at 18- and 24-month well-child visits were examined among 290 primary care providers within 54 pediatric practices between June 2014 and June 2016. Demographic, referral, and diagnostic data were abstracted from the medical records for all children who failed the M-CHAT (ie, score of ≥3) at either or both visits. RESULTS: Rates of M-CHAT screening were 93% at 18 months and 82% at 24 months. Among 23 514 screens, scores of 648 (3%) were ≥3 (386 at 18 months, 262 at 24 months) among 530 unique children who failed 1 or both screenings. Among screen-failed cases, 18% received a diagnosis of ASD and 59% received ≥1 non-ASD neurodevelopmental disorder diagnosis within the follow-up period. Only 31% of children were referred to a specialist for additional evaluation. CONCLUSIONS: High rates of ASD-specific screening do not necessarily translate to increases in subsequent referrals for ASD evaluation or ASD diagnoses. Low rates of referrals and/or lack of follow-through on referrals appear to contribute to delays in children's receipt of ASD diagnoses. Additional education of primary care providers regarding the referral process after a failed ASD screening is warranted.


Assuntos
Transtorno do Espectro Autista/diagnóstico , Lista de Checagem , Pediatria/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Fatores Etários , Transtorno do Espectro Autista/epidemiologia , Pré-Escolar , Humanos , Lactente , Perda de Seguimento , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/epidemiologia
4.
J Pediatr Orthop ; 39(9): e722-e728, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503236

RESUMO

INTRODUCTION: Electronic medical record (EMR) use among pediatric orthopaedic surgeons has evolved substantially within the past decade. In response to the Patient Protection and Affordable Care Act, large hospitals and tertiary pediatric medical centers rapidly acquired and implemented EMRs with uncertainty as to the potential impact on patient care and operational efficiency of subspecialists. This study reviews the background and regulatory framework for Meaningful Use of EMR and assesses the current landscape of EMR utilization by pediatric orthopaedic surgeons. METHODS: In 2015, the Practice Management Committee distributed a survey regarding EMR use and satisfaction to members of the Pediatric Orthopaedic Society of North America. Survey responses from 324 members were used to analyze levels of satisfaction by EMR platform and practice type and to consider drivers of satisfaction or dissatisfaction of end users. RESULTS: Although there were no differences in overall satisfaction based on vendor or practice type, significant differences were noted for 5 specific parameters of satisfaction, including: usefulness of templates, efficiency of practice workflow, information services support, number of logon events, and speed of the system. A user/vendor map is provided to facilitate networking among providers and groups utilizing common EMR platforms to help bring about rational improvements in EMR functionality for the future. CONCLUSIONS: Substantial effort needs to be made to improve subspecialty-specific EMR documentation, order entry, research tools, and clinical workflows to enhance the processes of care for children with orthopaedic conditions in the era of EMR. LEVEL OF EVIDENCE: Level IV.


Assuntos
Atitude do Pessoal de Saúde , Comportamento do Consumidor , Registros Eletrônicos de Saúde/estatística & dados numéricos , Ortopedia/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Registros Eletrônicos de Saúde/legislação & jurisprudência , Registros Eletrônicos de Saúde/normas , Humanos , Uso Significativo/legislação & jurisprudência , Patient Protection and Affordable Care Act , Software/normas , Inquéritos e Questionários , Estados Unidos , Fluxo de Trabalho
6.
Niger Postgrad Med J ; 26(3): 158-163, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31441453

RESUMO

Background: An early first dental clinic appointment offers the prospect of prompt preventative care and parental education regarding the oral health of the child. The evidence-based recommendation by dental professionals all over the world is that a child should visit a dentist before or by 1 year of age. Aim: This study aimed to determine the chronological age at and the purpose for a first dental clinic visit amongst children aged 16 years and below attending the Paediatric Dental Clinic at the Lagos University Teaching Hospital (LUTH). Materials and Methods: This was a retrospective study conducted amongst children who attended the Paediatric Dental Clinic at the LUTH between January 2017 and December 2018. Data on age at first dental visit, reasons for attending and other information relevant to the study were collected. Descriptive statistics and Chi-square analysis were conducted, and the level of significance was set at P < 0.05. Results: A total of 1157 children were studied, comprising 580 (50.5%) males and 577 (49.9%) females. Their mean age on their first dental visit was 7.9 ± 3.7 years. Most of the children (31.4%) had their first dental visits at 7 and 9 years, and 0.8% of the children had their first dental visit below the age of 1 year. The most common reason for visiting the dental clinic was dental pain (33.1%). A higher proportion of the children (911 [79.0%]) had their first dental visit for therapeutic purposes, whereas 246 (21.0%) children visited the dental clinic for preventive care. Sex and age at first dental visit were statistically significantly associated with the reason for attendance (P < 0.001). Conclusion: Most children had their first dental visit between the ages of 7 and 9 years, mainly because of pain. It is necessary to create more awareness among parents/caregivers and to establish the concept of dental home.


