1
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Akande M, Paquette ET, Magee P, Perry-Eaddy MA, Fink EL, Slain KN. Screening for Social Determinants of Health in the Pediatric Intensive Care Unit: Recommendations for Clinicians. Crit Care Clin 2023; 39:341-355. [PMID: 36898778 PMCID: PMC10332174 DOI: 10.1016/j.ccc.2022.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Social determinants of health (SDoH) play a significant role in the health and well-being of children in the United States. Disparities in the risk and outcomes of critical illness have been extensively documented but are yet to be fully explored through the lens of SDoH. In this review, we provide justification for routine SDoH screening as a critical first step toward understanding the causes of, and effectively addressing health disparities affecting critically ill children. Second, we summarize important aspects of SDoH screening that need to be considered before implementing this practice in the pediatric critical care setting.
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Affiliation(s)
- Manzilat Akande
- Section of Critical Care, Department of Pediatrics, Oklahoma University Health Sciences Center, OU Children's Physicians Building, 1200 Children's Avenue, Oklahoma City, OK 73104, USA.
| | - Erin T Paquette
- Division of Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East, Chicago Avenue, Box 73, Chicago, IL 60611, USA
| | - Paula Magee
- Division of Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East, Chicago Avenue, Box 73, Chicago, IL 60611, USA
| | - Mallory A Perry-Eaddy
- University of Connecticut School of Nursing, 231 Glenbrook Rd, U-4026, Storrs, CT 06269, USA; Department of Pediatrics, University of Connecticut School of Medicine, 200 Academic Way, Farmington, CT 06032, USA
| | - Ericka L Fink
- Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 2nd floor, Pittsburgh, PA 15206, USA
| | - Katherine N Slain
- Division of Pediatric Critical Care Medicine, University Hospitals Rainbow Babies & Children's Hospital, 11100 Euclid Avenue, RBC 6010 Cleveland, OH 44106, USA; Department of Pediatrics, Case Western Reserve University School of Medicine, 9501 Euclid Avenue, Cleveland, OH 44106, USA
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2
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Affiliation(s)
- Sabrina F. Derrington
- Center for Pediatric Bioethics and the Department of Anesthesiology Critical Care Medicine, Children’s Hospital Los Angeles
- Keck School of Medicine of the University of Southern California
| | - Paula Magee
- McGaw Medical Center of Northwestern University
- Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Erin T. Paquette
- Ann & Robert H. Lurie Children’s Hospital of Chicago
- Department of Pediatrics, Northwestern University Feinberg School of Medicine
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3
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Gard LA, Bartell T, Shah AK, Setrini AB, Sheehan K, Miller CH, Paquette ET. Interprofessional Education in Medical-Legal Partnerships (MLPs) to Address Social Determinants of Health. J Health Care Poor Underserved 2021; 32:1720-1733. [PMID: 34803038 DOI: 10.1353/hpu.2021.0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Medical-legal partnerships (MLP) address legal needs that contribute to health inequities. Health providers express discomfort accessing legal services and a desire for greater training, however best practices remain unclear. METHODS We conducted a scoping literature review and interviews with key informants to identify essential components of MLP training and best practices in MLP training. RESULTS Twenty-one articles out of an initial 1,247 met criteria. Most learners were medical (11; 52%) or law (13; 62%) students or residents (12; 57%). Training was primarily led by lawyers (18; 86%). Educational approaches included didactics (15; 71%). Content was focused on skill-acquisition (18; 86%). Most training was presented as stand-alone (5; 24%) courses. Essential skills included issuespotting, adaptability, and trauma-informed care. CONCLUSION Medical-legal partnerships make use of varied perspectives to address unmet legal needs. This review helped identify best practices in training and a need for future study on evaluation. Future research should explore how best to evaluate the effectiveness of MLP training.
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4
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Weaver MS, Boss RD, Christopher MJ, Gray TF, Harman S, Madrigal VN, Michelson KN, Paquette ET, Pentz RD, Scarlet S, Ulrich CM, Walter JK. Top Ten Tips Palliative Care Clinicians Should Know About Their Work's Intersection with Clinical Ethics. J Palliat Med 2021; 25:656-661. [PMID: 34807737 DOI: 10.1089/jpm.2021.0521] [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] [Indexed: 11/13/2022] Open
Abstract
Palliative care (PC) subspecialists and clinical ethics consultants often engage in parallel work, as both function primarily as interprofessional consultancy services called upon in complex clinical scenarios and challenging circumstances. Both practices utilize active listening, goals-based communication, conflict mediation or mitigation, and values explorations as care modalities. In this set of tips created by an interprofessional team of ethicists, intensivists, a surgeon, an attorney, and pediatric and adult PC nurses and physicians, we aim to describe some paradigmatic clinical challenges for which partnership may improve collaborative, comprehensive care.
