Pediatrics

Dear Colleagues!

Preface

You keep in your hands the first release of clinical recommendations for childhood diseases recommended by the Union of Pediatricians in Russia. This collection includes 12 recommendations for the most common child diseases that are developed by leading experts and are intended for pediatrician doctors.

Clinical recommendations Describe a doctor's actions algorithm for the diagnosis, treatment and prevention of diseases and help him quickly make the right clinical solutions. They are designed to introduce into everyday clinical practice most efficient and safe medical technologies (including medicines), impede decision-making on unreasonable interventions and, thus, contribute to improving quality medical care. In addition, clinical recommendations become a fundamental document, on the basis of which a system of continuous medical education is being built.

Traditionally, clinical recommendations are developed by professional medical communities. For example, in the US, this is the American Academy of Pediatrics, Society of Children's Neurologists, National Institute child health. In the European Union - British Thoracic Society, French Association of Children's Doctors, European Respiratory Society, etc. In Russia - the Union of Pediatricians of Russia, the All-Russian Scientific Society of Cardiologists, Russian Respiratory Society, etc.

The most famous children's doctors who have extensive experiences of clinical and research work have been attracted to writing articles, which owns the international methodology for the development of clinical recommendations.

Development of guideline recommendations has its own characteristics. For ethical considerations, clinical trials are particularly difficult in children. All medicines, including those used in pediatrics, can bring both benefit and potential harm (risks). Therefore, when describing medical treatment Children in order to increase its security detail the age limits of the use of drugs, the features of their use in pediatric practice are described. possible risks (Even not enough proven) related to their application.

Pediatrician clinical recommendations will be regularly updated (at least 1 time in 2 years), electronic version Recommendations will be available on CDs. The second release will be released in 2006 and will contain about 10 new clinical recommendations. At the same time, more detailed guidelines for individual diseases are preparing and a guide to the medicines used in pediatrics.

I am confident that clinical guidelines developed by the Soystone Pediatricians will be useful in your work and will contribute to improving the quality of medical care to your patients.

Developers of recommendations invite readers to cooperate. Comments, critical comments, questions and wishes can be sent to the address: 119828, Moscow, ul. Small Pirogovskaya, 1a, Publishing Group "Gootar-Media" (email address: [Email Protected]).

Participants of the publication

Participants of the publication

Chief Editor

A.A. Baranov, Dr. honey. Sciences, prof., Acad. Ramne

Responsible editor

L.S. Namazov, Dr.. honey. Sciences, prof.

Allergic rhinitis

I.I. Balabolkin, Dr. honey. science, prof., ChL-Corr. RAMS (Reviewer) M.R. Bogomilsky, dock. honey. science, prof., ChL-Corr. RAMS (Reviewer) N.I. Voznesenskaya, Cand. honey. Sciences O.V. Karneeva, Cand. honey. Science I.V. Ryleyev, Dokk Honey. Science

Atopic dermatitis

L.S. Namazov, Dr.. honey. Sciences, prof. SOUTH. Levin, Cand. honey. Science A.G. Surkov K.E. Efendiyev, Cand. honey. Science

I.I. Balabolkin, Dr. honey. science, prof., ChL-Corr. RAMS (Reviewer) T.E. Borovik, Dr. honey. Sciences, prof.

N.I. Voznesenskaya, Cand. honey. Science L.F. Treaschaez, Dokk. honey. Sciences, prof. L.P. Mazitova, Cand. honey. Science I.V. Ryleyev, Dokk Honey. Sciences G.V. Yatsyk, dock. honey. Sciences, prof.

Bronchial asthma

L.S. Namazov, Dr.. honey. Sciences, prof. LM GORODOVA, DCT. honey. Sciences, prof. SOUTH. Levin, Cand. honey. Science A.G. Surkov K.E. Efendiyev, Cand. honey. Science

I.I. Balabolkin, Dr. honey. science, prof., ChL-Corr. RAMS (Reviewer) N.I. Voznesenskaya, Cand. honey. Sciences N.A. Heppe, Dr. honey. Sciences, prof. (reviewer)

D.S. Korostovtsy, dock. honey. Sciences, prof. F.I. Petrovsky, Cand. honey. Science I.V. Ryleyev, Dokk Honey. Science I.V. Sidorenko, Cand. honey. Sciences Yu.S. Smallkin, Dr.. honey. Science

A.A. Cheburkin, Dr. honey. Sciences, prof.

