1
|
Noyes M, Delaney A, Lang M, Maybury M, Moloney S, Bradford N. Preparing for Death While Investing in Life: A Narrative Inquiry and Case Report of Home-Based Paediatric Palliative, End-of-Life, and After-Death Care. Children (Basel) 2023; 10:1777. [PMID: 38002868 PMCID: PMC10670542 DOI: 10.3390/children10111777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/23/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023]
Abstract
Paediatric palliative care is pivotal for addressing the complex needs of children with incurable diseases and their families. While home-based care offers a familiar and supportive environment, delivering comprehensive services in this context is challenging. The existing literature on home-based palliative care lacks detailed guidance for its organization and implementation. This qualitative narrative inquiry explores the organization and provision of home-based paediatric palliative care. Data were collected from healthcare practitioners using conversations, storytelling, and reflective journaling. Schwind's Narrative Reflective Process was applied to synthesize the data, resulting in an in-depth case description. The narrative approach illuminates the complexities of home-based paediatric palliative, end-of-life, and after-death care. Key findings encompass the importance of early-care coordination, interprofessional collaboration, effective symptom management, emotional and psychosocial support, and comprehensive end-of-life planning. Through the case study of the child patient, the challenges and strategies for providing holistic, family-centred care within the home environment are described. Practical insights gained from this report can inform the development and improvement of home-based palliative care programs, benefiting researchers, practitioners, and policymakers seeking to optimize care for children and families in similar contexts.
Collapse
Affiliation(s)
- Michelle Noyes
- Department of Paediatrics, Gold Coast University Hospital, Southport, QLD 4215, Australia; (M.N.); (M.L.); (S.M.)
| | - Angela Delaney
- Paediatric Palliative Care Service, Queensland Children’s Hospital, South Brisbane, QLD 4101, Australia;
- Centre for Children’s Health Research, Children’s Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia
| | - Meagan Lang
- Department of Paediatrics, Gold Coast University Hospital, Southport, QLD 4215, Australia; (M.N.); (M.L.); (S.M.)
| | - Mellissa Maybury
- Queensland Children’s Tumour Bank, Child Health Research Centre, University of Queensland, South Brisbane, QLD 4101, Australia;
| | - Susan Moloney
- Department of Paediatrics, Gold Coast University Hospital, Southport, QLD 4215, Australia; (M.N.); (M.L.); (S.M.)
- School of Medicine, Griffith University, Southport, QLD 4215, Australia
| | - Natalie Bradford
- Paediatric Palliative Care Service, Queensland Children’s Hospital, South Brisbane, QLD 4101, Australia;
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, QLD 4001, Australia
| |
Collapse
|
2
|
Thomas ET, Thomas ST, Perera R, Gill PJ, Moloney S, Heneghan C. The quality of diagnostic guidelines for children in primary care: A meta-epidemiological study. J Paediatr Child Health 2023; 59:1053-1060. [PMID: 37335248 DOI: 10.1111/jpc.16454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/02/2023] [Indexed: 06/21/2023]
Abstract
AIM To determine the quality of paediatric guidelines relevant to diagnosis of three of the most common conditions in primary care: fever, gastroenteritis and constipation. METHODS We undertook a meta-epidemiological study of paediatric guidelines for fever, gastroenteritis and gastroenteritis. We systematically searched MEDLINE, Embase, Trip Database, Guidelines International Network, the National Guideline Clearinghouse and WHO from February 2011 to September 2022 for guidelines from high-income settings containing diagnostic recommendations. We assessed the quality of guideline reporting for included guidelines using the AGREE II tool. RESULTS We included 16 guidelines: fever (n = 7); constipation (n = 4) and gastroenteritis (n = 5). The overall quality across the three conditions was graded moderate (median AGREE II score 4.5/7, range 2.5-6.5) with constipation guidelines rated the highest (median 6/7), and fever rated the lowest (median 3.8/7). Major methodological weaknesses included consideration of guideline applicability. Half of the guidelines did not report involving parent representatives, and 56% did not adequately declare or address their competing interests. CONCLUSIONS Substantial variations exist in the quality of paediatric guidelines related to the diagnosis of primary care presentations. Better quality guidance is needed for general practitioners to improve diagnosis for children in primary care.
Collapse
Affiliation(s)
- Elizabeth T Thomas
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sarah T Thomas
- Department of Neurology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Peter J Gill
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Susan Moloney
- Department of Paediatrics, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Carl Heneghan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
3
|
Thomas ET, Thomas ST, Perera R, Gill PJ, Moloney S, Heneghan CJ. The quality of paediatric asthma guidelines: evidence underpinning diagnostic test recommendations from a meta-epidemiological study. Fam Pract 2023:7169412. [PMID: 37196169 DOI: 10.1093/fampra/cmad052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Asthma is one of the most frequent reasons children visit a general practitioner (GP). The diagnosis of childhood asthma is challenging, and a variety of diagnostic tests for asthma exist. GPs may refer to clinical practice guidelines when deciding which tests, if any, are appropriate, but the quality of these guidelines is unknown. OBJECTIVES To determine (i) the methodological quality and reporting of paediatric guidelines for the diagnosis of childhood asthma in primary care, and (ii) the strength of evidence supporting diagnostic test recommendations. DESIGN Meta-epidemiological study of English-language guidelines from the United Kingdom and other high-income countries with comparable primary care systems including diagnostic testing recommendations for childhood asthma in primary care. The AGREE-II tool was used to assess the quality and reporting of the guidelines. The quality of the evidence was assessed using GRADE. RESULTS Eleven guidelines met the eligibility criteria. The methodology and reporting quality varied across the AGREE II domains (median score 4.5 out of 7, range 2-6). The quality of evidence supporting diagnostic recommendations was generally of very low quality. All guidelines recommended the use of spirometry and reversibility testing for children aged ≥5 years, however, the recommended spirometry thresholds for diagnosis differed across guidelines. There were disagreements in testing recommendations for 3 of the 7 included tests. CONCLUSIONS The variable quality of guidelines, lack of good quality evidence, and inconsistent recommendations for diagnostic tests may contribute to poor clinician adherence to guidelines and variation in testing for diagnosing childhood asthma.
Collapse
Affiliation(s)
- Elizabeth T Thomas
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sarah T Thomas
- Department of Neurology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Peter J Gill
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Susan Moloney
- Department of Paediatrics, Gold Coast University Hospital, Southport, Queensland, Australia
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Carl J Heneghan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
4
|
Clarke E, Anderson-Saria G, Kisoli A, Urasa S, Moloney S, Safic S, Rogathi J, Walker R, Robinson L, Paddick SM. Patient priority setting in HIV ageing research: exploring the feasibility of community engagement and involvement in Tanzania. Res Involv Engagem 2023; 9:3. [PMID: 36805028 PMCID: PMC9938604 DOI: 10.1186/s40900-022-00409-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/23/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVE The chronic complications of ageing with HIV are not well studied in sub-Saharan Africa (SSA) where general healthcare resources are limited. We aimed to collaborate with individuals living with HIV aged ≥ 50 years, and community elders (aged ≥ 60 years) living with non-communicable diseases in the Kilimanjaro region of Tanzania in a health research priority-setting exercise. METHODS We conducted structured workshops based on broad questions to aid discussion and group-based patient priority setting, alongside discussion of the feasibility of future community research engagement. Participant priorities were tallied and ranked to arrive at core priorities from consensus discussion. RESULTS Thirty older people living with HIV and 30 community elders attended separate priority setting workshops. Both groups reported motivation to participate in, conduct, and oversee future studies. In this resource-limited setting, basic needs such as healthcare access were prioritised much higher than specific HIV-complications or chronic disease. Stigma and social isolation were highly prioritised in those living with HIV. CONCLUSIONS Community engagement and involvement in HIV and ageing research appears feasible in Tanzania. Ageing and non-communicable disease research should consider the wider context, and lack of basic needs in low-income settings. A greater impact may be achieved with community involvement.
Collapse
Affiliation(s)
- Ellisiv Clarke
- Newcastle University, Campus for Ageing and Vitality, Westgate Road, Newcastle Upon Tyne, NE4 6BE, UK
| | | | - Aloyce Kisoli
- Anderson Memorial Rehabilitation and Care Organisation (AMRCO), Moshi, Tanzania
| | - Sarah Urasa
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Susan Moloney
- Newcastle University, Campus for Ageing and Vitality, Westgate Road, Newcastle Upon Tyne, NE4 6BE, UK
| | | | - Jane Rogathi
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Richard Walker
- Newcastle University, Campus for Ageing and Vitality, Westgate Road, Newcastle Upon Tyne, NE4 6BE, UK
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Louise Robinson
- Newcastle University, Campus for Ageing and Vitality, Westgate Road, Newcastle Upon Tyne, NE4 6BE, UK
| | - Stella-Maria Paddick
- Newcastle University, Campus for Ageing and Vitality, Westgate Road, Newcastle Upon Tyne, NE4 6BE, UK.
