Improving paediatric care in the community

Stiris, Tom; Torso, Stefano del; Mercier, J; Barak, Shimon; Wettergrem, Bjorn; Ross-Russell, Robert; Valiulis, Arūnas; Hadjipanayis, Adamos

doi:10.1016/s0140-6736(15)60745-0

Cited by 3 publications

(2 citation statements)

References 3 publications

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“…Data of over 1000 children till 15 years of age living in a rural area near Padova (Italy, 45°N latitude) were made available for analysis in the electronic medical record system of a primary care paediatrician (PCP, or family paediatrician). In Italy a PCP provides comprehensive and continuing free health care to children, ordinarily from 0 to 14 years of age, as recommended by the European Academy of Paediatrics [36]. All children having at least one serum 25-OH-D measurement between November 2010 and January 2015 were identified; the 25-OH-D test was part of a panel of laboratory tests prescribed for various clinical reasons (such as suspected anaemia, poor growth, fatigue, etc).…”

Section: Methodsmentioning

confidence: 99%

Effect of vitamin D3 seasonal supplementation with 1500 IU/day in north Italian children (DINOS study)

2019

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BackgroundThe appropriate dose of vitamin D supplementation in children is still debated. We calculated that the recommended dose of 600–1000 IU vitamin D3/day is not sufficient to reach a serum 25-hydroxyvitamin D (25-OH-D) level of at least 30 ng/ml (75 nmol/l) in north Italian children > 12 months. The aim of this study was to analyse the effect of seasonal supplementation with 1500 IU (=37.5 μg) vitamin D3/day.MethodsDINOS (D-vitamIN Oral Supplementation) study was a pilot, monocentric, non-random case-control register study. It was conducted in a paediatric primary care setting near Padova (North Italy, 45°N latitude). The data of 203 children (girls:boys 1:1,33) aged 2–15 years, collected between November 2010 and January 2015, were analysed. Active group A (n = 82) were given 1500 IU vitamin D3/day from November to April; control Group B (n = 121) received no supplementation. The serum 25-OH-D test was part of a laboratory tests panel and performed using a chemiluminescence immunoassay method.ResultsSerum 25-OH-D mean level + standard deviation throughout the period was 32 + 13 ng/ml (80 + 32 nmol/l) in group A vs 22 + 10 ng/ml (55 + 25 nmol/l) in group B. In group A 12% had vitamin D deficiency 25-OH-D < 20 ng/ml (50 nmol/l) and 1.2% severe vitamin D deficiency 25-OH-D < 10 ng/ml (25 nmol/l). In group B 46% had vitamin D deficiency and 9% severe deficiency (P < 0.001). In group A mean levels were normal or near-normal all the year except in May. Group B reached mean 25-OH-D levels close to 30 ng/ml (75 nmol/l) only in late summer. The active group mean 25-OH-D level was normal in preschoolers and schoolers but not in adolescents. Non-white children had a three-times vitamin D deficiency probability despite supplementation.ConclusionsVitamin D supplementation with at least 1500 IU vitamin D3/day from November to April was found appropriate for children in North Italy. A prolongation until May could be useful. Higher doses and/or prolonged periods could be more appropriate especially in adolescents and in non-white children.Study registrationDINOS gained the approval of Padova Ethics Committee (n. 3960/U16/2016).Electronic supplementary materialThe online version of this article (10.1186/s13052-018-0590-x) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Effect of vitamin D3 seasonal supplementation with 1500 IU/day in north Italian children (DINOS study)

2019

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“…The need to increase exposure to paediatrics in GP training has been recognized in the UK [ 25 ]. The training for paediatric physiotherapists [ 26 ] and podiatrists [ 27 ] does, however, include competencies to identify and manage normal variants and also to identify serious MSK pathology and when to refer.…”

Section: Discussionmentioning

confidence: 99%

RightPath: a model of community-based musculoskeletal care for children

Smith

Mercer

Firth

et al. 2020

Rheumatology Advances in Practice

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Objectives Musculoskeletal presentations are common (reported prevalence 1 in 8 children) and a frequent cause of consultations (6% of 7 year olds in a cohort study from the UK). Many causes are self-limiting or raised as concerns about normal development (so called ‘normal variants’). We aimed to describe a new model of care to identify children who may be managed in the community by paediatric physiotherapists and/or podiatrists rather than referral to hospital specialist services. Methods Using mixed methods, we tested feasibility, acceptability and transferability of the model in two UK sites. Evaluation included patient flow, referral times, diagnosis and feedback (using questionnaires, focus groups and interviews). Results All GP referrals for MSK presentations (in individuals under 16 years) were triaged by nurses or allied health professionals using a triage guide; approximately 25% of all MSK referrals were triaged to be managed by community-based paediatric physiotherapists/podiatrists and most (67%) had a diagnosis of ‘normal variants’. Families reported high satisfaction with no complaints or requests for onward specialist referral. No children re-presented to the triage service or with serious MSK pathology to hospital specialist services in the subsequent 6-months after triage. Triagers reported paediatric experience important in triage decision-making and case-based-learning as the preferred training format. Conclusions . The triage model is acceptable, feasible and transferable to enable appropriate care in the community for a proportion of children with MSK complaints. This is a multi-professional model of ‘better working together’ between primary community and specialist providers.

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