Pediatric Health Care Professionals Research Articles

The lactation skill gaps of multidisciplinary paediatric healthcare professionals in the United Kingdom.

Breastfeeding is an important public health priority and may be particularly beneficial for medically complex infants and children. However, childhood illness and disability are associated with increased challenges and lower breastfeeding rates. The Baby Friendly Initiative has been shown to increase initiation of breastfeeding and improve health professional skills although as yet the standards have not been adopted in paediatrics. Previous studies have found breastfeeding knowledge gaps among paediatric nurses, and a recent systematic review highlighted insufficient lactation support, discouragement by healthcare professionals and lack of resources. The aim of this survey of UK paediatric professionals was to establish their self-defined confidence and skills supporting breastfeeding. An online survey was developed to explore associations between level of training and staff confidence and perceived skill, to establish whether there is evidence that more training and/or higher breastfeeding training credentials improve skill. In total, 409 professionals, including paediatric doctors at all grades, paediatric nurses and allied health professionals, were included in the analysis. This study identified specific skill gaps among professionals. Many healthcare professionals felt that different skills and specific training are required to support medically complex children. Several professionals noted that existing breastfeeding training focuses on establishing breastfeeding in healthy newborns rather than sick children in paediatrics. Participants were asked about 13 clinical competencies, and an aggregate skill score was calculated. Multiple univariate analysis of variance found that more extensive training and higher credentials are correlated with higher skill scores (p ≤ 0.001), whereas type of professional was not. Despite this being a relatively motivated sample of healthcare professionals, the findings of this study suggest that breastfeeding skills are patchy and inconsistent, and particularly lacking when it comes to more complex clinical scenarios. This is significant, because it may mean that children who have more significant illness or medical complexity are disproportionately affected by gaps in knowledge and skill. Medically complex children encounter many barriers to optimal feeding - including absence of designated paediatric lactation staff, resources and support - and may have challenges such as low tone, higher calorie need and transitioning to the breast after ventilation or enteral feeding. Current skill gaps indicate that existing training would be insufficient, and bespoke paediatric breastfeeding training based on identified clinical challenges is thus justified.

Weight-biased attitudes about pediatric patients with obesity in Dutch healthcare professionals from seven different professions.

Little is known about the prevalence of negative weight-biased attitudes among Dutch healthcare professionals (HCPs) when treating children and adolescents with obesity and whether interdisciplinary differences are present. Accordingly, we asked Dutch HCPs that treat pediatric patients with obesity to complete a validated 22-item self-report questionnaire about their weight-biased attitudes. In total, 555 HCPs participated from seven different disciplines: 41 general practitioners (GPs), 40 pediatricians, 132 youth healthcare physicians, 223 youth healthcare nurses, 40 physiotherapists, 40 dieticians, and 39 mental health professionals. HCPs from all disciplines reported to experience negative weight-biased attitudes among themselves. Pediatricians and GPs scored highest on negative weight-biased attitudes, including frustrations in treating children with obesity, and feeling less confident and prepared to treat children with obesity. Dieticians scored the least negative weight-biased attitudes. Participants from all groups perceived weight bias expressed by their colleagues, toward children with obesity. These findings are comparable to results reported by adult HCPs from other countries. Interdisciplinary differences were found and underscore the need for more research on contributing factors that impact explicit weight bias among pediatric HCPs.

Perceived Knowledge and Confidence for Providing Youth-Specific Type 1 Diabetes Exercise Recommendations amongst Pediatric Diabetes Healthcare Professionals: An International, Cross-Sectional, Online Survey

