ABSTRACT
OBJECTIVES: To assess the degree of consensus among a multidisciplinary expert panel on the transition of adolescents with severe asthma from pediatric to adult care. METHODS: A 61-item survey was developed based on guidelines for other chronic diseases, covering transition planning, preparation, effective transfer, and follow-up. A 2-round Delphi process assessed the degree of consensus among 98 experts (49 pediatricians, 24 allergists, and 25 pulmonologists). Consensus was established with ≥70% agreement. RESULTS: Consensus was reached for 42 items (70%). Panelists were unable to agree on an age range for initiation of transition. The main goal during the transition identified by the experts is for adolescents to gain autonomy in managing severe asthma and prescribed treatments. The panelists agreed on the importance of developing an individualized plan, promoting patient autonomy, and identifying factors associated with the home environment. They agreed that the adult health care team should have expertise in severe asthma, biologics, and management of adolescent patients. Pediatric and adult health care teams should share clinical information, agree on the criteria for maintaining biological therapy, and have an on-site joint visit with the patient before the effective transfer. Adult health care professionals should closely follow the patient after the effective transfer to ensure correct inhaler technique, adherence, and attendance at health care appointments. CONCLUSION: This consensus document provides the first roadmap for Spanish pediatric and adult teams to ensure that key aspects of the transition process in severe asthma are covered. The implementation of these recommendations will improve the quality of care offered to the patient.
Subject(s)
Asthma , Transition to Adult Care , Humans , Adolescent , Adult , Child , Consensus , Spain , Asthma/drug therapy , Biological TherapyABSTRACT
Objective: To assess the degree of consensus among a multidisciplinary expert panel on the transition of adolescents with severe asthma from pediatric to adult care. Methods: A 61-item survey was developed based on guidelines for other chronic diseases, covering transition planning, preparation, effective transfer, and follow-up. A 2-round Delphi process assessed the degree of consensus among 98 experts (49 pediatricians, 24 allergists, and 25 pulmonologists). Consensus was established with ≥70% agreement. Results: Consensus was reached for 42 items (70%). Panelists were unable to agree on an age range for initiation of transition. The main goal during the transition identified by the experts is for adolescents to gain autonomy in managing severe asthma and prescribed treatments. The panelists agreed on the importance of developing an individualized plan, promoting patient autonomy, and identifying factors associated with the home environment. They agreed that the adult health care team should have expertise in severe asthma, biologics, and management of adolescent patients. Pediatric and adult health care teams should share clinical information, agree on the criteria for maintaining biological therapy, and have an on-site joint visit with the patient before the effective transfer. Adult health care professionals should closely follow the patient after the effective transfer to ensure correct inhaler technique, adherence, and attendance at health care appointments. Conclusions: This consensus document provides the first roadmap for Spanish pediatric and adult teams to ensure that key aspects of the transition process in severe asthma are covered. The implementation of these recommendations will improve the quality of care offered to the patient (AU)
Objetivo: Evaluar el grado de consenso con un panel multidisciplinar de expertos sobre la transición del adolescente con asma grave de los servicios de pediatría a atención de adultos. Métodos: Se elaboró un cuestionario de 61 ítems basado en recomendaciones de transición para otras patologías crónicas, abarcando la planificación de la transición, preparación, transferencia efectiva y seguimiento. Se evaluó el nivel de consenso entre 98 expertos (49 pediatras, 24 alergólogos y 25 neumólogos) mediante un proceso Delphi de dos rondas. El consenso se estableció con un acuerdo ≥70%. Resultados: Cuarenta y dos ítems (70%) alcanzaron consenso. Los panelistas no alcanzaron consenso en el rango de edad para iniciar la transición. El principal objetivo a conseguir durante la transición según los expertos fue que el adolescente gane autonomía en el manejodel asma grave y tratamientos prescritos. Asimismo, alcanzaron acuerdo en la importancia de desarrollar un plan individualizado, promover la autonomía del paciente e identificar los factores clave en el entorno familiar. Los especialistas de adultos deben tener experiencia en asma grave y tratamientos biológicos, así como en el manejo de pacientes adolescentes. Los equipos sanitarios de pediatría y de adultos deben compartir la información clínica, consensuar los criterios para mantener la terapia biológica y realizar una visita conjunta con el paciente antes de la transferencia. Los especialistas de adultos deben realizar un seguimiento estrecho del paciente tras la transferencia para asegurar una correcta técnica inhalatoria, el cumplimiento del tratamiento y la asistencia a las citas sanitarias. Conclusiones: Este documento de consenso proporciona la primera hoja de ruta en España para que los equipos especialistas de pediatría y adultos garanticen aspectos clave del proceso de transición en pacientes adolescentes con asma grave. La aplicación de estas (AU)
