Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.979
Filtrar
2.
Tidsskr Nor Laegeforen ; 142(18)2022 12 13.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-36511750

RESUMO

BACKGROUND: A goal has been set to establish paediatric high dependency units (PHDUs) in Norwegian hospitals. We sought to describe the patient population in one such unit, and to investigate whether the need for admission to an intensive care unit (ICU) changed after the unit was established. MATERIAL AND METHOD: Information was obtained from electronic patient records, patient administration systems and the quality register for the PHDU at the Department of Paediatrics and Adolescent Medicine at Haukeland University Hospital. All patients admitted to the PHDU within five years of its opening in 2017 were included. A comparison was made between ICU patients in the five years before and the five years after the establishment of the PHDU. RESULTS: The PHDU had a total of 851 patient admissions in the period 2017-2021, increasing from 125 in 2017 to 247 in 2021. This accounted for 3.5 % and 7.6 % of the total number of patients admitted to the Department of Paediatrics and Adolescent Medicine in these years, respectively. The ICU had 185 paediatric patient admissions in the period 2012-2016 and 187 in the period 2017-2021, which constituted 0.9 % and 1.1 % of all patients admitted to the Department of Paediatrics and Adolescent Medicine during the periods, respectively. After the start-up of the PHDU, a lower proportion of patients were admitted to the ICU in the diagnostic groups diabetic ketoacidosis (15 % in 2017-2021 versus 20 % in 2012-2016) and sepsis (12 % in 2017-2021 versus 19 % in 2012-2016). INTERPRETATION: The introduction of a PHDU was not associated with a simultaneous reduction in the number of ICU admissions overall. For diabetic ketoacidosis and sepsis, however, the proportion of transfers to the ICU was reduced.


Assuntos
Medicina do Adolescente , Cetoacidose Diabética , Sepse , Adolescente , Humanos , Criança , Cetoacidose Diabética/epidemiologia , Cetoacidose Diabética/terapia , Unidades de Terapia Intensiva , Admissão do Paciente , Sepse/epidemiologia , Sepse/terapia , Estudos Retrospectivos , Tempo de Internação
3.
Pediatr Clin North Am ; 69(5): 847-864, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36207097

RESUMO

Adolescent Medicine addresses the health care of adolescents, young adults, and their families. Adolescent psychology constitutes an important part. The COVID-19 pandemic has given insight into adolescent needs, bringing the focus on prevention rather than mere correction. One needs to factor in the unique aspects of adolescence, their need to impress peers and gain acceptance, and their unique information processing, not calculating trade-offs between risk and reward the way adults might, in a linear, rational, logical, and verbal manner. The article focuses on the need for collaborative training among the various stakeholders in Child and Adolescent Mental Health.


Assuntos
Medicina do Adolescente , COVID-19 , Adolescente , COVID-19/epidemiologia , Criança , Humanos , Internacionalidade , Pandemias , Psicologia do Adolescente , Adulto Jovem
6.
J Adolesc Health ; 71(1): 105-111, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35346557

RESUMO

PURPOSE: Poorly planned healthcare transition (HCT) from pediatric to adult-based care for adolescents and young adults with special healthcare needs (AYASHCN) is associated with increased morbidity and mortality. Most pediatricians and pediatric residents are not trained to assist AYASHCN with HCT planning. An electronic medical record-based Transition Planning Tool (TPT) was developed at a large children's hospital to guide provider-patient interactions around HCT planning. The purpose of this study was to evaluate an educational intervention to promote residents' use of the TPT. METHODS: A multimodal (TPT training, demonstrations, use prompts, and case discussions) curriculum promoting the use of the TPT was developed and implemented within a one-month Adolescent Medicine Rotation. A prospective, nonrandomized, quasi-experimental design with Intervention and Historical Control groups was used. Forty-two residents received the intervention. Twenty-three Historical Control residents received minimal formal training in the TPT. Intervention Group residents completed prerotation/postrotation assessments measuring perceived importance of/comfort with HCT planning and self-reported HCT planning activities. TPT use was compared between the two groups. RESULTS: Compared to the Historical Control Group, Intervention Group residents were significantly more likely to use the TPT (98% vs. 37%, p < .001) and had a higher mean number of uses (5.5 ± 3.0 vs. 2.6 ± 1.2, p < .001). Residents reported greater perceived importance of (p < .001) and engagement in (p < .001) transition planning activities after completing the intervention. Nearly all (91%) reported that their training increased their comfort in HCT planning. CONCLUSIONS: A targeted intervention improved pediatric residents' use of the TPT and HCT planning activities.


