Journal articles on the topic 'Paediatric healthcare design'
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Saad, Rima, Lina Badr Kurdahi, Nuhad Yazbick-Dumit, Christelle Irani, and Samar Muwakkit. "Paediatric oncology providers' perspectives on early integration of paediatric palliative care." International Journal of Palliative Nursing 26, no. 3 (March 2, 2020): 100–109. http://dx.doi.org/10.12968/ijpn.2020.26.3.100.
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Background: Healthcare providers' perceptions of palliative care in children with cancer influence care management, specifically that of its early integration. Thus, it is crucial to understand the perspectives of the providers on early integration of palliative care so that measures to create informed care decisions are based on reconciling their views. Aims: To explore the perceptions of paediatric oncology providers at the Children's Cancer Institute (CCI) in Lebanon regarding the integration of early paediatric palliative care (PPC) in the management of children with cancer. Methods: A qualitative descriptive research design with focus groups was used in a leading paediatric oncology setting. Findings: The thematic analysis yielded four themes: (1) healthcare providers understood palliative care as pain relief and psychological support mainly at the end of life; (2) the timing of integrating PPC is linked to end of life, advanced disease or treatment failure; (3) interdisciplinary collaboration is important for addressing patients' and families' needs effectively; and (4) communication with the child and family is one of the most difficult aspects of integrating PPC. Conclusion: This study demonstrated the perceptions of healthcare providers about early palliative care in paediatric oncology in Lebanon. It also highlighted the importance of interdisciplinary collaboration and effective communication with the child and family for better management of PPC.
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Paulovich, Belinda. "Clinicians as mediators in participatory design research: a communication design study in paediatric healthcare." J. of Design Research 17, no. 1 (2019): 47. http://dx.doi.org/10.1504/jdr.2019.10023871.
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Paulovich, Belinda. "Clinicians as mediators in participatory design research: a communication design study in paediatric healthcare." J. of Design Research 17, no. 1 (2019): 47. http://dx.doi.org/10.1504/jdr.2019.102231.
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Ekberg, Stuart, Anthony Herbert, Kristi Johns, Gabrielle Tarrant, Holly Sansone, Patsy Yates, Susan Danby, and Natalie K. Bradford. "Finding a way with words: Delphi study to develop a discussion prompt list for paediatric palliative care." Palliative Medicine 34, no. 3 (November 22, 2019): 291–99. http://dx.doi.org/10.1177/0269216319888988.
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Background: Effective communication is a cornerstone of quality paediatric palliative care. Families report struggling, however, to know what to discuss, with whom, and when. Although question prompt lists exist for adult palliative care, they do not suit the unique circumstances of paediatric palliative care. Aim: To develop a prompt list suitable for paediatric palliative care. Design: Underpinned by Delphi methodology, a six-phase procedure was adopted: (1) drafting items based on the findings of a literature review, (2) condensing the list of items based on group discussion, (3) refining items based on a survey of expert healthcare professionals, (4) additional refining of items based on another survey of professionals, (5) further refining of items based on cognitive interviews with family members, and (6) final review by healthcare professional and family member groups. Participants: Three participant groups were involved during various phases: (1) members of an Australasian paediatric palliative care national reference group, (2) healthcare professionals associated with a local paediatric palliative care service, and (3) family members who were users of the same local service. Results: Through multi-phase consultation across participant groups, the draft question prompt list was refined progressively to 28 items, split across two booklets to allow end-of-life items to be provided separately, and reconceptualised as a discussion prompt list rather than a question prompt list. Conclusion: By involving representatives of major stakeholder groups, this study has facilitated the design of a prompt list suited to the circumstances of paediatric palliative care. Future research should trial the effectiveness of this resource.
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Falkenstein, Lina, Nathalie Eckel, Simone B. Kadel, Jochem Koenig, David Litaker, and Michael Eichinger. "Service provision and utilisation in German paediatric primary care practices during public health crises: Protocol of the mixed-methods COVID-19 PedCare Study." BMJ Open 12, no. 10 (October 2022): e054054. http://dx.doi.org/10.1136/bmjopen-2021-054054.
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IntroductionPublic health crises such as pandemics can cause serious disruptions to the utilisation and provision of healthcare services with negative effects on morbidity and mortality. Despite the important role of paediatric primary care in maintaining high-quality healthcare services during crises, evidence about service utilisation and provision remains limited especially in Germany. This study, therefore, explores the utilisation and provision of paediatric primary care services during the ongoing COVID-19 pandemic and their barriers and facilitators.Methods and analysisThe study uses a convergent mixed-methods design and comprises online surveys to parents, adolescents and primary care paediatricians (PCPs) and semistructured interviews with parents and PCPs. We recruit parents and adolescents from paediatric primary care practices and PCPs via email using mailing lists of the German Professional Association of Paediatricians and the German Society of Ambulatory Primary Care Paediatrics. The parent and adolescent surveys assess, inter alia, the utilisation of paediatric primary care services and its correlates, aspects of parental and child health as well as socioeconomic characteristics. The PCP survey investigates the provision of paediatric primary care services and its correlates, aspects of PCP health as well as sociodemographic and practice characteristics. The semistructured interviews with parents and PCPs explore several aspects of the online surveys in more detail. We use descriptive statistics and generalised linear mixed models to assess service utilisation and provision and specific correlates covered in the online surveys and apply qualitative content analysis to explore barriers and facilitators of service utilisation and provision more broadly in the semistructured interviews. We will integrate findings from the quantitative and qualitative analyses at the interpretation stage.Ethics and disseminationThe study was approved by the Medical Ethics Review Board of the Medical Faculty Mannheim at Heidelberg University (2020–650N). Study results will be published in journals with external peer-review.
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Hein, Kerstin, Kathrin Knochel, Vedrana Zaimovic, Daniel Reimann, Anna Monz, Nari Heitkamp, Gian Domenico Borasio, and Monika Führer. "Identifying key elements for paediatric advance care planning with parents, healthcare providers and stakeholders: A qualitative study." Palliative Medicine 34, no. 3 (January 27, 2020): 300–308. http://dx.doi.org/10.1177/0269216319900317.
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Background: Although international guidelines recommend discussions about goals of care and treatment options for children with severe and life-limiting conditions, there are still few structured models of paediatric advance care planning. Aim: The study aimed at identifying key components of paediatric advance care planning through direct discussions with all involved parties. Design: The study had a qualitative design with a participatory approach. Participants constituted an advisory board and took part in two transdisciplinary workshops. Data were collected in discussion and dialogue groups and analysed using content analysis. Setting/participants: We included bereaved parents, health care providers and stakeholders of care networks. Results: Key elements were discussions, documentation, implementation, timing and participation of children and adolescents. Parents engage in discussions with facilitators and persons of trust to reach a decision. Documentation constitutes the focus of professionals, who endorse brief recommendations for procedures in case of emergencies, supplemented by larger advance directives. Implementation hindrances include emotional barriers of stakeholders, disagreements between parents and professionals and difficulties with emergency services. Discussion timing should take into account parental readiness. The intervention should be repeated at regular intervals, considering emerging needs and increasing awareness of families over time. Involving children and adolescents in advance care planning remains a challenge. Conclusion: A paediatric advance care planning intervention should take into account potential pitfalls and barriers including issues related to timing, potential conflicts between parents and professionals, ambiguity towards written advance directives, the role of non-medical carers for paediatric advance care planning implementation, the need to involve the child and the necessity of an iterative process.
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Horavova, L., K. Nebeska, L. Souckova, R. Demlova, and P. Babula. "The Current Status of European and National Financial Sources for Clinical Research and Their Impact on Paediatric Non-commercial Clinical Trials: A Case Study of the Czech Republic." Therapeutic Innovation & Regulatory Science 54, no. 6 (June 5, 2020): 1461–72. http://dx.doi.org/10.1007/s43441-020-00173-9.
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Abstract Introduction Paediatric non-commercial interventional clinical trials (NICTs) are crucial for healthcare provision. In spite of the fact that current regulations and initiatives try to enhance the quantity and quality of paediatric NICTs, there are still shortcomings that need to be addressed in order to accelerate the conduct of relevant clinical trials in children. To improve the current landscape of paediatric clinical research, it is necessary to identify and analyse the main trends and shortcomings, along with their impact on national performance in paediatric NICTs and this is the aim of this work. Method A retrospective systematic search of paediatric NICTs was performed on four international clinical trials registries. Entries were filtered by date from 01/01/2004 to 31/12/2017. Each identified paediatric NICT was screened and analysed for sponsors, funders, type of intervention, therapeutic area, design characteristics and associated publications. Results The search identified 439 unique NICTs. When stratifying the trials by enrolment ages, 86 trials were found involving the paediatric population. Most trials investigated the use of medicinal products and were focused on cancer or cardiovascular diseases. The most common sources of the funding were non-profit organizations. Furthermore, from the total number of completed trials, only half of them already published their results. Conclusion The main shortcomings—specifically, ethical, methodological and, in particular, economic obstacles were identified. There is a continual need for greater support and collaboration between all major stakeholders including health policymakers, grant agencies, research institutions, pharmaceutical industries and healthcare providers at the national and international level.
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McLaughlan, Rebecca, and Alan Pert. "Evidence and speculation: reimagining approaches to architecture and research within the paediatric hospital." Medical Humanities 44, no. 3 (November 25, 2017): 146–52. http://dx.doi.org/10.1136/medhum-2017-011285.
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As the dominant research paradigm within the construction of contemporary healthcare facilities, evidence-based design (EBD) will increasingly impact our expectations of what hospital architecture should be. Research methods within EBD focus on prototyping incremental advances and evaluating what has already been built. Yet medical care is a rapidly evolving system; changes to technology, workforce composition, patient demographics and funding models can create rapid and unpredictable changes to medical practice and modes of care. This dynamism has the potential to curtail or negate the usefulness of current best practice approaches. To imagine new directions for the role of the hospital in society, or innovative ways in which the built environment might support well-being, requires a model that can project beyond existing constraints. Speculative design employs a design-based research methodology to imagine alternative futures and uses the artefacts created through this process to enable broader critical reflection on existing practices. This paper examines the contribution of speculative design within the context of the paediatric hospital as a means of facilitating critical reflection regarding the design of new healthcare facilities. While EBD is largely limited by what has already been built, speculative design offers a complementary research method to meet this limitation.
