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Trends in Well-Child Visits and Routine Vaccination among Children of U.S. Military Members: An Evaluation of the COVID-19 Pandemic Effects. J Clin Med 2022; 11:jcm11226842. [PMID: 36431319 PMCID: PMC9699213 DOI: 10.3390/jcm11226842] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
The COVID-19 pandemic has drastically impacted administration of healthcare including well-child visits and routine vaccinations. The purpose of this study was to determine the impact of COVID-19 pandemic disruption on childhood health maintenance: well-child visits and scheduled vaccinations. We queried the TRICARE Management Activity's Military Health System (MHS) database for outpatient well-child visits and vaccinations for all children 0 to 23 months of age eligible for TRICARE healthcare. The median rate of well-child visits, during the COVID-19 period (March 2020-July 2021), was significantly declined for all demographic groups: all ages, parental military ranks, sex, and regions as compared to the pre-COVID-19 period (February 2019-February 2020). Similar to rates of well-child visits, the rate of vaccinations declined during the COVID-19 period as compared to the pre-COVID-19 period for all demographic groups, except children 12-23 months. Rates of well-child visits for military dependent children under 2 years of age were decreased during the 16 month COVID-19 period, with large increases seen in the first 2 months of the pandemic; the consequences of missed well-child visits and vaccination are unknown.
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Ambati SR, Tamuz M, DeVoe B, Rotjan A, Lesser M, Gangadharan S. Improving Resuscitation Timing: Random Assignment of Interprofessional Team Leaders in Simulated Resuscitation. Pediatr Emerg Care 2022; 38:e978-e982. [PMID: 35100786 DOI: 10.1097/pec.0000000000002507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aims of the study were to assess whether preassigning a team leader influences resuscitation timing using simulation and to examine relationship between response timeliness and designated leader's profession, whether physician or nurse. METHODS This is a prospective study of intervention (leader assigned) and control (no assigned leader) teams of residents and nurses participating in a simulated scenario. The primary outcome was time to bag-valve-mask (BVM) ventilation. A secondary outcome measure compared difference in time to BVM between physician- and nurse-led teams. RESULTS We assessed 25 teams, leader assigned (n = 14) or control (n = 11), composed of 92 clinicians. Leaders emerged in most of the controls (10 of 11). The median time to BVM in the leader-assigned group was 41.5 seconds (interquartile range, 34-49 seconds) compared with 53 seconds (interquartile range, 27-85 seconds) for controls (P = 0.13). In the leader-assigned group, 85% (12 of 14) of teams initiated BVM in less than 1 minute compared with only 54% teams (6 of 11) in controls (P = 0.18). Among the leader-assigned teams, we randomly assigned residents to lead 8 teams and nurses to lead 6 teams. All the nurse-led teams (6 of 6) initiated BVM in less than 1 minute compared with fewer physician-led teams (6 of 8) and only approximately half of controls (6 of 11, P = 0.19). CONCLUSIONS The leader-assigned teams and controls did not differ in resuscitation timeliness. Among leader-assigned teams, the differences in time to BVM between physician- and nurse-led teams were not statistically significant. However, all 6 nurse-led teams demonstrated timely resuscitation, suggesting a direction for future research on the feasibility of bedside nurses taking the lead during resuscitation, pending code team arrival.
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Affiliation(s)
- Shashikanth R Ambati
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics, Albany Medical Center, Albany
| | | | - Barbara DeVoe
- Patient Safety Institute, Center for Learning and Innovation
| | | | - Martin Lesser
- Biostatistics Unit, Feinstein Institute for Medical Research, Northwell Health, New Hyde Park
| | - Sandeep Gangadharan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mount Sinai School of Medicine, New York City, NY
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Amer YS, Al Nemri A, Osman ME, Saeed E, Assiri AM, Mohamed S. Perception, attitude, and satisfaction of paediatric physicians and nurses towards clinical practice guidelines at a university teaching hospital. J Eval Clin Pract 2019; 25:543-549. [PMID: 29611621 DOI: 10.1111/jep.12923] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 02/27/2018] [Accepted: 03/02/2018] [Indexed: 01/09/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES To explore perception, attitude, and satisfaction of paediatric clinicians, trainees, and nurses at King Khalid University Hospital towards clinical practice guidelines (CPGs) including the locally adapted diabetic ketoacidosis CPG (DKA-CPG). METHODS A cross-sectional survey was distributed to 260 doctors and nurses working in the paediatrics department. RESULTS The response rate was 95.4%. The respondents had a positive perception and attitude towards general CPGs and specifically for the DKA-CPG; 98.7% thought CPGs were useful sources of advice, improved safety, and decreased risk, and reduced variation in practice. A total of 99.2% thought CPGs were good clinical tools, 98.3% satisfied with, had confidence in well-developed CPGs, and would recommend them to their colleagues to use, and 94.6% agreed they were cost-effective. The preferred format for CPGs was paper (46.6%) and electronic (42.9%). The DKA-CPG helped in managing patients and respondents were all satisfied and had confidence with it (100%). The rationale and objectives of the DKA-CPG were clear for 99.25%; 98.5% thought the layout was clear and well organized and user-friendly (96.2%). Compared with nurses, physicians had a higher perception towards CPGs in general (P < .05) and the DKA-CPG (P < .05). CONCLUSIONS The paediatric doctors, and nurses have a great perception and satisfaction and positive attitude towards CPGs in general, towards the paediatric diabetic ketoacidosis CPG in particular, which in turn had a positive impact on the acceptability and implementation of the CPGs. These findings could help in sustaining a safe and high-quality health care environment through implementation of evidence-based CPGs.
