Pediatric Health Care System Research Articles

Cluster randomized trial of a team communication training implementation strategy for depression screening in a pediatric healthcare system: a study protocol

BackgroundPediatric depression is a global concern that has fueled efforts for enhanced detection and treatment engagement. As one example, the US Preventive Services Task Force recommends depression screening for adolescents ages 12–18 years. While many health systems have implemented components of depression screening protocols, there is limited evidence of effective follow-up for pediatric depression. A key barrier is timely team communication and coordination across clinicians and staff within and across service areas for prompt service linkage. However, team effectiveness interventions have been shown to improve team processes and outcomes and can be applied in healthcare settings.MethodsThis project aims to refine and test a team communication training implementation strategy to improve implementation of an existing pediatric depression screening protocol in a large pediatric healthcare system. The team will be defined as part of the study but is expected to include medical assistants, nurses, physicians, and behavioral health clinicians within and across departments. The implementation strategy will target team mechanisms at the team-level (i.e., intra-organizational alignment and implementation climate) and team member-level (i.e., communication, coordination, psychological safety, and shared cognition). First, the project will use mixed methods to refine the team training strategy to fit the organizational context and workflows. Next, a hybrid type 3 implementation-effectiveness pilot trial will assess the initial effectiveness of the team communication training (implementation strategy) paired with the current universal depression screening protocol (clinical intervention) on implementation outcomes (i.e., feasibility, acceptability, appropriateness, workflow efficiency) and clinical/services outcomes (increased frequency of needed screening and reduced time to service linkage). Finally, the study will assess mechanisms at the team and team member levels that may affect implementation outcomes.DiscussionTeam communication training is hypothesized to lead to improved, efficient, and effective decision-making to increase the compliance with depression screening and timely service linkage. Findings are expected to yield better understanding and examples of how to optimize team communication to improve efficiency and effectiveness in the pediatric depression screening-to-treatment cascade. This should also culminate in improved implementation outcomes including patient engagement critical to address the youth mental health crisis.Trial registrationNCT06527196.Trial Sponsor: University of California San Diego.

Risk for Suicide Attempts Assessed Using the Patient Health Questionnaire–9 Modified for Teens

Suicide is a leading cause of death in US youths. To assess whether screening with supplemental items 10 to 13 on the Patient Health Questionnaire-9 modified for teens (PHQ-9M) improves prediction of youth suicide attempts beyond the information provided by the first 9 items alone (the PHQ-9). This retrospective cohort study used a retrospective cohort of adolescents aged 12 to 17 years who were screened for depression in outpatient facilities within a pediatric health care system between January 1, 2016, and December 31, 2022, with up to 1 year of follow-up to assess the occurrence of suicidal behavior. Follow-up was completed on December 31, 2023. Screening with the PHQ-9M. This study developed and compared prediction using 3 Cox proportional hazards regression models (CR-9, CR-13, and CR-3) of subsequent suicide attempts, determined by the hospital's electronic health records up to 1 year following the last PHQ-9M screening. The CR-9 model used the PHQ-9 and the CR-13 model used all 13 items of PHQ-9M. The CR-3 model used the 3 most impactful variables selected from the 13 PHQ-9M items and PHQ-9 total score. All models were evaluated across 4 prediction horizons (30, 90, 180, and 365 days) following PHQ-9M screenings. Evaluation metrics were the area under the receiver operating characteristic curve (AUROC) and the area under the precision recall curve (AUPRC). Of 130 028 outpatients (65 520 [50.4%] male) with 272 402 PHQ-9M screenings, 549 (0.4%) had subsequent suicide attempts within 1 year following the PHQ-9M screening. The AUROC of the CR-9 model in the 365-day horizon was 0.77 (95% CI, 0.75-0.79); of the CR-13 model, 0.80 (95% CI, 0.78-0.82); and of the CR-3 model, 0.79 (95% CI, 0.76-0.81); the AUPRC of the CR-9 model was 0.02 (95% CI, 0.02-0.03); of the CR-13 model, 0.03 (95% CI, 0.02-0.03); and of the CR-3 model, 0.02 (95% CI, 0.02-0.03). The 3 most impactful items using adjusted hazard ratios were supplemental item 13 (lifetime suicide attempts; 3.06 [95% CI, 2.47-3.80]), supplemental item 10 (depressed mood severity in the past year; 2.99 [95% CI, 2.32-3.86]), and supplemental item 12 (serious suicidal ideation in the past month; 1.63 [95% CI, 1.25-2.12]). All of the models achieved higher AUROCs as prediction horizons shortened. In this cohort study of adolescent PHQ-9M screenings, the supplemental items on PHQ-9M screening improved prediction of youth suicide attempts compared with screening using the PHQ-9 across all prediction horizons, suggesting that PHQ-9M screening should be considered during outpatient visits to improve prediction of suicide attempts.

