Hospital pediatrics最新文献

Background: In health care conversations, clinicians continue to use medical jargon despite assuming they are communicating clearly, causing confusion for patients. Prior studies have evaluated adults' perception of medical jargon, but few studies have evaluated how teenagers perceive it.

Objectives: To characterize teenagers' comprehension of common phrases used in medical settings via a cross-sectional, survey-based investigation.

Methods: A total of 71 teenagers aged between 13 and 17 years were recruited at the 2023 Minnesota State Fair to participate in an anonymous survey assessing their understanding of common phrases a doctor might say or write. Responses were coded as correct, partially correct, or incorrect by 2 independent researchers, with a third reconciling discrepancies. Secondary analyses evaluated the associations between participant demographics and understanding.

Results: Teenagers demonstrated a poor understanding of many phrases evaluated. While 97% knew that "negative cancer screening" results meant they did not have cancer, fewer (69%) understood that "the tumor is progressing" was unwelcome news. More teenagers understood "your blood test shows me you do not have an infection in your blood" (89%) vs "your blood culture was negative" (52%). Only 10% understood that "bugs in the urine" conveyed a urinary tract infection, with 37% expressing a literal interpretation. None knew what was meant by an "occult infection" nor by "febrile," with 13% believing that it was related to fertility or sexual activity.

Conclusions: Teenagers frequently misunderstood common phrases used within a medical context, with interpretations, at times, representing the opposite of what a health care provider intended.

Between 2007 and 2017, rates of neonatal opioid withdrawal syndrome (NOWS) have drastically increased. Although current evidence suggests that chronic prenatal opioid exposure may result in adverse neurodevelopmental consequences, there is no standardized protocol for the follow-up care of affected patients. We call on the American Academy of Pediatrics to develop a standardized protocol for the follow-up care of infants prenatally exposed to opioids that also supports families and providers. More specifically, special consideration should be given to identifying and providing solutions to barriers of care for families, as well as for providers. Educating families on the importance of follow-up care would also be beneficial, as well as educating providers on how to address family barriers. Prioritizing and attending to this call to action will allow for improvement in practice and patient care over time and potentially reduce hospital readmission rates commonly associated with NOWS.

Objectives: Nonnutritive breastfeeding (NNBF) benefits preterm infants younger than 34 weeks' gestational age (GA), but it is often delayed in those on noninvasive respiratory support. Our primary aim was to reduce the mean number of days to NNBF by 50% in infants born at less than 34 weeks' and more than 30 weeks' corrected GA within a 12-month period. Our global aim was to increase provision of human milk at discharge.

Methods: This 1-year quality improvement (QI) initiative involved a multidisciplinary team employing a key driver diagram, fishbone analysis, and "Wee Nuzzle" guidelines, implemented through Plan-Do-Study-Act cycles. The first cycle focused on training health care providers, the second on integrating NNBF into medical progress notes, and the third on incorporating NNBF into the electronic medical record (EMR). Data were collected using EMR and the California Perinatal Quality Care Collaborative database.

Results: The initiative achieved its Specific, Measurable, Achievable, Realistic and Time bound (SMART) aim, reducing the mean time to first NNBF by 66%, from 12.0 to 4.1 days. Additionally, the global aim of increasing human milk provision at discharge improved from 59% to 72%.

Conclusion: This QI initiative effectively reduced the time to first NNBF attempt and increased human milk provision at discharge. Ongoing assessment of human milk exposure post-neonatal intensive care unit discharge is needed.

Background/objectives: Patients who use a language other than English (LOE) for health care communication are at increased risk of experiencing adverse events and worse outcomes. The objectives of this research are (1) to understand the lived experience of families who speak LOEs around the hospitalization of their child and (2) to understand the perspectives of patients and families who speak LOEs on opportunities to improve their experiences during hospitalization.

Methods: This study is grounded in patient- and family-informed research. We designed a qualitative study involving children hospitalized in the general pediatric inpatient unit at a Canadian children's hospital. We conducted semistructured individual interviews with children and families with a medical interpreter. We used thematic analysis, and all interviews were coded by 2 reviewers.

Results: A total 20 families of 16 different languages participated in the interviews. Themes important to understanding their lived experience were the following: (1) communication uncertainty-families experienced inconsistent interpreter use and availability, which affected in-the-moment communication and families' ability to understand the overall clinical context, leading to increased uncertainty; (2) lack of belonging-despite communicating that they had positive experiences in the hospital, families described a lack of belonging and felt that they were "other" during hospitalization; (3) altered trust-in addition to language, each patient/family's unique and complex social contexts contribute to developing an altered trust relationship with the health system that impacts their engagement in care processes. Families described opportunities for improvement such as supporting patient-initiated interpretation, increasing workforce diversity, and tailoring concepts such as shared decision making to their realities.

