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2.
PLoS One ; 15(2): e0228377, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32012194

RESUMO

AIM: To identify subgroups regarding paediatricians' awareness, attitude, practice and satisfaction about management of Sleep-Disordered Breathing (SDB) in Italy using Latent Class Analysis (LCA). METHODS: A cross-sectional study was conducted on a large sample of Italian paediatricians. Using a self-administered questionnaire, the study collected information on 420 Paediatric Hospital Paediatricians (PHPs) and 594 Family Care Paediatricians (FCPs). LCA was used to discover underlying response patterns, thus allowing identification of respondent groups with similar awareness, attitude, practice and satisfaction. A logistic regression model was used to investigate which independent variables influenced latent class membership. Analyses were performed using R 3.5.2 software. A p-value<0.05 was considered statistically significant. RESULTS: Two classes were identified: Class 1 (n = 368, 36.29%) "Untrained and poorly satisfied" and Class 2 (n = 646, 63.71%) "Trained and satisfied." Involving paediatric pneumologists or otorhinolaryngologists in clinical practice was associated with an increased probability of Class 2 membership (OR = 5.88, 95%CI [2.94-13.19]; OR = 15.95, 95% CI [10.92-23.81] respectively). Examining more than 20 children with SDB during the last month decreased the probability of Class 2 membership (OR = 0.29, 95% CI [0.14-0.61]). FCPs showed a higher probability of Class 2 membership than PHPs (OR = 4.64, 95% CI [3.31-6.55]). CONCLUSIONS: These findings suggest that the LCA approach can provide important information on how education and training could be tailored for different subgroups of paediatricians. In Italy standardized educational interventions improving paediatricians' screening of SDB are needed in order to guarantee efficient management of children with SDB and reduce the burden of disease.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Hospitais Pediátricos/normas , Pediatras/psicologia , Pediatria/educação , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Síndromes da Apneia do Sono/terapia , Criança , Estudos Transversais , Humanos , Itália , Análise de Classes Latentes , Pediatras/normas , Pediatras/estatística & dados numéricos , Pediatria/normas , Satisfação Pessoal , Projetos Piloto , Inquéritos e Questionários
3.
Pediatr Emerg Care ; 36(1): e25-e29, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895204

RESUMO

This fifth article in our series focuses on burnout in practicing pediatric emergency medicine physicians. As opposed to a general review of burnout, we address understudied and undervalued risk factors, drivers, and individual- and organizational-level solutions applicable to the emergency medicine workplace.Conflicting studies impact our understanding of the prevalence of burnout in our field and the role of depression. This article's story is anonymously submitted and leads us to our discussion of the heightened risk of burnout in underrepresented physicians, those who identify themselves as women, as belonging to a racial, ethnic, gender and/or sexual minority group, and/or as having a physical and/or sensory disability.Thus far, our articles have described coping tools for individuals and health care organizations to prevent and/or mitigate the untoward effects of life-changing stressors on a pediatric emergency physician's life. They include staying healthy and active, cultivating outside interests, and nurturing relationships with peers, friends, and family. We have shared the techniques and benefits of constructive engagement when one is faced with challenging events or individuals. We have underscored the value of peer support, support groups, emotional debriefing, and engaging with outside organizations able to address specific stressors. We have introduced the practice of political engagement as a way of addressing systems-level pressures. Throughout this series, we have emphasized the need to ask for help from family, friends, peers, primary care providers, and mental health professionals. This article describes the benefits of Employee Assistance Programs, Physician Wellness Programs, positive psychology, and grounding behaviors as self-care strategies.


