home Audience 4 Federal standards and clinical guidelines for pediatrics. Pediatrics. Clinical guidelines. Referral of a child to palliative care: ways of making medical decisions

Federal standards and clinical guidelines for pediatrics. Pediatrics. Clinical guidelines. Referral of a child to palliative care: ways of making medical decisions

Clinical guidelines for pediatrics were developed by a group of experienced pediatric specialists on behalf of the Minister of Health of the Russian Federation. We recommend that you familiarize yourself with the current version of the document for the application of national recommendations in the daily activities of a pediatrician

We recommend that you familiarize yourself with the current version of the document for the application of national recommendations in the daily activities of a pediatrician.

Download the checklist for the implementation of clinical guidelines.

↯ More articles in the journal

From the article you will learn

On their basis, under the leadership of the Ministry of Health of Russia, criteria for assessing the quality of medical care for specific groups of conditions and diseases of underage patients are being developed.

Main changes for chief medical officers in 2019

Look at the algorithm for implementing clinical recommendations that have been in effect since 2019. It was developed by the experts of the magazine "Deputy Chief Physician". Click on the sections and follow the instructions.

Are the 2019 Federal Clinical Guidelines for Pediatrics mandatory for healthcare providers to apply? In accordance with the Federal Law “On Health Protection”, when providing care to patients, attending physicians are guided by medical standards, procedures and clinical recommendations.

Referral of a child to palliative care: ways of making medical decisions

Order of the Ministry of Health of Russia dated April 14, 2015 No. 193n approved the Procedure for the provision of palliative care to children. The decision to send the child to palliative care should be made by the medical commission of the medical organization.

At the same time, the Procedure does not detail the methodology for selecting pediatric patients for referral to palliative care.

Stratification of patients into certain clinical groups is necessary for proper planning of the scope and nature of palliative care:

Category 1 - life-threatening diseases for which definitive treatment may be feasible but often fails (eg, malignancy, irreversible/malignant heart, liver, and kidney failure);
Category 2 - conditions in which premature death is inevitable, but prolonged intensive treatment can increase the life expectancy of the child and allow him to keep his activity (cystic hypoplasia of the lung / polycystic lung) ...

How to organize palliative care for children

Palliative care for children can be provided by visiting patronage services, palliative care departments, and children's hospices. View convenient tables with indicators and practical experience in the field of pediatric palliative care in the Chief Physician System.

Vaccination of Haemophilus influenzae type b in children
Very long chain fatty acid acyl-CoA dehydrogenase deficiency in children
Immunoprophylaxis of respiratory syncytial virus infection in children
Acute obstructive laryngitis (croup) and epiglottitis in children
Consequences of perinatal lesions of the central nervous system with atonic-astatic syndrome
Consequences of perinatal lesions of the central nervous system with hydrocephalic and hypertension syndromes
Consequences of perinatal lesions of the central nervous system with hyperexcitability syndrome

We recommend that you familiarize yourself with the current version of the document for the application of national recommendations in the daily activities of a pediatrician.

Download the checklist for the implementation of clinical guidelines.

↯ More articles in the journal

From the article you will learn

Main changes for chief medical officers in 2019

Look at the algorithm for implementing clinical recommendations that have been in effect since 2019. It was developed by the experts of the magazine "Deputy Chief Physician". Click on the sections and follow the instructions.

Referral of a child to palliative care: ways of making medical decisions

At the same time, the Procedure does not detail the methodology for selecting pediatric patients for referral to palliative care.

Stratification of patients into certain clinical groups is necessary for proper planning of the scope and nature of palliative care:

Category 1 - life-threatening diseases for which definitive treatment may be feasible but often fails (eg, malignancy, irreversible/malignant heart, liver, and kidney failure);
Category 2 - conditions in which premature death is inevitable, but prolonged intensive treatment can increase the life expectancy of the child and allow him to keep his activity (cystic hypoplasia of the lung / polycystic lung) ...

