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Quach, Alicia, Shidan Tosif, Herfina Nababan, Trevor Duke, Stephen M. Graham, Wilson M. Were, Moise Muzigaba, and Fiona M. Russell. "Assessing the quality of care for children attending health facilities: a systematic review of assessment tools." BMJ Global Health 6, no. 10 (October 2021): e006804. http://dx.doi.org/10.1136/bmjgh-2021-006804.
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IntroductionAssessing quality of healthcare is integral in determining progress towards equitable health outcomes worldwide. Using the WHO ‘Standards for improving quality of care for children and young adolescents in health facilities’ as a reference standard, we aimed to evaluate existing tools that assess quality of care for children.MethodsWe undertook a systematic literature review of publications/reports between 2008 and 2020 that reported use of quality of care assessment tools for children (<15 years) in health facilities. Identified tools were reviewed against the 40 quality statements and 510 quality measures from the WHO Standards to determine the extent each tool was consistent with the WHO Standards. The protocol was registered in PROSPERO ID: CRD42020175652.ResultsNine assessment tools met inclusion criteria. Two hospital care tools developed by WHO-Europe and WHO-South-East Asia Offices had the most consistency with the WHO Standards, assessing 291 (57·1%) and 208 (40·8%) of the 510 quality measures, respectively. Remaining tools included between 33 (6·5%) and 206 (40·4%) of the 510 quality measures. The WHO-Europe tool was the only tool to assess all 40 quality statements. The most common quality measures absent were related to experience of care, particularly provision of educational, emotional and psychosocial support to children and families, and fulfilment of children’s rights during care.ConclusionQuality of care assessment tools for children in health facilities are missing some key elements highlighted by the WHO Standards. The WHO Standards are, however, extensive and applying all the quality measures in every setting may not be feasible. A consensus of key indicators to monitor the WHO Standards is required. Existing tools could be modified to include priority indicators to strengthen progress reporting towards delivering quality health services for children. In doing so, a balance between comprehensiveness and practical utility is needed.PROSPERO registration numberCRD42020175652.
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Lynch-Godrei, Anisha, Megan Doherty, and Christina Vadeboncoeur. "interRAI Pediatric Home Care (PEDS-HC) Assessment Tool: Evaluating Ontario Healthcare Workers’ Experience." Health Services Insights 15 (January 2022): 117863292210781. http://dx.doi.org/10.1177/11786329221078124.
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High quality pediatric homecare requires comprehensive assessment of the needs, supports, and health care challenges of children with special healthcare needs and their families. There is no standardized homecare assessment system to evaluate children’s clinical needs in the home (support services, equipment, etc.) in Ontario, Canada, which contributes to inequitable homecare service allocation. In 2017, the interRAI Pediatric Home Care assessment tool (PEDS-HC) was implemented on a pilot basis in several regions of Ontario. This qualitative descriptive study explores the experiences of homecare coordinators using the PEDS-HC, seeking to understand the utility and feasibility of this tool through focus group discussion. Four major themes were identified including: the benefits of the tool; areas for modification; challenges to use; and Clinical Assessment Protocols to develop. These themes can guide modifications to the tool to improve utility and improve pediatric home care services. The PEDS-HC is an effective tool to assess children needing homecare in a standardized and comprehensive manner. Use of the tool can improve the quality of homecare services by ensuring equity in service provision and facilitate early identification of clinical issues to prevent unexpected health deteriorations.
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Díaz-Fabregat, Beatriz, Wilmer Ramírez-Carmona, Eliane Cristina Gava Pizi, Juliane Avansini Marsicano, and Rosana Leal do Prado. "Quality of Primary Health Care models for brazilian children." Research, Society and Development 10, no. 8 (July 16, 2021): e48610817584. http://dx.doi.org/10.33448/rsd-v10i8.17584.
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Aim. To evaluate the quality of Primary Health Care (PHC) models for Brazilian children. Methods. A cross-sectional study was performed with 516 parents or guardian of children in the public preschools from a city in São Paulo State, Brazil. The participants completed the questionnaires on the perception of the quality of the PHC (Primary Care Assessment Tool-PCATool), and the socioeconomic conditions in their families. The data were analyzed by statistical tests (95% confidence level). Results. Private services, Family Health Strategies (FHS), and Conventional Health Care (CHC) were the modalities of PHC used by children. Among the three modalities, in all groups were observed statistically significant differences (p<0.001), the best quality of care was provided by FHS (8.22±1.69). The CHC (5.69±1.34) and the private service (6.65±0.99) need improvement in accessibility, continuity of care, integrality, family, and community orientation. The socioeconomic class of the families was associated with modalities of PHC (p<0.001). Conclusions. The quality of primary care for children in the public health system still requires much improvement, primarily in conventional model. However, the Family Health Strategies was the model that presented the best quality of primary health care for children.
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Evans, Anna, Mary Beth Vingelen, Candy Yu, Jennifer Baird, Paula Murray, and Pamela Bryant. "Nausea in Numbers: Electronic Medical Record Nausea and Vomiting Assessment for Children With Cancer." Journal of Pediatric Oncology Nursing 37, no. 3 (January 29, 2020): 195–203. http://dx.doi.org/10.1177/1043454219900467.
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Purpose: Chemotherapy-induced nausea and vomiting (CINV) is a distressing, underrecognized effect of treatment that can occur in up to 80% of patients. The purpose of this quality improvement project was to evaluate the impact of implementation of a standardized nausea assessment tool, the Baxter Animated Retching Faces (BARF) scale, on nursing compliance with nausea assessment and the frequency and severity of patient-reported CINV for children with cancer. Method: The Plan-Do-Study-Act cycle was used to implement this practice change. With stakeholder support and hospital governance council approval, the BARF scale was introduced into the electronic medical record. Nurses were provided education about the assessment tool and were given badge buddy cards to prompt use of the tool, and workstation reminders were created. A root cause analysis was conducted to provide feedback for continuous quality improvement. Results: Retrospective, aggregate electronic medical record data from May 2018 to April 2019 were analyzed for assessment compliance, total number of admissions with vomiting episodes, and average BARF score. Over the 12-month implementation period, run charts demonstrated a shift in nursing practice with increased compliance in documented nausea assessments during the second 6-month period. There was not a significant decrease in patient-reported CINV. Conclusion: The use of standardized nausea assessments based on patient self-reporting can provide useful and consistent feedback for nurses and health care providers. This quality improvement project demonstrated increased compliance with nausea assessment documentation. Further studies are needed to demonstrate that improvements in nausea assessment may reduce the frequency and severity of CINV.
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Sathenahalli, Veeraraja B., G. R. Rajashekar Murthy, Netra Gouda, and Sanjay K. Shivanna. "Assessment of quality of life in transfusion dependent thalassemic children - need to address parents/care givers." International Journal of Contemporary Pediatrics 8, no. 1 (December 23, 2020): 147. http://dx.doi.org/10.18203/2349-3291.ijcp20205522.
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Background: Thalassemia is an autosomal recessive congenital disease caused by the reduced or absent beta globin chain synthesis of hemoglobin tetramer. The degree of imbalance between alpha and non alpha globin chains determines the severity of clinical manifestations. The disabling nature of the disease and chronic therapy affects the normal life causing psychosocial burden. Overall patient’s life, such as education, free-time, physical activities, skills, capabilities, and family adjustment is affected. The effects of which often result in psychological, emotional and social compromise. Health-Related Quality of Life (HRQoL) measurement is a multidimensional concept that focuses on the impact of the disease and its treatment on the well being of an individual.Methods: A descriptive observational hospital based study was conducted over a period of 3 months. Transfusion dependency in thalassemic children aged between 5 years and 18 years was the inclusion criteria. Thalassemic children having debilitating illnesses unrelated to thalassemia were excluded. Quality of life was assessed using Pediatric Quality of Life Inventory (PedsQL™ 4.0)4. The tool assesses the quality of life in five domains: physical functioning (PF: 8 items), psychosocial functioning (sum of emotional, social and school functioning), emotional functioning (EF: 5 items), social functioning (SF: 5 items) and school functioning (SC: 5 items).Results: Total of 125 children were enrolled with a mean age of 9.4±4.6 years (age range 5-18 yrs). According to the PedsQL questionnaire, the quality of life was similarly assessed by both parents and children. The total mean QoL score of the parents was 72.36±11.47 and of the children was 77.63±14.17. Emotional, school and psycho-social function were significantly affected according to both child and parents without statistical significance.Conclusions: Thalassaemia patients and their parents require lifelong psychological support for prevention of mental health issues. By increasing the awareness and knowledge levels of the parents, we can help sick children in developing countries to get the best care locally and to thus improve HRQoL.
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Daftary, Rajesh Kirit, Brittany Lee Murray, and Teri Ann Reynolds. "Development of a simple, practice-based tool to assess quality of paediatric emergency care delivery in resource-limited settings: identifying critical actions via a Delphi study." BMJ Open 8, no. 8 (August 2018): e021123. http://dx.doi.org/10.1136/bmjopen-2017-021123.
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ObjectiveProvision of timely, high-quality care for the initial management of critically ill children in African hospitals remains a challenge. Monitoring the completion of critical actions during resuscitations can inform efforts to reduce variability and improve outcomes. We sought to develop a practice-based tool based on contextually relevant actions identified via a Delphi process. Our goal was to develop a tool that could identify gaps in care, facilitate identification of training and standardised assessment to support quality improvement efforts.DesignSix sentinel conditions were selected based on disease epidemiology and mortality at rural and urban African emergency departments. Potential critical actions were identified through focused literature review. These actions were evaluated within a three-round modified Delphi process. A set of logistical filters was applied to the candidate list to derive a practice-based tool.Setting and participantsAttendees at an international emergency medicine conference comprised an expert panel of 25 participants, with 84% working primarily in African settings. Consensus rounds allowing novel responses were conducted via online and in-person surveys.ResultsThe expert panel generated 199 actions that apply to six conditions in emergently ill children. Application of appropriateness criteria refined this to 92 candidate actions across the following seven categories: core skills, active seizure, altered mental status, diarrhoeal illness, febrile illness, respiratory distress and polytrauma. From these, we identified 28 actions for inclusion in a practice-based tool contextually relevant to the initial management of critically ill children in Africa.ConclusionsA group consensus process identified critical actions for severely ill children with select sentinel conditions in emergency paediatric care in an African setting. Absence of these actions during resuscitation might reflect modifiable gaps in quality of care. The resulting practice-based tool is context relevant and can serve as a foundation for training and quality improvement efforts in African hospitals and emergency departments.
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Abadeh, Aryan, Carolina de Carvalho Ligocki, Kuan Chung Wang, Thomasin Adams-Webber, Victor S. Blanchette, and Andrea S. Doria. "A Systematic Review of Ultrasound Imaging As a Tool for Evaluating Hemophilic Arthropathy in Children and Adults." Blood 126, no. 23 (December 3, 2015): 4464. http://dx.doi.org/10.1182/blood.v126.23.4464.4464.
