2
|
Hernández Borges ÁA, Jiménez Sosa A, Pérez Hernández R, Ordóñez Sáez O, Aleo Luján E, Concha Torre A. Paediatric intensive care 'do not do' recommendations in Spain: Selection by Delphi method. An Pediatr (Barc) 2023; 98:28-40. [PMID: 36509646 DOI: 10.1016/j.anpede.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/21/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Health care is not free of ineffective, unsafe or inefficient diagnostic and therapeutic practices. To address this, different scientific societies and health authorities have proposed 'do not do' recommendations (DNDRs). Our goal was the selection by consensus of a set of DNDRs for paediatric intensive care in Spain. MATERIAL AND METHOD The research was carried out in 2 phases: first, gathering potential DNDRs; second, selecting the most important ones, using the Delphi method, based on the prevalence of the practice to be modified, the severity of its potential risks and the ease with which it could be modified. Proposals and evaluations were both made by members of working groups of the Sociedad Española de Cuidados Intensivos Pediátricos (SECIP, Spanish Society of Paediatric Intensive Care), coordinated by email. The initial set of DNDRs was reduced based on the coefficient of variation (<80%) of the corresponding evaluations. RESULTS A total of 182 DNDRs were proposed by 30 intensivists. The 14 Delphi evaluators managed to pare down the initial set to 85 DNDRs and, after a second round, to the final set of 26 DNDRs. The care quality dimensions most represented in the final set are clinical effectiveness and patient safety. CONCLUSIONS This study allowed the selection by consensus of a series of recommendations to avoid unsafe, inefficient or ineffective practices in paediatric intensive care in Spain, which could be useful for improving the quality of clinical care in our field.
Collapse
Affiliation(s)
| | - Alejandro Jiménez Sosa
- Unidad de Investigación, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Rosalía Pérez Hernández
- UCIP, Servicio de Pediatría, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | | | | | | |
Collapse
|
3
|
Aleo Luján E, Lopez-Picado A, Rivas A, Joyanes Abancens B, Rodríguez Rojo ML, Fernández García P, Soto Beauregard C, Rodríguez Alarcón J, González Perrino C, San Pedro de Urquiza B, Arias E, Rodriguez D, Esteban Polonio C, Torrejón MJ. Pre-operative anxiolysis in children through a combined pharmacological therapy with hydroxyzine and a non-pharmacological distraction technique with a clown (SONRISA): study protocol for randomised double-blind clinical trial. Trials 2020; 21:1. [PMID: 31898511 PMCID: PMC6941242 DOI: 10.1186/s13063-019-3906-2] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 11/15/2019] [Indexed: 11/17/2022] Open
Abstract
Background Surgery can generate significant stress and anxiety in up to 70% of the paediatric population. There are several pharmacological and non-pharmacological strategies to reduce pre-operative anxiety in children, however, they have several side effects and the available information about them is contradictory. The role of clowns and hydroxyzine in the management of anxiety is controversial, with some studies supporting and others contraindicating both strategies. Methods We propose a randomised double-blind, controlled clinical trial that will evaluate the effectiveness of both interventions (hydroxyzine and clowns), alone or in combination, to reduce pre-operative anxiety (using the modified Yale scale of preoperative anxiety) in children aged 2–16 years undergoing outpatient surgery (n = 188). Subjects will be randomised into two groups – (1) standard procedure (parental accompaniment) combined with placebo or (2) standard procedure combined with preoperative hydroxyzine. After randomisation, they will be divided by chance into two further groups, depending on the presence of clowns on the patient’s surgery day. Control of pre-operative anxiety will be determined in the four groups by a modified Yale scale of preoperative anxiety and cortisol levels. Compliance of children during induction of anaesthesia, time until anaesthesia recovery, presence of postoperative delirium and use of analgesia until discharge will be also assessed. For additional information, the children, parents and healthcare professionals involved in the study will complete a satisfaction survey. Conclusions This study aims to gather evidence on which of these four therapeutic options achieves the highest reduction of pre-operative anxiety with the best safety profile to allow paediatricians and anaesthesiologists to use the most effective and safe option for their patients. Trial registration ClinicalTrials.gov identifier: NCT03324828. Registered 21 September 2017.