How to organize palliative care for children

Vaccination of Haemophilus influenzae type b in children
Very long chain fatty acid acyl-CoA dehydrogenase deficiency in children
Immunoprophylaxis of respiratory syncytial virus infection in children
Acute obstructive laryngitis (croup) and epiglottitis in children
Consequences of perinatal lesions of the central nervous system with atonic-astatic syndrome
Consequences of perinatal lesions of the central nervous system with hydrocephalic and hypertension syndromes
Consequences of perinatal lesions of the central nervous system with hyperexcitability syndrome

Pediatrics


Foreword ................................................................ ...............................................
Publication contributors .............................................................. ...............................
.........
Abbreviations ................................................................ ...................................
Allergic rhinitis .................................................................. .........................
Atopic dermatitis................................................ ......................
Bronchial asthma................................................ .........................
Urinary tract infection ............................................................... ....
Fever................................................. .........................................
Fever with no apparent source of infection ..............................................
Nephrotic Syndrome .................................................................. ................
Pneumonia................................................. ......................................
Systemic lupus erythematosus ............................................................... ..........
Febrile convulsions .................................................................. ...................
Epilepsy................................................. ...............................................
Juvenile rheumatoid arthritis .......................................................................
Subject index................................................ ....................

Dear Colleagues!

Foreword

You are holding in your hands the first issue of clinical guidelines on childhood diseases, recommended by the Russian Union of Pediatricians. This compilation includes 12 recommendations for the most common childhood diseases, which were developed by leading experts and are intended for pediatricians.

Clinical guidelines describe the doctor's algorithm for diagnosing, treating and preventing diseases and help him quickly make the right clinical decisions. They are designed to introduce the most effective and safe medical technologies (including medicines) into everyday clinical practice, prevent decisions on unreasonable interventions and, thus, contribute to improving the quality of medical care. In addition, clinical guidelines become the fundamental document on the basis of which the system of continuing medical education is built.

Traditionally, clinical guidelines have been developed by medical professional communities. For example, in the USA, these are the American Academy of Pediatrics, the Society of Pediatric Neurologists, and the National Institute of Child Health. In the European Union - the British Thoracic Society, the French Association of Pediatricians, the European Respiratory Society, etc. In Russia - the Union of Pediatricians of Russia, the All-Russian Scientific Society of Cardiology, the Russian Respiratory Society, etc.

The most famous pediatric doctors with extensive experience in clinical and research work, who own the international methodology for developing clinical recommendations, were involved in writing the articles.

The development of guidelines for pediatrics has its own characteristics. For ethical reasons, conducting clinical trials is particularly difficult in children. All drugs, including those used in pediatrics, can bring both benefits and potential harm (risks). Therefore, when describing the drug treatment of children in order to increase its safety, age restrictions on the use of drugs, the features of their use in pediatric practice, and the possible risks (even insufficiently proven ones) associated with their use are described.

Clinical guidelines for pediatrics will be updated regularly (at least once every 2 years), the electronic version of the guidelines will be available on CD. The second issue will be published in 2006 and will contain about 10 new clinical guidelines. At the same time, more detailed guidelines for individual diseases and a guide to medicines used in pediatrics are being prepared.

I am sure that the clinical guidelines developed by the Union of Pediatricians of Russia will be useful in your work and will help improve the quality of medical care for your patients.

The developers of recommendations invite readers to cooperate. Comments, criticisms, questions and wishes can be sent to the address: 119828, Moscow, st. Malaya Pirogovskaya, 1a, GEOTAR-Media Publishing Group (e-mail address: [email protected]).

PARTICIPANTS OF THE EDITION

Members of the publication

Chief Editor

A.A. Baranov, Dr. honey. sciences, prof., acad. RAMS

Responsible editor

L.S. Namazova, Dr. honey. sciences, prof.

allergic rhinitis

I.I. Balabolkin, Dr. honey. Sciences, prof., corresponding member. RAMS (reviewer) M.R. Bogomilsky, Dr. honey. Sciences, prof., corresponding member. RAMS (reviewer) N.I. Voznesenskaya, Ph.D. honey. Sciences O.V. Karneeva, Ph.D. honey. Sciences I.V. Ryleeva, Dr. med. Sciences

Atopic dermatitis

L.S. Namazova, Dr. honey. sciences, prof. SOUTH. Levina, Ph.D. honey. Sciences A.G. Surkov K.E. Efendieva, Ph.D. honey. Sciences

I.I. Balabolkin, Dr. honey. Sciences, prof., corresponding member. RAMS (reviewer) T.E. Borovik, Dr. honey. sciences, prof.

