RESUMEN
This Viewpoint explores the politicized nature of gender-affirming care for transgender and nonbinary youth and how children's hospitals can provide education, resources, and access to families seeking care.
Asunto(s)
Atención de Afirmación de Género , Educación en Salud , Accesibilidad a los Servicios de Salud , Hospitales Pediátricos , Personas Transgénero , Adolescente , Femenino , Humanos , Masculino , Estados Unidos , Atención de Afirmación de Género/ética , Atención de Afirmación de Género/normas , Política , Accesibilidad a los Servicios de Salud/ética , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/normas , Personal de Salud/educación , Personal de Salud/legislación & jurisprudencia , Educación en Salud/ética , Educación en Salud/normas , Hospitales Pediátricos/ética , Hospitales Pediátricos/legislación & jurisprudencia , Hospitales Pediátricos/normas , Seguridad/legislación & jurisprudencia , Seguridad/normasAsunto(s)
Equidad en Salud/legislación & jurisprudencia , Hospitales Pediátricos/legislación & jurisprudencia , Neoplasias/terapia , Terapias en Investigación , Antineoplásicos/uso terapéutico , Tratamiento Basado en Trasplante de Células y Tejidos , Niño , Ensayos Clínicos como Asunto , Diseño de Fármacos , Femenino , Humanos , Neoplasias/tratamiento farmacológico , Estados UnidosRESUMEN
With the rapid development of the child welfare system in China over recent years, medical social work has been increasingly involved in providing child protection services in several hospitals in Shanghai. Focusing on five cases in this paper, the exploratory study aims to present a critical overview of current practices and effects of medical social work for child protection, based on a critical analysis of the multidimensional role of social work practitioners engaged in the provision of child protection services as well as potential challenges. Implications and suggestions for future improvements of China's child protection system are also discussed.
Asunto(s)
Maltrato a los Niños/legislación & jurisprudencia , Servicios de Protección Infantil/legislación & jurisprudencia , Protección a la Infancia/legislación & jurisprudencia , Costos de la Atención en Salud , Hospitales Pediátricos/legislación & jurisprudencia , Servicio Social/legislación & jurisprudencia , Adopción/legislación & jurisprudencia , Niño , Maltrato a los Niños/economía , Custodia del Niño/legislación & jurisprudencia , Servicios de Protección Infantil/economía , Servicios de Protección Infantil/métodos , Servicios de Protección Infantil/tendencias , Protección a la Infancia/economía , Protección a la Infancia/tendencias , Preescolar , China , Violencia Doméstica/economía , Violencia Doméstica/legislación & jurisprudencia , Femenino , Hospitales Pediátricos/economía , Hospitales Pediátricos/organización & administración , Hospitales Pediátricos/tendencias , Humanos , Lactante , Masculino , Estudios de Casos Organizacionales , Servicio Social/economía , Servicio Social/métodos , Servicio Social/tendencias , Factores SocioeconómicosRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Femenino , Niño , Historia del Siglo XX , Pediatría/historia , Hospitales Pediátricos/historia , Hospitales Pediátricos , Hospitales Pediátricos/organización & administración , Unidades de Cuidado Intensivo Pediátrico/historia , Hospitales Pediátricos/legislación & jurisprudencia , Hospitales Pediátricos/normas , Asistentes de Pediatría/historia , Asistentes de Pediatría/organización & administraciónRESUMEN
El Servicio de Neonatología del Hospital General Universitario Gregorio Marañón es un servicio de nivel IIIC, integrado en un hospital perteneciente al sistema público de salud de la Comunidad de Madrid, que presta servicios de atención sanitaria especializada. Es un hospital universitario adscrito a la Universidad Complutense de Madrid y realiza actividades docentes, pre y posgrado e investigadoras. Es un servicio cuyo objetivo es la calidad asistencial centrada en el paciente y en la familia (AU)
The Neonatology division of the University General Hospital 'Gregorio Marañón' is a service level IIIC, integrated into a hospital belong to the public health system of the Community of Madrid, which provides specialized health care services. It is associated with the Complutense University of Madrid and performs grade and postgrade teaching and training and research. It is a service whose objective is the quality of care focused on the family centered care (AU)
Asunto(s)
Humanos , Masculino , Femenino , Niño , Unidades de Cuidado Intensivo Pediátrico/historia , Unidades de Cuidado Intensivo Pediátrico/organización & administración , Unidades de Cuidado Intensivo Pediátrico/normas , Hospitales Pediátricos/historia , Hospitales Pediátricos/organización & administración , Hospitales Pediátricos/normas , Neonatología/historia , Neonatología/organización & administración , Cuidado del Niño/métodos , Cuidado del Niño/organización & administración , Hospitales Pediátricos/legislación & jurisprudencia , Hospitales Pediátricos , Neonatología/instrumentación , Neonatología/normas , Personal de Salud/educación , Servicios de Salud del Niño/normas , Servicios de Salud del Niño/organización & administraciónRESUMEN
