Years Of Pediatric Experience Research Articles

Clinician Knowledge, Confidence, and Practice Patterns Defining, Identifying, and Quantifying Dystonia in Children: A Cross-Sectional Survey Study

ABSTRACT A survey was completed by 183 clinicians at a pediatric hospital to investigate knowledge, confidence, and practice patterns defining, identifying, and quantifying dystonia in children. The definition of dystonia was correctly identified by 86% of participants. While 88% reported identifying dystonia, only 42% of physicians and therapists reported quantifying dystonia. A weak, significant correlation, rs =.339, p ≤ .001, was found between years of pediatric experience and confidence identifying dystonia. Clinician reported higher confidence levels identifying and quantifying dystonia if they perform a neurological exam. Clinical training initiatives are needed to improve standardization and build confidence in defining, identifying, and quantifying dystonia.

Assessment of Nurses' Knowledge and Confidence Regarding Tracheostomy Care in a Pediatric Long Term Care Hospital in Saudi Arabia.

BackgroundThe incidence of tracheostomy insertion in pediatric patients has increased over the last few decades. Tracheostomized pediatric patients need daily, meticulous care by qualified nurses to minimize severe, avoidable complications. Adequately trained nurses facilitate patients’ stability, accelerate weaning from the ventilator, and reduce potential tracheostomy dislodgement.MethodsA cross-sectional, retrospective cohort survey was conducted in September 2021, using an electronic version of a self-questionnaire, to assess nurses’ knowledge and comfort level regarding tracheostomy care of pediatric patients at the International Extended Care Center in Jeddah, Saudi Arabia. Statistical analysis of the accrued data was performed using the SPSS 21.0 software package and a P-value <0.05 calculated by t-Test, was considered significant.ResultsAmong 43 nurses included in the study, 14 (32.6%) were very comfortable taking care of tracheostomized patients, 13 (30.2%) were comfortable, and 16 (37.2%) were uncomfortable. Regarding knowledge, three main aspects of tracheostomy care were correctly answered (%) by all the nurses: knowledge of routine tracheal care (55%), tracheal care skills (11.6%), and tracheal emergency care (2.3%). The study showed a significant positive correlation between nurses’ comfort level with tracheal care and academic degree, duration of pediatric experience, completion of more than one life support course, and attendance at the annual local tracheostomy care competency learning program (TCCLP; all P <0.05).ConclusionDeficits exist in nurses’ knowledge of tracheostomy care. Improved knowledge garnered through repetitive participation in tracheostomy competency programs and life support courses correlate with greater comfort and more than 5 years of pediatric experience. Nurses’ deficits in emergency care knowledge and skills should be addressed through a structured educational program and a simulation, hands-on based TCCLP course, irrespective of comfort level with tracheostomy care.

Knowledge translation following the implementation of a state-wide Paediatric Sepsis Pathway in the emergency department- a multi-centre survey study

BackgroundSeveral health care systems internationally have implemented protocolised sepsis recognition and treatment bundles for children to improve outcomes, as recommended by the Surviving Sepsis Campaign. Successful implementation of clinical pathways is challenging and dependent on nurse engagement. There is limited data on knowledge translation during implementation of sepsis quality improvement programs.MethodsThis cross-sectional, multicentre observational survey study evaluated knowledge and perceptions of Emergency Department nurses in relation to the recognition, escalation and management of paediatric sepsis following implementation of a sepsis pathway. The study was conducted between September 2019 and March 2020 across 14 Emergency Departments in Queensland, Australia. The primary outcome was a sepsis knowledge score. An exploratory factor analysis was conducted to identify factors impacting nurses’ perceptions of recognition, escalation and management of paediatric sepsis and their association with knowledge. Using a logistic mixed effects model we explored associations between knowledge, identified factors and other clinical, demographic and hospital site variables.ResultsIn total, 676 nurses responded to the survey and 534 were included in the analysis. The median knowledge score was 57.1% (IQR = 46.7–66.7), with considerable variation observed between sites. The exploratory factor analysis identified five factors contributing to paediatric sepsis recognition, escalation and management, categorised as 1) knowledge and beliefs, 2) social influences, 3) beliefs about capability and skills delivering treatment, 4) beliefs about capability and behaviour and 5) environmental context. Nurses reported strong agreement with statements measuring four of the five factors, responding lowest to the factor pertaining to capability and skills delivering treatment for paediatric sepsis. The factors knowledge and beliefs, capability and skills, and environmental context were positively associated with a higher knowledge score. Years of paediatric experience and dedicated nurse funding for the sepsis quality improvement initiative were also associated with a higher knowledge score.ConclusionTranslation of evidence to practice such as successful implementation of a sepsis care bundle, relies on effective education of staff and sustained uptake of protocols in daily practice. Our survey findings identify key elements associated with enhanced knowledge including dedicated funding for hospitals to target paediatric sepsis quality improvement projects.

