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2.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31488695

RESUMO

This is an executive summary of the 2019 update of the 2004 guidelines and levels of care for PICU. Since previous guidelines, there has been a tremendous transformation of Pediatric Critical Care Medicine with advancements in pediatric cardiovascular medicine, transplant, neurology, trauma, and oncology as well as improvements of care in general PICUs. This has led to the evolution of resources and training in the provision of care through the PICU. Outcome and quality research related to admission, transfer, and discharge criteria as well as literature regarding PICU levels of care to include volume, staffing, and structure were reviewed and included in this statement as appropriate. Consequently, the purposes of this significant update are to address the transformation of the field and codify a revised set of guidelines that will enable hospitals, institutions, and individuals in developing the appropriate PICU for their community needs. The target audiences of the practice statement and guidance are broad and include critical care professionals; pediatricians; pediatric subspecialists; pediatric surgeons; pediatric surgical subspecialists; pediatric imaging physicians; and other members of the patient care team such as nurses, therapists, dieticians, pharmacists, social workers, care coordinators, and hospital administrators who make daily administrative and clinical decisions in all PICU levels of care.


Assuntos
Cuidados Críticos/normas , Unidades de Terapia Intensiva Pediátrica , Admissão do Paciente/normas , Alta do Paciente/normas , Pediatria/normas , Triagem/normas , Comitês Consultivos , Criança , Cuidados Críticos/tendências , Técnica Delfos , Humanos , Lactente , Pediatria/tendências
3.
World Neurosurg ; 130: e1000-e1003, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31306836

RESUMO

BACKGROUND: Ventriculoperitoneal shunt (VPS) placement is one of the most common neurosurgical procedures. VPSs are associated with high costs, which predominantly arise from relatively high complication and revision rates. It is reasonable to assume that revision rates in developing countries would be higher. In this study we report the single-institution revision rates and costs from a high-volume department in sub-Saharan Africa. METHODS: A pediatric neurosurgical database was studied in the extent of 5 years. The 30-day shunt failure rate, overall revision rate, and costs were calculated, and results were compared with previously published studies from developed countries. RESULTS: In the selected time period 1840 VPS surgeries were performed, of which 592 were shunt revisions (32.14%). The majority of revision surgeries was performed in the first year- 501 (representing 84.63%); second year, 64; third year, 21; fourth year, 6; and fifth year, 2. The overall shunt revision rate was 28.94% with a 30-day revision rate of 14.58%. During the course of the study, costs of VPS surgery, the shunt, and daily ward charges did not change significantly. The average total charge for VPS insertion was 60,000 KES (586 USD), VPS removal 30,000 KES (293 USD), and VPS revision 50,000 KES (489 USD). CONCLUSIONS: This retrospective study proves that VPSs, with their known complication risks, can be performed in a sub-Saharan missionary hospital with acceptable costs and results that are comparable with those achieved in some Western hospitals. Keys to those outcomes include high volume and a highly experienced team.


Assuntos
Custos Hospitalares , Pediatria/economia , Reoperação/economia , Derivação Ventriculoperitoneal/economia , África ao Sul do Saara/epidemiologia , Criança , Feminino , Seguimentos , Custos Hospitalares/tendências , Humanos , Tempo de Internação/tendências , Masculino , Procedimentos Neurocirúrgicos/economia , Procedimentos Neurocirúrgicos/tendências , Pediatria/tendências , Reoperação/tendências , Estudos Retrospectivos , Derivação Ventriculoperitoneal/tendências
4.
Curr Opin Ophthalmol ; 30(5): 337-346, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31261187

RESUMO

PURPOSE OF REVIEW: Despite the impressive results of recent artificial intelligence applications to general ophthalmology, comparatively less progress has been made toward solving problems in pediatric ophthalmology using similar techniques. This article discusses the unique needs of pediatric patients and how artificial intelligence techniques can address these challenges, surveys recent applications to pediatric ophthalmology, and discusses future directions. RECENT FINDINGS: The most significant advances involve the automated detection of retinopathy of prematurity, yielding results that rival experts. Machine learning has also been applied to the classification of pediatric cataracts, prediction of postoperative complications following cataract surgery, detection of strabismus and refractive error, prediction of future high myopia, and diagnosis of reading disability. In addition, machine learning techniques have been used for the study of visual development, vessel segmentation in pediatric fundus images, and ophthalmic image synthesis. SUMMARY: Artificial intelligence applications could significantly benefit clinical care by optimizing disease detection and grading, broadening access to care, furthering scientific discovery, and improving clinical efficiency. These methods need to match or surpass physician performance in clinical trials before deployment with patients. Owing to the widespread use of closed-access data sets and software implementations, it is difficult to directly compare the performance of these approaches, and reproducibility is poor. Open-access data sets and software could alleviate these issues and encourage further applications to pediatric ophthalmology.