- Gateshead Health NHS Foundation Trust, Gateshead, UK.
| |
Collapse
|
5
|
Franklin D, Babl FE, George S, Oakley E, Borland ML, Neutze J, Acworth J, Craig S, Jones M, Gannon B, Shellshear D, McCay H, Wallace A, Hoeppner T, Wildman M, Mattes J, Pham TMT, Miller L, Williams A, O’Brien S, Lawrence S, Bonisch M, Gibbons K, Moloney S, Waugh J, Hobbins S, Grew S, Fahy R, Dalziel SR, Schibler A. Effect of Early High-Flow Nasal Oxygen vs Standard Oxygen Therapy on Length of Hospital Stay in Hospitalized Children With Acute Hypoxemic Respiratory Failure: The PARIS-2 Randomized Clinical Trial. JAMA 2023; 329:224-234. [PMID: 36648469 PMCID: PMC9856857 DOI: 10.1001/jama.2022.21805] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
IMPORTANCE Nasal high-flow oxygen therapy in infants with bronchiolitis and hypoxia has been shown to reduce the requirement to escalate care. The efficacy of high-flow oxygen therapy in children aged 1 to 4 years with acute hypoxemic respiratory failure without bronchiolitis is unknown. OBJECTIVE To determine the effect of early high-flow oxygen therapy vs standard oxygen therapy in children with acute hypoxemic respiratory failure. DESIGN, SETTING, AND PARTICIPANTS A multicenter, randomized clinical trial was conducted at 14 metropolitan and tertiary hospitals in Australia and New Zealand, including 1567 children aged 1 to 4 years (randomized between December 18, 2017, and March 18, 2020) requiring hospital admission for acute hypoxemic respiratory failure. The last participant follow-up was completed on March 22, 2020. INTERVENTIONS Enrolled children were randomly allocated 1:1 to high-flow oxygen therapy (n = 753) or standard oxygen therapy (n = 764). The type of oxygen therapy could not be masked, but the investigators remained blinded until the outcome data were locked. MAIN OUTCOMES AND MEASURES The primary outcome was length of hospital stay with the hypothesis that high-flow oxygen therapy reduces length of stay. There were 9 secondary outcomes, including length of oxygen therapy and admission to the intensive care unit. Children were analyzed according to their randomization group. RESULTS Of the 1567 children who were randomized, 1517 (97%) were included in the primary analysis (median age, 1.9 years [IQR, 1.4-3.0 years]; 732 [46.7%] were female) and all children completed the trial. The length of hospital stay was significantly longer in the high-flow oxygen group with a median of 1.77 days (IQR, 1.03-2.80 days) vs 1.50 days (IQR, 0.85-2.44 days) in the standard oxygen group (adjusted hazard ratio, 0.83 [95% CI, 0.75-0.92]; P < .001). Of the 9 prespecified secondary outcomes, 4 showed no significant difference. The median length of oxygen therapy was 1.07 days (IQR, 0.50-2.06 days) in the high-flow oxygen group vs 0.75 days (IQR, 0.35-1.61 days) in the standard oxygen therapy group (adjusted hazard ratio, 0.78 [95% CI, 0.70-0.86]). In the high-flow oxygen group, there were 94 admissions (12.5%) to the intensive care unit compared with 53 admissions (6.9%) in the standard oxygen group (adjusted odds ratio, 1.93 [95% CI, 1.35-2.75]). There was only 1 death and it occurred in the high-flow oxygen group. CONCLUSIONS AND RELEVANCE Nasal high-flow oxygen used as the initial primary therapy in children aged 1 to 4 years with acute hypoxemic respiratory failure did not significantly reduce the length of hospital stay compared with standard oxygen therapy. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12618000210279.
Collapse
Affiliation(s)
- Donna Franklin
- Children’s Emergency and Critical Care Research, Gold Coast University Hospital, Southport, Australia
- Emergency Department, Gold Coast University Hospital, Southport, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Australia
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
| | - Franz E. Babl
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
- Emergency Department, Royal Children’s Hospital, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Shane George
- Children’s Emergency and Critical Care Research, Gold Coast University Hospital, Southport, Australia
- Emergency Department, Gold Coast University Hospital, Southport, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Australia
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
| | - Ed Oakley
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
- Emergency Department, Royal Children’s Hospital, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Meredith L. Borland
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
- Emergency Medicine, Perth Children’s Hospital, Nedlands, Australia
- Divisions of Emergency Medicine and Paediatrics, School of Medicine, University of Western Australia, Crawley
| | - Jocelyn Neutze
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
- Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
- KidzFirst Middlemore Hospital, Auckland, New Zealand
| | - Jason Acworth
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
- Emergency Department, Queensland Children’s Hospital, South Brisbane, Australia
| | - Simon Craig
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
- Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Australia
- Emergency Department, Monash Medical Centre, Melbourne, Australia
| | - Mark Jones
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Brenda Gannon
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, Australia
| | - Deborah Shellshear
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
- Emergency Department, Queensland Children’s Hospital, South Brisbane, Australia
| | - Hamish McCay
- Department of Paediatrics, Waikato Hospital, Hamilton, New Zealand
| | - Alexandra Wallace
- Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
- Department of Paediatrics, Waikato Hospital, Hamilton, New Zealand
| | - Tobias Hoeppner
- Emergency Medicine, Perth Children’s Hospital, Nedlands, Australia
| | - Mark Wildman
- Emergency Department, Townsville University Hospital, Douglas, Australia
| | - Joerg Mattes
- Paediatric Respiratory and Sleep Medicine, John Hunter Children’s Hospital, New Lambton Heights, Australia
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, Australia
| | - Trang M. T. Pham
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Letitia Miller
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Amanda Williams
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
- Emergency Department, Royal Children’s Hospital, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
| | - Sharon O’Brien
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
- Emergency Medicine, Perth Children’s Hospital, Nedlands, Australia
| | - Shirley Lawrence
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
- KidzFirst Middlemore Hospital, Auckland, New Zealand
| | - Megan Bonisch
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
- Children’s Emergency Department, Starship Children’s Hospital, Auckland, New Zealand
| | - Kristen Gibbons
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Susan Moloney
- Paediatric Department, Gold Coast University Hospital, Griffith University School of Medicine, Southport, Australia
| | - John Waugh
- Paediatric Department, Ipswich General Hospital, Ipswich, Australia
- Paediatric Department, Caboolture Hospital, Caboolture, Australia
| | - Sue Hobbins
- Paediatric and Emergency Departments, Prince Charles Hospital, Chermside, Australia
| | - Simon Grew
- Paediatric Department, Redcliffe Hospital, Redcliffe, Australia
| | - Rose Fahy
- Paediatric and Emergency Departments, Prince Charles Hospital, Chermside, Australia
| | - Stuart R. Dalziel
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
- Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
- Children’s Emergency Department, Starship Children’s Hospital, Auckland, New Zealand
- University of Auckland, Auckland, New Zealand
| | - Andreas Schibler
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
- St Andrew’s War Memorial Hospital, Brisbane, Australia
- Critical Care Research Group, St Andrew’s War Memorial Hospital, Brisbane, Australia
- Wesley Medical Research, Wesley Hospital, Auchenflower, Australia
| |
Collapse
|
6
|
Noyes M, Herbert A, Moloney S, Irving H, Bradford N. Location of end-of-life care of children with cancer: A systematic review of parent experiences. Pediatr Blood Cancer 2022; 69:e29621. [PMID: 35293690 DOI: 10.1002/pbc.29621] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To synthesize existing qualitative research exploring the experiences of parents caring for children with cancer during the end-of-life phase, and the factors that influence parental decision-making when choosing the location of end-of-life care and death for their child. RESULTS This review included 15 studies of 460 parents of 333 children and adolescents who died from progressive cancer. Where reported, the majority (58%) of children died at home or in a hospital (39%), with only a small fraction dying in a hospice. Factors impacting decision-making for the location of care included the quality of communication and the quality of care available. Themes related to choosing home for end-of-life care and death included honoring the child's wishes, the familiarity of home, and parents' desire to be their child's primary carer. Preference for the location of death in the hospital included trust in hospital staff, practical logistics, and the safety of the hospital environment.
