17,804 results on '"PEDIATRICS"'
Search Results
2. After-Hours Telephone Coverage: The Application of an Area-Wide Telephone Triage and Advice System for Pediatric Practices.
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Poole, Steven R.
- Abstract
Examines data from four years of operation of a program to manage after-hours pediatrics calls using specially trained pediatric nurses with standardized protocols to provide triage and advice. Found that over 100,000 calls had been successfully managed without adverse clinical outcomes. Satisfaction among subscribing pediatricians was 100%, and among parents was 96-99%. (HTH)
- Published
- 1993
3. A Comparative Review of Developmental Screening Tests.
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Glascoe, Frances P.
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To help physicians select appropriate screening tests for early childhood identification of developmental disabilities, 19 screening tests were administered by a pediatrician and rated by a panel of pediatricians and a special educator. Five of the tests were identified that approached standards for educational and psychological tests. (TJH)
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- 1990
4. The Prevention of Unintentional Injury among American Indian and Alaska Native Children: A Subject Review (RE9908). Policy Statement.
- Abstract
American Indian and Alaska Native children have almost twice the injury mortality rate for all U. S. children. Recommendations to pediatricians working with Native patients cover communication strategies, collaboration with tribes and the Indian Health Service to develop community-based coalitions and culturally relevant accident prevention programs, respect for tribal sovereignty and community culture, and advocacy of relevant tribal legislation. (TD)
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- 1999
5. Child Psychiatry and Pediatrics: The State of the Relationship
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Anders, Thomas F.
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Available from: Arthur Retlaw and Associates, Inc., Suite 2080, 1603 Orrington Avenue, Evanston, Illinois 60201.
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- 1977
6. Systematic Utilization of Data for Analysis of a Pediatric Emergency-Room Experience
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Lamb, George A.
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- 1975
7. The Pediatric Examination of Educational Readiness: Validation of an Extended Procedure.
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Levine, Melvin D.
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The Pediatric Examination of Educational Readiness, a standardized observation system which combines a prekindergarten physical examination with a neurodevelopmental and behavioral assessment, was field tested on 386 children, of whom 22 percent revealed a "definite concern" in one area of development or behavior, 8 percent in two, and 14 percent in three or more areas. (Author)
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- 1980
8. Studies of the Sudden Infant Death Syndrome in King County, Washington. Part 3: Epidemiology
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Bergman, Abraham B.
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- 1972
9. Intellectual Levels of School Children Severely Malnourished During the First Two Years of Life
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Hertzig, Margaret E.
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- 1972
10. Control of Staphylococcal Infections and Disease in the Newborn through the Use of Hexachlorophene Bathing
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Gezon, Horace M.
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- 1973
11. The Chronic Disease Flow Sheet in Ambulatory Pediatrics
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Schmitt, Barton D.
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- 1973
12. Familial Recurrence of Autism: Updates From the Baby Siblings Research Consortium.
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Ozonoff, Sally, Young, Gregory S, Bradshaw, Jessica, Charman, Tony, Chawarska, Katarzyna, Iverson, Jana M, Klaiman, Cheryl, Landa, Rebecca J, McDonald, Nicole, Messinger, Daniel, Schmidt, Rebecca J, Wilkinson, Carol L, and Zwaigenbaum, Lonnie
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Paediatrics ,Biomedical and Clinical Sciences ,Mental Health ,Clinical Research ,Pediatric ,Brain Disorders ,Intellectual and Developmental Disabilities (IDD) ,Behavioral and Social Science ,Autism ,Mental health ,Humans ,Male ,Female ,Siblings ,Infant ,Child ,Preschool ,Recurrence ,Autism Spectrum Disorder ,Prospective Studies ,Longitudinal Studies ,Sex Factors ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Pediatrics ,Biomedical and clinical sciences ,Health sciences ,Psychology - Abstract
ObjectivesAutism spectrum disorder (ASD) is estimated to be ∼10 times higher in children with versus without an autistic sibling in population-based studies. Prospective studies of infant siblings have revealed even higher familial recurrence rates. In the current prospective longitudinal study, we provide updated estimates of familial ASD recurrence using a multinational database of infants with older autistic siblings.MethodsData were collated across 18 sites of the Baby Siblings Research Consortium, an international network studying the earliest manifestations of ASD. A total of 1605 infants with an older autistic sibling were followed from early in life to 3 years, when they were classified as ASD or non-ASD. Hierarchical generalized linear modeling, with site as a random effect, was used to examine predictors of recurrence in families and calculate likelihood ratios.ResultsA total of 20.2% of siblings developed ASD, which is not significantly higher than the previously reported rate of 18.7%. Male infant sex and >1 older affected sibling were significant predictors of familial recurrence. Proband sex also influenced recurrence rates, with siblings of female probands significantly more likely to develop ASD than siblings of male probands. Race and maternal education were also associated with recurrence in families.ConclusionsThe familial recurrence rate of ASD, as measured in infant sibling studies, has not changed appreciably since previous estimates were made in 2011. Younger siblings of autistic children, particularly those who are male, have an affected female sibling, multiple affected siblings, or are impacted by social inequities, should be closely monitored and promptly referred for diagnostic evaluation.
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- 2024
13. Special Requirements of Electronic Health Record Systems in Pediatrics: Clinical Report.
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Dufendach, Kevin R., Lehmann, Christoph U., and Spooner, S. Andrew
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CLINICAL medicine , *MEDICAL information storage & retrieval systems , *IMMUNIZATION , *MEDICAL quality control , *PATIENTS , *IDENTIFICATION , *SOCIAL determinants of health , *GENDER identity , *CLINICAL decision support systems , *ARTIFICIAL intelligence , *CERTIFICATION , *HUMAN growth , *PEDIATRICS , *TELEMEDICINE , *ELECTRONIC health records , *CHILD development , *GENETIC testing - Abstract
Pediatricians' use of electronic health record (EHR) systems has become nearly ubiquitous in the United States, yet many systems lack full functionality to deliver effective and efficient pediatric care. This clinical report seeks to provide a compendium of core pediatric functionality of importance to child health care providers that may serve as the focus for EHR developers and clinicians as they evaluate their EHR needs. Also reviewed are important but less critical functions, any of which might be of importance in a specific pediatric context. The major areas described here are immunization management, growth and development, social drivers of health tracking, decision support for orders, patient identification, data normalization, privacy, and system functionality standards in pediatric contexts. [ABSTRACT FROM AUTHOR]
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- 2024
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14. Use of Antibiotics in Animal Agriculture: Implications for Pediatrics: Technical Report.
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Katz, Sophie E. and Banerjee, Ritu
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ANTIBIOTICS , *PREVENTION of infectious disease transmission , *CHILDREN'S health , *DRUG resistance in microorganisms , *ANTIMICROBIAL stewardship , *FOOD safety , *STAPHYLOCOCCUS aureus , *METHICILLIN-resistant staphylococcus aureus , *SALMONELLA , *INFORMATION resources , *PEDIATRICS , *CAMPYLOBACTER , *ESCHERICHIA , *ZOONOSES , *AGRICULTURE - Abstract
Antimicrobial resistance is a global public health threat. Antimicrobial-resistant infections are on the rise and are associated with increased morbidity, mortality, and health care costs. Infants and children are affected by transmission of antimicrobial-resistant zoonotic pathogens through the food supply, direct contact with animals, environmental pathways, and contact with infected or colonized humans. Although the judicious use of antimicrobial agents is necessary for maintaining the health and welfare of humans and animals, it must be recognized that all use of antimicrobial agents exerts selective pressure that increases the risk of development of resistance. This report describes historical and recent use of antibiotics in animal agriculture, reviews the mechanisms of how such use contributes to development of resistance and can adversely affect child health, and discusses US initiatives to curb unnecessary use of antimicrobial agents in agriculture. [ABSTRACT FROM AUTHOR]
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- 2024
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15. School Suspension and Expulsion: Policy Statement.
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Jain, Susanna K., Beers, Nathaniel, and Padrez, Ryan
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ADOLESCENT development , *HEALTH status indicators , *RACISM , *PEDIATRICS , *SCHOOL administration , *SCHOOL discipline , *CHILD development , *HEALTH care teams - Abstract
Exclusionary school discipline practices--ie, suspension and expulsion--represent some of the most severe consequences a school district can implement for unacceptable student behavior. Suspension and expulsion were traditionally used for student behaviors that caused serious harm, such as bringing a weapon to school. Currently, the most common indications for exclusionary school discipline are for behaviors that are neither violent nor criminal. There is little evidence that exclusionary school discipline practices make schools safer or deter future misbehavior. American Indian/Alaska Native students, Black students, students whose caregivers have low socioeconomic status, male students, lesbian, gay, bisexual, transgender, and queer or questioning students, and students with disabilities are disproportionately disciplined with suspension and expulsion. In addition, exclusionary school discipline in the preschool period can be harmful to early childhood development. Children and adolescents affected by exclusionary school discipline are at higher risk for dropping out of high school and for involvement with the juvenile justice system. Both of those experiences are associated with a worse profile of physical and mental health outcomes. A multidisciplinary and trauma-informed approach to reducing exclusionary school discipline practices is described. Recommendations are provided at both the practice level for pediatric health care providers and at the systems level for both pediatric health care providers and educators. [ABSTRACT FROM AUTHOR]
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- 2024
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16. Rotavirus Vaccine Effectiveness Against Severe Acute Gastroenteritis: 2009-2022.
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Diallo, Alpha Oumar, Wikswo, Mary E., Sulemana, Iddrisu, Sahni, Leila C., Boom, Julie A., Ramani, Sasirekha, Selvarangan, Rangaraj, Moffatt, Mary E., Harrison, Christopher J., Halasa, Natasha, Chappell, James, Stewart, Laura, Staat, Mary Allen, Schlaudecker, Elizabeth, Quigley, Christina, Klein, Eileen J., Englund, Janet A., Zerr, Danielle M., Weinberg, Geoffrey A., and Szilagyi, Peter G.
