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van Teunenbroek KC, Mulder RL, Ahout IML, Bindels-de Heus KGCB, Delsman-van Gelder CM, Galimont-Collen AFS, de Groot MAR, Heitink-Polle KMJ, Looijestijn J, Mensink MO, Mulder S, Schieving JH, Schouten-van Meeteren AYN, Verheijden JMA, Rippen H, Borggreve BCM, Kremer LCM, Verhagen AAE, Michiels EMC. A Dutch paediatric palliative care guideline: a systematic review and evidence-based recommendations for symptom treatment. BMC Palliat Care 2024; 23:72. [PMID: 38481215 PMCID: PMC10935792 DOI: 10.1186/s12904-024-01367-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/23/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Children with life-threatening and life-limiting conditions can experience high levels of suffering due to multiple distressing symptoms that result in poor quality of life and increase risk of long-term distress in their family members. High quality symptom treatment is needed for all these children and their families, even more so at the end-of-life. In this paper, we provide evidence-based recommendations for symptom treatment in paediatric palliative patients to optimize care. METHODS A multidisciplinary panel of 56 experts in paediatric palliative care and nine (bereaved) parents was established to develop recommendations on symptom treatment in paediatric palliative care including anxiety and depression, delirium, dyspnoea, haematological symptoms, coughing, skin complaints, nausea and vomiting, neurological symptoms, pain, death rattle, fatigue, paediatric palliative sedation and forgoing hydration and nutrition. Recommendations were based on evidence from a systematic literature search, additional literature sources (such as guidelines), clinical expertise, and patient and family values. We used the GRADE methodology for appraisal of evidence. Parents were included in the guideline panel to ensure the representation of patient and family values. RESULTS We included a total of 18 studies that reported on the effects of specific (non) pharmacological interventions to treat symptoms in paediatric palliative care. A few of these interventions showed significant improvement in symptom relief. This evidence could only (partly) answer eight out of 27 clinical questions. We included 29 guidelines and two textbooks as additional literature to deal with lack of evidence. In total, we formulated 221 recommendations on symptom treatment in paediatric palliative care based on evidence, additional literature, clinical expertise, and patient and family values. CONCLUSION Even though available evidence on symptom-related paediatric palliative care interventions has increased, there still is a paucity of evidence in paediatric palliative care. We urge for international multidisciplinary multi-institutional collaboration to perform high-quality research and contribute to the optimization of symptom relief in palliative care for all children worldwide.
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Affiliation(s)
| | - Renée L Mulder
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Inge M L Ahout
- Department of Pediatrics, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | | | - Marinka A R de Groot
- Emma Palliative Care Team, Emma Children's Hospital, Amsterdam University Medical Centre (UMC), Amsterdam, the Netherlands
| | | | - Jeffry Looijestijn
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Maarten O Mensink
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Selma Mulder
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Jolanda H Schieving
- Department of Pediatric Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | - Hester Rippen
- Stichting Kind en Ziekenhuis, Utrecht, the Netherlands
| | | | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
- Department of Pediatrics, Emma Children's Hospital, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - A A Eduard Verhagen
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Erna M C Michiels
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Stevens J, de Groot J, Luijmes M, Bouwens J, Rippen H, Hoogervorst-Schilp J, Fuijkschot J. Study protocol of a national multicentre prospective evaluation study assessing the validity and impact of the Dutch Paediatric Early Warning Score (PEWS) in the Netherlands. BMJ Paediatr Open 2024; 8:e002214. [PMID: 38325899 PMCID: PMC10860074 DOI: 10.1136/bmjpo-2023-002214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/21/2023] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION Early recognition of clinical deterioration and timely intervention are important to improve morbidity and mortality in paediatric care. The Paediatric Early Warning Score (PEWS) is a scoring system aiming to identify hospitalised children at risk for deterioration. Currently, there is a large heterogeneity of PEWS systems in the Netherlands, with a considerable number remaining unvalidated or self-designed. Therefore, a consensus-based Dutch PEWS has been developed in a national study using the Core Outcome Measures in Effectiveness Trials initiative. The Dutch PEWS is a uniform system that integrates a core set of vital parameters together with pre-existing risk factors and uses risk stratification to proactively follow-up on patients at risk (so-called 'watcher patients'). This study aims to validate the Dutch PEWS and to determine its impact on improving patient safety in various hospital settings. METHODS AND ANALYSIS This national study will be a large multicentre evaluation study, in which the Dutch PEWS will be implemented and evaluated in 12 hospitals in the Netherlands. In this study, a mixed methods methodology will be used and evaluated on predefined outcome measures. To examine the validity of the Dutch PEWS, statistical analyses will be undertaken on quantitative data retrieved from electronic health records. Surveys among physicians and nurses; semistructured interviews with healthcare providers and parents; and daily evaluation forms are being conducted to determine the impact of the Dutch PEWS. The study is being conducted from December 2020 to June 2024.
