Search

Equity, diversity, and inclusion (EDI) research is increasing, and there is a need for a more standardized approach for methodological and ethical review of this research. A supplemental review process for EDI-related human subject research protocols was developed and implemented at a pediatric academic medical center (AMC). The goal was to ensure that current EDI research principles are consistently used and that the research aligns with the AMC's declaration on EDI. The EDI Research Review Committee, established in January 2022, reviewed EDI protocols and provided recommendations and requirements for addressing EDI-related components of research studies. To evaluate this review process, the number and type of research protocols were reviewed, and the types of recommendations given to research teams were examined. In total, 78 research protocols were referred for EDI review during the 20-month implementation period from departments and divisions across the AMC. Of these, 67 were given requirements or recommendations to improve the EDI-related aspects of the project, and 11 had already considered a health equity framework and implemented EDI principles. Requirements or recommendations made applied to 1 or more stages of the research process, including design, execution, analysis, and dissemination. An EDI review of human subject research protocols can provide an opportunity to constructively examine and provide feedback on EDI research to ensure that a standardized approach is used based on current literature and practice., (Copyright © 2024 by the American Academy of Pediatrics.)

Objectives: To describe the effects of the coronavirus disease 2019 (COVID-19) pandemic and associated practice shifts on consultation and referral patterns of an intimate partner violence program at a large, urban children's hospital., Methods: Secondary data analyses examined COVID-19-related variations in patterns of consultations and referrals in the 11 months before the COVID-19 pandemic (April 1, 2019-February 29, 2020) and those after its emergence (April 1, 2020-February 28, 2021). χ2 analyses were used to examine differences in categorical outcomes of interest by time and practice setting, as well as differences within practice settings. Poisson regressions were used to compare the number of reasons for consultation and the number of referrals during the 2 periods., Results: Analyses revealed significant decreases in face-to-face consults (28% to 2%; P < .001) during the period after COVID-19 emergence alongside significant increases in the total number of consults (240 to 295; P < .001), primarily for emotional abuse (195 to 264; P = .007). Psychoeducation referrals also increased significantly (199 to 273; P < .001), whereas referrals to community resources decreased significantly (111 to 95; P < .001). Setting-specific analyses revealed that primary care settings were the only practice settings to demonstrate significant differences in overall number of and specific reasons for consultation and associated referral types before and after COVID-19 emergence., Conclusions: Even during a shift away from face-to-face care, there was an increase in intimate partner violence referrals after the start of the COVID-19 pandemic. These findings suggest the importance of pediatric primary care as a location for survivors to access support., (Copyright © 2022 by the American Academy of Pediatrics.)

As part of establishing a gender surgery center at a pediatric academic hospital, we undertook a process of identifying key ethical, legal, and contextual issues through collaboration among clinical providers, review by hospital leadership, discussions with key staff and hospital support services, consultation with the hospital's ethics committee, outreach to other institutions providing transgender health care, and meetings with hospital legal counsel. This process allowed the center to identify key issues, formulate approaches to resolving those issues, and develop policies and procedures addressing stakeholder concerns. Key issues identified during the process included the appropriateness of providing gender-affirming surgeries to adolescents and adults, given the hospital's mission and emphasis on pediatric services; the need for education on the clinical basis for offered procedures; methods for obtaining adequate informed consent and assent; the lower and upper acceptable age limits for various procedures; the role of psychological assessments in determining surgical eligibility; the need for coordinated, multidisciplinary patient care; and the importance of addressing historical access inequities affecting transgender patients. The process also facilitated the development of policies addressing the identified issues, articulation of a guiding mission statement, institution of ongoing educational opportunities for hospital staff, beginning outreach to the community, and guidance as to future avenues of research and policy development. Given the sensitive nature of the center's services and the significant clinical, ethical, and legal issues involved, we recommend such a process when a establishing a program for gender surgery in a pediatric institution., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2019 by the American Academy of Pediatrics.)