Assuntos
Assistência Odontológica para Crianças/estatística & dados numéricos , Clínicas Odontológicas/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Saúde Bucal , Pediatria/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Hospitais de Ensino , Humanos , Masculino , Nigéria , Estudos Retrospectivos
7.
J Pediatr Orthop ; 39(8): e572-e577, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31393291

RESUMO

BACKGROUND: Tibial spine fractures are rare, complex injuries. Management remains varied given a lack of consensus about the optimal approach. Thus, the purpose of this study is to determine prevailing strategies among pediatric orthopaedists and establish areas of agreement and ongoing controversy in the management of tibial spine fractures. METHODS: An electronic survey was distributed to the Pediatric Orthopaedic Society of North America (POSNA) membership. Surgeon demographics, experience, and responses to clinical vignettes were collected. Surgeons were grouped according to how frequently they treat tibial spine fractures and responses were compared. RESULTS: Of the 180 POSNA members who completed the survey, all were attending surgeons and nearly all (90.4%) had academic affiliations, treated mostly skeletally immature patients (88.5%), and 3 or fewer fractures per year (62.4%). In younger patients, respondents were more likely to treat type II fractures closed and less likely to cross the physis. Arthrofibrosis was the most commonly reported complication and postoperative duration of immobilization was identified as a risk factor by most. However, high-frequency surgeons identified this risk factor more often (P=0.015) and recommended immobilization for <2 weeks more frequently (P=0.018). There was, however, considerable discrepancy regarding the duration of immobilization. Although there were areas of agreement on general principles, there continues to be disagreement regarding specific treatment strategies. CONCLUSIONS: Surgeons within POSNA agree on general principles of treatment for tibial spine fractures. Members, regardless of high-volume or low-volume caseload, are all less likely to pursue surgical options when treating younger patients and treating arthrofibrosis during the first 2 postoperative months. The most commonly reported adverse outcome after treatment was arthrofibrosis, for which high-frequency surgeons identified length of immobilization as a significant risk factor more often and thus, recommended shorter periods of immobilization. Although surgeons may agree on general principles in some cases, there continues to be disagreement regarding specific strategies suggesting that a prospective multicenter study of this topic is warranted. LEVEL OF EVIDENCE: Level V.


Assuntos
Fraturas Intra-Articulares/cirurgia , Articulação do Joelho/patologia , Ortopedia/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Fraturas da Tíbia/cirurgia , Adolescente , Criança , Fibrose , Humanos , Fraturas Intra-Articulares/complicações , Ortopedia/métodos , Pediatria/métodos , Estudos Prospectivos , Inquéritos e Questionários , Fraturas da Tíbia/complicações
8.
BMC Public Health ; 19(1): 958, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31319834

RESUMO

BACKGROUND: Dengue fever is the world's fastest spreading mosquito borne viral infection. It is prevalent throughout both subtropical and tropical region, and affects over 128 countries. Dengue virus (DENV) infection poses a serious global public health challenge to three billion people, resulting in approximately 200 million cases of morbidity and 50,000 cases of mortality annually. In Cameroon like in most sub-Saharan African countries, DENV infection occur concurrently with other infectious diseases whose symptoms often overlap, rendering differential diagnosis challenging. This study aims at determining the frequency of acute dengue among febrile children under 15 years attending hospitals in some areas of Cameroon. METHODS: A total of 961 children under the age of 15 were recruited in a cross-sectional study using systematic sampling technique and by selecting each subject out of the three. The study was conducted in 10 public health centers in Cameroon. Demographic data and risk factors of the subjects were obtained using well-structured questionnaires. Dengue virus NS1 antigen, IgM and IgG were analysed using a Tell me fast® Combo Dengue NS1-IgG/IgM Rapid Test. An in-house ELISA test for dengue specific IgM antibody was equally performed for confirmation. Descriptive statistical analysis was performed using Graph pad version 6.0. RESULTS: A prevalence of 6.14% acute dengue virus infection was observed among children with febrile illness with a significant difference (p = 0.0488) between males (4.7%) and females (7.7%). In addition, children who reportedly were unprotected from vectors, showed a comparatively higher prevalence of the disease seropositivity than those practicing protective measures. CONCLUSION: DENV infection therefore is an important cause of fever among children in Cameroon. Thus, there is a need to include differential screening for DENV infections as a tool in the management of fever in children in the country.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Vírus da Dengue , Dengue/epidemiologia , Febre/epidemiologia , Pediatria/estatística & dados numéricos , Adolescente , Anticorpos Antivirais/análise , Anticorpos Antivirais/imunologia , Camarões/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Dengue/virologia , Vírus da Dengue/imunologia , Ensaio de Imunoadsorção Enzimática , Feminino , Febre/virologia , Humanos , Imunoglobulina M/análise , Imunoglobulina M/imunologia , Masculino , Prevalência , Fatores de Risco
9.
Ann Clin Microbiol Antimicrob ; 18(1): 20, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31269955