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ROTAVIRUS vaccines , *ACUTE diseases , *RESEARCH funding , *FECES , *VACCINE effectiveness , *QUESTIONNAIRES , *POLYMERASE chain reaction , *LOGISTIC regression analysis , *RETROVIRUS diseases , *IMMUNOENZYME technique , *MULTIVARIATE analysis , *PEDIATRICS , *ODDS ratio , *CASE-control method , *GASTROENTERITIS , *COLLECTION & preservation of biological specimens , *CONFIDENCE intervals , *TIME , *GENOTYPES , *EVALUATION - Abstract
BACKGROUND: Rotavirus was the leading cause of acute gastroenteritis among US children until vaccine introduction in 2006, after which, substantial declines in severe rotavirus disease occurred. We evaluated rotavirus vaccine effectiveness (VE) over 13 years (2009--2022). METHODS: We analyzed data from the New Vaccine Surveillance Network using a test-negative casecontrol design to estimate rotavirus VE against laboratory-confirmed rotavirus infections among children seeking care for acute gastroenteritis ($3 diarrhea or $1 vomiting episodes within 24 hours) in the emergency department (ED) or hospital. Case-patients and control-patients were children whose stool specimens tested rotavirus positive or negative, respectively, by enzyme immunoassay or polymerase chain reaction assays. VE was calculated as (1-adjusted odds ratio) x 100%. Adjusted odds ratios were calculated by multivariable unconditional logistic regression. RESULTS: Among 16 188 enrolled children age 8 to 59 months, 1720 (11%) tested positive for rotavirus. Case-patients were less often vaccinated against rotavirus than control-patients (62% versus 88%). VE for receiving $1 dose against rotavirus-associated ED visits or hospitalization was 78% (95%confidence interval [CI] 75%-80%). Stratifying by amodified Vesikari Severity Score, VE was 59% (95% CI 49%-67%), 80% (95% CI 77%-83%), and 94% (95% CI 90%-97%) against mild, moderately severe, and very severe disease, respectively. Rotavirus vaccines conferred protection against common circulating genotypes (G1P[8], G2P[4], G3P[8], G9P[8], and G12[P8]). VE was higher in children<3 years (73%to 88%); protection decreased as age increased. CONCLUSIONS: Rotavirus vaccines remain highly effective in preventing ED visits and hospitalizations in US children. [ABSTRACT FROM AUTHOR]
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- 2024
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17. The RACE Act and Pediatric Trials of Adult Cancer Drugs.
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Liu, Ian T. T. and Kesselheim, Aaron S.
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DRUG approval laws , *THERAPEUTIC use of antineoplastic agents , *CLINICAL trial laws , *MEDICAL research laws , *CLINICAL drug trials , *DATABASES , *MEDICAL information storage & retrieval systems , *RESEARCH funding , *CLINICAL trials , *RETROSPECTIVE studies , *DESCRIPTIVE statistics , *PEDIATRICS , *LONGITUDINAL method , *MEDICAL records , *ACQUISITION of data , *DRUG laws , *COMPARATIVE studies , *CHILDREN - Abstract
BACKGROUND AND OBJECTIVES: Adult cancer drugs have historically been exempted from pediatric testing requirements. In 2017, Congress passed the Research to Accelerate Cures and Equity (RACE) for Children Act to expand mandatory pediatric testing to cancer drugs; the law took effect in 2020. With this study, we sought to evaluate how the pediatric testing of molecularly targeted adult cancer drugs changed after the RACE Act. METHODS: In this retrospective cohort study, we used publicly available Food and Drug Administration data to compare pediatric post-approval requirements, trials, and trial characteristics, including timing, in adult cancer drugs before and after the RACE Act. RESULTS: Between 2017 and 2024, the Food and Drug Administration approved 61 adult cancer drugs with molecular targets relevant to pediatric cancer; 40 were submitted before 2020, and 21 were submitted after 2020. The 40 pre-RACE Act drugs were associated with no pediatric post-approval requirements, whereas the 21 post-RACE Act drugs were associated with 15 pediatric post-approval testing requirements. Approximately two-thirds (26/40, 65%) of pre-RACE Act drugs and 57% (12/21) of post-RACE Act drugs were evaluated in pediatric trials. Among pre-RACE Act cancer drugs, pediatric trials were initiated a median of 0.04 years after approval (interquartile range: -3.3 to 1.9 years), whereas post-RACE Act trials were initiated a median of 2.8 years before approval (interquartile range: -4.3 to 0.3 years). CONCLUSIONS: The RACE Act has been associated with greater numbers of pediatric postapproval testing requirements and the earlier initiation of pediatric trials, although early pediatric trial rates appear unchanged. Formalizing pediatric testing requirements may lead to the timely completion of pediatric studies to the benefit of pediatric patients with cancer. [ABSTRACT FROM AUTHOR]
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- 2024
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18. Nirsevimab and Acute Bronchiolitis Episodes in Pediatric Emergency Departments.
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Andina Martínez, David, Claret Teruel, Gemma, Gijón Mediavilla, Manuel, Cámara Otegui, Amaia, Baños López, Laura, de Miguel Lavisier, Begoña, García-Loygorri, Clara Ferrero, Sánchez Tatay, Victoria, Pavlovic Nesic, Svetlana, Clerigué Arrieta, Nuria, Gimeno-Hernández Garza, Verónica, Guerra Diez, Jose Lorenzo, Ranera Málaga, Adrián, Escalada Pellitero, Silvia, Barrueco Ramos, Clara, and Alonso-Cadenas 2, Jose Antonio
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THERAPEUTIC use of monoclonal antibodies , *IMMUNIZATION , *ACUTE diseases , *SEASONS , *PATIENTS , *BRONCHIOLE diseases , *HOSPITAL admission & discharge , *EMERGENCY medical services , *RESPIRATORY syncytial virus infections , *TREATMENT effectiveness , *RETROSPECTIVE studies , *DESCRIPTIVE statistics , *PEDIATRICS , *INTENSIVE care units , *CONFIDENCE intervals , *CHILDREN - Abstract
BACKGROUND AND OBJECTIVES: In the 2023--2024 respiratory syncytial virus (RSV) season, Spain became one of the first countries to introduce universal RSV prophylaxis, during which all infants born at this time were eligible to receive nirsevimab. Locally, most Spanish regions also immunized infants younger than age 6 months at the start of the season (extended catch-up). The aim of this study was to assess how RSV prophylaxis affected the number of infants presenting to pediatric emergency departments with acute respiratory infections. METHODS: A retrospective study was conducted in 15 Spanish pediatric emergency departments from 9 different regions between the 2018 and 2024 epidemic seasons (November-January). We compared the seasons occurring in 2018-2023 and the 2023-2024 season regarding the number of episodes of lower respiratory tract infection and acute bronchiolitis, acute bronchiolitis- related hospital admissions, and PICU admissions. RESULTS: A comparison with the average rates for the previous epidemic seasons revealed a 57.7% decrease in episodes of lower respiratory tract infection in 2023-2024 (95% CI, 56.5-58.8; P < .001; range among hospitals, 4.8-82.8), a 59.2% decrease in episodes of acute bronchiolitis (95% CI, 57.9-60.4; P < .001; range, 6.9-84.1), a 63.1% reduction in acute bronchiolitis- related hospital admissions (95% CI, 60.9-65.2; P < .001; range, 31.4-86.8), and a 63.1% reduction in PICU admissions (95% CI, 58.1-67.9; P < .001; range, 18.2-81.8). Hospitals in regions applying extended catch-up showed better results. CONCLUSIONS: Nirsevimab can protect a broad infant population against RSV infection with high effectiveness. Approaches including extended catch-up are the most effective, although costeffectiveness must be considered. [ABSTRACT FROM AUTHOR]
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- 2024
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19. Improving Timely Administration of Essential Outpatient Medications in a Pediatric ED.
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Creedon, Jessica K., Marini, Michelle, Erdner, Kim, Trexler, Megan, Gerling, Megan, Porter, John J., Kent, Caitlin, Capraro, Andrew, Volpe, Diana, Shah, Dhara, Paydar-Darian, Niloufar, Perron, Catherine, Stack, Anne, and Hudgins, Joel D.
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MEDICATION error prevention , *ESSENTIAL drugs , *CARDIOVASCULAR diseases , *IMMUNOSUPPRESSIVE agents , *HOSPITAL emergency services , *NURSING education , *DESCRIPTIVE statistics , *PEDIATRICS , *ELECTRONIC health records , *QUALITY assurance , *TIME , *ANTICONVULSANTS , *MEDICAL triage , *EVALUATION - Abstract
BACKGROUND AND OBJECTIVES: The complexity of pediatric patients' outpatient medication regimens is increasing, and risk for medication errors is compounded in a busy emergency department (ED). As ED length of stay (LOS) increases, timely and accurate administration of essential outpatient medications has become increasingly challenging. Our objective was to increase the frequency of ordering of essential outpatient medications for patients with ED LOS >4 hours from 56%to 80% by June 2023. METHODS: We conducted a quality improvement (QI) initiative in a pediatric ED with ~60 000 annual visits comprising a total of 91 000 annual medication orders. We defined essential outpatient medications as antiepileptic drugs, cardiovascular medications, and immunosuppressants. Our QI interventions included a combination of electronic health record interventions, a triage notification system to identify patients with essential outpatient medications, and widespread educational interventions including trainee orientation and individualized nursing education. The primary outcome measure was percentage of essential outpatient medications ordered among patients with an ED LOS >4 hours,with a secondary measure of outpatientmedication safety events. RESULTS: Baseline monthly ordering rate of selected medications for patients with an ED LOS >4 hours was 54%, with an increase to 66% over the study period. Refining our population yielded a rate of 81%. Outpatient medication safety events remained unchanged, with an average of 952 ED encounters between events. CONCLUSIONS: A multidisciplinary QI initiative led to increased essential outpatient medication ordering for patients in a pediatric ED with no change in safety events. [ABSTRACT FROM AUTHOR]
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- 2024
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20. Parent Council for a Pediatric Stroke Rehabilitation Clinical Trial.