Improving the Pediatric Patient Experience During Radiation Therapy – A Children’s Oncology Group Study

Treatment with radiation therapy (RT) can cause anxiety for pediatric patients and their families. Radiation oncology (RO) teams have developed strategies to reduce the negative psychological impact. This survey study aimed to characterize these methods. A survey was sent to all RO discipline members of the Children’s Oncology Group (COG), representing 210 institutions. The survey included 37 questions exploring strategies to improve the pediatric patient experience. Wilcoxon rank-sum test was used to assess for associations. Surveys were completed by 104 individuals from 82/210 institutions (39%; 66 academic & 16 private). Respondents included 87 radiation oncologists and 17 supportive staff. The median number of pediatric patients treated with RT per year per at these institutions is between 26-50 children. Preparatory strategies include early consultations before initiation of RT (83%), tours of the RO department (72%), child life specialist support (67%), information packet (57%), practice simulation (46%), RT videos/photographs (43%), model simulators/linear accelerators (23%), RT activity/coloring books (23%), practice laying still at home (23%), web-based tools or iPhone/iPad apps (10%) and virtual reality (VR; 6%). Methods for improving mask tolerance include modification (ex. cutting eye holes; 80%), decoration (71%), and making masks on objects (40%) or family members (24%). During the simulation/RT, strategies include comfort objects (77%), music/audiobooks (63%), anticipatory guidance (55%), audio between child/family (57%), tattoo avoidance (36%), caregiver presence during the simulation scan with a lead apron (16%), video-based distraction (VBD; 16%), and aromatherapy (11%). Additional methods include end-of-treatment gifts/celebrations (63%), treasure chests (48%), countdown treatment charts (37%), bravery beads (21%), and mini cars/airplanes to ride to treatment (15%). The greatest obstacles to implementation include insufficient lead time (40%), inadequate funding/support staff (36%), and lack of awareness of these strategies (26%). The median age at which most children no longer require anesthesia for RT was reported as 6-years-old (range 3-8); anesthesia use at an older age was associated with physician’s lack of awareness of these strategies (p = .041) and <5 years of pediatric experience (p = .049). Anesthesia use adds a median time between 46-60 minutes daily for patients in the department. Of responding physicians, 26% plan to implement new strategies within the next 2 years to improve the pediatric patient experience, primarily (65%) focusing on VBD and/or VR. Many strategies are used to improve children’s experience during RT. Lack of awareness of these interventions is a common barrier. We plan to disseminate these methods with the goal of raising awareness, facilitating implementation, and, ultimately, improving the experience of pediatric cancer patients and their caregivers.

Do Paediatric Physiotherapists Promote Community-Based Physical Activity for Children and Youth with Disabilities? A Mixed-Methods Study.

Purpose: Although the importance of increased physical activity for children with disabilities is widely acknowledged, formal links between rehabilitation practitioners and community physical activity programmes are often lacking. The role of physiotherapists in the promotion of community physical activity is also often unclear. This study set out to describe the beliefs, knowledge, and practices of Canadian physiotherapists related to promoting community-based physical activity for children with disabilities. Method: We used a mixed-methods design: a survey of Canadian physiotherapists and qualitative focus group interviews with physiotherapists. Results: A total of 116 therapists participated in the survey. Of these, 80 (69.0%) considered the promotion of community-based physical activity programmes to be a physiotherapy role, and 89 (76.7%) recommended programmes to families. Therapists with less than 6 years of paediatric experience were less likely to recommend programmes to families (χ2 4 = 40.46, p < 0.001). Qualitative analysis resulted in three themes: (1) lack of clarity regarding the physiotherapy role, (2) "it's not easy" - challenges related to community-based physical activity promotion, and (3) one size does not fit all. Conclusions: Various factors shaped physiotherapists' ability to promote community physical activity, specifically their knowledge, practice setting expectations, and beliefs about their role. Concerted efforts to promote community-based physical activity may increase community capacity to support all children in physical activities.

