RESUMO
Introducción: La leucemia es el cáncer más frecuente en la infancia y representan 41 % de todas las neoplasias malignas en niños menores de 15 años. Objetivo: Describir las características clinicoepidemiológicas y supervivencia de niños y adolescentes con leucemia. Método: Se realizó un estudio descriptivo, longitudinal y retrospectivo de 82 pacientes menores de 19 años de edad, con diagnóstico de leucemia, atendidos en el Servicio Regional de Hematología del Hospital Infantil Sur Docente Dr. Antonio María Béguez César de Santiago de Cuba, desde enero de 2014 hasta diciembre de 2018. Resultados: En la casuística predominaron el grupo de 1-4 años de edad (42,7 %), el sexo masculino (59,7 %), los mestizos (48,8 %), la leucemia linfoide aguda como variante morfológica (73,2 %), así como el síndrome anémico y febril (97,7 y 86,6 %, respectivamente). En 89,0 % de los pacientes se logró la remisión completa al finalizar la primera fase del tratamiento y 17,1 % presentó algún tipo de recaída en su evolución, donde la médula ósea resultó ser el sitio más afectado. Se logró una supervivencia global de 67,1 %. Conclusiones: Los resultados del estudio no difieren del contexto clínico y epidemiológico mundial y resultan alentadores, teniendo en cuenta la no disponibilidad en la provincia de medios de diagnóstico, con tecnología de avanzada, para una mejor estratificación de los pacientes.
Introduction: Leukemia is the most frequent cancer in childhood and represents 41 % of all the malignancies in children under 15 years. Objective: To describe the clinical epidemiological characteristics and survival in children and adolescents with leukemia. Method: A descriptive, longitudinal and retrospective study of 82 patients under 19 years, with diagnosis of leukemia was carried out. They were assisted in the Regional Service of Hematology at Dr. Antonio María Béguez César Teaching Southern Children Hospital in Santiago de Cuba, from January, 2014 to December, 2018. Results: In the case material there was a prevalence of the 1-4 age group (42.7 %), male sex (59.7 %), mixed race children (48.8 %), acute lymphoid leukemia as morphological variant (73.2 %), as well as the anemic and fever syndrome (97.7 and 86.6 %, respectively). Complete remission was achieved in 89.0 % of the patients after concluding the first phase of the treatment and 17.1 % presented some type of relapse during their clinical course, where the most affected site was the bone marrow. A global survival of 67.1 % was achieved. Conclusions: The results of the study are encouraging and do not differ from the world clinical and epidemiological context, taking into account the non availability of diagnosis means in the province, with advanced technology, for a better stratification of patients.
Assuntos
Leucemia/epidemiologia , Sobrevivência , Atenção Secundária à Saúde , Criança , Pré-Escolar , Adolescente , Hospitais PediátricosRESUMO
Introducción. Las infecciones por Staphylococcus aureus resistente a meticilina adquirido de la comunidad (SARM-AC) se han incrementado en los últimos años. Neumonías necrotizantes y empiemas por SARM-AC son cada vez más frecuentes en niños.Objetivos. Determinar la prevalencia de neumonías por SARM-AC y sus características clínico-epidemiológicas, en comparación con las neumonías por Streptococcus pneumoniae (SP) en la misma población.Material y métodos. Estudio descriptivo, observacional, transversal, de pacientes internados con neumonía por SARM-AC en el Hospital de Niños Víctor J. Vilela (período: 1/2008-12/2017).Resultados. De 54 neumonías por Staphylococcus aureus, 46 (el 85 %) fueron SARM-AC. El índice de neumonías por SARM-AC varió de 4,9/10 000 (2008) a 10/10 000 egresos (2017). Presentaron sepsis/shock séptico el 41 %; empiema, el 96 %; neumotórax, el 35 %; requirieron drenaje pleural el 90 % y toilette quirúrgica el 55 %. Ingresaron a Terapia Intensiva el 65 %; la mitad necesitó asistencia respiratoria mecánica. Hubo dos muertes. Resistencia de las cepas: el 17 % a gentamicina, el 13 % a eritromicina, el 11 % a clindamicina. En las neumonías por SARM-AC vs. las neumonías por SP, se observó mayor riesgo de sepsis (IC 95 %; RR 7,38; 3,32-16,38) e ingreso a Terapia Intensiva (RR 4,29; 2,70-6,83). No hubo muertes por SP.Conclusiones. La prevalencia de neumonías por SARM-AC se duplicó durante la última década. Comparadas con las neumonías por SP, las neumonías por SARM-AC se acompañaron, más frecuentemente, de cuadros de sepsis y shockséptico, ingreso a Terapia Intensiva y asistencia respiratoria.
