[Development of an indicator set for the evaluation of the quality of routine ambulatory health care for common disorders in children and adolescents]

BACKGROUND

In Germany, no consented quality indicator set (QI set) exists to date that can be used to assess the quality of pediatric care. Therefore, the aim of the project "Assessment of the quality of routine ambulatory health care for common disorders in children and adolescents" (QualiPäd) funded by the Innovation Committee of the Federal Joint Committee (grant no.: 01VSF19035) was to develop a QI set for the diseases asthma, atopic eczema, otitis media, tonsillitis, attention-deficit hyperactivity disorder (ADHD), depression and conduct disorder.

METHODS

For the observation period 2018/2019, quality indicators (QIs) were searched in indicator databases, guidelines and literature databases and complemented in part by newly formulated QIs (e.g., derived from guideline recommendations). The QIs were then assigned to content categories and dimensions according to Donabedian and OECD and reduced by removing duplicates. Finally, a panel of experts consulted the QIs using the modified RAND-UCLA Appropriateness Method (RAM).

RESULTS

The search resulted in a preliminary QI set of 2324 QIs. After the reduction steps and the evaluation of the experts, 282 QIs were included in the QI set (asthma: 72 QIs, atopic eczema: 25 QIs, otitis media: 31 QIs, tonsillitis: 12 QIs, ADHD: 53 QIs, depression: 43 QIs, conduct disorder: 46 QIs). The QIs are distributed among the following different categories: Therapy (138 QIs), Diagnostics (95 QIs), Patient-reported outcome measures/Patient-reported experience measures (PROM/PREM) (45 QIs), Practice management (31 QIs), and Health reporting (4 QIs). In the Donabedian model, 89% of the QIs capture process quality, 9% outcome quality, and 2% structural quality; according to the OECD classification, 61% measure effectiveness, 23% patient-centeredness, and 16% safety of care.

CONCLUSION

The consented QI set is currently being tested and can subsequently be used (possibly modified) to measure the quality of routine outpatient care for children and adolescents in Germany, in order to indicate the status quo and potential areas for improvement in outpatient care.

[Climate change and child health: A nationwide survey among paediatricians in Germany]

BACKGROUND

Children are a vulnerable group affected by climate change. Paediatricians are important actors in protecting children from climate change-related health risks and in identifying and treating relevant health effects. The main objectives of this study were to determine how paediatricians assess the relevance of climate change-related health impacts, through which channels paediatricians can be reached most effectively, how often climate change-specific prevention measures are implemented and how they are assessed.

METHODS

Between February and July 2020, an online survey was conducted among paediatricians. The cross-sectional survey was designed to gather knowledge and attitudes about the relevance of climate change, sources of information and prevention measures. All participants who answered only one question or none at all were excluded. Differences between groups were determined using one-factorial analysis of variance. Correlations were determined using Pearson's bivariate correlation analysis and tested for two-sided significance.

RESULTS

A total of 408 questionnaires were analysed. Over 95% of the respondents were paediatricians, with just under half of them working in children's hospitals and a good third in paediatric practices. According to paediatricians, climate change has a relevant impact on children's health. The most significant effects on children's health were considered to be longer and stronger pollen seasons, neophytes and neozoa, Lyme disease and TBE (tick-borne encephalitis, summer meningoencephalitis), UV radiation and air pollutants. Certified training options in professional journals and participation in lectures or workshops at relevant congresses were identified as the two preferred types of training. Especially professional journals as the most frequently used source of information could function as a suitable tool to reach as many paediatricians as possible. 76% of the paediatricians have not yet carried out any corresponding prevention activities, although information activities for parents or children were seen as being effective by 80%. Whereas the possibilities of integrating climate change-oriented prevention activities into everyday practice, were perceived less positively. The most frequent reason given was lack of time.

DISCUSSION

To satisfy this future need for knowledge, but also for offerings from paediatricians for patients and their parents, concrete further continuous education and consultancy services must be prepared. In the future, further training offers, including the consultancy services, should be integrated into profession-specific training modules, presented at congresses, and then implemented into paediatricians' daily routine.

CONCLUSION

The results of the study illustrate that the topic "climate change and health" has a high relevance for paediatricians and that information measures for parents are considered to be effective. Although paediatricians are concerned with the topic, there is an implementation deficit. Support is needed in the form of intensifying awareness-raising projects and educational modules for paediatricians to move from knowledge to action.

[Similarities and differences in specialized outpatient palliative care for adults, children and adolescents: results from focus group discussions with health care professionals]

BACKGROUND

In Germany, people with life-limiting conditions and complex symptoms are eligible for specialized outpatient palliative care (SOPC). Requirements, delivery and goals of SOPC have been laid down by the Federal Joint Committee in a nationwide guideline. The guideline emphasizes the need to consider the special needs of children and adolescents with life-limiting conditions. A specification of these needs has so far been missing. The focus group discussion presented here aimed at investigating similarities and differences between the specialized outpatient palliative care of adults (SOPC for adults) on the one hand, and children and adolescents (SOPPC) on the other hand, from the perspective of health care professionals in order to further define specifics of SOPPC.

