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Over the last three quarters of a century, international guidelines and regulations have undergone significant changes in how children are problematised as participants in biomedical research. While early guidelines enacted children as vulnerable subjects with diminished autonomy and in need of special protection, beginning in the early 2000s, international regulatory frameworks defined the paediatric population as vulnerable due to unaddressed public health needs. More recently, ethical recommendations have promoted the active engagement of minors as research partners. In this paper, I adopt a post-structuralist approach to policy analysis to examine deep-seated assumptions and presuppositions underlying the changes in the problematisation of children as biomedical research participants over time. While biomedical research ethics focuses on the autonomy and vulnerability of minors, ethical guidelines are situated in specific sociocultural contexts, shaped, among other things, by contingent public health needs and changing conceptions of the value of research and science for society. In the process, I demonstrate the challenge of moving away from an approach that in taking adults as the model overshadows the complexity of children's lived experiences as well as their personal, cultural, and social lives. The lack of acknowledgement of this complexity makes children vulnerable to epistemic injustice, which is particularly crucial to address in public involvement initiatives.

Background: Sleep plays an integral role in a child's physical and neuropsychological development. Children with sleep disorders are at risk of developing inattention, hyperactivity, and learning difficulties, challenges that impact them, their families, their classmates, and their communities. There is a paucity of pediatric sleep medicine providers equipped to partner with families in identifying and addressing sleep disorders. Additional barriers to accessing this specialized care include geographic proximity, parental ability to take time off from work, and hesitance for a child to miss valuable learning time at school. During the SARS-CoV-2 pandemic, our pediatric sleep department transitioned from largely in-person care to a predominantly virtual platform and collected data to monitor the impact of this transition. In this study, we share several key trends that emerged which may have broad implications on how pediatric sleep medicine providers can better support school-aged children with sleep challenges. Methods: We performed a chart review of all scheduled pediatric sleep medicine visits from June 2019 to June 2021, a time frame that included the pandemic-driven overnight transition from in-person to virtual clinic visits. The STEM framework was developed by pediatric telehealth experts to provide a unified approach to assessing the impact of telehealth programs. We applied this framework to the collected data to gauge the impact on the four major domains highlighted in STEM: health outcomes, healthcare delivery, individual experience (patient and provider), and program implementation. Results: The data demonstrated an increased proportion of completed visits and a decreased proportion of canceled/no-show visits when care was provided virtually. Patients accessing virtual care were doing so from greater distances than those who had in-person visits. The school-aged (5-12 years) cohort utilizing telehealth had notable differences in past medical history, with significantly more Attention Deficit-Hyperactivity Disorder. They also presented with significantly more insomnia and behavioral sleep difficulties. Discussion: Sleep disorders are common, and school-aged children have much to gain from sleep optimization. However, pediatric sleep care can be challenging to access. Geographic distance and time away from school and work preclude many families from formal sleep consultations. Telehealth allows high-quality pediatric sleep care to be offered in an easily accessible format to those near and far, resulting in clinics running more efficiently and school-aged children, who need it most, to receive the tools they need to sleep soundly. With a convenient click, families are better able to fit virtual sleep consultations into their day, without the stress of travel or the waiting room. They complete more scheduled visits, allowing pediatric sleep medicine departments to deliver care more efficiently. The low-pressure virtual platform also permits families to seek care for behavioral sleep issues. While our department's transition to predominantly virtual care occurred amidst a pandemic, with many confounding factors limiting the interpretation of the data we collected, the trends seen are very promising.

Background: Low adolescent HPV vaccination initiation due to parents declining vaccination remains a challenge for providers. In 2018, 65% of adolescent girls and 56% of adolescent boys in Texas initiated HPV vaccination. Gaps between HPV vaccination rates and those for Tdap (83%) and meningococcal vaccines (87%) among 13-17 year olds highlights missed opportunities to prevent HPV-related cancers. While leading medical organizations endorse a presumptive, bundled recommendation, in which the provider presents HPV vaccination the same way as other vaccines, bundled between Tdap and meningococcal at 11- or 12-year-old visits, provider recommendations vary. Methods: In 2015, we surveyed pediatricians in a large Texas pediatric clinic network to assess physician knowledge, beliefs, attitudes and behaviors regarding adolescent HPV vaccination. To ascertain HPV vaccination outcomes, survey data were merged with patient electronic health records. We examined the association of pediatrician HPV vaccination recommendation and vaccination using multivariable multilevel generalized linear models clustered by physicians. Adjusted odds ratios were calculated. Results: Among 226 physicians, 59.8% completed the emailed survey. Controlling for patient and physician demographics, odds of HPV vaccination initiation were significantly increased if physicians used a bundled approach to recommend the HPV vaccine: "Your child is due for three vaccines: Tdap, HPV, and meningococcal vaccine" versus "Your child is due for two vaccines, Tdap and meningococcal. There is also the HPV vaccine, which is optional" (OR: 1.59, 95% CI 1.30-1.96). Conclusion: This study links physician HPV vaccine recommendation wording and outcomes, showing the significant effect of bundling HPV vaccination for adolescent patients.