Urinary tract infection

Fever

Fever without visible focus of infection

VC. Tasteenko, Dr.. honey. Sciences, prof.

Nephrotic syndrome

A.N. Tsygin, Dr.. honey. Sciences, prof. O.V. Komba, Cand. honey. Sciences T.V. Sergeeva, Dr. honey. Sciences, prof. A.G. Timofeev, Cand. honey. Sciences O.V. Chumakov, dock. honey. Science

Pneumonia

VC. Tasteenko, Dr.. honey. Sciences, prof.

G.A. Samsygin, dock. honey. Sciences, prof. (Reviewer) A.I. Ishignikov, Dr. honey. Sciences, prof. (reviewer)

V.F. Pirikhin, Dr. honey. Sciences, prof., Acad. RAMN (Reviewer)

Systemic Red Volchanka

N.S. Under History, Dr.. honey. Sciences, prof. O.A. Solnev

Participants of the publication

Frebel convulsions

O.I. Maslova, Dr.. honey. Sciences, prof. V.M. Studenkin, Dokk. honey. Sciences, prof. LM Kuzinkova, Dr. honey. Science

Epilepsy

O.I. Maslova, Dr.. honey. Sciences, prof. V.M. Studenkin, Dokk. honey. Sciences, prof.

Juvenile rheumatoid arthritis

E.I. Alekseeva, Dr.. honey. Sciences, prof. TM Bzarov, Cand. honey. Sciences I.P. Nikishin, Dr.. honey. Sciences, prof.

MK Sobolev, Dr. honey. Sciences, prof. (Reviewer) M.Yu. Shcherbakova, dock. honey. Sciences, prof. (reviewer)

Project Managers

G.E. Ulumbekova, President of the Publishing Group "Gootar Media", Executive Director of the Association of Medical Societies in Q.I. Sitekulov, Director of New Projects of the Publishing Group "Goeotarmedia"

Methodology of creation and quality assurance program

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

Why are clinical recommendations necessary? Because in the conditions of 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. In compiling clinical recommendations, these steps have already been implemented by developers.

Qualitative clinical recommendations are created according to a certain methodology, which guarantees their modernity, reliability, summarizing the best world experience and knowledge, applicability in practice and ease of use. In this advantage of clinical recommendations to traditional sources of information (textbooks, monographs, manuals).

A set of international requirements for clinical guidelines was developed in 2003 by specialists from Great Britain, Canada, Germany, France, Finland and other countries. Among them is a tool for assessing the quality of clinical recommendations Agree1, the methodology for developing clinical recommendations SIGN 502, etc.

We offer you a description of the requirements and events that were used in the preparation of this publication.

1. Concept and project management

To work on the project, a management team was created as part of project managers and administrator.

To develop a concept and project management system, project executives conducted many consultations with domestic and foreign specialists (epidemiologists, economists and health organizers, specialists in finding medical information, representatives of insurance companies, representatives of industry - manufacturers of medicines, medical equipment, heads of professional societies, leading clinical developers

1 Appraisal of Guidelines for Research and Evaluation - Tool for assessing the quality of clinical recommendations, http://www.agreecollaboration.org/

2 Scottish Intercollegiate Guidelines Network - Scottish Intercalliegial Organization for the Development of Clinical Recommendations

Methodology of creation and quality assurance program

Methodology of creation and quality assurance program

commandations, practitioners). Analyzed reviews for the first transfer publication of clinical recommendations based on evidence-based medicine (clinical recommendations for general practitioners. - M.: Goeotar-Honey, 2004).

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

General: appointment of effective interventions, avoiding unreasonable interventions, reducing the number of medical errors, improving the quality of medical care

Specific - see the section "Treats of Treatment" of clinical recommendations.

3. Audience

Designed to pediatricians, therapists, specialist physicians (eg, allergists, neurologists), interns, allers, students of senior courses.

Compilers and editors evaluated the feasibility of recommendations in pediatric practice in Russia.

Choosing diseases and syndromes.The first edition was selected diseases and syndromes that are most common in the practice of a doctor. The final list was approved by the chief editor of the publication.

4. Stages of development

Creating a management system, concepts, selection, creating a group of developers, search for literature, formulation of recommendations and their ranking on the level of reliability, examination, editing and independent review, publication, distribution, implementation.

6. Applicability to groups of patients

A group of patients, to which these recommendations (floor, age, severity of the disease, related diseases apply, are applicable.

7. Developers

Authors-compilers (practitioners who have experience clinical work and writing scientific articles knowledgeable english and owning work skills on the computer), chief editors of sections (leading domestic experts, main specialists of the Ministry of Health and Social Development of the Russian Federation, leaders of leading research institutions, professional societies, heads of departments), scientific editors and independent reviewers (faculty of educational and academic institutions) , Publishing editors (practitioners with experience with writing scientific articles who know English, who have operating skills on a computer, with experience in publishing not less than 5 years) and project managers (Experience of project management with a large number of participants with limited creation timing, owning methodology Creating clinical recommendations).

