Child Care Research Articles

Whole-genome sequencing of Klebsiella pneumoniae MDR circulating in a pediatric hospital setting: a comprehensive genome analysis of isolates from Guayaquil, Ecuador

BackgroundKlebsiella pneumoniae is the major cause of nosocomial infections worldwide and is related to a worsening increase in Multidrug-Resistant Bacteria (MDR) and virulence genes that seriously affect immunosuppressed patients, long-stay intensive care patients, elderly individuals, and children. Whole-Genome Sequencing (WGS) has resulted in a useful strategy for characterizing the genomic components of clinically important bacteria, such as K. pneumoniae, enabling them to monitor genetic changes and understand transmission, highlighting the risk of dissemination of resistance and virulence associated genes in hospitals. In this study, we report on WGS 14 clinical isolates of K. pneumoniae from a pediatric hospital biobank of Guayaquil, Ecuador.ResultsThe main findings revealed pronounced genetic heterogeneity among the isolates. Multilocus sequencing type ST45 was the predominant lineage among non-KPC isolates, whereas ST629 was found more frequently among KPC isolates. Phylogenetic analysis suggested local transmission dynamics. Comparative genomic analysis revealed a core set of 3511 conserved genes and an open pangenome in neonatal isolates. The diversity of MLSTs and capsular types, and the high genetic diversity among these isolates indicate high intraspecific variability. In terms of virulence factors, we identified genes associated with adherence, biofilm formation, immune evasion, secretion systems, multidrug efflux pump transporters, and a notably high number of genes related to iron uptake. A large number of these genes were detected in the ST45 isolate, whereas iron uptake yersiniabactin genes were found exclusively in the non-KPC isolates. We observed high resistance to commonly used antibiotics and determined that these isolates exhibited multidrug resistance including β-lactams, aminoglycosides, fluoroquinolones, quinolones, trimetropins, fosfomycin and macrolides; additionally, resistance-associated point mutations and cross-resistance genes were identified in all the isolates. We also report the first K. pneumoniae KPC-3 gene producers in Ecuador.ConclusionsOur WGS results for clinical isolates highlight the importance of MDR in neonatal K. pneumoniae infections and their genetic diversity. WGS will be an imperative strategy for the surveillance of K. pneumoniae in Ecuador, and will contribute to identifying effective treatment strategies for K. pneumoniae infections in critical units in patients at stratified risk.

Efficacy of a burn prevention educational program to diminish the incidence of burn injuries in the pediatric population

BackgroundPediatric burn injuries are a significant public health issue in low- and middle-income countries, leading to substantial morbidity and mortality. This study aimed to evaluate the efficacy of the No+Quema2 educational program, implemented in Aguascalientes, Mexico, in preventing burn injuries among children under nine years old. MethodsThe No+Quema2 program, initiated in 2014, included educational courses for children, training for health workers, and specialized care for children with burn sequelae. Epidemiological data on burn injuries from 2014 to 2022 were retrieved from the National System of Epidemiological Surveillance of the Health Ministry of Mexico. Monthly incidence rates per 100,000 inhabitants were analyzed using the Mann-Kendall trend test and segmentation analysis to detect trends and changes. ResultsThe program trained over 25,000 scholars from 1750 elementary schools and distributed medical kits for immediate burn care. Additionally, 200 children with burn sequelae received scheduled treatment. The analysis showed a significant decrease in the state incidence rate of burn injuries compared to the national mean post-implementation. The estimated number of burn injuries prevented during the study period was approximately 3839, or 604 per year. ConclusionThe No+Quema2 program has made a significant impact on burn prevention among children in Aguascalientes, Mexico. Despite the limitations of relying on government-reported data, the correlation between the program's activities and the observed decrease in burn injuries is promising. These findings underscore the critical importance of the No+Quema2 program's activities in achieving sustained, targeted educational interventions and long-term reductions in burn injury incidence. They also highlight the need for more robust study designs to validate these outcomes, emphasizing the importance of evidence-based strategies in future burn prevention efforts.