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Khan, Farrah. "P22 Developing a pharmacology module for the paediatric non-medical prescribing course." Archives of Disease in Childhood 105, no. 9 (August 19, 2020): e17.2-e18. http://dx.doi.org/10.1136/archdischild-2020-nppg.31.
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IntroductionDemand from local NHS stakeholders identified a gap for a taught education course tailored to the niche requirements of paediatric healthcare staff wishing to become non-medical prescribers. This was seen as an excellent opportunity to review and develop the pharmacology module within the Non-medical Prescribing (NMP) course by giving it a paediatric focus.AimTo develop a pharmacology module with an emphasis on paediatric prescribing that meets the professional requirements of the General Pharmaceutical Council (GPhC), the Nursing and Midwifery Council (NMC) and the Health Care Professions Council (HCPC).MethodKnowledge of curriculum design and structure was utilised in developing the paediatric pharmacology module. This ensured that the underpinning theory of prescribing medicines safely for children was delivered at the right academic level. The content, delivery and learning outcomes were dictated by the Prescribing Competency Framework for All Prescribers (RPS, 2016).1 But the cognitive teaching and learning methods arose from the rigid expectation to meet the regulatory requirements of each professional body. To ensure consistency across the whole NMP programme, the structure of the pharmacology module assessments (both formative and summative) was kept the same. The summative (final) assessments consisted of a multiple choice question (MCQ) paper requiring the students to answer a total of twenty MCQs, with the pass mark set by the regulatory bodies at 80%; a drug calculations paper consisting of five questions with a 100% pass mark; and a 5 minute information giving OSCE (objective structured clinical examination). The whole module was looked at a fresh from a paediatric perspective. The content and timetable were compiled and reviewed jointly by a paediatric pharmacist and a paediatric nurse. Both were experienced academics already teaching on the NMP course. While some of the lectures were delivered by in-house university academic staff, the majority of the sessions were delivered by specialist paediatric guest lecturers who were actively working in their respective clinical fields. This ensured that the knowledge imparted to students was practical, current and relevant to prescribing for children.ResultsAll students had to be practising in paediatrics for a minimum period of two years and have evidence of studying at level 6 (graduate level) or equivalent. The target audience consisted of allied healthcare professionals specialising in paediatrics, including nurses, pharmacists, optometrists, physiotherapists, podiatrists, dieticians and therapeutic radiographers. However, the first cohort of 51 students comprised entirely of paediatric nurses. The majority of students passed each assessment first time. All students passed the 5-minute information giving OSCE, but 25% of the students had to re-sit the pharmacology MCQ paper and 17% had to re-sit the drug calculations paper. Following the resits the remaining students all passed except for one student who failed the course.ConclusionOverall, the course was well received, with positive feedback from most students and stakeholders. Valuable suggestions were also received for further improvements to the course and pharmacology module. These are currently being implemented with intake of students.ReferenceRoyal Pharmaceutical Society ( 2016) A competency framework for all prescribers. Available from: http://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Professional%20standards/Prescribing%20competency%20framework/prescribing-competency-framework.pdf [Accessed 25/6/19]
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Jones, Catherine, Jennifer Fraser, and Sue Randall. "The evaluation of a home-based paediatric nursing service: concept and design development using the Kirkpatrick model." Journal of Research in Nursing 23, no. 6 (July 31, 2018): 492–501. http://dx.doi.org/10.1177/1744987118786019.
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Background A new paediatric hospital-in-the-home nursing service required evaluation. Aims To determine whether the education and training provided for nursing staff employed in the service was effective. Methods This paper presents the way in which a training evaluation model supported the design and evaluation of a training programme for registered nurses working in an out-of-hospital, home-based nursing service for paediatric patients. Results The Kirkpatrick model provides a framework for evaluating the effectiveness of workforce training for any industry including healthcare (Kirkpatrick, 2009). Conclusions That the Kirkpatrick model is an appropriate framework to evaluate a nursing training programme, but it is imperative to evaluate all levels of the model to be able to ascertain the success of the training and the impact on clinical practice.
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Nicholson, Emma, Therese McDonnell, Moayed Hamza, Michael Barrett, Christopher Brunsdon, Gerard Bury, Martin Charlton, et al. "Factors that influence family and parental preferences and decision making for unscheduled paediatric healthcare: a systematic review protocol." HRB Open Research 2 (June 14, 2019): 11. http://dx.doi.org/10.12688/hrbopenres.12897.1.
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There is a plethora of factors that dictate where parents and families choose to seek unscheduled healthcare for their child; and the complexity of these decisions can present a challenge for policy makers and healthcare planners as these behaviours can have a significant impact on resources in the health system. The systematic review will seek to identify the factors that influence parents’ and families’ preferences and decision making when seeking unscheduled paediatric healthcare. Five databases will be searched for published studies (CINAHL, PubMed, SCOPUS, PsycInfo, EconLit) and grey literature will also be searched. Inclusion and exclusion criteria will be applied and articles assessed for quality. A narrative approach will be used to synthesise the evidence that emerges from the review. By collating the factors that influence decision-making and attendance at these services, the review can inform future health policies and strategies seeking to expand primary care to support the provision of accessible and responsive care. The systematic review will also inform the design of a discrete choice experiment (DCE) which will seek to determine parental and family preferences for unscheduled paediatric healthcare. Policies such as Sláintecare that seek to expand primary care and reduce hospital admissions from emergency departments need to be cognisant of the nuanced and complex factors that govern patients’ behaviour.
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Nicholson, Emma, Therese McDonnell, Moayed Hamza, Michael Barrett, Christopher Brunsdon, Gerard Bury, Martin Charlton, et al. "Factors that influence family and parental preferences and decision making for unscheduled paediatric healthcare: a systematic review protocol." HRB Open Research 2 (September 30, 2019): 11. http://dx.doi.org/10.12688/hrbopenres.12897.2.
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There is a plethora of factors that dictate where parents and families choose to seek unscheduled healthcare for their child; and the complexity of these decisions can present a challenge for policy makers and healthcare planners as these behaviours can have a significant impact on resources in the health system. The systematic review will seek to identify the factors that influence parents’ and families’ preferences and decision making when seeking unscheduled paediatric healthcare. Five databases will be searched for published studies (CINAHL, PubMed, SCOPUS, PsycInfo, EconLit) and grey literature will also be searched. Inclusion and exclusion criteria will be applied and articles assessed for quality. A narrative approach will be used to synthesise the evidence that emerges from the review. By collating the factors that influence decision-making and attendance at these services, the review can inform future health policies and strategies seeking to expand primary care to support the provision of accessible and responsive care. The systematic review will also inform the design of a discrete choice experiment (DCE) which will seek to determine parental and family preferences for unscheduled paediatric healthcare. Policies that seek to expand primary care and reduce hospital admissions from emergency departments need to be cognisant of the nuanced and complex factors that govern patients’ behaviour.
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Anthony, Samantha J., Sarah J. Pol, Jia Lin, Melanie Barwick, Michael Brudno, Dorin Manase, Rulan Savita Parekh, Amanda Silva, and Jennifer Stinson. "Creation of an electronic patient-reported outcome measure platform Voxe: a mixed methods study protocol in paediatric solid organ transplantation." BMJ Open 11, no. 10 (October 2021): e053119. http://dx.doi.org/10.1136/bmjopen-2021-053119.
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IntroductionPatient-reported outcome measures (PROMs) provide an opportunity for meaningful patient engagement and shared decision-making. The objective of this research programme is to improve health outcomes for paediatric solid organ transplant patients by implementing PROMs into clinical care. The current study aims to create Voxe, a paediatric user-centred electronic PROM platform, by engaging patients and healthcare providers throughout the design and development process.Methods and analysisThe creation of Voxe will occur over two phases that build on previous research. The user interface design phase employs a ‘user-centric’ approach to identify end-users’ needs and iteratively refine the look and layout of Voxe to meet these needs. Transplant recipients, aged 10–17, and healthcare providers will participate in three rounds of testing (24 participants total). Participants will: (1) complete task-based activities (outcomes—effectiveness and efficiency), (2) complete questionnaires (outcome—satisfaction) and (3) participate in a semi-structured interview. The following phase involves software development and Voxe usability testing. Transplant recipients, aged 8–17, and healthcare providers will participate in four rounds of iterative testing (24–40 participants total). The think-aloud technique will be employed, and participants will describe their thoughts and feelings while interacting with a Voxe prototype. Participants will: (1) log into Voxe and complete tasks (outcomes—time on task, successful task completion, frequency of critical and non-critical errors and error-free rate), (2) complete questionnaires (outcome—satisfaction) and (3) participate in a semi-structured interview. Findings will result in the creation and launch of a user-centred electronic PROM platform.Ethics and disseminationResearch ethics board approval has been provided by The Hospital for Sick Children. This research is critical to answering methodological and operational questions to inform Voxe implementation in paediatric clinical settings and facilitate PROM data collection. Future investigations will include an implementation-effectiveness evaluation.
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Bartholdson, Cecilia, Margareta af Sandeberg, Kim Lützén, Klas Blomgren, and Pernilla Pergert. "Healthcare professionals’ perceptions of the ethical climate in paediatric cancer care." Nursing Ethics 23, no. 8 (August 3, 2016): 877–88. http://dx.doi.org/10.1177/0969733015587778.