In Their Own Words: Narratives of Sudanese Pediatricians Displaced By Conflict

Background: This study examines the profound personal and professional impact of the armed conflict in Sudan since April 2023 on pediatricians, particularly focusing on their displacement from Khartoum and the resultant challenges in providing essential health services to children in conflict-affected areas. Methods: Utilizing a mixed-methods approach, this study targeted displaced pediatricians from Khartoum identified via purposive sampling. Data were collected through a semi-structured questionnaire, featuring both quantitative items and an open-ended question for qualitative insights, administered electronically. The analysis combined descriptive statistics and thematic analysis with ethical oversight provided by the IRB of Prince Sattam Bin Abdulaziz University. Results: In a study of 42 displaced pediatricians from Sudan, 66.67% were female and the majority were aged between 30 and 45 years. Despite facing adversities due to armed conflict, these pediatricians displayed remarkable resilience and continued to provide pediatric care under challenging conditions. Key themes emerged from their narratives, including professional commitment amid scarcity, emotional turmoil coupled with spiritual reflection, and relentless pursuit of providing care. Safety concerns primarily drove displacement, with 95.24% citing this as a reason. While 61.90% of the respondents relocated within Sudan, 38.10% moved abroad, reflecting the profound personal and professional impact of the conflict. Conclusion: The armed conflict in Sudan has severely disrupted the pediatric healthcare system, leading to widespread displacement of pediatricians and jeopardizing child healthcare. The study highlights the resilience of healthcare professionals amidst adversity, their struggle to maintain care delivery, and the critical need for support and strategic planning to restore healthcare services in conflictaffected areas.

Fostering Tomorrow: Uniting Artificial Intelligence and Social Pediatrics for Comprehensive Child Well-being.

This comprehensive review explores the integration of artificial intelligence (AI) in the field of social pediatrics, emphasizing its potential to revolutionize child healthcare. Social pediatrics, a specialized branch within the discipline, focuses on the significant influence of societal, environmental, and economic factors on children's health and development. This field adopts a holistic approach, integrating medical, psychological, and environmental considerations. This review aims to explore the potential of AI in revolutionizing child healthcare from social pediatrics perspective. To achieve that, we explored AI applications in preventive care, growth monitoring, nutritional guidance, environmental risk factor prediction, and early detection of child abuse. The findings highlight AI's significant contributions in various areas of social pediatrics. Artificial intelligence's proficiency in handling large datasets is shown to enhance diagnostic processes, personalize treatments, and improve overall healthcare management. Notable advancements are observed in preventive care, growth monitoring, nutritional counseling, predicting environmental risks, and early child abuse detection. We find that integrating AI into social pediatric healthcare aims to enhance the effectiveness, accessibility, and equity of pediatric health services. This integration ensures high-quality care for every child, regardless of their social background. The study elucidates AI's multifaceted applications in social pediatrics, including natural language processing, machine learning algorithms for health outcome predictions, and AI-driven tools for health and environmental monitoring, collectively fostering a more efficient, informed, and responsive pediatric healthcare system.

