Reducing Waiting Time in the General Pediatric Clinic at Al Wakra Hospital, Qatar

Background: Waiting times for clinic appointments constitute a key indicator of an outpatient department performance for access to care and patient satisfaction. This is particularly relevant for pediatric population. The Ministry of Public Health in Qatar set a waiting time of 28 days for patients to get new appointment in General Outpatient Department (GOPD). The current average waiting time to get a new appointment in the general pediatric clinic (GPC) at AWH is 57 days. Aim: Decrease the average waiting time to get a new clinic appointment from 57 days to 28 days by the end of December 2018, and to meet the national targets set by the Ministry of Public Health. Methodology: This is a Quality Improvement (QI) project using the Model for Improvement (MFI). The MFI framework is designed to support organizations answering fundamental questions before agreeing on drivers for change. The implementation of change was be facilitated by the Plan-Do-Study-Act (PDSA) cycles methodology. The QI project team performed a root cause analysis using the Ishikawa diagram and identified the key contributing factors to the long waiting times to get a new appointment. Twenty-seven PDSA cycle ramps were designed with support of predictive tool to test innovative changes in current operational processes in an attempt to improve waiting time in the general pediatric clinic at Al Wakra Hospital. Results: The monthly average number of referrals for GPC increased by 200% between the pre and post implementation periods. The average triage waiting time improved from 6 to 2.6 days in 2018 and the average become 1 day in 2019. Post-implementation the average waiting time for patients to get new appointment improved from 57 days to 28 days in 2018 and the average waiting time improved to 16 days in 2019. Conclusion: The quality improvement project for the AWH general pediatric clinic demonstrates significant improvement in waiting times for new appointments, the recommendation for the hospital leadership would be to rollout the improvement methodology to other clinics that suffer from similar challenges.

Assessment of pattern of refractive errors in infantile esotropia- A single-center cross-sectional study

This was a cross-sectional study conducted to explore the patterns of refractive errors found in infantile esotropia patients from newborns to the age of 15 years, attending the Pediatric clinic of Al-Ibrahim Eye Hospital, Karachi, Sindh, Pakistan. Data was collected on a pre-designed proforma. A total of 79 patients (total of 158 eyes) including 44 males (55%) and 36 females (45%) were recruited. All these patients had infantile esotropia. The study showed out of 79 patients (158 eyes), 89 eyes had hyperopia, 15 eyes had myopic astigmatism, 44 eyes had hyperopic astigmatism, while 4 eyes had mixed astigmatism, and 6 eyes had myopia. The hypermatropia was found to be the most commonly occurring refractive error in infantile esotropia resulting in inward eye deviation.

A 3-Item Measure of Digital Healthcare Literacy: Development and Validation (Preprint)

BACKGROUND With increased reliance on digital healthcare, including telehealth, efficient and effective ways are needed to assess patients’ comfort and confidence with utilizing these services. OBJECTIVE The goal of this study was to develop and validate a brief scale that assesses digital healthcare literacy. METHODS We first developed an item pool using the existing literature and expert review. We then administered the items to participants as part of a larger study. Participants were caregivers of children receiving care at a pediatric clinic who completed a survey either online or over the phone. We randomized participants into a development and confirmatory sample stratifying by language so that exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) could be performed with a separate sample of participants. We assessed the scale’s validity by examining its associations with participants’ demographics, digital access, and prior digital healthcare use. RESULTS Participants (N=507) were, on average, aged 33.7 (SD 7.7) years and 89% female. Approximately half (55%) preferred English as their primary language, 31% preferred Spanish, and 14% Arabic. Around half (45%) had a high school degree or less and 45% had an annual household income less than US $35,000. Using the EFA, three items were retained in a reduced score with excellent reliability (Cronbach’s alpha = 0.90) and a high variance explained (78%). The reduced scale had excellent CFA fit with factor loadings between 0.82 and 0.94. All fit statistics exceeded the criteria for good fit between the proposed factor structure and the data. We refer to this scale as the Digital Healthcare Literacy Scale (DHLS). The scale was positively associated with education (ρ =0.139, p=.005) and income (ρ =0.379, p<.001). Arabic speakers had lower scores compared to English (p<.001) and Spanish speakers (p=.015), and Spanish speakers had lower scores relative to English speakers (p<.001). Participants who did not own a smartphone (p=0.13) or laptop (p<.001) had lower scores than those who did own these devices. Finally, participants who had not used digital tools, including health apps (p<.001) and video telehealth (p<.001), had lower scores than those who had. CONCLUSIONS Despite the potential for digital healthcare to improve quality of life and clinical outcomes, many individuals may not have the skills to engage with and benefit from it. Moreover, these individuals may be those who already experience worse outcomes. A screening tool like DHLS could be a useful resource to identify patients who require additional assistance to use digital health services and help ensure health equity. CLINICALTRIAL N/A