Introduction. Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have increased in recent years. CA-MRSA necrotizing pneumonia and empyema are now more common in children.Objectives. To determine the prevalence of CA-MRSA pneumonia and its clinical and epidemiological characteristics compared to Streptococcus pneumoniae (SP) pneumonia in the same population.Material and methods. Descriptive, observational, cross-sectional study of patients hospitalized due to CA-MRSA pneumonia at Hospital de Niños Víctor J. Vilela (period: January 2008-December 2017).Results. Out of 54 Staphylococcus aureus pneumonia cases, 46 (85 %) corresponded to CA-MRSA. The rate of CA-MRSA pneumonia ranged from 4.9/10 000 (2008) to 10/10 000 hospital discharges (2017). Sepsis/septic shock was observed in 41 %; empyema, in 96 %; pneumothorax, in 35 %; 90 % of cases required pleural drainage and 55 %, surgical debridement. Also, 65 % of patients were admitted to the intensive care unit (ICU); half of them required assisted mechanical ventilation. Two patients died. Strain resistance: 17 %, gentamicin; 13 %, erythromycin; and 11 %, clindamycin. Compared to SP pneumonia, CA-MRSA pneumonia showed a higher risk for sepsis (95 % confidence interval; relative risk: 7.38; 3.32-16.38) and admission to the ICU (RR: 4.29; 2.70-6.83). No patient died due to SP pneumonia.Conclusions. The prevalence of CA-MRSA pneumonia doubled in the past decade. Compared to SP pneumonia, CA-MRSA pneumonia was more commonly accompanied by sepsis and septic shock, admission to the ICU, and ventilatory support requirement
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Infecções Estafilocócicas/epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Staphylococcus aureus Resistente à Meticilina , Argentina/epidemiologia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Testes de Sensibilidade Microbiana , Epidemiologia Descritiva , Incidência , Prevalência , Estudos Transversais , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/microbiologia , Hospitais PediátricosRESUMO
Resumen Introducción: en el siguiente artículo se describen los sentidos que asocian al juego y al juguete algunos profesionales de diversas áreas de la salud en el ámbito hospitalario. Objetivo: analizar los sentidos que asocian al juego y al juguete algunos profesionales de diversas áreas de la salud. Materiales y métodos: desde un diseño cualitativo y bajo el método de estudio de caso, se utiliza como técnica de construcción de datos la entrevista semiestructurada para exponer los resultados de la categoría sentidos a partir de dos núcleos de significación teórica: sentido subjetivo autobiográfico y sentido clínico. Resultados: en los hallazgos se pone de manifiesto la manera como el sentido subjetivo autobiográfico de estos profesionales permeó la práctica profesional y se describen algunos sentidos clínicos con relación a la manera como el juego y el juguete permite a estos profesionales formular hipótesis sobre aspectos subjetivos, afectivos, relacionales y comunicativos en los que se apoya un ejercicio diagnóstico, terapéutico o educativo. Conclusiones: estos sentidos se abordan desde dos pilares: la propia infancia de estos profesionales como punto de partida para construir los lazos con el paciente, ya que se evidencia una fuerte conexión entre la propia subjetividad para dinamizar, de manera particular, la relación terapéutica con los niños del hospital y, el segundo, la práctica profesional como experiencia a partir de la cual se configura un sentido para el juego y el juguete.
Abstract Introduction: this article describes the senses associated with plays and toys, by professionals from different areas of health in the hospital environment. Objective: analyze the senses associated with plays and toys, by professionals from different areas of health in the hospital environment. Materials and methods: from a qualitative design and under the case study method, the semi-structured interview is used as a data construction technique to expose the results of the senses category from two nuclei of theoretical significance: autobiographical subjective sense and clinical sense. Results: the findings reveal the way in which the subjective autobiographical sense of these professionals permeated the professional practice and some clinical senses are described in relation to the way in which play and toy allow these professionals to formulate hypotheses about subjective, affective, relational and communicative aspects in which a diagnostic, therapeutic or educational exercise is supported. Conclusions: these senses are oriented from two pillars: the infancy of these professionals as a starting point to build ties with the patient, since there is a strong connection between the subjectivity itself to dynamize, in particular, the therapeutic relationship with children in the hospital and, the second, the professional practice as an experience from which a sense for the play and the toy is configured.
Resumo Introdução: no seguinte artigo descreve-se os sentidos que associam ao jogo e ao brinquedo alguns profissionais de diversas áreas da saúde no âmbito hospitalar. Objetivo: analisar os sentidos que associam ao jogo e ao brinquedo alguns profissionais de diversas áreas da saúde no âmbito hospitalar. Materiais e métodos: desde um desenho qualitativo e através do método de estudo de caso, se utiliza como técnica de construção de dados a entrevista semiestruturada para apresentar os resultados da categoria sentidos a partir de dois núcleos de significação teórica: sentido subjetivo autobiográfico e sentido clínico. Resultados: nos resultados fica claro a forma como o sentido subjetivo autobiográfico destes profissionais permeou a prática profissional e descrevem-se alguns sentidos clínicos em relação à maneira como o jogo e o brinquedo permite a estes profissionais formular hipóteses sobre aspectos subjetivos afetivos, relacionais e comunicativos nos que se apoia um exercício diagnóstico, terapêutico ou educativo. Conclusões: estes sentidos se abordam desde dois pilares: a própria infância destes profissionais como ponto de partida para construir os laços com o paciente, já que evidencia-se uma forte conexão entre a própria subjetividade para dinamizar, de maneira particular, a relação terapêutica com as crianças do hospital e, o segundo, a prática profissional como experiência a partir da qual configura-se um sentido para o jogo e o brinquedo.
