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Abell B, Rodwell D, Eagleson KJ, Parsonage W, Auld B, Bora S, Kasparian NA, Justo R, McPhail SM. "It's more than just a conversation about the heart": exploring barriers, enablers, and opportunities for improving the delivery and uptake of cardiac neurodevelopmental follow-up care. Front Pediatr 2024; 12:1364190. [PMID: 38863525 PMCID: PMC11165703 DOI: 10.3389/fped.2024.1364190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/08/2024] [Indexed: 06/13/2024] Open
Abstract
Introduction Surveillance, screening, and evaluation for neurodevelopmental delays is a pivotal component of post-surgical care for children with congenital heart disease (CHD). However, challenges exist in implementing such neurodevelopmental follow-up care in international practice. This study aimed to characterise key barriers, enablers, and opportunities for implementing and delivering outpatient cardiac neurodevelopmental follow-up care in Australia. Methods an exploratory descriptive qualitative study was conducted with healthcare professionals across Australia who had lived experience of designing, implementing, or delivering neurodevelopmental care for children with CHD. Online semi-structured interviews were conducted using a guide informed by the Consolidated Framework for Implementation Research to explore contextual influences. Interview transcripts were analysed using a rapid qualitative approach including templated summaries and hybrid deductive-inductive matrix analysis. Results fifty-two participants were interviewed. Perceived barriers and enablers were organised into six higher-order themes: factors in the broader environmental, economic, and political context; healthcare system factors; organisational-level factors; provider factors; patient and family factors; and care model factors. The largest number of barriers occurred at the healthcare system level (service accessibility, fragmentation, funding, workforce), while service providers demonstrated the most enabling factors (interprofessional relationships, skilled teams, personal characteristics). Strategies to improve practice included building partnerships; generating evidence; increasing funding; adapting for family-centred care; and integrating systems and data. Discussion Australia shares many similar barriers and enablers to cardiac neurodevelopmental care with other international contexts. However, due to unique geographical and health-system factors, care models and implementation strategies will require adaption to the local context to improve service provision.
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Affiliation(s)
- Bridget Abell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Facultyof Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - David Rodwell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Facultyof Health, Queensland University of Technology, Brisbane, QLD, Australia
- Centre for Accident Research & Road Safety—Queensland (CARRS-Q), School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Karen J. Eagleson
- Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, South Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - William Parsonage
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Facultyof Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Ben Auld
- Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, South Brisbane, QLD, Australia
| | - Samudragupta Bora
- Health Services Research Center, University Hospitals Research & Education Institute and Department of Pediatrics, University Hospitals Rainbow Babies & Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Nadine A. Kasparian
- Heart and Mind Wellbeing Center, Heart Institute and the Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Robert Justo
- Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, South Brisbane, QLD, Australia
| | - Steven M. McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Facultyof Health, Queensland University of Technology, Brisbane, QLD, Australia
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Bolduc ME, Rennick JE, Gagnon I, Sokol E, Majnemer A, Brossard-Racine M. Navigating the healthcare system with my child with CHD: parental perspectives on developmental follow-up practices. Cardiol Young 2024; 34:37-43. [PMID: 37138527 DOI: 10.1017/s1047951123001051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Parents of children with CHD face several barriers when trying to access the services needed to support their child's development. In fact, current developmental follow-up practices may not identify developmental challenges in a timely manner and important opportunities for interventions may be lost. This study aimed to explore the perspectives of parents of children and adolescents with CHD with respect to developmental follow-up in Canada. METHODS Interpretive description was used as a methodological approach for this qualitative study. Parents of children aged 5-15 years with complex CHD were eligible. Semi-structured interviews that aimed to explore their perspectives regarding their child's developmental follow-up were conducted. RESULTS Fifteen parents of children with CHD were recruited for this study. They expressed that the lack of systematic and responsive developmental follow-up services and limited access to resources to support their child's development placed an undue burden on their families, and as a result, they needed to assume new roles as case managers or advocates to address these limitations. This additional burden resulted in a high level of parental stress, which, in turn, affected the parent-child relationship and siblings. CONCLUSIONS The limitations of the current Canadian developmental follow-up practices put undue pressure on the parents of children with complex CHD. The parents stressed the importance of implementing a universal and systematic approach to developmental follow-up to allow for the timely identification of challenges, enabling the initiation of interventions and supports and promoting more positive parent-child relationships.