Assuntos
Inteligência Artificial/tendências , Oftalmologia/tendências , Pediatria/tendências , Criança , Assistência à Saúde/tendências , Oftalmopatias/diagnóstico , Oftalmopatias/terapia , Humanos
5.
Sensors (Basel) ; 19(13)2019 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-31261884

RESUMO

There is interest in using wearable sensors to measure infant movement patterns and physical activity, however, this approach is confounded by caregiver motion. The purpose of this study is to estimate the extent that caregiver motion confounds wearable sensor data in full-day studies of infant leg movements. We used wearable sensors to measure leg movements of a four-month-old infant across 8.5 hours, during which the infant was handled by the caregiver in a typical manner. A researcher mimicked the actions of the caregiver with a doll. We calculated 7744 left and 7107 right leg movements for the infant and 1013 left and 1115 right "leg movements" for the doll. In this case, approximately 15% of infant leg movements can be attributed to background motion of the caregiver. This case report is the first step toward removing caregiver-produced background motion from the infant wearable sensor signal. We have estimated the size of the effect and described the activities that were related to noise in the signal. Future research can characterize the noise in detail and systematically explore different methods to remove it.


Assuntos
Técnicas Biossensoriais , Cuidadores , Monitorização Fisiológica , Dispositivos Eletrônicos Vestíveis , Adulto , Fenômenos Biomecânicos , Exercício/fisiologia , Feminino , Humanos , Lactente , Masculino , Movimento (Física) , Pediatria/tendências
6.
Pediatr Ann ; 48(6): e243-e248, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31185116

RESUMO

Telemedicine (TM) is undergoing unprecedented growth that is being driven by numerous factors, one of which is patient preference. Providers who use this tool to deliver health care tend to be early adoptors of new technology, but do they also represent a nascent specialty of pediatric virtualist? We believe that such practitioners, although exhibiting characteristics common to all early adopters, represent the cutting edge of what will become routine medical care. They tend to engage in less small talk with patients, focus more on efficient problem-solving, and collect less data while achieving patient outcomes and satisfaction that are as good as, or possibly even better than, their colleagues who practice in traditional settings. In doing so, they are leading the way for all providers to deliver care to patients using this new technology. Eventually, we feel that medical encounters using TM will be referred to simply as "patient care." [Pediatr Ann. 2019;48(6):e243-e248.].


Assuntos
Pediatria/tendências , Especialização/tendências , Telemedicina/tendências , Adolescente , Criança , Humanos , Pediatria/métodos , Pediatria/organização & administração , Telemedicina/métodos , Telemedicina/organização & administração
7.
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
10.
Biomed Res Int ; 2019: 2450605, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31119157

RESUMO

Atopic dermatitis (AD) prevalence is rising worldwide. Literature data suggest the incidence of AD in developing countries is gradually getting close to that of developed ones, in which AD affects 20% of the paediatric population. Such an increment, associated with significant variations in prevalence among the various countries, underlines the importance of environmental factors in the disease onset. Among these, great importance is given to hygiene, intestinal microbiota, exposure to bacterial endotoxins, outdoor living with contact to animals, atmospheric pollution, weather, and diet. Genetic (alteration of the skin barrier function) as well as immunologic factors concur with the environmental ones. Only the systematical study of all these elements can best elucidate AD epidemiology.