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Yale, Mara M., Boland Birch, Torrey, Murray, Jennifer, Dodds, Nicole, Hindery, Kimberly, Darragh, Amy, Landesman Ramey, Sharon, and Lo, Warren D.
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EDUCATION of parents , *INTERPROFESSIONAL relations , *PARENT attitudes , *DECISION making , *MEMBERSHIP , *INFORMATION resources , *PEDIATRICS , *STROKE rehabilitation , *STROKE , *COMMITTEES - Abstract
The article presents the benefits and lessons learned by the Parent Council for a pediatric stroke rehabilitation and how to provide a framework for researchers. Topics discussed include background and need for parent partnership, formation of the Parent Council, and description and activities of the Parent Council.
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- 2024
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21. A Coproduced Family Reporting Intervention to Improve Safety Surveillance and Reduce Disparities.
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Khan, Alisa, Baird, Jennifer, Mauskar, Sangeeta, and Haskell, Helen W.
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FAMILIES & psychology , *HEALTH literacy , *MOBILE apps , *NURSES , *PATIENT safety , *RESEARCH funding , *MEDICAL quality control , *MEDICAL errors , *LEADERS , *CHRONIC diseases in children , *CLINICAL trials , *HOSPITAL nursing staff , *FAMILIES , *DESCRIPTIVE statistics , *HOSPITAL medical staff , *SURVEYS , *PEDIATRICS , *ODDS ratio , *FAMILY-centered care , *HEALTH equity , *PSYCHOLOGY of parents , *PHYSICIANS , *ADVERSE health care events , *CONFIDENCE intervals , *HOSPITAL care of children , *MEDICAL incident reports , *COVID-19 pandemic , *EDUCATIONAL attainment - Abstract
OBJECTIVES: Examine family safety-reporting after implementing a parent--nurse--physician--leader coproduced, health literacy-informed, family safety-reporting intervention for hospitalized families of children with medical complexity. METHODS: We implemented an English and Spanish mobile family-safety-reporting tool, staff and family education, and process for sharing comments with unit leaders on a dedicated inpatient complex care service at a pediatric hospital. Families shared safety concerns via predischarge surveys (baseline and intervention) and mobile tool (intervention). Three physicians with patient safety expertise classified events. We compared safety-reporting baseline (via survey) versus intervention (via survey and/or mobile tool) with generalized estimating equations and sub-analyzed data by COVID-19-era and educational attainment. We also compared mobile tool-detected event rates with hospital voluntary incident reporting. RESULTS: 232 baseline and 208 intervention parents participated (78.2% consented); 29.5% of baseline families versus 38.2% of intervention families reported safety concerns (P = .09). Adjusted odds ratio (95% CI) of families reporting safety concerns intervention versus baseline was 1.6 (1.0-2.6) overall, 2.6 (1.3-5.4) for those with< college education, and 3.1 (1.3-7.3) in the COVID-19--era subgroup. Safety concerns reported via mobile tool (34.6% of enrolled parents) included 42 medical errors, 43 nonsafety-related quality issues, 11 hazards, and 4 other. 15%ofmobile tool concernswere also detectedwith voluntary incident reporting. CONCLUSIONS: Family safety-reporting was unchanged overall after implementing a mobile reporting tool, though reporting increased among families with lower educational attainment and during the COVID-19 pandemic. The tool identified many events not otherwise captured by staff-only voluntary incident reporting. Hospitals should proactively engage families in reporting to improve safety, quality, and equity. [ABSTRACT FROM AUTHOR]
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- 2024
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22. Medical Home Care for Children with Deafness and Hearing Problems.
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Khalsa, Inderpreet Kaur and Chan, Dylan K.
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TREATMENT of deafness , *TREATMENT of hearing disorders , *HEALTH services accessibility , *PRIMARY health care , *MEDICAL care , *LOGISTIC regression analysis , *DESCRIPTIVE statistics , *PEDIATRICS , *ODDS ratio , *STATISTICS , *FAMILY-centered care , *HEALTH equity , *CONFIDENCE intervals , *MEDICAL referrals - Abstract
BACKGROUND AND OBJECTIVES: Since 2001, the American Academy of Pediatrics (AAP) has advocated for improving the effectiveness of early hearing screening, diagnosis, and intervention (EHDI) and reducing hearing health disparities through the medical home model of care (MHMOC). However, the scope of the MHMOC and its components and potential disparities among US children with deafness or hearing problems (DHH) have not been identified. METHODS: Data from the 2016 to 2020 National Survey of Children's Health (N = 174 551) were analyzed, including 12 121 children with DHH, 171 523 children without DHH, and 38 722 with other special health needs (SHCN). Univariable statistics and multivariable logistic regression were used to analyze the association of hearing problems with medical home composite and components and cohort disparities. RESULTS: After adjusting for sociodemographic characteristics,medical home carewas less likely for children with DHH (adjusted odds ratio: 0.74; 95% confidence interval: 0.56-0.97) compared with children without DHH. Children with DHH and SHCN were also less likely to receive medical home care compared with other SHCN children (adjusted odds ratio: 0.71; 95% confidence interval: 0.55-0.92). Specific medical home components significantly less prevalent among children with DHH included family-centered care, ease of referrals, and effective care coordination, whereas a usual source for sick carewasmore prevalent, although not statistically significant. CONCLUSIONS: Despite over two decades of efforts to improve EHDI through the medical home, rates of the MHMOC for children with DHH remain disparately low. Systems-level quality improvement efforts supporting the medical home will be necessary to allow the MHMOC to support early hearing detection and intervention (EHDI) systems. [ABSTRACT FROM AUTHOR]
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- 2024
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23. The Challenges of Treating Lead Toxicity During the COVID-19 Pandemic.
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Dreher, Mackenzie R., Printy, Ann, Davidson, Joel, Schneider, Bruna, Neuhauser, Andrew, Besunder, James B., and Blackford, Martha G.
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LEAD poisoning prevention , *COMMUNITY health services , *LEAD poisoning , *CHELATING agents , *TREATMENT effectiveness , *HOSPITAL emergency services , *BLOOD cell count , *INVENTORY shortages , *AGE distribution , *PEDIATRICS , *CLINICAL pathology , *DRUGS , *MEDICAL screening , *COVID-19 pandemic , *SICKLE cell trait , *LEAD , *PREVENTIVE health services , *CHILDREN - Abstract
Despite decades of environmental reform, legacy lead is a persistent health hazard within communities. Secondary prevention with screening for childhood lead exposure typically occurs at the 12-month and 24-month well visits, and early identification of toxicity is of vital importance to reduce morbidity and mortality. Over the past few years, there have been multiple challenges impacting the management of lead toxicity, including the coronavirus disease 2019 pandemic, a national shortage of the chelation agent CaNa2EDTA, and housing-related concerns that may result in re-exposure of lead before lead abatement. This report identifies the importance of lead screening and limitations that a pandemic has placed on health care while emphasizing access to care and community resources needs to be a priority. [ABSTRACT FROM AUTHOR]
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- 2024
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24. Phototherapy to Prevent Severe Neonatal Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation: Technical Report.
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Bhutani, Vinod K., Wong, Ronald J., Turkewitz, David, Rauch, Daniel A., Mowitz, Meredith E., and Barfield, Wanda D.
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MEDICAL protocols , *PATIENT safety , *TREATMENT effectiveness , *PHOTOTHERAPY , *PEDIATRICS , *GESTATIONAL age , *ALTERNATIVE medicine , *NEONATAL jaundice , *CHILDREN - Abstract
OBJECTIVE: To summarize the principles and application of phototherapy consistent with the current 2022 American Academy of Pediatrics "Clinical Practice Guideline Revision for the Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation." METHODS: Relevant literature was reviewed regarding phototherapy devices in the United States, specifically those that incorporate blue to blue-green light-emitting diode, fluorescent, halogen, or fiberoptic light sources, and their currently marketed indications. RESULTS: The efficacy of phototherapy devices varies widely because of nonstandardized use of light sources and configurations and irradiance meters. In summary, the most effective and safest devices have the following characteristics: (1) incorporation of narrow band blue-to-green light-emitting diode lamps (~460-490 nm wavelength range; 478 nm optimal) that would best overlap the bilirubin absorption spectrum; (2) emission of irradiance of at least 30 µW/cm²/nm (in term infants); and (3) illumination of the exposed maximal body surface area of an infant (35% to 80%). Furthermore, accurate irradiance measurements should be performed using the appropriate irradiance meter calibrated for the wavelength range delivered by the phototherapy device. CONCLUSIONS: With proper administration of effective phototherapy to an infant without concurrent hemolysis, total serum or plasma bilirubin concentrations will decrease within the first 4 to 6 hours of initiation safely and effectively. [ABSTRACT FROM AUTHOR]
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- 2024
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25. Disparities in Access to Timely Waitlisting Among Pediatric Kidney Transplant Candidates.