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Background: How well ethical concerns are handled in healthcare is influenced by the ethical climate of the workplace, which in this study is described as workplace factors that contribute to healthcare professionals’ ability to identify and deal with ethical issues in order to provide the patient with ethically good care. Objectives: The overall aim of the study was to describe perceptions of the paediatric hospital ethical climate among healthcare professionals who treat/care for children with cancer. Research design: Data were collected using the Hospital Ethical Climate Survey developed by Olsson as a separate section in a questionnaire. Descriptive statistics were used to analyse perceptions of the ethical climate. Participants and research context: Physicians, nurses and nurse-aides (n = 89) from three paediatric units participated in this study: haematology/oncology, chronic diseases and neurology. Ethical considerations: The study was approved by the regional ethical review board. Findings: Different perceptions of the ethical climate were rated as positive or negative/neutral. Nurses’ ratings were less positive than physicians on all items. One-third of the participants perceived that they were able to practice ethically good care as they believed it should be practised. Discussion: Differences in professional roles, involving more or less power and influence, might explain why physicians and nurses rated items differently. A positive perception of the possibility to practice ethically good care seems to be related to inter-professional trust and listening to guardians/parents. A negative/neutral perception of the possibility to practice ethically good care appears to be influenced by experiences of ethical conflicts as well as a lack of ethical support, for example, time for reflection and discussion. Conclusion: The two-thirds of participants who had a negative/neutral perception of the possibility to practice ethically good care are at risk of developing moral stress. Clinical ethics support needs to be implemented in care where important values are at stake.
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Major, János, Zsófia K. Varga, Andrea Gyimesi-Szikszai, and Szilvia Ádám. "A two-week inpatient programme with a booster improved long-term management of severe chronic paediatric pain." Journal of Child Health Care 21, no. 2 (March 15, 2017): 171–80. http://dx.doi.org/10.1177/1367493517697479.
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In the context of limited healthcare resources and increasing demands for more cost-effective healthcare solutions, this study assessed the short- and long-term clinical outcomes and resource utilization of a two-week inpatient, interdisciplinary, pain treatment (IIPT) including individual and group cognitive behavioural, occupational, physical and recreational therapy, education and family intervention and a booster in the chronic paediatric pain setting. Using a longitudinal design with a two-year follow-up, two-week IIPT resulted in sustainable improvements in mean and maximum pain intensity, physical functioning and internalization and reductions in the mean number of medical visits, school absence and frequency of pain medication at year 2 following IIPT. While pain-related disability scores did not improve, problem-focused coping became more prevalent, and patient and parent-assessed satisfaction as well as pain experience continued to improve throughout the study. Our results demonstrate that a two-week IIPT with a booster confers meaningful short- and long-term improvements in clinical outcomes and resource utilization among paediatric patients with severe chronic pain.
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Pergert, Pernilla, Cecilia Bartholdson, Klas Blomgren, and Margareta af Sandeberg. "Moral distress in paediatric oncology: Contributing factors and group differences." Nursing Ethics 26, no. 7-8 (November 9, 2018): 2351–63. http://dx.doi.org/10.1177/0969733018809806.
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Background: Providing oncological care to children is demanding and ethical issues concerning what is best for the child can contribute to moral distress. Objectives: To explore healthcare professionals’ experiences of situations that generate moral distress in Swedish paediatric oncology. Research design: In this national study, data collection was conducted using the Swedish Moral Distress Scale-Revised. The data analysis included descriptive statistics and non-parametric analysis of differences between groups. Participants and research context: Healthcare professionals at all paediatric oncology centres in Sweden were invited to participate. A total of 278 healthcare professionals participated. The response rate was 89%. Ethical considerations: In its advisory statement, the Regional Ethical Review Board decided that the study was of such a nature that the legislation concerning ethical reviews was not applicable. All participants received written information about the aim of the study and confidentiality. Participants demonstrated their consent by returning the survey. Findings: The two situations with the highest moral distress scores concerned lack of competence and continuity of personnel. All professional groups reported high levels of disturbance. Nurses rated significantly higher frequencies and higher total Moral Distress Scale scores compared to medical doctors and nursing assistants. Discussion: Lack of competence and continuity, as the two most morally distressing situations, confirms the findings of studies from other countries, where inadequate staffing was reported as being among the top five morally distressing situations. The levels of total Moral Distress Scale scores were more similar to those reported in intensive care units than in other paediatric care settings. Conclusion: The two most morally distressing situations, lack of competence and continuity, are both organisational in nature. Thus, clinical ethics support services need to be combined with organisational improvements in order to reduce moral distress, thereby maintaining job satisfaction, preventing a high turnover of staff and ensuring the quality of care.
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Sever, Zoe, Luregn J. Schlapbach, Melanie Jessup, Shane George, and Amanda Harley. "Parental and healthcare professional concern in the diagnosis of paediatric sepsis: a protocol for a prospective multicentre observational study." BMJ Open 11, no. 9 (September 2021): e045910. http://dx.doi.org/10.1136/bmjopen-2020-045910.
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IntroductionPaediatric sepsis is a major contributor to morbidity and mortality worldwide. Assessing concern from parents and healthcare professionals to determine disease severity in a child evaluated for sepsis remains a field requiring further investigation. This study aims to determine the diagnostic accuracy of parental and healthcare professional concern in the diagnosis of children evaluated for sepsis.Methods and analysisThis prospective multicentre observational study will be conducted over a 24-month period in the paediatric emergency department (ED) at two tertiary Australian hospitals. A cross-sectional survey design will be used to assess the level of concern in parents, nurses and doctors for children presenting to ED and undergoing assessment for sepsis. The primary outcome is a diagnosis of sepsis, defined as suspected infection plus organ dysfunction at time of survey completion. Secondary outcomes include suspected or proven infection and development of organ dysfunction, defined as a Paediatric Sequential Organ Failure Assessment Score >0, within 48 hours of presentation, paediatric intensive care unit admission, confirmed or probable bacterial infection independent of organ dysfunction, and hospital length of stay.Ethics and disseminationEthics approval was obtained from Children’s Health Queensland’s Human Research Ethics Committee (HREC/17/QRCH/85). Findings will be shared with relevant stakeholders and disseminated via conferences and peer-reviewed journalsTrial registration numberWHO Universal Trial Number, U1111-1256-4537; ANZCTR number, ACTRN1262000134092.
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Gilmore, Grace, Louise Kiernan, Eoin White, and Bernard Hartigan. "GROWING UP AND MOVING ON - INSIGHTS FROM THE HEALTH CARE PROFESSIONALS AND ADOLESCENTS’ PERSPECTIVES ON THE ISSUES AND BARRIERS IN THE TRANSFER OF CARE FROM PAEDIATRICS TO ADULT CARE." Proceedings of the Design Society 1 (July 27, 2021): 1677–86. http://dx.doi.org/10.1017/pds.2021.429.
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AbstractThe aim of this research is to report the finding from the perspective of the Healthcare Professionals and the adolescents and young adults (AYA's) to identify issues and barriers to a successful transition for adolescents with Juvenile Idiopathic Arthritis (JIA) as they move from Paediatric Healthcare setting to Adult Healthcare.Healthcare services that fail to adequately meet the needs of young people and their families at this time of considerable change may result in a decline in their health status that can have a negative long-term impact. Through a user-centered research design (UCD) and Universal Design, the needs of all participants and stakeholders will be assessed. This paper applies the most appropriate proposed methods for the development of a solution to mitigate against some of the issues in tangent with the needs and feedback identified during the research process.
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McLaughlan, Rebecca, and Alan Pert. "Briefing a children’s hospice: bridging the evidence gap and redefining value in contemporary healthcare design." Architectural Research Quarterly 24, no. 3 (September 2020): 265–76. http://dx.doi.org/10.1017/s1359135520000275.
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Increasingly, healthcare providers are asking for evidence based design solutions in the construction of new facilities. But where does a designer begin when there is no credible evidence to support the design process because it has yet to gain the attention of researchers? Within this paper we reflect on a university-practice partnership undertaken to provide a feasibility study for the future redevelopment of an eight-bed paediatric hospice in Australia. In embarking on this project, the project team assumed that a thorough literature review would furnish a body of research to rigorously inform the feasibility study. The realisation that this research was not available necessitated an evidence gathering process from first principles, where methods from academic practice required translation and customisation to fit within commercial time frames and resourcing constraints. This article recommends a selection of research methods for use by architects working within healthcare settings where foundational research to inform the design process is not available. It also argues for a re-conceptualisation of the built environment’s value relative to wellbeing.
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Inhestern, Laura, Verena Paul, Jana Winzig, Stefan Rutkowski, Gabriele Escherich, and Corinna Bergelt. "Children with cancer and their families after active treatment: analyses of biopsychosocial needs and implications for healthcare – a study protocol." BMJ Open 12, no. 4 (April 2022): e055633. http://dx.doi.org/10.1136/bmjopen-2021-055633.
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IntroductionPatients and families affected by paediatric cancer experience psychosocial burden not only during active treatment but also during follow-up care. Use of health services during follow-up treatment should be organised according to patients’ and family members’ needs with regard to their physical and mental situation. This study aims (1) at analysing healthcare use (medical and psychosocial) and associated factors in follow-up care of paediatric cancer patients and (2) at investigating the psychosocial situation and support needs of children and their families during follow-up care. Based on the results, recommendations for healthcare planning and for the development of new and the optimisation of existing support offers will be derived.Methods and analysisWe will conduct a prospective observational study using a naturalistic explorative design with quantitative and qualitative methods. Paediatric cancer patients in follow-up care, their parents and siblings will be invited to fill out a questionnaire at three measurement points (baseline, 6 months follow-up, 12 months follow-up; target n=252 complete data sets over all measurement points). Additionally, parents will be interviewed using a semistructured interview guideline (target n=15–20) at baseline. Quantitative data will be analysed using descriptive statistics, linear mixed models and regression models. Moreover, explorative analyses will be conducted. Qualitative data will be analysed using qualitative content analyses.Ethics and disseminationThe study was approved by the Local Psychological Ethics Committee (LPEK-0281). Our findings will be published in scientific, peer-reviewed journals and presented to clinicians and researchers on conferences. To assure that results will be available to affected patients and families, a lay summary will be written and disseminated using several ways (upload on the homepage of the research group, upload on the homepage of the psychosocial working group in the Society for Paediatric Oncology/Haematology in Germany, sending to relevant patient organisations).Trial registration numberDRKS00025289.
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Wakawa, Usman Bukar, and Ismail Bin Said. "Natural Play Materials as Motivator for Health Restoration in Paediatric Ward of Nigerian Hospital." Advanced Materials Research 988 (July 2014): 407–10. http://dx.doi.org/10.4028/www.scientific.net/amr.988.407.
