Mealtime duration in problem and non-problem eaters.

Young children commonly encounter difficulties at mealtimes, which are important to address early to avoid the maintenance of problematic eating behaviour. Amongst these are drawn-out meals, which some research has associated with more mealtime problems. However, research on meal duration, and therefore guidelines for appropriate meal length, is lacking. This research aimed to compare the meal duration of problem-eaters and controls, and to examine changes to meal length amongst problem-eaters following a parenting intervention. The mealtimes of 96 problem-eaters and 105 controls were examined via parent-report and in-home observations; meal length was also compared amongst problem-eaters who had received intervention and a waitlist control. Meal duration was similar across groups, though problem-eaters engaged in more aversive behaviour and less eating than controls. Observed eating and mealtime behaviour altered following intervention but not duration. Parents who reported meal length as a specific concern had longer meals and reported less successful feeding than those who did not. These results suggest that what is happening during the meal may better distinguish problem-eaters than duration alone.

Effectiveness and Safety of an Emergency Department Code Sepsis Protocol: A Pragmatic Clinical Trial.

RATIONALE: Sepsis care delivery - including initiation of prompt, appropriate antimicrobials - remains suboptimal. OBJECTIVE: Determine direct and off-target effects of emergency department (ED) sepsis care reorganization. METHODS: This pragmatic pilot trial enrolled adult patients presenting November 2019 to February 2021 to an ED in Utah before and after implementation of a multimodal, team-based "Code Sepsis" protocol. Patients presenting to two other EDs where usual care was continued served as contemporaneous controls. The primary outcome was door-to-antimicrobial time among patients meeting Sepsis-3 criteria before ED departure. Secondary and safety outcomes included all-cause 30-day mortality, antimicrobial utilization and overtreatment, and antimicrobial-associated adverse events. Multivariable regression analyses employed difference-in-differences methods to account for trends in outcomes unrelated to the studied intervention. RESULTS: Code Sepsis protocol activation (N=307) exhibited 8.5% sensitivity and 66% positive predictive value for patients meeting sepsis criteria before ED departure. Among 10,151 patients meeting sepsis criteria during the study, adjusted difference-in-differences analysis demonstrated a 13-minute (95% CI 7-19-minute) decrease in door-to-antimicrobial time associated with Code Sepsis implementation (p<0.001). Mortality and clinical safety outcomes were unchanged, but Code Sepsis implementation was associated with increased false-positive presumptive infection diagnosis among patients meeting sepsis criteria in the ED and increased antimicrobial utilization. CONCLUSIONS: Implementation of a team-based protocol for rapid sepsis evaluation and treatment during the COVID-19 pandemic's first year was associated with decreased ED door-to-antimicrobial time but also increased antimicrobial utilization. Measurement of both patient-centered and off-target effects of sepsis care improvement interventions is essential to comprehensive assessment of their value. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (NCT04148989) This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Hassle Free Mealtimes Triple P: a randomised controlled trial of a brief parenting group for childhood mealtime difficulties.

Mealtime difficulties are common in typically developing young children. Easily accessible, wide-reaching, early intervention is needed to meet demand for assistance, and prevent the development of more serious feeding and psychosocial problems. Behavioural parent training is an efficacious intervention for childhood mealtime problems, however, existing programmes are long, intensive, and costly. The current study aimed to evaluate the efficacy of a brief parenting discussion group for young children's mealtime difficulties. Eighty-six parents of 2- to 5-year-old children with mealtime difficulties participated in a randomised controlled trial of Hassle Free Mealtimes Triple P (HFMTP; Morawska & Sanders, 2012), a 2-h discussion group on positive parenting strategies specific to the mealtime context. Results of parent-report measures showed that after intervention, there were significant improvements with large effect sizes in children's mealtime behaviour, parents' mealtime practices and cognitions, and both mealtime and general parenting confidence, compared to a waitlist control group. Parents also reported high satisfaction with the programme and effects were maintained at 6-month follow-up. These results support the efficacy of a brief parenting discussion group for childhood mealtime difficulties. This low intensity format of intervention has the potential to meet the high demand for assistance with young children's mealtime difficulties.

Childhood feeding difficulties: a randomized controlled trial of a group-based parenting intervention.

BACKGROUND: Difficulty with feeding is common during early childhood. Behavioral techniques have shown considerable utility for difficult feeding, although large-scale studies of behavioral parenting interventions with typically developing young children, and in group formats, are limited. OBJECTIVE: The current study aimed to evaluate the efficacy of a group-based, behavioral family intervention for typically developing healthy children with problem eating via a fully randomized 2-group design. METHODS: : Ninety-six families of children aged 1.5 to 6 years with feeding difficulties participated in a trial of Hassle Free Mealtimes Triple P (A. Morawska and M.R. Sanders, unpublished data, 2008) in regional and metropolitan Queensland (Australia). RESULTS: Results support the utility of a group-based behavioral parenting program for childhood feeding issues, with significant improvements to the mealtime and general behavior of target children, the mealtime and general practices of parents, parental confidence and cognitions, compared with a waitlist control. Six-month follow-up data and clinical and reliable change indices support the intervention's utility. Parents were also highly satisfied with the program. CONCLUSION: The current study provides evidence of the efficacy of a group-based behavioral family intervention for mealtime difficulties, including observational and more extended outcome measures. Future directions and clinical implications of this research are discussed.