Collapse
Affiliation(s)
- Esther Aleo Luján
- Unidad de Cuidados Intensivos Pediátricos y Unidad de Recuperación Postanestésica, Servicio de Pediatría, Instituto del Niño y del Adolescente, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/ Profesor Martin Lagos s/n, 28040, Madrid, Spain. .,Departamento de Pediatría, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
| | - Amanda Lopez-Picado
- Unidad de Investigación Clinica y Ensayos Clínicos, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Ana Rivas
- Unidad de Investigación Clinica y Ensayos Clínicos, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.,Departamento de Enfermería, Facultad Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | - Belén Joyanes Abancens
- Unidad de Cuidados Intensivos Pediátricos y Unidad de Recuperación Postanestésica, Servicio de Pediatría, Instituto del Niño y del Adolescente, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/ Profesor Martin Lagos s/n, 28040, Madrid, Spain.,Departamento de Pediatría, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Marina Laura Rodríguez Rojo
- Unidad de Cuidados Intensivos Pediátricos y Unidad de Recuperación Postanestésica, Servicio de Pediatría, Instituto del Niño y del Adolescente, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/ Profesor Martin Lagos s/n, 28040, Madrid, Spain
| | - Patricia Fernández García
- Unidad de Cuidados Intensivos Pediátricos y Unidad de Recuperación Postanestésica, Servicio de Pediatría, Instituto del Niño y del Adolescente, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/ Profesor Martin Lagos s/n, 28040, Madrid, Spain
| | - Carmen Soto Beauregard
- Departamento de Pediatría, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.,Servicio de Cirugía Pediátrica, Instituto del Niño y del Adolescente, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Jaime Rodríguez Alarcón
- Servicio de Cirugía Pediátrica, Instituto del Niño y del Adolescente, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.,Departamento de Pediatría, Facultad de Medicina Universidad Francisco de Vitoria, Madrid, Spain
| | - Carlos González Perrino
- Servicio de Anestesiología y Reanimación, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Borja San Pedro de Urquiza
- Servicio de Anestesiología y Reanimación, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Eva Arias
- Unidad de Cuidados Intensivos Pediátricos y Unidad de Recuperación Postanestésica, Servicio de Pediatría, Instituto del Niño y del Adolescente, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/ Profesor Martin Lagos s/n, 28040, Madrid, Spain
| | - Diamelis Rodriguez
- Unidad de Cuidados Intensivos Pediátricos y Unidad de Recuperación Postanestésica, Servicio de Pediatría, Instituto del Niño y del Adolescente, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), C/ Profesor Martin Lagos s/n, 28040, Madrid, Spain
| | - Carmen Esteban Polonio
- Supervisora de Enfermería del Servicio de Pediatría, Instituto del Niño y del Adolescente, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Maria José Torrejón
- Servicio de Análisis Clínicos, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| |
Collapse
|
5
|
Fuente MÁ, Costa TS, García BS, Serrano MA, Alonso MS, Luján EA. Practical approach to screen vesicoureteral reflux after a first urinary tract infection. Indian J Urol 2014; 30:383-6. [PMID: 25378818 PMCID: PMC4220376 DOI: 10.4103/0970-1591.142055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Vesicoureteral reflux (VUR) is a common pediatric urologic disorder. After the first urinary tract infection (UTI), imaging studies are recommended, starting with a renal ultrasound (RUS). Voiding cystourethrography (VCUG) and dimercaptosuccinic acid (DMSA) scan are the other main radiologic studies used to detect VUR. We evaluated the use of RUS as a screening method for VUR in children below 2 years of age, in order to avoid unnecessary VCUG. Materials and Methods: Medical records and imaging studies of infants (<2 years) who had their first UTI in a 6 year period were retrospectively reviewed. We evaluated the sensitivity, specificity, and negative predictive values of RUS and DMSA for diagnosing VUR. Results: Among 155 children (51% males) with their first UTI, 148 RUS were performed, 128 VCUG and 29 DMSA. VUR was detected in 21% patients; 14.5% low grade and 6.5% high grade. One hundred and twenty-one patients underwent both RUS and VCUG, 101 RUS were normal and 20 abnormal. Of the normal RUS 98% had no or low grade VUR. Among those with an abnormality on RUS 30% had high grade VUR (P < 0.001). Conclusions: After the first UTI in infants (<2 years) RUS is a good screening method for VUR. Among such shildren with a normal RUS, we do not recommend VCUG or DMSA. In our opinion, VCUG should be performed only in patients with abnormal findings in RUS or in recurrent UTI.
Collapse
Affiliation(s)
| | - Talía Sainz Costa
- Department of Pediatrics, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | | | - Esther Aleo Luján
- Department of Pediatrics, Hospital Clínico San Carlos, Madrid, Spain
| |
Collapse
|