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In paediatric ward, children are exposed to new environment which can exposed them to psychological and emotional stress. The paediatric ward setting in developing countries like Nigeria, seldom provides an environment that has facilities for positive distraction. Understanding the importance of play activities as a result of natural play materials, will allow facilitators to provide space and materials for play activities in the ward. This study examines the effect of natural play materials as motivator in healthcare settings on the health restoration of paediatric patients. The study was conduct at paediatric ward of Abubakar Tafawa Balewa University Teaching Hospital Bauchi, using an observational qualitative design. The data were generated from photographic documentation of five paediatric patients for seven days. The data was analysed using deductive content analysis. The result indicates that the ward as play environment provides restoration for children, when the environment is organized to house patients with access to nature inclined elements. Such as play activities in the case of children, with quality standard of upkeep and concern. The organization of the ward to accommodate natural play activities alongside norms and protocol that provide a genuine atmosphere for restoration. This is as a result of the inherent play behavior associated with early and middle childhood children. Therefore natural play improves children ability to cope with hospitalization.
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Curran, Janet A., Christine Cassidy, Andrea Bishop, Lori Wozney, Amy C. Plint, Krista Ritchie, Sharon E. Straus, et al. "Codesigning discharge communication interventions with healthcare providers, youth and parents for emergency practice settings: EDUCATE study protocol." BMJ Open 10, no. 5 (May 2020): e038314. http://dx.doi.org/10.1136/bmjopen-2020-038314.
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IntroductionDischarge communication is an important aspect of patient care but frequently has shortcomings in emergency departments (EDs). In a paediatric context, youth or parents with young children often leave the ED with minimal opportunity to ask questions or to ensure comprehension of important information. Strategies for improving discharge communication have primarily targeted patients and/or parents, although neither group has been engaged in intervention design or implementation. Furthermore, ED healthcare providers (HCPs), important actors in discharge communication practice, are rarely consulted regarding intervention design decisions. We will generate evidence to enhance discharge communication by engaging youth, parents and HCPs in the codesign of ED discharge communication strategies (EDUCATE) for asthma and minor head injury.Methods and analysisThis mixed methods study will take place at two academic paediatric EDs in Canada. The study will occur in two phases: (A) codesign and refinement of the intervention prototypes; and (B) usability testing of the prototypes. During the first phase, two codesign teams (one for each condition) will follow a series of structured design meetings based on the Behavior Change Wheel to develop the EDUCATE interventions. Each codesign team (composed of youth, parents, HCPs and study researchers) will collaborate to identify priority target behaviours and acceptable components to include in the interventions. During the second phase, we will conduct usability testing in two EDs with a group of youth, parents and HCPs to refine the interventions. Two cycles of usability testing will be conducted with intervention refinement occurring at the end of each cycle.Ethics and disseminationInformed consent will be obtained from all participants. Ethics approval for this study has been obtained from the Research Ethics Board, IWK Health Centre. Results from this study will form the basis of a future effectiveness implementation trial. Key findings will be presented at national and international conferences and published within peer-reviewed journals.
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Sharif, Muhammad, Aqsa ., Muhammad Soban Sharif, Hafiz Muhammad Arif, Ahmad Hassan, and Javaria . "Knowledge about Folic Acid Supplementation for Prevention of Neural Tube Defects among Gynecologist and Paediatric Surgeon." Pakistan Journal of Medical and Health Sciences 16, no. 2 (February 26, 2022): 179–81. http://dx.doi.org/10.53350/pjmhs22162179.
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Aim: To assess the knowledge of gynecologist & Paediatric Surgeon about the role of folic acid in prevention of neural tube defects. Study design: Cross Sectional Study Setting & duration of study: Department of Paediatirc Surgery, KEMU/Mayo Hospital Lahore from 1st November to 15 December. Methodology: After ethical approval data was collected on a questioner performa created on google doc regarding demographic variables, knowledge about neural tube defects, dose and timing of folic acid supplementation in prevention of neural tube birth defects. Results: 70% of the doctor who took part in this study work between 20-30 year of age. 50% were male & 50% were female. Majority of doctors (80%) have experience of 1-10 years after graduation. The participants doctors include postgraduate residents (68%) followed by consultant (11.1%), Medical Officer, Senior Registrar, Registrar & House Officer. 90.7% were government employee most of them have knowledge about meningomylocele but majority of them (57.4%) did not have proper knowledge about dose and timing of folic acid supplementation for prevention of neural tube defects. Conclusions: We conclude that most of gynecologist and paediatric surgeons don’t have sufficient knowledge about role of folic acid in prevention of neural tube defects, specially meningomyelocele in children. There is a need to launch awareness campaign among healthcare providers through social media, symposium, and newspaper about supplementation of folic acid before conception in women so that this important disability condition/disease incidence may be reduced Keywords: Meningomyeloclele, Folic Acid Supplementation, Prevention
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Stark, Daniel, Sophie Thomas, David Dawson, Emily Talbot, Emily Bennett, and Arleta Starza-Smith. "Paediatric neuropsychological assessment: an analysis of parents’ perspectives." Social Care and Neurodisability 5, no. 1 (February 4, 2014): 41–50. http://dx.doi.org/10.1108/scn-07-2013-0027.
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Purpose – Modern healthcare services are commonly based on shared models of care, in which a strong emphasis is placed upon the views of those in receipt of services. The purpose of this paper is to examine the parents’ experiences of their child’s neuropsychological assessment. Design/methodology/approach – This was a mixed-methodology study employing both quantitative and qualitative measures. Findings – The questionnaire measure indicated a high overall level of satisfaction. Qualitative analysis of parental interviews provided a richer insight into the parental experience and indicated four major themes. Practical implications – Implications covered three major areas. Firstly, whilst a high value was placed upon the assessment, the need for further comprehensive neurorehabilitation and intervention was highlighted. Secondly, this study highlights the significant adversity experienced by such families and subsequent unmet psychological needs which also require consideration. Finally, findings from the current study could assist in improving future measures of satisfaction in similar services. Originality/value – This is the first published study of parental experiences of and satisfaction with paediatric neuropsychological assessment in the UK.
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Greenfield, Katie, Simone Holley, Daniel E. Schoth, Emily Harrop, Richard F. Howard, Julie Bayliss, Lynda Brook, et al. "A mixed-methods systematic review and meta-analysis of barriers and facilitators to paediatric symptom management at end of life." Palliative Medicine 34, no. 6 (March 31, 2020): 689–707. http://dx.doi.org/10.1177/0269216320907065.
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Background: Symptom management for infants, children and young people at end of life is complex and challenging due to the range of conditions and differing care needs of individuals of different ages. A greater understanding of these challenges could inform the development of effective interventions. Aim: To investigate the barriers and facilitators experienced by patients, carers and healthcare professionals managing symptoms in infants, children and young people at end of life. Design: A mixed-methods systematic review and meta-analysis was undertaken (PROSPERO ID: CRD42019124797). Data sources: The Cochrane Library, PROSPERO, CINAHL, MEDLINE, PsycINFO, Web of Science Core Collection, ProQuest Dissertations & Theses Database, Evidence Search and OpenGrey were electronically searched from the inception of each database for qualitative, quantitative or mixed-methods studies that included data from patients, carers or healthcare professionals referring to barriers or facilitators to paediatric end-of-life symptom management. Studies underwent data extraction, quality appraisal, narrative thematic synthesis and meta-analysis. Results: A total of 64 studies were included (32 quantitative, 18 qualitative and 14 mixed-methods) of medium-low quality. Themes were generated encompassing barriers/facilitators experienced by carers (treatment efficacy, treatment side effects, healthcare professionals’ attitudes, hospice care, home care, families’ symptom management strategies) and healthcare professionals (medicine access, treatment efficacy, healthcare professionals’ demographics, treatment side effects, specialist support, healthcare professionals’ training, health services delivery, home care). Only one study included patients’ views. Conclusion: There is a need for effective communication between healthcare professionals and families, more training for healthcare professionals, improved symptom management planning including anticipatory prescribing, and urgent attention paid to the patients’ perspective.
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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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Hirsch-Moverman, Yael, Michael Strauss, Gavin George, Anthony Mutiti, Arnold Mafukidze, Siphesihle Shongwe, Gloria Sisi Dube, Wafaa M. El Sadr, Joanne E. Mantell, and Andrea A. Howard. "Paediatric tuberculosis preventive treatment preferences among HIV-positive children, caregivers and healthcare providers in Eswatini: a discrete choice experiment." BMJ Open 11, no. 10 (October 2021): e048443. http://dx.doi.org/10.1136/bmjopen-2020-048443.
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ObjectiveIsoniazid preventive therapy initiation and completion rates are suboptimal among children. Shorter tuberculosis (TB) preventive treatment (TPT) regimens have demonstrated safety and efficacy in children and may improve adherence but are not widely used in high TB burden countries. Understanding preferences regarding TPT regimens’ characteristics and service delivery models is key to designing services to improve TPT initiation and completion rates. We examined paediatric TPT preferences in Eswatini, a high TB burden country.DesignWe conducted a sequential mixed-methods study utilising qualitative methods to inform the design of a discrete choice experiment (DCE) among HIV-positive children, caregivers and healthcare providers (HCP). Drug regimen and service delivery characteristics included pill size and formulation, dosing frequency, medication taste, treatment duration and visit frequency, visit cost, clinic wait time, and clinic operating hours. An unlabelled, binary choice design was used; data were analysed using fixed and mixed effects logistic regression models, with stratified models for children, caregivers and HCP.SettingThe study was conducted in 20 healthcare facilities providing TB/HIV care in Manzini, Eswatini, from November 2018 to December 2019.ParticipantsNinety-one stakeholders completed in-depth interviews to inform the DCE design; 150 children 10–14 years, 150 caregivers and 150 HCP completed the DCE.ResultsDespite some heterogeneity, the results were fairly consistent among participants, with palatability of medications viewed as the most important TPT attribute; fewer and smaller pills were also preferred. Additionally, shorter waiting times and cost of visit were found to be significant drivers of choices.ConclusionPalatable medication, smaller/fewer pills, low visit costs and shorter clinic wait times are important factors when designing TPT services for children and should be considered as new paediatric TPT regimens in Eswatini are rolled out. More research is needed to determine the extent to which preferences drive TPT initiation, adherence and completion rates.
