Management of Discharge Instructions for Children With Medical Complexity: A Systematic Review
CONTEXT/UNASSIGNED:Children with medical complexity (CMC) are at risk for adverse outcomes after discharge. Difficulties with comprehension of and adherence to discharge instructions contribute to these errors. Comprehensive reviews of patient-, caregiver-, provider-, and system-level characteristics and interventions associated with discharge instruction comprehension and adherence for CMC are lacking. OBJECTIVE/UNASSIGNED:To systematically review the literature related to factors associated with comprehension of and adherence to discharge instructions for CMC. DATA SOURCES/UNASSIGNED:PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, Web of Science (database initiation until March 2023), and OAIster (gray literature) were searched. STUDY SELECTION/UNASSIGNED:Original studies examining caregiver comprehension of and adherence to discharge instructions for CMC (Patient Medical Complexity Algorithm) were evaluated. DATA EXTRACTION/UNASSIGNED:Two authors independently screened titles/abstracts and reviewed full-text articles. Two authors extracted data related to study characteristics, methodology, subjects, and results. RESULTS/UNASSIGNED:Fifty-one studies were included. More than half were qualitative or mixed methods studies. Few interventional studies examined objective outcomes. More than half of studies examined instructions for equipment (eg, tracheostomies). Common issues related to access, care coordination, and stress/anxiety. Facilitators included accounting for family context and using health literacy-informed strategies. LIMITATIONS/UNASSIGNED:No randomized trials met inclusion criteria. Several groups (eg, oncologic diagnoses, NICU patients) were not examined in this review. CONCLUSIONS/UNASSIGNED:Multiple factors affect comprehension of and adherence to discharge instructions for CMC. Several areas (eg, appointments, feeding tubes) were understudied. Future work should focus on design of interventions to optimize transitions.
Achieving Child Health Equity: Policy Solutions
Policy solutions to address child health equity, with evidence to support the policies, are presented. Policies address health care, direct financial support to families, nutrition, support for early childhood and brain development, ending family homelessness, making housing and neighborhoods environmentally safe, gun violence prevention, LGBTQ + health equity, and protecting immigrant children and families. Federal, state, and local policies are addressed. Recommendations of the National Academy of Science, Engineering, and Medicine and the American Academy of Pediatrics are highlighted when appropriate.
Engaging pediatricians to address workforce diversity
Developmental screening of full-term infants at 16 to 18 months of age after in-utero exposure to maternal SARS-CoV-2 infection
OBJECTIVE:To screen for neurodevelopmental delays in a cohort of full-term infants born to mothers with SARS-CoV-2. STUDY DESIGN/METHODS:-3) at 16 to 18 months age. RESULTS:Of 51 subjects, twelve (24%) were below cutoff, and twenty-seven (53%) were either below or close to the cutoff in at least one developmental domain. Communication (29%), fine motor (31%), and problem-solving (24%) were the most affected domains. There were no differences in outcomes between infants born to asymptomatic and mildly symptomatic mothers. CONCLUSION/CONCLUSIONS:We observed increased risk of neurodevelopmental delays during screening of infants born at full-term to mothers with SARS-CoV-2 at 16 to 18 months age. These results highlight the urgent need for follow-up studies of infants born to mothers with SARS-CoV-2.
Stepping Up to the Plate-The Role of Pediatricians in Addressing the Child and Adolescent Mental Health Crisis
Validation of the StimQ2: A parent-report measure of cognitive stimulation in the home
Considerable evidence demonstrates the importance of the cognitive home environment in supporting children's language, cognition, and school readiness more broadly. This is particularly important for children from low-income backgrounds, as cognitive stimulation is a key area of resilience that mediates the impact of poverty on child development. Researchers and clinicians have therefore highlighted the need to quantify cognitive stimulation; however existing methodological approaches frequently utilize home visits and/or labor-intensive observations and coding. Here, we examined the reliability and validity of the StimQ2, a parent-report measure of the cognitive home environment that can be delivered efficiently and at low cost. StimQ2 improves upon earlier versions of the instrument by removing outdated items, assessing additional domains of cognitive stimulation and providing new scoring systems. Findings suggest that the StimQ2 is a reliable and valid measure of the cognitive home environment for children from infancy through the preschool period.
