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Zavaleta-Ramírez P, Rosetti M, Albores-Gallo L, López ON, González PP. Pediatric and psychiatric models of autism care in Mexico: Differences in diagnostic tools and prescribed interventions. Clin Child Psychol Psychiatry 2024; 29:232-244. [PMID: 37541309 DOI: 10.1177/13591045231193817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
Low- and middle-income countries face heterogeneity in the way clinicians' approach Autism Spectrum Disorder (ASD) diagnosis and treatment. The current study analyzes the diagnostic tools, laboratory tests, pharmacological and psychosocial interventions received by patients during the steps to diagnosis and treatment of two specialized care centers. Researchers interviewed families with a child with ASD receiving services at either a child psychiatric or a pediatric hospital. Of the total sample, 47% reported clinicians not using a diagnostic tool, 20% reported not receiving any psychosocial intervention, and 88% reported receiving a pharmacological prescription. Patients at the pediatric hospital were more likely to receive interventions with some components of Applied Behavioral Analysis, Early Start Denver Model, Treatment and Education of Autistic and Related Communication Handicapped Children, and Sensory integration therapy; while patients at the psychiatric hospital were more likely to undergo learning, daily living skills, and socialization therapies. Patients at the psychiatric hospital received significantly more requests to obtain auditory and vision tests whilst genetic testing and imaging were more common in the pediatric hospital. The range and variability in terms of diagnostic tools, laboratory tests, and treatment options observed for both sites reflect a lack of consensus. Recommendations to improve ASD diagnostic and treatment in Mexico are given.
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Affiliation(s)
- Patricia Zavaleta-Ramírez
- Hospital Psiquiátrico Infantil Dr. Juan N. Navarro, Servicios de Atención Psiquiátrica, Mexico City, Mexico
| | - Marcos Rosetti
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Instituto Nacional de Psiquiatría Dr. Ramón de la Fuente Muñiz, México City, México
| | - Lilia Albores-Gallo
- Hospital Psiquiátrico Infantil Dr. Juan N. Navarro, Servicios de Atención Psiquiátrica, Mexico City, Mexico
| | - Omar Nafate López
- Hospital de Especialidades Pediátricas, Tuxtla Gutiérrez, Chiapas, México
| | - Paula Padierna González
- Hospital Psiquiátrico Infantil Dr. Juan N. Navarro, Servicios de Atención Psiquiátrica, Mexico City, Mexico
- Fundación Alicia Koplowitz, Madrid, España
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Fearns N, Walker L, Graham K, Gibb N, Service D. User testing of a Scottish Intercollegiate Guideline Network public guideline for the parents of children with autism. BMC Health Serv Res 2022; 22:77. [PMID: 35033068 PMCID: PMC8761326 DOI: 10.1186/s12913-021-07384-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/29/2021] [Indexed: 11/26/2022] Open
Abstract
Background The Scottish Intercollegiate Guidelines Network (SIGN) is the leading national clinical guideline producer in Scotland. Improved design and dissemination of guidelines produced for the public can empower people to take an active role in self-management and shared decision-making. The public version of the guideline examined covered getting assessed and diagnosed with autism, and approaches that can help. The aim of this study was to test a public version of a guideline for the parents of children and young people with autism, implement improvements, and identify what works in making it usable and accessible. Methods We recruited mothers from across Scotland. User testing involved formal ‘think aloud’ semi-structured interviews that guided users through the booklet. Interviews took place individually and were recorded and transcribed. Key findings were identified and themed using the honeycomb user experience model. Results Fourteen user-testing interviews were conducted. Facilitators for usability and desirability of the guideline included the chunking of text, consistent use of colour and boxes to highlight important information. Simple language, written in a tone of partnership, helped to engage mothers. Value arose from the guidelines ability to explain the process of diagnosis and make mothers feel empowered in their relationships with healthcare professionals. There was a lack of consensus on the usefulness of rating the strength of evidence and recommendations. Conclusion There was a marked similarity between what was important to the mothers and what has been found to be important to other groups. The involvement of service users and carers in the guidelines development was key to its credibility. One size does not fit all in presenting evidence-based recommendations to the public and it is a challenge to provide sufficient information while avoiding information overload. Recommendations and evidence levels are suitable for use in public versions, but these should be kept as simple as possible.