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Tomo, Andrea, and Stefania De Simone. "Using the job demands-resources approach to assess employee well-being in healthcare." Health Services Management Research 32, no. 2 (August 2, 2018): 58–68. http://dx.doi.org/10.1177/0951484818787687.
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The aim of this study is to advance a model to assess the overall level of well-being within healthcare organizations. Design/methodology/approach: The paper employs a job demands-resources approach by considering the multilevel model of employee well-being as theoretical framework, integrated with personal resources and health indicators. A specific case is built in the Italian context, with empirical data gathered from three Italian paediatric hospitals belonging to the same healthcare organizations. Findings: Results show that the job demand-resource model may well explain differences in the work environment, and that personality enables coping with negative effects of work environment settings. Originality/value. The paper contributes to extending the literature on well-being and the management of healthcare organizations, by providing interesting insights on the multilevel model of employee well-being. It also has interesting academic and practical implications, since it tries to put forward a model to assess employee well-being and provides an empirical application of a well-known theoretical model.
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Holmström, Malin Rising, Marie Häggström, and Siv Söderberg. "Supporting young people with type 1 diabetes: experiences from healthcare professionals in Sweden." British Journal of Child Health 2, no. 3 (June 2, 2021): 117–24. http://dx.doi.org/10.12968/chhe.2021.2.3.117.
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Background Healthcare professionals in paediatric care face great demands to provide high-quality acute care and support for young people with long-term illnesses, such as type 1 diabetes. This study aims to describe healthcare professionals' experiences of supporting young people with type 1 diabetes in order to improve care. Methods A qualitative research design was used to conduct individual interviews with seven healthcare professionals. The interview transcripts were subjected to inductive qualitative thematic content analysis. Results Four themes were identified: strengthening young people's motivation, sharing knowledge for better support, the imbalance between resources and needs and the transition of responsibility to the young person and their family. Conclusions Healthcare professionals described motivating young people to improve their metabolic control by using a person-centred approach. Working in a team strengthened cross-professional perspectives, competence and understanding of young people's support needs and developed diabetes care. The transition of responsibility from healthcare to families and young people was important in improving glycemic control. The increased imbalance in resources and support needs in diabetes care must be addressed at a societal level and adapted according to today's needs.
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King, Carina, Nicholas Boyd, Isabeau Walker, Beatiwel Zadutsa, Abdullah H. Baqui, Salahuddin Ahmed, Mazharul Islam, et al. "Opportunities and barriers in paediatric pulse oximetry for pneumonia in low-resource clinical settings: a qualitative evaluation from Malawi and Bangladesh." BMJ Open 8, no. 1 (January 2018): e019177. http://dx.doi.org/10.1136/bmjopen-2017-019177.
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ObjectiveTo gain an understanding of what challenges pulse oximetry for paediatric pneumonia management poses, how it has changed service provision and what would improve this device for use across paediatric clinical settings in low-income countries.DesignFocus group discussions (FGDs), with purposive sampling and thematic analysis using a framework approach.SettingCommunity, front-line outpatient, and hospital outpatient and inpatient settings in Malawi and Bangladesh, which provide paediatric pneumonia care.ParticipantsHealthcare providers (HCPs) from Malawi and Bangladesh who had received training in pulse oximetry and had been using oximeters in routine paediatric care, including community healthcare workers, non-physician clinicians or medical assistants, and hospital-based nurses and doctors.ResultsWe conducted six FGDs, with 23 participants from Bangladesh and 26 from Malawi. We identified five emergent themes: trust, value, user-related experience, sustainability and design. HCPs discussed the confidence gained through the use of oximeters, resulting in improved trust from caregivers and valuing the device, although there were conflicts between the weight given to clinical judgement versus oximeter results. HCPs reported the ease of using oximeters, but identified movement and physically smaller children as measurement challenges. Challenges in sustainability related to battery durability and replacement parts, however many HCPs had used the same device longer than 4 years, demonstrating robustness within these settings. Desirable features included back-up power banks and integrated respiratory rate and thermometer capability.ConclusionsPulse oximetry was generally deemed valuable by HCPs for use as a spot-check device in a range of paediatric low-income clinical settings. Areas highlighted as challenges by HCPs, and therefore opportunities for redesign, included battery charging and durability, probe fit and sensitivity in paediatric populations.Trial registration numberNCT02941237.
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McConnell, Tracey, David Scott, and Sam Porter. "Healthcare staff ’s experience in providing end-of-life care to children: A mixed-method review." Palliative Medicine 30, no. 10 (July 10, 2016): 905–19. http://dx.doi.org/10.1177/0269216316647611.
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Background: Staff who provide end-of-life care to children not only have to deal with their own sense of loss but also that of bereaved families. There is a dearth of knowledge on how they cope with these challenges. Aim: The aim of this review is to explore the experiences of healthcare professionals who provide end-of-life care to children in order to inform the development of interventions to support them, thereby improving the quality of paediatric care for both children and their families. Data sources: Searches included CINAHL, MEDLINE, Web of Science, EMBASE, PsychINFO and The Cochrane Library in June 2015, with no date restrictions. Additional literature was uncovered from searching reference lists of relevant studies, along with contacting experts in the field of paediatric palliative care. Design: This was a systematic mixed studies review. Study selection, appraisal and data extraction were conducted by two independent researchers. Integrative thematic analysis was used to synthesise the data. Results: The 16 qualitative, 6 quantitative and 8 mixed-method studies identified included healthcare professionals in a range of settings. Key themes identified rewards and challenges of providing end-of-life care to children, the impact on staff’s personal and professional lives, coping strategies and key approaches to help support staff in their role. Conclusion: Education focusing on the unique challenges of providing end-of-life care to children and the importance of self-care, along with timely multidisciplinary debriefing, are key strategies for improving healthcare staff’s experiences, and as such the quality of care they provide.
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Norton-Westwood, Deborah, Alan Pearson, and Suzanne Robertson-Malt. "The ability of environmental healthcare design strategies To impact event related anxiety in paediatric patients: A comprehensive systematic review." JBI Database of Systematic Reviews and Implementation Reports 9, no. 44 (2011): 1828–82. http://dx.doi.org/10.11124/01938924-201109440-00001.
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Norton-Westwood, Deborah, Alan Pearson, and Suzanne Robertson-Malt. "The ability of environmental healthcare design strategies To impact event related anxiety in paediatric patients: A comprehensive systematic review." JBI Library of Systematic Reviews 9, no. 44 (2011): 1828–82. http://dx.doi.org/10.11124/jbisrir-2011-105.
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Lignou, Sapfo, Jenny Greenwood, Mark Sheehan, and Ingrid Wolfe. "Changes in Healthcare Provision During Covid-19 and Their Impact on Children With Chronic Illness: A Scoping Review." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 59 (January 2022): 004695802210814. http://dx.doi.org/10.1177/00469580221081445.
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This paper provides an overview of the evidence around how the health systems and policy response to the Covid-19 pandemic affected children with long-term conditions in the UK. We conducted a scoping review guided by the PRISMA-ScR Checklist. The PubMed and PsycINFO databases (2019-August 2021) were searched and screened for papers (of any design) by 2 reviewers independently. The electronic database search was supplemented by manual searching. A total of 32 papers were identified, including studies on UK paediatric populations, studies on chronic illness in the UK, and international studies on chronic illness and children (including data from the UK). Most studies focussed on epilepsy, cancer, diabetes or asthma. Three categories of impact were identified: ( a) impact of policy response on the delivery of and access to child healthcare ( b) impact of innovative practice on children’s physical and mental health ( c) impact of service restrictions on children’s physical health. Our results showed that policy response to the pandemic significantly affected healthcare provision for children with chronic illness in the UK. However, the specific assessment of the impact of service restrictions and innovative practice on children’s health and wellbeing is limited. Future research is required to fill knowledge gaps on changes in access to effective diagnostic and treatment investigations and their impact on a range of paediatric patients during the pandemic.
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Ávila-Álvarez, Adriana, Jerónimo Pardo-Vázquez, Iván De-Rosende-Celeiro, Rita Jácome-Feijoo, and Gabriel Torres-Tobío. "Assessing the Outcomes of an Animal-Assisted Intervention in a Paediatric Day Hospital: Perceptions of Children and Parents." Animals 10, no. 10 (October 1, 2020): 1788. http://dx.doi.org/10.3390/ani10101788.
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There is a growing interest in the use of animal-assisted intervention (AAI) as a non-pharmacological strategy to improve child welfare in hospitals. However, the efficacy of implementation of programmes based on activities with dogs in a paediatric day hospital is not known. An intra-subject quasi-experimental longitudinal design was used for the purpose of assessing the feasibility of such an intervention, as well as exploring the perceptions of its outcomes by children and parents/guardians. A total of 55 children in outpatient care at a paediatric day hospital participated in an AAI session. The application of this intervention was feasible. Self-assessment by the paediatric patients revealed a statistically significant improvement in their emotional state after the session, which was large in size. Parents confirmed this improvement in their child, perceiving significant changes in their mood, which were large in size. This study suggests that AAI is an effective approach when it comes to promoting the emotional welfare of children during their stay in hospital care environments. Participating in recreational occupations with dogs could contribute in a relevant and efficient way to the development of significant and gratifying experiences and to a more positive perception of healthcare centres on the part of children.
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Dyson, Michele P., Kassi Shave, Allison Gates, Ricardo M. Fernandes, Shannon D. Scott, and Lisa Hartling. "Which outcomes are important to patients and families who have experienced paediatric acute respiratory illness? Findings from a mixed methods sequential exploratory study." BMJ Open 7, no. 12 (December 2017): e018199. http://dx.doi.org/10.1136/bmjopen-2017-018199.