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Abstract PURPOSE: To semi-quantitatively assess the evidence on the value of ultrasound (US) for assessment of hemophilic arthropathy (HA) in children and adults. We sought to provide the answer to the following questions: (1) Are currently available US techniques accurate for early diagnosis of pathological findings? (2) Can treatment reduce the incidence of US-detectable findings in HA? (3) Do US scores correlate with clinical/radiological constructs in the evaluation of HA? (4) Are US findings associated with functional status of joints? METHODS: Articles were screened using MEDLINE (n= 519), EMBASE (n= 493), and the Cochrane Library (n=24) (1946-2015). Two independent reviewers assessed the reporting quality and the methodological quality of articles by using the Standards for Reporting of Diagnostic Accuracy (STARD) and the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tools respectively. 4 different US scanning protocols for assessment of hemophilic joints were compared based on scanning times and anatomical landmarks. 6 US scoring systems were also compared according to number of soft-tissue and osteochondral parameters evaluated. RESULTS: Out of 16 full-text articles, 9 diagnostic accuracy studies (417 patients with hemophilia A, B and von Willebrand's disease) were evaluated for reporting and methodological quality using STARD and QUADAS-2 assessment tools respectively. Seven studies were of moderate reporting quality and 2 of low reporting quality. When using QUADAS-2, 1 study was of high, 3 of moderate, 2 of low, and 3 of very low methodological quality. Out of 9 diagnostic accuracy studies, 1 evaluated HA in ankles, knees, elbows, and shoulders while 3 evaluated ankles, knees, and elbows and only 2 evaluated ankles and knees. 2 more studies focused solely on knees and 1 on shoulders. Six US interpretation scores were reviewed and compared. All 6 articles included synovial hypertrophy in their evaluation. 5 articles incorporated cartilage modification while only 2 articles assessed hemosiderin deposition in their evaluation. Among these 6 scores, 4 were of moderate reporting quality, 1 of low and 1 of very low reporting quality. When using QUADAS-2 however, only 1 study was of high, 1 of moderate, 2 of of low, and 2 of very low methodological quality. Four US scanning protocols were also assessed, all evaluated the joints in both prone and supine positions. 3 suggested an extended scanning procedure of up to 30 minutes per joint, while 1 proposed a more simplified procedure. Two scanning protocols evaluated knees and ankles, while one focused on elbows. Only one scanning protocol included ankles, knees, and elbows in its assessment. CONCLUSIONS: There is insufficient evidence (Grade I) to recommend US as an accurate technique for early diagnosis of pathologic findings, to demonstrate that US scores correlate with clinical/radiological constructs, that treatment can reduce the incidence of US-detectable findings in HA, and to prove an association between US findings and the functional status of the joint. Further studies are required to establish standardized US scanning protocols and scoring systems and to determine US as a valuable tool for early diagnosis of hemophilic arthropathy (HA) in children and adults. ACKNOWLEDGEMENTS: This work was funded by Novo Nordisk Health Care AG. Disclosures Abadeh: Novo Nordisk Health Care AG: Other: Funding. Blanchette:Bayer Healthcare: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Octapharma: Other: Data Safety Monitoring Board; Novo Nordisk: Honoraria, Membership on an entity's Board of Directors or advisory committees; Baxter Corporation: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Data Safety Monitoring Board, Research Funding. Doria:Novo Nordisk Health Care AG: Other: Funding.
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Petersson, Christina, Karin Åkesson, Karina Huus, Karin Enskär, and Marie Golsäter. "To promote child involvement - healthcare professionals’ use of a health-related quality of life assessment tool during paediatric encounters." European Journal for Person Centered Healthcare 5, no. 1 (May 23, 2017): 26. http://dx.doi.org/10.5750/ejpch.v5i1.1201.
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Background, aims and objectives: Children and healthcare professionals should be provided with easy-to-use tools which could lead to actionable results. There is increasing interest in the use of patient-reported outcomes to aid management of individual care; therefore the use of health-related quality of life (HRQOL) assessments during consultations need to be studied. The aim of this study was to explore how healthcare professionals use a HRQOL assessment tool during paediatric encounters. Methods: A descriptive, explorative design with a qualitative approach based on video-recordings was chosen. Twenty-one video recordings, from 9 different healthcare professionals’ consultations where an assessment tool of HRQOL were used, were analysed by content analysis. Results: The healthcare professionals were using different strategies and when they combined these strategies 3 approaches emerged. The instructing approach was characterized by healthcare professionals giving a summary of the results, leading to children becoming passive bystanders in the encounter. An inviting approach, requesting the children’s perceptions of their situation resulted in the children becoming involved in the conversations. Conclusions: The child’s involvement could be facilitated depending on which approach was being used. When an inviting and engaging approach is used, actions in a non-linear set of interactions was co-produced with the child. The use of an HRQOL assessment tool changed the management during consultations and acted to promote child involvement.
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Semple, D., M. M. Howlett, J. D. Strawbridge, C. V. Breatnach, and J. C. Hayden. "A Systematic Review and Pooled Prevalence of Paediatric Delirium in Critically Ill Children." International Journal of Pharmacy Practice 29, Supplement_1 (March 26, 2021): i31—i32. http://dx.doi.org/10.1093/ijpp/riab015.038.
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Abstract Introduction Paediatric Delirium (PD) is a neuropsychiatric complication that occurs during the management of children in the critical care environment (Paediatric Intensive Care (PICU) and Neonatal Intensive Care (NICU). Delirium can be classified as hypoactive (decreased responsiveness and withdrawal), hyperactive (agitation and restlessness), and mixed (combined) (1). PD can be assessed using a number of assessment tools. PD has been historically underdiagnosed or misdiagnosed, having many overlapping symptoms with other syndrome such as pain and iatrogenic withdrawal syndrome (2). An appreciation of the extent of PD would help clinicians and policy makers drive interventions to improve recognition, prevention and management of PD in clinical practice. Aim To estimate the pooled prevalence of PD using validated assessment tools, and to identify risk factors including patient-related, critical-care related and pharmacological factors. Methods A systematic search of PubMed, EMBASE and CINAHL databases was undertaken. Eligible articles included observational studies or trials that estimated a prevalence of PD in a NICU/PICU population using a validated PD assessment tool. Validated tools are the paediatric Confusion Assessment Method-ICU (pCAM-ICU), the Cornell Assessment of Pediatric Delirium (CAPD), the PreSchool Confusion Assessment Method for the ICU (psCAM-ICU), pCAM-ICU severity scale (sspCAM-ICU), and the Sophia Observation Withdrawal Symptoms scale Paediatric Delirium scale (SOS-PD) (1). Only full text studies were included. No language restrictions were applied. Two reviewers independently screened records. Data was extracted using a pre-piloted form and independently verified by another reviewer. Quality was assessed using tools from the National Institutes of Health. A pooled prevalence was calculated from the studies that estimated PD prevalence using the most commonly applied tool, the CAPD (1). Results Data from 23 observational studies describing prevalence and risk factors for PD in critically ill children were included (Figure 1). Variability in study design and outcome reporting was found. Study quality was generally good. Using the validated tools prevalence ranged from 10–66% of patients. Hypoactive delirium was the most prevalent sub-class identified. Using the 13 studies that used the CAPD tool, a pooled prevalence of 35% (27%-43% 95%CI) was calculated. Younger ages, particularly less than two years old, sicker patients, particularly those undergoing mechanical and respiratory ventilatory support were more at risk for PD. Restraints, the number of sedative medications, including the cumulative use of benzodiazepines and opioids were identified as risk factors for the development of PD. PD was associated with longer durations of mechanical ventilation, longer stays and increased costs. Data on association with increased mortality risk is limited and conflicting. Conclusion PD affects one third of critical care admissions and is resource intense. Routine assessment in clinical practice may facilitate earlier detection and management strategies. Modifiable risk factors such as the class and number of sedative and analgesic medications used may contribute to the development of PD. Early mobility and lessening use of these medications present strategies to prevent PD occurrence. Longitudinal prospective multi-institutional studies to further investigate the presentations of the different delirium subtypes and modifiable risk factors that potentially contribute to the development of PD, are required. References 1. Semple D (2020) A systematic review and pooled prevalence of PD, including identification of the risk factors for the development of delirium in critically ill children. doi: 10.17605/OSF.IO/5KFZ8 2. Ista E, te Beest H, van Rosmalen J, de Hoog M, Tibboel D, van Beusekom B, et al. Sophia Observation withdrawal Symptoms-Paediatric Delirium scale: A tool for early screening of delirium in the PICU. Australian Critical Care. 2018;31(5):266–73
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Lazzerini, Marzia, Humphrey Wanzira, Peter Lochoro, Richard Muyinda, Giulia Segafredo, Henry Wamani, and Giovanni Putoto. "Supportive supervision to improve the quality and outcome of outpatient care among malnourished children: a cluster randomised trial in Arua district, Uganda." BMJ Global Health 4, no. 4 (July 2019): e001339. http://dx.doi.org/10.1136/bmjgh-2018-001339.
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IntroductionSuboptimal quality of paediatric care has been reported in resource-limited settings, but little evidence exists on interventions to improve it in such settings. This study aimed at testing supportive supervision (SS) for improving health status of malnourished children, quality of case management, overall quality of care, and the absolute number of children enrolled in the nutritional services.MethodsThis was a cluster randomised trial conducted in Arua district. Six health centres (HCs) with the highest volume of work were randomised to either SS or no intervention. SS was delivered by to HCs staff (phase 1), and later extended to community health workers (CHWs) (phase 2). The primary outcome was the cure rate, measured at children level. Quality of case management was assessed by six pre-defined indicators. Quality of care was assessed using the national Nutrition Service Delivery Assessment (NSDA) tool. Access to care was estimated with the number of children accessing HC nutritional services.ResultsOverall, 737 children were enrolled. In the intervention arm, the cure rate (83.8% vs 44.9%, risk ratio (RR)=1.91, 95% CI: 1.56–2.34, p=0.001), quality of care as scored by NSDA (RR=1.57, 95% CI: 1.01–2.44, p=0.035) and correctness in complementary treatment (RR=1.52, 95% CI: 1.40–1.67, p=0.001) were significantly higher compared with control. With the extension of SS to CHWs (phase 2), there was a significant 38.6% more children accessing care in the intervention HCs (RR=1.26, 95% CI: 1.11–1.44, p=0.001) compared with control.ConclusionSS significantly improved the cure rate of malnourished children, and the overall quality of care, SS to CHWs significantly increased the crude number of children enrolled in the nutritional services. More studies should confirm these results, and evaluate the cost-effectiveness of SS.
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Lazzerini, Marzia, Kajal Chhaganlal, Augusto Cesar Macome, and Giovanni Putoto. "Nutritional services for children in Beira, Mozambique: a study reporting on participatory use of data to generate quality improvement recommendations." BMJ Open Quality 8, no. 4 (October 2019): e000758. http://dx.doi.org/10.1136/bmjoq-2019-000758.
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BackgroundExisting literature suggest frequent gaps in the quality of care (QoC) provided to children with malnutrition in low-income and middle-income countries. Beira is the second largest city in Mozambique. This study included two phases: phase 1 was a systematic assessment of the QoC provided to malnourished children in Beira; phase 2 aimed at using findings of the assessment to develop recommendations, with a participatory approach, to improve QoC.MethodsIn phase 1, all facilities offering nutritional care to children in Beira were included, and exit health outcomes were reviewed against international SPHERE standards. A sample of four (66%) facilities was randomly selected for a comprehensive assessment of all areas contributing to QoC using an adapted WHO tool. In phase 2, key stakeholders were identified, and using a participatory approach, a list of actions for improving the QoC for malnourished children was agreed.ResultsIn phase 1, outcomes of 1428 children with either severe acute malnutrition or moderate acute malnutrition (MAM) were reviewed. In-hospital recovery rate (70.1%) was almost in line with the SPHERE standard (75%), while at outpatient level, it was significantly lower (48.2%, risk ratio (RR) 0.68, p<0.0001). Recovery rate was significantly lower in HIV seropositive compared with seronegative (39.2% vs 52.8%, RR 1.34, p=0.005). High heterogeneity in MAM recovery rate was detected among facilities (range 32.5%–61.0%). Overall, out of all domains contributing to QoC in the sample, 28/46 (60.8%) indicated suboptimal care with significant health hazards and 13/46 (28.2%) indicated totally inadequate care with severe health hazards. In phase 2, a list of 38 actions to improve QoC for malnourished children was agreed among 33 local and national stakeholders.ConclusionsLarge heterogeneity in QoC for malnourished children in Beria was detected. The study documents a concrete example of using data proactively, for agreeing actions to improve QoC.
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Bergman, David A. "Thriving in the 21st Century: Outcome Assessment, Practice Parameters, and Accountability." Pediatrics 96, no. 4 (October 1, 1995): 831–35. http://dx.doi.org/10.1542/peds.96.4.831.
