Hospitalización a domicilio. Una alternativa asistencial / Hospital at home. A care alternative

La hospitalización a domicilio (HADO) supone una alternativa asistencial capaz de dispensar asistencia médica de rango hospitalario a los pacientes en sus domicilios, cuando ya no precisan de la infraestructura hospitalaria. Proporciona una atención integral al enfermo de determinadas patologías crónicas y agudas y permiten a los niños enfermos permanecer en el domicilio, rodeados de sus familiares y en su entorno. En otros países la hospitalización a domicilio está ampliamente desarrollada en adultos y en el ámbito pediátrico. En España, aunque es una realidad creciente, resulta aún insuficiente y precisa un mayor desarrollo para proporcionar una atención adecuada de los niños enfermos en sus domicilios (AU)

Hospital at Home (HaH) is a care alternative capable of providing hospital range medical care to patients in their homes when they do not require the hospital infrastructure. It provides comprehensive care to the patient with certain chronic and acute conditions and permits ill children to remain at home, surrounded by their family and environment. In other countries, hospital at home is widely developed in adults and in the pediatric setting. In Spain, although in is growing at present, greater development to provide adequate care of ill children in their homes is still insufficient and precise (AU)

Cumplimiento de los requisitos de los servicios de urgencias de España: encuesta de autoevaluación / Compliance with the requirements of paediatric emergency departments in Spain: a self-assessment survey

Introducción: La medicina de urgencias pediátrica en España se practica en servicios de distinta configuración. Nuestro objetivo es conocer su situación y adaptación a los requisitos del Cuerpo Doctrinal de la Sociedad Española de Urgencias Pediátricas. Método: Se envió por correo electrónico una encuesta con el cuestionario de Autoevaluación del Cuerpo Doctrinal a los responsables de 47 servicios. Consta de 101 ítems, 69 considerados de cumplimiento obligatorio. Se establecieron 4 grupos de servicios según el cumplimiento de esos 69 ítems: I o situación óptima (cumplen 69); II o que precisan cambios mínimos (cumplen 62-68); III o que precisan cambios mayores (cumplen 41-61); IV o que precisan grandes modificaciones (cumplen menos de 41). Resultados: Contestaron 39 servicios, que atienden una media de 35.310 urgencias anuales (5.000-115.000). Ninguno ha quedado incluido en el grupo I, 6 en el II, 27 en el III y 6 en el IV. Hay una tendencia a un mayor cumplimiento en los servicios más frecuentados, pero sin relación significativa entre el número de urgencias y los ítems cumplimentados. Conclusiones: 1) Muchos servicios de urgencias pediátricos en España tienen problemas estructurales y funcionales que pueden dificultar dar una asistencia de calidad, sin relación significativa con el volumen de urgencias atendidas; 2) los puntos de mejora afectan principalmente a cuestiones funcionales, que deben ser acometidas por sus responsables; 3) un número significativo tienen serios problemas arquitectónicos y de dotación, que precisarían medidas económicas por parte de sus órganos directivos, y 4) nuestro cuestionario de autoevaluación permite identificar acciones de mejora (AU)

Background: Paediatric emergency medicine in Spain is practiced in differently configured departments, staffing and organisation. Our goal was to determine the situation in Paediatric Emergency Departments (PED) and their adaptation to the quality standards proposed by the Spanish Society of Paediatric Emergencies. Method: A self-assessment questionnaire on standards performance was sent to 47 PED directors by e-mail. It consisted of 101 items, 69 considered mandatory. According to the fulfilment of these 69 items 4 PED groups were selected: group I: in the best position (met 69), group II: requiring minimal changes (meeting 62-68), group III: requiring major changes (meeting 41-61); group IV: requiring a lot of major changes (meeting less than 41). Results: Thirty nine questionnaires were completed in full. The PED included in the study tended to an average of 35310 annual emergencies (5000-115000). No PED was included in group I, 6 in II 27 in III and 6 in IV. There was a tendency towards higher compliance with standards in larger PED, but there was no significant relationship between the number of emergencies and the number of items fulfilled. Conclusions: 1. Staffing and architectural and organizational aspects may not be adequate to achieve optimal patient outcome in many PED in Spain. This fact does not appear to be related to the annual patient census. 2. The areas for improvement mainly affect functional issues that must be undertaken by those responsible. 3. A significant number of PED have serious architectural and staffing deficiencies, which would require economic measures by their managers. 4. Our self-assessment questionnaire identifies improvement actions (AU)

[Compliance with the requirements of paediatric emergency departments in Spain: a self-assessment survey]. / Cumplimiento de los requisitos de los servicios de urgencias de España: encuesta de autoevaluación.

