Steering the Titanic: One tertiary care children's hospital's experience navigating safe sleep for hospitalized infants.

BACKGROUND: Sudden Unexpected Infant Death (SUID) is the leading cause of death in infants 1 month to 1 year of age in the United States. Despite extensive efforts in research and public education, rates of sleep-related infant death have plateaued since the late-1990s, largely due to unsafe sleep practices and environments. LOCAL PROBLEM: A multidisciplinary team assessed our institution's compliance with its own infant safe sleep policy. Data was collected on infant sleep practices, nurses' knowledge and training on the hospital policy, and teaching practices for parents and caregivers of hospitalized infants. Zero crib environments from our baseline observation met all the American Academy of Pediatrics recommendations for infant safe sleep. METHODS: A comprehensive safe sleep program was implemented in a large pediatric hospital system. The purpose of this quality improvement project was to improve compliance with safe sleep practice from 0% to 80%, documentation of infant sleep position and environment every shift from 0% to 90%, and documentation of caregiver education from 12% to 90% within 24 months. INTERVENTIONS: Interventions included revision of hospital policy, staff education, family education, environmental modifications, creation of a safe sleep taskforce, and electronic health record modifications. RESULTS: Documented compliance with infant safe sleep interventions at the bedside improved from 0% to 88%, while documentation of family safe sleep education improved from 12% to 97% during the study period. CONCLUSIONS: A multifaceted, multidisciplinary approach can lead to significant improvements in infant safe sleep practices and education in a large tertiary care children's hospital system.

"They stand in the middle now": Pathways to meeting psychological needs by adolescents who are refugees from sub-Saharan Africa.

OBJECTIVES: This study explored the psychological needs of refugee youth from sub-Saharan Africa resettled in a large city in Southwest United States. We utilized the framework of Basic Psychological Needs Theory (Deci & Ryan, 2000) which proposes that competence, relatedness, and autonomy are universal psychological needs. We examined the challenges to meeting these needs and resolutions to these challenges. Integral to understanding these needs was to place them in the context of a bicultural model of adaptation. Of particular interest was discovering how these young people negotiate and reconcile home and host cultural demands while meeting needs. METHOD: From July 2019 to August 2020, semistructured individual interviews (N = 44) were completed with youth, parents, and cultural experts. Data were analyzed using a hybrid inductive and deductive approach and thematic content analysis. RESULTS: Active engagement, assertion, and self-advocacy were delineated as important pathways to achieve competence. Relatedness needs were served by inclusive ties, and frequently included other "outsiders." Autonomy came from self-sufficiency, agency, and "voice." Altruism was common, extending beyond ethnic community, and promoted competence, relatedness, and empowerment. Conflicts between family and host culture were managed by accepting parental authority. Parents contributed to integrating home and host cultures by flexibly interpreting traditional rules. CONCLUSIONS: Our findings illustrate the strengths of these youth who manage tremendous challenges to meeting their psychological needs. We highlight how in the process of cultural adaptation they retain ties to their home culture. They choose diversity in their relationships and find agency and purpose by supporting others. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Abusive Injuries Are Worse Than Vehicular Injuries: Should We Refocus Prevention?

OBJECTIVES: The objective of this study was to compare the injury severity and outcome of motor vehicle and nonaccidental traumatic injuries and examine trends in mortality rates over time. METHODS: We reviewed data from 2005 to 2013 from a level 1 pediatric trauma center including demographics, injury severity, and outcomes. Primary outcomes of interest were mortality rates and hospital length of stay. RESULTS: Injury severity scores were significantly worse for nonaccidental traumas (NATs) (P < 0.001) compared with motor vehicle collisions and motor pedestrian collisions. Nonaccidental traumas were also found to have significantly longer length of stay and higher fatality rates (P < 0.001). Significant differences were also found for the types of injuries sustained for head, extremity, trunk, and other injuries (P < 0.001), and for internal injuries (P < 0.01. Admission rates also dropped for both motor vehicle collisions and motor pedestrian collisions across the 9-year period (P < 0.001) but remained stable for NATs. CONCLUSION: In this study population, more severe injuries, higher mortality rates, and longer hospital stays were observed in pediatric NAT compared with those sustained through vehicular means. Furthermore, we observed statistically significant declines in motor vehicle-related injuries compared with NAT.

