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A new paper in the journal Development discusses the research conducted by J. Guillermo Sanchez and Jim Wells on the role of the transcription factor RFX6 in intestinal patterning. The authors derived human intestinal organoids from an individual with duodenal defects and a variant in the RFX6 gene. Through their study, they identified novel roles for RFX6 in intestinal development. The authors also discuss their use of induced pluripotent stem cell-derived organoids for disease modeling and their efforts to generate functional tissues for transplantation. [Extracted from the article]

Those concerned with the wellbeing of youth have been studying factors which impact the mental health of young people for quite some time. In 1995, the Centers for Disease Control (CDC) and Kaiser Permanente Health Care Providers began studying the impact on this population where Adverse Childhood Experiences (ACEs) are concerned. A particular focus has recently been placed on the mental state of youth given the impact of COVID-19. The intersection of the events experienced by youth due to the pandemic and existing mental health challenges has resulted in an emergency situation in the United States. This crisis is recognized widely and has caused organizations such as the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children's Hospital Association to call for action. Educators play a pivotal role in shaping the lives of youth and impacting their mental health. Hence, their ability to employ trauma informed practices in schools has the potential to positively impact youth and their existing mental health challenges. Techniques portrayed in the documentary film, Paper Tigers, should be studied by all who are interested in gaining knowledge about working to end the youth mental health crisis in America. [ABSTRACT FROM AUTHOR]

Correct management and classification of anaphylaxis is mandatory. Records of emergency department (ED) visits to any of the three pediatric hospitals in Stockholm, because of reactions to foods during 2007, were identified. A retrospective analysis of clinical ED records of 371 children with 381 unique occasions of reactions to foods was performed. Symptoms/signs of reactions to foods recorded for classification of anaphylaxis were related to those presented in the EAACI Taskforce position paper on Anaphylaxis in Children (Allergy 2007; 62: 857). Forty-six different symptoms/signs of reactions to foods were retrieved. Several severe signs or symptoms from the respiratory tract and signs indicating reduced brain perfusion were not described in detail in the EAACI paper, hampering correct classification of anaphylaxis including grading of severity in our material. After modification of the EAACI classification including such signs and symptoms, we were able to classify 128 (35%) children with anaphylaxis. Seventy children (19%) did not fulfill our modified EAACI's criteria for anaphylaxis. They had been given adrenaline before or at arrival to hospital, possibly preventing anaphylaxis. Another 173 (47%) children/ adolescents had neither been given adrenalin, nor fulfilled the criteria for anaphylaxis. Classification of food-induced anaphylaxis and severity grading should be built on signs and symptoms to facilitate diagnosis. The existing EAACI tool is helpful, but for Swedish children it is not quite applicable, in particular because of the lack of description of some respiratory, neurological or possible cardiovascular signs and symptoms. [ABSTRACT FROM AUTHOR]

Simple Summary: Large datasets concerning childhood cancers are rare. Therefore, it is important to fully exploit all available data, which are distributed over several resources, including biomaterials, images, clinical trials, and registries. With privacy-preserving record linkage (PPRL), datasets can be merged, without disclosing the patients' identities. Although PPRL is already implemented or described in various settings, use case descriptions are fragmented and incomplete. The present paper gives an overview of current and future use cases of PPRL in childhood cancer. We screened the literature, projects, and trial protocols, analysed a hypothetical patient journey, and discussed use cases with experts. All the identified use cases were structured along six key dimensions. We conclude that PPRL is a key concept in childhood cancer. Therefore, PPRL strategies should already be considered when starting research projects, to avoid distributed data silos, to maximise the knowledge derived from collected data, and, ultimately, to improve outcomes for children with cancer. Large datasets in paediatric oncology are inherently rare. Therefore, it is paramount to fully exploit all available data, which are distributed over several resources, including biomaterials, images, clinical trials, and registries. With privacy-preserving record linkage (PPRL), personalised or pseudonymised datasets can be merged, without disclosing the patients' identities. Although PPRL is implemented in various settings, use case descriptions are currently fragmented and incomplete. The present paper provides a comprehensive overview of current and future use cases for PPRL in paediatric oncology. We analysed the literature, projects, and trial protocols, identified use cases along a hypothetical patient journey, and discussed use cases with paediatric oncology experts. To structure PPRL use cases, we defined six key dimensions: distributed personalised records, pseudonymisation, distributed pseudonymised records, record linkage, linked data, and data analysis. Selected use cases were described (a) per dimension and (b) on a multi-dimensional level. While focusing on paediatric oncology, most aspects are also applicable to other (particularly rare) diseases. We conclude that PPRL is a key concept in paediatric oncology. Therefore, PPRL strategies should already be considered when starting research projects, to avoid distributed data silos, to maximise the knowledge derived from collected data, and, ultimately, to improve outcomes for children with cancer. [ABSTRACT FROM AUTHOR]

