** Please refer to the embargo times listed below for each item.**
PARENTS FAVOR EMAIL ACCESS TO THEIR PEDIATRICIANS*****************************************************Embargoed for release on Sunday, May 2 at 7 p.m. EDT*****************************************************Given the option, most parents would gladly e-mail their child’s pediatrician with non-urgent questions about minor ailments or symptoms, medication, feeding, sleeping and follow-up appointments, according to a preliminary small survey conducted by Johns Hopkins Children’s Center . The study’s findings are to be presented on May 2 at the annual meeting of the Pediatric Academic Societies in Vancouver. In the survey of 229 parents of children seen at Hopkins Children’s, 171 described themselves as regular e-mail users. Of these, nearly 90 percent said they would welcome e-mail as a way to communicate with their child’s doctor, yet only 11 percent said they currently do so. Three-quarters of the 171 said e-mail would improve communication and increase contact between parents and doctors. While e-mail and text-messaging remain uncommon in pediatric practices, the Hopkins investigators say it is likely only a matter of time before their use becomes widespread. The researchers caution that African-American parents and those with annual household incomes of $30,000 or less were less likely to endorse email as a desired mode of communication with their pediatricians. African-American parents, in particular, were more skeptical than white parents about e-mail and its capability to improve communication with doctors. Black parents were 68 percent less likely than white parents to describe e-mail as a satisfying form of communication, and were 66 percent less likely to endorse it as a good communication device between parents and pediatricians. Although the study did not explore the reasons for their reluctance, the researchers say the finding somewhat surprised them and clearly begs further research before adopting e-mail as a mainstream tool of doctor-patient communication. “The last thing we want to do is inadvertently create a gap in access or communication between those who use e-mail regularly and those who shun it, and before we incorporate e-mail into mainstream medical practice, we need to factor in any racial, cultural or socioeconomic preferences,” says lead researcher Michael Crocetti, M.D., M.P.H. Crocetti communicates via e-mail with about a quarter of his patients’ parents. One-third of the parents surveyed who regularly use e-mail had a child with a chronic condition. Among these parents, 65 percent said they would strongly favor e-mail communication with their pediatrician to improve management of their child’s condition, but less than half said they would be comfortable receiving test results via e-mail. The Hopkins investigators are planning a study of pediatricians’ attitudes toward e-mail. Robert Dudas, M.D., of the Johns Hopkins Bayview Medical Center, was co-investigator on the research.
* * *PEDIATRIC RESIDENTS SAY THEY ARE UNPREPARED FOR EMOTIONAL TURMOIL THAT COMES WITH CRITICALLY ILL CHILDREN*****************************************************Embargoed for release on Saturday, May 1 at 11 a.m. EDT*****************************************************
Pediatric residents say they are unprepared to deal with some of the intense emotions they face when caring for critically ill children in the pediatric intensive care unit, according to a survey led by scientists at the Johns Hopkins Children’s Center. In the study, the residents said the sudden death of a patient, a parent’s grief and anger, and discord within the medical team about how to best manage the illness were the most disturbing scenarios and the ones they felt least prepared to handle. The findings, the researchers say, underscore the need for training programs — including role play — that prepare pediatricians to manage the emotional turmoil inherent in their work. “Successfully tackling the tough emotional issues involving critically ill children is as much a true marker of a good physician as basic medical knowledge,” said the study’s lead investigator Chris Yang, M.D., a critical-care specialist at Hopkins Children’s. “Yet, most residency programs lack such training.”
In the study of 51 pediatric residents at the Johns Hopkins School of Medicine, 32 said they had faced the sudden death of a child, but only five felt prepared to manage the event. Twenty-two said they had experienced conflict within the medical team about how to treat a patient, but only 10 knew what to do when such conflict arises. Some 28 out of 40 did not know how to manage the grief and anger of parents who have a critically ill child, and 26 out of 47 were frustrated and confused about managing a child with a terminal illness when there is no defined treatment plan. Team discussions with fellow residents and with senior physicians in the PICU were the most helpful learning tools, the residents said.
The Johns Hopkins PICU team has instituted monthly debriefings and preemptive orientation of all incoming PICU residents, but more training is coming, the researchers say, including role-play involving situations specific to pediatric intensive care. Co-authors on the study included Jennifer Leung, M.D., Elizabeth Hunt, M.D., Ph.D., Janet Serwint, M.D., Matt Norvell, and Lewis Romer, M.D., all of Hopkins; and Elizabeth Keene, of St. Mary’s Health System in Lewistown, Maine. * * *
PHOTOS MAY HELP MOTHERS WITH END-OF-LIFE DECISIONS FOR HIGH-RISK PREMATURE BABIES*****************************************************Embargoed for release on Sunday, May 2 at 7 p.m. EDT***************************************************** For a woman trying to make the agonizing choice between resuscitating her critically ill premature baby or letting go, a picture may be worth a thousand words, according to a small pilot study among women with full-term newborns conducted by researchers at Johns Hopkins Children’s Center.