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Affiliation(s)
- Yasser Sami Amer
- Quality Management Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.,Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.,Alexandria Centre for Evidence-Based Clinical Practice Guidelines, Alexandria University Medical Council, Alexandria University, Alexandria, Egypt
| | - Abdulrahman Al Nemri
- Department of Paediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed Elfaki Osman
- Department of Paediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Elshazaly Saeed
- Prince Abdullah Bin Khalid Celiac Disease Research Chair, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia
| | - Asaad Mohamed Assiri
- Department of Paediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Prince Abdullah Bin Khalid Celiac Disease Research Chair, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia
| | - Sarar Mohamed
- Department of Paediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Prince Abdullah Bin Khalid Celiac Disease Research Chair, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.,Department of Paediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Ruano Cea E, Constantin E, Thomas A. Reverse Educational Distance: Exploring a novel concept to enhance Resident-As-Teacher curricula. MEDICAL TEACHER 2019; 41:773-779. [PMID: 30990734 DOI: 10.1080/0142159x.2019.1578875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose: The learning benefits associated with residents teaching peers and junior trainees are well documented. However, the concept of Reverse Educational Distance (RED), when residents teach an academically senior audience, is poorly described. Methods: We explored Pediatric residents' and community health care providers' (cHCPs) perceptions of a RED teaching intervention, whereby residents would engage in teaching cHCPs. We explored the anticipated learning benefits, challenges, and ways to optimize its implementation in a residency program. We conducted a descriptive qualitative study with focus groups. We also compared RED with the traditional Resident-As-Teacher (RAT) approach from a theoretical framework perspective. Results: Benefits anticipated by residents included: (1) optimizing their incentive to learn; (2) focusing on the practical 'real-world application' of knowledge; and (3) a better understanding of community practice. Benefits anticipated by cHCPs included: (1) being updated on evidence-based practices; and (2) improving collaboration between cHCPs and future pediatricians. The major anticipated challenge was the residents' lack of clinical experience, for which key solutions were proposed. Conclusions: Engaging residents in teaching cHCPs could lead to enhanced and unique learning benefits compared to the traditional RAT approach. RED is a promising strategy for RAT curricula aiming at best preparing trainees for their future role as educators.
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Affiliation(s)
- Elisa Ruano Cea
- a Department of Pediatrics , McGill University , Montreal , Canada
- b Centre for Medical Education, Faculty of Medicine , McGill University , Montreal , Canada
| | - Evelyn Constantin
- a Department of Pediatrics , McGill University , Montreal , Canada
- b Centre for Medical Education, Faculty of Medicine , McGill University , Montreal , Canada
| | - Aliki Thomas
- b Centre for Medical Education, Faculty of Medicine , McGill University , Montreal , Canada
- c School of Physical and Occupational Therapy , McGill University , Montreal , Canada
- d Centre for Interdisciplinary Research in Rehabilitation , McGill University , Montreal , Canada
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Ambrose MJ, Walton EA, Lerner M, De Pinto C, Baum M, Beers NS, Bode S, Gibson EJ, Gorski P, Kjolhede C, O’Leary SC, Schumacher H, Weiss-Harrison A. Improving Health and Safety at Camp. Pediatrics 2019; 144:peds.2019-1355. [PMID: 31209160 DOI: 10.1542/peds.2019-1355] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The American Academy of Pediatrics has created recommendations for health appraisal and preparation of young people before participation in day, resident, or family camps and to guide health and safety practices at camp. These recommendations are intended for parents and families, primary health care providers, and camp administration and health center staff. Although camps have diverse environments, there are general guidelines that apply to all situations and specific recommendations that are appropriate under special conditions. This policy statement has been reviewed and is supported by the American Camp Association and Association of Camp Nursing.