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The past two decades have brought about major health care changes that have been driven by an ever-increasing cost of health care, practice variability, and medical malpractice litigation. These changes pose a challenge to pediatricians to contain costs, to reduce inappropriate use of health care services, and to demonstrate improved health care outcomes. To meet this challenge, a new "clinical tool kit" is required, one that will allow the pediatrician to analyze current practices and to document effective interventions. Two of the major tools in this kit are practice guidelines and outcomes assessment instruments. Practice guidelines are optimal care specifications that provide an analytic framework for defining high-quality care and measuring health care outcomes. Ideally, these guidelines should be developed from scientific evidence. In practice, however, scientific evidence to support the majority of recommendations made in guidelines is insufficient. Consequently, these recommendations are instead developed by expert consensus. Measurement of health outcomes includes clinical outcomes, patient satisfaction, cost and use, and quality of life. Health care organizations have become very sophisticated in measuring cost and use, but considerably less work has been done in the patient-centered areas of satisfaction and quality of life. This is particularly true for children, because measures are dependent on the viewpoint chosen (parent, child, or teacher), the age of the child, and the adjustment for severity of illness. Analyzing practice patterns and improving health outcomes will not be easy tasks to accomplish. For the pediatrician to use these tools in an efficient and effective manner, a new research agenda and new skills will be required.
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Chatziparasidis, Grigorios, Sotirios Fouzas, and Ahmad Kantar. "Childhood chronic cough made easy: a simplified approach for the primary care setting." Allergologia et Immunopathologia 49, no. 2 (March 1, 2021): 170–77. http://dx.doi.org/10.15586/aei.v49i2.38.
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Cough is a defense mechanism, but when it becomes persistent and troublesome, it must be carefully assessed. Chronic cough, that is, cough persisting for more than 4 weeks, has a proven negative impact on a child’s quality of life; it interferes with daily activities, sleep, and schooling and may involve frequent health care visits and long-lasting treatments. Currently, there is a plethora of algorithms in the literature aiming to assist in the assessment of chronic cough in children; however, referring to complex flowcharts may be impractical for the usually busy primary care physician. Herein, we provide a simplified tool for the assessment of children with chronic cough in the primary care setting, presenting a basic approach to the most common causes along with hints to avoid common pitfalls in everyday practice. Finally, the most common clinical scenarios are analyzed, aiming to assist primary care physicians in providing the appropriate care to these patients.
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Ireys, Henry T., and Jamie J. Perry. "Development and Evaluation of a Satisfaction Scale for Parents of Children With Special Health Care Needs." Pediatrics 104, Supplement_6 (November 1, 1999): 1182–91. http://dx.doi.org/10.1542/peds.104.s6.1182.
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Objective. This article describes the development and evaluation of the Multidimensional Assessment of Parental Satisfaction (MAPS) for Children With Special Needs, a tool for measuring satisfaction with providers at the individual level of care. Methods. Two studies were conducted. The first study created and pilot-tested the scale, using data from 158 parents of children with 4 selected chronic conditions to calculate estimates of reliability and validity. Initial psychometric characteristics were sufficiently strong to warrant further testing. The second study was a field trial of the 12-item MAPS, using data from 302 parents of children with diverse chronic conditions. Results. Reliability estimates were >.85. The scale's discriminative validity was supported by sharp distinctions between satisfaction ratings for different types of providers. Correlations in the .80s with general satisfaction items indicated strong concurrent validity. Factor analysis revealed a single factor. Conclusions. The MAPS has psychometric integrity. Assessing satisfaction for children with special health care needs is a complex, necessary part of a comprehensive assessment of quality of care.
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McKinnon, Krista, and Jennifer Jupp. "Integration of a nausea and vomiting assessment tool into antineoplastic management of pediatric oncology patients." Journal of Oncology Pharmacy Practice 26, no. 6 (December 22, 2019): 1353–60. http://dx.doi.org/10.1177/1078155219892666.
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Background Antineoplastic-induced nausea and vomiting (AINV) is a treatment-related issue that can have significant negative influences on the cancer patient’s quality of life. Assessment of nausea is challenging in children as few studies include the perception of nausea as an outcome, and the severity is rarely evaluated with the use of a validated instrument. We describe our experience of integrating an AINV tool into patient care at the Alberta Children’s Hospital. Procedure: The Pediatric Nausea Assessment Tool (PeNAT) was adapted to create a standardized tool that could be used by the clinical pharmacists for AINV assessment. From February to August 2017, 74 patients receiving 217 cycles of highly or moderately emetogenic chemotherapy (HEC or MEC) were eligible to use the AINV tool. Patients that completed the AINV tool were contacted to complete a satisfaction survey. Results AINV tool uptake was low: 47 (22%) eligible chemotherapy cycles utilized the tool (24 (32%) and 23 (16%) cycles of HEC and MEC, respectively, ( p < 0.01)). Ifosfamide-containing cycles received the highest nausea ratings, with nausea severity correlated with agent emetogenicity. Mean nausea rating was 2.07 versus 1.76 for patients receiving HEC or MEC, respectively. Clinical pharmacists performed 1.24 AINV interventions per day. Patient satisfaction with AINV care overall was high; however, 51% of patients indicated that the tool led to no changes in nausea symptoms. Conclusions AINV tool uptake was low with limited value in improving outcomes. Incorporation of nausea assessment into the electronic health record and potential use of a mobile application may improve uptake.
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Ferrer, Ana Paula Scoleze, and Sandra Josefina Ferraz Ellero Grisi. "Assessment of access to primary health care among children and adolescents hospitalized due to avoidable conditions." Revista da Associação Médica Brasileira 62, no. 6 (September 2016): 513–23. http://dx.doi.org/10.1590/1806-9282.62.06.513.
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Introduction: Hospitalizations for ambulatory care-sensitive conditions (HACSC) are considered an indicator of the effectiveness of primary health care (PHC). High rates of HACSC represent problems in the access or the quality of health care. In Brazil, HACSC rates are high and there are few studies on the factors associated with it. Objective: To evaluate the access to PHC offered to children and adolescents hospitalized due to ACSC and analyze the conditioning factors. Method: Cross-sectional study with a quantitative and qualitative approach. Five hundred and one (501) users (guardians/caregivers) and 42 professionals of PHC units were interviewed over one year. Quantitative data were obtained using Primary Care Assessment Tool validated in Brazil (PCATool-Brazil), while qualitative data were collected by semi-structured interview. The independent variables were: age, maternal education, family income, type of diagnosis, and model of care offered, and the dependent variables were access and its components (accessibility and use of services). Results: Sixty-five percent (65.2%) of hospitalizations were ACSC. From the perspective of both users and professionals, access and its components presented low scores. Age, type of diagnosis, and model of care affected the results. Conclusion: The proportion of HACSC was high in this population. Access to services is inappropriate due to: barriers to access, appreciation of the emergency services, and attitude towards health needs. Professional attitudes and opinions reinforce inadequate ideas of users reflecting on the pattern of service use.
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Williams, Bethany D., Susan B. Sisson, Emily L. Stinner, Hope N. Hetrick, Marny Dunlap, Jennifer Graef-Downard, Kathrin Eliot, Karla Finnell, and Alicia L. Salvatore. "Quality of Nutrition Environments, Menus and Foods Served, and Food Program Achievement in Oklahoma Family Child Care Homes." Nutrients 13, no. 12 (December 15, 2021): 4483. http://dx.doi.org/10.3390/nu13124483.
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Child care environments foster children’s healthy eating habits by providing exposure to healthy foods and feeding practices. We assessed the healthfulness of nutrition environments, menu/meal quality, and the achievement of Child and Adult Care Food Program (CACFP) guidelines and best practices in Oklahoma CACFP-enrolled family child care homes (FCCHs) (n = 51). Two-day classroom observations were conducted. Healthfulness of classroom nutrition environments was assessed using the Environment and Policy Assessment and Observation (EPAO). Foods served to and consumed by children were quantified using the Dietary Observations in Child Care (DOCC) tool. Nutrient analysis was performed to determine total energy for foods listed on menus, served to, and consumed by children. Menu and meal food variety and CACFP Guideline Achievement Scores were determined. Average nutrition environment score was 11.7 ± 1.2 (61.5% of maximum possible score). Energy (kcals) from menus and consumed by children was insufficient to meet two-thirds of their daily reference intake. Children were exposed to 1.7 vegetables and 1.3 fruits per meal. CACFP Guideline Achievement Scores were 66.3% ± 7.8 for menus and 59.3% ± 7.6 for mealtimes. Similar to previous research, our findings indicate a need for improved FCCH nutrition practices. Tailored interventions for FCCHs are needed.
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McLaughlin, Paul, Melanie Bladen, Mike Holland, and Kate Khair. "Joint assessment in haemophilia – current physiotherapist practice in the UK." Journal of Haemophilia Practice 1, no. 3 (October 1, 2014): 9–13. http://dx.doi.org/10.17225/jhp.00029.
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Abstract Aim: UK guidelines recommend regular assessment of joint status in children with haemophilia using a standardised tool performed by haemophilia physiotherapists. We surveyed UK physiotherapists working in haemophilia care regarding their current practice with respect to joint scoring. Methods: A survey was posted on SurveyMonkey and all haemophilia physiotherapists practising in the UK were invited to respond. Responses were analysed and discussed at a roundtable meeting attended by invited physiotherapists and specialist haemophilia nurses. Results: In all, responses were received from 29 of the estimated 37 physiotherapists in the UK who see haemophilia patients. Both the survey and subsequent discussion reflected agreement that joint scoring offers a valuable tool to clinicians, but that better ways of assessing joint health were needed. There was enthusiasm for combining joint scoring with systematic and validated patient-reported outcome measures. Conclusion: Greater understanding is needed of the relationship between joint scores and measures of physical function and quality of life.
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Alamri, Hamdan, Falah R. Alshammari, Abdullah Bin Rahmah, and Marwan Aljohani. "Quality of Clinical Guidelines on Oral Care for Children with Special Healthcare Needs: A Systematic Review." International Journal of Environmental Research and Public Health 20, no. 3 (January 17, 2023): 1686. http://dx.doi.org/10.3390/ijerph20031686.
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Robust evidence-based guidelines are important in everyday clinical practice, especially when delivering and managing oral care needs to a vulnerable group such as children with special healthcare needs (SHCNs). Methods: To assess the quality of guidelines on the management of oral care for children with special healthcare needs (SHCNs) and to find appropriate guidelines, an electronic search of MEDLINE Ovid was carried out alongside an additional search of common guideline websites. The AGREE II tool was used to assess the quality of the guidelines. Assessment was undertaken independently by three assessors. Furthermore, the underlying evidence used to formulate recommendations in the identified guidelines was qualitatively assessed. Results: There were nine guidelines, with 41 recommendations, that met the eligibility criteria. The quality of the guidelines was generally found to be poor. Only one guideline was assessed as “recommended” by the assessors, based on the quality of the methods, the reporting, or both. Only 2 of the 41 sets of recommendations, made across the nine guidelines, were judged to be valid and based on a rigorous systematic review of the evidence. Conclusions: The current state of guidelines on oral care management for children with special healthcare needs (SHCNs) is, on the whole, of very low quality. The scientific community should work together to enhance the quality and strength of the current clinical guidelines and to ensure that they are trustworthy prior to implementation.
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Cassady, Charlyn E., Barbara Starfield, Margarita P. Hurtado, Ronald A. Berk, Joy P. Nanda, and Lori A. Friedenberg. "Measuring Consumer Experiences With Primary Care." Pediatrics 105, Supplement_3 (April 1, 2000): 998–1003. http://dx.doi.org/10.1542/peds.105.s3.998.
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Objective. To assess the adequacy of the Primary Care Assessment Tool-Child Edition (PCAT-CE) for evaluating the attainment of the key characteristics of primary care services for children and youth. Design. Community-based telephone survey. Setting. Specific political subdivision in Washington, DC. Participants. Four hundred fifty parents/guardians of offspring 18 years of age or less. Measures. Reliability, validity and principal component analysis of 5 scales representing key aspects of the 4 cardinal domains of primary care included in the PCAT-CE. In addition, 2 subdomains (first contact use and extent of affiliation with a primary care source) were included as indices to describe overall patterns of use and affiliation with the particular source of care. Results. Most scales had adequate internal consistency, test-retest reliability, and construct validity. The principal components factor analysis yielded 5 separate factors. These corresponded to the subdomains of first contact accessibility; coordination of care; characteristics of the professional-patient relationship over-time; and comprehensiveness (both services available and indicated services received). Conclusions. Psychometric assessment supported the integrity and general adequacy of the PCAT-CE for assessing the characteristics and quality of primary care for children and youth. Testing of revised versions in a variety of different settings is underway. A major component of this testing is to explore the possibility of reducing the number of items while retaining sufficient detail about each component of primary care to make judgements about people's experiences with that care.