8. Developer training

There are several training seminars on the principles of evidence-based medicine and the methodology for developing clinical recommendations.

All specialists provide a description of the project, the format of the article, instructions for the preparation of clinical recommendation, sources of information and instructions for their use, an example of a clinical recommendation.

With all developers, the project manager and responsible editors supported a continuous telephone connection and email in order to solve operational issues.

9. Independence

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

The instructions for compilers indicated the need to confirm the effectiveness of (benefit / harm) interventions in independent sources of information (see paragraph 10), the inadmissibility of mentioning any commercial items. There are international (non-commercial) names medicinal preparationswho were checked by the editors of the Publishing House for the State Register of Medicines (as of the summer of 2005).

10. Sources of information and instructions for their use

Approved sources of information for the development of clinical recommendations.

Methodology of creation and quality assurance program

The clinical recommendations for pediatrics are developed by a group of experienced specialists in the field of pediatrics on behalf of the Minister of Health of the Russian Federation. We recommend familiarizing yourself with the current version of the document for use. national Recommendations In the daily activities of the pediatrician

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

Download the verification sheet of the execution of clinical recommendations.

↯ More articles in the magazine

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 states and diseases of minor patients are being developed.

Main changes for Nachmedov in 2019

Watch the algorithm for the introduction of clinical recommendations, which are valid since 2019. He was developed by experts of the magazine "Deputy Chief Doctor". Click on sections and follow the instructions.

Do federal clinical recommendations for pediatrics 2019 applications are required medical institutions? In accordance with the Federal Law "On Health Protection", attending physicians when assisting patients are guided medical standards, orders and clinical guidelines.

Direction of a child for palliative care: ways of adopting medical solutions

Order of the Ministry of Health of Russia dated 04.04.2015 No. 193n approved the procedure for the provision of palliative care for children. The decision to send a child to the provision of palliative care should receive a medical commission of a medical unit.

At the same time, the order does not detail the patient selection technique children's age For referring to palliative care.

Patient stratification into certain clinical groups is necessary for proper scheduling and the nature of palliative care:

1. Category 1 - threatening the life of the disease in which radical treatment can be feasible, but often does not give results (for example, malignant neoplasms, irreversible / malignant cardiac, liver and renal failure);
2. Category 2 - states in which premature death is inevitable, but long-term intensive treatment can increase the life expectancy of the child and will preserve its activity (mossy lung hypoplasia / polycystic lungs) ...

How to organize palliative care for children

To provide palliative care for children can exit patronage services, palliative care departments, children's hospices. See comfortable tables with indicators and practical developments in the field of children's Palliament in the System Chief Doctor.

1. Vaccinoproprophylaxis of hemophilic infection type B in children
2. The deficiency of acyl-co-dehydrogenase fatty acids with a very long carbon chain in children
3. Immunoprophylaxis of respiratory syncytial viral infection in children
4. Acute obstructive laryngitis (croup) and epiglotte in children
5. The consequences of perinatal damage to the central nervous system with atronic-astatic syndrome
6. The consequences of perinatal damage to the central nervous system with hydrocyphal and hypertensive syndromes
7. The consequences of perinatal lesion of the central nervous system with hypermatibility syndrome

Deep-valued colleagues!

In accordance with the Federal Law of December 25, 2018 No. 489-FZ "On Amendments to Article 40 Federal Law "On compulsory health insurance in Russian Federation"And the federal law" On the basics of the health of citizens' health in the Russian Federation "on clinical recommendations" Clinical recommendations are currently determined as a document containing scientific evidence-based structured information on prevention, diagnosis, treatment and rehabilitation.

This federal law defines a transitional period until December 31, 2021, necessary to revise and approve clinical recommendations in accordance with the norms introduced by the draft law. Approved clinical recommendations will contain parameters reflecting the correctness of the choice of diagnostic and treatment methods based on the principles of evidence-based medicine. The application of clinical recommendations will allow health workers to determine the patient tactics with specific nosology at all stages of medical care.