Background. Managing glycemia around exercise is challenging for individuals with type 1 diabetes (T1D) and their healthcare professionals (HCP). We investigated HCP knowledge and confidence around exercise counseling for youth with T1D worldwide. Objective. To assess HCP familiarity with ISPAD Clinical Practice Consensus Guidelines and confidence to deliver recommendations about T1D and exercise. Methods. A new online survey was developed on strategies and competencies about exercise for youth with T1D, comprising of 64 questions, divided into eight different categories, assessing HCPs perceived exercise knowledge, confidence, training, and barriers to exercise counseling. Results. A total of 125 HCPs mean ± SD age 42 ± 8.2 years (74% female, 73% physicians) completed the survey. The ISPAD exercise guidelines were considered familiar to 68/125 (54%) of responders. Overall, 91/125 (73%) felt confident with giving recommendations about exercise with 47/125 (38%) recommending 45–60 mins/day of physical activity, while 16/125 (13%) recommended >60 mins/day. Several topics related to self-management around exercise were covered by most, but not all responders, and differences were observed in exercise content “confidence” and/or “competence” based on geographic location ( p = 0.048 ). No differences in exercise recommendation dose, confidence, or familiarity with ISPAD guidelines were observed for age, sex, type of HCP, years in practice, or healthcare type. Conclusions. Exercise counseling for youth with T1D remains a challenge in most healthcare settings, globally. In general, the number of physically active minutes per week is under-prescribed for youth with T1D and many HCPs in various settings around the world feel that more professional education is needed to boost confidence around the education of several exercise-related topics.

Clinical practice guideline recommendation summaries for pediatric oncology health care professionals: A qualitative study.

To develop a summary format of clinical practice guideline (CPG) recommendations to improve understandability among health care professionals. We developed a summary format based on current research and used the "Think Aloud" technique in one-on-one cognitive interviews to iteratively improve it. Interviews of health care professionals from Children's Oncology Group-member, National Cancer Institute Community Oncology Research Program sites were conducted. After every five interviews (a round), responses were reviewed, and changes made to the format until it was well understood and no new, substantive suggestions for revision were raised. We took a directed (deductive) approach to content analysis of the interview notes to identify concerns related to recommendation summary usability, understandability, validity, applicability and visual appeal. During seven rounds of interviews with 33 health care professionals, we identified important factors that influenced understandability. Participants found understanding weak recommendations more challenging than strong recommendations. Understanding was improved when the term 'conditional' recommendation was used instead of 'weak' recommendation. Participants found a Rationale section to be very helpful but desired more information when a recommendation entailed a practice change. In the final format, the recommendation strength is clearly indicated in the title, highlighted, and defined within a text box. The rationale for the recommendation is in a column on the left, with supporting evidence on the right. In a bulleted list, the Rationale section describes the benefits and harms and additional factors, such as implementation, that were considered by the CPG developers. Each bullet under the supporting evidence section indicates the level of evidence with an explanation and the supporting studies with hyperlinks when applicable. A summary format to present strong and conditional recommendations was created through an iterative interview process. The format is straightforward, making it easy for organizations and CPG developers to use it to communicate recommendations clearly to intended users.

Outgrowing the Pediatric Intensive Care Unit: Adults With a Pediatric Medically Complex Condition.

With more than 20 years of experience as pediatric and adult critical care nurses, we have observed an increase in the number of medically complex children who are living into adulthood and a troubling lack of adult intensive care unit (ICU) systems and processes for these patients.Medical advances have resulted in a significant decline in the mortality rate in the pediatric ICU (PICU), from 15% in 1980 to 4% in 2006. However, an unintended consequence is that more children experience significant morbidity. In fact, more than 50% of all PICU admissions are children with medical complexity.1,2 Families caring for a child who is chronically critically ill have special care requirements. Nurses in the PICU have extensive experience with pediatric-onset conditions such as congenital heart defects, sickle cell disease, neurodegenerative diseases, chromosomal abnormalities, and muscular dystrophies. They are also familiar with growth and development and have expertise in providing developmentally appropriate care. In addition, PICU nurses are trained in the principles of family- and patient-centered care, which include communicating and collaborating with family caregivers about the processes of care to a much greater extent than usually done in an adult ICU. Certified child life specialists are also available in the PICU to provide specific tools to assist in meeting the needs of the family, including siblings. When medically complex children become adults, many of them transition to adult ICUs that may not be ready for them. As a result, approximately 2% of PICU admissions (range 0%-9%) are adults who have had complex medical needs as children.3,4 However, as the number of medically complex children reaching adulthood continues to grow, the “PICU for adults” model is not sustainable.At this time, many adult ICUs are not prepared for patients with pediatric conditions. Creating an environment in which adult and pediatric health care professionals work collaboratively is essential to providing quality care to these patients and families. Systems need to be developed and expanded to provide complex care in the adult ICU. A proactive, interdisciplinary approach including specialized training for the adult ICU team is needed to sustain a high level of quality care and to support the transition to adult care. Staff in the PICU can help to prepare families for the transition as well as provide education and support to the adult ICU team. Issues to consider include differences in anatomy and physiology of pediatric patients, the unique developmental needs of this population, expansion of specialized services (ie, child life specialists), dedicated sleep areas for parents, and involving parents in decisions and patient care.