Assuntos
Medicina do Adolescente , Internato e Residência , Transição para Assistência do Adulto , Adolescente , Criança , Currículo , Humanos , Estudos Prospectivos , Adulto Jovem
8.
Acad Pediatr ; 22(7): 1153-1157, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35219852

RESUMO

OBJECTIVE: Examine the relationship between the gender distribution of the pediatric subspecialty workforce and lifetime earning potential. METHODS: We estimated lifetime earning potential for pediatric academic subspecialists using mean debt and compensation data from national physician surveys for 2019 to 2020 and examined the relationship between the workforce gender composition and lifetime earning potential across the pediatric subspecialties using linear regression analysis. RESULTS: Subspecialties with a higher proportion of women had lower lifetime earning potential (-$55,215 in lifetime earning potential/1% increase in the percentage of female subspecialists; P value .002, 95% CI -$24,429 to -$86,000). Similarly, a higher proportion of female first-year fellows was associated with lower lifetime earning potential (-$61,808 in lifetime earning potential/1% increase in the percentage of female first-year fellows; P value .026, 95% CI -$9,210 to -$114,405). CONCLUSIONS: Consistent with patterns seen in other areas of adult medicine and surgery, pediatric subspecialties with higher proportions of women, such as adolescent medicine and endocrinology, tended to have lower lifetime earning potentials than subspecialties with higher proportions of men, such as cardiology and critical care. Lower earning subspecialties also tended to train higher proportions of women, suggesting that this trend may worsen over time as pediatrics in general and individual subspecialties in particular become increasingly female predominant.


Assuntos
Medicina do Adolescente , Cardiologia , Pediatria , Médicos , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Estados Unidos , Recursos Humanos
9.
J Adolesc Health ; 70(4): 692-696, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35181244

RESUMO

Adolescent and young adult (AYA) health care providers (HCPs) frequently serve sexual and gender-diverse (SGD) youth. Sexual orientation refers to a person's sexual identity in relation to the gender(s) to which they are attracted. Gender-diverse, sometimes addressed as gender-expansive, persons are a subset of the population whose gender identity, expressions, or behaviors differ from those typically associated with the sex they were assigned at birth in the society in which they live. These constructs may develop separately, and terminology should acknowledge and include the broad range of SGD identities that exist. Although many SGD AYAs navigate the adolescent transition successfully and become healthy, happy, successful adults, the pervasive discrimination, stigma, bias, and disparities they face throughout society place many at risk for poor health and developmental outcomes. The resilience and risk profiles of these youth are further compounded by the intersectionality of the person's unique identities, including, but not limited to, race/ethnicity, religion, and language. Support for SGD AYAs is critical at all levels. The Society for Adolescent Health and Medicine (SAHM) encourages HCPs who care for AYAs and researchers to incorporate the impact of these developmental processes (and understand the consequences of concurrent potential discrimination) when working with SGD adolescents. SAHM also encourages HCPs to advocate for improved policy related to sexual and gender diversity within families, schools, the foster care system, and the juvenile justice system. Consistent with other professional organizations, SAHM rejects the mistaken notion that SGD identities are mental disorders and opposes the use of any type of reparative therapy for SGD adolescents.


Assuntos
Medicina do Adolescente , Pessoas Transgênero , Adolescente , Feminino , Identidade de Gênero , Promoção da Saúde , Humanos , Recém-Nascido , Masculino , Comportamento Sexual , Adulto Jovem
10.
J Pediatr Adolesc Gynecol ; 35(3): 249-259, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34999228

RESUMO

In 2015, the Resident Education Committee of the North American Society for Pediatric and Adolescent Gynecology published the Long Curriculum in Resident Education to provide educators with a comprehensive document to be used in postgraduate medical education. The original curriculum was designed to meet the resident learning objectives for the Council on Resident Education in Obstetrics and Gynecology, the American Board of Pediatrics, and the Royal College of Physicians and Surgeons of Canada and to provide a more intensive, broader learning experience. The curriculum was updated in 2018. This Committee Document is the third updated version (3.0) of the Long Curriculum in Resident Education.