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Affiliation(s)
- Marie-Eve Bolduc
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Janet E Rennick
- Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Nursing, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada
- Ingram School of Nursing, McGill University, Montreal, Canada
- Department of Pediatrics, McGill University, Montreal, Canada
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Eva Sokol
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Annette Majnemer
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Pediatrics, McGill University, Montreal, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Marie Brossard-Racine
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Pediatrics, McGill University, Montreal, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
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Bolduc ME, Rennick JE, Gagnon I, Sokol E, Brossard-Racine M, Majnemer A. Identifying developmental challenges of youth with congenital heart defects: A patient-oriented perspective. Child Care Health Dev 2023; 49:258-267. [PMID: 35945137 DOI: 10.1111/cch.13037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/08/2022] [Accepted: 08/01/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Youth with congenital heart disease (CHD) are at high risk for a range of developmental impairments that become evident at different times across childhood and adolescence. This study aimed to explore perspectives of youth with CHD with respect to their developmental follow-up across childhood. METHODS Interpretive description was used as a methodological approach for this qualitative study. Youth aged 12-22 years with CHD requiring open-heart surgery before 2 years of age and who had received health services in Canada since birth were enrolled. RESULTS Ten youth with CHD, two males and eight females, aged 13-22 years (mean 19.8) participated in this study. With higher social and academic demands as well as increased level of autonomy associated with older age, some youth faced new challenges that they had not encountered as children. Youth with CHD identified four aspects of the continuum of care as needing to be changed to better respond to their needs. First, the format of developmental follow-up needs to be adapted to their unique challenges. Second, resources must be more easily accessible throughout childhood and adolescence. Third, planning for transition to adult care is essential to ensure continuity of services. Finally, they identified that the school system is an essential component of the continuum of care. CONCLUSIONS Adolescents and young adults with CHD are at high risk of developing physical, academic and psychosocial challenges; however, timely identification of challenges does not appear to be optimal across domains and transition points, from the perspective of the youth themselves. Youth with CHD reported not having the resources and supports they required to optimize their functioning. Our findings suggest that several approaches could be adopted to enhance identification and outcomes to address the limitations of current Canadian practices.
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Affiliation(s)
- Marie-Eve Bolduc
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Janet E Rennick
- Research Institute of the McGill University Health Centre, Montreal, Canada.,Department of Nursing, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada.,Ingram School of Nursing, McGill University, Montreal, Canada.,Department of Pediatrics, McGill University, Montreal, Canada
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Research Institute of the McGill University Health Centre, Montreal, Canada
| | | | - Marie Brossard-Racine
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Research Institute of the McGill University Health Centre, Montreal, Canada.,Department of Pediatrics, McGill University, Montreal, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Annette Majnemer
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Research Institute of the McGill University Health Centre, Montreal, Canada.,Department of Pediatrics, McGill University, Montreal, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
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Neurodevelopmental Outcomes in Children with Congenital Heart Disease: Ten Years After the American Heart Association Statement. Clin Perinatol 2023; 50:53-66. [PMID: 36868713 DOI: 10.1016/j.clp.2022.10.002] [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: 03/05/2023]
Abstract
Even before birth, children with congenital heart disease (CHD) are at risk for neurodevelopmental concerns, with additional insults occurring as part of their treatment course and from subsequent exposures to socioeconomic stressors. With multiple affected neurodevelopmental domains, individuals with CHD face lifelong cognitive, academic, psychological, and quality-of-life difficulties. Early and repeated neurodevelopmental evaluation is key to receiving appropriate services. However, obstacles at the level of the environment, provider, patient, and family can make the completion of these evaluations difficult. Future neurodevelopmental endeavors should aim to evaluate CHD-specific programs, their effectiveness, and barriers to access.
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Lee FT, Sun L, Freud L, Seed M. A guide to prenatal counseling regarding neurodevelopment in congenital heart disease. Prenat Diagn 2022; 43:661-673. [PMID: 36575573 DOI: 10.1002/pd.6292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 12/07/2022] [Accepted: 12/17/2022] [Indexed: 12/29/2022]
Abstract
Advances in cardiac surgical techniques taking place over the past 50 years have resulted in the vast majority of children born with congenital cardiac malformations now surviving into adulthood. As the focus shifts from survival to the functional outcomes of our patients, it is increasingly being recognized that a significant proportion of patients undergoing infant cardiac repair experience adverse neurodevelopmental (ND) outcomes. The etiology of abnormal brain development in the setting of congenital heart disease is poorly understood, complex, and likely multifactorial. Furthermore, the efficacy of therapies available for the learning disabilities, attention deficit, and hyperactivity disorders and other ND deficits complicating congenital heart disease is currently uncertain. This situation presents a challenge for prenatal counseling as current antenatal testing does not usually provide prognostic information regarding the likely ND trajectories of individual patients. However, we believe it is important for parents to be informed about potential issues with child development when a new diagnosis of congenital heart disease is disclosed. Parents deserve a comprehensive and thoughtful approach to this subject, which conveys the uncertainties involved in predicting the severity of any developmental disorders encountered, while emphasizing the improvements in outcomes that have already been achieved in infants with congenital heart disease. A balanced approach to counseling should also discuss what local arrangements are in place for ND follow-up. This review presents an up-to-date overview of ND outcomes in patients with congenital heart disease, providing possible approaches to communicating this information to parents during prenatal counseling in a sensitive and accurate manner.
