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1.
Eur J Pediatr ; 172(6): 797-802, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23404734

RESUMO

UNLABELLED: We aim to describe the number of health care visits before and after pediatric emergency department (PED) visits for common illnesses in a French tertiary pediatric hospital. This was a prospective cohort study with 501 children under 6 years of age who were evaluated and discharged from a tertiary care PED. Enrollment occurred on eight randomly selected study days between November 2010 and June 2011. The caregivers were then contacted via telephone 8 days later to obtain follow-up data, including information about return visits to health care facilities. Multiple visits were made by 206 (41 %) children, previous visits had occurred for 139 (28 %) children, and return visits had occurred for 94 (19 %) children. Previous and return visits were made at the PED as well as in general practitioners' offices and private pediatric offices. The median age of the subjects was 18 months. Fever was the most common complaint and was associated with more frequent multiple heath care visits. CONCLUSION: Multiple heath care visits for the same illness are frequent, especially for febrile children. Interestingly, this phenomenon concerns every type of health care facility, including the PED, general practitioners' offices, and private pediatric offices. Further studies should be performed to achieve a better understanding of this phenomenon and to test specific interventions, such as parental education and improvement of the information system.


Assuntos
Tosse/terapia , Diarreia/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Febre/terapia , Hospitais Pediátricos/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Vômito/terapia , Pré-Escolar , Feminino , Seguimentos , França , Medicina Geral , Hospitais de Ensino/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Pediatria , Estudos Prospectivos , Centros de Atenção Terciária/estatística & dados numéricos
2.
Eur J Clin Microbiol Infect Dis ; 31(7): 1295-303, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22002230

RESUMO

Acute respiratory tract infections (ARTIs) are the main reason for antibiotic prescription in children. In 2005, the French Drug Agency published guidelines to minimise inappropriate use of antibiotics for ARTI. The purpose of this study was to assess the impact of implementing these guidelines in a paediatric emergency department. We retrospectively analysed data collected prospectively in a French paediatric emergency department from November 2005 (date of guideline implementation) to October 2009. For each child diagnosed with ARTI, we collected age, diagnosis, and prescribed antibiotics. We computed antibiotic prescription rates in the study population. During the study period, 53,055 children were diagnosed with ARTI and 59% of the 22,198 antibiotic prescriptions given at discharge were related to ARTI. The proportion of ARTI patients given antibiotic prescriptions fell from 32.1% during the first year to 21% in year 4 (p<10(-4), Cochran-Armitage test). Amoxicillin-clavulanic acid and amoxicillin accounted for 50% and 34% of antibiotic prescriptions for ARTI, respectively. French antibiotic guidelines led to significant decreases in antibiotic prescription for ARTI in our paediatric emergency department.


Assuntos
Antibacterianos/administração & dosagem , Infecções Bacterianas/tratamento farmacológico , Tratamento Farmacológico/normas , Pesquisa sobre Serviços de Saúde , Infecções Respiratórias/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Prescrições de Medicamentos/estatística & dados numéricos , Serviços Médicos de Emergência , Feminino , França , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Masculino , Guias de Prática Clínica como Assunto , Estudos Prospectivos
3.
Emerg Med J ; 28(11): 924-6, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20943835

RESUMO

INTRODUCTION: The influenza A (H1N1) 2009 outbreak caused death and a disruption of public health services. Rapid influenza diagnostic tests (RIDT) could be helpful to ease the triage of patients and prevent an overload of emergency and laboratory facilities. OBJECTIVES: To compare the sensitivity and specificity of the Clearview Exact Influenza A&B test and real-time reverse transcription(RT)-PCR to detect influenza A (H1N1) 2009 in a paediatric emergency department of a paediatric teaching hospital in Paris, France. METHODS: 76 children with an influenza-like illness and either severe symptoms or an underlying medical condition were prospectively recruited between July 2009 and October 2009. RIDT and RT-PCR were simultaneously performed and compared. RESULTS: Among 39 influenza A (H1N1) 2009 RT-PCR-positive children (median age 5 years), 23 Clearview Exact Influenza A&B tests were positive. Sensitivity was 59% (95% CI 42.2 to 74) and specificity was 94.6% (95% CI 80.5 to 99.1). CONCLUSIONS: This study shows a sensitivity of RIDT of 59%, in agreement with other prospective studies, which could be useful in clinical practice for diagnosis influenza A (H1N1) 2009 in children. In outbreaks of a high prevalence, such as the 2009 outbreak, this test can help to prevent an overload of public health services.


