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2.
Am J Nurs ; 121(2): 69, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33497134

RESUMO

According to this study: In children younger than age two, treatment with ibuprofen was associated with reduced fever and less pain within the first 24 hours compared with acetaminophen.The incidence of adverse events was low with both treatments.


Assuntos
Acetaminofen/normas , Febre/tratamento farmacológico , Ibuprofeno/normas , Pediatria/normas , Acetaminofen/uso terapêutico , Anti-Inflamatórios não Esteroides/normas , Anti-Inflamatórios não Esteroides/uso terapêutico , Febre/fisiopatologia , Humanos , Ibuprofeno/uso terapêutico , Incidência , Pediatria/métodos
3.
J Surg Res ; 257: 455-461, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32892145

RESUMO

BACKGROUND: The preinduction checklist, part of the three-phase surgical safety checklist, is performed before induction of anesthesia. Our previous research demonstrated higher checklist adherence by perioperative staff when parents were engaged in the preinduction checklist. We hypothesized that use of a parent-centered script (PCS) during the preinduction checklist would increase parent engagement and checklist adherence. METHODS: A single-center, prospective, observational study was conducted in which parents of children (<18 y) undergoing nonemergent surgeries (June 2018-July 2019) were observed before and after PCS implementation. The PCS, developed by the health care team, engaged parents by directly asking them to contribute information relevant to parent knowledge. Parent engagement was rated using a five-point Likert scale, and adherence was scored for each relevant checkpoint completed. RESULTS: Of 270 checklists, 154 (57%) occurred before and 116 (43%) after PCS implementation. Groups were similar by primary language, patient age, and type of surgery, but more postimplementation children had a prior surgery. The overall parent engagement score did not improve with the PCS (P = 0.8); however, there was an improvement in eye contact by parents. After introduction of the PCS, checklist adherence decreased from a median score of 6 (interquartile range 5-6) to 4 (interquartile range 4-5) (P < 0.001). CONCLUSIONS: Use of a PCS did not improve parent engagement during the preinduction checklist and an unexpected decline in checklist adherence was observed. Further research, with parent and staff input, is necessary to determine how best to engage parents while ensuring high checklist adherence.


Assuntos
Lista de Checagem , Cirurgia Geral/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Pais , Segurança do Paciente , Pediatria/normas , Criança , Pré-Escolar , Cirurgia Geral/estatística & dados numéricos , Humanos , Pediatria/estatística & dados numéricos , Estudos Prospectivos
4.
JAMA Netw Open ; 3(12): e2029411, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33315113

RESUMO

Importance: Genotype-guided prescribing in pediatrics could prevent adverse drug reactions and improve therapeutic response. Clinical pharmacogenetic implementation guidelines are available for many medications commonly prescribed to children. Frequencies of medication prescription and actionable genotypes (genotypes where a prescribing change may be indicated) inform the potential value of pharmacogenetic implementation. Objective: To assess potential opportunities for genotype-guided prescribing in pediatric populations among multiple health systems by examining the prevalence of prescriptions for each drug with the highest level of evidence (Clinical Pharmacogenetics Implementation Consortium level A) and estimating the prevalence of potential actionable prescribing decisions. Design, Setting, and Participants: This serial cross-sectional study of prescribing prevalences in 16 health systems included electronic health records data from pediatric inpatient and outpatient encounters from January 1, 2011, to December 31, 2017. The health systems included academic medical centers with free-standing children's hospitals and community hospitals that were part of an adult health care system. Participants included approximately 2.9 million patients younger than 21 years observed per year. Data were analyzed from June 5, 2018, to April 14, 2020. Exposures: Prescription of 38 level A medications based on electronic health records. Main Outcomes and Measures: Annual prevalence of level A medication prescribing and estimated actionable exposures, calculated by combining estimated site-year prevalences across sites with each site weighted equally. Results: Data from approximately 2.9 million pediatric patients (median age, 8 [interquartile range, 2-16] years; 50.7% female, 62.3% White) were analyzed for a typical calendar year. The annual prescribing prevalence of at least 1 level A drug ranged from 7987 to 10 629 per 100 000 patients with increasing trends from 2011 to 2014. The most prescribed level A drug was the antiemetic ondansetron (annual prevalence of exposure, 8107 [95% CI, 8077-8137] per 100 000 children). Among commonly prescribed opioids, annual prevalence per 100 000 patients was 295 (95% CI, 273-317) for tramadol, 571 (95% CI, 557-586) for codeine, and 2116 (95% CI, 2097-2135) for oxycodone. The antidepressants citalopram, escitalopram, and amitriptyline were also commonly prescribed (annual prevalence, approximately 250 per 100 000 patients for each). Estimated prevalences of actionable exposures were highest for oxycodone and ondansetron (>300 per 100 000 patients annually). CYP2D6 and CYP2C19 substrates were more frequently prescribed than medications influenced by other genes. Conclusions and Relevance: These findings suggest that opportunities for pharmacogenetic implementation among pediatric patients in the US are abundant. As expected, the greatest opportunity exists with implementing CYP2D6 and CYP2C19 pharmacogenetic guidance for commonly prescribed antiemetics, analgesics, and antidepressants.