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Affiliation(s)
- Naomi Fearns
- Healthcare Improvement Scotland, Gyle Square 1 South Gyle Crescent, Edinburgh, EH12 9EB, Scotland, UK.
| | - Laura Walker
- Healthcare Improvement Scotland, Gyle Square 1 South Gyle Crescent, Edinburgh, EH12 9EB, Scotland, UK
| | - Karen Graham
- Healthcare Improvement Scotland, Gyle Square 1 South Gyle Crescent, Edinburgh, EH12 9EB, Scotland, UK
| | - Norman Gibb
- Healthcare Improvement Scotland, Gyle Square 1 South Gyle Crescent, Edinburgh, EH12 9EB, Scotland, UK
| | - Duncan Service
- Healthcare Improvement Scotland, Gyle Square 1 South Gyle Crescent, Edinburgh, EH12 9EB, Scotland, UK
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Uygun SD, Çakmak FH, Canlı M, Temeltürk RD, Efe A, Gürel Y, Açıkel SB, Çetinkaya M. Psychotropic Drug Use in Children with Autism Spectrum Disorder Admitted to a Training and Research Hospital Outpatient Clinic: A Retrospective Cross-Sectional Study. JOURNAL OF CHILD SCIENCE 2020. [DOI: 10.1055/s-0040-1721679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractThis study aimed to examine demographic and clinical variables, psychiatric comorbidities, the prevalence of psychotropic drug use, relationships between drug use, demographic and clinical variables, and predictors of drug use in children with autism spectrum disorder (ASD) admitted to a training and research hospital outpatient clinic. Four hundred and eleven children with ASD admitted to the Department of Child and Adolescent Psychiatry, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, between October 1, 2019 and December 31, 2019, were retrospectively reviewed. Demographic and clinical variables, psychiatric comorbidities, and characteristics of drug use for the cases were recorded. Psychotropic drug use was found in 34.3% (n = 141) of the cases. Our results revealed male sex and psychiatric comorbidity as predictors of psychotropic drug use. Antipsychotics were the most prescribed drugs, and the most common psychiatric comorbidity was conduct disorder. Also, children with ASD who had been toilet-trained, and could express sentences but were illiterate, were using psychotropic drugs more often than others. Future multicentered, large clinic-based studies from training and research hospitals should focus on trends of treatment in psychiatric comorbidities accompanying ASD, and constitute a systematic approach for the psychopharmacological treatment of these cases.
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Affiliation(s)
- Sabide Duygu Uygun
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Fatma Hülya Çakmak
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Merve Canlı
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Rahime Duygu Temeltürk
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Ayşegül Efe
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Yusuf Gürel
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Sadettin Burak Açıkel
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Miray Çetinkaya
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
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Murray RE, Barton EE. Training Pediatricians to Implement Autism Screening Tools: a Review of the Literature. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2020. [DOI: 10.1007/s40489-020-00206-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Camodeca A, Todd KQ, Croyle J. Utility of the Asperger Syndrome Diagnostic Scale in the Assessment of Autism Spectrum Disorders. J Autism Dev Disord 2020; 50:513-523. [DOI: 10.1007/s10803-019-04272-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Churruca K, Ellis LA, Long JC, Pomare C, Wiles LK, Arnolda G, Ting HP, Woolfenden S, Sarkozy V, de Wet C, Hibbert P, Braithwaite J. The Quality of Care for Australian Children with Autism Spectrum Disorders. J Autism Dev Disord 2019; 49:4919-4928. [PMID: 31473948 DOI: 10.1007/s10803-019-04195-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Knowledge about the quality of care delivered to children with autism spectrum disorders (ASD) in relation to that recommended by clinical practice guidelines (CPGs) is limited. ASD care quality indicators were developed from CPGs and validated by experts, then used to assess the quality of care delivered by general practitioners (GPs) and pediatricians in Australia. Data were retrospectively collected from the medical records of 228 children (≤ 15 years) with ASD for 2012-2013. Overall quality of care was high, but with considerable variation among indicators, and between GPs and pediatricians-e.g., GPs were less likely to complete the assessment care bundle (61%; 95% CI 21-92). Findings highlight potential areas for improvement in the need for standardized criteria for diagnosis.