Assuntos
Esgotamento Profissional/terapia , Medicina de Emergência , Médicos/psicologia , Autocuidado/métodos , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/prevenção & controle , Depressão/complicações , Pessoas com Deficiência/psicologia , Feminino , Humanos , Masculino , Serviços de Saúde do Trabalhador , Pediatras/psicologia , Fatores de Risco , Minorias Sexuais e de Gênero/psicologia , Estresse Psicológico
4.
Pediatrics ; 144(6)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31740497

RESUMO

Despite significant declines over the past 2 decades, the United States continues to experience birth rates among teenagers that are significantly higher than other high-income nations. Use of emergency contraception (EC) within 120 hours after unprotected or underprotected intercourse can reduce the risk of pregnancy. Emergency contraceptive methods include oral medications labeled and dedicated for use as EC by the US Food and Drug Administration (ulipristal and levonorgestrel), the "off-label" use of combined oral contraceptives, and insertion of a copper intrauterine device. Indications for the use of EC include intercourse without use of contraception; condom breakage or slippage; missed or late doses of contraceptives, including the oral contraceptive pill, contraceptive patch, contraceptive ring, and injectable contraception; vomiting after use of oral contraceptives; and sexual assault. Our aim in this updated policy statement is to (1) educate pediatricians and other physicians on available emergency contraceptive methods; (2) provide current data on the safety, efficacy, and use of EC in teenagers; and (3) encourage routine counseling and advance EC prescription as 1 public health strategy to reduce teenaged pregnancy.


Assuntos
Anticoncepção Pós-Coito/métodos , Papel do Médico , Relações Médico-Paciente , Sexo sem Proteção/efeitos dos fármacos , Adolescente , Feminino , Antagonistas de Hormônios/administração & dosagem , Humanos , Masculino , Pediatras/psicologia , Papel do Médico/psicologia , Comportamento Sexual/efeitos dos fármacos , Comportamento Sexual/fisiologia , Comportamento Sexual/psicologia , Sexo sem Proteção/fisiologia , Sexo sem Proteção/psicologia
5.
Pediatrics ; 144(6)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31690710

RESUMO

BACKGROUND AND OBJECTIVES: The American Board of Pediatrics (ABP) certifies that general and subspecialty pediatricians meet standards of excellence established by their peers, immediately after training and over the course of their careers (ie, Maintenance of Certification [MOC]). In 2015-2016, the ABP developed the Maintenance of Certification Assessment for Pediatrics (MOCA-Peds) as an alternative assessment to the current proctored, closed-book general pediatrics (GP) MOC examination. This article is 1 of a 2-part series examining results from the MOCA-Peds pilot in 2017. METHODS: We conducted quantitative and qualitative analyses with 5081 eligible pediatricians who registered to participate in the 2017 pilot; 81.4% (n = 4016) completed a quarter 4 survey and/or end-of-year survey (January 2018) and comprise the analytic sample. RESULTS: The majority of pediatricians considered the MOCA-Peds to be feasible and acceptable as an alternative to the proctored MOC GP examination. More than 90% of respondents indicated they would participate in the proposed MOCA-Peds model instead of the examination. Participants also offered recommendations to improve the MOCA-Peds (eg, enhanced focus of questions on outpatient GP, references provided before taking questions); the ABP is carefully considering these as the MOCA-Peds is further refined. CONCLUSIONS: Pilot participant feedback in 2017 suggested that the MOCA-Peds could be implemented for GP starting in January 2019, with all 15 subspecialties launched by 2022. Current and future evaluations will continue to explore feasibility, acceptability, and learning and practice change as well as sustainability of participation.


Assuntos
Atitude do Pessoal de Saúde , Certificação/normas , Competência Clínica/normas , Pediatras/psicologia , Pediatras/normas , Inquéritos e Questionários , Adulto , Idoso , Certificação/métodos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
6.
Pediatrics ; 144(6)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31690712

RESUMO

BACKGROUND AND OBJECTIVES: This article is the second of a 2-part series examining results regarding self-reported learning and practice change from the American Board of Pediatrics 2017 pilot of an alternative to the proctored, continuing certification examination, termed the Maintenance of Certification Assessment for Pediatrics (MOCA-Peds). Because of its design, MOCA-Peds has several learning advantages compared with the proctored examination. METHODS: Quantitative and qualitative analyses with 5081 eligible pediatricians who registered to participate in the 2017 pilot; 81.4% (n = 4016) completed a quarter 4 survey and/or the end-of-year survey (January 2018) and compose the analytic sample. RESULTS: Nearly all (97.6%) participating pediatricians said they had learned, refreshed, or enhanced their medical knowledge, and of those, 62.0% had made a practice change related to pilot participation. Differences were noted on the basis of subspecialty status, with 68.9% of general pediatricians having made a practice change compared with 41.4% of subspecialists. Within the 1456 open-ended responses about participants' most significant practice change, responses ranged widely, including both medical care content (eg, "care for corneal abrasions altered," "better inform patients about. . .flu vaccine") and nonspecific content (eg, providing better patient education, using evidence-based medicine, increased use of resources in regular practice). CONCLUSIONS: As a proctored examination alternative, MOCA-Peds positively influenced self-reported learning and practice change. In future evaluation of MOCA-Peds and other medical longitudinal assessments, researchers should study ways to further encourage learning and practice change and sustainability.