Introducing Tina Spagnola

Introducing Tina Spagnola

소아 가정방문 물리치료의 인식도와 수요도에 관한 설문조사

Pediatric home-based physical therapy (PHBPT) provides professional rehabilitation programs at the patient's home, where the activities of daily life are actually performed. PHBPT also allows to avoid the difficulties of transporting children with disabilities to the clinic. Despite these advantages, PHBPT is not yet widely practiced in Korea. There is little objective information regarding the opinions of the main stakeholders on PHBPT. To investigate the awareness and demand of PHBPT among the main stakeholders, 41 pediatric physical therapists (PT) (of 60 contacted) were recruited from different regions of Korea on the basis of the regional population distribution. The recruited PTs completed their questionnaires and also participated in collecting questionnaires from 35 medical doctors (MD) with whom they worked and from randomly selected 201 parents of children with disabilities recruited. The overall response rate was 85.5%. The awareness of PHBPT differed between PTs (95.1%) and parents (67.2%) (p<.001). The survey showed that 82.9% of MDs had at least heard about PHBPT. Significantly more parents (83.5%) than MDs (57.1%), and 70.0% of PTs, wanted to start PHBPT service immediately (p<.001). Significantly more parents (90.0%) than PTs (73.2%) were willing to participate in PHBPT (p<.001). Opinions on the details of policies and procedures (i.e., necessity for prescription, treatment cost, and treatment frequency) differed among the respondent groups, but all favored a minimal qualification of 6~10 years of pediatric experience and a treatment session duration of 1 hour. These findings provide objective information to support health service administrators to understand the current demand and develop feasible policies and procedures of PHBPT in Korea.

Pediatric nurses' cognitive representations of children's pain.

The aim of this mixed methods exploratory study was to describe pediatric nurses' cognitive representations (CRs) of the assessment and management of children's pain and to determine the relationships between their CRs and their choices about pain assessment and morphine administration. We recruited a convenience sample of 87 nurses caring for hospitalized children at 4 institutions. We measured the CRs with the Conceptual Content Cognitive Map (3CM) technique and pain assessment and morphine administration with smiling and grimacing child vignettes. We used content analyses for the 3CM data and fit logistic regression models to predict participants' analgesic choice for each vignette. Nearly all (91%) participants identified the child's behavior as an assessment approach; 48% indicated it as most important. Participants (92%) identified pharmacologic as a management approach; 47% indicated it as most important. Participants' CRs did not predict assessment or morphine administration choices. Significantly more participants chose the appropriate analgesic response for the grimacing child than they did for the smiling child. Nurses with more years of pediatric experience were less likely to select administration of the appropriate morphine dose. The 3CM method provided insights into nurses' thinking about pain that are indicative of gaps, which may be amenable to interventions. Findings are from an innovative, unique measure of nurses' knowledge and beliefs about the complex phenomenon of children's pain management. Extensive details about the thought processes of pediatric nurses regarding pain assessment and management surfaced through this analysis, which provide excellent information for direction of future research and practice innovations.

A survey of pediatric caudal extradural anesthesia practice

Caudal extradural blockade is one of the most commonly performed procedures in pediatric anesthesia. However, there is little information available on variations in clinical practice. To perform a survey of members of the Association of Paediatric Anaesthetists of Great Britain and Ireland who undertake caudal anesthesia. An 'online' World Wide Web questionnaire collected information on various aspects of clinical practice. The survey ran from April to June 2008. There were 366 questionnaires completed. The majority of respondents had >5 years of pediatric experience and performed up to ten caudal extradural procedures a month. The commonest device used was a cannula (69.7%) with 68.6% using a 22G device. There was a trend toward the use of a cannula in those anesthetists with <15 years experience, while those with >15 years experience tended to use a needle. Most anesthetists (91.5%) did not believe that there was a significant risk of implantation of dermoid tissue into the caudal extradural space. The majority used a combination of clinical methods to confirm correct placement. Only 27 respondents used ultrasound. The most popular local anesthetics were bupivacaine (43.4%) and levobupivacaine (41.7%). The most common additives were clonidine (42.3%) and ketamine (37.5%). The caudal catheter technique was used by 43.6%. Most anesthetists (74%) wear gloves for a single shot caudal injection. This survey provides a snapshot of current practice and acts a useful reference for the development of enhanced techniques and new equipment in the future.