Background: In this paper, we used search engine technology to study outcome analysis and cost awareness of child hydrocephalus in the literature. Methods: The aggregate hospital charges of hydrocephalus treatment procedures for patients <18 years old was extracted from the Nationwide Inpatient Sample (NIS) data. Hydrocephalus literature was probed through the PubMed biomedical search engine. Results: Aggregate hospital charges associated with ventriculo-peritoneal shunting as the principle procedure for patients <18 years old have increased 1.7-fold over a 13-year period to 235.6 million in 2009. Hospital discharges, however, decreased from 3,390 in 1997 to 2,525 in 2009 (25.5% decrease over 13 years). The number of papers in English language indexed by PubMed in relation to child hydrocephalus in humans increased from 81 papers in 1996 to 133 in 2010 (1.6-fold increase), totaling 1,694 over 15 years. Randomized controlled trials published in relation to child hydrocephalus totaled 16 over the same period (0.94% of child hydrocephalus papers). Papers related to child hydrocephalus with 'costs and cost analysis' as medical subject heading totaled 13 papers (0.77%). Conclusions: Over the past 15 years, disappointingly the number of printed child hydrocephalus papers appeared to have only plateaued. Strikingly, only a very small number of these papers were directed toward randomized control studies, the sine qua non of high-grade clinical evidence. Moreover, very few papers make reference to cost analysis or economics in the treatment of hydrocephalus - an issue coming increasingly before the nation at this point. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial stewardship programs (ASP) often function naturally as facilitators within clinical hospital settings, by working with individuals and teams to reduce unnecessary antibiotics. Within implementation science, facilitation has been studied and evaluated as an implementation strategy that can accelerate and improve fidelity to implementation efforts. This study describes a novel, virtual facilitation strategy developed and served as an intervention within the optimizing perioperative antibiotics for children trial (OPERATIC trial). This paper: (1) describes ASP team's preferences for and use of a facilitation workshop and (2) describes sustained use of facilitation skills throughout the study period. Methods: Study participants included antimicrobial stewardship team members from the nine children's hospitals that participated in this study and completed facilitation training. All individuals who completed facilitation training were asked to evaluate the training through an online survey. Additionally, site leads were interviewed by the site coordinator every other month and asked about their team's use of facilitation skills throughout the rest of the study period. Survey data were managed and coded in R, and qualitative interview data were analyzed using rapid methodology. Results: 30 individuals, including both physicians and pharmacists, completed the evaluation. Individuals largely rated themselves as novice facilitators (53%). Individuals reported satisfaction with virtual facilitation and identified different components of the workshops as valuable. An additional 108 interviews were performed throughout the study period. These interviews found that facilitators reported using all skills throughout the study period and described varied use of skills over time. All nine sites applied facilitation strategies, team building techniques, and communication/conflict skills at some point during the intervention phase. Conclusion: We describe the use of virtual facilitation as an acceptable and appropriate strategy to enhance facilitation skills for ASP teams working to reduce unnecessary postoperative antibiotics. Participants reported different useful components of facilitation training and described using differing facilitation skills throughout the trial. Overall, the use of facilitation skills continued throughout the duration of the study period. This paper outlines how facilitation training can be conducted virtually in a way that is feasible and acceptable to clinicians. Trial registration: NCT04366440, April 24, 2020. [ABSTRACT FROM AUTHOR]