Assuntos
Atitude do Pessoal de Saúde , Certificação/normas , Competência Clínica/normas , Educação Médica Continuada/normas , Aprendizagem , Pediatras/normas , Adulto , Certificação/métodos , Educação Médica Continuada/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pediatras/psicologia , Projetos Piloto , Padrões de Prática Médica/normas , Inquéritos e Questionários
7.
JAMA ; 322(15): 1453-1454, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31613349
9.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31506304

RESUMO

BACKGROUND: Physicians must balance career and home responsibilities, yet previous studies on work-life balance are focused primarily on work-based tasks. We examined gender discrepancies and factors related to household responsibilities and work-life balance among pediatricians. METHODS: We used 2015 data from the American Academy of Pediatrics Pediatrician Life and Career Experience Study, a longitudinal study of early-career pediatricians. χ2 tests and multivariable logistic regression were used to examine the effects of gender on household responsibilities, satisfaction, and work-life balance attainment. We formally reviewed responses from 2 open-ended questions on work-life balance challenges and strategies for common themes. RESULTS: Seventy-two percent of participants completed the survey (1293 of 1801). Women were more likely than men to report having primary responsibility for 13 of 16 household responsibilities, such as cleaning, cooking, and routine care of children (all P < .001). All gender differences except budget management remained significant when controlling for part-time work status and spouse or partner work status (P < .05). Women were less satisfied with their share of responsibilities relative to others (52% vs 62%; P < .001), and few women and men report being very successful at achieving balance between their job and other life areas (15% vs 19%, respectively; P = .05). Open-ended responses (n = 1145) revealed many barriers to achieving work-life balance. Strategies to increase work-life balance included reducing work hours, outsourcing household-related work, and adjustments to personal responsibilities and relationships. CONCLUSIONS: Female pediatricians spend more time on household responsibilities than male pediatricians, and gender is a key factor associated with work-life balance satisfaction.


Assuntos
Serviço de Limpeza/organização & administração , Pediatras/organização & administração , Fatores Sexuais , Equilíbrio Trabalho-Vida/organização & administração , Distribuição de Qui-Quadrado , Criança , Cuidado da Criança/organização & administração , Cuidado da Criança/estatística & dados numéricos , Estudos Transversais , Emprego , Características da Família , Feminino , Serviço de Limpeza/estatística & dados numéricos , Humanos , Modelos Logísticos , Estudos Longitudinais , Manutenção/organização & administração , Manutenção/estatística & dados numéricos , Masculino , Pediatras/psicologia , Pediatras/estatística & dados numéricos , Satisfação Pessoal , Médicas/psicologia , Médicas/estatística & dados numéricos , Inquéritos e Questionários , Equilíbrio Trabalho-Vida/métodos , Equilíbrio Trabalho-Vida/estatística & dados numéricos
12.
S D Med ; 72(8): 349-353, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31465639

