Pediatric Care Unit Research Articles

The final hospital need in children discharged from a cardiology acute care unit: a single-centre survey study.

Children with heart disease may require inpatient care for many reasons, but ultimately have a final reason for hospitalisation prior to discharge. Factors influencing length of stay in paediatric cardiac acute care units have been described but the last reason for hospitalisation has not been studied. Our aim was to describe Final Hospital Need as a novel measure, determine Final Hospital Need in our patients, and describe factors associated with this Need. Single-centre survey design. Discharging providers selected a Final Hospital Need from the following categories: cardiovascular, respiratory, feeding/fluid, haematology/ID, pain/sedation, systems issues, and other/wound issues. Univariable and multivariable analyses were performed separately for outcomes "cardiovascular" and "feeding/fluid." Survey response rate was 99% (624 encounters). The most frequent Final Hospital Needs were cardiovascular (36%), feeding/fluid (24%) and systems issues (13%). Probability of Final Hospital Need "cardiovascular" decreased as length of stay increased. Multivariate analysis showed Final Hospital Need "cardiovascular" was negatively associated with aortic arch repair, Norwood procedure, and Final ICU Need "respiratory" and "other." Final Hospital Need "feeding/fluid" was negatively associated with left-sided valve procedure, but positively associated with final ICU need "respiratory," and tube feeding at discharge. Final Hospital Need is a novel measure that can be predicted by clinical factors including age, Final ICU Need, and type of surgery. Final Hospital Need may be utilised to track changes in clinical care over time and as a target for improvement work.

Racial inequities in opioid use disorder management: can the anesthesiologist improve outcomes?

Racial inequities in opioid use disorder management: can the anesthesiologist improve outcomes?

HEMŞİRELER İÇİN BASINÇ YARALANMASI YÖNETİMİ ÖZ YETERLİLİK ÖLÇEĞİ’NİN TÜRKÇE GEÇERLİLİK VE GÜVENİRLİLİK ÇALIŞMASI

Bu araştırmanın amacı, Hemşireler için Basınç Yaralanması Yönetimi Öz Yeterlilik Ölçeği’nin Türkçe geçerlilik ve güvenilirliğini yapmaktır. Bu metodolojik tipteki çalışmaya, 149 hemşire katıldı. Araştırma verilerin toplanmasında “Hemşire Bilgi Formu” ve “Hemşireler için Basınç Yaralanması Yönetimi Öz Yeterlilik Ölçeği (BYY-ÖYÖ)” kullanıldı. Ölçek toplam 10 maddeden oluşmaktadır. Her bir madde 1 (hiç yetkin değil)’den 5 (tamamıyla yetkin)’e kadar puanlandırılıp geçerlik analizi sonucunda, Hemşireler için Basınç Yaralanması Yönetimi Öz Yeterlilik Ölçeğinin dört alt boyuttan oluştuğu belirlendi. Ölçeğin hiçbir maddesi çıkarılmamış olup çalışmanın kapsam geçerlik indeksi 0.83-1.00 arasında bulundu. Ölçeğin yapı geçerliliği için korelasyon analizi yapılıp ve yapılan analiz sonucunda; 10 maddelik ölçeğin toplam varyansı en çok %74.41’ini açıkladığı bulundu. Ölçeğin güvenirliliği için maddelerin toplam puan korelasyon değerlerinin 0.404 ile 0.661 arasında olup Cronbach Alpha değerinin 0.838 olduğu saptandı. Ölçeğin, hemşireler için basınç yaralanması yönetimi öz yeterlilik düzeyini ölçmek için kullanılabileceği sonucuna varıldı.

Expert survey on coverage and characteristics of pediatric palliative care in Europe – a focus on home care

BackgroundFor children with life-limiting conditions home care is a key component of pediatric palliative care. However, poor information is available on service coverage and in particular on country-specific pediatric palliative home care characteristics. The aim of the study was therefore to describe the association between pediatric palliative care coverage and national activities and obtain detailed information on the pediatric palliative home care structure in different European countries.MethodsOnline survey with in-country experts from N = 33 European countries.ResultsPediatric palliative home care (65.6%) represented the most pediatric palliative care units (15.6%) and the least common services. National documents constituted the most widespread national pediatric palliative care activity (59.4%) and were associated with available services. Pediatric palliative home care could be mostly accessed as a service free of charge to families (95.2%) from the time of a child's diagnosis (85.7%). In most countries, oncological and non-oncological patients were cared for in pediatric palliative home care. Only a minority of home care teams covered home-ventilated children. Pediatric palliative home care usually comprised medical care (81.0%), care coordination (71.4%), nursing care (75.0%) and social support (57.1%). Most countries had at least two professional groups working in home care teams (81.0%), mostly physicians and nurses. In many countries, pediatric palliative home care was not available in all regions and did not offer a 24 h-outreach service.ConclusionsPediatric palliative care provision in Europe is heterogeneous. Further work on country-specific structures is needed.

