SARS-CoV-2 and Swabs: Disease Severity and the Numbers of Cycles of Gene Amplification, Single Center Experience.

Pediatric COVID-19 determines a mild clinical picture, but few data have been published about the correlation between disease severity and PCR amplification cycles of SARS-CoV-2 from respiratory samples. This correlation is clinically important because it permits the stratification of patients in relation to their risk of developing a serious disease. Therefore, the primary endpoint of this study was to establish whether disease severity at the onset, when evaluated with a LqSOFA score, correlated with the gene amplification of SARS-CoV-2. LqSOFA score, also named the Liverpool quick Sequential Organ Failure Assessment, is a pediatric score that indicates the severity of illness with a range from 0 to 4 that incorporates age-adjusted heart rate, respiratory rate, capillary refill and consciousness level (AVPU). The secondary endpoint was to determine if this score could predict the days of duration for symptoms and positive swabs. Our study included 124 patients aged between 0 and 18 years. The LqSOFA score was negatively correlated with the number of PCR amplification cycles, but this was not significant (Pearson's index -0.14, p-value 0.13). Instead, the correlation between the LqSOFA score and the duration of symptoms was positively related and statistically significant (Pearson's index 0.20, p-value 0.02), such as the correlation between the LqSOFA score and the duration of a positive swab (Pearson's index 0.40, p-value < 0.01). So, the LqSOFA score upon admission may predict the duration of symptoms and positive swabs; the PCR amplification of SARS-CoV-2 appears not to play a key role at onset in the prediction of disease severity.

Pediatricians' experiences of managing outpatient care during the COVID-19 pandemic: A qualitative study in Germany.

Background: Pediatricians are important sources of information for parents regarding their children's health. During the COVID-19 pandemic, pediatricians faced a variety of challenges regarding information uptake and transfer to patients, practice organization and consultations for families. This qualitative study aimed at shedding light on German pediatricians' experiences of providing outpatient care during the first year of the pandemic. Methods: We conducted 19 semi-structured, in-depth interviews with pediatricians in Germany from July 2020 to February 2021. All interviews were audio recorded, transcribed, pseudonymized, coded, and subjected to content analysis. Results: Pediatricians felt able to keep up to date regarding COVID-19 regulations. However, staying informed was time consuming and onerous. Informing the patients was perceived as strenuous, especially when political decisions had not been officially communicated to pediatricians or if the recommendations were not supported by the professional judgment of the interviewees. Some felt that they were not taken seriously or adequately involved in political decisions. Parents were reported to consider pediatric practices as sources of information also for non-medical inquiries. Answering these questions was time consuming for the practice personnel and involved non-billable hours. Practices had to adapt their set-up and organization immediately to the new circumstances of the pandemic, which proved costly and laborious as well. Some changes in the organization of routine care, such as the separation of appointments for patients with acute infection from preventive appointments, were perceived as positive and effective by some study participants. Telephone and online consultations were established at the beginning of the pandemic and considered helpful for some situations, whereas for others these methods were deemed insufficient (e.g. for examinations of sick children). All pediatricians reported reduced utilization mainly due to a decline in acute infections. However, preventive medical check-ups and immunization appointments were reported to be mostly attended. Conclusion: Positive experiences of reorganizing pediatric practice should be disseminated as "best practices" in order to improve future pediatric health services. Further research could show how some of these positive experiences in reorganizing care during the pandemic are to be maintained by pediatricians in the future.

