Pediatric Health Care Professionals Research Articles

Pediatric Palliative Care

Good communication is essential but sometimes challenging in pediatric palliative care. We describe 3 cases whereby miniature chairs made of various materials and colors were used successfully to encourage communication among pediatric patients, family, and health care professionals. This chair-inspired model may serve as a simple tool to facilitate complex discussions and to enable self-expression by children in the pediatric palliative care setting.

Adolescent Psychosocial, Social, and Cognitive Development

Adolescent Psychosocial, Social, and Cognitive Development

Thrombotic Thrombocytopenic Purpura, from the Perspectives of a Pediatrician

Thrombotic thrombocytopenic purpura (TTP) is a rare pediatric disease, yet has grave outcome if not managed properly. It shares many common clinical features with hemolytic uremic syndrome (HUS). While it is still disputable whether TTP and HUS are clinically related disorders, recent studies indicate that severe deficiency of a von Willebrand factor (vWF) cleaving protease is one of the primary causes of TTP. In this discussion, we will focus on TTP in reference to the deficiency of this protease, with the objective of increasing awareness among pediatric healthcare professionals of this less commonly recognized disease. Keywords: Thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, TTP, HUS.

Exercise-Deficit Disorder in Children: Are We Ready to Make this Diagnosis?

Primary care physicians, particularly pediatricians, are expected to promote physical activity and prescribe exercise to patients. Unfortunately, many health care professionals do not have adequate skills or experience in this area, making exercise intervention logistically and psychologically challenging. Exercise-deficit disorder (EDD), which is a new term to the literature, is defined as reduced levels of moderate-to-vigorous physical activity, inconsistent with public health recommendations. Physicians are in a unique position to identify children who are deficient in exercise and initiate prevention strategies. To aid physicians in the diagnosis and treatment of children with EDD, we propose integrating exercise assessment into primary care practice, and, when appropriate, referral to a pediatric exercise specialist. This approach should ensure adequate development of muscle strength and motor skills that are required for successful physical activity participation. The timely identification of children with EDD is essential in preventing resistance to intervention. Connecting pediatric health care professionals with pediatric exercise specialists, culminating in an established professional collaborative system, is critical for promoting healthy behaviors throughout childhood and adolescence.

Introducing the Tran Qol: A New Disease-Specific Quality of Life Measure for Children and Adults with Thalassemia Major

Background: Patients with thalassemia major require red cell transfusions for survival and have to deal with iron overload and chelation. Chelation is burdensome, traditionally involving nightly prolonged subcutaneous infusion therapy. We developed a disease-specific tool for these patients (TranQol) to measure their unique quality of life issues. Methods: Pediatric and adult thalassemia health care professionals and quality of life methodology experts generated 69 potential items. 74 further questions were generated through interviews with patients (pediatric and adult) and parents. Results: 120 participants contributed: 16 healthcare workers, 31 children and 30 adults with thalassemia and 43 parents. Duplicate and infrequent questions were discarded leaving 58 items. Three self-reported questionnaires (child, parent and adult) and one child proxy-report for parents were developed. Questionnaire length ranged from 29 (child’s) to 39 (parent’s). Questions were grouped into four domains: physical health, emotional health, family functioning, and school and career functioning. A fifth category on sexual activity included only one item. Cognitive debriefing was done by interviewing additional children, parents, and adults. As a result, three items were added, one was deleted and 16 were modified. Conclusion: The TranQol is a new disease-specific quality of life measure for thalassemia major patients developed using rigorous methodology.

Assent and Dissent in Pediatric Progressive and Critical Care

Assent and Dissent in Pediatric Progressive and Critical Care

The needs of professionals in the palliative care of children and adolescents

The main objectives of this qualitative study were to describe the perceptions and needs of pediatric health care professionals (HCPs) taking care of children with palliative care needs and to develop a concept for the first Center of Competence for Pediatric Palliative Care (PPC) in Switzerland. Within two parts of the study, 76 HCPs were interviewed. The main interview topics were: (1) definition of and attitude toward PPC; (2) current provision of PPC; (3) the support needs of HCPs in the provision of PPC; and (4) the role of specialized PPC teams. HCPs expressed openness to PPC and reported distinctive needs for support in the care of these patients. The main tasks of specialized PPC teams in Switzerland would encompass the coaching of attending teams, coordination of care, symptom control, and direct support of affected families during and beyond the illness of their child. This study indicates the need for specialized PPC in Switzerland both inside and outside of centers providing top quality medical care (Spitzenmedizin). Specialized PPC teams could have a significant impact on the care of children and families with PPC needs. Whether hospices are an option in Switzerland remains unanswered; however, a place to meet other families with similar destinies was emphasized.