Implementation of a Pediatric Neurocritical Care Program for Children With Status Epilepticus: Adherence to Continuous Electroencephalogram Monitoring.

To describe adherence to continuous electroencephalogram (cEEG) monitoring as part of a pediatric neurocritical care (PNCC) program for status epilepticus (SE). Retrospective review of pre- and postintervention cohorts. A pediatric referral hospital. Children admitted to the PICU for SE. We restructured the care delivery model to include a pediatric neurointensive care unit (neuro-ICU) and expanded the cEEG capacity. We created a criteria-based cEEG pathway. We provided education to all providers including the nursing staff. The main outcomes were: 1) the percentages of children meeting American Clinical Neurophysiology Society (ACNS) criteria who underwent cEEG monitoring and 2) the time interval between PICU arrival and cEEG initiation. PICU admissions with the diagnosis of SE from May 2017 to December 2017 served as the baseline, which was compared with the same periods in 2018 to 2020 (PNCC era).There were 60 admissions in the pre-PNCC period (2017), 111 in 2018, 118 in 2019, and 108 in 2020. The percentages of admissions from each period that met ACNS criteria for cEEG monitoring were between 84% and 97%. In the pre-PNCC era, 22 of 52 (42%) admissions meeting ACNS criteria underwent cEEG monitoring. In the PNCC era, greater than or equal to 80% of the qualified admissions underwent cEEG monitoring (74/93 [80%] in 2018, 94/115 [82%] in 2019, and 87/101 [86%] in 2020). Compared with the pre-PNCC era, the neuro-ICU had a shorter interval between PICU arrival and cEEG initiation (216 min [141-1,444 min] vs 138 min [103-211 min]). The implementation of a PNCC program with initiatives in care delivery, allocation of resources, and education was associated with increased adherence to best care practices for the management of SE.

Association of intensive care unit or paediatric intensive care unit admissions with the method of transporting patients: a multicentre retrospective study

BackgroundReports regarding transportation methods of severely critical patients admitted to an intensive care unit (ICU) or paediatric ICU (PICU) are limited. In an attempt to address this research gap, this study aimed to test the hypothesis that prognosis is worse in patients transported by family members.MethodsThis multicentre study collected data from the Japanese Registry of Paediatric Acute Care database. Data concerning patients aged ≤16 years admitted to a participating hospital ICU or PICU and their transportation method to the hospital were extracted and divided into two groups: transported by family and transported by emergency medical services (EMS).ResultsOf the 2963 patients who met the criteria, 871 (29.4%) were transported by family and 2092 (70.6%) were transported by EMS. Significantly more patients with chronic conditions (551 patients, 63.3% vs. 845 patients, 40.4%; p < 0.01) or respiratory failure (414 patients, 47.5% vs. 455 patients, 21.7%; p < 0.01) were admitted to the ICU or PICU in the family transport group. There was no significant difference in survival rate between EMS and family transport group, matched by PIM2, chronic condition status and transport distance (OR:1.17, 95%CI:0.39–3.47, p = 0.78).ConclusionThe results of this study show that the transportation method does not affect the survival rate of paediatric patients. The proportion of patients with chronic conditions or those admitted because of respiratory failure was higher in the family transport group than in the EMS group. Therefore, as these patients are more likely to be admitted to the ICU or PICU, it is important to provide prompt respiratory care and medical interventions to achieve the best outcomes.

Impact of presence of paediatric palliative care units in hospitals on the confidence, knowledge and attitudes of paediatricians: the case of Turkey.

