Care Pediatric Hospital Research Articles

Economic Evaluations of Health Care Interventions in Pediatric Hospital Care.

The hospital medicine movement thrives in a health care environment committed to providing high-quality, safe, and value-based care. Hospitalists and hospitals continually grapple with many decisions regarding adopting new interventions and deadopting established ones. These decisions span the gamut from tests, treatments, and supportive care, to care models. Traditionally, the choice to adopt one intervention over another is commonly thought of in terms of its direct impact on patient outcomes, benefits, and harms. However, the evolving landscape of health care, characterized by increasing constraints on resources necessitates a broader perspective, one that includes a thorough consideration of the economic implications. The goal is not to minimize costs but rather to maximize value, outcomes achieved for money spent. Economic evaluations of health care interventions can provide this information by quantifying value and assisting health care providers, hospitals, and health systems in deciding which intervention to adopt. Economic evaluations deal with both inputs (ie, costs) and outputs (ie, consequences). Few economic evaluations in pediatric hospital medicine have been published, and many clinicians are unfamiliar with them. This paper discusses the economic evaluation of health care interventions with special attention to the pediatric hospitalist and hospital care. The paper aims to give readers an understanding of the key concepts underlying economic evaluations.

Cat Scratch Disease in Pediatrics: Who Has Systemic Involvement?

Bartonella henselae is the agent responsible for cat scratch disease (CSD). Although lymphadenopathy is typically the defining symptom, some patients develop potentially severe systemic compromise. It is unknown why some patients progress to systemic disease. The objective of this study was to describe the clinical, epidemiologic and laboratory characteristics of children with CSD and to analyze the differences between systemic versus localized infections. Patients were identified by a retrospective review of medical records at a tertiary pediatric care hospital in Buenos Aires, Argentina, from January 2012 to July 2021. A CSD case was defined as any patient who presented compatible clinical findings with a positive serologic test (IgG >1/64 or IgM immunofluorescence) for B. henselae. A total of 197 patients were identified, with a median age of 8 years (range: 1-17.4 years). The most frequent clinical symptoms were fever and lymphadenopathy. Systemic involvement was present in 34.5% (n = 68) of patients and the most common presentation was splenic abscess (n = 51), followed by liver abscess (n = 23), chorioretinitis (n = 9), osteomyelitis (n = 5) and pneumonitis (n = 3). Patients with invasive disease more frequently presented with fever (79.4% vs. 50.3%) (P<0.001) and had higher C-reactive protein levels (24.9 vs. 6.7 mg/L) (P<0.001). Antibiotic therapy was administered to 95.9% (n = 187) of patients and most with systemic disease (77%) used combination treatment. Most patients recovered fully, and there were no reported deaths. CSD must be considered a potential cause of lymphadenopathy. Patients with fever and elevated C-reactive protein should be evaluated to rule out systemic compromise.

The Family Talk Intervention Among Families Affected by Severe Illness: Hospital Social Workers’ Experiences of Facilitators and Barriers to its Use in Clinical Practice

Hospital social workers (HSW) play an important role in health care, providing psychosocial support to families affected by severe illness, and having palliative care needs involving dependent children. However, there are few evidence-based family interventions for HSWs to apply when supporting these families. The Family Talk intervention (FTI), a psychosocial family-based intervention, was therefore evaluated in an effectiveness-implementation study. Within the study, HSWs were educated and trained in the use of FTI in clinical practice. This study examined HSWs’ experiences of barriers and facilitating factors during their initial use of FTI in clinical practice. Altogether, 10 semi-structured focus groups were held with HSWs (n = 38) employed in cancer care and specialized palliative home care for adults, pediatric hospital care, and a children’s hospice. Data were analyzed using content analysis. HSWs considered FTI to be a suitable psychosocial intervention for families affected by severe illness with dependent children. However, the way in which the care was organized acted either as a barrier or facilitator to the use of FTI, such as the HSWs’ integration in the team and their possibility to organize their own work. The HSWs’ work environment also impacted the use of FTI, where time and support from managers was seen as a significant facilitating factor, but which varied between the healthcare contexts. In conclusion, HSWs believed that FTI was a suitable family intervention for families involving dependent children where one family member had a severe illness. For successful initial implementation, strategies should be multi-functional, targeting the care organization and the work environment.