The Feasibility of a Pediatric Distance Learning Curriculum for Emergency Nurses During the COVID-19 Pandemic: An Improving Pediatric Acute Care Through Simulation Collaboration

To develop and evaluate the feasibility and effectiveness of a longitudinal pediatric distance learning curriculum for general emergency nurses, facilitated by nurse educators, with central support through the Improving Acute Care Through Simulation collaborative. Kern's 6-step curriculum development framework was used with pediatric status epilepticus aimed at maintaining physical distancing, resulting in a 12-week curriculum bookended by 1-hour telesimulations, with weekly 30-minute online asynchronous distance learning. Recruited nurse educators recruited a minimum of 2 local nurses. Nurse educators facilitated the intervention, completed implementation surveys, and engaged with other educators with the Improving Pediatric Acute Care through Simulation project coordinator. Feasibility data included nurse educator project engagement and curriculum engagement by nurses with each activity. Efficacy data were collected through satisfaction surveys, pre-post knowledge surveys, and pre-post telesimulation performance checklists. Thirteen of 17 pediatric nurse educators recruited staff to complete both telesimulations, and 38 of 110 enrolled nurses completed pre-post knowledge surveys. Knowledge scores improved from a median of 70 of 100 (interquartile range: 66-78) to 88 (interquartile range: 79-94) (P =.018), and telesimulation performance improved from a median of 60 of 100 (interquartile range: 45-60) to 100 (interquartile range: 85-100) (P =.016). Feedback included a shortened intervention and including physician participants. A longitudinal pediatric distance learning curriculum for emergency nurses collaboratively developed and implemented by nurse educators and Improving Pediatric Acute Care through Simulation was feasible for nurse educators to implement, led to modest engagement in all activities by nurses, and resulted in improvement in nurses' knowledge and skills. Future directions include shortening intervention time and broadening interprofessional scope.

Toward Evidence-Based Practice

Experts suggest how 6 research articles can be used in nursing practice.

Establishing a Breastfeeding Consortium for Clinicians in Pediatric Outpatient Care

Creating a supportive environment for breastfeeding mothers in the primary care setting has been shown to improve breastfeeding rates and duration. An important aspect of establishing a breastfeeding-friendly practice is to engage and educate health care providers. To increase consistency of breastfeeding care and interventions across a large primary care network, we established an Ambulatory Breastfeeding Consortium (ABC) focused on information sharing and discussion centered on care of breastfeeding and lactating families. The COVID-19 pandemic further highlighted the need to share up-to-date education and guidance, and the importance of the role of primary care providers in breastfeeding support. The ABC has been effective in engaging primary care nurses and other clinicians and disseminating information while encouraging discussion on the importance of providing informed care to breastfeeding families. Although more breastfeeding-specific education is recommended for clinicians, the ABC serves as a model for primary care clinicians to improve their knowledge and provide support for families through education, shared experience, and awareness across many pediatric primary care network sites. Development of a breastfeeding consortium for ambulatory care clinics in the Children's Hospital of Philadephia primary care network including 31 sites across Pennsylvania and New Jersey is presented. Virtual monthly meetings and education facililtated clinicians knowledge on various breastfeeding topics. The consortium has been especially helpful during the COVID-19 pandemic as birthing hospitals discharge new mothers ealier than usual and often without full assessment of the breastfeeding couplet. Ongoing updates of information from the government and professional organizations were able to be shared with members of the interdisciplinary team.

'Most children's hospitals are struggling'...John Nickens

The article focuses on the challenges facing children's hospitals in the U.S. Topics discussed include the problem on shortage in medical professionals at these hospitals, events that have affected children's hospitals in the country, an increase in the number of child patients in the emergency room, and the conversion of hospital rooms to navigate capacity issues.

The Impact of COVID-19 Pandemic and Quarantine Process a Center in Turkey on Anxiety Levels of Pediatric Patients with Epilepsy