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Transition to Adult Care/standards , Asthma/therapy , Severity of Illness Index , Delphi Technique , Consensus , SpainABSTRACT
Introducción: el volumen urinario bajo (< 1 ml/kg/h) es el factor etiológico más frecuente en la litiasis renal. Frecuentemente, se asume que los niños que refieren beber mucho tienen una diuresis protectora. En este estudio analizamos el hábito de consumo de líquidos en niños sanos y su relación con el volumen urinario. Metodología: se estudiaron 84 niños, de 5 a 17 años. Se registró la percepción de consumo habitual de líquidos como: "poco", "normal" o "mucho" y los tipos de bebida habitual. Se cuantificó el volumen en orina de 24 h y se relacionó con la percepción de la ingesta de líquidos. Resultados: la ingesta habitual de líquidos fue calificada como "poca" en el 23% de los casos, "normal" en un 56% y "mucha" en un 21%. El 39% de los niños (33/84) presentó una diuresis > 1 ml/kg/h que, por grupos, supone el 38,9% de los que refirieron una ingesta escasa, el 63% de los de consumo "normal" y el 73,7% de los que refirieron ingesta elevada. El 56% de los niños de los grupos de ingesta "normal" y "elevada" mostraron una diuresis < 1 ml/kg/h. Conclusiones: la mayoría de niños mostraron una diuresis por debajo del límite recomendado, incluso entre los que refieren una ingesta "normal" o "elevada" de líquidos. Estos hallazgos hacen visible la necesidad de promover estrategias encaminadas a aumentar el consumo de agua en la población (AU)
Introduction: a low urine volume is a main etiological factor for renal lithiasis (< 1 ml/kg/h). It is commonly assumed that children who report a high fluid intake have a protective urine volume. The purpose of the present study is to assess the habit of fluid intake in healthy schoolchildren and to evaluate its relation with the urinary volume. Methods: eighty-four healthy schoolchildren (5-17 years) were asked to categorize their usual fluid intake amount by choosing one of the three options: "low", "normal" or "high" fluid intake. The usual consumed types of beverage were also recorded. Twenty-four-hour urine volume was measured in each child. The results of the questionnaire were compared to that from the urine samples. Results: a "low" fluid intake was referred by 23% of children, a "normal" fluid intake by 57% and a "high" fluid intake by 21%. Diuresis values > 1 ml/kg/h were observed in 39% of children (that is: 38.9% of the "low intake" group, 63% of the "normal intake" group and 73.7% of the "high intake" group). Among "normal" and "high" intake groups, a urinary output < 1 ml/kg/h was found in 56% of children. Conclusions: a majority of the studied children did not reach the minimum recommended diuresis to prevent urinary lithiasis, even among children who report a high intake of fluids. Strategies aimed at increasing water intake by children population should be highly encouraged (AU)
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Drinking/physiology , Perception/physiology , Diuresis/physiology , Motor Activity/physiology , Feeding Behavior/physiology , Healthy Volunteers/statistics & numerical data , Urine/physiology , Cross-Sectional Studies/methods , Informed Consent/standardsABSTRACT
La neumonía adquirida en la comunidad (NAC) en la edad pediátrica ha sufrido, en la última década, una serie de cambios epidemiológicos, clínicos, etiológicos y de resistencias a antibióticos, que obligan a replantear su abordaje terapéutico. En este documento, dos de las principales sociedades de especialidades pediátricas involucradas en el diagnóstico y tratamiento de esta entidad, como son la Sociedad Española de Infectología Pediátrica y la Sociedad Española de Neumología Pediátrica, así como el Comité Asesor de Vacunas de la AEP, proponen unas pautas consensuadas de tratamiento y prevención, con el fin de proporcionar a todos los pediatras una guía actualizada. En esta primera parte del consenso, se aborda el tratamiento de los pacientes sin enfermedades de base relevantes con NAC que no precisan ingreso hospitalario, así como la prevención global de esta patología con vacunas. En un siguiente documento se expondrá el abordaje terapéutico tanto de aquellos pacientes en situaciones especiales como de las formas complicadas de la enfermedad
