Parents' perceived obstacles to pediatric clinical trial participation: Findings from the clinical trials transformation initiative.

Enrollment of children into pediatric clinical trials remains challenging. More effective strategies to improve recruitment of children into trials are needed. This study used in-depth qualitative interviews with parents who were approached to enroll their children in a clinical trial in order to gain an understanding of the barriers to pediatric clinical trial participation. Twenty-four parents whose children had been offered the opportunity to participate in a clinical trial were interviewed: 19 whose children had participated in at least 1 clinical trial and 5 who had declined participation in any trial. Each study aspect, from the initial explanation of the study to the end of the study, can affect the willingness of parents to consent to the proposed study and future studies. Establishing trust, appropriate timing, a transparent discussion of risks and benefits oriented to the layperson, and providing motivation for children to participate were key factors that impacted parents' decisions. In order for clinical trial accrual to be successful, parents' priorities and considerations must be a central focus, beginning with initial trial design. The recommendations from the parents who participated in this study can be used to support budget allocations that ensure adequate training of study staff and improved staffing on nights and weekends. Studies of parent responses in outpatient settings and additional inpatient settings will provide valuable information on the consent process from the child's and parent's perspectives. Further studies are needed to explore whether implementation of such strategies will result in improved recruitment for pediatric clinical trials

Prioritization of critically unwell children in low resource primary healthcare centres in Cape Town, South Africa

Background: Every day, sick children die from time sensitive preventable illnesses. Due to an inadequate number of trained healthcare workers and high volumes of children presenting to Primary Healthcare Centres (PHC), waiting times remain high and often result in significant delays for critically ill children. Delays in the recognition of critically unwell children are a key contributing factor to avoidable childhood mortality in Cape Town, South Africa. Methodology: A stepped implementation approach was undertaken to develop and evaluate a context-appropriate prioritization tool to identify and expedite the care of critically ill children PHC in Cape Town, South Africa. Aim 1: To conduct a systematic review of paediatric triage and prioritization tools for low resource settings in order to evaluate the evidence supporting the use of these tools. Aim 2: To perform an exploratory study, to identify barriers to optimal care for critically ill children in the pre-hospital setting in Cape Town, South Africa. Aim 3: To develop an implementable context-appropriate tool to identify and expedite the care of critically ill children in PHC in the City of Cape Town, South Africa. Aim 4: Evaluate the reliability of this tool compared to established triage tools currently used in this setting. Aim 5: Evaluate the impact of implementing this tool, on waiting times for children presenting for care to PHC. Aim 6: Evaluate the effectiveness of this tool post real-world implementation in identifying and expediting the care for critically ill children. Findings: Post real world implementation SCREEN was able to significantly reduce waiting times in PHC for critically ill children. Compared to pre-SCREEN implementation, post-SCREEN the proportion of critically ill children who saw a PN within 10 minutes increased tenfold from 6.4% (pre-SCREEN) to 64% (post-SCREEN) (p<0.001). SCREEN is also able to accurately identify critically ill children, in an audit of 827 patient-charts SCREEN had a sensitivity of 94.2% and a specificity of 88.1% when compared to IMCI. Interpretation: The SCREEN program when implemented in a real-world setting has shown that it can effectively identify and expedite the care of critically ill children in PHC

Consensus-based recommendations on priority activities to address acute kidney injury in children: A modified Delphi consensus statement