Statement of Purpose: Pediatric firearm access is a significant risk factor for unintentional injury and suicide. This study investigated parents' perspectives on an adapted firearm safety program, "S.A.F.E. Firearm," to ensure acceptability and optimize effectiveness prior to the launch of an upcoming hybrid effectiveness-implementation trial. Methods/Approach: We administered a cross-sectional survey with a convenience sample of U.S. parents to measure the acceptability of "S.A.F.E. Firearm" and other key variables (e.g., relationship with pediatrician) that may impact our implementation approach. The sample included 97 participants (52 firearm-owning and 45 non-owning) from across the country. We also conducted semi-structured interviews using a Think Aloud exercise with 11 survey participants that were analyzed with directed content analysis. Results: The mean acceptability score was 4.35 [SD 0.52] on a 1-5 Likert scale, indicating that participants viewed S.A.F.E. Firearm as highly acceptable. Most participants (84%) either agreed or completely agreed with recommending that a friend receive "S.A.F.E. Firearm." No significant differences in acceptability scores were found by firearm ownership status, gender, race and ethnicity, or region of residence. Parent-pediatrician depth of relationship was associated with acceptability (r= 0.21, p=0.038). Interviews indicated that a collaborative approach to decision-making, neutral messaging, and provision of tangible resources were key factors that contributed to the program's overall high acceptability scores. Conclusion & Significance: The present study served as the final check in our process of adapting an evidence-based safe firearm storage program to increase reach and effectiveness as a universal suicide prevention strategy in pediatric primary care. Convergent parent feedback confirms that "S.A.F.E. Firearm" is highly acceptable and ready for implementation. Moreover, our findings suggest that family-centeredness may be enhanced through explicit integration of parents' needs and preferences into program refinements. Use of qualitative Think Aloud exercises with end user groups can add value when actual implementation of firearm safety programs can only be approximated.

Securing clinical locations for Bachelor of Nursing Science (BSN) programs is always a complex challenge, particularly when clinical experiences are focused on vulnerable populations such as pediatric psychiatric patients. To provide students with a meaningful clinical experience during the first weeks of the COVID-19 pandemic, we developed a telehealth simulation centered on a pediatric psychiatric patient with unfolding adolescent depression and suicidal ideation. This case study uses qualitative data analysis of student debriefing sessions as well as a pre/posttest design to explore the effectiveness of the simulation. Results suggest that simulations can be useful for presenting unique patient scenarios focused on therapeutic communication in psychiatric assessment, particularly for vulnerable patient populations. Quantitative data analysis showed BSN students improved their understanding of communication needs of adolescents and retained their knowledge over time; qualitative comments showed that students felt the simulation was a valuable learning experience and achieved key learning outcomes.

The article is aimed at studying medical students' reflective strategies for learning the Pediatric Surgery course at medical university. We used a modified version of the Motivated Strategies for Learning questionnaire (Soemantri et al., 2018) which has four subscales: self-orientation, critical thinking, self-regulation, and feedback seeking. The self-orientation component deals with students' perceptions on their self-efficacy and internal motivation. The participants were fourty-six 5-th year medical students from the Bogomolets National Medical University, Kyiv, Ukraine. The survey was held in May 2021 when the students finished their spring semester in the online mode. We observed the prevalence of high and moderate levels in all the variables, but the indicators of Feedback seeking are lower which can be explained by the specificities of online learning. The authors propose methodological recommendations for educators how to create an environment for reflective learning to develop students' reflective skills and employ alternative assessment strategies in the classroom.

Research ethics committees (RECs) have a crucial role in protecting children in research. However, studies on REC members' perspectives on paediatric research are scarce. We conducted a qualitative study to explore Swedish scientific REC members' perspectives on ethical aspects in applications involving children with severe health conditions. The REC members considered promoting participation, protecting children and regulatory adherence to be central aspects. The results underscored the importance of not neglecting ill children's rights to adapted information and participation. REC members supported a contextual and holistic approach to vulnerability and risk, which considers the child's and parents' psychological wellbeing and the child's integrity, both short and long term. The ethical complexity of paediatric research requires continuous ethical competence development within RECs.

Psychoeducation, where clinicians teach problem-solving skills in a supportive environment, can help address families' social vulnerabilities and promote well-being. Group well-child care (GWCC) may provide unique opportunities for pediatric residents to improve their skills in psychoeducation. Our aim was to characterize pediatric residents' perspectives and experiences of communication while conducting both individual well-child care and GWCC. We used a longitudinal qualitative study design to conduct 15 semistructured interviews with five pediatric residents who facilitated GWCC. Using the constant comparative method, we characterized pediatric residents' perspectives and experiences of communication while conducting both individual well-child care and GWCC. Four themes emerged. Residents perceived that GWCC (i) enabled families to honestly share their knowledge and parenting practices, (ii) allowed time and a space for families to share personal stories and scenarios, (iii) facilitated discussions of maternal health and psychosocial matters, toward which residents felt ambivalence, and (iv) fostered skills in psychoeducation that transferred to the rest of their clinical practice. When pediatric residents lead GWCC, they perceive that they can facilitate key aspects of psychoeducation, enabling them to assist families in meeting complex social needs. Residents describe that they transfer psychoeducation skills learned in GWCC to the rest of their practice.

Empathy is a fundamental quality that nursing staff should possess, but the empathy ability of nursing students in China is currently at an intermediate level and requires improvement. This study aimed to explore teaching methods for nursing humanistic education, that can improve the empathy ability of nursing students and cultivate high-quality nursing talents. This study employed narrative education and experiential teaching methods to develop empathic competence in teaching pediatric nursing courses. The empathic ability of nursing students was measured using the JSPE-NS scale before and after teaching and was analyzed to refine the teaching reflection theme words. After teaching, nursing students scored higher on the total empathy scale, perspective-taking dimension, and emotional care dimension than before teaching, with statistically significant differences (p < 0.05). Five themes were extracted from the teaching reflection, including emotional empathy, pediatric nursing skills, gratitude to parents, reverence for life, and course experience. The results show that the combination of narrative education and experiential teaching methods applied to pediatric nursing courses effectively improved nursing students' empathy, strengthened their identification with the nursing profession, and promoted the teaching reform of humanistic education in nursing courses. The combination of narrative education and experiential teaching methods can improve the empathic ability of nursing students. This approach is suitable for integrating humanistic education into nursing professional courses and provides a feasible idea for developing humanistic qualities in nurses.