The European Paediatric Association affiliation with The Journal

The Journal is pleased to announce an affiliation with the European Paediatric Association (EPA). The EPA is an association established in 1976 for practicing general pediatricians in the 40+ national pediatric societies it represents, along with individual members. EPA strives “to provide general pediatricians with the tools and resources they need to improve the quality of care for their young patients.” The Journal seeks “to inform immediate care decisions, deepen knowledge, and advance further scientific discovery to improve the quality of care and the health of infants, children, and adolescents.” Therefore, the mission and objectives of the EPA and The Journal are aligned. Because of the global scope of The Journal, members of EPA will have access to research pertaining to European countries, as well as the broader worldwide scope of investigation and practice to enhance child health. In a new section of The Journal, “European Paediatric Association Pages,” the EPA will publish member announcements, organizational changes, and new initiatives that also may be of interest to the general readership of The Journal. In this issue of The Journal, the first pieces published in this section include an introduction from the president of the EPA, Andreas Konstantopoulos, MD, which provides background information about the EPA and what readers can expect to see in these pages in future issues, as well as a historical piece about the EPA's growth and development by Ehrich et al. The Journal welcomes the members of the EPA as readers, and encourages all readers to find out more about EPA (http://www.epa-unepsa.org/). Article page 373▶ Article page 374▶ The European Paediatric Association Partners with The Journal of Pediatrics to Make Original Research Available to Our MembersThe Journal of PediatricsVol. 161Issue 2PreviewThe European Paediatric Association (EPA) is pleased to announce a new partnership with The Journal of Pediatrics. We are proud to have established an affiliation with this prominent journal, which is published monthly by Elsevier. The Journal's mission is: “Through a rigorous process of evaluation and peer review, The Journal of Pediatrics strives to publish pediatric research of the highest value for a diverse audience of pediatric healthcare professionals... The Journal seeks to inform immediate care decisions, deepen knowledge, and advance further scientific discovery to improve the quality of care and the health of infants, children, and adolescents” ( http://www.jpeds.com/content/missionstatement ). Full-Text PDF Thirty-Six Years of the European Paediatric Association–Union of National European Paediatric Societies and Associations (EPA-UNEPSA)The Journal of PediatricsVol. 161Issue 2PreviewManaging the health care of infants, children, and adolescents in Europe requires balancing clinical aims, research findings, and socioeconomic goals within an international environment characterized by cultural and economic complexity and large disparity in availability, affordability, and accessibility of pediatric care. Since 1976, the European Paediatric Association (EPA), formerly Union of National European Paediatric Societies and Associations (UNEPSA), has been trying to establish this balance, involving almost two generations of European pediatricians. Full-Text PDF

Obesity Counseling by Pediatric Health Professionals: An Assessment Using Nationally Representative Data

Examine the rate of screening for adolescent overweight and obesity by pediatric health care professionals and the provision of advice on healthy eating and physical activity. Our sample contains adolescents 11 to 17 years old (6911 girls and 6970 boys) from the 2001-2007 Medical Expenditure Panel Survey who reported having at least 1 health provider visit in the previous 12 months. Using logistic regression, we investigated factors associated with whether parents reported that their children were weighed and measured and whether they or their children received counseling on their eating habits and physical activity. All models were estimated separately by gender. Forty-seven percent of girls and 44% of boys who visited a health provider were advised to eat healthy, and 36% of boys and girls were advised to exercise more. Obese boys and girls were both more likely to be advised to eat healthy (odds ratio [OR] = 2.10, P < .001 and OR = 1.70, P < .001) and exercise more (OR = 2.37, P < .001 and OR = 1.90, P < .001) than adolescents who have normal weight. However, overweight boys and girls were counseled at a much lower rate than those who were obese. Adolescents who were more likely to receive such advice lived in the northeast, were from higher-income households, had parents with at least some college education, and had a usual source of medical care. Greater efforts should be made to incorporate guidelines on childhood obesity screening and counseling into clinical practice.