Assuntos
Serviços de Saúde da Criança , Cálculos da Dosagem de Medicamento , Testes Farmacogenômicos , Padrões de Prática Médica , Medicamentos sob Prescrição , Criança , Serviços de Saúde da Criança/normas , Serviços de Saúde da Criança/estatística & dados numéricos , Estudos Transversais , Citocromo P-450 CYP2C19/genética , Citocromo P-450 CYP2D6/genética , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Perfil Genético , Humanos , Masculino , Pediatria/métodos , Pediatria/normas , Testes Farmacogenômicos/métodos , Testes Farmacogenômicos/estatística & dados numéricos , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Medicina de Precisão/métodos , Medicamentos sob Prescrição/classificação , Medicamentos sob Prescrição/uso terapêutico , Estados Unidos
5.
Medicine (Baltimore) ; 99(45): e23057, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157961

RESUMO

To investigate the use of abdominal CT scanning in the management of pediatric blunt abdominal trauma in pediatric and non-pediatric departments.In this observational cohort study, anonymized data were extracted from 2 large German statutory health insurances (∼5.9 million clients) in a 7-year period (2010-2016). All patients with inpatient International Classification of Diseases (ICD) codes S36.- and S37.- (injury of intra-abdominal organs; injury of urinary and pelvic organs) aged ≤18 years were included. Demographic and clinical data were analyzed by logistic regression analysis for associations with the use of abdominal CT.A total of 524 children with blunt abdominal trauma (mean age 11.0 ±â€Š5.2 years; 62.6% males) were included; 164 patients (31.3%) received abdominal CT-imaging. There were no significant differences in traumatic non-intraabdominal comorbidity patterns (injuries of external causes; injuries to the head or thorax). There was substantial variability in the rate of abdominal CT imaging among different medical disciplines ranging from 11.6% to 44.5%. Patients admitted to pediatric departments (Pediatrics and Pediatric Surgery) underwent abdominal CT imaging significantly less frequently (19.7%; N = 55) compared to patients treated in non-pediatric departments (General/Trauma Surgery: 44.5%; N = 109) irrespective of concomitant injuries. The estimated OR for the use of abdominal CT by General/Trauma Surgery was 6.2-fold higher (OR: 6.15 [95-%-CI:3.07-13.21]; P < .001) compared to Pediatric Surgery. Other risk factors associated with the use of abdominal CT were traumatic extra-abdominal comorbidities, increasing age, male gender, and admission to a university hospital.Abdominal CT imaging was significantly less frequently used in pediatric departments. The substantial variability of the abdominal CT rate among different medical disciplines and centers indicates a potential for reduction of CT imaging by implementation of evidence-based guidelines. Furthermore, our study underlines the need for centralization of pediatric trauma care in Germany not only to improve patient outcome but to avoid radiation-induced cancer mortality.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Pediatria/normas , Tomografia Computadorizada por Raios X/métodos , Ferimentos não Penetrantes/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Comorbidade , Feminino , Alemanha/epidemiologia , Hospitalização , Humanos , Masculino , Pediatria/estatística & dados numéricos , Fatores de Risco , Tomografia Computadorizada por Raios X/estatística & dados numéricos
6.
Ital J Pediatr ; 46(1): 149, 2020 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-33032650

RESUMO

The rapid spread of the COVID-19 outbreak in Italy has dramatically impacted the National Healthcare System, causing the sudden congestion of hospitals, especially in Northern Italy, thus imposing drastic restriction of almost all routine medical care. This exceptional adaptation of the Italian National Healthcare System has also been felt by non-frontline settings such as Pediatric Orthopaedic Units, where the limitation or temporary suspension of most routine care activities met with a need to maintain continuity of care and avoid secondary issues due to the delay or suspension of the routine clinical practice. The Italian Society of Pediatric Orthopaedics and Traumatology formulated general and specific recommendations to face the COVID-19 outbreak, aiming to provide essential care for children needing orthopaedic treatments during the pandemic and early post-peak period, ensure safety of children, caregivers and healthcare providers and limit the spread of contagion.