Pediatric wrist fractures: variations in management across countries. An evidence-based summary of evidence.

Fractures of the distal radius are common in pediatric population, with considerable variation in the management of pediatric wrist fractures across different countries. It is crucial to consider the different approaches to conservative management and surgical intervention. The decision on the appropriate treatment method often depends on the type and severity of the fracture, as well as the available healthcare resources and expertise in each country. This article tries to identify these variations, so the various healthcare systems can work toward implementing best practices in the management of pediatric wrist fractures on a global scale. Published peer-reviewed articles identified in electronic databases, including PubMed Scopus and Google Scholar. The management of pediatric wrist fractures can differ significantly among countries given the high variability in healthcare resources and cultural practices. The management of pediatric wrist fractures can be challenging in certain countries, especially in developing regions with limited resources. Challenges such as long therapeutic delays, lack of appropriate anesthesia, and the absence of fluoroscopy can complicate the treatment process. Randomized controlled clinical trials (RCTs) are vital in providing high-quality evidence to guide clinical decision-making, especially in the field of pediatric wrist fractures. Efforts to support and prioritize the conduct and dissemination of RCTs in pediatric wrist fracture management can ultimately lead to more consistent, effective, and evidence-based care for children with wrist fractures worldwide.

Do kindergartens mitigate or exacerbate socioeconomic inequalities in language exposure? The case of home-based and kindergarten-based shared book reading activities in China

Shared book reading is a well-established practice for boosting children’s language exposure and enhancing early development at home and in child care settings. The present study examined the socioeconomic gaps in home-based and kindergarten-based shared book reading practices in China. The participants were 1095 parents and 111 teachers in 69 classes from kindergartens in Chongqing, China. Differences in terms of the quantity of both home-based and kindergarten-based shared book reading across SES spectrums were tested. Multi-level modelling was conducted to examine the factors associated with the quantity of home-based and kindergarten-based shared book reading. The results revealed that the socioeconomic gap in home-based shared book reading and the resultant language exposure were significant. Family SES and home literacy resources were associated with the quantity of home-based shared book reading and the availability of literacy resources in the classroom is associated with the quantity of kindergarten-based shared book reading. Kindergartens did not mitigate the socioeconomic inequities of language exposure related to shared book reading. Intervention programs shall focus on improving access to both home-based and kindergarten-based literacy materials.

Multidimensional patterns of early care and education access through a family centered lens

Despite evidence of the benefits of early care and education (ECE) for child development and family employment, the supply of providers is scarce and variable; leading many families with young children to experience limited and inequitable access. To examine the multidetermined nature of access, this study leverages a multidimensional, family-centered definition and a nationally representative sample of families of preschoolers from the Early Childhood Longitudinal Study – Birth Cohort to examine (1) patterns of access-related features present in preschool-age children's ECE arrangements, and (2) child characteristics, household circumstances, and care setting type that may be related to patterns of access. Latent class analysis model enumeration revealed five latent classes of children's nonparental care arrangements along features of accessibility: High Across Most Access Features (26.4 %), Single, Long-Term Provider (30.1 %), Limited Across Most Access Features (11.6 %), Low Affordability, Multiple Providers (10.1 %), and High Affordability, Recent Transition (21.8 %). These results suggested many children were in ECE that met multiple dimensions of access, with others in care arrangements that reflected trade-offs. Children were also differentially classified into types of ECE arrangements in relation to care setting type, race/ethnicity, income, household urbanicity, and parental employment. The implications of investigating ECE access as a multidimensional construct, and recommendations for how ECE providers and policy can more closely align with family needs are discussed.

