In outpatient settings, the role of nursing has shifted from episodic, reactive care to management of patients with higher acuity. In a pediatric outpatient clinic specializing in burn injuries, it ...became apparent that the lack of an acuity tool to measure patient complexity challenged efficient nurse staffing and patient satisfaction. In this quality improvement project, we developed a patient acuity tool to help determine nurse staffing, improve workload efficiencies, and improve the delivery of care.
This report supports policy recommendations in the accompanying policy statement "Child Pedestrian Safety" (www.pediatrics.org/cgi/doi/10.1542/peds.2023-62506). It reviews trends in public health and ...urban design relevant to pedestrian safety and provides information to assist practicing pediatricians discussing the benefits of active transportation and the specific risks and safety precautions to consider for child pedestrians at different ages. The report offers the evidence base for which programs and policies that, if implemented, could foster independent mobility for children while increasing pediatric pedestrian safety. Since the previous policy statement was published in 2009, the field of pedestrian safety has advanced with new evidence related to pediatric pedestrian education, the risks of distracted walking, the benefits of design and programming in safe routes to school, and the emergence of the "Vision Zero" public health and safety initiatives to prevent all serious and fatal transportation injuries.
Child Pedestrian Safety Kendi, Sadiqa; Johnston, Brian D
Pediatrics,
2023-Jul-01, 2023-07-01, 20230701, Letnik:
152, Številka:
1
Journal Article
Recenzirano
Odprti dostop
The field of pedestrian safety has advanced with new evidence related to pediatric pedestrian education, the risks of distracted walking, the benefits of design and programming in safe routes to ...school, and the emergence of the "Vision Zero" strategy to eliminate all traffic fatalities and severe injuries while increasing safe, healthy, equitable mobility for all. This statement is a revision of the 2009 American Academy of Pediatrics policy statement "Pedestrian Safety" and is accompanied by a technical report (www.pediatrics.org/cgi/doi/10.1542/peds.2023-062508) providing additional detail to support recommendations. This statement is intended to assist practicing pediatricians to offer evidence-based advice to families about the benefits of active transportation and the specific risks and safety precautions to consider for child pedestrians at different ages. For community pediatricians and the American Academy of Pediatrics, the statement provides an overview of specific programs and policies that, if implemented, could foster independent mobility for children while increasing pediatric pedestrian safety. This statement identifies trends in public health and urban design relevant to pedestrian safety.
Intimate Partner Violence: Role of the Pediatrician Thackeray, Jonathan; Livingston, Nina; Ragavan, Maya I ...
Pediatrics (Evanston),
2023-Jul-01, 2023-07-01, 20230701, Letnik:
152, Številka:
1
Journal Article
Recenzirano
The American Academy of Pediatrics and its members recognize the importance of improving the physician's ability to recognize intimate partner violence (IPV) and understand its effects on child ...health and development and its role in the continuum of family violence. Pediatricians are in a unique position to identify IPV survivors in pediatric settings, to evaluate and treat children exposed to IPV, and to connect families with available local and national resources. Children exposed to IPV are at increased risk of being abused and neglected and are more likely to develop adverse health, behavioral, psychological, and social disorders later in life. Pediatricians should be aware of these profound effects of exposure to IPV on children and how best to support and advocate for IPV survivors and their children.
Understanding why children die is necessary to implement strategies to prevent future deaths and improve the health of any community. Child fatality review teams (CFRTs) have existed since the 1970s ...and provide a necessary framework to ensure that proper questions are asked about a child's death. CFRTs provide a vital function in a community to ensure that preventable causes of deaths are identified. Pediatricians are necessary members of CFRTs because they provide medical expertise and context around a child's death. All CFRTs should have pediatric physician representation, and results from team meetings should inform public policy at all levels of government. Pediatricians should be supported in their efforts to be present on CFRTs, and they should use data from team meetings to help advocate for implementing prevention strategies.
To examine literature on recruitment and retention of military women in research studies as an underrepresented, and potentially marginalized, population.
A literature search was conducted to examine ...challenges, identify potential barriers and facilitators, and to inform strategies for recruitment and retention of military women in research studies. This search was supplemented by findings in military-specific databases and discussions with Military Women's Health Research Interest Group subject matter experts.
Ten articles addressed research recruitment and retention challenges and strategies in marginalized/underrepresented populations, providing an effective context to inform research recruitment and retention in military settings. Research with military women is often challenged by logistical, cultural, social, ethical, and methodological issues, which may hinder exploration of potentially sensitive issues.
Researchers must consider military-specific challenges to conducting research that include lengthy deployments, unpredictable military exercises, and foreign assignments, in accessing research participants. A case example shows strategies used in a military cervical cancer screening study.
There are few published articles specific to research recruitment and retention in female military populations. Available resources broadly address recruitment challenges for Veterans, marginalized, hard-to-access, and transient research participants, which may provide guidance and strategies for success when applied to military populations.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Introduction
Recent policy revisions allow greater inclusion of military women in operational and/or deployable positions (ie, shipboard, overseas, and war zone duty assignments), but these positions ...can create unique health care challenges. Military members are often transient due to deployments and change of duty stations, impacting timely follow‐up care for treatable health conditions. There has been minimal research on challenges or strategies in preventive health screening and follow‐up for US military women.