Current and detailed knowledge of antibiotic use is essential in order to implement strategies for reducing the overuse of antibiotics. The objective of our study was to determine the effectiveness of the implementation of the hospital antibiotic policy (HAP) by assessing antibiotic consumption in the Special Neonatal Care Unit (SNCU) in Warsaw, Poland, before and after this intervention. Antibiotic use was calculated in daily defined doses (DDDs) per 100 patient-days and DDDs per 100 admissions. The antibiotics were ranked by volume of DDDs and the number of antibiotics, which accounted for 90 % and 100 % of the total volume, respectively: DU90% and DU100% (where DU stands for drug use). Total antibiotic consumption increased slightly after the introduction of the HAP: the total DDDS was 707.87 and 753.12 in 2011 and 2012, while the number of DDDs/100 admissions was 352.17 and 369.12 in 2011 and 2012, respectively. After the introduction of the HAP, an increase in ampicillin and aminoglycoside use was observed, along with a reduction in the DU100% and DU90% rates (15 vs. 9 and 4 vs. 3, respectively). The introduction of the HAP resulted in changes in antibiotic consumption patterns, but the general antibiotic consumption density remained the same.
Asunto(s)
Antibacterianos/uso terapéutico , Revisión de la Utilización de Medicamentos , Hospitales Pediátricos/legislación & jurisprudencia , Política Organizacional , Antibacterianos/economía , Humanos , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Guías de Práctica Clínica como AsuntoRESUMEN
To our knowledge, no widely used pediatric standards for hospital discharge care exist, despite nearly 10 000 pediatric discharges per day in the United States. This lack of standards undermines the quality of pediatric hospital discharge, hinders quality-improvement efforts, and adversely affects the health and well-being of children and their families after they leave the hospital. In this article, we first review guidance regarding the discharge process for adult patients, including federal law within the Social Security Act that outlines standards for hospital discharge; a variety of toolkits that aim to improve discharge care; and the research evidence that supports the discharge process. We then outline a framework within which to organize the diverse activities that constitute discharge care to be executed throughout the hospitalization of a child from admission to the actual discharge. In the framework, we describe processes to (1) initiate pediatric discharge care, (2) develop discharge care plans, (3) monitor discharge progress, and (4) finalize discharge. We contextualize these processes with a clinical case of a child undergoing hospital discharge. Use of this narrative review will help pediatric health care professionals (eg, nurses, social workers, and physicians) move forward to better understand what works and what does not during hospital discharge for children, while steadily improving their quality of care and health outcomes.
Asunto(s)
Cuidado del Niño/normas , Hospitales Pediátricos/normas , Alta del Paciente/normas , Cuidados Posteriores/métodos , Niño , Cuidado del Niño/legislación & jurisprudencia , Atención a la Salud/normas , Objetivos , Educación en Salud , Hospitales Pediátricos/legislación & jurisprudencia , Humanos , Registros Médicos , Evaluación de Necesidades , Planificación de Atención al Paciente/legislación & jurisprudencia , Planificación de Atención al Paciente/organización & administración , Grupo de Atención al Paciente/organización & administración , Alta del Paciente/legislación & jurisprudenciaAsunto(s)
Intercambios de Seguro Médico/legislación & jurisprudencia , Hospitales Pediátricos/legislación & jurisprudencia , Cobertura del Seguro/legislación & jurisprudencia , Disentimientos y Disputas/economía , Disentimientos y Disputas/legislación & jurisprudencia , Intercambios de Seguro Médico/economía , Hospitales Pediátricos/economía , Humanos , Cobertura del Seguro/economía , Estados Unidos , WashingtónAsunto(s)
Servicios Contratados/legislación & jurisprudencia , Empleo/legislación & jurisprudencia , Hospitales Pediátricos/legislación & jurisprudencia , Programas Nacionales de Salud/legislación & jurisprudencia , Ejecutivos Médicos/legislación & jurisprudencia , Confidencialidad/legislación & jurisprudencia , Infección Hospitalaria/prevención & control , Infección Hospitalaria/transmisión , Notificación de Enfermedades , Alemania , Humanos , Recién Nacido , Enfermedades del Prematuro/prevención & control , Profesionales para Control de Infecciones/legislación & jurisprudencia , Perfil Laboral , Masculino , Política Organizacional , Gestión de Riesgos/legislación & jurisprudenciaRESUMEN
Despite the advances in medical technology, health care improvements have not always been accompanied by commensurate attention to the child's well-being. Psychological and emotional status of children during hospital treatment is often underestimated. Namely, certain kind of institutional negligence is frequently present in everyday practice in children's institutions. Many hospitals in Bosnia and Herzegovina (B&H) have become child-friendly during the implementation of the Project on Child-Friendly Hospitals supported by UNICEF and WHO. Apart from the introduction of child friendly environment, staff in hospitals was trained to provide a holistic approach. The program was closely linked to the Baby Friendly Hospital Initiative that supported breastfeeding. A few years thereafter, our focus is still on the physical treatment of sick children, whereas the attention to their anxieties, fears and suffering has failed. A more serious approach to this problem is needed and should begin at an educational level in medical school programs. Accordingly, our philosophy (mission) should change from a mechanical (techno-) medicine to holistic medicine.