Collapse
Affiliation(s)
- Michelle Noyes
- Oncology Services, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Anthony Herbert
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Queensland Paediatric Palliative Care Haematology and Oncology Network, Oncology Services Group, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Susan Moloney
- Oncology Services, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Helen Irving
- Queensland Paediatric Palliative Care Haematology and Oncology Network, Oncology Services Group, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - Natalie Bradford
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Queensland Paediatric Palliative Care Haematology and Oncology Network, Oncology Services Group, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia.,Cancer and Palliative Care Outcome Centre, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| |
Collapse
|
7
|
Ismail K, Hughes I, Moloney S, Grimwood K. Streptococcus anginosus group infections in hospitalised children and young people. J Paediatr Child Health 2022; 58:809-814. [PMID: 34854155 DOI: 10.1111/jpc.15840] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 10/22/2021] [Accepted: 11/21/2021] [Indexed: 11/29/2022]
Abstract
AIM The Streptococcus anginosus group (SAG) comprises three bacterial species colonising the mouth and gastrointestinal and genitourinary tracts and capable of serious pyogenic infections. Although well-described in adults, studies in children are limited. Here, we characterise paediatric SAG infections from a single Australian centre. METHODS Hospitalised patients aged ≤18 years with positive SAG cultures from January 2009 to December 2019 were identified from Pathology Queensland's Gold Coast Laboratory database and their medical records were reviewed. RESULTS Two-hundred children (62% male), median age 12 years (interquartile range 6-16), with positive SAG cultures were identified. Overall, 90% received intravenous antibiotics, 89% underwent surgical drainage, 23% were readmitted and 15% required additional surgery. The most common sites were the abdomen (39%), soft tissues (36%) and head and neck regions (21%). Since 2011, Pathology Queensland reported SAG at the species level (n = 133). Of these, S. anginosus was the most prevalent (39%), then S. constellatus (34%) and S. intermedius (27%). Compared with the other two species, S. intermedius was most commonly associated with head and neck infections (relative risk (RR) = 2.2, 95% confidence interval (CI) 1.4-3.5), while S. constellatus (RR = 1.7, 95% CI 1.2-2.4) and S. anginosus (RR = 1.5, 95% CI 1.0-2.0) were each associated with a higher risk of intra-abdominal infection than S. intermedius. Since February 2015, the number of children admitted with SAG-associated intra-abdominal infection per 1000 hospitalisations increased by 29% annually compared with an annual decline of 8% in previous years. CONCLUSIONS SAG infections occur at various anatomical sites. Despite antibiotics and surgical management, almost one-quarter are re-hospitalised for further treatment.
Collapse
Affiliation(s)
- Khairul Ismail
- Department of Paediatrics, Gold Coast Health, Gold Coast, Queensland, Australia.,School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Ian Hughes
- Office of Research Governance and Development, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Susan Moloney
- Department of Paediatrics, Gold Coast Health, Gold Coast, Queensland, Australia.,School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Keith Grimwood
- Department of Paediatrics, Gold Coast Health, Gold Coast, Queensland, Australia.,School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia.,Department of Infectious Diseases, Gold Coast Health, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| |
Collapse
|
8
|
Frakking TT, Teoh HJ, Shelton D, Moloney S, Ward D, Annetts K, David M, Levitt D, Chang AB, Carty C, Barber M, Carter HE, Mickan S, Weir KA, Waugh J. Effect of Care Coordination Using an Allied Health Liaison Officer for Chronic Noncomplex Medical Conditions in Children: A Multicenter Randomized Clinical Trial. JAMA Pediatr 2022; 176:244-252. [PMID: 34962514 PMCID: PMC8715383 DOI: 10.1001/jamapediatrics.2021.5465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
IMPORTANCE There is a paucity of high-quality evidence on the effect of care coordination on health-related quality of life among children with chronic noncomplex medical conditions (non-CMCs). OBJECTIVE To examine whether care coordination delivered by an Allied Health Liaison Officer results in improved quality-of-life (QOL) outcomes for children with chronic non-CMCs and their families. DESIGN, SETTING AND PARTICIPANTS This multicenter, open label, randomized clinical trial was conducted in pediatric outpatient clinics at 3 Australian hospitals with tertiary- and secondary-level pediatric care facilities. A total of 81 children with chronic non-CMCs and their families participated in the trial for a period of up to 12 months between October 2017 to October 2020. Primary care reviews were offered at 1 week, 3 months, and 6 months after diagnosis. INTERVENTIONS Eligible children were randomized 1:1 to receive care coordination or standard care. Families of children receiving care coordination were provided access to an Allied Health Liaison Officer, who was responsible for facilitation of health care access across hospital, education, primary care, and community sectors. MAIN OUTCOMES AND MEASURES The primary outcomes were scores on the Pediatric Quality of Life Inventory (PedsQL), version 4.0, and the PedsQL Family Impact Module, version 2.0, measured at 6 and 12 months. An intent-to-treat approach was used to analyze the data. RESULTS Of 81 children (mean [SD] age, 8.2 [3.5] years; 55 [67.9%] male), 42 (51.9%) were randomized to care coordination and 39 (48.1%) to standard care. Compared with standard care, care coordination resulted in greater improvements in overall PedsQL scores (difference in score changes between groups, 7.10; 95% CI, 0.44-13.76; P = .04), overall PedsQL Family Impact Module scores (difference in score changes between groups, 8.62; 95% CI, 1.07-16.16; P = .03), and family functioning QOL (difference in score changes between groups, 15.83; 95% CI, 5.05-26.62; P = .004) at 12 months after diagnosis. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, care coordination improved the quality of life of children with chronic non-CMCs and their families. Further studies should explore specific non-CMCs that may benefit most from care coordination and whether an orientation among health services to provide such a coordination model could lead to longer-term improved clinical outcomes. TRIAL REGISTRATION http://anzctr.org.au Identifier: ACTRN12617001188325.
Collapse
Affiliation(s)
- Thuy Thanh Frakking
- Research Development Unit, Caboolture Hospital, Queensland Health, Caboolture, Queensland, Australia,Centre for Clinical Research, School of Medicine, The University of Queensland, Herston, Queensland, Australia,Speech Pathology Department, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Hsien-Jin Teoh
- Psychology Department, Redcliffe Hospital, Queensland Health, Queensland, Australia
| | - Doug Shelton
- Department of Paediatrics, Gold Coast University Hospital, Queensland Health, Southport, Queensland, Australia
| | - Susan Moloney
- Department of Paediatrics, Gold Coast University Hospital, Queensland Health, Southport, Queensland, Australia,School of Medicine and Dentisry, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Donna Ward
- Allied Health, Caboolture Hospital, Queensland Health, Caboolture, Queensland, Australia
| | - Kylie Annetts
- Research Development Unit, Caboolture Hospital, Queensland Health, Caboolture, Queensland, Australia
| | - Michael David
- School of Medicine and Dentisry, Griffith University, Gold Coast Campus, Queensland, Australia
| | - David Levitt
- Department of Paediatrics, Queensland Children’s Hospital, Queensland Health, South Brisbane, Queensland, Australia
| | - Anne B. Chang
- Queensland Children’s Respiratory Centre, Queensland Children’s Hospital, South Brisbane, Queensland, Australia,Child Health Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia,Centre for Children’s Health Research, Queensland University of Technology, Level 7, South Brisbane, Queensland Australia
| | - Christopher Carty
- Research Development Unit, Caboolture Hospital, Queensland Health, Caboolture, Queensland, Australia,Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | | | - Hannah E. Carter
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Sharon Mickan
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Kelly A. Weir
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Gold Coast, Queensland, Australia,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia,Allied Health Research, Gold Coast University Hospital, Southport, Queensland, Australia
| | - John Waugh
- Department of Paediatrics, Caboolture Hospital, Queensland Health, Caboolture, Queensland, Australia,School of Clinical Medicine, The University of Queensland, Herston, Queensland, Australia,Department of Paediatrics, Ipswich Hospital, Queensland Health, Queensland, Australia
| |
Collapse
|
9
|
Sreelakshmi PR, Iype T, Varma R, Moloney S, Babu V, Krishnapilla V, Kutty VR, Robinson L. Exploring the barriers for guideline-based management of dementia amongst consultants in Kerala, South India: A qualitative study. Indian J Med Res 2022; 155:311-314. [PMID: 35946210 PMCID: PMC9629520 DOI: 10.4103/ijmr.ijmr_3_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- P Raghunath Sreelakshmi
- Department of Community Medicine, SUT Academy of Medical Sciences, Vattappara, Thiruvananthapuram 695 028, Kerala, India
| | - Thomas Iype
- Department of Neurology, Government Medical College, Thiruvananthapuram 695 011, Kerala, India
| | - Raviprasad Varma
- Department of Public Health, Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram 695 011, Kerala, India
| | - Susan Moloney
- NIHR Global Health Research Group on Dementia Prevention & Enhanced Care, Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE4 5PL, United Kingdom
| | - Veena Babu
- Health Action by People, Thiruvananthapuram 695 011, Kerala, India
| | - Vijayakumar Krishnapilla
- Department of Community Medicine, Amrita Institute of Medical Sciences, Edappally, Kochi 682 041, Kerala, India
| | - V Raman Kutty
- Department of Public Health, Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences & Technology; Health Action by People, Thiruvananthapuram 695 011, Kerala, India
| | - Louise Robinson
- Department of Primary Care & Ageing, Population Health Sciences Institute, Newcastle University Institute for Ageing, Campus for Ageing & Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom
| |
Collapse
|
10
|
Penugonda M, Walsh J, Barry JJ, Govern RM, Bradley D, Bolger M, English G, Moore J, Nolan N, Treacy E, Burke J, Dwyer N, Gallagher D, Macken S, McCaffrey S, Moloney S, Murphy R, Murray M, Hanlon EO. 231 ESTABLISHING AN INTERVENTIONS BUNDLE TO IMPROVE INPATIENT CARE FOR PATIENTS WITH PARKINSON’S DISEASE: A MULTIDISCIPLINARY QUALITY IMPROVEMENT PROJECT. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Patients with Parkinson’s (PwP) are at a higher risk of complications once admited to hospital compared to their age-matched peers. Medication mismanagement is a well-known obstacle, which puts PwP at risk of sub-optimal treatment leading to an unnecessary deterioration of baseline and potentially increases risk of adverse sequelae.