Vomiting of Oral Medications by Pediatric Patients: Survey of Medication Redosing Practices

At the time of this study, the authors' pediatric tertiary care hospital had no policy to guide actions when a child vomited after ingesting oral medication, and limited information was available in the literature. To characterize this clinical problem at the study hospital, to identify current practices related to redosing of medications at the study hospital, and to collect guidelines and opinions of health care professionals at other pediatric hospitals on this topic. Two online surveys were conducted, each over a 1-month period in late 2010, to identify current practices and opinions of pediatric health care professionals about redosing of medications after vomiting. E-mail distribution lists and health care forums were used to recruit participants. Of the 76 responses from the study hospital, 65 were suitable for analysis. Many respondents reported encountering vomiting after administration of oral medications on a weekly (25 [38%]) or monthly (24 [37%]) basis. Most of the respondents reported that they would follow a general rule to redose if vomiting occurred within 30 min (39 [60%]) or 15 min (21 [32%]) after initial ingestion. When respondents were asked to rate the importance of 8 factors potentially affecting the decision to redose, more than half indicated that time after dose ingestion (59 [91%]), medication type (45 [69%]), patient status (39 [60%]), and visibility of medication in the vomitus (36 [55%]) were very important. Of the 53 respondents to the survey of health care professionals at other institutions, 16 (30%) indicated that their pediatric hospital or ward had a guideline on redosing in cases of vomiting after administration of oral medications. Most respondents (12/13 [92%]) stated that the guideline took into account the interval between initial ingestion and vomiting. The problem of vomiting after administration of an oral medication was prevalent at the study hospital, and guidelines were scarce at other pediatric institutions. Health care professionals at the study hospital and other institutions listed the time between ingestion and vomiting as the most important factor in the decision to redose the medication.

A Letter to the Editor in Defense of Sleep Recommendations

As an international group of pediatric sleep specialists and health care professionals deeply committed to the health and welfare of children and adolescents, we the undersigned feel compelled to respond to the conclusions outlined in the article “Never Enough Sleep: A Brief History of Sleep Recommendations for Children,” published in Pediatrics , Volume 129, Issue 3, March 2012.1 In particular, we strenuously challenge the validity of the statement that there is a “universally acknowledged” lack of “meaningful evidence” for sleep recommendations. While we acknowledge there is still much we need to learn and we fully support and encourage additional research on optimal sleep in children, there have been a significant number of rigorous pediatric sleep research studies, many of which were not included in the article, that have done much to help address the issue of optimal sleep duration and healthy sleep practices in children and adolescents.2–5 The publication of this article and the unfortunate subsequent sensationalistic media coverage (ie, “100 Years of Sleep Recommendations…ALL WRONG”) have not only misrepresented an entire body of scientific …

Psychiatric disease and drug abuse

The term 'dual diagnosis' most commonly refers to the combination of severe mental illness and substance-use disorder (SUD). It is estimated that 7-10 million people in the USA alone have at a minimum one psychiatric disorder in addition to a SUD. As many of the psychiatric illnesses implicated have their origins in childhood, the pediatric population is not immune to this 'dual diagnosis', particularly with the increasing availability of street drugs and increasing accessibility to prescription drugs. The purpose of this review is to identify the magnitude of the problem and strengthen awareness among pediatric healthcare professionals who may provide prevention and/or early intervention. Causes for the dual diagnosis are unknown, but there are four hypotheses: common factors (risk factors common to both disorders), secondary mental disorder (substance use precipitates mental disorder), secondary substance use ('self-medication hypothesis') and bidirectional (presence of either mental illness or SUD can contribute to the development of the other). Those with the presence of this dual diagnosis are more likely to be nonadherent to treatment and may well have poorer outcomes. Integrated care for the maladies rather than split or isolated care is recommended. Psychosocial therapy holds promise for treating patients with dual diagnosis.

Disaster Risk and Children Part II: How Pediatric Healthcare Professionals Can Help

