BACKGROUND This study will pilot test an innovative just-in-time adaptive intervention to reduce severe respiratory illness for children with severe cerebral palsy (CP). Our intervention program, RE-PACT (Respiratory Exacerbation – Plans for Action and Care Transitions), delivers timely, customized action planning and rapid clinical response when hospitalization risk is elevated. OBJECTIVE To establish RE-PACT’s feasibility, acceptability, and fidelity in up to 90 children with severe CP. An additional aim is to preliminarily estimate RE-PACT’s effect size. METHODS RE-PACT will be run through three successively larger 6-month trial waves, allowing ongoing protocol refinement according to pre-specified definitions of success for measures of feasibility, acceptability, and fidelity. RESULTS Feasibility measures include recruitment and intervention time. Acceptability measures include recruitment and completion rates as well as intervention satisfaction. Fidelity measures include observed versus expected rates of intervention and data collection activities. The primary clinical outcome is a severe respiratory illness, defined as a respiratory diagnosis requiring hospitalization. Secondary clinical outcomes include hospital days and emergency department visits, systemic steroid courses, systemic antibiotic courses, and death from severe respiratory illness. CONCLUSIONS This pilot intervention, using adaptive just-in-time strategies, represents a novel approach to reducing the incidence of significant respiratory illness for children with severe cerebral palsy. This protocol may be helpful to other researchers and healthcare providers caring for patients at high risk for acute severe illness exacerbations. CLINICALTRIAL ClinicalTrials.gov NCT05292365
Background We know little about how pediatric hospital medicine (PHM) physicians conceptualize their professional fulfillment (PF). The objective of this study was to determine how PHM physicians conceptualize PF. Objective The objective of this study was to determine how PHM physicians conceptualize PF. Methods We performed a single‐site group concept mapping (GCM) study to create a stakeholder‐informed model of PHM PF. We followed established GCM steps. For brainstorming, PHM physicians responded to a prompt to generate ideas describing the concept of PHM PF. Next, PHM physicians sorted the ideas based on conceptual relatedness and ranked them on importance. Responses were analyzed to create point cluster maps where each idea represented one point, and point proximity illustrated how often ideas were sorted together. Using an iterative and consensus‐driven approach, we selected a cluster map best representing the ideas. Mean rating scores for all the items in each cluster were calculated. Results Sixteen PHM physicians identified 90 unique ideas related to PHM PF. The final cluster map described nine domains for PHM PF: (1) work personal‐fit, (2) people‐centered climate, (3) divisional cohesion and collaboration, (4) supportive and growth‐oriented environment, (5) feeling valued and respected, (6) confidence, contribution, and credibility, (7) meaningful teaching and mentoring, (8) meaningful clinical work, and (9) structures to facilitate effective patient care. The domains with the highest and lowest importance ratings were divisional cohesion and collaboration and meaningful teaching and mentoring. Conclusion Domains of PF for PHM physicians extend beyond existing PF models, particularly the importance of teaching and mentoring.
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