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https://www.readbyqxmd.com/read/27846070/implementation-and-operational-research-an-integrated-and-comprehensive-service-delivery-model-to-improve-pediatric-and-maternal-hiv-care-in-rural-africa
#1
Anna Gamell, Tracy R Glass, Lameck B Luwanda, Herry Mapesi, Leila Samson, Tom Mtoi, Angelo Nyamtema, Lukas Muri, Alex Ntamatungiro, Marcel Tanner, Christoph Hatz, Manuel Battegay, Emilio Letang
BACKGROUND: Strategies to improve HIV diagnosis and linkage into care, antiretroviral treatment coverage, and treatment outcomes of mothers and children are urgently needed in sub-Saharan Africa. METHODS: From December 2012, we implemented an intervention package to improve prevention of mother-to-child transmission (PMTCT) and pediatric HIV care in our rural Tanzanian clinic, consisting of: (1) creation of a PMTCT and pediatric unit integrated within the reproductive and child health clinic; (2) implementation of electronic medical records; (3) provider-initiated HIV testing and counseling in the hospital wards; and (4) early infant diagnosis test performed locally...
December 15, 2016: Journal of Acquired Immune Deficiency Syndromes: JAIDS
https://www.readbyqxmd.com/read/27757471/appointment-lead-time-policy-development-to-improve-patient-access-to-care
#2
Yu-Li Huang, Sarah M Bach
BACKGROUND: Patient access to care has been a known and continuing struggle for many health care providers. In spite of appointment lead time policies set by government or clinics, the problem persists. Justification for how lead time policies are determined is lacking. OBJECTIVES: This paper proposed a data-driven approach for how to best set feasible appointment target lead times given a clinic's capacity and appointment requests. METHODS: The proposed approach reallocates patient visits to minimize the deviation between actual appointment lead time and a feasible target lead time...
October 19, 2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27748332/implementation-of-a-pediatric-emergency-triage-system-in-xiamen-china
#3
Gang-Xi Lin, Yin-Ling Yang, Denise Kudirka, Colleen Church, Collin K K Yong, Fiona Reilly, Qi-Yi Zeng
BACKGROUND: Pediatric emergency rooms (PERs) in Chinese hospitals are perpetually full of sick and injured children because of the lack of sufficiently developed community hospitals and low access to family physicians. The aim of this study was to evaluate the clinical value of a new five-level Chinese pediatric emergency triage system (CPETS), modeled after the Canadian Triage System and Acuity Scale. METHODS: In this study, we compared CPETS outcomes in our PER relative to those of the prior two-level system...
2016: Chinese Medical Journal
https://www.readbyqxmd.com/read/27599265/effects-of-social-needs-screening-and-in-person-service-navigation-on-child-health-a-randomized-clinical-trial
#4
Laura M Gottlieb, Danielle Hessler, Dayna Long, Ellen Laves, Abigail R Burns, Anais Amaya, Patricia Sweeney, Christine Schudel, Nancy E Adler
Importance: Social determinants of health shape both children's immediate health and their lifetime risk for disease. Increasingly, pediatric health care organizations are intervening to address family social adversity. However, little evidence is available on the effectiveness of related interventions. Objective: To evaluate the effects of social needs screening and in-person resource navigation services on social needs and child health. Design, Setting, and Participants: Patients were randomized to intervention or active control conditions by the day of the week...
September 6, 2016: JAMA Pediatrics
https://www.readbyqxmd.com/read/27599004/an-integrated-and-comprehensive-service-delivery-model-to-improve-pediatric-and-maternal-hiv-care-in-rural-africa
#5
Anna Gamell, Tracy R Glass, Lameck B Luwanda, Herry Mapesi, Leila Samson, Tom Mtoi, Angelo Nyamtema, Lukas Muri, Alex Ntamatungiro, Marcel Tanner, Christoph Hatz, Manuel Battegay, Emilio Letang
BACKGROUND: Strategies to improve HIV diagnosis and linkage into care, antiretroviral treatment coverage and treatment outcomes of mothers and children are urgently needed in sub-Saharan Africa. METHODS: From 12/2012, we implemented an intervention package to improve Prevention of Mother-To-Child Transmission (PMTCT) and pediatric HIV care in our rural Tanzanian clinic, consisting of: a) creation of a PMTCT and pediatric unit integrated within the reproductive and child health clinic; b) implementation of electronic medical records; c) provider-initiated HIV testing and counseling in the hospital wards; and d) early infant diagnosis test performed locally...