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Affiliation(s)
- Fu-Tsuen Lee
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Translational Medicine Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Liqun Sun
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Translational Medicine Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Lindsay Freud
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Translational Medicine Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Mike Seed
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Translational Medicine Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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6
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deRegnier RA. Disparities in Neurodevelopmental Services Between Children with Congenital Heart Disease and Children Born Very Preterm. J Pediatr 2022; 250:9-10. [PMID: 35944712 DOI: 10.1016/j.jpeds.2022.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/29/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Raye-Ann deRegnier
- Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
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7
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Bolduc ME, Rennick JE, Gagnon I, Majnemer A, Brossard-Racine M. Canadian Developmental Follow-up Practices in Children With Congenital Heart Defects: A National Environmental Scan. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2022; 1:3-10. [PMID: 37969558 PMCID: PMC10642138 DOI: 10.1016/j.cjcpc.2021.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2023]
Abstract
Background Developmental follow-up is central to the timely identification of delays in at-risk children. Throughout Canada, data are currently lacking on the follow-up of children with congenital heart disease (CHD) after open-heart surgery. The objective of this study was to describe current Canadian developmental follow-up practices and to explore barriers to optimal follow-up. Methods A cross-sectional study was implemented with health professionals involved with the developmental follow-up of children with CHD in the 8 specialized hospitals that perform pediatric open-heart surgery in Canada. A questionnaire collected descriptive information about the setting and current follow-up practices. In addition, an interview was conducted to explore what would be considered optimal developmental follow-up in Canada and identify potential barriers. Results Four of the 8 tertiary care centres had a systematic developmental follow-up program that included screening and formal evaluation. These programs were only accessible to a subset of children with CHD identified to be at higher risk. Participants described current practices as suboptimal and aimed to develop a more systematic developmental follow-up program or expand an existing one. Participants emphasized the lack of human resources, financial supports, and limited dedicated time as major barriers to offering optimal follow-up care. Conclusions Current follow-up practices in Canada are considered suboptimal by health care specialists involved in treating children with CHD. These practices may fail to promptly identify children and adolescents with CHD who have developmental challenges. It is essential that we develop national recommendations to optimize the developmental follow-up practices in Canada for this high-risk population.
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Affiliation(s)
- Marie-Eve Bolduc
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
- Advances in Brain and Child Development Research Laboratory, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Janet E. Rennick
- Department of Nursing, The Montreal Children’s Hospital, McGill University Health Centre, Montréal, Québec, Canada
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
| | - Annette Majnemer
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada
| | - Marie Brossard-Racine
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
- Advances in Brain and Child Development Research Laboratory, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada
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8
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Commentary on "Motor Developmental Delay After Cardiac Surgery in Children With a Critical Congenital Heart Defect: A Systematic Literature Review and Meta-analysis". Pediatr Phys Ther 2021; 33:198-199. [PMID: 34618743 DOI: 10.1097/pep.0000000000000839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Lee TL, Ronai C, Saxton SN, Madriago E. Congenital heart disease and neurodevelopmental evaluation: National guidelines vs. single center utilization. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Peterson JK, Casida J. Critical Care Clinical Nurse Specialist Role in Developmental Care for Infants With Heart Disease. AACN Adv Crit Care 2021; 32:204-208. [PMID: 34161962 DOI: 10.4037/aacnacc2021425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Jennifer K Peterson
- Jennifer K. Peterson is Assistant Professor, Johns Hopkins University School of Nursing, 525 N Wolfe Street, Baltimore, MD 21205
| | - Jesus Casida
- Jesus Casida is Associate Professor, Johns Hopkins University School of Nursing, Baltimore, Maryland
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Utilisation of early intervention services in infants with congenital heart disease following open-heart surgery. Cardiol Young 2021; 31:786-791. [PMID: 33377857 DOI: 10.1017/s1047951120004655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the use of early intervention services in infants with CHD after open-heart surgery and identify factors associated with receipt of services. STUDY DESIGN Surveys were administered to caregivers of infants who underwent open-heart surgery before 1 year of age at a single institution between July, 2017 and July, 2018. Information regarding the infant's use of early intervention services and the caregiver's experience with the programme was obtained. Clinical data were retrieved from the medical record review. Logistic regression identified factors associated with receipt of services. RESULTS The study included 158 eligible infants. Ninety-eight caregivers (62%) completed the surveys. Of those surveyed, 53.1% of infants were currently or previously enrolled in early intervention services. Infants most frequently received physical therapy (76.9%). The majority of caregivers found services to be moderately/very helpful (92.3%) and sufficient for their child (76.9%). In the univariate analysis, single-ventricle disease, known syndrome/genetic abnormality, extracardiac anomaly, and longer intensive care and hospital length of stay were associated with receipt of services. Single-ventricle disease (p = 0.004) and known syndrome/genetic abnormality (p < 0.0001) remained independently associated with receipt of services in the multivariable analysis. CONCLUSION Amongst infants at risk for neurodevelopmental deficits, approximately half received services after open-heart surgery. Caregivers expressed satisfaction with the programme. While infants with single-ventricle disease and a known syndrome/genetic abnormality were more likely to receive early intervention services, many at-risk infants with CHD failed to receive services. Further research is needed to identify barriers to early intervention services and promote developmental outcomes.