In the Response to Intervention framework, a psychometrically sound screening tool is essential for identification of children with emotional and behavioral risk. The purpose of this study was to examine the validity of the Pediatric Symptom Checklist-17 (PSC-17) screener in school-based settings. Forty-four teachers rated 738 preschoolers using the PSC-17; children were later assessed using long forms of the Behavior Assessment System for Children (BASC-2) Preschool form or the Achenbach System of Empirically Based Assessment (ASEBA) Caregiver--Teacher Report Form to identify emotional and behavioral disorder. Validity evidence including examinations of a multilevel factor structure, internal consistency, and criterion-related validity supported the conclusion that the PSC-17 is a high-quality universal screening tool in school-based settings. Finally, to identify emotional and behavioral risk with young children, receiver operating characteristic curve analyses with the PSC-17 yielded a lower cutoff score (i.e., 7) than the original cutoff score (i.e., 15) based on a clinical sample.

Simulation practices are growing in both popularity and necessity within speech pathology programs. Simulation use can serve to not only minimize client risk but to increase student confidence and competence prior to patient contact, particularly with low incidence or medically fragile patients. This paper describes and reflects on four individual simulation experiences within one graduate speech language pathology program and their outcomes. The use of both simulated patients and mannequin training resulted in an increase in students' perception of knowledge and confidence in their clinical skills with medical patients.

Little is known about the process of tracking the activity and days-to-productivity of new research faculty in pediatric academic medical centers in the United States. The purpose of this study was to design a quantitative technique for measuring the startup journey and academic productivity of new research faculty at an established research academic medical center. Three measures, (1) engagement, (2) efficiency, and (3) publication, were used to identify the total number of days that it takes for a new research faculty member to move from the discovery phase (value-consumed) into the engagement phase (value-created) after accepting a new position. General findings were that the typical research faculty member hired from 2014 to 2018 at Children's Mercy was male, submitted his first research project within the first three months of employment and averaged one new research submission per year. He would collaborate on a publication as a co-author within the first six months of employment, his first primary author publication would be published near his first employment anniversary, and he would average 2.9 publications per year in the first few years. The current study hopes to fill a gap in existing literature regarding the best practices for tracking, reporting and comparing the startup journey and academic productivity of new research faculty in pediatric academic medical centers.

The birth of a child diagnosed with autism spectrum disorder (ASD) tends to strongly disrupt family dynamics and functioning. However, the severity of the impact may be softened if the family feels supported during the diagnostic process. The Valencia region (Spain)--where this study is located--recently put in place a protocol to improve ASD detection and support for families. The aim of this study was to identify these families' views on the quality of the process experienced and the operation of the new system. The participants were 34 families with a child who had been diagnosed with this condition. A mixed methodological approach was adopted. A descriptive analysis and an interpretative-phenomenological study were performed using SPSS v. 25 and AQUAD 7, respectively. The results showed that while families seemed to be relatively satisfied, there is still room for improvement in some important areas such as guidance and emotional support, the training of the professionals involved, and waiting time. It was concluded that significant improvements must be implemented in the new diagnostic model to successfully meet the demands of families in a context characterized by a paucity of studies.

Background: Equitable healthcare outcomes are compromised in the absence of strong medical care and social services linkages. In May 2019, Children's Health, the largest health system for pediatric care in North Texas, initiated a three-pronged social determinants of health (SDOH) quality improvement (QI) project that included: (1) baseline and ongoing clinical team training; (2) implementation of an electronic health record (EHR)-embedded SDOH screening tool; and (3) patient referrals to community resources in three inpatient hospital units and one outpatient specialty clinic serving medically complex patients. The purpose of the study is to identify hospital unit/clinic-level implementation factors associated with effective utilization of a SDOH screening tool newly introduced into the clinical setting and outcomes associated with this screening such as referrals to community-based organizations. Methods: A mixed-methods, descriptive study was conducted in the following four pediatric care settings: (1) intensive care unit (PICU); (2) acute, long-term hospitalized patients (LTP); (3) inpatient multi-specialty step-down facility serving patients with special healthcare needs (SHCN); and (4) cystic fibrosis clinic (CF). Quantitative measurement tools (i.e. clinical care team pre/post surveys, EHR data) were merged with focus groups to elucidate factors influencing implementation. The Consolidated Framework of Implementation Research guided assessment. Results: Of the 506 eligible patients, SDOH screening rates (PICU=42%; CF=76%; LTP=85%; SHCN=93%) and referral to community resources rates (PICU=20%; CF=46%; SHCN=52%; LTP=91%) significantly differed across the various hospital units. Among the clinical care team surveys, PICU clinical team members reported significantly lower baseline confidence to discuss SDOH (mean=2.93; SD=0.95) and significantly lower knowledge of SDOH (mean=2.66; SD= 0.88) compared to the three other clinics. Qualitative data indicated that all hospital units prioritized the intervention, had clinical champions, and used thoughtful planning. Screening and referral rate differences were attributed to several factors: (1) settings (e.g., inpatient vs. outpatient setting, resistance to change); (2) individual characteristics (e.g., self-efficacy, baseline confidence, licensure of implementer); and (3) intervention characteristics (e.g. adaptability, compatibility). Conclusions: Results suggest that the successful implementation of a SDOH screener in pediatric health care settings serving medically complex patients is a multifaceted process involving multilevel factors. These findings can guide feasibility of further dissemination and scalability efforts in particular.