Outpatient encounters, continuity of care, and unplanned hospital care for children and young people with cerebral palsy.

https://onlinelibrary.wiley.com/doi/full/10.1111/dmcn.15800

Nurses’ perceptions of compassionate care in pediatric oncology: a qualitative interview study

BackgroundCompassion is a crucial aspect in the management of pediatric oncology patients as it has the potential to enhance nurse satisfaction levels, thereby further enhancing the quality and safety of the care they deliver. This study aimed to investigate nurses’ understanding and experience of compassionate care when working in pediatric oncology departments.MethodsThis research utilized a qualitative descriptive design. Content analysis was used to make sense of data collected via individual and semi-structured interviews conducted with nurses (n = 32) working in pediatric oncology departments.ResultsNurses’ understanding of compassionate care for children with cancer was organized into two categories: Humanistic compassionate care and compassionate end-of-life care. The humanistic compassionate care category comprised of three subcategories: (1) empathy, (2) altruism, and (3) respect for the cultural values and beliefs of the family. The compassionate end-of-life care category comprised of two subcategories: (1) facilitating parents’ presence at the child’s bedside and (2) creating suitable conditions for accepting the death of a child.ConclusionCompassionate care for children with cancer is marked by a strong emphasis on humanistic, cultural, and end-of-life considerations. Our findings further emphasize the paramount importance of taking families’ presence, wishes and beliefs into consideration within this context.

Non-invasive positive pressure ventilation for acute asthma in children.

Asthma is one of the most common reasons for hospital admission among children, with significant economic burden and impact on quality of life. Non-invasive positive pressure ventilation (NPPV) is increasingly used in the care of children with acute asthma, although the evidence supporting it is weak, and clinical guidelines do not offer any recommendations on its routine use. However, NPPV might be an effective way to improve outcomes for some children with asthma. A previous review did not demonstrate a clear benefit, but was limited by few studies with small sample sizes. This is an update of the previous review. To assess the benefits and harms of NPPV as an add-on therapy to usual care (e.g. bronchodilators and corticosteroids) in children (< 18 years) with acute asthma. We searched the Cochrane Airways Group Specialised Register, CENTRAL, MEDLINE, and Embase. We also conducted a search of ClinicalTrials.gov and the WHO ICTRP. We searched all databases from their inception to March 2023, with no restrictions on language of publication. We included randomised clinical trials (RCTs) assessing NPPV as add-on therapy to usual care versus usual care for children hospitalised for acute asthma exacerbations. We used standard Cochrane methods. We included three RCTs randomising 60 children with acute asthma to NPPV and 60 children to control. All included trials assessed the effects of bilevel positive airway pressure (BiPAP) for acute asthma in a paediatric intensive care unit (PICU) setting. None of the trials used continuous positive airway pressure (CPAP). The controls received standard care. The median age of children ranged from three to six years, and asthma severity ranged from moderate to severe. Our primary outcome measures were all-cause mortality, serious adverse events, and asthma symptom score. Secondary outcomes were non-serious adverse events, health-related quality of life, arterial blood gases and pH, pneumonia, cost, and PICU length of stay. None of the trials reported any deaths or serious adverse events (except one trial that reported intubation rate). Two trials reported asthma symptom score, each demonstrating reductions in asthma symptoms in the BiPAP group. In one trial, the asthma symptom score was (mean difference (MD) -2.50, 95% confidence interval (CI) -4.70 to -0.30, P = 0.03; 19 children) lower in the BiPAP group. In the other trial, a cross-over trial, BiPAP was associated with a lower mean asthma symptom score (MD -3.7; 16 children; very low certainty evidence) before cross-over, but investigators did not report a standard deviation, and it could not be estimated from the first phase of the trial before cross-over. The reduction in both trials was above our predefined minimal important difference. Overall, NPPV with standard care may reduce asthma symptom score compared to standard care alone, but the evidence is very uncertain. The only reported serious adverse event was intubation rate in one trial. The trial had an intubation rate of 40% and showed that BiPAP may result in a large reduction in intubation rate (risk ratio 0.47, 95% CI 0.23 to 0.95; 78 children), but the evidence is very uncertain. Post hoc analysis showed that BiPAP may result in a slight decrease in length of PICU stay (MD -0.87 day, 95% CI -1.52 to -0.22; 100 children), but the evidence is very uncertain. Meta-analysis or Trial Sequential Analysis was not possible because of insufficient reporting and different scoring systems. All three trials had high risk of bias with serious imprecision of results, leading to very low certainty of evidence. The currently available evidence for NNPV is uncertain. NPPV may lead to an improvement in asthma symptom score, decreased intubation rate, and slightly shorter PICU stay; however, the evidence is of very low certainty. Larger RCTs with low risk of bias are warranted.

