Preschool children’s communication,motor and social development: Parents’ and educators’ concerns

Purpose: During early childhood, it is important to identify which children require intervention before they face the increased demands of school. This study aimed to: (1) compare parents’ and educators’ concerns, (2) examine inter-rater reliability between parents’ and educators’ concerns and (3) determine the group difference between level of concern and children’s performance on clinical testing.

Method: Parents and educators of 1205 4- to 5-year-old children in the Sound Start Study completed the Parents’ Evaluation of Developmental Status. Children whose parents/educators were concerned about speech and language underwent direct assessment measuring speech accuracy (n?=?275), receptive vocabulary (n?=?131) and language (n?=?274).

Result: More parents/educators were concerned about children’s speech and expressive language, than behaviour, social–emotional, school readiness, receptive language, self-help, fine motor and gross motor skills. Parents’ and educators’ responses were significantly correlated (except gross motor). Parents’ and educators’ level of concern about expressive speech and language was significantly correlated with speech accuracy on direct assessment. Educators’ level of concern was significantly correlated with a screening measure of language. Scores on a test of receptive vocabulary significantly differed between those with concern and those without.

Conclusion: Children’s communication skills concerned more parents and educators than other aspects of development and these concerns generally aligned with clinical testing.     

Physicians’ and pharmacists’ information provision and patients’ psychological distress

Providing information related to medication has many benefits for patients. However, patients’ conflicting perceptions about medical information provided by physicians and pharmacists may be associated with their psychological distress regarding treatment and medication. This study investigated associations between patients’ perceptions of agreement between physicians and pharmacists about medical information and improvements in their psychological distress. It also clarified the specific relationships of their perceptions with psychological distress. A cross-sectional survey was conducted in Japanese community pharmacy settings. Pharmacists approached 1,500 patients visiting community pharmacies and provided them with questionnaire packages. Patients completed the questionnaires at home and returned them to the researchers by mail. Multivariate logistic regression analysis and signal detection analysis were conducted to examine associations of patients’ perceptions of information agreement with improvement in psychological distress. Measures of improvement in worry and anxiety about disease, improvement in worry and anxiety about medication, and improvement in depressive mood were used to assess alleviation of psychological distress. A total of 645 patients returned the questionnaires; 628 contributed to the data. Multivariate logistic regression analyses clarified that patients’ perceptions of agreement in information regarding need for medication, methods for adverse drug reaction reduction, adverse drug reaction symptoms, coping with forgetting to take medication, and advice for daily life were significantly associated with improvements in psychological distress. Furthermore, signal detection analysis showed that several combinations of patients’ perceptions of agreement between physicians and pharmacists about specific medical information were also significantly associated with improvement in psychological distress. Consistent information provision by physicians and pharmacists could contribute to decreased psychological distress in patients, and consequently to adherence to treatment and taking medication.     

‘… and in This Corner,the Patient’

Readers are invited to submit questions relating to problem cases. Inquiries will be answered by qualified consultants and replies forwarded by mail promptly. Selected problems and solutions are published every month in this section.     

Impact of Virtual Learning Environment on Students’ Satisfaction,Engagement, Recall,and Retention

BackgroundVirtual learning environments (VLEs) were introduced to progress students from passive to active learners. Active learning promotes the critical thinking skills essential for the transfer/use of classroom-acquired knowledge into the clinical setting. A VLE forms an increasingly vital component of clinical skills development in a range of disciplines.Material and MethodsA randomized control trial was conducted with students randomly attending one of two teaching sessions about radiation therapy. Both sessions were identical except a VLE was used in the second talk with the first being solely didactic. Anonymous questionnaires were distributed. Two weeks after the talks, participants were required to complete the same knowledge questionnaire to determine retention. Mann-Whitney, means, standard deviations, and chi-squared tests were used according to data characteristics. Qualitative data (open-ended questions) were analysed thematically.ResultsVirtual learning seemed to significantly improve students' satisfaction/engagement and recall. A total of 40 students attended the teaching sessions. The student group taught using the VLE had higher mean scores for retention than the didactic group; however, this was not statistically significant. Use of VLEs was associated with greater satisfaction/engagement than didactic information (P = .003). Students' learning styles seemed to have no effect on their satisfaction/engagement and ease of learning. Three key themes emerged from the qualitative data: (1) the visuals were good/helpful, (2) the talk was informative, and (3) more details/visuals were required.Discussion and ConclusionThe key findings from this study suggest that there is a role for VLEs in the teaching of students. There is a need for the introduction of advanced technology into health care education as virtual reality, such as Virtual Environment of Radiotherapy, has shown improvement in students' satisfaction, engagement, and recall. Whether VLEs qualify students better than conventional didactic teaching is still undetermined, but these first results are encouraging.     

