Thematic grouping of barriers and enablers for physician participation following the domains of the TDF.

<p>Thematic grouping of barriers and enablers for physician participation following the domains of the TDF.</p

Model summarizing key TDF domains influencing physician participation in the initiative.

<p>The five TDF domains are shown with the barriers and enablers that map to each domain listed below the name of the domain. Barriers are indicated with a “-” sign and enablers with a “+” sign.</p

Lactation Support and Breastfeeding Duration in Jaundiced Infants: A Randomized Controlled Trial

<div><p>Objectives</p><p>Neonatal jaundice is the most common problem in full-term infants during the immediate post-natal period. We examined the effect of a lactation support intervention on breastfeeding duration in hospitalized jaundiced infants.</p><p>Study Design</p><p>We conducted a randomized controlled trial with a qualitative component involving mothers of hospitalized jaundiced breastfed infants <4 weeks of age. Mothers receiving the intervention met with an International Board-Certified Lactation Consultant in hospital and 1–3 times post discharge. Both groups received the standard care for jaundice. The primary outcome was exclusive breastfeeding at 3 months. To the exception of research assistants enrolling participants and completing qualitative interviews, all research staff, investigators and statisticians were blinded to group assignment. Qualitative interviews elicited feedback on breastfeeding experiences for both groups.</p><p>Results</p><p>99 participants were recruited, and 86 analyzed for primary outcome. There was no difference in exclusive breastfeeding at 3 months between groups (RR 0.84, 95% CI 0.56–1.24, p = 0.40) or in the secondary outcomes. 31 participants were included in the qualitative analysis. Participants in the intervention group described an increase in comfort and confidence levels with breastfeeding. Participants in the control group reported limited lactation support.</p><p>Conclusions</p><p>Our hospital-based lactation support program did not result in a higher proportion of mothers exclusively breastfeeding at 3 months compared to current hospital standard care. Qualitative feedback from the intervention group suggests that mothers’ confidence was increased, which is linked to breastfeeding duration. The decision to breastfeed is multifactorial and hospital-based lactation support may be only a small piece of the puzzle in hospitalized jaundiced infants. Further studies may be needed to fully elucidate the impact of an in-hospital lactation support program on successful breastfeeding for these infants.</p><p>Trial Registration</p><p>ClinicalTrials.gov NCT00966719 <a href="https://www.clinicaltrials.gov/ct2/show/NCT00966719?term=Lactation+Support+and+Breastfeeding+Duration+in+Jaundiced+Infants%3A+a+Randomized+Controlled+Trial&rank=1" target="_blank">https://www.clinicaltrials.gov/ct2/show/NCT00966719?term=Lactation+Support+and+Breastfeeding+Duration+in+Jaundiced+Infants%3A+a+Randomized+Controlled+Trial&rank=1</a></p></div

CONSORT diagram.

<p>CONSORT diagram.</p

Demographics and clinical characteristics of all participating mothers.

<p>^an = 97,</p><p>^bn = 98,</p><p>^cn = 45</p><p>Demographics and clinical characteristics of all participating mothers.</p

Comparison of proportions of mothers breastfeeding in study control group and community in general.

<p>^a Ottawa Public Health. Infant Care Survey 2005 [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0119624#pone.0119624.ref016" target="_blank">16</a>]</p><p>^bP values obtained through one-sample binomial tests</p><p>Comparison of proportions of mothers breastfeeding in study control group and community in general.</p

Understanding Low-Acuity Visits to the Pediatric Emergency Department

<div><p>Background</p><p>Canadian pediatric emergency department visits are increasing, with a disproportionate increase in low-acuity visits locally (33% of volume in 2008-09, 41% in 2011-12). We sought to understand: 1) presentation patterns and resource implications; 2) parents’ perceptions and motivations; and 3) alternate health care options considered prior to presenting with low-acuity problems.</p><p>Methods</p><p>We conducted a prospective cohort study at our tertiary pediatric emergency department serving two provinces to explore differences between patients with and without a primary care provider. During four, 2-week study periods over 1 year, parents of low-acuity visits received an anonymous survey. Presentation times, interventions, diagnoses and dispositions were captured on a data collection form linked to the survey by study number.</p><p>Results</p><p>Parents completed 2,443 surveys (74.1% response rate), with survey-data collection form pairs available for 2,146 visits. Overall, 89.7% of respondents had a primary care provider; 68% were family physicians. Surprisingly, 40% of visits occurred during weekday office hours and 27.3% occurred within 4 hours of symptom onset; 67.5% of those early presenters were for injuries. Few parents sought care from their primary care provider (25%), health information line (20.7%), or urgent care clinic (18.5%); 36% reported that they believed their child’s problem required the emergency department. Forty-five percent required only a history, physical exam and reassurance; only 11% required an intervention not available in an office setting. Patients without a primary care provider were significantly more likely to present during weekday office hours (<i>p</i> = 0.003), have longer symptom duration (<i>p</i><0.001), and not know of other options (<i>p</i> = 0.001).</p><p>Conclusions</p><p>Many parents seek pediatric emergency department care for low-acuity problems despite their child having a primary care provider. Ensuring timely access to these providers may help reduce pediatric emergency department overuse. Educational initiatives should inform parents about low-acuity problems and where appropriate care can/should be accessed.</p></div

Motivations and perceptions about coming to the emergency department.

<p>PCP-, Patient does not have a primary care provider. PCP+, Patient does have a primary care provider p values represent significant differences between subgroups by Pearson’s chi-square test. * p = 0.001. ** p<0.001. *** p = 0.005.</p

Chief complaint, as reported by the parent.

<p>PCP-, Patient does not have a primary care provider (n = 210). PCP+, Patient does have a primary care provider (n = 1,854).</p

Duration of symptoms prior to presentation*.

<p>PCP-, Patient does not have a primary care provider (n = 250). PCP+, Patient does have a primary care provider (n = 2,134). * p<0.001.</p