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Affiliation(s)
- Jikke Stevens
- Pediatrics, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Janke de Groot
- Kennisinstituut van de Federatie Medisch Specialisten, Utrecht, The Netherlands
| | - Marie Luijmes
- Pediatrics, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Janneke Bouwens
- Pediatrics, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Hester Rippen
- Stichting Kind En Ziekenhuis, Utrecht, The Netherlands
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Maat SC, Gorter RR, van Heurn ELW, Rippen H, Butcher NJ, Offringa M, Derikx JPM. Development of an international core outcome set for treatment trials in paediatric inguinal hernia: protocol for a three-phase study including a systematic review and Delphi survey. BMJ Open 2023; 13:e077452. [PMID: 38097238 PMCID: PMC10728975 DOI: 10.1136/bmjopen-2023-077452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION In children, open inguinal hernia repair has been the gold standard for treatment, but with recent technical advancements in laparoscopy, laparoscopic hernia repair is gaining popularity. Despite available results from comparative studies, there is still no consensus regarding the superiority of open versus laparoscopic treatment strategy. An important reason for lack of consensus is the large heterogeneity in the trials' reported outcomes and outcome definitions, which limits comparisons between studies and precludes conclusions regarding the superiority of treatment strategies. The development and implementation of a core outcome set (COS) is a solution for this heterogeneity in the selection, measurement and reporting of trial outcome measures across studies. Currently, there is no COS for the treatment of paediatric inguinal hernia. METHODS AND ANALYSIS The aim of this project is to reach international consensus on a minimal set of outcomes that should be measured and reported in all future clinical trials investigating inguinal hernia repair in children. The development process comprises three phases. First, we identify outcome domains associated with paediatric inguinal hernia repair from a patient perspective and through a systematic review of the literature using EMBASE, MEDLINE and the Cochrane Library databases. Second, we conduct a three-step Delphi study to identify and prioritise 'core' outcomes for the eventual minimal set. In the third phase, an expert meeting is held to establish the final COS and develop implementation strategies with participants from all stakeholder groups: healthcare professionals, parents and patients' representatives. The final COS will be reported in accordance with the COS-Standards for Reporting statement. ETHICS AND DISSEMINATION The medical research ethics committee of the Amsterdam UMC confirmed that the Dutch Medical Research Involving Human Subjects Act (WMO) does not apply to this study and that full approval by the committee is not required. Electronic informed consent will be obtained from all participants. Results will be presented in peer-reviewed academic journals and at relevant conferences. PROSPERO REGISTRATION NUMBER CRD42021281422.