Introduction: In this study, we aimed to compare the levels of state and trait anxiety in pediatric patients with epilepsy and healthy controls during the COVID-19 outbreak in Turkey. Materials and Methods: In this study, the state (STAI-I) and trait (STAI-II) anxiety scales were applied to patients between the ages of 10-17 years that had been followed due to epilepsy and were in quarantine. Anxiety status and potential risk factors were compared with healthy age and gender-matched control group. Results: This study included 40 epilepsy patients and 40 controls. Among the patients in the epilepsy group 92.5% had moderate and 7.5% had severe anxiety (mean value of STAI-I and STAI-II were 40.3±4.8 and 40.9±10.5, respectively). There was no significant difference between epilepsy and controls groups in terms of mean STAI-I and STAI-II scale scores (p=0.756, 0.914). When the state anxiety scores were categorized as low, moderate, and high anxiety levels, moderate-to-high state anxiety was detected in the epilepsy group, and moderate-to-low state anxiety in the control group. The state anxiety level was found to be high in patients with high seizure frequency (p=0.045). No significant relationship was found between state and trait anxiety scale scores and factors such as epilepsy duration, quarantine duration, seizure type, drug resistance, and type of antiepileptics. Conclusion: In situations that commonly affect community health, clinicians should focus also on the mental health of epileptic patients. Therefore, we believe that mental health support should be provided to pediatric patients with epilepsy.

Medical Education in Times of Pandemic: To Practice or to Protect?

Introduction: In the beginning of March 2020 with first case of COVID-19 reported in Turkey, measures that were assumed to decrease the spread of SARS-CoV-2 were taken quickly. Use of personel protective equipments and limiting number of people contacting with the patients were some of the most important precautions. Although these precautions protected medical student from risk of infection, they limited their practical learning oportunities and probably negatively effected their education. Aim of our study was to measure the effect of pandemic on medical education of grade 6 medical students. Materials and Methods: We had 6th grade medical students that finished their education between July 2020 and June 2021 fill out a questionnaire that measures their self-esteem on evaluation and procedural practice in pediatric patients and presents their subjective opinions on this period and their solution suggestions with closed and open ended questions. Results: Forty nine grade 6 student was included in the study. Their self-esteem was average (general competency in pediatric patients was 2.31±0.94 and general self reported competency in clinical practices was 2.65±1.42). The practice they feel most confident was hand washing (4.44±1.16), and the practice the feel least confident was establishment of vascular access (1.94±1.09). When they were asked to evaluate their self-competency in pediatric patients from 1 to 5,the procedure they most frequently observed was establishment of vascular access (74%) and least frequently observed was lumbar puncture (12%). Most frequently performed procedure was urinary catheterization (20%). 80.9% them stated that they felt unlucky to be 6th grade in COVID-19 pandemic and they would like to have more opportunities to contact with the patients with personal protective equipment (PPE). Conclusion: Education of 6th grade medical students affected negatively with decreasing number and diversity of patients and limited opportunity to evaluate patients and observe and perform procedures. Improvements should be made in pediatric departments to increase possibility of student to encounter patients and continue hands on learning with the right precautions.

Parent Satisfaction With Pediatric Speech-Language Pathology Telepractice Services During the COVID-19 Pandemic: An Early Look

Purpose: The aim of this study was to evaluate parent/guardian satisfaction with speech-language pathology telepractice services provided at a New York--based pediatric health care facility during the COVID-19 pandemic. Specifically, satisfaction with appointment maintenance, progress, acquisition of goals, and parent education was measured. Method: Researchers identified patients from 0 to 21 years of age who received at least one speech-language pathology telepractice service from May 1 to May 29, 2020, for study inclusion. One hundred seven patients met the inclusion criteria. A qualitative survey with four Likert scale questions was e-mailed to a parent/guardian of these patients. Questions assessed interest in maintaining telepractice services following the COVID-19 pandemic in addition to rating satisfaction with appointment maintenance, parent/caregiver education, and patient progress. Thirty participants completed the survey, reflecting 28% completion rate. Results: Parents/guardians indicated overall satisfaction with pediatric speech-language pathology telepractice services. Qualitative analyses revealed subthemes for advantages and disadvantages of the telepractice platform. Advantages included convenient scheduling and session maintenance, improved safety in the setting of COVID-19, opportunities for visual models that were not possible while masked, and increased opportunities for parent education and training in the child's natural environment. High-level clinician engagement, continuity of care, creativity, and a well-established clinical rapport improved the efficacy of telepractice sessions. Reported disadvantages included distractibility, patient age contingencies, technological difficulties, restricted treatment modalities, and virtual session structure. Results implied a preference for in-person speech-language pathology sessions versus telepractice at this facility. Conclusions: The results of this survey study indicated parent satisfaction with speech-language pathology services via telepractice. Patients' return to in-person speech-language pathology sessions when available in subsequent months does imply a preference for in-person care. However, the notable advantages and disadvantages of telepractice expressed by parents/guardians at the researchers' facility during the early months of the COVID-19 pandemic offer valuable insights for current and future speech-language pathology telepractice providers.