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Affiliation(s)
- K Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia.
| | - L A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia
| | - J C Long
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia
| | - C Pomare
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia
| | - L K Wiles
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia.,Australian Centre for Precision Health, School of Health Sciences, University of South Australia Cancer Research Institute, University of South Australia, Level 8, North Terrace, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - G Arnolda
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia
| | - H P Ting
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia
| | - S Woolfenden
- Department of Community Child Health, Sydney Children's Hospitals Network, School of Women and Children's Health, University of New South Wales, Sydney Children's Hospital, Level 3, High Street, Randwick, NSW, 2031, Australia
| | - V Sarkozy
- Tumbatin Developmental Clinic, Sydney Children's Hospital Network, School of Women and Children's Health, University of New South Wales, Sydney Children's Hospital, High Street, Randwick, NSW, 2031, Australia
| | - C de Wet
- Healthcare Improvement Unit, Clinical Excellence Division, Queensland Health, Brisbane, Australia.,School of Medicine, Griffith University, Gold Coast, Gold Coast Campus, Brisbane, QLD, 4222, Australia
| | - P Hibbert
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia.,Australian Centre for Precision Health, School of Health Sciences, University of South Australia Cancer Research Institute, University of South Australia, Level 8, North Terrace, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - J Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia
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Rutherford M, Burns M, Gray D, Bremner L, Clegg S, Russell L, Smith C, O'Hare A. Improving Efficiency and Quality of the Children's ASD Diagnostic Pathway: Lessons Learned from Practice. J Autism Dev Disord 2019; 48:1579-1595. [PMID: 29189916 PMCID: PMC5889773 DOI: 10.1007/s10803-017-3415-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The 'autism diagnosis crisis' and long waiting times for assessment are as yet unresolved, leading to undue stress and limiting access to effective support. There is therefore a significant need for evidence to support practitioners in the development of efficient services, delivering acceptable waiting times and effectively meeting guideline standards. This study reports statistically significant reductions in waiting times for autism diagnostic assessment following a children's health service improvement programme. The average wait between referral and first appointment reduced from 14.2 to 10.4 weeks (t(21) = 4.3, p < 0.05) and between referral and diagnosis shared, reduced from 270 to 122.5 days, (t(20) = 5.5, p < 0.05). The proportion of girls identified increased from 5.6 to 2.7:1. Methods reported include: local improvement action planning; evidence based pathways; systematic clinical data gathering and a training plan. This is a highly significant finding for many health services wrestling with the challenges of demand and capacity for autism diagnosis and assessment.
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Affiliation(s)
- Marion Rutherford
- School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Edinburgh, Scotland, EH21 6UU, UK.
- NHS Lothian, Children's Services, Royal Hospital for Sick Children, 5 Rillbank Terrace, Edinburgh, EH9 1LS, UK.
| | - Morag Burns
- NHS Lothian, Children's Services, Royal Hospital for Sick Children, 5 Rillbank Terrace, Edinburgh, EH9 1LS, UK
| | - Duncan Gray
- NHS Lothian, Children's Services, Royal Hospital for Sick Children, 5 Rillbank Terrace, Edinburgh, EH9 1LS, UK
| | - Lynne Bremner
- School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Edinburgh, Scotland, EH21 6UU, UK
- NHS Lothian, Children's Services, Royal Hospital for Sick Children, 5 Rillbank Terrace, Edinburgh, EH9 1LS, UK
| | - Sarah Clegg
- NHS Lothian, Children's Services, Royal Hospital for Sick Children, 5 Rillbank Terrace, Edinburgh, EH9 1LS, UK
| | - Lucy Russell
- NHS Lothian, Children's Services, Royal Hospital for Sick Children, 5 Rillbank Terrace, Edinburgh, EH9 1LS, UK
| | - Charlie Smith
- Mental Health Access Improvement Team (MHAIST), Information Services Division (ISD), NHS Scotland, St Andrew's House, Waterloo Place, Edinburgh, UK
| | - Anne O'Hare
- Child Life & Health, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
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A Pilot Project Using Pediatricians as Initial Diagnosticians in Multidisciplinary Autism Evaluations for Young Children. J Dev Behav Pediatr 2019; 40:1-11. [PMID: 30461593 DOI: 10.1097/dbp.0000000000000621] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Wait times for autism spectrum disorder (ASD) evaluations are long, thereby delaying access to ASD-specific services. We asked how our traditional care model (requiring all patients to see psychologists for ASD diagnostic decisions) compared to an alternative model that better utilizes the available clinicians, including initial evaluation by speech, audiology, and pediatrics (trained in Level 2 autism screening tools). Pediatricians could diagnose immediately if certain about diagnosis but could refer uncertain cases to psychology. Accuracy and time to diagnosis, charges, and parent satisfaction were our main outcome measures. METHODS Data were gathered through record extraction (n = 244) and parent questionnaire (n = 57). We compared time to diagnosis, charges, and parent satisfaction between traditional and alternative models. Agreement between pediatrician and psychologist diagnoses was examined for a subset (n = 18). RESULTS The alternative model's time to diagnosis was 44% faster (85 vs 152 d) and 33% less costly overall. Diagnostic agreement was 93% for children with ASD diagnoses and 100% for children without ASD diagnoses. Pediatricians expressed higher diagnostic certainty about children with higher levels of ASD symptoms. Parents reported no differences in high satisfaction with experiences, family-centered care, and shared decision making. CONCLUSION Efficient use of available clinicians with additional training in Level 2 autism screening resulted in improvements in time to diagnosis and reduced charges for families. Coordination of multidisciplinary teams makes this possible, with strategic sequencing of patients through workflow. Flexibility was key to not only allowing pediatricians to refer uncertain cases to psychology for diagnosis but also allowing for diagnosis by a pediatrician when symptomatic presentation clearly met diagnostic criteria.
