Max's legacy: an evaluation of the impacts of baby loss on staff and families
Female; Descriptive Research; Human; Thematic Analysis; Bereavement; Family Attitudes; Semi-Structured Interview; Abortion, Spontaneous; After Care; Attitude of Health Personnel; Focus Groups; Multimethod Studies; Pregnancy Trimester, First; Pregnancy; Safety; United Kingdom
Background/Aims There is a paucity of literature on the impact of baby loss experiences on family and staff. This study aimed to explore existing support available to families and staff in a UK hospital for first trimester miscarriage, as well as experiences of baby loss, and make recommendations for future care. Methods A mixed-methods service evaluation was conducted. Data were gathered from healthcare professionals (surveys, phase 1; interviews, phase 2) and service users who had experienced baby loss (focus group discussions, phase 3). Qualitative data were analysed thematically, alongside descriptive quantitative results. Results Communication, support, recognition of loss and environment were key contributors to positive and negative experiences for staff and families. Peer support enhanced communication, reduced isolation and increased ability to function on a daily basis following loss. Conclusions Formal, resourced maternity bereavement aftercare services are essential to the support the experiences, outcomes and safety of staff and families experiencing baby loss and miscarriage.
Whitehouse C; Crane R; Rostron H; Cater K
British Journal of Midwifery
2023
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.12968/bjom.2023.31.7.368%5C">10.12968/bjom.2023.31.7.368\</a>"
Safety in Pediatric Hospice and Palliative Care: A Qualitative Study
hospice; palliative care; pediatrics; qualitative study; safety
INTRODUCTION: Patient safety is extensively studied in both adults and pediatric medicine; however, knowledge is limited regarding particular safety events in pediatric hospice and palliative care (HPC). Additionally, pediatric HPC lacks a unified definition of safe care. This qualitative study sought to explore caregiver views regarding safe care in pediatric HPC. METHODS: This is a secondary analysis of qualitative data from a multisite study utilizing semistructured interview data to evaluate parental perspectives of quality in pediatric home-based HPC programs across 3 different pediatric tertiary care hospitals. Eligible participants included parents and caregivers of children who were enrolled in a pediatric home-based hospice and palliative care program (HBHPC) from 2012 to 2016. The analysis was done using grounded theory methodology. RESULTS: Forty-three parents participated in 39 interviews across all 3 sites; 19 families were bereaved. Responses to the prompt regarding safe care produced 8 unique domains encompassing parental definitions of safe care in pediatric HPC. DISCUSSION: Parents of children in HPC programs describe "safe care" in novel ways, some of which echo Maslow's hierarchy of needs. The use of traditional hospital safety measures for patients receiving HPC could undermine the patient's goals or dignity, ultimately leading to harm to the patient. CONCLUDING SUMMARY: Patients' and families' unique goals and values must be considered when defining safety for children in this population. Future studies should continue to explore family perspectives of safety in the hospital and ambulatory settings and seek to identify measurable indicators in safety which are truly patient- and family-centered.
Pestian T; Thienprayoon R; Grossoehme D; Friebert S; Humphrey L
Pediatric Quality and Safety
2020
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/pq9.0000000000000328" target="_blank" rel="noreferrer noopener">10.1097/pq9.0000000000000328</a>
Cannabis-based products for pediatric epilepsy: An updated systematic review
Cannabidiol; Efficacy; Living systematic review; Paediatric drug-resistant epilepsy; Safety; Seizure
PURPOSE: To provide an up-to-date summary of the benefits and harms of cannabis-based products for epilepsy in children. METHODS: We updated our earlier systematic review, by searching for studies published up to May 2019. We included randomized controlled trials (RCTs) and non-randomized studies (NRS) involving cannabis-based products administered to children with epilepsy. Outcomes were seizure freedom, seizure frequency, quality of life, sleep, status epilepticus, death, gastrointestinal adverse events, and emergency room visits. RESULTS: Thirty-five studies, including four RCTs, have assessed the benefits and harms of cannabis-based products in pediatric epilepsy (12 since April 2018). All involved cannabis-based products as adjunctive treatment, and most involved cannabidiol. In the RCTs, there was no statistically significant difference between cannabidiol and placebo for seizure freedom (relative risk 6.77, 95 % confidence interval [CI] 0.36-128.38), quality of life (mean difference [MD] 0.6, 95 %CI -2.6 to 3.9), or sleep disruption (MD -0.3, 95 %CI -0.8 to 0.2). Data from both RCTs and NRS suggest that cannabidiol reduces seizure frequency and increases treatment response; however, there is an increased risk of gastrointestinal adverse events. CONCLUSION: Newly available evidence supports earlier findings that cannabidiol probably reduces the frequency of seizures among children with drug-resistant epilepsy. PROSPERO: CRD42018084755.