Assuntos
Alérgenos/efeitos adversos , Dermatite Atópica/epidemiologia , Dermatite Atópica/etiologia , Animais , Dermatite Atópica/patologia , Dieta/efeitos adversos , Endotoxinas/efeitos adversos , Poluição Ambiental/efeitos adversos , Microbioma Gastrointestinal , Humanos , Higiene , Pediatria/tendências , Fatores de Risco , Tempo (Meteorologia)
11.
Pediatrics ; 143(6)2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31142579

RESUMO

For 25 years, the American Academy of Pediatrics (AAP) Community Access to Child Health (CATCH) program has supported pediatricians in collaborating within their communities to advance the health of all children. CATCH grants support pediatric residents and pediatricians in planning or implementing community-based child health initiatives. The CATCH program has provided almost 10 million dollars through 842 planning, 585 resident, and 305 implementation grants to >1700 pediatricians. Urban, rural, suburban, and tribal communities in every state as well as the District of Columbia and Puerto Rico have benefited from CATCH-funded projects. Collaborations with community partners such as schools, homeless shelters, and mental health centers have led to programs serving children and families, especially those living in poverty and in minority groups. The most recent program data reveal that 87.5% of the projects are operating 2 years after funding. Many CATCH projects have not only sustained themselves but have grown into larger programs with funding from other sources. CATCH has influenced pediatricians' careers by providing important skills, networking opportunities, career legitimacy, mentoring opportunities, and increased engagement with the AAP. More than 350 pediatricians have served the AAP as CATCH facilitators, the network of physicians that provides technical assistance to applicants and reviews grant applications. Responding to changing trends, CATCH leaders have looked at other funding models and recently launched the CATCH-On initiative. CATCH-On creates and provides templates from successful CATCH projects to busy pediatricians who can then implement the project in their communities with minimal funding.


Assuntos
Academias e Institutos/economia , Serviços de Saúde da Criança/economia , Serviços de Saúde Comunitária/economia , Acesso aos Serviços de Saúde/economia , Pediatria/economia , Academias e Institutos/tendências , Serviços de Saúde da Criança/tendências , Pré-Escolar , Serviços de Saúde Comunitária/tendências , Acesso aos Serviços de Saúde/tendências , Humanos , Pediatria/tendências , Fatores de Tempo , Estados Unidos/epidemiologia
12.
J Pak Med Assoc ; 69(4): 489-494, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31000850

RESUMO

OBJECTIVE: To determine career choices of medical students of public-sector medical universities and factors affecting their career choices. METHODS: The cross-sectional study was conducted at Dow University of Health Sciences and Jinnah Sindh Medical University, Karachi, from May 2015 to May 2016, and comprised 4th and 5th year medical students and house officers. A self-administrated structured questionnaire was used to collect data which was entered and analysed using SPSS 20. RESULTS: Of the 445 Subjects, 314(70.6%) were females. There were 206(46.3%) 4th year students, 194(43.6%) were from the 5th year and 45(10%) were house officers. Top 15 medical specialties were ranked according to the respondents' top three choices. Internal medicine 67(15.1%), cardiology 47(10.6%), paediatrics 46(10.3%) and general surgery 40(9.0%) were the four highest ranked specialties. Overall, 377(84.7%) subjects said prestige in working in that field was the reason of their respective choices. CONCLUSIONS: Medical students chose a wider range of specialties and stated varying factors affecting their choices.


Assuntos
Cardiologia/tendências , Escolha da Profissão , Cirurgia Geral/tendências , Medicina Interna/tendências , Internato e Residência , Pediatria/tendências , Estudantes de Medicina , Adulto , Feminino , Humanos , Masculino , Motivação , Paquistão , Setor Público , Faculdades de Medicina , Adulto Jovem
16.
Rev Bras Enferm ; 72(2): 435-441, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31017207

RESUMO

OBJECTIVE: To evaluate the satisfaction index of the pediatric patient's caregiver (person responsible for the child) regarding the waiting time for the care flow in an emergency service. METHOD: A prospective, cross-sectional, quantitative study with 300 family members in the Pediatric Emergency Department of a general hospital. An instrument was used to analyze the service flow, waiting time and satisfaction evaluation. Descriptive statistical analysis was performed. RESULTS: The satisfaction index of caregivers was statistically significant (p<0.05) the lower was the waiting time for patient screening, care by the doctors and for receiving the prescribed medication. Caregivers who took their children to the emergency department because of the disease (p -0.029) or because they did not find doctors in other hospitals (p-0.021) were satisfied with the waiting time for this service. CONCLUSION: The quality of care is evaluated as satisfactory by caregivers when children are treated quickly in the Pediatric Emergency Department.


