Current Problems in Pediatric and Adolescent Health Care最新文献

Animal-assisted therapies have been increasingly used as part of treatment for a range of emotional-behavioral conditions and have more recently been incorporated into treatment for children with symptoms associated with autism spectrum disorder. Autism spectrum disorder affects one in 36 children and early interventions can be very effective. The aims of this paper are to: 1) provide background into animal-assisted therapies including a breakdown on the subtypes of therapies, 2) report broad summaries of research outcomes across various domains: social-emotional, physical, quality of life, behavioral skills, and adaptive skills, and 3) summarize key takeaways for pediatric practitioners when supporting families of youth with autism spectrum disorder who are interested in participating in animal-assisted therapy. This paper is not a systematic review or meta-analysis as several rigorous review studies have been published already. This paper is an overview of the background and research for pediatric practitioners when advising families on treatment options. Implications for future research are covered.

There is a need for novel techniques for disease detection in humans. Research has shown that using animals for detection of disease is a promising area of study. A literature review was conducted using the terms animals, disease detection, seizures, epilepsy, infectious disease, cancer, and pediatrics to determine the published literature to date of the use of animals in detection of disease. Research studies between 1999-2022 were included in this article. The published studies demonstrate that animals have been used for disease detection in seizures, infectious diseases, Type I diabetes mellitus, and cancer. However, these studies have predominantly focused on the adult patient population. There is limited data available regarding the use of animals in disease detection within pediatrics, which warrants further research into this topic.

The paper reviews the impact of the COVID-19 pandemic on children's and adolescents’ well-being. A trauma-informed framework is employed to discuss the emerging evidence of notable changes in youth's psychological, developmental, academic, and social well-being since the start of the COVID-19 pandemic. Children and adolescents have been uniquely affected based on their age at the start of the pandemic. Despite multiple resiliency factors, COVID-19 and its ramifications have had an adverse effect on youth in general and have exacerbated preexisting racial and socioeconomic disparities. This review concludes with recommendations for child health clinicians.

Introduction

An increasing number of pediatric patients with mental and behavioral health (MBH) conditions present to Emergency Department (ED) and inpatient settings with behavioral events that require physical restraint (PR). PR usage is associated with adverse outcomes. Clinical debriefing (CD) programs have been associated with improved performance but have not been studied in this population. After implementing an MBH-CD program in our Children's Hospital, we aimed to decrease the baseline (7/2018-3/2021) rate of a second PR episode (2PR) by 50 % in the ED and inpatient settings over two years.

Methods

A multidisciplinary team implemented an MBH-CD process in April 2021 for hospital teams to use immediately after behavioral events. We included patients ≤18 years old, with an ED or inpatient discharge MBH diagnosis, between July 2018 and June 2023. Pre- and post-implementation secondary outcomes included the ED median duration of PR and the ED PR time per 1000 h of ED care. ED and inpatient mean length of stay (LOS) and mean monthly visits (MMV) in pre- and post-implementation were also compared. Qualitative analysis identified major themes.

Results

Post-implementation, the ED significantly decreased 2PR rate by 67 %; in inpatients, no significant change was demonstrated. Median duration of ED PR decreased from 112 to 71 min (p = 0.006) and ED PR time significantly decreased by 82 % (14.8 to 2.7 h per 1000 h). In the post-implementation period, mean LOS (ED and inpatient) and MMV (ED only) were significantly higher. Fifty-one percent of 494 behavioral alerts were debriefed. Median debriefing duration was 6 min (IQR 4,10). Common themes included cooperation and coordination (23 %) and clinical standards (14 %).

Discussion

Clinical debriefing implementation was associated with significant improvement in ED patient outcomes. Inpatient outcomes were unchanged, but debriefings in both settings should enable frontline teams to continuously identify opportunities to improve future outcomes.

Surgical site infections are a burden to patients, families and healthcare systems. Preoperative preparation is a crucial part in the multifaceted approach to SSI prevention. Preoperative bathing is a customary procedure that is seemingly straightforward yet challenging to implement. On the basis of best-practices and lived experience, this essay identifies potential barriers and presents several recommendations for improvement of preoperative preventive measures.