Assuntos
Medicina do Adolescente , Ginecologia , Internato e Residência , Obstetrícia , Pediatria , Adolescente , Medicina do Adolescente/educação , Criança , Currículo , Feminino , Ginecologia/educação , Humanos , Obstetrícia/educação , Pediatria/educação , Gravidez , Estados Unidos
11.
J Pediatr ; 243: 158-166, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34952007

RESUMO

OBJECTIVE: To report on long-acting reversible contraception (LARC) experience and continuation rates in the Adolescent Medicine LARC Collaborative. STUDY DESIGN: LARC insertion data (682 implants and 681 intrauterine devices [IUDs]) were prospectively collected from January 1, 2017, through December 31, 2019, across 3 Adolescent Medicine practices. Follow-up data through December 31, 2020, were included to ensure at least 1 year of follow-up of this cohort. Continuation rates were calculated at 1, 2, and 3 years, overall and by Adolescent Medicine site, as were descriptive statistics for LARC procedural complications and patient experience. RESULTS: Implant and IUD insertion complications were uncommon and largely self-limited, with no IUD-related uterine perforations. Uterine bleeding was the most frequently reported concern at follow-up (35% implant, 25% IUD), and a common reason for early device removal (45% of implant removals, 32% of IUD removals). IUD malposition or expulsion occurred following 6% of all insertions. The pooled implant continuation rate at 1 year was 87% (range, 86%-91% across sites; P = .63), 66% at 2 years (range, 62%-84%; P = .01), and 42% at 3 years (range, 36%-60%; P = .004). The pooled IUD continuation rate at 1 year was 88% (range, 87%-90% across sites; P = .82), 77% at 2 years (range, 76%-78%; P = .94), and 60% at 3 years (range, 57%-62%; P = .88). CONCLUSIONS: LARC is successfully provided in Adolescent Medicine clinical settings, with continuation rates analogous to those of well-resourced clinical trials. Uterine bleeding after LARC insertion is common, making counselling imperative. Future analyses will assess whether the medical management of LARC-related nuisance bleeding improves continuation rates in our Adolescent Medicine patient population.


Assuntos
Medicina do Adolescente , Anticoncepcionais Femininos , Contracepção Reversível de Longo Prazo , Adolescente , Anticoncepção/efeitos adversos , Anticoncepcionais Femininos/uso terapêutico , Feminino , Humanos , Contracepção Reversível de Longo Prazo/efeitos adversos , Hemorragia Uterina/etiologia , Adulto Jovem
13.
Med J Aust ; 215(1): C1, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34218444
15.
J Clin Pharmacol ; 61 Suppl 1: S117-S124, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34185904

RESUMO

Pediatric labeling information for novel atypical antipsychotics can be significantly delayed as the result of time lag between initial drug approval in adults and the completion of pediatric clinical trials. This delay can lead health care providers to rely on limited evidence-based literature to make critical therapeutic decisions for pediatric patients. Effective and scientifically justified dosing recommendations are needed to improve treatment outcomes in pediatric patients with schizophrenia and bipolar I disorder. Extrapolation-based drug development strategies rely on leveraging prior data to reduce evidentiary requirements for newer data in establishing drug efficacy. On January 13, 2020, the US Food and Drug Administration (FDA) released a general advice letter to sponsors highlighting the acceptance of extrapolating efficacy of atypical antipsychotics to pediatric patients. This review provides insight into the FDA's justification for extrapolating efficacy from adult to pediatric patients and provides a rationale for dose selection in pediatric patients with schizophrenia and bipolar I disorder.


