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Journal of Hospital Medicine Apr 2024High rates of posthospitalization errors are observed in children with medical complexity (CMC). Poor parent comprehension of and adherence to complex discharge...
BACKGROUND
High rates of posthospitalization errors are observed in children with medical complexity (CMC). Poor parent comprehension of and adherence to complex discharge instructions can contribute to errors. Pediatrician views on common barriers and facilitators to parent comprehension and adherence are understudied.
OBJECTIVE
To examine pediatrician perspectives on barriers and facilitators experienced by parents in comprehension of and adherence to inpatient discharge instructions for CMC.
DESIGN, SETTINGS, AND PARTICIPANTS
We conducted a qualitative, descriptive study of attending pediatricians (n = 20) caring for CMC in inpatient settings (United States and Canada) and belonging to listservs for pediatric hospitalists/complex care providers. We used purposive/maximum variation sampling to ensure heterogeneity (e.g., hospital, region).
MAIN OUTCOME AND MEASURES
A multidisciplinary team designed and piloted a semistructured interview guide with pediatricians who care for CMC. Team members conducted semistructured interviews via phone or video call. Interviews were audiorecorded and transcribed. We analyzed transcripts using content analysis; codes were derived a priori from a conceptual framework (based on the Pediatric Self-Management Model) and a preliminary transcript analysis. We applied codes and identified emerging themes.
RESULTS
Pediatricians identified three themes as barriers and facilitators to discharge instruction comprehension and adherence: (1) regimen complexity, (2) access to the healthcare team (e.g., inpatient team, outpatient pediatrician, home nursing) and resources (e.g., medications, medical equipment), and (3) need for a family centered and health literacy-informed approach to discharge planning and education. Next steps include the assessment of parent perspectives on barriers and facilitators to discharge instruction comprehension and adherence for prents of CMC and the development of intervention strategies.
Topics: Humans; Child; Patient Discharge; Comprehension; Qualitative Research; Parents; Pediatricians
PubMed: 38445808
DOI: 10.1002/jhm.13319 -
Journal of Nutrition Education and... Jan 2020Assess pediatrician practices around growth and nutrition for children under 2 years.
OBJECTIVE
Assess pediatrician practices around growth and nutrition for children under 2 years.
DESIGN
2017 cross-sectional survey of a national random sample of the American Academy of Pediatrics members.
SETTING
US.
PARTICIPANTS
Practicing primary care pediatricians and residents (n = 698).
MAIN OUTCOME MEASURES
World Health Organization growth chart use, solid food introduction recommendations, healthy behaviors discussion.
ANALYSIS
Descriptive statistics were calculated for nutrition-related questions. McNemar tests compared recommendations on the introduction of different solid foods at <6 months; chi-square tests of independence examined outcomes by pediatrician and practice characteristics.
RESULTS
Most respondents (82.2%) reported using the World Health Organization growth charts at all well visits. Nearly half (45.3%) recommended solid food introduction at 6 months; 48.2% recommended <6 months. Cereals were more frequently recommended at <6 months than fruits/vegetables or meats (P <.001). Topics most frequently discussed were limiting juice (92.3%), and sugar-sweetened beverages (92.0%), avoiding restrictive and permissive food practices (30.7%), and avoiding food as a reward (29.1%) were least discussed. Pediatricians in hospital/clinic settings discussed healthy behaviors less than group or solo/2-physician practices.
CONCLUSIONS AND IMPLICATIONS
For children under 2 years, most pediatricians reported using recommended growth charts and discussing healthy behaviors. Fewer discussed responsive feeding topics. Results for guiding solid food introduction were mixed. Continued efforts to support pediatricians' work could improve the implementation of recommended practices.