There have been significant changes in community acquired pneumonia (CAP) in children in the last decade. These changes relate to epidemiology and clinical presentation. Resistance to antibiotics is also a changing issue. These all have to be considered when treating CAP. In this document, two of the main Spanish pediatric societies involved in the treatment of CAP in children, propose a consensus concerning therapeutic approach. These societies are the Spanish Society of Paediatric Infectious Diseases and the Spanish Society of Paediatric Chest Diseases. The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) has also been involved in the prevention of CAP. An attempt is made to provide up-to-date guidelines to all paediatricians. The first part of the statement presents the approach to ambulatory, previously healthy children. We also review the prevention with currently available vaccines. In a next second part, special situations and complicated forms will be addressed
Subject(s)
Child , Female , Humans , Male , Pneumonia/mortality , Pneumonia/etiology , Pneumonia/drug therapy , Pneumonia/prevention & control , Community-Acquired Infections/epidemiology , Amoxicillin/administration & dosage , Amoxicillin/therapeutic use , Drug Resistance, Microbial , Epidemiological Monitoring/trends , Haemophilus influenzae type b/pathogenicity , Streptococcus pneumoniae/pathogenicity , Staphylococcus aureus/pathogenicity , Streptococcus pyogenes/pathogenicity , Pneumococcal Vaccines , Vaccines, Conjugate , Haemophilus Vaccines , Influenza Vaccines , Spain/epidemiologyABSTRACT
Desde hace más de una década, los casos complicados de neumonía adquirida en la comunidad, fundamentalmente con empiema pleural o formas necrosantes, comenzaron a ser más frecuentes en niños, según la amplia documentación procedente de numerosos países. El abordaje terapéutico óptimo de estos casos, tanto desde el punto de vista médico (antibióticos, fibrinolíticos) como técnico-quirúrgico, (drenaje pleural, videotoracoscopia) continúa siendo controvertido. En este documento, la Sociedad Española de Infectología Pediátrica y la Sociedad Española de Neumología Pediátrica revisan la evidencia científica y proponen unas pautas consensuadas de tratamiento de estos casos, fundamentalmente para el abordaje del derrame pleural paraneumónico en niños, así como la actuación en situaciones especiales, sobre todo en la cada vez más frecuente población pediátrica con enfermedades de base o inmumodepresión
The incidence of community-acquired pneumonia complications has increased during the last decade. According to the records from several countries, empyema and necrotizing pneumonia became more frequent during the last few years. The optimal therapeutic approach for such conditions is still controversial. Both pharmacological management (antimicrobials and fibrinolysis), and surgical management (pleural drainage and video-assisted thoracoscopic surgery), are the subject of continuous assessment. In this paper, the Spanish Society of Paediatric Infectious Diseases and the Spanish Society of Paediatric Chest Diseases have reviewed the available evidence. Consensus treatment guidelines are proposed for complications of community-acquired pneumonia in children, focusing on parapneumonic pleural effusion. Recommendations are also provided for the increasing population of patients with underlying diseases and immunosuppression
Subject(s)
Child , Female , Humans , Infant , Male , Pneumonia/drug therapy , Pneumonia/therapy , Pneumonia/prevention & control , Pneumonia/complications , Pleural Effusion/drug therapy , Pleural Effusion/therapy , Anti-Bacterial Agents/therapeutic use , Thoracoscopy/methods , Community-Acquired Infections , Epidemiological Monitoring/trends , Empyema, Pleural , Hyponatremia , Oxygen Inhalation Therapy , Oximetry , Energy Drinks , Respiration, Artificial , Noninvasive Ventilation , Immunocompromised Host , Treatment Failure , Spain/epidemiologyABSTRACT
The incidence of community-acquired pneumonia complications has increased during the last decade. According to the records from several countries, empyema and necrotizing pneumonia became more frequent during the last few years. The optimal therapeutic approach for such conditions is still controversial. Both pharmacological management (antimicrobials and fibrinolysis), and surgical management (pleural drainage and video-assisted thoracoscopic surgery), are the subject of continuous assessment. In this paper, the Spanish Society of Paediatric Infectious Diseases and the Spanish Society of Paediatric Chest Diseases have reviewed the available evidence. Consensus treatment guidelines are proposed for complications of community-acquired pneumonia in children, focusing on parapneumonic pleural effusion. Recommendations are also provided for the increasing population of patients with underlying diseases and immunosuppression.