RESUMO

BACKGROUND: Despite their critical role in antimicrobial stewardship programs, data on antimicrobial consumption among the pediatric and neonatal population is limited internationally and lacking in Saudi Arabia. The current study was done as part of our antimicrobial stewardship activities. OBJECTIVES: To calculate overall and type-specific antimicrobial consumption. METHODS: A prospective surveillance study was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between October 2012 and June 2015 in two pediatric and one neonatal intensive care units (ICUs). Consumption data were collected manually on a daily basis by infection control practitioners. Data were presented as days of therapy (DOT) per 1000 patient-days and as frequency of daily consumption. RESULTS: During the 33 months of the study, a total of 30,110 DOTs were monitored during 4921 admissions contributing 62,606 patient-days. Cephalosporins represented 38.0% of monitored antimicrobials in pediatric ICUs followed by vancomycin (21.9%), carbapenems (14.0%), aminoglycosides (8.8%), and piperacillin/tazobactam (8.8%). Their consumption rates were 265.1, 152.6, 97.6, 61.4, and 61.4 DOTs per 1000 patient-days (respectively). Aminoglycosides represented 45.4% of monitored antimicrobials in neonatal ICU followed by cephalosporins (30.4%) vancomycin (13.6%), and carbapenems (8.3%). Their consumption rates were 147.5, 98.7, 44.3, and 27 DOTs per 1000 patient-days (respectively). CONCLUSION: Cephalosporins are frequently used in pediatric ICU while aminoglycosides are frequently used in neonatal ICU. The local consumption of cephalosporins and carbapenems in both ICUs is probably higher than international levels. Such data can help in establishing and monitoring the functions of antimicrobial stewardship activities aiming to ensure judicious consumption of antimicrobials.


Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecção Hospitalar/tratamento farmacológico , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Adolescente , Bactérias/efeitos dos fármacos , Bactérias/genética , Bactérias/isolamento & purificação , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Carbapenêmicos/uso terapêutico , Cefalosporinas/uso terapêutico , Criança , Pré-Escolar , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Monitoramento Epidemiológico , Feminino , Humanos , Lactente , Masculino , Pediatria/estatística & dados numéricos , Estudos Prospectivos , Arábia Saudita/epidemiologia , Vancomicina/uso terapêutico
10.
Spine (Phila Pa 1976) ; 44(18): E1103-E1107, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31261266