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Maclay, Lindsey M., Yu, Miko, Amaral, Sandra, Adler, Joel T., Sandoval, P. Rodrigo, Ratner, Lloyd E., Schold, Jesse D., Mohan, Sumit, and Husain, Syed Ali
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TREATMENT of chronic kidney failure , *KIDNEY transplantation , *RISK assessment , *PATIENTS , *TRANSPLANTATION of organs, tissues, etc. , *RESEARCH funding , *SEX distribution , *HISPANIC Americans , *HEALTH insurance , *RETROSPECTIVE studies , *REPORTING of diseases , *HEMODIALYSIS , *DESCRIPTIVE statistics , *RELATIVE medical risk , *TREATMENT effectiveness , *PEDIATRICS , *LONGITUDINAL method , *RACE , *HEALTH equity , *CONFIDENCE intervals , *REGRESSION analysis - Abstract
BACKGROUND AND OBJECTIVES: Kidney transplantation with minimal or no dialysis exposure provides optimal outcomes for children with end-stage kidney disease. We sought to understand disparities in timely access to transplant waitlisting. METHODS: We conducted a retrospective, registry-based cohort study of candidates ages 3 to 17 added to the US kidney transplant waitlist 2015 to 2019. We defined "preemptive waitlisting" as waitlist addition before receiving dialysis and compared demographics of candidates based on preemptive status. We used competing risk regression to determine the association between preemptive waitlisting and transplantation. We then identified waitlist additions age >18 who initiated dialysis as children, thereby missing pediatric allocation prioritization, and evaluated the association between waitlisting with pediatric prioritization and transplantation. RESULTS: Among 4506 pediatric candidates, 48% were waitlisted preemptively. Female sex, Hispanic ethnicity, Black race, and public insurance were associated with lower adjusted relative risk of preemptive waitlisting. Preemptive listing was not associated with time from waitlist activation to transplantation (adjusted hazard ratio 0.94, 95% confidence interval 0.87-1.02). Among transplant recipients waitlisted preemptively, 68% had no pretransplant dialysis, whereas recipients listed nonpreemptively had median 1.6 years of dialysis at transplant. Among 415 candidates initiating dialysis as children but waitlisted as adults, transplant rate was lower versus nonpreemptive pediatric candidates after waitlist activation (adjusted hazard ratio 0.54, 95% confidence interval 0.44-0.66). CONCLUSIONS: Disparities in timely waitlisting are associated with differences in pretransplant dialy- sis exposure despite no difference in time to transplant after waitlist activation. Young adults who experience delays may miss pediatric prioritization, highlighting an area for policy intervention. [ABSTRACT FROM AUTHOR]
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- 2024
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26. Social Needs Screening Via Electronic Tablet in Pediatric Primary Care.
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Gorecki, Michelle C., Klein, Melissa D., Anyigbo, Chidiogo U., Beck, Andrew F., Henize, Adrienne W., Ehrlich, Shelley R., MacDougall, Melinda C., and Burkhardt, Mary Carol
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MEDICAL care laws , *MENTAL health , *SOCIAL determinants of health , *PRIMARY health care , *POCKET computers , *RETROSPECTIVE studies , *TIME series analysis , *DESCRIPTIVE statistics , *PEDIATRICS , *SOCIAL case work , *ODDS ratio , *NEEDS assessment , *MEDICAL screening , *MEDICAL needs assessment , *CONFIDENCE intervals , *MEDICAL referrals , *CAREGIVER attitudes , *CHILDREN - Abstract
OBJECTIVES: (1) Assess whether health-related social needs (HRSN)/caregiver mental health concerns (CMHC) disclosure rates differ when screening questions are administered on paper versus electronic tablet. (2) Evaluate whether changes in need identification alters referral rates to social work and our medical-legal partnership (MLP). METHODS: We conducted a retrospective review of HRSN/CMHC screening in publicly insured patients 0-18 years presenting for well-child visits in three primary care practices. Our primary outcome was HRSN/CMHC disclosure rate, comparing the proportion of positive HRSN/ CMHC screens during the 11 months before and after screening modality change. Generalized estimating equations and interrupted time series (ITS) were used to assess changes over time. Mediation analyses assessed the indirect effect of HRSN/CMHC disclosure during the electronic screening period on changes in referrals to social work/MLP. RESULTS: A total of 16,151 patients had paper-based HRSN/CMHC screens; 13,019 patients had electronic screens. Overall, 11% of paper-based screens identified ≥1 need, compared to 26% of electronic screens (p<0.001). All three practices saw an increase in disclosure rate after transition from paper to electronic screening (odds ratio [OR] range 1.54 to 4.24). Using ITS, two of three practices had significantly increased odds of need disclosure with electronic screens compared to paper (OR 3.0, 95% confidence interval [CI] 2.5, 3.6; and OR 1.7, 95%CI 1.2, 2.4). Increased HRSN/CMHC disclosure rates from transitioning to electronic screening mediated increased referrals to social work/MLP. CONCLUSIONS: Electronic screening was associated with an increased HRSN/CMHC disclosure rate compared to paper, which led to increased referrals to social work/MLP. [ABSTRACT FROM AUTHOR]
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- 2024
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27. Variability of Care Practices for Extremely Early Deliveries.
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LoRe, Danielle, Groden, Catherine M., Schuh, Allison R., Holmes, Chondraah, Ostilla, Lorena, Vogel, Maggie M., Murray, Peter D., Yamasato, Kelly, Tonismae, Tiffany, Anani, Uchenna E., Henner, Natalia, Famuyide, Mobolaji, Leuthner, Steven R., Laventhal, Naomi, Andrews, Bree Landis, Tucker Edmonds, Brownsyne M., Brennan, Kathleen G., and Feltman, Dalia M.
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VERY low birth weight , *ADRENOCORTICAL hormones , *CESAREAN section , *RESEARCH funding , *NEONATOLOGY , *DATA analysis , *PREMATURE infants , *FISHER exact test , *MULTIPLE regression analysis , *RETROSPECTIVE studies , *RESUSCITATION , *MULTIVARIATE analysis , *CHI-squared test , *MANN Whitney U Test , *PEDIATRICS , *PRENATAL care , *RACE , *LONGITUDINAL method , *ODDS ratio , *GESTATIONAL age , *RESEARCH , *STATISTICS , *BIRTH weight , *CONFIDENCE intervals , *DATA analysis software , *MEDICAL referrals , *CHILDBIRTH , *OVERALL survival , *BIRTHING centers - Abstract
OBJECTIVES: Assess temporal changes, intercenter variability, and birthing person (BP) factors relating to interventions for extremely early deliveries. METHODS: Retrospective study of BPs and newborns delivered from 22-24 completed weeks at 13 US centers from 2011-2020. Rates of neonatology consultation, antenatal corticosteroids, cesarean delivery, live birth, attempted resuscitation (AR), and survival were assessed by epoch, center, and gestational age. RESULTS: 2028 BPs delivering 2327 newborns were included. Rates increased in epoch 2--at 22 weeks: neonatology consultation (37.6 vs 64.3%, P < .001), corticosteroids (11.4 vs 29.5%, P < .001), live birth (66.2 vs 78.6%, P < .001), AR (20.1 vs 36.9%, P < .001), overall survival (3.0 vs 8.9%, P = .005); and at 23 weeks: neonatology consultation (73.0 vs 80.5%, P = .02), corticosteroids (63.7 vs 83.7%, P < .001), cesarean delivery (28.0 vs 44.7%, P < .001), live birth (88.1 vs 95.1%, P < .001), AR (67.7 vs 85.2%, P < .001), survival (28.8 vs 41.6%, P < .001). Over time, intercenter variability increased at 22 weeks for corticosteroids (interquartile range 18.0 vs 42.0, P = .014) and decreased at 23 for neonatology consultation (interquartile range 23.0 vs 5.2, P = .045). In BP-level multivariate analysis, AR was associated with increasing gestational age and birth weight, Black BP race, previous premature delivery, and delivery center. CONCLUSIONS: Intervention rates for extremely early newborns increased and intercenter variability changed over time. In BP-level analysis, factors significantly associated with AR included Black BP race, previous premature delivery, and center. [ABSTRACT FROM AUTHOR]
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- 2024
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28. Predicting Recovery After Concussion in Pediatric Patients: A Meta-Analysis.
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Wyrwa, Jordan M., Hoffberg, Adam S., Stearns-Yoder, Kelly A., Lantagne, Ann C., Kinney, Adam R., Reis, Daniel J., and Brenner, Lisa A.
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MEDICAL information storage & retrieval systems , *MEN , *PREDICTION models , *RESEARCH funding , *CINAHL database , *SEX distribution , *SPORTS injuries , *META-analysis , *HOSPITAL emergency services , *PEDIATRICS , *SYSTEMATIC reviews , *MEDLINE , *CONVALESCENCE , *MEDICAL databases , *MATHEMATICAL models , *THEORY , *TIME , *BRAIN concussion , *PSYCHOLOGY information storage & retrieval systems - Abstract
CONTEXT: Prognostic prediction models (PPMs) can help clinicians predict outcomes. OBJECTIVE: To critically examine peer-reviewed PPMs predicting delayed recovery among pediatric patients with concussion. DATA SOURCES: Ovid Medline, Embase, Ovid PsycInfo, Web of Science Core Collection, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Google Scholar. STUDY SELECTION: The study had to report a PPM for pediatric patients to be used within 28 days of injury to estimate risk of delayed recovery at 28 days to 1 year postinjury. Studies had to have at least 30 participants. DATA EXTRACTION: The Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies checklist was completed. RESULTS: Six studies of 13 PPMs were included. These studies primarily reflected male patients in late childhood or early adolescence presenting to an emergency department meeting the Concussion in Sport Group concussion criteria. No study authors used the same outcome definition nor evaluated the clinical utility of a model. All studies demonstrated high risk of bias. Quality of evidence was best for the Predicting and Preventing Postconcussive Problems in Pediatrics (5P) clinical risk score. LIMITATIONS: No formal PPM Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) process exists. CONCLUSIONS: The 5P clinical risk score may be considered for clinical use. Rigorous external validations, particularly in other settings, are needed. The remaining PPMs require external validation. Lack of consensus regarding delayed recovery criteria limits these PPMs. [ABSTRACT FROM AUTHOR]
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- 2024
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29. Large Language Models in Pediatric Education: Current Uses and Future Potential.
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Suresh, Srinivasan and Misra, Sanghamitra M.