Sociodemographic Factors and Trends in Bronchiolitis-Related Emergency Department Visit and Hospitalization Rates

Bronchiolitis is the most common and most cumulatively expensive condition in pediatric hospital care. Few population-based studies have examined health inequalities in bronchiolitis outcomes over time. To examine trends in bronchiolitis-related emergency department (ED) visit and hospitalization rates by sociodemographic factors in a universally funded health care system. This repeated cross-sectional cohort study was performed from April 1, 2004, to March 31, 2022, using population-based health administrative data from children younger than 2 years in Ontario, Canada. Bronchiolitis ED visit and hospitalization rates per 1000 person-years reported for the equity stratifiers of sex, residence location (rural vs urban), and material resources quintile. Trends in annual rates by equity stratifiers were analyzed using joinpoint regression and estimating the average annual percentage change (AAPC) with 95% CI and the absolute difference in AAPC with 95% CI from April 1, 2004, to March 31, 2020. Of 2 921 573 children included in the study, 1 422 088 (48.7%) were female and 2 619 139 (89.6%) lived in an urban location. Emergency department visit and hospitalization rates were highest for boys, those with rural residence, and those with least material resources. There were no significant between-group absolute differences in the AAPC in ED visits per 1000 person-years by sex (female vs male; 0.22; 95% CI, -0.92 to 1.35; P = .71), residence (rural vs urban; -0.31; 95% CI -1.70 to 1.09; P = .67), or material resources (quintile 5 vs 1; -1.17; 95% CI, -2.57 to 0.22; P = .10). Similarly, there were no significant between-group absolute differences in the AAPC in hospitalizations per 1000 person-years by sex (female vs male; 0.53; 95% CI, -1.11 to 2.17; P = .53), residence (rural vs urban; -0.62; 95% CI, -2.63 to 1.40; P = .55), or material resources (quintile 5 vs 1; -0.93; 95% CI -3.80 to 1.93; P = .52). In this population-based cohort study of children in a universally funded health care system, inequalities in bronchiolitis ED visit and hospitalization rates did not improve over time.

How to follow the guidelines, when the appropriate fluid is missing?

Intravenous maintenance fluid therapy (IV-MFT) is probably the most prescribed drug in paediatric hospital care. Recently paediatric societies have produced evidence-based practice guidelines that recommend the use of balanced isotonic fluid when prescribing IV-MFT in both acute and critical paediatric care. Unfortunately, the applicability of these guidelines could be called into question when a ready-to-use glucose-containing balanced isotonic fluid is not available. The main objective of this study was to describe the availability of glucose-containing balanced isotonic fluids in European and Middle Eastern paediatric acute and critical care settings. This work is an ancillary study of the survey dedicated to IV-MFT practices in the paediatric acute and critical care settings in Europe and Middle East, a cross-sectional electronic 27-item survey, emailed in April-May 2021 to paediatric critical care physicians across 34 European and Middle East countries. The survey was developed by an expert multi-professional panel within the European Society of Peadiatric and Neonatal Intensive Care (ESPNIC). Balanced isotonic fluid with glucose 5% was available for only 32/153 (21%) responders. Balanced isotonic fluid with glucose 5% was consistently available in the UK (90%) but not available in France, Greece, The Netherlands and Turkey. Conclusion: Ready-to-use isotonic balanced IV solutions containing glucose in sufficient amount exist but are inconsistently available throughout Europe. National and European Medication Safety Incentives should guarantee the availability of the most appropriate and safest IV-MFT solution for all children. What is Known: • Intravenous maintenance fluid therapy (IV-MFT) is probably the most prescribed drug in paediatric hospital care. • Balanced isotonic fluid is recommended when prescribing IV-MFT in both acute and critical paediatric care. What is New: • Balanced isotonic fluid with glucose 5% is available for less than 25% of the prescribers in Europe and the Middle East.Availability of balanced isotonic fluid with glucose 5% varies from one country to another but can also be inconsistent within the same country. • Clinicians who have access to a ready-to-use balanced isotonic fluid with glucose 5% are more likely to consider its use than clinicians who do not have access to such an IV solution.