Methods
Retrospective electronic patient records (EPR)/chart review of 47 admissions was conducted, across three hospital sites.
Data attaining to correct prescribing of medication on admission and discharge, prescribing of contraindicated medications, reasons for medication lapses and complications of inpatient stay were collected. EPR of 17 patients’ were reviewed to assess if Parkinson’s disease (PD) medication administrations occurred within 30 minutes of patient schedule, as recommended by NICE guidelines. Key areas for improvement were identified based on the results.
Results
47 charts (30 Males, 17 Females) with mean age 72 (range:57–90), were reviewed. Average number of co-morbidities:4.5 and Clinical Frailty Scale ranged 5–9 (n = 30). LOS averaged 12.4 days and 43% of patients had ≥2 hospital admissions in the preceeding year.
38% (17/44) of admissions correctly documented patient specific medication times. Only 48% of patients (n = 638) received their medications within 30 minutes of the scheduled time. 47% (22/47) experienced complications attributable to PD. Contraindicated medications were noted in 5 cases. 84% of discharging prescriptions did not mention timing of PD medication and 3 prescriptions had errors with regards to dosage/omission of medication.
Conclusion
We implemented across two sites: 1) Care protocol flag in patient’s chart highlighting simple avoidable complications. 2) Laminated over the bed signpost alerting ‘time critical medication’. 3) ‘Time critical medication’ stickers in drug kardex 4) Education sessions for Medical, Nursing and Ward staff. 6) Establishing out of hours access to PD medications and protocols for NPO/poor swallow. We plan to reassess significance of efforts post intervention.
Collapse
Affiliation(s)
| | - J Walsh
- St. Luke's General Hospital , Kilkenny, Ireland
| | - J J Barry
- St. Michael's Hospital , Dublin, Ireland
| | - R M Govern
- St. Luke's General Hospital , Kilkenny, Ireland
| | - D Bradley
- St. James Hospital , Dublin, Ireland
| | - M Bolger
- St. Luke's General Hospital , Kilkenny, Ireland
| | - G English
- St. Luke's General Hospital , Kilkenny, Ireland
| | - J Moore
- St. Luke's General Hospital , Kilkenny, Ireland
| | - N Nolan
- St. Luke's General Hospital , Kilkenny, Ireland
| | - E Treacy
- St. Luke's General Hospital , Kilkenny, Ireland
| | - J Burke
- St. Michael's Hospital , Dublin, Ireland
| | - N Dwyer
- St. Michael's Hospital , Dublin, Ireland
| | | | - S Macken
- St. Michael's Hospital , Dublin, Ireland
| | | | - S Moloney
- St. Michael's Hospital , Dublin, Ireland
| | - R Murphy
- St. Michael's Hospital , Dublin, Ireland
| | - M Murray
- St. Michael's Hospital , Dublin, Ireland
| | | |
Collapse
|
11
|
Goodson M, McLellan E, Rosli R, Tan MP, Kamaruzzaman S, Robinson L, Moloney S. A Qualitative Study on Formal and Informal Carers' Perceptions of Dementia Care Provision and Management in Malaysia. Front Public Health 2021; 9:637484. [PMID: 34368037 PMCID: PMC8333996 DOI: 10.3389/fpubh.2021.637484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 06/08/2021] [Indexed: 11/14/2022] Open
Abstract
Background: The number of people living with dementia worldwide is increasing, particularly in low- and middle-income countries (LMICs) where little is known about existing post-diagnostic care and support. This study aimed to better understand healthcare provision for people living with dementia in Malaysia, and to identify priorities for providing timely, quality, and accessible care and support to all. Methods: This is a qualitative interview study on care providers and facilitators (health and community care professionals, paid carers, traditional medicine practitioners, faith healers, community leaders, non-governmental organisations). A topic guide, piloted in Malaysia and peer reviewed by all LMIC partners, elicited the understanding of dementia and dementia care and barriers and facilitators to care for people living with dementia and carers, and perceptions of key priorities for developing efficient, feasible, and sustainable dementia care pathways. Verbatim transcription of audio-recorded interviews was followed by iterative, thematic data analysis. Results: Twenty interviews were conducted (11 healthcare professionals, 4 traditional medicine practitioners, and 5 social support providers). The findings indicate that dementia care and support services exist in Malaysia, but that they are not fully utilised because of variations in infrastructure and facilities across the country. Despite a locally recognised pathway of care being available in an urban area, people with dementia still present to the healthcare system with advanced disease. The interviewees linked this to a public perception that symptoms of dementia, in particular, are normal sequelae of ageing. Earlier detection of dementia is commonly opportunistic when patients present to GPs, government clinic staff, and general physicians with other ailments. Dementia may only be identified by practitioners who have some specialist interest or expertise in it. Workforce factors that hindered early identification and management of dementia included lack of specialists, overburdened clinics, and limited knowledge of dementia and training in guideline use. Post-diagnostic social care was reported to be largely the domain of families, but additional community-based support was reported to be available in some areas. Raising awareness for both the public and medical professionals, prevention, and more support from the government are seen as key priorities to improve dementia management. Conclusions: This qualitative study provides novel insight into the availability, delivery, and use of post-diagnostic care and support in Malaysia from the perspective of care providers. The respondents in this study perceived that while there was a provision for dementia care in the hospital and community settings, the different care sectors are largely unaware of the services each provides. Future work should explore how care provision across different service sectors and providers can be supported to better facilitate patient access and referral between primary, secondary, and social care. The importance of supporting families to understand dementia and its progression, and strategies to help them care for relatives was emphasised. There is also a need for broad workforce training and development, at both the postgraduate and undergraduate levels, as well as improved general awareness in the community to encourage earlier help-seeking for symptoms of dementia. This will enable the use of preventive strategies and access to specialist services to optimise care and quality of life for people living with dementia in Malaysia.
Collapse
Affiliation(s)
- Michaela Goodson
- The Medical School, Newcastle University Medicine Malaysia, Iskandar Puteri, Malaysia
| | - Emma McLellan
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Roshaslina Rosli
- Division of Geriatric Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- Division of Geriatric Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shahrul Kamaruzzaman
- Division of Geriatric Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Louise Robinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Susan Moloney
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
12
|
Tajouri L, Campos M, Olsen M, Lohning A, Jones P, Moloney S, Grimwood K, Ugail H, Mahboub B, Alawar H, McKirdy S, Alghafri R. The role of mobile phones as a possible pathway for pathogen movement, a cross-sectional microbial analysis. Travel Med Infect Dis 2021; 43:102095. [PMID: 34116242 DOI: 10.1016/j.tmaid.2021.102095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Mobile phones are used the world over, including in healthcare settings. This study aimed to investigate the viable microbial colonisation of mobile phones used by healthcare personnel. METHODS Swabs collected on the same day from 30 mobile phones belonging to healthcare workers from three separate paediatric wards of an Australian hospital were cultured on five types of agar plate, then colonies from each phone were pooled, extracted and sequenced by shotgun metagenomics. Questionnaires completed by staff whose phones were sampled assisted in the analysis and interpretation of results. RESULTS AND DISCUSSION All phones sampled cultured viable bacteria. Overall, 399 bacterial operational taxonomic units were identified from 30 phones, with 1432 cumulative hits. Among these were 58 recognised human pathogenic and commensal bacteria (37 Gram-negative, 21 Gram-positive). The total number of virulence factor genes detected was 347, with 1258 cumulative hits. Antibiotic resistance genes (ARGs) were detected on all sampled phones and overall, 133 ARGs were detected with 520 cumulative hits. The most important classes of ARGs detected encoded resistance to beta-lactam, aminoglycoside and macrolide antibiotics and efflux pump mediated resistance mechanisms. CONCLUSION Mobile phones carry viable bacterial pathogens and may act as fomites by contaminating the hands of their users and indirectly providing a transmission pathway for hospital-acquired infections and dissemination of antibiotic resistance. Further research is needed, but meanwhile adding touching mobile phones to the five moments of hand hygiene is a simple infection control strategy worth considering in hospital and community settings. Additionally, the implementation of practical and effective guidelines to decontaminate mobile phone devices would likely be beneficial to the hospital population and community at large.