N.I. Voznesenskaya, Ph.D. honey. Sciences L.F. Kaznacheeva, Dr. honey. sciences, prof. L.P. Mazitova, Ph.D. honey. Sciences I.V. Ryleeva, Dr. med. Sciences G.V. Yatsyk, dr. honey. sciences, prof.

Bronchial asthma

L.S. Namazova, Dr. honey. sciences, prof. L.M. Ogorodova, Dr. honey. sciences, prof. SOUTH. Levina, Ph.D. honey. Sciences A.G. Surkov K.E. Efendieva, Ph.D. honey. Sciences

I.I. Balabolkin, Dr. honey. Sciences, prof., corresponding member. RAMS (reviewer) N.I. Voznesenskaya, Ph.D. honey. Sciences N.A. Geppe, dr. honey. sciences, prof. (reviewer)

D.S. Korostovtsev, Dr. honey. sciences, prof. F.I. Petrovsky, Ph.D. honey. Sciences I.V. Ryleeva, Dr. med. Sciences I.V. Sidorenko, Ph.D. honey. Sciences Yu.S. Smolkin, Dr. honey. Sciences

A.A. Cheburkin, Dr. honey. sciences, prof.

urinary tract infection

Fever

Fever with no apparent source of infection

VC. Tatochenko, Dr. honey. sciences, prof.

nephrotic syndrome

A.N. Tsygin, Dr. honey. sciences, prof. O.V. Komarova, Ph.D. honey. Sciences T.V. Sergeeva, Dr. honey. sciences, prof. A.G. Timofeeva, Ph.D. honey. Sciences O.V. Chumakova, Dr. honey. Sciences

Pneumonia

VC. Tatochenko, Dr. honey. sciences, prof.

G.A. Samsygin, Dr. honey. sciences, prof. (reviewer) A.I. Sinopalnikov, Dr. honey. sciences, prof. (reviewer)

V.F. Uchaikin, Dr. honey. sciences, prof., acad. RAMS (reviewer)

Systemic lupus erythematosus

N.S. Podchernyaeva, Dr. honey. sciences, prof. O.A. Solntseva

Members of the publication

Febrile convulsions

O.I. Maslova, Dr. honey. sciences, prof. V.M. Studenikin, Dr. honey. sciences, prof. L.M. Kuzinkova, Dr. honey. Sciences

Epilepsy

O.I. Maslova, Dr. honey. sciences, prof. V.M. Studenikin, Dr. honey. sciences, prof.

Juvenile rheumatoid arthritis

E.I. Alekseeva, Dr. honey. sciences, prof. T.M. Bzarova, Ph.D. honey. Sciences I.P. Nikishina, Dr. honey. sciences, prof.

M.K. Soboleva, Dr. honey. sciences, prof. (reviewer) M.Yu. Shcherbakova, Dr. honey. sciences, prof. (reviewer)

Project Managers

G.E. Ulumbekova, President of the GEOTAR-Media Publishing Group, Executive Director of the Association of Medical Societies for Quality K.I. Saitkulov, Director of New Projects, GEOTARMEDIA Publishing Group

CREATION METHODOLOGY AND QUALITY ASSURANCE PROGRAM

This publication is the first issue of Russian clinical guidelines on childhood diseases. The aim of the project is to provide the practitioner with recommendations for the prevention, diagnosis and treatment of the most common childhood illnesses.

Why are clinical guidelines needed? Because in the conditions of the explosive growth of medical information, the number of diagnostic and therapeutic interventions, the doctor must spend a lot of time and have special skills to search, analyze and apply this information in practice. When compiling clinical guidelines, these steps have already been completed by the developers.