METHOD

In three focus group discussions a total of 11 nursing and 8 medical professionals from SOPC for adults and SOPPC engaged in face-to-face discussions on the similarities and differences of both care forms. Discussions were designed openly and stimulated with three guiding questions only. Focus group discussions were audio-recorded, transcribed verbatim and analyzed by thematic analysis supported by the software MAXQDA.

RESULTS

Within the following six themes, similarities as well as key differences between SOPC and SOPPC were identified: the participants discussed diseases, coverage area and locations, therapy goals, the psychosocial care situation, the role of relatives and end-of-life care. From the participants' perspective different underlying diseases constitute a main difference that causes further differences in the expertise required. Furthermore, SOPC for adults and SOPPC differ in the dimension of areas covered by one team, the number of patients per team and the reasons for SOPC visits. Differences in terminal care and the mourning process within the team became evident. Some similarities existed regarding goal-setting, psychosocial care and the role of relatives, but concrete patterns and the importance of these aspects differed because a particularly complex and emotional communication is required when a child is dying.

CONCLUSION

From the perspective of health care professionals, SOPC for adults and SOPPC differ with regard to underlying diseases as well as care patterns such as collaboration with relatives and their need for psychosocial support. Therefore, the care for children, adolescents and young adults with life-limiting conditions and pediatric diseases all over Germany should be delivered within the frame of an independent care structure by teams whose members possess specific pediatric expertise.

[Pharmacokinetic and pharmacodynamic modelling in paediatric drug development with a focus on physiology-based pharmacokinetic simulations]

Pharmacokinetic and pharmacodynamic models are mandatory for dosing and the safe use of drugs in the paediatric population. Different modelling methods allow for the development of dosing regimens for children requiring only a small number of blood samples or none at all. The medicines regulatory authorities recommend using these methods for paediatric drug development programs. Taking sildenafil as an example, the least invasive method of physiology-based pharmacokinetic simulation for the development of dosing regimens in the paediatric population is presented.

ALL OUR SONS: THE DEVELOPMENTAL NEUROBIOLOGY AND NEUROENDOCRINOLOGY OF BOYS AT RISK

Why are boys at risk? To address this question, I use the perspective of regulation theory to offer a model of the deeper psychoneurobiological mechanisms that underlie the vulnerability of the developing male. The central thesis of this work dictates that significant gender differences are seen between male and female social and emotional functions in the earliest stages of development, and that these result from not only differences in sex hormones and social experiences but also in rates of male and female brain maturation, specifically in the early developing right brain. I present interdisciplinary research which indicates that the stress-regulating circuits of the male brain mature more slowly than those of the female in the prenatal, perinatal, and postnatal critical periods, and that this differential structural maturation is reflected in normal gender differences in right-brain attachment functions. Due to this maturational delay, developing males also are more vulnerable over a longer period of time to stressors in the social environment (attachment trauma) and toxins in the physical environment (endocrine disruptors) that negatively impact right-brain development. In terms of differences in gender-related psychopathology, I describe the early developmental neuroendocrinological and neurobiological mechanisms that are involved in the increased vulnerability of males to autism, early onset schizophrenia, attention deficit hyperactivity disorder, and conduct disorders as well as the epigenetic mechanisms that can account for the recent widespread increase of these disorders in U.S. culture. I also offer a clinical formulation of early assessments of boys at risk, discuss the impact of early childcare on male psychopathogenesis, and end with a neurobiological model of optimal adult male socioemotional functions.

[Evaluation of pediatric Advanced Practice Nurse: quality and benefit for Switzerland?]

Die Betreuung von chronisch kranken Kindern und Jugendlichen mit multiplen Einschränkungen ist komplexer geworden und stellt Gesundheitseinrichtungen und Fachpersonen vor Herausforderungen. Neue Versorgungsmodelle wie die Implementierung von Advanced Practice Nursing sind angemessen, um auch zukünftig qualitativ hochstehende Versorgung zu gewährleisten. Im Kinderspital Zürich sichern Advanced Practice Nurses (APNs) die komplexe Betreuung der betroffenen Familien. Ziel dieser Studie ist, die Tätigkeiten der APNs Kontinenz und Wundpflege aus interdisziplinärer Sicht auf ihre Qualität und ihren Nutzen zu untersuchen. Einem Mixed Method-Ansatz folgend wurden Handlungen und Nutzen der APNs anhand von zehn qualitativen Interviews und einer parallelen Fragebogenerhebung (N = 96) evaluiert. Die Resultate zeigen die Umsetzung zentraler APN-Kompetenzen und weisen eine hohe Qualität der Tätigkeiten aus. Der Nutzen umfasst positive Auswirkungen auf die betroffenen Kinder und Familien und das interdisziplinäre Fachpersonal. Eine professionelle Wundversorgung und das Erlangen von Kontinenz wurden als Effekte identifiziert.