Occupational performance: a case for self‐determination

The term, ‘self‐determination’, implies that individuals have choice and control over aspects of their lives. Individual/family preferences and choices are now core aspects of Australia's National Disability Insurance Scheme, underpinning the importance attributed to these concepts in relation to the fostering of wellbeing. As occupational therapists, in collaboration with our clients, we facilitate and enable occupational performance goals which are personally meaningful and self‐endorsed. As such, our professional practice provides us with a powerful motivational tool by which we can harness individuals’ energies in the pursuit of their goals – occupation. Self‐Determination Theory (SDT) is an influential theory of human motivation and is presented as a way of understanding the elements of our occupational therapy transactions, and the way in which we enact them so as to enhance client outcomes. In SDT, it is proposed that individuals engage in, pursue and persist with certain behaviours when three psychological needs are being met. These needs are for autonomy (engaging in behaviour that is self‐endorsed), relatedness (feeling cared for and connected to others) and competence (feeling effective in one's environment). A focus on supporting satisfaction of these basic psychological needs, it will be argued, engenders therapeutic alliance and internalisation of goal pursuits, thus optimising therapy engagement and outcomes. Examples of practice approaches that attend to the psychological needs for autonomy, relatedness and competence will be presented. A case will be made for embedding SDT into our models of practice as a sound way of articulating how we practise.     

Vitamin D insufficiency and deficiency in pediatric renal transplant recipients

Vitamin D deficiency is prevalent in the pediatric CKD population. Recognizing that renal transplant recipients have CKD, we assessed the prevalence of vitamin D insufficiency and deficiency in pediatric renal transplant recipients, compared to a healthy pediatric population. We prospectively studied 25(OH)D levels in 29 pediatric renal transplant recipients and 45 control patients over one yr. The overall prevalence of vitamin D insufficiency and deficiency was common in both populations, at 76% (95% CI: 61, 87%) in the pediatric renal transplant recipients and 91% (95% CI: 80, 98%) in the control group. In the paired renal transplant samples, the mean 25(OH)D level was 52.3 ± 17.9 nmol/L in the winter and 65.6 ± 18.8 nmol/L in the summer (95% CI diff.: 3.9, 22.7), in keeping with a significant seasonal difference. The mean dietary intake of vitamin D in the renal transplant recipients, assessed by three‐day dietary record, was 5.7 μg/day, with a vitamin D intake below the EAR in the majority. We did not find an association between vitamin D intake and 25(OH)D levels in this study, likely due to the low dietary intake of vitamin D within the transplant population, identifying a potential area for intervention and improvement.     

Pediatric patients who receive antibiotics for fever and neutropenia in less than 60 min have decreased intensive care needs

Background

Antibiotic delivery to patients with fever and neutropenia (F&N) in <60 min is an increasingly important quality measure for oncology centers, but several published reports indicate that a time to antibiotic delivery (TTA) of <60 min is quite difficult to achieve. Here we report a quality improvement (QI) effort that sought to decrease TTA and assess associated clinical outcomes in pediatric patients with cancer and F&N.

Procedure

We used Lean‐Methodology and a Plan‐Do‐Study‐Act approach to direct QI efforts and prospectively tracked TTA measures and associated clinical outcomes (length of stay, duration of fever, use of imaging studies to search for occult infection, bacteremia, intensive care unit (ICU) consultation or admission, and mortality). We then performed statistical analysis to determine the impact of our QI interventions on total TTA, sub‐process times, and clinical outcomes.

Results

Our QI interventions significantly improved TTA such that we are now able to deliver antibiotics in <60 min nearly 100% of the time. All TTA sub‐process times also improved. Moreover, achieving TTA <60 min significantly reduced the need for ICU consultation or admission (P = 0.003) in this population.

Conclusion

Here we describe our QI effort along with a detailed assessment of several associated clinical outcomes. These data indicate that decreasing TTA to <60 min is achievable and associated with improved outcomes in pediatric patients with cancer and F&N. Pediatr Blood Cancer 2015;62:807–815. © 2015 The Authors. Pediatric Blood & Cancer, published by Wiley Periodicals, Inc.     

Blood donation fears inventory: development and validation of a measure of fear specific to the blood donation setting

Background and ObjectivesAlthough individual differences in fear of stimuli related to blood donation is a key determinant of donor recruitment and retention, a donation-specific fear measure has yet to be developed.Materials and MethodsA donation-related fear measure was developed and tested on an initial sample of donors and non-donors, and then re-evaluated on a second sample to confirm the observed factor structure.ResultsAnalyses supported a four-factor structure, with subscales related to fear of: (1) syncopal symptoms, (2) blood and needles, (3) social evaluation, and (4) health screen results.ConclusionThe Blood Donation Fears Inventory is a novel measure to assess fears held by current and potential blood donors.