An examination of traffic-related traumatic injuries among children at a Level-1 pediatric trauma center, 2005-2014.

BACKGROUND: Traffic-related injuries are the leading fatal injury among children in the United States, but no published study compares the different types of traffic-related pediatric injuries to date. Thus, this study was aimed at examining the10-year trend of traffic-related injury among children at a pediatric hospital and to assess if there were differences in injury mechanism. METHODS: All data were drawn from a Level-1 pediatric trauma center in North Texas in 2005-2014. Demographic characteristics, length of hospitalization, and patient type were included. Severity of injury outcome was assessed by injury severity score and fatality. The traffic-related injury mechanism included motor vehicle collision (MVC), motor-pedestrian collision (MPC), and motorcycle/moped collision (MMC). Description analyses and multinominal logistic regressions were applied to examine the factors associated with the type of motor-related injuries adjusting for covariates. All analyses were conducted by STATA version 14.0. RESULTS: A total of 3,742 traffic-related pediatric injuries were identified. The mean (SD) age was 6.4 (4.0) years; most patients were boys (59%) and Hispanic (40%). There was a waving trend of the number of traffic-related injuries over the 10-year period. Compared with MVC, demographic disparities exist with children experiencing an MPC injury. Hispanic and African American children were more likely to have an MPC but less likely to have a motorcycle/moped collision injury (relative risk [RR], 1.6; 95% confidence interval, 1.3-1.9; RR, 2.0; 95% confidence interval, 1.9-2.4, respectively). Children with an MPC injury had a more severe outcome than those with an MVC injury, but no difference was found in fatality. The MCC injuries did not significantly differ from MVC in injury severity. CONCLUSIONS: Although efforts have been made to prevent MVC-related pediatric injuries, the trend of MVCs was stable in the most recent years. The MPC-related injury continues to be a higher likelihood of severe pediatric trauma. Thus, continuing efforts and innovative intervention programs are still needed to prevent traffic-related pediatric injuries. LEVEL OF EVIDENCE: Epidemiologic study, level III.

Revisiting comfort: strategies observed in the direct observation study.

The Surgeon General's 2000 report on oral health found that one-third of adults in the U.S. had not visited a dentist in the previous year. Fear of treatments received during a dental encounter can create a barrier to patients receiving care. Most studies of dental anxiety have focused on phobic patients; relatively few studies have explored attempts to provide comfort and alleviate anxiety among everyday patients. This study describes comforting strategies that were performed by dentists, dental assistants, and hygienists for their patient population as a whole. As part of the Direct Observation Study, 120 dental practices in Ohio were observed over a four-day period by trained research hygienists. Researchers observed and recorded 3,800 patient interactions with dentists and hygienists at 30-second intervals using 24 behavior-specific codes. In addition, observers composed qualitative notes detailing the patient visits and recorded in their notes specific comforting techniques performed by dentists, hygienists, and dental assistants.

A survey of language barriers from the perspective of pediatric oncologists, interpreters, and parents.

BACKGROUND: Oncologists in the US increasingly face the challenge of communicating with non-English speaking parents of children with cancer. This study explores this challenge from the perspectives of a sample of pediatric oncologists, interpreters, and Spanish-speaking parents of children with newly diagnosed leukemia. PROCEDURE: Thirty-seven oncologists and 17 professional language interpreters based at two non-profit pediatric hospitals in the US were surveyed on the topic of language barriers in pediatric care. Seventeen parents who communicated with their child's oncologist through an interpreter were also surveyed. RESULTS: All groups expressed considerable concern over the process of communicating across a language barrier. For oncologists, these concerns included the accuracy and completeness of interpretations, complexity of information, and loss of confidence and control over the communication process. For interpreters, they included complexity of information, information overload, and lack of clinician sensitivity toward the cultural and socioeconomic backgrounds of limited English proficiency (LEP) families. Parent concerns included difficulties comprehending information and anxiety over the possibility of missing out on important information. All groups provided multiple suggestions for improving communication across a language barrier. CONCLUSIONS: Oncologists, interpreters, and parents expressed considerable concern over the process of communicating across a language barrier. Some of these concerns could be minimized through efforts to boost interpreter accuracy and completeness, including the use of more simple, easy to understand language. Other issues, such as differences in culture and socioeconomic background, warrant consideration of the intercultural knowledge and skills of interpreters.