Adoption from care, the reunification principle and consensual placements: the political promotion of a controversial child protection measure in Sweden

ABSTRACT Swedish child welfare policies have traditionally been family-centred, and great importance has been placed on consensual measures and the reunification of children in care with their birth families. Adoptions of children from care are rare. Thus, when the government commissioned the Swedish Board of Health and Welfare (NBHW) to improve social services’ knowledge about adoption, it seemed to indicate an ideological shift in Swedish child protection policies. For over a year, we documented the activities of the working group at the NBHW as they tried to mediate between what they interpreted as a political attempt to promote adoption on the one hand and social services’ reluctant stance towards adoption on the other. We identified three main challenges in this task: (i) the handling of the commission’s ideological premises, (ii) the question of what kind of knowledge about adoption should be disseminated to social services, and (iii) the question of what knowledge is relevant for social services. The article uses theories of metagovernance to show how the NBHW dealt with these challenges by reframing the commision’s premises, adapting the message and by balancing the objectives of addressing the issues social services identified as relevant and of fulfilling its remit.

General emergency physician perceptions of caring for children: A qualitative interview study.

Emergency physicians care for most children presenting to U.S. emergency departments (EDs). Pediatric exposure during emergency medicine (EM) residency can be variable and critically ill children are rarely encountered. A recent needs assessment revealed that emergency physicians feel less prepared to manage various conditions in children and that infants, regardless of presenting complaint, pose particular challenges. Emergency physician perceptions of the experience of caring for pediatric patients have not been widely examined through a qualitative lens. We designed an interview-based qualitative study to explore emergency physician perspectives on pediatric patient care. We recruited emergency physicians who graduated from residency in 2015-2019 and all rotated through the same large tertiary children's hospital. Four trained interviewers conducted in-depth, one-on-one virtual interviews. An interdisciplinary team transcribed and then coded the interviews. The team performed a conventional content analysis for themes. Recruitment continued until thematic saturation was achieved. Twelve participants completed interviews. These participants trained in five diverse residency programs. Likewise, the participants now practice in a variety of settings. Three major themes emerged from the data: (1) experience and exposure are key to establishing comfort caring for children; (2) simulation, pathways, and the pediatric anesthesia rotation are educationally useful; and (3) caring for children poses unique emotional challenges. Participants shared many recommendations for future pediatric education for EM trainees, including increasing autonomy and exposure to neonates and considering how care might differ in a community setting. This interview-based qualitative study elucidates key themes in recently graduated emergency physicians' perceived experience of caring for children. Our findings have important educational implications for this group of emergency physicians and those who share similar experiences in training and practice.

Child Protection Staff Perspectives of the SOFT Program: Touch, Textures, Weights, and Pressures