Collapse
Affiliation(s)
- Lotti Tajouri
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia; Harry Butler Institute, Murdoch University, Murdoch, WA, 6150, Australia; Dubai Future Council on Community Security, Dubai, United Arab Emirates; Dubai Police Scientists Council, Dubai Police, Dubai, United Arab Emirates.
| | - Mariana Campos
- Harry Butler Institute, Murdoch University, Murdoch, WA, 6150, Australia; CSIRO Health & Biosecurity, CSIRO Land & Water, Australia
| | - Matthew Olsen
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Anna Lohning
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Peter Jones
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Susan Moloney
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia; Department of Paediatrics, Gold Coast University Hospital, Southport, Australia
| | - Keith Grimwood
- Griffith University and Gold Coast Health, Southport, QLD, Australia; Department of Paediatrics, Gold Coast University Hospital, Southport, Australia
| | - Hassan Ugail
- Centre for Visual Computing, University of Bradford, Bradford, United Kingdom
| | | | - Hamad Alawar
- General Department of Forensic Science and Criminology, Dubai Police, Dubai, United Arab Emirates
| | - Simon McKirdy
- Harry Butler Institute, Murdoch University, Murdoch, WA, 6150, Australia
| | - Rashed Alghafri
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia; Harry Butler Institute, Murdoch University, Murdoch, WA, 6150, Australia; General Department of Forensic Science and Criminology, Dubai Police, Dubai, United Arab Emirates; Dubai Future Council on Community Security, Dubai, United Arab Emirates; Dubai Police Scientists Council, Dubai Police, Dubai, United Arab Emirates
| |
Collapse
|
13
|
Alao A, Burford B, Alberti H, Barton R, Moloney S, Vance G. Real-time patients' perspectives about participating in teaching consultations in primary care: A questionnaire study. Med Teach 2021; 43:669-676. [PMID: 33617391 DOI: 10.1080/0142159x.2021.1887840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Patients presenting with undifferentiated illnesses provide valuable learning opportunities for medical students. Evidence detailing the factors that affect patient participation in undergraduate medical education is limited. This study examines how patients regard their participation in teaching consultations in primary care. METHODS We conducted a cross-sectional questionnaire survey in four GP practices. We tested the relationship between variables of interest and willingness to participate, using hierarchical logistic regression. RESULTS We analysed 525 questionnaires. 88% of respondents were willing to have students take part in their consultation, and 72% were willing to see a student alone before seeing the doctor. Older patients and those with less sensitive clinical problems were more likely to participate. Willingness to participate was also associated with patients' perceptions of certain costs and benefits of participation. Respondents had poor knowledge about medical education, and a sizeable minority perceived a lack of autonomy about the presence of students in their encounters. More than one-third of respondents expressed the presence of a clinician as a precondition for approval of students' performing some active roles. DISCUSSION The findings have identified potential interventions to enhance patient involvement including patient education, respecting patient autonomy, and ensuring appropriate student supervision.
Collapse
Affiliation(s)
- Adedoyin Alao
- School of Medical Education, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Bryan Burford
- School of Medical Education, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Hugh Alberti
- School of Medical Education, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Roger Barton
- School of Medical Education, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Susan Moloney
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gillian Vance
- School of Medical Education, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
14
|
Norton L, Hart LM, Butel F, Moloney S, O'Connor N, Attenborough V, Roberts S. Promoting Confident Body, Confident Child in community child health: A mixed-methods implementation study. Health Promot J Austr 2021; 33:297-305. [PMID: 33772911 DOI: 10.1002/hpja.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 03/23/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To evaluate population-level implementation of Confident Body, Confident Child (CBCC); an evidence-based program providing parenting strategies to promote healthy eating, physical activity and body satisfaction in children aged 2-6 years; with community child health nurses (CHNs). METHODS This study utilised an implementation-effectiveness hybrid design, with dual focus on assessing: (a) CBCC implementation into Child Health Centres at a regional health service in Queensland, Australia (process evaluation); and (b) CBCC's effect on CHNs' knowledge and attitudes (outcomes evaluation). Process (CBCC reach, dose, fidelity) and outcome data (CHN knowledge of child body image; and attitudes towards higher body weights) were collected during implementation, and pre- and post-intervention delivery to CHNs, respectively. RESULTS Twenty-six CHNs (all female; mean age 52.7 ± 9.5 years) participated in the study by attending a 1-day CBCC training workshop and completing demographic and outcome surveys. Process evaluation found that CBCC was implemented as planned and reached 56% of CHNs across the health service. Outcome evaluation showed small but non-significant improvements in CHN knowledge (P = .077) and attitudes towards overweight (using Anti-Fat Attitudes scale; significant improvements on willpower sub-scale only (P < .05)). DISCUSSION This is the first study to evaluate population-wide CBCC implementation in a real-world health service setting with CHNs. Findings highlight the potential for using pragmatic, implementation-focused methodologies to translate preventive eating disorder programs into community child health services.
Collapse
Affiliation(s)
- Lyza Norton
- Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Laura M Hart
- School of Psychology and Public Health, La Trobe University, Bundoora, Melbourne, VIC, Australia.,Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
| | - Francoise Butel
- Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Susan Moloney
- Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Narelle O'Connor
- Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | | | - Shelley Roberts
- Gold Coast Hospital and Health Service, Southport, QLD, Australia.,School of Allied Health Sciences, Griffith University, Griffith University, Southport, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| |
Collapse
|
15
|
Moloney S. PO-1383: Comparing the error detection performance of Portal Dosimetry & PerFraction in pre-treatment VMAT QA. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01401-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
16
|
Moloney K, Moloney S. Australian Quarantine Policy: From Centralization to Coordination with Mid-Pandemic COVID-19 Shifts. Public Adm Rev 2020; 80:671-682. [PMID: 32836437 PMCID: PMC7276748 DOI: 10.1111/puar.13224] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 05/23/2023]
Abstract
Combining a historical institutionalism approach with institutional isomorphism and punctuated equilibrium, this article analyzes quarantine policy change across 120 years of Australian quarantine history. By anchoring its analysis within specific time periods (the years before the Spanish flu, seven decades of inaction, and multiple post-1997 pandemic updates and responses), the authors highlight when and why policies did or did not change and how the constant push-and-pull between state and Commonwealth institutional ownership altered policy possibilities. The heart of the analysis showcases how Australia's successful COVID-19 response is a unique output of prior quarantine policies, institutional evolution, and mid-pandemic alterations of key national pandemic response plans.
Collapse
|
17
|
Prentice B, Moloney S, Hort J, Hibbert P, Wiles LK, Molloy CJ, Arnolda G, Ting HP, Braithwaite J, Jaffe A. Assessing the adherence to guidelines in the management of croup in Australian children: a population-based sample survey. Int J Qual Health Care 2019; 31:759-767. [PMID: 31665290 DOI: 10.1093/intqhc/mzz088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/28/2019] [Accepted: 07/17/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine the extent to which care received by Australian children presenting with croup is in agreement with Clinical Practice Guidelines (CPGs). DESIGN Retrospective population-based sample survey. Croup clinical indicators were derived from CPGs. DATA SOURCES/STUDY SETTING Medical records from three healthcare settings were sampled for selected visits in 2012 and 2013 in three Australian states. DATA COLLECTION Data were collected by nine experienced paediatric nurses, trained to assess eligibility for indicator assessment and adherence to CPGs. Surveyors undertook criterion-based medical record reviews using an electronic data collection tool. RESULTS Documented guideline adherence was lower for general practitioners (65.9%; 95% CI: 60.8-70.6) than emergency departments (91.1%; 95% CI: 89.5-92.5) and inpatient admissions (91.3%; 95% CI: 88.1-93.9). Overall adherence was very low for a bundle of 10 indicators related to assessment (4.5%; 95% CI: 2.4-7.6) but higher for a bundle of four indicators relating to the avoidance of inappropriate therapy (83.1%; 95% CI: 59.5-96.0). CONCLUSIONS Most visits for croup were characterized by appropriate treatment in all healthcare settings. However, most children had limited documented clinical assessments, and some had unnecessary tests or inappropriate therapy, which has potential quality and cost implications. Universal CPG and clinical assessment tools may increase clinical consistency.
