Current Issue : April - June Volume : 2017 Issue Number : 2 Articles : 8 Articles
Background: Case management is a subject of interest within pediatric palliative care. Detailed descriptions of the\ncontent of this type of case management are lacking. We aim to describe the contents of care provided, utilization\nof different disciplines, and times of usage of a pediatric palliative care case management program compared for\npatients with malignant disease (MD) and non-malignant disease (NMD).\nMethods: A three-month prospective study, with questionnaires filled in by members of a pediatric palliative care\nteam (PPCT) for each contact with parents.\nResults: Four hundred fifty-five contacts took place with parents of 70 patients (27MD, 43NMD). Sixty-two percent of all\ncontacts were with the specialized nurse. The child life specialists, psychologist and social worker were also regularly\nconsulted, the chaplain was not consulted. Ninety-five percent of all contacts took place between 8 am and 6 pm during\nweekdays, a limited number between 6 pm and 9 pm. Twenty-five percent of all contacts were proactively initiated by\nthe PPCT, 25 % were initiated by parents. In these care characteristics, no differences were seen for MD and NMD\npatients. Psychosocial topics were addressed most frequently. MD patients consulted the PPCT more often about school\nand NMD patients about socio-economic issues.\nConclusions: All different disciplines of the PPCT were regularly consulted, except for the chaplain. With an easy\naccessible team with a highly pro-active approach, availability from 8 am to 9 pm seems sufficient to accommodate\npatient�s and parent�s needs. More anticipation seems required for socio-economic topics. This insight in pediatric\npalliative case management can provide guidance in the development of a new PPCT....
Achondroplasia is a rare genetic condition that results in abnormally short stature. This is characterized by macrocephaly with a prominent forehead (frontal bossing), flat (depressed) nasal bridge, short upper arms and legs (rhizomelic dwarfism), unusually prominent abdomen and buttocks and short hands with fingers that assume a "trident" or three-pronged position during extension. This is caused by mutations in the FGFR3 gene. There can be number of complications including hydrocephalus, apnea, and upper-airway obstruction. Achondroplasia does not cause any impairment or deficiencies in mental abilities. This can be diagnosed before birth by fetal ultrasound or after birth by complete medical history and physical examination. There’s no cure or specific treatment for achondroplasia. Growth hormone therapy may result in a transient increase in growth rate but not effective in significantly increasing stature. Nutritional counseling is helpful. Caring for a child with a rare genetic disorder often has profound effects on health professionals as well as their families. The children require holistic approach to lead a normal life and cope up with medical and social challenges of life. Nurses can play a vital role in identification, diagnosis, Coordination of Care, Health Teaching and Health Promotion, Counseling and referral. This case report highlights this rare anomaly and its manifestations....
Background: Skin-to-skin care immediately following delivery is a common practice for term infants and has been\nshown to improve cardiorespiratory stability, facilitate early bonding, and promote breastfeeding. Since 2007, the\nuse of skin-to-skin care has been practiced for preterm infants from 32 weeks of gestation in the delivery room at\nSt. Olavââ?¬â?¢s University Hospital. In the present study we aim to investigate whether skin-to-skin care following delivery\nis safe, and how it affects early and late outcomes compared to standard care for very preterm infants.\nMethods/Design: A randomized controlled trial (RCT) of skin-to-skin care in the delivery room for very preterm\ninfants born at gestational age 280ââ?¬â??316 weeks with birth weight >1000 grams. Infants with severe congenital\nmalformations or need of intubation in the delivery room are excluded. A detailed checklist and a flowchart were\nprepared for the study, and all involved professionals (neonatologists, neonatal nurses, obstetricians, anesthesiologists,\nmidwives) participated in medical simulation training prior to study start on February 1, 2014. A consultant in\nneonatology and a neonatal nurse are present at all deliveries. Infants with birth weight <1500 grams receive\nan intravenous line with glucose, amino acids, and caffeine citrate in the delivery room. Infants with gestational\nage <30 weeks are routinely put on continuous positive airway pressure (CPAP). After initial stabilization, infants are\nrandomized to skin-to-skin care or are transferred to the nursery in an incubator. Primary outcome is cognitive\ndevelopment at 2 years measured with the Bayley Scales of Infant Development, Third Edition. Secondary outcomes\nare safety defined as hypothermia, respiratory failure, and/or cardiopulmonary resuscitation, physiological stability\nafter birth and motor, language and cognitive development at 1 year for the child, and mental health measured\nwith the State-Trait Anxiety Inventory (STAI) at discharge, and at 3 months and 2 years after expected date of\ndelivery for the mothers.\nDiscussion: The study may have important implications for the initial care for very preterm infants after delivery\nand increase our understanding of how early skin-to-skin care affects preterm infants and their mothers....