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CURRICULUM , *PATIENT education , *ARTIFICIAL intelligence , *TEACHING aids , *PEDIATRICS , *COMPUTER assisted instruction - Abstract
Generative artificial intelligence, especially large language models (LLMs), has the potential to affect every level of pediatric education and training. Demonstrating speed and adaptability, LLMs can aid educators, trainees, and practicing pediatricians with tasks such as enhancing curriculum design through the creation of cases, videos, and assessments; creating individualized study plans and providing real-time feedback for trainees; and supporting pediatricians by enhancing information searches, clinic efficiency, and bedside teaching. LLMs can refine patient education materials to address patients' specific needs. The current versions of LLMs sometimes provide "hallucinations" or incorrect information but are likely to improve. There are ethical concerns related to bias in the output of LLMs, the potential for plagiarism, and the possibility of the overuse of an online tool at the expense of in-person learning. The potential benefits of LLMs in pediatric education can outweigh the potential risks if employed judiciously by content experts who conscientiously review the output. All stakeholders must firmly establish rules and policies to provide rigorous guidance and assure the safe and proper use of this transformative tool in the care of the child. In this article, we outline the history, current uses, and challenges with generative artificial intelligence in pediatrics education. We provide examples of LLM output, including performance on a pediatrics examination guide and the creation of patient care instructions. Future directions to establish a safe and appropriate path for the use of LLMs will be discussed. [ABSTRACT FROM AUTHOR]
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- 2024
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30. The Case for Specialty Summer Camp: A Palliative Care Perspective.
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McEvoy, Matthew T., Cowfer, Brittany A., Knutson, Lyndsay, and Amylon, Michael D.
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HEALTH services accessibility , *PALLIATIVE treatment , *SEASONS , *AFFINITY groups , *PEDIATRICS , *CAMPING , *INTERPERSONAL relations , *SOCIAL support , *WELL-being - Abstract
The article addresses specialty summer camps (SSCs) which create accessible opportunities for youths who face medical barriers. Topics discussed include mission of SSCs, benefits of attending SSCs, according to studies across pediatric disciplines, and similarities between SSCs and palliative care. It also mentions SSCs for children who are not medically ill themselves but endure other health-related difficulties.
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- 2024
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31. PROFESSIONAL: A Practical and Equitable Approach to Assessing Professionalism.
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Cochran, Lauren W., Rose, Stacey R., and Thompson, Jennifer
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PEDIATRICS , *MEDICAL coding , *NOSOLOGY - Abstract
The article proposes a framework that pediatric educators may use for behaviorally based assessment of learner professionalism. It describes factors to consider in assessing professionalism in medical trainees, including educators' biases and experiences that may affect the way they perceive learner behaviors. It explains the PROFESSIONAL framework that outlines the core elements of medical professionalism to be assessed, including descriptions and examples of narrative comments.
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- 2024
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32. Collecting Sociodemographic Data in Pediatric Emergency Research: A Working Group Consensus.
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Zamor, Ronine L., Liberman, Danica B., Hall, Jeanine E., Rees, Chris A., Hartford, Emily A., Chaudhari, Pradip P., Portillo, Elyse N., and Johnson, Michael D.
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CONSENSUS (Social sciences) , *CHILDREN'S health , *SEXUAL orientation , *GENDER identity , *SOCIOECONOMIC factors , *QUESTIONNAIRES , *HOSPITAL emergency services , *POPULATION geography , *PEDIATRICS , *RACE , *CONTENT mining , *SOCIODEMOGRAPHIC factors , *HEALTH equity - Abstract
Understanding and addressing health care disparities relies on collecting and reporting accurate data in clinical care and research. Data regarding a child's race, ethnicity, and language; sexual orientation and gender identity; and socioeconomic and geographic characteristics are important to ensure equity in research practices and reported outcomes. Disparities are known to exist across these sociodemographic categories. More consistent, accurate data collection could improve understanding of study results and inform approaches to resolve disparities in child health. However, published guidance on standardized collection of these data in children is limited, and given the evolving nature of sociocultural identities, requires frequent updates. The Pediatric Emergency Care Applied Research Network, a multi-institutional network dedicated to pediatric emergency research, developed a Health Disparities Working Group in 2021 to support and advance equitable pediatric emergency research. The working group, which includes clinicians involved in pediatric emergency medical care and researchers with expertise in pediatric disparities and the conduct of pediatric research, prioritized creating a guide for approaches to collecting race, ethnicity, and language; sexual orientation and gender identity; and socioeconomic and geographic data during the conduct of research in pediatric emergency care settings. Our aims with this guide are to summarize existing barriers to sociodemographic data collection in pediatric emergency research, highlight approaches to support the consistent and reproducible collection of these data, and provide rationale for suggested approaches. These approaches may help investigators collect data through a process that is inclusive, consistent across studies, and better informs efforts to reduce disparities in child health. [ABSTRACT FROM AUTHOR]
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- 2024
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33. Health Supervision for Children and Adolescents With Sickle Cell Disease: Clinical Report.
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Yates, Amber M., Aygun, Banu, Nuss, Rachelle, and Rogers, Zora R.
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SUPERVISION of employees , *PATIENT education , *SICKLE cell anemia , *PRIMARY health care , *FAMILIES , *GENETIC counseling , *PEDIATRICS , *SOCIAL support , *HEALTH care teams - Abstract
Sickle cell disease (SCD) is a group of complex genetic disorders of hemoglobin with multisystem manifestations. The scope of this clinical report is such that in-depth recommendations for management of all complications is not possible. Rather, the authors present an overview focused on the practical management of children and adolescents with SCD and the complications that are of particular relevance to pediatric primary care providers. References with detailed commentary provide further information. Timely and appropriate treatment of acute illness is critical, because life-threatening complications may develop rapidly. Specialized comprehensive medical care decreases morbidity and mortality during childhood. The provision of comprehensive care is a timeintensive endeavor that includes ongoing patient and family education, periodic comprehensive evaluations and other disease-specific health maintenance services, nursing support, psychosocial care, and genetic counseling. Ideally, this care includes comanagement by the pediatrician or other pediatric primary care provider and a team of specialist SCD experts: Hematologist, other pediatric specialists, advanced practice providers, nurse specialists, social workers, patient navigators, and educational liaisons. [ABSTRACT FROM AUTHOR]
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- 2024
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34. Initiation of Buprenorphine Treatment of Opioid Use Disorder in Pediatric Emergency Departments.
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Kumar, Prianka, Kaliamurthy, Sivabalaji, and Thomas, Jasmine
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SUBSTANCE abuse , *PATIENT compliance , *HOSPITAL emergency services , *DECISION making , *TREATMENT effectiveness , *PEDIATRICS , *NARCOTICS , *BUPRENORPHINE , *ADOLESCENCE - Abstract
Pediatric emergency departments (EDs) in the United States are facing a rise in the number of children and adolescents who present with opioid use disorder (OUD), often driven by illicitly manufactured fentanyl. Medication treatment of pediatric OUD in the ED setting is often limited to symptomatic treatment of opioid withdrawal. Pediatric patients are rarely offered medications for OUD, especially in the ED setting. Buprenorphine is a partial opioid agonist that is Food and Drug Administration--approved for the treatment of OUD in patients aged 16 years and older. Adult studies have demonstrated that ED initiation of medication for OUD such as buprenorphine is feasible, safely treats withdrawal symptoms, and can improve patient compliance with outpatient follow-up. However, initiation of buprenorphine in the ED has not been well-studied in the pediatric population. We present 2 cases of adolescent patients, a 16-year-old male and 17-year-old female, who presented to the ED with opioid withdrawal. They were both diagnosed with severe OUD because of their use of counterfeit pills containing fentanyl. Both patients were successfully started on buprenorphine/naloxone in the pediatric ED before transitioning to an outpatient addiction clinic for continued treatment. The case series demonstrates the feasibility of ED-based buprenorphine initiation for adolescents, an important and timely intervention for adolescents with OUD. [ABSTRACT FROM AUTHOR]
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- 2024
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35. Race, Ethnicity, and Pediatric Postsurgical Mortality: Current Trends and Future Projections.
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Nafiu, Olubukola O., Mpody, Christian, Aina, Titilopemi A., Ehie, Odinakachukwu, Tobias, Joseph D., and Best, Ana F.
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PEDIATRIC surgery , *RISK assessment , *POLICY sciences , *RESEARCH funding , *AFRICAN Americans , *HISPANIC Americans , *WHITE people , *HOSPITAL mortality , *SURGICAL complications , *PEDIATRICS , *RACE , *LONGITUDINAL method , *HEALTH equity , *CONFIDENCE intervals , *MEDICAL care costs , *DISEASE risk factors - Abstract
BACKGROUND: No study has contextualized the aggregate human costs attributable to disparities in pediatric postsurgical mortalities in the United States, a critical step needed to convey the scale of racial inequalities to clinicians, policymakers, and the public. METHODS: We conducted a population-based study of 673 677 children from US hospitals undergoing intermediate to high-risk surgery between 2000 and 2019. We estimated the excess deaths that could be avoided if Black and Hispanic children had comparable mortality rates to white children. We estimated the mortality reduction required to eliminate disparities within the next decade. We finally evaluated the impact of policy changes targeting a modest annual 2.5% reduction in disparity-attributable mortality. RESULTS: During 2000 to 2019, risk-adjusted postoperative mortality trended consistently higher for both Black (adjusted RR [aRR]: 1.42, 95% confidence interval [CI]: 1.36-1.49) and Hispanic children (aRR: 1.22, 95% CI: 1.17-1.27) than for white children. These disparity gaps were driven by higher mortality in Black and Hispanic children receiving surgery in nonteaching hospitals (Black versus white aRR: 1.63, 95% CI: 1.38-1.93; Hispanic versus white aRR: 1.50, 95% CI: 1.33-1.70). There were 4700 excess deaths among Black children and 5500 among Hispanic children, representing. 10 200 (average: 536 per year) excess deaths among minoritized children. Policy changes achieving an annual 2.5% reduction in postoperative mortality would prevent approximately 1100 deaths among Black children in the next decade. CONCLUSIONS: By exploring the solution, and not just the problem, our study provides a framework to reduce disparities in pediatric postoperative mortality over the next decade. [ABSTRACT FROM AUTHOR]
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- 2024
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36. Improving Antibiotic Stewardship in a Pediatric Long-term Care Facility.
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Safarians, Gevick, Rong Guo, Weiss, Irwin K., and Lin, James A.