Subject(s)
Pneumonia, Bacterial/therapy , Pneumonia, Viral/therapy , Child , Community-Acquired Infections/therapy , Humans , Pneumonia, Bacterial/complications , Pneumonia, Viral/complications , RiskABSTRACT
There have been significant changes in community acquired pneumonia (CAP) in children in the last decade. These changes relate to epidemiology and clinical presentation. Resistance to antibiotics is also a changing issue. These all have to be considered when treating CAP. In this document, two of the main Spanish pediatric societies involved in the treatment of CAP in children, propose a consensus concerning therapeutic approach. These societies are the Spanish Society of Paediatric Infectious Diseases and the Spanish Society of Paediatric Chest Diseases. The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) has also been involved in the prevention of CAP. An attempt is made to provide up-to-date guidelines to all paediatricians. The first part of the statement presents the approach to ambulatory, previously healthy children. We also review the prevention with currently available vaccines. In a next second part, special situations and complicated forms will be addressed.
Subject(s)
Community-Acquired Infections/prevention & control , Community-Acquired Infections/therapy , Pneumonia, Bacterial/prevention & control , Pneumonia, Bacterial/therapy , Anti-Bacterial Agents/therapeutic use , Child , Drug Resistance, Bacterial , Humans , Outpatients , Practice Guidelines as Topic , Societies, Medical , SpainABSTRACT
No disponible
Subject(s)
Humans , Male , Infant , Bronchiolitis/diagnosis , Seizures/complications , /complications , Respiratory Syncytial Viruses/pathogenicityABSTRACT
No disponible
Subject(s)
Humans , Laryngoscopy , Laryngopharyngeal Reflux/diagnosis , Dyspepsia/etiology , Inflammation/diagnosis , Risk FactorsABSTRACT
Cada año un gran número de niños viajan en avión y se desplazan a lugares con altitud significativa. La mayoría de estos viajes se producen sin incidentes reseñables. Debido a los numerosos cambios socioeconómicos recientes, también ha aumentado la cantidad de pacientes con patología cardiopulmonar previa que realizan este tipo de desplazamientos. Los cambios ambientales en estos entornos, en especial la hipoxia, puede conllevar un riesgo de sucesos adversos importantes. El pediatra debe de conocer las patologías susceptibles de complicaciones en altitud, así como los estudios previos necesarios y las recomendaciones de prevención y tratamiento de las complicaciones en estas circunstancias. El Grupo de Trabajo de Técnicas de la Sociedad Española de Neumología Pediátrica se propuso la elaboración de un documento que revisara la literatura publicada sobre el tema, estableciendo unas recomendaciones de utilidad en el manejo de estos pacientes (AU)
Every year a large number of children travel by plane and/or to places with high altitudes. Most of these journeys occur without incident. Immigration and recent socioeconomic changes have also increased the number of patients with cardiopulmonary disease who travel. Environmental changes in these places, especially lower oxygen, can lead to a risk of significant adverse events. The paediatrician must be aware of the diseases that are susceptible to complications, as well as the necessary preliminary studies and recommendations for treatment in these circumstances. The Techniques Group of the Spanish Society of Paediatric Chest Diseases undertook to design a document reviewing the literature on the subject, providing some useful recommendations in the management of these patients (AU)
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Dyspnea/diagnosis , Dyspnea/prevention & control , Headache/diagnosis , Headache/therapy , Altitude Sickness/epidemiology , Hypoxia/complications , Hypoxia/diagnosis , Dyspnea/complications , Headache/epidemiology , Headache/prevention & control , Altitude Sickness/complications , Altitude Sickness/diagnosis , Hypoxia/epidemiology , Hypoxia/prevention & controlABSTRACT
Every year a large number of children travel by plane and/or to places with high altitudes. Most of these journeys occur without incident. Immigration and recent socioeconomic changes have also increased the number of patients with cardiopulmonary disease who travel. Environmental changes in these places, especially lower oxygen, can lead to a risk of significant adverse events. The paediatrician must be aware of the diseases that are susceptible to complications, as well as the necessary preliminary studies and recommendations for treatment in these circumstances. The Techniques Group of the Spanish Society of Paediatric Chest Diseases undertook to design a document reviewing the literature on the subject, providing some useful recommendations in the management of these patients.
