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Harris M, Cusatis R, Malnory M, Dawson S, Konduri GG, Lagatta J. Identifying barriers and facilitators to care for infants with bronchopulmonary dysplasia after NICU discharge: a prospective study of parents and clinical stakeholders. J Perinatol 2024; 44:970-978. [PMID: 38278963 DOI: 10.1038/s41372-024-01880-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE Understand barriers and facilitators to follow-up care for infants with bronchopulmonary dysplasia (BPD). METHODS Qualitative study of parents and clinical stakeholders caring for infants with BPD. The interview guide was developed by a mother of a former 23-week preterm infant, neonatologist, pulmonologist, nurse, and qualitative researcher. Purposive sampling obtained a heterogenous sociodemographic and professional cohort. Subjects discussed their experience with BPD, barriers to care, caregiver quality of life and health education. Interviews were audio-recorded, transcribed and coded. Thematic analysis was used. RESULTS Eighteen parents and 20 stakeholders completed interviews. Family-level themes included pragmatic barriers like transportation being multi-faceted; and caregiving demands straining mental health. System-level themes included caregiver education needing to balance immediate caregiving activities with future health outcomes; and integrating primary care, specialty, and community supports. CONCLUSIONS Individual and system barriers impact follow-up for infants with BPD. This conceptual framework can be used to measure and improve care.
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Affiliation(s)
- Melissa Harris
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rachel Cusatis
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Margaret Malnory
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sara Dawson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - G Ganesh Konduri
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joanne Lagatta
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
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2
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Lagatta J, Harris M, Cusatis R, Malnory M, Dawson S, Konduri G. Identifying Barriers and Facilitators to Care for Infants with Bronchopulmonary Dysplasia After NICU Discharge: A Prospective Study of Parents and Clinical Stakeholders. RESEARCH SQUARE 2023:rs.3.rs-3377817. [PMID: 37886597 PMCID: PMC10602170 DOI: 10.21203/rs.3.rs-3377817/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Objective Understand barriers and facilitators to follow-up care for infants with bronchopulmonary dysplasia (BPD). Methods Qualitative study of parents and clinical stakeholders caring for infants with BPD. The interview guide was developed by a mother of a former 23-week preterm infant, neonatologist, pulmonologist, nurse, and qualitative researcher. Purposive sampling obtained a heterogenous sociodemographic and professional cohort. Subjects discussed their experience with BPD, barriers to care, caregiver quality of life and health education. Interviews were audio-recorded, transcribed and coded. Thematic analysis was used. Results Eighteen parents and 20 stakeholders completed interviews. Family-level themes included pragmatic barriers like transportation being multi-faceted; and caregiving demands straining mental health. System-level themes included caregiver education needing to balance process needs with future trajectories; and integration of primary care, specialty care, and community supports. Conclusions Individual and system barriers impact follow-up for infants with BPD. This conceptual framework can be used to measure and improve care.
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Affiliation(s)
| | | | | | - Margaret Malnory
- Med College of Wisconsin & Children's Research Institute of Children's Hospital of Wisconsin
| | - Sara Dawson
- Med College of Wisconsin & Children's Research Institute of Children's Hospital of Wisconsin
| | - Girija Konduri
- Med College of Wisconsin & Children's Research Institute of Children's Hospital of Wisconsin
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3
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Silberberg A, Paladino MS, Moreno-Villares JM. An Ethical Pathway to Quality of Life in Critically Ill Newborns. New Bioeth 2021; 27:148-158. [PMID: 33848235 DOI: 10.1080/20502877.2021.1911741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Advances in perinatology have permitted the survival of fragile neonates. Quality of life (QoL) has been considered a key element in medical decision-making. In this review we analyse the role of QoL regarding the decision of withholding or withdrawing of life-sustaining treatment (LST). The role of QoL is debated because of the conceptual difficulties it raises. The lack of consensus on its definition and the difficulties in measuring it objectively, mean that basing clinical decisions solely on QoL has some risks. To avoid a purely subjective assessment, the principle of totality, and the principle of therapeutic adequacy should be considered. In case of uncertain prognosis, some therapeutic persistence seems reasonable. If this does not benefit the clinical condition of the child, then it may be no longer appropriate to continue the LST in case of severe disabilities. QoL is essential in medical decision-making, but is insufficient as the only criterion.
