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Decision-making in fetal cardiology is fraught with ethical issues yet education in bioethics for trainees is limited or nonexistent. In this innovation report, we describe the development of a fetal cardiology bioethics curriculum designed to address this gap. The curriculum was developed to supplement the core curriculum for cardiology fellows and fetal cardiology subspecialty trainees. The series combines didactic and interactive teaching modalities and contains 5 key components: (1) introduction to bioethics and its role in fetal cardiology, (2) counseling and pathways for compassionate terminal care, (3) case vignette-based ethical analysis and discussion cases, (4) fetal counseling considerations for shared decision-making and recommendations, (5) facilitated communications role play. The curriculum was refined using session evaluations from end users. This report describes the innovative curriculum as a starting point for further incorporation and study of bioethical education in pediatric cardiology and fetal training programs. [ABSTRACT FROM AUTHOR]

Objective: To determine the cost effectiveness of a public health legislative/educational strategy to reduce tap water scalds in children less than 10 years of age. Design: Cost-effectiveness analysis conducted from the government perspective over a 10-year time horizon. Population: Children under 10 years of age in Ontario, Canada Interventions: Legislation to set thermostat settings on new domestic water heaters to lower temperatures (maximum 49°C) plus annual educational notices to utility customers versus status quo. Main outcome measures: The burden of tap water scalds, healthcare resource utilization, the cost and effectiveness of the proposed intervention, and the probabilities assigned to health outcomes were modeled in a decision analysis based on population-based data, patient charts, and the published medical literature. All costs and health outcomes beyond 1 year were discounted at 3%. Results: An estimated 182 children under 10 require medical care for tap water scald injuries annually in Ontario (13.98 per 100 000). Of these, 65 require emergency department (ED) care only (median cost $C149 per injury), 103 require ED care with clinic follow-up ($C577 per injury), 14 require hospital admission ($C5203 per injury), and two require surgical skin grafting ($C28 526 per injury). The estimated cost of the intervention was $C51 000 annually, with a projected 56% reduction in tap water scald injuries. Over 10 years, the intervention group would show total costs of $C1.17 million and 704 scalds, compared with $C1.65 million and 1599 scalds in the status quo group. Therefore, the intervention would be cost saving, with an incremental ratio of $C531 saved per scald averted. Sensitivity analyses showed that the intervention would remain cost saving through a wide range of variable estimates. Conclusions: Legislation to lower thermostat settings on domestic water heaters plus annual educational notices to utility customers would generate cost savings while reducing the morbidity from tap water scalds in children. [ABSTRACT FROM AUTHOR]

Determines differences in characteristics, findings and complications between patients with acute Kawasaki disease who received treatment with gamma globulin for persistent or recurrent fever versus those who did not. Cardiac complications; Demographic and clinical characteristics of patients receiving additional treatment for persistent or recurrent fever.

Focuses on how Kawasaki disease is the leading cause of acquired heart disease in children. Specifics on the delays in diagnosis and reasons for delays; Association with increased risk of coronary artery aneurysms; Statistics of annual incidence of Kawasaki disease in Canada. Methods; Results; Interpretation.

Objectives: To determine the amount of time spent providing medication education to older patients, the impact of medication education on patients' knowledge and satisfaction, and barriers to providing medication education.Design: Telephone survey of patients within 48 hours of hospital discharge and direct survey of physicians and pharmacists.Setting: Internal medicine ward in a tertiary care teaching hospital.Participants: Patients 65 years of age and over regularly taking at least one medication.Measurements: Patient demographics, medication use, time spent receiving or providing medication education, and satisfaction scores.Main Results: Forty-seven respondents with a mean age of 77.1 years reported that physicians spent a mean of 10.5 minutes (range, 0-60 minutes) and pharmacists spent a mean of 5.3 minutes (range, 0-40 minutes) providing medication education. Fifty-one percent reported receiving no education from either physician or pharmacist, and only 30% reported receiving written medication instructions. Respondents were generally quite satisfied with their education. Physicians identified one or more barriers to providing education 51% of the time and pharmacists 80%. Lack of time was the most common barrier (18%) identified by physicians, but pharmacists cited lack of notification of discharge plans (41%) and lack of time (39%) as the main barriers. Respondents made many medication errors and knew little about their medications.Conclusions: Although older hospitalized patients received little medication education or written information and made many medication errors with and without medication education, approximately one half of physicians perceived no barriers to providing education. [ABSTRACT FROM AUTHOR]