Collapse
Affiliation(s)
- Bernadette Prentice
- Department of Respiratory Medicine, Sydney Children's Hospital, High St., Randwick, NSW, 2031, Australia.,School of Women's and Children's Health, University of New South Wales, High St., Randwick, NSW, 2031, Australia
| | - Susan Moloney
- Department of Paediatrics, Gold Coast University Hospital, Hospital Blvd., Southport, QLD, 4215, Australia.,School of Medicine, Griffith University, Parklands Dr., Gold Coast, QLD, 4222, Australia.,Faculty of Health Sciences and Medicine, Bond University, University Dr., Gold Coast, QLD, 4226, Australia
| | - Jason Hort
- Emergency Department, Sydney Children's Hospital, Harkesbury Rd. and Hainsworth St., Westmead, NSW, 2145, Australia.,Children's Hospital Westmead Clinical School, Sydney Medical School, University of Sydney, Manning Rd., Sydney, NSW, 2050, Australia
| | - Peter Hibbert
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Talavera Rd., North Ryde, NSW, 2109, Australia.,Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), School of Health Sciences, University of South Australia, Currie St., Adelaide, SA, 5000, Australia.,South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, 5000, Australia
| | - Louise K Wiles
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Talavera Rd., North Ryde, NSW, 2109, Australia.,Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), School of Health Sciences, University of South Australia, Currie St., Adelaide, SA, 5000, Australia.,South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, 5000, Australia
| | - Charlotte J Molloy
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Talavera Rd., North Ryde, NSW, 2109, Australia.,Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), School of Health Sciences, University of South Australia, Currie St., Adelaide, SA, 5000, Australia.,South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, 5000, Australia
| | - Gaston Arnolda
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Talavera Rd., North Ryde, NSW, 2109, Australia
| | - Hsuen P Ting
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Talavera Rd., North Ryde, NSW, 2109, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Talavera Rd., North Ryde, NSW, 2109, Australia
| | - Adam Jaffe
- Department of Respiratory Medicine, Sydney Children's Hospital, High St., Randwick, NSW, 2031, Australia.,School of Women's and Children's Health, University of New South Wales, High St., Randwick, NSW, 2031, Australia
| |
Collapse
|
18
|
Franklin D, Shellshear D, Babl FE, Schlapbach LJ, Oakley E, Borland ML, Hoeppner T, George S, Craig S, Neutze J, Williams A, Acworth J, McCay H, Wallace A, Mattes J, Gangathimn V, Wildman M, Fraser JF, Moloney S, Gavranich J, Waugh J, Hobbins S, Fahy R, Grew S, Gannon B, Gibbons K, Dalziel S, Schibler A. Multicentre, randomised trial to investigate early nasal high-flow therapy in paediatric acute hypoxaemic respiratory failure: a protocol for a randomised controlled trial-a Paediatric Acute respiratory Intervention Study (PARIS 2). BMJ Open 2019; 9:e030516. [PMID: 31857300 PMCID: PMC6937038 DOI: 10.1136/bmjopen-2019-030516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Acute hypoxaemic respiratory failure (AHRF) in children is the most frequent reason for non-elective hospital admission. During the initial phase, AHRF is a clinical syndrome defined for the purpose of this study by an oxygen requirement and caused by pneumonia, lower respiratory tract infections, asthma or bronchiolitis. Up to 20% of these children with AHRF can rapidly deteriorate requiring non-invasive or invasive ventilation. Nasal high-flow (NHF) therapy has been used by clinicians for oxygen therapy outside intensive care settings to prevent escalation of care. A recent randomised trial in infants with bronchiolitis has shown that NHF therapy reduces the need to escalate therapy. No similar data is available in the older children presenting with AHRF. In this study we aim to investigate in children aged 1 to 4 years presenting with AHRF if early NHF therapy compared with standard-oxygen therapy reduces hospital length of stay and if this is cost-effective compared with standard treatment. METHODS AND ANALYSIS The study design is an open-labelled randomised multicentre trial comparing early NHF and standard-oxygen therapy and will be stratified by sites and into obstructive and non-obstructive groups. Children aged 1 to 4 years (n=1512) presenting with AHRF to one of the participating emergency departments will be randomly allocated to NHF or standard-oxygen therapy once the eligibility criteria have been met (oxygen requirement with transcutaneous saturation <92%/90% (dependant on hospital standard threshold), diagnosis of AHRF, admission to hospital and tachypnoea ≥35 breaths/min). Children in the standard-oxygen group can receive rescue NHF therapy if escalation is required. The primary outcome is hospital length of stay. Secondary outcomes will include length of oxygen therapy, proportion of intensive care admissions, healthcare resource utilisation and associated costs. Analyses will be conducted on an intention-to-treat basis. ETHICS AND DISSEMINATION Ethics approval has been obtained in Australia (HREC/15/QRCH/159) and New Zealand (HDEC 17/NTA/135). The trial commenced recruitment in December 2017. The study findings will be submitted for publication in a peer-reviewed journal and presented at relevant conferences. Authorship of all publications will be decided by mutual consensus of the research team. TRIAL REGISTRATION NUMBER ACTRN12618000210279.
Collapse
Affiliation(s)
- Donna Franklin
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- School of Medicine, The University Of Queensland, St Lucia, Queensland, Australia
- Mater Medical Research Institute, South Brisbane, Queensland, Australia
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
| | - Deborah Shellshear
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Franz E Babl
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Royal Childrens Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Melbourne, Victoria, Australia
| | - Luregn J Schlapbach
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- School of Medicine, The University Of Queensland, St Lucia, Queensland, Australia
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Ed Oakley
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Royal Childrens Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Services, University of Melbourne, Melbourne, Victoria, Australia
| | - Meredith L Borland
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency, Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia
- University of Western Australia, School of Medicine, Divisions of Emergency Medicine and Paediatrics, Crawley, Western Australia, Australia
| | - Tobias Hoeppner
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency, Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia
| | - Shane George
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- School of Medicine, The University Of Queensland, St Lucia, Queensland, Australia
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Simon Craig
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Monash Medical Centre Clayton, Clayton, Victoria, Australia
- Department of Medicine, School of Clinical Science, Monash University, Clayton, Victoria, Australia
| | - Jocelyn Neutze
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- KidzFirst Middlemore Emergency Department, Middlemore Hospital, Auckland, New Zealand
- University of Auckland, Auckland, New Zealand
| | - Amanda Williams
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Royal Childrens Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jason Acworth
- School of Medicine, The University Of Queensland, St Lucia, Queensland, Australia
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Hamish McCay
- Paediatrics, Waikato Hospital, Hamilton, New Zealand
| | - Alex Wallace
- Paediatrics, Waikato Hospital, Hamilton, New Zealand
| | - Joerg Mattes
- Paediatrics, John Hunter Children's Hospital, Hunter Region Mail Centre, New South Wales, Australia
- University of Newcastle, Priority Research Centre GrowUpWell, Callaghan, New South Wales, Australia
| | - Vinay Gangathimn
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Townsville General Hospital, Townsville, Queensland, Australia
| | - Mark Wildman
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Emergency Department, Townsville General Hospital, Townsville, Queensland, Australia
| | - John F Fraser
- Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Queensland, Australia
| | - Susan Moloney
- Paediatric Department, Gold Coast University Hospital, Southport, Queensland, Australia
| | - John Gavranich
- Paediatrics, Ipswich Hospital, Ipswich, Queensland, Australia
| | - John Waugh
- Paediatrics, Caboolture Hospital, Caboolture, Queensland, Australia
| | - Sue Hobbins
- Paediatrics, Prince Charles Hospital, Chermside, Queensland, Australia
| | - Rose Fahy
- Paediatrics, Prince Charles Hospital, Chermside, Queensland, Australia
| | - Simon Grew
- Paediatrics, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Brenda Gannon
- The University of Queensland, Centre for Business and Economics of Health, St Lucia Qld, Queensland, Australia
| | - Kristen Gibbons
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Mater Medical Research Institute, South Brisbane, Queensland, Australia
| | - Stuart Dalziel
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- University of Auckland, Auckland, New Zealand
- Starship Children's Health, Emergency Department, Newmarket, New Zealand
- Department of Surgery and Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Andreas Schibler
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- School of Medicine, The University Of Queensland, St Lucia, Queensland, Australia
- Mater Medical Research Institute, South Brisbane, Queensland, Australia
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, Victoria, Australia
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| |
Collapse
|
19
|
Franklin D, Babl FE, Gibbons K, Pham TMT, Hasan N, Schlapbach LJ, Oakley E, Craig S, Furyk J, Neutze J, Moloney S, Gavranich J, Shirkhedkar P, Kapoor V, Grew S, Fraser JF, Dalziel S, Schibler A. Nasal High Flow in Room Air for Hypoxemic Bronchiolitis Infants. Front Pediatr 2019; 7:426. [PMID: 31709201 PMCID: PMC6823186 DOI: 10.3389/fped.2019.00426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/04/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Bronchiolitis is the most common reason for hospital admission in infants, with one third requiring oxygen therapy due to hypoxemia. It is unknown what proportion of hypoxemic infants with bronchiolitis can be managed with nasal high-flow in room air and their resulting outcomes. Objectives and Settings: To assess the effect of nasal high-flow in room air in a subgroup of infants with bronchiolitis allocated to high-flow therapy in a recent multicenter randomized controlled trial. Patients and Interventions: Infants allocated to the high-flow arm of the trial were initially treated with room air high-flow if saturations were ≥85%. Subsequently, if oxygen saturations did not increase to ≥92%, oxygen was added and FiO2 was titrated to increase the oxygen saturations. In this planned sub-study, infants treated during their entire hospital stay with high-flow room air only were compared to infants receiving either standard-oxygen or high-flow with oxygen. Baseline characteristics, hospital length of stay and length of oxygen therapy were compared. Findings: In the per protocol analysis 64 (10%) of 630 infants commenced on high-flow room air remained in room air only during the entire stay in hospital. These infants on high-flow room air were on average older and presented with moderate hypoxemia at presentation to hospital. Their length of respiratory support and length of stay was also significantly shorter. No pre-enrolment factors could be identified in a multivariable analysis. Conclusions: In a small sub-group of hypoxemic infants with bronchiolitis hypoxemia can be reversed with the application of high-flow in room air only. Trial registration: ACTRN12615001305516.