Health care reaches more children under age three in the United States than any other family-facing system and represents the most common entry point for developmental assessment of and services for children. In this article, Adam Schickedanz and Neal Halfon examine how well the child health care system promotes healthy child development early in life. They also review children's access to health care through insurance coverage, the health care system's evolution in response to scientific and technical advances, and the shifting epidemiology of health and developmental risk. The authors find that the health care system is significantly underperforming because it is constrained by antiquated conventions, insufficient resources, and outmoded incentive structures inherent in the traditional medical model that still dominates pediatric care. These structural barriers, organization challenges, and financial constraints limit the system's ability to adequately recognize, respond to, and, most importantly, prevent adverse developmental outcomes at the population level. To achieve population-level progress in healthy child development, Schickedanz and Halfon argue that pediatric care will need to transform itself and go beyond simply instituting incremental clinical process improvement. This will require taking advantage of opportunities to deliver coordinated services that bridge sectors and focusing not only on reducing developmental risk and responding to established developmental disability but also on optimizing healthy child development before developmental vulnerabilities arise. New imperatives for improved population health, along with the growing recognition among policy makers and practitioners of the social and developmental determinants of health, have driven recent innovations in care models, service coordination, and coverage designs. Yet the available resources and infrastructure are static or shrinking, crowded out by rising overall health care costs and other policy priorities. The authors conclude that child health systems are at a crossroads of conflicting priorities and incentives, and they explore how the health system might successfully respond to this impasse.

Research on intradisciplinary variations in self-mention marker use in research articles (RAs) in dentistry subdisciplines is lacking. The present study investigates self-mention markers used in each of the seven dentistry subdisciplines (oral sciences, periodontics, endodontics, pediatrics, prosthodontics, oral and maxillofacial surgery, and orthodontics), sections of RAs that employ more self-mention devices in each of the seven dentistry subdisciplines, and common rhetorical realizations of first-person pronouns in the seven dentistry subdisciplines. The analytical framework was primarily based on Hyland's (2003) four rhetorical functions of self-mentions in RAs. The findings showed the lack of qualitative and quantitative intradisciplinary variations across six of the seven dentistry subdisciplines. The first-person plural pronouns "we" and "our" were the most frequently employed self-mention devices in the Discussion section of RAs. Authors in the periodontics subdiscipline preferred to retain an objective stance through the use of passive constructions, abiding by the conventional norms of academic writing that restrict them. The findings also revealed that "explaining a procedure" and "stating findings/claims" were the most frequent realizations associated with the use of self-mention devices, with the exception of periodontics RAs that employed passive constructions instead. The findings contribute to the fields of discourse and genre studies as well as ESP/EAP courses. They may have implications for dentistry RA writing and teaching. An awareness of more frequently used self-mentions in dentistry RAs and their rhetorical functions can help English dentistry scholars successfully produce RAs in line with the academic writing norms of each subdiscipline.

This study examined the effectiveness of a physical activity (PA) intervention among obese Hispanic children delivered by a free mobile phone game application (app) recommended by a pediatrician. A sample of 40 (age M=10.16[2.01] years) children participated in this pilot study. Pre- and posttest data were collected on participants' PA attitudes, intention, and objectively measured PA. The intervention was a game-based exercise prescription to engage in at least 20 minutes daily for seven days in moderate-to-vigorous PA (MVPA) delivered by their primary care pediatrician. The results showed a statistically significant decrease in sedentary time (SED) (t(26)=3.03, p=0.007, d=0.66) and an increase in moderate PA (MPA) (t(26)=3.19, p=0.005, d=-0.69), vigorous PA (VPA) (t(26)=-5.74, p<0.001, d=-1.25), and MVPA (t(26)=-9.09, p<0.001, d=-1.89). In addition, the study showed increase in PA attitudes (t(26)=-3.63, p<0.001, d=-1.10) and PA intention (t(20)=-3.13, p=0.001, d=-0.94) after the intervention. This study provides evidence that a mobile app gaming-based exercise prescription may help to engage obese Hispanic children in health enhancing PA.

In this article, Trenna Valado, Jennifer Tracey, Jonathan Goldfinger, and Rahil Briggs highlight the potential to expand the promise of pediatric care to encompass the full array of child and family needs that can affect the long-term wellbeing of infants and toddlers. Pediatric care is not stigmatized, nearly universally accessed, and oriented toward prevention. The American Academy of Pediatrics already urges pediatricians to screen for adverse childhood experiences, maternal depression, behavioral and developmental risk, and even the effects of poverty on children. Most pediatricians would like to extend their narrow health care mandate to broader social-emotional and behavioral care and education, but they're often constrained by issues of time, training, and reimbursement. Valado and her colleagues offer a solution to those constraints: HealthySteps, a risk-stratified, population health model that integrates a skilled child development professional--called a HealthySteps specialist--into the pediatric care team. The model comprises eight core components that can be divided into three tiers of service, beginning with universal screening that allows practices to identify children and families at higher risk of negative outcomes. These families are then offered the more intensive service tiers, in which they receive customized support based on their needs. The evidence supporting HealthySteps comes from a large multi-site evaluation conducted by Johns Hopkins University, which included a randomized controlled trial component, as well as several site-level research studies. Results from this research indicate that HealthySteps had an array of positive impacts on practices that adopted the program and clients they served, including increased physician and caregiver satisfaction, improved continuity of care, greater adherence to recommended well-child visits and vaccinations, and increased rates of developmental screening and other services. There were also positive impacts on children and parents over time, though many of these impacts were modest. The HealthySteps National Office is continuing to evaluate implementation, training, impact, and cost as the program spreads across the nation. Questions that remain to be answered include how such a model should be financed and how health insurance could pay for it.