Background: Advances in diagnostic and therapeutic interventions for rare diseases result in greater survival rates, with on the flipside an expanding group of children with medical complexity (CMC). When CMC leave the protective hospital environment to be cared for at home, their parents face many challenges as they take on a new role, that of caregiver rather than care-recipient. However, an overview of needs and experiences of parents of CMC during transition from hospital-to-home (H2H) is lacking, which hampers the creation of a tailored H2H care pathway. Here we address this unmet medical need by performing a literature review to systematically identify, assess and synthesize all existing qualitative evidence on H2H transition needs of CMC parents. Methods: An extensive search in Medline, PsychINFO and CINAHL (up to September 2022); selection was performed to include all qualitative studies describing parental needs and experiences during H2H transition of CMC. All papers were assessed by two independent investigators for methodological quality before data (study findings) were extracted and pooled. A meta-aggregation method categorized the study findings into categories and formulated overarching synthesized findings, which were assigned a level of confidence, following the ConQual approach. Results: The search yielded 1880 papers of which 25 met eligible criteria. A total of 402 study findings were extracted from the included studies and subsequently aggregated into 50 categories and 9 synthesized findings: (1) parental empowerment: shifting from care recipient to caregiver (2) coordination of care (3) communication and information (4) training skills (5) preparation for discharge (6) access to resources and support system (7) emotional experiences: fatigue, fear, isolation and guilt (8) parent-professional relationship (9) changing perspective: finding new routines and practices. The overall ConQual Score was low for 7 synthesized findings and very low for 2 synthesized findings. Conclusions: Despite the variability in CMC symptoms and underlying (rare disease) diagnoses, overarching themes in parental needs during H2H transition emerged. We will augment this new knowledge with an interview study in the Dutch setting to ultimately translate into an evidence-based tailored care pathway for implementation by our interdisciplinary team in the newly established 'Jeroen Pit Huis', an innovative care unit which aims for a safe and sustainable H2H transition for CMC and their families. [ABSTRACT FROM AUTHOR]

Purpose: Genetic counselors (GCs) increasingly play key roles in advancing genomic medicine through innovative research. Here, we examine one large cohort of GCs' evolving contributions to the literature, with the goal of facilitating worldwide professional development for GCs through scholarly activities. Methods: Publications were cataloged by members of the Section of Genetic Counseling (Section), established at the Children's Hospital of Philadelphia and the University of Pennsylvania in 2014, including publication year, journal, impact factor, and author position. Data were organized using the "My Bibliography" tool on the National Center for Biotechnology Information website and a Research Electronic Data Capture database created to initially collect manuscripts published through 30 June 2020. A subsequent survey captured publications through 5 February 2024. Results: An amount of 52 of 120 (43%) GCs shared their curriculum vitae/papers. 992 unique publications were identified from 1986 to 2024. Since 2013, no less than 32 papers were published annually by Section members and no less than 10 GCs contributed to publications yearly. Impact factors typically averaged >5.0 per year. Areas of foci diversified considerably since 2015. Conclusions: Here, we establish that GCs indeed contribute to scholarly work as evidenced by the number of publications alone. The establishment of an academic home may have contributed, given publications increased concurrent to launching the Section, providing a model for organizing GCs at institutions nationally and internationally. Highlighting such achievements will foster the expansion of GC roles in the era of precision genomic medicine and therapy. Considering ways to support GCs towards expanding these activities is equally important. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this paper is to conduct a bibliometric analysis to examine the research status and development trend of anterior cruciate ligament injury and reconstruction in children and adolescents over the past 20 years. Design: Descriptive Research. Methods: This study obtained information regarding studies on Anterior Cruciate Ligament Reconstruction in Children and Adolescents from the Web of Science Core Collection database. Visual and bibliometric analysis were conducted using VOSviewer, Origin 2022, Pajek64 5.18and Excel 2019. These analytic tools facilitated the analysis of various aspects, including countries/regions, institutions, authors, journals and keywords related to the research. Results: From 2003 to 2023, a total of 1328 articles were retrieved in WOS, and 637 articles were selected by two authors. The most productive institutions are Childrens Hosp Philadelphia, Kocher, ms. Their articles have the highest number of publications and citations. The American journal of sports medicine is the most frequently cited journal for articles on anterior cruciate ligament reconstruction in children and adolescents. The most common keywords used in these articles were "anterior cruciate ligament reconstruction", "injury, children, adolescent", and "skeletally immature patients". Conclusions: This study provides valuable insights into the research focus of anterior cruciate ligament reconstruction in children and adolescents. In recent years, there has been significant attention paid to areas of "the return to sport, re-repture rate and functional recovery after anterior cruciate ligament reconstruction" in this specific population. These aspects have emerged as key directions for future research in this field. [ABSTRACT FROM AUTHOR]