Paediatric palliative care (PPC) focuses on improving the quality of life of children dealing with life-threatening conditions, as well as their families. To evaluate the knowledge and attitudes of paediatricians regarding palliative care in Turkey and the impact of PPC units on their confidence and symptom management abilities. This was a multicentre descriptive study conducted in 2019. A questionnaire consisting of 24 questions and 4 parts on palliative care was prepared. Paediatricians in hospitals with or without PPC units completed the questionnaire. Analyses were performed using NCSS 10 (2015) software. There were 199 participants in the study, out of which 55 (27.6%) received palliative care training. One hundred and sixty-seven (83.9%) paediatricians defined palliative care as improving the quality of life of patients in the terminal period, and 77 (38.7%) stated that palliative care can be started after diagnosis. The groups of patients who would benefit from palliative care were most frequently identified as those with diseases that could not be cured (e.g. cystic fibrosis). Paediatricians with a PPC unit in their work environment, compared with those without a PPC unit, were significantly more competent in pain management (36.8% vs 6.4%, P < 0.001), symptom management (42.1% vs 19.2%, P < 0.001), and coping with the psychosocial problems of end-stage paediatric patients (36.8% vs 8.4%, P < 0.001). PPC units in hospitals contributed to paediatricians' ability to manage symptoms and communicate with families. The number of PPC units should be increased, especially in developing countries such as Turkey.

Achromobacter species, an emerging cause of bacteremia in tertiary healthcare facilities in Egypt

During our laboratory routine, we detected Gram-negative, motile, aerobic, oxidase- and catalase-positive, lactose non-fermenting bacilli during microbial isolation from blood cultures of immune compromised patients. Our study investigates this phenomenon. Blood culture results from 1000 samples were taken during febrile attacks in immune compromised patients in adult intensive care units (AICUs), pediatric and neonatal intensive care units (PICUs and NICUs, respectively), liver and kidney departments, and oncology and hematology departments in a tertiary healthcare facility in Cairo, Egypt. The blood cultures were processed in the microbiology laboratory and incubated in an automated system. An automated system was also used to identify the species in positive cultures and perform antimicrobial susceptibility testing. Achromobacter sp. were identified and isolated according to their morphological and biochemical characteristics. Of one thousand blood cultures performed, 310 were positive (Gram-negative: 195, 63%; Gram-positive: 105, 34%; fungi: 10, 3%). Of these positive cultures, 16 (5.2%) were positive for Achromobacter sp., the most common being Achromobacter xylosoxidans (15/16, 93.75%), while A. dentrificans was identified in one case (6.25%). Among those affected, 37.5% were patients with hematological malignancies, 6.25% had organ transplants, 56.5% were in the ICUs (25% were in AICU, 18.8% in the PICU, and 12.5% in the NICU). Achromobacter sp. were resistant to cefepime, aminoglycosides, and fluoroquinolones. Central venous catheter infection occurred in 13 (81.25%) cases. Our findings open discussion concerning Achromobacter sp. as an opportunistic pathogen in immune compromised patients and contribute to the development of future treatment approaches.

P29. Decreasing the rate of unnecessary pediatric deformity surgery allogenic blood transfusions

<h3>BACKGROUND CONTEXT</h3> Spinal deformity surgery is associated with a high perioperative blood loss and risk for allogenic blood transfusion (ABT). Previous studies have shown ABT has an increased risk of surgical site infection, acute hemolytic reaction, and transfusion-related lung injury. During our yearly review, our institution was noted to have a high rate of ABT compared to other hospitals in the United States. In this study, we examined the efficacy of strategies taken to decrease our transfusion rate. <h3>PURPOSE</h3> To decrease the rate of allogenic blood transfusions in a pediatric spinal deformity population by increasing awareness and scrutiny. <h3>STUDY DESIGN/SETTING</h3> Prospective cohort. <h3>PATIENT SAMPLE</h3> Patients included had a diagnosis of AIS, underwent posterior instrumentation and fusion (PSIF), were between ages 10-18, and had a major cobb angle between 45-70°. <h3>OUTCOME MEASURES</h3> Allogenic blood transfusion rate. <h3>METHODS</h3> Interventions to reduce ABT included a meeting with the postoperative care unit (PCU) and pediatric intensive care unit (PICU) where scoliosis patients recovered, encouraging increased use of cell saver or intraoperative blood salvage, a change in our postoperative protocol template stating, "notify spine surgery team if blood transfusion is considered," aweekly report of AIS surgeries and if transfusion occurred. <h3>RESULTS</h3> A total of 197 patients met criteria over 3 years. The rate of ABT from January 2019 to 2020 was 19.5% (15/77) and from January 2020 to 2021 13.3% (8/60). The interventions to reduce ABT rates were implemented between November 2020 to January 2021. From January 2021 to November 2021 only 5% (3/60) of patients received an ABT, representing a significant decrease from 2020 to 2021 (p<0.01). No significant difference in demographics between groups existed including gender or age. <h3>CONCLUSIONS</h3> The rate of ABT at our institution was significantly lowered from 19.5% to 5%. This was accomplished by increasing scrutiny prior to transfusion, including meeting with the postoperative care units, change in our protocol template and increasing scrutiny after transfusion by performing a weekly review of AIS surgeries and if transfusion occurred. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