This study explored the experiences of families in navigating the Ghanaian health system to address the general health needs of their children with intellectual and developmental disabilities (IDD). The sample involved 22 primary caregivers of children with IDD aged 3-18 years who participated in a semi-structured interview. The interviews were analyzed using the constant comparison analytical method. The findings highlighted key enablers and barriers related to three overarching themes: entry into the health system; consultation with health professionals; and service coordination. The findings showed that the families and their children gained entry into the health system in many health facilities. However, the families revealed that some facilities denied the children services, either because the children had difficulties following entry processing protocols or there were no health professionals willing to address the children's needs. Although health professionals perform their duties professionally during consultation and care administration in many cases, the families reported on some challenges. Service coordination was seamless in some facilities; however, the families reported on other facilities they accessed where service coordination was not seamless. The study findings illustrate that the experiences of families and their children with IDD in the Ghanaian health system may be mixed.

An onboarding program is a powerful tool to welcome new employees and support their productivity. Children's Mercy Hospital created a systematic Research Faculty Onboarding Program (RFOP) to engage new research faculty from their first day with the hospital and to shorten the startup time to productivity. Surveys and interviews indicated that onboarding has provided new faculty with a sense of community with the larger organization. The RFOP has four aims: 1) to increase new researcher productivity, 2) to improve retention rates of new faculty by helping them become involved and connected with the organization, 3) to provide audience-specific, in-depth, timely information that is useful and memorable, and 4) to reduce redundant conversations while guaranteeing the delivery of high-quality, consistent, and accurate information. Prior to their start date, faculty receive a web survey designed to communicate the scope of their research and immediate logistical needs. Based on this information, faculty receive personalized quick-start guides, crucial introductions, and logistical setup within their first 10 days. Finally, the program includes a Triage Unit to provide just-in-time training as faculty set up their first research projects. This structured Research Faculty Onboarding Program is competency-based through mentorship and classroom-setting lectures.

The nation's leading academic hospitals aspire to being the leader in medical research, but as the role of medical research grows in size and complexity, many departments are left without proper research support or oversight. This research explored the need for a research administrative support program to resolve many of the issues facing faculty researchers in the 21st century. This research resulted in a comprehensive departmental program design for the General Research Administrative Support Program (GRASP) within the Department of Pediatrics at a prominent Midwestern pediatric hospital. The program fosters ongoing communication among all research centers, the department, and the researcher. It will maintain a viable research effort by developing a strategic plan that adheres to the institution's long-term research objectives. The program will create an interactive website that contains educational resources, a research toolkit, and announcements of new funding opportunities. The program office will update faculty regularly on issues with compliance to keep researchers abreast of trends in funded research and requirements, and will create a research mentorship program for new faculty members. The General Research Administrative Support Program (GRASP) will standardize the research support system to foster consistent and reliable administrative support for the modern academic pediatric researcher.

Purpose: The purpose of the study was to identify major symptom domain variables common to child trauma and create a prototype short trauma symptom screening tool (STST) intended for use in pediatric medical settings. Methods: This manuscript describes the first two phases of an on-going prospective mixed-method instrument development study. Phase 1 exploratory factor analysis was conducted with an archived LONGSCAN CBCL dataset to: (1) identify behavioral symptoms endorsed by children with known trauma exposure; and (2) generate a preliminary STST item pool. During Phase 2, researchers convened an expert panel (N = 10) and conducted Content Validity Index (CVI) procedures with the 20-item preliminary STST item pool, to further inform item retention, elimination and modification for an updated prototype STST. Findings: Expert quantitative scores yielded a CVI of 0.90 for the overall preliminary STST. The first two phases of this study assisted researchers with identifying 12 items that represent nine child trauma symptom domain variables, which include: (1) aggression/anger; (2) anxiety/fear; (3) sexual concerns; (4) elimination concerns; (5) somatic concerns; (6) depression; (7) dissociation; (8) physical acting out; and (9) dysregulation. Conclusions: The first two phases of STST development resulted in development of a brief, empirically-derived prototype screening tool that features 12 items operationalizing nine domains of child trauma symptoms. Developers can now advance to the next phase of STST development; feasibility assessment and psychometric testing.

The simulation technology is rapidly expanding and has been used in several nursing programs around the world and in Saudi Arabia too. The aim of this study was to evaluate the effect of using a simulation based scenarios on the pediatric nursing students' students' knowledge, self-efficacy, satisfaction, and confidence. This study used Bandura's Social Cognitive Learning Theory (1977; 1986) as a theoretical framework. 158 third year baccalaureate nursing students enrolled in a pediatric nursing course participated in the study. Data was collected using demographic data profile questionnaire, knowledge questionnaire, Learner Satisfaction and Self Confidence in Learning Questionnaire (NLN, 2009) and the General Self-Efficacy. The simulation activities were conducted in the pediatric nursing lab. The simulation activities consisted of three respiratory problems and one cardiac scenario. High and low fidelity simulators were used. The majority of the students were unmarried (96.84%) and had no previous experience in simulation. There was a significant statistical difference in pre- and posttest knowledge and self-efficacy scores. Students were satisfied with the simulation experience and their self-confident scores were higher after the simulation session. The post simulation self-efficacy was positively correlated with satisfaction (r = 0.46, P = 0.001) and self-confidence (r = 0.50, P = 0.001). Satisfaction with simulation was also positively correlated with self-confidence (r = 0.46, P = 0.001). Although the interpretation of the study results is limited due to the short time frame between the pretest and the posttest, this study provides a stepping point for understanding how simulation may affect the pediatric nursing students' knowledge, self-efficacy and confidence.