Topics: Adult; Cross-Sectional Studies; Female; Growth Charts; Health Promotion; Humans; Infant; Infant Nutritional Physiological Phenomena; Infant, Newborn; Male; Middle Aged; Pediatricians; Physician-Patient Relations; Practice Patterns, Physicians'
PubMed: 31759892
DOI: 10.1016/j.jneb.2019.10.006 -
BMC Oral Health Jul 2020Dental caries is a significant public health problem and one of the most common chronic conditions affecting children. The potential for the non-dental workforce to... (Review)
Review
BACKGROUND
Dental caries is a significant public health problem and one of the most common chronic conditions affecting children. The potential for the non-dental workforce to improve children's oral health is well documented. For well over a decade, there have been calls for pediatricians to address children's oral health, but the incorporation of oral health screening, referral, and oral healthcare in pediatric practice remains underdeveloped. Developing action to strengthen the role of pediatricians' in children's oral health requires an understanding of their current knowledge and practice. In this scoping review, we aimed to comprehensively map what is known about the knowledge and practice of pediatricians regarding children's oral health.
METHODS
Arksey & O'Malley's five-stage review process was used to comprehensively map studies undertaken on pediatrician's knowledge and practice regarding children's oral health. Key search terms were developed and a total of 42 eligible articles are included in the review.
RESULTS
The studies were conducted in 19 countries. The majority (41/42) were quantitative, with over 90% using self-reported surveys. Only four studies used previously validated survey tools, with most adapting questions from previous studies. Observational designs were used in two studies and one used qualitative methods. Sample size ranged from 15 to 862. Oral health knowledge amongst pediatricians was reported to be mostly poor, with many gaps in key areas including age for first dental visit, dental caries and oral health risk assessments. Studies on the translation of oral health knowledge to practice were limited, with wide variation in rates of assessment. Few studies assessed actual practice.
CONCLUSIONS
This scoping review highlights growing international interest in the role of pediatricians in children's oral health. Findings demonstrate that pediatricians have limited knowledge and understanding in critical areas, including; initial clinical signs of dental caries, recommended age for first dental visit, etiology of dental caries and recommended use of fluorides. Barriers for pediatricians include inadequate education and training, time constraints in practice and lack of referral pathways. Development of a validated tool to assess knowledge and practice is needed. This review provides a starting point to guide future research and areas for systematic reviews.
Topics: Child; Dental Caries; Humans; Oral Health; Pediatricians; Referral and Consultation; Surveys and Questionnaires
PubMed: 32711481
DOI: 10.1186/s12903-020-01198-0 -
Pediatric Annals Jan 2024Primary care pediatricians, family practitioners, and primary care advanced practice clinicians frequently need to examine male adolescent genitalia as part of a... (Review)
Review
Primary care pediatricians, family practitioners, and primary care advanced practice clinicians frequently need to examine male adolescent genitalia as part of a comprehensive physical examination. Although this part of the examination may be uncomfortable for clinicians, taking a structured approach to the examination can mitigate clinicians' apprehension as well as enhance their ability to use this evaluation to identify potential pathology for the patient. Familiarity with the male genitourinary examination will also allow clinicians to definitively identify medical urgencies and emergencies for timely intervention. This review will provide the clinician with a structured approach to the male genitourinary examination while highlighting common pathology that may be encountered during the examination. .
Topics: Adolescent; Male; Humans; Scrotum; Penis; Genitalia; Pediatricians; Physical Examination
PubMed: 38194659
DOI: 10.3928/19382359-20231114-03 -
Medecine Sciences : M/S May 2016
Topics: Anemia, Sickle Cell; France; Hemoglobinopathies; History, 20th Century; History, 21st Century; Pediatricians; Research Personnel
PubMed: 27225929
DOI: 10.1051/medsci/20163205023 -
Advances in Pediatrics Aug 2022The COVID-19 pandemic is an unprecedented event with devastating effects on children and families, highlighting and broadening disparities in the care of children with... (Review)
Review
The COVID-19 pandemic is an unprecedented event with devastating effects on children and families, highlighting and broadening disparities in the care of children with developmental disabilities, while simultaneously catalyzing innovation. Children are vulnerable to the impacts of COVID-19, resulting in increased stress, anxiety, isolation, and health challenges, further amplified in autistic children and children with other neurodevelopmental disabilities. These children are uniquely vulnerable due to communication impairments, comorbid medical disorders, reduced adaptability, and reliance on therapeutic interventions. Abrupt reduction in services and access to care during the pandemic compromised physical and mental health and led to missed intervention opportunities at critical times. It is important to examine the effects that the pandemic triggered, address deficiencies, and recognize new opportunities to improve systems of care to prepare for unforeseen futures.