Elliott J; DeJean D; Clifford T; Coyle D; Potter B K; Skidmore B; Alexander C; Repetski A E; Shukla V; McCoy B; Wells G A
Seizure
2019
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.seizure.2019.12.006" target="_blank" rel="noreferrer noopener">10.1016/j.seizure.2019.12.006</a>
A Scoping Review of Transdermal Buprenorphine Use for Non-surgical Pain in the Pediatric Population
buprenorphine transdermal patch; pain; palliative; pediatrics; safety
A preliminary evaluation to review the scope and quality of evidence surrounding transdermal buprenorphine use in the pediatric setting for non-surgical pain was conducted. Our review revealed limited data available on the use of transdermal buprenorphine in pediatric patients. Most studies surrounding this subject involve accidental ingestion of buprenorphine and its use in the treatment of neonatal abstinence syndrome. While indicated for use only in adult populations, small studies have shown encouraging results in reducing pain in children with few, if any, adverse effects. This is reassuring from a clinical perspective, as we hope to highlight the available evidence and invite researchers to expand future studies. Through this review, we have identified significant gaps in the literature surrounding the safety and use of buprenorphine in the pediatric population. To our knowledge, there are no major studies investigating this subject, and it is our hope that future studies will explore the use of transdermal buprenorphine as an alternative pain management technique in pediatrics. The intent of our scoping review is to highlight the lack of research in this area; therefore, future studies may be conducted to support its use in North America.
Haupt T S; Smyth M; Gregoire M C
Cureus
2019
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.7759/cureus.5954" target="_blank" rel="noreferrer noopener">10.7759/cureus.5954</a>
Cannabis for pediatric epilepsy: protocol for a living systematic review.
Cannabidiol; Cannabinoids; Cannabis; Efficacy; Living systematic review; Meta-analysis; Pediatric epilepsy; Safety; Seizure
BACKGROUND: Pediatric epilepsy, including treatment-resistant forms, has a major effect on the quality of life, morbidity, and mortality of affected children. Interest has been growing in the use of medical cannabis as a treatment for pediatric epilepsy, yet there has been no comprehensive review of the benefits and harms of cannabis use in this population. In this systematic review, we will search for, synthesize, and assess the published and gray literature in order to provide usable and relevant information to parents, clinicians, and policy makers. METHODS: We will perform a living systematic review of studies involving the use of cannabis to treat pediatric epilepsy. We will search the published and gray literature for studies involving children with any type of epilepsy taking any form of cannabis. Studies will be selected for inclusion by two independent reviewers. The primary outcome is seizure freedom. Secondary outcomes are seizure frequency, quality of life (child, caregiver), quality and quantity of sleep, status epilepticus, tonic-clonic seizures, death (all-cause, sudden unexpected death in epilepsy), gastrointestinal adverse events (diarrhea, vomiting), and visits to the emergency room. The quality of each included study will be assessed. If data are sufficient in quantity and sufficiently similar, we will conduct pairwise random-effects meta-analysis. We will repeat the literature search every 6 months to identify studies published after the previous search date. Sequential meta-analysis will be performed as necessary to update the review findings. DISCUSSION: Our review aims to provide a comprehensive and up-to-date summary of the available evidence to inform decisions about the use of cannabis in children with treatment-resistant epilepsy. The results of this review will be of use to parents, clinicians, and policy makers as they navigate this rapidly evolving area. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018084755.