Journal for Specialists in Pediatric NursingVolume 17, Issue 3 p. 258-260 Disaster Risk and Children Part II: How Pediatric Healthcare Professionals Can Help John S. Murray PhD, RN, FAAN, Corresponding Author John S. Murray PhD, RN, FAAN Director, Nursing Research, Surgical Programs/Emergency Department, Children's Hospital Boston, Boston, Massachusetts, USA[email protected], with a copy to the Editor: [email protected]Search for more papers by this authorStephen Monteiro MS, EMT-P, Stephen Monteiro MS, EMT-P Director, Emergency Management, Children's Hospital Boston, Boston, Massachusetts, USASearch for more papers by this author John S. Murray PhD, RN, FAAN, Corresponding Author John S. Murray PhD, RN, FAAN Director, Nursing Research, Surgical Programs/Emergency Department, Children's Hospital Boston, Boston, Massachusetts, USA[email protected], with a copy to the Editor: [email protected]Search for more papers by this authorStephen Monteiro MS, EMT-P, Stephen Monteiro MS, EMT-P Director, Emergency Management, Children's Hospital Boston, Boston, Massachusetts, USASearch for more papers by this author First published: 31 January 2012 https://doi.org/10.1111/j.1744-6155.2011.00321.x Column Editor: John S. Murray, Ask the Expert provides research-based answers to practice questions submitted by JSPN readers. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume17, Issue3July 2012Pages 258-260 RelatedInformation

P-350 - Training Resident Physicians in Pediatric Psychopharmacology for ADHD

Children and adolescents experience significant emotional disorders and the prevalence of these conditions is notable. There is a dearth of pediatric mental health care professionals in the U.S., and among those professionals available, geographic and reimbursement limitations restrict access to the care. Primary health care providers are being encouraged to provide some of the identification and care management to offset this access problem. Expand clinical skills of pediatric providers through enhanced training of residents in the use of psychopharmaceuticals for the most common psychiatric diagnosis in U.S. children (ADHD). Second- and third-year pediatric residents attended an intensive 10-hour training in pediatric psychopharmacology for ADHD in 2010. The curriculum was based on a well-established 3-day program that teaches primary care clinicians the elements of guideline-level care for common behavioral health conditions. The program included pre- and post- training assessment of resident knowledge of current practice guidelines for ADHD and intention to use them. Special attention was given to proper use of screening instruments, diagnostic scales, treatment options, importance of medication options and increased frequency of visits during drug initiation and titration of dosages, and obstacles to implementation. Results showed significant and sometimes large post-training increases in intentions to use medication therapies, systematic progression through stimulant and non-stimulant alternatives, parent and teacher symptom rating scales throughout treatment, and side effect scales during dose titration. A one-day enhanced training program improved knowledge of, attitudes toward, and intention to use guidelines of care for youth with ADHD.

Perceptions of Pediatric Nurse Practitioners and How a Pulmonary Function Printout Influenced Practice

The rate of asthma in the pediatric population has risen over the last two decades and is now considered to be the most common serious chronic disease in children and adolescents as well as a serious public health concern. In one suburban, Pennsylvania nurse-managed clinic, a group of pediatric nurse practitioners (PNPs), noted an increase in the number of children with asthma and purchased a pulmonary function machine (Spirometer). The purpose of this paper is to discuss how the integration of a pulmonary function measurement printout influenced a small group of PNPs visit satisfaction, their delivery of nursing care, and the response of the families. As the incidence of asthma increases in the pediatric population, nurse practitioners and other healthcare professionals can take a leading role in patient teaching and provision of care by augmenting their practice with new technology combined with continued education for the client and family.

Care of the Well Newborn

The birth of an infant is one of the most memorable experiences a family shares. Pediatric health care professionals are privileged to participate in this experience and recognize it as a time to promote the health of the newborn and family. Ideally, a well-designed care system would be replete with comprehensive supports during the prenatal period, birth, and transition to home. Opportunities exist to improve the care we deliver with universal screening of all pregnant women; coordinated assessments of family health, including mental health; and access to coordinated supports and services for mother and infant. If 90% of US families could comply with medical recommendations to breastfeed exclusively for 6 months, it is estimated the United States would save billions of dollars per year and prevent more than 900 deaths, nearly all of which would be in infants. All infants, whether breastfed or formula fed, should receive 400 IU supplemental vitamin D. Influenza and TdaP vaccination of postpartum mothers and other caregivers helps cocoon the vulnerable infant from influenza and pertussis until he or she can be fully vaccinated. When children reach the highest weight or length allowed by the manufacturer of their infant-only seat, they should continue to ride rear-facing in a convertible seat. It is best for children to ride rear-facing as long as possible to the highest weight and height allowed by the manufacturer of their convertible seat.