Assuntos
Infecção Hospitalar/prevenção & controle , Assistência à Saúde/organização & administração , Procedimentos Ortopédicos/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Guias de Prática Clínica como Assunto/normas , Criança , Pré-Escolar , Tomada de Decisão Clínica , Feminino , Humanos , Itália , Masculino , Saúde do Trabalhador/estatística & dados numéricos , Procedimentos Ortopédicos/métodos , Ortopedia/normas , Segurança do Paciente , Pediatria/normas , Sociedades Médicas/normas , Traumatologia/normas
7.
Ital J Pediatr ; 46(1): 146, 2020 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-33023616

RESUMO

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


Assuntos
Conjuntivite Alérgica/epidemiologia , Infecções por Coronavirus/epidemiologia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Rinite Alérgica/epidemiologia , Inquéritos e Questionários , Adolescente , Distribuição por Idade , Causalidade , Criança , Conjuntivite Alérgica/diagnóstico , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Feminino , Humanos , Incidência , Itália/epidemiologia , Masculino , Pandemias/prevenção & controle , Pediatras/estatística & dados numéricos , Pediatria/normas , Pneumonia Viral/prevenção & controle , Rinite Alérgica/diagnóstico , Medição de Risco , Distribuição por Sexo , Sociedades Médicas
8.
Pediatr Crit Care Med ; 21(11): e1031-e1037, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32886460

RESUMO

Severe acute respiratory syndrome coronavirus 2 is a novel cause of organ dysfunction in children, presenting as either coronavirus disease 2019 with sepsis and/or respiratory failure or a hyperinflammatory shock syndrome. Clinicians must now consider these diagnoses when evaluating children for septic shock and sepsis-associated organ dysfunction. The Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-associated Organ Dysfunction in Children provide an appropriate framework for the early recognition and initial resuscitation of children with sepsis or septic shock caused by all pathogens, including severe acute respiratory syndrome coronavirus 2. However, the potential benefits of select adjunctive therapies may differ from non-coronavirus disease 2019 sepsis.


Assuntos
Infecções por Coronavirus/complicações , Pediatria/normas , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto , Sepse/terapia , Algoritmos , Atitude Frente a Saúde , Betacoronavirus , Criança , Cuidados Críticos/normas , Humanos , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/terapia , Pandemias , Ressuscitação/normas , Sepse/etiologia , Choque Séptico/etiologia , Choque Séptico/terapia , Vasoconstritores/uso terapêutico
10.
Medicine (Baltimore) ; 99(32): e21643, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769932

RESUMO

BACKGROUND: We design this study to assess the efficacy and safety of Chinese herbal compound for allergic rhinitis in children. METHODS: PubMed, EMbase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang, the Chongqing VIP Chinese Science and Technology Periodical Database, and China biomedical literature database (CBM) will be searched from the establishment of each database to July 2020. Randomized controlled trials of Chinese herbal compound for the treatment of allergic rhinitis in children will be included. Two researchers will screen the literature, extract data, and assess the risk of bias independently. Statistical analysis will be performed in RevMan 5.3. RESULTS: This study will summarize high quality evidence of randomized controlled trials on exploring the efficacy and safety of Chinese herbal compound for allergic rhinitis in children. CONCLUSIONS: The findings of study will provide scientific evidence of the efficacy and safety of Chinese herbal compound for allergic rhinitis in children for clinician and further studies. ETHICS AND DISSEMINATION: The private information from individuals will not be published. This systematic review also will not involve endangering participant rights. Ethical approval is not required. The results may be published in a peer-reviewed journal or disseminated in relevant conferences. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/Q5TRZ.