Assessing the Pediatricians' Role in Improving Young Children's Oral Health in Telangana State: A Cross-sectional Study.

Primary precautionary approaches for oral health is an essential tool concerning public health, as dental caries is one of the eminently prevailing chronic diseases among children across the globe. As pediatricians and pediatric healthcare professionals are more likely to encounter children when compared to general dentists, it is crucial for them to be acquainted with possible risk factors and diseases occurring in early childhood. Therefore, it is highly advocated to take necessary steps at an initial stage to help promote pragmatic results during childhood and succeeding adulthood phases. The pediatrician's attitude toward dental health and his dental screening, counseling, and referral practices. This was a cross-sectional study in the Hyderabad district, following area sampling on a sample of 200 child healthcare professionals, as calculated based on a pilot study. A definitive and validated questionnaire was used for the collection of data, and pediatric health professionals were approached in their workplaces. About 44.5% of pediatricians usually check teeth during routine tongue and throat examinations. Around 59.5% of them suspect cavities when the child looks undernourished. A total of >80% of them voted that oral health cannot be neglected, as it is an integral part of a child's general health and dental screening, and referral at regular intervals of time is their responsibility. Only 8.5% advised fluoridated toothpaste, whereas only 62.5% counseled parents on the dental ill effects of nighttime bottle-feeding and digit sucking. Although all the pediatricians had appropriate attitudes toward oral health, they were not put into action by many. Pediatricians play a vital role as potential partners in the oral health promotion of children and their families. A pediatric primary care provider's regular screening, counseling, and referral would help his/her patients in getting the right treatment done at the right time. Reddy SM, Shaik N, Pudi S, et al. Assessing the Pediatricians' Role in Improving Young Children's Oral Health in Telangana State: A Cross-sectional Study. Int J Clin Pediatr Dent 2022;15(5):591-595.

Factors Associated with the Lifestyle of Pediatric Healthcare Professionals during the COVID-19 Pandemic.

The objective of this study was to analyze the association between sociodemographic and occupational variables with the lifestyle of health professionals in pediatric units during the COVID-19 pandemic. A cross-sectional study was conducted with 407 health professionals working in four pediatric health units in the State of Bahia, northeast Brazil. The Fantastic Lifestyle Questionnaire and a questionnaire with sociodemographic and employment variables self-applied via Google Forms were used. The final binary logistic regression models revealed significant associations between those who received 3 to 5 minimum wages, without a marital relationship and with more than one employment relationship. Data suggest that these sociodemographic and occupational profiles are more exposed to risky lifestyle behaviors. The findings of this study demonstrated the need for greater attention to the health of health professionals in the pediatric field, as well as the promotion of initiatives that seek to value the work of these professionals and reduce the damage caused to their lifestyle, especially in a pandemic scenario.

A-TEAM: An Interprofessional Approach to Mandated Reporting in the Hospital Setting

Reporting suspected child maltreatment in pediatric settings presents unique challenges. Variation in mandated reporter training may lead to discomfort and emotional dysregulation. Failure to collaborate inter-professionally potentially results in suboptimal care for vulnerable children and families. A-TEAM promotes awareness, transparency, empathy, a nonjudgmental strategy, and management by an interprofessional team when referring patients for child protective services evaluation. A faculty trained in pediatric trauma nursing led the development of A-TEAM. Integrating nursing and social work expertise protects the integrity of family-centered patient care. The A-TEAM approach may be a valuable contribution to the continuing education of pediatric health care professionals.