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Reeves, Patrick, Scott Penney, Kristen Aileen Romanelli, Donald Rees, Philip Rogers, and Susan L. Whiteway. "Development and Assessment of a Low Literacy, Pictographic Nausea Action Plan." Blood 138, Supplement 1 (November 5, 2021): 2978. http://dx.doi.org/10.1182/blood-2021-145935.
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Abstract Objective Chemotherapy-induced nausea and vomiting (CINV) is characterized by disabling nausea and emesis that can recur throughout the treatment of cancer and affects approximately 59% of pediatric and young adult patients. CINV can be associated with significant clinical morbidity, frequent hospital admissions, negative effects on health care related quality-of-life and can exhibit downstream effects such as weight loss that can worsen overall outcomes. Despite the vast number and potential combinations of pharmacotherapies and lifestyle modifications available to manage CINV in children, there are currently no clinical action tools offered to manage this condition better at home. We aimed to develop and assess an evidence-based, personalized pictogram-based nausea action plan (NAP) to aid providers, parents, and patients in the management of CINV. Methods The USNAP (Figure 1) facilitates the management of CINV by using a health literacy-informed approach to provide instructions for pharmacotherapies and lifestyle modifications. This study included Part 1 (Pictogram Validation) and Part 2 (Assessment). For Part 1, Pictogram transparency, translucency, and recall were assessed by parent survey with transparency ≥85%, mean translucency score ≥5, recall ≥85% required for validation. For Part 2, the USNAP was assessed by parents, clinical librarians, and clinicians. Patient/caregiver perceptions (n=27) were assessed using the Consumer Information Rating Form (17 questions) to gauge comprehension, design quality and usefulness. Readability was assessed by 5 formulas and a Readability Consensus Score was calculated. Clinical Librarians (n=2) used the Patient Education Materials Assessment Tool to measure the understandability (19 questions) and actionability (7 questions) of the plan and audiovisual educational content (>80% acceptable.) Suitability was assessed by clinicians (n=16) using Doaks' Suitability Assessment of Materials (superior≥70% rating). Results All 15 pictograms demonstrated appropriate transparency, translucency, and recall. Patient/caregiver perceptions reflected appropriate comprehension, design quality, and usefulness. The Readability Composite Score measured at a fourth-grade level. Clinical librarians reported acceptable understandability and actionability. Clinicians reported superior suitability. Conclusion The Uniformed Services Nausea Action Plan (USNAP) is the first clinical action tool designed to assist in managing CINV at home. Although recent clinical practice updates provide guidance on the therapeutic management of CINV in pediatric and young adult patients with cancer, these recommendations do not fully address the needs of the patient at home or adequately inform in instances of low health literacy. The USNAP seeks to mitigate this by making the clinical practice guidance useful to patients and caregivers at home. In addition, the USNAP is poised to identify other urgent clinical developments for patients with cancer that could masquerade as nausea and may serve as an early warning sign in these instances. The USNAP met all criteria for clinical implementation. The USNAP has potential to become an important tool in the care of patients with CINV, improving both quality-of-care and clinical outcomes. Future study of USNAP implementation for treating children with chronic CINV is needed. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.
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Guimarães, Alessandro Fernandes, Davi Vilela de Carvalho, Nathália Ádila A. Machado, Regiane Aparecida N. Baptista, and Stela Maris A. Lemos. "Risk of developmental delay of children aged between two and 24 months and its association with the quality of family stimulus." Revista Paulista de Pediatria 31, no. 4 (December 2013): 452–58. http://dx.doi.org/10.1590/s0103-05822013000400006.
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OBJECTIVE: To analyze the association between neurodevelopment and the family environment resources of children from the coverage area of a Basic Health Unit (BHU) of Belo Horizonte, Brazil, using a tool based on the Integrated Management of Childhood Illness (IMCI) strategy. METHODS: Cross-sectional study with a non-probabilistic sample involving 298 children aged between 2-24 months old, who attended a BHU in 2010. The assessment of child development and family resources made at the BHU lasted, in average, 45 minutes and included two tests - an adaptation of the Handbook for Monitoring Child Development in the Context of IMCI and an adapted version of the Family Environment Resource (FER) inventary. The nonparametric tests of Kruskal-Wallis and Mann-Whitney were used for the statistical analysis. RESULTS: The sample included 291 assessments, with 18.2% of children between 18 and 24 months old, 53.6% male gender, and 91.4% who did not attend day care centers. According to IMCI, 31.7% of the children were in the risk group for developmental delay. The total average score in FER was 38.0 points. Although it has been found an association between the IMCI outcome and the total FER score, all groups had low scores in the family environment assessment. CONCLUSIONS: The data indicate the need for childhood development screening in the primary health care and for early intervention programs aimed at this age group.
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Suh, Eugene, Erika D. Owen, Jennifer Reichek, Betty Roggenkamp, Julia Rachel Trosman, Tara O. Henderson, Nupur Mittal, et al. "“Getting to Know You and Your Child” screening questionnaire: Results from a Chicago pediatric collaborative." Journal of Clinical Oncology 36, no. 30_suppl (October 20, 2018): 163. http://dx.doi.org/10.1200/jco.2018.36.30_suppl.163.
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163 Background: In 2012, a congressional symposium identified the need for services to address psychosocial issues of children with cancer. In 2013, the Institute of Medicine recommended supportive oncology services be initiated at cancer diagnosis. Chicago providers of pediatric cancer are collaborating to improve care for children with cancer and their families focusing on psychosocial stressors and quality of life. Methods: The collaborative conducted a structured review of tools: Psychosocial Assessment Tool (PAT), Social Work Assessment Tool (SWAT), National Comprehensive Cancer Network (NCCN) Problem List, and √IN; with input from providers on stressors throughout the care continuum. The resulting screening tool was created and piloted in English and Spanish at 7 pediatric cancer hospitals. Social workers (SW) informally reported assessment of its usefulness. Results: Parents (n = 85) completed “Getting to Know You and Your Child” screening tool which inquired about caregivers, siblings, child’s interests, school, SSI/SNAP, challenges, and cultural/religious preferences. Providers reported families found the tool useful “to think about support needs.” The tool assessed 12 psychosocial stressors; the mean per patient/family was 2.4 (range 0-11). Most frequent stressors included: lack of support from friends, family, community (29%), paying for food (26%), job flexibility (26%), paying for utilities (25%), medical costs (23%), emotional support for family (22%), school concerns (21%). All who reported temporary residence also reported difficulty paying for housing (p < 0.01). Ten SWs reported this screening tool generated new insight into family structures, identified stressors and informed resolution efforts. Provider recommended adjustments to the screening tool: simplify terms for siblings, hobbies and spiritual, add pet question. Conclusions: Pilot testing of a psychosocial screening tool for pediatric and adolescent oncology informed providers of patient/family needs in a standard manner. Six of the seven pilot sites are implementing this tool as a standard practice. Preliminary data suggests patients and providers find the screener easy to use and informative.
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Zimmerman, Kathrin, Bobby May, Katherine Barnes, Anastasia Arynchyna, Elizabeth N. Alford, Gustavo Chagoya, Caroline Arata Wessinger, et al. "Hydrocephalus-related quality of life as assessed by children and their caregivers." Journal of Neurosurgery: Pediatrics 26, no. 4 (October 2020): 353–63. http://dx.doi.org/10.3171/2020.4.peds19660.
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OBJECTIVEHydrocephalus is a chronic medical condition that has a significant impact on children and their caregivers. The objective of this study was to measure the quality of life (QOL) of children with hydrocephalus, as assessed by both caregivers and patients.METHODSPediatric patients with hydrocephalus and their caregivers were enrolled during routine neurosurgery clinic visits. The Hydrocephalus Outcomes Questionnaire (HOQ), a report of hydrocephalus-related QOL, was administered to both children with hydrocephalus (self-report) and their caregivers (proxy report about the child). Patients with hydrocephalus also completed measures of anxiety, depression, fatigue, traumatic stress, and headache. Caregivers completed a proxy report of child traumatic stress and a measure of caregiver burden. Demographic information was collected from administration of the Psychosocial Assessment Tool (version 2.0) and from the medical record. Child and caregiver HOQ scores were analyzed and correlated with clinical, demographic, and psychological variables.RESULTSThe mean overall HOQ score (parent assessment of child QOL) was 0.68. HOQ Physical Health, Social-Emotional Health, and Cognitive Health subscore averages were 0.69, 0.73, and 0.54, respectively. The mean overall child self-assessment (cHOQ) score was 0.77, with cHOQ Physical Health, Social-Emotional Health, and Cognitive Health subscore means of 0.84, 0.79, and 0.66, respectively. Thirty-nine dyads were analyzed, in which both a child with hydrocephalus and his or her caregiver completed the cHOQ and HOQ. There was a positive correlation between parent and child scores (p < 0.004 for all subscores). Child scores were consistently higher than parent scores. Variables that showed association with caregiver-assessed QOL in at least one domain included child age, etiology of hydrocephalus, and history of endoscopic third ventriculostomy. There was a significant negative relationship (rho −0.48 to −0.60) between child-reported cHOQ score and child-reported measures of posttraumatic stress, anxiety, depression, and fatigue. There was a similar significant relationship between caregiver report of child’s QOL (HOQ) and caregiver assessment of the child’s posttraumatic stress symptoms as well as their assessment of burden of care (rho = −0.59 and rho = −0.51, respectively). No relationship between parent-reported HOQ and child-reported psychosocial factors was significant. No clinical or demographic variables were associated with child self-assessed cHOQ.CONCLUSIONSPediatric patients with hydrocephalus consistently rate their own QOL higher than their caregivers do. Psychological factors such as anxiety and posttraumatic stress may be associated with lower QOL. These findings warrant further exploration.
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Dahlen, Sara, Dean Connolly, Isra Arif, Muhammad Hyder Junejo, Susan Bewley, and Catherine Meads. "International clinical practice guidelines for gender minority/trans people: systematic review and quality assessment." BMJ Open 11, no. 4 (April 2021): e048943. http://dx.doi.org/10.1136/bmjopen-2021-048943.
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ObjectivesTo identify and critically appraise published clinical practice guidelines (CPGs) regarding healthcare of gender minority/trans people.DesignSystematic review and quality appraisal using AGREE II (Appraisal of Guidelines for Research and Evaluation tool), including stakeholder domain prioritisation.SettingSix databases and six CPG websites were searched, and international key opinion leaders approached.ParticipantsCPGs relating to adults and/or children who are gender minority/trans with no exclusions due to comorbidities, except differences in sex development.InterventionAny health-related intervention connected to the care of gender minority/trans people.Main outcome measuresNumber and quality of international CPGs addressing the health of gender minority/trans people, information on estimated changes in mortality or quality of life (QoL), consistency of recommended interventions across CPGs, and appraisal of key messages for patients.ResultsTwelve international CPGs address gender minority/trans people’s healthcare as complete (n=5), partial (n=4) or marginal (n=3) focus of guidance. The quality scores have a wide range and heterogeneity whichever AGREE II domain is prioritised. Five higher-quality CPGs focus on HIV and other blood-borne infections (overall assessment scores 69%–94%). Six lower-quality CPGs concern transition-specific interventions (overall assessment scores 11%–56%). None deal with primary care, mental health or longer-term medical issues. Sparse information on estimated changes in mortality and QoL is conflicting. Consistency between CPGs could not be examined due to unclear recommendations within the World Professional Association for Transgender Health Standards of Care Version 7 and a lack of overlap between other CPGs. None provide key messages for patients.ConclusionsA paucity of high-quality guidance for gender minority/trans people exists, largely limited to HIV and transition, but not wider aspects of healthcare, mortality or QoL. Reference to AGREE II, use of systematic reviews, independent external review, stakeholder participation and patient facing material might improve future CPG quality.PROSPERO registration numberCRD42019154361.
