Risk classification in a pediatric service: evaluation of the structure, process, and outcome

ABSTRACT Objectives: to evaluate a pediatric risk evaluation and classification service in the aspects of structure, process, and outcome. Methods: a cross-sectional, descriptive, and exploratory study in which qualitative data complement the results. Data collection by non-participant observation, interview, and consultation of medical records. Results: we observed two hundred and four visits. The service works in a makeshift room and without privacy. The nurses did not use various materials/equipment available for evaluation, rarely performed a physical examination, used the interview most of the time, and did not consult the protocol. Parents/companions received no information, and medical records showed incomplete records. Nurses classified 69.1% of the children as non-emergency. The most frequent outcome of the visits was discharge. Conclusions: the service showed weaknesses in the physical structure, in the risk classification process, and the outcomes, but it presents a good resolution in the assistance. We recommend a revision in the protocol used and sensitize nurses about the work process and communication with parents/companions.

ANALYSIS OF THE IMPLEMENTATION OF A NEW MODEL OF A MEDICAL ORGANIZATION PROVIDING PRIMARY HEALTH CARE IN CHILDREN'S STRUCTURAL UNITS

Вопросы улучшения оказания первичной медико-санитарной помощи детскому населению всегда выступали в качестве приоритетных при оптимизации деятельности службы охраны материнства и детства и вызывали особое внимание организаторов здравоохранения. Одним из значимых решений по повышению качества оказания медико-санитарной помощи, в том числе и детям, является проект по реализации «Новой модели медицинской организации, оказывающей первичную медико-санитарную помощь» в детских структурных подразделениях. Одной из основных задач педиатрической службы Воронежской области является реализация мероприятий региональной программы «Развитие детского здравоохранения Воронежской области, включая создание современной инфраструктуры оказания медицинской помощи детям», которой предусмотрено достижение целевых показателей и выполнение определённых задач. В данной статье рассматриваются вопросы организации деятельности педиатрической службы Воронежской области в плане реализации новой модели медицинской организации, оказывающей первичную медико-санитарную помощь в детских структурных подразделениях. Определяются направления развития детского здравоохранения, включая создание современной инфраструктуры оказания медицинской помощи детям. Приводятся данные по достижению в детских поликлиниках и детских поликлинических отделениях Воронежской области организационно-планировочных решений внутренних пространств, создание условий для внедрения принципов бережливого производства и комфортного пребывания детей и их родителей при оказании первичной медико-санитарной помощи, с акцентом на воплощении идей оптимизации первичной медико-санитарной помощи путем использования принципов и методов бережливого производства в части реализации регионального проекта «Развитие системы оказания первичной медико-санитарной помощи» Нацпроекта «Здравоохранение» в рамках создания и тиражирования «Новой модели медицинской организации, оказывающей первичную медико-санитарную помощь» The issues of improving the provision of primary health care to the children's population have always been a priority in optimizing the activities of the maternal and child health care service and have caused special attention of health care organizers. One of the significant decisions to improve the quality of health care, including for children, is the project to implement the "New model of a medical organization providing primary health care" in children's structural units. One of the main tasks of the pediatric service of the Voronezh region is the implementation of the activities of the regional program "Development of children's health care of the Voronezh region, including the creation of a modern infrastructure for the provision of medical care to children", which provides for the achievement of targets and the implementation of certain tasks. The article deals with the organization of the activities of the pediatric service of the Voronezh region in terms of implementing a new model of a medical organization that provides primary health care in children's structural units. The directions of development of children's health care, including the creation of a modern infrastructure for the provision of medical care to children, are determined. The data on the achievement in children's polyclinics and children's polyclinic departments of the Voronezh region of organizational and planning solutions of internal spaces, the creation of conditions for the introduction of the principles of lean production and a comfortable stay of children and their parents in the provision of primary health care, with an emphasis on the implementation of ideas for optimizing primary health care through the use of principles and methods of lean production in terms of implementation regional project "Development of the system of primary health care" of the National Project "Healthcare" in the framework of the creation and replication of the "New model of a medical organization providing primary health care"

Indicators of the management performance of the chief nurse depending on her personal qualities

The aim of the study is to study and analyze the development of the personality of a nurse-head of the pediatric service. Results. An analysis of the moral and business qualities of nursing service leaders allowed us to summarize the research results and determine the main directions — a constant increase in the level of professional activity, the desire for further creative growth, the development of the latest technologies. Conclusion. This study made it possible to analyze and evaluate the quality and level of activity of the children’s polyclinic, its staff, the level of personality development of the head of the nursing service from the standpoint of senior and middle medical personnel, and revealed patterns in the formation of management activities.