Family-centered service through the eyes of insiders: Healthcare providers who are parents speak about receiving and providing healthcare in child health

BackgroundWhen healthcare providers (HCPs) become patients, the experience affects their sense of identity, the care they receive, and their clinical practice. In child health, considerably less is known about the experiences of HCP-parents who access the pediatric healthcare system with their own children with disabilities and/or chronic medical conditions. AimsThis study aimed to examine the experiences of HCPs who have children with disabilities to identify their experiences with healthcare delivery. Methods and proceduresA qualitative descriptive study was conducted with HCP-parents, using focus groups and open-ended interviews. Data were analyzed using reflexive thematic analysis. ResultsFor HCP-parents, the experience of having a child with a disability affects how they see themselves, their patients, service organizations, and the healthcare system in general. Having medical knowledge and access to networks brings both benefits and unique challenges. HCP-parents also have unique needs that are not currently being addressed. The lived experiences of HCP-parents can contribute to improving patient care. However, the value of this lived experience is unrecognized and underutilized. ConclusionsThe lived experiences of HCP-parents can contribute important insights regarding service delivery, and in particular regarding the application of Family-Centered Service.

SURGICAL TACTICS TO ELIMINATE COMPLEX VARIANTS OF CONGENITAL CLEFT PALATE

The scientific justification and practice of surgical methods ofcorrection of congenital cleft lip and palate are widely presented in the specialized literature concerning various types of lesions of the maxillofacial region [7, 13, 20, 21, 23-25]. At the same time, the results of international and domestic experienceand scientific research on these issues contribute to the development and implementation of new methods for correcting facial and jaw deformities, continuous improvement of surgical and rehabilitation techniques, the application of innovations in the pediatric healthcare system itself and the accumulation of experience in specialized areas of practice [1, 4, 17 , 19, 20, 23, 24]. In addition, the use of "additional materials" -types of implants (for example, plastic, biologically inert metal), which are surgically implanted into the destroyed structures of the maxillofacial region and meet the requirements of safety, indifference to surrounding tissues, targeted regeneration and the formation of adequate support for the restoration of the upper jaw, including using existing "classic" techniques, detailed and updated. classic" techniques, detailed and updated [5, 6, 8, 9, 15]. In most cases, the use of new surgical techniques of zygoplasty and ureteroplasty requires comprehensive medical and rehabilitation measures with the participation of highly qualified specialists of various profiles, however, it should be emphasized that the main stage of the algorithm of comprehensive care is the operation must be performed [7, 11, 13, 14, 16, 18, 21]. In parallel, theauthors of scientific research note that surgical methods for eliminating congenital clefts of the face and palate are constantly developing and becoming more rational: multi-stage surgical interventions are excluded, and the restoration of maxillofacial structures is achieved by two to three years of a child's life [2, 3, 7, 11].

Nationwide epidemiology and health resource use among children with COVID-19 in Japan

BackgroundThe COVID-19 pandemic posed substantial challenges to healthcare systems. Understanding the responses of pediatric health services is crucial for future pandemic planning and preparedness, yet such data remains limited. MethodsIn this retrospective cohort study, we analyzed data from administrative databases developed by Japan Medical Data Center and DeSC Healthcare Inc. The dataset comprised records of 2,612,511 children, totaling 60,224,888 person-months, from January 2020 to May 2022. Multivariate generalized estimation equations were used to examine the incidence rates of COVID-19 and associated health resource use. ResultsOur analysis revealed that the incidence rates of COVID-19 gradually increased from Wave I (2.2 cases per 100,000 person-months) to Wave V (177.8cases per 100,000 person-months), with a notable elevation during Wave VI (2367.7 cases per 100,000 person-months). While nucleic acid amplification tests were primarily used during Waves I–V, the use of rapid antigen tests markedly increased in Wave VI. The hospitalization rates increased gradually from 0.2 in Wave I to 10.2 events per 100,000 person-months in Wave VI, and the case-hospitalization risk decreased from 14.9% in Wave II to 0.7% in Wave VI. Additionally, we observed decreasing trends in the use of antibiotics (Wave I, 31.8%; Wave VI, 9.0%), whereas antipyretic use rose from Wave I (56.1%) to Wave VI (86.6%). ConclusionsOur study highlighted essential changes in the nationwide pediatric healthcare system's response to the COVID-19 pandemic. These findings provide valuable insights into the future pandemic planning and preparedness.

