Publication of pediatric theses defended at the Tunis Faculty of Medicine: A 15-year study.

INTRODUCTION: The valorisation of thesis through its publication is necessary to enhance its visibility. Few data exist concerning the characteristics of theses defended at the Tunis faculty of medicine. AIM: Examine the publication rate of pediatric theses and identify factors associated with an increased publication rate. METHODS: We conducted a cross-sectional descriptive bibliometric study of pediatric theses defended at the Faculty of Medicine of Tunis over 15 years, from 2006 to 2020. Theses were retrieved from the catalog of the faculty library. Publications had been searched in databases "Pub Med ", and "Google Scholar" until December2021. RESULTS: The study involved 235 pediatric theses. Sixty-eight theses were published, representing 29% of the total. The main topics of published theses were neonatology (16%) and hematology (15%). The language of publication was French and English in 55% and 45% of cases, respectively. All publications in Q1 and Q2 journals were written in English. The only independent factor predicting publication of theses was the very honourable mention with congratulations of the jury and proposal for the thesis prize (p=0,007). CONCLUSION: Additional assessments will be necessary to identify the obstacles to the publication of theses.

[The challenges of pediatric emergencies in the office]. / Les défis des urgences pédiatriques au cabinet.

This article examines the diversity of pediatric emergencies in a medical office, shedding light on the complexity of some situations. To address emergencies that are both psychosocial and biomedical, the pediatrician must possess a variety of skills and have an in-depth understanding of the local medical network. Limited communication with young children requires the search for clues, generating uncertainty. This uncertainty is mitigated when the relationship with parents is of high quality. Consequently, the pediatrician must be an effective communicator to manage the triangular relationship. Regarding treatments, it is crucial to consider the latest "smarter medicine" recommendations, as well as the growing resistance to antibiotics.

Cet article s'intéresse à la diversité des urgences pédiatriques en cabinet médical en mettant en lumière la complexité de quelques situations. Pour faire face à des urgences à la fois psychosociales et biomédicales, le pédiatre doit posséder une variété de compétences et connaître de manière approfondie le réseau médical local. La communication limitée avec les jeunes enfants nécessite la recherche d'indices, ce qui génère de l'incertitude. Celle-ci est atténuée lorsque la relation avec les parents est de bonne qualité. En conséquence, le pédiatre doit être un communicateur efficace pour gérer la relation triangulaire. En ce qui concerne les traitements, il est crucial de prendre en considération les dernières recommandations « smarter medicine ¼ ainsi que la résistance croissante aux antibiotiques.

The Role of Clinic Preparedness to Support Patients and Strengthen the Medical System During and After a Pandemic.

Pediatric clinic preparedness is essential to improve the care and health outcomes for children during a pandemic and to decrease the burden on hospital systems. Clinic preparedness is a process that involves a well thought out plan that includes coordination with staff, open communication between the clinic and patient families, and collaboration with community partners. Planning for disasters can decrease some of the risks for our most vulnerable patients, including children and youth with special health care needs. There are plans, coalitions, and community partners that can help clinics in their preparedness journey.

How primary care research can be improved in clinical practice? An Italian case study.

BACKGROUND: Primary care is considered essential for the sustainability of the Health System. Practice-Based Research Networks (PBRN) play a strategic role in translation of primary care research into practice. Research Capacity Building in primary care requires a improvement and development strategy and well-developed research infrastructures to support physicians. METHODS: We used the system development methodology referring to the Lean Thinking to create and support a research team in primary and pediatric care. In particular a "cascade" deployment model and the X-Matrix, a framework used in management studies to support strategy definition and management process. RESULTS: A research unit in primary and pediatric care has been created, by sharing vision, mission, core values, long-term strategies. The definition of a annual planning led to monitoring actions to guarantee the expected goals. CONCLUSIONS: Lean methodology is useful to adapt to various managerial and operational contexts, including healthcare. In our case it allowed team members to spread the culture of research, its importance and role to improve the health of patients, thank to the organizational support of a hospital IR, the Research and Innovation Department.

