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Acta Paediatrica (Oslo, Norway : 1992) Apr 2022A follow-up conversation with bereaved parents is a relatively well-established intervention in paediatric clinical practice. Yet, the content and value of these... (Review)
Review
AIM
A follow-up conversation with bereaved parents is a relatively well-established intervention in paediatric clinical practice. Yet, the content and value of these conversations remain unclear. This review aims to provide insight into the content of follow-up conversations between bereaved parents and regular healthcare professionals (HCPs) in paediatrics and how parents and HCPs experience these conversations.
METHODS
Systematic literature review using the methods PALETTE and PRISMA. The search was conducted in PubMed and CINAHL on 3 February 2021. The results were extracted and integrated using thematic analysis.
RESULTS
Ten articles were included. This review revealed that follow-up conversations are built around three key elements: (1) gaining information, (2) receiving emotional support and (3) facilitating parents to provide feedback. In addition, this review showed that the vast majority of parents and HCPs experienced follow-up conversations as meaningful and beneficial for several reasons.
CONCLUSION
An understanding of what parents and HCPs value in follow-up conversations aids HCPs in conducting follow-up conversations and improves care for bereaved parents by enhancing the HCPs' understanding of parental needs.
Topics: Bereavement; Child; Communication; Follow-Up Studies; Humans; Parents; Pediatrics
PubMed: 34995378
DOI: 10.1111/apa.16248 -
BMC Public Health Aug 2021HIV epidemic remains a major public health issue in Malawi especially among adolescent girls and young women (AGYW). Comprehensive HIV/AIDS knowledge (defined as correct...
Prevalence and correlates of comprehensive HIV/AIDS knowledge among adolescent girls and young women aged 15-24 years in Malawi: evidence from the 2015-16 Malawi demographic and health survey.
BACKGROUND
HIV epidemic remains a major public health issue in Malawi especially among adolescent girls and young women (AGYW). Comprehensive HIV/AIDS knowledge (defined as correct knowledge of two major ways of preventing the sexual transmission of HIV and rejection of three misconceptions about HIV) is a key component of preventing new HIV infections among AGYW. Therefore, the aim of this study was to identify the correlates of comprehensive HIV/AIDS knowledge among AGYW in Malawi.
METHODS
The study was based on cross-sectional data from the 2015-2016 Malawi Demographic and Health Survey. It involved 10,422 AGYW aged 15-24 years. The outcome variable was comprehensive HIV/AIDS knowledge. Data were analysed using descriptive statistics, bivariate and multivariable logistic regression model. All the analyses were performed using complex sample analysis procedure of the Statistical Package for Social Sciences to account for complex survey design.
RESULTS
Approximately 42.2% of the study participants had comprehensive HIV/AIDS knowledge. Around 28% of the participants did not know that using condoms consistently can reduce the risk of HIV and 25% of the participants believed that mosquitoes could transmit HIV. Multivariable logistic regression model demonstrated that having higher education (AOR = 2.97, 95% CI: 2.35-3.75), belonging to richest households (AOR = 1.24, 95% CI: 1.05-1.45), being from central region (AOR = 1.65, 95% CI:1.43-1.89), southern region (AOR = 1.65, 95% CI: 1.43-1.90),listening to radio at least once a week (AOR = 1.27, 95% CI: 1.15-1.40) and ever tested for HIV (AOR = 1.88, 95% CI: 1.68-2.09) were significantly correlated with comprehensive HIV/AIDS knowledge.
CONCLUSIONS
The findings indicate that comprehensive HIV/AIDS knowledge among AGYW in Malawi is low. Various social-demographic characteristics were significantly correlated with comprehensive HIV/AIDS knowledge in this study. These findings suggest that public health programmes designed to improve comprehensive HIV/AIDS knowledge in Malawi should focus on uneducated young women, those residing in northern region and from poor households. There is also a need to target AGYW who have never tested for HIV with voluntary counselling and testing services. This measure might both improve their comprehensive HIV/AIDS knowledge and awareness of their health status.
Topics: Acquired Immunodeficiency Syndrome; Adolescent; Cross-Sectional Studies; Female; HIV Infections; Humans; Malawi; Prevalence
PubMed: 34348679
DOI: 10.1186/s12889-021-11564-4 -
Frontiers in Immunology 2023Accurate and standardized phenotypic descriptions are essential in diagnosing rare diseases and discovering new diseases, and the Human Phenotype Ontology (HPO) system...