Methods
The purpose of this qualitative research study was to describe US Navy women's experiences with abnormal cervical cancer screenings requiring colposcopic follow‐up care. Ship‐ and shored‐based women receiving care at a military colposcopy clinic completed interviews about their experience. Two forms of narrative analysis, Labov's sociolinguistic structural analysis and Braun and Clarke's thematic analysis, were employed to gain a more robust understanding of the women's experiences.
Results
The sample was comprised of 26 women (16 ship‐based, 10 shore‐based). Five themes were identified: 1) It's like this bombshell (initial abnormal results notification); 2) I didn't understand (self‐discovery process); 3) Freaked (emotional toll); 4) It's kind of like this back and forth (scheduling and navigating care); and 5) It really opened my eyes (lessons learned).
Discussion
The women's stories highlighted some issues unique to military health care, such as operational demands and follow‐up care; other issues are likely common for most women learning about an abnormal cervical cancer screening result. Areas important for practice and future research include improving notification practices, providing information, understanding women's fear, and continuity of care. Research exploring educational initiatives and self‐management practices are critical within military populations.
Elder neglect is the one of the most pervasive forms of mistreatment, and often the only place outside of the individual's residence to identify and assist neglected individuals is in a medical ...setting. However, elder neglect cases treated in hospitals do not present with a single diagnosis or clinical sign, but rather involve a complex constellation of clinical signs. Currently, there is a lack of comprehensive guidelines on which clinical signs to use in screening tools for neglect among patients treated in hospitals. Using the DELPHI method, a group of experts developed and tested a scale to be used as a pre-screener that conceptually could be integrated into electronic health record systems so that it could identify potential neglect cases in an automated manner. By applying the scale as a pre-screener for neglect, the tool would reduce the pool of at-risk patients who would benefit from in-depth screening for elder neglect by 95%.
The heterogeneous nature of stem cells is an important issue in both research and therapeutic use in terms of directing cell lineage differentiation pathways, as well as self-renewal properties. ...Using flow cytometry we have identified two distinct subpopulations by size, large and small, within cultures of human embryonic stem (hES) cell lines. These two cell populations respond differentially to retinoic acid (RA) differentiation and several endocrine disruptor compounds (EDC). The large cell population responds to retinoic acid differentiation with greater than a 50% reduction in cell number and loss of Oct-4 expression, whereas the number of the small cell population does not change and Oct-4 protein expression is maintained. In addition, four estrogenic compounds altered SSEA-3 expression differentially between the two cell subpopulations changing their ratios relative to each other. Both populations express stem cell markers Oct-4, Nanog, Tra-1–60, Tra-1–80 and SSEA-4, but express low levels of differentiation markers common to the three germ layers. Cloning studies indicate that both populations can revive the parental population. Furthermore, whole genome microarray identified approximately 400 genes with significantly different expression between the two populations (p<0.01). We propose the differential response to RA in these populations is due to differential gene expression of Notch signaling members, CoupTF1 and CoupTF2, chromatin remodeling and histone modifying genes that render the small population resistant to RA differentiation. The findings that hES cells exist as heterogeneous populations with distinct responses to differentiation signals and environmental stimuli will be relevant for their use for drug discovery and disease therapy.
► We describe functional and structural heterogeneity of human embryonic stem cell (hESCs). ► We show that hESCs have two subpopulations that differ in size and gene expression signatures. ► hESC subpopulations display differential expression of key signaling and chromatin regulators. ► Subpopulations may explain unique responsiveness to retinoic acid and endocrine disruptors. ► Understanding hESC subpopulations may have important implications for regenerative medicine.
Concern exists that prednisone-free maintenance immunosuppression in kidney transplant recipients will increase acute and/or chronic rejection.
From October 1, 1999, through February 29, 2004, at our ...center, 477 kidney transplant recipients (341 living donor, 136 cadaver) discontinued prednisone on postoperative day 6, per our protocol. Immunosuppression consisted of polyclonal antibody (Thymoglobulin) for 5 days, prednisone intraoperatively and for 5 days, a calcineurin inhibitor, and either sirolimus or mycophenolate mofetil. We compared outcome with that of historical controls who did not discontinue prednisone.
The recipients on prednisone-free maintenance immunosuppression had excellent 4-year actuarial patient survival (92%), graft survival (90%), acute rejection-free graft survival (86%), and chronic rejection-free graft survival (95%). The mean serum creatinine level (+/- SD) at 1 year was 1.6 +/- 0.6; at 4 years, 1.6 +/- 0.6. We noted that 8% of recipients had cytomegalovirus (CMV) disease; 4.5%, fractures; 2.8%, cataracts; 1%, posttransplant diabetes; 0.2%, avascular necrosis; 0.2%, posttransplant lymphoproliferative disease; and 0%, polyomavirus. In all, 85% of kidney recipients with functioning grafts remain prednisone-free as of April 1, 2004. As compared with historical controls, the recipients on prednisone-free maintenance immunosuppression had better patient (P = 0.02) and graft survival (P < 0.0001) and lower rates of acute (P = 0.0004) and chronic (P = 0.02) rejection. In addition, they had a significantly lower rate of CMV disease (P < 0.0001), cataracts (P < 0.0001), posttransplant diabetes (P < 0.0001), and avascular necrosis (P = 0.0003).
Prednisone-related side effects can be minimized without maintenance immunosuppression; our prednisone-free recipients do not have increased acute or chronic rejection.
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