Pediatric Health Care Providers Research Articles

Cost-effectiveness analysis of workplace-based distributed cardiopulmonary resuscitation training versus conventional annual basic life support training

ContextAlthough distributed cardiopulmonary resuscitation (CPR) practice has been shown to improve learning outcomes, little is known about the cost-effectiveness of this training strategy. This study assesses the cost-effectiveness of workplace-based...

Pediatric hospital screening for suicide risk in adolescents referred for maltreatment

• Adolescents who experience maltreatment are at increased risk for suicide. • One-third of maltreated adolescents screened positive of suicide risk. • Systematic suicide risk screening in pediatric hospitals is important. • Screening protocols using a brief and valid tool can improve identification of risk. • There are protocol adherence facilitators to promote and barriers to overcome. Adolescents who have experienced the trauma of physical or sexual abuse are at increased risk for suicidal ideation and attempt, underscoring the importance of effective screening to detect and mitigate risk. This quality improvement study aimed to develop, implement, and monitor a suicide risk screening protocol to improve consistency and efficacy in identifying and preventing suicidality among maltreated adolescents referred to a pediatric hospital for medical evaluation. Mixed methods design using (1) retrospective patient chart review ( N = 132) to examine case characteristics, rates of protocol adherence, and screening outcomes; and (2) clinician focus group interview ( N = 7) to explore multilevel facilitators and barriers to protocol uptake. The frequency and uniformity of screening for suicide risk improved following execution of a standardized protocol administering a brief and valid instrument. The extent of clinician adherence to the protocol was promoted and inhibited by a range of personal and organizational factors. Acute risk for suicide was identified in one-third of the adolescents screened, and suicidal thoughts or behaviors were reported by more than one-quarter. Findings demonstrate the utility of routine suicide risk screening with adolescents who have experienced maltreatment and are thus at elevated risk for suicide. The sequential process outlined for establishing an evidence-informed screening protocol offers a practical resource for pediatric healthcare providers concerned with prioritizing patient safety and well-being.

Effectiveness of an Exercise-Based Active Rehabilitation Intervention for Youth Who Are Slow to Recover After Concussion.

(1) To determine the impact of providing participants aged 8 to 17 years who are slow to recover after a concussion with a well-developed active rehabilitation intervention (ARI), compared with receiving standard care alone, on postconcussion symptoms (PCS) at 2 and 6 weeks after the initiation of ARI; and (2) to investigate functional recovery 6 weeks after initiation of ARI. A multicenter prospective quasi-experimental control group design. Tertiary care pediatric trauma center and community health care providers. Forty-nine youth were enrolled (experimental n = 36; control n = 13). Participants were assessed on 3 different occasions: (1) initial visit (baseline); (2) 2 weeks; and (3) 6 weeks after enrollment. Child- and parent-reported PCS were obtained by the PCS Inventory Scale (primary outcome). Secondary outcomes included: (1) mood and anxiety; (2) quality of life; (3) energy level; (4) coordination and balance; (5) neurocognition; (6) parental anxiety; and (7) satisfaction with intervention. Both groups reported decrease of PCS over time (child: P = 0.01; parent: P = 0.03). Children in the experimental group presented higher quality of life (P = 0.04) and less anger (P = 0.02). A trend toward significance was observed for better tandem gait (P = 0.07) and for less general fatigue on self-reported PCS (P = 0.09) in the experimental group. Active rehabilitation intervention does not affect the PCS beyond the usual management, but it increases their quality of life, decreases anger, and potentially increases energy level and balance.

Management and Referral Patterns in Pediatric Atopic Dermatitis: A Survey of Pediatric Healthcare Professionals

Background: The incidence of pediatric atopic dermatitis (AD) has continued to increase worldwide and pediatric healthcare providers (PHPs) are typically the initial healthcare provider tasked with management of this disease. The consequences of inadequately managed AD and misdiagnosed food allergies are devastating for patients and their families, and the financial burden associated with these scenarios can be overwhelming. Objective: To assess the management and referral patterns of pediatric AD patients by PHPs in the Jacksonville, Florida (FL) area. Methods: An online electronic survey was distributed to 70 PHPs using Survey Monkey©. Data was collected over a 6-week period. The survey yielded a sample size of 28. Results: Most participants were physicians (92.8%), with an average of 21.75 years in practice. Just over half (53%) of PHPs were aware of the American Academy of Dermatology (AAD) Guidelines of care for the management of AD. Dermatologists were the initial referral choice for AD management in 2/3, while 1/3 indicated preference for an allergist. Diet alteration was used by 14.3% as an initial AD management step and 35.7% tried elimination diets prior to referral to an allergist. Referral to specialists were low with 75% PHPs referring <25 % of their AD patients to dermatology. Conclusion: With the number of outpatient AD visits increasing amongst PHPs, knowledge of management guidelines, in-depth understanding of appropriate use and limitations of elimination diets and food allergen testing, and referral to specialists suitable for management of this cutaneous disorder are imperative, but found to be highly variable.