The proliferation of electronic content and limited exposure of children to books in Jordan has made both parents and health-care providers more concerned about healthy child development. This research aimed to determine if pediatric primary prevention programs were helpful in reducing screen-time and improving reading habits of children in Jordan, and if there was a correlation between these two factors. Parents attended classes on various topics, one of which dealt with screen-time and reading. Six months later, they were surveyed on these topics. The test group (took the relevant class) and control group (did not take the class) included 30 families each. The mean screen-time was above the recommended guideline of 2 h/day in both groups. Only 37% of the families in the test group, and 17% in the control group followed the guideline. A significant difference in screen-time between the groups was found only during weekends. When asked about the ideal screen-time, parents from the test group reported screen-times that were significantly closer to the recommendations, showing an increase in knowledge, but not a significant change in behavior. Parents, also, believed that children's exposure to books should be at the much later age of 3-4 years, with actual exposure being < 1 h/day. Moreover, no correlation was found between screen-time and reading time. These findings suggest that short, evidence-based classes helped raise awareness, but were not sufficient for parents to fully adopt the guidelines. Programs that promote behavior modification should be explored to reinforce knowledge gained from educational classes.

This study investigated the effects of hospital Clown Doctors intervention on child and caregiver preoperative anxiety at the entrance to the surgery care unit and separation from caregivers. A total of 88 children (aged 4-12 years) were assigned to one of the following two groups: Clown Doctors intervention or control group (standard care). Independent observational records using the modified Yale Preoperative Anxiety Scale instrument assessed children's anxiety, while the State-Trait Anxiety Inventory measured caregiver's state anxiety. In addition, caregivers assessed the children's functional health problems by completing the Functional Status Questionnaire. Although no effects of Clown Doctors were found on children's anxiety, results showed that both low functional health problems and Clown Doctors intervention were significant predictors of lower caregiver anxiety. Caregivers also reported being very satisfied with their intervention. Overall, this study demonstrated the positive role of Clown Doctors for caregivers at a specific pediatric hospital setting.

Objective: In this study, it was aimed to determine knowledge, "attitudes" and "behaviors" in mothers with a child aged 0-5 years regarding factors causing "home accidents" and prevention. Method: The target population of the study consisted of mothers with a child aged 0-5 years who were admitted to pediatrics ward of A County Hospital. The sample size was determined as 305 subjects by power analysis. Overall, 340 mothers were recruited. The data sheet developed by researchers and a questionnaire on parental attitudes about home accidents developed by Yalaki et al. were used for data collection. Before data collection, verbal consent was obtained from mothers. The study was approved by local Ethics Committee. Data were analyzed by using Kruskal-Wallis test, t test and chi-square test. Results: Mean age was 30.11 ± 5.8 years among mothers included. A significant association was detected between experiencing home accident and maternal age, maternal education level, number of child, number of person in the family and income of family (p<0.05). In this study, it was found that wrong attitudes and behaviors were more common among mothers of children experienced home accident (p<0.05). Conclusions: It was found that there is a significant association between home accident and maternal age, maternal education level, number of child, number of person in the family, residence and income level. In addition, it was found that mother of "children" experience home accident have inappropriate attitudes and behaviors regarding prevention of home accidents and that education is an important factor in prevention of home accidents.

Venipuncture and other invasive procedures as blood draws, intramuscular injections or heel pricks are the most commonly performed painful procedures in children. These can be a terrifying and painful experience for children and their families. The present study aimed to identify Pain intensity after an ice pack application prior to venipuncture among school-age children. Fifty (50) school-age children aged from 6-12 years whom ordered to vein-puncture were included in the study, and they are chosen by simple random sample from the pediatric medical, surgical wards and pediatric emergency department in King Fahd Hospital of the University (KFUH) at the Al-Khobar city, Kingdom of Saudi Arabia. They divided equally into 2 groups, the study group who received an ice pack application for three minutes prior to venipuncture procedure over the insertion site while the control group received routine hospital care. A structured interview questionnaire sheet was used included age, gender, venipuncture procedure data and log table for recorded child's blood pressure, pulse rate and oxygen saturation as well as Wong-Baker (FACES) Self- report Pain Rating Scale, to assess pain intensity during the venipuncture among children in both groups. Results of the study revealed that, during venipuncture procedure, mean self-report pain score was lower among children in the study group than those in the control group with statistically significant difference, Mean ±SD (1.92±0.316 and 4.40±0.490) respectively P<0.001. Self-reported pain intensity was decreased in older school-age children than the younger ones and was higher among male's children than females. The study concluded that the application of an ice pack prior to vein puncture procedure was effective in reducing pain intensity among school age children and it recommended that application of an ice pack has to be a part of the routine care of all children admitted to venipuncture procedure, so educational course related the ice back storage, uses and its application time over the vein puncture site should be conducted.