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Braithwaite J, Hibbert PD, Jaffe A, White L, Cowell CT, Harris MF, Runciman WB, Hallahan AR, Wheaton G, Williams HM, Murphy E, Molloy CJ, Wiles LK, Ramanathan S, Arnolda G, Ting HP, Hooper TD, Szabo N, Wakefield JG, Hughes CF, Schmiede A, Dalton C, Dalton S, Holt J, Donaldson L, Kelley E, Lilford R, Lachman P, Muething S. Quality of Health Care for Children in Australia, 2012-2013. JAMA 2018; 319:1113-1124. [PMID: 29558552 PMCID: PMC5885883 DOI: 10.1001/jama.2018.0162] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
IMPORTANCE The quality of routine care for children is rarely assessed, and then usually in single settings or for single clinical conditions. OBJECTIVE To estimate the quality of health care for children in Australia in inpatient and ambulatory health care settings. DESIGN, SETTING, AND PARTICIPANTS Multistage stratified sample with medical record review to assess adherence with quality indicators extracted from clinical practice guidelines for 17 common, high-burden clinical conditions (noncommunicable [n = 5], mental health [n = 4], acute infection [n = 7], and injury [n = 1]), such as asthma, attention-deficit/hyperactivity disorder, tonsillitis, and head injury. For these 17 conditions, 479 quality indicators were identified, with the number varying by condition, ranging from 9 for eczema to 54 for head injury. Four hundred medical records were targeted for sampling for each of 15 conditions while 267 records were targeted for anxiety and 133 for depression. Within each selected medical record, all visits for the 17 targeted conditions were identified, and separate quality assessments made for each. Care was evaluated for 6689 children 15 years of age and younger who had 15 240 visits to emergency departments, for inpatient admissions, or to pediatricians and general practitioners in selected urban and rural locations in 3 Australian states. These visits generated 160 202 quality indicator assessments. EXPOSURES Quality indicators were identified through a systematic search of local and international guidelines. Individual indicators were extracted from guidelines and assessed using a 2-stage Delphi process. MAIN OUTCOMES AND MEASURES Quality of care for each clinical condition and overall. RESULTS Of 6689 children with surveyed medical records, 53.6% were aged 0 to 4 years and 55.5% were male. Adherence to quality of care indicators was estimated at 59.8% (95% CI, 57.5%-62.0%; n = 160 202) across the 17 conditions, ranging from a high of 88.8% (95% CI, 83.0%-93.1%; n = 2638) for autism to a low of 43.5% (95% CI, 36.8%-50.4%; n = 2354) for tonsillitis. The mean adherence by condition category was estimated as 60.5% (95% CI, 57.2%-63.8%; n = 41 265) for noncommunicable conditions (range, 52.8%-75.8%); 82.4% (95% CI, 79.0%-85.5%; n = 14 622) for mental health conditions (range, 71.5%-88.8%); 56.3% (95% CI, 53.2%-59.4%; n = 94 037) for acute infections (range, 43.5%-69.8%); and 78.3% (95% CI, 75.1%-81.2%; n = 10 278) for injury. CONCLUSIONS AND RELEVANCE Among a sample of children receiving care in Australia in 2012-2013, the overall prevalence of adherence to quality of care indicators for important conditions was not high. For many of these conditions, the quality of care may be inadequate.