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Affiliation(s)
- Agustín Silberberg
- Department of Bioethics, Hospital Universitario Austral, Universidad Austral, Pilar, Argentina
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Abstract
Purpose of Review This paper seeks to explore the definitions of quality of life and its application to pediatric research and clinical practice. This paper also highlights some of the imperfections in evaluating patient-reported outcomes designed to measure quality of life in pediatrics. Additionally, this paper explores some of the unique challenges in promoting quality of life during the COVID-19 pandemic. Recent Findings There are numerous different measurement scales to examine quality of life in children of different ages, and with a variety of disease states. Summary Despite the number of quality of life measurement tools, not every patient population has a validated measure, including patients with palliative care needs. There is no consensus on how to incorporate findings from patient-reported outcomes into clinical practice recommendations. Professional organizations offer guidance and resources for families to encourage focus on quality of life during the COVID-19 pandemic.
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Affiliation(s)
- Teresa Vente
- Division of Palliative Care, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue Box 117, Chicago, IL 60611 USA
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5
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Abstract
Health-related quality of life (HRQOL) is central to how clinicians and parents make choices about medical care for pediatric neurology patients. To provide parents with the information they need to make these decisions and plan for the future, it is necessary for parents and clinicians to understand how HRQOL is defined and measured in the setting of pediatric neurodevelopmental impairment. We review challenges that exist in measuring HRQOL in pediatric neurology, examine existing measures, and outline key principles to guide selection and interpretation of HRQOL measures in children with neurologic conditions.
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Affiliation(s)
- Monica E. Lemmon
- Department of Pediatrics, Duke University Medical Center, Durham, NC,Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD,Margolis Center for Health Policy, Duke University, Durham, NC
| | | | - Bryce B. Reeve
- Department of Pediatrics, Duke University Medical Center, Durham, NC,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC,Center for Health Measurement, Duke University School of Medicine, Durham, NC
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6
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Banazadeh M, Rafii F. A Concept Analysis of Neonatal Palliative Care in Nursing: Introducing a Dimensional Analysis. Compr Child Adolesc Nurs 2020:1-26. [PMID: 32790478 DOI: 10.1080/24694193.2020.1783029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/10/2020] [Indexed: 10/23/2022]
Abstract
Despite the increasing need for neonatal palliative care, it is not adequately implemented in practice. This analysis aimed to clarify the dimension of the neonatal palliative care concept to increase understanding of the concept to give more insight into clinical practice. Using dimensional analysis methodology, 46 English language papers from 2001-2018 were analyzed. The coding of the literature for the perspective, context, conditions, process, and consequences of the concept was completed. Five dimensions informed the conceptualization of this concept and interrelationships among their themes/sub-themes were presented in the matrix named, "improving quality of life and death". Within the family-centered care perspective and under different conditions/contexts through the processes of neonate's comfort and providing holistic care, the consequences of this care were improving quality of life/a good death. Family-centered care was the fundamental dimension and essential to achieving the consequences. The other dimensions of context, conditions, and processes were also affected by the family's needs, preferences, culture, and expectations. This analysis reinforces that neonatal palliative care is a multidimensional concept. To provide the standard of neonatal palliative care an integrated plan to get together many stakeholders including community, parents, clinical staff, policymakers, insurance authorities, health care systems, and education system is required. All NICUs should have neonatal palliative care-trained nurses and protocols with a family-centered care approach to focus on the quality of life of neonates with life-threatening conditions from diagnosis of disease to death. Regular training and educational courses on neonatal palliative care and family-centered care principles can make nurses more sensitive to their advocacy role.