Assuntos
Protocolos Clínicos , Medicamentos de Ervas Chinesas/normas , Rinite Alérgica/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Humanos , Metanálise como Assunto , Pediatria/instrumentação , Pediatria/métodos , Pediatria/normas , Revisões Sistemáticas como Assunto , Resultado do Tratamento
11.
Curr Opin Anaesthesiol ; 33(4): 584-588, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32628407

RESUMO

PURPOSE OF REVIEW: Nonoperating room anesthesia (NORA) cases performed in pediatric patients have increased over the past decade. It is imperative for the anesthesia provider to be familiar with the nuances of this environment and the myriad of cases to ensure delivery of safe and efficient care. RECENT FINDINGS: Though case volume has increased, sedative agents have largely remained unchanged. NORA sites must meet the same operating room standards and expectations of anesthesia established by the American Society of Anesthesiologists. Despite the increasing NORA volume and efforts to instill a similar culture of safety as the operating room complex, NORA cases present challenges with limited resources and access to the patient, highlighting the need for resident and fellow training to include NORA experiences. SUMMARY: Experience working in the NORA environment helps provide, maintain, and improve the cognitive fitness and resilience that an anesthesiologist needs to tackle the complexities from the variety of NORA cases and locations. Patient factors aside, procedural considerations can affect the anesthetic plan, so understanding the nuances of the procedure helps the anesthesia provider provide safe and efficient care.


Assuntos
Anestesia/normas , Anestesiologia/normas , Anestesiologistas , Anestésicos/administração & dosagem , Criança , Humanos , Salas Cirúrgicas , Pediatria/normas
12.
J Laryngol Otol ; 134(8): 661-664, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32613918

RESUMO

BACKGROUND: The following position statement from the Union of the European Phoniatricians, updated on 25th May 2020 (superseding the previous statement issued on 21st April 2020), contains a series of recommendations for phoniatricians and ENT surgeons who provide and/or run voice, swallowing, speech and language, or paediatric audiology services. OBJECTIVES: This material specifically aims to inform clinical practices in countries where clinics and operating theatres are reopening for elective work. It endeavours to present a current European view in relation to common procedures, many of which fall under the aegis of aerosol generating procedures. CONCLUSION: As evidence continues to build, some of the recommended practices will undoubtedly evolve, but it is hoped that the updated position statement will offer clinicians precepts on safe clinical practice.


Assuntos
Audiologia/métodos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/prevenção & controle , Otolaringologia/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Audiologia/normas , Criança , Pré-Escolar , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/cirurgia , Transtornos de Deglutição/virologia , Europa (Continente)/epidemiologia , Humanos , Testes Obrigatórios/normas , Otolaringologia/normas , Pediatria/normas , Equipamento de Proteção Individual/normas , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Guias de Prática Clínica como Assunto , Sociedades Médicas/organização & administração , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/cirurgia , Distúrbios da Voz/virologia
13.
Eur J Endocrinol ; 183(4): P11-P18, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32698145

RESUMO

Background: Currently, there are no European recommendations for the management of pediatric thyroid cancer. Other current international guidelines are not completely concordant. In addition, medical regulations differ between, for instance, the US and Europe. We aimed to develop new, easily accessible national recommendations for differentiated thyroid carcinoma (DTC) patients <18 years of age in the Netherlands as a first step toward a harmonized European Recommendation. Methods: A multidisciplinary working group was formed including pediatric and adult endocrinologists, a pediatric radiologist, a pathologist, endocrine surgeons, pediatric surgeons, pediatric oncologists, nuclear medicine physicians, a clinical geneticist and a patient representative. A systematic literature search was conducted for all existing guidelines and review articles for pediatric DTC from 2000 until February 2019. The Appraisal of Guidelines, Research and Evaluation (AGREE) instrument was used for assessing quality of the articles. All were compared to determine dis- and concordances. The American Thyroid Association (ATA) pediatric guideline 2015 was used as framework to develop specific Dutch recommendations. Discussion points based upon expert opinion and current treatment management of DTC in children in the Netherlands were identified and elaborated. Results: Based on the most recent evidence combined with expert opinion, a 2020 Dutch recommendation for pediatric DTC was written and published as an online interactive decision tree (www.oncoguide.nl). Conclusion: Pediatric DTC requires a multidisciplinary approach. The 2020 Dutch Pediatric DTC Recommendation can be used as a starting point for the development of a collaborative European recommendation for treatment of pediatric DTC.