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CIPROFLOXACIN , *ANTIMICROBIAL stewardship , *LONG-term health care , *RESPIRATORY diseases , *RETROSPECTIVE studies , *DESCRIPTIVE statistics , *PEDIATRICS , *MEDICAL records , *ACQUISITION of data , *ARTIFICIAL respiration ,TRACHEOTOMY equipment - Abstract
OBJECTIVES: Antimicrobial stewardship is little studied in pediatric long-term care facilities. We sought to determine whether empirical ciprofloxacin for febrile respiratory illnesses could be safely reduced in our pediatric long-term care facility. METHODS: All patients living in the 45-bed facility were included. A 1-year educational intervention for antimicrobial stewardship was implemented. Days of ciprofloxacin therapy, infections, microbiology, hospitalizations, other antibiotic use, methicillin-resistant Staphylococcus aureus and Clostridioides difficile infections, and mortality were recorded at regular intervals retrospectively from 5 years before intervention and prospectively for 8 years after intervention. Data were analyzed using statistical process control charts. RESULTS: A majority of patients had tracheostomy tubes (96%) and ventilator dependence (58%). Ciprofloxacin use declined by 76% (17 to 4 days/1000 facility patient days). Antibiotic prescriptions for bacterial tracheitis decreased by 89% (38 to 4 courses per 6-month period). No increases in positive blood or urine cultures, hospitalizations, or need for hospital antibiotics were observed. CONCLUSIONS: An antimicrobial stewardship intervention in a pediatric long-term care facility led to decreases in ciprofloxacin use, bacterial tracheitis diagnoses, and overall antibiotic use without increasing negative outcomes. [ABSTRACT FROM AUTHOR]
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- 2024
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37. Early Audiometric Intervention in Bacterial Meningitis: Cochlear Implantation in a 10-Week-Old Child.
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Schwartz, Tyler R., Novak, Jessica, Scott, Alison, Patel, Sachin, Halvorson, Kyle, and Jayawardena, Asitha D. L.
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BACTERIAL meningitis , *COCHLEAR implants , *AUDITORY perception testing , *MEDICAL protocols , *DELIVERY (Obstetrics) , *VAGINA , *SENSORINEURAL hearing loss , *AUDIOMETRY , *TREATMENT effectiveness , *MAGNETIC resonance imaging , *PEDIATRICS , *GESTATIONAL age , *EARLY diagnosis , *CEREBROSPINAL fluid shunts , *DISEASE complications , *CHILDREN - Abstract
Sensorineural hearing loss is a well-known complication of Streptococcus pneumoniae meningitis. Given the propensity for fibrosis and ossification of the cochlea in bacterial meningitis, implantation must be performed in a timely fashion because a delayed attempt at implantation can frustrate obtaining an optimal technical result or lead to an inability to implant. Obtaining optimal audiometric outcomes is reliant on early hearing screening in patients with streptococcal meningitis. In the absence of standardized protocols, audiometric testing is often overlooked or delayed in the workup and management of meningitis. Our institution implemented a meningitis protocol with a particular focus on timing of audiometric testing in patients with meningitis. We present a patient diagnosed with streptococcal meningitis in the first week of life. Early hearing screening allowed the diagnosis of profound unilateral sensorineural hearing loss and subsequent cochlear implantation at 10 weeks of age, the youngest described in the medical literature. Despite early implantation, there was cochlear fibrosis at the time of implantation. Fortunately, the majority of electrodes were implanted to achieve a serviceable hearing outcome. Serial magnetic resonance imaging scans were obtained because of her contralateral ventriculoperitoneal shunt that allowed unique visualization of the progression of cochlear fibrosis over time. This case demonstrates the importance of including audiometric testing in a standardized meningitis protocol to diagnose hearing loss in a timely and accurate way and to achieve optimal long-term hearing outcomes. [ABSTRACT FROM AUTHOR]
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- 2024
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38. Pediatric Device Clinical Trials Activity: 1999-2022.
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Dienstman, Joshua, Stachelek, Stanley J., Krieger, Abba M., Eskandanian, Kolaleh, Espinoza, Juan C., Harrison, Michael R., Koh, Chester J., Peiris, Vasum, Torjusen, Erika, and Levy, Robert J.
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T-test (Statistics) , *RESEARCH funding , *CLINICAL trials , *CHILDREN'S hospitals , *BIOLOGICAL products , *DESCRIPTIVE statistics , *PEDIATRICS , *MEDICAL equipment , *EQUIPMENT & supplies , *NEW product development laws , *CLINICAL trial registries - Abstract
OBJECTIVES: This study assessed the state of pediatric medical device (PMD) development by comparing PMD clinical trials to pediatric trials evaluating drugs and biologics, from 1999 to 2022. METHODS: The site www.clinicaltrials.gov was used to identify and quantify both PMD clinical trials and pediatric trials for drugs and biologics. Clinical specialty was also assessed. The institutions included were the 7 children's hospitals primarily affiliated with the Food and Drug Administration (FDA) Pediatric Device Consortia (PDC) grant program between 2018 and 2023. For a national comparison, an additional search assessed PMD trials across all US medical institutions. RESULTS: A total of 243 PMD clinical trials were identified at the FDA-PDC institutions on the basis of the year of initiation; the average number of PMD trials initiated per year per institution was 1.5 from 1999 to 2022. However, PMD trials significantly increased during the period 2014 to 2022 compared with 1999 to 2013 (P < .001); the rate of initiation of drug and biologic pediatric trials demonstrated no significant differences between these time periods. A national survey of all institutions initiating PMD trials, and drugs and biologics trials, identified 1885 PMD trials out of a total 12 943. A comparable trend was noted in the national survey with initiation of PMD trials increasing significantly from 2014 to 2022 (P < .001), compared with 1999 to 2013, whereas the rate of initiation of drug and biologic trials during these periods did not demonstrate a significant change. CONCLUSIONS: Although pediatric clinical trial initiation for drugs and biologics remained stable from 1999 to 2022, the rate of new PMD trials significantly increased during the period 2014 to 2022 at FDA-PDC institutions and nationally. [ABSTRACT FROM AUTHOR]
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- 2024
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39. Parent-Reported Clinical Utility of Pediatric Genomic Sequencing.
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Smith, Hadley Stevens, Ferket, Bart S, Gelb, Bruce D, Hindorff, Lucia, Ferar, Kathleen D, Norton, Mary E, Sahin-Hodoglugil, Nuriye, Slavotinek, Anne, Lich, Kristen Hasmiller, Berg, Jonathan S, and Russell, Heidi V
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Health Services and Systems ,Biomedical and Clinical Sciences ,Clinical Sciences ,Health Sciences ,Behavioral and Social Science ,Health Services ,Pediatric ,Clinical Research ,Good Health and Well Being ,Humans ,Child ,Parents ,Surveys and Questionnaires ,Life Style ,Genomics ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Pediatrics ,Biomedical and clinical sciences ,Health sciences ,Psychology - Abstract
Background and objectivesGenomic sequencing (GS) is increasingly used for diagnostic evaluation, yet follow-up care is not well understood. We assessed clinicians' recommendations after GS, parent-reported follow-up, and actions parents initiated in response to learning their child's GS results.MethodsWe surveyed parents of children who received GS through the Clinical Sequencing Evidence Generating Research consortium ∼5 to 7 months after return of results. We compared the proportion of parents who reported discussing their child's result with a clinician, clinicians' recommendations, and parents' follow-up actions by GS result type using χ2 tests.ResultsA total of 1188 respondents completed survey measures on recommended medical actions (n = 1187) and/or parent-initiated actions (n = 913). Most parents who completed recommended medical actions questions (n = 833, 70.3%) reported having discussed their child's GS results with clinicians. Clinicians made recommendations to change current care for patients with positive GS results (n = 79, 39.1%) more frequently than for those with inconclusive (n = 31, 12.4%) or negative results (n = 44, 11.9%; P < .001). Many parents discussed (n = 152 completed, n = 135 planned) implications of GS results for future pregnancies with a clinician. Aside from clinical recommendations, 13.0% (n = 119) of parents initiated changes to their child's health or lifestyle.ConclusionsIn diverse pediatric clinical contexts, GS results can lead to recommendations for follow-up care, but they likely do not prompt large increases in the quantity of care received.
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- 2023
40. Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department: Technical Report.
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Marin, Jennifer R., Lyons, Todd W., Claudius, Ilene, Fallat, Mary E., Aquino, Michael, Ruttan, Timothy, and Daugherty, Reza J.
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DIAGNOSTIC imaging , *RADIOLOGIC technology , *HEALTH policy , *CLINICAL decision support systems , *RADIATION injuries , *EMERGENCY medical services , *DECISION making in clinical medicine , *ULTRASONIC imaging , *MAGNETIC resonance imaging , *DECISION making , *PEDIATRICS - Abstract
Advanced diagnostic imaging modalities, including ultrasonography, computed tomography, and magnetic resonance imaging, are key components in the evaluation and management of pediatric patients presenting to the emergency department. Advances in imaging technology have led to the availability of faster and more accurate tools to improve patient care. Notwithstanding these advances, it is important for physicians, physician assistants, and nurse practitioners to understand the risks and limitations associated with advanced imaging in children and to limit imaging studies that are considered low value, when possible. This technical report provides a summary of imaging strategies for specific conditions where advanced imaging is commonly considered in the emergency department. As an accompaniment to the policy statement, this document provides resources and strategies to optimize advanced imaging, including clinical decision support mechanisms, teleradiology, shared decision-making, and rationale for deferred imaging for patients who will be transferred for definitive care. [ABSTRACT FROM AUTHOR]
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- 2024
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41. Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department: Policy Statement.
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Marin, Jennifer R., Lyons, Todd W., Claudius, Ilene, Fallat, Mary E., Aquino, Michael, Ruttan, Timothy, and Daugherty, Reza J.
