Home Care for Bronchiolitis: A Systematic Review
CONCLUSIONSEvidence exists to support HOT as feasible, acceptable, and safe. Evidence of cost-effectiveness remains limited. Further research is needed to understand the relevant impact of HAH versus alternative interventions to reduce oxygen prescribing. Other models of care looking at nasogastric feeding support and remote monitoring should be explored. (Source: PEDIATRICS)
Source: PEDIATRICS - September 6, 2022 Category: Pediatrics Source Type: research
Recommendations for Prevention and Control of Influenza in Children, 2022 –2023
This technical report accompanies the recommendations of the American Academy of Pediatrics for the routine use of influenza vaccine and antiviral medications in the prevention and treatment of influenza in children during the 2022 to 2023 season. The American Academy of Pediatrics recommends annual influenza vaccination of all children without medical contraindications starting at 6 months of age. Influenza vaccination is an important strategy for protecting children and the broader community as well as reducing the overall burden of respiratory illnesses when other viruses, including severe acute respiratory syndrome-cor...
Source: PEDIATRICS - September 6, 2022 Category: Pediatrics Source Type: research
HIV Transmission Through Premastication
We report the case of a 13-month-old Alaska Native child from rural Alaska who presented with failure to thrive, recurrent pneumonias, severe dental decay, and dysphagia. The mother was HIV-uninfected. Respiratory failure prompted transfer to a children ’s hospital outside of Alaska where the child received a diagnosis of HIV infection. A grandparent who had been acting as primary caregiver was discovered to be HIV-infected with detectable viral load resulting from intermittent nonadherence to her medication regimen. This grandparent reported fee ding the child premasticated food. Sequencing of the hypervariable C2V5 reg...
Source: PEDIATRICS - September 2, 2022 Category: Pediatrics Source Type: research
Neighborhood Child Opportunity and Emergency Department Utilization
CONCLUSIONSChildren from neighborhoods with low COI had higher ED utilization overall and more LRI visits, as well as visits more cost-effectively managed in primary care settings. Identifying neighborhood opportunity-related drivers can help us design interventions to optimize child health and decrease unnecessary ED utilization and costs. (Source: PEDIATRICS)
Source: PEDIATRICS - September 2, 2022 Category: Pediatrics Source Type: research
Plugging the Leaky Pipeline: The Role of Peer Mentorship for Increasing Diversity
I arrived to my shift early, nervous about caring for critically ill patients as a first-year fellow. I sat in the workroom alone, paralyzed, not sure how to preround despite being months into fellowship. The senior fellow appeared minutes before sign-out; fresh, knowledgeable, and calm, despite her busy night and lack of sleep. She asked me how I was doing. With tears in my eyes, my emotions poured out. I explained that I felt lost, unsure of myself, my place, and my knowledge. For the first time, I confessed out loud, “I don’t think I’m supposed to be here. I have no idea what I’m doing.” I could trust her in a...
Source: PEDIATRICS - September 1, 2022 Category: Pediatrics Source Type: research
Lesion-Specific Congenital Heart Disease Mortality Trends in Children: 1999 to 2017
CONCLUSIONSCHD mortality is decreasing for most lesions. Because of the heterogenicity of CHD lesions, there is expected variability in mortality trends by lesion and age group. Single ventricle lesions continue to contribute most heavily to premature death because of CHD demonstrated by significant increases in mortality rate for children aged 5 to 17 years. (Source: PEDIATRICS)
Source: PEDIATRICS - September 1, 2022 Category: Pediatrics Source Type: research
Context in Implementation Science
Changing health care delivery systems and processes of care to improve health care quality is complex. What is done (intervention) is equally important as how it is done (implementation) and where it is done (context). Furthermore, it has been consistently observed that among groups participating in multisite quality improvement (QI) efforts and implementation studies, significant heterogeneity in the improvements is seen. Our objective is to provide a step-by-step guide to assist both researchers and groups practicing QI on the frontlines in addressing context in planning, implementing, and disseminating their QI and impl...
