19 Anxiolysis for laceration repair in children: A survey of pediatric emergency providers in Canada

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e12-e12
Author(s):  
Kriti Kumar ◽  
Samina Ali ◽  
Vikram Sabhaney ◽  
Evelyne D Trottier ◽  
Amy Drendel ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Online Survey ◽  
Physical Restraint ◽  
Pediatric Emergency ◽  
Subject Area ◽  
Perceived Barriers ◽  
Independent Practice ◽  
Topical Anesthetics ◽  
Practice Experience ◽  
Intranasal Midazolam

Abstract Primary Subject area Emergency Medicine - Paediatric Background Laceration repair accounts for half of procedures performed in pediatric emergency departments. Although commonly used, topical anesthetics do little to alleviate emotional distress, particularly in young children. Intranasal midazolam is frequently used but is not consistently effective. Intranasal dexmedetomidine (IND) is a new and potentially effective anxiolytic but clinical uptake is limited by a lack of pediatric data. Objectives Our objective was to understand pediatric emergency providers’ willingness, preferences, and perceived barriers surrounding anxiolysis for laceration repair in children, to inform the design of a future clinical trial of IND. Design/Methods This was an online survey of Canadian pediatric emergency providers listed in the Pediatric Emergency Research Canada database. The survey was developed according to published guidelines and featured a vignette of a 3-year-old distressed child requiring laceration repair. It was hosted on the Research Electronic Data Capture platform in English and French, and was disseminated from September to December 2020. The primary outcome was the proportion of respondents that would provide anxiolysis. Secondary outcomes included perceived barriers to IND use. Data were reported using summary statistics. Results The response rate was 155/225 (68.9%), of which 98/141 (70%) were Royal College accredited pediatric emergency physicians. For 129/147 (88%) of respondents, 80-100% of their patients were children. 123/146 (84%) had > 6 years independent practice experience and 126/146 (86%) performed > 4 laceration repairs per month. 127/148 (86%) believed that > 25% of children experienced distress significant enough to require physical restraint during laceration repair. 116/148 (78%) indicated they would provide anxiolysis, mainly as intranasal benzodiazepines, such as midazolam (100/109, 92%). 95/148 (64%) indicated that they would consider IND if evidence suggested it was effective. Common perceived barriers included inadequate personal (114/145, 79%) and nursing (109/145, 75%) experience with IND, and lack of formulary access to IND (60/145, 41%). Conclusion Most pediatric emergency providers believe that laceration repair in a young child is distressing and would provide anxiolysis. Most providers would consider IND if there was evidence of benefit, suggesting that favourable findings from a clinical trial would have good clinical uptake.

scholarly journals A tale of two parts of Switzerland: regional differences in the impact of the COVID-19 pandemic on parents

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Michelle Seiler ◽  
Georg Staubli ◽  
Julia Hoeffe ◽  
Gianluca Gualco ◽  
Sergio Manzano ◽  
...  
Keyword(s):  
Public Health ◽  
Regional Differences ◽  
Online Survey ◽  
Pediatric Emergency ◽  
The South ◽  
Public Health Agencies ◽  
The North ◽  
Regional Strategies ◽  
Health Agencies ◽  
The Impact

Abstract Background We aimed to document the impact of the coronavirus disease 2019 (COVID-19) pandemic on regions within a European country. Methods Parents arriving at two pediatric emergency departments (EDs) in North of Switzerland and two in South of Switzerland completed an online survey during the first peak of the pandemic (April–June 2020). They were asked to rate their concern about their children or themselves having COVID-19. Results A total of 662 respondents completed the survey. Parents in the South were significantly more exposed to someone tested positive for COVID-19 than in the North (13.9 and 4.7%, respectively; P <  0.001). Parents in the South were much more concerned than in the North that they (mean 4.61 and 3.32, respectively; P <  0.001) or their child (mean 4.79 and 3.17, respectively; P <  0.001) had COVID-19. Parents reported their children wore facemasks significantly more often in the South than in the North (71.5 and 23.5%, respectively; P <  0.001). Conclusion The COVID-19 pandemic resulted in significant regional differences among families arriving at EDs in Switzerland. Public health agencies should consider regional strategies, rather than country-wide guidelines, in future pandemics and for vaccination against COVID-19 for children.