High-quality clinical guidelines are created according to a specific methodology that guarantees their up-to-dateness, reliability, generalization of the best world experience and knowledge, applicability in practice and ease of use. This is the advantage of clinical recommendations over traditional sources of information (textbooks, monographs, guidelines).

A set of international requirements for clinical guidelines was developed in 2003 by specialists from the UK, Canada, Germany, France, Finland and other countries. Among them are the AGREE1 clinical guidelines quality assessment tool, the SIGN 502 clinical guidelines development methodology, etc.

We bring to your attention a description of the requirements and activities that were used in the preparation of this publication.

1. Concept and project management

A management team consisting of project managers and an administrator was created to work on the project.

To develop the concept and project management system, the project leaders held many consultations with domestic and foreign specialists (epidemiologists, economists and health care organizers, medical information retrieval specialists, representatives of insurance companies, industry representatives - manufacturers of medicines, medical equipment, heads of professional societies, leading developers of clinical

1 Appraisal of Guidelines for Research and Evaluation - Clinical Guideline Quality Assessment Tool, http://www.agreecollaboration.org/

2 Scottish Intercollegiate Guidelines Network - Scottish Intercollegiate Guidelines Development Organization

Creation methodology and quality assurance program

recommendations, practitioners). Reviews of the first translated edition of clinical guidelines based on evidence-based medicine (Clinical guidelines for general practitioners. - M.: GEOTAR-MED, 2004) are analyzed.

As a result, the concept of the project was developed, stages were formulated, their sequence and deadlines, requirements for stages and performers; approved instructions and methods of control.

General: prescribing effective interventions, avoiding unnecessary interventions, reducing the number of medical errors, improving the quality of medical care

Specific - see the "Treatment Goals" section of the clinical guidelines.

3. Audience

Intended for pediatricians, internists, medical specialists (eg allergists, neurologists), interns, residents, senior students.

The compilers and editors assessed the feasibility of the recommendations in pediatric practice in Russia.

Choice of diseases and syndromes. In the first issue, the diseases and syndromes most frequently encountered in the practice of a pediatrician were selected. The final list was approved by the editor-in-chief of the publication.

4. Stages of development

Creation of a management system, concepts, selection of topics, creation of a development team, literature search, formulation of recommendations and their ranking in terms of reliability, examination, editing and independent review, publication, distribution, implementation.

6. Applicability to groups of patients

The group of patients to which these recommendations apply (gender, age, disease severity, comorbidities) is clearly defined.

7. Developers

Authors-compilers (practitioners with experience in clinical work and writing scientific articles, who know English and have computer skills), chief editors of sections (leading domestic experts, chief specialists of the Ministry of Health and Social Development of the Russian Federation, heads of leading research institutions, professional societies, heads of departments), scientific editors and independent reviewers (professional staff of educational and academic institutions), editors of a publishing house (practitioners with experience in writing scientific articles, who know English, have computer skills, with at least 5 years of experience in a publishing house ) and project managers (experience in managing projects with a large number of participants with a limited timeframe for creation, knowledge of the methodology for creating clinical recommendations).

8. Developer training

Several training seminars were held on the principles of evidence-based medicine and the methodology for developing clinical guidelines.

All specialists were provided with a description of the project, the format of the article, instructions for compiling a clinical recommendation, sources of information and instructions for their use, and an example of a clinical recommendation.

With all developers, the project manager and responsible editors maintained continuous communication by phone and e-mail in order to resolve operational issues.

9. Independence

The opinion of the developers does not depend on the manufacturers of medicines and medical equipment.

The instructions for compilers indicated the need to confirm the effectiveness (benefit / harm) of interventions in independent sources of information (see paragraph 10), the inadmissibility of mentioning any commercial names. The international (non-commercial) names of medicines are given, which were checked by the editors of the publishing house according to the State Register of Medicines (as of summer 2005).

10. Sources of information and instructions for their use

Approved sources of information for the development of clinical guidelines.

Creation methodology and quality assurance program

Dear colleagues!

In accordance with the Federal Law of December 25, 2018 No. 489-FZ "On Amendments to Article 40 of the Federal Law "On Compulsory Health Insurance in the Russian Federation" and the Federal Law "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation" on clinical recommendations » Clinical guidelines are currently defined as a document containing structured information based on scientific evidence on prevention, diagnosis, treatment and rehabilitation.