RESUMO

STUDY DESIGN: A retrospective review of prospectively collected data. OBJECTIVE: Our purpose was to evaluate the volume of pediatric spine cases being done by surgeons applying for American Board of Orthopaedic Surgeons (ABOS) certification. SUMMARY OF BACKGROUND DATA: Pediatric orthopedic surgery has become increasingly subspecialized over the past decade. METHODS: Data were reviewed from the ABOS for surgeons undergoing part II of ABOS certification between 2004 and 2014. Applicants were divided into pediatric orthopedic surgeons and spine surgeons based on their self-declared subspecialty for the ABOS Part II examination. A total of 102,424 cases were reviewed to identify spine cases performed on patients <18 years old. RESULTS: Between 2004 and 2014, the total number of ABOS part II pediatric candidates increased significantly, from a low of 15 to a high of 44 (r = 0.68, P = 0.001). During this time frame, there has been no significant increase in the total number of pediatric spine cases reported (r = 0.09, P = 0.19). In 2004, 46.5% (33/71) of the pediatric spine cases were done by spine surgeons, which decreased to 17.3% (28/162) in 2014. Conversely in 2004, 53.5% (38/71) of pediatric spine cases were done by pediatric orthopedists, which increased to 82.7% (134/162) in 2014. The number of pediatric candidates performing pediatric spine cases decreased 35% from 2004 to 2014, but the percentage performing >20 spine cases during their candidate year has increased from 0% to 7% (r = 0.31, P = 0.04). CONCLUSION: The share of pediatric spine surgeries performed by pediatric candidates has increased from 54% in 2004 to 83%, with a corresponding fall in the share surgeries performed by spine candidates (47% to >17%). The percentage of pediatric candidates performing more than 20 spine cases/year increased from 0% to 7%, reflecting a trend of spine subspecialization within pediatric surgery. LEVEL OF EVIDENCE: 3.


Assuntos
Cirurgiões Ortopédicos/estatística & dados numéricos , Cirurgiões Ortopédicos/tendências , Coluna Vertebral/cirurgia , Acidentes por Quedas , Adolescente , Certificação , Criança , Coleta de Dados , Bases de Dados Factuais , Feminino , Humanos , Pediatria/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
11.
Curr Microbiol ; 76(9): 1020-1027, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31187207

RESUMO

Emerging evidence exists that an altered gut microbiota is a key factor in the pathophysiology of a variety of diseases. Consequently, microbiota-targeted interventions, including administration of probiotics, have increasingly been evaluated. Mechanisms on how probiotics contribute to homeostasis or reverse (effects of) dysbiosis remain yet to be elucidated. In the current study, we assessed the effects of daily Lactobacillus casei strain Shirota (LcS) ingestion in healthy children aged from 12-18 years on gut microbiota compositional diversity and stability. Results were compared to healthy children without LcS exposure. For a period of 6 weeks, fecal samples were collected weekly by both groups. In total, 18 children were included (6 probiotics; 12 non-probiotics). At 1-week intervals, no differences in diversity and stability were observed in children exposed to LcS versus controls. LcS ingestion by healthy children does not result in a more diverse and stable gut microbiota composition. Large double-blind placebo-controlled randomized clinical trials in children should be performed to gain more insight on potential beneficial health consequences.


Assuntos
Microbioma Gastrointestinal , Lactobacillus casei/fisiologia , Probióticos/administração & dosagem , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Fezes/microbiologia , Feminino , Humanos , Masculino , Pediatria/estatística & dados numéricos
13.
Orthop Clin North Am ; 50(3): 315-325, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31084833

RESUMO

Pediatric orthopedic surgery has changed in many ways over the past 2 decades. Member surveys and recent literature confirm that there has been a sustained balance of interest and opportunity in growth of applicant numbers and fellowship spots. Pediatric orthopedics is leading the way in gender diversity in orthopedics. Concerns of competition are valid and appear to be rising; however, case load data suggest that with increased training of pediatric orthopedists, there seems to be an adequate increase in cases. Periodic workforce analysis should continue to gauge any changes in attitudes or monitor concerns of competition.


Assuntos
Mão de Obra em Saúde/tendências , Ortopedia/tendências , Pediatria/tendências , Bolsas de Estudo , Previsões , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Ortopedia/economia , Ortopedia/educação , Ortopedia/estatística & dados numéricos , Pediatria/economia , Pediatria/educação , Pediatria/estatística & dados numéricos , Salários e Benefícios , Especialização
14.
Ir Med J ; 112(3): 896, 2019 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-31045335

RESUMO

Introduction Elective and emergency paediatric general surgery is performed in numerous hospitals but with differing exclusion and transfer thresholds. Recent national guidelines detail necessary surgical, anaesthetic and nursing resources for safe and efficient delivery of services. Methods A retrospective review of paediatric surgical admissions was performed from January 2015 to December 2016. Charts of prolonged admissions or readmissions were reviewed. Results There was a total of 2,079 surgical admissions. 575 (27.2%) were elective and 1504 (71.2%) were emergency admissions. Significantly more surgical procedures were performed in 2016 (n=546, 56% versus n=433, 44.2%). Laparoscopic appendicectomy was the most commonly performed procedure. Re-admission rates were lower in 2016 (n=9, 0.8% versus n=21, 2.2%). All complications were Clavien-Dindo Grade I or II. Discussion Paediatric general surgery can be safely and efficiently performed by staffed and resourced Model III hospitals.