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Affiliation(s)
- Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter D. Hibbert
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Centre for Population Health Research, Sansom Institute for Health Research, The University of South Australia, Adelaide, South Australia, Australia
- Australian Patient Safety Foundation, Adelaide, South Australia, Australia
| | - Adam Jaffe
- School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Respiratory Medicine, Sydney Children’s Hospital, Sydney Children’s Hospital Network, Randwick, New South Wales, Australia
| | - Les White
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Discipline of Paediatrics, School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Children’s Hospital, Sydney Children’s Hospital Network, Randwick, New South Wales, Australia
| | - Christopher T. Cowell
- Kids Research Institute, Sydney Children’s Hospital Network, Westmead, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Mark F. Harris
- Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - William B. Runciman
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Centre for Population Health Research, Sansom Institute for Health Research, The University of South Australia, Adelaide, South Australia, Australia
- Australian Patient Safety Foundation, Adelaide, South Australia, Australia
| | - Andrew R. Hallahan
- Children’s Health Queensland Hospital and Health Service, Herston, Queensland, Australia
| | - Gavin Wheaton
- Division of Paediatric Medicine, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia
| | - Helena M. Williams
- Russell Clinic, Blackwood, South Australia, Australia
- Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
- Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
| | - Elisabeth Murphy
- New South Wales Ministry of Health, North Sydney, New South Wales, Australia
| | - Charlotte J. Molloy
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Centre for Population Health Research, Sansom Institute for Health Research, The University of South Australia, Adelaide, South Australia, Australia
| | - Louise K. Wiles
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Centre for Population Health Research, Sansom Institute for Health Research, The University of South Australia, Adelaide, South Australia, Australia
| | - Shanthi Ramanathan
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Centre for Population Health Research, Sansom Institute for Health Research, The University of South Australia, Adelaide, South Australia, Australia
| | - Gaston Arnolda
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Hsuen P. Ting
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Tamara D. Hooper
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Centre for Population Health Research, Sansom Institute for Health Research, The University of South Australia, Adelaide, South Australia, Australia
| | - Natalie Szabo
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Centre for Population Health Research, Sansom Institute for Health Research, The University of South Australia, Adelaide, South Australia, Australia
| | - John G. Wakefield
- Clinical Excellence Division, Queensland Department of Health, Brisbane, Queensland, Australia
| | - Clifford F. Hughes
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- International Society for Quality in Health Care, Dublin, Ireland
| | - Annette Schmiede
- Bupa Health Foundation Australia, Sydney, New South Wales, Australia
| | - Chris Dalton
- Bupa Health Foundation Australia, Sydney, New South Wales, Australia
| | - Sarah Dalton
- Sydney Children’s Hospital, Sydney Children’s Hospital Network, Randwick, New South Wales, Australia
- New South Wales Agency for Clinical Innovation, Chatswood, New South Wales, Australia
- Clinical Excellence Commission, Sydney, New South Wales, Australia
| | - Joanna Holt
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Liam Donaldson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- World Health Organization, Geneva, Switzerland
| | - Ed Kelley
- World Health Organization, Geneva, Switzerland
| | | | - Peter Lachman
- International Society for Quality in Health Care, Dublin, Ireland
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Are patients being evaluated for periprosthetic joint infection prior to referral to a tertiary care center? Arthroplast Today 2017; 4:216-220. [PMID: 29896556 PMCID: PMC5994562 DOI: 10.1016/j.artd.2017.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/30/2017] [Accepted: 10/01/2017] [Indexed: 11/24/2022] Open
Abstract
Background Patients with a painful or failed total joint arthroplasties should be evaluated for periprosthetic joint infection (PJI). The purpose of this study is to determine if patients referred to a tertiary care center had been evaluated for PJI according to the American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines. Methods One hundred thirteen patients with painful hip (43) or knee (70) arthroplasties were referred to a single provider by orthopaedic surgeons outside our practice between 2012 and 2014. We retrospectively evaluated the workup by referring physicians, including measurement of serum erythrocyte sedimentation rate and C-reactive protein, performance of a joint aspiration if these values were abnormal, and obtainment of synovial fluid white blood cell count, differential, and cultures. Results Sixty-two of 113 patients (55%) did not have a workup that followed AAOS guidelines. Serum erythrocyte sedimentation rate and C-reactive protein were ordered for 64 of the 113 patients (57%). Of 25 patients with elevated inflammatory markers warranting aspiration, 15 (60%) had an aspiration attempted, with synovial fluid white blood cell, differential, and cultures obtained in 9 of 12 (75%) aspirations that yielded fluid. Of the 62 patients with an incomplete infection workup, 11 (18%) had a bone scan, 6 (10%) a computed tomography scan, and 3 (5%) a magnetic resonance imaging. Twelve of the 113 patients (11%) were ultimately diagnosed with PJI, with 5 undiagnosed prior to referral. Conclusions The AAOS guidelines to evaluate for PJI are frequently not being followed. Improving awareness of these guidelines may avoid unnecessary and costly evaluations and delay in the diagnosis of PJI.