ABSTRACT Aboriginal children are overrepresented in Australia’s child protection system, and limited tools are available to assist with connecting these children to their culture. The Stitching Our Future Together (SOFT) Program, developed in consultation with Aboriginal and non-Aboriginal peoples, services, and other specialists, is used within the Department of Communities’ Child Protection and Family Support (CPFS) Division in Western Australia to address big emotions and safe behaviours with Aboriginal children in care. This study used phenomenology and social constructivism to explore CPFS staff’s perspectives and experiences of the SOFT Program. Seven semistructured in-depth interviews took place with CPFS staff. Five themes were identified: the SOFT Program and its use, culturally responsive practice, facilitating relationships, communication, and recommendations and implementation challenges. Participants expressed that the SOFT Program fostered an understanding of, and communication about, pertinent issues such as family and domestic violence, drug and alcohol addiction, mental health, and child neglect and abuse. The findings show how staff described the program’s capacity to help them navigate complex situations, highlighting the need to incorporate more culturally centred and creative-based work into child protection practice. IMPLICATIONS The SOFT Program positively supports culturally responsive practice and facilitates relationships and communication for child protection workers and children in care. The integration of creative and legislated practices assists with personalising and enhancing the effectiveness of child protection work with children in care.

Navigating Life: Delaware Families Experiencing Homelessness with Young Children.

This study explored the lived experience of Delaware families residing in homeless shelters and motels with young children. We focused on their daily experiences to gain understanding about their day-to-day living to foster understanding about optimal supports that can facilitate more permanent housing arrangements. We used qualitative approaches to obtain descriptions about the daily lives of families experiencing homelessness with young children. Semi-structured interviews were conducted between November 2022 and February 2023. This study analyzes data from three families using open and thematic coding methods. Families experiencing homelessness with young children discussed their struggle to locate housing, attend to day-to-day tasks, and maintain and obtain employment. Having access to conveniently located affordable and available child care and reliable transportation were discussed across the themes. Evidence building through gathering pertinent qualitative information is a critical step toward understanding the needs of families experiencing homeless. Findings from this study can inform state-level policy and state and non-profit agencies' practices. Current policies that support family homelessness could be adjusted to better address connecting families to resources (e.g., direct connection to landlords), transportation (e.g., increasing allotted bus passes, providing a "free" monthly bus pass), and child care (e.g., co-located care - shelter plus child care, funding enrollment slots left "open" specifically for families experiencing homelessness).

Association of Allergy Specialty Care and Asthma Outcomes for Medicaid-Enrolled Children

To evaluate the comparative effectiveness of allergy specialist care for children with asthma enrolled in the Arkansas Medicaid program. We used the Arkansas All-Payers Claims Database (APCD) to identify Medicaid-enrolled children with asthma who had an allergy specialist visit in 2018. These children were propensity score matched to children without an allergy specialist visit to evaluate differences in asthma-related adverse events (AAE), specifically emergency department visits and/or hospitalizations in 2019. Multivariable logistic regression was used to assess the association between allergy specialist care in 2018 and AAEs in 2019. Prior to matching, a higher percentage of children with an allergy specialist visit had persistent asthma, were atopic, and received influenza vaccination. In the matched sample, 10.1% of identified patients experienced an AAE in 2019. Adjusted analysis showed 21.0% lower odds of AAEs (aOR: 0.79; 95%CI: 0.63, 0.98) in 2019 for children with an allergy specialist visit (n=2,964) in 2018 compared with those without an allergy specialist visit (ME: 9.1% vs 11.0%; p=0.04). Children with asthma enrolled in Arkansas Medicaid who saw an allergy specialist were less likely to have an AAE. Asthma quality metrics developed using guideline-based recommendations for allergy specialist care should be considered for asthma health management programs.

The quality of nursing care in dying children from the nurses’ point of view in Iran: A cross-sectional study