RESUMO

INTRODUCTION: Safe sleep recommendations for infants have been evolving over the past three decades. It has been shown that physicians' recommendations strongly influence parents' choice of infant sleep position. However, the proportion of physicians and/or nurses giving infant sleep advice to parents is reportedly low. METHODS: A survey was conducted in South Dakota to evaluate pediatricians' and family practitioners' knowledge of safe sleep recommendations for infants. Survey questions assessed their beliefs regarding risk factors for sudden infant death syndrome (SIDS) and their recommendations for safe sleep environments provided to parents/caregivers. RESULTS: Among the respondents, 98 percent felt that it is important to discuss SIDS with every parent and 80 percent of them indicated a need within their profession to have further information on the topic of SIDS. However, 31 percent of physicians with 16 years or more since training and 64.5 percent of those with less than 16 years since training did provide safe sleep advice to parents and caregivers. CONCLUSIONS: Despite the knowledge of SIDS risk factors, gaps were seen in dissemination of information regarding all risk factors to parents. While sleep position, postnatal exposures and breast feeding were more likely to be addressed, other elements of a safe sleep environment such as bedding surface, bed sharing, pacifier use and room ventilation were less likely to be covered. These findings indicate the need for improved health care provider education/communication in South Dakota.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pediatras/psicologia , Guias de Prática Clínica como Assunto , Morte Súbita do Lactente , Leitos , Humanos , Lactente , Pediatras/normas , Fatores de Risco , Sono , South Dakota , Decúbito Dorsal
13.
BMC Res Notes ; 12(1): 474, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370850

RESUMO

OBJECTIVE: The Japanese Midwifery Association (JMA) guidelines allow midwives to manage group B Streptococcus (GBS)-positive women during pregnancy and labour at maternity homes. However, no guidelines exist to manage neonates born to GBS-positive women in Japan. We aimed to investigate the opinions of paediatricians regarding optimal management strategies for neonates born to GBS-positive women in maternity homes. A questionnaire was sent to paediatricians at 396 Japanese perinatal medical centres. We examined opinions regarding examinations and routine clinical tests for neonates born to GBS-positive women in maternity homes. RESULTS: Of 235 paediatricians, only 11.2% considered that paediatric examinations were unnecessary for neonates born to GBS-positive women in maternity homes. Moreover, 20.5%, 13.2%, and 11.1% of paediatricians considered culture test of the nasal cavity, serum C-reactive protein level analysis, and blood cell count analysis, respectively, necessary for neonates born to GBS-positive pregnant women with intrapartum antibiotic prophylaxis (IAP), whereas 36.3%, 56.2%, and 40.6% of paediatricians considered these tests necessary in cases without IAP. The JMA guidelines had low penetration rates among paediatricians in Japan. To manage neonates born to GBS-positive women in maternity homes, midwives should engage with commissioned paediatricians in more detail and develop appropriate strategies to increase awareness and cooperation.


Assuntos
Transmissão Vertical de Doença Infecciosa/prevenção & controle , Tocologia/ética , Pediatras/psicologia , Complicações Infecciosas na Gravidez/terapia , Infecções Estreptocócicas/terapia , Adulto , Antibioticoprofilaxia/métodos , Contagem de Células Sanguíneas , Gerenciamento Clínico , Feminino , Maternidades , Humanos , Recém-Nascido , Japão , Parto , Guias de Prática Clínica como Assunto , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/microbiologia , Estudos Retrospectivos , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/transmissão , Streptococcus agalactiae/efeitos dos fármacos , Streptococcus agalactiae/crescimento & desenvolvimento , Inquéritos e Questionários
14.
J Korean Med Sci ; 34(26): e183, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31269544

RESUMO

BACKGROUND: This study aimed to investigate the awareness and application of ROME IV criteria for functional constipation (FC) in real-world practices and assessed differences between pediatric gastroenterologists (PGs) and general pediatricians. METHODS: A total of 239 (47.8%) out of 500 nationwide pediatricians answered a questionnaire for diagnosis and management of pediatric FC; 60 were PGs (75% of total PGs in Korea). RESULTS: A total of 16.6% of pediatricians were aware of the exact ROME IV criteria. Perianal examination and digital rectal examination were practiced less, with a higher tendency among PGs (P < 0.001). Treatment duration was longer among PGs for > 6 months (63.8%) than < 3 months among general pediatricians (59.2%, P < 0.001). Fecal disimpaction and rectal enema were practiced among 78.8% and 58.5% of pediatricians, respectively. High dose medication for initial treatment phase was prescribed by 70.7% of pediatricians, primarily within the first 2 weeks (48.3%). The most commonly prescribed medications in children aged > 1-year were lactulose (59.1%), followed by polyethylene glycol (PEG) 4000 (17.7%), and probiotics (11.8%). Prescription priority significantly differed between PGs and general pediatricians; lactulose or PEG 4000 were most commonly prescribed by PGs (89.7%), and lactulose or probiotics (75.7%) were prescribed by general pediatricians (P < 0.001). For patients aged < 1-year, lactulose (41.6%) and changing formula (31.7%) were commonly prescribed. Most participants recommended diet modification, and PGs more frequently used defecation diary (P = 0.002). CONCLUSION: Discrepancies between actual practice and Rome IV criteria and between PGs and general pediatricians were observed. This survey may help construct practice guidelines and educational programs for pediatric FC.