Collapse
Affiliation(s)
- Donna Franklin
- Paediatric Critical Care Research Group, Queensland Children's Hospital, The University of Queensland, Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia.,Critical Care Research Group, Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, QLD, Australia.,Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC, Australia
| | - Franz E Babl
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC, Australia.,Royal Children's Hospital, Emergency Department, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Kristen Gibbons
- Paediatric Critical Care Research Group, Queensland Children's Hospital, The University of Queensland, Brisbane, QLD, Australia.,Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Trang M T Pham
- Paediatric Critical Care Research Group, Queensland Children's Hospital, The University of Queensland, Brisbane, QLD, Australia.,Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Nadia Hasan
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Luregn J Schlapbach
- Paediatric Critical Care Research Group, Queensland Children's Hospital, The University of Queensland, Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Ed Oakley
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC, Australia.,Royal Children's Hospital, Emergency Department, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Simon Craig
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC, Australia.,Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia.,Monash Medical Centre, Emergency Department, Melbourne, VIC, Australia
| | - Jeremy Furyk
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC, Australia.,College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.,The Townsville Hospital, Emergency Department, Townsville, QLD, Australia
| | - Jocelyn Neutze
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC, Australia.,KidzFirst Middlemore Hospital, Auckland, New Zealand.,University of Auckland, Auckland, New Zealand
| | - Susan Moloney
- Department of Paediatrics, Gold Coast University Hospital, Southport, QLD, Australia.,School of Medicine, Griffith University, Gold Coast, QLD, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - John Gavranich
- Paediatric Department, Ipswich General Hospital, Ipswich, QLD, Australia
| | | | - Vishal Kapoor
- Paediatric Critical Care Research Group, Queensland Children's Hospital, The University of Queensland, Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Simon Grew
- Paediatric Department, Redcliffe Hospital, Redcliffe, QLD, Australia
| | - John F Fraser
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Critical Care Research Group, Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Stuart Dalziel
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC, Australia.,Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Andreas Schibler
- Paediatric Critical Care Research Group, Queensland Children's Hospital, The University of Queensland, Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia.,Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC, Australia
| | | |
Collapse
|
20
|
Watson L, Cartwright D, Jardine LA, Pincus D, Koorts P, Kury S, Bezieau S, George S, Moloney S, Holt J, Coman D. Transient neonatal zinc deficiency in exclusively breastfed preterm infants. J Paediatr Child Health 2018; 54:319-322. [PMID: 29143460 DOI: 10.1111/jpc.13780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 08/17/2017] [Accepted: 08/21/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Lauren Watson
- Department of Palliative Care, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - David Cartwright
- Department of Paediatrics, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Luke A Jardine
- Department of Neonatology, Mater Mother's Hospital, Brisbane, Queensland, Australia
| | - David Pincus
- Leading Steps Paediatric Clinic, Brisbane, Queensland, Australia
| | - Pieter Koorts
- Department of Neonatology, Queensland Health, Queensland Health/University of Pretoria, Brisbane, Queensland, Australia
| | - Sebastien Kury
- Laboratory of Molecular Genetics, Medical Genetics Service, CHU de Nantes - Institute of Biology, Nantes, France
| | - Stephanie Bezieau
- Laboratory of Molecular Genetics, Medical Genetics Service, CHU de Nantes - Institute of Biology, Nantes, France
| | - Shane George
- Paediatric Emergency Department, Gold Coast University Hospital, Queensland Health, University of Queensland, Gold Coast, Queensland, Australia
| | - Susan Moloney
- Department of Paediatrics, Gold Coast University, Gold Coast, Queensland, Australia
| | - Johanna Holt
- Paediatric Medicine, Wesley Medical Centre, Brisbane, Queensland, Australia
| | - David Coman
- Department of Paediatrics, Wesley Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
21
|
Frakking TT, Waugh J, Teoh HJ, Shelton D, Moloney S, Ward D, David M, Barber M, Carter H, Mickan S, Weir K. Integrated children's clinic care (ICCC) versus a self-directed care pathway for children with a chronic health condition: a multi-centre randomised controlled trial study protocol. BMC Pediatr 2018; 18:72. [PMID: 29458335 PMCID: PMC5817718 DOI: 10.1186/s12887-018-1034-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 01/29/2018] [Indexed: 11/20/2022] Open
Abstract
Background Children with chronic health conditions have better health-related outcomes when their care is managed in a personalised and coordinated way. However, increased demand on Australian ambulatory care hospital services has led to longer waitlist times to access specialists and appropriate intervention services; placing vulnerable children at increased risk of poorer short-term (e.g. social difficulties) and long-term (e.g. convictions) health and social outcomes. Traditional approaches to increasing frequency and service of delivery are expensive and can have minimal impact on caregiver burden. A community based service-integration approach, rather than self-directed care is proposed as increased service linkages are more likely to occur and improve the health outcomes of children with a chronic health condition. Methods An open, unblinded, multi-centre randomised controlled trial in two Australian public hospitals. 112 children (0–16 years) fulfilling the inclusion criteria will be randomised to one of two clinical pathways for management of their chronic health condition: (1) integrated children’s care clinic (ICCC) or (2) self-directed care pathway. All children and caregivers will be interviewed at 1 week, and 3, 6 and 12 month time intervals. Primary outcome measures include the Pediatric Quality of Life (PedQOL) questionnaire, Subjective Units of Distress Scale, Child Behaviour Checklist (CBCL) and Rotter’s Locus of Control Scale. Secondary outcome measures include the total number of medical appointments, school days missed and quantity of services accessed. Our main objectives are to determine if the ICCC results in better health and economics outcomes compared to the self-directed care pathway. Discussion The success of a health systems approach needs to be balanced against clinical, mortality and cost-effectiveness data for long-term sustainability within a publicly funded health system. A clinical pathway that is sustainable, cost-effective, provides efficient evidence-based care and improves the quality of life outcomes for children with chronic health conditions has the potential to reduce waitlist times, improve access to health services, increase consumer satisfaction; and prevent costs associated with poorly managed chronic health conditions into adulthood. This study will be the first to provide clinical and health economics data on an integrated care pathway for the management of chronic health conditions in children. On a broader scale, results from this study will help guide care coordination frameworks for children with chronic health conditions; particularly with the introduction and implementation of a National Disability Insurance Scheme (NDIS) across Australia. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR) ACTRN12617001188325. Registered: 14th August, 2017. Electronic supplementary material The online version of this article (10.1186/s12887-018-1034-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Thuy Thanh Frakking
- Research Development Unit, Caboolture Hospital, Queensland Health, McKean St, Caboolture, QLD, 4510, Australia. .,School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia.