Associations between Child Opportunity Index and Pediatric Cardiac Surgical Outcomes

To assess the relationship between the Child Opportunity Index (COI), a comprehensive measurement of social determinants of health, and specific COI domains on patient-specific outcomes following congenital cardiac surgery in the metropolitan region of Atlanta, Georgia. In this retrospective chart review, we included patients who underwent an index operation for congenital heart disease between 2010 and 2020 in a single pediatric health care system. Patients' addresses were geocoded and mapped to census tracts. Descriptive statistics, univariable analysis, and multivariable regression models were employed to assess associations between variables and outcomes. Of the 7460 index surgeries, 3798 (51%) met eligibility criteria. Presence of an adverse outcome, defined as either mortality or 1 of several other major postoperative morbidities, was significantly associated with COI in the univariable model (P=.008), but not the multivariable regression model (P=.39). Postoperative hospital length of stay was significantly associated with COI (P<.001) in univariable and multivariable regression models. There was no significant association between COI and readmission within 30days of hospital discharge in univariable (P<.094) and multivariable (P=.49) models. COI is associated with postoperative hospital length of stay but not all outcomes in patients aftercongenital heart surgery. By understanding the role of COI in outcomes related to cardiac surgery, targeted interventions can be developed to improve health equity.

Applying data science methodologies with artificial intelligence variant reinterpretation to map and estimate genetic disorder prevalence utilizing clinical data.

Data science methodologies can be utilized to ascertain and analyze clinical genetic data that is often unstructured and rarely used outside of patient encounters. Genetic variants from all genetic testing resulting to a large pediatric healthcare system for a 5-year period were obtained and reinterpreted utilizing the previously validated Franklin© Artificial Intelligence (AI). Using PowerBI©, the data were further matched to patients in the electronic healthcare record to associate with demographic data to generate a variant data table and mapped by ZIP codes. Three thousand and sixty-five variants were identified and 98% were matched to patients with geographic data. Franklin© changed the interpretation for 24% of variants. One hundred and fifty-six clinically actionable variant reinterpretations were made. A total of 739 Mendelian genetic disorders were identified with disorder prevalence estimation. Mapping of variants demonstrated hot-spots for pathogenic genetic variation such as PEX6-associated Zellweger Spectrum Disorder. Seven patients were identified with Bardet-Biedl syndrome and seven patients with Rett syndrome amenable to newly FDA-approved therapeutics. Utilizing readily available software we developed a database and Exploratory Data Analysis (EDA) methodology enabling us to systematically reinterpret variants, estimate variant prevalence, identify conditions amenable to new treatments, and localize geographies enriched for pathogenic variants.

Respiratory virus infections in symptomatic and asymptomatic children upon hospital admission: new insights