Assuntos
Constipação Intestinal/diagnóstico , Pediatras/psicologia , Pré-Escolar , Doenças do Colo , Constipação Intestinal/tratamento farmacológico , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Laxantes/uso terapêutico , Masculino , Padrões de Prática Médica , Probióticos/uso terapêutico , República da Coreia
15.
Int J Clin Pharm ; 41(4): 1074-1084, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31197546

RESUMO

Background Off-label prescribing in children is associated with several prerequisites such as ensuring sound and scientific evidence and obtaining written consent prior to use of off-label drugs to ensure that protection is provided to patients and healthcare professionals. Adherence to the pre-requisites depends on the attitude, views and knowledge of the pharmacists and doctors involved in this practice. Objective To explore the attitudes, knowledge and views on off-label prescribing in children among hospital-based pharmacists and paediatric doctors. Setting The study was conducted in a 620-bedded general hospital located in the urban area of central Peninsular Malaysia. Method Face to face, semi-structured interviews with 12 pharmacists and 12 paediatric doctors. Interviews were audio-recorded, transcribed and analysed using constant comparison method. Main outcome measure Themes surrounding hospital-based pharmacists' and paediatric doctors' attitude, knowledge and views on off-label prescribing in children. Results Four themes were derived: knowledge on off-label prescribing in children, views on off-label prescribing in children, attitude towards off-label prescribing in children and guidance on off-label prescribing in children. Conclusion There is a need to increase the knowledge of hospital-based pharmacists and paediatric doctors and address several concerns on off-label prescribing in children. The decision to prescribe or dispense off-label drugs involved collective decision-making mechanisms and guidance is required with regards to offlabel prescribing in children.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Uso Off-Label , Pediatras/psicologia , Farmacêuticos/psicologia , Feminino , Humanos , Malásia , Masculino
16.
Biomed Res Int ; 2019: 8638174, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31183376

RESUMO

The prevalence and feature of online textual pediatrician-parent communication (OPPC) have been recognized, but evidence on OPPC assessment remains insufficient. This study aimed to develop and validate an OPPC instrument to provide measurement and quality characteristics for quality assessment and management. 490 OPPC exchanges of 61 tertiary hospitals from 9 Chinese provinces were obtained from the Spring Rain Doctor website. The SEGUE framework, OPPC feature, and a pilot study were considered to establish the instrument. An empirical study was conducted to validate it and the incidence of OPPC items was also analyzed. As a result, a four-dimensional, 15-item OPPC instrument was developed. The empirical results are as follows. Cronbach's α values of dimensions were 0.80, 0.62, 0.64, and 0.60; the mean interrater reliability was 0.93; the correlation coefficients between items and their corresponding dimensions' scores ranged from 0.51 to 0.89 (P<0.001). The goodness-of-fit indices were acceptable. The overall incidence rate of parent-dominated/cooperative items (46.9%) was higher than that of pediatrician-dominated items (39.6%). Thus, the instrument is acceptable and OPPC quality is characterized by more parent-dominated and cooperative behaviors.


Assuntos
Pais/psicologia , Relações Médico-Paciente , Psicometria , Comunicação , Comportamento Cooperativo , Humanos , Pediatras/psicologia , Estudos Retrospectivos , Inquéritos e Questionários
17.
Orthop Clin North Am ; 50(3): 327-330, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31084834

RESUMO

Physician burnout is a pervasive problem affecting our workforce. More than one-third of surveyed pediatric orthopedists are experiencing symptoms of burnout. Engagement and transparency with the problem are required to support physicians throughout their career. Both personal strategies to foster resilience and systemic responses to make space for supporting physician wellness are required to truly effect change. Mindfulness is a studied tool that can be easily and strategically implemented to help combat physician burnout.