End-of-life care in pediatric palliative care

The problem of EOL care of a child is very important because the recovery of a family from grief over a child’s death depends on that manner. For improving the quality of this specific care, it would be useful to assess the life expectancy/survival of congenital anomalies, life-threatening diseases, conditions that may shorten a child’s life, and the outcomes of palliative care units regarding mortality. Besides, there is an urgent need for more data on what families define as ‘good death’ and how to cope with the loss. Not only caregivers but also siblings, grandparents, relatives, and healthcare professionals are impacted by a child’s death and their needs must be explored. Pediatric palliative care staff in low/middle-income countries need educational assistance for skills of multidisciplinary training about end-of-life care to improve appropriate care for dying children and their families. It is important to provide sensitive and empathetic end-of-life care to children in a family-centered manner helping them to find comfort, meaning, and support while enhancing the quality of a child’s life and death. Many attending physicians felt inexperienced when communicating with dying patients and their families while discussing the transition to palliative care and resuscitation status. Also, the good death of a child is an emerging concept in this research domain to improve end-of-life care for dying children and their families. The goal of this review was to provide pediatric healthcare professionals and physicians with an overview of palliative care regarding end-of-life issues.

Provider Educational Needs and Preferences Regarding Transition from Pediatric to Adult Care in a Pediatric Health System.

There is limited evidence on educational needs and preferences of pediatric health care professionals regarding transition from pediatric to adult health care. We distributed an anonymous online survey to physicians and advanced practice providers at a large, free-standing children's hospital and associated primary care network to assess attitudes, practices, and educational preferences about transition. We analyzed data with descriptive statistics, chi-square, and logistic regression. A total of 178 providers responded (20% response rate) across 31 specialties (66% attending physicians, 19% fellows, and 15% advanced practice providers). Less than half (43%) were comfortable in their knowledge of transition, with fellows reporting significantly lower comfort than attendings ( P < .05). In total, 47% reported annually discussing transition with their patients (fellows: 17% vs. attendings: 50%, P < .05). Educational topics of greatest interest included legal (71%) and financial concerns (69%), whereas preferred educational formats included Grand Rounds/lectures (68%) and webinars (63%). Facilitators to transition included lists of local adult providers for transition (89%), parent/family educational resources (88%), and a medical summary template in the electronic health record (85%). Major gaps exist in attitudes and practices related to transition. Identified educational strategies may serve as targets to improve the transition process through educational interventions.

Longitudinal Associations Between Use of Mobile Devices for Calming and Emotional Reactivity and Executive Functioning in Children Aged 3 to 5 Years

Mobile devices are often used to keep young children occupied or calm, but it is not known whether this practice influences child development. To examine the longitudinal, bidirectional associations between the parent-reported frequency of using mobile devices to calm young children and children's executive functioning (EF) and emotional reactivity, testing moderation by child sex and temperament. This prospective cohort study included a community-based convenience sample of English-speaking parents of typically developing children aged 3 to 5 years. The study duration was from August 2018 to January 2020, with baseline (T1), 3-month follow-up (T2), and 6-month follow-up (T3) waves. Parent-reported frequency of use of mobile devices to calm children when upset (5-point Likert scale). At each wave, the child's EF was assessed with the Behavior Rating Inventory of Executive Function-Preschool Version Global Executive Composite and emotional reactivity with the Child Behavior Checklist Emotional Reactivity subscale. Structural equation models were built to examine cross-lagged associations of the use of devices for calming, EF, and emotional reactivity, testing for moderation by child sex or temperament (Child Behavior Questionnaire-Very Short Form surgency score, median split). Of 422 eligible parents with data at T1, 375 (88.9%) provided data at T2 and 366 (86.7%) at T3. At baseline, the mean (SD) age of the 422 children was 3.8 (0.5) years, the number of boys in the sample was 224 (53.1%), the number of individuals of non-Hispanic White race and ethnicity was 313 (74.2%), and among the parents, 254 (60.2%) had a college degree or higher. Among the boys, the use of devices to calm at T2 was associated with higher emotional reactivity at T3 (r [standardized regression coefficient] = 0.20; 95% CI, 0.10-0.30), while higher emotional reactivity at T2 had a nonsignificant association with increased device use for calming at T3 (r = 0.10; 95% CI, -0.01 to 0.21). Among children with high temperamental surgency, the use of devices to calm at T2 was associated with increased emotional reactivity at T3 (r = 0.11; 95% CI, 0.01-0.22), while higher emotional reactivity at T2 was associated with increased device use for calming at T3 (r = 0.13; 95% CI, 0.02-0.24). The findings of this study suggest that the frequent use of mobile devices for calming young children may displace their opportunities for learning emotion-regulation strategies over time; therefore, pediatric health care professionals may wish to encourage alternate calming approaches.