Parental presence, participation, and engagement in paediatric hospital care: A conceptual delineation.

To delineate between the concepts of parental presence, participation, and engagement in paediatric hospital care. The concepts' uses in the literature were analysed to determine attributes, influences, and relationships. Delineations of each concept are established and conceptual definitions are proposed following Morses' methods. MEDLINE (PubMed); CINAHL, PsycINFO, Sociology Source Ultimate (EBSCOhost); Embase, Scopus (Elsevier); Google Scholar. Search dates October 2021, February 2023. Multinational publications dated 1991-2023 revealed these concepts represent a range of parental behaviours, beliefs, and actions, which are not always perceptible to nurses, but which are important in family-integrated care delivery. Parental presence is the state of a parent being physically and/or emotionally with their child. Parental participation reflects parents' performing caregiving activities with or without nurses. Parental engagement is a parents' state of emotional involvement in their child's health and the ways they act on their child's behalf. These concepts' manifestations are important to parental role attainment but may be inadequately understood and considered by healthcare providers. Nurses have influence over parents' parental presence, participation, and engagement in their child's care but need support from healthcare institutions to ensure equitable family-integrated care delivery. Problem: Lack of clear definition among these concepts results in incomplete and at times inequitable family-integrated care delivery. Parental presence is an antecedent to parental participation, and parental presence and participation are elements of parental engagement. The concepts interact to influence one another. Hospitalized children, their families, nurses, and researchers will benefit through a better understanding of the concepts' attributes, interactions, and implications for enhanced family-integrated care delivery.

Children’s interaction with a dog when having Animal Assisted Activity in paediatric hospital care

The aim of the study was to investigate the interaction process between child and dog and how it possibly affects children's wellbeing during Animal Assisted Activity.Children have reported negative feelings such as fear and anxiety when being cared for in hospital and various kinds of complementary treatment can alleviate this. Different complementary treatments, including interaction with a dog, can create positive emotions and the treatment has been reported to have both physiological and psychological beneficial effects. However, there is a lack of studies describing children's interaction with a dog.This is an observational study, analysed from field notes with qualitative content analysis using a deductive approach. Children (n = 49) aged 3–18 years of age at a paediatric hospital voluntarily participated in the study.The results are reported on a six-level scale that describes the child-dog interaction: 1. Passive interaction, 2. One-way non-spoken communication, 3. Facilitating the interaction, 4. Interaction by activity encouragement, 5. Interaction initiated by the child, and 6. Interaction through deepened interplay. All children attained level five. Eighty-nine per cent attained level six and these children interacted fully, having a two-way deepened interplay with the dog. Further, when the interaction proceeded to a deepened interplay this affected the children positively both physically and emotionally.Structured Animal Assisted Activity with a dog that includes an introduction, an active part and a relaxing part is a suitable model to offer children in paediatric hospital care since the children attained a child-initiated interaction or interaction through deepened interplay.

Traumatic Injuries and Radiographic Study Utilization Among Children With Drowning Presenting to U.S. Pediatric Hospitals

ObjectiveThe role of traumatic injuries in fatal and nonfatal drownings is poorly described. We sought to characterize the incidence of traumatic injuries and diagnostic imaging performed among children who received pediatric hospital care for drowning. MethodsWe conducted a retrospective study of children (≤18 years) with drowning encounters at 45 pediatric hospitals, October 2015 through December 2020. We described the presence of clinically important traumatic injuries to the following body regions: brain, spinal cord, thoracic and intra-abdominal organs, axial skeleton, pelvis, and long bones, and major vessels. We described patient characteristics and radiographic testing. We compared patients with and without traumatic injuries using the Fisher’s exact and Wilcoxon signed rank tests. ResultsWe identified 10,397 children with a drowning encounter. Most (83.4%) were treated in the emergency department and 52.8% were admitted. There were 238 (2.3%) encounters with clinically important traumatic injuries. Intracranial injury was the most common (1.0%) with other traumatic injuries occurring in ≤0.5%. Less than 2% of children had a moderate or severe injury severity score and approximately half of these children had a clinically important traumatic injury. Among children with traumatic injuries, a higher proportion were 10 to 14 or 15 to 18 years old and from ZIP codes with lower median household income. Computerized tomography imaging was performed in the following proportions: brain (11.4%), cervical spine (3.7%), abdomen/pelvis (1.2%), chest (0.5%) and face/orbits (0.2%). ConclusionsClinically important traumatic injuries in children with drowning are rare. Further studies are needed to guide the optimal utilization of radiographic studies in this population.