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Corrick, Fenella, Sharon Conroy, Helen Sammons, and Imti Choonara. "Paediatric Rational Prescribing: A Systematic Review of Assessment Tools." International Journal of Environmental Research and Public Health 17, no. 5 (February 25, 2020): 1473. http://dx.doi.org/10.3390/ijerph17051473.
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Rational prescribing criteria have been well established in adult medicine for both research and quality improvement in the appropriate use of medicines. Paediatric rational prescribing has not been as widely investigated. The aims of this review were to identify and provide an overview of all paediatric rational prescribing tools that have been developed for use in paediatric settings. A systematic literature search was made of MEDLINE, Embase, CINAHL and IPA from their earliest records until July 2019 for all published paediatric rational prescribing tools. The characteristics of the tools were recorded including method of development, types of criteria, aspects of rational prescribing assessed, and intended practice setting. The search identified three paediatric rational prescribing tools: the POPI (Pediatrics: Omissions of Prescriptions and Inappropriate Prescriptions) tool, the modified POPI (UK) tool, and indicators of potentially inappropriate prescribing in children (PIPc). PIPc comprises explicit criteria, whereas POPI and the modified POPI (UK) use a mixed approach. PIPc is designed for use in primary care in the UK and Ireland, POPI is designed for use in all paediatric practice settings and is based on French practice standards, and the modified POPI (UK) is based on UK practice standards and is designed for use in all paediatric practice settings. This review describes three paediatric rational prescribing tools and details their characteristics. This will provide readers with information for the use of the tools in quality improvement or research and support further work in the field of paediatric rational prescribing.
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Silva, Kenya de Lima, Yolanda Dora Martinez Évora, and Camila Santana Justo Cintra. "Software development to support decision making in the selection of nursing diagnoses and interventions for children and adolescents." Revista Latino-Americana de Enfermagem 23, no. 5 (October 2015): 927–35. http://dx.doi.org/10.1590/0104-1169.0302.2633.
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Objective: to report the development of a software to support decision-making for the selection of nursing diagnoses and interventions for children and adolescents, based on the nomenclature of nursing diagnoses, outcomes and interventions of a university hospital in Paraiba.Method: a methodological applied study based on software engineering, as proposed by Pressman, developed in three cycles, namely: flow chart construction, development of the navigation interface, and construction of functional expressions and programming development.Result: the software consists of administrative and nursing process screens. The assessment is automatically selected according to age group, the nursing diagnoses are suggested by the system after information is inserted, and can be indicated by the nurse. The interventions for the chosen diagnosis are selected by structuring the care plan.Conclusion: the development of this tool used to document the nursing actions will contribute to decision-making and quality of care.
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Ryan, Paul M., Michael Zahradnik, Kristin J. Konnyu, Tamara Rader, Michael Halasy, Rayzel Shulman, Noah Ivers, Colin P. Hawkes, and Jeremy M. Grimshaw. "Effectiveness of quality improvement strategies for type 1 diabetes in children and adolescents: a systematic review protocol." HRB Open Research 4 (August 10, 2021): 87. http://dx.doi.org/10.12688/hrbopenres.13223.1.
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Introduction: Optimal glycaemic control is often a challenge in children and adolescents with type 1 diabetes (T1D). Implementation of patient, clinician or organisation-targeted quality improvement (QI) strategies has been proven to be beneficial in terms of improving glycaemic outcomes in adults living with diabetes. This review aims to assess the effectiveness of such QI interventions in improving glycaemic control, care delivery, and screening rates in children and adolescents with T1D. Methods and analysis: MEDLINE, EMBASE, CINAHL and Cochrane CENTRAL databases will be searched for relevant studies up to January 2021. Trial registries, ClinicalTrials.gov and ICTRP, will also be explored for any ongoing trials of relevance. We will include trials which examine QI strategies as defined by a modified version of the Cochrane Effective Practice and Organisation of Care 2015 Taxonomy in children (<18 years) with a diagnosis of T1D. The primary outcome to be assessed is glycated haemoglobin (HbA1c), although a range of secondary outcomes relating to clinical management, adverse events, healthcare engagement, screening rates and psychosocial parameters will also be assessed. Our primary intention is to generate a best-evidence narrative to summarise and synthesise the resulting studies. If a group of studies are deemed to be highly similar, then a meta-analysis using a random effects model will be considered. Cochrane Risk of Bias 1.0 tool will be applied for quality assessment. All screening, data extraction and quality assessment will be performed by two independent researchers. Dissemination: The results of this review will be disseminated through peer-reviewed publication in order to inform invested partners (e.g., Paediatric Endocrinologists) on the potential of QI strategies to improve glycaemic management and other related health outcomes in children with T1D, thereby guiding best practices in the outpatient management of the disorder. PROSPERO registration number: CRD42021233974 (28/02/2021).
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Brisendine, Anne E., Elizabeth L. Blunck, Cathy Caldwell, Stacey Neumann, Elizabeth Taylor, Julie Preskitt, and Matthew Fifolt. "Creating a Virtual Meeting Platform Via Online Survey Tool: Leveraging Community Engagement Technology in the Early Days of COVID-19." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 60 (January 2023): 004695802211468. http://dx.doi.org/10.1177/00469580221146831.
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At the outset of the COVID-19 pandemic, Alabama’s Title V Children and Youth with Special Health Care Needs (CYSHCN) team was forced to innovate in order to gather community input and to prioritize the findings of the 2020 Title V Maternal and Child Health Five-Year Comprehensive Needs Assessment. On a shortened timeline, the team pivoted from a full-day, in-person meeting of professionals and family representatives to an asynchronous, online “meeting” that included all planned and necessary content, allowed for comment by community members, and resulted in a prioritized list of needs. This needs assessment process showed that by using a platform like the online survey tool, Qualtrics, in an innovative way, programs can capture broader, more diverse perspectives without sacrificing quality of communication, content, or feedback. It shows the possibility for strengthening maternal and child health (MCH) systems and other systems of care though rich engagement. This model can be easily replicated in other survey tools, benefiting other states that are faced with difficulties convening geographically dispersed professionals and communities.
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Hajek, André, Benedikt Kretzler, and Hans-Helmut König. "Informal Caregiving, Loneliness and Social Isolation: A Systematic Review." International Journal of Environmental Research and Public Health 18, no. 22 (November 18, 2021): 12101. http://dx.doi.org/10.3390/ijerph182212101.
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Background: Several empirical studies have shown an association between informal caregiving for adults and loneliness or social isolation. Nevertheless, a systematic review is lacking synthesizing studies which have investigated these aforementioned associations. Therefore, our purpose was to give an overview of the existing evidence from observational studies. Materials and Methods: Three electronic databases (Medline, PsycINFO, CINAHL) were searched in June 2021. Observational studies investigating the association between informal caregiving for adults and loneliness or social isolation were included. In contrast, studies examining grandchild care or private care for chronically ill children were excluded. Data extractions covered study design, assessment of informal caregiving, loneliness and social isolation, the characteristics of the sample, the analytical approach and key findings. Study quality was assessed based on the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Each step (study selection, data extraction and evaluation of study quality) was conducted by two reviewers. Results: In sum, twelve studies were included in our review (seven cross-sectional studies and five longitudinal studies)—all included studies were either from North America or Europe. The studies mainly showed an association between providing informal care and higher loneliness levels. The overall study quality was fair to good. Conclusion: Our systematic review mainly identified associations between providing informal care and higher loneliness levels. This is of great importance in assisting informal caregivers in avoiding loneliness, since it is associated with subsequent morbidity and mortality. Moreover, high loneliness levels of informal caregivers may have adverse consequences for informal care recipients.
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Sato, Hiroko, Aya Goto, Michio Murakami, and Yasuhiro Kawabata. "Development of a Pediatric Dermatology Screening Tool Based on Two Parent-Reported Skin Symptoms: Comparison of Parental Recognition and Physician Diagnosis of Skin Symptoms of Infants and Toddlers." Journal of Primary Care & Community Health 11 (January 2020): 215013272097488. http://dx.doi.org/10.1177/2150132720974883.
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Aim The objective of the present study was to develop a tool for mothers to assess their children’s skin condition with the ultimate goal of its wider use in general health checkups for infants and toddlers. Methods This was a single-institution, cross-sectional study in Japan, targeting parents of 200 infants and toddlers who visited a dermatology clinic between December 2018 and March 2019. The parents completed a self-administered survey of the mother’s perception of her child’s dermatological symptoms, itchiness, and sleep status, and a quality-oflife assessment, using a nine-question version of the Quality of life in Primary Caregivers of children with Atopic Dermatitis questionnaire (QP9). The attending physician was asked to complete a form about the child’s dermatological condition and the treatment prescribed. The severity of the dermatological condition noted by the physician was compared with the combined response to the 3 perception items (dermatological condition, itchiness, and sleep) reported by the parents, in order to identify the optimal cutoff score. Results Of 200 parent questionnaires distributed, 198 (99% response rate) were returned and analyzed, along with the responses from 198 physician records (100% response rate). The optimal cutoff score was 2/3 for the total score (range 0-6) for 2 items, itchiness and sleep status (sensitivity 73%, specificity 64%). There was a significant difference in QP9 scores between the 2 groups categorized by the cutoff score Conclusions A pediatric dermatological screening tool based on 2 symptoms reported by the parents of children with atopic dermatitis was developed, and its precision and criterion-related validity were confirmed. This simple tool could help parents become better aware of their children’s skin condition and allow healthcare workers to provide adequate skin care advice. This practical tool could be widely applicable in primary child care and public health service settings.
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Bewley, Susan, Sara Dahlen, Dean Connolly, Isra Arif, Muhammad Junejo, and Meads Catherine. "International Clinical Practice Guidelines for Gender Minority/Trans People: Systematic Review & Quality Assessment. How Does the Endocrine Society Fare?" Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A791. http://dx.doi.org/10.1210/jendso/bvab048.1609.
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Abstract Aim: High quality care depends on evidence being used in clinical practice guidelines (CPGs) & processes to create recommendations. This study identified & critically appraised published international CPGs regarding health care of gender minority/ trans people. Methods: Prospectively registered systematic review(1); searched 6 databases & 6 CPG websites & approached international key opinion leaders; quality assessment using AGREE II, Appraisal of Guidelines for Research & Evaluation tool(2); & stakeholder domain prioritization. CPGs relating to gender minority/ trans adults &/or children were included, with any health-related intervention connected to their care & no exclusions for comorbidities except differences in sex development. Outcome measures: number & quality of relevant international CPGs, information on estimated changes in mortality or quality of life (QoL), recommendation consistency across CPGs & appraisal of key messages for patients. Results: A 2017 Endocrine Society Guideline(3) was one of 12 international CPGs found. Five higher-quality CPGs focused on HIV & other blood-borne infections (overall assessment scores 69-94%). Six lower-quality CPGs concerned transition-specific interventions (overall assessment scores 11-56%). None dealt with primary care, mental health, or longer-term medical issues. Sparse information on estimated changes in mortality & QoL was conflicting. None provided key messages for patients. Endocrine Society was ranked 6th by overall assessment score (56%), the highest of CPGs addressing transition-related care. Domain scores were; scope & purpose 65%, stakeholder involvement 40%, rigour of development 41%, clarity & presentation 73%, applicability 29%, editorial independence 65%. Conclusion: Future iterations of the Endocrine Society CPG might be strengthened by referencing AGREE II, greater use of systematic reviews, considering applicability, independent external review, encouraging stakeholder participation & producing patient facing material. Lack of primary research into gender minority/trans health was noted & ought to be addressed. References: 1. PROSPERO CRD42019154361, 2. AGREE Next Steps Consortium (2017) The AGREE II Instrument [Electronic version]. http://www.agreetrust.org, 3. Hembree WC, Cohen-Kettenis PT, Gooren L, et al (2017) Endocrine treatment of gender-dysphoric/ gender-incongruent persons: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 102:3869-3903
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Kaladze, Nikolay N., and A. Yuschenko. "PECULIARITIES OF LIFE QUALITY IN KIDS WITH DEFECT OF INTERVENTRICULAR SEPTUM." Tavricheskiy Mediko-Biologicheskiy Vestnik 23, no. 1 (October 18, 2022): 111–16. http://dx.doi.org/10.29039/2070-8092-2020-23-1-111-116.