INTRODUCTION
Accurate and standardized phenotypic descriptions are essential in diagnosing rare diseases and discovering new diseases, and the Human Phenotype Ontology (HPO) system was developed to provide a rich collection of hierarchical phenotypic descriptions. However, although the HPO terms for inborn errors of immunity have been improved and curated, it has not been investigated whether this curation improves the diagnosis of systemic autoinflammatory disease (SAID) patients. Here, we aimed to study if improved HPO annotation for SAIDs enhanced SAID identification and to demonstrate the potential of phenotype-driven genome diagnostics using curated HPO terms for SAIDs.
METHODS
We collected HPO terms from 98 genetically confirmed SAID patients across eight different European SAID expertise centers and used the LIRICAL (Likelihood Ratio Interpretation of Clinical Abnormalities) computational algorithm to estimate the effect of HPO curation on the prioritization of the correct SAID for each patient.
RESULTS
Our results show that the percentage of correct diagnoses increased from 66% to 86% and that the number of diagnoses with the highest ranking increased from 38 to 45. In a further pilot study, curation also improved HPO-based whole-exome sequencing (WES) analysis, diagnosing 10/12 patients before and 12/12 after curation. In addition, the average number of candidate diseases that needed to be interpreted decreased from 35 to 2.
DISCUSSION
This study demonstrates that curation of HPO terms can increase identification of the correct diagnosis, emphasizing the high potential of HPO-based genome diagnostics for SAIDs.
Topics: Humans; Animals; Pilot Projects; Simian Acquired Immunodeficiency Syndrome; Databases, Genetic; Phenotype; Hereditary Autoinflammatory Diseases
PubMed: 37781402
DOI: 10.3389/fimmu.2023.1215869 -
The Pan African Medical Journal 2022To attain the HIV 95-95-95 goals by 2030 in Cameroon, high quality research to inform policy and patient care is of utmost importance. In the context of limited...
To attain the HIV 95-95-95 goals by 2030 in Cameroon, high quality research to inform policy and patient care is of utmost importance. In the context of limited workforce and resources, collaborations, sharing of locally-adapted strategies and other field experience, leveraging on existing and innovative platforms would facilitate a coordinated and optimal AIDS response at country level. The second edition of the Cameroon HIV Research Forum (CAM-HERO) conference took place both physically and virtually on November 18 and 19, 2021 in Kribi, on the theme "Research for Policy and Care". This scientific event brought together Cameroonian HIV/AIDS researchers, experienced clinicians and regulatory authorities to foster i) the dissemination of research findings and facilitate translation into policy, ii) operational research collaboration, iii) identification of new research areas, and iv) capacity building. To achieve the set objectives during this event, a consensus on research priorities for accelerating the achievement of three 95 HIV goals in Cameroon were summarized; meeting sessions included 31 abstract presentations, 13 discussions, and presentations on various aspects of HIV research including ethics, administrative procedures and needs for capacity building; training of young scientists on guidelines for research proposal development toward ethical clearance was done; and a platform for discussion between researchers and regulatory authorities was conducted around the design and setting-up of a national HIV/AIDS research agenda. CAM-HERO 2021 brought together HIV researchers, experts and junior scientists around major programmatic challenges, evidence to translate into practice, research priorities on HIV/AIDS. Collaborations were reinforced, capacities were strengthened, and footprints were established towards a consensus on a national HIV/AIDS research agenda.
Topics: Humans; Acquired Immunodeficiency Syndrome; Cameroon; Policy; Capacity Building; HIV Infections
PubMed: 36699972
DOI: 10.11604/pamj.2022.43.92.37080 -
Healthcare Quality for Acute Illness during the COVID-19 Pandemic: A Multisite Qualitative Analysis.Pediatric Quality & Safety 2021The coronavirus disease 2019 (COVID-19) pandemic incited substantial changes to acute care delivery, including the rapid scale-up of telehealth and numerous changes to...
UNLABELLED
The coronavirus disease 2019 (COVID-19) pandemic incited substantial changes to acute care delivery, including the rapid scale-up of telehealth and numerous changes to in-person care. This study explored health system changes associated with the COVID-19 pandemic and their influences on pediatric acute care delivery and quality of care.