HEALTH CARE IN PEDIATRIC EMERGENCIES

In pediatric emergencies, care is defined according to the priority of the cases, analyzed from a triage in order to filter this priority, as an urgency or emergency, based on the complaints and the clinical scenario of the patients. Study of reflective origin, built in 2022, through a combination of readings. Thus, there are numerous factors that place the child in risk situations. The main causes of emergency care in pediatric care units include respiratory diseases, convulsive states, poisoning, accidents and trauma.

Initiating a Validated Pediatric Post-Anesthesia Emergence Delirium Scale in the Pediatric Post-Anesthesia Care Unit

<h3>Introduction</h3> Emergence Delirium(ED) is a frequent occurrence in the pediatric PACU. The PAED scale is a research validated tool that has been shown to help nurses and anesthesiologists recognize and appropriately treat ED. <h3>Identification of the problem</h3> OurPACU was currently not using a measuring tool. After learning about the scales already in place at a national conference, I discussed with the unit manager and she agreed that a PAED scale would be a valuable tool. The anesthesiologist that agreed to be physician support recommended that we carry this out as a research project. <h3>Purpose of the study</h3> The aim of this study is to assess our PACU nurse's current knowledge of delirium, implement education, as well as encourage documentation of the PAED score. The potential benefits of the study include benefiting future pediatric patients and their nurses by improving how our institution approaches pediatric post-anesthesia delirium. <h3>Methods</h3> IRBapproval was obtained. A survey was constructed to measure 2 things: 1) nurses knowledge of PAED pre and post education and implementation of a PAED scale 2) nurses confidence and satisfaction with several aspects of PAED pre and post education and implementation. An invitation email with a link to the online survey was sent to all nurses who worked in the pediatric PACU. Consent was in the email. The prospective participant can elect to participate in the survey or not participate. The consent described the anonymity of the survey by including the statement "Identifiers will be removed and the de-identified information may be used for future research without additional informed consent from the subject." Pre-interventiondata was collected via survey answers. Training for the PAED scale was implemented in concurrence with pediatric emergence delirium training by anesthesia. One month post intervention, the survey was re-sent. A final six-month post intervention survey was repeated. Each survey knowledge question was scored and results were analyzed using the T-test. <h3>Outcomes/Results</h3> A total of 15 PACU nurses participated. 14 responded to the one month survey and 7 responded to the 6 month survey. The most significant increase was knowledge of the PAED scale (↑ 58.3%, p < 0.0001)) as well as knowledge about patient risk factors (↑ 13.3%, p = 0.01) and dispelling common myths surrounding PAED (↑ 14.6%, p = 0.01). It is unclear at this time if the education initiative was ineffective in regards to the other goals of PAED knowledge, or if our pediatric PACU nurses simply pre-possessed much of this knowledge prior to implementation. Nursing confidence and satisfaction also increased with the largest gains being seen in their satisfaction with the tools they have at their disposal (↑28.8%) and the responsiveness of anesthesiologists (↑26.5%). The anesthesiologists were not included in the education sessions; therefore the increase in satisfaction is likely due to either a change in nursing perception or a change in anesthesiologist behavior due to nurses reporting the PAED score. A six-month follow-up survey was distributed to see how these gains change over time. The complete results are pending analysis. <h3>Discussion</h3> ThePAED scale is a research-validated tool that is easy to use to quickly identify and discern if emergence delirium is present. The nursing education initiative and implementation was successful in increasing knowledge of the PAED scale as well as increasing knowledge about patient risk factors and dispelling common myths surrounding PAED. The documentation piece has taken several months to get built as we have 3^rd party vendors to develop most of our screens. Currently we are waiting for the screen to be included in our assessment options. During the study, a verbal reporting of the score was provided to the anesthesia provider. Further studies to determine documentation compliance would be helpful. <h3>Conclusion</h3> The findings have demonstrated that the pediatric PACU nurses are more confident in identifying true ED. Additionally, it showed that they are more aware of the tool used to score delirium and what intervention(s) are the best to implement. <h3>Implications for perianesthesia nurses and future research</h3> The PAED scale chosen for this study promotes quick and easy scoring. Identifying emergence delirium quickly in pediatric patients is crucial to implementing the appropriate intervention(s). Future research desired is to determine if having the parent at bedside before onset of delirium would decrease the intensity and/or longevity of ED.