The Indian Academy of Pediatrics and Directorate General of Health Services, Government of India White Paper on Transition of Care for Youth with Special Health Care Needs.

Over the years, survival of children with chronic diseases has significantly improved and a large proportion of them now are entering into adulthood. Transition of Care (ToC) of such patients with having childhood onset of chronic diseases to the adult health care system is well organized in developed countries, although it is an emerging concept in India. In situations where the systems for ToC are not in place, such cases are fraught with unsatisfactory health outcomes. With proper ToC in place, these patients are likely to receive uninterrupted care by the adult care physicians and hence reach their full potential. This document highlights the need, rationale and way forward for ToC of youth with special health care needs (YSHCN) across the country. It also describes the standard operating procedures to develop the ToC at a hospital level for clinicians and administrators.

Development, contributions, and future directions of a multicenter child abuse research network.

CAPNET is a multicenter child abuse pediatrics research network developed to support research that will make the medical care of potentially abused children more effective, safe, and fair. CAPNET currently collects detailed clinical data from child physical abuse evaluations from 11 leading pediatric centers across the U.S. From its inception, the goal of CAPNET was to support multiple research studies addressing the care of children undergoing evaluations for physical abuse and to create a flexible data collection and quality assurance system to be a resource for the wider community of child maltreatment l researchers. Annually, CAPNET collects rich clinical data on over 4000 children evaluated due to concerns for physical abuse. CAPNET's data are well-suited to studies improving the standardization, equity, and accuracy of evaluations in the medical setting when child physical abuse is suspected. Here we describe CAPNET's development, content, lessons learned, and potential future directions of the network.

Improving Access to Specialty Pediatric Care: Innovative Referral and eConsult Technology in a Specialized Acute Care Hospital.

Background: The COVID-19 pandemic has exacerbated wait times for pediatric specialty care. Transformative technologies such as electronic referral (eReferral-automation of patient information) and electronic consultations (eConsult-asynchronous request for specialized advice by primary care providers) have the potential to increase timely access to specialist care. The objective of this study was to present an overview of the current state and characteristics of referrals directed to a pediatric ambulatory medical surgery center, with an emphasis on the innovative use of an eConsult system and to indicate key considerations for system improvement. Methods: This cross-sectional study was conducted at a specialized pediatric acute care hospital in Ottawa, Ontario. Secondary data were obtained over a 2-year period during the COVID-19 pandemic (2019-2022). To gain insights and identify areas of improvement related to the factors pertaining to referrals and eConsults at the process and system levels, quality improvement (QI) methodologies were employed. Descriptive statistics provide a summary of the trends and characteristics of referrals and the utilization of eConsult. Results: Among the 113,790 referrals received, 31,430 were denied. Most common reasons for referral denial were other/null (e.g., unspecified) (29.3%), inappropriate referrals (12.6%), and duplicate referrals (12.4%). Four clinics (e.g., endocrinology, cardiology, neurology, and neurosurgery) reported a total of 277 eConsults, with endocrinology accounting for 95.0% of all eConsults. QI findings revealed the need for standardized workflows among specialties and ensuring that eConsult options are accessible and integrated within the electronic medical record (EMR). Conclusions: Refining the pediatric referral management process and optimizing eConsult through existing clinical systems have the potential to improve the timeliness and quality of specialty care. The results inform future research initiatives targeting improved access to pediatric specialty care and serve as a benchmark for hospitals utilizing EMRs and eConsult.