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Hedley D, Nevill RE, Monroy-Moreno Y, Fields N, Wilkins J, Butter E, Mulick JA. Efficacy of the ADEC in Identifying Autism Spectrum Disorder in Clinically Referred Toddlers in the US. J Autism Dev Disord 2016; 45:2337-48. [PMID: 25737020 DOI: 10.1007/s10803-015-2398-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Autism Detection in Early Childhood (ADEC) is a brief, play-based screening tool for the assessment of autism spectrum disorder (ASD) in children aged 12-36 months. We examined the psychometric properties of the ADEC in a clinical sample of toddlers (n = 114) referred to a US pediatric hospital for assessment due to concerns of developmental delay or ASD. The ADEC (cutoff = 11) returned good sensitivity (.93-.94) but poorer specificity (.62-.64) for best estimate clinical diagnosis of ASD, and compared favorably with the ADOS-2. Internal consistency was acceptable, α = .80, and inter-rater reliability was high, ICC = .95. Results support the use of the ADEC as a clinical screen for ASD.
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Affiliation(s)
- Darren Hedley
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University, Bundoora, VIC, 3086, Australia,
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Oetgen ME, Blatz AM, Matthews A. Impact of Clinical Practice Guideline on the Treatment of Pediatric Femoral Fractures in a Pediatric Hospital. J Bone Joint Surg Am 2015; 97:1641-6. [PMID: 26491127 DOI: 10.2106/jbjs.o.00161] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Clinical practice guidelines are being developed for a number of topics in medicine to decrease practice variability and to improve evidenced-based care. Within orthopaedic surgery, the American Academy of Orthopaedic Surgeons (AAOS) has a dedicated committee that produces these clinical practice guidelines on a variety of issues. One such issue was the treatment of pediatric diaphyseal femoral fractures, with the clinical practice guideline being published in 2009. We performed a retrospective review of the treatment of pediatric diaphyseal femoral fractures at a single institution from 2007 to 2012 to assess the clinical impact of this clinical practice guideline on the treatment of this condition. METHODS A retrospective review of all patients treated at a single pediatric hospital between 2007 and 2012 for a pediatric diaphyseal femoral fracture was conducted. The 2009 AAOS clinical practice guideline on the treatment of this condition was assessed and each patient record was analyzed to determine if the clinical practice guideline was followed, based on the age-specific recommendations. The percentage of treatment rendered adhering to the clinical practice guideline recommendations was compared in the pre-guideline group (prior to June 2009) and the post-guideline group (after June 2009). RESULTS A total of 361 patients were treated for a diaphyseal femoral fracture during this time frame and were included in this study. Overall, little change in treatment was found following the publication of this clinical practice guideline. The only significant change noted over this time period was a decrease (p = 0.03) in the percentage of patients between the ages of five and eleven years who were treated with flexible nails, at odds with this specific clinical practice guideline recommendation. CONCLUSIONS We found little direct clinical impact of the recently published AAOS clinical practice guideline on the treatment of pediatric diaphyseal femoral fractures. This analysis suggests an important role for clinical assessment after guideline publication to identify areas of potentially important future clinical research and to assess the utility of this guideline.
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Affiliation(s)
- Matthew E Oetgen
- Department of Orthopaedic Surgery and Sports Medicine, Children's National Medical Center, 111 Michigan Avenue N.W., W1.5, Suite 400, Washington, DC 20010. E-mail address for M.E. Oetgen:
| | - Allison M Blatz
- The George Washington University School of Medicine, Ross Hall, 2300 Eye Street N.W., Washington, DC 20037
| | - Allison Matthews
- Department of Orthopaedic Surgery and Sports Medicine, Children's National Medical Center, 111 Michigan Avenue N.W., W1.5, Suite 400, Washington, DC 20010. E-mail address for M.E. Oetgen:
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