RESUMO
Background: Telelactation, a virtual lactation support platform, is a convenient and effective way of providing virtual breastfeeding support services and communicating proper breastfeeding techniques to new mothers to address any breastfeeding challenges and boost overall maternal breastfeeding confidence all from the comfort of their homes. This Ontario Health Insurance Plan (OHIP) covered service benefits more mothers in the remote areas where in-person LC service is not easily accessible. Objective: The objective of this cross-sectional survey study is to explore the feasibility, potential benefits, and challenges, and level of patient satisfaction in virtual lactation consultation services along with virtual paediatrician consultation available in Ontario, Canada. Method: Patient satisfaction was assessed using a structured online survey as a part of a cross-sectional observational study that asked questions relevant to several independent demographic variables as well as specific Likert type scale questions to gauge patient satisfaction with virtual lactation consultation. Results: Data were analyzed from 177 survey responses (n=177), of which study revealed that 86.44% (153/177) were satisfied with the virtual lactation services they received. Patient satisfaction was found to be higher in the first-time mothers with high school or undergraduate education between the age group of 26 to 35 years living in the Greater Toronto Area (GTA). In terms of connectivity, participants from the GTA had a better experience overall compared those living outside the GTA. Conclusion: OHIP covered telelactation with a paediatrician consultation is an innovative and feasible health care delivery platform for providing remote professional breastfeeding support to mothers of all socio-economic strata with great potential to further improve both patient experience and efficiency in patient care.
RESUMO
OBJECTIVE: The study aimed to assess current practices of a community hospital for collection of urine sample when diagnosis of urinary tract infection (UTI) is suspected in children aged 0 to 36 months old. METHODS: An analysis of paediatric patients aged 0 to 36 months old was performed in two separate audits to assess the quality of urine sampling. The first, retrospective analysis comprised of urine collections techniques in a community hospital for diagnosis of UTI followed by an education intervention in which the hospital staff was briefed regarding the Canadian Paediatric Society (CPS) position statement for diagnosis and management of UTI. CPS recommendations were transposed using PowerPoint presentations, reminders at unit huddles, and other educational forums. Second audit was a prospective analysis which was conducted 6 months after the educations intervention. RESULTS: Bagged sampling had higher sensitivity and lower specificity due to sample contamination, versus transurethral bladder catheterization and suprapubic aspiration. The first audit showed that while 66% of culture-positive urine sampling was performed via the bagging, only 26% those positive cultures were repeated before treatment. In the second audit, after educational intervention, 33% of culture-positive urine collection was done via the bagging method and repeat testing was done in 83% of positive results on a bagged sample before initiating treatment. The false-positive rate for the diagnosis of UTIs in the first and second audit was 65.7 and 60%, respectively. CONCLUSION: Our study recognizes the flaws in community hospital practices in the diagnosis of UTI in children and validates the significance of educational intervention in improving health care.
RESUMO
BACKGROUND: Ultrasound has the first line investigation role in the diagnosis of acute appendicitis in children. The purpose of this study was to perform a quality assessment review on the visualization rate of appendix on ultrasound in children in the community hospital setting. METHODS: A retrospective chart review of the abdominal ultrasound findings for the visualization of the appendix was performed on paediatric patients ranging from 5 to 18 years. Data were collected from the two community hospitals of Toronto by using hospital electronic medical record for the ultrasound findings in patients presented with abdominal pain. RESULTS: Data from two community hospitals indicated visualization rate of the appendix as 11.0% and 23.2% for site 1 and site 2 respectively. In cases where the ultrasound was repeated the visualization rate remains the same. A two-proportion z-test was performed to find whether the visualization of appendix increases the likelihood of diagnosing appendicitis. The results revealed that the visualization of an appendix (P=0.52), significantly improved the diagnosis of appendicitis (z=34, P<0.001). CONCLUSION: Visualization of an appendix on ultrasound increases the likelihood of correctly diagnosing appendicitis. In our study, we found low visualization rate of appendix on ultrasound that could be the result of many factors that contribute towards the low visualization rate of an appendix on ultrasound. Hence, the challenges in identifying appendix should be minimized to improve the visualization and diagnosis of appendicitis on ultrasound.
