Journal of Pediatric Health Care最新文献

Introduction: In natural disasters, children encounter serious health problems.

Method: This qualitative phenomenological study investigated the problems encountered by children with a diagnosis of celiac disease who lived in the earthquake region of Kahramahmaras in Turkey. Colaizzi method, a phenomenological research method, was used in the study. Data collection involved in-depth interviews conducted with the 'Introductory Information Form' and 'Semi-structured Interview Form,' both developed by the researchers.

Results: This study was conducted with 17 children diagnosed with celiac disease living in the Kahramanmaras earthquake region of Turkey. Four main themes emerged from the data: (1) nutrition security and access problems, (2) dietary noncompliance, (3) psychological effects, and (4) difficulties in accessing health services.

Conclusions: The earthquake not only disrupted the physical and emotional well-being of children with celiac disease but also highlighted systemic vulnerabilities in disaster preparedness and response for individuals with special dietary needs.

Introduction: Pediatric anxiety is rapidly increasing, and in 2022, the US Preventive Services Task Force recommended universal anxiety screening using a validated tool for children 8-18 years.

Method: This evidence-based practice quality improvement initiative integrated an educational process, a validated anxiety screening tool, and a Caregiver Satisfaction Survey into all primary care wellness visits for patients aged 8-18 years.

Results: Significant increases in screening and referrals for mental healthcare were observed postinitiative implementation, especially in ages 8-11 years. Anxiety diagnosis and referral for treatment increased from 6.1% to 21.3%, demonstrating the importance of screening and early action at a younger age than previously recommended. However, many telephone follow-ups to caregivers for mental health referrals were unanswered.

Discussion: Integrating mental health services within pediatric primary care settings is recommended to increase timely treatment accessibility. Results from this initiative may be transferable to other primary care practices.

Behavioral and mental health (BMH) issues are increasing in adolescents as shortages of primary care and BMH providers are also rising. The healthcare burden has fallen especially hard on primary care providers (PCPs), who are showing increasing signs of burnout and making plans to reduce their work hours or leave the profession altogether. These factors impede their ability to be the first line of defense in providing emotional support to children and families. Current solutions to BMH provider shortages include integrated models for primary and BMH health care and child psychiatric consultation services for PCPs. However, this does not diminish PCP perceptions that they are doing more screening and struggling to offer BMH support, all within shorter visit times. In this paper, we explore potential solutions to increasing time with patients and efficiency of primary care visits, and proposals to increase reimbursement for primary care providers.

Background: Primary care physicians (PCPs) and nurse practitioners play a key role in guiding caregivers on early peanut protein (PP) introduction, yet many lack adequate knowledge.

Aim statement: This quality improvement study aimed to enhance understanding among PCPs and caregivers about evidence-based guidelines for early PP introduction in infants' diets.

Methods: Using the Stetler Model, PCP knowledge was evaluated through pre-test, educational video and some posttest material. Caregivers completed the Patient Education Materials Assessment Tool (PEMAT) survey after reviewing an educational handout RESULTS: The N = 22 PCPs pre-education test score had an average of 61.11% and noted N = 21 PCPs posteducation test score average to increase to 84.09%. The N = 68 caregivers completed the PEMAT survey, with results indicating enhanced caregiver knowledge. Infant participation in PP introduction was tracked, alongside ingestion frequency.

Conclusions: Findings in this study underscore the value of education in fostering proactive counseling and informed practices in clinical settings.

Introduction: We aimed to evaluate the efficacy, safety, and immunogenicity profile of Etanercept (ETA) and Adalimumab (ADA) biosimilars (BIOs) compared to their originators in children with juvenile idiopathic arthritis (JIA).

Method: Eighty-one JIA children treated with ETA or ADA originators or BIOs were examined at baseline (T0) and after 3- (T1), 6- (T2), 12- (T3), and 24-(T4) months after starting treatment.

Results: Lower Juvenile Arthritis Disease Activity Score 10 (JADAS-10) scores were reported at T1, T2, T3, and T4 in JIA children treated with BIOs than originators (all p < 0.05). At T1 and T3, anti-drugs antibodies levels were lower in children receiving BIOs than originators (p = 0.04 and p = 0.0007, respectively), even after adjustments (both p < 0.05). Relapses were lower for BIOs compared to originators (p < 0.001). Safety profile was comparable between the groups (p > 0.05).

Discussion: A better overall profile of BIOs than originators was demonstrated in JIA children, but larger confirmatory studies are needed.

Introduction: Burnout and mental health disorders in parents can have significant implications for families. Little is known about these conditions in working parents. The purpose of this study was to identify the prevalence and mental health risk factors for working parent burnout.

Method: De-identified data were collected on a convenience sample of 1285 working parents through an online survey.

Results: Sixty-five percent of working parents reported burnout. Depression, anxiety, attention deficient hyperactivity disorder, abuse, or history of a mental health disorder in the parent were significantly correlated with parental burnout. Anxiety, attention deficient hyperactivity disorder, presence of a mental health disorder in the child, or if parents thought their child might have a mental health disorder were significantly correlated with parent burnout. Parental burnout was significantly associated with greater risk of child maltreatment.

Discussion: This study provides insight into the prevalence and mental health risk factors for parental burnout specific to the working parent.

These case reports describe two neonates, born at term, diagnosed with bacterial meningitis and septicemia caused by uncommon organisms. The clinical presentation, diagnostic reasoning, national guidelines, hospital course, and follow-up are discussed. Meningitis is among the differential diagnoses when there is a concern for neonatal sepsis. Concern for sepsis can arise from a variety of antepartum, intrapartum, and postpartum risk factors and present with a variety of symptoms. Neonatal sepsis is a significant cause of mortality, with 750,000 infant deaths annually. Effective treatment of neonatal sepsis requires timely diagnosis and tailored antimicrobial therapy that targets the causative pathogens.

Background: Discharge delays of Medical-Surgical Pediatric Intensive Care Unit (PICU) patients with Obstructive Sleep Apnea (OSA) following tonsillectomy or tonsillectomy with adenoidectomy (T&A) negatively impact hospital bed availability.

Aim statement: This project identified process improvements to reduce discharge delays and increase PICU bed availability.

Methods: A Failure Modes and Effects Analysis (FMEA) was implemented to identify care and process failures that result in discharge delays.

Intervention: Through the FMEA, failure risk profile numbers with the highest impact were recognized for improvement (Institute for Healthcare Improvement, 2017; VHA National Center for Patient Safety, 2023).

Results: Forty failure modes were identified. High-impact failures included not administering dexamethasone early for patient pain or desaturation, intervening for desaturations consistent with the patient's baseline, and not anticipating family needs for discharge.

Conclusions: The FMEA identified several actionable changes that if implemented, could promote timely discharge of patients with OSA following tonsillectomy or T&A.