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Bolduc ME, Dionne E, Gagnon I, Rennick JE, Majnemer A, Brossard-Racine M. Motor Impairment in Children With Congenital Heart Defects: A Systematic Review. Pediatrics 2020; 146:peds.2020-0083. [PMID: 33208496 DOI: 10.1542/peds.2020-0083] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT With improvements in survival rates in newborns with congenital heart defects (CHDs), focus has now shifted toward enhancing neurodevelopmental outcomes across their life span. OBJECTIVE To systematically review the prevalence and extent of motor difficulties in infants, children, and adolescents with CHD requiring open-heart surgery. DATA SOURCES Data sources included Embase, Medline and the Cumulative Index to Nursing and Allied Health Literature. STUDY SELECTION Original studies published between 1997 and 2019 examining gross and/or fine motor skills in children born with a CHD requiring open-heart surgery were selected. DATA EXTRACTION The prevalence of motor impairments and mean scores on standardized motor assessments were extracted. Findings were grouped in 5 categories on the basis of the age of the children. RESULTS Forty-six original studies were included in this systematic review. The prevalence of mild to severe motor impairments (scores <-1 SD below normative data or controls) across childhood ranged from 12.3% to 68.6%, and prevalence ranged from 0% to 60.0% for severe motor impairments (<-2 SDs). Although our results suggest that the overall prevalence of motor impairments <-1 SD remains rather constant across childhood and adolescence, severe motor impairments (<-2 SDs) appear to be more prevalent in younger children. LIMITATIONS Variability in sampling and methodology between the reviewed studies is the most important limitation of this review. CONCLUSIONS The results of this review highlight that infants with CHD have an increased risk of motor impairments across infancy, childhood, and adolescence. These findings stress the importance of systematic screening or evaluation of motor skills across childhood and adolescence in children with CHD.
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Affiliation(s)
- Marie-Eve Bolduc
- School of Physical and Occupational Therapy.,Advances in Brain and Child Development Research Laboratory, The Research Institute of the McGill University Health Centre, Montreal, Canada; and
| | - Eliane Dionne
- School of Physical and Occupational Therapy.,Advances in Brain and Child Development Research Laboratory, The Research Institute of the McGill University Health Centre, Montreal, Canada; and
| | | | - Janet E Rennick
- Ingram School of Nursing, and.,Departments of Pediatrics and.,Department of Nursing, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada
| | - Annette Majnemer
- School of Physical and Occupational Therapy.,Departments of Pediatrics and.,Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Marie Brossard-Racine
- School of Physical and Occupational Therapy, .,Departments of Pediatrics and.,Neurology and Neurosurgery, McGill University, Montreal, Canada.,Advances in Brain and Child Development Research Laboratory, The Research Institute of the McGill University Health Centre, Montreal, Canada; and
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Aparicio Rodrigo M, Ruiz Canela J, Buñuel Álvarez JC, García Vera C, Esparza Olcina MJ, Barroso Espadero D, González Rodríguez P, Juanes Toledo B, Martínez Rubio V, Ortega Páez E. Paediatricians provide higher quality care to children and adolescents in primary care: A systematic review. Acta Paediatr 2020; 109:1989-2007. [PMID: 32311805 DOI: 10.1111/apa.15324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 02/26/2020] [Accepted: 04/17/2020] [Indexed: 11/29/2022]
Abstract
AIM The number of primary care paediatricians is decreasing in Europe without a justifiable reason. We aimed to compare the clinical practice of paediatricians and family doctors attending children and adolescents in primary care. METHODS MEDLINE, Embase, CENTRAL, TRIP and Google Scholar were searched from December 2008 to February 2018. No language or study design restrictions were applied. Three reviewers assessed eligibility of the studies. Seven pairs of reviewers performed the data extraction and assessed the methodological quality independently. Discrepancies were resolved by consensus. RESULTS Fifty-four, out of 1150 studies preselected, were included. We found that paediatricians show more appropriate pharmacology prescription patterns for the illness being treated; they achieve higher vaccination rates and have better knowledge of vaccines and fewer doubts about vaccine safety; their knowledge and implementation of different screening tests are better; they prescribe psychoactive drugs more cautiously and more in line with current practice guidelines; their evaluation and treatment of obesity and lipid disorders follow criteria more consistently with current clinical practice guidelines; and they perform fewer diagnostic test, show a more suitable use of the test and request fewer referrals to specialists. CONCLUSION According to published data, in developed countries, paediatricians provide higher quality care to children than family doctors.