scholarly journals Physical Restraint of Older Adults at Home: Preliminary Analysis of a Prospective Cohort Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 683-683
Author(s):  
Asa Inagaki ◽  
Ayumi Igarashi ◽  
Maiko Noguchi-Watanabe ◽  
Mariko Sakka ◽  
Chie Fukui ◽  
...  
Keyword(s):  
Older Adults ◽  
Online Survey ◽  
Physical Restraint ◽  
Community Dwelling ◽  
Physical Restraints ◽  
Care Nurse ◽  
Factors Associated ◽  
Home Care Nurse ◽  
Community Dwelling Older Adults ◽  
At Home

Abstract Our study aimed to explore the prevalence and factors of physical restraints among frail to dependent older adults living at home. We conducted an online survey to ask about the physical/mental conditions, demographics, service utilization, and physical restraints of community-dwelling older adults. Either home care nurse or care managers who were responsible for the older adult answered the survey that were conducted at baseline and one month later. We obtained data from 1,278 individuals. Physical restraint was reported for 53 (4.1%) participants. Multiple logistic regression revealed the factors associated with physical restraints at home: having been restrained at baseline, having pneumonia or heart failure, receiving home bathing, or using rental assistive devices were associated with physical restraints at one month. The findings could be used to promote discussion about which services prevent physical restraints and what we should do to support clients and their family to stay at home safely.

scholarly journals How Is Geriatric Assessment Used in Clinical Practice for Older Adults With Cancer? A Survey of Cancer Providers by the American Society of Clinical Oncology

2020 ◽  
pp. OP.20.00442
Author(s):  
William Dale ◽  
Grant R. Williams ◽  
Amy R. MacKenzie ◽  
Enrique Soto-Perez-de-Celis ◽  
Ronald J. Maggiore ◽  
...  
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Online Survey ◽  
Task Force ◽  
Statistical Significance ◽  
Geriatric Oncology ◽  
Perceived Barriers ◽  
Patients With Cancer ◽  
Change Behavior ◽  
American Society

PURPOSE: For patients with cancer who are older than 65 years, the 2018 ASCO Guideline recommends geriatric assessment (GA) be performed. However, there are limited data on providers’ practices using GA. Therefore, ASCO’s Geriatric Oncology Task Force conducted a survey of providers to assess practice patterns and barriers to GA. METHODS: Cancer providers treating adult patients including those ≥ 65 years completed an online survey. Questions included those asking about awareness of ASCO’s Geriatric Oncology Guideline (2018), use of validated GA tools, and perceived barriers to using GA. Descriptive statistics and statistical comparisons between those aware of the Guideline and those who were not were conducted. Statistical significance was set at P < .05. RESULTS: Participants (N = 1,277) responded between April 5 and June 5, 2019. Approximately half (53%) reported awareness of the Guideline. The most frequently used GA tools, among those aware of the Guideline and those who were not, assessed functional status (69% v 50%; P < .001) and falls (62% v 45%; P < .001). Remaining tools were used < 50% of the time, including tools assessing weight loss, comorbidities, cognition, life expectancy, chemotherapy toxicity, mood, and noncancer mortality risk. GA use was two to four times higher among those who are aware of the Guideline. The most frequent barriers for those who reported being Guideline aware were lack of resources, specifically time (81.7%) and staff (77.0%). In comparison, those who were unaware of the Guideline most often reported the following barriers: lack of knowledge or training (78.4%), lack of awareness about tools (75.2%), and uncertainty about use of tools (75.0%). CONCLUSION: Among providers caring for older adults, 52% were aware of the ASCO Guideline. Some domains were assessed frequently (eg, function, falls), whereas other domains were assessed rarely (eg, mood, cognition). Guideline awareness was associated with two to four times increased use of GA and differing perceived barriers. Interventions facilitating Guideline-consistent implementation will require various strategies to change behavior.