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A ventricular septal defect is the most common congenital heart disease. With the improvement of cardiac surgery, the survival rates of children with heart disease have improved. In addition to clinical and hemodynamic improvement, an important task is to study the perception of the quality of life of children with an interventricular septal defect. The purpose of the study is to compare the quality of life of children with a ventricular septal defect. Materials and methods of the study: a survey was conducted of children with ventricular septal defect 3-17 years old (median age 9 years (Q1-Q3 - 5-12 years), as well as their parents using the Russian-language version of the international tool Pediatric Quality of Life Inventory (PEDsQL) 3.0 Cardiac Module used to assess the quality of life of children with diseases of the cardiovascular system. Results: the quality of life on the “heart problems” scale in children operated on for an interventricular septal defect was significantly lower than in children without surgical defect correction. In patients with FC | and || (n = 14) according to NYHA and Ross, the quality of life was statistically significantly lower on the scales “heart problems”, “anxiety associated with treatment”, “learning problems” than in patients with FC 0 (p <0.05). The quality of life of children with a body mass index below the norm on the “heart problems” scale was significantly lower than in children with a body mass index higher and within the norm (p <0.05). Conclusions: the quality of life of children with a ventricular septal defect may be impaired. Nevertheless, children without operational correction, with normal and above normal levels of physical development, in the absence of heart failure, better perceive the quality of life. In order to provide high-quality care, in addition to a thorough clinical assessment, quality of life should be an important aspect of the comprehensive treatment of heart disease
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Propp, Roni, Peter Gill, Sherna Marcus, Lily Yuxi Ren, Eyal Cohen, Jeremy Friedman, and Sanjay Mahant. "109 Effectiveness of Neuromuscular Electrical Stimulation for Children with Dysphagia: A Systematic Review." Paediatrics & Child Health 26, Supplement_1 (October 1, 2021): e78-e79. http://dx.doi.org/10.1093/pch/pxab061.089.
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Abstract Primary Subject area Complex Care Background Dysphagia is common in children with medical complexity and can result in undernutrition, respiratory complications and negatively impact child and caregiver quality of life; however, evidence on the effectiveness of treatments for dysphagia in children is limited. Neuromuscular electrical stimulation (NMES) is a novel proposed treatment for dysphagia where electrical current is applied to neck muscles using cutaneous electrodes during swallowing therapy. It is hypothesized that NMES improves dysphagia by strengthening swallowing muscles and/or enhancing sensory signals of the swallowing response. Objectives To systematically review the evidence on the effectiveness of NMES for treatment of oropharyngeal dysphagia in children. Design/Methods MEDLINE, EMBASE, PsycINFO, CINAHL, CENTRAL and Scopus databases were searched from inception to November 2020. Studies of children (18 years and younger) diagnosed with oropharyngeal dysphagia using NMES in the throat/neck region were included. Screening, data extraction, and risk of bias assessment followed PRISMA guidelines. Risk of bias was assessed using the Cochrane Collaboration’s tool for RCTs and the Newcastle-Ottawa tool for observational studies. [Registration: PROSPERO CRD42019147353] Results Of the 844 records screened, 26 were identified for full text review, and 8 studies were included (4 RCTs and 4 cohort studies). These studies represented 338 children, with a mean (or median) age below 7 years, including children with and without neurological impairments. In all studies, swallowing function as measured by imaging studies improved after NMES treatment; in the trials, the standardized mean difference ranged from 0.32 (95% CI -0.56, 1.20) to 1.18 (95% CI 0.40, 1.97) compared to control groups who received usual care without NMES. Seven of eight studies reported on the child’s feeding ability, and, with one exception, there was improvement in feeding ability (Figure 1). Few studies reported on health status (N=1), child’s quality of life (N=1), and adverse events and harms (N=1). No studies reported on the social impact on the child, impact on the caregiver, and the caregiver’s quality of life. In most studies, outcome follow-up was limited to less than 6 months. Overall, the studies demonstrated moderate to high risk of bias. A pooled intervention effect and meta-analysis was not conducted due to clinical heterogeneity. Conclusion NMES treatment may be beneficial in improving swallowing function for children with dysphagia, however, given the quality of the studies, inadequate outcome reporting, and short follow-up duration, additional well-designed RCTs are needed to establish its effectiveness.
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Dorscheidt, Jozef H. H. M., and Irma M. Hein. "Medical Research Involving Children – Giving Weight to Children’s Views." International Journal of Children’s Rights 26, no. 1 (March 7, 2018): 93–116. http://dx.doi.org/10.1163/15718182-02601006.
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The quality of health care for children depends much on the availability of relevant results from medical research with children as subjects. Yet, because of their vulnerability and assumed incompetence to take part in decision-making, children have often been excluded from taking part in medical research, so as to prevent them from harm. Empirical data on children’s competence to consent to such research used to be rare, but recent developments in this field have created more insights in the myths and realities concerning minor patients’ capacities to decide on medical research participation. Against the background of relevant international, European and domestic legal frameworks concerning the rights of children as participants in medical research, this article goes into instruments such as MacCAT-CR, a semi-structured interview format useable as a competence assessment tool for clinical research involving children. On the basis of this, several recommendations are defined to enhance such research, as these may do sufficient justice to the health interests and the capacities of children, while at the same time supporting researchers and child research participants when facing decisions about pediatric research options.
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Oo, Nwe Nwe Linn, David Chee Chin Ng, Truls Ostbye, John Carson Allen, Pratibha Keshav Agarwal, Sita Padmini Yeleswarapu, Shu-Ling Chong, Xiaoxuan Guo, and Yoke Hwee Chan. "Novel two-tiered developmental screening programme for Singaporean toddlers: a quality improvement report." BMJ Open Quality 10, no. 4 (October 2021): e001327. http://dx.doi.org/10.1136/bmjoq-2020-001327.
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Early identification of developmental delays with timely intervention, especially before the age of 3 years, can improve child development. In Singapore, however, diagnosis and intervention for developmental delays occur at a median age of 44 months. As early detection and intervention depends on an effective developmental screening programme, we aimed to improve the detection of developmental delays before the age of 3 years in a primary care setting. We did this by implementing a novel two-tiered screening programme which uses three standardised screening tools (Parents’ Evaluation of Developmental Status, PEDS-Developmental Milestones and Ages and Stages Questionnaire-3). We used quality improvement methods to integrate and optimise this two-tiered programme into the existing 9-month and 18-month screening schedule, with an additional screening at 30 months to replace the pre-existing 36-month screening of the National Child Health Surveillance Programme. A total of three Plan–Do–Study–Act cycles were performed to ensure programme feasibility and sustainability. They focused on adequately training the primary care nurses, targeting an 80% screening rate and aiming for 20 min screening tool administration time per child. We assessed the proportion of children referred to the child development units after positive screening for developmental concerns under the new programme, with a pre–post and with–without intervention comparison, and reviewed the screening rates and screening tool administration time. The proportion of 18-month old children referred for developmental concerns improved from 3.5%–7.1% over a 6-month period. For those who received further assessment by developmental specialists after the two-tiered screening, 100% received a definitive diagnosis of developmental delays, similar to the situation before programme introduction. Our quality improvement efforts facilitated successful integration of the two-tiered programme into the pre-existing screening schedule with minimal impact to the clinic workflow. While we highlight challenges in implementation that need to be addressed, our findings support a potential nationwide adoption of the two-tiered programme.
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Frerichs, Wiebke, Wiebke Geertz, Lene Marie Johannsen, Laura Inhestern, and Corinna Bergelt. "Child- and family-specific communication skills trainings for healthcare professionals caring for families with parental cancer: A systematic review." PLOS ONE 17, no. 11 (November 9, 2022): e0277225. http://dx.doi.org/10.1371/journal.pone.0277225.
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Introduction As part of high-quality cancer care, healthcare professionals (HCPs) play a significant role in identifying and addressing specific needs of cancer patients parenting minor children. However, HCPs experience various barriers to adequately support parents with cancer. This systematic review explores current CSTs incorporating child- and family- specific modules for HCPs in oncology. Moreover, outcome measures and effectiveness of trainings are systematically investigated. Methods The systematic review was registered within PROSPERO (registration code: CRD42020139783). Systematic searches were performed in four databases (PubMed, Cinahl, PsycInfo, Web of Science) in 12/2020, including an update in 12/2021 and 08/2022. Quantitative, primary studies fulfilling the pre-defined inclusion criteria were included. Due to the expected heterogeneity a meta-analysis was not conducted. Study selection and quality assessment were conducted by two independent researchers, data extraction by one. Study quality was assessed using an adapted version of the National Institutes of Health quality assessment tool for pre-post studies without control group. Results Nine studies were included in this review following an experimental pre-post design only. Two CSTs were specifically designed to improve communication with cancer patients parenting minor children, the remaining seven incorporated a brief family module only. Seven programs were face-to-face trainings, one an e-learning and one a webinar. Eight studies found at least one statistically significant improvement in communication after training. However, quality of most studies was fair. Conclusion This is the first review exploring specific CSTs for HCPs caring for cancer patients parenting minor children. As only two CSTs focused on parental cancer, evidence on the effectiveness of such CSTs is limited. Existing CSTs should be evaluated properly and include details on content of family modules. Further studies including and evaluating specific CSTs focusing on parental cancer are needed in order to strengthen HCPs’ competencies to meet specific needs of patients parenting minor children.
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Reeves, Patrick T., Ashley C. Packett, Carolyn Sullivan Burklow, Sofia Echelmeyer, and Noelle S. Larson. "Development and assessment of a low-health-literacy, pictographic adrenal insufficiency action plan." Journal of Pediatric Endocrinology and Metabolism 35, no. 2 (September 30, 2021): 205–15. http://dx.doi.org/10.1515/jpem-2021-0541.
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Abstract Objectives Adrenal insufficiency (AI) is an overall rare disorder characterized by the chronic need for pharmacotherapy to prevent threat to life. The Pediatric Endocrine Society has recommended the use of clinical action tools to improve patient education and help guide acute management of AI. We aimed to develop and assess an easy-to-use, patient-friendly, evidence-based, personalized pictogram-based adrenal insufficiency action plan (AIAP) to aid in the management of AI in children. Methods Patients/caregivers (P/Cs) responded to surveys which measured the concepts of transparency, translucency, and recall in order to assess the pictograms. Readability was assessed using six formulas to generate a composite readability score. Quality was graded by P/Cs using the Consumer Information Rating Form (CIRF) (>80% rating considered acceptable). Understandability and actionability was assessed by medical librarians using the Patient Education Materials Assessment Tool-Printable (PEMAT-P) (>80% rating was acceptable). Suitability was evaluated by clinicians using the Suitability Assessment of Materials (SAM) instrument (>70% rating considered superior). Results All pictograms met criteria for inclusion in the AIAP. Composite readability score=5.4 was consistent with a fifth-grade level. P/Cs (n=120) judged the AIAP to be of high quality with CIRF rating=85.2%. Three medical librarians rated the AIAP to have 100% understandability and 100% actionability. Thirty-three clinicians completing the SAM generated a suitability rating of 90.0%. Conclusions The AIAP visually highlights individualized care plan components to facilitate optimized preventative and acute AI care. Further investigation will determine if AIAP improves clinical outcomes for patients with AI.
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Rowland, Andrew, Sarah Cotterill, Calvin Heal, Natalie Garratt, Tony Long, Laura Jayne Bonnett, Stephen Brown, Steve Woby, and Damian Roland. "Observational cohort study with internal and external validation of a predictive tool for identification of children in need of hospital admission from the emergency department: the Paediatric Admission Guidance in the Emergency Department (PAGE) score." BMJ Open 10, no. 12 (December 2020): e043864. http://dx.doi.org/10.1136/bmjopen-2020-043864.