RESUMO
Given Haiti's longstanding socioeconomic burden and recent environmental and epidemiological catastrophes, the capacity for neurosurgery within Haiti has been limited, and outcomes for patients with neurosurgical conditions have remained poor. With few formally trained neurosurgeons (4) in a country of 10.5 million inhabitants, there is a significant need for the development of formal structured neurosurgical training. To mitigate the lack of neurosurgical care within Haiti, the authors established the first neurosurgical residency program within the country by creating an integrated model that uniquely fortifies existing Haitian neurosurgery with government sponsorship (Haitian Ministry of Health and National Medical School) and continual foreign support. By incorporating web-based learning modules, online assessments, teleconferences, and visiting professorships, the residency aims to train neurosurgeons over the course of 3-5 years to meet the healthcare needs of the nation. Although in its infancy, this model aims to facilitate neurosurgical capacity building by ultimately creating a self-sustaining residency program.
Assuntos
Internato e Residência , Neurocirurgia/educação , Fortalecimento Institucional , Currículo , Educação a Distância , Haiti/epidemiologia , Humanos , Internato e Residência/métodos , Internato e Residência/organização & administração , Doenças do Sistema Nervoso/epidemiologia , Setor Privado , Parcerias Público-Privadas , TelecomunicaçõesRESUMO
Se realizó un estudio descriptivo, transversal y retrospectivo de 23 pacientes con tumores de cabeza y cuello, atendidos en el Servicio de Oncología Pediátrica del Hospital Infantil Sur Docente Dr Antonio María Béguez César de Santiago de Cuba durante el período 2000-2016. En la casuística predominaron el grupo etario de 10-14 años (39,1 por ciento), el sexo masculino, la localización nasofaríngea (39,1 por ciento), el linfoma no Hodking y el carcinoma papilar como variedades histológicas, el estadio clínico III y el mayor número de pacientes diagnosticados en 2013 y 2014
A descriptive, cross-sectional and retrospective study of 23 patients with head and neck tumors, assisted in the Oncology Pediatric Service of Dr Antonio María Béguez César Southern Teaching Children Hospital was carried out in Santiago de Cuba during 2000-2016. In the case material there was a prevalence of the 10-14 age group (39.1 percent), male sex, nasopharingeal localization (39.1 percen), non Hodking lymphoma and papillary carcinoma as histological varieties, phase III clinical stage and the highest number of patients diagnosed in 2013 and 2014
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Autopsia , Serviço Hospitalar de Oncologia , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias/epidemiologia , Institutos de Câncer , Epidemiologia Descritiva , Estudos Transversais , Estudos Retrospectivos , Estadiamento de NeoplasiasRESUMO
BACKGROUND: Children and adolescents necessitating hospitalization for physical health conditions are at high risk for mental health conditions; however, the prevalence of mental health conditions and symptoms among hospitalized children and adolescents is uncertain. The objective of this study was to determine the proportion of hospitalized children and adolescents who have diagnosed mental health disorders or undiagnosed mental health problems. METHODS: In this single-center point prevalence study of hospitalized children between the ages of 4 and 21 years, patients or their parents reported known mental health diagnoses and use of services using the Services Assessment for Children and Adolescent, and they reported patient mental health symptoms using the Pediatric Symptom Checklist, 17-item form (PSC-17). RESULTS: Of 229 eligible patients, 119 agreed to participate. Demographic characteristics of patients who enrolled were not statistically significantly different from those of patients who declined to participate. Among participants, 26% (95% confidence interval [CI], 18%-35%) reported a known mental health diagnosis. On the PSC-17, 29% (95% CI, 21%-38%) of participants had a positive screen for mental health symptoms. Of those with a positive screen, 38% (95% CI, 21%-55%) had no known mental health diagnosis, and 26% (95% CI, 12%-43%) had not received ambulatory mental health services in the 12 months before hospitalization. CONCLUSIONS: Mental health conditions and symptoms are common among patients hospitalized in a tertiary children's hospital, and many affected patients are not receiving ambulatory mental health services.
