Approach to paediatric care

2019 ◽  
pp. 297-306
Author(s):  
Daniel Martinez Garcia ◽  
Harriet Roggeveen ◽  
Jaap Karsten
Keyword(s):  
Decision Making ◽  
Clinical Care ◽  
Clinical Judgement ◽  
Humanitarian Settings ◽  
Paediatric Care ◽  
Paediatric Patients ◽  
Key Aspects

This chapter outlines the fundamentals of providing care in humanitarian settings, including overall guidance to clinical care, key aspects of patient triage, and approaches for paediatrics. This chapter on the approach to paediatric care in humanitarian, conflict, or disaster setting, aims to assist the non-paediatrician presented with paediatric patients, by highlighting approaches, key insights, and guidance to help with clinical judgement and decision-making.

Approach to clinical care in humanitarian contexts

2019 ◽  
pp. 267-274
Author(s):  
Raghu Venugopal
Keyword(s):  
Clinical Care ◽  
Humanitarian Settings ◽  
Key Aspects

This chapter on the approach to clinical care in humanitarian contexts outlines the fundamentals of providing care in humanitarian settings, including overall guidance on clinical care, key aspects of patient triage, and approaches for paediatrics. It providers important overarching considerations for readers, recognizing the realities and challenges in providing care in the field.

Medical triage

2019 ◽  
pp. 289-296
Author(s):  
Peter Moons
Keyword(s):  
Clinical Care ◽  
Humanitarian Settings ◽  
Key Aspects

This chapter on medical triage outlines the fundamentals of providing care in humanitarian settings, including overall guidance to clinical care, key aspects of patient triage, and approaches for paediatrics, and emergency triage. It outlines the process of rapidly sorting patients into groups based on the urgency of their condition, ensuring that the most appropriate patients get treatment first hand.

scholarly journals WHO guidance for refugees in camps: systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e027094 ◽  
Author(s):  
Harriet Blundell ◽  
Rachael Milligan ◽  
Susan L Norris ◽  
Paul Garner
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Treatment Guidelines ◽  
Clinical Care ◽  
Refugee Camps ◽  
Who Guidelines ◽  
Clinical Guidance ◽  
Humanitarian Settings ◽  
Common Framework ◽  
Evidence Summaries

ObjectivesThe circumstances of people living in refugee camps means that they have distinct medical care requirements. Our objective is to describe clinical guidance in published WHO guidelines that refer to people living in refugee camps; and how evidence and context are used and reported in making recommendations.DesignSystematic review and analysis of WHO guidelines approved by the organisation’s quality oversight body and published between 2007 and 2018. We sought for key terms related to camps and humanitarian settings, and identified text that included guidance. We compared this to Mèdecins Sans Frontièrs (MSF) guidelines.ResultsNo WHO guideline published in the last 10 years focused exclusively on clinical guidance for healthcare in camp settings. Seven guidelines contained guidance about camps; three made recommendations for camps—but only two used formal evidence summaries. We did not find any structured consideration of the situation in camps used in the decision-making process. We examined seven WHO guidelines and six chapters within guidelines that concerned humanitarian settings: none of these documents contained recommendations based on formal evidence summaries for camp settings. One of the eight MSF guidelines was devoted to clinical care in refugees and the authors had clearly linked the health problems and recommendations to the setting, but this guideline is now >20 years old.ConclusionsThere is an absence of up-to-date, evidence-based medical treatment guidelines from WHO and MSF that comprehensively address the clinical needs for people living in camps; and there is no common framework to help guideline groups formulate recommendations in these settings. WHO may wish to consider context of special populations more formally in the evidence to decision-making approach for clinical guidelines relevant to primary care.

Mass casualty triage

2019 ◽  
pp. 275-288
Author(s):  
Christos Giannou ◽  
Jennifer Turnbull
Keyword(s):  
Clinical Care ◽  
Mass Casualty ◽  
Humanitarian Settings ◽  
Large Numbers ◽  
Key Aspects

This chapter on mass casualty triage outlines the fundamentals of providing care in humanitarian settings, including overall guidance to clinical care, key aspects of patient triage, including the rationing of care based on priority for treatment, and approaches for paediatrics. It clarifies the differences between medical triage and mass casualty triage, describes the process of balancing needs with the resources available, recognizing situations where large numbers of patients overwhelm resources, and discusses triage models and organization, triage teams, and triage algorithms.