BackgroundNowadays, the quality of nursing care is one of the most essential factors in health services and patient care. The quality of end-of-life care is of high importance, especially in vulnerable groups such as children. In the final stages of life, the needs of patients and their companions, as well as stressful conditions cause avoidance of participation in treatment, and dissatisfaction of caregivers which can reduce the quality of patient care. The present study aimed to examine the quality of nursing care in children from the point of view of nurses in hospitals related to Birjand, Iran. Materials and methodsThe present descriptive study was conducted on 350 nurses. The data collection tools used in this study were demographic questionnaire and Quality Patient Care Scale (QUALPAC). ResultsA total of 270 completed questionnaires were entered into the statistical analysis. The average quality of nursing care score in dying children was 266.17 ± 27.79. Also, the results of the present study showed that the gender, age, marital status, and work experience of nurses have no significant effect on the quality of nursing care in dying children from the nurses’ viewpoint. ConclusionThe quality of nursing care of dying children from the point of view of nurses was satisfactory. Nurses reported that the physical dimension of nursing care had the highest quality and the psychosocial dimension had the lowest quality. Therefore, psychological support and follow-ups for improving social support for these clients are suggested to the nursing managers and healthcare administrators.

Genetic testing for pediatric sensorineural hearing loss in the era of gene therapy.

To summarize indications, methods, and diagnostic yields for genetic testing for pediatric hearing loss. Genetic testing has become a cornerstone of clinical care for children with sensorineural hearing loss. Recent studies have shown the efficacy of gene panels and exome sequencing for any child with sensorineural hearing loss. Recent findings have underscored the importance of a diagnosis in clinical care. Clinical trials for gene therapy for hearing loss have begun. Genetic testing has become critical for personalized care for children with hearing loss. Recent studies have shown a 43% overall diagnostic yield for genetic testing for pediatric hearing loss, though the diagnostic yield may range from 10 to 60% depending on clinical features. Syndromic diagnoses comprise 25% of positive genetic tests for pediatric sensorineural hearing loss. While diagnostic yield is lower for children with unilateral or asymmetric sensorineural hearing loss, the likelihood of syndromic hearing loss finding is higher. An early and accurate genetic diagnosis is required for participating in clinical trials for gene therapy for hearing loss.

Upper tract dilation is an independent risk factor for febrile UTI in children with primary vesicoureteral reflux

BackgroundChildren with vesicoureteral reflux (VUR), particularly high-grade VUR, are known to be at increased risk for urinary tract infection (UTI). Current guidelines highlight certain clinical factors in the management of children with VUR; however, the clinical utility of upper tract dilation in the setting of VUR remains unclear. ObjectiveThe purpose of this study is to evaluate risk factors for febrile UTI (fUTI) in children with primary VUR in a modern cohort with emphasis on upper tract dilation parameters, including hydronephrosis and hydroureter. MethodsA prospectively maintained database of children with VUR at a single academic institution from July 2013 to February 2023 was reviewed. Demographic and clinical data were included. Ultrasounds closest to initial VCUG were reviewed for upper tract dilation, including the presence of hydronephrosis, Society of Fetal Urology (SFU) hydronephrosis grade, presence of hydroureter, and anterior-posterior renal pelvic diameter (APRPD). The primary outcome of interest was the development of a fUTI after VUR diagnosis. Patients were censored after their first fUTI or after VUR surgery. ResultsA total of 235 children with primary VUR were evaluated, including 125 (53.2%) females and 110 (46.8%) males. The median age of VUR diagnosis was 10.8 months (IQR: 2.3-63.6 months). A total of 41 (17.4%) children developed a fUTI after VUR diagnosis with a median follow up of 2.3 years (IQR: 0.9-4.6 years). On univariate analysis, variables found to be associated with fUTI included age < 1 year at VUR diagnosis (p=0.021), female sex (p=0.013), high-grade VUR (p=0.024), APRPD ≥ 7 mm (p=0.007), high-grade hydronephrosis (p=0.004), presence of hydronephrosis (p=0.029), and hydroureter (p=0.008). In children with VUR and high-grade hydronephrosis, a larger APRPD was associated with higher fUTI rates (p=0.008). On multivariate analysis controlling for age, sex, and VUR grade, APRPD ≥ 7 mm (OR 2.8, p=0.009), high-grade hydronephrosis (OR 2.5, p=0.025), and presence of hydronephrosis (OR 2.3, p=0.049) were independent risk factors for fUTI. On multivariate models controlling for other upper tract dilation parameters, APRPD ≥ 7 mm was the most significant parameter associated with increased fUTI risk in primary VUR. ConclusionUpper tract dilation is a novel, independent risk factor for fUTI in children with primary VUR, with APRPD being the strongest predictor. Clinicians may consider upper tract dilation parameters in addition to age, sex, and VUR grade when individualizing care in children with primary VUR.