Assuntos
Hospitalização , Transtornos Mentais/epidemiologia , Adolescente , Ansiolíticos/uso terapêutico , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Ansiedade/tratamento farmacológico , Ansiedade/epidemiologia , Ansiedade/psicologia , Transtornos de Ansiedade/tratamento farmacológico , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtorno Autístico/tratamento farmacológico , Transtorno Autístico/epidemiologia , Transtorno Autístico/psicologia , Criança , Pré-Escolar , Depressão/tratamento farmacológico , Depressão/epidemiologia , Depressão/psicologia , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/psicologia , Feminino , Hospitais Pediátricos , Humanos , Masculino , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/psicologia , Saúde Mental , Serviços de Saúde Mental/estatística & dados numéricos , Philadelphia/epidemiologia , Prevalência , Adulto JovemRESUMO
BACKGROUND: Triage process implementation has been shown to be effective at improving patient outcomes. This study sought to develop, implement and assess the impact of an Emergency Triage Assessment and Treatment (ETAT)-based emergency triage process in the paediatric emergency department (PED) of a public hospital in Guatemala. METHODS: The study was a quality improvement comparison with a before/after design. Uptake was measured by percentage of patients with an assigned triage category. Outcomes were hospital admission rate, inpatient length of stay (LOS), and mortality as determined by two distinct medical record reviews for 1 year pre- and post-intervention: a random sample (RS) of all PED patients and records for all critically-ill (CI) children [serious diagnoses or admission to the paediatric intensive care unit (PICU)]. Demographics, diagnoses and disposition were recorded. RESULTS: The RS totalled 1027 (51.4% male); median ages pre- and post-intervention were 2.0 and 2.4 years, respectively. There were 196 patients in the CI sample, of whom 56.6% were male and one-third were neonates; median ages of the CI group pre- and post-intervention were 3.1 and 5.6 months, respectively. One year after implementation, 97.5% of medical records had been assigned triage categories. Triage categories (RS/CI) were: emergency (2.9%/54.6%), priority (47.6%/44.4%) and non-urgent (49.4%/1.0%). The CI group was more frequently diagnosed with shock (25%/1%), seizures (9%/0.5%) and malnutrition (6%/0.5%). Admission rates for the RS (8% vs 4%, P=0.01) declined after implementation. For the CI sample, admission rate to the PICU (47% vs 24%, P=0.002) decreased and LOS (7.3 vs 5.7 days, P=0.09) and mortality rates (12% vs 6%, P=0.15) showed trends toward decreasing post-implementation. CONCLUSIONS: Paediatric-specific triage algorithms can be implemented and sustained in resource-limited settings. Significant decreases in admission rates (both overall and for the PICU) and trends towards decreased LOS and mortality rates of critically ill children suggest that ETAT-based triage systems have the potential to greatly improve patient care in Latin America.
Assuntos
Estado Terminal/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Melhoria de Qualidade , Triagem/métodos , Criança , Mortalidade da Criança , Pré-Escolar , Serviço Hospitalar de Emergência/normas , Feminino , Guatemala , Hospitais Públicos , Humanos , Lactente , Recém-Nascido , Masculino , Pediatria , Estudos Prospectivos , Estudos Retrospectivos , Triagem/estatística & dados numéricosRESUMO
BACKGROUND: The benefit of Ladd's procedure for malrotation at a Children's Hospital (CH) has not previously been established. Our aim was to characterize the potential variations in management and outcomes between CH and Non-Children's Hospitals (NCH) in the treatment of malrotation with Ladd's procedure. METHODS: There were 2827 children identified with malrotation and complete information from the Kids' Inpatient Database (2003, 2006, 2009). Outcomes were compared between CH and NCH and evaluated with logistic and linear regressions. Additional propensity score matching was used to balance covariates between CH and NCH. RESULTS: There were 2261 (80.0%) children with malrotation undergoing Ladd's procedures treated at CH; 566 (20.0%) were treated at NCH. In multivariate analysis, CH was associated with a 39% lower odds of resection (p=0.004), with no differences observed for mortality, morbidity and LOS. Comparison of a propensity score matched cohort confirmed these findings, as well as demonstrated no significant differences in associated costs. CONCLUSIONS: The majority of pediatric intestinal malrotation is managed at CH. While measured outcomes of mortality, morbidity, LOS, and costs were not different at NCH, CH was less likely to perform intestinal resection during Ladd's procedure.
Assuntos
Anormalidades do Sistema Digestório/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Hospitais Pediátricos/estatística & dados numéricos , Volvo Intestinal/cirurgia , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais/estatística & dados numéricos , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação , Masculino , Morbidade , Pontuação de Propensão , Resultado do TratamentoRESUMO
OBJECTIVE: To compare the diagnostic performance of 2 height-independent equations used to calculate estimated glomerular filtration rate (eGFR), those of Pottel (eGFR-Pottel) and the British Columbia Children's Hospital (BCCH) (eGFR-BCCH), with the commonly used Schwartz equation (eGFR-Schwartz). STUDY DESIGN: We externally validated eGFR-Pottel and eGFR-BCCH in a well-characterized pediatric patient population (n = 152) and compared their diagnostic performance with that of eGFR-Schwartz using Bland-Altman analysis. All patients underwent glomerular filtration rate measurement using the gold standard single-injection inulin clearance method (GFR-inulin). RESULTS: Median GFR-inulin was 92.0 mL/min/1.73 m² (IQR, 76.1-107.4 mL/min/1.73 m²). Compared with GFR-inulin, the mean bias for eGFR-Schwartz was -10.1 mL/min/1.73 m(2) (95% limits of agreement [LOA], -77.5 to 57.2 mL/min/1.73 m(2)), compared with -12.3 mL/min/1.73 m² (95% LOA, -72.6 to 47.9 mL/min/1.73 m(2)) for eGFR-Pottel and -22.1 mL/min/1.73 m² (95% LOA, -105.0 to 60.8 mL/min/1.73 m(2)) for eGFR-BCCH. eGFR-Pottel showed comparable accuracy to eGFR-Schwartz, with 77% and 76% of estimates within 30% of GFR-inulin, respectively. eGFR-BCCH was less accurate than eGFR-Schwartz (66% of estimates within 30% of GFR-inulin; P < .01). CONCLUSION: The performance of eGFR-Pottel is superior to that of eGFR-BCCH and comparable with that of eGFR-Schwartz. eGFR-Pottel is a valid alternative to eGFR-Schwartz in children and could be reported by the laboratory if height data are not available.