Direct costs of blood drawings with pre-analytical errors in tertiary paediatric hospital care.

Blood drawings is a common hospital procedure involving laboratory and clinical disciplines that is important for the diagnosis and management of illnesses in children. Blood drawings with pre-analytical error (PAE) can lead to increased costs for hospitals and healthcare organisations. The direct cost of blood drawings after a PAE is not fully understood in paediatric hospital care. The aim of this study was to estimate the average direct cost of PAE per year and per 10,000 blood drawings in tertiary paediatric care. A cost analysis using a bottom-up approach was conducted on the basis of combined information from the hospital's laboratory register for the period 2013-2014 and clinical in-ward observations at a tertiary children's referral hospital in Sweden, the Astrid Lindgren Children's Hospital. For the analysis, we hypothesised the re-collection of all blood drawings with PAE and included the average costs of the sampling materials, the time of the healthcare personnel, the laboratory analyses, and in-ward premises based on the time spent on the blood sampling procedure. The annual cost of PAE was estimated to be 74,267 euros per 54,040 blood drawings, which corresponds to 13,756 euros per 10,000 blood drawings or 1.5 euros per draw. The personnel cost represented 60.1% (45,261 euros per year) of the cost due to PAE, followed by costs for hospitalisation (25.2%), laboratory analyses (8.1%), and materials (5.7%). PAEs lead to substantial increases in the costs in tertiary paediatric hospital care. If these PAEs can be avoided, costs related to the re-collection of blood drawings with PAE may be re-allocated to other health-promoting activities for children visiting hospital institutions.

Neighborhood Poverty and Distance to Pediatric Hospital Care.

To describe the relationship between neighborhood poverty and geographic access to pediatric inpatient care. This is a retrospective, cross-sectional study using 2017-18 hospital and demographic data, as well as geographic data from the 2010 census. Acute care hospitals in 17 states were included, comprising approximately one-third of the national population. The main outcome was distance to capable pediatric hospital care by neighborhood Area Deprivation Index (ADI), both overall and by urbanicity. Median distance to pediatric hospital care increased linearly with poverty across ADI national deciles (Pearson coefficient of 0.986; P < .001). The most advantaged neighborhoods were a median of 2.5 miles from the nearest pediatric capable hospital (interquartile range [IQR] 1.2-5.6) while those in the most disadvantaged were a median of 13.8 miles away (IQR 3.3-35.9; P < .001). The nearest hospital admitted children in 51.17% (7927) of advantaged neighborhoods (lowest national ADI quintile) and only 26.02% (3729) of disadvantaged neighborhoods (highest national ADI quintile). The association between poverty and median distance to care was observed in rural, suburban, and urban census block groups (P < .001 for all trends). In suburban neighborhoods, children from the most disadvantaged neighborhoods were 3 times as likely as children from the most advantaged neighborhoods to live more than 20 miles from pediatric inpatient care (27.85%, 456,533 of children from bottom quintile neighborhoods vs 9.24%, 259,787 of children from top quintile neighborhoods, P < .001). Distances to capable pediatric hospital care are greater from poor than affluent neighborhoods. This carries potential implications for disparities in pediatric health outcomes.

The long-term boomerang effect of COVID-19 on admissions for non-COVID diseases: the ECIEN-2022 study.