Educating paediatric health-care providers about human trafficking.

Human trafficking is a public health issue and humanitarian crisis. Most alarming is that children are especially at risk. Although many studies demonstrate that the majority of trafficked persons surveyed engage with the health-care system during the time in which they are trafficked, health-care practitioners lack the knowledge, tools and resources to assist these patients. The present efforts in training health-care professionals have been fragmented and largely ineffective. While prior training has produced short-term changes in knowledge or attitudes of health professionals, it has not produced sustained changes in knowledge and attitudes nor meaningful changes in screening or intervention. No training has demonstrated changes in patient outcomes. Trafficked persons, particularly children and survivors of labour trafficking, are inadequately served by our present training options for health-care practitioners, and evidence-based protocols are needed to care for this underserved, disenfranchised and traumatised population. To provide optimal care for trafficked youth, health-care practitioners may benefit from: (i) evaluating training for health care providers (HCP) rigorously and meaningfully; (ii) advocating for high-quality training for all HCPs; (iii) fostering partnerships with key stakeholders to inform training and practice; and (iv) designing HCP training that is comprehensive, spanning all forms of human trafficking and including all populations involved.

Should Lipoprotein(a) be Measured in Youth?

Should Lipoprotein(a) be Measured in Youth?

A Call for Pediatric COVID-19 Clinical Trials.

* Abbreviations: COVID-19 — : coronavirus disease 2019 CQ — : chloroquine HCQ — : hydroxychloroquine SARS-CoV-2 — : severe acute respiratory syndrome coronavirus 2 Should children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection receive antiviral therapy? If so, what should we give, to which children, and for what disease severity? Despite brisk scientific progress elucidating the biology and transmission of SARS-CoV-2, and numerous adult trials testing antiviral therapies, we may pass the formative stages of this pandemic without defining antiviral agents’ appropriate role in pediatric management. We urgently need pediatric clinical trials to establish the efficacy, safety, and pharmacokinetics of the most promising experimental and repurposed coronavirus disease 2019 (COVID-19) therapies proposed to date.1 Researchers of early reports show that pediatric SARS-CoV-2 infection tends to be mild but that some children develop severe disease.2 In these reports, researchers highlight differences between pediatric and adult COVID-19 and argue that risk/benefit calculations of therapies derived from adult trials cannot be readily extrapolated to children. Gaps in our knowledge of pediatric COVID-19 further complicate assessments of risk and benefit. To date, we have a limited understanding of viral kinetics or immune responses in children, what factors predispose some children to severe disease, or how these variables affect responses to therapies. We have equally limited comprehension of how SARS-CoV-2 affects children with primary immunodeficiencies, illnesses requiring immune-compromising therapies, or other complex conditions. Nonetheless, treatment planning for severe pediatric cases, even if they will be few, has spurred children’s hospitals to develop algorithms that include antiviral agents, such as remdesivir, chloroquine (CQ), and … Address correspondence to Jeffrey I. Campbell, MD, Division of Infectious Diseases, Boston Children’s Hospital, 333 Longwood Ave, 6th Floor, Boston, MA 02115. E-mail: jeffrey.campbell{at}childrens.harvard.edu

Pediatric Healthcare Providers’, College Students’, and Community Adults’ Moral Condemnation Beliefs Toward Sexual and Gender Minority Individuals

Prejudice toward sexual and gender minority (SGM) individuals plays a significant role in SGM youth healthcare. This study examines relations between psychosocial predictors (spirituality, religiosity, SGM education, experience with SGM individuals) and SGM moral condemnation among three distinct samples. This study utilized online questionnaires to assess moral condemnation toward SGM individuals, religiosity, spirituality, SGM experience, and education/training about SGM individuals. The questionnaires were distributed to a college sample, community sample, and pediatric healthcare provider sample. Data were collected in years 2016–2019. Religiosity positively predicted moral condemnation in all three samples. Spirituality positively predicted moral condemnation in the community and college samples, but not the provider sample. Education about SGM individuals, previous experience with SGM individuals, having a close SGM friend/family member, and self-reporting previous personal discrimination experiences, as a set, significantly explained additional variance in SGM moral condemnation within the community and college sample, but not within the healthcare provider sample. This study lays groundwork for innovative research to further improve pediatric SGM healthcare and to increase the extent to which SGM youth disclose and discuss specific healthcare risks with their medical providers. There is a significant need for social policy focused on decreasing SGM stigmatization and discrimination within the healthcare environment.

