Modelling collaboration of primary and secondary care for children with complex care needs: long-term ventilation as an example

A Systems Map of the Challenges of Climate Communication

Over the past sixty years, scientists have been warning about climate change and its impacts on human health, but evidence suggests that many may not be heeding these concerns. This raises the question of whether new communication approaches are needed to overcome the unique challenges of communicating what people can do to slow or reverse climate change. To better elucidate the challenges of communicating about the links between human activity, climate change and its effects, and identify potential solutions, we developed a systems map of the factors and processes involved based on systems mapping sessions with climate change and communication experts. The systems map revealed 27 communication challenges such as "Limited information on how individual actions contribute to collective human activity," "Limited information on how present activity leads to long-term effects," and "Difficult to represent and communicate complex relationships." The systems map also revealed several themes among the identified challenges that exist in communicating about climate change, including a lack of available data and integrated databases, climate change disciplines working in silos, a need for a lexicon that is easily understood by the public, and the need for new communication strategies to describe processes that take time to manifest.

The care burden for technology-dependent children with long-term home ventilation increases along with the improvement of their motor functions

Since the establishment of Japan's publicly supported pediatric home medical care (PHMC) system in 2012, the number of technology-dependent children (TDC) who are supported by PHMC has been increasing. We expected care to become easier as TDC mobility increased. However, many family caregivers complained of the opposite, that the burden of care increased as TDC's mobility increased. Therefore, we aimed to study the problems of the care burden of families in relation to the improvement of mobility of TDC with a focus on respiratory support. We conducted a survey among caregivers of TDC in two parts: a first survey was done between 2018 and 2020, and a follow-up survey in 2023. In each medical procedure, the correlation of TDC's motor function level with care burden was analyzed by using correlation analysis. In 15 households, caregivers' activities were monitored to elucidate the problems of the care objectively. The second survey was conducted in February 2023 in TDC whose medical records were available. Analysis of 418 cases showed that care-burden increased with improvements in the children's motor ability in tracheostomy, or remained the same in other procedures. A follow-up study in 262/418 cases of this group showed that part of these TDC with high mobility aged 1-8, after passing through the mobile phase with increased burden of care, had a high potential to be weaned from medical devices.  Conclusion: For TDC who acquire motor skills during PHMC, the burden of care for caregivers either increases or remains the same. It is important to maintain social support for TDC on the recovering mobile stage. What is Known: • There was no clear information on the care burden when TDC become mobile. What is New: • We did a qualitative study to show that the care burden increases when TDC become mobile. • In addition, mobike TDC showed a high potential for recovery.

Using Unified Modeling Language to Analyze Business Processes in the Delivery of Child Health Services

Business Process Management (BPM) has been increasingly used in recent years in the healthcare domain to analyze, optimize, harmonize and compare clinical and healthcare processes. The main aim of this methodology is to model the interactions between medical and organizational activities needed to deliver health services, measure their complexity, variability and deviations to improve the quality of care and its efficiency. Among the different tools, languages and notations developed in the decades, UML (Unified Modeling Language) represents a widely adopted technique to model, analyze and compare business processes in healthcare. We adopted its diagrams in the MOCHA project to compare the different ways of organizing, coordinating and delivering child care across 30 EU/EEA countries both from an organization and control-flow perspectives. This paper provides an overview of the main components used to represent the business process using UML diagrams, also highlighting how we customized them to capture the specificity of the healthcare domain taking into account that processes are reconstructed on the basis of country experts' responses to questionnaires. The benefits of the application of this methodology are demonstrated by providing examples of comparing different aspects of child care.

Mothers' experiences of giving medicines to children with severe and profound intellectual disabilities-The impact on time

BACKGROUND

Chronic health conditions experienced by children with severe and profound intellectual disabilities are accompanied by numerous challenges because of the prolonged period over which children take medication and the large number of drugs they take. Mothers experience many challenges in giving medicines, from difficulties in physical administration to manipulation of medication, covert administration and alternative formulations. The aim of this study was to explore mothers' lived experience of giving medicines to children with severe and profound intellectual disabilities.