Since COVID-19 pandemic started, many changes have been seen in the cycling patterns of pediatric pathologies. On year 2020, we described the initial effects of COVID-19, with a significant decrease in emergency visits and admissions, but 2years later the situation seems to be reversed. Our study bridges a literature gap by exploring the lasting effects of COVID-19 on pediatric non-COVID admissions, particularly the resurgence of respiratory illnesses.ECIEN-2022 is a single-center, retrospective, observational-study conducted 3years after the pandemic onset, to describe the long-term effects of COVID-19 in pediatric admissions for non-COVID diseases. Admissions during year 2022 were compared with the Pre-Pandemic Period (PPP: 2015-2019). Pediatric Emergency Department (P-ED) visits, hospital, and Intensive Care Unit (P-ICU) admissions were compared across pre- and post-pandemic periods. Monthly distribution and year-waves are presented.P-ED monthly visits (mean and Standard deviation (SD) raised from 3521 (533) in the PPP to 3775 (996) in 2022 (p < 0.001). Monthly hospital admissions in the 3rd quarter of the Pre-Pandemic Period were 111.7/month (SD:29), dropped to 88.5(SD:6.5) in 2020 and raised to 149(SD:38.8) in 2022 (p = 0.036). An increase in respiratory illnesses was observed in 2022 compared to PPP; Bronchiolitis increased 38%, bronchitis 56%, and admissions for Respiratory Syncytial Virus 67%. Conclusion: COVID-19 pandemic has had a significant impact on the use and nature of pediatric health services. The initial decrease has been followed by a boomerang effect with an increase of cases, mainly due to an increase in respiratory infections when pandemic control measures and social restrictions have been lifted. It is essential to maintain an active surveillance and monitorization of these patterns to ensure appropriate healthcare access and utilization. What is Known: • COVID-19 pandemic initially led to a significant decrease in emergency visits and admissions for non-COVID diseases. What is New: • ECIEN-2022 study investigated the long-term effects of COVID-19 on pediatric admissions for non-COVID diseases, detecting a "boomerang effect" with an increase in pediatric admissions for non-COVID diseases in year 2022. • Pediatric Emergency Department visits and hospital admissions for non-COVID diseases, especially those due to respiratory infections, increased significantly in 2022 when compared to the Pre-Pandemic Period.

Gambaran Intervensi Family Centered Care pada Pasien Balita di RS Perkebunan Wilayah Karesidenan Besuki Raya

The implementation of family-centered care in pediatric hospitals in developed countries has been well-standardized. But, in Indonesia, it can be implemented with the possibility to be realized ideally is not easy because of many health workers do not understand family-centered care properly. The purpose of this study is to describe the application of Family Centered Care in toddler patients in inpatient rooms conducted by nurses. This research is a descriptive study with a cross-sectional approach using a purposive sampling technique. The study was conducted at Kaliwates General Hospital, Jember Klinik Hospital and Elizabeth Situbondo Hospital Data collection was performed using a Family Centered Care questionnaire. Data Collection was carried out from September 2019 to December 2019. The study Participants were 98 families selected by purposive sampling technique. Data were collected techniques using in-depth interviews and documentation. The results showed that the majority of families (83.7%) were good. Nurses can be good counselors and educators in meeting the needs of families and children in the hospital to have a good cooperative relationship between family and nurses. Nurses can improve the quality of their services by understanding more deeply about family needs and strengths.

Systematic review of the development and effectiveness of digital health information interventions, compared with usual care, in supporting patient preparation for paediatric hospital care, and the impact on their health outcomes.

Elective surgery can be overwhelming for children, leading to pre-operative anxiety, which is associated with adverse clinical and behavioural outcomes. Evidence shows that paediatric preparation digital health interventions (DHIs) can contribute to reduced pre-operative anxiety and negative behavioural changes. However, this evidence does not consider their design and development in the context of behavioural science. This systematic review used the Theoretical Domains Framework (TDF) to evaluate the design and development of DHIs used to support children up to 14 years of age and their parents, prepare for hospital procedures, and determine any correlation to health outcomes. It also considered whether any behavioural frameworks and co-production were utilised in their design. A search of the MEDLINE, EMBASE, PsycINFO, and HMIC databases was carried out, looking for original, empirical research using digital paediatric preparation technologies to reduce pre-operative anxiety and behavioural changes. Limitations for the period (2000-2022), English language, and age applied. Seventeen studies were included, sixteen randomised control trials and one before and after evaluation study. The results suggest that paediatric preparation DHIs that score highly against the TDF are (1) associated with improved health outcomes, (2) incorporate the use of co-production and behavioural science in their design, (3) are interactive, and (4) are used at home in advance of the planned procedure. Paediatric preparation DHIs that are co-produced and designed in the context of behavioural science are associated with reduced pre-operative anxiety and improved health outcomes and may be more cost-effective than other interventions. https://www.crd.york.ac.uk/prospero/, identifier: CRD42022274182.