Assuntos
Estatura , Taxa de Filtração Glomerular , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Matemática , Estudos Retrospectivos , Adulto JovemRESUMO
Pediatric rapid response teams have become standard over the past decade, but are organized heterogeneously at US academic hospitals, with rare financial support. To compare rapid response team efficacy, pediatric hospitals should agree on standard outcome measures, whether it be a standard definition of floor arrest or of clinical deterioration.
Assuntos
Equipe de Respostas Rápidas de Hospitais/estatística & dados numéricos , Equipe de Respostas Rápidas de Hospitais/normas , Hospitais Pediátricos , Criança , Humanos , Inquéritos e Questionários , Estados UnidosRESUMO
OBJECTIVES: To identify specific fecal biomarkers for symptomatic Clostridium difficile infection and predictors of poor outcomes. STUDY DESIGN: We enrolled 65 children with positive C difficile testing (cases) and 37 symptomatic controls. We also analyzed stool samples from colonized and non-colonized asymptomatic children. We performed enzyme immunoassays to determine fecal interleukin (IL)-8, lactoferrin, and phosphorylated-p38 protein concentrations, and quantitative polymerase chain reaction to determine IL-8 and chemokine ligand (CXCL)-5 RNA relative transcript abundances, and C difficile bacterial burden. RESULTS: Of 68 asymptomatic controls, 16 were colonized with C difficile. Phosphorylated-p38 was specific for C difficile infection but lacked sensitivity. Fecal cytokines were elevated in samples from symptomatic children, whether cases or controls. In children with C difficile infection, fecal CXCL-5 and IL-8 messenger RNA abundances at diagnosis correlated with persistent diarrhea after 5 days of C difficile infection therapy and with treatment with vancomycin. When children with concomitant viral gastroenteritis were excluded, these correlations persisted. Time-to-diarrhea resolution was significantly longer in patients with elevated fecal cytokines at diagnosis. A logistic regression model identified high CXCL-5 messenger RNA abundance as the only predictor of persistent diarrhea. Conversely, fecal C difficile bacterial burden was not different in symptomatic and asymptomatic children and did not correlate with any clinical outcome measure. CONCLUSIONS: Fecal inflammatory cytokines may be useful in distinguishing C difficile colonization from disease and identifying children with C difficile infection likely to have prolonged diarrhea.
Assuntos
Enterocolite Pseudomembranosa , Fezes/química , Interleucina-8/análise , Lactoferrina/análise , Proteínas Quinases p38 Ativadas por Mitógeno/análise , Biomarcadores/análise , Estudos de Casos e Controles , Criança , Enterocolite Pseudomembranosa/diagnóstico , Enterocolite Pseudomembranosa/imunologia , Feminino , Humanos , Masculino , Estudos ProspectivosRESUMO
OBJECTIVE: To evaluate the effectiveness of a hospital-wide initiative to improve patient safety by implementing high-reliability practices as part of a quality improvement (QI) program aimed at reducing all preventable harm. STUDY DESIGN: A hospital wide quasi-experimental time series QI initiative using high-reliability concepts, microsystem-based multidisciplinary teams, and QI science tools to reduce hospital acquired harm was implemented. Extensive error prevention training was provided for all employees. Change concepts were enacted using the Institute for Healthcare Improvement's Model for Improvement. Compliance with change packages was measured. RESULTS: Between 2010 and 2012, the serious safety event rate decreased from 1.15 events to 0.19 event per 10â000 adjusted hospital-days, an 83.3% reduction (P < .001). Preventable harm events decreased by 53%, from a quarterly peak of 150 in the first quarter of 2010 to 71 in the fourth quarter of 2012 (P < .01). Observed hospital mortality decreased from 1.0% to 0.75% (P < .001), although severity-adjusted expected mortality actually increased slightly, and estimated harm-related hospital costs decreased by 22.0%. Hospital-wide safety climate scores increased significantly. CONCLUSION: Substantial reductions in serious safety event rate, preventable harm, hospital mortality, and cost were seen after implementation of our multifaceted approach. Measurable improvements in the safety culture were noted as well.