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Affiliation(s)
- Sanne C Maat
- Department of Pediatric Surgery, Amsterdam Reproduction and Development Research Institute, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
- Department of Pediatric Surgery, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
- Department of Pediatric Surgery, Amsterdam Public Health Research Institute, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Ramon R Gorter
- Department of Pediatric Surgery, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
| | - Ernest L W van Heurn
- Department of Pediatric Surgery, Amsterdam Reproduction and Development Research Institute, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
- Department of Pediatric Surgery, Amsterdam Public Health Research Institute, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Hester Rippen
- Child and Hospital Foundation (Stichting Kind en Ziekenhuis), Utrecht, The Netherlands
| | - Nancy J Butcher
- Child Health Evaluative Sciences, Sick Kids, Toronto, Ontario, Canada
| | - Martin Offringa
- Child Health Evaluation Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joep P M Derikx
- Department of Pediatric Surgery, Amsterdam Reproduction and Development Research Institute, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
- Department of Pediatric Surgery, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
- Department of Pediatric Surgery, Amsterdam Public Health Research Institute, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
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van Teunenbroek KC, Kremer LCM, Verhagen AAE, Verheijden JMA, Rippen H, Borggreve BCM, Michiels EMC, Mulder RL. Palliative care for children: methodology for the development of a national clinical practice guideline. BMC Palliat Care 2023; 22:193. [PMID: 38041060 PMCID: PMC10691037 DOI: 10.1186/s12904-023-01293-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/19/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Provision of paediatric palliative care for children with life-threatening or life-limiting conditions and their families is often complex. Guidelines can support professionals to deliver high quality care. Stakeholders expressed the need to update the first Dutch paediatric palliative care guideline with new scientific literature and new topics. This paper provides an overview of the methodology that is used for the revision of the Dutch paediatric palliative care guideline and a brief presentation of the identified evidence. METHODS The revised paediatric palliative care guideline was developed with a multidisciplinary guideline panel of 72 experts in paediatric palliative care and nine (bereaved) parents of children with life-threatening or life-limiting conditions. The guideline covered multiple topics related to (refractory) symptom treatment, advance care planning and shared-decision making, organisation of care, psychosocial care, and loss and bereavement. We established six main working groups that formulated 38 clinical questions for which we identified evidence by updating two existing systematic literature searches. The GRADE (CERQual) methodology was used for appraisal of evidence. Furthermore, we searched for additional literature such as existing guidelines and textbooks to deal with lack of evidence. RESULTS The two systematic literature searches yielded a total of 29 RCTs or systematic reviews of RCTs on paediatric palliative care interventions and 22 qualitative studies on barriers and facilitators of advance care planning and shared decision-making. We identified evidence for 14 out of 38 clinical questions. Furthermore, we were able to select additional literature (29 guidelines, two textbooks, and 10 systematic reviews) to deal with lack of evidence. CONCLUSIONS The revised Dutch paediatric palliative care guideline addresses many topics. However, there is limited evidence to base recommendations upon. Our methodology will combine the existing evidence in scientific literature, additional literature, expert knowledge, and perspectives of patients and their families to provide recommendations.