Pediatric Health Care Provider Perspectives on Injury Prevention Counseling in Acute and Primary Care Settings.

The objective of this study was to characterize how pediatric primary care and emergency medicine health care providers and trainees engage in injury prevention counseling and assess perceptions toward injury prevention resources. We surveyed physicians, advanced practice providers, and trainees in the Emergency Department, Primary Care Network, and Pediatric Residency Program at Children's Hospital of Philadelphia from September to November 2019. Of the 578 eligible participants, 208 (36.0%) completed the survey. When asked to rank the suitability of alternative personnel for providing counseling, 63.0% of the participants selected an injury prevention specialist as best suited. Seventy-six percent of the providers considered a tablet or mobile device used before a patient encounter to be a helpful resource. Variability existed in provider comfort, knowledge, and frequency of counseling by injury topic. Free-text responses cited time as a barrier to counseling. Opportunities exist to improve the provision of injury education through the utilization of novel resources and personnel.

Defining Legacy: The Perceptions of Pediatric Health Care Providers.

Legacy building interventions like plaster hand molds are offered in most children's hospitals, yet little is known about how the concept of legacy is understood and described by pediatric health care providers. Therefore, this study explored pediatric health care providers' perceptions of legacy at an academic medical center to ensure that future legacy interventions are evidence-informed and theoretically grounded. An electronic survey featuring three open-ended questions and two multiple-choice questions with an option for free text response was completed by 172 medical and psychosocial health care providers. Analysis yielded four themes: (1) legacy is intergenerational, enduring, and typically associated with end-of-life; (2) legacies articulate the impacts on others for which one is known and remembered; (3) legacies can be expressed through tangible items or intangible qualities; and (4) legacies are informed and generated by family relationships and work experiences. By understanding legacy as a personally and professionally contextualized experience, health care providers can better assess and meet the legacy needs of hospitalized pediatric patients and families.

Communication Between Pediatric Healthcare Providers and Somali Patients and Families: A Thematic Analysis

Communication Between Pediatric Healthcare Providers and Somali Patients and Families: A Thematic Analysis

Communication Between Pediatric Healthcare Providers and Somali Patients and Families: A Thematic Analysis

Background: Healthcare providers (HPs) receive variable training in cultural sensitivity despite an increasingly diverse US population. Somali refugee and immigrant families face challenges navigating the US healthcare system, yet little is known about how HPs understand or address existing communication barriers. We aimed to understand HPs’ perceptions of clinical interactions with Somali patient families, specifically related to potential barriers present during communication surrounding pediatric chronic diseases. Methods: A convenience sample of HPs from a US academic children’s hospital completed an anonymous, voluntary, online survey in 2019. Demographic data and a self-reported Likert scale (1=not confident/understood …

Reliability and Validity of Nurses’ Experiences of Infection Prevention and Control Questionnaire

Objective: Nosocomial infections are the primary reason of morbidity and mortality especially at children’s hospitals. Thus, educating pediatric health care providers is rather crucial in order to protect children from exposure to infection. This study was planned to examine reliability and validity of Nurses’ Infection Prevention and Control Observation Questionnaire in Turkish Language. Methods: This methodological study was carried out at a randomly selected Children’s Hospital from each of the 7 regions of Turkey. In total, 443 pediatric nurses from those hospitals participated in the study. Content validity, construct validity, inter-consistency reliability and item total correlation of the questionnaire were analysed in order to adjust reliability and validity. Results: The questionnaire has good content, face and construct validity. The acceptable level for scales’ items was above 0.30 and had one factor according to results of explanatory factor analysis. The questionnaire model fitted the data according to confirmatory factor analysis. A level of Cronbach's alpha at 0.74 was considered to be an acceptable level of reliability and item-total score correlation of the study –except for four items- was identified above 0.30.Conclusion: The questionnaire was determined as a reliable and validate tool in evaluation of observation for nurses’ infection prevention and control.