The use of pediatric short-stay observation in Italy

BackgroundIn Italy, the State Regions Conference on 1st August 2019 approved the Guidelines for Short-Stay Observation (SSO). At the beginning of 2022, the main Scientific Societies of the pediatric hospital emergency-urgency area launched a national survey to identify the extent to which these national guidelines had been adopted in the emergency rooms and pediatric wards of the Italian Regions.MethodsA survey has been widespread, among Pediatric Wards and Pediatric Emergency Departments (EDs), using both a paper questionnaire and a link to a database on Google Drive, for those who preferred to fill it directly online. Those who did not spontaneously answer, where directly contacted, via email and/or through a phone call and invited to participate. The data collected have been: age of managed children, presence of triage, presence of Sub-intensive Care Unit and Intensive Care Unit and special questions about Pediatric SSO, availability of training courses for workers, number of ED access in the last 4 years.ResultsThis survey is still ongoing, without a definite deadline, so we presented the preliminary data.Currently, 8/20 Regions have not yet adopted the Guidelines. Till 02 January 2023, data from 253 hospitals were collected. There are currently 180/253 active Pediatric SSO (71.03% of the Hospitals). There are not active SSO in 33.27% of first level ED, in 19.35% of second level ED and in 33.66% of General Hospitals with Pediatric Wards. Active SSO are located mainly (75.97%) within Pediatric Wards. At the moment, the survey has been completed in 16 Regions: in the 8 Regions which are using guidelines, pediatric SSOs are active in all the second level ED (compared to 60.87% of the other 8 regions), in the 91.66% of first level ED (compared to the 33.3%), and in the 97.1% of General Hospitals (compared to 33.3%), with a statistically significance (p < 0.0001).The territorial analysis of these 16 regions highlighted geographical differences in the percentage of SSOs active: 35.22% are active in hospitals in Southern Italy, 88.64% in Central Italy and 91.67% in those of the North.ConclusionsThe delay in adopting specific guidelines negatively influences activation of pediatric SSOs in hospital system and prevents the adjustment of welfare level to new needs. To facilitate the activation of SSOs in hospitals, it is also necessary to guarantee adequate economic recognition. It is essential to implement public interventions to overcome the current inequalities in the interest of children and their families: the current delay seriously penalizes emergency pediatric hospital care, especially in the southern Italian Regions.

Multi-inflammatory syndrome in children (MIS-C) associated with COVID-19: a nursing perspective experience report from a high-income tertiary paediatric hospital context

BackgroundIn the midst of the COVID-19 coronavirus pandemic, a new disease that affects children has arisen called multisystem inflammatory syndrome in children (MIS-C). Several research articles focusing on its medical aspects have been published, but very few have focused on nursing care. The aim of this study was therefore to describe the nursing status of children suffering from MIS-C and the experiences of registered nurses (RNs) in caring for these children in paediatric hospital inpatient care.Methods The study design includes both quantitative nursing clinical record data and qualitative interview data. Quantitative data from the clinical records were analysed using descriptive statistics. Qualitative data analysis of the interviews was conducted using both deductive and inductive approaches with content analysis.ResultsIn total, 47 clinical records from children with MIS-C were investigated during January–March 2021. The mean age of the children was 8.8 years. Boys were more affected than girls. Challenges in children’s nursing status were related to circulation (fever and swelling), nutrition (great thirst and loss of appetite), pain, and psychosocial situations. When caring for children with MIS-C, nurses experienced “frustration over uncertainty of care”, “children’s illbeing” and “unavoidable procedures”.ConclusionThis study contributes knowledge to the ongoing nursing care of children suffering from MIS-C. The results show many different areas of nursing focus, which challenges nurses and other disciplines within paediatric hospital care. One important factor when caring for these children was the use of a central venous line early in the care process, which improved the quality of care. Moreover, the care of children suffering from MIS-C demands resources and time from healthcare professionals, especially RNs, to meet caring needs and reduce illbeing.

