It Takes a Village: Multidisciplinary Approach to Screening and Prevention of Pediatric Sleep Issues.

Sleep is essential to human development. Poor sleep can have significant effects on cognition, learning and memory, physical and behavioral health, and social-emotional well-being. This paper highlights the prevalence of common pediatric sleep problems and posits that a multidisciplinary approach to the assessment and intervention of sleep problems is ideal. Primary care providers are often the first professionals to discuss sleep issues with youth and families. However, dentists, otolaryngologists, childcare providers, school personnel, and behavioral health providers have a vital role in screening and prevention, providing intervention, and monitoring the progress of daily functioning. The strengths of this approach include better provider-to-provider and provider-to-family communication, streamlined assessment and intervention, earlier identification of sleep issues with more efficient referral, and longer-term monitoring of progress and impact on daily functioning. Barriers to this approach include difficulty initiating and maintaining collaboration among providers, limited provider time to obtain the necessary patient permission to collaborate among all multidisciplinary providers, lack of financial support for consultation and collaboration outside of seeing patients face-to-face, geographic location, and limited resources within communities. Research investigating the utility of this model and the overall impact on pediatric patient sleep issues is warranted and strongly encouraged.

Quality Improvement Targeting Adherence During the Transition from a Pediatric to Adult Liver Transplant Clinic.

The transition from pediatric to adult transplant care is a high risk period for non-adherence and poor health outcomes. This article describes a quality improvement initiative integrated into a pediatric liver transplant program that focused on improving outcomes following the transfer from pediatric to adult liver transplant care. Using improvement science methodology, we evaluated the impact of our center's transition readiness skills (TRS) program by conducting a chart review of 45 pediatric liver transplant recipients who transferred to adult transplant care. Medication adherence, clinic attendance, and health status variables were examined for the year pre-transfer and first year post-transfer. 19 recipients transferred without participating in the TRS program (control group) and 26 recipients participated in the program prior to transferring to the adult clinic (TRS group). The TRS group was significantly older at the time of transfer, more adherent with medications, and more likely to attend their first adult clinic visit compared to the control group. Among the TRS group, better adolescent and parent regimen knowledge were associated with greater adherence to post-transfer clinic appointments. Transition planning should focus on the gradual shift in responsibility for health management tasks, including clinic attendance, from parent to adolescent. There may be support for extending transition support for at least 1 year post-transfer to promote adherence.

Effects of interaction experiences and undergraduate coursework on attitudes toward gay and lesbian issues.

College experiences can expand knowledge, decrease negative stereotypes, and increase acceptance toward diversity, especially regarding gay and lesbian issues. This study found that the more interaction undergraduate students have with gay and lesbian people on campus, the more accepting their attitudes are regarding (1) same-sex, consensual sex, (2) same-sex relations between adults is not unnatural, (3) vote for a gay presidential candidate, (4) friends with a feminine man, (5) friends with a masculine woman, (6) knowledge of GL issues important for future career, and (7) comfortable with GL roommate. Furthermore, the more undergraduate students are exposed to coursework addressing gay and lesbian issues, the more positive their attitudes are regarding the importance of knowledge of gay/lesbian issues for future career and comfort with a gay/lesbian roommate. Discussion explores possible long-term implications of systematic interaction experiences and coursework at all levels within the educational system to prevent negative attitude formation.