Obesity care strategies in primary care practices

We evaluated pediatric obesity clinics for internal referrals developed at 5 primary care offices. Clinics developed site-specific strategies: 1 group approach and 4 clinics providing individualized care only. Clinicians reported patient/family motivation as an important referral consideration and compliance as the greatest challenge and perceive clinics to have provided some help.     

Newborn care at peripheral health care facilities

Primary health centres, sub-district hospitals (first referral units) and district hospitals constitute the backbone of the health services in the country. These facilities are expected to cater to the care of the newborn infants who are delivered there, as well as those brought from the community with sickness. This paper, based on a survey in Orissa, and studies in a district hospital in Himachal Pradesh and a sub-district hospital in Haryana, is an attempt to piece together the present status of neonatal care at these facilities. In Orissa, the district and sub-district hospitals cater to a median of 100 and 30 deliveries per month, respectively. Most of the deliveries at these facilities are conducted by the nurses and not the physicians. Neonates are generally kept in the facility only for a day. Hardly any deliveries take place at primary health centres. Cesarean deliveries are mostly confined to the district hospitals. The commonest diagnosis of neonates admitted in the district and sub-district facilities is sepsis (septicemia pneumonia, skin infections, diarrhea and meningitis). Primary health centres seldom admit a sick neonate. It is reassuring to note that the outcome of sick neonates admitted at a functional district or sub-district hospital manned by a pediatrician is highly rewarding with low mortality rates.     

Health care of young children in foster care

Greater numbers of infants and young children with increasingly complicated and serious physical, mental health, and developmental problems are being placed in foster care. All children in foster care need to receive initial health screenings and comprehensive assessments of their medical, mental, dental health, and developmental status. Results of these assessments must be included in the court-approved social services plan and should be linked to the provision of individualized comprehensive care that is continuous and part of a medical home. Pediatricians have an important role in all aspects of the foster care system.     

Wound care in the neonatal intensive care unit

The skin is a vital organ with key protective functions. Infants in the NICU are at risk for skin injury because of developmental immaturity and intensive care treatments. When skin injury occurs, the neonatal nurse is challenged to provide wound care to optimize functional and cosmetic healing. Optimal wound care requires basic knowledge of the mechanisms of injury, physiology of wound healing, host factors affecting wound healing, and wound assessment. This knowledge provides the basis for determining appropriate wound treatment, including dressing selection. Attention to pain issues associated with wound care is difficult because of the infant's developmental stage, but is essential because of the potentially negative life-long impact of pain. The premature infant's propensity for skin stripping limits the selection of appropriate dressing, as does the paucity of research examining wound care products in this population.     

Palliative care in the neonatal intensive care unit

With increasing facilities for antenatal diagnosis, lowering gestation for intiation of intensive care, palliative care in the perinatal period is increasingly recognized as a specialist area. There have been standards and pathways developed in the UK that provides guidance to health professionals. Providing holistic perinatal palliative care depends on close multiprofessional working between the neonatal team and the palliative care professionals who are being integrated into the core neonatal services. Even though most neonates will continue to receive end of life care within the NICU, there are increasing number of families who choose to have end of life care either at home or a hospice. There is a need to develop services across the regions to provide equitable access to excellent clinical care as well as ongoing support to families following loss of a neonate. This short article explores the issues raised in the provision of palliative care in the perinatal period and offers practical guidance for paediatricians in this emerging area.     

远程重症监护

远程重症监护(tele-intensive care)在解决重症监护专业人员不足,提高社区及偏远地区ICU诊疗水平,降低ICU病死率,缩短ICU住院时间,促进ICU最佳医疗实践的实施,提高用药安全等方面有明显优势.但远程ICU的效益、运营模式还有许多不明晰之处,有待深入研究.远程ICU成功的基本要素包括:数据安全、法律与制度保障、专业人员的认同、管理与质量改进、患者、家庭和公众的理解.上述环节不断改进,必使远程ICU发展更快、应用更广泛.     

Pediatric care recommendations for freestanding urgent care facilities

Freestanding urgent care centers are not emergency departments or medical homes, yet they are sometimes used as a source of pediatric care. The purpose of this policy statement is to provide updated and expanded recommendations for ensuring appropriate stabilization in pediatric emergency situations and timely and appropriate transfer to a hospital for definitive care when necessary.     

Family-centered care

The dramatic changes in medical science over the past 30 years have enabled the survival of children with severe chronic impairments and the development of a complicated system of specialized health care for them. The current health care system does not recognize the expertise or the primacy of the family in providing for the well-being of their children. Both professionals and parents acknowledge the challenge to organize the delivery of health care in a manner that supports the growth and development of the child and family. Family-centered care is a new philosophy of health care that places the family rather than the hospital and medical staff at the center of the health care delivery system. The eight essential components have been described. Parents remain the most knowledgeable and committed advocates for their children. Successful implementation of family-centered care for this nation's population of children with chronic illness and physical disability requires significant changes in the roles currently played by professionals and by parents, as well as major reforms in the policies and practices of the health care system.     

Foster care

The placement of children in foster care is a signal that families are in trouble and that our social system is struggling. Foster care, designed to provide remedial services to the child and family and thus to facilitate family reconstitution, often fails. Health care of children in foster care cannot be separated from the circumstances that led to their placement or from the structure and operation of the foster care system itself. Physicians caring for children in foster care should be aware of the challenges presented by these children's high rate of chronic illness and emotional problems and by the barriers imposed by the foster care system.