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PubMed1996

The use of chaperones during the physical examination of the pediatric patient. American Academy of Pediatrics Committee on Practice and Ambulatory Medicine.

The intent of this statement is to inform practitioners about the purpose and scope of an appropriate physical examination for children, adolescents, and young adults, and the need to communicate this information to the parents and the patient. Issues of patient comfort, confidentiality, and the use of a chaperone are addressed. An appropriate physical examination should result in efficient, sensitive, and effective health care.

Adolescent↗
PubMedDate not supplied

[Pediatric version of the Adequacy Evaluation Protocol: application of the four Diagnostic Related Groups most frequently used in a pediatric hospital at La Coruña].

BACKGROUND: There is wide-spread consensus that a part of the use of hospital resources is inadequate in the sense that the patients receive services that do not provide them with any significant benefits, or that could be more beneficial, or less costly, with a lower care standard. The main aim of this work is to determine the percentage of inadequate admissions and stays in hospital for the four most frequent Diagnosis-Related Groups (DRGs) in a maternity-children's hospital through the retrospective application of the paediatric version of the Adequacy Evaluation Protocol (AEP). METHOD: It was a retrospective study in which 353 out of the 361 medical records that made up the covered population were analysed. Chi-square and linear trend were the statistical analysis methods used. A variance analysis and the Scheffé multiple comparison test were applied to the average values obtained. RESULTS: The admissions were judged to be adequate in 284 (80.5%) of the cases and inadequate in 69 (19.5%). Of the stays in hospital, 76% were deemed to be appropriate and 24% inappropriate. In DRG 030 (stupor and trauma-related coma, coma < 1 hour, age 0-17), a direct relation can be found between the length of the stay in hospital and the inappropriate use of hospitalisation. CONCLUSIONS: The results of this study show that a substantial proportion of the use of the hospital is inappropriate and that, particularly in DRG 030, this use is probably handled in an overly conservative way.

Analysis of Variance↗
PubMed1997

[Exposure of the pediatric surgeon to inhalation-anesthetic during pediatric bronchoscopy procedures].

BACKGROUND: General anaesthetic agents are frequently used for paediatric bronchoscopy. A disadvantage of this open system anaesthesia seems to be the contamination of the working environment. The aim of this study was to determine the exposure of the endoscopist during paediatric bronchoscopy under general anaesthesia in different working environments and to compare these measurements with the currently valid international threshold limit values. MATERIAL AND METHODS: 25 children (ASA I-III) scheduled for diagnostic bronchoscopy were included in the study. After inhalational induction all children were intubated with a nonflexible bronchoscope and manually ventilated through a side arm of the bronchoscope. Maintenance of anaesthesia was achieved with sevoflurane (2-3 vol%) in 80% oxygen. Trace concentrations were measured every 90 seconds in the breathing zones of the paediatrician by means of a highly sensitive direct-reading instrument (Brüel & Kjaer 1302). The lower detection limit was 0.02 ppm. The investigation was done in an OT with and without air conditioning and scavening system. RESULTS: The mean age of the children was 50.3 months (range: 3-109 months). Ventilation and oxygenation were stable throughout the bronchoscopic procedure. Mean exposure of the paediatrician without air-conditioning and scavening system to sevoflurane was over 50 ppm for the endoscopist. All international threshold limit values were exceeded. Peak concentrations higher than 100 ppm sevoflurane were detected repeatedly in 40% of anaesthesias. During bronchoscopy in the operating room equipped with laminar air flow (20.2 air exchanges per hour) and narcotic gas evacuation (30 l/min) the mean exposure of the paediatrician was 26.4 ppm sevoflurane. CONCLUSIONS: The main finding of the present study is that under inhalation anaesthesia with sevoflurane for paediatric bronchoscopy occupation exposure is higher than the limits stated in all known health regulation guidelines. Therefore, in case of such working conditions, the use of total intravenous anaesthesia is advocated also in very small infants.

Adult↗