APA’s Government, Policy, and Advocacy Update (December 2022)

Back to table of contents Previous article Next article Government & LegalFull AccessAPA’s Government, Policy, and Advocacy Update (December 2022)Search for more papers by this authorPublished Online:27 Nov 2022https://doi.org/10.1176/appi.pn.2022.12.12.49APA Responds to Recommendations Related to Screening for Depression, Suicide Risk in AdultsEarlier this year, the U.S. Preventive Services Task Force (USPSTF) released draft recommendations around screening for depression and suicide risk in patients over age 18. In its draft, USPSTF recommended screening adults, including pregnant and postpartum adults, for depression. Further, they concluded that current evidence is insufficient to assess the balance of risks and benefits of screening for suicide in adults.APA provided comments, signed by APA CEO and Medical Director Saul Levin, M.D., M.P.A. APA strongly encouraged USPSTF to expand the depression screening recommendation to include screening with a brief evidence-based intervention and/or referral when indicated as opposed to screening alone.Further, APA urged USPSTF to recommend targeted suicide screening, such as for individuals who screen positive for depression. This would be “a more balanced and reasonable recommendation” than not screening for suicide risk at all. “This is especially important in groups at high risk for suicide, such as individuals over the age of 65,” the comments stated.Finally, APA raised concerns with USPSTF’s statements regarding pharmacologic agents taken by individuals who are pregnant or postpartum, suggesting that they could be interpreted as a recommendation against medications for depression in this population. “[I]t may reinforce the already reflexive tendency on the part of many clinicians to discontinue (or avoid) psychotropic medications during pregnancy for those individuals who might need and benefit from them,” the comments stated. APA attached a more detailed response to this aspect of the USPSTF recommendations in its comments, developed by APA’s Committee on Women’s Mental Health.APA’s comments on USPSTF Recommendation on Depression and Suicide Risk in Adults APA Joins Letter Urging Biden to Declare National Emergency on Children’s Mental HealthOctober marked the one-year anniversary of three organizations—the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association—declaring a national state of emergency on children’s mental health. APA joined the Sound the Alarm for Kids initiative last year, and this year, to commemorate the anniversary, APA and over 130 organizations sent a letter to President Joe Biden, urging him to declare a national emergency for the youth mental health crisis.“While much has been done by the federal government to address the crisis, the mental health of our nation’s youth continues to deteriorate,” the letter stated. It points to increasing rates of suicide among children (especially Black boys and girls under age 12), increasing number of emergency department visits for suspected youth suicide attempts and diagnoses of anxiety, depression, and behavioral or conduct issues. It also noted the challenges imposed by systemic inequities such as racism, homophobia, transphobia, economic inequality, and under-resourced schools.“Issuing a National Emergency Declaration would galvanize existing critical funding streams and support to help ensure that all children and adolescents can access the full continuum of mental and behavioral health care from promotion and prevention to early identification and treatment, especially in times of crisis,” the letter continued. “Of particular note, we need a robust and comprehensive mental health workforce strategy that prioritizes recruitment of underrepresented populations and ensures trained pediatric mental health and primary care professionals are adequately paid for the services they provide.” ■APA’s letter to President Biden ISSUES NewArchived

Time for Action: Understanding Health Care Professionals Views on Pain and Pain Management in a Pediatric Hospital

