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Tube-fed children demonstrated significantly higher calculus levels and less caries, MS, and LB levels then healthy children or children with disabilities eating PO.

The COVID-19 pandemic forced many health care providers to modify their service model by adopting telehealth and tele-rehabilitation with minimal time to plan for its execution. ALYN—Pediatric Rehabilitation Hospital in Jerusalem, Israel, responded with alacrity by providing a broad range of rehabilitation services to young people via online therapy during the first 5 months of the pandemic. The objectives of this naturalistic study were: (1) to monitor usage and user experience of online rehabilitation provided to young people receiving out-patient sessions of physical therapy, occupational therapy, speech and language therapy and psychology and (2) to consider the advantages and disadvantages of retaining this model of online treatment in full or in part post-COVID-19. The online rehabilitation treatment program was provided to 147 young people, aged 3 months to 20 years (mean 8.5 y; SD 5.3), and monitored and evaluated via data from the medical records as well as interviews, questionnaires and focus groups. The results use descriptive and inferential statistics to analyze data on the types and frequencies of therapy provided to 147 young people. Over a five month-period, 2392 therapy sessions were provided, 61 therapists from four disciplines were involved and 56.4% of the young people received two or more types of therapies via online rehabilitation. A repeated measures ANOVA showed significant differences over time per therapy. Feedback and recommendations about the process from therapists, parents and young people were collected during two focus groups of the professional staff (n = 12), parents and young people (parents n = 5, young people n = 3). Tele-rehabilitation services were perceived to be beneficial and effective by the great majority of young people, their parents and the healthcare professionals. The results are discussed within the context of conventional therapy as well as in comparison to reports of other online services for similar populations. We conclude that a hybrid approach in which in-person therapy sessions are coordinated with synchronous, online sessions, will provide a best-case fit for young people with chronic disabilities.

This commentary describes how the first program for enhancing cultural competence in an Israeli healthcare facility was implemented at the ALYN Hospital Pediatric and Adolescent Rehabilitation Center in Jerusalem, and the lessons that can be learned from the ALYN experience for other healthcare facilities attempting to enhance their cultural competence, particularly in environments of heightened inter-cultural tension. A structured program was developed to educate hospital staff and optimize the hospital’s administrative functioning towards the goal of enhanced cultural competence. The program was initiated with an international conference on site to promote awareness of the concept, and included, among other steps, the appointment of a senior administration “Coordinator of Cultural Competence”, improvements in translation services, regular educational seminars, the opening of a Muslim prayer room in the hospital, and accommodations for Sabbath and Ramadan observance. Enhancing cultural competence was found to be an ongoing work-in-progress, with unanticipated cultural challenges constantly emerging, and demanding ad-hoc solutions. Some elements of the program encountered resistance from members of staff, and occasionally from members of the hospital’s dominant patient cultures. Overall, enhanced cultural competence at ALYN brought benefit to both patients and the institution, ranging from a more pleasant patient experience to improved patient adherence to treatment plans, better patient-caregiver communication and a more positive and cohesive professional team and work environment.

Mind the gap: Israel straddles the gap between Western medicine and Middle-Eastern cultural and political challenges. Maintaining state-of-the-art paediatric rehabilitation in an era of economic and political constrictions is described and analysed in this review.