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ObjectivesTo identify the outcome priorities of parents of children who had experienced an acute respiratory infection (ARI).DesignThis was a two-phase, mixed methods study with a sequential exploratory design. We used a cross-sectional quantitative web-based survey to elicit parents’ priorities for paediatric ARI. We then used a discussion moderated via Facebook to elucidate richer descriptions of parents’ priorities.SettingSurvey and discussion data were collected via the internet.Participants110 parents (90% women, median age 35 years, 92.7% urban dwelling, 94.5% with a postsecondary education) with a child who had experienced an ARI responded to the survey. Four parents participated in the Facebook discussion.Primary and secondary outcome measuresThe primary outcome was parents’ rankings of outcomes related to paediatric ARI. The secondary outcomes were the alignment of parent-reported important outcomes with those commonly reported in Cochrane systematic reviews (SRs).ResultsCommonly reported ARIs included croup (44.5%), wheezing (43.6%) and influenza (38.2%). Parents ranked major complications, illness symptoms and length of stay as the most important outcome categories. With respect to specific outcomes, severe complications, major side effects, doctor’s assessment, relapse, oxygen supplementation and results from laboratory measures were reported as most important (75th–99th percentile). Taking time off work, mild complications, interference with daily activities, treatment costs, absenteeism, follow-up visits and other costs were deemed minimally important (<25th percentile). In 35 Cochrane SRs, 29 unique outcomes were reported. Although participants’ priorities sometimes aligned with outcomes frequently reported in the literature, this was not always true. Additional priorities from the survey (n=50) and Facebook discussions (n=4) included healthcare access, interacting with healthcare providers, education, impact on daily activities and child well-being.ConclusionsIn the context of paediatric ARI, parents’ priorities did not always align with commonly researched outcomes. Appealing and efficient strategies to engage patients and parents in research should be developed.
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Marcinko, Josip, Julia Orkin, Eyal Cohen, Michelle Ho, Chitra Lalloo, Annie Jiwan, Adam McKillop, Yalinie Kulandaivelu, and Jennifer Stinson. "PAEDIATRIC PROJECT ECHO: EXPLORING THE EDUCATIONAL NEEDS OF ONTARIO HEALTHCARE PROVIDERS WITH INTEREST IN CARING FOR CHILDREN WITH MEDICAL COMPLEXITY." Paediatrics & Child Health 23, suppl_1 (May 18, 2018): e5-e6. http://dx.doi.org/10.1093/pch/pxy054.014.
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Abstract BACKGROUND Project ECHO® is an innovative, interactive model for medical education and healthcare delivery that expands access and capacity to provide evidence-informed care. This model virtually connects specialist interprofessional teams with community healthcare providers (HCPs). It aims to increase knowledge, build capacity, and ultimately, improve patient outcomes by bringing expertise to the community. This project focuses on the first paediatric implementation of Project ECHO for children with medical complexity. This is the first Project ECHO for this population. OBJECTIVES In preparation for this novel program launch in January 2018, a needs assessment was conducted with the objectives of: (1) informing the complex care-specific ECHO curriculum; and (2) assessing community partner preferences for program format and delivery modality. DESIGN/METHODS An online survey (38 items; 15-minutes) was distributed via targeted emails to professional networks, associations, and allied health organizations related to complex care throughout Ontario. The survey assessed interest in specific educational topics as well as program format preferences. An online survey and data management tool (REDCap) was used to build the survey and ensure data quality and security. RESULTS 49 HCPs completed the survey for Paediatric Project ECHO for Children with Medical Complexity. Profession breakdown was: 29% paediatricians, 19% dieticians, 16% nurses, 14% nurse practitioners with the remaining being allied health care professionals, including occupational therapists, social workers and psychologists. Overall, 39% of participants practiced in academic hospitals, 27% in non-academic hospitals, and 35% in other community settings. In terms of program format, 63% preferred weekly 1- or 2-hour educational sessions versus longer sessions. Top medical topics rated by HCPs were: management of nutrition, pain or irritability of unknown origin, and challenging behaviours in children with complex care needs. Other topics of interest included: developmental review, transition to adult care, advanced care planning, funding opportunities, and social supports for the patient as well as caregivers and siblings. CONCLUSION HCPs who expressed interest in Paediatric Project ECHO for Children with Medical Complexity are generally experienced professionals who preferred short educational sessions. The themes that emerged from this needs assessment spanned the biological, psychological and social domains of management of complex care patients. Survey results are being used to inform the development of an evidence-based paediatric complex care curriculum that meets the needs of community HCPs. This project is funded by the MOHLTC.
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Huang, I.-Anne, Yiing-Jenq Chou, I.-Jun Chou, Yu-Tung Huang, Jhen-Ling Huang, Tang-Her Jaing, Chang-Teng Wu, Hsiang-Ju Hsiao, and Nicole Huang. "Low acuity paediatric emergency visits under single-payer universal health insurance in Taiwan, 2000–2015: a population-based repeated cross-sectional design." BMJ Open 11, no. 1 (January 2021): e042084. http://dx.doi.org/10.1136/bmjopen-2020-042084.
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ObjectivesEmergency services utilisation is a critical policy concern. The paediatric population is the main user of emergency department (ED) services, and the main contributor to low acuity (LA) ED visits. We aimed to describe the trends of ED and LA ED visits under a comprehensive, universal health insurance programme in Taiwan, and to explore factors associating with potentially unnecessary ED utilisation.Design and settingWe used a population-based, repeated cross-sectional design to analyse the full year of 2000, 2005, 2010 and 2015 National Health Insurance claims data individually for individuals aged 18 years and under.ParticipantsWe identified 5 538 197, 4 818 213, 4 401 677 and 3 841 174 children in 2000, 2005, 2010 and 2015, respectively.Primary and secondary outcome measuresWe adopted a diagnosis grouping system and severity classification system to define LA paediatric ED (PED) visits. Generalised estimating equation was applied to identify factors associated with LA PED visits.ResultsThe annual LA PED visits per 100 paediatric population decreased from 10.32 in 2000 to 9.04 in 2015 (12.40%). Infectious ears, nose and throat, dental and mouth diseases persistently ranked as the top reasons for LA visits (55.31% in 2000 vs 33.94% in 2015). Physical trauma-related LA PED visits increased most rapidly between 2000 and 2015 (0.91–2.56 visits per 100 population). The dose–response patterns were observed between the likelihood of incurring LA PED visit and either child’s age (OR 1.06–1.35 as age groups increase, p<0.0001) or family socioeconomic status (OR 1.02–1.21 as family income levels decrease, p<0.05).ConclusionDespite a comprehensive coverage of emergency care and low cost-sharing obligations under a single-payer universal health insurance programme in Taiwan, no significant increase in PED utilisation for LA conditions was observed between 2000 and 2015. Taiwan’s experience may serve as an important reference for countries considering healthcare system reforms.
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Mello, Maria Júlia Gonçalves de, Maria de Fátima Pessoa Militão de Albuquerque, Heloísa Ramos Lacerda, Wayner Vieira de Souza, Jailson B. Correia, and Murilo Carlos Amorim de Britto. "Risk factors for healthcare-associated infection in pediatric intensive care units: a systematic review." Cadernos de Saúde Pública 25, suppl 3 (2009): S373—S391. http://dx.doi.org/10.1590/s0102-311x2009001500004.
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A systematic review of observational studies on risk factors for healthcare-associated infection in pediatric Intensive Care Units (ICU) was carried out. Studies indexed in MEDLINE, LILACS, Cochrane, BDENF, CAPES databases published in English, French, Spanish or Portuguese between 1987 and 2006 were included and cross references added. Key words for search were "cross infection" and "Pediatric Intensive Care Units" with others sub-terms included. 11 studies were selected from 419 originally found: four studies had healthcare-associated infection as the main outcome without a specific site; three articles identified factors associated with lower respiratory tract infection (pneumonia or tracheitis); three articles were concerned with laboratory-confirmed bloodstream infection; and a single retrospective study analyzed urinary tract infection. The production of evidence on risk factors Paediatric ICU has not kept up the same pace of that on adult - there are few studies with adequate design and statistical analysis. The methodological diversity of the studies did not allow for a summarized measurement of risk factors.
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Garland, Hilarie. "Impact of high flow nasal cannula implementation on the rate of intubation for bronchiolitis in Canada." Paediatrics & Child Health 23, suppl_1 (May 18, 2018): e32-e32. http://dx.doi.org/10.1093/pch/pxy054.082.
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Abstract BACKGROUND Bronchiolitis affects more than one-third of children less than two years of age and is the most common reason for admission to hospital in the first year of life. Hospitalization rates have been on the rise, leading to an increase in healthcare expense, morbidity and impact on families. Bronchiolitis can have a heavy burden on health care resources including intubation and Intensive Care Unit (ICU) admissions. Non-invasive respiratory support with high-flow nasal cannula (HFNC) is being used more routinely in paediatric centers, though evidence of efficacy in bronchiolitis is insufficient to date. We examined the impact that implementation of HFNC has had on intubation rate and ICU admissions for patients with bronchiolitis in Paediatric centres in Canada. OBJECTIVES Our primary objective was to determine the impact of HFNC on intubation rate in Canada for paediatric patients with bronchiolitis. Our secondary objectives were to determine the impact of HFNC on ICU admission rate, ICU length of stay (LOS) and total hospital LOS. DESIGN/METHODS We conducted a multicentre, interrupted time series analysis to examine intubation rates pre- to post-implementation of HFNC for children less than 2 years with bronchiolitis. Data were obtained from the CIHI database using the Canadian Coding Standards. Paediatric tertiary centres that introduced HFNC between 2009–2014 were included, and data were collected from January 2005 to December 2016. RESULTS A total of 17,643 patients met inclusion criteria; 5,862 were before and 11,791 after implementation of HFNC. Comparing the two groups, there was no significant change in the rate of intubation after HFNC was introduced. There was also no significant change in the trend of average LOS in hospital between the two groups. There was a significant increase in ICU admission rates after the introduction of HFNC. Prior to HFNC implementation, there was an increase in average ICU LOS, with a decrease in the overall trend following the introduction of HFNC. CONCLUSION Initiating HFNC in Canadian paediatric centres resulted in no significant change in intubation rates or total LOS in hospital, but was associated with an increase in ICU admissions and a decrease in ICU LOS. Though HFNC does not prevent intubations, it may improve clinical severity with shorter time in ICU needed. Adopting use of HFNC on the ward in the tertiary care setting may help to address increasing ICU admission rates with associated healthcare expenses.
