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Utilizing screening as a trauma-responsive approach in pediatric health care settings 在儿科医疗机构中利用筛查作为创伤应对方法。
IF 1.6 4区 医学 Q1 Medicine Pub Date : 2024-02-01 DOI: 10.1016/j.cppeds.2023.101548
Shannon D. Chaplo PhD, Lindsay D. Shepard Abdulahad PhD, LCSW, Brooks R. Keeshin MD

Given the widespread impact of child trauma, it is important that child- and family-serving systems adopt trauma-informed care. Because of their integral relationships with families, pediatricians and family medicine physicians play critical roles in disrupting negative societal and developmental cascades for trauma-exposed youth through their potential for early identification and intervention. When implemented alongside organization-wide trauma-informed care practices, trauma screening is one concrete trauma-informed care practice that has shown both feasibility and positive impacts on pediatric healthcare. In support of this practice, the Care Process Model for Pediatric Traumatic Stress (CPM-PTS) helps pediatric care providers to identify and respond to children and adolescents who may need trauma-focused supports. In this paper we discuss the importance of pediatric physicians adopting trauma-informed care and how evidence-based screening practices in pediatric settings is a trauma-responsive approach with great potential for meeting unmet needs among trauma-exposed children and families.

鉴于儿童创伤的广泛影响,儿童和家庭服务系统采用创伤知情护理非常重要。由于儿科医生和家庭医生与家庭有着不可分割的关系,他们通过早期识别和干预的潜力,在为遭受创伤的青少年阻断消极的社会和发展级联方面发挥着至关重要的作用。创伤筛查是一项具体的创伤知情护理实践,它与整个组织的创伤知情护理实践一起实施时,已显示出可行性和对儿科医疗保健的积极影响。为支持这一实践,儿科创伤压力护理流程模型(CPM-PTS)帮助儿科护理提供者识别并应对可能需要以创伤为重点的支持的儿童和青少年。在本文中,我们将讨论儿科医师采用创伤知情护理的重要性,以及在儿科环境中以证据为基础的筛查实践是一种创伤响应方法,在满足受创伤儿童和家庭的未满足需求方面具有巨大潜力。
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引用次数: 0
FOREWORD: Expanding horizons in child abuse pediatrics, part 1 前言:拓展虐待儿童儿科领域的视野,第 1 部分。
IF 1.6 4区 医学 Q1 Medicine Pub Date : 2024-02-01 DOI: 10.1016/j.cppeds.2024.101587
Louis M. Bell MD (Associate Editor)
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引用次数: 0
Specialized programs employing different models of care delivery work collaboratively to address the health care needs of children in foster care 采用不同护理提供模式的专业计划通力合作,以满足寄养儿童的医疗保健需求。
IF 1.6 4区 医学 Q1 Medicine Pub Date : 2024-02-01 DOI: 10.1016/j.cppeds.2024.101577
Jennifer Keim , Kristine Fortin

Specialized knowledge and skills applicable to caring for children in foster care include guidelines developed to address this population's special health care needs, cross-system collaboration, and helping families cope with the health impacts of trauma. This paper begins with a review of the special health care needs of children in foster care and relevant guidelines. We discuss different models of health care delivery that can be employed to meet the special health care needs of children in foster care. We then provide examples of two programs employing different models of care that work collaboratively to deliver care to children in foster care in our community.

适用于照顾寄养儿童的专业知识和技能包括:为满足这一群体的特殊医疗需求而制定的指南、跨系统合作以及帮助家庭应对创伤对健康的影响。本文首先回顾了寄养儿童的特殊医疗需求和相关指南。我们讨论了可用于满足寄养儿童特殊医疗需求的不同医疗服务模式。然后,我们举例说明了两个采用不同护理模式的项目,这两个项目合作为我们社区的寄养儿童提供护理服务。
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引用次数: 0
Expanding horizons in child abuse pediatrics 扩大虐待儿童儿科的视野。
IF 1.6 4区 医学 Q1 Medicine Pub Date : 2024-02-01 DOI: 10.1016/j.cppeds.2024.101571
Kristine Fortin, Colleen E. Bennett
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引用次数: 0
Current status of pediatric palliative care and decision making in Japan 日本儿科姑息治疗和决策的现状。
IF 1.6 4区 医学 Q1 Medicine Pub Date : 2024-01-01 DOI: 10.1016/j.cppeds.2024.101557
Nobuyuki Yotani M.D., Ph.D.