METHODS
We conducted 38 semistructured interviews May-November 2020 with families and clinicians from 3 US regions, eliciting their perspectives and experiences regarding changes to acute care delivery during the pandemic. Interviews were analyzed using a general inductive approach to identify relationships between clinical care infrastructure, care processes, and healthcare quality.
RESULTS
Emerging knowledge of COVID-19 epidemiology and associated restrictions influenced care-seeking behaviors and clinical infrastructure and processes. Infrastructure changes included the closure of some clinics, limited "sick visit" hours and locations, and increased resources for telehealth. Modified care processes included the assignment of clinicians to specific roles, limitations on sibling attendance, increased referrals to other clinics, and iterative development of procedures and protocols. Although intended to increase safety, these changes appear to have decreased access, timeliness, and equity of care. High-quality care was supported by telephone triage processes, in-person visits following initial assessments by telehealth, and identification of diagnoses and populations best-suited to telehealth versus in-person care.
CONCLUSIONS
Changes in acute care delivery during the COVID-19 pandemic may have negatively impacted healthcare quality in some domains. Implementation of pediatric-specific guidelines and decision aids describing diagnoses, populations, and procedures best-suited to telehealth may improve the quality of acute care delivery.
PubMed: 34589650
DOI: 10.1097/pq9.0000000000000476 -
PLoS Pathogens Dec 2023Virologic suppression with antiretroviral therapy (ART) has significantly improved health outcomes for people living with HIV, yet challenges related to chronic...
Virologic suppression with antiretroviral therapy (ART) has significantly improved health outcomes for people living with HIV, yet challenges related to chronic inflammation in the central nervous system (CNS)-known as Neuro-HIV- persist. As primary targets for HIV-1 with the ability to survey and populate the CNS and interact with myeloid cells to co-ordinate neuroinflammation, CD4 T cells are pivotal in Neuro-HIV. Despite their importance, our understanding of CD4 T cell distribution in virus-targeted CNS tissues, their response to infection, and potential recovery following initiation of ART remain limited. To address these gaps, we studied ten SIVmac251-infected rhesus macaques using an ART regimen simulating suboptimal adherence. We evaluated four macaques during the acute phase pre-ART and six during the chronic phase. Our data revealed that HIV target CCR5+ CD4 T cells inhabit both the brain parenchyma and adjacent CNS tissues, encompassing choroid plexus stroma, dura mater, and the skull bone marrow. Aligning with the known susceptibility of CCR5+ CD4 T cells to viral infection and their presence within the CNS, high levels of viral RNA were detected in the brain parenchyma and its border tissues during acute SIV infection. Single-cell RNA sequencing of CD45+ cells from the brain revealed colocalization of viral transcripts within CD4 clusters and significant activation of antiviral molecules and specific effector programs within T cells, indicating CNS CD4 T cell engagement during infection. Acute infection led to marked imbalance in the CNS CD4/CD8 ratio which persisted into the chronic phase. These observations underscore the functional involvement of CD4 T cells within the CNS during SIV infection, enhancing our understanding of their role in establishing CNS viral presence. Our findings offer insights for potential T cell-focused interventions while underscoring the challenges in eradicating HIV from the CNS, particularly in the context of sub-optimal ART.
Topics: Animals; Humans; CD4-Positive T-Lymphocytes; Simian Acquired Immunodeficiency Syndrome; Simian Immunodeficiency Virus; Macaca mulatta; Central Nervous System; HIV Infections; Viral Load
PubMed: 38060615
DOI: 10.1371/journal.ppat.1011844 -
BMJ Global Health May 2020
Topics: Betacoronavirus; COVID-19; Child; Child Health; Coronavirus Infections; Developing Countries; Global Health; Humans; Pandemics; Pneumonia, Viral; Poverty; Risk Factors; SARS-CoV-2
PubMed: 32461228
DOI: 10.1136/bmjgh-2020-002844 -
The American Journal of Tropical... Sep 2021As North American hospitals serve increasingly diverse patient populations, including recent immigrants, refugees, and returned travelers, all pediatric hospitalists...