Elliott J; DeJean D; Clifford T; Coyle D; Potter B; Skidmore B; Alexander C; Repetski AE; McCoy B; Wells GA
Systematic reviews
2018
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1186/s13643-018-0761-2" target="_blank" rel="noreferrer noopener">10.1186/s13643-018-0761-2</a>
Adolescent psychopharmacology: drugs for mood disorders
Humans; Comorbidity; Diagnostic and Statistical Manual of Mental Disorders; Primary Health Care; adolescent; Safety; Antimanic Agents/adverse effects/therapeutic use; Antidepressive Agents/adverse effects/therapeutic use; Attention Deficit Disorder with Hyperactivity/epidemiology; Mood Disorders/diagnosis/drug therapy/epidemiology; Suicide/prevention & control
This article reviews mood disorders in children and adolescents, the diagnostic criteria, and important differential diagnoses to be considered. Critical points in the treatment of mood disorders and comorbid conditions and the important role the primary care provider can play in their management are stressed. Warning signs to identify adolescents who may be at risk of attempting suicide are discussed.
2006
Bolfek A; Jankowski JJ; Waslick B; Summergrad P
Adolescent Medicine Clinics
2006
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/j.admecli.2006.06.003" target="_blank" rel="noreferrer">10.1016/j.admecli.2006.06.003</a>
Patient safety in anesthesia--continuing challenges and opportunities
Humans; Canada; Analgesia; Anesthesia/adverse effects; Medical Errors/prevention & control; Patient-Controlled/adverse effects; Safety
2003
Wade JG
Canadian Journal Of Anaesthesia
2003
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1007/bf03021025" target="_blank" rel="noreferrer">10.1007/bf03021025</a>
Open lung biopsy in neonatal and paediatric patients referred for extracorporeal membrane oxygenation (ECMO)
Child; Humans; infant; Extracorporeal Membrane Oxygenation; infant; referral and consultation; Newborn; retrospective studies; Heart Defects; Safety; Biopsy/methods; Congenital/pathology; Hyperplasia/pathology; Lung/pathology; Respiratory Insufficiency/pathology/surgery/therapy; Thoracotomy/methods
BACKGROUND: This study was undertaken to determine the usefulness, safety, and most appropriate timing of open lung biopsy in infants and children considered for and on extracorporeal membrane oxygenation (ECMO) for respiratory failure. METHODS: A retrospective review of children referred for consideration of and placed on ECMO in our institution in the period 1996-2002. RESULTS: 506 patients were referred, 15 (3%) of whom underwent antemortem open lung biopsy (eight neonatal, four paediatric, and three cardiac patients). In the neonatal group open lung biopsy contributed to clinical decision making in all patients. Four neonates had a fatal lung dysplasia (three alveolar capillary dysplasia and one surfactant protein B deficiency) and treatment was withdrawn. Of the other four neonates, two had pulmonary hypoplasia, one had pulmonary lymphangiectasia, and one had meconium aspiration with mild barotrauma. Treatment was continued in these four patients and two survived. In the paediatric group the biopsies were of clinical relevance in two infants with pertussis who had lung infarction on biopsy in whom treatment was withdrawn. In the other two paediatric patients the biopsies were equivocal, treatment was continued, but both patients died. In the cardiac group, who presented perioperatively with pulmonary hypertension, the biopsies excluded a fatal lung dysplasia and severe pulmonary vascular disease but all three infants died. One patient had non-fatal bleeding complications. CONCLUSION: Open lung biopsy is clinically most useful when performed to diagnose fatal lung dysplasias in neonates and to confirm the presence of viable lung tissue in patients with acute lung injury due to pertussis infection.