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Glotzbach KL, Ward JJ, Marietta J, Eckhauser AW, Winter S, Puchalski MD, Miller TA. The Benefits and Bias in Neurodevelopmental Evaluation for Children with Congenital Heart Disease. Pediatr Cardiol 2020; 41:327-333. [PMID: 31865442 DOI: 10.1007/s00246-019-02260-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022]
Abstract
Neurodevelopmental (ND) impairment is common in children with congenital heart disease (CHD). While routine ND surveillance and evaluation of high-risk patients has become the standard-of-care, capture rate, barriers to referral, and potential patient benefits remain incompletely understood. Electronic data warehouse records from a single center were reviewed to identify all eligible and evaluated patients between July 2015 and December 2017 based on current guidelines for ND screening in CHD. Diagnoses, referring provider, and payor were considered. Potential benefit of the evaluation was defined as receipt of new diagnosis, referral for additional evaluation, or referral for a new service. Contingencies were assessed with Fisher's exact test. In this retrospective, cohort study, of 3434 children identified as eligible for ND evaluation, 135 were evaluated (4%). Appropriate evaluation was affected by diagnostic bias against coarctation of the aorta (CoArc) and favoring hypoplastic left heart syndrome (HLHS) (1.8 vs. 11.9%, p<0.01). Referrals were disproportionally made by a select group of cardiologists, and the rate of ND appointment non-compliance was higher in self-pay compared to insured patients (78% vs 27%, p<0.01). Potential benefit rate was 70-80% amongst individuals with the three most common diagnoses requiring neonatal surgery (CoArc, transposition of the great arteries, and HLHS). Appropriate ND evaluation in CHD is impacted by diagnosis, provider, and insurance status. Potential benefit of ND evaluation is high regardless of diagnosis. Strategies to improve access to ND evaluations and provider understanding of the at-risk population will likely improve longitudinal ND surveillance and clinical benefit.
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Affiliation(s)
- Kristi L Glotzbach
- Department of Pediatrics, Division of Critical Care Medicine, University of Utah, Salt Lake City, UT, USA.
| | - John J Ward
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jennifer Marietta
- Department of Pediatrics, Division of Cardiology, University of Utah, Salt Lake City, UT, USA
| | - Aaron W Eckhauser
- Department of Surgery, Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Sarah Winter
- Department of Pediatrics, Division of General Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Michael D Puchalski
- Department of Pediatrics, Division of Cardiology, University of Utah, Salt Lake City, UT, USA
| | - Thomas A Miller
- Department of Pediatrics, Division of Cardiology, University of Utah, Salt Lake City, UT, USA
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15
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Davis S, Crerand C, Hutaff-Lee C, Thompson T, Tishelman A, Samara O, Umbaugh H, Nahata L, Kremen J. Neurodevelopmental and Mental Health Screening for Patients with Turner Syndrome in Pediatric Endocrine Clinics: Results of a Pediatric Endocrine Society Survey. Horm Res Paediatr 2020; 93:643-650. [PMID: 33915553 PMCID: PMC8205091 DOI: 10.1159/000516126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/25/2021] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION International Turner syndrome (TS) Clinical Practice Guidelines recommend screening for neurodevelopmental (ND) and mental health (MH) concerns in girls with TS; however, it remains unclear whether this is implemented in current practice. The objective of this mixed methods study was to assess screening practices for ND and MH in girls with TS from the perspective of pediatric endocrinologists. METHODS Pediatric Endocrine Society members who provide care for girls with TS were invited to complete an electronic survey on screening practices. Descriptive statistics were used to summarize quantitative results concurrently with thematic analysis of free-text survey responses. RESULTS A total of 124 surveys were completed (86% attending pediatric endocrinologists, 81% at academic institutions). Overall, 25% of providers reported their patients with TS received both ND and MH screenings. Only 9 (9%) respondents endorsed screening for ND concerns themselves, while more providers (26%) reported they screen for MH concerns. Multiple barriers to screening for ND and MH concerns within the clinical setting were endorsed. Nearly all providers (>93%) reported they would consider using a short, validated screening tool for ND and MH concerns if such tools were available. DISCUSSION A minority of pediatric endocrinologists currently perform ND or MH screening for patients with TS, however, many would be interested in implementing a brief screening tool into their clinical practice. Given almost all girls with a TS diagnosis receive care from pediatric endocrinologists at least annually, this may be an effective method to increase the proportion of girls with TS who receive recommended screenings.