Improving Delirium Assessments in Vanderbilt Pediatric and Pediatric Cardiovascular Intensive Care Units.

Introduction:Delirium is a disturbance of attention and awareness that represents a change from baseline mental status. Accurate diagnosis of delirium is of paramount importance to improving the management of pediatric delirium in the intensive care unit. Despite ongoing education, inconsistencies in delirium assessments occur. Here, we aimed to determine the extent of the problem and increase compliance with delirium assessments.Methods:We collected preintervention data to assess baseline compliance of delirium assessments in the Pediatric Intensive Care Unit (PICU) and Pediatric Cardiac Intensive Care Unit (PCICU) at Monroe Carell Jr Children’s Hospital at Vanderbilt in November 2020. We executed 2 Plan-Do-Study-Act cycles with different interventions and collected data after each and approximately 1 year after the interventions. The first intervention consisted of virtual lectures on delirium assessments for the nursing staff. The second intervention included an educational handout and a new electronic medical record documentation tool.Results:Five hundred five individual nurse-patient encounters were assessed and collected throughout the project. The mean compliance of delirium documentation before the interventions was 52.5%. Target compliance after interventions was 70%. Mean compliance was 70% after cycle 1, 78% after cycle 2, and 86% in March 2022.Conclusions:Using pre- and postintervention data from chart reviews and nurse interviews regarding delirium screenings, we found that interventions targeting nurse education and EMR flowsheet improved compliance with delirium assessment and documentation in the PICU and PCICU. Future work should focus on assessing the clinical implications of this project in diagnosing and treating delirium.

Case Series

Health technology managers play a vital role in medical device safety for pediatric patients in the neonatal intensive care unit and the pediatric intensive care unit. Medical device malfunctions and failures can contribute to potential for harm and adverse events. These patients are especially vulnerable to harm when these incidents occur. When health technology managers provide their expertise on medical device malfunction reports, their valuable input can provide a more complete view of the safety concerns to the US Food and Drug Administration and the device manufacturer. The examples in this article are from medical device reports submitted to the US Food and Drug Administration's MedSun program and illustrate how health technology managers' input has advanced US Food and Drug Administration's understanding of medical device safety concerns and contributed to subsequent recalls and other safety actions for devices used in the neonatal intensive care unit and pediatric intensive care unit.

Targeted Genotyping of MIS-C Patients Reveals a Potential Alternative Pathway Mediated Complement Dysregulation during COVID-19 Infection.

Complement dysregulation has been documented in adults with COVID-19 and implicated in relevant pediatric inflammatory responses against SARS-CoV-2. We propose that signatures of complement missense coding SNPs associated with dysregulation could also be identified in children with multisystem inflammatory syndrome (MIS-C). We investigated 71 pediatric patients with RT-PCR validated SARS-CoV-2 hospitalized in pediatric COVID-19 care units (November 2020–March 2021) in three major groups. Seven (7) patients suffered from MIS-C (MIS-C group), 32 suffered from COVID-19 and were hospitalized (admitted group), whereas 32 suffered from COVID-19, but were sent home. All patients survived and were genotyped for variations in the C3, C5, CFB, CFD, CFH, CFHR1, CFI, CD46, CD55, MASP1, MASP2, MBL2, COLEC11, FCN1, and FCN3 genes. Upon evaluation of the missense coding SNP distribution patterns along the three study groups, we noticed similarities, but also considerably increased frequencies of the alternative pathway (AP) associated with SNPs rs12614 CFB, rs1061170, and rs1065489 CFH in the MIS-C patients. Our analysis suggests that the corresponding substitutions potentially reduce the C3b-inactivation efficiency and promote slower and weaker AP C3bBb pre-convertase assembly on virions. Under these circumstances, the complement AP opsonization capacity may be impaired, leading to compromised immune clearance and systemic inflammation in the MIS-C syndrome.