Assuntos
Surtos de Doenças , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/diagnóstico , Adolescente , Criança , Pré-Escolar , Testes Diagnósticos de Rotina/normas , Feminino , Humanos , Lactente , Influenza Humana/epidemiologia , Masculino , Paris/epidemiologia , Reação em Cadeia da Polimerase/métodos , Estudos Prospectivos , Sensibilidade e Especificidade
4.
Arch Dis Child ; 101(4): 359-64, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26729746

RESUMO

OBJECTIVE: To study reconstitution and preparation dosing errors of liquid oral medications given by caregivers to children. METHODS: A prospective observational study was carried out in the departments of general paediatrics and emergency paediatrics at the Robert-Debré Children's University Hospital. An interview with caregivers involved (1) practical reconstitution and preparation of an oral liquid medication from a prescription drawn at random (amoxicillin (Clamoxyl, dosing spoon) or josamycin (Josacine, dose-weight pipette)) and (2) a questionnaire about their use. RESULTS: One hundred caregivers were included. Clamoxyl and Josacine were incorrectly reconstituted in 46% (23/50) and 56% (28/50) of cases, respectively, with a risk of underdosing of Clamoxyl (16/23) and overdosing of Josacine (23/28). Dose preparation with the dosing spoon was incorrect in 56% of cases, and in 10% of cases with the dose-weight pipette. Female sex, native French speaker, and age were significantly associated with correct reconstitution. Male sex and medication were significantly associated with correct preparation. CONCLUSIONS: This study highlights the high incidence of errors made by caregivers in reconstituting and preparing doses of these liquid oral medicines, which are associated with considerable risks of over- and underdosing. Factors associated with these errors have been identified which could help health professionals to optimise their strategy for educating families about the use of liquid oral medications and the need to check that they understand these instructions.


Assuntos
Amoxicilina/administração & dosagem , Antibacterianos/administração & dosagem , Josamicina/administração & dosagem , Erros de Medicação/estatística & dados numéricos , Administração Oral , Adolescente , Adulto , Cuidadores , Criança , Pré-Escolar , Feminino , Hospitais Pediátricos , Humanos , Incidência , Masculino , Pediatria , Estudos Prospectivos , Inquéritos e Questionários
5.
Arch Pediatr ; 20(11): 1260-1264, 2013 Nov.
Artigo em Francês | MEDLINE | ID: mdl-24094758

RESUMO

Quinine was the main treatment for malaria between 1630 and the beginning of the XXth century. In the 1940s, the synthesis of chloroquine gave rise to the hope of eliminating this plague. Falciparum resistance to chloroquine, first observed in Asia then in sub-Saharan Africa, lead researchers to discover halofantrine, mefloquine, atovaquone-proguanil and artemisinin combined therapies. There is no ideal treatment for uncomplicated imported malaria in children. Medical teams have to develop a protocol according to available drugs and their personal experience, with a special attention to follow-up at days 3-4 and day 28. From now on, severe malaria must be treated with intravenous artesunate, a more effective therapy than quinine.


Assuntos
Malária Falciparum/tratamento farmacológico , Antimaláricos/uso terapêutico , Combinação Arteméter e Lumefantrina , Artemisininas/uso terapêutico , Artesunato , Atovaquona/uso terapêutico , Criança , Combinação de Medicamentos , Etanolaminas , Fluorenos , França , Humanos , Malária Falciparum/epidemiologia , Proguanil/uso terapêutico , Quinolinas/uso terapêutico
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