Assuntos
Adenocarcinoma/terapia , Pediatria/normas , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/estatística & dados numéricos , Padrões de Prática Médica/normas , Neoplasias da Glândula Tireoide/terapia , Adenocarcinoma/epidemiologia , Adenocarcinoma/patologia , Idade de Início , Diferenciação Celular , Criança , Humanos , Comunicação Interdisciplinar , Países Baixos/epidemiologia , Pediatria/organização & administração , Pediatria/estatística & dados numéricos , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/patologia
14.
Eur J Endocrinol ; 183(4): 419-426, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32688338

RESUMO

Objective: The need for personalization of the reference values of thyroid function tests has been previously suggested. We aimed at determining TSH reference values in a large cohort of children according to age, sex, BMI, and ethnicity. Design: A population-based cohort study. Methods: The study cohort included 75 549 healthy children aged 5-18 years. Data analyzed included age, gender, TSH, FT4 levels, BMI and ethnicity. Multivariate logistic regression analysis examined the associations between the study parameters. Results: TSH in the Jewish population is lower than in the non-Jewish population (median: 2.1 IU/L (IQR: 1.5) vs 2.2 IU/L (IQR: 1.5), P < 0.0001). TSH is significantly affected by BMI for children defined as underweight, normal weight, overweight or obese, levels increased as weight diverged from the normal range (median levels: 2.1 IU/L (IQR: 1.4), 2.0 IU/L (IQR: 1.3), 2.1 IU/L (IQR: 1.4), 2.4 (IQR: 1.5), respectively, P < 0.001). The 2.5 percentile is affected by gender and BMI (P < 0.02 and P < 0.001, respectively), while the 97.5 percentile is affected by ethnic origin and BMI (P < 0.001 for both). New TSH reference intervals (RI) adjusted according to BMI and ethnicity are suggested. Comparison of the old and new RI demonstrate the significance of RI personalization: 25.1% of the children with TSH levels above the old RI are within the new RI, while 2.3% of the children who were in the old RI are below the new RI. Conclusions: TSH reference values in children are affected by BMI and ethnicity. Reference values should be individualized accordingly to improve future clinical decision-making and treatment.


Assuntos
Índice de Massa Corporal , Grupos Étnicos , Medicina de Precisão/métodos , Testes de Função Tireóidea/normas , Tireotropina/sangue , Adolescente , Análise Química do Sangue/normas , Criança , Pré-Escolar , Técnicas de Diagnóstico Endócrino/normas , Feminino , Humanos , Judeus , Masculino , Pediatria/métodos , Pediatria/normas , Medicina de Precisão/normas , Valores de Referência , Estudos Retrospectivos , Tireotropina/normas , Tiroxina/sangue
15.
Bull World Health Organ ; 98(6): 406-412F, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32514214

RESUMO

Objective: To compare dosing guidance in the paediatric formularies of high- and middle-income countries for 32 commonly prescribed antibiotics on the World Health Organization's (WHO's) 2017 Model list of essential medicines for children. Methods: We identified paediatric antibiotic guidelines that were either widely used internationally or originated from countries in which antibiotic use has increased markedly in recent years (i.e. Brazil, China, India, the Russian Federation and South Africa). Findings: The study analysis considered five leading antibiotic guidelines: (i) the Manual of childhood infections: the blue book; (ii) the BNF (British national formulary) for children; (iii) the Red book®: 2018-2021 report of the committee on infectious diseases; (iv) WHO's Pocket book of hospital care for children; and (v) Indian National treatment guidelines for antimicrobial use in infectious diseases. There was marked heterogeneity in the recommended dosing (i.e. daily dose, age dosing bands and dose frequency) for most commonly used antibiotics. The rationale for dosing recommendations was generally unclear. Conclusion: The pharmacokinetic, pharmacodynamic and clinical evidence supporting paediatric antibiotic dosing, particularly on total doses and on age or weight dosing bands, needs to be improved. Future research should consider whether the variations in guidance identified stem from different clinical disease patterns, varying levels of antibiotic resistance or drug availability rather than historical preferences. Interested global parties could collaborate with WHO's Model list of essential medicines antibiotic working group to develop an evidence-based consensus and identify research priorities.