Importance: Increasing evidence indicates that acute kidney injury (AKI) occurs frequently in children and young adults and is associated with poor short-term and long-term outcomes. Guidance is required to focus efforts related to expansion of pediatric AKI knowledge. Objective: To develop expert-driven pediatric specific recommendations on needed AKI research, education, practice, and advocacy. Evidence Review: At the 26th Acute Disease Quality Initiative meeting conducted in November 2021 by 47 multiprofessional international experts in general pediatrics, nephrology, and critical care, the panel focused on 6 areas: (1) epidemiology; (2) diagnostics; (3) fluid overload; (4) kidney support therapies; (5) biology, pharmacology, and nutrition; and (6) education and advocacy. An objective scientific review and distillation of literature through September 2021 was performed of (1) epidemiology, (2) risk assessment and diagnosis, (3) fluid assessment, (4) kidney support and extracorporeal therapies, (5) pathobiology, nutrition, and pharmacology, and (6) education and advocacy. Using an established modified Delphi process based on existing data, workgroups derived consensus statements with recommendations. Findings: The meeting developed 12 consensus statements and 29 research recommendations. Principal suggestions were to address gaps of knowledge by including data from varying socioeconomic groups, broadening definition of AKI phenotypes, adjudicating fluid balance by disease severity, integrating biopathology of child growth and development, and partnering with families and communities in AKI advocacy. Conclusions and Relevance: Existing evidence across observational study supports further efforts to increase knowledge related to AKI in childhood. Significant gaps of knowledge may be addressed by focused efforts

Uncomplicated Acute Appendicitis – Studies on Diagnosis and Treatment Outcomes

ABSTRACT Appendectomy has been the indisputable treatment of acute appendicitis for over a century. Acute appendicitis has been evaluated to always progress to perforation. Current evidence suggests complicated and uncomplicated acute appendicitis to be different forms of the disease. Complicated appendicitis requires emergency appendectomy with the exception of a restricted periappendicular abscess. Evidence of the feasibility of antibiotic therapy in the treatment of uncomplicated acute appendicitis has been provided by several randomized trials and meta-analyses mainly investigating combinations of intravenous followed by peroral antibiotics. In addition to treatment success, we need to consider treatment costs and patient-centered factors in assessing all different treatment options. With the emerging possibility of nonoperative treatment, accurate diagnosis and differential diagnosis of the appendicitis severity is of vital importance. Computed tomography (CT) is the current gold standard in appendicitis diagnostics, but it is accurately criticized for ionizing radiation, especially with appendicitis patient population consisting of mainly young adults. Low-dose CT protocols have been developed to address this issue. This series of studies aimed at comparing overall treatment costs (Study I) and patient quality of life (QOL), satisfaction, and treatment preference (Study III) between appendectomy and antibiotic therapy. To assess the issue of CT radiation, a low-dose protocol was compared with standard CT in the OPTICAP trial (Study II). The APPAC II trial (Study IV) aimed at optimizing antibiotic therapy for uncomplicated acute appendicitis by comparing p.o. monotherapy with i.v. followed by p.o. antibiotics. The possibility of symptomatic treatment is visited in the APPAC III study protocol (Study V). The overall cost of antibiotic therapy was significantly lower compared to appendectomy with similar QOL, but the patient satisfaction was higher in the appendectomy group. The low-dose CT protocol had comparable diagnostic accuracy with standard CT with significantly less radiation. Treatment success of the peroral monotherapy was clinically comparable to intravenous followed by peroral in the treatment of uncomplicated acute appendicitis. KEYWORDS: acute appendicitis, antibiotics, appendectomy, computed tomography imaging, costs, quality of life, uncomplicated acute appendicitis.TIIVISTELMÄ Umpilisäkkeen poisto on ollut umpilisäketulehduksen hoito yli vuosisadan ajan. Umpilisäketulehduksen on aiemmin ajateltu johtavan aina umpilisäkkeen puhkeamiseen, mutta nykyään tunnistetaan erikseen lievä ja vaikea tautimuoto. Vaikea umpilisäketulehdus vaatii kiireellisen leikkaushoidon lukuun ottamatta umpilisäkkeen vieruskudoksen paisetta. Useat satunnaistetut tutkimukset ja meta-analyysit ovat osoittaneet, että lievempää muotoa voidaan turvallisesti ja tehokkaasti hoitaa suonensisäisten (i.v.) ja tablettimuotoisten (p.o.) antibioottien yhdistelmällä. Verrattaessa leikkaus- ja antibioottihoitoa toisiinsa tulee hoidon tehon lisäksi huomioida hoidon kustannukset ja potilaskohtaiset tekijät. Antibioottihoidon mahdollisuus korostaa lievän umpilisäketulehduksen oikean diagnoosin ja tautimuotojen erottamisen välttämättömyyttä. Tietokonekuvantaminen (TT) on diagnostiikan kultainen standardi, mutta sen ongelmana on säderasitus. Tämä korostuu umpilisäketulehduksen yhteydessä, koska potilaat ovat pääasiassa nuoria aikuisia, minkä vuoksi on kehitetty matala-annoksisia TT-kuvantamistapoja. Tämän tutkimuksen tavoitteena oli verrata leikkaus- ja antibioottihoidon kokonaiskustannuksia (Työ I) sekä potilaiden elämänlaatua ja tyytyväisyyttä (Työ III). Säderasituksen vähentämiseksi vertasimme matala-annoksista TT-kuvantamista standardiin TT-kuvantamiseen OPTICAP-tutkimuksessa (Työ II). APPAC II-tutkimuksessa vertasimme p.o. antibioottia i.v. ja p.o. antibiootin yhdistelmään antibioottihoidon optimoimiseksi (Työ IV). Oireenmukaisen hoidon mahdollisuutta arvioitiin suunnittelemalla lumekontrolloitu APPAC III -tutkimus (Työ V). Antibioottihoidon kustannukset olivat leikkaushoitoa merkittävästi alhaisemmat eikä potilaiden elämänlaadussa ollut eroa, mutta leikatut potilaat olivat tyytyväisempiä saamaansa hoitoon. Matala-annoksisen TT:n diagnostinen tarkkuus vastasi standardia TT:tä merkittävästi alhaisemmalla säderasituksella. Lievän umpilisäketulehduksen hoidossa p.o. antibiootti oli kliinisesti yhtä tehokas kuin i.v. ja p.o. hoidon yhdistelmä. AVAINSANAT: akuutti umpilisäketulehdus, antibiootti, elämänlaatu, kulut, lievä umpilisäketulehdus, umpilisäkkeen poisto, tietokonekuvantamine

