Benefits of Medical Home Care Reaching Beyond Chronically Ill Teens: Exploring Parent Health-Related Quality of Life

Background

Caring for teens with special health care needs places physical and mental health burdens on parents, which can be exacerbated by the stresses of transitions to independence. Medical homes can improve teen transitions to greater self-management and reduce health care–related time and financial burdens for families. We examined the association between parent-reported teen medical home status and caregiver health-related quality of life (HRQOL).

Collaborative Care of Attention Deficit Hyperactivity Disorder: An Innovative Partnership to Serve Rural Pediatric Patients

Attention deficit hyperactivity disorder (ADHD) is a common behavioral health disorder in childhood that causes significant impairments in quality of life, home relationships, and school success. Despite a substantial evidence base and corresponding practice guidelines established by the American Academy of Pediatrics that support use of behavioral therapy to treat ADHD, affected patients infrequently receive therapy. This article will review the causes of underuse of behavioral therapy and methods to overcome these barriers such as integrating behavioral health care, thereby creating a pediatric patient–centered medical home. Additionally, a novel practice model of a behavioral health care collaboration being piloted in a rural pediatric office will be presented, including methods to screen, assess, and treat ADHD patients and families within the comfort of the primary care office.     

Electrolyte Emergencies and Acute Renal Failure in Pediatric Critical Care

Electrolyte and renal function issues in critically ill children are vast requiring many different approaches to treatment. Each disease state with its special considerations and problems poses many challenges but fortunately improved technologies have provided many treatment options. Knowledge of the pathophysiology of renal disease, its manifestations, and its treatment options is essential for optimizing care of the critically ill child.     

Use of Medical Care and Antibiotics among Preschool Children in Different Day Care Settings

ABSTRACT. The use of medical care among 880 1-5 year olds in different day care settings was studied using register information on physician visits, purchases of antibiotics and municipal day care in 1984. The unit of analysis was months in the different day care settings and not children. The rates of physician visits were 1.4 to 1.8 times higher for acute upper respiratory tract infections and all acute infections and 2 to 3 times higher for secretory otitis media during day care centre months and family day care months as compared to home care months. The rate of visits for bronchial asthma was 5 times higher during day care centre months than during home care months. No differences were found between day care centre months and family day care months with respect to the rates of physician visits for acute upper respiratory tract infections, acute otitis media and all acute infections. Among children in family day care, the daily number of hours in day care, and size, average age and age homogeneity of the groups were not significantly associated with rates of visits for all acute infections or purchases of antibiotics.     

Adapting an Evidence-Based Pediatric Acute Asthma Exacerbation Severity Assessment Tool for Pediatric Primary Care

Introduction

The purposes of this project were (a) to examine criteria derived from evidence-based pediatric acute asthma exacerbation assessment tools, asthma scores, and the acute asthma prediction rule validated and used in the emergency department and (b) to adapt these criteria for pediatric primary care.

Basic Concepts in Pediatric Patient Safety: Actions Toward a Safer Health Care System

Patient safety is everyone's responsibility. The leaders in the health care delivery system are critical in establishing the direction and expectations for staff and management. In most areas with significant change occurring and facing a major overhaul to the system, leaders and leadership become paramount to the success of the change. The information presented here was designed to serve as a backdrop for the basic organizational processes that need to be applied to improve quality and safety in pediatric health care. The 4 key areas to impact the safety agenda in health care—leadership, reporting systems, local team problem solving, and clear standards of behaviors—are the foundation for establishing a patient safety model.     

Effect of Facilitated Discharge in Pediatric Orthopedic Patients at an Academic Medical Facility

Introduction

Because health care reimbursement is being linked to discharge quality and patient satisfaction, this quality improvement initiative reviewed the outcomes of embedding a pediatric nurse practitioner within the resident team at an academic medical facility.

Lack of Preparedness for Pediatric to Adult-Oriented Health Care Transition in Hospitalized Adolescents and Young Adults

Objective

We examined the self-reported preparedness of hospitalized adolescents and young adults (AYA) for transition from pediatric to adult-oriented health care with regard to: 1) previous health care transition (HCT) preparation, 2) Self-Determination Theory (SDT) constructs of health self-management autonomy and competence, and 3) their perception of medical knowledge, attitudes, and concerns.

Unexplained Practice Variation in Primary Care Providers' Concern for Pediatric Obstructive Sleep Apnea

Objective

To examine primary care provider (PCP) screening practice for obstructive sleep apnea (OSA) and predictive factors for screening habits. A secondary objective was to describe the polysomnography completion proportion and outcome. We hypothesized that both provider and child health factors would predict PCP suspicion of OSA.

Depression in the School-Aged Child With Type 1 Diabetes: Implications for Pediatric Primary Care Providers

Depression is a common comorbid condition experienced by children with type 1 diabetes that, if undiagnosed, can lead to deterioration in glycemic control and other serious health complications. Although it is documented that children with type 1 diabetes experience high rates of depression, a comprehensive clinical guide does not exist to help direct the pediatric provider on how to best care for these children. The purpose of this article is to synthesize current evidence to aid the pediatric primary care provider in the detection and management of depression in the school-aged child with type 1 diabetes.     

《儿科重症监护输血和贫血专家倡议：危重儿童红细胞输注专家共识》介绍

贫血是危重症患儿常见表现, 红细胞（red blood cell, RBC）输注是儿科重症监护病房（pediatric intensive care unit, PICU）常用治疗手段, 在挽救患儿生命的同时, 也带来输血相关性严重危害。为促进危重症患儿合理输注RBC,降低输血相关的严重危害, 儿科重症监护输血和贫血专家倡议（transfusion and anemia expertise initiative, TAXI）专家组制订了危重症儿童RBC输注的专家共识。共识由12篇独立文章组成, 包括共识推荐意见汇总1篇, 涉及一般危重症、 呼吸衰竭、 非失血性休克、 非危及生命的出血或失血性休克、 急性脑损伤、 获得性/先天性心脏病、 血液系统和肿瘤性疾病、 体外膜氧合/心室辅助装置/肾脏替代支持治疗共9类特殊人群的RBC输注的专家共识8篇, RBC的选择和处理、 专家共识制订方法及共识应用的共识各1篇; 包括102项推荐意见, 其中57项为临床推荐意见（20项基于循证医学证据, 37项基于专家共识）, 45项为对相关研究的推荐意见。该文仅介绍临床推荐意见。