| | - John Waugh
- School of Clinical Medicine, The University of Queensland, St Lucia, QLD, 4067, Australia.,Department of Paediatrics, Caboolture Hospital, Queensland Health, McKean St, Caboolture, QLD, 4510, Australia
| | - Hsien-Jin Teoh
- School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Doug Shelton
- Department of Community Child Health, Gold Coast University Hospital, Queensland Health, Southport, QLD, 4215, Australia
| | - Susan Moloney
- Department of Paediatrics, Gold Coast University Hospital, Queensland Health, Southport, QLD, 4215, Australia
| | - Donna Ward
- School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Michael David
- School of Population Health, The University of Queensland, Herston, QLD, 4006, Australia
| | - Matthew Barber
- Ningi Doctors, 1421-1423 Bribie Island Rd, Ningi, QLD, 4511, Australia.,Brisbane North Primary Healthcare Network, Lutwyche, QLD, 4030, Australia
| | - Hannah Carter
- Australian Centre for Health Services Innovation, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia
| | - Sharon Mickan
- School of Allied Health Sciences & Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, 4222, Australia.,Clinical Governance, Education & Research, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, 4215, Australia
| | - Kelly Weir
- School of Allied Health Sciences & Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, 4222, Australia.,Clinical Governance, Education & Research, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, 4215, Australia
| |
Collapse
|
22
|
Auld B, Noyes M, Moloney S. Home high-flow therapy: How technology is contributing to palliation in paediatric cardiorespiratory disease. J Paediatr Child Health 2017; 53:202. [PMID: 28194895 DOI: 10.1111/jpc.13382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/14/2016] [Accepted: 08/25/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Ben Auld
- Department of Paediatrics, Gold Coast University Hospital, Queensland, Australia.,Griffith University, Gold Coast Campus Gold Coast, Queensland, Australia.,Queensland Paediatric Cardiac Service Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Michelle Noyes
- Department of Paediatrics, Gold Coast University Hospital, Queensland, Australia.,Griffith University, Gold Coast Campus Gold Coast, Queensland, Australia
| | - Susan Moloney
- Department of Paediatrics, Gold Coast University Hospital, Queensland, Australia.,Griffith University, Gold Coast Campus Gold Coast, Queensland, Australia
| |
Collapse
|
23
|
Sureshkumar P, Zurynski Y, Moloney S, Raman S, Varol N, Elliott EJ. Female genital mutilation: Survey of paediatricians' knowledge, attitudes and practice. Child Abuse Negl 2016; 55:1-9. [PMID: 27045807 DOI: 10.1016/j.chiabu.2016.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/11/2016] [Accepted: 03/17/2016] [Indexed: 05/21/2023]
Abstract
The study objective was to determine paediatricians' experience with female genital mutilation (FGM) in Australian children and adolescents. A cross-sectional, pilot-tested national survey of paediatricians practising in Australia and contributing to the Australian Paediatric Surveillance Unit was conducted. Clinicians' knowledge, attitudes and clinical experience with FGM, awareness of clinical guidelines and education/training needs were recorded. Of 1311 paediatricians surveyed, 497 (38%) responded. Fifty-seven percent were aged 50 years or more, and 51.3% were males. Over half believed that FGM was performed in children in Australia and most were aware of its complications, but few asked about or examined for FGM. Fifty (10.3%) had seen at least one case of FGM in girls aged <18 years during their clinical career, including 16 (3.3%) in the past 5 years. Most were aware that FGM is illegal in Australia (93.9%), agreed all types of FGM were harmful (97.4%) and agreed that FGM violated human rights (98.2%). Most (87.6%) perceived FGM as a traditional cultural practice, although 11.6% thought it was required by religion. The majority (81.8%) knew notification of FGM to child protection authorities was mandatory. Over half (62.0%) were aware of the WHO Statement on FGM, but only 22.0% knew the WHO classification of FGM. These novel data indicate a minority of paediatricians in Australia have clinical experience with or education about FGM. Educational programs, best-practice clinical guidelines and policies are required to address knowledge gaps and help paediatricians identify, manage and prevent FGM in children.
Collapse
Affiliation(s)
- Premala Sureshkumar
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia; Australian Paediatric Surveillance Unit, Sydney Children's Hospitals Network (Westmead), Sydney, Australia.
| | - Yvonne Zurynski
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia; Australian Paediatric Surveillance Unit, Sydney Children's Hospitals Network (Westmead), Sydney, Australia.
| | - Susan Moloney
- Division of Paediatrics and Child Health, Royal Australasian College of Physicians, Sydney, Australia; Gold Coast University Hospital, Queensland, Australia.
| | - Shanti Raman
- Department of Community Paediatrics, South Western Sydney Local Health District, Sydney, Australia; University of New South Wales, Sydney, Australia.
| | - Nesrin Varol
- Australian Paediatric Surveillance Unit, Sydney Children's Hospitals Network (Westmead), Sydney, Australia; Discipline of Obstetrics, Gynaecology & Neonatology, Sydney Medical School, University of Sydney, Australia.
| | - Elizabeth J Elliott
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia; Australian Paediatric Surveillance Unit, Sydney Children's Hospitals Network (Westmead), Sydney, Australia.
| |
Collapse
|
24
|
Gupta S, Brumby J, Burton J, Moloney S, Kenny B. Group A Streptococcus and hepatitis – streptococcal toxic shock syndrome. J PEDIAT INF DIS-GER 2015. [DOI: 10.3233/jpi-2009-0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sanjeev Gupta
- Department of Pediatrics, Gold Coast Hospital, Southport, Queensland, Australia
| | - Jarrod Brumby
- Department of Pediatrics, Gold Coast Hospital, Southport, Queensland, Australia
| | - Joanna Burton
- Department of Pediatrics, Gold Coast Hospital, Southport, Queensland, Australia
| | - Susan Moloney
- Department of Pediatrics, Gold Coast Hospital, Southport, Queensland, Australia
| | - Benjamin Kenny
- Department of Pediatrics, Gold Coast Hospital, Southport, Queensland, Australia
| |
Collapse
|
25
|
Creedy D, Collis D, Ludlow T, Cosgrove S, Houston K, Irvine D, Fraser J, Moloney S. Development and evaluation of an intensive intervention program for children with a chronic health condition: A pilot study. Contemp Nurse 2014; 18:46-56. [PMID: 15729797 DOI: 10.5172/conu.18.1-2.46] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A range of developmental risk factors threatens the psychosocial well-being of children with a chronic health condition (CCHC). Early intervention and prevention programs are emerging as an effective response to improving individual and family coping mechanisms. In particular, efforts to address individual and family coping throughout the important pre-teen transitional ages for CCHC have gained popularity although their effectiveness has not been adequately demonstrated. We conducted a pre-post intervention study to evaluate an intensive intervention program for CCHC aged 10-14 years that aimed to enhance well-being. Twelve CCHC participated in a pilot 8-week intensive intervention program. At three month follow-up there was a significant increase in children's self esteem (t = 3.39, p < .01). There was a decrease in mean scores for anxiety and depression symptoms. Parental perceptions of the impact of the condition on the child reduced significantly (t = 2.37, p < .05). It was beyond the scope of the present study to conclusively evaluate the effectiveness of the intensive intervention program, however results show that it was a promising strategy to improve a range of outcomes for CCHC. Further research using a larger sample is needed to determine the ways in which this program influences psychosocial well-being of CCHC and their families.
Collapse
Affiliation(s)
- Debra Creedy
- Research Centre for Clinical Practice Innovation, Griffith University, Gold Coast, Australia
| | | | | | | | | | | | | | | |
Collapse
|
26
|
|
27
|
Smith AD, Moloney S, Khoyi MA, Westfall DP. Species-dependent effects of adenosine receptor agonists on contractile responses of vas deferens to ATP. J Auton Pharmacol 1999; 19:181-4. [PMID: 10511475 DOI: 10.1046/j.1365-2680.1999.00132.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
1. Experiments were carried out to examine the postjunctional actions of adenosine receptor agonists on the smooth muscle of the vas deferens of the guinea-pig and rabbit. 2. Although they produced neither contraction nor relaxation by themselves, adenosine analogues enhanced contractions of the guinea-pig vas deferens induced by 10 microm ATP. The rank order of potency was N6-cyclopentyladenosine (CPA) > 5'-N-ethylcarboxamidoadenosine (NECA) > adenosine > CGS 21680. Dose-response curves for NECA were shifted to the right by the nonselective adenosine receptor antagonist 8(p-sulphophenyl)theophylline (8-SPT; 100 microM) and by the selective A1-receptor antagonist 1,3-dipropyl-8-cyclopentylxanthine (DPCPX; 1 mM). 3. In the rabbit vas deferens, contractions induced by ATP (1 mM) were inhibited rather than facilitated by NECA. Neither CPA, R(-)-N6-(2-phenyl isopropyl)-adenosine (R-PIA) nor CGS 21680 had any effect. 4. The results indicate that the smooth muscle of the guinea-pig vas deferens expresses facilitatory adenosine A1 receptors but not adenosine A2 receptors. In contrast, in rabbit there are postjunctional inhibitory adenosine A2A receptors but not adenosine A1 receptors.
Collapse
Affiliation(s)
- A D Smith
- Department of Pharmacology, School of Medicine, University of Nevada, Reno 89557, USA
| | | | | | | |
Collapse
|
28
|
O'Dell C, Mangin RJ, Leavitt LE, Levine TC, Moloney S, Schwartz F, Winton R. Teaching employees breast self examination. Factors that may influence practice. AAOHN J 1991; 39:385-91. [PMID: 1888393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Breast self examination is a widely known technique used for detection of breast lumps. Many women do not practice monthly breast self examination, although it has been proven that with early detection the prognosis of breast cancer can be improved greatly. When tend to be taught, or learn about, breast self examination at an early age. The educational techniques used during the instruction can influence the practice of BSE later on. Health professionals can make a difference in the practice of BSE by communicating the value of this detection technique. BSE is a viable breast cancer detection technique that employees can be taught easily in employee wellness programs by health professionals.
Collapse
|