Assuntos
Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Hospitais , Humanos , Lactente , Tempo de Internação , Masculino , Readmissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Segurança , Fatores de Tempo
15.
Int J Pediatr Otorhinolaryngol ; 123: 22-25, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31054537

RESUMO

OBJECTIVES: The objective of this study is to examine the impact that an institution-wide policy to reduce radiation exposure in pediatric patients had on the use of computed tomography (CT) imaging in children presenting with suspected peritonsillar abscess (PTA)1. METHODS: A single institution retrospective review was conducted for all pediatric patients under the age of 18 who presented to the emergency department with suspected PTA over a ten-year period. Patients were divided into two groups; those that presented during the years prior to policy implementation and those that presented during the years following. Main outcome measures were the frequency of patients who underwent CT scanning as a part of their workup, the specialty of the ordering physician, and the treatment for suspected PTA. RESULTS: A total of 317 patients with suspected PTA were seen prior to policy implementation, with an additional 275 patients seen in the years after. The frequency of CT use was 41% (131/317) in pre-policy patients, and 28% (77/275) in post-policy patients (p = 0.004). The most common specialty of ordering physician was Pediatrics in the pre-policy patients (45%), and Otolaryngology in the post-policy patients (41%) (p = 0.0003). Of the 131 patient who underwent CT scanning before policy implementation, 36 patients (27%) required incision and drainage (I&D) of their PTA in the OR. This is in comparison to 42/77 patients (55%) in the post-policy group who underwent I&D in the OR (p < 0.0001). CONCLUSION: An institution-wide policy to decrease unnecessary imaging studies in pediatric patients resulted in a significant reduction in the use of CT imaging in the work-up for suspected PTA. Additionally, there was increase in the frequency of patients who underwent surgical intervention for their PTA after CT imaging, suggesting a more scrutinized approach to CT usage since policy implementation.


Assuntos
Política Organizacional , Otolaringologia/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Abscesso Peritonsilar/diagnóstico por imagem , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Drenagem , Serviço Hospitalar de Emergência , Feminino , Hospitais Pediátricos , Humanos , Masculino , Abscesso Peritonsilar/cirurgia , Estudos Retrospectivos , Procedimentos Desnecessários/estatística & dados numéricos
16.
Fam Syst Health ; 37(2): 162-166, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31058527

RESUMO

INTRODUCTION: The disproportionate time required to effectively manage psychosocial concerns is a key barrier to advancing delivery of behavioral care by primary care providers. Improved time efficiency is one potential benefit of the integration of behavioral health consultants (BHCs) into pediatric care, but few studies have systematically studied this outcome. We examined the impact of embedded BHCs on duration of medical encounters in a pediatric primary care clinic. METHOD: We conducted a retrospective matched-pairs analysis of encounters involving behavioral consultations versus encounters for similar patients that did not include a consultation (N = 114) using electronic health record timestamp data. We examined both medical duration (i.e., medical provider services) and total duration (i.e., medical services + behavioral consultation). RESULTS: Patient encounters involving behavioral consultation had a significantly longer (+11.23 min) total duration than matched controls, but significantly shorter (-11.67 min) medical duration. DISCUSSION: The results indicate BHCs may improve primary care provider efficiency for patients with behavioral concerns, a notable finding given the impact of clinical time-constraints on important health care outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Medicina do Comportamento/normas , Atenção Primária à Saúde/métodos , Encaminhamento e Consulta/normas , Fatores de Tempo , Medicina do Comportamento/métodos , Medicina do Comportamento/estatística & dados numéricos , Criança , Pré-Escolar , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Humanos , Lactente , Masculino , Pediatria/métodos , Pediatria/normas , Pediatria/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Fluxo de Trabalho
17.
Ear Nose Throat J ; 98(5): 279-282, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30939913