Factors Affecting Resiliency in Outpatient Pediatric Occupational Therapist...American Congress of Rehabilitation Medicine (ACRM) Annual Conference, November 8-11, 2022, Chicago, Illinois

1. To investigate the resilience of pediatric occupational therapy practitioners during the Covid-19 pandemic. 2. To investigate the factors that may contribute to resilience levels in occupational therapists. This short-term, mixed-methods study utilized an electronic survey that consisted of demographic, qualitative, and quantitative questions to examine what factors were in place to aid in the overall resilience of pediatric occupational therapy practitioners working in an outpatient setting. Study setting included a pediatric outpatient clinic located in the suburbs of a small, midwestern city. A voluntary response sample was recruited from an outpatient pediatric therapy clinic in Iowa. Eleven (n=11) occupational therapy practitioners met the inclusion criteria and completed at least 50% of the survey. Participants voluntarily completed the electronic survey that was shared via an anonymous survey link. Twenty-one survey questions collected demographic, qualitative, and quantitative data. The survey included ten questions adapted from the Life Orientation Test-Revised (LOT-R) which is used to measure optimism versus pessimism. Four additional qualitative questions were included to assess protective factors for psychosocial resilience and implications resulting from the Covid-19 pandemic. The results of the LOT-R demonstrated that the participants who had prior resilience training did not display a greater level of resilience or perceived ability to overcome adversity when compared to those who did not have prior resilience training. Positive resilience themes that emerged from the qualitative data include having a support system, practicing safety precautions, and taking life one day at a time. Future research should consider factors that support caregivers, specifically occupational therapy practitioners and their quality of life. By understanding what factors contribute to resilience levels, these factors can further be implemented and supported in the workplace environment. Targeted education and training for practitioners focused on resilience building should be considered. This implementation could lead to stronger support networks and reduced burnout and compassion fatigue resulting in better resilience outcomes. No known conflicts to declare.

Psychological distress among the nursing workforce in the United Arab Emirates: Comparing levels before and during the COVID-19 pandemic.

BACKGROUND: Nurses make up the majority of the healthcare workforce. They contribute to the development of healthcare systems and the provision of high-quality, effective, and patient-centered healthcare services. However, nurses need good mental and emotional well-being to provide adequate care and the necessary physical and mental health support for their clients. This study aimed to determine the level of generalized psychological distress among nurses in the United Arab Emirates. As this study was initiated before the coronavirus disease 2019 (COVID-19) pandemic, we were able to compare data gathered before and during the pandemic. METHOD: This study used a cross-sectional correlational design. The Kessler Psychological Distress Scale (K10) was used to measure generalized psychological distress. Nurses' distress levels were measured and compared before and during the COVID-19 pandemic. RESULTS: In total, 988 participants completed the questionnaire. The majority (n = 629, 63.7%) were employed in hospitals and the remainder worked in primary healthcare settings (n = 359, 36.3%). The mean distress score was 27.1 ± 13.7; 42.1% (n = 416) of participants had a severe level of distress, and only 36.4% (n = 360) reported no distress. More participants had severe stress levels before COVID-19 (59.5%, n = 386) compared with during COVID-19 (10.9%, n = 30). CONCLUSIONS: Participants' K10 scores suggest that nurses experience significant distress, which may compromise their ability to care for their clients. This study emphasizes the importance of supporting nurses as a preliminary step to improving patient care. Despite the pressure of working during the COVID-19 pandemic, participants' general distress scores were lower during than before the pandemic. Organizational, governmental, and global support and appreciation may have contributed to relieving the distress nurses experienced. This may be a useful ongoing approach for enhancing healthcare systems.