Children admitted to the hospital experience pain. ChildKind International (CKI) is an organization dedicated to improving the quality of pediatric pain care worldwide. In 2019, BC Children hospital (BCCH) clinicians set out to achieve this certification. A qualitative study was performed in order to fully comprehend the current state of pain assessment and management at BCCH. The objective of this study is to characterize the perceptions of health care professionals (HCPs) about pediatric pain and pain management in a pediatric hospital. We choose a quantitative methodology as it allows us to delve more deeply into the HCPs' personal experience with pain and pain management of children in the hospital. We interviewed 31 pediatric healthcare professionals (N=31). HCPs believe there is a significant lack of resources, especially educational resources, to adequately assess and treat pain in children. There is a lack of time to evaluate each patient appropriately and use pain tools consistently for both verbal and non-verbal children. HCPs varied in their opinions as to whether a procedure is painful or uncomfortable, and this opinion often differs from the perception of the child. Additionally, staff recognize that cultural diversity of both staff and patients can influence pain assessment and management in children. Therefore, there is a need for increased cultural diversity training for staff. Pain management and treatment of children in the hospital remain inconsistent and inadequate. ChildKind certification will help hospitals to address this gap in their clinical practice.

Recognising and raising safeguarding and child protection issues in childrens diabetes. Early findings from a qualitative study exploring specialist paediatric diabetes healthcare professionals' experiences

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Experiences of parents and caregivers in pediatric intensive care units: A qualitative study

BackgroundIn pediatric intensive care units (PICUs), parents and healthcare professionals attend to children who verbally and non-verbally express their pain and suffering, fears, anxieties, desires, and wishes in complex intensive care situations. What can we learn from these experiences to improve the way we can take care of and support children? ObjectivesThe main objective of this clinical ethics study was to focus on the experience stories of parents during their child's hospitalization in a PICU, to analyze their discourse, and to propose an ethical perspective. MethodThe current research collects the experience reports of parents during their child's hospitalization in a PICU and those of the caregivers who treated them. A total of 17 semi-directive interviews were conducted in the PICU of the Nantes University Hospital from November 2017 to June 2019. Each interview lasted around 1 h. The main results of our study are analyzed and informed by the four ethical principles of T. Beauchamp and J. Childress: autonomy, beneficence, non-maleficence, and justice. ResultsThe interviews highlighted the difficulties encountered by parents during the hospitalization of their children, such as the distance between their home and the hospital, the technicality of PICU environment, and the difficulty in finding their place as parents. For medical and paramedical teams, their main concerns are undoubtedly to improve the coherence and continuity of their stand toward parents, to promote parental autonomy, and to remain fully aware of the profound existential changes that the child's illness brings about for parents: It is the caregivers’ duty to take this into account and to respect the parents’ rhythm as much as possible. ConclusionsThe main disagreements between healthcare teams and parents, where they exist, are communication problems that are easily controlled, for the most part, by caregivers.

Pediatric healthcare professionals' opinions, attitudes, and vaccine hesitancy toward personal and children’s COVID-19 vaccination

Background/Aim: Pediatric healthcare professionals are at the forefront of both facilitating an increase vaccine acceptability and reduction in vaccine hesitancy and play a vital role in eliminating vaccine hesitancy of families. In this context, it was thought that the individual pediatric healthcare professional’s vaccine hesitancy could affect successful administration of the coronavirus 2019 (COVID-19) vaccination. This study aimed to determine the opinions and attitudes of pediatricians and pediatric nurses toward the COVID-19 vaccination and the reasons for vaccine hesitancy. The study also aimed to identify their views and attitudes toward COVID-19 vaccination in children. Methods: The survey was carried out as a cross-sectional study between February and May 2021. The study sample consisted of 83 pediatricians and 79 pediatric nurses. Necessary permission was obtained before the study began. Data were collected using questionnaires that had been prepared by researchers. Data were analyzed using descriptive statistical methods and a chi-squared test. Results: Almost all pediatricians and more than half of the pediatric nurses reported that they considered getting vaccinated/were vaccinated; however, a greater proportion of nurses were vaccine-hesitant (P = 0.001). Reasons for not being vaccinated/being hesitant among healthcare professionals included harmful ingredients in the COVID-19 vaccines, thinking that vaccines were developed too quickly, vaccine development studies in different phases did not yield conclusive outcomes, hearing from the social media that vaccines are harmful, believing it is not necessary to receive a vaccine that is not included in the routine immunization schedule, and lack of knowledge about vaccines. The majority of the physicians and nurses who participated in the study reported that, if COVID-19 vaccines were available for children, they would not consider advising it or were unsure (P = 0.003). When asked about the reasons for hesitancy, a greater proportion of nurses reported they thought that vaccines had been developed too quickly (P &lt; 0.001) and that the outcomes of vaccine development studies in different phases were not conclusive (P = 0.008). Conclusion: Healthcare workers serve as role models for vaccination acceptance in the community. Identifying the reasons for vaccine hesitancy among healthcare professionals is key to encouraging vulnerable populations to accept and take the vaccine. Vaccine hesitancy may be countered by comprehensive in-service trainings on vaccine development processes and phases of trials relating to COVID-19 vaccines.