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Affiliation(s)
| | - Leontien C M Kremer
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
- Department of Paediatrics, Emma Children's Hospital, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, the Netherlands
- University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - A A Eduard Verhagen
- Department of Paediatrics, Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Hester Rippen
- Stichting Kind en Ziekenhuis, Utrecht, the Netherlands
| | | | - Erna M C Michiels
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - Renée L Mulder
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
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Fuijkschot J, Stevens J, Teheux L, de Loos E, Rippen H, Meurs M, de Groot J. Development of the national Dutch PEWS: the challenge against heterogeneity and implementation difficulties of PEWS in the Netherlands. BMC Pediatr 2023; 23:387. [PMID: 37550704 PMCID: PMC10405440 DOI: 10.1186/s12887-023-04219-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/28/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND For the early recognition of deteriorating patients several Pediatric Early Warning Score (PEWS) systems have been developed with the assumption that early detection can prevent further deterioration. Although PEWS are widely being used in hospitals in the Netherlands, there is no national consensus on which score to use and how to embed the score into a PEWS system. This resulted in a substantial heterogeneity of PEWS systems, of which many are unvalidated or self-designed. The primary objective of this study was to develop a pragmatic consensus-based PEWS system that can be utilized in all Dutch hospitals (University Medical Centers, teaching hospitals, and general hospitals). METHODS This study is an iterative mixed-methods study. The methods from the Core Outcome Measures in Effectiveness Trials (COMET) initiative were used and consisted of two Delphi rounds, two inventories set out to all Dutch hospitals and a focus group session with parents. The study was guided by five expert meetings with different stakeholders and a final consensus meeting that resulted in a core PEWS set. RESULTS The first Delphi round was completed by 292 healthcare professionals, consisting of pediatric nurses and physicians. In the second Delphi round 217 healthcare professionals participated. Eventually, the core PEWS set was been developed comprising of the parameters work of breathing, respiratory rate, oxygen therapy, heart rate and capillary refill time, and AVPU (Alert, Verbal, Pain, and Unresponsive). In addition, risk stratification was added to the core set with standardized risk factors consisting of [1] worried signs from healthcare professionals and parents and [2] high-risk treatment, with the option to add applicable local defined risk factors. Lastly, the three categories of risk stratification were defined (standard, medium, and high risk) in combination with standardized actions of the professionals for each category. CONCLUSION This study demonstrates a way to end a country's struggle with PEWS heterogeneity by co-designing a national Dutch PEWS system. Currently, the power of the system is being investigated in a large multi-center study in the Netherlands.
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Affiliation(s)
- Joris Fuijkschot
- Radboud University Medical Center, Radboudumc Amalia Childrens Hospital, Nijmegen, The Netherlands.
| | - Jikke Stevens
- Radboud University Medical Center, Radboudumc Amalia Childrens Hospital, Nijmegen, The Netherlands
| | - Lara Teheux
- Radboud University Medical Center, Radboudumc Amalia Childrens Hospital, Nijmegen, The Netherlands
| | - Erica de Loos
- Dutch Hospital Association, Utrecht, The Netherlands
| | - Hester Rippen
- Dutch Foundation Child & Hospital, Utrecht, The Netherlands
| | - Maaike Meurs
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Janke de Groot
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Knowledge Institute for Medical Specialists, Utrecht, The Netherlands
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Joren CY, Kars MC, Kremer LCM, Rippen H, Verhagen AAE, Aris-Meijer JL. Improvement and implementation of a national individual care plan in paediatric palliative care: a study protocol. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2022-001677. [PMID: 36697034 PMCID: PMC9884846 DOI: 10.1136/bmjpo-2022-001677] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Paediatric palliative care (PPC) is care for children with life-threatening or life-limiting conditions, and can involve complex high-tech care, which can last for months or years. In 2015, the National Individual Care Plan (ICP) for PPC was developed and has shown to be successful. The ICP can be seen as an instrument to facilitate coordination, quality and continuity of PPC. However, in practice, an ICP is often completed too late and for too few children. We aim to improve the coordination, quality and continuity of care for every child with a life-threatening or life-limiting condition and his/her family by further developing and implementing the ICP in the Netherlands. METHODS AND ANALYSIS To evaluate the original ICP, ICP 1.0, interviews and questionnaires will be held among parents of children who have or have had an ICP 1.0 and healthcare professionals (HCPs) who used ICP 1.0. Based on the results, ICP 1.0 will be further developed. An implementation strategy will be written and the renewed ICP, ICP 2.0, will be nationally tested in an implementation period of approximately 7 months. During the implementation period, ICP 2.0 will be used for all children who are registered with Children's Palliative Care teams. After the implementation period, ICP 2.0 will be evaluated using interviews and questionnaires among parents of children who received ICP 2.0 and HPCs who worked with ICP 2.0. Based on these results, ICP 2.0 will be further optimised into the final version: ICP 3.0. ETHICS AND DISSEMINATION This study received ethical approval. The ICP 3.0 will be disseminated through the Dutch Centre of Expertise in Children's Palliative Care, to ensure wide availability for the general public and HCPs within PPC. Additionally, we aim to publish study results in open-access, peer-reviewed journals and to present results at national and international scientific meetings.