Assuntos
Mortalidade Hospitalar , Hospitalização/economia , Hospitais Pediátricos , Dano ao Paciente/prevenção & controle , Segurança do Paciente/normas , Melhoria de Qualidade , Criança , Controle de Custos , Humanos , Reprodutibilidade dos TestesRESUMO
OBJECTIVES: To validate an algorithm to identify cases of intussusception using the health administrative data of Ontario, Canada, and to apply the algorithm to estimate provincial incidence of intussusception, preceding the introduction of the universal rotavirus vaccination program. STUDY DESIGN: We determined the accuracy of various combinations of diagnostic, procedural, and billing codes using the chart-abstracted diagnoses of patients of the Children's Hospital of Eastern Ontario as the reference standard. We selected an algorithm that maximized positive predictive value while maintaining a high sensitivity and used it to ascertain annual incidence of intussusception for fiscal years 1995-2010. We explored temporal trends in incidence using Poisson regression. RESULTS: The selected algorithm included only the International Classification of Diseases (ICD)-9 or ICD-10 code for intussusception in the hospitalization database and was sensitive (89.3%) and highly specific (>99.9%). The positive predictive value of the ICD code was 72.4%, and the negative predictive value was >99.9%. We observed the highest mean incidence (34 per 100000) in male children <1 year of age. Temporal trends in incidence varied by age group. There was a significant mean decrease in incidence of 4% per year in infants (<1 year) until 2004 and rates stabilized thereafter. CONCLUSIONS: We have demonstrated that intussusception can be accurately identified within health administrative data using validated algorithms. We have described changes in temporal trends in intussusception incidence in Ontario and established a baseline to allow ongoing monitoring as part of vaccine safety surveillance.
Assuntos
Classificação Internacional de Doenças , Intussuscepção/diagnóstico , Intussuscepção/epidemiologia , Adolescente , Algoritmos , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Hospitalização , Humanos , Incidência , Lactente , Intussuscepção/classificação , Masculino , Ontário , Distribuição de Poisson , Valor Preditivo dos Testes , Vacinas contra Rotavirus/uso terapêutico , Sensibilidade e Especificidade , Fatores de TempoRESUMO
BACKGROUND & AIMS: Cdc42 is a Rho GTPase that regulates diverse cellular functions, including proliferation, differentiation, migration, and polarity. In the intestinal epithelium, a balance among these events maintains homeostasis. We used genetic techniques to investigate the role of Cdc42 in intestinal homeostasis and its mechanisms. METHODS: We disrupted Cdc42 specifically in intestinal epithelial cells by creating Cdc42flox/flox-villin-Cre+ and Cdc42flox/flox-Rosa26-CreER+ mice. We collected intestinal and other tissues, and analyzed their cellular, molecular, morphologic, and physiologic features, compared with the respective heterozygous mice. RESULTS: In all mutant mice studied, the intestinal epithelium had gross hyperplasia, crypt enlargement, microvilli inclusion, and abnormal epithelial permeability. Cdc42 deficiency resulted in defective Paneth cell differentiation and localization without affecting the differentiation of other cell lineages. In mutant intestinal crypts, proliferating stem and progenitor cells increased, compared with control mice, resulting in increased crypt depth. Cdc42 deficiency increased migration of stem and progenitor cells along the villi, caused a mild defect in the apical junction orientation, and impaired intestinal epithelium polarity, which can contribute to the observed defective intestinal permeability. The intestinal epithelium of the Cdc42flox/flox-villin-Cre+ and Cdc42flox/flox-Rosa26-CreER+ mice appeared similar to that of patients with microvillus inclusion disease. In the digestive track, loss of Cdc42 also resulted in crypt hyperplasia in the colon, but not the stomach. CONCLUSIONS: Cdc42 regulates proliferation, polarity, migration, and differentiation of intestinal epithelial cells in mice and maintains intestine epithelial barrier and homeostasis. Defects in Cdc42 signaling could be associated with microvillus inclusion disease.
Assuntos
Mucosa Intestinal/citologia , Intestino Delgado/citologia , Proteína cdc42 de Ligação ao GTP/fisiologia , Animais , Diferenciação Celular , Movimento Celular , Polaridade Celular , Proliferação de Células , CamundongosRESUMO
OBJECTIVE: To determine the incidence of pathology during routine screening of healthy short children, testing adherence to a consensus statement on the diagnosis and treatment of children with idiopathic short stature, and the cost per identified diagnosis resulting from comprehensive screening. STUDY DESIGN: Retrospective chart review of 1373 consecutive short stature referrals evaluated at the Cincinnati Children's Hospital Medical Center Pediatric Endocrinology Clinic between 2008 and 2011. We identified 235 patients with a height of <3rd percentile, negative history and review of systems, and normal physical examination. Outcome measures were incidence of pathology detection, diagnostic group characteristics, clinicians' adherence to testing guidelines, and screening costs. ANOVA and χ(2) were used to analyze the data. RESULTS: Nearly 99% of patients were diagnosed as possible variants of normal growth: 23% with familial short stature, 41% with constitutional delay of growth and maturation, and 36% with idiopathic short stature. The incidence of newly diagnosed pathology was 1.3%: 1 patient with biopsy-proved celiac disease, 1 with unconfirmed celiac disease, and 1 with potential insulin-like growth factor I receptor defect. On average, each patient had 64.3% of the recommended tests for age and sex; 2.1% of patients had all of the recommended testing. The total screening tests costs were $315321, yielding $105107 per new diagnosis entertained. CONCLUSIONS: Healthy short children do not warrant nondirected, comprehensive screening. Future guidelines for evaluating short stature should include patient-specific testing.