Background: Involvement in research activities is complex in pediatric nursing and allied health professionals (AHPs). It is important to understand which individual factors are associated with it to inform policy makers in promoting research. Methods: A cross-sectional observational study was conducted to describe the level of participation in research activities over the last ten years of nurses and AHPs working in a tertiary pediatric hospital. A large sample of nurses and AHPs working in an Italian academic tertiary pediatric hospital completed an online self-report questionnaire between June and December 2018. Three multivariate logistic regression analyses were performed to predict participation in research projects, speaking at conferences, and writing scientific articles. Results: Overall, data from 921 health professionals were analyzed (response rate = 66%), of which about 21% (n = 196) reported participating in a research project, while 33% (n = 297) had attended a scientific conference as a speaker, and 11% (n = 94) had written at least one scientific paper. Having a Master or a Regional Advanced Course, working as an AHP or a ward manager, as well as regularly reading scientific journals and participation in an internal hospital research group or attendance in a specific course about research in the hospital, significantly predicted participation in research projects, speaking at conferences and writing scientific papers. It is important to foster research interest and competencies among health professionals to improve participation in research projects, speaking at conferences, and writing scientific papers. Conclusions: Overall, we found a good level of attendance at conferences as speakers (33%), a moderate level of participation in research (21%), and low levels for writing scientific papers (11%). Our study highlighted the need to support participation in research activities among nurses and AHPs. Policymakers should identify strategies to promote research among nurses and AHPs, such as protected rewarded time for research, specific education, strengthened collaboration with academics, and financial support. Moreover, hospital managers should promote the development of research culture among health professionals, to improve their research competencies and evidence-based practice. [ABSTRACT FROM AUTHOR]

ABSTRACT: Introduction: The classical definition of patient safety given by the IOM is, "the prevention of harm to patients." To expect error less performance from human beings working in a complex, highly challenging, and stressful health care environment is unrealistic. The emphasis must be on fostering a culture of safety that involves multiple stakeholders including healthcare workers, healthcare organizations, and patients. Aim: To assess the culture of patient safety among healthcare professionals. Settings and Design: A descriptive cross-sectional study was conducted using a pre-validated survey instrument in a tertiary care pediatric hospital. Methods and Material: The data were collected over a period of 1 month (from 4th January 2022 to 5th February 2022) using pre-validated questionnaire based on "Surveys on Patient Safety Culture™ (SOPS™) Hospital Survey Version 2.0 (SOPS Hospital Survey 2.0)". Both web-based and paper-based questionnaire forms were distributed among the health care workers. Results: Totally, 61% of the respondents had average positive response to patient safety, 75% positive response about communication of patient safety error and 74% about teamwork in crisis. A total of 74% responded that supervisors or clinical leaders support them in pursuit of patient safety, 73% about proper handovers. About 69% mentioned about a culture of organizational learning and continuous improvement, 59% reported any patient safety event, 49% believed in support from Hospital management and 42% believed that if a patient safety error is reported it is responded to positively by the seniors by taking corrective measures. Conclusions: The study presented with a plethora of outcomes that can be used for promoting safe healthcare. A policy for continuous improvement should be implemented to ensure the culture of safe and sustainable patient care. [ABSTRACT FROM AUTHOR]