Highlights from the study will be presented on May 2 at the annual meeting of the Pediatric Academic Societies. A range of options exists for managing infants born before 25 weeks of gestation — from resuscitation to palliative care. But many such babies face grim prognoses, and parents and doctors must often make decisions within minutes of delivery. To test the value of photographs in helping explain the full spectrum of possible lifelong neurological and developmental outcomes facing very premature babies — ranging from normal development to severe disability—the Hopkins researchers recruited 90 women who had just given birth to full-term babies. The women were given a hypothetical scenario and asked to make a resuscitation decision following a standard prenatal counseling for extremely premature delivery. Then they were asked to make that decision again, but this time after also viewing photos of school-aged children with a wide range of outcomes, from normal development to severe neurological and developmental disabilities associated with severe prematurity. After seeing the photographs, many mothers said they felt greater certainty about their decision and reported a better grasp of the risks and benefits of each alternative. Nearly 77 percent said they preferred the counseling augmented by the photographs.
Specifically, after the picture-free counseling, 40 percent of the women were still struggling and could not make a decision, but after seeing the pictures, one-third of the undecided women said they felt comfortable making a choice. “It can be hard for someone to imagine their newborn 10, 20, 30 years down the road,” says lead investigator Colleen Hughes-Driscoll, M.D., a neonatologist at Hopkins Children’s. “But with these powerful images, the data suggest we can help mothers during this critical time by making the often-confusing ‘doctor speak’ more concrete and by putting vague medical terms into real context.” The photographs can also narrow the gap between what is being said and what is being heard, the investigators say, so much so that these pictures can be an invaluable tool for doctors and patients alike. “The bottom line is that neonatologists need to talk about long-term outcomes during prenatal counseling of women with high-risk pregnancies,” says study senior investigator Pamela Donohue, Sc.D., of Hopkins Children’s. “One of the reasons why they don’t is that they don’t have the right words, and this is where pictures can help.” Researchers measured a woman’s degree of uncertainty or conflict about her choice using a standard 1 to 5 scale. The average conflict score dropped from 1.88 to 1.74 after the women saw the images. The researchers plan to next study the approach in a group of mothers getting ready to give birth to a very premature baby. Up to 1.7 percent of the 4.2 million births in the United States each year involve severely premature babies weighing less than 1,500 grams.
Co-authors on the study included Renee Boss, M.D., Jessica Bienstock, M.D., M.P.H., and Jennifer Shepard. * * *
MOCK DRILLS DURING H1N1 OUTBREAK EXPOSE GAPS IN INFECTION PROTECTION AMONG HOSPITAL STAFF*****************************************************Embargoed for release on Tuesday, May 4 at 1:15 p.m. EDT*****************************************************
Resuscitation drills conducted during the first weeks of the H1N1 outbreak in May 2009 have exposed critical gaps in basic protection among hospital first-responders, according to a Johns Hopkins Children’s Center study. Failing to use personal protection such as gowns, glasses, respirator masks and gloves during infection outbreaks makes hospital staff vulnerable to infection and increases the risk for transmission to patients, the researchers say. The findings, to be presented May 4 at the Pediatric Academic Societies meeting, emphasize the need for repeat mock drills, the researchers say, and suggest that personal-protection exercises should be included in monthly mock crisis sessions held at Hopkins Children’s. “Having another contagious outbreak is a matter of when, not if, and the time to master protection techniques is now, before it hits us,” says study lead investigator Christopher Watson, M.D., M.P.H., a pediatric critical-care fellow. The researchers conducted 11 drills on all inpatient units at Hopkins Children’s. The scenarios involved a pediatric patient infected with H1N1 experiencing a cardiopulmonary arrest. Of the 84 participants, only 51 used protective eyeglasses, while 73 used gowns and 68 used a special respirator mask. The mock drills showed that two simple measures — stacking carts with isolation materials in key areas and designating a “gatekeeper” to control access to the patient’s room and ensure that everyone is wearing protection — can go a long way toward improving performance. Teams that had a designated gatekeeper managed to start ventilation of the patient much faster (2.7 minutes) than teams that didn’t have one (4.7 minutes). The target time for initiating this lifesaving maneuver is less than one minute, the investigators say. In teams with assigned gatekeepers, all members used respirators, compared to 77 percent among teams without a gatekeeper. Co-authors on the study included Jordan Duval-Arnould, M.P.H., Michael McCrory, M.D., Stephan Froz, E.M.T., Trish Perl, M.D., Ms.C., and Elizabeth Hunt, M.D., Ph.D.
RSS