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

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

1. Order of the Ministry of Health of Russia dated February 28, 2019 No. 101n "On approval of criteria for the formation of a list of diseases, states (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-PrakticHeskiy-Sovet;
2. Order of the Ministry of Health of Russia of 28.02.2019 No. 102n "On approval of the Regulation on the Scientific and Practical Council of the Ministry of Health of the Russian Federation";
3. Order of the Ministry of Health of Russia dated February 28, 2019 No. 103N "On approval of the procedure and timing of the development of clinical recommendations, their revision, a typical form of clinical recommendations and requirements for their structure, composition and scientific substantiation of information included in clinical recommendations";
4. Order of the Ministry of Health of Russia dated February 28, 2019 No. 104n "On approval of the procedure and deadlines for approval and approval of clinical recommendations, criteria for the adoption by the scientific and practical council of the decision on approval, rejection or direction to the refinement of clinical recommendations or a decision on their revision."

According to the order of the Ministry of Health of Russia of 28.02.2019 No. 103n "Medical professional non-profit organizations develop projects of 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 the Federal Law N 323-FZ, as well as by placing the Internet in the information and telecommunication network.

According to the order of the Ministry of Health of Russia No. 102n of February 28, 2019, after the development of clinical recommendations, further will be considered by the Scientific and Practical Council of the Ministry of Health of Russia and approve, deviate either to refinement 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-commercial organizations.

In connection with the above, we inform you about the start of developing a medical professional non-commercial organization of the Russian pediatrician union of clinical recommendations for diseases, states (groups of diseases, conditions) included in the list by which clinical recommendations should be developed / updated. .

We also report that the formation of working groups will be implemented in collaboration with medical professional non-profit organizations on relevant profiles and include, including specialists who provide medical assistance to patients with an adult age category.

The Russian pediatrician union is widely attracted to the formation of clinical recommendations, professional communities, as well as scientific, educational organizations and the public.

President of the Russian Pediatrician Union,
The main freelance children's specialist in preventive medicine of the Ministry of Health of Russia,
Acad. RAS LS Namazo-Baranova

Honorary President of Russian Pediatricians Union,
Chief Freelance Specialist Pediatrician of the Ministry of Health of Russia,
Acad. RAS A.A. Baranov

• Vaccinoproprophylaxis of hemophilic infection type B in children
• Vaccinoprophylaxis of diseases caused by human papilloma virus
• Vaccinionfilax of pneumococcal infection in children
• Vaccinoproprophy of rotavirus infection in children
• The deficiency of acyl-co-dehydrogenase fatty acids with a very long carbon chain in children
• Immunoprophylaxis of meningococcal infection in children

The clinical recommendations for pediatrics are developed by a group of experienced specialists in the field of pediatrics on behalf of the Minister of Health of the Russian Federation. We recommend to familiarize yourself with the current version of the document for the application of national recommendations in the daily activities of the Pediatrician

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

Download the verification sheet of the execution of clinical recommendations.

↯ More articles in the magazine

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 states and diseases of minor patients are being developed.

Main changes for Nachmedov in 2019

Watch the algorithm for the introduction of clinical recommendations, which are valid since 2019. He was developed by experts of the magazine "Deputy Chief Doctor". Click on sections and follow the instructions.

Are federal clinical recommendations for pediatrics of 2019 applications by medical institutions? In accordance with the Federal Law "On Health Protection", attending physicians when assisting patients are guided by medical standards, orders and clinical guidelines.

Direction of a child for palliative care: ways of adopting medical solutions

Order of the Ministry of Health of Russia dated 04.04.2015 No. 193n approved the procedure for the provision of palliative care for children. The decision to send a child to the provision of palliative care should receive a medical commission of a medical unit.

At the same time, the order does not detail the methodology for the selection of childhood patients to referred to palliative care.

Patient stratification into certain clinical groups is necessary for proper scheduling and the nature of palliative care:

1. Category 1 - threatening the life of the disease in which radical treatment can be feasible, but often does not give results (for example, malignant neoplasms, irreversible / malignant cardiac, liver and renal failure);
2. Category 2 - states in which premature death is inevitable, but long-term intensive treatment can increase the life expectancy of the child and will preserve its activity (mossy lung hypoplasia / polycystic lungs) ...

How to organize palliative care for children

To provide palliative care for children can exit patronage services, palliative care departments, children's hospices. See comfortable tables with indicators and practical developments in the field of children's Palliament in the System Chief Doctor.

1. Vaccinoproprophylaxis of hemophilic infection type B in children
2. The deficiency of acyl-co-dehydrogenase fatty acids with a very long carbon chain in children
3. Immunoprophylaxis of respiratory syncytial viral infection in children
4. Acute obstructive laryngitis (croup) and epiglotte in children
5. The consequences of perinatal damage to the central nervous system with atronic-astatic syndrome
6. The consequences of perinatal damage to the central nervous system with hydrocyphal and hypertensive syndromes
7. The consequences of perinatal lesion of the central nervous system with hypermatibility syndrome