Urinary tract dilations (UTDs) are the most frequent prenatal renal anomaly. The spectrum of etiologies causing UTD ranges from mild spontaneously resolving obstruction to severe upper and lower urinary tract obstruction or reflux. The early recognition and management of these anomalies allows for improved renal endowment prenatally and ultimately better outcome for the child. The role of the general obstetrician and pediatrician is to recognize potential prenatal and postnatal cases addressed to their practice and to refer patients to specialized pediatric nephrology and urology centers with a sense of the urgency of such a referral. The aim of this paper is to offer clinical recommendations to clinicians regarding the management of neonates and children born with prenatally detected UTD, based on a consensus between Swiss pediatric nephrology centers. The aim is to give suggestions and recommendations based on the currently available literature regarding classifications and definitions of prenatal and postnatal UTD, etiologies, prenatal and postnatal renal function evaluation, investigations, antibiotic prophylaxis, and the need for referral to a pediatric nephrologist and/or urologist. The overarching goal of a systematic approach to UTD is to ultimately optimize kidney health during childhood and improve long-term renal function prognosis. [ABSTRACT FROM AUTHOR]

Aim: The aim is to examine whether using a portable spring‐infusor device to deliver antibiotics compared with a standard infusion pump (SIP) translated to (i) improve health outcomes, (ii) reduce the length of stay (LoS), and (iii) reduce cost for treatment of exacerbations of cystic fibrosis (CF). Methods: An observational cohort study was conducted between December 2020 and June 2022 with participants aged 8–19 years admitted for exacerbation of CF. An activity monitor was fitted to participants to measure physical activities for the final 5 days of hospital admission. LoS was measured (days). Group allocation was according to participant preference. Costs were compared between the two groups for LoS, pump cost, and preparation and administration of antibiotics. Results:Twenty‐seven of 30 eligible participants were approached, and 22 consented. Data were captured for 16 participants (spring‐infusor n = 9): 10 female; mean (SD) age 14.5 (2.1) years. Average step count was negatively associated with age (rho = 0.50), and greater overall in participants using spring‐infusors (mean 5324 (SD 2873) steps) versus SIPs (4806 (3116) steps) ‐ mean (95% CI) increase in the spring‐infusor group of 3246 (54‐6438) for participants of the same age. LoS was longer on average in the SIP group, (mean (SD) LoS: 16.1 (4.3) versus 12.4 (1.7)). The estimated cost saving for a child using a spring‐infusor was AUS$12,000. Conclusion:Results from the study suggest that children hospitalised for exacerbations of CF are more active if they receive antibiotics via a spring‐infusor device compared with a SIP, and have reduced hospital stay that results in cost saving to the hospital. What is already known? Spring‐infusors are small, portable, and mechanical devices to deliver intravenous antibiotics to patients. Spring‐infusors are preferred by patients with CF at Perth Children's Hospital Physical activity in children with CF is recommended, including during hospital admissions to promote wellbeing, quality of life, and health outcomes. What this paper adds? Children hospitalised for exacerbations of CF may be more active if they receive antibiotics via a portable spring‐infusor device compared with a SIP. Children using spring‐infusors had reduced hospital stays that results in cost saving to the hospital. Children hospitalised for exacerbations of CF step on average, fewer than 5000 steps per day, which is well below recommendations. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to examine the experiences of diverse interprofessional participants in an Equity, Diversity and Inclusion (EDI) working group with a common interest in EDI in one of the largest pediatric teaching hospitals in Canada and how the impacts of this experience extend outside of the group. Design/methodology/approach: This qualitative research utilized an inductive approach in line with the Gioia methodology (Gioia et al., 2013) to explore individual experiences as participants in an EDI working group. Seven group members were interviewed in-depth and engaged in storytelling and journaling to capture their experiences and perspectives. The perspectives of six members are reflected here, representing diversity across ethnicity, professions and subjective experiences, with a common interest in working together to improve EDI knowledge dissemination, training and practice in a healthcare setting in Canada. Findings: Retrospective research activities facilitated a co-constructed account. The analysis reveals that EDI group participation is a positive learning experience for individuals described as thriving in their careers. Analysis of collaborative perspectives emphasizes how collective identity cultivates vitality in the EDI group environment. EDI group members exhibit agency as proponents of social change, navigating and negotiating institutional norms in varying professional spaces. Research limitations/implications: The participants included members of an EDI working group in healthcare. Six perspectives are reflected here. Implications for personal experience and career development in organizations are discussed. Originality/value: This study contributes to understanding how participating in specific interest groups, such as a group focused on EDI, informs personal and career development. It also contributes to our understanding of intrinsic motivation, as evidenced among volunteers in this healthcare setting. Our study also depicts an environment of vitality and learning and that collective thriving can be produced and may have extra-role implications. [ABSTRACT FROM AUTHOR]