Medication Errors

Paxlovid drug interaction... Eprontia oral solution concentration conversion... Different concentrations of oral liquid Baclofen

Impact Of Covid-19 Pandemi On Mortality Profile Of Pediatric Oncology Patient In Referral Hospital

Background cancer patients are at higher risk of COVID-19 infection and more likely to have higher morbidity and mortality than the general population, While cancer it self is still the main cause of death in children around the world, In countries with limited health facilities, that might cause delayed of seeking treatment, cancer death rate in children could reach 90%, this condition would become bigger in the pandemic condition expecially in hospital that appointed as a referral hospital for COVID-19 but also tertiary hospital for hematology and oncology cases. The aim of the study was to describe is there any differences mortality profile of pediatric oncology patient before and during COVID-19 pandemic. Method : we collected data pediatric oncology patient aged 1 to 18 years that admitted to Hasan Sadikin General Hospital from Hospital Information Systems, IP-CAR, and Waiting List of Oncology Ward Hospital Admission, data conducted to differentiate between Admission Rate, New case Diagnosis and abandonment rate before and during COVID-19 pandemic. Mortality data and what might caused it also collected after audited by experts from Hasan Sadikin General Hospital. Results There were 87 death cases from January to Desember 2021 when pandemi has already happened, Acute lymphoblastic leukemia still the main oncology diagnosis for those cases (33%), most of the death cases was caused by septic Shock ((24%), the second leading caused was covid 19 (8%). We also found in our research there was a significantly increased rate of treatment abandonment from 1.1% before to 17% during COVID-19 pandemic. This may pose risk for the patients involved, not only cause treatment failure, increased toxicity or complications. Conclusion Pandemic COVID-19 increased abandonment rate that could impact the general condition of oncology patient, that might indirectly related to mortality rate. While infection as the leading causes of death before and after pandemic remain the same but the distinction was the COVID-19 as a second most caused of death. Optimal efforts should be made to avoid abandonment and prevent the occurrence of infection

Declining Influenza Vaccination Rates in an Underserved Pediatric Primary Care Center During the COVID-19 Pandemic