Assuntos
Estatura , Transtornos do Crescimento/diagnóstico , Transtornos do Crescimento/economia , Pediatria/economia , Adolescente , Algoritmos , Biópsia , Criança , Pré-Escolar , Medicina Baseada em Evidências , Feminino , Custos de Cuidados de Saúde , Humanos , Lactente , Masculino , Pediatria/métodos , Estudos RetrospectivosRESUMO
OBJECTIVES: To characterize variation and inequalities in neighborhood child asthma admission rates and to identify associated community factors within one US county. STUDY DESIGN: This population-based prospective, observational cohort study consisted of 862 sequential child asthma admissions among 167â653 eligible children ages 1-16 years in Hamilton County, Ohio. Admissions occurred at a tertiary-care pediatric hospital and accounted for nearly 95% of in-county asthma admissions. Neighborhood admission rates were assessed by geocoding addresses to city- and county-defined neighborhoods. The 2010 US Census provided denominator data. Neighborhood admission distribution inequality was assessed by the use of Gini and Robin Hood indices. Associations between neighborhood rates and socioeconomic and environmental factors were assessed using ANOVA and linear regression. RESULTS: The county admission rate was 5.1 per 1000 children. Neighborhood rates varied significantly by quintile: 17.6, 7.7, 4.9, 2.2, and 0.2 admissions per 1000 children (P < .0001). Fifteen neighborhoods containing 8% of the population had zero admissions. The Gini index of 0.52 and Robin Hood index of 0.38 indicated significant inequality. Neighborhood-level educational attainment, car access, and population density best explained variation in neighborhood admission rates (R(2) = 0.55). CONCLUSION: In a single year, asthma admission rates varied 88-fold across neighborhood quintiles in one county; a reduction of the county-wide admission rate to that of the bottom quintile would decrease annual admissions from 862 to 34. A rate of zero was present in 15 neighborhoods, which is evidence of what may be attainable.
Assuntos
Asma/terapia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Adolescente , Asma/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Ohio , Estudos Prospectivos , Fatores SocioeconômicosRESUMO
OBJECTIVE: To describe adherence to clinical practice guidelines for the treatment of childhood type 1 diabetes and identify associated patient and system level factors. STUDY DESIGN: This prospective cohort study used population-based administrative data to describe individuals aged 1-24 years who had been diagnosed with type 1 diabetes at <20 years of age (1472 unique individuals and 5883 person-years over a 7-year period) living in British Columbia, Canada. The outcome measure was proportion 'at goal,' which was defined as having optimal adherence (3 diabetes-related physician visits/year, 3 hemoglobin A1c (HbA1c) tests/year, 1 glucagon prescription dispensed/year, and appropriate screening for diabetes-related comorbidity [ie, hypothyroidism] and complications [ie, retinopathy and nephropathy]), or good adherence to guidelines (2 diabetes-related physician visits/year, 2 HbA1c tests/year, and appropriate screening for diabetes-related comorbidity and complications). Statistical methods included descriptive statistics and logistic regression modeling. RESULTS: Fifty-four percent person-years had poor adherence to guidelines (<2 diabetes-related physician visits and HbA1c tests/year) and 7.4% had optimal adherence. The proportion of person-years at goal was higher in females vs males (41.0% vs 37.6%; P = .007). Individuals 4-years post-diagnosis of diabetes were 78% less likely to be at goal compared with the year of diagnosis (P < .0001). CONCLUSIONS: The treatment of pediatric type 1 diabetes likely does not meet national and international standards. Future studies should explore facilitators and barriers to adherence to guidelines among health care providers, patients, and families, and whether adherence to guidelines is associated with glycemic control.
Assuntos
Diabetes Mellitus Tipo 1/terapia , Fidelidade a Diretrizes/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Adulto JovemRESUMO
Se realizó un estudio descriptivo y transversal de 31 pacientes con neumonía asociada a la ventilación, ingresados en la Unidad de Cuidados Intensivos del Hospital Infantil Norte Docente Dr Juan de la Cruz Martínez Maceira de Santiago de Cuba, desde enero de 2007 hasta diciembre de 2011, a fin de caracterizarles desde el punto de vista clinicoepidemiológico. En la serie predominaron los niños menores de un año, la insuficiencia respiratoria como la causa principal de ventilación, los pacientes con 4 o más días de ventilados como los más afectados, la fiebre y los cambios de las secreciones bronquiales como los síntomas más comunes, la sedación como el factor de riesgo más frecuente, los sedantes y los relajantes musculares como los medicamentos que más causaron neumonía y las cefalosporinas de tercera generación como los fármacos más usados.
