Guidance for Structuring a Pediatric Intermediate Care Unit

The purpose of this policy statement is to update the 2004 American Academy of Pediatrics clinical report and provide enhanced guidance for institutions, administrators, and providers in the development and operation of a pediatric intermediate care unit (IMCU). Since 2004, there have been significant advances in pediatric medical, surgical, and critical care that have resulted in an evolution in the acuity and complexity of children potentially requiring IMCU admission. A group of 9 clinical experts in pediatric critical care, hospital medicine, intermediate care, and surgery developed a consensus on priority topics requiring updates, reviewed the relevant evidence, and, through a series of virtual meetings, developed the document. The intended audience of this policy statement is broad and includes pediatric critical care professionals, pediatric hospitalists, pediatric surgeons, other pediatric medical and surgical subspecialists, general pediatricians, nurses, social workers, care coordinators, hospital administrators, health care funders, and policymakers, primarily in resource-rich settings. Key priority topics were delineation of core principles for an IMCU, clarification of target populations, staffing recommendations, and payment.

'I'm praying for a miracle': characteristics of spiritual statements in paediatric intensive care unit care conferences

CONTEXT

Supporting spiritual needs is a well-established aspect of palliative care, but no data exist regarding how physicians engage with patients and families around spirituality during care conferences in paediatric intensive care units (PICU).

OBJECTIVES

To assess the frequency and characteristics of family and physician spiritual statements in PICU care conferences.

METHODS

We performed qualitative analysis of 71 transcripts from PICU conferences, audio-recorded at an urban, quaternary medical centre. Transcripts were derived from a single-centre, cross-sectional, qualitative study.

RESULTS

We identified spiritual language in 46% (33/71) of PICU care conferences. Spiritual statements were divided relatively evenly between family member (51%, 67/131) and physician statements (49%, 64/131). Physician responses to families' spiritual statements were coded as supportive (46%, 31/67), deferred (30%, 20/67), indifferent (24%, 16/67) or exploratory (0/67).

CONCLUSIONS

In this single-centre PICU, spiritual statements were present 46% of the time during high stakes decision-making conferences, but there was little evidence of spiritual care best practices, such as offering chaplain support and performing open-ended spiritual assessments. PICU clinicians should expect spiritual statements in care conferences and be prepared to respond.

"Good-Parent Beliefs": Research, Concept, and Clinical Practice

Parents of ill children have willingly identified their personal beliefs about what they should do or focus on to fulfill their own internal definition of being a good parent for their child. This observation has led to the development of the good-parent beliefs concept over the past decade. A growing qualitative, quantitative, and mixed-methods research base has explored the ways that good-parent beliefs guide family decision-making and influence family relationships. Parents have expressed comfort in speaking about their good-parent beliefs. Whether parents achieve their unique good-parent beliefs definition affects their sense of whether they did a good job in their role of parenting their ill child. In this state-of-the-art article, we offer an overview of the good-parent beliefs concept over the past decade, addressing what is currently known and gaps in what we know, and explore how clinicians may incorporate discussions about the good-parent beliefs into clinical practice.

Seroprevalence of hepatitis C virus infection among indigent urban pregnant women in Zimbabwe

OBJECTIVE

To estimate the seroprevalence of hepatitis C virus (HCV) infection among indigent pregnant women.

DESIGN

A serological survey study of indigent pregnant women admitted for labour and delivery.

SETTING

Harare Maternity Hospital, Harare, Zimbabwe.

SUBJECTS

A random sample of 1,607 women, delivering at the hospital during the study period agreed to participate in the research. Serum samples were available for 1,591 women.

MAIN OUTCOME MEASURES

Serum samples were tested for the presence of antibodies to HCV using a second generation agglutination assay and a third generation enzyme immuno-assay (EIA).

RESULTS

Of the 1,591 women tested 25 (1.6%) were anti-HCV positive (95% confidence interval 1.0% to 2.2%). The frequency of anti-HCV positives was associated with maternal age (p = 0.0202) and maternal syphilis status (p = 0.020). Gravidas aged 25 to 29 years had the highest anti-HCV seroprevalence (3.4%) as compared with gravidas of other age categories (1.0% to 1.5%). Women with serologic evidence of syphilis infection during the index pregnancy had an increased prevalence of anti-HCV as compared with those women without evidence of syphilis infection (7.9% versus 1.4%, p = 0.020). There was some evidence (p = 0.094) that a positive prior history of delivering a stillborn infant was also associated with an increased prevalence of anti-HCV (4.1% vs 1.4%). Other maternal characteristics, including hepatitis B virus carriage status, parity, and whether she had received prenatal care during the index pregnancy were not determinants of maternal anti-HCV status.

CONCLUSIONS

Overall, hepatitis C antibody was detected in 1.6% of indigent women delivering at Harare Maternity Hospital. This proportion of anti-HCV positive pregnant women is similar to estimates published for North American and European women. Factors positively associated with maternal seropositivity in our population included maternal age (between 25 to 29 years), prior history of delivering a stillborn infant, and seropositivity for syphilis during the index pregnancy. Given the relatively low seroprevalence of HCV and the fact that risk factors for HCV infection remain largely unknown, more studies are needed to identify high risk populations likely to benefit from HCV screening and treatment programmes.