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Affiliation(s)
- Shanlee Davis
- Department of Pediatrics, University of Colorado School of
Medicine, Anschutz Medical Campus, Aurora, CO, USA,eXtraOrdinary Kids Turner Syndrome Clinic,
Children’s Hospital Colorado, Aurora, CO, USA
| | - Canice Crerand
- Center for Biobehavioral Health, The Abigail Wexner
Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA,Department of Pediatrics, The Ohio State University College
of Medicine, Columbus, OH, USA
| | - Christa Hutaff-Lee
- Department of Pediatrics, University of Colorado School of
Medicine, Anschutz Medical Campus, Aurora, CO, USA,eXtraOrdinary Kids Turner Syndrome Clinic,
Children’s Hospital Colorado, Aurora, CO, USA
| | - Talia Thompson
- Department of Pediatrics, University of Colorado School of
Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Amy Tishelman
- Department of Pediatrics, Harvard Medical School, Boston,
MA, USA,Division of Endocrinology, Boston Children’s
Hospital, Boston, MA, USA
| | - Omar Samara
- Department of Pediatrics, University of Colorado School of
Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Hailey Umbaugh
- Department of Pediatrics, The Ohio State University College
of Medicine, Columbus, OH, USA
| | - Leena Nahata
- Center for Biobehavioral Health, The Abigail Wexner
Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA,Department of Pediatrics, The Ohio State University College
of Medicine, Columbus, OH, USA
| | - Jessica Kremen
- Department of Pediatrics, Harvard Medical School, Boston,
MA, USA,Division of Endocrinology, Boston Children’s
Hospital, Boston, MA, USA
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16
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Howell HB, Zaccario M, Kazmi SH, Desai P, Sklamberg FE, Mally P. Neurodevelopmental outcomes of children with congenital heart disease: A review. Curr Probl Pediatr Adolesc Health Care 2019; 49:100685. [PMID: 31708366 DOI: 10.1016/j.cppeds.2019.100685] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Congenital heart defects are the most common birth anomaly affecting approximately 1% of births. With improved survival in this population, there is enhanced ability to assess long-term morbidities including neurodevelopment. There is a wide range of congenital heart defects, from those with minimal physiologic consequence that do not require medical or surgical intervention, to complex structural anomalies requiring highly specialized medical management and intricate surgical repair or palliation. The impact of congenital heart disease on neurodevelopment is multifactorial. Susceptibility for adverse neurodevelopment increases with advancing severity of the defect with initial risk factors originating during gestation. Complex structural heart anomalies may pre-dispose the fetus to abnormal circulatory patterns in utero that ultimately impact delivery of oxygen rich blood to the fetal brain. Thus, the brain of a neonate born with complex congenital heart disease may be particularly vulnerable from the outset. That vulnerability is compounded during the newborn period and through childhood, as this population endures a myriad of medical and surgical interventions. For each individual patient, these factors are likely cumulative and synergistic with progression from fetal life through childhood. This review discusses the spectrum of risk factors that may impact neurodevelopment in children with congenital heart disease, describes current recommendations and practices for neurodevelopmental follow-up of children with congenital heart disease and reviews important neurodevelopmental trends in this high risk population.