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Gigli KH, Beauchesne MA, Dirks MS, Peck JL. White Paper: Critical Shortage of Pediatric Nurse Practitioners Predicted. J Pediatr Health Care 2019; 33:347-355. [PMID: 30878267 DOI: 10.1016/j.pedhc.2019.02.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/11/2019] [Accepted: 02/18/2019] [Indexed: 11/29/2022]
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Abstract
OBJECTIVES To describe physicians' and nurse practitioners' perceptions of the national and local PICU physician and other provider supply in institutions that employ PICU nurse practitioners, assess for differences in perceptions of supply, and evaluate the intent of institutions to hire additional nurse practitioners to work in PICUs. DESIGN National, quantitative, cross-sectional descriptive study via a postal mail survey from October 2016 to January 2017. SETTING Institutions (n = 140) identified in the 2015 American Hospital Association Annual Survey with a PICU who employ PICU nurse practitioners. SUBJECTS PICU physician medical directors and nurse practitioners. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS There were 119 respondents, representing 93 institutions. Responses were received from 60 PICU medical directors (43%) and 59 lead nurse practitioners (42%). More than half (58%) of all respondents reported the national supply of PICU physicians is less than demand and 61% reported the local supply of PICU providers (physicians in all stages of training, nurse practitioners, and physician assistants) is less than demand. Of the respondents from institutions that self-reported a local provider shortage (n = 54), three fourths (78%) reported plans to increase the number of PICU nurse practitioners in the next 3 years and 40% were likely to expand the nurse practitioner's role in patient care. CONCLUSIONS Most PICU medical directors and lead nurse practitioners in institutions that employ PICU nurse practitioners perceived that national and local supply of providers to be less than the demand. Nurse practitioners are employed in PICUs as part of interdisciplinary models of care being used to address provider demand. The demand for more PICU nurse practitioners with expanded roles in care delivery was reported. Further evaluation of models of care and provider roles in care delivery can contribute to aligning provider supply with demand for care delivery.
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Katkin JP, Kressly SJ, Edwards AR, Perrin JM, Kraft CA, Richerson JE, Tieder JS, Wall L, Alexander JJ, Flanagan PJ, Hudak ML, Quinonez RA, Shenkin BN, Smith TK. Guiding Principles for Team-Based Pediatric Care. Pediatrics 2017; 140:peds.2017-1489. [PMID: 28739656 DOI: 10.1542/peds.2017-1489] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The American Academy of Pediatrics (AAP) recognizes that children's unique and ever-changing needs depend on a variety of support systems. Key components of effective support systems address the needs of the child and family in the context of their home and community and are dynamic so that they reflect, monitor, and respond to changes as the needs of the child and family change. The AAP believes that team-based care involving medical providers and community partners (eg, teachers and state agencies) is a crucial and necessary component of providing high-quality care to children and their families. Team-based care builds on the foundation of the medical home by reaching out to a potentially broad array of participants in the life of a child and incorporating them into the care provided. Importantly, the AAP believes that a high-functioning team includes children and their families as essential partners. The overall goal of team-based care is to enhance communication and cooperation among the varied medical, social, and educational partners in a child's life to better meet the global needs of children and their families, helping them to achieve their best potential. In support of the team-based approach, the AAP urges stakeholders to invest in infrastructure, education, and privacy-secured technology to meet the needs of children. This statement includes limited specific examples of potential team members, including health care providers and community partners, that are meant to be illustrative and in no way represent a complete or comprehensive listing of all team members who may be of importance for a specific child and family.