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ObjectivesTo devise an assessment tool to aid discharge and admission decision-making in relation to children and young people in hospital urgent and emergency care facilities, and thereby improve the quality of care that patients receive, using a clinical prediction modelling approach.DesignObservational cohort study with internal and external validation of a predictive tool.SettingTwo general emergency departments (EDs) and an urgent care centre in the North of England.ParticipantsThe eligibility criteria were children and young people 0–16 years of age who attended one of the three hospital sites within one National Health Service (NHS) organisation. Children were excluded if they opted out of the study, were brought to the ED following their death in the community or arrived in cardiac arrest when the heart rate and respiratory rate would be unmeasurable.Main outcome measuresAdmission or discharge. A participant was defined as being admitted to hospital if they left the ED to enter the hospital for further assessment, (including being admitted to an observation and assessment unit or hospital ward), either on first presentation or with the same complaint within 7 days. Those who were not admitted were defined as having been discharged.ResultsThe study collected data on 36 365 participants. 15 328 participants were included in the final analysis cohort (21 045 observations) and 17 710 participants were included in the validation cohort (23 262 observations). There were 14 variables entered into the regression analysis. Of the 13 that remained in the final model, 10 were present in all 500 bootstraps. The resulting Paediatric Admission Guidance in the Emergency Department (PAGE) score demonstrated good internal validity. The C-index (area under the ROC) was 0.779 (95% CI 0.772 to 0.786).ConclusionsFor units without the immediate availability of paediatricians the PAGE score can assist staff to determine risk of admission. Cut-off values will need to be adjusted to local circumstance.Study protocolThe study protocol has been published in an open access journal: Riaz et al Refining and testing the diagnostic accuracy of an assessment tool (Pennine Acute Hospitals NHS Trust-Paediatric Observation Priority Score) to predict admission and discharge of children and young people who attend an ED: protocol for an observational study. BMC Pediatr 18, 303 (2018). https://doi.org/10.1186/s12887-018-1268-7.Trial registration numberThe protocol has been published and the study registered (NIHR RfPB Grant: PB-PG-0815–20034; ClinicalTrials.gov:213469).
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Kremska, Anna. "Analysis of parents’ satisfaction with caring for children hospitalized in a pediatric ward – part 1." Medical Science Pulse 14, SUPPLEMENT 1 (December 31, 2020): 1–7. http://dx.doi.org/10.5604/01.3001.0014.6575.
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Background: The quality of medical services offered is a factor that strongly determines patient satisfaction. Aim of the study: The aim of the study was to evaluate parent’s satisfaction with the care and conditions experienced during their child’s stay in a Pediatric Ward. Material and methods: The study involved 293 parents from two pediatric wards of the Clinical Provincial Hospital No. 2 in Rzeszow. The PASAT PEDIATRIA package was used as a research tool. Results: The functioning of the admission room was good. Parents of children on the Pediatric Ward ranked medical and nursing friendliness the highest (mean = 4.34 and 4.37, respectively), followed by the availability of doctors (mean = 3.97) and the amount of time they devoted to the patient’s family (mean = 3.97). Respondents assessed the ward best in terms of the cleanliness of the room (mean = 4.12) and the possibility of spending free time in an interesting way (mean = 4.07). Conclusions: Parents of children hospitalized in the Pediatric Ward were slightly more satisfied with nursing than medical care. Doctors should make every effort to improve the availability and amount of time devoted to the child’s family. The overall assessment of the conditions in the ward was “fairly good”, indicating the need for monitoring and improvement.
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Mohamed, Ashraf Mahmoud, Christine Marie Bolen, Jennifer Morgan, Patricia Rice, Meredith Speas, and Carolyn Russo. "A quality improvement initiative for reducing morning hypoglycemia in children undergoing treatment for acute lymphoblastic leukemia." Journal of Clinical Oncology 37, no. 27_suppl (September 20, 2019): 240. http://dx.doi.org/10.1200/jco.2019.37.27_suppl.240.
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240 Background: Hypoglycemia has been observed in children receiving Acute Lymphoblastic Leukemia (ALL) therapy. It affects patients’ outcome. The current quality initiative was piloted at two of the St Jude affiliate clinics. Each month about 10% of children with ALL develop hypoglycemia in those two clinics. Methods: Data was collected for the eight months prior to intervention. Root Cause Analysis (RCA) using fish bone diagram, and Pareto chart to find out the most likely causes of hypoglycemia. Prolonged hours of fasting for procedures, giving 6MP at night on empty stomach, seem to further prolong hours of fasting, and lack of awareness of the new 6MP administration guidelines were the top likely causes. Interventions based on RCA: Developed Hypoglycemia educational brochure addressing causes and prevention of hypoglycemia for care givers followed by knowledge assessment tool, in addition two educational sessions for staff. Plan, Do, Study, Act (PDSA) was used to guide implementation. 4 PDSA cycles were done. Results: Combined monthly average number of ALL patients seen in both centers was 43 (range 38-51) patients with monthly average of 94 (range 71-141) blood glucose samples drawn from them. Process Measure 1: % care givers received hypoglycemia education after 1st cycle was 16.3% which increased to 88% after PDSA cycle # 4. Process Measure 2: % of caregivers scored above 75% in the knowledge of morning hypoglycemia after education were 78%. Outcome Measure: At the end of intervention the average monthly patients with hypoglycemia decreased from 9.4% to 7.8% representing 17% reduction. Hypoglycemic episodes dropped from 6% to 4.2%, showing 30% reduction in hypoglycemic episodes. More reduction in hypoglycemic episodes was observed in clinic 1 (68%) compared to 22% reduction in clinic 2. Conclusions: Using quality improvement methodology in implementing hypoglycemia education led to drop in hypoglycemia episodes among children on ALL therapy. Despite using similar approach, yet one of the two clinics showed higher improvement compared to the other. This may reflect the possible impact of local institutional factors on implementation.
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Chan, Adrienne YL, Mengqin Ge, Emily Harrop, Margaret Johnson, Kate Oulton, Simon S. Skene, Ian CK Wong, Liz Jamieson, Richard F. Howard, and Christina Liossi. "Pain assessment tools in paediatric palliative care: A systematic review of psychometric properties and recommendations for clinical practice." Palliative Medicine 36, no. 1 (December 29, 2021): 30–43. http://dx.doi.org/10.1177/02692163211049309.
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Background: Assessing pain in infants, children and young people with life-limiting conditions remains a challenge due to diverse patient conditions, types of pain and often a reduced ability or inability of patients to communicate verbally. Aim: To systematically identify pain assessment tools that are currently used in paediatric palliative care and examine their psychometric properties and feasibility and make recommendations for clinical practice. Design: A systematic literature review and evaluation of psychometric properties of pain assessment tools of original peer-reviewed research published from inception of data sources to April 2021. Data sources: PsycINFO via ProQuest, Web of Science Core, Medline via Ovid, EMBASE, BIOSIS and CINAHL were searched from inception to April 2021. Hand searches of reference lists of included studies and relevant reviews were performed. Results: From 1168 articles identified, 201 papers were selected for full-text assessment. Thirty-four articles met the eligibility criteria and we examined the psychometric properties of 22 pain assessment tools. Overall, the Faces Pain Scale-Revised (FPS-R) had high cross-cultural validity, construct validity (hypothesis testing) and responsiveness; while the Faces, Legs, Activity, Cry and Consolability (FLACC) scale and Paediatric Pain Profile (PPP) had high internal consistency, criterion validity, reliability and responsiveness. The number of studies per psychometric property of each pain assessment tool was limited and the methodological quality of included studies was low. Conclusion: Balancing aspects of feasibility and psychometric properties, the FPS-R is recommended for self-assessment, and the FLACC scale/FLACC Revised and PPP are the recommended observational tools in their respective age groups.
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Hajek, André, Benedikt Kretzler, and Hans-Helmut König. "Informal caregiving for adults, loneliness and social isolation: a study protocol for a systematic review." BMJ Open 11, no. 5 (May 2021): e044902. http://dx.doi.org/10.1136/bmjopen-2020-044902.
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IntroductionSome empirical studies have identified an association between informal caregiving for adults and loneliness or social isolation. However, there is a lack of a review systematically synthesising empirical studies that have examined these associations. Hence, the aim of this systematic review is to provide an overview of evidence from observational studies.Methods and analysisThree electronic databases (Medline, PsycINFO, CINAHL) will be searched (presumably in May 2021), and reference lists of included studies will be searched manually. Cross-sectional and longitudinal observational studies examining the association between informal caregiving for adults and loneliness or social isolation will be included. Studies focusing on grandchildren care or private care for chronically ill children will be excluded. Data extraction will include information related to study design, definition and measurement of informal caregiving, loneliness and social isolation, sample characteristics, statistical analysis and main results. The quality of the studies will be evaluated using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Two reviewers will perform the selection of studies, data extraction and assessment of study quality. Figures and tables will be used to summarise and report results. A narrative summary of the findings will be provided. If data permit, a meta-analysis will be conducted.Ethics and disseminationNo primary data will be collected. Therefore, approval by an ethics committee is not required. We plan to publish our findings in a peer-reviewed journal.PROSPERO registration numberCRD42020193099.
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MacDougall, Terri, Shawna Cunningham, Leeann Whitney, and Monakshi Sawhney. "Improving pediatric experience of pain during vaccinations: a quality improvement project." International Journal of Health Care Quality Assurance 32, no. 6 (July 8, 2019): 1034–40. http://dx.doi.org/10.1108/ijhcqa-07-2018-0185.
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Purpose The purpose of this paper is to share lessons learned from a quality improvement (QI) project that studied pediatric pain assessment scores after implementing additional evidence-based pain mitigation strategies into practice. Most nurses will acknowledge they implement some practices to mitigate pain during injections. Addressing pain during vaccination is important to prevent needle fear, vaccine hesitancy and health care avoidance. The aim of this project was to reduce pain as evidenced by pain scores at the time of vaccination at the North Bay Nurse Practitioner-Led Clinic (NBNPLC). Design/methodology/approach The design for this study was quasi-experimental utilizing descriptive statistics and QI tools. The NBNPLC utilized the model for improvement to test change ideas. A validated observation tool to assess pain during vaccination with the pediatric population (revised Face Legs Activity Cry and Consolability) was used to test changes. The team deliberately planned improvements according to best practice guidelines to optimize use of strategies to mitigate pain during injections. QI tools and leadership skills were utilized to improve the pediatric experience of pain during vaccinations. Parents and clinicians provided qualitative and quantitative feedback to the project. Findings Nurses tested pain assessment tools and agreed to use a validated tool to assess pain during vaccinations. Parents agreed to use of topical anesthetic during vaccinations. Improved pain scores during vaccinations were demonstrated with the use of topical anesthetic. Parents agreed to use of standardized sucrose solution during vaccination. Reduced pain scores were observed with the use of standardized sucrose water. To sustain implementation of the guideline, a nursing documentation form was devised with nurses agreeing to ongoing use of the form. Research limitations/implications This is a QI project that examined the intricacies of moving clinical practice guidelines into clinical practice. The project validates guidelines for pain management during vaccinations. Leaders within clinics who want to improve pediatric pain during vaccinations will find this paper helpful as a guide. Practical implications Pain management in the pediatric population will be touched on in the context of parental expectations of pain. QI tools, lessons learned and suggestions for nurses will be outlined. Leadership plays an influential role in translating practice guidelines into practice. Originality/value This paper outlines how organizational supports were instrumental to give clinicians time to deliberately challenge practice to improve quality of care of children during vaccinations.
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Nyamwaya, Doris K., Samuel M. Thumbi, Philip Bejon, George M. Warimwe, and Jolynne Mokaya. "The global burden of Chikungunya fever among children: A systematic literature review and meta-analysis." PLOS Global Public Health 2, no. 12 (December 21, 2022): e0000914. http://dx.doi.org/10.1371/journal.pgph.0000914.