Specialized pediatric palliative care (PPC) in Japan evolved primarily to care for children with cancer. As a result, the system for providing PPC to pediatric cancer patients is much more advanced than systems for non-cancer patients with life-limiting diseases. About 40% of pediatric cancer patients die at home, while most non-cancer patients die in the hospital under intensive care. In Japan, the wishes of the family tend to precede the children in decision-making for children who lack decision-making capacity. This is true even for adolescents whose medical treatment decisions may not fully reflect the wishes and preferences of the teen patients. There are efforts to empower adolescents to participate in shared decision making.

日本专门的儿科姑息治疗(PPC)主要是为癌症患儿提供护理而发展起来的。因此,为儿科癌症患者提供姑息治疗的系统比为患有局限生命疾病的非癌症患者提供姑息治疗的系统要先进得多。约 40% 的儿科癌症患者在家中去世,而大多数非癌症患者是在医院的重症监护下去世的。在日本,对于缺乏决策能力的儿童,家属的意愿往往优先于儿童的决策。即使是青少年也是如此,他们的医疗决定可能无法完全反映青少年患者的意愿和偏好。日本正在努力增强青少年参与共同决策的能力。
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引用次数: 0
Shared-decision-making and communication in paediatric palliative care within Uganda 乌干达儿科姑息治疗中的共同决策和沟通。
IF 1.6 4区 医学 Q1 Medicine Pub Date : 2024-01-01 DOI: 10.1016/j.cppeds.2024.101556
J Downing PhD, RGN , E Namukwaya MBchB, PhD , J Nakawesi MMed, MPH, MD , M Mwesiga MPH, MMS

The first palliative care services were started in Uganda 30 years ago with services continuing to develop since then. The Ministry of Health and the Palliative Care Association of Uganda have played key roles in the development of paediatric palliative care in the country. There are a range of paediatric palliative care service providers in Uganda, and these have developed alongside educational programmes and research in PPC. Care is provided across the Uganda health system and across the age range from neonates through to adolescents and young adults. Whilst recognising the importance of shared decision-making there is little literature with regards to this in the Ugandan context. However, a variety of factors have been shown to influence decision-making, along with the challenges and recommendations for the future. Uganda has made significant strides in the provision of paediatric palliative care although there is still a way to go before all children with palliative care needs, and their families, can access palliative care.

30 年前,乌干达开始提供首批姑息关怀服务,此后,姑息关怀服务不断发展。乌干达卫生部和姑息关怀协会在该国儿科姑息关怀的发展中发挥了关键作用。乌干达有一系列儿科姑息关怀服务提供商,这些服务提供商是与儿科姑息关怀的教育计划和研究同时发展起来的。乌干达医疗系统提供的姑息关怀服务涵盖了从新生儿到青少年的各个年龄段。虽然认识到共同决策的重要性,但在乌干达很少有这方面的文献。不过,有多种因素被证明会影响决策,同时也存在挑战和对未来的建议。乌干达在提供儿科姑息关怀方面取得了长足的进步,尽管距离所有有姑息关怀需求的儿童及其家庭都能获得姑息关怀还有很长的路要走。
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引用次数: 0
Shared decision-making in pediatric palliative care in the Netherlands 荷兰儿科姑息治疗中的共同决策。
IF 1.6 4区 医学 Q1 Medicine Pub Date : 2024-01-01 DOI: 10.1016/j.cppeds.2023.101549
Michiels EM , Joren CY , Kars MC , Aris JL , Verhagen AAE

Shared decision-making (SDM) is a process in which health care professionals (HCPs) involve parents and children - when appropriate- to decide together on future treatment. These decisions are based on values that are important for the family, goals of care and preferences for future care and treatment. Elucidation of these values and preferences is preferably done early in the disease trajectory via so-called Advance Care Planning (ACP) conversations.

