Pediatric Intensive Care Unit Early Mobility Program: Impact on Patient Functional Status.

INTRODUCTION: Patients admitted to the pediatric Intensive Care Unit (PICU) are frequently sedated, restrained, and placed on bed rest. These practices have known negative impacts including prolonged hospital stay and diminished functional status after discharge. The authors' objective was to investigate the impact of a PICU early mobility protocol on the frequency of orders for physical, occupational, and speech therapy (PT, OT, ST) and improvement in patient functional status. METHODS: Patients admitted in 2019 prior to the development of the PICU early mobility protocol were compared to those admitted in 2020 who underwent the protocol. Differences in clinical characteristics; PICU length of stay; rates of PT, OT, and ST orders; rates of bedside mobility activities; and functional status scores (FSSs) were assessed in bivariate and multivariate analyses. The protocol included early PT, OT, and ST order placement and frequent in-room mobility activities. RESULTS: Of the 384 patients included in the study, 216 (56%) were preprotocol patients, and 168 (44%) underwent the protocol. Patients in 2020 were more likely to receive a physical therapy order compared to their 2019 counterparts (79% vs 47%, p < 0.001). Patients in 2020 had a higher daily incidence of mobility activities compared to those in 2019 (4.88 activities vs 4.1 activities, p < 0.001). Changes in functional status scores were similar between the 2 groups. CONCLUSION: PICU early mobility was associated with increased physical, occupational, and speech therapy orders and daily mobility activities but was not associated with a reduction in functional morbidity at discharge or 3 months post-discharge.

Food Insecurity Screening in a Pediatric Clinic: Findings on Documentation and Multidimensional Care Needs.

Background The American Academy of Pediatrics recommends routine screening and resource provision for food insecurity (FI). The authors describe documentation of FI, as well as social, developmental, and health care utilization characteristics, among patients with and without FI in a pediatric clinic. Methods This data-only case-control study describes patients with and without FI seen by pediatricians who identified at least 10 patients with FI between January 2019 and January 2020. Controls were seen by the same pediatrician on the same day, matched 2:1 with cases. Chart review identified FI documentation. Bivariate analyses were used to describe demographic, clinical, and health care utilization characteristics. Results The authors identified 74 patients with FI (cases) and 144 controls. Pediatricians documented FI in the medical record for 76% of patients identified with FI, although only 43% had FI in the problem list. There were no differences between cases and controls in the distribution of age or sex. A larger proportion of cases used the emergency department (25.7% vs 9.6%; p < 0.05), were Black (36.5% vs 15.3%; p < 0.05) or Hispanic (44.6% vs 18.8%; p < 0.05), utilized Medi-Cal (41.9% vs 16.7%; p < 0.05), had developmental delay (13.5% vs 4.2%; p < 0.05), received speech therapy (20.3% vs 4.9%; p < 0.05), or were referred to a social worker (37.8% vs 3.5%; p < 0.05). Discussion Our findings show inconsistent documentation of FI in medical records and that FI is associated with increased social, developmental, and health care utilization needs. Conclusion Further research is needed to assess the impact of documenting FI in patient charts.

Barriers to cervical cancer screening in Mulanje, Malawi: a qualitative study.

BACKGROUND: In Malawi, cervical cancer is the most prevalent form of cancer among women, with an 80% mortality rate. The Mulanje Mission Hospital has offered free cervical cancer screening for eight years; however, patients primarily seek medical help for gynecologic complaints after the disease is inoperable. METHODS: We investigated how women in rural Malawi make health-seeking decisions regarding cervical cancer screening using qualitative research methods. The study was conducted between May and August of 2009 in Mulanje, Malawi. RESULTS: This study found that the primary cue to action for cervical cancer screening was symptoms of cervical cancer. Major barriers to seeking preventative screening included low knowledge levels, low perceived susceptibility and low perceived benefits from the service. Study participants did not view cervical cancer screening as critical health care. Interviews suggested that use of the service could increase if women are recruited while visiting the hospital for a different service. CONCLUSION: This study recommends that health care providers and health educators target aspects of perceived susceptibility among their patients, including knowledge levels and personal risk assessment. We believe that continued support and advertisement of cervical cancer screening programs along with innovative recruitment strategies will increase usage density and decrease unnecessary deaths from cervical cancer in Malawi.