September 1, 2016: Journal of Acquired Immune Deficiency Syndromes: JAIDS
https://www.readbyqxmd.com/read/27557912/guidelines-for-monitoring-and-management-of-pediatric-patients-before-during-and-after-sedation-for-diagnostic-and-therapeutic-procedures-update-2016
#6
Charles J Coté, Stephen Wilson
The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical/dental supervision, careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications, appropriate fasting for elective procedures and a balance between the depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure, a focused airway examination for large (kissing) tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction, a clear understanding of the medication's pharmacokinetic and pharmacodynamic effects and drug interactions, appropriate training and skills in airway management to allow rescue of the patient, age- and size-appropriate equipment for airway management and venous access, appropriate medications and reversal agents, sufficient numbers of staff to both carry out the procedure and monitor the patient, appropriate physiologic monitoring during and after the procedure, a properly equipped and staffed recovery area, recovery to the presedation level of consciousness before discharge from medical/dental supervision, and appropriate discharge instructions...
2016: Pediatric Dentistry
https://www.readbyqxmd.com/read/27399743/pediatric-canadian-triage-and-acuity-scale-paedsctas-as-a-measure-of-injury-severity
#7
Morgan Thorn Yates, Takuro Ishikawa, Amy Schneeberg, Mariana Brussoni
This research explored whether the pediatric version of the Canadian Triage Acuity Scale (PaedsCTAS) represented a valid alternative indicator for surveillance of injury severity. Every patient presenting in a Canadian emergency department is assigned a CTAS or PaedsCTAS score in order to prioritize access to care and to predict the nature and scope of care that is likely to be required. The five-level PaedsCTAS score ranges from I (resuscitation) to V (non-urgent). A total of 256 children, 0 to 17-years-old, who attended a pediatric hospital for an injury were followed longitudinally...
2016: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/27354454/guidelines-for-monitoring-and-management-of-pediatric-patients-before-during-and-after-sedation-for-diagnostic-and-therapeutic-procedures-update-2016
#8
Charles J Coté, Stephen Wilson
The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical/dental supervision, careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications, appropriate fasting for elective procedures and a balance between the depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure, a focused airway examination for large (kissing) tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction, a clear understanding of the medication's pharmacokinetic and pharmacodynamic effects and drug interactions, appropriate training and skills in airway management to allow rescue of the patient, age- and size-appropriate equipment for airway management and venous access, appropriate medications and reversal agents, sufficient numbers of staff to both carry out the procedure and monitor the patient, appropriate physiologic monitoring during and after the procedure, a properly equipped and staffed recovery area, recovery to the presedation level of consciousness before discharge from medical/dental supervision, and appropriate discharge instructions...
July 2016: Pediatrics
https://www.readbyqxmd.com/read/27120318/the-use-of-angiography-in-pediatric-blunt-abdominal-trauma-patients
#9
Stephen J Fenton, Kristin N Sandoval, Austin M Stevens, Eric R Scaife
BACKGROUND: Angiography is a common treatment used in adults with blunt abdominal trauma and/or severe pelvic fractures. The Committee on Trauma of the American College of Surgeons has recently advocated for this resource to be urgently available at pediatric trauma centers; however, its usefulness in the pediatric setting is unclear. The purpose of this study was to determine the incidence of angiography in the treatment of blunt abdominal trauma among injured children. METHODS: An analysis was performed using an established public use data set of children (younger than 18 years) treated at 20 participating trauma centers for blunt torso trauma through the Pediatric Emergency Care Applied Research Network...
August 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/26999485/psychiatric-diagnoses-and-comorbidities-in-a-diverse-multicity-cohort-of-young-transgender-women-baseline-findings-from-project-lifeskills
#10
Sari L Reisner, Katie B Biello, Jaclyn M White Hughto, Lisa Kuhns, Kenneth H Mayer, Robert Garofalo, Matthew J Mimiaga
IMPORTANCE: Transgender youth, including adolescent and young adult transgender women assigned a male sex at birth who identify as girls, women, transgender women, transfemale, male-to-female, or another diverse transfeminine gender identity, represent a vulnerable population at risk for negative mental health and substance use outcomes. Diagnostic clinical interviews to assess prevalence of mental health, substance dependence, and comorbid psychiatric disorders in young transgender women remain scarce...