METHODS

A hermeneutic phenomenological approach was used. Semistructured face-to-face interviews and participant diaries were adopted for data collection, resulting in 28 interviews undertaken and 7 diaries completed with mothers of children with severe and profound intellectual disabilities. Van Manen's method for thematic analysis was used for data analysis.

RESULTS

The concept of time and the impact of giving medicines were apparent, mothers being 'always on call' and the constant full-time pace of their caring role evident. There was little spontaneity in their lives, dampened by the routine of giving medicines and their caregiving role. The necessity to be prepared and organized was highlighted as important in ensuring children got their medications on time and safely.

CONCLUSIONS

This study provides insight into the phenomenon of mothers' lived experience of giving medicines to children with severe and profound intellectual disabilities. It has enabled exploration and familiarity with the lifeworld of mothers and offers meaning on the phenomena of giving medicines. It was concluded that this experience is a relentless and challenging one, yet appears invisible as an element of care in professional discourse. Through addressing the gap in understanding and exploring the meaning of this phenomenon, it may be useful in developing care for mothers and children with severe and profound intellectual disabilities.

[Current situation of children with medical complexity: An experience between primary and hospital care]

Objetivo

Analizar la valoración de la atención a los niños con patología crónica compleja (NPCC) en atención primaria (AP), desde el punto de vista de sus médicos y de sus familias.

Diseño

Estudio observacional, descriptivo y transversal.

Emplazamiento

Pediatría de AP y unidad de patología crónica compleja (UPCC) del Hospital Universitario La Paz (HULP).

Participantes

Pacientes y familiares de la UPCC y sus médicos de AP de la Comunidad de Madrid (CAM).

Intervenciones

Realización de encuestas validadas presenciales y online.

Mediciones principales

Grado de satisfacción en la formación, capacitación y manejo específico del NPCC según escalas tipo Likert.

Resultados

Se encuestaron 53 familias y 170 médicos de AP (96,5% pediatras). Los resultados de la encuesta a familiares revelan descoordinación entre niveles asistenciales (73,6%), escasa confianza en el primer nivel asistencial e impresión de poca capacidad de resolución de problemas por parte de pediatría de AP (50%).

Entre los médicos de AP destaca la poca formación para el seguimiento de los NPCC (96,5%), escasa experiencia en su manejo (93%) e insuficiente comunicación con el hospital (80,5%).

La falta de tiempo en las consultas es un problema común, percibido por pediatras y pacientes.

Conclusiones

La falta de coordinación entre AP y atención hospitalaria (AH) se detecta como un problema importante en la continuidad asistencial de NPCC. Son necesarias intervenciones que mejoren esta coordinación. La AP es cercana a la familia, pero precisa mejorar la formación y capacitación de los profesionales en problemas de salud y soporte tecnificado de NPCC, así como incrementar el tiempo necesario para su atención.

Rapid detection of fast innovation under the pressure of COVID-19

Covid-19 has rapidly redefined the agenda of technological research and development both for academics and practitioners. If the medical scientific publication system has promptly reacted to this new situation, other domains, particularly in new technologies, struggle to map what is happening in their contexts. The pandemic has created the need for a rapid detection of technological convergence phenomena, but at the same time it has made clear that this task is impossible on the basis of traditional patent and publication indicators. This paper presents a novel methodology to perform a rapid detection of the fast technological convergence phenomenon that is occurring under the pressure of the Covid-19 pandemic. The fast detection has been performed thanks to the use of a novel source: the online blogging platform Medium. We demonstrate that the hybrid structure of this social journalism platform allows a rapid detection of innovation phenomena, unlike other traditional sources. The technological convergence phenomenon has been modelled through a network-based approach, analysing the differences of networks computed during two time periods (pre and post COVID-19). The results led us to discuss the repurposing of technologies regarding "Remote Control", "Remote Working", "Health" and "Remote Learning".