Be Well

Including family in rounds

July 5, 2010

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Hospital rounds bring together doctors, nurses, and physicians in training so they can discuss their patients’ care. Traditionally these teams have streamed past the bedside, moving from patient to patient, but these conversations also happen in conference rooms. In 2003, the American Academy of Pediatrics recommended that rounds be conducted in the child’s hospital room and include the family. A new survey estimates how prevalent family-centered rounds have become and how well they are working.

Dr. Vineeta Mittal of the University of Texas Southwestern Medical Center led a team that surveyed 377 pediatric hospitalists — physicians who specialize in caring for hospital patients — about rounds at their 80 hospitals in the United States and Canada. The 265 doctors who responded said 44 percent of their hospitals used family-centered rounds. Academic medical centers were more likely than community hospitals to have adopted them.

The hospitalists said the rounds increased the family’s involvement and improved their understanding of their child’s care. Communication among the medical team also improved and role modeling for trainees was enhanced, they said. There were some barriers to conducting family-center rounds: Some doctors said patient rooms were too small to hold the team and others said that trainees felt uncomfortable about appearing less knowledgeable in front of the families. Family-centered rounds did not take significantly longer than traditional rounds, the hospitalists said.

BOTTOM LINE: Family-centered rounds that include parents in discussions of care for hospitalized children are the most common form of rounds.

CAUTIONS: The survey is based on the personal perceptions of hospital doctors, not on objective measures of how long rounds took or how families responded to them.

WHAT’S NEXT: Focus groups with families and with doctors in training will bring in their points of view.

WHERE TO FIND IT: Pediatrics, online June 29

Physical activity’s after-effects

Add one more reason physical activity is a good idea. A new study that surveyed elderly women about their exercise habits has found an association between early activity and later mental sharpness.

Laura Middleton of Sunnybrook Health Sciences Center in Toronto led an analysis of data from more than 9,000 women who had participated in a study of bone health. They were asked about their physical activities — from gardening to tennis to skiing — when they were teenagers, age 30, age 50, and over 65. They also took tests that measured their cognitive abilities when their average age was 71.

Women who were physically active at any of the four ages were less likely to test poorly on the cognition test, but the biggest difference was between women who were active as teenagers and women who were not active then. This difference held up even after the researchers examined other factors that might account for better cognitive performance, such as education, smoking, and diabetes.

Women who weren’t active teenagers but became active at 30 and 50 were less likely to do poorly on the cognition test than women who remained inactive, hinting that adding exercise after the teen years may also be tied to better cognition late in life.

BOTTOM LINE: Women who were physically active as teenagers were less likely than similar women who were not active to show signs of cognitive impairment later in life.

CAUTIONS: The study, which was based on the women’s reports of activity, can show only an association between activity and cognitive performance, and not that one caused the other.

WHERE TO FIND IT: Journal of the American Geriatrics Society, June 30