Abstract Objective: Describe and compare the prevalence of symptomatic and asymptomatic or recently resolved respiratory infections in hospitalized children. Design: Cross-sectional study. Setting: Three hospital primary-to-quaternary care pediatric healthcare system. Patients: People less than 22 years old who underwent admission screening for respiratory viruses using a multitarget polymerase chain reaction (PCR) panel from August 2020 through April 2022. Methods: The symptom status of each patient was recorded by the ordering provider. The prevalence of each virus was described comparing symptomatic and asymptomatic patients. Results for each virus were stratified by age group and trends were examined over time. Results: Of the 32,812 eligible PCR panels collected, 12,965 (39.5%), 18,651 (56.8%), and 1,196 (3.6%) were obtained from patients who were symptomatic, asymptomatic, or had missing or unknown symptom status, respectively. Symptomatic patients were much more likely to test positive for a respiratory virus (67.3% vs 27.0%). The most common viruses detected in asymptomatic patients were rhinovirus/enterovirus (18.0%), SARS-CoV-2 (3.6%), and parainfluenza viruses (2.3%). The odds ratio of testing positive when symptomatic was significantly greater than unity for all viruses but varied by virus and age group. The proportion of positive tests for each virus was dynamic and changed with intermittent epidemics, or viral “waves.” Conclusions: More than one-quarter of children without respiratory symptoms admitted to a pediatric healthcare system had PCR-detectable respiratory viruses. Children with symptoms of a respiratory infection are nevertheless much more likely to have a respiratory virus detected by PCR.

The Impact of the COVID-19 Pandemic on Pediatric Clinical Practice in Chinese Children’s Hospital: A Retrospective Study

COVID-19 has affected the various aspects of social service delivery worldwide. Explicitly, pediatric service was affected mainly due to the travel restrictions, and children were at heightened risk due to these circumstances. Therefore, this study aims to analyze the Pediatric Clinical Practice in a Chinese children’s hospital to describe and acknowledge the impact of COVID-19 on the pediatric healthcare system. For this purpose, the hospital’s outpatient registration database was the primary information source, which comprises demographic data, including age, gender, city of residence, and hospital departments visited. Data on patients admitted from January 25, 2019, to April 16, 2019, were collected and used as a baseline. The results revealed that the number of pediatric visits to the case study hospital decreased during the COVID-19 pandemic, accounting for 40% of that in 2019, especially during the early stage of the pandemic. The proportion of pediatric patients from outside Chongqing decreased by approximately 14% in the early stages and increased by 24% in the second and third stages, corresponding to an overall decrease of 8.5%. Accordingly, the hospital responds to COVID-19 by providing valuable information and a guiding framework to the rest of the world on how to respond to a crisis.

Factors Associated With Actionable Gastrointestinal Panel Results in Hospitalized Children.

There is uncertainty regarding which hospitalized patients with acute gastroenteritis (AGE) benefit from gastrointestinal panel (GIP) testing. Unnecessary testing may lead to increased costs, overdiagnosis, and overtreatment. In general, AGE management and outcomes are most impacted if an actionable (bacterial or parasitic) result is obtained. We aimed to assess which clinical reasons for ordering GIP testing ("order indications") and patient factors were associated with actionable results. This is a cross-sectional study of pediatric patients hospitalized between 2015 and 2018 at a large pediatric health care system with diarrhea and a GIP performed. Multivariable regression analysis was used to determine associations between actionable GIP results and order indication, stool frequency, and demographics. Findings were evaluated in patients with complex chronic conditions (CCC) and non-CCC patients. There were 1124 GIPs performed in 967 encounters. Non-CCC patients had more actionable results than CCC patients, and reasons for testing differed. Across both cohorts, age ≥1 year old was positively associated with actionable results. For non-CCC patients, actionable results were associated with "diarrhea with blood or pus" order indication and nonwinter season; international travel was associated with non-Clostridioides difficile bacteria and parasites. No order indications were associated with actionable results for CCC patients. Patient factors and order indications that may help identify children hospitalized for AGE with actionable GIP results include older age (regardless of CCC status), as well as bloody stools and international travel in previously healthy children. Prospective validation of these findings could help improve diagnostic stewardship and decrease unnecessary testing.