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Affiliation(s)
- Marjan Banazadeh
- School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Forough Rafii
- School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
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Abstract
BACKGROUND Infants who are admitted to a neonatal intensive care unit (NICU) may experience significant symptom burden. Parents are often distressed by these symptoms, which can affect their long-term coping and distress. There is limited research examining nurse perceptions of infant well-being (symptoms, suffering, and quality of life [QOL]) and associations with nurse distress. OBJECTIVE The objective of this descriptive study was to explore associations between nurse perceptions of infant well-being and self-reported distress. METHODS Nurses caring for infants with potentially life-threatening/life-limiting conditions were recruited from a Level IV NICU in the Midwestern United States as a part of a study on infant symptom burden. Nurses reported their perceptions of infant well-being and their own distress on a 5-point Likert scale. Surveys were administered at the bedside weekly for up to 12 weeks, depending on length of stay. Infant suffering and QOL were examined in relation to nurse distress. A cross-classified multilevel model was used to account for dependence within nurse and within patient. RESULTS A total of 593 surveys were collected from nurses. Using a cross-classified multilevel model with variables entered simultaneously, nurse perceptions of greater infant suffering and lower infant QOL were significantly associated with greater nurse distress. DISCUSSION Preliminary evidence shows that greater perceived infant suffering and lower perceived infant QOL may be associated with greater levels of self-reported distress in NICU nurses. Further work is needed to better understand factors related to symptom management in the NICU and the potential role of caregiver distress and compassion fatigue in NICU nurses.
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Deuitch N, Soo-Jin Lee S, Char D. Translating genomic testing results for pediatric critical care: Opportunities for genetic counselors. J Genet Couns 2019; 29:78-87. [PMID: 31701594 DOI: 10.1002/jgc4.1182] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 12/12/2022]
Abstract
Genomic sequencing (GS), such as whole genome and exome sequencing, is rapidly being integrated into pediatric critical care settings. Results are being used to make high impact decisions including declarations of futility, withdrawal of care, and rationing of scarce resources. In this qualitative study, we conducted interviews with clinicians involved in the care of critically ill children with congenital heart disease (CHD) to investigate their views on implementation of GS into clinical practice. Interviews were transcribed and inductively analyzed for major themes using grounded theory and thematic analysis. Three major themes emerged surrounding the use of genomic information in the high-stakes, time pressured decision making that characterizes clinical care of critically ill children with CHD: (a) that clinicians felt they did not have sufficient training to accurately assess genetic results despite pressure to incorporate results into clinical decisions; (b), that they desire knowledge support from genetic specialists, such as genetic counselors, who both understand the critical care context and are available within the time constraints of critical care clinical pressures; and (c), that clinicians feel a pressing need for increased genetics education to be able to safely and appropriately incorporate GS results into clinical decisions Our data suggest that genetics specialists may need a stronger presence in the pediatric critical care setting.
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Affiliation(s)
- Natalie Deuitch
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Sandra Soo-Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, NY, USA
| | - Danton Char
- Department of Anesthesiology, Perioperative and Pain Management, Stanford University School of Medicine, Stanford University, Stanford, CA, USA.,Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA
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9
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Feudtner C, Rosenberg AR, Boss RD, Wiener L, Lyon ME, Hinds PS, Bluebond-Langner M, Wolfe J. Challenges and Priorities for Pediatric Palliative Care Research in the U.S. and Similar Practice Settings: Report From a Pediatric Palliative Care Research Network Workshop. J Pain Symptom Manage 2019; 58:909-917.e3. [PMID: 31445136 PMCID: PMC8499153 DOI: 10.1016/j.jpainsymman.2019.08.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 12/11/2022]
Abstract
CONTEXT To dramatically advance the evidence base for pediatric palliative care (PPC) interventions, practices, and programs in the U.S. and similar practice settings, the field needs to better understand the challenges and opportunities for rigorous scholarship. OBJECTIVES The Pediatric Palliative Care Research Network conducted a workshop to clarify challenges and identify key priorities. METHODS The workshop focused on PPC research topics and methods, including outcomes measurement, qualitative inquiry, analyses of big data, prospective collection of research data, case series and cohort studies, and intervention trials, with synthesizing summary and follow-up discussions. All attendees reviewed and approved the final report. RESULTS Five common challenges were identified: patient diversity and small population size; interdependencies and dynamic interactions between child, family members, and disease processes over time; outcomes and measurement; workforce and infrastructure limitations; and presumed burden of PPC research on participants. Seven priorities emerged: bolster training and development of PPC investigators; develop core resources; advance symptom measurement (and measurements of other exposures and outcomes); improve symptom management and quality of life interventions; improve communication, elicitation of goals of care, and decision making; understand family impact and facilitate or improve family adaptation and coping; and analyze and improve systems of care, policy, and education. CONCLUSION These challenges and priorities identify key research areas that can guide individual investigators and research funders to advance the field.