A descriptive and cross-sectional study was carried out in 31 patients with ventilator-associated pneumonia, admitted to the Intensive Care Unit of Dr Juan de la Cruz Martínez Maceira Northern Teaching Children Hospital of Santiago de Cuba, from January 2007 to December 2011, in order to characterize them clinically and epidemiologically. Children under one year, respiratory failure as the main cause of ventilation, patients with 4 or more days of ventilation as the most affected predominated in the series, as well as fever and changes in bronchial secretions as the most common symptoms, sedation as the most common risk factor, sedatives and muscular relaxers as drugs that mostly caused pneumonia, and third generation-cephalosporins as the most used drugs.
Assuntos
Humanos , Masculino , Feminino , Criança , Unidades de Terapia Intensiva Pediátrica , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Pneumonia Associada à Ventilação Mecânica/etiologia , Respiração Artificial/efeitos adversos , Estudos Transversais , Epidemiologia DescritivaRESUMO
Se realizó un estudio descriptivo y transversal de los 1 311 pacientes que recibieron antimicrobianos de amplio espectro en el Hospital Infantil Norte Docente "Dr. Juan de la Cruz Martínez Maceira" de Santiago de Cuba, desde enero hasta diciembre de 2009, a fin de analizar el uso de estos medicamentos, para lo cual se revisaron las historias clínicas correspondientes y los controles del Departamento de Farmacia. En la casuística predominaron la ceftriaxona como medicamento más empleado (64,8 %), la Unidad de Cuidados Intensivos como el servicio que más lo utilizó (41,7 %), la neumonía bacteriana como entidad clínica más común (42,0 %) y la evolución favorable de los afectados (98,5 %).
A descriptive and cross-sectional study of the 1 311 patients who received wide spectrum antimicrobials in "Dr. Juan de la Cruz Martínez Maceira" Teaching Northern Children Hospital in Santiago de Cuba was carried out from January to December, 2009, in order to analyze the use of these drugs. For this aim, the corresponding medical records and the controls of the Pharmacy Department were reviewed. Ceftriaxone as the most used medication (64.8 %), the Intensive Care Unit as the most used service (41.7 %), the bacterial pneumonia as the most common clinical entity (42.0 %) and the favorable clinical course of those affected (98.5 %) prevailed in the case material.
RESUMO
Se realizó un estudio descriptivo y transversal de 200 niños y adolescentes obesos, con edades de 5 a 18 años, que acudieron a la consulta de Endocrinología del Hospital Docente Infantil Norte "Dr. Juan de la Cruz Martínez Maceira" de Santiago de Cuba, desde enero del 2008 hasta igual mes del 2010, a fin de determinar la existencia del síndrome metabólico en estos, para lo cual se consideraron las variables: edad, sexo, presencia de síndrome metabólico (según el National Cholesterol Education Program Adult Treatment Panel III), índice de masa corporal, bajo peso al nacer, antecedentes obstétricos de la madre (crecimiento intrauterino retardado, diabetes e hipertensión gestacionales) y patológicos familiares (obesidad, diabetes mellitus e hipertensión arterial), así como parámetros bioquímicos. En la casuística se observó un bajo porcentaje del síndrome metabólico (12,0 %), con predominio en las edades de 15 a 18 años, el cual estuvo estrechamente relacionado con la circunferencia abdominal, que se presentó por encima de 95 percentil en 100,0 % de los pacientes; el bajo peso al nacer, que primó en 70,8 % de los afectados con la entidad clínica; y la severidad de la obesidad, que mostró la importante cifra de 95,8 % en la génesis de dicho síndrome.
A descriptive and cross-sectional study was conducted in 200 obese children and adolescents between 5 and 18 years of age that attended the Endocrinology Department of «Dr. Juan de la Cruz Martínez Maceira¼ Northern Teaching Children Hospital in Santiago de Cuba, from January 2008 to January 2010, in order to determine the occurrence of metabolic syndrome in these patients, for which the variates such as age, sex, presence of metabolic syndrome (according to the National Cholesterol Education Program Adult Treatment Panel III), and body mass index, low birth weight, mother's reproductive history (intrauterine growth retardation, gestational diabetes and hypertension), family history (obesity, diabetes mellitus and hypertension), as well as biochemical parameters were considered. A low percentage of metabolic syndrome (12.0%), predominantly in the ages from 15 to 18 years, which was closely related to abdominal circumference that was above 95 percentile in 100.0% of patients; the low birth weight prevailing in 70.8% of those affected with the clinical entity; and the severity of the obesity that showed the significant rate of 95.8% in the genesis of this syndrome were observed in the case material.