2004
Inwald D; Brown K; Gensini F; Malone M; Goldman A
Thorax
2004
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1136/thx.2003.010793" target="_blank" rel="noreferrer">10.1136/thx.2003.010793</a>
Patient-controlled analgesia
Humans; Pain; Adult; Analgesics; Patient Selection; Analgesia; Infusions; Injections; Intravenous; Dose-Response Relationship; Drug; Opioid/adverse effects/therapeutic use; Safety; Patient-Controlled/instrumentation; Postoperative/prevention & control; Respiration/drug effects
In appropriately selected patients, PCA safely provides analgesia superior to that obtained with traditional IM prn opioid administration; however, to date, no compelling evidence shows that PCA is associated with a reduction in morbidity or a more rapid recovery. PCA is deceptively easy to prescribe; however, to use it effectively and safely requires experience, frequent patient assessment, and a skilled and knowledgeable nursing staff.
1999
Etches RC
The Surgical Clinics Of North America
1999
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/s0039-6109(05)70384-4" target="_blank" rel="noreferrer">10.1016/s0039-6109(05)70384-4</a>
Pediatric utilization of rapamycin for severe cardiac allograft rejection
Child; Female; Humans; Adult; Animals; Acute Disease; Rabbits; Safety; Platelet Count; dosage; Antilymphocyte Serum/administration &; Cyclosporine/administration &; derivatives; dosage/adverse effects/therapeutic use; dosage/analogs &; Graft Rejection/drug therapy/etiology/pathology; Heart Transplantation/adverse effects; Immunosuppressive Agents/administration &; Methotrexate/administration &; Methylprednisolone/administration &; Mycophenolic Acid/administration &; Prednisone/administration &; Sirolimus/administration &; T-Lymphocytes/immunology; Tacrolimus/administration &
BACKGROUND: Rapamycin is a new immunosuppressive agent that has been shown to be effective in the treatment of acute cardiac rejection in the adult population. METHODS: This case documents a pediatric patient with ongoing cardiac rejection that did not abate despite treatment with antithymocyte serum (RATS), corticosteroid pulses, and methotrexate in addition to daily prednisone, mycophenolate mofetil, and tacrolimus. RESULTS: Initiation of therapy with rapamycin resulted in a rapid resolution of cardiac rejection and reduction of concomitant immunosuppressive agents and few side effects. CONCLUSIONS: This case illustrated the utilization of rapamycin in a pediatric patient with ongoing acute rejection despite several modifications in treatment.
2000
Straatman LP; Coles JG
Transplantation
2000
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1097/00007890-200008150-00025" target="_blank" rel="noreferrer">10.1097/00007890-200008150-00025</a>
Development Of Research Priorities In Paediatric Pain And Palliative Care
Chronic Pain; Palliative Therapy; Research Priority; Awareness; Child; Clinical Research; Clinical Study; Clinical Trial; Data Base; Exercise; Gabapentin; Human; Nonsteroid Antiinflammatory Agent; Opiate; Pharmacokinetics; Postoperative Pain; Safety; Symptom; Uncertainty; United Kingdom
Liossi C; Anderson AK; Howard R
British Journal Of Pain
2017
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
10.1177/2049463716668906
Blended Foods For Tube-fed Children: A Safe And Realistic Option? A Rapid Review Of The Evidence
Child; Clinical Research; Constipation; Human; Nervous System Diseases; Nutrition; Only Child; Safety
With the growing number of children and young people with complex care needs or life-limiting conditions, alternative routes for nutrition have been established (such as gastrostomy feeding). The conditions of children and young people who require such feeding are diverse but could relate to problems with swallowing (dysphagia), digestive disorders or neurological/muscular disorders. However, the use of a blended diet as an alternative to prescribed formula feeds for children fed via a gastrostomy is a contentious issue for clinicians and researchers. From a rapid review of the literature, we identify that current evidence falls into three categories: (1) those who feel that the use of a blended diet is unsafe and substandard; (2) those who see benefits of such a diet as an alternative in particular circumstances (eg, to reduce constipation) and (3) those who see merit in the blended diet but are cautious to proclaim potential benefits due to the lack of clinical research. There may be some benefits to using blended diets, although concerns around safety, nutrition and practical issues remain.
Coad J; Toft A; Lapwood S; Manning J; Hunter M; Jenkins H; Sadlier J; Kennedy A; Murch S; Widdas D
Archives Of Disease In Childhood
2017
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
http://dx.doi.org/10.1136/archdischild-2016-311030