Topics: Autistic Disorder; COVID-19; Child; Humans; Mental Health; Pandemics; Pediatricians
PubMed: 35985716
DOI: 10.1016/j.yapd.2022.04.001 -
JAMA Network Open Jan 2023Wait times for autism spectrum disorder (ASD) diagnosis are lengthy because of inadequate supply of specialist teams. General pediatricians may be able to diagnose some...
IMPORTANCE
Wait times for autism spectrum disorder (ASD) diagnosis are lengthy because of inadequate supply of specialist teams. General pediatricians may be able to diagnose some cases of ASD, thereby reducing wait times.
OBJECTIVE
To determine the accuracy of ASD diagnostic assessments conducted by general pediatricians compared with a multidisciplinary team (MDT).
DESIGN, SETTING, AND PARTICIPANTS
This prospective diagnostic study was conducted in and a specialist assessment center in Toronto, Ontario, Canada, and Ontario general pediatrician practices from June 2016 to March 2020. Children were younger than 5.5 years, referred with a developmental concern, and without an existing ASD diagnosis. Data analysis was performed from October 2021 to February 2022.
EXPOSURES
The pediatrician and MDT each conducted blinded assessments and recorded a decision as to whether the child had ASD.
MAIN OUTCOMES AND MEASURES
Main outcomes included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). A logistic regression was performed to identify factors associated with accurate pediatrician assessment for children with or without an ASD diagnosis.
RESULTS
Seventeen pediatricians (12 women [71%]) participated in the study and referred 106 children (79 boys [75%]; mean [SD] age, 41.9 [13.3] months). Sixty participants (57%) were from minoritized racial and ethnic groups (eg, Black, Asian, Hispanic, Middle Eastern, and multiracial). Seventy-two participants (68%) received a diagnosis of ASD by the MDT. Sensitivity and specificity of the pediatrician assessments compared with MDT were 0.75 (95% CI, 0.67-0.83) and 0.79 (95% CI, 0.62-0.91), respectively. The PPV of the pediatrician assessments was 0.89 (95% CI, 0.80-0.94) (ie, 89% agreement with the MDT), and NPV was 0.60 (95% CI, 0.49-0.70) (ie, 60% agreement with the MDT). Higher pediatrician certainty (odds ratio [OR], 3.33; 95% CI, 1.71-7.34; P = .001) was associated with increased diagnostic accuracy for children with ASD. Lower accuracy was seen for children with higher Visual Reception subscale developmental skills (OR, 0.93; 95% CI, 0.89-0.97; P = .001), speaking abilities (OR, 0.17; 95% CI, 0.03-0.67; P = .03), and White race (OR, 0.32; 95% CI, 0.10-0.97; P = .04). Age, gender, and Autism Diagnostic Observation Schedule, 2nd Edition composite scores were not significantly associated with the accuracy of assessments. All 7 children with a sibling with ASD received an accurate diagnosis; otherwise, no significant factors were identified for accuracy in children without ASD.
CONCLUSIONS AND RELEVANCE
This study of concordance of autism assessment between pediatricians and an expert MDT in young children found high accuracy when general pediatricians felt confident and lower accuracy when ruling out ASD. These findings suggest that children with co-occurring delays may be potential candidates for community assessment.
