Spiritual Care

Zusammenfassung Der Tod von Kindern ist für alle beteiligten Personen ein schwer auszuhaltendes Ereignis. Der vorliegende Beitrag beschäftigt sich damit, wie ein solches Geschehen aus der Perspektive von Spiritualität und spiritueller Begleitung verstanden werden kann. Dabei wird Spiritualität als Teilnahme und Teilhabe am Leben sowohl im biologischen als auch im das Biologische transzendierenden Sinn verstanden. Aufgabe spiritueller Begleitung ist es, sich des Lebens aller Beteiligten zu vergewissern und die künftige Teilhabe am Leben zu sichern. Als Professionswissen ist eine spirituelle Anamnese allen therapeutisch Handelnden möglich. Dabei kommen Erinnerungsgegenständen und Ritualen lebenswichtige Bedeutung zu. Der Beitrag ist im unmittelbaren Kontext der seelsorgerlichen Praxis verankert.     

Health Care Utilization for Children in Foster Care

ObjectiveTo utilize hospital EMR data for children placed in foster care (FC) and a matched control group to compare: 1) health care utilization rates for primary care, subspecialty care, emergency department (ED) visits, and hospitalizations; 2) overall charges per patient-year; and 3) prevalence of complex chronic conditions (CCC) and their effect on utilization.MethodsChildren ≤18 years old with a designation of FC placement and controls matched on age, race/ethnicity, gender, and zip code who had an encounter at an urban pediatric health system between 7/1/11 and 6/30/12 were identified in the EMR. Data on outpatient, ED, and inpatient encounters and charges for 7/1/12 to 6/30/13 were obtained. A general linear mixed-effects model was applied to estimate means and rates for each group. Analyses were repeated among the subpopulations of children with and without CCCs.ResultsA total of 1156 FC cases were matched to 4062 controls (mean = 3.5 controls/case). FC cases had significantly higher rates (per 100 patient-years) of hospitalizations (18.5 vs 12.7, P = .005), and subspecialty visits (173.3 vs 113.6; P < .001) but not ED (50.4 vs 45.2, P = .056) or primary care visits (154.6 vs 149.8; P = .50). FC cases had higher charges ($14,372 vs $7082; P < .001). Among children with CCCs, health care utilization rates and charges were higher among FC cases (all P < .001). Among children without CCC, rates and charges were similar for FC cases and controls (all P > .20).ConclusionsFC children utilized more hospitalizations and subspecialty office visits. The increased utilization rates and charges among children in FC were driven by the subset of children with CCCs.     

Point of Care Investigations in Pediatric Care to Improve Health Care in Rural Areas

The good quality laboratory services in developing countries are often limited to major urban centers. As a result, many commercially available high-quality diagnostic tests for infectious diseases are neither accessible nor affordable to patients in the rural areas. Health facilities in rural areas are compromised and this limits the usability and performance of the best medical diagnostic technologies in rural areas as they are designed for air-conditioned laboratories, refrigerated storage of chemicals, a constant supply of calibrators and reagents, stable electrical power, highly trained personnel and rapid transportation of samples. The advent of new technologies have allowed miniaturization and integration of complex functions, which has made it possible for sophisticated diagnostic tools to move out of the developed-world laboratory in the form of a “point of care”(POC) tests. Many diagnostic tests are being developed using these platforms. However, the challenge is to develop diagnostics which are inexpensive, rugged and well suited to the medical and social contexts of the developing world and do not compromise on accuracy and reliability. The already available POC tests which are reliable and affordable, like for HIV infection, malaria, syphilis, and some neglected tropical diseases, and POC tests being developed for other diseases if correctly used and effectively regulated after rigorous evaluation, have the potential to make a difference in clinical management and improve surveillance. In order to use these tests effectively they would need to be supported by technically competent manpower, availability of good-quality reagents, and healthcare providers who value and are able to interpret laboratory results to guide treatment; and a system for timely communication between the laboratory and the healthcare provider. Strengthening the laboratories at the rural level can enable utilization of these diagnostics for improving the diagnosis and management of infectious diseases among children which require prompt treatment and thus, considerably reduce morbidity and mortality among the pediatric age group.     

新生儿重症监护室中的发育支持护理

随着新生儿重症监护室（NICU）各种生命支持技术的应用，危重新生儿抢救成功率与存活率明显提高，然而各种后遗症发生率也增多。据国外资料报道，极低出生体质量（VLBW）儿脑性瘫痪发生率为5％～10％，而且10％～25％发生认知功能缺陷。新生儿，尤其是VLBW和超低出生体质量（ELBW）早产儿，由于组织器官结构和功能发育未成熟，易发生各种危重症，是NICU医护的主要对象，而NICU不适宜的环境及干预措施，可影响疾病的发生、发展、结局及各器官的发育成熟，其中神经系统最易受累，     

Respite Care:

Respite care, orginally developed to provide relief to gamily members of developmentally disabled individuals, is growing in popularity with families and service providers. Different forms of respite care are emerging to serve the families of individuals of all ages who have chronic disabling conditions. In this review, various trends in respite care are defined and described, and diverse roles for therapists involved in this growing community service are identified. Special emphasis is placed on the needs of developmentally disabled children and their families.     

A Primary Care Approach for Adolescent Care and Counseling Services

Objective

Adolescents can have mental, emotional, and behavior problems that are a source of stress for the child as well as the family, school and community. These may disrupt the adolescent’s ability to function normally. Adolescents also have reproductive concerns especially at menarche. Considering the extent of problems of adolescents and the lack of adolescent care and counseling services, it was felt that community adolescent care counseling services should be made available. This article describes the steps involved in the setting up of Taluk model of adolescent care and counseling services.

Methods

Following steps were involved in setting up a Taluk model of adolescent care counseling service delivery system. Step I: Focus Group Discussions (FGDs) among Stakeholders. Step II: Conceptualization and Strategy planning for service delivery. III: Finalization of service delivery model Step IV: Workshops for finalization of TSQ-T 2008 version the tool to be used for assessing the adolescents in the ARSH clinics. Step V: Training Programme for Medical/Paramedical health staff. Step VI: Awareness programs for mothers of adolescents. Step VII: Setting up of ACS/ARSH clinics at Taluk hospitals. Step VIII: Evaluation of the utilization of services at Taluk hospitals. The clinic has been well utilized with 1,588 adolescents being seen in 2 years.

Results

Medical and Reproductive problems among adolescent girls were anemia, underweight, dysmenorrhoea, menstrual irregularities and symptoms of Polycystic Ovarian Syndrome, whereas among boys problems were mostly related to concerns about masturbation and its perceived ill effects. The psychosocial problems ranged from minor anxieties, sadness and adjustment problems to psychiatric disorders. Scholastic problems included poor concentration, poor study habits and low intelligence quotient.

Conclusions

The success of the clinics in these five hospitals can be replicated in other parts of the state as well as the country. These will go a long way to ameliorate the morbidity of adolescents.

     

Respiratory Syncytial Virus: From Primary Care to Critical Care

Respiratory syncytial virus (RSV) is a common disease in pediatrics. Certain subpopulations of children are at greatest risk for serious disease. However, previously healthy children also may become critically ill. In the clinic or the intensive care unit, children with RSV pose the challenge of how to treat a disease when evidence to support therapeutic options is severely limited. Prophylaxis is an option for certain children, although many do not qualify. RSV has been implicated in continued wheezing and the subsequent development of asthma. While evidence for this implication is still being sought, researchers are working on finding new ways to treat and prevent RSV.