Search

Aim: To identify multi‐disciplinary paediatric weight management services currently available in Australia and determine gaps in service provision for children and adolescents with obesity. Methods: Surveys were distributed to 17 identified Australian multi‐disciplinary paediatric weight management services. A representative from each service was asked to complete an online survey regarding service and patient characteristics, assessment and management practices, and professional development approaches. Results: Representatives from 16 multi‐disciplinary paediatric weight management services completed the survey. Fourteen services were based in major metropolitan cities and two in regional areas. Fourteen services provided care to pre‐school aged children (0–4 years old), 15 to primary school aged children (5–12 years old) and 13 to high school aged children (13–18 years old). The number of patients seen per year per service ranged from 20 to 250 and duration of waiting lists ranged from 2 months to more than 12 months. Conclusions: The current availability and accessibility of multi‐disciplinary paediatric weight management services is inadequate to service Australian children and adolescents with obesity, particularly those with severe obesity and those in rural and remote communities. To better address the issue of paediatric obesity, establishment of additional multi‐disciplinary services, training for health‐care professionals and monitoring of the provision of evidence‐based care is urgently needed. [ABSTRACT FROM AUTHOR]

Summary: To optimize treatment for children and adolescents with obesity and minimize attrition, consideration of parents' engagement and satisfaction with paediatric weight management services is crucial. The aim of this study was to conduct a mixed‐methods evaluation of parental acceptability and satisfaction of available paediatric weight management services in New South Wale, Australia's most populous state. Parents/carers referred to one of six weight management services between March 2018 and July 2019 were invited to participate. The study involved: (a) surveys and one‐on‐one phone interviews to assess overall satisfaction, acceptability of service design and delivery, treatment expectations, and service accessibility, strengths, weaknesses and areas of improvement; (b) a survey to determine costs to families of attending the service; and (c) a survey assessing families' reasons for treatment non‐attendance. N = 146 participants completed the survey to assess service satisfaction and acceptability and 37 of these also participated in phone interviews. Ninety‐three per cent were satisfied with the overall care they received and patient weight loss/cessation of weight gain and improvement in the family's overall health were rated as the most valued changes. Content analysis of interviews highlighted participants' recognition of positive changes achieved during treatment and appreciation of the resources provided, and the encouraging/empathetic nature of staff. The most common reasons for treatment attrition were difficulty in accessing the weight management service and flexibility of appointment times. Findings from this study can be utilized in future planning and development of paediatric weight management services to facilitate integrated, responsive and effective care of children and adolescents with obesity. [ABSTRACT FROM AUTHOR]

Background: Pediatric obesity is a serious, but clinically neglected, chronic health problem. Despite the high prevalence, excess weight problems are rarely managed when children attend clinical services. It is recommended that obesity treatment uses a "chronic-care" approach to management, with different types and intensity of treatment dependent upon severity of obesity. There are several new secondary and tertiary weight management services being implemented within New South Wales (NSW), Australia in 2017/2018 with differing models of care. This study will ascertain what factors affect acceptability, reach, and participation, as well as measure the clinical effectiveness of these services.Methods: This is a acceptability and effectiveness study building upon existing and planned secondary and tertiary level service delivery in several health districts. This study will recruit participants from seven different pediatric weight management services (PWMS) across five Local Health Districts in NSW, Australia. Using a mixed-methods approach we will document a range of process, impact and clinical outcome measures in order to better understand the context and the effectiveness of each PWMS model. The project development and implementation is guided by the Theoretical Domains Framework. Participants will include parents of children less than 18 years of age attending PWMS, clinicians working as part of PWMS and health service managers. Data will be captured using a combination of anthropometric measures, questionnaires, one-on-one semi-structured interviews and focus groups.Discussion: Results from this study will assess the acceptability and effectiveness of different models of care for pediatric weight management. Such information is required to inform long-term sustainability and scalability of secondary and tertiary care services to the large number of families with children above a healthy weight. [ABSTRACT FROM AUTHOR]

Clinician and healthcare managers' (HCMs) views on weight management service delivery are imperative for informing the nature of future services to treat children with obesity. This qualitative study used semi-structured focus groups and one-on-one semi-structured interviews. Participants were 27 clinicians (medical, nursing, or allied health) and nine HCMs (senior executives in the hospital) who worked in six secondary or tertiary pediatric weight management clinics across five public hospitals in New South Wales, Australia. Clinicians reported that using a combination of group and individual sessions improved engagement with families and reduced attrition rates. Clinicians and HCMs recommended integrating clinics into community centers and providing specific programs for sub-groups, such as children from culturally and linguistically diverse communities or children with developmental delay. Many clinicians and HCMs stressed the importance of pediatric weight clinics using a holistic approach to treatment. To improve the likelihood of future funding for pediatric weight management clinics and to optimize models of care, centers must embed research into their practice. Addressing common barriers to current pediatric weight management services and designing future models of care based on key stakeholders' preferences is critical to achieving optimal care provision for this high-risk population.

Background: With improved long-term health outcomes and survivorship, the long-term nutritional management of childhood cancer survivors, from diagnosis to long-term follow-up, has become a priority. The aim of this study was to examine the diet quality of children receiving treatment for cancer. Methods: Participants were parents of children with cancer who were receiving active treatment and not receiving supplementary nutrition. A 24-h dietary recall assessed food and nutrient intake. Serves of food group intakes and classification of core and discretionary items were made according to the Australian Dietary Guidelines and compared with age and sex recommendations. Results: Sixty-four parents participated (75% female). Most children were not consuming adequate intake of vegetables (94% of patients), fruit (77%), and milk/alternatives (75%). Of the vegetables that were consumed, half were classified as discretionary foods (e.g., chips/fries). Nearly half (49%) of children exceeded recommendations for total sugar intake and 65% of patients had an excessive sodium intake. Discussion: Children receiving cancer treatment are consuming diets of reasonable quantity, but poor quality. Information provided during treatment should focus on educating parents on a healthy diet for their child, the importance of establishing healthy eating habits for life, and strategies to overcome barriers to intake during treatment.

Background: The purpose of this study is to determine whether direct involvement by dietitians in parenteral nutrition (PN) ordering resulted in a reduction in PN prescriptions errors., Methods: A prospective audit of PN prescriptions was undertaken at a pediatric hospital over 50 weeks. Prescriptions for PN that had dietitian involvement (dietitian group) were compared with prescriptions in which dietitians were not directly involved (nondietitian group). The number of total prescriptions, the number of prescriptions with errors, and the types of errors from both groups were recorded. Errors were classified into "dietitian-preventable errors" and "nondietitian-preventable errors." Comparisons were made between prescriptions with and without errors, between dietitian-preventable and nondietitian-preventable errors, and between the dietitian and nondietitian groups per error type., Results: The total number of PN prescriptions was 725 (from 45 patients) and 471 (from 66 patients) for the dietitian and nondietitian groups, respectively. The nondietitian group was more likely than the dietitian group to prescribe PN incorrectly-18.0% (85 of 471) vs 12.4% (90 of 725; P = .007)-with the nondietitian group having 1.5-times more PN prescriptions with errors (risk ratio = 1.5, 95% CI: 1.1-1.9). The total number of prescription errors was 126 and 146 for the dietitian and nondietitian groups, respectively. The dietitian group was less likely than the nondietitian group to be associated with dietitian-preventable errors: 65.9% (83 of 126) vs 87.0% (127 of 146; risk ratio = 1.3, 95% CI: 1.1-1.5; P < .0001)., Conclusion: Dietitian input into prescription of PN reduced the number of prescriptions with errors., (© 2017 American Society for Parenteral and Enteral Nutrition.)