Assuntos
Medicina do Adolescente/métodos , Antipsicóticos/administração & dosagem , Transtorno Bipolar/tratamento farmacológico , Pediatria/métodos , Esquizofrenia/tratamento farmacológico , Adolescente , Antipsicóticos/efeitos adversos , Interpretação Estatística de Dados , Desenvolvimento de Medicamentos , Humanos , Resultado do Tratamento
16.
Acad Med ; 96(7S): S22-S28, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34183598

RESUMO

PURPOSE: Entrustable professional activities (EPAs) are one approach to competency-based medical education (CBME), and 7 EPAs have been developed that address content relevant for all pediatric subspecialties. However, it is not known what level of supervision fellowship program directors (FPDs) deem necessary for graduation. The Subspecialty Pediatrics Investigator Network (SPIN) investigated FPD perceptions of the minimum level of supervision required for a trainee to successfully graduate. METHOD: In 2017, SPIN surveyed all FPDs of accredited fellowships for 14 subspecialties. For each EPA, the minimum supervision level for graduation (ranging from observation only to unsupervised practice) was set such that no more than 20% of FPDs would accept a lower level. RESULTS: The survey response rate was 82% (660/802). The minimum supervision level for graduation varied across the 7 EPAs from 2 (direct) to 4 (indirect for complex cases), with significant differences between EPAs. The percentage of FPDs desiring a lower minimum supervision level ranged from 3% to 17%. Compared with the 4 nonclinical EPAs (quality improvement, management, lead within the profession, scholarship), the 3 clinical EPAs (consultation, handover, lead a team) had higher minimum supervision graduation levels (P < .001), with less likelihood that an FPD would graduate a learner below their minimum level (P < .001). CONCLUSIONS: Consensus among FPDs across all pediatric subspecialties demonstrates the potential need for ongoing supervision for graduates in all 7 common pediatric subspecialty EPAs after fellowship. As CBME programs are implemented, processes and infrastructure to support new graduates are important considerations for leaders.


Assuntos
Educação Baseada em Competências , Educação de Pós-Graduação em Medicina , Bolsas de Estudo , Medicina do Adolescente/educação , Endocrinologia/educação , Gastroenterologia/educação , Hematologia/educação , Humanos , Infectologia/educação , Oncologia/educação , Medicina , Neonatologia/educação , Medicina de Emergência Pediátrica/educação , Pediatria/educação , Pneumologia/educação , Inquéritos e Questionários
19.
Int J Adolesc Med Health ; 33(3): 83-88, 2021 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-33855842

RESUMO

OBJECTIVES: Paediatricians increasingly need to take care of adolescents, a life stage with specific needs, however many of them admit a limitation in their medical education regarding Adolescent Medicine. The objective of this paperwork is to evaluate the formative model adopted in the Department of Paediatrics, Hospital de Santa Maria, and assess the impact of the training in Adolescent Medicine. METHODS: We surveyed the current Paediatric Residents and those who graduated as Paediatricians from the Department in the past five years, in order to get feedback on the one-month compulsory training at the Adolescent Medicine Division during their Residency. RESULTS: Both groups considered it as a very interesting/useful training. Paediatricians considered that the training had an insufficient duration, with statistical difference comparing to the current Residents' opinion. Conversely, Residents considered more often that the acquired competencies would be useful in their future clinical practice, when compared to Paediatricians. CONCLUSIONS: In order to potentiate learning and training during such a short period of time, a few changes were identified as beneficial to be implemented.


Assuntos
Medicina do Adolescente/educação , Pediatria/educação , Adolescente , Criança , Currículo , Humanos , Internato e Residência , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários
20.
J Pediatr Adolesc Gynecol ; 34(3): 291-296, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33810968

RESUMO

Exposure to pediatric and adolescent gynecology (PAG) varies across residency programs in obstetrics and gynecology, family medicine, and pediatrics, as well as fellowship programs in adolescent medicine. Nevertheless, these programs are responsible for training residents and fellows and providing opportunities within their programs to fulfill PAG learning objectives. To that end, the North American Society for Pediatric and Adolescent Gynecology has taken a leadership role in PAG education by creating and systematically updating the Short Curriculum. This curriculum outlines specific learning objectives that are central to PAG education and lists essential resources for learners' reference. This updated curriculum replaces the previous 2018 publication with added content, resources, and updated references.


Assuntos
Medicina do Adolescente/educação , Currículo , Ginecologia/educação , Internato e Residência/métodos , Pediatria/educação , Adolescente , Criança , Feminino , Humanos , Estados Unidos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...