Assuntos
Antibacterianos/administração & dosagem , Pediatria/normas , Guias de Prática Clínica como Assunto/normas , Fatores Etários , Antibacterianos/farmacocinética , Peso Corporal , Relação Dose-Resposta a Droga , Saúde Global , Humanos , Organização Mundial da Saúde
18.
J Cardiovasc Med (Hagerstown) ; 21(7): 467-471, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32487868

RESUMO

: The recent outbreak of 2019 severe acute respiratory syndrome coronavirus-2 is having major repercussions on healthcare services provision in Italy and worldwide. Data suggest the virus has a strong impact on the cardiovascular system, and cardiac imaging will play an important role in patients affected by coronavirus disease-2019. Although paediatric patients are mildly affected, they represent a clear accelerator in spreading the virus, and healthcare workers are at higher risk of infection. The aim of this position paper is to provide clinical recommendation regarding the execution of imaging investigations for the cardiac diagnostic work-up of paediatric patients with suspected or confirmed infection.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Cardiologia , Infecções por Coronavirus , Cardiopatias Congênitas , Exposição Ocupacional/prevenção & controle , Pandemias , Pediatria , Pneumonia Viral , Betacoronavirus/isolamento & purificação , Cardiologia/métodos , Cardiologia/normas , Criança , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/epidemiologia , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Itália/epidemiologia , Pandemias/prevenção & controle , Pediatria/métodos , Pediatria/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Sociedades Médicas
19.
Pediatrics ; 145(Suppl 3): S243-S268, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32482738

RESUMO

OBJECTIVE: To critically review the evidence for the selection and insertion of pediatric vascular access devices (VADs). DATA SOURCES: Data were sourced from the US National Library of Medicine, Cumulative Index to Nursing and Allied Health, the Cochrane Library databases, Embase, and international clinical trial databases. STUDY SELECTION: Clinical practice guidelines, systematic reviews, cohort designs, randomized control trials (RCTs), quasi RCTs, before-after trials, or case-control studies that reported on complications and/or risk as well as reliability of VADs in patients aged 0 to 18 years were included. DATA EXTRACTION: Articles were independently reviewed to extract and summarize details on the number of patients and catheters, population, age of participants, VAD type, study method, indication, comparators, and the frequency of VAD failure or complications. RESULTS: VAD selection and insertion decision-making in general hospitalized and some specialized patient populations were well evidenced. The use of single-lumen devices and ultrasound-guided techniques was also broadly supported. There was a lack of RCTs, and for neonates, cardiac patients, patients with difficult venous access, midline catheters, catheter-to-vein ratio, and near-infrared devices, the lack of evidence necessitated broadening the review scope. LIMITATIONS: Limitations include the lack of formal assessment of the quality of evidence and the lack of RCTs and systematic reviews. Consequently, clinical decision-making in certain pediatric populations is not guided by strong, evidence-based recommendations. CONCLUSIONS: This is the first synthesis of available evidence for the selection and insertion of VADs in pediatric patients and is important for determining the appropriateness of VADs in pediatric patients.


Assuntos
Pediatria/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Dispositivos de Acesso Vascular/normas , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Pediatria/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos
20.
Pediatrics ; 145(Suppl 3): S269-S284, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32482739

RESUMO

OBJECTIVES: Vascular access device decision-making for pediatric patients remains a complex, highly variable process. To date, evidence-based criteria to inform these choices do not exist. The objective of the Michigan Appropriateness Guide for Intravenous Catheters in pediatrics (miniMAGIC) was to provide guidance on device selection, device characteristics, and insertion technique for clinicians, balancing and contextualizing evidence with current practice through a multidisciplinary panel of experts. METHODS: The RAND Corporation and University of California, Los Angeles Appropriateness Method was used to develop miniMAGIC, which included the following sequential phases: definition of scope and key terms, information synthesis and literature review, expert multidisciplinary panel selection and engagement, case scenario development, and appropriateness ratings by an expert panel via 2 rounds. RESULTS: The appropriateness of the selection, characteristics, and insertion technique of intravenous catheters commonly used in pediatric health care across age populations (neonates, infants, children, and adolescents), settings, diagnoses, clinical indications, insertion locations, and vessel visualization devices and techniques was defined. Core concepts including vessel preservation, insertion and postinsertion harm minimization (eg, infection, thrombosis), undisrupted treatment provision, and inclusion of patient preferences were emphasized. CONCLUSIONS: In this study, we provide evidence-based criteria for intravenous catheter selection (from umbilical catheters to totally implanted venous devices) in pediatric patients across a range of clinical indications. miniMAGIC also highlights core vascular access practices in need of collaborative research and innovation.


Assuntos
Cateterismo Venoso Central/normas , Prova Pericial/normas , Pediatria/normas , Guias de Prática Clínica como Assunto/normas , Dispositivos de Acesso Vascular/normas , Adolescente , Cateterismo Venoso Central/métodos , Criança , Pré-Escolar , Prova Pericial/métodos , Humanos , Lactente , Recém-Nascido , Michigan , Pediatria/métodos
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