bims-hylehe 2019-10-27 papers

Issue of 2019‒10‒27
six papers selected by
Richard James
University of Pennsylvania

Prenat Diagn. 2019 Oct 25.

Improving fetal congenital heart disease screening using a checklist-based approach.

Janicki MB, Fernandez CG, Wakefield D, Shepherd JP, Figueroa R.

OBJECTIVE: To determine if using a checklist of specific ultrasound image criteria to screen the fetal heart improves the cardiac exam completion rate, defined as the ability to classify the heart as normal or abnormal.METHOD: This is a retrospective cohort study of patients with singleton pregnancies who underwent a fetal anatomy survey between 18 and 28 weeks' gestation. A checklist was used from 9/1/15 to 3/31/16 to categorize exams as complete-normal, complete-abnormal, or incomplete. Performance was compared with a seven-month period prior to checklist introduction (12/1/14-6/30/15).
RESULTS: Checklist utilization improved the cardiac exam completion rate by 8.9%. With the checklist, 1,083/1,202 exams (90.1%) were completed compared to 987/1,193 (82.7%) pre-checklist, p<0.001. We did not detect a change in cases classified as abnormal and referred for echocardiography: 25 (2.1%) with the checklist and 16 (1.3%) pre-checklist, p=0.16. We did not detect more congenital heart disease, 12 (1.0%) with checklist screening, 5 (0.4%) pre-checklist, p=0.14. Critical congenital heart disease was not missed in either group.
CONCLUSION: Using the checklist improved the cardiac exam completion rate. There was no change in congenital heart disease detection.

DOI: https://doi.org/10.1002/pd.5581

Palliat Med. 2019 Oct 24. 269216319874689

Medical and end-of-life decision making in adolescents' pre-heart transplant: A descriptive pilot study.

Cousino MK, Miller VA, Smith C, Uzark K, Lowery R, Rottach N, Blume ED, Schumacher KR.

BACKGROUND: Adolescents and young adults undergoing heart transplantation experience risks of morbidity and mortality both pre- and post-transplant. To improve end-of-life care for this population, it is necessary to understand their medical and end-of-life decision-making preferences.AIM: (1) To examine adolescent/young adult decision-making involvement specific to heart transplant listing, and (2) to characterize their preferences specific to medical and end-of-life decision making.
DESIGN: This cross-sectional research study utilized survey methods. Data were collected from October 2016 to March 2018.
SETTING/PARTICIPANTS: Twelve adolescent and young adult patients listed for heart transplant (ages = 12-19 years) and one parent for each were enrolled at a single-center, US children's hospital.
RESULTS: Consistent with their preferences, the majority of adolescent/young adult participants (82%) perceived a high level of involvement in the decision to be listed for transplant. Patient involvement in this decision was primarily by way of seeking advice or information from their parents and being asked to express their opinion from parents. Despite a preference among patients to discuss their prognosis and be involved in end-of-life decision making if seriously ill, only 42% of patients had discussed their end-of-life wishes with anyone. Few parents recounted having such discussions. Preferences regarding the timing and nature of end-of-life decision-making discussions varied.
CONCLUSIONS: Although young people are involved in the decision to pursue heart transplantation, little attention is paid to involving them in discussions regarding end-of-life decision making in a manner that is consistent with individual preferences.

Keywords: Child; advance care planning; decision making; heart transplantation

DOI: https://doi.org/10.1177/0269216319874689

Curr Opin Cardiol. 2019 Oct 21.

Virtual reality in pediatric cardiology: hype or hope for the future?

Sacks LD, Axelrod DM.

PURPOSE OF REVIEW: In the field of pediatric cardiology, a sub-specialty that relies on an understanding of complex three-dimensional structures, virtual reality technology may represent a new and exciting tool for both practitioners and patients. Here, the current medical and surgical applications of virtual reality are reviewed and the potential for future applications explored.RECENT FINDINGS: Multiple centers have begun to develop software designed to bring virtual reality technology to bear on congenital heart disease. These efforts have focused on surgical preparation, on education of medical providers, and on preparation of patients and their family members for cardiac interventions. Though relatively little statistical evidence for benefit has been generated to date, those studies currently available suggest that virtual reality may provide a significant benefit in all three of these aspects of medical care.
SUMMARY: The immersive nature of virtual reality meshes well with the learning styles of adult practitioners and promises to be a powerful tool for both pediatric cardiologists and the patients with whose care they are entrusted. Though additional studies are clearly needed, this technology promises to improve the field's ability to prepare providers and patients alike for challenge of treating congenital heart disease.

DOI: https://doi.org/10.1097/HCO.0000000000000694

Adv Neonatal Care. 2019 Oct 23.

Promoting Parent Partnership in Developmentally Supportive Care for Infants in the Pediatric Cardiac Intensive Care Unit.

Klug J, Hall C, Delaplane EA, Meehan C, Negrin K, Mieczkowski D, Russell SK, Hamilton BO, Hehir DA, Sood E.

BACKGROUND: Limited opportunities for parents to care for their critically ill infant after cardiac surgery can lead to parental unpreparedness and distress.PURPOSE: This project aimed to create and test a bedside visual tool to increase parent partnership in developmentally supportive infant care after cardiac surgery.
METHODS: The Care Partnership Pyramid was created by a multidisciplinary team and incorporated feedback from nurses and parents. Three Plan-Do-Study-Act (PDSA) cycles tested its impact on parent partnership in care. Information about developmentally supportive care provided by parents during each 12-hour shift was extracted from nursing documentation. A staff survey evaluated perceptions of the tool and informed modifications.
RESULTS: Changes in parent partnership during PDSA 1 did not reach statistical significance. Staff perceived that the tool was generally useful for the patient/family but was sometimes overlooked, prompting its inclusion in the daily goals checklist. For PDSA 2 and 3, parents were more often observed participating in rounds, asking appropriate questions, providing environmental comfort, assisting with the daily care routine, and changing diapers.
IMPLICATIONS FOR PRACTICE: Use of a bedside visual tool may lead to increased parent partnership in care for infants after cardiac surgery.
IMPLICATIONS FOR RESEARCH: Future projects are needed to examine the impact of bedside care partnership interventions on parent preparedness, family well-being, and infant outcomes.

DOI: https://doi.org/10.1097/ANC.0000000000000679