RESUMO

The purpose of this article is to differentiate pediatric patients with chronic adenoiditis from those with chronic rhinosinusitis (CRS) based on presenting symptoms. A chart review from a tertiary care facility with pediatric patients who presented with suspected CRS from 2006 to 2014 was identified. We compared patient characteristics, clinical symptoms, duration of symptoms, and past medial history using univariate and multivariate logistic regression models. Based on recent literature, utilizing the computed tomography (CT) score, we identified those children with CRS versus those with chronic adenoiditis. Of the 99 pediatric patients included, 22 patients had diagnosis of adenoiditis and 77 had diagnosis of CRS. When purulent rhinorrhea was present with facial pain, CRS was statistically more prevalent than chronic adenoiditis (P = .017). Symptoms including cough (P = .022), rhinorrhea (P = .27), and facial pressure (P = .98) were not predictive of one diagnosis over the other. Past medical history of asthma or allergy was similar in both groups. Smoke exposure was associated with CT scores >5 (odds ratio 2.4, 95% confidence interval, 0.799-7.182). We conclude that purulent rhinorrhea in the presence of facial pain is more indicative of CRS versus chronic adenoiditis. For all other children, an adenoidectomy without the need for a CT scan can be entertained.


Assuntos
Adenoidectomia/métodos , Tonsila Faríngea , Doenças Linfáticas , Rinite , Sinusite , Avaliação de Sintomas/métodos , Tonsila Faríngea/diagnóstico por imagem , Tonsila Faríngea/patologia , Tonsila Faríngea/fisiopatologia , Adolescente , Criança , Pré-Escolar , Doença Crônica , Diagnóstico Diferencial , Dor Facial/diagnóstico , Dor Facial/etiologia , Feminino , Humanos , Doenças Linfáticas/diagnóstico , Doenças Linfáticas/epidemiologia , Doenças Linfáticas/fisiopatologia , Masculino , Pediatria/métodos , Pediatria/estatística & dados numéricos , Prevalência , Rinite/diagnóstico , Rinite/epidemiologia , Rinite/fisiopatologia , Sinusite/diagnóstico , Sinusite/epidemiologia , Sinusite/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Estados Unidos
18.
J Pediatr Surg ; 54(6): 1112-1117, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30922686

RESUMO

PURPOSE: Geographic proximity to pediatric surgical care has not been evaluated using the Decennial Census nor have racial, ethnic, gender, or urbanization variations been reported. This study's aim is to describe proximity of children living in the continental U.S. to a pediatric surgeon with respect to these variations. METHODS: The 2010 American Pediatric Surgical Association member file and the 2010 Decennial Census were used to calculate straight-line distances between pediatric surgeons' zip code centroids and census block centroids. RESULTS: In 2010, 716 practicing pediatric surgeons were identified, 6,182,882 populated Census blocks were identified, and 73,690,271 children were enumerated. Of white non-Hispanic children, 30.1% lived greater than 40 miles from care. Of Native American children, 40.5% lived more than 60 miles from care. Among children 0-5 years of age, the median (IQR) miles to closest pediatric surgeon was 14.2 (6.2, 39.6), and 3,010,698 of these children lived more than 60 miles from care. CONCLUSION: More than 10 million children lived greater than 60 miles from a pediatric surgeon in 2010. Racial, ethnic, age, and urbanization variations in proximity to pediatric surgeons were present. This method is feasible to describe distance-to-care with the upcoming 2020 Decennial Census and may benefit future allocation of pediatric surgeons. LEVEL OF EVIDENCE: IV.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Criança , Estudos Transversais , Humanos , Estados Unidos
19.
Acta Med Port ; 32(2): 101-110, 2019 Feb 28.
Artigo em Português | MEDLINE | ID: mdl-30896390