Reliability and validity of pediatric triage tools evaluated in Low resource settings: a systematic review

Background: Despite the high burden of pediatric mortality from preventable conditions in low and middle income countries and the existence of multiple tools to prioritize critically ill children in low-resource settings, no analysis exists of the reliability and validity of these tools in identifying critically ill children in these scenarios. Methods: The authors performed a systematic search of the peer-reviewed literature published, for studies pertaining to for triage and IMCI in low and middle-income countries in English language, from January 01, 2000 to October 22, 2013. An updated literature search was performed on on July 1, 2015. The databases searched included the Cochrane Library, EMBASE, Medline, PubMed and Web of Science. Only studies that presented data on the reliability and validity evaluations of triage tool were included in this review. Two independent reviewers utilized a data abstraction tool to collect data on demographics, triage tool components and the reliability and validity data and summary findings for each triage tool assessed. Results: Of the 4,717 studies searched, seven studies evaluating triage tools and 10 studies evaluating IMCI were included. There were wide varieties in method for assessing reliability and validity, with different settings, outcome metrics and statistical methods. Conclusions: Studies evaluating triage tools for pediatric patients in low and middle income countries are scarce. Furthermore the methodology utilized in the conduct of these studies varies greatly and does not allow for the comparison of tools across study sites

Data Science Methods for Nursing-Relevant Patient Outcomes and Clinical Processes The 2019 Literature Year in Review

Data science continues to be recognized and used within healthcare due to the increased availability of large data sets and advanced analytics. It can be challenging for nurse leaders to remain apprised of this rapidly changing landscape. In this article, we describe our findings from a scoping literature review of papers published in 2019 that use data science to explore, explain, and/or predict 15 phenomena of interest to nurses. Fourteen of the 15 phenomena were associated with at least one paper published in 2019. We identified the use of many contemporary data science methods (eg, natural language processing, neural networks) for many of the outcomes. We found many studies exploring Readmissions and Pressure Injuries. The topics of Artificial Intelligence/Machine Learning Acceptance, Burnout, Patient Safety, and Unit Culture were poorly represented. We hope that the studies described in this article help readers: (1) understand the breadth and depth of data science\u27s ability to improve clinical processes and patient outcomes that are relevant to nurses and (2) identify gaps in the literature that are in need of exploratio