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Chikungunya fever (CHIKF) is an arboviral illness that was first described in Tanzania (1952). In adults, the disease is characterised by debilitating arthralgia and arthritis that can persist for months, with severe illness including neurological complications observed in the elderly. However, the burden, distribution and clinical features of CHIKF in children are poorly described. We conducted a systematic literature review and meta-analysis to determine the epidemiology of CHIKF in children globally by describing its prevalence, geographical distribution, and clinical manifestations. We searched electronic databases for studies describing the epidemiology of CHIKF in children. We included peer-reviewed primary studies that reported laboratory confirmed CHIKF. We extracted information on study details, sampling approach, study participants, CHIKF positivity, clinical presentation and outcomes of CHIKF in children. The quality of included studies was assessed using Joanna Briggs Institute Critical Appraisal tool for case reports and National Institute of Health quality assessment tool for quantitative studies and case series. Random-effects meta-analysis was used to estimate the pooled prevalence of CHIKF among children by geographical location. We summarised clinical manifestations, laboratory findings, administered treatment and disease outcomes associated with CHIKF in children. We identified 2104 studies, of which 142 and 53 articles that met the inclusion criteria were included in the systematic literature review and meta-analysis, respectively. Most of the selected studies were from Asia (54/142 studies) and the fewest from Europe (5/142 studies). Included studies were commonly conducted during an epidemic season (41.5%) than non-epidemic season (5.1%). Thrombocytopenia was common among infected children and CHIKF severity was more prevalent in children <1 year. Children with undifferentiated fever before CHIKF was diagnosed were treated with antibiotics and/or drugs that managed specific symptoms or provided supportive care. CHIKF is a significant under-recognised and underreported health problem among children globally and development of drugs/vaccines should target young children.
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Bhatti, Muhammad Naveed, Rubab Zohra, Nabila Talat, and Muhammad Ihsan. "Existing perception of Patient safety among health personnel in operating room at CHICH (Children Hospital & Institute of Child Health, Lahore." Professional Medical Journal 28, no. 10 (September 30, 2021): 1413–17. http://dx.doi.org/10.29309/tpmj/2021.28.10.4757.
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Background: Patient Safety is the key concept of every healthcare setup worldwide as it depicts the perception of health care personnel about patient safety and quality of care delivered to patients. The World Health Organization along with other major organizations has taken initiatives to deal with patient safety challenges. Objective: To assess the existing perception of patient safety among health personnel in operating rooms of tertiary care hospital in Pakistan. Study Design: Cross Sectional study. Setting: Children Hospital & Institute of Child Health Lahore. Period: July 2018 to December 2018. Material & Method: Participants were selected through proportionate simple random sampling. The WHO patient safety survey was used to assess perception of patient safety culture. Data was collected after taking consent. The data was entered in SPSS version 25 and analyzed by it. “Composite positive response rate” for the various dimensions were calculated. Reliability was checked by Cronabach alpha which was more than 0.7 (70%). Results: The overall response rate in the study was 100%. Average composite positive response percentage was 65.17% and it varied among different cadres of HCPs ranged from 51% to 88%. The dimensions “Personal attitude to Patient safety” and “Personal influence over safety” showed highest positive response among all cadres (88 % and 67 %) respectively. composite Positive percent response about patient safety culture varied among different cadres of health personnel, nurses showed highest positive response percentage of 71.2%. Conclusion: Safety culture assessment is a useful tool for evaluation of patient safety interventions, measuring organization’s safety culture and raising awareness. WHO patient safety study tool showed the average positive response rate of 65.17% but the dimension “Safety of health care system”, and “Error and patient safety” have least positive response which shifts the focus to organizational conditions that lead to adverse events and patient harm in healthcare organizations. The result also highlighted areas that required improvement, as perceived by health care workers.
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Lindemann, Daniela, Gian Domenico Borasio, Monika Führer, and Maria Wasner. "Visualizing social support in home pediatric palliative care using network maps." Palliative Medicine 34, no. 3 (August 30, 2019): 378–86. http://dx.doi.org/10.1177/0269216319870673.
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Background: Home care of children with life-limiting diseases is extremely challenging for parents/family caregivers and their social environment. In order to gain new insights into the perspective of family caregivers, we employed digital Network Maps for the first time in the field of pediatric palliative care. Aim: To examine whether the use of Network Maps helps to identify and visualize significant members of the social support system and the quality of the relationship, as well as the main areas of life that are experienced as being supportive by each individual. Design: The design was an integrated mixed methods study. Creation of Network Maps was assessed in conjunction with qualitative interviews. In addition, participants gave an oral feedback on the Network Maps themselves. Setting/participants: Parents of patients supported by a Specialized Home Pediatric Palliative Care team were eligible for inclusion. Forty-five parents were enrolled in the study. Results: All mothers and fathers were able to generate their individual Network Map without problems. The composition of the support systems differed greatly, even between members of the same family. Parents named on average 11 supporting actors, mainly family members and health care professionals. Some relationships were perceived as helpful and stressful at the same time. Conclusion: Network Maps appear to be an appropriate tool for the collection, reconstruction, and assessment of the current support situation of parents of dying children. Further studies should examine the usefulness of Network Maps for the understanding of the caregivers’ support needs and for the development of psychosocial interventional strategies by pediatric palliative care teams.
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Wright, Barry, Melissa Barry, Ellen Hughes, Dominic Trépel, Shehzad Ali, Victoria Allgar, Lucy Cottrill, et al. "Clinical effectiveness and cost-effectiveness of parenting interventions for children with severe attachment problems: a systematic review and meta-analysis." Health Technology Assessment 19, no. 52 (July 2015): 1–348. http://dx.doi.org/10.3310/hta19520.
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Background and objectivesServices have variable practices for identifying and providing interventions for ‘severe attachment problems’ (disorganised attachment patterns and attachment disorders). Several government reports have highlighted the need for better parenting interventions in at-risk groups. This report was commissioned to evaluate the clinical effectiveness and cost-effectiveness of parenting interventions for children with severe attachment problems (the main review). One supplementary review explored the evaluation of assessment tools and a second reviewed 10-year outcome data to better inform health economic aspects of the main review.Data sourcesA total of 29 electronic databases were searched with additional mechanisms for identifying a wide pool of references using the Cochrane methodology. Examples of databases searched include PsycINFO (1806 to January week 1, 2012), MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations (1946 to December week 4, 2011) and EMBASE (1974 to week 1, 2012). Searches were carried out between 6 and 12 January 2012.Review methodsPapers identified were screened and data were extracted by two independent reviewers, with disagreements arbitrated by a third independent reviewer. Quality assessment tools were used, including quality assessment of diagnostic accuracy studies – version 2 and the Cochrane risk of bias tool. Meta-analysis of randomised controlled trials (RCTs) of parenting interventions was undertaken. A health economics analysis was conducted.ResultsThe initial search returned 10,167 citations. This yielded 29 RCTs in the main review of parenting interventions to improve attachment patterns, and one involving children with reactive attachment disorder. A meta-analysis of eight studies seeking to improve outcome in at-risk populations showed statistically significant improvement in disorganised attachment. The interventions saw less disorganised attachment at outcome than the control (odds ratio 0.47, 95% confidence interval 0.34 to 0.65;p < 0.00001). Much of this focused around interventions improving maternal sensitivity, with or without video feedback. In our first supplementary review, 35 papers evaluated an attachment assessment tool demonstrating validity or psychometric data. Only five reported test–retest data. Twenty-six studies reported inter-rater reliability, with 24 reporting a level of 0.7 or above. Cronbach’s alphas were reported in 12 studies for the comparative tests (11 with α > 0.7) and four studies for the reference tests (four with α > 0.7). Three carried out concurrent validity comparing the Strange Situation Procedure (SSP) with another assessment tool. These had good sensitivity but poor specificity. The Disturbances of Attachment Interview had good sensitivity and specificity with the research diagnostic criteria (RDC) for attachment disorders. In our supplementary review of 10-year outcomes in cohorts using a baseline reference standard, two studies were found with disorganised attachment at baseline, with one finding raised psychopathology in adolescence. Budget impact analysis of costs was estimated because a decision model could not be justifiably populated. This, alongside other findings, informed research priorities.LimitationsThere are relatively few UK-based clinical trials. A 10-year follow-up, while necessary for our health economists for long-term sequelae, yielded a limited number of papers.ConclusionsMaternal sensitivity interventions show good outcomes in at-risk populations, but require further research with complex children. The SSP and RDC for attachment disorders remain the reference standards for identification until more concurrent and predictive validity research is conducted. A birth cohort with sequential attachment measures and outcomes across different domains is recommended with further, methodologically sound randomised controlled intervention trials. The main area identified for future work was a need for good-quality RCTs in at-risk groups such as those entering foster care or adoption.Study registrationThis study is registered as PROSPERO CRD42011001395.FundingThe National Institute for Health Research Health Technology Assessment programme.
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Mignolli, Ester, Alessia Scialpi, Donatella Valente, Anna Berardi, Giovanni Galeoto, and Marco Tofani. "Sleep Disturbance Scale for Children: Italian Validation in Autism Spectrum Disorder Population." International Journal of Environmental Research and Public Health 19, no. 16 (August 16, 2022): 10163. http://dx.doi.org/10.3390/ijerph191610163.
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Sleep disorders in children with autism spectrum disorders (ASDs) are well-described. However, there is a lack of specific assessment tools to investigate sleep disturbance in this target population. The present investigation reports the Italian validation of the Sleep Disturbance Scale for Children (SDSC) in the ASD population, also investigating the correlation between sleep disorders In both children and parents. Internal consistency and test–retest reliability were investigated using Cronbach’s alpha and intraclass correlation coefficient (ICC), respectively. Concurrent validity was analyzed by comparing the score of the SDSC with the Pittsburgh Sleep Quality Index (PSQI), while the correlation between the SDCS score and the General Sleep Disturbance Scale (GSDS) was used to analyze the correlation between sleep disorders in children and sleep disorders in their parents. In total, 99 children with a diagnosis of ASD participated in the study. Cronbach’s alpha revealed satisfactory value (0.853), as well as reliability (ICC 0.972) and concurrent validity (0.745). Our results also revealed a significant linear correlation between children’s and parents’ sleep disorders (p < 0.05). In conclusion, we found the SDSC to be a useful tool for measuring sleep disorders in ASD children. Our findings offer concrete inputs to achieve adequate pathways for taking care of children with ASDs and their parents.
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Lehr, Anab R., Martha L. McKinney, Serge Gouin, Jean-Guy Blais, MV Pusic, and Francine M. Ducharme. "Development and Pretesting of an Electronic Learning Module to Train Health Care Professionals on the Use of the Pediatric Respiratory Assessment Measure to Assess Acute Asthma Severity." Canadian Respiratory Journal 20, no. 6 (2013): 435–41. http://dx.doi.org/10.1155/2013/148645.
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BACKGROUND: Severity-specific guidelines based on the Pediatric Respiratory Assessment Measure (PRAM), a validated clinical score, reduce pediatric asthma hospitalization rates.OBJECTIVE: To develop, pretest the educational value of and revise an electronic learning module to train health care professionals on the use of the PRAM.METHODS: The respiratory efforts of 32 children with acute asthma were videotaped and pulmonary auscultation was recorded. A pilot module, composed of a tutorial and 18 clinical cases, was developed in French and English. Health care professionals completed the module and provided feedback. The performance of participants, case quality and difficulty, and learning curve were assessed using the Rasch test; quantitative and qualitative feedback served to revise the module.RESULTS: Seventy-two participants (19 physicians, 22 nurses, four respiratory therapists and 27 health care trainees) with a balanced distribution across self-declared expertise (26% beginner, 35% competent and 39% expert) were included. The accuracy of experts was superior to beginners (OR 1.79, 1.15 and 2.79, respectively). Overall performance significantly improved between the first and latter half of cases (P<0.001). Participants assessed the module to be clear (96%), relevant (98%), realistic (94%) and useful (99%) to learn the PRAM. The qualitative/quantitative analysis led to the deletion of three cases, modification of remaining cases to further enhance quality and reordering within three levels of difficulty.DISCUSSION: Using rigorous educational methods, an electronic module was developed to teach health care professionals on use of the PRAM score. Using the back-translation technique, both French and English versions were developed and validated simultaneously. The pilot module comprised a tutorial and three case-scenario sections, and was tested on a target audience of physicians, nurses, respiratory therapists and medical trainees.CONCLUSION: The final electronic learning module met the clarity and quality requirements of a good teaching tool, with a demonstrated learning effect and high appreciation by health care professionals. Available in French and English, it is offered to facilitate implementation of PRAM-based acute pediatric asthma guidelines.