Perioperative considerations for non-cardiac procedures in patients with congenital heart disease: A practical overview

Providing thorough care for children with congenital heart disease (CHD) undergoing non-cardiac surgery requires a strong understanding of common heart defects and the procedures used to treat them. To care for these patients, multidisciplinary teams must consider the severity of the underlying cardiac disease, comorbid conditions, and preoperative severity of illness. The American Heart Association's Scientific Statement on Perioperative Considerations for Pediatric Patients with Congenital Heart Disease Presenting for Noncardiac Procedures offers valuable guidance.

Kinder und Jugendliche mit Post-COVID-Syndrom: eine qualitative Studie zu Erfahrungen und Zufriedenheit mit der Versorgung in einem Modellprojekt in Bayern (Post-COVID Kids Bavaria)

BackgroundAgainst the background of inadequate healthcare provision for children and adolescents with post-COVID-19 syndrome (PCS), a model project was initiated in Bavaria (PoCoKiBa: Post-COVID Kids Bavaria), offering specialized diagnostics and care. The aim of this study was to explore and describe the experiences and satisfaction of children and adolescents with PCS, as well as their parents, with the healthcare provided in the model project. MethodsFrom October to December 2022, seven focus group discussions were conducted via video conference or in person with a total of 32 participants (19 children/adolescents, twelve mothers, one father). These represented 28 children and adolescents affected by PCS (aged 7 to 17 years). The focus group discussions were recorded, transcribed and analysed using qualitative content analysis. ResultsStudy participants talked about their experiences with the care they received within and beyond the model project, continuity of care, communication between doctors and patients, patient information, and the accompanying study. At the sites of the model project, patients found physicians who spent more time with their patients and took them seriously. Following diagnosis, some patients have benefited from recommendations for therapeutic services or everyday behaviours, while others complained about a lack of treatment suggestions or support for dealing with PCS in their everyday life. DiscussionThe experiences of study participants with the medical care of their PCS symptoms within or beyond the model project mirror the well-known challenges of healthcare provision. There is considerable room for improvement in the care of children and adolescents with PCS, particularly in the organization of the complex diagnostic process, which involves several organ systems, and in the provision of targeted information to patients and families affected. ConclusionThe supply of healthcare services, as established and offered in the PoCoKiBa model project, is crucial for families with a child affected by PCS, since it can offer expertise in diagnosis and treatment that is currently not available in routine health care.

Cost-Effectiveness And Health Impact Of Increasing Emergency Department Pediatric Readiness In The US.

The quality of emergency department (ED) care for children in the US is highly variable. The National Pediatric Readiness Project aims to improve survival for children receiving emergency services. We conducted a cost-effectiveness analysis of increasing ED pediatric readiness, using a decision-analytic simulation model. Previously published primary analyses of a nationally representative, population-based cohort of children receiving emergency services at 747 EDs in eleven states provided clinical and cost parameters. From a health care sector perspective, we used a 3percent annual discount rate and quantified lifetime costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). We performed probabilistic, one-way, and subgroup sensitivity analyses. Increasing ED pediatric readiness yields 69,100 QALYs for the eleven-state cohort, costing $9,300 per QALY gained. Achieving high readiness nationally yields 179,000 QALYs at the same ICER (with implementation costs of approximately $260million). Implementing high ED pediatric readiness for all EDs in the US is highly cost-effective.

Families and Businesses in Delaware Share a Common Challenge: Child Care.

Families and Businesses in Delaware Share a Common Challenge: Child Care.