Source: PEDIATRICS - March 1, 2022 Category: Pediatrics Source Type: research
Editors ’ Note and Prologue
Quality improvement (QI) and implementation science are key approaches to improving child health outcomes across diverse populations. Unfortunately, these approaches are not typically taught in classic pediatric training programs. The development of a cadre of professionals in child health who are trained in QI and implementation science research will lead to better child health outcomes and reduce child-adult health care delivery discrepancies. (Source: PEDIATRICS)
Source: PEDIATRICS - March 1, 2022 Category: Pediatrics Source Type: research
All Quality Improvement Is Health Equity Work: Designing Improvement to Reduce Disparities
Quality improvement (QI) can be a critical means by which to achieve equity in health and health care. QI efforts, however, often fail to be designed and implemented through the lens of health equity. In this article, we will discuss the current state of the intersection between QI and health equity, then lay out specific steps researchers and practitioners can take to ensure that their QI work reduces, rather than increases or maintains, existing disparities. These steps include first, understanding existing disparities and, second, utilizing community engagement to ensure that QI enhances health equity. Before embarking ...
Source: PEDIATRICS - March 1, 2022 Category: Pediatrics Source Type: research
Do We Really Need a Scholarly Quality Improvement Workforce?
Over the past two decades there has been a burgeoning in the fields of quality improvement (QI) and patient safety and in the numbers of academic faculty and trainees who are involved in QI. During this time, however, the development of scholarly quality improvement has lagged somewhat. Scholarly QI should be considered as a distinct field that requires special emphasis and development of trainees and faculty. The foundational elements of scholarly QI are an understanding of relevant study designs; of QI measure validity and reliability; of analytic methods to understand common cause and special cause variation; and of acc...
Source: PEDIATRICS - March 1, 2022 Category: Pediatrics Source Type: research
Equity and the Hazard of Veiled Injustice: A Methodological Reflection on Risk Adjustment
We present an overview of the literature and a conceptual framework that suggests two specific threats to validity associated with the interplay between risk adjustment and health equity. (Source: PEDIATRICS)
Source: PEDIATRICS - March 1, 2022 Category: Pediatrics Source Type: research
Diagnostic Error in Pediatrics: A Narrative Review
A priority topic for patient safety research is diagnostic errors. However, despite the significant growth in awareness of their unacceptably high incidence and associated harm, a relative paucity of large, high-quality studies of diagnostic error in pediatrics exists. In this narrative review, we present what is known about the incidence and epidemiology of diagnostic error in pediatrics as well as the established research methods for identifying, evaluating, and reducing diagnostic errors, including their strengths and weaknesses. Additionally, we highlight that pediatric diagnostic error remains an area in need of both ...
Source: PEDIATRICS - March 1, 2022 Category: Pediatrics Source Type: research
Quarantine Elimination for K –12 Students With Mask-on-Mask Exposure to SARS-CoV-2
CONCLUSIONSSchool-based COVID-19 transmission was exceptionally low in this large K –12 Nebraska school district. Elimination of student quarantine after masked exposure to COVID-19 within school was not associated with secondary transmission. Elimination of unnecessary quarantine elimination may help maximize in-person learning in the 2021–2022 school year. (Source: PEDIATRICS)
Source: PEDIATRICS - February 1, 2022 Category: Pediatrics Source Type: research
Implementation of School-Based COVID-19 Testing Programs in Underserved Populations
We describe key implementation barriers and strategies that have been operationalized across 5 projects working to help schools with predominantly underserved populations who have faced significant COVID-19 –related health disparities. We leveraged a key framework from the implementation science field to identify the challenges and used a matching tool to align implementation strategies to these challenges. Our findings suggest that the biggest obstacles to COVID-19 testing were the perceived relativ e advantages versus burden of COVID-19 testing, limited engagement with the target beneficiaries (eg, families, students, ...
Source: PEDIATRICS - February 1, 2022 Category: Pediatrics Source Type: research
Urban Classification, Not COVID-19 Community Rates, Was Associated With Modes of Learning in US K –12 Schools?
CONCLUSIONSCommunity COVID-19 rates did not appear to influence the decision of when to provide in-person learning. Further understanding of factors driving the decisions to bring children back into the classroom are needed. Standardizing policies on how schools apply national guidance to local decision-making may decrease disparities in emergent crises. (Source: PEDIATRICS)
Source: PEDIATRICS - February 1, 2022 Category: Pediatrics Source Type: research