Background: Stillbirths and neonatal deaths are devastating events for both parents and clinicians and are global\npublic health concerns. Careful clinical management after these deaths is required, including appropriate investigation\nand assessment to determine cause (s) to prevent future losses, and to improve bereavement care for families. An\neducational programme for health care professionals working in maternal and child health has been designed to address\nthese needs according to the Perinatal Society of Australia and New Zealand Guideline for Perinatal Mortality: IMproving\nPerinatal mortality Review and Outcomes Via Education (IMPROVE). The programme has a major focus on stillbirth\nand is delivered as six interactive skills-based stations. We aimed to determine participants� pre- and post-programme\nknowledge of and confidence in the management of perinatal deaths, along with satisfaction with the programme.\nWe also aimed to determine suitability for international use.\nMethods: The IMPROVE programme was delivered to health professionals in maternity hospitals in all seven Australian\nstates and territories and modified for use internationally with piloting in Vietnam, Fiji, and the Netherlands (with the\nassistance of the International Stillbirth Alliance, ISA). Modifications were made to programme materials in consultation\nwith local teams and included translation for the Vietnam programme. Participants completed pre- and post-programme\nevaluation questionnaires on knowledge and confidence on six key components of perinatal death management as well\nas a satisfaction questionnaire.\nResults: Over the period May 2012 to May 2015, 30 IMPROVE workshops were conducted, including 26 with 758\nparticipants in Australia and four with 136 participants internationally. Evaluations showed a significant improvement\nbetween pre- and post-programme knowledge and confidence in all six stations and overall, and a high degree of\nsatisfaction in all settings.\nConclusions: The IMPROVE programme has been well received in Australia and in three different international settings\nand is now being made available through ISA. Future research is required to determine whether the immediate\nimprovements in knowledge are sustained with less causes of death being classified as unknown, changes in clinical\npractice and improvement in parents� experiences with care. The suitability for this programme in low-income countries\nalso needs to be established...
Background: Recruiting to target in randomised controlled trials of investigational medicinal products (CTIMPs) in\nprimary care and paediatric populations is notoriously difficult. More evidence is needed for effective recruitment\nstrategies in these settings. We report on the impact of different recruitment strategies used in the Choice of\nMoisturiser in Eczema Treatment (COMET) study ââ?¬â?? a feasibility trial comparing the effectiveness of four emollients\nfor the treatment of childhood eczema ââ?¬â?? recruiting via general practitioner (GP) surgeries.\nMethods: Initially, 16 GP practices invited potentially eligible children to take part in the trial by sending an\ninvitation letter (self-referral pathway) or by consenting and randomising them into the study during a visit to\nthe practice (in-consultation referral). Measures implemented during the study to maximise accrual included signing\nup six additional GP practices, increasing the upper age limit eligibility criterion from 3 to 5 years, and permitting\nhealthcare professionals other than doctors to confirm participant eligibility. We used descriptive statistics and\nunivariate linear regression models to explore associations with practice recruitment rates.\nResults: A total of 197 participants were recruited, exceeding the target of 160. Of these, 107 children entered via\nself-referral and 90 by in-consultation pathways. Of the recruited population, 12.6 % were aged between 3 and\n5 years (the raised upper age limit). The six additional practices contributed 37.4 % (40 of 107) of participants\nrecruited by self-referral. Only almost one-third (18 of 56 [32.1 %]) of potential recruiting clinicians recruited one\nor more participants in-consultation, which was a more problematic pathway because of data verification issues.\nThree research nurses and a pharmacist from four practices recruited 48.9 % (44 of 90) of participants via this\npathway. Univariate linear regression models showed no evidence of association between the number of children\nrecruited via the self-referral pathway by practice and practice list size (p = 0.092) or practice deprivation decile\n(p = 0.270), but practice deprivation was associated with a higher number of children recruited in-consultation\n(p = 0.020) by practice.\nConclusions: Self-referral and in-consultation recruitment yielded similar numbers, but the in-consultation pathway\nwas more problematic. Future trials of this type should consider the condition, normal care pathway and number\nof potentially eligible children and be prepared to use multiple recruitment strategies to achieve recruitment\ntargets....