Clonal and Horizontal Transmission of blaNDM among Klebsiella pneumoniae in Children's Intensive Care Units.

ABSTRACTIncreasing infections caused by blaNDM-carrying Klebsiella pneumoniae (NDM-KP) are an urgent threat to children with weakened immunity and limited antibiotic use. Preventing and intervening in NDM-KP infections requires a clear understanding of the pathogen’s molecular and epidemiological characteristics. We investigated the prevalence and characteristics of NDM-KP in six children’s hospitals from five Chinese provinces/municipalities. We collected 111 NDM-KP strains (40 NDM-1, one NDM-4 and 70 NDM-5) from neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs) from June 2017 to June 2018; these strains accounted for 31.62% of all carbapenem-resistant K. pneumoniae (CR-KP). Although NDM-KP isolates exhibited high resistance to all carbapenems, including ertapenem (MIC: ≥32 mg/L, 96.4%), imipenem (MIC: ≥16 mg/L, 90.1%) and meropenem (MIC: ≥16 mg/L, 99.1%), they were fully sensitive to amikacin, tigecycline and polymyxin B, and presented low resistance to levofloxacin (9.9%) and gentamicin (15.3%). Whole-genome sequencing was conducted to gain insight into the molecular characterizations of NDM-KP isolates. The NDM-KP isolates belonged to 20 sequence types (STs), and ST2407 (n = 45) dominated in one hospital from Chengdu. ST2407 isolates with fewer single-nucleotide polymorphisms (SNP < 38) were found either in the same hospital or different hospitals. Most blaNDM (81.1%, 90/111), including all blaNDM-5 and blaNDM-4 and 47.5% (19/40) of blaNDM-1, in NDM-KP isolates with 13 STs were associated with the IncX3 plasmid. Our results indicated that both explosive clonal transmission and horizontal transmission of blaNDM occur among NDM-KP strains in children's hospitals. These data provide a basis for preventing and controlling NDM-KP-associated infectious diseases in hospitalized children, especially in neonates.IMPORTANCE The blaNDM gene is playing an increasingly important role in infections caused by CR-KP, especially in children. However, systematic detection and bioinformatics analysis of NDM-KP in children's hospitals are lacking in China. In this study, a total of 111 NDM-positive K. pneumoniae isolates were selected from the China Antimicrobial Surveillance Network for further investigation. The isolates were further characterized using state-of-the-art molecular techniques. Our findings suggested the clonal and horizontal transmission of blaNDM in K. pneumoniae in NICUs/PICUs. Key plasmids (IncX3) and ST diversity contribute to the spread of blaNDM. In addition, our findings provided recommendations for pediatric clinicians to use antibiotics to treat NDM-KP infections. Our current large-scale epidemiological survey would support further infection intervention strategies of NDM-KP in NICU/PICU of children's hospitals.

The German EMPATHIC-30 Questionnaire Showed Reliability and Convergent Validity for Use in an Intermediary/General Pediatric Cardiology Unit: A Psychometric Evaluation.

BackgroundFamily-Centered Care is a useful framework for improving care for hospitalized children with congenital heart disease. The EMpowerment of PArents in THe Intensive Care-30 (EMPATHIC-30) questionnaire is a widely accepted tool to measure parental satisfaction with Family-Centered Care. Psychometric properties of the EMPATHIC-30 have been evaluated in neonatal and pediatric intensive care units, but not in pediatric cardiac care units. Therefore, our aim was to assess the psychometric properties of the German EMPATHIC-30 in an intermediary/general pediatric cardiology unit.MethodsWe used data from a quality management survey comprising the German EMPATHIC-30, a sociodemographic questionnaire and four general satisfaction items. Data were collected at the intermediary/general pediatric cardiology unit of a specialized heart center in Germany (n = 366). We split the data randomly into two subsets. In the first subset, we assessed internal consistency reliability with McDonald's omega and Cronbach's alpha, and convergent validity using Spearman's rank correlation. Furthermore, we explored the internal structure with Principal Component Analysis (PCA). In the second subset, we validated the resulting structure using Confirmatory Factor Analysis (CFA).ResultsThe reliability estimates exceeded 0.70 for all five domain scores and 0.90 for the full-scale score. Convergent validity between EMPATHIC-30 domain scores/ the full-scale score and the four general satisfaction items was adequate (rs = 0.40–0.74). The PCA suggested three components, accounting for 56.8% of the total variance. Cross-validation via CFA showed poor model fit (χ2 = 1545.78, χ2/df = 3.85, CFI = 0.70, TLI = 0.66, RMSEA = 0.13), indicating that the EMPATHIC-30 shows no clear and generalizable factor structure in this sample.DiscussionThe German version of the EMPATHIC-30 exhibited reasonable psychometric properties in an intermediary/general pediatric cardiology unit. Follow-up studies should investigate the factor structure of the EMPATHIC-30 in other pediatric inpatient care settings.

