This article discusses the issues of modern ethical standards in pediatrics, considers the essence of the concept “a good pediatrician”. The key components of the practical professional activity of a pediatrician, such as honesty and integrity, reliability and responsibility, respect for others, compassion and sensitivity, self-improvement, self-awareness and knowledge of the professional limits of providing medical care, connections and cooperation, altruism and protection the interests of the patient and members of his/her family are considered by the authors. Information is provided regarding the basic ethical principles, duties and competencies of the practical professional activity of a pediatrician in the American healthcare system and the ethical principles of a doctor’s activity in Ukraine. The standards of behavior of a pediatrician are described, according to which he can be evaluated both by medical students, residents and colleagues, as well as by parents, which is necessary for providing quality medical care to children and adolescents. The reasons for the formation of conflict situations in the pediatrician’s practice and approaches to their effective resolution are considered, as well as the role of confidentiality and collegiality.
Spinal muscular atrophy (SMA) is a rare genetic inherited neuromuscular disease that requires a comprehensive multidisciplinary approach to diagnosis and treatment. Purpose - to provide a review of scientific works on comprehensive care for children with SMA according to the principles of the International Classification of Functioning, Disability and Health (ICF), standardized tools for assessing the functional status of the patient. Materials and methods. The article presents the data of the literature review on the use of ICF principles in the organization of care for children with SMA, the use of standardized tools for assessing the functional status of the patient. Review and discussion. The implementation of the IСF in daily practice helps to improve the rehabilitation aid to children with SMA. Using the philosophy of the ICF, physicians began to comprehensively assess the health of the child, to estimate the functionality of the child using standardized tools, to form rehabilitation goals in accordance with the functional capabilities of the child, to determine environmental factors which do not allow the child to fully realize their rehabilitation potential. Conclusions. ICF makes it possible to determine of all aspects of the life of a child with SMA and to determine the impact of environmental factors on its level of functioning. According to ICF principles it is necessary to use standardized tools to assess the health status and the functional activity of a child with SMA, for evaluating the effectiveness of rehabilitation. No conflict of interests was declared by the authors. Key words: ICF, spinal muscular atrophy, rehabilitation, functioning.
Cerebral palsy (CP) represents a group of disorders of the mechanisms of movement and body position, causing limitations of activity, which are caused by non-progressive damage to the developing brain, fetus or child. About 80% of cases are spastic forms of cerebral palsy. Along with motor rehabilitation, the use of botulinum toxin type A (BoNT-A) is considered one of the main methods of treatment of choice for focal spastic and dystonic syndromes, regardless of their etiology. At present, there are no studies in Ukraine on the analysis of the costs of using drugs based on BoNT-A, taking into account the recommended dose and frequency of administration. The aim of the work. Carrying out an analysis of minimizing the cost of botulinum therapy for spastic forms of cerebral palsy in patients aged two years and older. The annual dosage and frequency of administration of abobotulotoxin and onabotolutoxin for the treatment of dynamic equinus deformity of the foot caused by focal spasticity due to cerebral palsy in children over two years of age were obtained from the instructions for use. The cost of abobotulotoxin and onabotolutoxin was obtained from the Register of Wholesale Prices of the Ministry of Health of Ukraine. Cost analysis for a model cohort of children in different weight categories showed that abobotulotoxin 500 U will be the least expensive treatment technology in the weight category of 21–33 kg at a dosage of 15 U/kg in the treatment of diplegia. Abobotulotoxin 300 U is most rationally used in weight categories 10–20 kg and 34–40 kg with a dosage of 15 U/kg in the treatment of hemiplegia and in the weight category 17–20 kg with a dosage of 30 U/kg in the treatment of diplegia. Weight categories were identified in which the costs of using abobotulotoxin 300 U and abobotulotoxin 500 U were equal to and less than the costs of onabotolutoxin treatment. The study was the first to analyze the cost of botulinum therapy, which identified the benefits of abobotulotoxin in the symptomatic treatment of hemiplegia and diplegia in cerebral palsy in the focus of different weight groups of children. Possible variability in the dosage and frequency of administration of onabotolutoxin per year indicates the relevance of collecting additional information on the application in real clinical practice and further pharmacoeconomic studies.
The aim of the work is to assess the degree of dysfunction and limitation in daily life activities in a child with cerebral palsy, to provide an expert opinion for medical and social expertise by Medical Supervisory Committee (MSC) in accordance with the principles of the International Classification of Functioning, Disability and Health (ICF). Materials and methods. A clinical example of measuring the degree of disability of the cerebral palsy child in accordance with the ICF principles using standardized tools for functional status assessment and the ICF Categorical Profile. International standardized scales recommended by the international expert group to be applied for cerebral palsy children were used at the State Institution “Ukrainian Medical Center for Rehabilitation of Children with Organic Nervous System Disorders of Ministry of Health”. Results. During a comprehensive examination of the child with cerebral palsy, a multidisciplinary team of specialists determined the degree of body dysfunction and limitation in daily life activities as well as environmental effect influence on the level of functioning and social adjustment. Based on these findings, ICF Categorical Profile of the patient was formed capturing all spheres of his activity according to the functional state. Parents of the child received the medical conclusion based on the results of the examination for MSC expertise at the place of residence. Conclusions. The IСF covers the whole complex of life activity and functioning of CP children and reflects all the changes associated with their growth, development and state of health, as distinct from the classical clinical examination of patients. Standardized tools for the assessment of the degree of dysfunction and life activity limitations in CP children allow to avoid controversies between specialists from different medical institutions during medical and social assessment and when making a rehabilitation diagnosis. Members of multidisciplinary rehabilitation team can timely identify and correct dysfunctions, provide early career guidance based on child functional capacity by using the IСF principles to assess life activity in CP children.
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