Stress among health care providers in NICU department, tertiary pediatric care hospital during COVID-19 pandemic in Egypt

Many of the pediatric health care workers (HCWs) suffered from sleep disturbance, anxiety, and potential stress disorder during the COVID-19 pandemic. Work-related stress is a potential cause of concern in HCWs and is associated with decreased job satisfaction, anxiety, depression, medical errors, and near misses. This study aims to investigate the various psychological consequences on medical personnel working in the neonatal intensive care unit (NICU) in the context of the COVID-19 pandemic. A cross-sectional analytical study was conducted on a convenient sample of doctors and nurses working in NICU in pediatric hospitals at Cairo University teaching hospitals, Egypt. Two anonymous self-administered validated questionnaires were used to assess the level of stress, and the COVID-19 Rapid Quantitative Assessment Tool to assess the knowledge, attitude, and perception about COVID-19. Among 96 participants, 66.7% were nurses, and 33.3% were physicians, 79.2% of the participants showed a reasonably safe level of stress. The mean work stress score was 43.89 ± 5.77. The mean score for commonly experienced stress symptoms was 7.53 ± 4.54, median 7, IQR (4, 10). Females and physicians were found to be with a statistically significantly higher median score of commonly experienced stress symptoms than males (p-value < 0.001 and 0.028 simultaneously). While such descriptive research provides valuable information on the scope of the problem, a strong theoretical framework is required to interpret these findings appropriately and develop preventive and therapeutic strategies. Particular attention should be warranted to the mental health well-being of women treating patients with COVID-19.

Medical records as screening tools for child death review in Japan.

Although many child death review (CDR) systems have been developed in Japan, the optimal system is still being identified. The aim of this study is to identify the etiologies of child deaths and to propose a screening method for initiating the CDR process in Japan. Clinical medical records (CMRs) in hospitals and autopsy records were surveyed for cases of deaths of children aged less than 15 years between 2014 and 2016 in Aichi Prefecture, Japan. The data were analyzed in three steps, and the findings were compared with the vital statistics. Of the 695 children whose death certificates were submitted to Aichi Prefecture, 590 could be traced to pediatric care hospitals. The distribution of causes of death was slightly different from the vital statistics, with 11.5% dying of extrinsic causes and 19.7% dying of unknown causes. Maltreatment was suspected in 64 cases, which was much higher than that in government statistics. Overall, 158 (26.8%) deaths were considered preventable. The number of unnatural deaths, which might be screened in, was calculated as 172 (29.2%) in the vital statistics, whereas the survey of CMRs revealed that 241 (40.8%) to 282 (47.8%) should be screened in. Surveying CMRs in hospitals may be a suitable method to detect and screen deaths to start the CDR process in Japan.

Assessment of Parent and Nurse Perceptions of Parental Participation in Hospital Paediatric Care

Background: Parent and nurse perceptions about the care of hospitalized children have been examined in developed countries, but little is known in developing countries. Objective: The study aims to evaluate the perceptions of nurses and parents towards parental participation in care for hospitalized children and associated factors. Methods: A cross-sectional design was used to collect data from nurses and parents in paediatric units in the Eastern Region of Saudi Arabia using a convenience sampling technique. Data were collected using the Parent Participation Attitude Scale (PPAS), and the agreement and differences between groups were analysed. Results: The present results found that both parents and nurses agreed on 7 out of 20 statements regarding parental involvement in care for their children. Nurses in paediatric surgery had a higher perception of involving parents (P = 0.002), while nurses in Well Baby Nursery (WBN) ward had the lowest perception. The present findings confirm that married caregivers had higher perceptions (P = 0.035) than their single counterparts. Conclusion: Parent participation attitude was agreed on for seven statements between parents and nurses. More studies are required to explore the relationship between healthcare providers and parents with regard to parental participation in caring for hospitalized children.