Health Care Providers’ Knowledge,Practices, and Barriers to Hepatitis Vaccination Guidelines

We administered an online survey to 400 health care providers (HCPs) to evaluate knowledge and self-reported practices regarding hepatitis A (HepA)/hepatitis B (HepB) vaccination. Most HCPs (73%) were familiar with the Advisory Committee on Immunization Practices; 89% and 90% reported adhering to the guidelines always/most of the time for HepA and HepB, respectively. Self-reported adherence to guidelines varied across specialties, with nurse practitioners reporting the highest adherence rate of 94%. Survey results, including perceived barriers, reasons for not stocking vaccines, and predictors of adherence to and familiarity with guidelines, may inform strategies to improve compliance with hepatitis vaccination recommendations.     

Postoperative diarrhea in Crohn’s disease: Pathogenesis,diagnosis, and therapy

Diarrhea is a frequent symptom in postoperative patients with Crohn’s diseases (CD), and several different mechanisms likely account for postoperative diarrhea in CD. A targeted strategy based on a comprehensive understanding of postoperative diarrhea is helpful for better postoperative recovery.     

Patients’ perspectives on care,communication, and teamwork in the emergency department

BackgroundThe work of healthcare professionals (HCPs) in the emergency department (ED) involves effective communication and efficient teamwork, which may be perceived differently by patients and HCPs. Therefore, it is important to explore patient perspectives of information exchange and clinical assessment.AimTo evaluate experiences of care, communication, and teamwork from ED patients’ perspectives.MethodsSemi-structured interviews were conducted with 17 patients who were assessed in a Swedish ED during Spring 2021. Thematic analysis was used.ResultsParticipants’ experiences reflected the complex environment of the ED. Findings emphasize the importance of information exchange in relation to a caring approach. Three themes emerged: the need for a caring approach by HCPs towards patients’; the need for dialogue between patient and HCPs; and the need for information on ED environment constraints.ConclusionsPatients felt comforted when they experienced a caring empathic approach from the HCPs. For example, patients valued an individual holistic approach rather than feeling that they were being objectified by their medical conditions. This was important in coping with the anxiety caused by a stressful ED environment. There is a critical need for effective exchange of information between patients and HCPs.     

Fibromyalgia’s Key Symptoms in Normal-Weight,Overweight, and Obese Female Patients

Factors affecting the symptomatology of fibromyalgia (FM) are not fully understood. The aim of the present study was to analyze the relationship of weight status with pain, fatigue, and stiffness in Spanish female FM patients, with special focus on the differences between overweight and obese patients. The sample comprised 177 Spanish women with FM (51.3 ± 7.3 years old). We assessed tenderness (using pressure algometry), pain and vitality using the General Health Short-Form Survey (SF36), and pain, fatigue, morning tiredness, and stiffness using the Fibromyalgia Impact Questionnaire (FIQ). The international criteria for body mass index was used to classify the patients as normal weight, overweight, or obese. Thirty-two percent were normal-weight, 35% overweight, and 32% obese. Both overweight and obese patients had higher levels of pain than normal-weight patients, as assessed by FIQ and SF36 questionnaires and tender point count (p < .01). The same pattern was observed for algometer score, yet the differences were not significant. Both overweight and obese patients had higher levels of fatigue, and morning tiredness, and stiffness (p < .05) and less vitality than normal-weight patients. No significant differences were observed in any of the variables studied between overweight and obese patients. In conclusion, FM symptomatology in obese patients did not differ from overweight patients, whereas normal-weight patients significantly differed from overweight and obese patients in the studied symptoms. These findings suggest that keeping a healthy (normal) weight is not only associated with decreased risk for developing FM but might also be a relevant and useful way of improving FM symptomatology in women.     

Patients’ ideas,concerns, expectations and satisfaction in primary health care – a questionnaire study of patients and health care professionals’ perspectives

Abstract

Objective: Explore the perceptions of patients and health care professionals about patients’ ideas, concerns, expectations (ICE), and satisfaction in consultations with general practitioners (GPs), district nurses (DNs) and physiotherapists (PTs).

Design: Cross-sectional questionnaire study of participants in planned consultations.

Setting: Five primary health care centers and two rehabilitation centers in Stockholm, Sweden.

Subjects: Pairs of patients and GPs (n?=?156), patients and DNs (n?=?73), and patients and PTs (n?=?69).