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WOUNDS & injuries , *HEALTH services accessibility , *DIAGNOSTIC imaging , *MEDICAL specialties & specialists , *HEALTH policy , *COMPUTED tomography , *MEDICAL care , *HOSPITAL emergency services , *ULTRASONIC imaging , *MAGNETIC resonance imaging , *DECISION making in clinical medicine , *PEDIATRICS , *INTENTION - Abstract
Advanced imaging, including ultrasonography, computed tomography, and magnetic resonance imaging, is an integral component to the evaluation and management of ill and injured children in the emergency department. As with any test or intervention, the benefits and potential impacts on management must be weighed against the risks to ensure that high-value care is being delivered. There are important considerations specific to the pediatric patient related to the ordering and interpretation of advanced imaging. This policy statement provides guidelines for institutions and those who care for children to optimize the use of advanced imaging in the emergency department setting and was coauthored by experts in pediatric and general emergency medicine, pediatric radiology, and pediatric surgery. The intent is to guide decision-making where children may access care. [ABSTRACT FROM AUTHOR]
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- 2024
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42. Supporting the Grieving Child and Family: Clinical Report.
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Schonfeld, David J., Demaria, Thomas, Nasir, Arwa, and Kumar, Sairam
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FAMILIES & psychology , *DEATH & psychology , *HEALTH self-care , *BEREAVEMENT in children , *CHILD health services , *PEDIATRICS , *GUILT (Psychology) , *SOCIAL support , *SHAME , *INTERMENT - Abstract
The death of someone close to a child often has a profound and lifelong effect on the child and results in a range of both short- and long-term reactions. Pediatricians, within a patient-centered medical home, are in an excellent position to provide guidance to caregivers and to offer assistance and support to grieving children of all ages and their families. This clinical report offers practical suggestions on how to talk with grieving children to help them better understand what has happened and its implications. An understanding of guilt, shame, and other common reactions as well as an appreciation of the role of secondary losses and the unique challenges facing children in communities characterized by chronic trauma and cumulative loss will help the pediatrician to address factors that may impair children's adjustment and to identify complicated mourning and situations when professional counseling is indicated. Advice on how to support children's participation in funerals and other memorial services and to anticipate and address grief triggers and anniversary reactions is provided so that pediatricians are in a better position to advise caregivers and to offer consultation to and collaborate with professionals in schools, early education and child care facilities, and other child congregate care sites. Pediatricians often enter their profession out of a profound desire to minimize the suffering of children and may find it personally challenging to bear witness to the distress of children who are acutely grieving. The importance of professional preparation and self-care is, therefore, emphasized, and resources are recommended. [ABSTRACT FROM AUTHOR]
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- 2024
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43. Respiratory Syncytial Virus-Associated Hospitalizations in Children <5 Years: 2016-2022.
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McMorrow, Meredith L., Moline, Heidi L., Toepfer, Ariana P., Halasa, Natasha B., Schuster, Jennifer E., Staat, Mary A., Williams, John V., Klein, Eileen J., Weinberg, Geoffrey A., Clopper, Benjamin R., Boom, Julie A., Stewart, Laura S., Selvarangan, Rangaraj, Schlaudecker, Elizabeth P., Michaels, Marian G., Englund, Janet A., Albertin, Christina S., Mahon, Barbara E., Hall, Aron J., and Sahni, Leila C.
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CROSS infection , *SEASONS , *PATIENTS , *OXYGEN , *RESEARCH funding , *HOSPITAL care , *RESPIRATORY syncytial virus infections , *CHILDREN'S hospitals , *DESCRIPTIVE statistics , *LONGITUDINAL method , *PEDIATRICS , *CLASSIFICATION , *ODDS ratio , *MEDICAL records , *ACQUISITION of data , *ARTIFICIAL respiration , *COMPARATIVE studies , *CONFIDENCE intervals , *COVID-19 pandemic , *HOSPITAL care of children , *CRITICAL care medicine , *CHILDREN - Abstract
BACKGROUND: The coronavirus disease 2019 pandemic disrupted respiratory syncytial virus (RSV) seasonality resulting in early, atypical RSV seasons in 2021 and 2022, with an intense 2022 peak overwhelming many pediatric healthcare facilities. METHODS: We conducted prospective surveillance for acute respiratory illness during 2016-2022 at 7 pediatric hospitals.We interviewed parents, reviewed medical records, and tested respiratory specimens for RSV and other respiratory viruses.We estimated annual RSV-associated hospitalization rates in children aged <5 years and compared hospitalization rates and characteristics of RSV-positive hospitalized children over 4 prepandemic seasons (2016-2020) to those hospitalized in 2021 or 2022. RESULTS: There was no difference in median age or age distribution between prepandemic and 2021 seasons. Median age of children hospitalized with RSV was higher in 2022 (9.6 months vs 6.0 months, P < .001). RSV-associated hospitalization rates were higher in 2021 and 2022 than the prepandemic average across age groups. Comparing 2021 to 2022, RSV-associated hospitalization rates were similar among children <2 years of age; however, children aged 24 to 59 months had significantly higher rates of RSV-associated hospitalization in 2022 (rate ratio 1.68 [95% confidence interval 1.37-2.00]). More RSV-positive hospitalized children received supplemental oxygen and there were more respiratory virus codetections in 2022 than in prepandemic seasons (P < .001 and P 5 .003, respectively), but there was no difference in the proportion hypoxemic, mechanically ventilated, or admitted to intensive care. CONCLUSIONS: The atypical 2021 and 2022 RSV seasons resulted in higher hospitalization rates with similar disease severity to prepandemic seasons. [ABSTRACT FROM AUTHOR]
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- 2024
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44. Guidance on Conversations About Race and Racism in Pediatric Clinical Settings.
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Clark, Shawnese, Cohen, Alyssa, Welch, Sarah B., Bate, Aleha, Anderson, Ashaunta T., Chomilo, Nathan, Dougé, Jacqueline, Durkee, Myles, Iruka, Iheoma U., Jindal, Monique, Jones, Shawn C. T., Li, Angie, Arshad, Aisha, and Heard-Garris, Nia
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PATIENTS' families , *CONSENSUS (Social sciences) , *MEDICAL personnel , *CONVERSATION , *QUALITATIVE research , *RESEARCH funding , *DESCRIPTIVE statistics , *CHILDREN'S hospitals , *RACISM , *PEDIATRICS , *THEMATIC analysis , *PHYSICIAN-patient relations , *COMMUNICATION , *ATTITUDES of medical personnel , *DELPHI method , *COUNSELING , *EXPERTISE - Abstract
OBJECTIVE: To develop guidance for pediatric clinicians on how to discuss race and racism in pediatric clinical settings. METHODS: We conducted a modified Delphi study from 2021 to 2022 with a panel of pediatric clinicians, psychologists, parents, and adolescents with expertise in racism and child health through scholarship or lived experience. Panelists responded to an initial survey with openended questions about how to talk to youth about race and racism. We coded the responses using qualitative methods and presented them back to the panelists. In iterative surveys, panelists reached a consensus on which themes were most important for the conversation. RESULTS: A total of 29 of 33 panelists completed the surveys and a consensus was reached about the concepts pediatric clinicians should consider before, during, and after conversations about race and racism and impediments clinicians may face while having these discussions. Panelists agreed that it was within the pediatric clinician's role to have these conversations. An overarching theme was the importance of having background knowledge about the systemic nature of racism. Panelists agreed that being active listeners, learning from patients, and addressing intersectionality were important for pediatric clinicians during conversations. Panelists also agreed that shortand long-term benefits may result from these conversations; however, harm could be done if pediatric clinicians do not have adequate training to conduct the conversations. CONCLUSIONS: These principles can help guide conversations about race and racism in the pediatric clinical setting, equipping clinicians with tools to offer care that acknowledges and addresses the racism many of their patients face. [ABSTRACT FROM AUTHOR]
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- 2024
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45. Developments in the Design, Conduct, and Reporting of Child Health Trials.
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Baba, Ami, Aregbesola, Alex, Caldwell, Patrina H. Y., Elliott, Sarah A., Elsman, Ellen B. M., Fernandes, Ricardo M., Hartling, Lisa, Heath, Anna, Kelly, Lauren E., Preston, Jennifer, Sammy, Adrian, Webbe, James, Williams, Katrina, Woolfall, Kerry, Klassen, Terry P., and Offringa, Martin
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CHILDREN'S health , *CLINICAL trials , *AGE distribution , *PEDIATRICS , *EXPERIMENTAL design , *MEDICAL research , *HEALTH outcome assessment , *STANDARDS - Abstract
To identify priority areas to improve the design, conduct, and reporting of pediatric clinical trials, the international expert network, Standards for Research (StaR) in Child Health, was assembled and published the first 6 Standards in Pediatrics in 2012. After a recent review summarizing the 247 publications by StaR Child Health authors that highlight research practices that add value and reduce research "waste," the current review assesses the progress in key child health trial methods areas: consent and recruitment, containing risk of bias, roles of data monitoring committees, appropriate sample size calculations, outcome selection and measurement, and age groups for pediatric trials. Although meaningful change has occurred within the child health research ecosystem, measurable progress is still disappointingly slow. In this context, we identify and review emerging trends that will advance the agenda of increased clinical usefulness of pediatric trials, including patient and public engagement, Bayesian statistical approaches, adaptive designs, and platform trials. We explore how implementation science approaches could be applied to effect measurable improvements in the design, conducted, and reporting of child health research. [ABSTRACT FROM AUTHOR]
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- 2024
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46. Performance of ChatGPT and Google Translate for Pediatric Discharge Instruction Translation.
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Brewster, Ryan C. L., Gonzalez, Priscilla, Khazanchi, Rohan, Butler, Alex, Selcer, Raquel, Chu, Derrick, Aires, Barbara Pontes, Luercio, Marcella, and Hron, Jonathan D.