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Affiliation(s)
- Chris Feudtner
- The Ingerman Center for Pediatric Palliative Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
| | - Abby R Rosenberg
- Palliative Care and Resilience Program, Seattle Children's Research Institute, Seattle, Washington, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Renee D Boss
- Department of Pediatrics, Johns Hopkins School of Medicine and Berman Institute of Bioethics, Baltimore, Maryland, USA
| | - Lori Wiener
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Maureen E Lyon
- Center for Translational Research, Children's National Health System, Washington, District of Columbia, USA; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Pamela S Hinds
- Children's National Health System, Department of Nursing Science, Professional Practice & Quality, and the George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Myra Bluebond-Langner
- Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom; Department of Sociology, Anthropology, and Criminal Justice, Rutgers University, Camden, New Jersey, USA
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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10
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Stanak M, Hawlik K. Decision-making at the limit of viability: the Austrian neonatal choice context. BMC Pediatr 2019; 19:204. [PMID: 31221128 PMCID: PMC6585118 DOI: 10.1186/s12887-019-1569-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 06/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to explore the shared decision-making context at the limit of viability (weeks 22-25 of gestation) through analyzing neonatologist's communication strategies with parents and their possible impact on survival and neurodevelopmental impairment (NDI) outcomes. METHODS A mixed methods approach was applied where a systematic literature search and in-depth semi-structured interviews with five heads of neonatology departments and one clinical ethicist from the Austrian context were integrated into a literature review. The aim was to identify decision practice models and the choice context specific to Austria. RESULTS Professional biases, parental understanding, and the process of information giving were identified as aspects possibly influencing survival and NDI outcomes. Institutions create self-fulfilling prophecies by recommending intensive/palliative care based upon their institutional statistics, yet those vary considerably among high-income countries. Labelling an extremely preterm (EP) infant by the gestational week was shown to skew the estimates for survival while the process of information giving was shown to be subject to framing effect and other cognitive biases. CONCLUSION Communication strategies of choice options to parents may have an impact on the way parents decide and hence also on the outcomes of EP infants.
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Affiliation(s)
- Michal Stanak
- Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090, Vienna, Austria. .,Department of Philosophy, University of Vienna, Vienna, Austria.
| | - Katharina Hawlik
- Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090, Vienna, Austria
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11
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Ferrand A, Gorgos A, Ali N, Payot A. Resilience Rather than Medical Factors: How Parents Predict Quality of Life of Their Sick Newborn. J Pediatr 2018; 200:64-70.e5. [PMID: 29958673 DOI: 10.1016/j.jpeds.2018.05.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 04/16/2018] [Accepted: 05/15/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To assess the influence of resiliency and stress on parental perspectives of the future quality of life (QOL) of neonatal intensive care unit (NICU) newborns at high risk of neurodevelopmental disability. STUDY DESIGN We conducted a prospective multicenter questionnaire study. Perspectives from parents of newborns at high risk of disability as per neonatal follow-up criteria were compared with a low-risk group consisting of parents of all other NICU newborns. Parental anxiety and resiliency, measured using Brief Symptom Inventory and Sense of Coherence scales, respectively, were associated with QOL projections. RESULTS Parents returned 129 (81%) questionnaires. Parents considering their newborn as currently sicker were more stressed (P = .011) and worried about future physical (P < .001) and mental (P < .001) health, QOL (P < .001), coping (P = .019), and financial (P < .001) and emotional (P = .002) impact on the family. Ooverall, there was no difference between parents of high-risk and low-risk newborns on QOL projections. Almost all parents projected a good future QOL. Less resilient parents projected more pain (P = .04), more financial (P = .019), and emotional (P = .031) impact on their family, and were 10 times more likely to predict that their newborn would remain chronically ill. CONCLUSIONS Parental projection of future QOL of NICU newborns is not associated with risk of disability. Most parents predict overall a good future QOL and focus more on familial impact. The Sense of Coherence scale may be used in clinical settings to identify less resilient parents.