Orbital Cellulitis in Children: Experience of the Pediatric Service at Mohammed v Military Hospital

Background: Orbital cellulitis is a diagnostic and therapeutic emergency, jeopardizing the vital and functional prognosis. This study aimed to analyze the epidemiological, therapeutic and evolutional aspects of orbital cellulitis cases treated at the pediatric service at Mohamed V military hospital. Patients and methods: retrospective study including all the children aged between 1 month and 15 years treated for orbital cellulitis at the pediatric service of the Mohamed V Hospital over a period of 3 years (1st January 2016-31st December 2019). Results: 24 cases of orbital cellulitis were gathered. Age varied between 1 month and 15 years with a median of age of 6. years. Feminine predominance (58%) was noted . The disease mainly involved the sinus (32%).Clinically, fever was present in 10 patients (41%),palpebral edema was universal, proptosis was noted in 5 cases(20.8%),chemosis and ptosis were noted in 4 cases(16.6%),bacteriological testing identified micro-organisms in 3 cases. An orbital CT scan was performed in all cases of our study, showing preseptal cellulitis in 14 cases (58.3%), orbital cellulitis in 3 cases(12.5%),and orbital abscess in 7 cases. The medical treatment consisted of ceftriaxone, metronidazole and aminoside or amoxicilline clavulanic acid, corticosteroid therapy prescribed in 5 cases. Surgical treatment was indicated in 3 patients. The outcome of All cases was favorable. Conclusion: The majority of our cases had a positive evolution highlighting the advantage of an early diagnosis, and adapted antibiotic and a multidisciplinary patient care making the need for surgery rarely necessary.

Can a Multi-Component Intervention Improve Pediatric Service Delivery in Guangzhou?

Background: Accessible, equitable, and efficient pediatric service is critical to achieve optimal child health. This study aimed to evaluate the effectiveness of a multi-component intervention on the pediatric health system over two different periods in Guangzhou.Methods: Based on the World Health Organization (WHO) “six building blocks” model and Donabedian's “Structure-Process-Outcomes” framework, an intervention package was developed to increase financial and human resouce investment to strengthen basic health care and strive for a better quality of pediatric care. This multi-component intervention package was conducted in Guangzhou to improve the pediatric service delivery during two stages (2011–2014 and 2016–2019). The main outcome indicators were the changes in the allocation of pediatricians and pediatric beds, pediatric service efficiency, and the impact of pediatricians on child mortality.Results: We found that pediatricians per 1,000 children (PPTC) and pediatric beds per 1,000 children (PBPTC) increased from 1.07 and 2.37 in 2010 to 1.37 and 2.39 in 2014, then to 1.47 and 2.93 in 2019, respectively. Infant mortality rate (IMR) and under-5 mortality rate (U5MR) dropped from 5.46‰ and 4.04‰ in 2010 to 4.35‰ and 3.30‰ in 2014 then to 3.26‰ and 2.37‰ in 2019. The Gini coefficients of PPTC and PBPTC decreased from 0.48 and 0.38 in 2010, to 0.35 and 0.28 in 2014, then to 0.35 and 0.22 in 2019, respectively, representing the improvement of pediatric resources distribution according to service population. However, equalities in the spatial distribution were not improved much. The average efficiency of pediatric service fluctuated from 2010 to 2019. A unit increase in PPTC was associated with an 11% reduction in IMR and a 16% reduction in U5MR.Conclusions: Findings suggest this multi-component intervention strategy is effective, particularly on the reduction of child mortality. In future, more rigorous and multi-faceted indicators should be integrated in a comprehensive evaluation of the intervention.

Problems in Diagnosing Autism Spectrum Disorders in the Irkutsk Region

The purpose of this study was to evaluate the effectiveness of methods for studying the neuropsychiatric development of children in regards to screening for the diagnosis of autism spectrum disorders (ASD) with the example of educational institutions in the Irkutsk region. Methods and Results: Two groups of children in educational institutions of the Irkutsk region regional center were studied: 187 children of preschool age (from 5 to 6 years) and 154 children studying at school (from 7 to 11 years). This study used the methods of neuropsychiatric research used by the pediatric service and the methods of screening diagnosis of autism spectrum disorders (ASD). It was shown that the level of obvious anxiety of schoolchildren (according to the scale developed by A.M. Prihozhan) was higher than in preschoolers and was 10.3±0.1% in girls and 10.6±0.2% in boys. Bad appetite was observed in 50.3±3.7% of preschool children and in 56.5±4.0% of schoolchildren. The selective appetite was observed in 16.6±2.7% of preschool children and in 7.1±2.1% of schoolchildren. The study of hyperactive traits showed that only 5.3±1.6% of parents of preschool children noted hyperactivity in their children while educators considered that 22.5±3.1% were hyperactive. The parents noted hyperactivity in 9.7±2.4% of children, and the teachers noted hyperactivity in 21.7±3.4% of children. The intellectual development of children, according to the Raven test, showed that the average IQ was observed in 47.6±3.7% preschoolers, and below-average IQ in 52.9±3.7% preschoolers. At the same time in schoolchildren, below-average IQ was found in 48.7±4.0% and average IQ in 51.3±4.0%. Conclusion: The study of the development of children’s mental processes and behavior is not informative for the early detection of ASD. Likewise, the screening methods for the detection of ASD known today and available to the pediatric service and based on the detection of social and communication disorders are poorly informative. However, if we consider ASD as a manifestation of genetic and cytogenetic pathology, we should look for screening methods in the field of genetics.