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Dharmaraj, Blossom, Catherine Diskin, Julia Orkin, Tanvi Agarwal, Arpita Parmar, Karima Karmali, and Jeremy Friedman. "88 Family Absence at the Bedside during the COVID-19 Pandemic." Paediatrics & Child Health 26, Supplement_1 (October 1, 2021): e64-e64. http://dx.doi.org/10.1093/pch/pxab061.070.
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Abstract Primary Subject area Hospital Paediatrics Background Child and family-centered care, a partnership approach to health care decision-making, is central to paediatric practice. To reduce transmission of SARS-CoV-2, healthcare institutions implemented policies to protect staff, patients and families. Family presence at the bedside was reduced to one caregiver, except in special circumstances requiring pre-approval by hospital leadership. Objectives We explored the impact of the COVID-19 pandemic on paediatric healthcare delivery, focusing on family presence. We describe the clinician's experience of restricted family presence during the COVID-19 pandemic in a paediatric hospital. Design/Methods Physicians, trainees, and nurses at The Hospital for Sick Children completed surveys between March-August 2020 to identify patients they perceived to have experienced a suboptimal quality of care or health-outcome related to changes that had occurred as a result of the pandemic and describe the impact. Data were analyzed via case report and thematic analysis. As part of a larger study, here we report on cases related to family presence in the hospital. Results A total of 212 clinicians reported 116 cases; eighteen cases specified an impact on child and family-centered care. Nine cases related to patient experiences and nine to family experiences of the restricted family presence policy. Clinicians reported a perceived distress in patients due to family members not being present. 6267 family restriction exemption requests were received. Cases described families who opted for a different location for end-of-life care so that extended family could be present. Further cases highlighted how important conversations such as disclosure of diagnosis involved one parent present and the other joining remotely. Siblings were also reported to be impacted by visitor restrictions and closure of the sibling play area. Exclusions were also reported to be challenging for children with complex medical needs and technology dependency whereby two-caregivers were often required. Clinicians reported experiencing stress and moral distress as part of being required to support family restriction policies, impairing their ability to provide care. Conclusion Family presence policies are a critical component of child and family-centered care and have been impacted by the pandemic as described both by family and clinician stress. Recommendations based on these findings would include: facilitating two-caregiver presence to support shared decision making, regular remote meetings to communicate information with families in cases where they cannot be physically present; using remote technology or implementing allotted visitation time for siblings, reviewing exceptions to caregiver restrictions, and mental health supports for clinicians such as peer-support groups, or wellness workshops.
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Sengupta, Mitali, Satyajit Chakrabarti, and Indraneel Mukhopadhyay. "Waiting Time: The Expectations and Preferences of Patients in a Paediatric OPD." Journal of Health Management 21, no. 3 (September 2019): 427–42. http://dx.doi.org/10.1177/0972063419868586.
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Quality healthcare and satisfaction are gradually emerging as important areas, which need much attention. The factors of patient satisfaction have been identified under varied conditions globally. In the Indian context, one key patient satisfaction factor has been attributed to waiting time. Long waiting time has been one of the major reasons of patient dissatisfaction and assumes significance when associated with paediatric events. The following study has successfully identified key attributes, which are associated with long waiting times within paediatric outpatient department (OPD) settings. The possible implications of the long waiting periods have been recorded through semi-structured interviews, and further in-depth analysis of individual factors were carried out to predict the probable outcomes. The qualitative exploratory study design has helped to understand the perception of parents/care givers (in case of neonates and toddlers) and adolescents, thereby successfully highlighting the need for further study in the patient satisfaction domain involving paediatric population. The various implications which the waiting time has on them have been taken into consideration. The inter-related themes have been identified after analyzing the interviews. These substantiate the fact that designing innovative mitigation strategies on proper and timely communication, updated technological know-how, improvising hospital protocols for better operational processes and coordination among the staff can go a long way in enhancing the patient/parent experience within OPD settings.
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Rizwan, Ayesha, and Shazeen Suleman. "115 An Evidence-Based Model of Care for Newcomer Children with Special Health Care Needs." Paediatrics & Child Health 25, Supplement_2 (August 2020): e47-e48. http://dx.doi.org/10.1093/pch/pxaa068.114.
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Abstract Background In 2018, Canada resettled the most refugees in the world, in response to the greatest migration crisis in global history. The refugee and resettlement experience at critical stages of children’s development places children at risk for a number of chronic illnesses. Newcomer children with chronic illnesses or special health care needs (NCSHCN) require services and care providers across many systems, but face greater barriers to healthcare access and are at an increased risk of unmet needs, yet no research has been done to identify best practices for this vulnerable population. Objectives To develop an evidence-based model for high-quality, patient-centered care for NCSHCN and identify areas of need in a large Canadian city with a high density of newcomers. Design/Methods Using formative research design, a literature review and thematic analysis was performed to develop a conceptual model of care for NCSHCN. Next, a local environmental scan was conducted to identify and evaluate current clinics serving newcomers in a large urban Canadian city. Variables collected included the constructs identified in the conceptual model, and information about population served, providers and services offered including access to paediatrics. Results 326 studies were identified, of which 43 studies underwent full-text review and 21 were included in the final synthesis. Six key components were identified to best support NCSHCN: access to interpreters and appropriately translated resources; delivery of culturally competent care; access to care coordination and system navigation; longer appointment times; family-centered care through medical homes and home-based services; and an enhanced knowledge and understanding of health insurance processes. The environmental scan identified 50 clinics and programs serving newcomers, with 88% providing referrals to paediatric services but only 12% with a paediatrician on-site. Eighty-eight percent offered some form of interpreter services and while 71% offered patient navigation/care coordination services, only one program was specific to navigating child health services and programs. Conclusion We propose a data-driven model of care for NCSHCN that can reduce the intersecting disparities these families face by promoting equitable access to health and community services, thereby improving child outcomes and quality of life. While many programs for newcomers exist, access to paediatric services remains elusive and training in cultural competency and insurance processes is variable. More programs that integrate paediatric services into the community to make quality care more accessible and family-centered are required.
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Ekenze, Sebastian O. "Funding paediatric surgery procedures in sub-Saharan Africa." Malawi Medical Journal 31, no. 3 (September 3, 2019): 233–39. http://dx.doi.org/10.4314/mmj.v31i3.13.
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BackgroundIn sub-Saharan Africa, there is a growing awareness of the burden of paediatric surgical diseases. This has highlighted the large discrepancy between the capacity to treat and the ability to afford treatment, and the effect of this problem on access to care. This review focuses on the sources and challenges of funding paediatric surgical procedures in sub-Saharan Africa. MethodsWe undertook a search for studies published between January 2007 and November 2016 that reported the specific funding of paediatric surgical procedures and were conducted in sub-Saharan Africa. Abstract screening, full-text review and data abstraction were completed and resulting data were analysed using Statistical Package for Social Sciences (SPSS) software. ResultsThirty-five studies met our inclusion criteria and were reviewed. The countries that were predominantly emphasized in the publications reviewed were Nigeria, South Africa, Kenya, Ghana and Uganda. The paediatric surgical procedures involved general paediatric surgery/urology, cardiac surgery, neurosurgery, oncology, plastics, ophthalmology, orthopaedics and otorhinolaryngology. The mean cost of these procedures ranged from 60 to 21,140 United States Dollars (USD). The source of funding for these procedures was mostly out-of-pocket payments (OOPs) by the patient’s family in 32 studies, (91.4%) and medical mission/non-governmental organizations (NGOs) in 21 (60%) studies. This pattern did not differ appreciably between the articles published in the initial and latter 5 years of the study period, although there was a trend towards a reduction in OOP funding. Improvements in healthcare funding by individual countries supported by international organizations and charities were the predominant suggested solutions to challenges in funding.ConclusionWhile considering the potential limitations created by diversity in study design, the reviewed publications indicate that funding for paediatric surgical procedures in sub-Saharan Africa is mostly by OOPs made by families of the patients. This may result in limited access to some procedures. Coordinated efforts, and collaboration between individual countries and international agencies, may help to reduce OOP funding and thus improve access to critical procedures.
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Shannon, Meggie, Qendresa Sahiti, and Amy Ornstein. "30 Exploring the lived experience of non-offending caregivers in paediatric abusive head trauma." Paediatrics & Child Health 27, Supplement_3 (October 1, 2022): e15-e15. http://dx.doi.org/10.1093/pch/pxac100.029.
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Abstract Background Abusive head trauma (AHT) is the most common cause of death due to physical abuse and despite prevention efforts, the incidence remains largely unchanged. For survivors, there can be multiple adverse health consequences with lifetime costs in the range of millions per child. While studies have focused on both short- and long-term outcomes for children with AHT, little is known about the experience of their non-offending caregivers (NOCs). Objectives To explore the lived experience of NOCs in paediatric AHT, including their perspectives on paediatric practice and prevention strategies. Design/Methods Institutional Research Ethics Board approval was obtained. Recruitment materials were shared through the National Centre on Shaken Baby Syndrome’s email, social media, and presentation at their Family Symposium. Inclusion criteria were North American NOCs in paediatric AHT, who lived with the offender. Using a phenomenological approach, six semi-structured interviews were conducted over Zoom for Healthcare, audio-recorded, transcribed, and rendered anonymous. Transcripts were coded using ATLAS.ti and classified by consensus into major themes and subthemes by the research team. Data collection and analysis continued until saturation was reached. Results All participants reported ongoing, multidimensional impacts of the trauma on their physical and mental health, years after occurrence. Primary themes identified included: (1) NOCs need compassion and support. Among other aspects of their experience, feeling judged and accused by healthcare providers (HCPs), compounded their trauma, (2) NOCs reported varied experiences within healthcare including a perceived lack of AHT knowledge among HCPs, and could be better served by an extension of multidisciplinary supports, (3) NOCs are resilient, devoted, and powerful advocates for their children all while managing negative emotions such as feeling betrayed, guilt and fear for their child’s life, (4) NOCs experienced challenges navigating systems and accessing supports, including financial, geographical and psychosocial barriers, and (5) There was varied exposure to AHT prevention materials, and many felt the stigma associated with AHT limits engagement with the subject, which may be a barrier to prevention efforts. Conclusion NOCs hold a unique and relevant perspective, not previously documented. While further research is required, our findings suggest that by extending compassion to caregivers and accessible multidisciplinary supports, the experience and overall wellbeing of NOCs could be improved. By better addressing the complex needs of NOCs, and increasing knowledge of AHT, HCPs have an opportunity to mitigate the negative impacts of the event and create better outcomes for children.