In the Netherlands, ACP and SDM are being adopted by most health care professionals. This has happened only recently. Ten years ago, ACP and SDM were unknown concepts for the vast majority of Dutch HCPs. Today, interest in these conversational approaches is booming in both daily practice and in research.

This rise has been reinforced by two recent major advancements in Dutch pediatric palliative care: the Individual Care Plan (ICP) and the Dutch Evidence-Based Guideline on Pediatric Palliative Care (DGPPC).

Despite this positive evolution, a lot of work is still ahead. ACP and SDM demand a change in mindset from the traditional paternalistic approach by which the HCP ‘knows what is best for this child’ to a more humble and open approach in which (non-medical) factors that are important to the child and family and may influence the final treatment decision. Such changes in mindset don't happen overnight.

In this article we describe the situation of pediatric palliative care in the Netherlands, with focus on the recent evolution of ACP and SDM.

共同决策(SDM)是一个过程,在这个过程中,医疗保健专业人员(HCPs)会在适当的时候让家长和孩子参与进来,共同决定未来的治疗方案。这些决定基于对家庭重要的价值观、护理目标以及对未来护理和治疗的偏好。这些价值观和偏好最好在疾病早期通过所谓的 "预先护理规划"(ACP)对话来阐明。在荷兰,ACP 和 SDM 正在被大多数医护人员所采用。这只是最近才发生的事情。十年前,ACP 和 SDM 对绝大多数荷兰医护人员来说还是未知的概念。如今,无论是在日常实践中还是在研究中,人们对这些对话式方法的兴趣都在蓬勃发展。最近,荷兰儿科姑息关怀领域的两项重大进展:个体关怀计划(ICP)和荷兰儿科姑息关怀循证指南(DGPPC),进一步推动了这一趋势的发展。尽管取得了这一积极进展,但仍有许多工作要做。ACP 和 SDM 要求改变思维方式,从传统的家长式方法(即保健医生 "知道什么对这个孩子最好")转变为更加谦逊和开放的方法,在这种方法中,(非医疗)因素对孩子和家庭非常重要,并可能影响最终的治疗决定。这种心态的转变并非一蹴而就。在这篇文章中,我们将描述荷兰儿科姑息关怀的现状,并重点介绍ACP和SDM的最新发展。
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引用次数: 0
Pediatric palliative care in Sweden 瑞典的儿科姑息治疗。
IF 1.6 4区 医学 Q1 Medicine Pub Date : 2024-01-01 DOI: 10.1016/j.cppeds.2023.101455
Charlotte Castor RN, PhD , Kerstin Ivéus RN , Ulrika Kreicbergs RN

In Sweden, the governance of healthcare is decentralized, so PC is provided with regional or local differences in organization, level of competence, and recourses. Ongoing regional and national initiative to increase quality of pediatric palliative care in Sweden aligns with the international standard of pediatric palliative care as a care directed towards all children with life-threatening or life-limiting illness or conditions from the time of diagnosis. Examples of such initiatives and of different care-services providing pediatric palliative care will be presented. Finally a case to highlighting how a child's care needs might change throughout the illness trajectory and how various healthcare facilities and organizations when collaborating can support the child's participation in decision making is presented.

在瑞典,医疗保健的管理是分散的,因此PC在组织、能力水平和资源方面存在区域或地方差异。瑞典正在进行的提高儿科姑息治疗质量的区域和国家倡议与儿科姑息治疗的国际标准保持一致,作为一种针对所有患有危及生命或限制生命的疾病或病症的儿童的护理,从诊断时开始。将介绍此类举措和提供儿科姑息治疗的不同护理服务的实例。最后,一个案例强调了儿童的护理需求如何在整个疾病轨迹中发生变化,以及各种医疗机构和组织在合作时如何支持儿童参与决策。
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引用次数: 0
Paediatric palliative care around the world: Malaysia 世界各地的儿科姑息治疗:马来西亚。
IF 1.6 4区 医学 Q1 Medicine Pub Date : 2024-01-01 DOI: 10.1016/j.cppeds.2023.101452
Erwin Jiayuan Khoo MBBS, FRCPCH