Safety and health immigrant paediatric oncology patients: a qualitative study.

A "risky situation" is a situation that potentially can lead to adverse event. Studies describe how language barriers can have an impact on patient safety. Several studies describe a lack in management of language barriers (detecting, reporting and bridging) in the hospital paediatric care. Immigration and cancer care are rarely discussed in the paediatric literature. The present study was inspired by our previous study where it was highlighted that the paediatric nurses in a Department of Paediatric Haematology and Oncology perceived how sometimes the paediatric patient and his family were at risk. We surmise that in the case of paediatric health immigrant patients, the issue of correct understanding deserves more care than in communication among adults only. A qualitative approach was used. 56 paediatric nurses were interviewed. Semi-structured-interviews were recorded, transcribed verbatim and analyzed using qualitative techniques for recurrent themes. Nurses were interviewed until data saturation was achieved. Analysis was conducted using the thematic synthesis approach. The results include the three main themes: "language barriers" , "therapeutic education" (sub-themes: hygiene, food beverages, behavioural rules), "resources". These mentioned factors seem influence, in turn, the safety of the paediatric patient . The results suggest linguistic barriers put at risk the whole relationship of care patient-family-nurse and is likely to jeopardize the patient's safety. Nurses are conscious they have to take under control the nursing process to care the patient and the family. Nurse would like to bridge difficulties to improve the safety for this kind of patient.

74 Patient-oriented research priorities for pediatric hospital care in Canada: a James Lind Alliance Priority Setting Partnership

Abstract Background The largest population of paediatric patients cared for in hospital are those with medical conditions managed in general paediatric inpatient units (GPIUs). Despite the large burden, there is a lack of high-quality research focused on the care of children and youth admitted to GPIUs. The Canadian Paediatric Inpatient Research Network (PIRN) was launched in 2019 to generate evidence to improve the care and outcomes for hospitalized children in GPIUs. To help establish a future research agenda, PIRN brought together clinicians, youth, patients and caregivers to identify important clinical management questions about the care of children in hospital. Objectives To conduct a research priority setting study to identify the most important unanswered clinical management research questions about paediatric hospital care in GPIUs that are important to patients, caregivers, and clinicians. Design/Methods Established James Lind Alliance Priority Setting Partnership methodology was utilized for this project, which was overseen by a Steering Group composed of patient partners, (youth, parents of patients) and clinicians (nurses, and paediatricians) (n=10), facilitated by a JLA Adviser. In phase 1, an online REDCap survey was administered to collect unanswered research questions regarding paediatric hospital care via 3 open-ended questions. Responses from the phase 1 survey went through a detailed evidence checking process. Subsequently, unanswered research questions were brought forward to a phase 2 interim prioritization online REDCap survey. A final list of top 10 unanswered research questions pertaining to paediatric hospital care was established at the final priority setting workshop. Results The phase 1 survey was completed by 188 participants and generated 495 unanswered research questions and comments, of which 58 were deemed out of scope. The remaining 437 responses were grouped into themes (e.g., hospital policy, communication, shared-decision making, health service delivery and health service management), and then refined to 75 unanswered research questions. Of these 75, 4 questions had sufficient evidence, and 21 were submitted by only one respondent. Fifty unanswered research questions were included in the phase 2 survey, which was completed by 201 participants. The top 16 questions – the top 10 from both patient partners (youth, parents of patients) and clinicians respectively – were presented at the final priority setting workshop and the top 10 questions were prioritized (Table 1). The top 10 questions focus on the care of special inpatient populations (e.g. children with medical complexity), communication, shared-decision making, support strategies, mental health supports, shortening length of stay, and supporting Indigenous patients, parents and families. Conclusion The top 10 unanswered questions on paediatric hospital care will help guide future research. PIRN will use these prioritized questions to generate scientific knowledge to improve the outcomes of hospitalized children and youth in GPIUs through the conduct of patient-oriented research.