Background: Growth of neonatal intensive care units in number and size has raised questions towards ability to\nmaintain continuity and quality of care. Structural organization of intensive care units is known as a key element for\nmaintaining the quality of care of these fragile patients. The reconstruction of megaunits of intensive care to\nsmaller care units within a single operational service might help with provision of safe and effective care.\nMethods/Design: The clinical team and patient distribution lay out, admission and discharge criteria and\ninterdisciplinary round model was reorganized to follow the microstructure philosophy. A working group met\nweekly to formulate the implementation planning, to review the adaptation and adjustment process and to\nascertain the quality of implementation following the initiation of the microsystem model.\nDiscussion: In depth examination of microsystem model of care in this study, provides systematic evaluation of\nthis model on variable aspects of health care. The individual projects of this trial can be source of solid evidence for\nguidance of future decisions on optimized model of care for the critically ill newborns....
Background: Bronchiolitis is a common respiratory illness of early childhood. For most children it is a mild self-limiting\ndisease but a small number of children develop respiratory failure. Nasal continuous positive airway pressure (nCPAP) has\ntraditionally been used to provide non-invasive respiratory support in these children, but there is little clinical trial evidence\nto support its use. More recently, high-flow nasal cannula therapy (HFNC) has emerged as a novel respiratory support\nmodality. Our study aims to describe current national practice and clinician preferences relating to use of non-invasive\nrespiratory support (nCPAP and HFNC) in the management of infants (<12 months old) with acute bronchiolitis.\nMethods: We performed a cross-sectional web-based survey of hospitals with inpatient paediatric facilities in England and\nWales. Responses were elicited from one senior doctor and one senior nurse at each hospital. We analysed the proportion\nof hospitals using HFNC and nCPAP; clinical thresholds for their initiation; and clinician preferences regarding first-line\nsupport modality and future research.\nResults: The survey was distributed to 117 of 171 eligible hospitals; 97 hospitals provided responses (response rate: 83%).\nThe majority of hospitals were able to provide nCPAP (89/97, 91.7%) or HFNC (71/97, 73.2%); both were available at 65\nhospitals (67%). nCPAP was more likely to be delivered in a ward setting in a general hospital, and in a high dependency\nsetting in a tertiary centre. There were differences in the oxygenation and acidosis thresholds, and clinical triggers such as\nrecurrent apnoeas or work of breathing that influenced clinical decisions, regarding when to start nCPAP or HFNC. More\nindividual respondents with access to both modalities (74/106, 69.8%) would choose HFNC over nCPAP as their first-line\ntreatment option in a deteriorating child with bronchiolitis.\nConclusions: Despite lack of randomised trial evidence, nCPAP and HFNC are commonly used in British hospitals to\nsupport infants with acute bronchiolitis. HFNC appears to be currently the preferred first-line modality for non-invasive\nrespiratory support due to perceived ease of use....
Background: Universal exclusive breastfeeding (EBF) for the first 6 months is estimated to reduce infant mortality\nby 13ââ?¬â??15% (9 million) in resource poor countries. Although 97% of women initiate breastfeeding in Tanzania,\nexclusive breastfeeding for 6 months remains below 50%. Accurate knowledge and practical skills pertaining to\nexclusive breastfeeding among health workers is likely to improve breastfeeding rates. Our study reports the health\nworkersââ?¬â?¢ knowledge and practice on EBF in Mwanza City, northwest of Tanzania.\nMethods: One principal researcher and two research assistants conducted data collection from 11 Juneââ?¬â??6 July\n2012. In total, 220 health care workers including: 64 clinicians (medical specialists, residents, registrars, assistant\nmedical officers and clinical officers) and 156 nurses were interviewed using a structured knowledge questionnaire.\nAmongst 220 health workers, 106 were observed supporting Breastfeeding using a checklist. Logistic regression was\nused to determine factors associated with exclusive breastfeeding knowledge and desirable skills.\nResults: Almost half of the 220 health workers interviewed correctly described EBF as defined by the World Health\nOrganization. Only 52 of 220 respondents had good knowledge. In the adjusted analysis, working at hospital facility\nlevel compared to dispensary (OR 2.1; 95% CI 1.1ââ?¬â??4.0, p-value = 0.032) and attending on job training (OR 2.7; 95%\nCI 1.2ââ?¬â??6.1, p-value = 0.015) were associated with better knowledge. In total, 38% of respondents had a desirable\nlevel of practical skills. Clinicians were more likely to have good practice (OR 3.6; 95% CI 1.2ââ?¬â??10.8; p-value = 0.020)\nthan nurses. Most of the health workers had no training on EBF, and were not familiar with breastfeeding policy.\nConclusion: Less than 25% of healthcare workers surveyed had good knowledge of EBF. These findings identify the\nneed for comprehensive training and mentoring of health workers on exclusive breastfeeding, making breastfeeding\npolicies available and understood, along with supportive supervision and monitoring....
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