Paediatric nursing : an investigation of the effect of specialist paediatric nurse education on the quality of children’s nursing care in Western Australia

In Australia, specialist education in paediatrics is not a requirement for nurses caring for hospitalised children. Thus, nurses can work in paediatrics without any prior knowledge of the unique needs of children such as developmental stages or separation anxiety. As a consequence, there are some clinicians and authors who advocate that when children require health care, they should be cared for by nurses who are educated in, and understand the specific physical, psychological and social needs of children. Despite this, the evidence is lacking as to whether specialist nurse education affects the quality of care in paediatrics. This study investigates whether the quality of care that children and their families receive is different to when they are nursed by specialist paediatric nurses (SPNs) compared to nonspecialist paediatric Registered Nurses (NSPNs). SPNs are Registered Nurses who have undertaken specific or further education in paediatrics and NSPNS are Registered Nurses who have no specific or further education in paediatrics. This research was prompted by national policy changes in Registered Nurse (RN) education which shifted the focus from hospital-based training to the tertiary sector. There has not been a review of paediatric nurse education in Australia since these changes in 1994. Quality measures have been developed for the admission procedure as it is the most common clinical procedure performed in hospital on children. The quality measures were defined by the literature and a Delphi Panel of international paediatric nursing experts. The five stage methodology incorporated: (i) a desk analysis of the literature and policies regarding paediatric nursing and education to identify quality measures (QMs); (ii) development of QMs for the most common hospital procedure for children, the admission procedure; (iii) the development of a consensus definition of QMs using the Delphi method; (iv) observation of RNs using video during the admission of children to the hospital to test the proposed QMs and measure whether SPNs behaved differently to NSPNs; and (v) a follow-up on-line survey of all of the observed RNs regarding their perceptions of other factors influencing their practice. This research found that overall, SPNs meet the quality measures during the admission procedure significantly more often than NSPNs (p=0.009). When the QMs were analysed individually, the analysis showed a significant relationship between education and some of the QMs, but not in others where the relationship was not statistically different. This leads to the assumption that there are other factors than the level of specialist education which affect the quality of care such as prompts on admission forms and/ or the RNs‘ personal experiences. However, in the on-line survey of the sample, the RNs reported that tailored education has played a major role in their care delivery to children and their families. The findings of this research indicate that in Australia, the ‗comprehensive‘ nursing model, which leads to the qualification of RN, may not be the best model for delivering the highest quality of care to children and their families

Improving Quality of Acute Asthma Care in US Hospitals Changes Between 1999-2000 and 2012-2013

BackgroundLittle is known about the longitudinal change in the quality of acute asthma care for hospitalized children and adults in the United States. We investigated whether the concordance of inpatient asthma care with the national guidelines improved over time, identified hospital characteristics predictive of guideline concordance, and determined whether guideline-concordant care is associated with a shorter hospital length of stay (LOS).MethodsThis study was an analysis of data from two multicenter chart review studies of hospitalized patients aged 2 to 54 years with acute asthma during two time periods: 1999-2000 and 2012-2013. Outcomes were guideline concordance at the patient and hospital levels, and association of patient composite concordance with hospital LOS.ResultsThe analytic cohort for the comparison of guideline concordance comprised 1,634 patients: 834 patients from 1999-2000 vs 800 patients from 2012-2013. Over these 15 years, inpatient asthma care became more concordant at the hospital-level, with the mean composite score increasing from 74 to 82 (P < .001). However, during 2012-2013, wide variability in guideline concordance of acute asthma care remained across hospitals, with the greatest variation in provision of individualized written action plan at discharge (SD, 36). Guideline concordance was significantly lower in Midwestern and Southern hospitals compared with Northeastern hospitals. After adjusting for severity, patients who received care perfectly concordant with the guidelines had significantly shorter hospital LOS (-14% [95% CI, -23 to -4]; P = .009).ConclusionsBetween 1999 and 2013, the guideline concordance of acute asthma care for hospitalized patients improved. However, interhospital variability remains substantial. Greater concordance with evidence-based guidelines was associated with a shorter hospital LOS

Whole genome, transcriptome and methylome profiling enhances actionable target discovery in high-risk pediatric cancer

The Zero Childhood Cancer Program is a precision medicine program to benefit children with poor-outcome, rare, relapsed or refractory cancer. Using tumor and germline whole genome sequencing (WGS) and RNA sequencing (RNAseq) across 252 tumors from high-risk pediatric patients with cancer, we identified 968 reportable molecular aberrations (39.9% in WGS and RNAseq, 35.1% in WGS only and 25.0% in RNAseq only). Of these patients, 93.7% had at least one germline or somatic aberration, 71.4% had therapeutic targets and 5.2% had a change in diagnosis. WGS identified pathogenic cancer-predisposing variants in 16.2% of patients. In 76 central nervous system tumors, methylome analysis confirmed diagnosis in 71.1% of patients and contributed to a change of diagnosis in two patients (2.6%). To date, 43 patients have received a recommended therapy, 38 of whom could be evaluated, with 31% showing objective evidence of clinical benefit. Comprehensive molecular profiling resolved the molecular basis of virtually all high-risk cancers, leading to clinical benefit in some patients