Medical staff's knowledge of pulse oximetry: a prospective survey conducted in a tertiary children's hospital.

To assess the knowledge of pulse oximetry of senior (SMO) and junior medical officers (JMO) in a tertiary paediatric hospital. A 16-item multiple choice questionnaire was administered to SMO and JMO without prior notice or instruction in the area. The questions were completed voluntarily and anonymously, then proctored and collated by the principal investigator. The mean test scores for SMO and JMO were 70 +/- 15% and 65 +/- 13%, respectively (P = 0.06). A significant negative correlation was found between the test scores and the years of paediatric experience with the SMO. The results of the survey showed there is an insufficiency of knowledge and understanding among medical staff concerning the principles, clinical applications and limitations of pulse oximetry. More emphasis needs to be placed on teaching these principles to ensure quality care for patients.

The Relationship Between Awake Positioning and Motor Performance Among Infants Who Slept Supine

The purpose of this study was to describe the gross motor development of infants who slept supine and spent different amounts of time in the prone position when awake. Thirty infants who were six months old and slept supine were evaluated using the Alberta Infant Motor Scale (AIMS) and then divided into two groups: prone (n = 16) and no prone (n = 14) based on the number of times per day they were placed in prone position while awake. The prone group scored higher than the no prone group on the AIMS total scores (U = 36, p = 0.004), total percentile scores (U = 42, p = 0.003), and prone subscale scores (U = 25, p < 0.001). Gross motor performance as measured by the AIMS was more advanced in infants who slept supine and had been placed in the prone position when awake than in infants who slept supine but had limited or no experience in the prone position while awake. The influence of awake positioning needs to be considered when interpreting the developmental motor performance of infants who are six months old.

Smith's Anesthesia for Infants and Children, 6th ed

Smith's Anesthesia for Infants and Children, 6th ed

Methods for Preparing Concentrated Infant Formulas Vary: A Survey of Pediatric Nutrition Practice Group Members

LEARNING OUTCOME: To identify methods used by pediatric dietitians to concentrate infant formulas.To data standards of practice or quality assurance criteria dealing with infant formula concentration have not been developed. A survey of/dietitians (N= 538) belonging to the Pediatric Nutrition Practice Group in Areas 3 (southeastern states) and 5 (midwestern states) was conducted to obtain information regarding practices followed when concentrating infant formulas. Of 283 responses received, 174 (52.6%) met the inclusion criteria. The majority (66%) of the respondents were employed as hospital impatient dietitians. Greater than two-thirds (81%) of the dietitians did not increase the caloric density to more than 29 kilocalories/ounce of infant formula using formula exclusively. More dietitians in hospital inpatient settings (68%) concentrated formulas to a higher caloric density than outpatient dietitians (32%) (p ≤ 0.01). Although the majority (97%) of the respondents who accounted for displacement of water by powder when making a small volume (6 ounces) of formula used the same method when preparing a large volume (25 ounces), only 67% of those who did not account for displacement when making a small volume continued this practice when making a larger volume (p≤0.0001). Respondents were also asked to indicate their use of modular components. Protein modules were used less frequently (71%) than carbohydrate and/or fat (90%). The percentage of respondents using protein modules who accounted for the additional volume contributed by the module increased with years of pediatric experience (p≤0.0001). These data suggest inconsistencies in dietitians' practices in their approaches to concentrating formulas. The development of quality assurance criteria related to the concentration of infant formulas would help standardize care and reduce the risk of recommending a concentrated formula that may compromise the infant's nutritional and/or medical status. Supported in part by Grant # MCJ-129162 from the Maternal and Child Health Bureau (Tide V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services.

Oropharyngeal Examination for Suspected Epiglottitis

Sir .—In 32 years of pediatric experience I have routinely examined the epiglottis in all children with laryngeal symptoms. The epiglottis can almost always be seen with the patient in the sitting position, with or without the use of a tongue depressor. I have detected four or five cases of epiglottitis without immediate respiratory compromise and, to my knowledge, I have not overlooked any. I have never been associated even peripherally with a case of diagnosed bacterial tracheitis.