Consent for babies born following surrogate pregnancies.

Surrogate pregnancies are becoming more common, but the law governing who can give consent following surrogate births is complex. Parental responsibility (PR) may be held by a variety of individuals, depending on the specific circumstances.We conducted a survey of paediatric medical staff within Health Education South West to establish knowledge regarding consent for a baby before a parental or adoption order is obtained. Our results showed that 19% of the 47 respondents answered all scenarios correctly. 43% of respondents knew that the surrogate mother had PR in all scenarios; however, 13% incorrectly assumed that either intended parent always had PR. Knowledge of other individuals who could provide consent in the scenarios was variable.Our survey revealed poor understanding regarding medicolegal aspects of consent in these complex situations, emphasising the need for more specific published guidance for primary and secondary healthcare professionals encountering these babies in the early postnatal period.

Using a Parent Coordinator to Support the Role of the Pediatric Nurse Practitioner in Care Coordination.

The role of the pediatric nurse practitioner is becoming more complex with time. Both patients and the health care system are becoming more intricate. Effective support of the PNP can consist of a nonclinical professional who is a parent of a chronically ill child. Support including data entry, preclinic planning, self-management support, appointment scheduling, research, and between-visit follow-up can be provided from the perspective of a parent. This article will describe the role of a parent coordinator who was hired in part to provide support for a pediatric nurse practitioner in a primary care clinic for patients with asthma.

Improving the acute care of COPD patients across Gloucestershire: a quality improvement project.

Admissions for exacerbations of chronic obstructive pulmonary disease (COPD) present a significant proportion of patients in the acute medical take. The British Thoracic Society (BTS) provides guidelines for time specific interventions, that should be delivered to those with an acute exacerbation of COPD through the admission care bundle. These include correct diagnosis, correct assessment of oxygenation, early administration of treatment, recognition of respiratory failure, and specialist review. Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) chose improvement in acute COPD care to be a local Commissioning for Quality and Innovation (CQUIN) scheme, which enables commissioners to reward excellence by linking a proportion of English healthcare providers' income to the achievement of local quality improvement goals. The effects of initiatives put in place by senior clinicians had waned, and further improvements were required to meet the CQUIN target. The aim of the scheme was to improve compliance with the BTS guidelines and CQUIN scheme for patients admitted with an exacerbation of COPD. Specific bundle paperwork to be used for all patients admitted to the Trust with an exacerbation of COPD was introduced to the Trust in June 2014, with training and education of medical staff at that time. This had improved compliance rates from 10% to 63% by September 2014. Compliance with each intervention was audited through the examination of notes of patients admitted with an exacerbation of COPD. Compliance rates had plateaued over the last three months, and so a focus group involving junior medical staff met in September 2014 to try to increase awareness further, in order to drive greater improvements in care, and meet the CQUIN requirements. Their strategies were implemented, and then compliance with the CQUIN requirements was reaudited as described above. The December 2014 audit results showed a further improvement in overall COPD care, with 73% of patients receiving all elements of the COPD admission care bundle, versus 63% in September 2014. Appropriate blood gas analysis, nebuliser administration, and respiratory review also improved. Prescription of steroids and antibiotics remained static, with 96% of patients receiving these treatments within four hours in the emergency department (ED). The only criteria which showed a decline was appropriate oxygen prescription, which dipped from 97% to 87%. After the effect of initial strategies plateaued, this quality improvement project facilitated a further increase in compliance with the CQUIN targets, both improving patient care, and safeguarding continued CQUIN funding. There is further work to be done to maintain and support further improvement in standards, and to encourage use of the COPD admission bundle paperwork for documentation purposes.

Evaluation of readiness to transfer to adult healthcare: What about the well adolescent?

BACKGROUND: Understanding readiness to transfer from pediatric to adult healthcare is important for all youth; however, research and implementation guidelines in this area have emphasized youth seen in pediatric subspecialty settings. The purpose of this study was to develop an approach for evaluating transition readiness in a primary care setting, collect pilot data that examined the transition readiness of teens in that program, and implement assessments as part of clinical care. METHOD: Forty boys and girls aged 12-22 were recruited from an adolescent medicine outpatient program in a large children's hospital. The first 10 adolescents provided responses to questions and participated in cognitive interviewing. Questions changed minimally and responses from all 40 participants were combined. After the study visit, a researcher compared participant responses to electronic medical records and coded responses for accuracy. The survey consisted of 41 transition readiness items from previously published measures. RESULTS: The research team was able to develop a tool to assess transition readiness within a clinical setting. When administered to participants from that program, participants demonstrated poor transition readiness. Modifications were made based on participant feedback and implementation in the clinical setting. Clinicians were successful with administering transition readiness assessments. CONCLUSIONS: It appears that even in youth who are generally well, transition readiness is low. Transition readiness assessments can be implemented in the primary care setting, and have been useful for guiding clinical care. Additional barriers and next steps will be discussed.

Using functional transcranial Doppler ultrasonography to assess language lateralisation: Influence of task and difficulty level.

Language is lateralised to the left hemisphere in most people, but it is unclear whether the same degree and direction of lateralisation is found for all verbal tasks and whether laterality is affected by task difficulty. We used functional transcranial Doppler ultrasonography (fTCD) to assess the lateralisation of language processing in 27 young adults using three tasks: word generation (WG), auditory naming (AN), and picture story (PS). WG and AN are active tasks requiring behavioural responses whereas PS is a passive task that involves listening to an auditory story accompanied by pictures. We also examined the effect of task difficulty by a post hoc behavioural categorisation of trials in the WG task and a word frequency manipulation in the AN task. fTCD was used to measure task-dependent blood flow velocity changes in the left and right middle cerebral arteries. All of these tasks were significantly left lateralised: WG, 77% of individuals left, 5% right; AN, 72% left: 4% right; PS, 56% left: 0% right. There were significant positive relationships between WG and AN (r=0.56) as well as AN and PS (r=.76) but not WG and PS (r = -0.22). The task difficulty manipulation affected accuracy in both WG and AN tasks, as well as reaction time in the AN task, but did not significantly influence laterality indices in either task. It is concluded that verbal tasks are not interchangeable when assessing cerebral lateralisation, but that differences between tasks are not a consequence of task difficulty.