EPIDEMIOLOGY AND TREATMENT OF FUNGAL INFECTIONS IN ONCO-PEDIATRIC PATIENTS AT A REFERRAL HOSPITAL

Aim: to identify the epidemiology of fungal infections in the pediatric service of a reference hospital for the treatment of cancer for 2016 to 2019, through the dispensing of antifungal drugs by the hospital pharmacy. Methods: Retrospective cohort analysis of 1.211 antifungal requests. Results and Discussion: 1.211 treatments with antifungal agents were performed in the period, with 71.9% of cases treated with empirical therapy, 64.1% of cases of mucocutaneous candidiasis and with the use of nystatin in 48.6% of cases. There were 114 episodes of IFIs, in which probable fungal pneumonia represented 40.4% of the therapeuticindications, based on suggestive tomographic images and clinical and epidemiological criteria in 40.3% of cases. Conclusions: There was an agreement between the epidemiology of fungal infections and the worldwide epidemiology, but there was disagreement between the therapies applied in the study hospital and the recent guidelines.

Structure and process of the patient records computerization project in hospitals of Burundi

Background: The computerization of patient records is an essential catalyst for the hospital performance. In Burundi the first patient records were computerized in 2015. The objective of this study is to evaluate the implementation of this project in order to identify the challenges for its success. Methods: This is a descriptive cross-sectional study conducted in 11 hospitals. An assessment tool was used to collect data on the availability and organization of resources at the beginning of the project, on the process and on the completeness of patient records. The data collection was been done in February 2020.Results: The structure and process components were moderately satisfactory with mean scores of 53% and 51% respectively. Governance (21%) for structure component, and maintenance (44%) for process component were the elements with the lowest scores. Concerning the completeness of the records, the main diagnosis at discharge was completed for 68% of the records in the gynecological-obstetrical consultation service; 58% for the pediatric service; 55% for the adult consultation service and 28% for the emergency service. Hospitals that were computerized in 2015 compared to 2017 (OR: 12.5 [10.9 -14.4]) and district hospitals compared to regional and national hospitals (OR: 22.1 [19.3 -25.2]) were more likely to have patient records with diagnosis at discharge.Conclusions: Continued mobilization of resources, making available the guidelines for managing the electronic patient record and implementing strategies to strengthen the capacity of users will ensure the sustainability of the patient record computerization project.

Screening methods for autism spectrum disorders in the study of neuropsychological development of preschool children

Aim. To assess the effectiveness of screening methods for diagnosing autism spectrum disorders available to the pediatric service; to prove in practice impossibilities to identify signs of autism spectrum disorders by using the existed pediatric methods. Methods. The neuropsychological development of 187 preschool children (56 years old) was investigated. The neurological status, anxiety according to A.M. Parishioners, level of intelligence using Raven's Progressive Matrices, the presence of hyperactivity according to the method of V.R. Kuchma, mental performance according to V.Ya. Anfimov, screening diagnostics of autism spectrum disorders were studied. Results. Assessment of the neurological status showed an increase in tendon reflexes in 10.22.2% of children, a decrease in 12.32.4%. The study of the intelligence levels in the Ravenna test showed that the average intelligence level was in 47.13.7% of the studied children, the intelligence was below the average in 52.93.7% of children. Screening diagnostics of autism spectrum disorders did not reveal abnormalities, however, 5.31.6% of children had signs of predisposition to the autism spectrum disorder (decreased adaptation to changes, nervousness and fears, verbal and non-verbal communication, level of activity and consistency of intellectual response). The indicator of the productivity of mental performance of preschool children was 5.40.5. Attention deficit was detected in 5.91.7% of children (according to the parent's questionnaire) and 8.62.0% children (according to the teachers' questionnaire). The level of anxiety was 9.60.3 points. Conclusion. The currently known screening methods for detecting autism spectrum disorders, available to the pediatric service, in our opinion, are uninformative; the search for the most sensitive markers of autism should be based on an understanding of the epigenetic mechanisms of autism spectrum disorders.