Testing children of mothers with HIV infection: experience in three south‐west London HIV clinics

There are several reported cases of vertically infected children presenting with advanced HIV infection in the UK. The children of women with HIV infection are at increased risk of being infected. There are few data available on the number of such children that are yet to be tested for HIV. This study looked at the HIV testing status of children whose mothers attend HIV services at three south-west London clinics. Case notes of women attending the clinics from 1 January to 30 June 2009 were reviewed. When data were incomplete, women were prospectively interviewed. Case notes of 605 women were reviewed; 478 women had 1107 children. The majority of women (386; 81%) were of Black African ethnicity. Sixty-one per cent (675 of 1107) of the children were known to have been tested for HIV. The children resident abroad were more likely to be untested compared with those resident in the UK; 186 of 255 (73%) vs. 246 of 852 (29%). A quarter (106 of 432) of the untested children were ≤ 18 years old; 49 (46%) of these were resident in the UK. The most common reason given by the mothers for not testing was a perceived 'unlikely risk'. A significant number of children at risk of vertically transmitted HIV infection, including 49 children ≤ 18 years and resident in the UK, were identified through this study. The mothers are being encouraged to have these children tested and a multidisciplinary team involving adult and paediatric HIV healthcare professionals has been set up to negotiate and facilitate testing.

Child With Idiopathic Pulmonary Hemosiderosis: A Case Report From Pakistan With Multiple Ethical and Moral Issues

This report discusses the case of a young Pakistani child diagnosed with idiopathic pulmonary hemosiderosis (IPH). The key features of IPH were iron deficiency anemia and pulmonary symptoms due to recurrent pulmonary hemorrhages. The child showed complications of the disease process because of late diagnosis. Because various ethical and moral issues were associated with the diagnosis and management of IPH, this case provides insights about the care burden of health care professionals and a child's parents in a Pakistani pediatric setting. During the course of the child's treatment at one of the private tertiary care settings of Karachi, Pakistan, the key challenges were as follows: declaring the diagnosis to the parents, dealing with the request of the child's parents for withdrawal of ventilatory support and withholding treatment, deciding the code status of the child, and ensuring the quality of the child's life after discharge from the hospital. It was learned from this case report that shared decision making and open communication with the child's family enabled the pediatric health care professionals to determine what was in the best interest of the child, resulting in provision of effective palliative care to the child. Moreover, it was realized that early detection of the disease and availability of hospice care can facilitate palliative care of children diagnosed with IPH.

Evidence-Based Policy in the New Organizational Paradigm Part 2

Wright State University, Dayton, OHThe Patient Protection and Affordable Care Act (PPAC;Public Law. No. 111-148) addresses the need for the use ofscientific evidence within health care initiatives. Integrationof evidence can be complex and involve multiple systemsfor successful application of evidence-based decisionmaking. As pediatric health care professionals begin tounderstand how the PPAC will impact the care we provideto our patients and families, it is essential that nurses areaware of the issues and possible implications to clinicalpractice. In this initial article, definitions and relationshipsbetween evidence-based practice (EBP), public policy, andthe new organizational paradigm will be explored. Inaddition, issues and barriers relevant and critical to evidenceuse within health care organizations are addressed. In asubsequent article, strategies for facilitating changes inorganizational and individual nurse behaviors toward acontext of EBP will be discussed.

Health care professionals' grief after the death of a child

To evaluate the intensity of grief experienced by health care professionals (HPs) after the death of a child, to explore factors associated with a memorable death (defined as an unforgettable child's death that has touched them in their career) and to identify the needs of HPs. A cross-sectional study was performed to assess emotional reactions, coping strategies and perceived needs of paediatric HPs in a general hospital. One hundred one HPs (46 nurses, 22 paediatric physicians, 11 paediatric residents, 13 respiratory therapists and nine 'others') completed the questionnaire. The level of grief experienced by HPs after a memorable death was intense. Respiratory therapists showed the highest mean (± SD) intensity of grief after a memorable death versus other HPs, as measured by the Texas Revised Inventory of Grief (TRIG) (29±15 versus 16±14; P=0.002). Younger HPs (20 to 25 years of age) reported higher early grief intensity than older ones (older than 50 years of age) (22±16 versus 10±8; P=0.01). There was no significant association between the TRIG score and an HP being a parent, having received palliative care training or the length of his/her relationship with the child and family. Seventy per cent of HPs spoke with their colleagues after the death of a child and 48% with family and friends. Many participants (37%) believed that this social support helped them the most. Grief after a child's death is intense for HPs. This emotional intensity and difference between professions raises issues about the emotional support received following the death of a patient.