Benjamin Wilander, a postdoc at Vanderbilt University Medical Center, published a paper in the Journal of Cell Science on the role of DRAK2 in regulating myosin light chain phosphorylation in T cells. His research shows that DRAK2 plays a crucial role in T cell migration and protein movement on their surface. Wilander credits his mentor, Alex Mandarano, for guiding him in his scientific development. He plans to continue his research in academia, focusing on how immune cells respond to temperature and inflammation. [Extracted from the article]

Background Institutional antibiograms play a key role in antimicrobial stewardship and may provide a venue for clinical decision support. Our institution recently transitioned our paper antibiogram to an enhanced digital antibiogram with antibiotic recommendations for common pediatric infections. The objectives of this study were (1) to improve the accessibility of our institutional antibiogram through a digital platform and (2) to improve trainee confidence when selecting empiric antibiotics by integrating clinical decision support. Methods The digital antibiogram was developed and evaluated at a tertiary children's hospital. The tool was developed iteratively over one year by our innovation and digital health accelerator with recommendations for empiric antibiotic selection provided by experts in pediatric infectious diseases (see Figure 1 for example). Usability pilot testing was performed with a group of ordering providers and the tool was released internally in October 2018. A paired pre- and post- implementation survey evaluated residents' perceptions of the accessibility of the paper vs. digital antibiogram and their confidence when selecting empiric antibiotics. Data were analyzed by Fisher exact test. Results During the 3 months after release, the digital antibiogram was accessed 1014 times with similar proportions of views for susceptibility data, dosing, and empiric antibiotic recommendations. Of the 31 pediatric residents who responded to both pre- and post- implementation surveys, only 59% had access to a copy of the paper antibiogram. Following release of the digital antibiogram, residents referred to antibiotic susceptibilities more frequently (P < 0.05, Figure 2) and were more frequently more confident when selecting the correct antibiotic dose (P < 0.01, Figure 3). See Figure 4 for dosing recommendation example. Conclusion Providing antibiotic susceptibility and dosing recommendations digitally improved accessibility and resident confidence during antibiotic prescribing. Our digital tool provides a successful platform for displaying the antibiotic data and recommendations that enable appropriate antibiotic use. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Currently, the management of public real estate stocks is one of the most challenging activities. In this case, facility management emerges as a strategic but complex discipline that requires a great amount of integrated and structured data and information of heterogeneous origin and nature. Starting from this premise, this paper focuses on how FM discipline can be supported by Building Information Modeling (BIM) and Geographic Information System (GIS) integrated methodologies and tools achieving high levels of effectiveness and efficiency in public building stock management. This led to the definition and development of a framework that mainly takes advantage of open-source tools (e.g., Quantum Geographic Information System—QGIS, and Dynamo) and non-proprietary data exchange formats like the COBie (Construction Operations Building Information Exchange) international standard. This methodological framework is capable of integrating different but strongly complementary tools, data, information, and expert knowledge for a multiscale approach. The methodology presented in this paper does not provide for an integral transfer of BIM data to the GIS platform but leads instead to an effective bidirectional integration between the two informative systems, by properly relating them and allowing for an easy switch from one system database to the other. The findings of experimental applications of the methodological approach to the former Macciotta pediatric hospital, a healthcare building owned by the University of Cagliari, are presented and discussed. Finally, the analysis about potentials and criticalities of the developed methodological framework aims to trigger the widest future development and dissemination of this research. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to characterize distal clavicle fractures in a cohort of pediatric and adolescent athletes who underwent operative treatment at a single, tertiary-care pediatric center, including surgical techniques used and resultant clinical outcomes. Methods: A retrospective review was performed of all clavicle fractures extending to the level of the corococlavicular ligaments or more lateral, which were treated operatively at a single tertiary-care pediatric hospital between the years of 2005-2020. Patients >19 years-old or those with pathological fractures were excluded. Radiographic fracture characteristics, surgical techniques, time to radiographic healing, return to sports, and complications were analyzed. Results: Fifty-two patients were identified, with mean age 13.8 ± 2.2 years. The majority of fractures were classified as Nenopoulus type IIB (transverse, displaced; 42.3%) or type IIIB (oblique, displaced; 26.9%), though type IIA (transverse, minor displacement; 3.8%), IV (comminuted; 11.6%), and V (AC dislocation; 15.4%) patterns were also observed. Primary direction of displacement was posterior in 90% of cases and superior in 10%. Plate fixation was performed in 53.8% of surgeries, with locking plate (26.9%) and hook plate (17.3%) most frequent. Suture-based fixation was performed in 32.7% of cases (Figure 1). Rate of implant removal was 66% after plate fixation, the majority of which (72.2%) were planned at the time of primary fixation. Total complication rate, including unplanned removal of implant, was higher in the plate fixation group (25%) than in the suture-based fixation group (11.2%). Time to radiographic healing was not significantly different between plate and suture-based constructs (2.9 vs. 2.9 months, p = 0.96) though patients with suture-based constructs returned to sport faster (2.5 vs. 3.6 months, p = 0.014). Conclusions: Posteriorly displaced fractures comprised the vast majority of surgically-treated distal clavicle fractures in pediatric and adolescent athletes. When chosen in the appropriate patient, based on age and fracture pattern, suture-only constructs can lead to similar time to radiographic healing and faster return to sports compared to plate-based constructs, with significantly reduced need for removal of hardware. These data provide a foundation for future comparative research to further elucidate precise surgical indications and optimal treatment approaches in this population. Table 1. Fixation Methods for Distal Clavicle Fractures [ABSTRACT FROM AUTHOR]

(1) Introduction: Since electric scooters were launched in 2017, they have become increasingly popular worldwide and a cause of childhood trauma. (2) Case reports: This paper has a double-fold purpose: it reports two cases of epidural hematomas and compares them with electric scooter-related head trauma in the literature. An overview of the literature on this topic was performed to make such a comparison. Our cases are one of almost 52 cm3 and one of 129 cm3, both in two eight-year-olds. (3) Discussion: Although usually mild, traumatic brain injuries following e-scooter falls can also be moderate and severe. Reduced helmet use, high speed, and a lack of experience are the perfect set-up for potential severe injuries. Intracranial bleeds are not frequent, and epidural hematomas are rare in such cases, but they can significantly impact the individual, community, and healthcare system. No other medium- or large-sized epidural hematomas were reported in children sustaining electric scooter-related head trauma. (4) Conclusions: Our review parallels the literature and our hospital's experience. Although there are both similarities and discrepancies between our cases and the literature, mild trauma should not be disregarded, for it may hide serious complications requiring immediate surgery. [ABSTRACT FROM AUTHOR]