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Affiliation(s)
- Chantal Y Joren
- Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands .,Department of Pediatrics, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Marijke C Kars
- Center of Expertise in Palliative Care Utrecht, Julius Center of Health and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | | | - Hester Rippen
- Dutch Foundation Child and Hospital, Utrecht, The Netherlands
| | - A A Eduard Verhagen
- Department of Pediatrics, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Judith L Aris-Meijer
- Department of Pediatrics, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
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de Jong-Witjes S, Kars MC, van Vliet M, Huber M, van der Laan SEI, Gelens EN, Berkelbach van der Sprenkel EE, Nijhof SL, de Jonge MV, Rippen H, van de Putte EM. Development of the My Positive Health dialogue tool for children: a qualitative study on children's views of health. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2021-001373. [PMID: 36053589 PMCID: PMC9014061 DOI: 10.1136/bmjpo-2021-001373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/20/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Children's views of health were explored in order to develop a health dialogue tool for children. METHODS A qualitative research design was used as part of a codesign process. Based on semi-structured interviews with both healthy children and children with a chronic condition (aged 8-18). Two approaches were applied. The first was an open exploration of children's views on health, which was then thematically analysed. Subsequently, a framework was used, based on the six-dimensional My Positive Health (MPH) dialogue tool for adults, to guide the second part of the interviews, focusing on reviewing the children's view on health within the context of the framework. For the final draft of the dialogue tool, a framework analysis was conducted and then validated by members of the 'children's council' of the Wilhelmina Children's Hospital. RESULTS We interviewed 65 children, 45 of whom had a chronic condition and 20 were healthy. The children described a broad concept of health with the central themes of 'feeling good about yourself' and 'being able to participate'. Based on the subsequent framework analysis, the wording of two of the six dimensions of the MPH dialogue tool was adjusted and the related aspects were adapted for better alignment with the children's concept of health. After these modifications, the tool fully matched the children's concept of health. CONCLUSION The MPH dialogue tool for children was developed for children with and without a chronic condition, to help them open up about what they consider important for their health and well-being, and to improve directorship over decisions and actions that would affect their health. The MPH dialogue tool aims to support healthcare professionals in providing the type of care and treatment that is in line with the needs of their young patients/clients.
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Affiliation(s)
- Stacey de Jong-Witjes
- Paediatrics, Wilhelmina Children's Hospital University Medical Centre, Utrecht, The Netherlands
| | - Marijke C Kars
- Julius Centre for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Marja van Vliet
- Institute for Positive Health Foundation, Utrecht, The Netherlands
| | - Machteld Huber
- Institute for Positive Health Foundation, Utrecht, The Netherlands
| | - Sabine E I van der Laan
- Paediatrics, Wilhelmina Children's Hospital University Medical Centre, Utrecht, The Netherlands
| | - Eva N Gelens
- Paediatrics, Wilhelmina Children's Hospital University Medical Centre, Utrecht, The Netherlands
| | | | - Sanne L Nijhof
- Paediatrics, Wilhelmina Children's Hospital University Medical Centre, Utrecht, The Netherlands
| | - Maretha V de Jonge
- Clinical Neurodevelopmental Sciences, Leiden University, Leiden, The Netherlands
| | - Hester Rippen
- Stichting Kind En Ziekenhuis, Utrecht, The Netherlands
| | - Elise M van de Putte
- Paediatrics, Wilhelmina Children's Hospital University Medical Centre, Utrecht, The Netherlands