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Affiliation(s)
- Heather B Howell
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA.
| | - Michele Zaccario
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA; Pace University, Department of Psychology, 41 Park Row, New York, NY 10038 USA
| | - Sadaf H Kazmi
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA
| | - Purnahamsi Desai
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA
| | - Felice E Sklamberg
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA
| | - Pradeep Mally
- New York University School of Medicine, Department of Pediatrics, 317 East 34th Street, Suite 902, New York, NY 10016, USA
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17
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Verrall CE, Blue GM, Loughran-Fowlds A, Kasparian N, Gecz J, Walker K, Dunwoodie SL, Cordina R, Sholler G, Badawi N, Winlaw D. 'Big issues' in neurodevelopment for children and adults with congenital heart disease. Open Heart 2019; 6:e000998. [PMID: 31354955 PMCID: PMC6615801 DOI: 10.1136/openhrt-2018-000998] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/18/2019] [Accepted: 04/26/2019] [Indexed: 12/12/2022] Open
Abstract
It is established that neurodevelopmental disability (NDD) is common in neonates undergoing complex surgery for congenital heart disease (CHD); however, the trajectory of disability over the lifetime of individuals with CHD is unknown. Several ‘big issues’ remain undetermined and further research is needed in order to optimise patient care and service delivery, to assess the efficacy of intervention strategies and to promote best outcomes in individuals of all ages with CHD. This review article discusses ‘gaps’ in our knowledge of NDD in CHD and proposes future directions.
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Affiliation(s)
- Charlotte E Verrall
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia
| | - Gillian M Blue
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia
| | - Alison Loughran-Fowlds
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia.,Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Nadine Kasparian
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Jozef Gecz
- Faculty of Health and Medical Sciences, University of Adelaide School of Medicine, Adelaide, South Australia, Australia
| | - Karen Walker
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Sally L Dunwoodie
- Developmental and Stem Cell Biology Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia.,Faculties of Medicine and Science, University of New South Wales, Sydney, NSW, Australia
| | - Rachael Cordina
- Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Discipline of Medicine, Sydney Medical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia
| | - Gary Sholler
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia
| | - Nadia Badawi
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia.,Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - David Winlaw
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia
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18
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Monteiro SA, Serrano F, Tsang R, Smith Hollier E, Guffey D, Noll L, Voigt RG, Ghanayem N, Shekerdemian L. Ancillary referral patterns in infants after initial assessment in a cardiac developmental outcomes clinic. CONGENIT HEART DIS 2019; 14:797-802. [DOI: 10.1111/chd.12789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/04/2019] [Accepted: 04/21/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Faridis Serrano
- Department of Pediatrics Baylor College of Medicine Houston Texas
| | - Rocky Tsang
- Department of Pediatrics Baylor College of Medicine Houston Texas
| | | | - Danielle Guffey
- Dan L Duncan Institute for Clinical and Translational Research Baylor College of Medicine Houston Texas
| | - Lisa Noll
- Department of Pediatrics Baylor College of Medicine Houston Texas
| | - Robert G. Voigt
- Department of Pediatrics Baylor College of Medicine Houston Texas
| | - Nancy Ghanayem
- Department of Pediatrics Baylor College of Medicine Houston Texas
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19
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Verrall CE, Walker K, Loughran-Fowlds A, Prelog K, Goetti R, Troedson C, Ayer J, Egan J, Halliday R, Orr Y, Sholler GF, Badawi N, Winlaw DS. Contemporary incidence of stroke (focal infarct and/or haemorrhage) determined by neuroimaging and neurodevelopmental disability at 12 months of age in neonates undergoing cardiac surgery utilizing cardiopulmonary bypass†. Interact Cardiovasc Thorac Surg 2017; 26:644-650. [DOI: 10.1093/icvts/ivx375] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/27/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Charlotte E Verrall
- Heart Centre for Children, The Children’s Hospital at Westmead, Sydney, Australia
| | - Karen Walker
- Grace Centre for Newborn Care, The Children’s Hospital at Westmead, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
- Cerebral Palsy Alliance, Sydney, Australia
| | - Alison Loughran-Fowlds
- Grace Centre for Newborn Care, The Children’s Hospital at Westmead, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Kristina Prelog
- Department of Medical Imaging, The Children’s Hospital at Westmead, Sydney, Australia
| | - Robert Goetti
- Department of Medical Imaging, The Children’s Hospital at Westmead, Sydney, Australia
| | | | - Julian Ayer
- Heart Centre for Children, The Children’s Hospital at Westmead, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Jonathan Egan
- Sydney Medical School, University of Sydney, Sydney, Australia
- Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, Australia
| | - Robert Halliday
- Grace Centre for Newborn Care, The Children’s Hospital at Westmead, Sydney, Australia