Intrathecal baclofen therapy as treatment for spasticity and dystonia: Review of cases in a pediatric palliative care unit

IntroductionPatients managed in the Pediatric Palliative Care Integral Unit (PPCIU) have serious neurological conditions that involve significant damage at central nervous system level. The movement disorder is a very common clinical problem and for the patients where an adequate control of muscle tone is not achieved with usual techniques or drugs, intrathecal baclofen therapy (IBT) should be considered. Materials and methodsDescriptive retrospective study based on the review of clinical records of patients who received IBT being followed by the PPCIU of Madrid Autonomous Region in the timeframe between September 2012 and February 2021. ResultsIBT was implanted in 8 patients affected by infantile cerebral palsy (ICP) with a Gross Motor Function Scale (GMFCS) IV–V, 3 patients was a Pantothenate kinase deficit-associated neurodegeneration (PKAN), 2 had Acquired Brain Damage, and the remaining 3 had, respectively, 2 glutaric aciduria type I (GA-1), and poly-malformative syndrome. In all patients we observed a period of clinical stability after IBT, we call this period “honeymoon”. Two patients died while in the honeymoon period, at 24.9 and 19.6 months from implantation of the pump; the median of duration of the honeymoon period in the remaining 14 was 14.4 months (IQ: 8.3–25.8). ConclusionsIBT was not only used in patients with non-progressive diseases, but also in the group of patients with neurodegenerative or progressive diseases. In all of them, after implantation of the device, we have objectified a period of clinical stability and a better control of muscle tone disorders.

Improvement of Hand Hygiene Compliance Using the Plan-Do-Study-Act Method: Quality Improvement Project From a Tertiary Care Institute in Bihar, India.

BackgroundHospital-acquired infections (HAIs) are the most severe complications of intensive care stay, especially in pediatric patients. Proper hand hygiene (HH) is the cheapest, simplest, but often neglected method to prevent HAIs. The World Health Organization (WHO) has formulated and promoted a standardized recommendation for HH. Both the WHO and the Centers for Disease Control and Prevention (CDC) recommend the use of soap and water for handwashing whenever there is visible dirt on the hands. In all other situations, an alcohol-based hand rub is an effective alternative. The quality improvement (QI) methodology has been widely followed in many countries to improve basic and advanced healthcare systems. The QI strategy follows the plan-do-study-act (PDSA) method.MethodologyThis quasi-experimental (pre- and post-intervention), prospective, QI study was conducted at the neonatal intensive care unit and pediatric intensive care unit of the pediatrics department in a tertiary care hospital in Bihar, India. A QI team was formed. The study was divided into four phases. WHO charts for assessing HH compliance were used for observation and data collection. The EQUATOR Checklist (Squire Checklist) was used to accurately report the QI work. Epi Info™ (version 7.2.5) was used for statistical analysis. The chi-square test was used to measure the statistical difference between pre- and post-intervention HH compliance (proportions).ResultsIn the pre-intervention phase, a total of 106 HH opportunities were observed. The HH compliance at this stage was 40.6%. The QI team conducted several meetings, and a root cause analysis was performed with the help of the Fishbone diagram. It was decided to target three probable causes, namely, (a) less awareness, (b) inconvenient locations of hand rub dispensers, and (c) forgetfulness. The QI team decided to run three PDSA cycles. In the last phase, 212 HH opportunities were observed with a compliance percentage of 69.8%. There was a significant improvement when data of pre- and post-intervention HH compliance were compared in all categories of healthcare workers (HCWs), except doctors, where the improvement was not statistically significant. When the cumulative data of all subtypes of HCWs were analyzed, there was a significant improvement (p < 0.0001). Run charts and box plots were used for the easy depiction of the results.ConclusionsAdopting proper HH methods remains the most effective way of preventing nosocomial infections, especially in intensive care units. We used the WHO model of HH in our study. The pre-intervention HH compliance was 40.6%. QI methodology using root cause analysis and implementation of three PDSA cycles were used to increase the HH compliance percentage. Post-intervention HH compliance increased to 69.8% and the effect was sustained. The study highlights the usefulness of the QI methodology in bringing small but important changes in clinical practice for better patient care.

