- Nocturnal enuresis. The management of bedwetting in children and young people.
- Part 13: Pediatric Basic Life Support. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
- Manejo de la hipertensión arterial en niños y adolescentes: Recomendaciones de la Sociedad Europea de Hipertensión.
- Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand
- TREATMENT GUIDELINE FOR HEMANGIOMAS AND VASCULAR MALFORMATIONS OF THE HEAD AND NECK.
Nocturnal enuresis. The management of bedwetting in children and young people.
Nocturnal enuresis. The management of bedwetting in children and young people . NICE clinical guideline 111 http://www.nice.org.uk/guidance/CG111/QuickRefGuide
Bedwetting is a widespread and distressing condition that can have a deep impact on a child or young person's behavior, emotional wellbeing and social life. It is also very stressful for the parents or carers. The prevalence of bedwetting decreases with age. Bedwetting less than 2 nights a week has a prevalence of 21% at about 4 and a half years and 8% at 9 and a half years. More frequent bedwetting is less common and has a prevalence of 8% at 4 and a half years and 1.5% at 9 and a half years1
The causes of bedwetting are not fully understood. Bedwetting can be considered to be a symptom that may result from a combination of different predisposing factors. There are a number of different disturbances of physiology that may be associated with bedwetting. These disturbances may be categorized as sleep arousal difficulties, polyuria and bladder dysfunction. Bedwetting also often runs in families. .
Experts and expert bodies differ in their definitions of 'nocturnal enuresis' (see the full guideline for a discussion). The term 'bedwetting' is used in this guideline to describe the symptom of involuntary wetting during sleep without any inherent suggestion of frequency of bedwetting or pathophysiology.
This guideline makes recommendations on the assessment and management of bedwetting in children and young people. The guidance applies to children and young people up to 19 years with the symptom of bedwetting. Children are generally expected to be dry by a developmental age of 5 years, and historically it has been common practice to consider children for treatment only when they reach 7 years. The guideline scope did not specify a minimum age limit to allow consideration of whether there are interventions of benefit to younger children previously excluded from advice and services due to their age. We have included specific advice for children under 5 years, and indicated treatment options for children between 5 and 7 years.
1 Butler RJ, Heron J (2008) The prevalence of infrequent bedwetting and nocturnal enuresis in childhood: A large British cohort. Scandinavian Journal of Urology and Nephrology 42: 257–64
NICE clinical guideline 111 – Nocturnal enuresis 6
Children and young people with bedwetting may also have symptoms related to the urinary tract during the day. A history of daytime urinary symptoms may be important in determining the approach to management of bedwetting and so the assessment sections include questions about daytime urinary symptoms and how the answers to these may influence the approach to managing bedwetting. However, the management of daytime urinary symptoms is outside the scope of this guideline.
The treatment of bedwetting has a positive effect on the self-esteem of children and young people. Healthcare professionals should persist in offering different treatments and treatment combinations if the first-choice treatment is not successful. Children and young people with bedwetting are cared for by a number of different healthcare professionals in a variety of settings. All healthcare professionals should be aware of and work within legal and professional codes and competency frameworks.
The guideline will assume that prescribers will use a drug's summary of product characteristics to inform decisions made with individual patients.
DESCARGAR PDF
Part 13: Pediatric Basic Life Support. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Marc D. Berg, Chair; Stephen M. Schexnayder; Leon Chameides; Mark Terry; Aaron Donoghue; Robert W. Hickey; Robert A. Berg; Robert M. Sutton; Mary Fran Hazinski Part 13: Pediatric Basic Life Support. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
http://circ.ahajournals.org/cgi/content/short/122/18_suppl_3/S862
sociation Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science
Key Words: automatic external defibrillator • cardiopulmonary resuscitation • pediatrics
For best survival and quality of life, pediatric basic life support (BLS) should be part of a community effort that includes prevention, early cardiopulmonary resuscitation (CPR), prompt access to the emergency response system, and rapid pediatric advanced life support (PALS), followed by integrated post– cardiac arrest care. These 5 links form the American Heart Association (AHA) pediatric Chain of Survival (Figure 1), the first 3 links of which constitute pediatric BLS.
Rapid and effective bystander CPR can be associated with successful return of spontaneous circulation (ROSC) and neurologically intact survival in children following out-of-hospital cardiac arrest.1–3 Bystander resuscitation may have the greatest impact for out-of-hospital respiratory
arrest, 4 because survival rates 70% have been reported with good neurologic outcome.5, 6 Bystander resuscitation may also have substantial impact on survival from primary ventricular fibrillation (VF), because survival rates of 20% to 30% have been documented in children with sudden out-of-hospital witnessed VF.7.