This Federal Law defines a transitional period until December 31, 2021, necessary for the revision and approval of clinical recommendations in accordance with the norms introduced by the bill. The approved clinical guidelines will contain parameters that reflect the correct choice of diagnostic and treatment methods based on the principles of evidence-based medicine. The application of clinical recommendations will allow medical workers to determine the tactics of managing a patient with a specific nosology at all stages of medical care.

Clinical guidelines will be used as a basis for developing other documents regulating the process of providing medical care, including standards and procedures for providing medical care, as well as criteria for assessing the quality of medical care. Thus, at the end of the transition period, an integral system for managing the quality of medical care will be created, based on clinical recommendations that take into account the best world practices.

The Ministry of Health of the Russian Federation issued a number of orders regulating the work on the development of clinical guidelines:

Order of the Ministry of Health of Russia dated February 28, 2019 No. 101n "On approval of the criteria for the formation of a list of diseases, conditions (groups of diseases, conditions) for which clinical recommendations are developed." Currently, this list is posted on the website of the Ministry of Health of the Russian Federation https://www.rosminzdrav.ru/poleznye-resursy/nauchno-prakticheskiy-sovet;
Order of the Ministry of Health of Russia dated February 28, 2019 No. 102n “On Approval of the Regulations on the Scientific and Practical Council of the Ministry of Health of the Russian Federation”;
Order of the Ministry of Health of Russia dated February 28, 2019 No. 103n “On approval of the procedure and terms for the development of clinical recommendations, their revision, the standard form of clinical recommendations and the requirements for their structure, composition and scientific validity of the information included in clinical recommendations”;
Order of the Ministry of Health of Russia dated February 28, 2019 No. 104n "On approval of the procedure and terms for the approval and approval of clinical recommendations, the criteria for the scientific and practical council to decide on the approval, rejection or referral for revision of clinical recommendations or the decision to revise them."

According to the order of the Ministry of Health of Russia dated February 28, 2019 No. 103n “Medical professional non-profit organizations develop draft clinical recommendations and organize their public discussion, including with the participation of scientific organizations, educational institutions of higher education, medical organizations, medical professional non-profit organizations, their associations (unions ) specified in Part 5 of Article 76 of Federal Law N 323-FZ, as well as by posting it on the Internet information and telecommunications network.

According to the order of the Ministry of Health of Russia No. 102n of February 28, 2019, after the development of clinical recommendations, they will be further considered by the Scientific and Practical Council of the Ministry of Health of Russia and approved, rejected or sent for revision in accordance with the terms and criteria regulated by the order of the Ministry of Health of Russia 104n.

With a positive decision of the Scientific and Practical Council of the Ministry of Health of Russia, clinical recommendations are approved by professional non-profit organizations.

In connection with the above, we inform you about the beginning of the development by the medical professional non-profit organization the Union of Pediatricians of Russia of clinical guidelines for diseases, conditions (groups of diseases, conditions) included in the List, for which clinical guidelines should be developed/updated. .

We also inform you that the formation of working groups will be carried out in cooperation with medical professional non-profit organizations in the relevant fields and will include, among other things, specialists providing medical care to patients of the adult age category.

The Union of Pediatricians of Russia widely involves professional communities, as well as scientific, educational organizations and the public, in the development of clinical recommendations.

President of the Union of Pediatricians of Russia,
Chief freelance pediatric specialist in preventive medicine of the Ministry of Health of Russia,
acad. RAS L.S. Namazova-Baranova

Honorary President of the Union of Pediatricians of Russia,
Chief freelance specialist pediatrician of the Ministry of Health of Russia,
acad. RAS A.A. Baranov

Vaccination of Haemophilus influenzae type b in children
Vaccination of diseases caused by the human papillomavirus
Vaccination of pneumococcal infection in children
Vaccination of rotavirus infection in children
Very long chain fatty acid acyl-CoA dehydrogenase deficiency in children
Immunoprophylaxis of meningococcal infection in children