Background Influenza vaccine hesitancy rates are increasing in the United States, even as influenza infection accounts for significant pediatric morbidity and mortality. Disinformation and controversy surrounding COVID-related public health protections and SARS-CoV-2 vaccine roll-out may have unintended consequences that impact pediatric influenza vaccination. We sought to assess influenza vaccination rates before and during the COVID-19 pandemic in one pediatric primary care center (PPCC), which serves a predominantly Medicaid-insured, minoritized population. Method A cross-sectional study assessed influenza vaccination rates for children aged 6 months to 12 years (~17,000 patients) over influenza seasons (September-March): 1) 2018-19 and 2019-20 (pre-pandemic rates), and 2) 2020-21 and 2021-22 (intra-pandemic rates). Demographic characteristics and social risk questionnaires (e.g. food and housing insecurity, transportation and public benefit issues, etc.) were pulled from PPCC electronic medical record data. Total tetanus vaccinations during each influenza season were used as a comparison for general vaccination rates, as clinic visits varied due to COVID-related shutdowns. Generalized linear regression models with robust standard errors (SEs) evaluated differences in demographics, social factors, and influenza vaccination rates by influenza season by specifying an appropriate distribution and link function for each factor. In a subgroup of patients with clinic visits in 2018-19 and 2020-21, influenza vaccine rates were compared using the McNemar test. Multivariable logistic regression with robust SEs evaluated associations between influenza season, demographic characteristics, reported social risks, and influenza vaccination. Results The percentages of patients receiving influenza vaccinations by influenza season are depicted in Table 1. Pre-pandemic, 42% of patients with a clinic visit were vaccinated (2019-20), and this rate decreased to 30% by 2021-22 during the pandemic. Both influenza and tetanus vaccinations significantly differed across influenza seasons, with lower uptake during the COVID-19 pandemic (p < 0.01, Table 1). Both mean age (5.5, 5.7, 6.0, and 6.2 years for the 2018-19, 2019-20, 2020-21, and 2021-22 influenza seasons, respectively) and positive social risk screens (13%, 22%, 25%, 27% for the 2018-19, 2019-20, 2020-21, and 2021-22 influenza seasons, respectively) significantly increased across influenza seasons (p < 0.01). Of a subset of 1629 patients with clinic visits in both 2018-19 and 2021-22 seasons, 42% received the influenza vaccine in 2018-19, but only 30% have received the vaccine in 2021-22 (McNemar's test, p < 0.01). In a multivariable regression model, the 2020-21 (OR 0.88 [0.82-0.94]) and 2021-22 (OR 0.68 [0.62-0.74]) influenza seasons, age (OR 0.98 [0.97-0.99]), black race (OR 0.58 [0.54-0.62]), and self-pay (OR 0.84 [0.72-0.99]) were associated with influenza vaccine refusal (p < 0.05). Conclusion Influenza vaccination rates within one PPCC decreased over the years of the COVID-19 pandemic and have not rebounded. New interventions to promote influenza and possibly other vaccines are needed to improve evidence-based child health measures.

Emergency Departments' Uptake of Telehealth for Stroke Versus Pediatric Care: Observational Study.

BACKGROUND: Telehealth for emergency stroke care delivery (telestroke) has had widespread adoption, enabling many hospitals to obtain stroke center certification. Telehealth for pediatric emergency care has been less widely adopted. OBJECTIVE: Our primary objective was to determine whether differences in policy or certification requirements contributed to differential uptake of telestroke versus pediatric telehealth. We hypothesized that differences in financial incentives, based on differences in patient volume, prehospital routing policy, and certification requirements, contributed to differential emergency department (ED) adoption of telestroke versus pediatric telehealth. METHODS: We used the 2016 National Emergency Department Inventory-USA to identify EDs that were using telestroke and pediatric telehealth services. We surveyed all EDs using pediatric telehealth services (n=339) and a convenience sample of the 1758 EDs with telestroke services (n=366). The surveys characterized ED staffing, transfer patterns, reasons for adoption, and frequency of use. We used bivariate comparisons to examine differences in reasons for adoption and use between EDs with only telestroke services, only pediatric telehealth services, or both. RESULTS: Of the 442 EDs surveyed, 378 (85.5%) indicated use of telestroke, pediatric telehealth, or both. EDs with both services were smaller in bed size, volume, and ED attending coverage than those with only telestroke services or only pediatric telehealth services. EDs with telestroke services reported more frequent use, overall, than EDs with pediatric telehealth services: 14.1% (45/320) of EDs with telestroke services reported weekly use versus 2.9% (8/272) of EDs with pediatric telehealth services (P<.001). In addition, 37 out of 272 (13.6%) EDs with pediatric telehealth services reported no consults in the past year. Across applications, the most frequently selected reason for adoption was "improving level of clinical care." Policy-related reasons (ie, for compliance with outside certification or standards or for improving ED performance on quality metrics) were rarely indicated as the most important, but these reasons were indicated slightly more often for telestroke adoption (12/320, 3.8%) than for pediatric telehealth adoption (1/272, 0.4%; P=.003). CONCLUSIONS: In 2016, more US EDs had telestroke services than pediatric telehealth services; among EDs with the technology, consults were more frequently made for stroke than for pediatric patients. The most frequently indicated reason for adoption among all EDs was related to clinical care.