As North American hospitals serve increasingly diverse patient populations, including recent immigrants, refugees, and returned travelers, all pediatric hospitalists (PHs) require foundational competency in global health, and a subset of PHs are carving out niches focused in global health. Pediatric hospitalists are uniquely positioned to collaborate with low- and middle-income country clinicians and child health advocates to improve the health of hospitalized children worldwide. Using the 2018 WHO standards for improving the quality of care for children and adolescents worldwide, we describe how PHs' skills align closely with what the WHO and others have identified as essential elements to bring high-quality, sustainable care to children in low- and middle-income countries. Furthermore, North American global health hospitalists bring home expertise that reciprocally benefits their home institutions.
Topics: Adolescent; Child; Child, Preschool; Culturally Competent Care; Evidence-Based Practice; Female; Global Health; Hospital Medicine; Hospitals, Pediatric; Humans; Infant; Infant, Newborn; International Cooperation; Male; Pediatrics; Practice Guidelines as Topic; World Health Organization
PubMed: 34491222
DOI: 10.4269/ajtmh.20-1201 -
Annals of African Medicine 2023Sub-Saharan Africa has the highest burden of childhood and adolescent mortality in the world. The leading causes of mortality in pediatric populations in Africa include...
Sub-Saharan Africa has the highest burden of childhood and adolescent mortality in the world. The leading causes of mortality in pediatric populations in Africa include preterm birth complications, pneumonia, malaria, diarrheal diseases, HIV/AIDS, and road injuries. These causes of childhood and adolescent mortality often lead to emergency room utilization due to critical presentation, placing emphasis on the importance of pediatric emergency services in Africa. Despite the criticality of pediatric emergency medicine (PEM) in the region, there is a paucity of PEM training programs in Africa. Ongoing interventions focused on addressing the poor access to PEM training and services include isolated efforts to provide PEM-specific training to nonemergency medicine (EM)-trained practitioners and expand current EM training to include PEM piloted in a single center in Kenya. Sustainable efforts require organized efforts with government and graduate medical education bodies. We discuss the existing infrastructure that can be utilized in promoting the establishment of PEM training programs and urge local governments' investment as well as other stakeholders, including graduate medical education, to address the issue of childhood mortality in Africa through the improved provision and access to PEM training.
Topics: Infant, Newborn; Female; Adolescent; Humans; Child; Pediatric Emergency Medicine; Emergency Medicine; Fellowships and Scholarships; Internship and Residency; Premature Birth; Africa
PubMed: 37417034
DOI: 10.4103/aam.aam_115_22 -
Pediatrics Apr 2021One in five pediatric patients suffers from adverse events related to hospital discharge. Current literature lacks evidence on effective interventions to improve...
BACKGROUND
One in five pediatric patients suffers from adverse events related to hospital discharge. Current literature lacks evidence on effective interventions to improve caregiver comprehension (CC) of discharge instructions. We examined if a standardized framework for written and verbal discharge counseling was associated with increased CC of key discharge instructions after discharge from a general pediatric inpatient unit.
METHODS
An interprofessional team created the SAFER Care framework to encourage standard, comprehensive discharge counseling. Plan-do-study-act cycles included electronic health record smartphrases, educational initiatives, data feedback, visual aids, and family outreach. Caregivers were surveyed by phone within 4 days of discharge. Our primary outcome was the proportion of caregivers correctly responding to all questions related to discharge care, comparing pre- and postintervention periods. Data were plotted on a statistical process control chart to assess the effectiveness of interventions.
RESULTS
A total of 171 surveys were analyzed in the preintervention period, and 262 surveys were analyzed in the postintervention period. A total of 37% of caregivers correctly responded to all questions in the preintervention period, compared with 62% of caregivers in the postintervention period, meeting rules for special cause variation.
CONCLUSIONS
Development of the SAFER Care framework and its use in written and verbal discharge counseling was associated with significantly improved CC of discharge instructions in a general pediatric inpatient unit. Further studies should be focused on expanding this to other populations, particularly limited-English-proficiency families.
Topics: Caregivers; Communication; Comprehension; Female; Hospitalization; Hospitals, Pediatric; Humans; Infant; Infant, Newborn; Male; Patient Discharge; Patient Discharge Summaries; Patient Education as Topic; Quality Improvement; Surveys and Questionnaires
PubMed: 33707198
DOI: 10.1542/peds.2020-0031