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Noman Ahmed, Mehatab Alam Khanzada, Nisar Ahmed Jandan, and Ashok Kumar Narsani. "Etiology, presentation and treatment of ocular trauma in paediatric population." Professional Medical Journal 29, no. 01 (December 31, 2021): 67–70. http://dx.doi.org/10.29309/tpmj/2022.29.01.6821.
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Objective: To determine the etiology, presentation and treatment of ocular trauma in paediatric population. Study Design: Cross Sectional Study. Setting: Institute of Ophthalmology, Liaquat University Hospital Jamshoro. Period: January, 2020 to December 2020. Material & Methods: Data was collected using a questionnaire having age, sex, cause of injury and time at presentation to the emergency. It also focused on which structures were damaged due to injury, investigations being used, and treatment performed. Results: In our study we found 80 cases of ocular trauma in pediatric population visiting the ophthalmology department. Gender distribution of the study group which includes 72.5% (n=58) males and 27.5% (n=22) females. It was found during playing 86.3% of children had ocular trauma followed by injury due to domestic stuff like glass, bleach cleaners in 7.5% of the study group. The most frequently occurring ocular trauma was found to be corneal tear occurring in 25% of the study group. Conclusion: Ocular trauma in children can be prevented by simple measures like supervising children and educating parents and teachers for potential hazard substances. It is important to address like healthcare issue as ocular trauma can lead to lifelong blindness along with psychological and financial burden for the caretaker and children themselves.
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Ge, Yipeng, Radha Jetty, Dennis Newhook, Richard Webster, Amanda Mills, Victoria McCann, Sara Trincao-Batra, Katherine Baba, Stephanie Sutherland, and Deepti Reddy. "136 Characterizing the medical and social complexity of Inuit children, youth, and their families from Nunavut who access care at an urban tertiary level paediatric hospital – A retrospective chart review of an Inuit child health clinic." Paediatrics & Child Health 26, Supplement_1 (October 1, 2021): e95-e96. http://dx.doi.org/10.1093/pch/pxab061.108.
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Abstract Primary Subject area Social Paediatrics Background The Inuit Child Health Clinic is a consulting general pediatric outpatient clinic at an urban tertiary level paediatric designed to improve integration and coordination of care for Inuit children, youth, and their families from Nunavut. Characterizing medical and social complexity for this patient population will help to address existing gaps in health and social care, as well as contribute to the development of a culturally safe and sensitive determinants of health screening tool. Objectives To study and characterize the complexities that families cared for by the Inuit Child Health Clinic experience in navigating the health and community environments to identify gaps that exist within their care and understand how we can better support their unique needs. We define medical complexity similarly, referenced in existing literature as multi-system or multi-service involvement or prolonged stay in the city of the urban tertiary level paediatric hospital to access medical care. Design/Methods A retrospective chart review of patients (children and youth between the ages of 0-18 years old) and their caregivers that attended an outpatient general paediatric medicine clinic visit appointment with the Inuit Child Health Clinic between September 30, 2016, and September 30, 2019. A review of 59 patient charts were completed by 2 independent reviewers each for demographic information, medical complexity variables, and social complexity variables. This research has been approved by a local Research Ethics Board as well as the Nunavut Research Institute. Results There are high levels of medical and social complexity as evident through the high average number of healthcare services accessed, number of comorbidities, and number of admissions to hospital. We also found considerable inconsistencies with respect to documentation by providers on the social determinants of health of patients. Note: In collaboration with the Inuuqatigiit Centre for Inuit Children Youth and Families, Qikiqtani Inuit Association (QIA), Nunavut Tunngavik Incorporated (NTI), and the Department of Health in Nunavut, the results and knowledge will be shared and mobilized to reflect a narrative that is community-driven and comments on any possible gaps in social determinants of health screening in clinical settings. Furthermore, in collaboration with the Qaujigiartiit Health Research Centre, this work will inform and support the broader program evaluation of the Inuit Child Health Clinic to meet the needs of patients, families, caregivers, and healthcare professionals. Conclusion A multidisciplinary team approach that focuses on integrative care may be an effective and efficient means to promote communication and collaboration between multiple service providers that are often involved in providing care to this population that is put at-risk due to systemic health and social inequities. Improving social history taking and integrating more formal screening for social determinants of health within the Inuit Child Health Clinic practice should be considered.
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Helmers, Andrew, Karen Dryden Palmer, and Rebecca A. Greenberg. "Moral distress: Developing strategies from experience." Nursing Ethics 27, no. 4 (April 2, 2020): 1147–56. http://dx.doi.org/10.1177/0969733020906593.
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Background Moral distress was first described by Jameton in 1984, and has been defined as distress experienced by an individual when they are unable to carry out what they believe to be the right course of action because of real or perceived constraints on that action. This complex phenomenon has been studied extensively among healthcare providers, and intensive care professionals in particular report high levels of moral distress. This distress has been associated with provider burnout and associated consequences such as job attrition, with potential impacts on patient and family care. There is a paucity of literature exploring how middle and late career healthcare providers experience and cope with moral distress. Objectives We explore the experience of moral distress and the strategies and resources invoked to mitigate that distress in mid- and late-career healthcare providers practicing in paediatric intensive care, in order to identify ways in which the work environment can build a culture of moral resilience. Research design An exploratory, qualitative quality improvement project utilizing focus group and semi-structured interviews with pediatric intensive care front-line providers. Participants Mid-and-later career (10 + years in practice) pediatric intensive care front line providers in a tertiary pediatric hospital. Research context This work focuses on paediatric intensive care providers in a single critical care unit, in order to explore the site-specific perspectives of health care providers in that context with respect to moral distress coping strategies. Ethical considerations The study was approved by the Quality Management Office at the institution; consent was obtained from participants, and no identifying data was included in this project. Findings Participants endorsed perspective-building and described strategies for positive adaptation including; active, reflective and structured supports. Participants articulated interest in enhanced and accessible formal supports. Discussion Findings in this study resonate with the current literature in healthcare provider moral distress, and exposed ways in which the work environment could support a culture of moral resilience. Avenues are described for the management and mitigation of moral distress in this setting. Conclusion This exploratory work lays the groundwork for interventions that facilitate personal growth and meaning in the midst of moral crises in critical care practice.
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Maria Piras, Enrico, and Alberto Zanutto. "“One day it will be you who tells us doctors what to do!”. Exploring the “Personal” of PHR in paediatric diabetes management." Information Technology & People 27, no. 4 (October 28, 2014): 421–39. http://dx.doi.org/10.1108/itp-02-2013-0030.
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Purpose – Personal Health Record (PHR) systems make possible to integrate data from different sources and circulate them within the illness care and management network. The new arrangements prefigure a redefinition of the relations among healthcare practitioners, patients, and caregivers. The purpose of this paper is to consider the role and the meanings attributed to information when a technical artifact enables new forms of communication within the healthcare management network. Design/methodology/approach – The authors adopted a qualitative research design, conducting a pre-post analysis on a theoretical sample of patients and of a paediatrics department. The authors selected 12 patients (six females and six males) aged between four and 20 years old. Findings – The patients were willing to act as “stewards of their own information” (Halamka et al., 2008), but they interpreted this role in terms of restricting access to their information, rather than facilitating its dissemination. In fact, the PHR was symbolized as an instrument to support personal diabetes management but the patients want to preserve their own competence and independent management on the information regarding their “Personal” diseases. Originality/value – This work highlights two connotation of “Personal” information. The first is the dimension of the right to the privacy of information when it is believed that it may be used to pass judgement on the patient. The second connotation of “Personal” is the assertion by patients of their competence and autonomy in interpreting the information on the basis of personal knowledge about their diabetes.
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Wray, Jo, and Geralyn Oldham. "Using parent-reported experience measures as quality improvement tools in paediatric cardiothoracic services: making it happen." International Journal for Quality in Health Care 32, no. 2 (March 2020): 140–48. http://dx.doi.org/10.1093/intqhc/mzaa001.
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Abstract Objective Patient experience is a core component of quality and service improvement. In the case of child health, it is parents who often report on their experiences of the child’s healthcare. However, these parent experiences are rarely used to drive change. Our aim was to develop and implement the systematic collection of parent experience data across a range of cardiothoracic services, using quality improvement methodology to implement change. Design Plan-Do-Study-Act methodology was used to develop parent-reported experience measures. Setting: Specialist children’s hospital. Participants Parents of children under the care of one of a number of cardiothoracic services at the hospital. Intervention(s) Completion of questionnaires about hospital experience comprising quantitative and qualitative questions. Main Outcome Measure(s) Response rates and completion of a specific-measurable-achievable-realistic-timely (SMART) action plan by the individual clinical teams. Results During the first cycle 17 surveys were developed for different clinical services and questionnaires sent/given to 1876 parents. The overall response rate was 30% (15–100%). Clinical teams developed SMART plans following eight (47%) surveys; three teams have reviewed and reported back on their progress against their plan and started on the second cycle of questionnaires. Challenges included lack of resources (time, finances and electronic data collection tools) and problems with actioning SMART plans. However, teams engaged positively, recognizing the importance of parent experience and actively seeking solutions to problems. Conclusions Parent-reported experience measures are practical and acceptable quality improvement tools in healthcare but challenges need to be addressed, primarily related to resources, training and sustainability.