Modelo de atención sanitaria a la infancia y adolescencia en Atención Primaria. La realidad de una atención integral compartida / Health Care Model for Children and Adolescents in Primary Care. The reality of shared comprehensive care

En la actualidad, el modelo de asistencia sanitaria a la población infantojuvenil en Atención Primaria es variable en todo el territorio nacional. La Atención Primaria es el primer contacto del paciente pediátrico y su familia, atención que mayoritariamente recaía sobre el pediatra y que debe ser abordada de forma integral por las categorías profesionales implicadas en la promoción, educación para la salud y atención integral del menor, como son el pediatra, la enfermería pediátrica y la enfermería referente de centro educativos. El pediatra y el enfermero de Pediatría son los profesionales formados adecuadamente para atender a la población infantojuvenil en la Atención Primaria y una buena atención requiere de la interdependencia de ambos profesionales y de la cooperación con otras figuras profesionales del centro educativo y del centro de salud. Son necesarias actividades de salud comunitaria y trabajar con los activos de la comunidad para conseguir una atención sanitaria basada en la equidad y en la calidad desde una perspectiva global del niño en su naturaleza biopsicosocial. (AU)

Currently, the health care model for the paediatric and juvenile population in primary care varies throughout Spain. Primary care is the first contact for paediatric patients and their families, care that was mainly provided by paediatricians and which must be addressed in an integrated manner by the professional categories involved in the promotion, health education and comprehensive care of children, such as paediatricians, paediatric nurses and nurses in charge of educational centres. The paediatrician and the paediatric nurse are the professionals adequately trained to care for the paediatric population in primary care and good care requires the interdependence of both professionals and cooperation with other professional figures in the educational centre and the health centre. Community health activities are necessary, working with the assets of the community to achieve health care based on equity and quality from a global perspective of the child in his or her biopsychosocial nature. (AU)

Cost-effectiveness of running a paediatric oncology unit in Ethiopia.

OBJECTIVE: To estimate the cost-effectiveness of running a paediatric oncology unit in Ethiopia to inform the revision of the Ethiopia Essential Health Service Package (EEHSP), which ranks the treatment of childhood cancers at a low and medium priority. METHODS: We built a decision analytical model-a decision tree-to estimate the cost-effectiveness of running a paediatric oncology unit compared with a do-nothing scenario (no paediatric oncology care) from a healthcare provider perspective. We used the recently (2018-2019) conducted costing estimate for running the paediatric oncology unit at Tikur Anbessa Specialized Hospital (TASH) and employed a mixed costing approach (top-down and bottom-up). We used data on health outcomes from other studies in similar settings to estimate the disability-adjusted life years (DALYs) averted of running a paediatric oncology unit compared with a do-nothing scenario over a lifetime horizon. Both costs and effects were discounted (3%) to the present value. The primary outcome was incremental cost in US dollars (USDs) per DALY averted, and we used a willingness-to-pay (WTP) threshold of 50% of the Ethiopian gross domestic product per capita (USD 477 in 2019). Uncertainty was tested using one-way and probabilistic sensitivity analyses. RESULTS: The incremental cost and DALYs averted per child treated in the paediatric oncology unit at TASH were USD 876 and 2.4, respectively, compared with no paediatric oncology care. The incremental cost-effectiveness ratio of running a paediatric oncology unit was USD 361 per DALY averted, and it was cost-effective in 90% of 100 000 Monte Carlo iterations at a USD 477 WTP threshold. CONCLUSIONS: The provision of paediatric cancer services using a specialised oncology unit is most likely cost-effective in Ethiopia, at least for easily treatable cancer types in centres with minimal to moderate capability. We recommend reassessing the priority-level decision of childhood cancer treatment in the current EEHSP.

Adapting a preschool disruptive behavior group for the underserved in pediatric primary care practice.