Rapid and effective bystander CPR can be associated with successful return of spontaneous circulation (ROSC) and neurologically intact survival in children following out-of-hospital cardiac arrest.1–3 Bystander resuscitation may have the greatest impact for out-of-hospital respiratory arrest,4 because survival rates 70% have been reported with good neurologic outcome.5,6 Bystander resuscitation may also have substantial impact on survival from primary ventricular fibrillation (VF), because survival rates of 20% to 30% have been documented in children with sudden out-of-hospital witnessed VF.7 Overall about 6%8 of children who suffer an out-of hospital cardiac arrest and 8% of those who receive prehospital emergency response resuscitation survive, but many suffer serious permanent brain injury as a result of their arrest.7,9 –14 Out-of-hospital survival rates and neurological outcome can be improved with prompt bystander CPR,3,6,15–17 but only about one third to one half of infants and children who suffer cardiac arrest receive bystander CPR.3,9,12,18 Infants are less likely to survive out-of hospital cardiac arrest (4%) than children (10%) or adolescents (13%), presumably because many infants included in the arrest figure are found dead after a substantial period of time, most from sudden infant death syndrome (SIDS).8 As in adults, survival is greater in pediatric patients with an initial rhythm of VF or pulseless ventricular tachycardia (VT) than in those with asystole or pulseless electric activity.7,8………………………………………………
DESCARGAR PDF
Manejo de la hipertensión arterial en niños y adolescentes: Recomendaciones de la Sociedad Europea de Hipertensión.
Introducción y objetivos
Las guías de la Sociedad Europea de Hipertensión (ESH) y de la Sociedad Europea de Cardiología (ESC) del tratamiento de la hipertensión arterial (HTA), publicadas en 2003 1 y actualizadas en2007 2, no incluyen lamentablemente ninguna sección dedicada a la HTA en niños y adolescentes.
No obstante, ello no se debe al desconocimiento de la importancia de esta cuestión. Al contrario, un número creciente de datos indica que la prevalencia de HTA moderada en niños y adolescentes es mucho mayor de lo que se creía anteriormente. Distintos estudios longitudinales han demostrado que las alteraciones en la presión arterial (PA) a esas edades con frecuencia se traducen en HTA en edades adultas, y resaltan la importancia de dichos antecedentes desde un punto de vista no solo epidemiológico, sino también clínico. Asimismo, la HTA en niños y adolescentes ha ido ganando terreno en la medicina cardiovascular, gracias a los avances producidos en distintas áreas de la investigación fisiopatológica y clínica. Por ejemplo, es posible determinar los valores de PA de niños y adolescentes no solo en la consulta del médico (un entorno artificial), sino también durante las actividades diarias habituales, sin duda un ámbito mucho más representativo. Asimismo, se ha podido determinar el daño subclínico en distintos órganos, mediante aparatos y marcadores mucho más sensibles que los disponibles hace unos años. Por ello ha sido posible detectar modificaciones precoces en la función y la estructura orgánica, algo impensable hasta hace poco, lo que ha permitido evaluar de forma más precisa la significación clínica de las alteraciones en la PA. En última instancia, se ha podido establecer la correlación entre la HTA y el daño orgánico en la edad adulta y las distintas alteraciones observadas en la edad juvenil, por ejemplo sobrepeso taquicardia. Ello no ha hecho sino enfatizarla importancia de implementar también en individuos jóvenes algunas de las estrategias de prevención cardiovascular originalmente destinadas a la población adulta.
Sin embargo, el hecho de que en guías previa son se haya tratado la HTA infantil puede deberse al menos a dos motivos. En primer lugar, médicos de distintas especialidades se encargan, por un lado, de la asistencia de niños y adolescentes y, por otro, de personas adultas. Ello implica que cualquier grupo de trabajo responsable de realizar recomendaciones relativas a la HTA en niños debería haber contado con la opinión fundamentada de expertos en esta área. Esto es precisamente lo que se ha hecho a la hora de elaborar el presente documento, centrado específicamente en la HTA pediátrica.