Challenges with providing gender-sensitive care: exploring experiences within pediatric rehabilitation hospital

Purpose The purpose of this study was to explore the perceived challenges with providing a gender-sensitive care approach among pediatric rehabilitation care providers. Methods Using a qualitative needs assessment design and a purposive sampling strategy, we recruited clinicians from a Canadian pediatric rehabilitation hospital. We conducted interviews with 23 pediatric rehabilitation healthcare providers (19 women, 3 men, 1 transgender man) from a range of disciplines. Three coders performed a thematic analysis of the transcripts. Results Our analysis revealed the following themes regarding the perceived challenges in providing a gender-sensitive care approach: (1) a lack of training and experience; (2) gender differences and stereotypes; (3) binary documentation and potential for misgendering; (4) the complexity of gender identity; and (5) the gender of the clinician. Conclusions Pediatric rehabilitation care providers face many challenges in offering a gender-sensitive care approach and need further training and systemic support. Implications for rehabilitation Awareness of the challenges in providing gender-sensitive care could be an important first step in helping to address inequities. Systemic and interpersonal barriers may impede the provision of gender-sensitive care among rehabilitation providers. Clinicians need more training and support in how to provide gender-sensitive care.

Digital Advertising to Children.

Advertising to children and teenagers is a multibillion-dollar industry. This policy statement reviews the forms of advertising that children and teenagers encounter, including newer forms of digital marketing, such as sponsored content, influencers, data collection, persuasive design, and personalized behavioral marketing driven by machine learning. Parents and pediatric health care providers need to be aware of the ways different marketing messages reach children and teenagers, including Internet sites, social media, and mobile apps. Evidence suggests that exposure to advertising is associated with unhealthy behaviors, such as intake of high-calorie, low-nutrient food and beverages; use of tobacco products and electronic cigarettes; use of alcohol and marijuana; and indoor tanning. Children are uniquely vulnerable to the persuasive effects of advertising because of immature critical thinking skills and impulse inhibition. School-aged children and teenagers may be able to recognize advertising but often are not able to resist it when it is embedded within trusted social networks, encouraged by celebrity influencers, or delivered next to personalized content. This policy statement expresses concern about the practice of tracking and using children's digital behavior to inform targeted marketing campaigns, which may contribute to health disparities among vulnerable children or populations. Pediatricians should guide parents and children to develop digital literacy skills to prevent or mitigate negative outcomes, but it is equally important that policy makers and technology companies embrace digital design, data collection, and marketing practices within today's broad digital environment that support healthier decision-making and outcomes.

Attitudes towards varicella vaccination in parents and paediatric healthcare providers in Hungary

BackgroundVaricella vaccination is important in prevention of childhood infection. Aim of this cross-sectional study was to survey attitudes and determinants of support or refusal of varicella vaccination in parents and in paediatric healthcare professionals, mainly health visitors in Hungary prior to the introduction of this vaccine in National Immunization Program in 2019. MethodsBetween October 2018 and February 2019, 1042 parents and 198 healthcare professionals completed a self-administered anonymous questionnaire regarding sociodemographic background, knowledge and attitudes towards varicella vaccination, and reasons for non-vaccination. ResultsFrom the participating parents 53.3% have vaccinated at least one of their children. Vaccination rate was significantly higher in families with <3 children, living in the capital, among those who have seen complications of varicella and among parents with university degree. Most important positive determinant was recommendation of the vaccine by healthcare professionals: 77.8% of parents accepted vaccination when recommended by the paediatrician, despite the cost of the vaccine, whereas only 17.3% of parents vaccinated their children when the vaccine was not recommended by paediatrician. Most important reasons for non-vaccination was finding the vaccine unnecessary, concerns regarding side effects, and not believing in the vaccine’s effectiveness. Among paediatric healthcare professionals, support rate of universal varicella vaccination was 76.3%. Support rate was higher among those who have seen complications of varicella more often and those who consider varicella a severe infection. Reasons of professionals who do not support universal varicella vaccination were similar to those of vaccine hesitant parents. Practice of intentional exposure of non-immune child to infected ones still exist. ConclusionsEducational programs are needed for parents and health visitors to address concerns regarding vaccination. Paediatricians are the most trusted source of information for parents hence they have a significant responsibility and parents likely follow their recommendations.