Asunto(s)
Actitud del Personal de Salud , Conocimientos, Actitudes y Práctica en Salud , Hospitales Pediátricos , Bosnia y Herzegovina , Niño , Niño Hospitalizado/legislación & jurisprudencia , Niño Hospitalizado/psicología , Hospitales Pediátricos/ética , Hospitales Pediátricos/legislación & jurisprudencia , Hospitales Pediátricos/normas , HumanosRESUMEN
The Affordable Care Act penalizes hospitals with high readmission rates. Children's hospitals are not yet among these hospitals, although that is likely to change. Because chronic neurologic conditions represent a sizable proportion of all children's hospitals costs, and because some/many of the readmissions might not be easily prevented, children's hospitals and neurologists who care for children might be inappropriately penalized for some readmissions. We encourage more study to identify the correlates of readmission of children who have a neurologic disorder.
Asunto(s)
Hospitales Pediátricos/legislación & jurisprudencia , Enfermedades del Sistema Nervioso/epidemiología , Enfermedades del Sistema Nervioso/terapia , Patient Protection and Affordable Care Act/legislación & jurisprudencia , Readmisión del Paciente/legislación & jurisprudencia , Readmisión del Paciente/estadística & datos numéricos , Garantía de la Calidad de Atención de Salud/legislación & jurisprudencia , Indicadores de Calidad de la Atención de Salud/legislación & jurisprudencia , Niño , Enfermedad Crónica/epidemiología , Humanos , Probabilidad , Recurrencia , Factores de Riesgo , Estados UnidosAsunto(s)
Servicio de Urgencia en Hospital/economía , Financiación Gubernamental/legislación & jurisprudencia , Niño , Servicio de Urgencia en Hospital/legislación & jurisprudencia , Financiación Gubernamental/economía , Hospitales Pediátricos/economía , Hospitales Pediátricos/legislación & jurisprudencia , Humanos , Medicaid/economía , Medicaid/estadística & datos numéricos , Gobierno Estatal , Texas , Estados UnidosRESUMEN
BACKGROUND: The abuse and neglect of children constitutes a social phenomenon that unfortunately is widespread irrespective of geographic, ethnic, or social background. Dentists may be the first health professionals to recognize signs of child maltreatment (CM) and have an important role in dealing with such incidents. AIM: To describe the training, experience, and personal views of dentists practicing in the Prefecture of Attica regarding the recognition and referral of abused and neglected children. DESIGN: A random sample was drawn from a target population of dentists registered with two of the largest dental associations in Greece. The dental practitioners were interviewed by two paediatric dentists using a specially designed questionnaire. Information was collected regarding their awareness on child maltreatment, the frequency of suspected incidents as well as the reasons for not reporting them. RESULTS: With a response rate of 83%, findings are reported from 368 interviews (54% male, mean age 43 years). Only 21% of respondents had received training on child protection at undergraduate level. Suspected abuse was 13% and suspected neglect was 35%. Only six of the 368 respondents made an official report of a suspected case of child maltreatment. The most common reason that might prevent a dentist from reporting a case was doubt over the diagnosis (44%). Ninety-seven per cent of dentists believed that recognition and referral of incidents should be part of undergraduate training. CONCLUSIONS: Dental practitioners did not feel adequately informed on recognizing and referring child abuse and neglect cases. The low percentage of reported incidents and the lack of legislation indicate a great need for continuously educating dentists on child maltreatment as well as for setting up an organized system in Greece for reporting such incidents to protect the dentist referring the case as well as the child being victimized.