Effects of Music Therapy on Vital Signs in Children with Chronic Disease

Background: Recent research found evidence supporting music therapy for hospitalized children with chronic diseases. The aim of this study was to investigate the effect of music therapy on hospitalized children’s vital signs. Methods: In this prospective study, children with chronic gastroenterological and nephrological diseases received active or receptive music therapy two to four times a week until discharge from hospital at the pediatric special care unit (SCU) and pediatric intensive care unit (ICU). Baseline and post-therapy heart rate, oxygen saturation and blood pressure were recorded and analyzed as control values at three points on the same day when the children were alone in their patient room at rest. Results: A total of 83 children, median 3 age of years (range one month to eighteen years) received music therapy. In total, 377 music therapy sessions were treated: 200 receptive therapy (78 ICU, 122 SCU) and 177 with active therapy (0 ICU, 177 SCU). Music therapy interventions showed changes in vital signs during music therapy sessions. After music therapy, heart rates decreased by 18 beats per minute (95% confidence interval (CI), −19.4 to (−16.8)), oxygen saturation increased by 2.3% (95% CI, 2.2 to 2.5), systolic blood pressure decreased by 9.2 (95% CI, −10.6 to −7.7) and diastolic blood pressure decreased by 7.9 (95% CI, −9.6 to −6.3). When music therapy was applied at the SCU (ICU), heart rates significantly reduced by 17.9 (18.9) beats per min, oxygen saturation increased by 2.4% (2.1%) and blood pressure reduced by 9.2 (2.8) mmHg (systolic) and 7.9 (0.3) mmHg (diastolic). Almost all control values were better than directly before the intervention. However, after music therapy intervention, the children showed better values in vital signs compared to being alone in their patient room. Conclusion: Music therapy is an added value for children with kidney and liver/gastrointestinal diseases during their hospital stay.

Effectiveness of Standardized Protocol for Oxygen Therapy on Improving Nurses' Performance and Patients' Health Outcome.

Aims: assess nurses’ knowledge and performance-related safe administration of oxygen (O2) therapy; apply an intervention program for nurses about standardized protocol for oxygen; and evaluate the effectiveness of standardized protocol for oxygen in improving nurses’ performance and patients’ health outcomes. Design: a quasi-experimental study was used. Setting: the current study was conducted at three hospitals in Sakaka City with totally different medical aid units (ICUs), CCUs, emergency care departments (ED), medical and surgical wards, pediatric care units (PICUs), neonatal intensive care units (NICUs), pediatric emergency care departments (PED) and pediatric inpatient\\outpatient departments. Subjects: a convenience sample of 105 nurses and 105 patients was divided into 55 patients in the control group who received routine care and 50 patients in the study group who received intervention. Findings: 34.3% of studied nurses had poor knowledge pre-intervention compared with 17% post-intervention. Moreover, 33.3% of them had satisfactory knowledge pre-intervention versus 21% post-intervention. Only 5.7% of them had excellent knowledge pre-intervention, compared with 34.4% post-intervention. Concerning the complications of oxygen therapy, only 10.5% did not have complications in the control group versus 62.9% in the study group, 33.3% of the control group had cyanotic lips and fingernails pre-intervention, versus 7.6% in the study group; 10.5% had oxygen toxicity in the control group, versus 7.6% in the study group, with a highly statistically significant difference at p 0.001 for all. Conclusion: the current results of this study concluded that there was improvement in nurses’ knowledge and practice related to oxygen therapy post-intervention. Moreover, when the standard protocol for safe oxygen therapy was used in a positive way, it led to better health for patients and fewer problems with oxygen therapy.