0944 Shhh! Initiative: Sleep Health Practices In Pediatric Hospitals

Abstract Introduction Hospitalizations often result in significant sleep disruption, despite the importance of sleep in healing (Cmiel, et al., 2004). Research-to-date has focused primarily on adult intensive care (ICU) with minimal focus on pediatric patients. The aim of this study was to assess pediatric inpatient healthcare providers’ understanding of and attitudes towards sleep in the hospital environment with the goal of developing a sleep health educational intervention as well as modifications to standards of care that unnecessarily interrupt sleep of pediatric inpatients. Methods An online survey was administered to pediatric inpatient staff (nurses, physicians, residents) at a Mid-Atlantic children’s hospital focused on assessing their understanding of sleep in the context of inpatient care (N = 316). Respondents were 30-50 years old (54%), primarily identified as female (88%), and most (60%) reported being in a nursing position. Results Quantitative findings (N = 316) revealed that 65% reported patients were sometimes, rarely, or never allowed to sleep without being awakened from administration of non-critical medications. A majority (63.8%) reported that sometimes, rarely, or never do they consider interruption of sleep in decisions on when to give medications, while 54.9% reported the quantity and quality of sleep is rarely/never considered in a patient’s treatment. Qualitative responses (N = 248) confirmed these findings with 34.3% reporting that they considered re-scheduling medications to minimize sleep interruptions. Despite this finding, only 15.7% reported they would assess or give attention to sleep in the context of patient recovery and treatment. Conclusion Pediatric healthcare providers are aware of the importance of sleep for their patients; however, they are not prioritizing sleep as a part of treatment in their behaviors and decisions. Next steps include developing and implementing an intervention for pediatric healthcare providers to follow through on limiting sleep interruptions as well as focusing on sleep in the treatment process. Support N/A

Contraceptive Counseling in the Postpartum Period: Could Pediatricians Have a Role?

Unplanned pregnancies lead to adverse health outcomes and contribute to economic burdens. A lack of continuity and consistency in immediate postpartum care may be a contributor. The most frequent postpartum medical encounters occur with the child's pediatric health care provider, which represents an opportunity to discuss postpartum contraception. Therefore, our objective was to evaluate postpartum family planning knowledge and behavior in women, and to assess the potential acceptability of a pediatrician-delivered intervention to improve knowledge of and convenient access to contraception among postpartum women. This was a non-interventional pilot study that employed survey and interview methodology. Women attending pediatric visits for their newborn or infant (N = 346) were surveyed; 35 were interviewed. On average, respondents were 27years old (SD = 6), 6months postpartum (SD = 5), and resumed sex 8weeks after delivery (SD = 6). Of those who had resumed sex, 68% were not using contraception at the time. However, only 18% of survey respondents wanted to have another child. Few exhibited accurate knowledge of birth spacing or long acting reversible contraception. Most interviewees (86%) supported the idea of pediatricians providing contraceptive counseling. Concerns identified included whether it was "allowable" and pediatrician's lack of knowledge of complex maternal health histories. This study highlights a gap between contraceptive need and provision in postpartum women. However, the findings suggest women's willingness to engage in conversations with their child's pediatrician about family planning. Future research should assess the feasibility and impact of integrating postpartum counseling into pediatric visits.

Themes in Superhero-Based Television Shows: An Opportunity for the Development of Children and Adolescents Through Co-Viewing and Active Mediation.

The depiction of superheroes and comic book characters in television shows has become incredibly popular. The objective of this study was to determine the positive and negative themes depicted in a select number of superhero-based television shows. A total of 49 episodes from 10 superhero-based television shows were analyzed by four independent reviewers. The average number of positive and negative themes was 18.8 and 36.9 mean events per hour, respectively, for all included episodes. The most common positive themes in our sample were associated with service, teamwork, and encouragement, and the most common negative themes were associated with violence, bullying, and alcohol use. Although exposure to positive themes depicted in superhero-based television shows may be beneficial to the development of children and adolescents, pediatric health care providers should counsel families in an attempt to limit their exposure to violence and other negative themes depicted in this genre of television shows.

Patient safety in Work Environments: Perceptions of Pediatric Healthcare Providers in Taiwan

BackgroundExtensive research on the link between the organizational characteristics of the work environment and patient safety in a healthcare organization has been conducted; yet, only a few studies have concentrated on care providers in a pediatric unit. ObjectivesTo determine the correlation between different work environment factors impacting patient safety in a pediatric care unit from the perspective of registered nurses working in these units. DesignCross-sectional design. Data sources and methodsThe study was conducted with 155 registered nurses from a pediatric unit in a medical center in Taiwan with the Chinese version of the Safety Attitudes Questionnaire (SAQ) 2014–2017. ResultsTeamwork climate, higher job satisfaction, and better working conditions are linked to positive perceptions of patient safety culture. Emotional exhaustion is negatively related to most dimensions of patient safety. ConclusionTeamwork climate, job satisfaction, working conditions, and emotional exhaustion were identified as critical factors impacting the patient safety climate. Implications for nursing or health policyInvestments to improve teamwork climate, job satisfaction, and working conditions and reduce emotional exhaustion may have a positive effect on patient safety in pediatric care units.