The evolution of paediatric palliative care in Malaysia has followed a distinct trajectory compared to adult palliative care. While adult palliative care was well-established by the mid-1990s, paediatric palliative care was still then largely ad hoc, with individual paediatricians and NGOs taking on the responsibility. Despite progress over the last decade, challenges persist. There is a shortage of trained paediatricians in this subspecialty, and financial constraints hinder progress. Decision-making in paediatric palliative care is also influenced by cultural values, religious beliefs, and societal norms. Parents are steered by cultural practices and the guidance of elder family members in a setting of communitarian traditions that are prevalent in Asian cultures. Discussions about end-of-life matters are hampered by cultural taboos. Additionally, the hierarchical medical culture, where doctors are seen as authoritative, hinder patients, including parents, from taking an active role in decision-making. The paper exemplifies these complexities through a case study, where the family's hopes and concerns were overlooked in a hectic and hurried hospital environment. The narrative calls for a compassionate, collaborative ecosystem that bridges cultural gaps and embraces shared decision-making in paediatric palliative care. It emphasizes the need to harmonize palliative care with societal values, involving healthcare providers, families, and the community. However, recognizing individual preferences and avoiding cultural assumptions are crucial. Healthcare professionals must develop skills in cultural diversity, delivering distressing news with compassion, and effectively communicate to involve families in decision-making, all while respecting their beliefs and values.

与成人姑息治疗相比,马来西亚儿科姑息治疗的发展轨迹截然不同。虽然成人姑息治疗在20世纪90年代中期已经建立起来,但当时儿科姑息治疗在很大程度上仍然是临时性的,由儿科医生和非政府组织承担责任。尽管在过去十年中取得了进展,但挑战依然存在。这一子专业缺乏训练有素的儿科医生,资金限制阻碍了进展。儿科姑息治疗的决策也受到文化价值观、宗教信仰和社会规范的影响。在亚洲文化中盛行的社群主义传统背景下,父母受到文化习俗和年长家庭成员的指导。关于临终事宜的讨论受到文化禁忌的阻碍。此外,医生被视为权威的等级医疗文化阻碍了包括父母在内的患者在决策中发挥积极作用。这篇论文通过一个案例研究说明了这些复杂性,在繁忙而匆忙的医院环境中,家人的希望和担忧被忽视了。该叙事呼吁建立一个富有同情心的合作生态系统,弥合文化差距,并在儿科姑息治疗中实现共同决策。它强调需要将姑息治疗与社会价值观相协调,包括医疗保健提供者、家庭和社区。然而,承认个人偏好和避免文化假设是至关重要的。医疗保健专业人员必须培养文化多样性方面的技能,以同情的态度传递令人痛心的消息,并有效沟通,让家庭参与决策,同时尊重他们的信仰和价值观。
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引用次数: 0
Pediatric palliative care in Canada 加拿大的儿科姑息治疗。
IF 1.6 4区 医学 Q1 Medicine Pub Date : 2024-01-01 DOI: 10.1016/j.cppeds.2023.101453
Marc-Antoine Marquis MD, MSc, MA , Antoine Payot MD, PhD

Pediatric palliative care (PPC) emerged during the late 20th century in Canada. It has steadily expanded and there are now programs in every province. Programs adhere to recognized standards of practice at both federal and provincial levels. PPC is recognized by government regulatory bodies and professional associations, including the Canadian Paediatric Society.

儿科姑息治疗(PPC)出现于20世纪末的加拿大。它稳步扩大,现在每个省都有项目。项目遵循联邦和省级公认的实践标准。PPC得到政府监管机构和专业协会的认可,包括加拿大儿科学会。
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引用次数: 0
期刊
Current Problems in Pediatric and Adolescent Health Care
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