Conclusions: Patients and families also revealed that they experience communication uncertainty, altered trust, and a lack of belonging within the hospital setting. Our research builds on the current literature and serves to advance our efforts to address health inequities experienced by this population.

Objective: The Eat, Sleep, Console (ESC) model of care is an innovative care approach for infants diagnosed with neonatal abstinence syndrome, improving patient and health system outcomes for this equity-deserving population. Little is known about sustainably implementing this model into practice. The objective is to map evidence on implementing the ESC model into clinical practice, including strategies, barriers and facilitators to implementation, and evaluation outcomes.

Methods: Data sources include MEDLINE, Embase, CINAHL, PsycINFO, Google Scholar, and websites identified by a Google search. The study selection included articles exploring the implementation or evaluation of the ESC model in clinical practice since its 2017 conception. Two reviewers independently screened each study using a predetermined screening tool. Data were extracted by 2 independent reviewers from included articles.

Results: The review identified 34 studies. Barriers to implementing the ESC model include resource limitations and systemic oppression and bias. Facilitators include health care provider education and empowerment of parent engagement. The most reported cluster of strategies (31.6%) included training and educating stakeholders. Gaps were noted in the exploration of implementation outcomes/processes, and equity implications on implementation.

Conclusions: The ESC model of care has been successfully implemented in various settings with positive patient and health system outcomes, including decreased hospital stay and pharmacological treatment of infants. However, there is a gap in exploring implementation processes and outcomes. Future research should explore the contextual elements of the implementation by equitably examining implementation outcomes specific to the ESC model of care.

Purpose: There is limited evidence to guide the treatment of enteral nutrition (EN) for children with bronchiolitis who receive biphasic positive airway pressure (BiPAP) support.

Methods: This quality improvement project included patients with bronchiolitis who were supported by BiPAP ventilation. An algorithm to increase EN treatment in those patients was created by stakeholders. Two periods of time were compared: group 1 (January 2023 to August 2023) without nutrition implementation protocol vs group 2 (September 2023 to February 2024) after the protocol was implemented. EN was provided via nasogastric tubes. The project aim was to decrease the mean time to initiation of EN by 50% after the start of BiPAP. Secondary end points were time to reach target calories (100 kcal/kg/d), BiPAP total duration, and the proportion of patients with adverse effects.

Results: For the 102 included patients (48 before and 54 after BiPAP ventilation), the median time to the start of EN decreased from 18 (8-26) hours to 6 (2-8) hours (P < 0.05) Median time to reach calorie goal decreased from 103 (85-120) hours to 48 hours (36-60) (P < 0.05). There were no differences in noninvasive ventilation mean duration. No episodes of aspiration or other adverse effects were documented.

Conclusions: The implementation of a standardized pathway for EN in patients with BiPAP was associated with faster initiation of EN and a shorter time to reaching caloric goals without any observed adverse events. Although our sample was small, the findings suggest that more aggressive enteral feeding should be considered in patients receiving noninvasive ventilation.

Objective: To describe the implementation of nirsevimab for the prevention of respiratory syncytial virus-associated lower respiratory tract disease in a pediatric hospital, focusing on strategies to ensure equitable access and address logistic challenges. Additionally, we aimed to identify predictors of nirsevimab deferral among eligible infants.

Methods: Our hospital implemented a universal immunization campaign to all eligible infants, including those discharged from the newborn nursery, intermediate care nursery, and neonatal intensive care unit. We identified key drivers and barriers, formed a multidisciplinary team, and applied a systematic approach for integration of nirsevimab orders into existing workflows. We developed and disseminated educational resources for staff and caregivers. After the implementation, we conducted univariable and multivariable analyses to identify predictors of nirsevimab deferral to evaluate implementation success and possible gaps.

Results: Despite challenges, we offered nirsevimab to 99% of eligible infants prior to discharge from the newborn nursery, intermediate care nursery, and neonatal intensive care unit with 71% receiving the immunization. On the multivariable analysis, independent predictors of nirsevimab deferral included preferred language of English, deferral of hepatitis B vaccine, discharge from the newborn nursery, and public insurance.

Conclusions: Our implementation strategy ensured equitable access to nirsevimab for newborns with both our high uptake and acceptance rate underscoring the effectiveness of our approach. Key strategies for success included early stakeholder engagement, multidisciplinary collaboration, and proactive logistic planning. Our approach serves as a model for other institutions to offer nirsevimab prior to hospital discharge and highlights the importance of addressing both clinical and socioeconomic barriers.