Assuntos
Família/psicologia , Satisfação do Paciente , Pediatria/normas , Criança , Pré-Escolar , Estudos Transversais , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/normas , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pediatria/tendências , Estudos Prospectivos , Qualidade da Assistência à Saúde , Inquéritos e Questionários
17.
Pediatrics ; 143(5)2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30962253

RESUMO

BACKGROUND AND OBJECTIVES: Use of commercial direct-to-consumer (DTC) telemedicine outside of the pediatric medical home is increasing among children, and acute respiratory infections (ARIs) are the most commonly diagnosed condition at DTC telemedicine visits. Our objective was to compare the quality of antibiotic prescribing for ARIs among children across 3 settings: DTC telemedicine, urgent care, and the primary care provider (PCP) office. METHODS: In a retrospective cohort study using 2015-2016 claims data from a large national commercial health plan, we identified ARI visits by children (0-17 years old), excluding visits with comorbidities that could affect antibiotic decisions. Visits were matched on age, sex, chronic medical complexity, state, rurality, health plan type, and ARI diagnosis category. Within the matched sample, we compared the percentage of ARI visits with any antibiotic prescribing and the percentage of ARI visits with guideline-concordant antibiotic management. RESULTS: There were 4604 DTC telemedicine, 38 408 urgent care, and 485 201 PCP visits for ARIs in the matched sample. Antibiotic prescribing was higher for DTC telemedicine visits than for other settings (52% of DTC telemedicine visits versus 42% urgent care and 31% PCP visits; P < .001 for both comparisons). Guideline-concordant antibiotic management was lower at DTC telemedicine visits than at other settings (59% of DTC telemedicine visits versus 67% urgent care and 78% PCP visits; P < .001 for both comparisons). CONCLUSIONS: At DTC telemedicine visits, children with ARIs were more likely to receive antibiotics and less likely to receive guideline-concordant antibiotic management compared to children at PCP visits and urgent care visits.


Assuntos
Assistência Ambulatorial/tendências , Antibacterianos/uso terapêutico , Publicidade Direta ao Consumidor/tendências , Prescrições de Medicamentos , Pediatria/tendências , Telemedicina/tendências , Adolescente , Assistência Ambulatorial/normas , Instituições de Assistência Ambulatorial/normas , Instituições de Assistência Ambulatorial/tendências , Criança , Pré-Escolar , Estudos de Coortes , Publicidade Direta ao Consumidor/normas , Prescrições de Medicamentos/normas , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Telemedicina/normas
18.
Pediatr Dermatol ; 36(4): 564-566, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30968450

RESUMO

The October 2018 report from the United Nations Intergovernmental Panel on Climate Change predicts significant threats to human health secondary to anthropogenic global warming; children have been and will continue to be disproportionately affected by these weather-related changes. Multiple physician groups have acknowledged climate change as a public health issue, calling upon providers to educate their communities about this looming health crisis while also reducing their individual carbon footprints. A significant body of literature has also documented the adverse dermatologic consequences of a warmer planet, highlighting the importance of pediatric dermatologists in addressing climate change. Here, we summarize the rationale for the pediatric dermatologist as public health advocate, providing specific actionable items through which our specialty can positively address the climate change crisis and in turn protect the health of our patients now and in the future.


Assuntos
Defesa da Criança e do Adolescente , Bem-Estar da Criança , Mudança Climática , Dermatologistas/estatística & dados numéricos , Dermatologia/tendências , Pediatria/tendências , Criança , Humanos , Papel do Médico , Saúde Pública , Sociedades Médicas , Estados Unidos
20.
Dev Cell ; 49(1): 10-29, 2019 04 08.
Artigo em Inglês | MEDLINE | ID: mdl-30930166

RESUMO

Single-cell gene expression analyses of mammalian tissues have uncovered profound stage-specific molecular regulatory phenomena that have changed the understanding of unique cell types and signaling pathways critical for lineage determination, morphogenesis, and growth. We discuss here the case for a Pediatric Cell Atlas as part of the Human Cell Atlas consortium to provide single-cell profiles and spatial characterization of gene expression across human tissues and organs. Such data will complement adult and developmentally focused HCA projects to provide a rich cytogenomic framework for understanding not only pediatric health and disease but also environmental and genetic impacts across the human lifespan.


Assuntos
Desenvolvimento Embrionário/genética , Redes Reguladoras de Genes/genética , Pediatria/tendências , Análise de Célula Única/métodos , Perfilação da Expressão Gênica , Regulação da Expressão Gênica no Desenvolvimento/genética , Humanos , Distribuição Tecidual/genética
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