Pasture renewal in the Waikato and Bay of Plenty regions: An overview of farmer practice, experience and attitudes

2011 ◽  
Vol 15 ◽  
pp. 21-24
Author(s):  
Kelly Smith ◽  
R. Brazendale
Keyword(s):  
Decision Making ◽  
Online Survey ◽  
Information Sources ◽  
Farm Management ◽  
Dairy Farmers ◽  
Practice Experience ◽  
Rate Information ◽  
And Performance ◽  
On Farm ◽  
Over Time

Pasture persistence and performance, and associated issues such as black beetle, are of central concern to dairy farmers. The Pasture Renewal Survey 2010 aimed to better understand farmers' confidence in their ability to make informed decisions on their pasture renewal practices, their satisfaction with the success of this decision-making and the performance of their renewed pastures over time. In addition, the survey investigated their attitudes to information sources and what barriers they saw to improving pasture performance on farm. A postal and online survey elicited responses from 776 dairy farmers in the Waikato and Bay of Plenty regions. The four main findings of the work were: 1. Farmers are more confident of their ability to make appropriate on-farm management decisions for renewed pasture than they are of their ability to choose appropriate cultivars and endophyte. 2. Farmers, while generally satisfied with their own success in renewing pasture, reported decreasing levels of satisfaction with renewed pastures over the 3 successive years following renewal. 3. Farmers do not rate information sources very highly in terms of their usefulness in relation to pasture renewal. 4. Weather-related issues and pest-related issues (particularly black beetle) were the most commonly identified barriers to improving pasture performance. Keywords: farmer confidence, farmer satisfaction, information sources, pasture renewal.

scholarly journals 149 Virtual Care: A Quality Improvement Project on the Experience of Paediatricians during the COVID-19 Pandemic

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e102-e104
Author(s):  
Emma McCrady ◽  
Julie Strychowsky ◽  
Jessica Woolfson
Keyword(s):  
Quality Improvement ◽  
Online Survey ◽  
Local Level ◽  
Standard Of Care ◽  
Subject Area ◽  
Future Research ◽  
Improvement Project ◽  
Diagnostic Uncertainty ◽  
Virtual Care ◽  
Practice Efficiency

Abstract Primary Subject area Practice/Office Management Background Prior to the COVID-19 pandemic, in-person visits were the standard of care for paediatricians at our centre. With the pandemic onset, virtual care (VC) was adopted at an unprecedented scale and pace. Studies have reported positive patient VC experience; however, few have explored physician experience. This quality improvement (QI) initiative sought to qualify the VC experience of local paediatricians during the pandemic, with the intention of implementing VC clinical practice changes at the department level. Objectives To determine key factors that have supported and challenged the adoption of, and that will support integration of, VC in the future. Design/Methods The Donabedian model for healthcare QI was used to evaluate VC experience through an online survey with a focus on structure, process, and outcome measures. All physicians affiliated with the Department of Paediatrics (generalists and subspecialists in medicine and surgery) were invited to participate via email. Three reminder emails were sent at 2-week intervals. Descriptive statistics were reported. Results The response rate was 32.3% (63 of 195 physicians). The majority of respondents were subspecialists (84.1%), and at academic centres (87.5%) (Table 1). Pre-pandemic, only 30.1% used VC and saw &lt;10% of patients virtually. During March-May 2020, 93.8% transitioned to VC, with &gt; 50% seeing over 75% of patients virtually. By summer 2020, VC use declined, but remained higher than pre-pandemic (53.6% seeing &lt; 25% of patients). OTN and telephone were platforms most used (32.8% and 28.6%, respectively). Most conducted visits from their work location (55.2%) versus home (44.8%). VC experience was considered positive by most physicians (73.6%), and only 18.8% found VC difficult to use despite technical difficulties reported by 41.5% (Figure 1). Physicians with ≤ 5 years in practice were most likely to find VC convenient (93.8%). Challenges with VC included lack of physical exam, diagnostic uncertainty, lower patient volumes, and poor patient VC etiquette. Regardless of practice location, specialty, years in practice, and prior experience, 96% would continue VC to 25% of patients, ideally for patients who live far away (26.4%) and for follow-ups of patients with established diagnoses (21.4%). Conclusion A rapid transition to VC during the COVID-19 pandemic was associated with challenges but also positive experiences. Willingness to continue VC was high. VC experience could be improved with greater patient education and focus on select patient populations. Future research is needed to improve practice efficiency and to inform regulatory guidelines for VC at a local level.

