General practitioner perspectives on a shared-care model for paediatric patients post-intensive care: A cross-sectional survey.

INTRODUCTION: While paediatric critical illness mortality rates in Australia are declining, the growing cohort of paediatric intensive care unit (PICU) survivors means an increasing number of children facing substantial health challenges after their discharge from intensive care. General practitioners (GPs) play a key role in provision of comprehensive health care to children and families and are ideally positioned to provide developmental surveillance and support the care of both the child and family following critical illness. METHODS: An anonymous, cross-sectional survey of 60 GPs, reached via private invitation (19% response) or via social media weblink, was conducted where the GPs were asked about their current confidence and knowledge in managing children post PICU. This included awareness of short- and long-term problems, of paediatric intensive care syndrome in paediatrics (PICS-p), and of educational materials. Lastly, a parent-completed screening questionnaire and shared-care pathway were proposed to GPs for their feedback on perceived benefit and willingness to participate. Data were analysed using frequency distributions and chi-square statistics. RESULTS: Ninety-three percent of GPs had some level of confidence in caring for a child post PICU admission and low confidence in their knowledge of potential short- and long-term complications. Eighty percent of GPs had not heard of PICS-p, and 93% were unaware of educational materials available on this topic. Ninety-five percent of GPs perceived that the proposed patient-screening tool and shared-care pathways would be beneficial, and 70% predicted that they would definitely use educational materials if accessible through GP central repositories. CONCLUSION: To reduce ongoing health problems for children recovering from critical illness, the family GP plays a pivotal role in providing community-level developmental care, particularly in Australia. Increasing GP confidence and knowledge through education is essential, and using a parent-completed screening questionnaire and shared-care pathway to improve care may be beneficial. GPs must also be involved in the implementation stages of future shared-care models.

Reactive uptake of O3 by multicomponent and multiphase mixtures containing oleic acid.

The heterogeneous reaction of O3 with lauric acid/oleic acid (LA/OA) mixtures and myristic acid/oleic acid (MA/OA) mixtures were studied as a function of composition, physical state, and microstructure at 298 K. Lauric acid and myristic acid are both alkanoic acids, whereas oleic acid is an alkenoic acid. Additionally, we investigated the uptake of O3 by multicomponent mixtures that closely represent the composition of meat-cooking aerosols. These measurements were performed with a rotating-wall flow-tube reactor coupled to a chemical ionization mass spectrometer. The reactive uptake coefficients (gamma) of O3 on liquid LA/OA and MA/OA solutions range from 4 x 10(-4) to 7.2 x 10(-4). The gamma values measured for solid-liquid LA/OA and MA/OA mixtures (which consist of solid LA or solid MA in equilibrium with a liquid) range from 2 x 10(-5) to 1.7 x 10(-4). These experiments show that only 7% solid by mass in the solid-liquid mixture can decrease gamma by an order of magnitude compared to the liquid mixtures. The gamma values for solid-liquid mixtures that closely represent the composition of meat-cooking aerosols range from 1.6 x 10(-5) to 6.9 x 10(-5). We found that gamma of solid-liquid mixtures depends on the microstructure of the mixtures, which in turn depends on the method of preparing the films. Furthermore, experiments employing solid-liquid mixtures show an increase in gamma with increasing film age. This can be explained either by the formation of a nonequilibrium phase followed by its relaxation to the stable phase or by Ostwald's ripening, which refers to a change in the solid microstructure due to a tendency to minimize the total surface free energy of the solid. We used the obtained gamma values to estimate OA lifetimes for polluted atmospheric conditions. For liquid solutions, the lifetimes were on the order of a few minutes. The lifetimes derived for solid-liquid mixtures are up to 75 min, significantly longer than for liquid solutions. Our study emphasizes the effect of the physical state and microstructure of multicomponent mixtures on the heterogeneous chemistry.