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Affiliation(s)
- Julie P. Katkin
- Pediatric Pulmonary Medicine Section, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | | | - James M. Perrin
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Colleen A. Kraft
- Health Network by Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | | | - Joel S. Tieder
- Department of Pediatrics, University of Washington, Seattle, Washington
- Seattle Children’s Hospital, Seattle, Washington
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington; and
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Lee H, Kim A, Meong A, Seo M. Pediatric nurse practitioners' clinical competencies and knowing patterns in nursing: Focus group interviews. Contemp Nurse 2017; 53:515-523. [PMID: 28415900 DOI: 10.1080/10376178.2017.1315827] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The generic competency domains of advanced nursing practice have been reported on in numerous countries, but rather few studies have examined competencies specific to pediatric nurse practitioners (PNPs). OBJECTIVES We identified the core clinical competencies of PNPs in South Korea and related these identified competencies to the five patterns of knowing in nursing. DESIGN Focus group interviews were conducted with five PNP students and four PNPs using two thematic questions, one on clinical competencies required for PNPs and the other on competencies specific to Korean PNPs. A purposive sampling method was used to choose nurses with varying work experience and age from different hospital units. The inclusion criterion for PNP students was having at least two years of clinical experience and that for PNPs was having at least two years of clinical experience as a PNP in pediatric units in tertiary hospitals. The verbatim transcriptions of these interviews were analysed by two researchers using inductive content analysis. RESULTS Six clinical competency domains were identified including advanced pediatric-specific knowledge and clinical skills, education and counseling, utilization and engagement in research, professional identity development, clinical and professional leadership, and holistic care. Some competencies identified were related to empirical and ethical knowledge that could be taught in nursing, whereas others were based on esthetic and personal knowledge, which can be mastered through professional experience. CONCLUSIONS To provide holistic care for children and families, PNPs must acquire all necessary patterns of knowing through continuing education and individual reflection on personal practice.
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Affiliation(s)
- Hyejung Lee
- a College of Nursing , Mo-Im Kim Nursing Research Institute, Yonsei University , Seoul , South Korea
| | - Anna Kim
- b College of Nursing , Yonsei University , Seoul , South Korea
| | - Anna Meong
- b College of Nursing , Yonsei University , Seoul , South Korea
| | - Minjeong Seo
- c College of Nursing, Gerontological Health Research Center in Institute of Health Science , Gyeongsang National University , Jinju , Korea
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Abstract
The American Academy of Pediatrics recognizes the important role school nurses play in promoting the optimal biopsychosocial health and well-being of school-aged children in the school setting. Although the concept of a school nurse has existed for more than a century, uniformity among states and school districts regarding the role of a registered professional nurse in schools and the laws governing it are lacking. By understanding the benefits, roles, and responsibilities of school nurses working as a team with the school physician, as well as their contributions to school-aged children, pediatricians can collaborate with, support, and promote school nurses in their own communities, thus improving the health, wellness, and safety of children and adolescents.
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Stiris T, del Torso S, Mercier JC, Barak S, Wettergrem B, Ross-Russell R, Valiulis A, Hadjipanayis A. Improving paediatric care in the community. Lancet 2015; 385:1505. [PMID: 25933273 DOI: 10.1016/s0140-6736(15)60745-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tom Stiris
- European Academy of Paediatrics, Brussels, Belgium
| | | | | | - Shimon Barak
- European Academy of Paediatrics, Brussels, Belgium
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Schell GJ, Lavieri MS, Li X, Toriello A, Martyn KK, Freed GL. Strategic modeling of the pediatric nurse practitioner workforce. Pediatrics 2015; 135:298-306. [PMID: 25624388 DOI: 10.1542/peds.2014-0967] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the current pediatric nurse practitioner (PNP) workforce and to investigate the impact of potential policy changes to address forecasted shortages. METHODS We modeled the admission of students into nursing bachelor's programs and followed them through advanced clinical programs. Prediction models were combined with optimal decision-making to determine best-case scenario admission levels. We computed 2 measures: (1) the absolute shortage and (2) the expected number of years until the PNP workforce will be able to fully satisfy PNP demand (ie, self-sufficiency). RESULTS There is a forecasted shortage of PNPs in the workforce over the next 13 years. Under the best-case scenario, it would take at least 13 years for the workforce to fully satisfy demand. Our analysis of potential policy changes revealed that increasing the specialization rate for PNPs by 4% would decrease the number of years required until there are enough PNPs from 13 years to 5 years. Increasing the certification examination passing rate to 96% from the current average of 86.9% would lead to self-sufficiency in 11 years. In addition, increasing the annual growth rate of master's programs to 36% from the current maximum of 10.7% would result in self-sufficiency in 5 years. CONCLUSIONS Current forecasts of demand for PNPs indicate that the current workforce will be incapable of satisfying the growing demand. Policy changes can result in a reduction in the expected shortage and potentially improve access to care for pediatric patients.
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Affiliation(s)
| | | | - Xiang Li
- Department of Industrial and Operations Engineering and
| | - Alejandro Toriello
- School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia; and
| | | | - Gary L Freed
- Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, Michigan
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