On the Relationship Between Serum Level of Interleukin-33 with Allergic Rhinitis and Its Severity in Children

Background: T helper type 2 (Th2) cells are critical cellular elements in allergic rhinitis. Interleukin-33 (IL-33) produces Th2-related cytokines and binds to the ST2 receptors. This is expressed strongly in mastocytes and discerningly in Th2 cells. Through Th2 cells, IL-33 may also have partly involved in immune responses. Objectives: This study aimed to measure the IL-33 serum levels in children suffering from allergic rhinitis and investigate its relationship with the disease. Methods: This case-control study was conducted on a population with the age range of 7-18 years, who referred to the Pediatric Clinic of the Shahid Beheshti Hospital in Kashan, Iran, in 2017. The study sample encompassed 57 patients with allergic rhinitis (case group) and 57 subjects with no allergic rhinitis (control group). The ELISA assay was used to measure the serum level of IL-33 in the case and control groups. Allergic rhinitis was diagnosed by a pediatric immunologist considering the patient’s history and the guidelines set out by the Allergic Rhinitis and its Impact on Asthma (ARIA). All study data were analyzed with SPSS software version 22. Results: There were significant differences between the two groups in terms of age (P = 0.001), gender (P = 0.0144), family history of atopy (P < 0.001), symptoms duration (P < 0.001), and comorbidities (e.g., atopic dermatitis and asthma) (P < 0.001). Furthermore, compared to the control group, the case group exhibited significantly higher IL-33 serum levels (P < 0.001). Conclusions: The high serum levels of IL-33 exhibited in patients with allergic rhinitis indicate its involvement in the pathogenesis of the concerned disease.

Examining the Use of a Brief Online Intervention in Primary Care for Changing Low-Income Caregivers’ Attitudes Toward Spanking

There is a robust and growing literature base indicating that spanking is a common, but potentially problematic, discipline strategy. Goals: Using a randomized controlled trial design, this study examined whether participation in a brief online program, Play Nicely, would result in favorable changes in caregivers’ attitudes toward spanking. The study also examined whether the intervention was equally effective for participants of color (POC) and White participants, and it assessed caregivers’ perceptions of the program’s cultural sensitivity. Methods: Participants were 52 caregivers from 1- to 5-year-old children who were visiting a pediatric clinic. Participants were enrolled and randomly assigned to either engage in the Play Nicely online program ( n = 21) or view a control condition website ( n = 31) in a clinic exam room. Results: There was not a statistically significant difference between the treatment and control groups’ scores on attitudes toward spanking (ATS) at post-test ( F (1, 49) = 1.515, p = 0.224), but a small between-group effect size was detected ( d = 0.20). Within the treatment condition, desired changes in ATS scores were significantly higher among White participants than POC ( t (17) = −2.125, p = 0.049), but there was not a significant difference in reported perceptions of Play Nicely’s cultural acceptability between White participants and POC ( t (19) = 0.469, p = 0.644). Conclusions: Findings suggest a need for further investigation of Play Nicely’s impact on caregivers’ ATS with a larger sample to clarify the program’s utility as a potential population-based tool for parent education and violence prevention. Additional research is needed to identify sociocultural factors that may moderate the effects of spanking interventions for families across diverse racial backgrounds.

Educational Intervention of Healthy Life Promotion for Children with a Migrant Background or at Socioeconomic Disadvantage in the North of Italy: Efficacy of Telematic Tools in Improving Nutritional and Physical Activity Knowledge

The aim of the “Smuovi La Salute” (“Shake Your Health”) project was to implement an integrated and comprehensive model to prevent and treat overweight and obesity in low socioeconomic status (SES) and minority groups living in three different districts in the north of Italy. An app and a cookbook promoting transcultural nutrition and a healthy lifestyle were developed, and no-cost physical activities were organized. Healthy lifestyle teaching was implemented in 30 primary school classrooms. Learning was assessed through pre- and post-intervention questionnaires. At the Obesity Pediatric Clinic, overweight and obese children of migrant background or low SES were trained on transcultural nutrition and invited to participate in the project. Primary school students increased their knowledge about healthy nutrition and the importance of physical activity (p-value < 0.001). At the Obesity Pediatric Clinic, after 6 months, pre–post-intervention variation in their consumption of vegetables and fruit was +14% (p < 0.0001) and no variation in physical activity habits occurred (p = 0.34). In this group, the BMI z-score was not significantly decreased (−0.17 ± 0.63, p= 0.15). This study demonstrates the feasibility and efficacy of telematic tools and targeted community approaches in improving students’ knowledge with regard to healthy lifestyle, particularly in schools in suburbs with a high density of migrants and SES families. Comprehensive and integrated approaches provided to the obese patients remain mostly ineffective.