INTRODUCTION: While behavioral parent training (BPT) is the first line treatment for preschool aged children with disruptive behavior, only a fraction of families receive these therapies. The integration of BPT within the pediatric primary care (PPC) setting is a promising way to address this need, as the PPC setting is the first and only point of contact for most children diagnosed with mental health disorders. We piloted a clinical innovation by implementing an adapted BPT group in an urban, academic, PPC practice, serving a low-income, predominantly Black population. METHOD: Using a formative program development approach and a cultural adaptation framework, structural and cultural adaptations to the program were implemented to increase engagement and adaptability of the group to meet the needs of our PPC population. RESULTS: Learnings indicated that these adaptations were feasible and acceptable to families. Specifically, they were effective in engaging families and transforming the practice of primary care providers. DISCUSSION: Our work offers a case example to guide efforts to thoughtfully and effectively adapt evidence-based interventions for disruptive behavior in primary care settings. These processes provide one strategy to ameliorate behavioral health disparities in diverse, racial/ethnic minority populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Contributions of Key Components of a Medical Home on Child Health Outcomes.

OBJECTIVES: The medical home model is a widely accepted model of team-based primary care. We examined five components of the medical home model in order to better understand their unique contributions to child health outcomes. METHODS: We analyzed data from the 2016-2017 National Survey of Children's Health (NSCH) to assess five key medical home components - usual source of care, personal doctor/nurse, family-centered care, referral access, and coordinated care - and their associations with child outcomes. Health outcomes included emergency department (ED) visits, unmet health care needs, preventive medical visits, preventive dental visits, health status, and oral health status. We used multivariate regression controlling for child characteristics including age, sex, primary household language, race/ethnicity, income, parental education, health insurance coverage, and special healthcare needs. RESULTS: Children who were not white, living in non-English households, with less family income or education, or who were uninsured had lower rates of access to a medical home and its components. A medical home was associated with beneficial child outcomes for all six of the outcomes and the family-centered care component was associated with better results in five outcomes. ED visits were less likely for children who received care coordination (aOR 0.81, CI 0.70-0.94). CONCLUSIONS FOR PRACTICE: Our study highlights the role of key components of the medical home and the importance of access to family-centered health care that provides needed coordination for children. Health care reforms should consider disparities in access to a medical home and specific components and the contributions of each component to provide quality primary care for all children.

Direct-to-patient telehealth equity: Reaching diverse pediatric populations in primary care.

INTRODUCTION: Telehealth is the use of electronic information and technology for long-distance clinical care. In direct-to-patient (DTP) telehealth, the patient initiates care from a personal computer or mobile device to a medical provider. While information on standard clinic-to-clinic telehealth exists, less is known about DTP telehealth in pediatric populations. Using quantitative and qualitative data, we examined DTP telehealth for low-income pediatric patient-families and compared the experience of English and non-English speakers. METHOD: Telehealth visits for acute and preventive care took place from April 2020 to May 2020 at a pediatric primary care clinic (80% Medicaid-insured, 40% non-English-speaking). Patients and primary care providers conducted the visit through the clinic's portal or other platforms (WhatsApp, FaceTime, Zoom). Providers completed an electronic survey with patient feedback about the telehealth experience and their own observations. An iterative inductive/deductive approach informed a coding scheme for free-text survey responses consisting of five domains. RESULTS: REDCap surveys were completed for 258 (52%) of telehealth visits. There was an overrepresentation of English visits compared to the overall clinic population and the majority of visits were via mobile phone. Visits with English speakers utilized the patient portal and had positive process ease ratings more often than those with non-English speakers. Providers rated most telehealth visits as satisfactory, with contributing elements including family call environment, technology process and experience, value added, and barriers. DISCUSSION: Expanding telehealth in pediatrics without worsening health disparities requires building digital health that is user-friendly on mobile technology, facilitating patient preferred language, and simplifying logistical processes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The PRINCIPAL Network: A Model to Optimize Infection Care and Prevention in Pediatric Oncology in the Latin American Region.