Main outcome measures: Multiple-choice questions about patients’ ICE and satisfaction.

Results: Approximately 75% of patients and GPs reported that patients’ thoughts and explanations about their symptoms emerged during the consultation. For patient-DN pairs, the figure was 60%, and for patient-PT pairs, 80%. A majority of patients reported not having concerns and anxiety about the investigation/treatment, whereas health care professionals thought patients were more concerned. One-third of patients consulting GPs and PTs expected to receive a reason/explanation for their symptoms. Figures were lower for the DNs. About 70% of patients were satisfied with the consultation.

Conclusions: Most patients expressed their ideas, a minority had concerns, and a minority expected an explanation of their illness. Patients and health care professionals rated patient satisfaction high, but health care professionals tended to believe patients were less satisfied than patients reported they were.

• Key points

• Patient surveys show that important aspects of patient-centeredness remain weak in Swedish primary health care; for example, shared decision-making.

• In this study of planned consultations, few patients expected to receive an explanation of their symptoms, but most were satisfied with the consultation.

• Health care professionals thought patients’ experiences were more negative than they were.

• This discrepancy was observed in responses to questions about patients’ concerns, expectations and satisfaction.

     

Emotional Abuse,Verbal Victimization,and the Development of Children’s Negative Inferential Styles and Depressive Symptoms

Given evidence that negative inferential styles contribute vulnerability to both symptoms and diagnoses of depression, it becomes important to examine factors that may contribute to the development of this cognitive vulnerability. The primary goal of the current studies was to test the hypotheses that experiences of emotional abuse from parents and verbal victimization from peers would contribute to negative changes in children’s inferential styles as well as increases in their depressive symptoms. We found support for these hypotheses among children of parents with a history of depression (Study 1) and among an unselected community sample of children (Study 2). These results add to the growing body of research suggesting the role of emotional abuse and verbal victimization in the development of depressive cognitions and symptoms.

An Online Educational Intervention to Influence Medical and Nurse Practitioner Students’ Knowledge,Self-Efficacy,and Motivation for Antepartum Depression Screening and Education

ObjectiveTo evaluate nurse practitioner and medical students’ knowledge, self-efficacy, and motivation for antepartum depression screening and education before and after an online educational intervention.DesignQuasi-experimental study design.Setting/Local ProblemThe University of South Florida, College of Nursing and College of Medicine. Historically, nursing and medical school curricula have a focus on postpartum depression. Testing nurse practitioner and medical students regarding maternal depression throughout pregnancy may give insight into curriculum preparedness.ParticipantsMedical and nurse practitioner students were recruited by convenience sampling. In total, 71 participants completed the study. There were 52 (73%) nurse practitioner students and 19 (27%) medical students.Intervention/MeasurementsParticipants used a self-directed learning activity in the form of a slide presentation on the virtual platform REDCap. Knowledge was tested before and after the intervention using the “Speak Up When You’re Down”—Postpartum Depression Awareness Campaign examination. Self-efficacy and motivation were measured before and after the intervention by using the Physician/Nurse Practitioner Student Teaching Self-Efficacy Questionnaire and the Physician/Nurse Practitioner Student Teaching Motivation Questionnaire.ResultsNurse practitioner and medical students exhibited a mean increase in scores for knowledge, self-efficacy, and motivation. Both groups performed similarly from before to after the intervention, and student profession did not moderate the increase from before to after the intervention.ConclusionAn intervention to influence health care students' knowledge, self-efficacy, and motivation for antepartum depression screening can be included in medical and nursing curricula and can also be used with currently practicing health care providers. Doing so could possibly benefit pregnant women by enhancing the antepartum care that they receive.     

Neonatal nurses’ self-reported practices,knowledge and attitudes toward premature infant pain assessment and management

AimTo identify neonatal nurses’ self-reported practices, knowledge and attitudes toward premature infant pain assessment and management.MethodAn exploratory cross sectional mixed methods survey.FindingsOf the 127 surveys distributed, 86 were returned (68% response rate). Those with postgraduate education had higher knowledge and reported more positive attitudes. Comfort measures and analgesia for painful procedures were reported as used more often in term infants. Analgesia was not used for endotracheal intubation. This was attributed to non-prescribing of analgesia by doctors.ConclusionNurses reported a positive attitude toward infant pain assessment and management but a low level of knowledge about premature infants’ response to pain. The non-use of analgesia for painful procedures presents a formidable challenge to changing practice. Evidenced based strategies may overcome barriers.