Subject(s)
Altitude , Respiration Disorders/therapy , Travel , Altitude Sickness/therapy , Child , HumansABSTRACT
No disponible
Subject(s)
Humans , Female , Adolescent , Neck Injuries/diagnosis , Neck Injuries/therapy , Radiography, Thoracic/methods , Osteolysis/complications , Osteolysis , Isoniazid/therapeutic use , Rifampin/therapeutic use , Ethambutol/therapeutic use , Neck Injuries/physiopathology , Neck Injuries , Radiography, Thoracic/trends , Pelvic Bones/pathology , Pelvic Bones , PelvisSubject(s)
Humans , Bronchiolitis/genetics , Bronchiolitis/pathology , Bronchiolitis/virology , Respiratory Syncytial Viruses/genetics , Respiratory Syncytial Viruses/immunology , Respiratory Syncytial Viruses/pathogenicity , Rhinovirus/pathogenicity , Tobacco Smoke Pollution/adverse effects , Pulmonary Surfactant-Associated Protein A , Pulmonary Surfactant-Associated Protein D , Pulmonary Surfactant-Associated Protein B , Pulmonary Surfactant-Associated Protein C , Pulmonary Surfactant-Associated ProteinsABSTRACT
No disponible
Subject(s)
Humans , Female , Child , Status Asthmaticus/complications , Status Asthmaticus/diagnosis , Status Asthmaticus/therapy , Hypercapnia/complications , Hypercapnia/diagnosis , Hypercapnia/therapy , Obesity/complications , Obesity/pathology , Hypoventilation/complications , Hypoventilation/pathology , Oxygen/therapeutic useABSTRACT
No disponible
Subject(s)
Humans , Tracheal Diseases/diagnosis , Respiratory Sounds/etiology , Tracheal Stenosis/diagnosis , Tracheal Neoplasms , Tracheomalacia/diagnosis , Radiography, Thoracic , Tracheoesophageal Fistula/diagnosisABSTRACT
All guidelines, protocols and recommendations underline the importance of therapeutic education as a key element in asthma management and control. Considerable evidence supports the efficacy and effectiveness of this measure. Health personnel, as well as patients and their parents, can and should be educated with two main objectives: to achieve the best possible quality of life and to allow self control of the disease. These goals can be attained through an educational process that should be individually tailored, continuous, progressive, dynamic, and sequential. The process poses more than a few difficulties involving patients, health professionals, and the health systems. Knowledge of the various psychological factors that can be present in asthmatic patients, as well as the factors related to the highly prevalent phenomenon of non-adherence, is essential. Awareness of the factors influencing physician-patient-family communication is also highly important to achieve the objectives set in therapeutic education. The educational process helps knowledge and abilities to be acquired and allows attitudes and beliefs to be modified. Patients and caregivers should be provided with an individual written action plan based on symptoms and/or forced expiratory volume in 1 second. Periodic follow-up visits are also required.