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Affiliation(s)
- Amaryllis Ferrand
- Division of Neonatology, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada
| | - Andreea Gorgos
- Division of Neonatology, Department of Pediatrics, McGill University Health Center, McGill University, Montreal, Québec, Canada
| | - Nabeel Ali
- Division of Neonatology, Department of Pediatrics, Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, Québec, Canada
| | - Antoine Payot
- Division of Neonatology, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada; Clinical Ethics Unit, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada; CHU Sainte-Justine Research Center, Department of Pediatrics, University of Montreal, Montreal, Québec, Canada; Palliative Care Unit, CHU Sainte-Justine, Montreal, Québec, Canada.
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12
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Effectiveness and safety of Noofen® in children with autonomic dysfunction with a lack of adaptive capacity and reduced cognitive function. Fam Med 2018. [DOI: 10.30841/2307-5112.3.2018.146800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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13
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Anticipating uncertainty and irrevocable decisions: provider perspectives on implementing whole-genome sequencing in critically ill children with heart disease. Genet Med 2018; 20:1455-1461. [PMID: 29493583 DOI: 10.1038/gim.2018.25] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 01/30/2018] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To investigate the potential impacts of whole-genome sequencing (WGS) in the pediatric critical-care context, we examined how clinicians caring for critically ill children with congenital heart disease (CHD) anticipate and perceive the impact of WGS on their decision-making process and treatment recommendations. METHODS We conducted semistructured in-person and telephone interviews of clinicians involved in the care of critically ill children with CHD at a high-volume pediatric heart center. We qualitatively analyzed the transcribed interviews. RESULTS In total, 34 clinicians were interviewed. Three themes emerged: (i) uncertainty about the accuracy of WGS testing and adequacy of testing validation; (ii) the use of WGS to facilitate life-limiting decisions such as futility, rationing, and selective prenatal termination; and (iii) moral distress over using WGS with a lack of decision support. CONCLUSION Despite uncertainty about WGS testing, the interviewed clinicians were using, and anticipated expanding the use of, WGS results to justify declarations of futility, withdrawal of care, and rationing in critically ill children with CHD. This situation is causing moral distress in providers who have to make high-stakes decisions involving WGS results, with only partial understanding of them. Decision support for clinicians, and discussion with families of the risks of using WGS for rationing or withdrawal, is needed.
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14
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Abstract
OBJECTIVE Neonatal ICUs and PICUs increasingly admit patients with chronic critical illness: children whose medical complexity leads to recurrent and prolonged ICU hospitalizations. We interviewed participants who routinely care for children with chronic critical illness to describe their experiences with ICU care for pediatric chronic critical illness. DESIGN Semi-structured interviews. Interviews were transcribed and analyzed for themes. SETTING Stakeholders came from five regions (Seattle, WA; Houston, TX; Jackson, MS; Baltimore, MD; and Philadelphia, PA). SUBJECTS Fifty-one stakeholders including: 1) interdisciplinary providers (inpatient, outpatient, home care, foster care) with extensive chronic critical illness experience; or 2) parents of children with chronic critical illness. INTERVENTIONS Telephone or in-person interviews. MEASUREMENTS AND MAIN RESULTS Stakeholders identified several key issues and several themes emerged after qualitative analysis. Issues around chronic critical illness patient factors noted that patients are often relocated to the ICU because of their medical needs. During extended ICU stays, these children require longitudinal relationships and developmental stimulation that outstrip ICU capabilities. Family factors can affect care as prolonged ICU experience leads some to disengage from decision-making. Clinician factors noted that parents of children with chronic critical illness are often experts about their child's disease, shifting the typical ICU clinician-parent relationship. Comprehensive care for children with chronic critical illness can become secondary to needs of acutely ill patients. Lastly, with regard to system factors, stakeholders agreed that achieving consistent ICU care goals is difficult for chronic critical illness patients. CONCLUSIONS ICU care is poorly adapted to pediatric chronic critical illness. Patient, family, clinician, and system factors highlight opportunities for targeted interventions toward improvement in care.