Pediatric-Adult Care Transition: Perceptions of Adolescent and Young Adult Patients with Sickle Cell Disease and Their Healthcare Providers.

IntroductionThe pediatric-adult care transition, which takes place during adolescence, is a high-risk period for medical care adherence in chronic diseases, this encompasses treatment adherence, attending medical consultations and following healthcare advice. Studying perceptions is needed to get a more comprehensive picture of this care transition and to propose interventions to address the gaps. The authors analyzed perceptions from patients and caregivers in adolescents with sickle cell disease. Although this is the first step to improving the actual care management, to our knowledge, no study has explored perceptions from healthcare providers and compared it to patients’ perceptions. The purpose of this study was to provide an insight on the experience of adolescent and adult patients, pediatric and adult healthcare providers in the context of pediatric to adult care transition, and analyze those concerns in order to better understand medical care adherence and improve patient care.Material and MethodsSemi-structured interviews were conducted with adolescent and adult patients, as well as healthcare professionals (HCPs) in pediatric and adult departments. These interviews were audiotaped and transcribed before manual inductive content analysis.ResultsA total of 15 adolescent patients, 10 adult patients, 9 pediatric HCPs and 13 adult HCPs - including 12 nurses - were interviewed. Patients and healthcare providers all agreed that the pediatric-adult care transition was poorly experienced. This was mainly due to various changes in habits, physicians, and care organization. Anticipating this transition and acquiring new skills both for patients and HCPs are essential steps for improving medical care adherence during this challenging pediatric-adult care transition.ConclusionPropositions emerged from patients and healthcare providers to improve care and subsequently to improve medical care adherence in patients with sickle cell disease during and after the pediatric to adult care transition.

Parents’ experiences following conversations about their young child’s weight in the primary health care setting: a study within the STOP project

BackgroundIn primary healthcare, conversations between clinicians and parents about young children’s overweight are key to providing support and initiating weight management. However, given the sensitivity of this topic, these conversations are difficult for both clinicians and parents and are sometimes delayed or avoided. To understand the emotional impact of these conversations, this study aims to shed light on parents’ experiences following conversations with primary care nurses about their child’s overweight.MethodsParticipants were recruited through a childhood obesity randomized controlled trial (RCT) conducted in Sweden. Telephone-based semi-structured interviews were conducted with 17 parents (mean age 40; the majority were women (n = 12/17), had a university degree (n = 14/17) and were born in Sweden (n = 13/16)). Their children were between 3 and 7 years old (mean age 4.8 years) with overweight (n = 7) or obesity (n = 10). The interviews were recorded, transcribed, and analyzed using thematic analysis.ResultsTwo main themes were developed. Theme 1, ‘Receiving the overweight/obesity diagnosis’, explores parents’ reactions to the conversation with the primary care nurse. Depending on how the nurse presented the topic, conversations either fostered an alliance between the parent and the nurse, encouraging parents to reflect and develop insights about the child’s and the family’s needs (subtheme Conversations that empower), or felt limited, uncomfortable, or belittling (subtheme Conversations that provoke resistance). Theme 2, ‘Parenting a child with a formal diagnosis of obesity’, explores challenges parents faced following the weight conversations, including managing their own feelings and concerns (subtheme Fear of transferring weight anxiety), dealing with others’ reactions (subtheme Involve family and manage surroundings) and asking for and receiving support from health care professionals (subtheme Obtain support from health care professionals).ConclusionsWhile conversations with primary care nurses about children’s weight were often emotional, most parents felt these conversations were ultimately helpful, as they encouraged them to enact positive lifestyle changes. Importantly, when nurses initiated conversations in a responsive, non-blaming way, inviting parents to reflect on their situation, parents felt more supported and empowered. These findings convey the importance of providing communication skills training to pediatric healthcare professionals, with particular focus on childhood overweight and obesity.Trial registration numberClinicalTrials.gov NCT03800823; 11 Jan 2019.