75 Parental perspective about the health and development of their extremely preterm child

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e55-e57
Author(s):  
Audrey-Anne Milette ◽  
Lindsay Richter ◽  
Claude-Julie Bourque ◽  
Annie Janvier ◽  
Kate Robson ◽  
...  
Keyword(s):  
Online Survey ◽  
Birth Outcome ◽  
Well Being ◽  
Subject Area ◽  
Common Source ◽  
Perinatal Medicine ◽  
Extremely Preterm ◽  
Health And Development ◽  
Parental Responses

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Preterm birth outcome studies and clinical follow-up have traditionally focused on neurodevelopment. We previously showed in a selected sample of parents that they also valued other types of outcomes. Objectives This study aimed to validate these findings in a more diverse cohort by examining parental perspectives about the positive and negative aspects of their very preterm child’s health and development in relation to level of neurodevelopment impairment (NDI). Design/Methods Parents of children born &lt; 29 weeks gestational age in 2016-2018 and seen at two Canadian neonatal follow-up clinics were invited to complete an online survey about their level of agreement with statements about their child’s health, development, and well-being. Parental responses in relation to their child’s level of NDI were examined using Kruskal-Wallis and chi-square for trends tests. Results 199 parental responses were obtained for 165 children (65% of eligible children). Of these children, 52%, 27% and 21% had, respectively, no, mild to moderate, and severe NDI. Development was the most common source of concerns (49%), followed by the child’s future (35%), and physical health (35%). Parents of children with severe NDI were more likely to express concerns than those with mild to moderate or no NDI. Parents rated their child’s health relatively high with a median score of 8/10 (range 3-10). Children with no NDI were given higher scores than those with NDI (p = 0.004). Regardless of level of NDI, almost all parents agreed with their child being happy (p = 1.000) and having a positive personality (p = 0.207). Figure 1 shows that parental concerns increased with level of NDI. Conclusion Parents of preterm children have a balanced perspective on their child’s outcome. Integrating their views when developing core sets of important outcomes for neonatal follow-up is critical.

Guidance for reporting clinical trial registry records and published protocols use in systematic reviews of interventions

2019 ◽  
Author(s):  
Julia Bidonde ◽  
Jose Francisco Meneses-Echavez ◽  
Angela Jean Busch ◽  
Catherine Boden
Keyword(s):  
Systematic Review ◽  
Clinical Trial ◽  
Systematic Reviews ◽  
Cochrane Collaboration ◽  
Subject Area ◽  
Selective Reporting ◽  
Trial Registry ◽  
Clinical Trial Registry ◽  
Reporting Practices ◽  
Starting Point

Abstract Background: Transparency is a tenet of systematic reviews. Searching for clinical trial registry records and published protocols has become a mandatory standard when conducting a systematic review of interventions. However, there is no comprehensive guidance for review authors on how to report the use of registry records and published protocols in their systematic review. The objective of this study was to generate initial guidance to assist authors of systematic reviews of interventions in the reporting of registry records and published protocols in systematic reviews of interventions. Methods: We used a compilation of the procedures recommended by expert organizations (e.g., Cochrane Collaboration) related to the reporting of use of registry records and published protocols in the conduct of systematic reviews. The compilation was developed by one of the authors in this study and served as a starting point in developing the algorithm. We extracted current practice data related to registry records and published protocols from a stratified random sample of Cochrane systematic reviews of interventions published between 2015 and 2016 (n=169). We identified examples that adhered to or extended the current guidance. Based on the on the elements above, we created the algorithm to bridge gaps and improve current reporting practices. Results: Trial protocols should be used to account for all evidence in a subject area, evaluate reporting bias (i.e. selective reporting and publication bias), and determine the nature and number of ongoing or unpublished studies for planning review updates. Review authors’ terminology (e.g., ongoing, terminated) and consequent reporting in the review should reflect the phase of the trial found. Protocols should be clearly and consistently reported throughout the review (e.g. abstract, methods, results) as is done with published articles. Conclusions: Our study expands on available guidance to describe in greater detail the reporting of registry records and published protocols for review authors. We believe this is a timely investigation that will increase transparency in the reporting of trial records in systematic reviews of interventions and bring clarification to current fuzziness in terminology. We invite researchers to provide feedback on our work for its improvement and dissemination. Trial Registration: not applicable