| | - Yishay Orr
- Heart Centre for Children, The Children’s Hospital at Westmead, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Gary F Sholler
- Heart Centre for Children, The Children’s Hospital at Westmead, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Nadia Badawi
- Grace Centre for Newborn Care, The Children’s Hospital at Westmead, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
- Cerebral Palsy Alliance, Sydney, Australia
| | - David S Winlaw
- Heart Centre for Children, The Children’s Hospital at Westmead, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
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20
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Joshi NS, Lucas BP, Schroeder AR. Physician Preferences Surrounding Urinary Tract Infection Management in Neonates. Hosp Pediatr 2017; 8:21-27. [PMID: 29196453 DOI: 10.1542/hpeds.2017-0082] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Variability exists in the treatment of neonates with urinary tract infection (UTI), potentially reflecting an overuse of resources. A cross-sectional vignette survey was designed to examine variability in physician preferences for intravenous (IV) antibiotic duration, genitourinary imaging, and prophylactic antibiotics and to evaluate drivers of resource use. METHODS The survey was administered to a random sample of pediatricians through the American Medical Association's Physician Masterfile. Respondents were provided with a case vignette of a 2-week-old neonate with a febrile UTI and asked to indicate preferences for IV antibiotic duration and rank drivers of this decision. Respondents were also asked whether they would obtain a voiding cystourethrogram (VCUG) and, regardless of preference, randomly presented with a normal result or bilateral grade II vesicoureteral reflux. The survey was delivered electronically to facilitate skip logic and randomization. RESULTS A total of 279 surveys were completed. Preference for total IV antibiotic duration differed significantly (P < .001) across specialty, with a median duration of 2 days for general pediatricians/hospitalists, 7 days for neonatologists, and 5 days for infectious disease pediatricians. For the 47% (n = 131) who did not want a VCUG, 24/61 (39%) wanted prophylactic antibiotics when presented with grade II vesicoureteral reflux (P < .001). CONCLUSIONS Subspecialty status appeared to be the most influential driver of IV antibiotic duration in the treatment of UTI. A substantial proportion of pediatricians who initially expressed a preference against ordering a VCUG wished to prescribe prophylactic antibiotics when results were abnormal, which suggests that even unwanted diagnostic test results drive treatment decisions.
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Affiliation(s)
- Neha S Joshi
- Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, California;
| | - Brian P Lucas
- White River Junction Veteran's Affairs Medical Center, Hartford, Vermont; and.,Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Alan R Schroeder
- Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, California
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21
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Lang SM, Daily JA, FitzGerald MR, Tang X, Best TH, Robbins JM, Collins RT. Knowledge of Appropriate Outpatient Pediatric Echocardiogram Ordering in Primary Care Physicians and Trainees. Am J Cardiol 2017; 120:1209-1213. [PMID: 28800832 DOI: 10.1016/j.amjcard.2017.06.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/26/2017] [Accepted: 06/15/2017] [Indexed: 10/19/2022]
Abstract
Appropriate Use Criteria (AUC) for the initial use of outpatient pediatric echocardiography were established to aid all clinicians in the evaluation of children with possible heart disease, and limit low diagnostic yield studies. We sought to (1) assess PCPs' and trainees' awareness of the AUC document; (2) compare their knowledge of appropriate echocardiogram ordering with that of pediatric cardiologists; and (3) identify additional medical and nonmedical factors affecting PCP echocardiogram ordering. An online survey with clinical scenarios derived from the AUC guidelines was distributed to PCPs and trainees in Arkansas, and pediatric cardiologists from Arkansas Children's Hospital and Cincinnati Children's Hospital Medical Center. Respondents were also asked to rate whether additional medical and nonmedical factors have "no," "mild," "moderate," or "major" impact on PCP echocardiogram ordering. Survey data were collected from 148 respondents. Awareness of the AUC was significantly lower in PCPs (21.4%) and trainees (14%) than in pediatric cardiologists (90.5%, p <0.001). For all rarely appropriate clinical scenarios, cardiologists had stronger agreement with the AUC document (90.9%) than did the PCP group (50.3%) and trainees (53.3%, p <0.001). The strongest additional factors affecting PCP echocardiogram ordering were parental anxiety, difficulty distinguishing innocent from pathologic murmurs, and legal implications of a missed diagnosis. In conclusion, PCPs and trainees are largely unaware of the existence of the pediatric echocardiogram AUC. Educational strategies to improve appropriate echocardiogram ordering should address not only increasing awareness of AUC, but also other factors affecting decision-making.
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22
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Social determinants of health: integral to developmental risk assessment in congenital heart disease. J Pediatr 2017; 183:201. [PMID: 27986271 DOI: 10.1016/j.jpeds.2016.11.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/22/2016] [Indexed: 11/21/2022]
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