Topics: Male; Child; Humans; Female; Child, Preschool; Adult; Autism Spectrum Disorder; Prospective Studies; Ontario; Ethnicity; Pediatricians
PubMed: 36696109
DOI: 10.1001/jamanetworkopen.2022.52879 -
Nutrients Jul 2022Studies suggest a decreasing trend in the consumption of meat products and a growing interest in vegetarian diets. Medical support may be relevant, especially when...
Studies suggest a decreasing trend in the consumption of meat products and a growing interest in vegetarian diets. Medical support may be relevant, especially when switching to a vegan diet. Our objective was to describe the beliefs and attitudes of primary care physicians toward vegetarian diets. A cross-sectional survey was conducted among general practitioners and pediatricians thorough a questionnaire including socio-demographic characteristics, specific care to vegetarians, and the risks and benefits of vegetarian diets according to physicians. Out of the 177 participating physicians, 104 (59%) have seen at least one vegetarian patient in consultation in the last three months. Half of the physicians declared that they would dissuade their patients from switching to a vegan diet ( = 88, 51%) and 14% ( = 24) from switching to an ovo-lacto-vegetarian (OLV) diet. Most physicians ( = 141, 88%) did not feel informed enough about these diets. Physicians thought that the most frequent deficiencies for OLV and vegan diets were iron (76% and 84%, respectively) and protein (45% and 79%, respectively). These results highlight the fact that French primary care physicians feel concerned by this subject and need more information on these diets. Specific recommendations would be useful to support their practice and relationship with vegetarians.
Topics: Cross-Sectional Studies; Diet; Diet, Vegan; Diet, Vegetarian; General Practitioners; Humans; Pediatricians; Vegetarians
PubMed: 35956277
DOI: 10.3390/nu14153101 -
Annals of Nutrition & Metabolism 2023Promoting and supporting breastfeeding is an important public health intervention with multiple benefits for both infants and mothers. Even modest increases in the... (Review)
Review
Role of Pediatricians in Promoting and Supporting Breastfeeding: A Position Paper of the International Pediatric Association Strategic Advisory Group on Infant, Child, and Adolescent Nutrition.
BACKGROUND
Promoting and supporting breastfeeding is an important public health intervention with multiple benefits for both infants and mothers. Even modest increases in the prevalence and duration of breastfeeding could significantly reduce healthcare costs and improve maternal and child health outcomes. However, widespread adoption of breastfeeding recommendations remains poor in most settings, which contributes to widening health and social inequalities. Pediatricians have a duty to advocate for improving child health, including promoting and supporting breastfeeding.
SUMMARY
This paper, from the International Pediatric Association Special Advisory Group on Nutrition, considers common barriers to breastfeeding and addresses how pediatricians can better promote and support breastfeeding, both at an individual level and by influencing practice and policy. All pediatricians need to understand the basics of breastfeeding, including lactation physiology, recognize common breastfeeding problems, and advise mothers or refer them for appropriate support; training curricula for general pediatricians and all pediatric subspecialties should reflect this. Even in the situation where their day-to-day work does not involve direct contact with mothers and infants, pediatricians can have an important influence on policy and practice. They should support colleagues who work directly with mothers and infants, ensuring that systems and environments are conducive to breastfeeding and, where appropriate, milk expression. Pediatricians and pediatric organizations should also promote policies aimed at promoting and supporting breastfeeding at local, regional, national, and international levels.
KEY MESSAGES
Pediatricians have a duty to promote and support breastfeeding, regardless of their day-to-day role and responsibilities. Pediatric training curricula should ensure that all trainees acquire a good understanding of breastfeeding so they are able to effectively support mothers in their personal practice but also influence breastfeeding practice and policy at a local, regional, national, and international level.
Topics: Infant; Female; Humans; Child; Adolescent; Breast Feeding; Health Promotion; Mothers; Lactation; Pediatricians
PubMed: 37673040
DOI: 10.1159/000534004 -
Archivos Argentinos de Pediatria Jun 2022
Topics: Humans; Pediatricians; Social Media
PubMed: 35533115
DOI: 10.5546/aap.2022.eng.150