Assuntos
Esgotamento Profissional , Cirurgiões Ortopédicos/psicologia , Pediatras/psicologia , Esgotamento Profissional/prevenção & controle , Depressão/prevenção & controle , Humanos , Atenção Plena , Resiliência Psicológica , Fatores de Risco
19.
Am J Otolaryngol ; 40(4): 525-529, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31064672

RESUMO

OBJECTIVE: To identify practice patterns regarding human papillomavirus (HPV) vaccination efforts and vaccination rates in context of head and neck cancer prevention, identify barriers to vaccination, and identify gaps in knowledge regarding the link between HPV and head and neck cancer in the pediatrician population. STUDY DESIGN/METHODS: A 27-question cross-sectional survey was distributed to members of the four California chapters of the American Academy of Pediatrics. RESULTS: Of the completed responses, 89.4% identified as "always" recommending the HPV vaccine to patients, but only 19.5% of pediatricians estimated that >75% of their eligible patients had completed the HPV vaccination series. 71.5% of respondents felt that further education about HPV's link to head and neck cancer them more comfortable discussing vaccination. Physicians who were in practice longer were less likely to respond that additional education about HPV and its link to head and neck cancer would make them more comfortable discussing vaccination with patients (p = 0.043). Physicians who were in practice longer were more likely to correctly respond that HPV type 16 is the most common strain linked to head and neck cancer (p = 0.021). CONCLUSION: There is need to improve both the knowledge base and comfort level of pediatricians in counseling their patients during vaccine recommendations. Otolaryngologists have a critical role in providing education to physicians, trainees, and the general public in the effort to combat the epidemic of HPV-associated head and neck cancer.


Assuntos
Neoplasias de Cabeça e Pescoço/virologia , Conhecimentos, Atitudes e Prática em Saúde , Programas de Imunização , Papillomaviridae , Infecções por Papillomavirus/prevenção & controle , Pediatras , Padrões de Prática Médica , California , Aconselhamento , Estudos Transversais , Educação Médica Continuada , Humanos , Vacinas contra Papillomavirus , Pediatras/psicologia , Inquéritos e Questionários
20.
Pediatr Int ; 61(7): 658-663, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31102485

RESUMO

BACKGROUND: A child's death affects not only family members but also the health-care professionals involved in patient care. The education system for bereavement care in Japan, however, is not set up in a systematic way, and the care provided is based on the individual experience of the health-care professional. The aim of this study was to investigate pediatrician awareness of and actual circumstances involved in bereavement care in Japan. METHODS: A qualitative descriptive study was conducted at four facilities in Japan. Data collected using semi-structured interviews of 11 pediatricians were assessed using inductive qualitative analysis. RESULTS: Pediatrician recognition of the elements of bereavement care was categorized as follows: (i) developing relationships with families before a child's death is important in bereavement care; (ii) after the child dies, family involvement is left to the doctor's discretion; (iii) coping with a child's death myself through past experience is essential; (iv) doctors involved in a child's death also experience mental burden; and (v) a system for the family's bereavement care must be established. Two categories were established according to actual circumstances involved in bereavement care: (i) attention must be given to the emotions of the families who lost a child; and (ii) doctor involvement with bereaved families depends on doctor awareness and expertise. CONCLUSION: Japanese pediatricians provided bereavement care to families who lost their children in a non-systematic manner. This is necessitates improvement of the self-care of health-care professionals with regard to grief by improving bereavement care-related education. Additionally, health-care professionals must be trained, and a national-level provision system must be established to provide high-quality bereavement care to families who lose a child.


Assuntos
Atitude do Pessoal de Saúde , Luto , Competência Clínica , Cuidados Paliativos na Terminalidade da Vida/psicologia , Pediatras/psicologia , Padrões de Prática Médica , Relações Profissional-Família , Adulto , Conscientização , Criança , Família/psicologia , Feminino , Cuidados Paliativos na Terminalidade da Vida/normas , Humanos , Entrevistas como Assunto , Japão , Masculino , Pessoa de Meia-Idade , Pediatras/educação , Pediatras/normas , Pediatria/educação , Pediatria/normas , Padrões de Prática Médica/normas , Pesquisa Qualitativa
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