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Affiliation(s)
- Meaghann S Weaver
- Department of Pediatrics, University of Nebraska, Omaha, Nebraska, USA.,National Center for Ethics in Health Care, Washington, District of Columbia, USA
| | - Renee D Boss
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Berman Institute of Bioethics, Baltimore, Maryland, USA
| | | | - Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Stephanie Harman
- Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Vanessa N Madrigal
- Department of Pediatrics, Children's National Hospital, Washington, District of Columbia, USA
| | - Kelly N Michelson
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Erin T Paquette
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Northwestern Pritzker School of Law, Chicago, Illinois, USA
| | - Rebecca D Pentz
- Winship Cancer Institute, Atlanta, Georgia, USA.,Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sara Scarlet
- Surgical Critical Care, University of North Carolina Health Care, Chapel Hill, North Carolina, USA
| | - Connie M Ulrich
- NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jennifer K Walter
- Department of Medical Ethics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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5
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Weese-Mayer DE, Leah Harris Z, Paquette ET, Sanchez-Pinto LN. In memoriam: Lauren E. Marsillio-Craney (1979-2020). Clin Auton Res 2021; 31:589-590. [PMID: 34120248 DOI: 10.1007/s10286-021-00812-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Debra E Weese-Mayer
- Division of Pediatric Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, 225 East Chicago Avenue, Box 165, Chicago, IL, 60611-2605, USA. .,Northwestern University Feinberg School of Medicine, Chicago, IL, 60611-2605, USA.
| | - Z Leah Harris
- Department of Pediatrics, Dell Children's Medical Center and Dell Pediatric Research Institute, 4900 Mueller Boulevard, Austin, TX, 78723, USA.,University of Texas at Austin Dell Medical School, Austin, TX, 78723, USA
| | - Erin T Paquette
- Northwestern University Feinberg School of Medicine, Chicago, IL, 60611-2605, USA.,Division of Critical Care Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, 225 East Chicago Avenue, Box 165, Chicago, IL, 60611-2605, USA
| | - L Nelson Sanchez-Pinto
- Northwestern University Feinberg School of Medicine, Chicago, IL, 60611-2605, USA.,Division of Critical Care Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, 225 East Chicago Avenue, Box 165, Chicago, IL, 60611-2605, USA
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Foster CC, Paquette ET. Improving Advance Care Planning for Seriously Ill Children: Engaging a Diverse Research Population Early and Often. J Pediatr 2021; 229:16-18. [PMID: 33121961 PMCID: PMC8480434 DOI: 10.1016/j.jpeds.2020.10.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/08/2020] [Accepted: 10/25/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Carolyn C. Foster
- Division of Academic General Pediatrics, Department of
Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL,Mary Ann & J. Milburn Smith Child Health Outcomes,
Research, and Evaluation Center, Ann & Robert H. Lurie Children’s
Hospital of Chicago
| | - Erin T. Paquette
- Division of Pediatric Critical Care, Department of
Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL,Center for Bioethics and Medical Humanities, Northwestern
University Feinberg School of Medicine, Chicago, IL,Northwestern University Pritzker School of Law, by
courtesy
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7
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Paquette ET, Shah SK. Towards Identifying an Upper Limit of Risk: A Persistent Area of Controversy in Research Ethics. Perspect Biol Med 2020; 63:327-345. [PMID: 33416656 DOI: 10.1353/pbm.2020.0022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Whether there is an upper limit of net risk that volunteers can consent to in research, and what that limit happens to be, has been the subject of persistent controversy in research ethics. This article defends the concept of an upper limit of risk in research against recent critics and supports the most promising approach for identifying this limit, that of finding comparator activities that are generally accepted in society and pose high levels of risk. However, high-risk activities that have been proposed as relevant comparators involve more certain benefits and confer considerable social esteem to those who take on the risks. This suggests that developing a robust approach to identifying social value, whether by developing a procedural safeguard or a systematic framework, could more effectively identify research with sufficient social value to justify high net risk. Additionally, the social status of research participants should be elevated to be more on par with others who laudably take on high risk for the benefit of others. By attending to the benefits necessary for the justification of high-risk research, the level of allowable risk will no longer be so controversial.
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Paquette ET, Joffe S. The Multidimensional Illness Severity Questionnaire: Preliminary evaluation of a brief parent-reported measure of illness severity. J Paediatr Child Health 2019; 55:1241-1246. [PMID: 30723995 DOI: 10.1111/jpc.14391] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 01/02/2019] [Accepted: 01/09/2019] [Indexed: 11/29/2022]
Abstract
AIM This study describes the reliability and concurrent validity of the Multidimensional Illness Severity Questionnaire (MISQ), a five-item measure for capturing parents' reports of their child's illness severity. METHODS We conducted a cross-sectional survey of parents of children participating in a paediatric research study (n = 20). We assessed parents' perceptions of illness severity using five measures: (i) the MISQ, (ii) the Lansky Play Performance scale, (iii) the Severity of Illness Scale, (iv) subscales of the Parent Experience of Child Illness and (v) general health. We calculated the internal reliability of the MISQ using Cronbach's alpha and assessed concurrent validity through correlations between scores on the MISQ and other measures. RESULTS MISQ scores ranged from 6/21 to 17/21 (mean = 11.5). The MISQ had adequate internal consistency (Cronbach's α = 0.76) and correlated strongly with other measures. CONCLUSION Preliminary evaluation suggests that the MISQ is an easy-to-administer and internally consistent multidimensional assessment of parent-reported illness severity.
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Affiliation(s)
- Erin T Paquette
- Department of Paediatrics, Northwestern University, Chicago, Illinois, United States
| | - Steven Joffe
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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