Response to Concerns Raised About the New American Academy of Pediatrics Febrile Infant Guideline
Cash Transfers and Reducing Child Poverty in the US
Racial-ethnic disparities in outcomes of children hospitalized for COVID-19: A virus registry report [Meeting Abstract]
INTRODUCTION: Adult racial and ethnic minorities in the U.S. with COVID-19 are known to have worse outcomes. The CDC reported higher incidence of COVID-19 among minority children, but data regarding disparities in pediatric COVID-19 outcomes remains limited.
METHOD(S): A total of 837 children < 18 years of age hospitalized with COVID-19 in the U.S. were entered into the SCCM VIRUS Registry from 03/2020 to 01/2021. They were grouped into either of the following: Hispanic, non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, Other or Unknown. Demographic and clinical characteristics, interventions and outcomes were compared. Critical illness was defined using a composite index of in-hospital mortality and organ support requirement, including vasopressors/inotropes, ECMO and CRRT. Comparisons were made using ANOVA, Kruskal-Wallis or Pearson's Chi-square. We used multivariable logistic and linear regression analysis to examine associations between race and ethnicity and critical illness, hospital and ICU length of stay and hospital mortality.
RESULT(S): Fever was reported in 67%, with no difference among the groups. MIS-C was reported with a significantly higher proportion in non-Hispanic Blacks (36%) than in non- Hispanic Whites (26%) [p=0.02]. Adjusting for age, sex, obesity, immune compromise and asthma, the non-Hispanic Asian group was significantly associated with higher odds of critical illness [OR=5.83, 95% CI=2.13-15.81]. Non-Hispanic Blacks also had higher odds of critical illness than non-Hispanic Whites, though not significant [OR=1.59, 95% CI=0.99-2.54]. With each yearly increase in age, the odds of critical illness was higher [OR=1.04, 95% CI=0.99-1.07] given all other covariates remain the same. While there was a higher proportion of obesity in the Hispanic group, this did not increase their odds of critical illness. Non- Hispanic Blacks had longer hospital length of stay compared to non-Hispanic Whites, though not significant [OR=1.76, 95% CI=-0.17-3.68]. ICU length of stay and mortality were not significantly associated with race or ethnicity.
CONCLUSION(S): Racial and ethnic disparities in pediatric COVID-19 outcomes exist that are not associated with preexisting conditions. These findings may guide the allocation of critical care resources towards minority groups at higher risk for severe disease
Patient and Family-Centered I-PASS SCORE Program: Resident and Advanced Care Provider Training Materials
Introduction:Patient and family-centered rounds (PFCRs) are an important element of family-centered care often used in the inpatient pediatric setting. However, techniques and best practices vary, and faculty, trainees, nurses, and advanced care providers may not receive formal education in strategies that specifically enhance communication on PFCRs. Methods:Harnessing the use of structured communication, we developed the Patient and Family-Centered I-PASS Safer Communication on Rounds Every Time (SCORE) Program. The program uses a standardized framework for rounds communication via the I-PASS mnemonic, principles of health literacy, and techniques for patient/family engagement and bidirectional communication. The resident and advanced care provider training materials, a component of the larger SCORE Program, incorporate a flipped classroom approach as well as interactive exercises, simulations, and virtual learning options to optimize learning and retention via a 90-minute workshop. Results:Two hundred forty-six residents completed the training and were evaluated on their knowledge and confidence regarding key elements of the curriculum. Eighty-eight percent of residents agreed/strongly agreed that after training they could activate and engage families and all members of the interprofessional team to create a shared mental model; 90% agreed/strongly agreed that they could discuss the roles/responsibilities of various team members during PFCRs. Discussion:The Patient and Family-Centered I-PASS SCORE Program provides a structured framework for teaching advanced communication techniques that can improve provider knowledge of and confidence with engaging and communicating with patients/families and other members of the interprofessional team during PFCRs.