Standardization of Antibiotic Management and Reduction of Opioid Prescribing in Pediatric Complicated Appendicitis: A Quality Improvement Initiative

BackgroundAppendicitis is one of the most common pediatric surgical procedures in the United States. However, wide variation remains in antibiotic prescribing and pain management across and within institutions. We aimed to minimize variation in antibiotic usage and decrease opioid prescribing at discharge for children with complicated appendicitis by implementation of a quality improvement (QI) initiative. MethodsOn December 1st, 2021, a QI initiative standardizing postoperative care for complicated appendicitis was implemented across a tertiary pediatric healthcare system with two main surgical centers. QI initiative focused on antibiotic and pain management. An extensive literature search was performed and a total of 20 articles matching our patient population were critically appraised to determine the best evidence-based interventions to implement. Antibiotic regimen included: IV or PO ceftriaxone/metronidazole immediately post-operatively and transition to PO amoxicillin-clavulanic acid for completion of 7-day total course at discharge. Discharge pain control regimen included acetaminophen, ibuprofen, as needed gabapentin, and no opioid prescription. Guideline compliance were closely monitored for the first six months following implementation. ResultsIn the first 6-months post-implementation, compliance with use of ceftriaxone/metronidazole as initial post-operative antibiotics was 75.6 %. Transition to PO amoxicillin-clavulanic acid prior to discharge increased from 13.7 % pre-implementation to 73.7 % 6-months post-implementation (p < 0.001). Compliance with a 7-day course of antibiotics within the first 6-months post-implementation was 60 % across both sites. After QI intervention, overall opioid prescribing remained at 0 % at one surgical site and decreased from 17.6 % to 0 % at the second surgical site over the study timeframe (p < 0.001). ConclusionAntibiotic use can be standardized and opioid prescribing minimized in children with complicated appendicitis using QI principles. Continued monitoring of the complicated appendicitis guideline is needed to assess for further progress in the standardization of post-operative care. Study TypeQuality improvement. Level of EvidenceLevel III.

The Psychosocial Impact of the COVID-19 Pandemic on Families of Youth of Color: A Prospective Cohort Study.

Prospectively examine racial and ethnic disparities in exposure to COVID-19-related stressors and their impact on families. A racially, ethnically, and socioeconomically diverse cohort of caregivers of youth (n = 1,581) representative of the population served by a pediatric healthcare system completed the COVID-19 Exposure and Family Impact Scales in Oct/Nov 2020 and March/April 2021. Linear mixed-effects models were used to examine exposure to COVID-19-related events (Exposure), impact of the pandemic on family functioning and well-being (Impact), and child and parent distress (Distress) across time and as a function of race and ethnicity, adjusting for other sociodemographic variables. Exposure and Distress increased over time for all participants. After adjusting for sociodemographic factors, caregivers of Black and Hispanic youth reported greater Exposure than caregivers of White youth and caregivers of Black youth had a greater increase in Exposure over time than caregivers of White youth. Caregivers of White youth reported greater Impact than caregivers of Black and Other race youth. Exposure to and impact of the COVID-19 pandemic on family psychosocial functioning varied by race and ethnicity. Although exposure to COVID-19-related events was greater among Hispanic and non-Hispanic Black families, those of marginalized races reported less family impact than non-Hispanic White families, suggesting resiliency to the pandemic. Research should examine such responses to public health crises in communities of color, with a focus on understanding protective factors. These findings suggest the importance of culturally tailored interventions and policies that support universal psychosocial screenings during times of public health crises.

Brain Growth Charts for Quantitative Analysis of Pediatric Clinical Brain MRI Scans with Limited Imaging Pathology.