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ARTIFICIAL intelligence tests , *HEALTH services accessibility , *RESEARCH funding , *TRANSLATIONS , *PROBABILITY theory , *MEDICAL care , *PATIENT discharge instructions , *DESCRIPTIVE statistics , *PEDIATRICS , *MULTILINGUALISM , *SEARCH engines , *SPANISH language , *COMPARATIVE studies , *MEDICAL practice - Abstract
BACKGROUND AND OBJECTIVES: Patients who speak languages other than English face barriers to equitable healthcare delivery. Machine translation systems, including emerging large language models, have the potential to expand access to translation services, but their merits and limitations in clinical practice remain poorly defined. We aimed to assess the performance of Google Translate and ChatGPT for multilingual translation of pediatric discharge instructions. METHODS: Twenty standardized discharge instructions for pediatric conditions were translated into Spanish, Brazilian Portuguese, and Haitian Creole by professional translation services, Google Translate and ChatGPT-4.0, and evaluated for adequacy (preserved information), fluency (grammatical correctness), meaning (preserved connotation), and severity (clinical harm), along with assessment of overall preference. Domain-level ratings and preferred translation source were summarized with descriptive statistics and compared with professional translations. RESULTS: Google Translate and ChatGPT demonstrated similar domain-level ratings to professional translations for Spanish and Portuguese. For Haitian Creole, compared with both Google Translate and ChatGPT, professional translations demonstrated significantly greater adequacy, fluency meaning, and severity scores. ChatGPT (33.3%, P < .001) and Google Translate (23.3%, P 5 .024) contained more potentially clinically significant errors (severity score ≤3) for Haitian Creole than professional translations (8.3%). Professional Haitian Creole (48.3%) and Portuguese (43.3%), but not Spanish (15%), translations weremost frequently preferred among translation sources. CONCLUSIONS: Machine translation platforms have comparable performance to professional translations for Spanish and Portuguese but shortcomings in quality, accuracy, and preference persist for Haitian Creole. Diverse multilingual training data are needed, along with regulations ensuring safe and equitable applications of machine translation in clinical practice. [ABSTRACT FROM AUTHOR]
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- 2024
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47. Pediatric Pharmacology for the Primary Care Provider: Advances and Limitations.
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Thompson, Elizabeth J., Wood, Charles T., and Hornik, Christoph P.
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MENTAL illness drug therapy , *DRUG therapy for asthma , *PHARMACOLOGY , *SKIN diseases , *PATIENT safety , *GENERAL practitioners , *PRIMARY health care , *INVESTIGATIONAL drugs , *INFECTION , *EVALUATION of medical care , *PEDIATRICS , *PHARMACY information services , *DRUG approval , *DRUG efficacy , *CHILDHOOD obesity , *EVIDENCE-based medicine , *DRUG development , *GENERIC drugs , *PSYCHOSOCIAL factors , *DRUG labeling , *MEDICAL care costs - Abstract
Despite >1 in 5 children taking prescription drugs in the United States, offlabel drug use is common. To increase the study of drugs in children, regulatory bodies have enacted legislation to incentivize and require pediatric drug studies. As a result of this legislation, novel trial approaches, and an increase in personnel with pediatric expertise, there have been numerous advancements in pediatric drug development. With this review, we aim to highlight developments in pediatric pharmacology over the past 6 years for the most common disease processes that may be treated pharmacologically by the pediatric primary care provider. Using information extracted from label changes between 2018 and 2023, the published literature, and Clinicaltrials.gov, we discuss advances across multiple therapeutic areas relevant to the pediatric primary care provider, including asthma, obesity and related disorders, mental health disorders, infections, and dermatologic conditions. We highlight instances in which new drugs have been developed on the basis of a deeper mechanistic understanding of illness and instances in which labels have been expanded in older drugs on the basis of newly available data. We then consider additional factors that affect pediatric drug use, including cost and nonpharmacologic therapies. Although there is work to be done, efforts focused on pediatric-specific drug development will increase the availability of evidence-based, labeled guidance for commonly prescribed drugs and improve outcomes through the safe and effective use of drugs in children. [ABSTRACT FROM AUTHOR]
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- 2024
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48. Factors Associated With Perinatal Hepatitis C Screening Among Exposed Children: 2016-2020.
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Kuncio, Danica E., Waterman, Emily J., Robison, S. Z. Ginny, and Roberts, Alison
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HEPATITIS C transmission , *HEPATITIS C risk factors , *NEWBORN screening , *RISK assessment , *CHILDREN'S health , *HEALTH services accessibility , *MATERNAL health services , *RESEARCH funding , *HEALTH policy , *MULTIPLE regression analysis , *RETROSPECTIVE studies , *CHI-squared test , *PREGNANT women , *POSTNATAL care , *DESCRIPTIVE statistics , *PEDIATRICS , *VERTICAL transmission (Communicable diseases) , *MEDICAL records , *ACQUISITION of data , *MEDICAL appointments , *TIME , *CHILDREN - Abstract
BACKGROUND AND OBJECTIVES: Children perinatally exposed to hepatitis C virus (HCV) should be screened for infection, yet testing rates are low. Clinical perinatal HCV testing recommendations vary and may contribute to poor completion. This study examines pediatric care factors associated with perinatal HCV testing completion. METHODS: A cohort of people living with HCV in Philadelphia, Pennsylvania, who delivered a live birth in 2016 to 2020 and their children were followed by the Philadelphia Department of Public Health. The association of completion of HCV screening with pregnant/postpartum person demographics, pediatric care factors, and testing policy were retrospectively explored. χ² and multivariable logistic regressions were used. RESULTS: HCV-positive pregnant people gave birth to 457 children of whom 307 (67.2%) were tested for HCV according to recommendations and 79 (17.2%) were inadequately tested. Children were more likely to be tested if born to a pregnant person with HIV coinfection (P = .007), if they were always on schedule for vaccinations (P < .001), and if they attended the 18-month well visit (P < .001). Completion rates varied significantly by pediatrician's testing policy: 90.9% tested if the policy was for 2 months, 79.6% if 2 to 12 months, 61.9% if 12 months, and 58.5% if 18 months of age (P < .001). CONCLUSIONS: Timing of perinatal HCV testing policies was significantly associated with testing completion rates. Testing at 2 months was associated with far better HCV testing completion than other strategies, regardless of birthing person and pediatrician factors. These findings suggest routine HCV testing of children perinatally exposed to HCV is best achieved in the first year of life. [ABSTRACT FROM AUTHOR]
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- 2024
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49. Emergency Department Antibiotic Prescribing for Pediatric Urinary Tract Infections, 2011-2020.
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Carpenter, Kathryn, Hinkle, Jane, Snow, Kathleen, Kalluri, Nikita S., Perkins, Ryan, and Nakamura, Mari M.
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ANTIBIOTICS , *URINARY tract infections , *THIRD generation cephalosporins , *STATISTICAL models , *MEDICAL prescriptions , *RESEARCH funding , *ACADEMIC medical centers , *LOGISTIC regression analysis , *HOSPITAL emergency services , *TREATMENT effectiveness , *RETROSPECTIVE studies , *DESCRIPTIVE statistics , *PEDIATRICS , *ODDS ratio , *SURVEYS , *PHYSICIAN practice patterns , *MEDICAL records , *ACQUISITION of data , *CO-trimoxazole , *DRUG prescribing , *DATA analysis software , *CONFIDENCE intervals - Abstract
The article discusses research which evaluated changes in antibiotic prescribing for pediatric urinary tract infections (UTI) at emergency departments (ED) visits in the U.S. from 2011 to 2020. The study assessed antibiotic prescribing trends and analyzed antibiotic prescriptions for pediatric UTI visits by time period, changes in trimethoprim-sulfamethoxazole, first-generation cephalosporin and third-generation cephalosporin use over time.
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- 2024
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50. Psychological Outcomes in Families of PICU Survivors: A Meta-Analysis.
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Shi Min Ko, Michelle, Wai Kit Lee, Sultana, Rehena, Murphy, Beverly, Yi Ching Heng, Katrina, Sin Wee Loh, Pei Fen, and Jan Hau Lee
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FAMILIES & psychology , *MENTAL illness risk factors , *MEDICAL information storage & retrieval systems , *STATISTICAL models , *POST-traumatic stress disorder , *PSYCHOLOGICAL distress , *RESEARCH funding , *CINAHL database , *META-analysis , *SEVERITY of illness index , *ANXIETY , *DESCRIPTIVE statistics , *CLASSIFICATION of mental disorders , *HOSPITAL mortality , *PEDIATRICS , *SYSTEMATIC reviews , *MEDLINE , *INTENSIVE care units , *PSYCHOLOGY of mothers , *ONLINE information services , *COUNSELING , *LENGTH of stay in hospitals , *PSYCHOLOGY of parents , *DATA analysis software , *CONFIDENCE intervals , *PSYCHOLOGY information storage & retrieval systems , *MENTAL depression , *COMORBIDITY , *REGRESSION analysis - Abstract
BACKGROUND: Pediatric critical illness exposes family members to stressful experiences that may lead to subsequent psychological repercussions. OBJECTIVE: To systematically review psychological outcomes among PICU survivors' family members. DATA SOURCES: Four medical databases (PubMed, Embase, CINAHL and PsycInfo) were searched from inception till October 2023. STUDY SELECTION: Studies reporting psychological disorders in family members of PICU patients with at least 3 months follow-up were included. Family members of nonsurvivors and palliative care patients were excluded. DATA EXTRACTION: Screening and data extraction was performed according to PRISMA guidelines. Data were pooled using a random-effects model. RESULTS: Of 5360 articles identified, 4 randomized controlled trials, 16 cohort studies, and 2 cross-sectional studies were included (total patients = 55 597; total family members = 97 506). Psychological distress was reported in 35.2% to 64.3% and 40.9% to 53% of family members 3 to 6 months and 1 year after their child's PICU admission, respectively. Posttraumatic stress disorder was diagnosed in 10% to 48% of parents 3 to 9 months later. Parents that experienced moderate to severe anxiety and depression 3 to 6 months later was 20.9% to 42% and 6.1% to 42.6%, respectively. Uptake of mental counseling among parents was disproportionately low at 0.7% to 29%. Risk factors for psychiatric morbidity include mothers, parents of younger children, and longer duration of PICU stay. LIMITATIONS: The majority of studies were on parents with limited data on siblings and second degree relatives. CONCLUSIONS: There is a high burden of psychological sequelae in family members of PICU survivors. Risk stratification to identify high-risk groups and early interventions are needed. [ABSTRACT FROM AUTHOR]
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- 2024
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