Asunto(s)
Actitud del Personal de Salud , Maltrato a los Niños/diagnóstico , Defensa del Niño/educación , Protección a la Infancia , Odontólogos/psicología , Adulto , Anciano , Niño , Maltrato a los Niños/legislación & jurisprudencia , Maltrato a los Niños/prevención & control , Protección a la Infancia/legislación & jurisprudencia , Competencia Clínica , Educación en Odontología , Femenino , Odontología General/estadística & datos numéricos , Grecia , Hospitales Pediátricos/legislación & jurisprudencia , Humanos , Masculino , Persona de Mediana Edad , Policia/legislación & jurisprudencia , Práctica Privada , Rol Profesional , Derivación y Consulta , Factores Sexuales , Servicio Social/legislación & jurisprudencia , Encuestas y CuestionariosRESUMEN
Pediatric risk is both unique and volatile. Children are more vulnerable when treated in any healthcare environment, but especially in the acute care setting. Children with chronic healthcare conditions are more challenging to treat and more susceptible to medical errors. Despite marked improvement in the national medical malpractice environment, the most volatile claims involve severely injured patients under age eighteen and especially those patients in the first year of life. This article provides the context of pediatric care in reviewing the demographics of children and the healthcare delivery system. The unique factors of pediatric care that create increased risk are also reviewed. Low frequency/high severity claims involving children are discussed in detail as well as physician claims in the specialty of general pediatrics. Risk management solutions for pediatric issues are proposed.
Asunto(s)
Hospitales Pediátricos/legislación & jurisprudencia , Mala Praxis/legislación & jurisprudencia , Errores Médicos/legislación & jurisprudencia , Pediatría/legislación & jurisprudencia , Enfermedad Aguda , Adolescente , Niño , Preescolar , Enfermedad Crónica , Diagnóstico Tardío/economía , Diagnóstico Tardío/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Hospitales Pediátricos/economía , Humanos , Lactante , Recién Nacido , Mala Praxis/economía , Errores Médicos/economía , Pediatría/economía , Gestión de Riesgos/economía , Gestión de Riesgos/legislación & jurisprudencia , Estados Unidos , Recursos HumanosAsunto(s)
Criminales , Criterios de Admisión Escolar , Facultades de Medicina/organización & administración , Estudiantes de Medicina/legislación & jurisprudencia , Crimen/legislación & jurisprudencia , Crimen/prevención & control , Empleo/legislación & jurisprudencia , Hospitales Pediátricos/legislación & jurisprudencia , Humanos , Política Organizacional , Sociedades Médicas , Revelación de la Verdad , Estados UnidosRESUMEN
OBJECTIVE: The objective of the study was to examine the impact of staffing ratios on risk-adjusted outcomes for pediatric cardiac surgery programs in California and relative to other states combined. BACKGROUND: California performs 20% of the nation's pediatric cardiac surgery and is the only state with a nurse ratio law. Understanding the imposition of mandated ratios on pediatric outcomes is necessary to inform the debate about nurse staffing. DATA SOURCES: Patient variables were extracted from the Healthcare Cost and Utilization Project Kids' Inpatient Database. The American Hospital Association database was used for institutional variables. METHODS: Descriptive analyses were used to identify and describe patient, nursing, and hospital characteristics. Changes in nursing ratios and full-time equivalents (FTEs) between 2003 and 2006 were examined. Associations between nursing characteristics and each outcome variable were examined using general estimating equation models. The RACHS-1 (Risk Adjustment for Congenital Heart Surgery) risk adjustment method was used for mortality. RESULTS: Hospitals in California significantly increased RN FTEs (P = .025) and RN ratios (P = .036) after enactment of AB 394 in 2006. Neither RN FTEs nor RN ratios were associated with mortality, complications, or resource utilization after risk adjustment. After the law, California's standardized mortality ratio (SMR) decreased more (33%) than in all other states combined (29%). Standardized complication ratio (SCR) increased by 5% but decreased by 5% for all other states combined, and the increase in charge differential ($53,443) was more than twice the increase ($23,119) for other states combined. CONCLUSION: Hospitals in California made upward adjustments in nursing FTEs and ratios after enactment of AB 394. There was a substantial increase in California's charge differential, a decrease in SMR, and an increase in SCR after enactment of the legislation.