Global child and family-centered care fellowship, education and mentorship for pediatric healthcare professionals: A literature review

Child- and family-centered care (FCC) is increasingly accepted and implemented to optimize the healthcare experience for patients, their families, and healthcare professionals. Standish Foundation for Children, a 501(c)(3) non-profit, has designed and piloted a fellowship to educate pediatric healthcare professionals in FCC & psychosocial care via an inquiry and mentorship model in Tbilisis, Georgia. This review aimed to evaluate and synthesize existing literature on psychosocial and FCC mentorship for pediatric healthcare professionals in four parts: ongoing need, effects on healthcare professionals, effects on children and their families and/or caregivers, and in cross-country healthcare settings. Reviewers searched open-source databases for articles in English published between 2010 and 2021. Opportunities for psychosocial and FCC skills development is both desired and needed by pediatric healthcare professionals, a viewpoint shared by families of pediatric patients. Existing mentorship models varied in design but overall improved provider confidence and ability to provide FCC in clinical settings. Some support for these interventions improving patient and family clinical outcomes is documented, although further research is necessary. In cross-country healthcare settings with varying resource levels, clinical mentorship in general can improve quality and delivery of care without requiring entirely new approaches. This review supports psychosocial mentorship models as an effective tool for child- and family-centered care delivery. Future research into long-term professional and patient outcomes, FCC impact on pediatric patients with non-traditional family units, and in cross-country settings is recommended to gain a more comprehensive understanding of how FCC can improve quality of healthcare.

#47 RESULTS OF AN EDUCATIONAL COMPONENT OF DECREASING TIME TO THERAPY (DoTT) IN PEDIATRIC CANCER PATIENTS WITH FEBRILE NEUTROPENIA IN PERU

Abstract Background In low-and middle-income countries, a limitation for optimal treatment of children with fever and neutropenia (FN) due to chemotherapy is the delay in administering the first dose of antibiotics. DoTT is a quality improvement project implemented in Peru and aligned to the WHO Global Initiative of Childhood Cancer. A component of DoTT is an educational intervention of health care providers to decrease the time to antibiotics (TTA) in pediatric patients presenting to the emergency room (ER) with FN. Method This study was performed at Hospital Nacional Edgardo Rebagliati, a tertiary care National Hospital in Lima. We defined TTA as the time elapsed between patient′s arrival to the ER and administering the first dose of an antibiotic. Patient Time to Arrival, PTA, is the time elapsed between onset of symptoms and arrival to the hospital. The intervention consisted of a synchronous and asynchronous educational course on managing FN in children with cancer. Trainees were attending pediatricians and pediatric residents. We compared the TTA between 22 patients admitted from October to November 2021 with fever and neutropenia (after educational intervention) and baseline data of 99 patients from 2020 January and 2021 August (before intervention). Results The median age considering the two groups was 5 years, 55 patients were female and 66 were male. 104/121 patients had leukemia, and 17/121 patients had solid malignant tumors. No patients required admission to ICU or died of sepsis in the pre-intervention group, in the post-intervention group one patient required admission to ICU and one patient died of sepsis. In the pre-intervention group (97 patients), the median TTA was 171 minutes (IQR: 102–293), and in the post-intervention group, the median TTA was 60 minutes (IQR: 35–73). Early results indicate a statistically significant decrease in the TTA (p=0.001). A long PTA was observed before intervention (median= 1483 minutes) which was decreased (median=1290 minutes) in the post-intervention group (p=0.06). Conclusion This study suggests the potential impact of the educational intervention in pediatric health care professionals in to decrease of TTA in pediatric patients with cancer and FN, which encourages the team to continue with the intervention in other health care providers in the emergency room. The PTA was very high in both groups and indicated the need for an additional intervention to improve these results.