Background Clinically acquired brain MRI scans represent a valuable but underused resource for investigating neurodevelopment due to their technical heterogeneity and lack of appropriate controls. These barriers have curtailed retrospective studies of clinical brain MRI scans compared with more costly prospectively acquired research-quality brain MRI scans. Purpose To provide a benchmark for neuroanatomic variability in clinically acquired brain MRI scans with limited imaging pathology (SLIPs) and to evaluate if growth charts from curated clinical MRI scans differed from research-quality MRI scans or were influenced by clinical indication for the scan. Materials and Methods In this secondary analysis of preexisting data, clinical brain MRI SLIPs from an urban pediatric health care system (individuals aged ≤22 years) were scanned across nine 3.0-T MRI scanners. The curation process included manual review of signed radiology reports and automated and manual quality review of images without gross pathology. Global and regional volumetric imaging phenotypes were measured using two image segmentation pipelines, and clinical brain growth charts were quantitatively compared with charts derived from a large set of research controls in the same age range by means of Pearson correlation and age at peak volume. Results The curated clinical data set included 532 patients (277 male; median age, 10 years [IQR, 5-14 years]; age range, 28 days after birth to 22 years) scanned between 2005 and 2020. Clinical brain growth charts were highly correlated with growth charts derived from research data sets (22 studies, 8346 individuals [4947 male]; age range, 152 days after birth to 22 years) in terms of normative developmental trajectories predicted by the models (median r = 0.979). Conclusion The clinical indication of the scans did not significantly bias the output of clinical brain charts. Brain growth charts derived from clinical controls with limited imaging pathology were highly correlated with brain charts from research controls, suggesting the potential of curated clinical MRI scans to supplement research data sets. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Ertl-Wagner and Pai in this issue.

Electronic health record time-tracking provides real-time data to measure and benchmark dietitian productivity.

Traditional methods for benchmarking dietitian productivity are time-consuming and fail to accurately measure the total time spent providing nutrition care. An electronic health record (EHR)-based tool that allows for daily tracking of both face-to-face and patient care coordination time for dietitians was created. We assessed whether it provided consistent, continuous measurement of time and productivity. This tool was created in an independent paediatric academic healthcare system in the USA. Time spent by dietitians in face-to-face settings and care coordination were tracked. Changes in time spent between the years 2013-2016 versus 2018-2019 were also analysed. The outpatient dietitian spent a mean total of 66.4 min per patient (37.8 ± 6.0 min in face-to-face care and 28.6 ± 5.2 min in care coordination). The total times and fractions spent on face-to-face and care coordination time varied by specialty. Comparison of the two periods of time revealed 75% more productivity on average of dietitians in different outpatient settings after including care coordination tracking. In addition, dietitians were more likely to document time spent in 5-min increments after the institution of this methodology as opposed to 15-min increments. An EHR-based tool that facilitates the documentation of both face-to-face time and patient care coordination time is feasible and enables consistent, continuous measurement of time and productivity. The real-time data from this tool can be used to support adequate dietitian staffing and be used to create a multicentre database to measure the actual time dietitians need to provide care and generate consistent staffing benchmarks.

Cliff or bridge: breaking up with the paediatric healthcare system.

Transition from paediatric to adult healthcare is a normal part of the care trajectory, yet the process often leaves much to be desired. In this commentary, I share my family's journey of this care transition, particularly the handover aspect, by providing examples of different ways that relationships were ended by paediatric healthcare professionals. The ending of these relationships often felt like 'breaking up'. I also share an example of a supported handover, which bridged the transition from paediatric to adult care. To improve transitions, we need genuine acknowledgement of the paediatric medical trauma stress (PMTS) experienced by families such as mine following years of interactions in the healthcare system. Along with following transition checklists, patients and families need authentic and meaningful closure to longitudinal relationships and trauma-informed care practices as we move forward into the adult care system.

Persistent symptoms and conditions among children and adolescents hospitalised with COVID-19 illness: a qualitative study

ObjectivesThere is limited in-depth research exploring persistent symptoms and conditions among children and adolescents who contracted COVID-19 illness that required hospitalisation. The main objective of this study was to conduct...

Teamwork Improving Malnutrition Screening and Referral to the RD in a Pediatric Healthcare System

Teamwork Improving Malnutrition Screening and Referral to the RD in a Pediatric Healthcare System

Antibiotic waste in a pediatric healthcare system: Wasting drugs that are in limited supply.

In a pediatric hospital system over 2 years, 58,607 doses of antibiotic were wasted, an average of 80 doses per day, including drugs in shortage nationwide. Approximately 50% of waste occurred within the first 2 days of admission or the day of discharge, with ampicillin being the most wasted drug (N = 7,789 doses).