PURPOSE: Children with cancer are at high risk for poor outcomes, and health care providers are often unfamiliar with best practices in infection care and prevention (IC&P) in this small and fragile population. Graduates of training courses in IC&P in immunocompromised hosts identified a need for a community that would enable members to share health care experiences, provide resources for continuing medical education, and foster collaborative research and quality improvement opportunities. We developed a Latin American network, Prevencionistas e Infectólogos para Cáncer Pediátrico en América Latina, to grow and sustain the expertise of the clinical workforce in IC&P. Here, we describe the network, how we built it, and its early outcomes. METHODS: We began by codesigning the mission, vision, objectives, and values. We then established the structure for leadership and network management to provide a functional uniformity and sustainability. Virtual meetings with network members and strategic in-person gatherings optimized the use of the time and resources of the network. RESULTS: The network has seen good participation by members and candidates for membership, who have provided feedback on case-based learning. Members have attended training sessions on quality improvement, research in human subjects, and IC&P in pediatric oncology at national and regional meetings and workshops. Network members have presented their work at regional and global meetings, and publications are beginning to emerge from this community. A direct effect of the Prevencionistas e Infectólogos para Cáncer Pediátrico en América Latina network has been the creation of a similar network for the Asia Pacific region, and a third network is being planned. CONCLUSION: We have demonstrated the power of a discipline-specific network structure to facilitate sharing of evidence-based information that enhances the quality-of-care delivery in pediatric oncology.

Role of Psychologists in Pediatric Subspecialties: Integrated Psychological Services Overarching Concepts Across Pediatric Subspecialties.

This article addresses, in more general terms, the overarching concepts of the role of integrated psychologists and how their services are incorporated in the medical home with the use of provider consultation, administering assessments in identifying common mental health concerns, providing interventions for treatment adherence and providing short-term therapy within pediatric subspecialties.

The impact of the COVID-19 pandemic on outpatients of internal medicine and pediatrics: A descriptive study.

ABSTRACT: This study analyzed the changes in the number of outpatients and disease presentation during the entirety of 2020, the period of COVID-19 pandemic.The average annual number of outpatient visits between 2017 and 2019 (before COVID-19) and the total number of outpatient visits in 2020 (COVID-19 period) were compared. Diagnostic codes were identified during 2 periods to analyze changes in the number of outpatient visits according to disease and month.The average annual number of outpatient visits was 47,105 before, and 40,786 during the COVID-19 pandemic, with a decrease of 13.4%. The number of outpatient visits in internal medicine decreased by 10.2% during the COVID-19 pandemic and tended to rebound during the second half of the year. However, the number of outpatient visits in the pediatric department decreased by 37.5% overall throughout the COVID-19 period and continued to decline in the second half of the year. The number of outpatients with infectious diseases decreased significantly (35.9%) compared to noninfectious diseases (cancer, 5.0%; circulatory disease, 4.1%). In addition, the number of outpatient visits due to viral diseases continued to decline, while the incidence of bacterial diseases increased rapidly in the second half of the year.This study confirmed that the number of outpatient visits due to bacterial or viral infections decreased throughout the COVID-19 crisis. Therefore, expanding public health and telemedicine services is necessary to prevent secondary health problems caused by essential medical use restrictions.

Telehealth: Opportunities to Improve Access, Quality, and Cost in Pediatric Care.

The use of telehealth technology to connect with patients has expanded significantly over the past several years, particularly in response to the global coronavirus disease 2019 pandemic. This technical report describes the present state of telehealth and its current and potential applications. Telehealth has the potential to transform the way care is delivered to pediatric patients, expanding access to pediatric care across geographic distances, leveraging the pediatric workforce for care delivery, and improving disparities in access to care. However, implementation will require significant efforts to address the digital divide to ensure that telehealth does not inadvertently exacerbate inequities in care. The medical home model will continue to evolve to use telehealth to provide high-quality care for children, particularly for children and youth with special health care needs, in accordance with current and evolving quality standards. Research and metric development are critical for the development of evidence-based best practices and policies in these new models of care. Finally, as pediatric care transitions from traditional fee-for-service payment to alternative payment methods, telehealth offers unique opportunities to establish value-based population health models that are financed in a sustainable manner.