Perceived barriers of Reporting Incidents Online Among Internal Medicine Physicians

2019 ◽  
Author(s):  
Mouhand F.H. Mohamed ◽  
Ibrahim Yusuf ◽  
Dabia Al-Mohanadi ◽  
Ahmed Al-Mohammed ◽  
Abdul-Badi Abou-Samra ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Online Survey ◽  
Perceived Barriers ◽  
Medicine Department ◽  
Incident Reporting Systems ◽  
Reporting Systems ◽  
Incident Reports ◽  
Main Barrier ◽  
Fear Of Retaliation ◽  
Previous Learning

Abstract Background: Incident reporting systems (IRS) facilitate incidents' reporting and tracking, and help in identifying gaps in health care (HC). Learnings from incident reports (IR) are extremely valuable. This study aimed to assess physician's knowledge and experience with an online IRS in a large tertiary academic institution and to identify barriers of reporting incidents. Methods: A 21-questions electronic online survey was sent to physicians working in the Internal Medicine Department of Hamad Medical Corporation. Results: A total of 115 physicians (76% trainees and 24% attending faculty) responded to the survey, 59% of them were aware of the availability of IRS at HMC. However, only 29% knew how to submit an online IR, and 20% have ever submitted an IR. The survey revealed that of 46% and 63% of participants are less likely to submit an IR when they or their colleague, respectively, commit an error. The main barriers of reporting incidents were, unawareness about the IRS (36%), inability to access it (26%), the perception that IR does not result in a change (13%), Also, the concern or fear of retaliation (13%). When asked about solutions, 57% recommended training and awareness, and 22% recommended sharing learnings and actions from previous IR. Conclusion: IRS is under-utilized by Internal Medicine physicians. The main barrier at the time of the survey is the lack of training and awareness. Promoting awareness and sharing previous learning and actions may improve the utilization of the IRS.

Physician Compliance With Bronchiolitis Guidelines in Pediatric Emergency Departments

2019 ◽  
Vol 58 (9) ◽  
pp. 1008-1018 ◽  
Author(s):  
Andrea V. Rivera-Sepulveda ◽  
Terri Rebmann ◽  
James Gerard ◽  
Rachel L. Charney
Keyword(s):  
Online Survey ◽  
Pediatric Emergency ◽  
Systemic Steroid ◽  
X Rays ◽  
Chi Square ◽  
X Ray ◽  
American Academy Of Pediatrics ◽  
Physician Compliance ◽  
Chest X Ray ◽  
Viral Testing

An online survey was administered through the American Academy of Pediatrics (AAP) Section of Emergency Medicine Survey Listserv in Fall, 2017. Overall compliance was measured as never using chest X-rays, viral testing, bronchodilators, or systemic steroids. Practice compliance was measured as never using those modalities in a clinical vignette. Chi-square tests assessed differences in compliance between modalities. t tests assessed differences on agreement with each AAP statement. Multivariate logistic regression determined factors associated with overall compliance. Response rate was 47%. A third (35%) agreed with all 7 AAP statements. There was less compliance with ordering a bronchodilator compared with chest X-ray, viral testing, or systemic steroid. There was no association between compliance and either knowledge or agreement with the guideline. Physicians with institutional bronchiolitis guidelines were more likely to be practice compliant. Few physicians were compliant with the AAP bronchiolitis guideline, with bronchodilator misuse being most pronounced. Institutional bronchiolitis guidelines were associated with physician compliance.

Sign in / Sign up

Export Citation Format

Share Document