Identifying Practices to Promote Inpatient Adolescent and Influenza Vaccine Delivery

OBJECTIVES Many hospitalized children are underimmunized. We assessed the association between hospital immunization practices and tetanus, diphtheria, and acellular pertussis (Tdap), meningococcal, human papillomavirus (HPV), and influenza vaccine delivery. METHODS An electronic survey regarding hospital vaccine delivery practices was distributed via the Pediatric Health Information System (PHIS) and Pediatric Research in Inpatient Settings networks to PHIS hospitals. Number of vaccines delivered and total discharges in 2018 were obtained from the PHIS database to determine hospital vaccine delivery rates; patients 11 to 18 years old (adolescent vaccines) and 6 months to 18 years old (influenza vaccine) were included. Vaccine delivery rates were risk adjusted by using generalized linear mixed-effects modeling and compared with survey responses to determine associations between the number or presence of specific practices and vaccine delivery. Adjusted HPV and meningococcal vaccine delivery rates could not be calculated because of low delivery. RESULTS Twenty-nine hospitals completed a survey (57%). 152 499 and 423 046 patient encounters were included for the adolescent and influenza vaccines, respectively. Unadjusted inpatient vaccine delivery rates varied. After adjustment, the number of practices was associated only with influenza vaccine delivery (P = .02). Visual prompts (P = .02), nurse or pharmacist ordering (P = .003), and quality improvement projects (P = .048) were associated with increased influenza vaccine delivery; nurse or pharmacist ordering had the greatest impact. No practices were associated with Tdap vaccine delivery. CONCLUSIONS The number and presence of specific hospital practices may impact influenza vaccine delivery. Further research is needed to identify strategies to augment inpatient adolescent immunization.

Healthcare Professionals’ Breastfeeding Attitudes and Hospital Practices During Delivery and in Neonatal Intensive Care Units: Pre and Post Implementing the Baby-Friendly Hospital Initiative

Background: The Baby-Friendly Hospital Initiative represents a global effort to support breastfeeding. Commitment to this program has been associated with the longer duration and exclusivity of breastfeeding and improvements in hospital practices. Further, healthcare professionals’ breastfeeding attitudes have been associated with the ability to provide professional support for breastfeeding. Research Aims: To determine healthcare professionals’ breastfeeding attitudes and hospital practices before and after the implementation of the Baby-Friendly Hospital Initiative. Methods: Using a quasi-experimental pretest–posttest study design, healthcare professionals ( N = 131) from the single hospital labor and delivery, maternity care, and neonatal intensive care were recruited before and after the Baby-Friendly Hospital Initiative intervention during 2017 and 2019. Breastfeeding attitudes with the validated Breastfeeding Attitude Questionnaire, breastfeeding-related hospital practices, and background characteristics were collected. Results: The healthcare professionals’ breastfeeding attitude scores increased significantly after the implementation of the Baby-Friendly Hospital Initiative, difference = 0.16, (95% CI [0.13, 0.19]) and became breastfeeding favorable among all professional groups in each study unit. Positive changes in breastfeeding-supportive hospital practices were achieved. The infants had significantly more frequent immediate and uninterrupted skin-to-skin contact with their mothers. The rate of early breastfeeding, as well as the number of exclusively breastfed infants, increased. Conclusions: After the Baby-Friendly Hospital Initiative and Baby-Friendly Hospital Initiative for neonatal wards (Neo-BFHI) interventions were concluded, we found significant improvements in the breastfeeding attitudes of healthcare professionals and in breastfeeding-related care practices. This RCT was registered (0307-0041) with ClinicalTrials.gov on 03/03/2017.

Examining the value of using naturally occurring data to facilitate qualitative health research with ‘seldom heard’ ‘vulnerable’ groups: A research note on inpatient care

This research note explores two inter-connected ideas. First, that the category of ‘vulnerable’ groups has expanded and has sometimes been used to exclude seldom heard groups from research. The underpinning protectionist polemic, whilst well-intended, has arguably led to disempowerment of the very groups they intended to safeguard. Learning lessons from advances in research with children can be utilised to develop a more inclusive and empowering approach with adults while simultaneously addressing safeguarding. Second, the note values the potential of using naturally occurring data as a mechanism for including vulnerable groups in research. An example is offered attending to frequently excluded inpatient voices in healthcare studies. The practical and ethical benefits of using naturally occurring data are explored for countering arguments against the inclusion of vulnerable groups using an example of autistic inpatient research from the UNITE study. Researchers are invited to make practical adjustments to maximise involvement opportunities, and a reminder that capacity to take part in research activity may be facilitated by these modifications. Naturally occurring data offer the possibility of understanding complex hospital practices without additional burdens of researcher-generated methods.