En segundo lugar, y no por ello menos importante, las recomendaciones para tratar la HTA en adultos y niños se basan en datos y argumentos de ámbitos completamente diferentes. En adultos, la mayoría de las recomendaciones incluidas en las guías se basan en datos obtenidos en estudios observacionales y de intervención 2,3. Por ejemplo, la definición de HTA en adultos se basa en datos observacionales de más de 1 millón de personas, que muestran que hay relación continua entre los valores crecientes de la PA sistólica (PAS) y la PA diastólica (PAD), ictus e infarto de Miocardio 4. Ello ha originado valores de corte aceptados convencionalmente que separan la presión normal de la HTA, así´ como sus diferentes grados. Por último, los ensayos clínicos, en los que se han incluido a más de 250.000 pacientes, proporcionan información comparativa sobre los efectos dela disminución de la PA per se y su reducción como resultado de la acción de distintos fármacos. Por el contrario, no se dispone de estudios de este tipo en niños y adolescentes. Resulta prácticamente imposible establecer algún tipo de relación entre los valores de PA y los episodios cardiovasculares que se producen de forma aislada, muchos años después. No pueden realizarse recomendaciones basadas en la evidencia respecto a los valores de corte que establezcan cuando ha de iniciarse el tratamiento, cuales son los objetivos o que clase de fármaco debería administrarse preferentemente en las distintas enfermedades. Muchas de las clasificaciones y recomendaciones dirigidas a niños se basan en consideraciones estadísticas y en extrapolaciones de los datos obtenidos en adultos. A pesar de que las guías relativas a la HTA pediátrica se basan fundamentalmente en la experiencia, no sería ético dejar de prestar la debida atención a esta importante cuestión, tanto desde un punto de vista médico como desde un punto de vista social. Las recomendaciones han de realizarse siendo conscientes de que aún no se dispone de información suficiente, lo que contribuirá´ a diseñar estudios observacionales y de intervención que permitan subsanar determinadas lagunas de conocimiento.
Ello no constituye un objetivo menor de estas guías y, de hecho, al final del presente documento se dedica una sección específicamente a la planificación de futuros estudios.
DESCARGAR PDF
Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand
Anne B Chang, Scott C Bell, Cass A Byrnes, Keith Grimwood, Peter W Holmes, Paul T King, John Kolbe, Louis I Landau, Graeme P Maguire, Malcolm I McDonald, David W Reid, Francis C Thien and Paul J Torzillo4
Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand
A position statement from the Thoracic Society of Australia and New Zealand and the Australian Lung Foundation MJA • Volume 193 Number 6 • 20 September 2010: 356-365
ABSTRACT
• Consensus recommendations for managing chronic suppurative lung disease (CSLD) and bronchiectasis, based on systematic reviews, were developed for Australian and New Zealand children and adults during a multidisciplinary workshop. • The diagnosis of bronchiectasis requires a high-resolution computed tomography scan of the chest. People with symptoms of bronchiectasis, but non-diagnostic scans, have CSLD, which may progress to radiological bronchiectasis. • CSLD/bronchiectasis is suspected when chronic wet cough persists beyond 8 weeks. Initial assessment requires specialist expertise. Specialist referral is also required for children who have either two or more episodes of chronic (>4 weeks) wet cough per year that
respond to antibiotics, or chest radiographic abnormalities persisting for at least 6 weeks after appropriate therapy. • Intensive treatment seeks to improve symptom control, reduce frequency of acute pulmonary exacerbations, preserve lung function, and maintain a good quality of life. • Antibiotic selection for acute infective episodes is based on results of lower airway culture, local antibiotic susceptibility patterns, clinical severity and patient tolerance. Patients whose condition
does not respond promptly or adequately to oral antibiotics are hospitalised for more intensive treatments, including intravenous antibiotics. • Ongoing treatment requires regular and coordinated primary health care and specialist review, including monitoring for complications and comorbidities. • Chest physiotherapy and regular exercise should be encouraged, nutrition optimised, environmental pollutants (including tobacco smoke) avoided, and vaccines dministered according to national immunisation schedules. • Individualised long-term use of oral or nebulised antibiotics, corticosteroids, bronchodilators and mucoactive agents may provide a benefit, but are not recommended routinely
DESCARGAR PDF
TREATMENT GUIDELINE FOR HEMANGIOMAS AND VASCULAR MALFORMATIONS OF THE HEAD AND NECK.
Jia Wei Zheng, DDS, MD,1 Qin Zhou, MS,1 Xiu Juan Yang, MS,1 Yan An Wang, DDS, MD,1 Xin Dong Fan, DDS, MD,1 Guo Yu Zhou, DDS, MD,1 Zhi Yuan Zhang, DDS, MD,1 James Y. Suen, MD2. TREATMENT GUIDELINE FOR HEMANGIOMAS AND VASCULAR MALFORMATIONS OF THE HEAD AND NECK. HEAD & NECK—DOI 10.1002/hed August 2010: 1088-1098
Abstract: Vascular anomalies are among the most common congenital and neonatal dysmorphogenesis, which are separated into hemangiomas and vascular malformations. They can occur in various areas throughout the body, with 60% being located in the head and neck. The true mechanism of pathogenesis of vascular anomalies is still unclear. Various treatment methods have been reported, and there are still controversies over the selection of different treatmment modalities.
Based on the clinical and basic research and current literature,the Chinese Division of Oral and Maxillofacial Vascular Anomalies formulated a treatment guideline for hemangiomas and vascular malformations of the head and neck, which will be modified and updated periodically based on new medical evidence and research. VVC 2009 Wiley Periodicals, Inc. Head
Keywords: hemangioma; vascular malformation; treatment guideline; head and neck
DESCARGAR PDF