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Perasso G, Camurati G, Morrin E, Dill C, Dolidze K, Clegg T, Simonelli I, Lo HYC, Magione-Standish A, Pansier B, Gulyurtlu SC, Garone A, Rippen H. Five Reasons Why Pediatric Settings Should Integrate the Play Specialist and Five Issues in Practice. Front Psychol 2021; 12:687292. [PMID: 34267710 PMCID: PMC8275832 DOI: 10.3389/fpsyg.2021.687292] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/02/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Giulia Perasso
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.,Porto dei Piccoli, Genoa, Italy
| | | | | | - Courtney Dill
- Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Khatuna Dolidze
- Georgian Association for the Care of Children's Health, Tiblisi, Georgia
| | - Tina Clegg
- Health Play Specialist Education Trust, Leicester, United Kingdom
| | - Ilaria Simonelli
- Health Promoting Hospitals and Health Care Services - Children's and Adolescents' Task Force, Trento, Italy
| | | | | | | | | | - Adam Garone
- Starlight Children's Foundation, Culver City, CA, United States
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van de Maat JS, van Klink D, den Hartogh-Griffioen A, Schmidt-Cnossen E, Rippen H, Hoek A, Neill S, Lakhanpaul M, Moll HA, Oostenbrink R. Development and evaluation of a hospital discharge information package to empower parents in caring for a child with a fever. BMJ Open 2018; 8:e021697. [PMID: 30166298 PMCID: PMC6119437 DOI: 10.1136/bmjopen-2018-021697] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES First, to explore parents' views on and experiences of managing their febrile child and to assess their behaviour and needs when in search of information about fever; second, to develop and evaluate a hospital discharge information package about fever in children. DESIGN Mixed methods: (A) qualitative study with semistructured interviews and a focus group discussion (FGD) and (B) quantitative survey. SETTING Emergency department, non-acute hospital setting and day nursery in Rotterdam, The Netherlands. PARTICIPANTS Parents of children <18 years (interviews, n=22) parents of children under 5 years (FGD (n=14), survey (n=38)). INTERVENTION Information package about fever in children (leaflet and website including videos). OUTCOME MEASURES QUANTITATIVE SURVEY Knowledge of fever and confidence in caring for a febrile child (Likert scale 0-5). RESULTS Parents found fever mostly alarming, especially high fever. Help-seeking behaviour was based on either specific symptoms or on an undefined intuition. When parents did not feel recognised in their concern or felt criticised, anxiety increased as well as the threshold to seek healthcare for future illnesses. Information was needed, especially for situations when the general practitioner or social network were less easily available. This information should be reliable, consistent, available in multiple formats and include advice on management of fever at home and precise referral to medical services. Parents reported improved knowledge about fever (p<0.05) and mentioned improved confidence in caring for a child with fever at home after consulting the information package. CONCLUSION Parents of children with a fever visiting the hospital are concerned about specific symptoms or based on an undefined intuition. Rather than telling parents that they should manage their child's illness at home, healthcare professionals should recognise parental intuition and provide clear information on alarming signs and potential diagnoses to empower parents in the management of their febrile child.
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Affiliation(s)
- Josephine S van de Maat
- Department of General Paediatrics, Erasmus Medical Centre – Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Daphne van Klink
- Department of General Paediatrics, Erasmus Medical Centre – Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Anine den Hartogh-Griffioen
- Department of General Paediatrics, Erasmus Medical Centre – Sophia Children’s Hospital, Rotterdam, The Netherlands
| | | | - Hester Rippen
- Stichting Kind en Ziekenhuis, Utrecht, The Netherlands
| | - Amber Hoek
- Emergency Department, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Sarah Neill
- Faculty of Health and Society, University of Northampton, Northampton, UK
| | | | - Henriette A Moll
- Department of General Paediatrics, Erasmus Medical Centre – Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Rianne Oostenbrink
- Department of General Paediatrics, Erasmus Medical Centre – Sophia Children’s Hospital, Rotterdam, The Netherlands
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