Background: Children with medical complexity (CMC) have high healthcare utilization and face unique challenges during hospital admissions. The evidence describing their experiences of inpatient care is distributed across disciplines. The aim of this scoping review was to map the evidence related to the inpatient experience of care for CMC and their families, particularly related to key aspects and methodological approaches, and identify gaps that warrant further study. Methods: This scoping review was conducted in accordance with JBI methodology and included all studies that reported experiences of acute hospital care for CMC/families. All study designs were included. Databases searched included EMBASE, CINAHL Plus with Full Text, Web of Science, MEDLINE(R) and APA PsycInfo from 2000 to 2022. Details about the participants, concepts, study methods and key findings were abstracted using a data abstraction tool. A thematic analysis was conducted. Results: Forty‐nine papers were included: 27 qualitative studies, 10 quantitative studies, six mixed methods studies, two descriptive studies and four reviews. Some quantitative studies used validated instruments to measure experience of care, but many used non‐validated surveys. There were a few interventional studies with a small sample size. Results of thematic analysis described the importance of negotiating care roles, shared decision‐making, common goal setting, relationship‐building, communication, sharing expertise and the hospital setting itself. Conclusion: CMC and families value relational elements of care and partnering through sharing expertise, decision‐making and collaborative goal‐setting when admitted to hospital. Patient or Public Contribution: This review was conducted in alignment with the principles of patient and family engagement. The review was conceptualized, co‐designed and conducted with the full engagement of the project's parent–partner. This team member was involved in all stages from constructing the review question, to developing the protocol, screening articles and drafting this manuscript. Practitioner Points: Qualitative research describes key elements of inpatient experience of care for CMC and their families as relationships, communication, respect for parent/provider expertise and the hospital setting. There is less evidence on measuring experience of care using quantitative methodology, particularly using validating instruments. This would be helpful to support the evaluation of inpatient interventions to improve the experiences of CMC. [ABSTRACT FROM AUTHOR]

Background: Adolescents with chronic medical conditions (CMC) use alcohol and marijuana at levels equal to or even greater than their peers without CMC and are more likely to initiate substance use at 14 years or younger. Approximately 33% of adolescents with CMC binge drink alcohol and 20% use marijuana. When using substances, adolescents with CMC are at elevated risk for problem use and adverse consequences given their medical conditions. Although there has recently been progress integrating substance use services into adult hospitals, there has been almost no implementation of standardized substance use services into pediatric hospitals for adolescents with CMC. Screening, Brief Intervention, and Referral to Treatment (SBIRT) for adolescents is an evidence-based, public health approach to promote the early detection and intervention of risky alcohol use in high-risk youth. This paper describes a study protocol combining two leading implementation science frameworks, the Consolidated Framework for Implementation Research (CFIR) and the Health Equity Implementation framework (HEIF), to engage pediatric hospital partners (hospital staff and clinicians, patients with CMC, and caregivers) to identify and specify contextual determinants of SBIRT implementation, which can be used to derive implementation strategies to optimize SBIRT adoption, reach, and fidelity. Method: This study will use semi-structured interviews and focus groups with pediatric hospital partners (e.g., hospital staff and clinicians, adolescent patients, and caregivers) to identify SBIRT implementation determinants, using semi-structured interview and focus group guides that integrate CFIR and HEIF dimensions. Discussion: Understanding implementation determinants is one of the first steps in the implementation science process. The use of two determinant frameworks highlighting a comprehensive set of determinants including health equity and justice will enable identification of barriers and facilitators that will then map on to strategies that address these factors. This study will serve as an essential precursor to further work evaluating the feasibility of and the degree of engagement with SBIRT among this vulnerable pediatric population. [ABSTRACT FROM AUTHOR]