May 1, 2016: JAMA Pediatrics
https://www.readbyqxmd.com/read/26912550/early-requirement-for-rrt-in-children-at-presentation-in-the-united-kingdom-association-with-transplantation-and-survival
#11
Rishi Pruthi, Anna Casula, Carol Inward, Paul Roderick, Manish D Sinha
BACKGROUND AND OBJECTIVES: We evaluated rates and factors associating with late referral (LR) and describe association of LR with access to renal transplantation and patient survival in children in the United Kingdom. Early requirement of RRT within 90 days of presentation to a pediatric nephrologist was classed as a LR, and those >90 days as an early referral (ER). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We included patients who commenced RRT, aged ≥3 months and <16 years, from 1996 to 2012...
May 6, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/26816175/the-therapeutic-itinerary-in-urgent-emergency-pediatric-situations-in-a-maroon-community
#12
Samylla Maira Costa Siqueira, Viviane Silva de Jesus, Climene Laura de Camargo
The goal was to understand the therapeutic itinerary of Maroon children in urgent/emergency situation. Is a descriptive research with a qualitative approach that uses the Health Care System model of Arthur Kleinman as its theoretical support. Participants included 12 mothers of children who had experienced any urgent or emergency medical situation. Data collection took place from December 2013 to June 2014 through semi-structured interviews with a thematic analysis of the data. The care of the child started in the "informal" subsystem, and access to a "formal" subsystem was characterized as a pilgrimage for health services...
January 2016: Ciência & Saúde Coletiva
https://www.readbyqxmd.com/read/26786633/family-adversity-and-resilience-measures-in-pediatric-acute-care-settings
#13
Donna M O'Malley, Kimberly A Randell, M Denise Dowd
OBJECTIVE: Adverse childhood experiences (ACEs) impact health across the life course. The purpose of this study was to identify caregiver ACEs, current adversity, and resilience in families seeking care in pediatric acute care settings. Study aims included identifying demographic characteristics, current adversities, and resilience measures associated with caregiver ACEs ≥4. DESIGN AND SAMPLE: A cross-sectional survey study design was used and a convenience sample (n = 470) recruited at emergency and urgent care settings of a large Midwest pediatric hospital system...
January 2016: Public Health Nursing
https://www.readbyqxmd.com/read/26578612/provision-of-palliative-care-in-low-and-middle-income-countries-overcoming-obstacles-for-effective-treatment-delivery
#14
REVIEW
Breffni Hannon, Camilla Zimmermann, Felicia M Knaul, Richard A Powell, Faith N Mwangi-Powell, Gary Rodin
Despite being declared a basic human right, access to adult and pediatric palliative care for millions of individuals in need in low- and middle-income countries (LMICs) continues to be limited or absent. The requirement to make palliative care available to patients with cancer is increasingly urgent because global cancer case prevalence is anticipated to double over the next two decades. Fifty percent of these cancers are expected to occur in LMICs, where mortality figures are disproportionately greater as a result of late detection of disease and insufficient access to appropriate treatment options...
January 1, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/26090548/mobile-pediatric-neurosurgery-rapid-response-neurosurgery-for-remote-or-urgent-pediatric-patients
#15
Brian K Owler, Kathryn A Browning Carmo, Wendy Bladwell, T Arieta Fa'asalele, Jane Roxburgh, Tina Kendrick, Andrew Berry
OBJECT: Time-critical neurosurgical conditions require urgent operative treatment to prevent death or neurological deficits. In New South Wales/Australian Capital Territory patients' distance from neurosurgical care is often great, presenting a challenge in achieving timely care for patients with acute neurosurgical conditions. METHODS: A protocol was developed to facilitate consultant neurosurgery locally. Children with acute, time-critical neurosurgical emergencies underwent operations in hospitals that do not normally offer neurosurgery...