BACKGROUND: Paediatric emergency medicine in Spain is practiced in differently configured departments, staffing and organisation. Our goal was to determine the situation in Paediatric Emergency Departments (PED) and their adaptation to the quality standards proposed by the Spanish Society of Paediatric Emergencies. METHOD: A self-assessment questionnaire on standards performance was sent to 47 PED directors by e-mail. It consisted of 101 items, 69 considered mandatory. According to the fulfilment of these 69 items 4 PED groups were selected: group I: in the best position (met 69), group II: requiring minimal changes (meeting 62-68), group III: requiring major changes (meeting 41-61); group IV: requiring a lot of major changes (meeting less than 41). RESULTS: Thirty nine questionnaires were completed in full. The PED included in the study tended to an average of 35310 annual emergencies (5000-115000). No PED was included in group I, 6 in II 27 in III and 6 in IV. There was a tendency towards higher compliance with standards in larger PED, but there was no significant relationship between the number of emergencies and the number of items fulfilled. CONCLUSIONS: 1. Staffing and architectural and organizational aspects may not be adequate to achieve optimal patient outcome in many PED in Spain. This fact does not appear to be related to the annual patient census. 2. The areas for improvement mainly affect functional issues that must be undertaken by those responsible. 3. A significant number of PED have serious architectural and staffing deficiencies, which would require economic measures by their managers. 4. Our self-assessment questionnaire identifies improvement actions.

Utilidad clínica de las pruebas de diagnóstico microbiológico rápido en Pediatría / Clinical utility of the rapid microbiological diagnostic tests in Pediatrics

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Presencia de familiares en los procedimientos realizados en urgencias de pediatría: opinión de la familia y de los profesionales / Family presence during pediatric emergency procedures: the perspectives of family

Objetivo: Conocer la opinión de familiares y profesionales sobre la presencia de familiares(PF) en los procedimientos realizados en un servicio de urgencias de pediatría(SUP).Métodos: Se realizaron dos estudios descriptivos transversales mediante encuestas anónimas semiestructuradas a 200 familiares elegidos aleatoriamente y a 36 profesionales(12 pediatras y 24 enfermeras) del SUP. Resultados: Entre los familiares, el deseo de presencia fue inversamente proporcional al grado de invasividad (aspiración secreciones 92%, canalización venosa 84%, sedoanalgesia81%, sondaje vesical 80%, suturas 79%, punción lumbar 66%, maniobras de reanimación pulmonar 44%). Las razones para estar presentes fueron tranquilizar al niño, sufrir menos angustia y vigilar el procedimiento. Y para no estar, interferencia con los profesionales, no tranquilizar al hijo y aumento de su angustia. Un 80% creían que la presencia familiar (PF) podría ser beneficiosa. Entre los profesionales las razones para permitirla fueron la colaboración en la contención emocional y la mejora en la relación con la familia. Y para rechazarla, menor tasa de éxitos, nerviosismo en los profesionales y angustia del familiar. Un 70% opinaron que puede resultar beneficiosa. Conclusiones: La mayoría de familiares desean estar presentes en los procedimientos realizados en un SUP. Su argumento principal es tranquilizar al niño. Los principales para no estar presentes son la interferencia con los sanitarios y su angustia. La categoría profesional influye en ofertar la PF. La razón principal para ofertarla es la contención emocional; para no hacerlo, la interferencia con la técnica y el aumento de fracasos. La mayoría tanto de familiares como de sanitarios cree que puede ser beneficiosa (AU)

Objective: To determine the opinions of family members and health care staff regarding the presence of the family during procedures carried out in our pediatric emergency department. Methods: Two cross-sectional surveys were performed. Semistructured questionnaires were answered by 200 randomly selected families and by 36 health-care professionals (12 pediatricians and 24 nurses) on our pediatric staff. Results: Among the families, the desire to be present was inversely proportional to the invasiveness of the procedure: aspiration of secretions, 92%; venous catheterization, 84%; sedation and analgesia, 81%; bladder catheterization, 80%;sutures, 79%; lumbar puncture, 66%; and cardiopulmonary resuscitation maneuvers, 44%. The families’ reasons for being present included calming the child, suffering less anxiety, and watching over the procedure. Reasons for not being present included not interfering with the professionals’ work, not being a calming influence on the child, and suffering greater anxiety. Eighty percent thought that the family’s presence could be beneficial. The professionals’ reasons for allowing family to be present included containing the child’s emotional response and improving relations with the family. Reasons for refusing family presence included a reduced success rate, staff nervousness, and family anxiety. Seventy percent of the professionals thought that the family’s presence could be beneficial (..) (AU)

Características epidemiológicas y factores de riesgo de los episodios aparentemente letales / Epidemiological characteristics and risk factors for apparent life-threatening events