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15
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Abstract
BACKGROUND: There are no universally agreed rules of healthcare ethics. Ethical decisions and standards tend to be linked to professional codes of practice when dealing with complex issues. OBJECTIVES: This paper aims to explore the ethical complexities on who should decide to give infants born on the borderline of viability lifesaving treatment, parents or the healthcare professionals. METHOD: The paper is a discussion using the principles of ethics, professional codes of practice from the UK, Nursing Midwifery Council and UK legal case law and statute. Healthcare professionals' experiences that influence parental decision are also considered. FINDINGS & DISCUSSION: There are considerable barriers to an effective discussion taking place in an environment where clinical decisions have to be made quickly once the baby is born. This is compounded by the need and respect for parental autonomy and the difficulties they face when making a best interest's decision knowing that this could cause more harm than good for their infant child and balancing any decision they make with quality of life. CONCLUSION: On deciding whether to give lifesaving treatment born at the borderline of viability, it should be a joint decision between the parents and the neonatal team.
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Affiliation(s)
| | - Emma Welch
- Hull & East Yorkshire Women's and Children's Hospital, UK
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16
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Lah Tomulic K, Mestrovic J, Zuvic M, Rubelj K, Peter B, Bilic Cace I, Verbic A. Neonatal risk mortality scores as predictors for health-related quality of life of infants treated in NICU: a prospective cross-sectional study. Qual Life Res 2016; 26:1361-1369. [PMID: 27848129 DOI: 10.1007/s11136-016-1457-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the relationship of Apgar scores, gestational age and neonatal risk mortality scores to health-related quality of life (HRQoL) for infants at the age of 8 months treated after birth in neonatal intensive care unit (NICU). METHODS All surviving infants treated in two-third level NICUs in Rijeka, Croatia (from August 2013 to August 2014) were included in this prospective, cross-sectional study. For all neonates, the Score for Neonatal Acute Physiology (SNAP), SNAP with Perinatal Extension (SNAP-PE) and their simplified modifications (SNAP II and SNAP-PE II) were calculated. At the corrected age of 8 months, the Pediatric Quality of Life Questionnaire (PedsQL)-infant scale-was completed by parents of surviving infants. Multiple regression analysis was performed in order to assess the value of neonatal risk mortality scores, Apgar scores and gestational age as possible predictors of HRQoL, measured by questionnaire score. RESULTS A strong correlation has been found between SNAP and 5-min Apgar scores to HRQoL. A positive correlation was also found between gestational age and HRQoL. CONCLUSION SNAP and 5-min Apgar scores are important outcome indicators, can aid clinicians' and parents' decision making on the benefits and burdens of acute medical interventions and help determine quantities of medical treatment. Educated medical staff, effective and efficient medical treatment and a high quality of care which prevent adverse events in the first minute of life should be a priority in efforts to improve the future quality of life.
