Visiting Jack: Mixed Methods Evaluation of a Virtual Home Visit Curriculum With a Child With Medical Complexity.

BACKGROUND: There are limited training opportunities for pediatricians in caring for children with medical complexity (CMC) in the home and community. Prior studies have described a lack of comfort caring for CMC among pediatric residents. OBJECTIVE: 1) To evaluate the impact of participation in a virtual home visit curriculum on pediatric residents' confidence, knowledge, and application of knowledge in complex care; 2) to explore changes in perspectives relating to the care of CMC after participation in the curriculum. METHODS: This was a prospective pre-post intervention study in 2019 with first-year pediatric residents, using quantitative and qualitative methods. The intervention, co-created with a family partner, was an online video-based curriculum followed by an in-person seminar. Pre- and postassessments were compared using paired t tests. Follow-up interviews and focus groups were performed 5 to 8 weeks after training. Transcripts were analyzed using inductive thematic analysis. RESULTS: Twenty-four residents (100%) participated. Residents reported increased confidence in all aspects of complex care presented in the curriculum, with significant increase in knowledge and application of knowledge (all P < .001). Twelve residents (50%) participated in a follow-up interview or focus group. Four themes were identified: 1) recognizing prior attitudes toward complexity, 2) new mental framework for complex care at home, 3) drivers of behavior change, and 4) commitment to change practice. CONCLUSIONS: Participation in this curriculum was associated with increased confidence, knowledge, and application of knowledge in complex care outside of the hospital. Qualitative findings align with transformative learning theory, lending insight into effective approaches to complex care training.

"This Is How Hard It Is". Family Experience of Hospital-to-Home Transition with a Tracheostomy.

Rationale: Expansion of chronic ventilation options and shared decision-making have contributed to an increasing population of technology-dependent children. One particularly vulnerable group is children with tracheostomy who depend on technology for basic respiratory functions. Chronic critical care is now provided in the homecare setting with implications for family caregivers.Objectives: This study explores the experience of family caregivers of children and young adults with a tracheostomy during the transition from hospital to home care. We sought to identify the specific unmet needs of families to direct future interventions.Methods: We recruited a convenience sample of families from an established home ventilation program to participate in semistructured interviews. Sessions were conducted in person or via teleconference. A grounded-theory qualitative analysis was performed.Results: Between March 2017 and October 2018, we interviewed 13 individuals representing 12 families of children and/or young adults with tracheostomy. Patients ranged in age from 9 months to 28 years, had a tracheostomy for 8 months to 18 years, and represented a variety of underlying diagnoses. Five key themes emerged: 1) navigating home nursing; 2) care coordination and durable medical equipment (DME) impediments; 3) learning as a process; 4) managing emergencies; and 5) setting expectations.Conclusions: Our findings support the need for family-centered discharge processes including coordination of care and teaching focused on emergency preparedness.

Female Sport Participation Effect on Long-Term Health-Related Quality of Life.

BACKGROUND: Female participation in sport has grown substantially over the last 4 decades. OBJECTIVES: We investigated the association between sports participation and (1) later-life health outcomes and (2) later-life quality-of-life (QoL) measures among female college alumni. METHODS: We conducted a cross-sectional study of female alumni between the ages of 40 and 70 years. Participants completed a questionnaire that included QoL measures assessing general health, negative consequences of alcohol use, mental health, and other self-reported health outcomes. We divided alumni into athletes and nonathletes. Between-group comparisons of health outcomes were adjusted for age; QoL measures were adjusted for age, exercise habits, cigarette smoking, alcohol use, and comorbidities. RESULTS: Questionnaires were sent to 47 836 alumni, 3702 (8%) responded. Forty-four percent of female respondents participated in collegiate sports. After adjusting for age, female respondents who participated in collegiate sports were more likely to exercise >3×/week (61.8% vs 50.2%; P ≤ 0.001), view themselves in good/great health (91% vs 85%; P < 0.001), and less likely to have ever smoked (13.6% vs 25.3%; P ≤ 0.001) or used recreational drugs (7.5% vs 9.5%; P = 0.018). A smaller proportion of female athletes reported hypertension (5.5% vs 13.5%; P ≤ 0.001), high cholesterol (9.9% vs 17.0%; P < 0.001), and obesity (3.1% vs 6.8%; P = 0.001) compared with nonathletes. Participation in sports was, however, associated with decreased mobility (R = 0.1826; P = 0.002) and increased anxiety (R = 0.039; P = 0.016) QoL scores. CONCLUSIONS: Sports participation for female collegiate athletes was associated with mostly positive health outcomes, but also with lower mobility and increased anxiety QoL scores.

Bridging the Stressful Gap Between ICU and Home: Medical Simulation for Pediatric Patients and Their Families.

OBJECTIVES: Introduce an expanding role for pediatric critical care and medical simulation to optimize the care for children with technology dependence. DATA SOURCES: Limited review of literature and practice for current teaching paradigms, vulnerability of the patient population, and efficacy of simulation as a medical educational tool. CONCLUSIONS: In accordance with new care models and patient need, critical care requires parallel evolution of care practices, including new educational and care models, in order to maximally reduce risk, fear, and anxiety and to insure quality and consistent care in the community for patients and families transitioning between the ICU and home environments.