Clinical training is of paramount importance in nursing education and clinical evaluation is one of the most challenging responsibilities of nursing faculty. The use of objective tools and criteria and involvement of the students in the evaluation process are some techniques to facilitate quality learning in the clinical setting. Aim: The aim of the present study was to assess the relationship of self and faculty evaluation of clinical competency of baccalaureate nursing students using SBAR tool. Methods: A cross-sectional comparative design was adopted. 53 undergraduate nursing students enrolled for pediatric nursing course during the study period were included in the study. Three pediatric nursing clinical faculty conducted evaluation of these students with SBAR tool followed by self-evaluation by students using the same tool. The data were analyzed using SPSS software descriptive (mean and standard deviation) and inferential (Independent sample t-test and Pearson correlation coefficients) statistics. Results: There was no significant difference between self and faculty evaluation on most of the domains of the tool and there was a significant correlation between self and faculty evaluation on all the four domains of SBAR. Conclusion: The results of the present study support the use of SBAR tool and self-evaluation along with faculty evaluation to facilitate clinical learning of undergraduate nursing students.

Objectives: To investigate the relation between the students' scores in MCQs and MEQs of the summative assessment in pediatrics at the College of medicine KKU. Introduction: Student assessment is the most difficult task in medicine since it is ultimately related to human life and safety. Assessment can take different types of formats with advantages and disadvantages and there is no single prescribed method of choice. Research Methods: This is a quantitative, observational retrospective study enrolling 50 students who completed the final MBBS examination in pediatrics in 2015. The medical students' scores in MCQs and MEQs in the final MBBS pediatrics examination were collected and SPSS used for analysis. Results: 52% of the students scored A and B, 46% scored C and 2% scored D and nobody scored F. The mean percentage scores in MCQs, MEQs and the combined are 75.03%, 79.99% and 76.68% respectively. The standard deviation (SD) for MCQs, MEQs and combined are 0.0753, 0.0763 and 0.0559 respectively. There are no significant differences in means and SD. The correlation (CR) between MCQs and MEQs is -1.73%. The CR between MCQs and MEQs for those who scored A and B is 7.38% which could indicate a weak but significant +ve CR (p value 0.017), (table 3). For those who scored C inverse CR (-74.38%) was observed between MCQs and MEQs. Discussion: The main finding of this study was the weakly negative CR between students' performance on MCQs and MEQs. Good performance in MCQs is not necessarily correlated with good performance in LEQs. This is not in agreement with Oyebola et al. and Moqattash et al findings, who reported positive CR in the performance of their students. The discrepancy observed in performance between MCQs and MEQs could be explained by the subjectivity and the difficulty in avoiding bias in setting and marking essay questions.

This study aimed to define the current functions and operations of hospital school programs nationwide. A 56-item survey was disseminated to hospital teachers across the country to examine perceptions about their work, programs, and professional practice. Quantitative findings were analyzed using descriptive statistics at the individual item-level. Qualitative responses were categorized for thematic review and analyzed using an inductive approach. The final sample included 88 completed surveys. Findings were classified into three broad categories: hospital school programming, hospital school teachers, and hospital school instruction. Results revealed that great variability exists across hospitals. Differences were evident in how programs were staffed, funded, and how services are allocated to patients during hospitalizations. Findings will contribute to the establishment of best practices for hospital school programs.

The study aimed to assess the nursing students' class engagement and academic performance using flipped class using a mixed-methods research and explored their feedback and perceptions about the flipped classroom (FCR) in comparison to the current teaching methodology. Participants were 22 females and 4 males, selected through convenience sampling method, and were evaluated at pre-cycle with case-based learning, post-cycle I with FCR, and post-cycle II, using FCR with an extra class time, in a cyclical nature of inquiry. Data collection involved a triangulation technique using checklists to observe and assess students' class engagement, quizzes for measuring class performance, and focus group interviews. The focus group interview reflections and feedback were used to refine and plan the next cycle.The quiz and the class engagement scores were highly significant at post-cycle II where the FCR was used with extra class time compared to post-cycle I and pre-cycle. The participants stated that they gained a deeper understanding of concepts, were motivated and more confident in learning the course material. The study findings support the use of FCR in learning pediatric course content. Further empirical evidence is required for adapting FCR to other courses in the curricula to determine its suitability to a particular teaching content.

Background: Medical research on children has increased in the last 20 years. International ethical regulations for conducting clinical research on children may not pertain to Muslim communities where religious beliefs play a big role in decision-making process. Methods: The aim of this paper was to illustrate the origins of bioethics principles in Islam, to appraise the existing regulations of Islamic countries, and to systematically review areas of improvements. Conclusion: This review recommends a customized approach for regulators to set culturally adapted ethical guidelines that highlight Islamic traditions in dealing with children of different ages.

Hypospadias is a common congenital anomaly with a prevalence estimated to be as high as 1 in 125 live male births. Complications after surgical procedures are possible. The incidence of complications can be reduced by meticulous preoperative planning, and judicious postoperative care. So the aim of the study was to investigate the effect of pre-designed instructions for mothers of children with hypospadias on reducing postoperative complications. A convenient sample consists of 60 mothers of children with hypospadias were included in the study. The sample was divided into 2 equal groups; the control group and the study group. Pre-post quasi experimental design was utilized to perform the aim of the study. The study was conducted in the pediatric surgical department and urology outpatient clinic at one Pediatric Hospital in Cairo. Three tools were carried out; first a questionnaire sheet (pre-post test) to assess mothers' knowledge about hypospadias, and includes also demographic data, second tool; observational checklist to evaluate mothers' practices regarding hypospadias, third tool, postoperative complications assessment sheet, which was examined occurrence of early postoperative complications. And pre-designed instructions were provided for those mothers preoperatively. The study results revealed that a highly significant difference was present between the control and the study group regarding mothers' knowledge in post-test. The majority of mothers in the control group and the study group had inadequate level of knowledge about hypospadias in pre-test. While more than two fifth of mothers in the study group had adequate level of knowledge in post-test. The results proved that the mothers' practices in post-test were increased more than in pre-test, less than half of the mothers in pre-test were not satisfied about performing diaper care correctly, however in post-test more than three quarters of those mothers were performed this procedure correctly, and there were highly statistical significant difference between pre and post-test. Regarding early postoperative complications; the results demonstrated that more than two thirds of children in pre-test, while less than two fifth in post-test suffering from postoperative complications as; infection, urinary tract obstruction and bleeding. The difference between pre and post-test was significant. The current study concluded that the pre-designed instructions for mothers of children with hypospadias were efficient by means of marked improvement of the knowledge and practices of the study group, which support the research hypotheses. So the results indicated that children with hypospadias were fewer early postoperative complications in the study group than the control group. The study recommended that important of pre-designed instructions for mothers of children with hypospadias for reducing postoperative complications. Also highlighting additional researches about assessment of mothers' knowledge and practice in relation to care provided to their children with hypospadias. In addition to a longer follow-up is necessary to monitor the late post operative complications.