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Affiliation(s)
- K Lah Tomulic
- Pediatric Intensive Care Unit, Department of Pediatrics, University Hospital Rijeka, Istarska 43, 51000, Rijeka, Croatia. .,Faculty of Medicine, University of Rijeka, Brace Brancheta 20/1, 51000, Rijeka, Croatia.
| | - J Mestrovic
- Pediatric Intensive Care Unit, Department of Pediatrics, University Hospital Split, Spinciceva 1, 21000, Split, Croatia.,Faculty of Medicine, University of Split, Soltanska 2, 21000, Split, Croatia
| | - M Zuvic
- Department of Biotechnology, University of Rijeka, Radmile Matejcic 2, 51000, Rijeka, Croatia
| | - K Rubelj
- Faculty of Medicine, University of Rijeka, Brace Brancheta 20/1, 51000, Rijeka, Croatia
| | - B Peter
- Neonatal Intensive Care Unit, Department of Gynecology and Obstetrics, University Hospital Centre Rijeka, Kresimirova 42, 51000, Rijeka, Croatia
| | - I Bilic Cace
- Faculty of Medicine, University of Rijeka, Brace Brancheta 20/1, 51000, Rijeka, Croatia.,Neonatal Intensive Care Unit, Department of Gynecology and Obstetrics, University Hospital Centre Rijeka, Kresimirova 42, 51000, Rijeka, Croatia
| | - A Verbic
- Pediatric Intensive Care Unit, Department of Pediatrics, University Hospital Rijeka, Istarska 43, 51000, Rijeka, Croatia
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Chen L, Huang LH, Xing MY, Feng ZX, Shao LW, Zhang MY, Shao RY. Using the Delphi method to develop nursing-sensitive quality indicators for the NICU. J Clin Nurs 2016; 26:502-513. [PMID: 27404730 DOI: 10.1111/jocn.13474] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2016] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To develop nursing-sensitive quality indicators consistent with current medical practices in Chinese neonatal intensive care units. BACKGROUND The development of nursing-sensitive quality indicators has become a top priority in nursing management. To the best of our knowledge, there has been no objective, scientific and sensitive evaluation of the quality of neonatal intensive care unit nursing in China. DESIGN A modified Delphi technique was used to seek opinions from experts about what should be used and prioritised as indicators of quality care in neonatal intensive care unit nursing. METHODS Based on a literature review, we identified 21 indicators of nursing-sensitive quality in the neonatal intensive care unit. Our group of 11 consultants chose 13 indicators to be discussed using the Delphi method. In October and November 2014, 39 neonatal intensive care unit experts in 18 tertiary hospitals spread across six provinces participated in two rounds of Delphi panels. RESULTS Of the 13 indicators discussed, 11 were identified as indicators of nursing-sensitive quality in the neonatal intensive care unit: rate of nosocomial infections, rate of accidental endotracheal extubation, rate of errors in medication administration, rate of treatment for pain, rate of peripheral venous extravasation, rate of compliance with handwashing techniques, incidence of pressure ulcers, incidence of noise, the bed-to-care ratio, the proportion of nurses with greater than five years neonatal intensive care unit experience and incidence of retinopathy. CONCLUSIONS The 11 neonatal intensive care unit nursing-sensitive indicators identified by the Delphi method integrated with basic Chinese practices provide a basis for nursing management and the monitoring of nursing quality. RELEVANCE TO CLINICAL PRACTICE This study identified nursing-sensitive quality indicators for neonatal intensive care unit care that are suitable for current clinical practice in China.
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Affiliation(s)
- Lin Chen
- Department of Nursing, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China.,Department of Nursing, Shaoxing Central Hospital, Shaoxing, Zhejiang Province, China
| | - Li-Hua Huang
- Department of Nursing, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Mei-Yuan Xing
- Library, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Zhi-Xian Feng
- Department of Nursing, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Le-Wen Shao
- Department of Nursing, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Mei-Yun Zhang
- Department of Nursing, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Rong-Ya Shao
- Department of Nursing, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China
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Abstract
Comparative effectiveness research (CER) is a relatively new term for clinical research that directly assists patients, clinicians, and policymakers in making informed decisions to improve health care. In neonatology, there are similarities and differences between CER and existing clinical research and quality improvement literature. This article uses existing examples in neonatal literature to describe CER methodology and list some future directions and challenges in neonatal CER.
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19
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Collins LM. Assessing the assessors of quality of life. Vet J 2013; 197:531-2. [DOI: 10.1016/j.tvjl.2013.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 05/12/2013] [Indexed: 10/26/2022]
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