Patient-Centered Care and Autonomy: Shared Decision-Making in Practice and a Suggestion for Practical Application in the Critically Ill

2019 ◽  
Vol 35 (11) ◽  
pp. 1352-1355
Author(s):  
Marianna V. Mapes ◽  
Peter A. DePergola ◽  
William T. McGee
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Critically Ill ◽  
Care Service ◽  
Clinical Care ◽  
Patient Centered Care ◽  
Practical Application ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Centered Care

Decision-making for the hospitalized dying and critically ill is often characterized by an understanding of autonomy that leads to clinical care and outcomes that are antithetical to patients’ preferences around suffering and quality of life. A better understanding of autonomy will facilitate the ultimate goal of a patient-centered approach and ensure compassionate, high-quality care that respects our patients’ values. We reviewed the medical literature and our experiences through the ethics service, palliative care service, and critical care service of a large community teaching hospital. The cumulative experience of a senior intensivist was filtered through the lens of a medical ethicist and the palliative care team. The practical application of patient-centered care was discerned from these interactions. We determined that a clearer understanding of patient-centeredness would improve the experience and outcomes of care for our patients as well as our adherence to ethical practice. The practical applications of autonomy and patient-centered care were evaluated by the authors through clinical interactions on the wards to ascertain problems in understanding their meaning. Clarification of autonomy and patient-centeredness is provided using specific examples to enhance understanding and application of these principles in patient-centered care.

A qualitative descriptive inquiry of the influences on nurses’ missed care decision‐making processes in acute hospital paediatric care

2020 ◽  
Vol 28 (8) ◽  
pp. 1929-1939
Author(s):  
Annamaria Bagnasco ◽  
Nicoletta Dasso ◽  
Silvia Rossi ◽  
Fiona Timmins ◽  
Giuseppe Aleo ◽  
...  
Keyword(s):  
Decision Making ◽  
Acute Hospital ◽  
Paediatric Care ◽  
Decision Making Processes ◽  
Qualitative Descriptive ◽  
Missed Care ◽  
Care Decision

scholarly journals An Analysis of Preferences in Housing Demand by Means of a Multicriteria Methodology (AHP). A More Sustainable Approach

2021 ◽  
Vol 13 (14) ◽  
pp. 7550
Author(s):  
Roberto Cervelló-Royo ◽  
Marina Segura ◽  
Regina García-Pérez ◽  
Baldomero Segura-García del Río
Keyword(s):  
Decision Making ◽  
Real Estate ◽  
Real Estate Market ◽  
Housing Demand ◽  
Decision Making Process ◽  
Analytic Hierarchy ◽  
The Real Estate ◽  
Qualitative Relationship ◽  
Key Aspects ◽  
Housing Attributes

This paper examines key aspects of the behavior of housing demand from a sustainable standpoint. Most studies have mainly focused on housing supply, looking at quantitative predictions without considering the qualitative relationship found between housing values and housing demand on a sustainable and microeconomic scale. We used a multicriteria decision methodology (analytic hierarchy process—AHP) for the analysis of preferences in demand, based on the theory of multi-attribute utility of housing, to determine the relative importance of each characteristic of housing and its influence on the decision-making process. For this purpose, we carried out the study over three main groups of stakeholders in the housing market: real estate surveyors, real estate agents, and housing buyers (the latter representing the housing demand). Results show that although there might be some slight discrepancies among the three groups in the decision-making process and the weighting of housing attributes, the three groups agree in most of the process, especially when defining the criteria and the importance that each criterion has on the process of valuation. This study provides important managerial and sustainable implications for the real estate market related to urban public policy, as we highlight which criteria are most preferred.

scholarly journals Lessons Learned From an Early Hotspot During the COVID-19 Pandemic

2021 ◽  
pp. 000313482199475
Author(s):  
Brett M. Chapman ◽  
George M. Fuhrman
Keyword(s):  
Decision Making ◽  
Surgical Education ◽  
Clinical Care ◽  
Well Being ◽  
Educational Environment ◽  
Lessons Learned ◽  
Residency Programs ◽  
Surgical Residency ◽  
The Impact

The Covid-19 pandemic has provided challenges for surgical residency programs demanding fluid decision making focused on providing care for our patients, maintaining an educational environment, and protecting the well-being of our residents. This brief report summarizes the impact of the impact on our residency programs clinical care and education. We have identified opportunities to improve our program using videoconferencing, managing recruitment, and maintaining a satisfactory caseload to ensure the highest possible quality of surgical education.