RESUMO

INTRODUCTION: Respiratory tract infections represent the most frequent conditions in pediatric clinical practice that motivate antibiotic prescribing. The objective was to identify the frequency and pattern of antibacterial prescribing in respiratory diseases. MATERIAL AND METHODS: Over a period of two years (divided by the presentation of the clinical guideline standards) data was collected from clinical records of children with respiratory disease. Chi-square tests or Fisher's exact test were used to test associations between variables, statistical significance p < 0.05. RESULTS: There were 547 visits (mean age 6 years ± 5.3, 55% male gender). Analysis for Group A Streptococcus of the oropharynx was most frequently requested by pediatric residents (p = 0.005). Chest x-rays were more frequently requested by the Family Physician (p = 0.033). An antibiotic was prescribed in 87% of pneumonias, 84% acute otitis media, 68% acute tonsillitis, 25% laryngitis, 17% upper respiratory infections, 16% acute bronchiolitis. The Family Physician prescribed antibiotics more often than the Pediatrics resident in acute tonsillitis (p = 0.003) and in acute otitis media (p = 0.013). The most frequently prescribed antibiotic was amoxicillin (61%). There were no significant differences between the two periods studied regarding the number of prescriptions and antibiotic choice of the conditions studied. DISCUSSION: Antibiotic prescribing in pediatric acute respiratory infections was high and the choice of antibiotic therapy could be adjusted. We found no difference in antibiotic prescribing after the presentation of the clinical guideline standards. CONCLUSION: An improvement in the antibiotic prescription in children and adolescents in the outpatient clinic is considered necessary.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Antibacterianos/uso terapêutico , Padrões de Prática Médica , Infecções Respiratórias/tratamento farmacológico , Adolescente , Amoxicilina/uso terapêutico , Anticorpos Antibacterianos/análise , Bronquite/tratamento farmacológico , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/tratamento farmacológico , Feminino , Medicina Geral/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Internato e Residência/estatística & dados numéricos , Masculino , Otite Média/tratamento farmacológico , Pediatria/estatística & dados numéricos , Pneumonia/tratamento farmacológico , Estudos Prospectivos , Infecções Respiratórias/diagnóstico por imagem , Infecções Respiratórias/microbiologia , Estudos Retrospectivos , Streptococcus pyogenes/imunologia , Tonsilite/tratamento farmacológico
20.
An. pediatr. (2003. Ed. impr.) ; 90(3): 194.e1-194.e11, mar. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-178376

RESUMO

Objetivo: Analizar la cobertura y los principales indicadores bibliométricos de ANALES DE PEDIATRÍA en las bases de datos Scopus y Science Citation Index Expanded de la Web of Science (SCIE). Material y método: Se identificó la evolución de la producción de la revista según los tipos documentales, los índices de colaboración entre autores e instituciones y los indicadores de citación e impacto (número de citas, factor de impacto, factor de impacto de 5años y sin autocitas, Scimago Journal Rank, cuartil, índice h y trabajos más citados). Resultados: Se han incluido 10.128 trabajos en Scopus (225 anuales de media) y 1.861 en SCIE (207 anuales de media). El índice de colaboración de los autores ha sido de 4,4 y el de las instituciones, de 2. La colaboración internacional se ha producido en el 4,2% de los trabajos. El número de citas recibidas en Scopus (619) supera en 234 las citas recibidas en SCIE (385). El promedio de citas por trabajo ha sido inferior en SCIE (2,27 en Scopus frente a 1,5 en SCIE). El índice h ha sido de 18 en Scopus y de 14 en SCIE. Conclusiones: Se observaron discrepancias en los indicadores obtenidos en ambas bases de datos debido a las diferentes políticas de indexación, cobertura y métodos de clasificación de los trabajos. El número de citas, el promedio de citas por trabajo y el índice h han sido más altos en Scopus debido a la mayor pervivencia de la revista en esa base de datos. Se observa una evolución positiva del factor de impacto en SCIE, del factor de impacto excluyendo las autocitas y del factor de impacto de 5 años


Purpose: To analyse the coverage and main bibliometric indicators of ANALES DE PEDIATRÍA in Scopus and Science Citation Index Expanded of the Web of Science (SCIE) databases. Material and method: The evolution of the journal production was identified according to the document types, collaboration indexes between authors and institutions, and citations, and impact indicators (number of citations, impact factor, 5-years impact factor and without self-citations, Scimago Journal Rank, quartile, h index and most cited works). Results: A total of 10,128 papers were included in Scopus (a mean of around 225 per year) and 1,861 in SCIE (a mean of around 207 per year). The index of collaboration was 4.4 for authors and 2 for institutions. There was international collaboration in 4.2% of the papers. The number of citations received in Scopus (619) exceeded the number of citations received in SCIE (385) by 234. The mean number of citations per paper was lower in SCIE (2.27 in Scopus compared to 1.5 in SCIE). The h index was 18 in Scopus and 14 in SCIE. Conclusions: Discrepancies were observed in the indicators obtained in both databases due to the different indexation policies, coverage, and classification methods of the papers. The number of citations, the mean number of citations per work, and the h index were higher in Scopus due to the longer life of the journal in that database. There is a positive evolution of the impact factor in SCIE, of the impact factor excluding self-citations, and of the 5-year impact factor


Assuntos
Publicações Periódicas como Assunto/estatística & dados numéricos , Fator de Impacto de Revistas , Indicadores Bibliométricos , Resumos e Indexação como Assunto , Bases de Dados como Assunto/normas , Bibliometria , Pediatria/estatística & dados numéricos
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