Promoting Breastfeeding at the Start: Hospital Practices and Breastfeeding Initiation and Exclusivity Among Low-income Women

Objectives To determine whether hospital breastfeeding-related practices are associated with breastfeeding initiation (BF) and exclusive breastfeeding (EBF) at discharge in a low-income population. Methods This is a secondary analysis of the Infant Toddler Feeding Practices Study II (ITFPS-2), a nationally representative sample of low-income mothers enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). This analysis included birth mothers who delivered at a hospital, whose infants did not spent time in the NICU, and had survey weighting data. BF and EBF (in women who initiated breastfeeding), hospital practices (rooming in, breastfeeding encouragement from staff, availability of staff who provided breastfeeding support, reception of gift pack, and among those who initiated breastfeeding, breastfeeding in the first hour and on demand, ) and sociodemographic data were collected via interview at 1 month postpartum. Logistic regression analysis, adjusting for maternal age, race and ethnicity, income, breastfeeding history, and delivery type, was conducted. We further adjusted for breastfeeding intentions, assessed in a sub-sample during pregnancy. Results The weighted analytic sample included 394,022 women (n = 311,355 for EBF). Rooming in was positively associated with BF (P < 0.0001). Among those who initiated breastfeeding, doing so within the first hour was associated with EBF (P < 0.0001). Breastfeeding encouragement from staff and availability of breastfeeding support staff were strongly associated with BF (both P < 0.0001), but not with EBF (P = 0.74 and P = 0.08, respectively). Receiving a pro-formula gift pack was associated with a 40% and 50% reduction in the odds of BF and EBF, respectively (both P < 0.0001). Further adjustment for breastfeeding intentions in a sub-sample (n = 250,665 for BF, n = 202,412 for EBF) provided similar findings. Conclusions Hospital practices were associated with breastfeeding practices, regardless of breastfeeding intentions. Limiting pro-formula gifts and providing breastfeeding support at hospitals, either directly or by creating an environment that allows for breastfeeding opportunities, may improve breastfeeding rates in the WIC population. Funding Sources The WIC ITFPS-2 is a federal study conducted under the direction of Office of Policy Support in the USDA FNS.

A Comparative Study of the Impact of Coronavirus (COVID -19) on the Therapeutic Practices of Cancer Patients in the Kingdom of Saudi Arabia and Egypt

Cancer patients are considered one of the most vulnerable to infection with Corona virus (COVID-19), especially who are elderly, multiple comorbidities, and are often immunosuppressed by their cancer or therapy. The immune system of cancer patients is very weak compared to the healthy individuals, so, morbidity and mortality of any serious infections expected to be high among them. This research aims to study the impact of COVID-19 pandemic on cancer patients practices in Saudi Arabia (KSA) and compare with the result in Egypt. It was conducted through a well-structured questionnaire, among cancer patients either online (KSA) or paper questionnaire (Egypt). The questionnaire consists of 16 questions about Scio-demographic and changes in time and method of treatment (chemotherapy and radiotherapy), postponed of surgical operations. Our results showed significant differences between KSA and Egypt hospital practices; cancer department was affected by postponed appointment (54.8% & 63.3%), diagnosis (32.7% & 60%) and treatment of cancer patients (37.1% & 63.3%) respectively. Also, postponed of chemotherapy/radiotherapy (56.8% & 73.3%), surgical operations (45% & 43.3%), an increase in the deterioration of cancer by (35.5% & 23.3%), switching from parenteral injection to oral (27.8% & 56.7%) and changing in the drug doses (19.5% & 40%) in KSA and Egypt respectively. We can conclude that management of cancer patients during COVID-19 pandemic of great importance and so, switching from parenteral to oral, prolongation of the treatment period and postponed of some surgical operations gave a good opportunity to maintain adequate care of cancer patient with minimum exposure of patients to infection.