Ventilator associated pneumonia (VAP) is a costly, preventable, and often fatal consequence of medical therapy that increases hospital and intensive care stays in mechanically ventilated patients. The prevention of VAP is primarily the responsibility of the bedside nurse whose knowledge, beliefs, and practices influence the health outcome of ICU patients. Unfortunately little is known about the degree of nursing knowledge on evidence based guidelines for the prevention of VAP. This descriptive study aimed to assess knowledge of pediatric critical care nurses regarding evidence based guidelines for prevention of VAP in both pediatric and neonatal intensive care units. The current study revealed inadequate knowledge of pediatric critical care nurses regarding evidence based guidelines for prevention of ventilator associated. There is strong correlation between years of experiences, previous training on guidelines of prevention of VAP and knowledge of nurses on the evidence based guidelines for prevention of VAP. Moreover, there is no correlation between age and knowledge of nurses on evidence based guidelines for prevention of VAP. The study concluded that written unit protocols should be present and reviewed regularly as updates and new evidence for best practice are constantly emerging and staff should be educated on the updated protocols.

Background: Educational surroundings is one of the most vital factors in figuring out the fulfillment of an powerful curriculum and gaining of knowledge. Aim: To compare students' perceptions of the academic learning environment in Pediatric and Maternity courses using DREEM Questionnaire. Design: This is a comparative study. Subjects: Five hundred and eleven of the third year nursing students studying maternity and pediatric courses by traditional policy participated in the study during the academic year 2014-2015. Setting: Pediatric and maternity nursing departments at Faculty of Nursing, Mansoura University, Egypt. Tool: An interviewing Questionnaire of two parts: First includes general characteristics such as: age, sex and courses involved. Part two: Includes the DREEM questionnaire. Results: The total mean score for pediatric and maternity nursing students' perception of their learning environment were 115.0±.23.02 and 110.3±17.4; respectively. Students' belief in their gaining knowledge of environment in both specialties were "more positive than negative" with a significant difference between both groups (t=2.6, p=0.01). All students agreed to a more positive approach regarding their learning "moving in the right direction" for their teachers, feeling "more on the positive side" for their academic self perception, feeling "more on the positive side" for their learning atmosphere "a more positive attitude" they also reported that their social self perceptions were" not too bad. The results showed that 10% of both pediatrics and maternity students have mean score = 2 consider (problem areas). More than one third of pediatrics and maternity students have mean score 2.1 - 3 (which needing improvement). About half of pediatrics and maternity students have mean score 3.1 - 3.5 (positive aspect) while none of our students scored >3.5 (excellent items). Conclusion: The perceptions of nursing students of their mastering learning environment were "more positive than negative" with a significant difference between pediatric and maternity students. Although the overall questionnaire score was showed to be "more positive than negative" there were five objects out of the 50 that determined mean scores of less than 2.00 that have to be tested greater carefully.

Due to medical advances, many students with acute chronic illnesses, like pediatric cancer, are able to attend school. The professional literature reflects the need for reform of educational strategies for children facing cancer treatment and who will be absent for extended periods of time. In order to promote successful educational services and the reintegration of students into school, it is vital for multidisciplinary teams and families to collaborate effectively. This article provides a plan to promote successful integration of students with cancer within regular classrooms.

Introduction: Worldwide, several studies have shown adolescent simulated patients being used for teaching of communications skills with adolescents. In Malaysia, there is scarce research demonstrating the educational benefits of simulated patients in adolescent medicine teaching over traditional teaching methods. Objective: To evaluate the role and effectiveness of adolescent aged simulated patient as a teaching tool, in the adolescent medicine module at National Defence University of Malaysia. Methodology: This is a cross-sectional study. Forty-four third year medical students participated. A total of 6 simulated patients (16 to 19 years old) were recruited to portray roles of adolescents with various psychosocial issues for two times during each posting for four postings. Each of the students, as a pair had two encounters, (as interviewer and observer). All students (in the interviewer roles) rated the abilities of the adolescent simulated patient playing a specific role on a validated questionnaire. The adolescent simulated patients and faculty teachers also gave feedback on similar validated questionnaires. Result: Forty-four students gave the adolescent simulated patients general performance a mean mark 3.4 out of 4 point scale (p=0.050). All medical students reported that the simulated patients helped them in: (a) communicating with adolescents (p=0.006), and (b) understanding the different psychosocial issues that adolescents may encounter (p=0.048). Feedback by teachers and adolescent simulated patient about the adolescent simulated patient program was very positive. Conclusion: The lessons learned have shown that structured case scenario portrayal by the simulated patients had significantly complemented students' learning in communicating with adolescents.