Creation of a Community-Driven Decision Support Tool for Caregivers of Children With Developmental Concerns

2021 ◽  
pp. 1-11
Author(s):  
Dawn M. Magnusson ◽  
Irena Shwayder ◽  
Natalie J. Murphy ◽  
Lindsay Ollerenshaw ◽  
Michele Ebendick ◽  
...  
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Shared Decision Making ◽  
Service Use ◽  
Decision Support Tool ◽  
Cultural Humility ◽  
Shared Decision ◽  
Plain Language ◽  
Support Tool ◽  
Key Aspects

Purpose Despite increasing standardization of developmental screening and referral processes, significant early intervention service disparities exist. The aims of this article are to: (a) describe methods used to develop a decision support tool for caregivers of children with developmental concerns, (b) summarize key aspects of the tool, and (c) share preliminary results regarding the tool's acceptability and usability among key stakeholders. Method Content and design of the decision support tool was guided by a systematic process outlined by the International Patient Decision Aid Standards (IPDAS) Collaborative. Three focus group interviews were conducted with caregivers ( n = 7), early childhood professionals ( n = 28), and a mix of caregivers and professionals ( N = 20) to assess caregiver decisional needs. In accordance with the IPDAS, a prototype of the decision support tool was iteratively cocreated by a subset of caregivers ( n = 7) and early child health professionals ( n = 5). Results The decision support tool leverages images and plain language text to guide caregivers and professionals along key steps of the early identification to service use pathway. Participants identified four themes central to shared decision making: trust, cultural humility and respect, strength-based conversations, and information-sharing. End-users found the tool to be acceptable and useful. Conclusions The decision support tool described offers an individualized approach for exploring beliefs about child development and developmental delay, considering service options within the context of the family's values, priorities, and preferences, and outlining next steps. Additional research regarding the tool's effectiveness in optimizing shared decision-making and reducing service use disparities is warranted.

scholarly journals Improving appropriateness of oxygen saturation monitoring in paediatric patients with acute respiratory illness: a QI initiative

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e15-e15
Author(s):  
Brigitte Parisien ◽  
Daryl Cheng ◽  
Maria Marano ◽  
Julie Johnstone ◽  
Nicole Carmichael ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Pulse Oximetry ◽  
Nursing Staff ◽  
Visual Cues ◽  
Clinical Care ◽  
Respiratory Illness ◽  
Appropriate Use ◽  
Post Intervention ◽  
Prolonged Length ◽  
Paediatric Patients

Abstract BACKGROUND Oxygen saturation monitoring (OSM) is a key aspect of clinical care in paediatric patients with acute respiratory disease. It is commonplace in the assessment of children with bronchiolitis, asthma and pneumonia and serves as a proxy for illness severity. However, there is a paucity of standardized guidelines around appropriate pulse oximetry and OSM use in these patients. Some preliminary evidence shows that intermittent pulse oximetry is as safe as continuous oximetry monitoring in children with bronchiolitis. Furthermore, inappropriate OSM may lead to overdiagnosis and overtreatment of mild hypoxia with no demonstrable clinical improvement and therefore contribute to prolonged length of stay. OBJECTIVES As part of The Choosing Wisely campaign, our aim is to increase the appropriate use of OSM in paediatric inpatients with asthma, bronchiolitis or pneumonia in our center to 90% by April 2018. DESIGN/METHODS Appropriate monitoring is defined as intermittent OSM when a patient is off oxygen for >2 hours and continuous OSM whilst the patient is receiving supplemental oxygen. A 4 week pre-intervention baseline chart review showed 62% (23/37) had appropriate OSM. Series of interventions along the hierarchy of effectiveness were then chosen to improve the main outcome measure: • Educational sessions oriented at medical and nursing staff were provided to guide evidence-based practice and to reinforce the use of specific orders around OSM; • Visual cues were used in strategic locations to remind medical staff of appropriate OSM and to prompt discussion during ward rounds; • Weekly reminders and performance updates were displayed and electronically circulated to medical and nursing staff. Post-intervention data collection occurred via convenience sampling by project leaders from December 2017 to April 2018. A PDSA cycle approach was used to modify interventions. RESULTS OSM appropriateness increased to 78% (56/72) in the first 4 weeks post-initial interventions. There were no negative impacts on balancing measures. We anticipate an ongoing graded increase in appropriateness across the study period triggered by collective staff awareness and synergistic interventions. CONCLUSION This QI initiative will improve the appropriate use of OSM in patients admitted for bronchiolitis, pneumonia or asthma at our paediatric tertiary hospital without increasing the number of patient safety events or admissions to the intensive care unit. Further interventions are planned to ensure greater uptake and sustainability.

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