Introducción: Aportar nuestra experiencia en la aplicación de un protocolo en nuestro servicio de urgencias de pediatría (SUP) en los episodios aparentemente letales (EAL), conocer su incidencia, su perfil epidemiológico y el rendimiento de las pruebas complementarias (PC) realizadas. Pacientes y métodos: Estudio prospectivo de casos y controles, de aplicación de un protocolo a lactantes menores de 12 meses que acudieron del 01/06/06 al 31/05/07 con historia de EAL. Se realizaron distintas PC en función de la clínica e historia. Todos ingresaron un mínimo de 12h. Se realizó una entrevista telefónica a los 12 meses. Resultados: Se seleccionaron 50 casos con una incidencia de 5 por cada 1.000 recién nacidos (RN) vivos. La edad fue de 8,46±8,7 semanas. Respecto a los controles hubo significativamente más primogénitos y con antecedentes de alteración del comportamiento. La exploración fue anormal en 13 y 6 presentaron recurrencia en el SUP. Cuarenta y uno (82%) tuvieron alterada alguna PC, pero sólo en 8 contribuyeron al diagnóstico. Veintinueve (58%) fueron idiopáticos y 21 (42%) fueron secundarios. Éstos tuvieron de forma significativa mayor incidencia de tabaquismo materno, edad>12 semanas y exploración alterada. Cuatro recidivaron las semanas posteriores, y uno presentó el síndrome de muerte súbita del lactante (SMSL). A los 12 meses, los casos tuvieron de forma significativa mayor incidencia de vómitos recurrentes, espasmos del sollozo, retraso psicomotor y pondoestatural. Conclusiones: La incidencia fue del 5‰ RN vivos. Fueron más frecuentemente primogénitos o presentaron anomalías en el comportamiento las semanas previas o a los 12 meses. El 42% tuvo un diagnóstico secundario que se asoció a edad >12 semanas, tabaquismo materno y exploración alterada en el SUP. Una lactante presentó un SMSL. Las PC realizadas en el SUP tuvieron un escaso rendimiento (AU)

Introduction: To report our experience with a guideline approach for the assessment of apparent life-threatening events (ALTE) in our pediatric emergency departments (PED), to know their incidence, epidemiological characteristics and the yield of laboratory investigations (LI). Patients and methods: Prospective, case-control study of a guideline approach for infants under age 12 months who suffered an ALTE between 01/06/06 and 31/05/07 and were attended at our PEDs. We ordered LI as a function of the clinical history. All the cases were admitted for a minimum of 12h. We conducted a telephone interview at 12 months. Results: Fifty ALTE were included, corresponding to an incidence of 5‰ live births. The median age was 8.46±8.7 weeks. Compared to controls they had significantly more primogenits and previous behavioral abnormalities. Only 13 presented significant abnormalities at examination, and 6 had recurrent ALTE at the PED. LI were abnormal in 41 (82%), but only in 8 cases did they contribute to a secondary diagnosis. There were 29 idiopathic ALTE (58%). Twenty one (42%) had associated conditions, who had smoked significantly more during pregnancy, age older than 12 weeks and abnormalities at examination. Four had recurrence of the episodes: one suffered a sudden infant death syndrome (SIDS). At 12 months the cases had a significantly higher incidence of recurrent vomiting, breath holding spells and weight-psychomotor retardation. Conclusions: The ALTE incidence was 5‰ live births. Primogenits and/or behavioral abnormalities were most frequent during the first weeks after birth and/or thereafter at 12 months of age. A total of 42% had a related diagnosis: associated with age older than 12 weeks, maternal smoking habits and abnormalities at examination. There was one case of SIDS. Laboratory investigations had a low yield (AU)

[Epidemiological characteristics and risk factors for apparent life-threatening events]. / Características epidemiológicas y factores de riesgo de los episodios aparentemente letales.

INTRODUCTION: To report our experience with a guideline approach for the assessment of apparent life-threatening events (ALTE) in our pediatric emergency departments (PED), to know their incidence, epidemiological characteristics and the yield of laboratory investigations (LI). PATIENTS AND METHODS: Prospective, case-control study of a guideline approach for infants under age 12 months who suffered an ALTE between 01/06/06 and 31/05/07 and were attended at our PEDs. We ordered LI as a function of the clinical history. All the cases were admitted for a minimum of 12h. We conducted a telephone interview at 12 months. RESULTS: Fifty ALTE were included, corresponding to an incidence of 5 per thousand live births. The median age was 8.46+/-8.7 weeks. Compared to controls they had significantly more primogenits and previous behavioral abnormalities. Only 13 presented significant abnormalities at examination, and 6 had recurrent ALTE at the PED. LI were abnormal in 41 (82%), but only in 8 cases did they contribute to a secondary diagnosis. There were 29 idiopathic ALTE (58%). Twenty one (42%) had associated conditions, who had smoked significantly more during pregnancy, age older than 12 weeks and abnormalities at examination. Four had recurrence of the episodes: one suffered a sudden infant death syndrome (SIDS). At 12 months the cases had a significantly higher incidence of recurrent vomiting, breath holding spells and weight-psychomotor retardation. CONCLUSIONS: The ALTE incidence was 5 per thousand live births. Primogenits and/or behavioral abnormalities were most frequent during the first weeks after birth and/or thereafter at 12 months of age. A total of 42% had a related diagnosis: associated with age older than 12 weeks, maternal smoking habits and abnormalities at examination. There was one case of SIDS. Laboratory investigations had a low yield.

Bronquiolitis aguda: ¿por qué no se aplica lo que se publica? Barreras en la transmisión del conocimiento / No disponible

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