September 2015: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/26083338/understanding-low-acuity-visits-to-the-pediatric-emergency-department
#16
Ken J Farion, Megan Wright, Roger Zemek, Gina Neto, Anna Karwowska, Sandra Tse, Sarah Reid, Mona Jabbour, Stephanie Poirier, Katherine A Moreau, Nicholas Barrowman
BACKGROUND: Canadian pediatric emergency department visits are increasing, with a disproportionate increase in low-acuity visits locally (33% of volume in 2008-09, 41% in 2011-12). We sought to understand: 1) presentation patterns and resource implications; 2) parents' perceptions and motivations; and 3) alternate health care options considered prior to presenting with low-acuity problems. METHODS: We conducted a prospective cohort study at our tertiary pediatric emergency department serving two provinces to explore differences between patients with and without a primary care provider...
2015: PloS One
https://www.readbyqxmd.com/read/26018565/understanding-nonurgent-pediatric-emergency-department-visits-using-hospital-and-family-centric-data-to-inform-system-redesign
#17
Deborah Swavely, Kathy Baker, Krista Bilger, David F Zimmerman, Andrew Martin
We conducted a mixed-method study to analyze the population and financial impact of emergency department use for pediatric nonurgent problems. Findings from this initial study led to our phase 2 case study, in which we interviewed 23 adults accompanying children younger than 4 years with nonemergent fever. The resulting qualitative analysis revealed that participants were unable to distinguish urgent from nonurgent conditions, perceived access limitations to care, and although they preferred the child's primary care physician, went to the emergency department for care...
October 2015: Journal of Nursing Care Quality
https://www.readbyqxmd.com/read/25830535/transforming-primary-care-residency-training-a-collaborative-faculty-development-initiative-among-family-medicine-internal-medicine-and-pediatric-residencies
#18
MULTICENTER STUDY
Patricia A Carney, M Patrice Eiff, Larry A Green, Carol Carraccio, David Gary Smith, Perry A Pugno, William Iobst, Gail McGuinness, Kathleen Klink, Samuel M Jones, Leslie Tucker, Eric Holmboe
PROBLEM: The scope and scale of developments in health care redesign have not been sufficiently adopted in primary care residency programs. APPROACH: The interdisciplinary Primary Care Faculty Development Initiative was created to teach faculty how to accelerate revisions in primary care residency training. The program focused on skill development in teamwork, change management, leadership, population management, clinical microsystems, and competency assessment...
August 2015: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/25536903/adult-care-for-duchenne-muscular-dystrophy-in-the-uk
#19
MULTICENTER STUDY
Sunil Rodger, Katherine L Woods, Catherine L Bladen, Angela Stringer, Julia Vry, Kathrin Gramsch, Janbernd Kirschner, Rachel Thompson, Katharine Bushby, Hanns Lochmüller
Survival in Duchenne muscular dystrophy (DMD) has increased in recent years due to iterative improvements in care. We describe the results of the CARE-NMD survey of care practices for adults with DMD in the UK in light of international consensus care guidelines. We also compare the UK experience of adult care with the care available to pediatric patients and adults in other European countries (Germany, Denmark, Bulgaria, Czech Republic, Hungary, and Poland). UK adults experience less comprehensive care compared to children in their access to specialized clinics, frequency of cardiac and respiratory assessments, and access to professional physiotherapy...
March 2015: Journal of Neurology
https://www.readbyqxmd.com/read/24957705/the-canadian-pediatric-weight-management-registry-canpwr-study-protocol
#20
MULTICENTER STUDY
Katherine M Morrison, Samah Damanhoury, Annick Buchholz, Jean-Pierre Chanoine, Marie Lambert, Mark S Tremblay, Glenn Berall, Jill Hamilton, Anne Marie Laberge, Laurent Legault, Lehana Thabane, Monica Jakymyshyn, Kathryn A Ambler, Geoff D C Ball
BACKGROUND: Over recent decades, the prevalence of pediatric obesity has increased markedly in developed and developing countries, and the impact of obesity on health throughout the lifespan has led to urgent calls for action. Family-based weight management interventions that emphasize healthy lifestyle changes can lead to modest improvements in weight status of children with obesity. However, these interventions are generally short in duration, reported in the context of randomized controlled trials and there are few reports of outcomes of these treatment approaches in the clinical setting...
2014: BMC Pediatrics
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