High Parental Satisfaction Research Articles

Quality of Recovery in Pediatrics After Tonsillectomy Under Total Intravenous Anesthesia Versus Sevoflurane Anesthesia

Introduction: Inhalational anesthetics are often the first choice in pediatric anesthesia. However, the most recent literature demonstrates possible advantages of total intravenous anesthesia (TIVA). The goal of this study was to compare the postoperative quality in children submitted to tonsillectomy under TIVA versus sevoflurane anesthesia. Materials and Methods: Prospective observational case-control study (Sevoflurane vs TIVA) including children submitted to (adeno) tonsillectomy to compare the quality of anesthesia considering intra and postoperative parameters. Data was collected from clinical records, anesthetic monitoring and interviews. Results: From the 52 children included, 25% received TIVA. TIVA group had a shorter time for liquid diet reintroduction (42 minutes vs. 95 minutes) (p<0.05) and the Sevoflurane group had a lower mean blood pressure variation (p=0.027). Mean wake up time was similar for both groups (11.3±6.2 minutes for TIVA and 11.6±5.3 minutes for Sevoflurane). In PACU, TIVA group demonstrated, although not statistically significant, a shorter time of stay (40 minutes vs. 41 minutes), less emergence delirium (7.7% vs. 12.5%) and less nausea and vomiting (0% vs. 5.1%). At 24 hours, TIVA group presented, although not statistically significant, less nausea and vomiting (7.7% vs 13.5%), lower pain (69.2% with <5 on the numerical pain scale vs 56.8%) and higher parental satisfaction (10 vs 8). Conclusion: This study suggests that TIVA for tonsillectomy may be associated with better recovery quality. However, given the limited sample size of this study, it should be repeated in a larger sample, or in a multicentric study, for more robust conclusions.

Implementation of a Nurse-led Paediatric Epistaxis Clinic at a tertiary hospital

IntroductionReferrals for recurrent epistaxis constitute a significant proportion of paediatric ENT consultations. In order to improve access to secondary care, a nurse-led paediatric epistaxis clinic (NPEC) was developed in collaboration with ENT specialist nurses. The purpose of this study was to describe the structure of NPEC at our institution and to assess the impact including safety, parental satisfaction and referral-to-clinic times. MethodsENT specialist nurses were trained by an ENT Consultant through teaching sessions and clinic observations. Standard operating procedure was developed, and competencies were granted before commencement of NPEC. Service evaluation was done to assess the impact of NPEC including safety, parental satisfaction and referral-to-clinic times. All patients who attended NPEC from March 2022-February 2023 were included. Parental satisfaction questionnaires completed at the end of the clinic visit were prospectively collected for first 25 consecutive patients. Patient chart review was performed to assess for complications, need for consultant reviews and waiting times. ResultsForty-seven patients attended NPEC during the study period (77 clinic visits). Median age was 10 years (range 3-16 years). Management included antibiotic ointment (25/77), silver nitrate cautery (28/77) and 3 were listed for nasal cautery under general anaesthesia. Among cases which underwent silver nitrate cautery, there was one minor complication reported. Consultant review was required in 18 clinic visits (23.3 %), including 5 patients requiring fiberoptic nasal endoscopy. Over the study period, median referral-to-clinic time for new patients was 77 days, compared to 229 days for consultant clinic (p= 0.003, Wilcoxon rank sum test). Overall quality of care in NPEC was described as "very satisfactory" and “fairly satisfactory” by 92% and 8% parents respectively. ConclusionNurse led paediatric epistaxis clinics are safe and is associated with high parental satisfaction. Critical to success of NPEC is appropriate patient selection, training and availability of clinician support. These clinics offer a sustainable option to improve access to secondary care for paediatric epistaxis patients.

Intranasal Dexmedetomidine-Esketamine Combination Premedication versus Monotherapy for Reducing Emergence Delirium and Postoperative Behavioral Changes in Pediatric Tonsillectomy and/or Adenoidectomy: A Randomized Controlled Trial.

Emergence delirium and postoperative negative behavioral changes (PNBC) are common complications in pediatric anesthesia. This study evaluated whether intranasal premedication combining dexmedetomidine and esketamine more effectively reduces these complications compared to either drug alone in children undergoing tonsillectomy and/or adenoidectomy with sevoflurane anesthesia. This randomized, double-blind trial involved 198 children aged 2-5 years undergoing tonsillectomy and/or adenoidectomy. Participants received intranasal premedication with either dexmedetomidine (2μg/kg), esketamine (1 mg/kg), or their combination (dexmedetomidine 1μg/kg plus esketamine 0.5 mg/kg). The primary outcome was the incidence of emergence delirium, defined as a Pediatric Anesthesia Emergence Delirium (PAED) scale score ≥ 10. Secondary outcomes included the incidence of PNBC, sedation depth, easiness of separation from parents, acceptance of the mask for induction, emergence time, postoperative pain score, parental satisfaction, and adverse events. The combination premedication significantly reduced emergence delirium incidence (9.4%) compared to esketamine alone (38.1%; relative risk [RR] 0.25, 95% confidence interval [CI] 0.11-0.57, p < 0.001), but not compared to dexmedetomidine alone (17.2%; RR 0.55, 95% CI 0.21-1.39, p = 0.193). PNBC incidence at day 7 was lower with the combination (28.1%) versus dexmedetomidine (48.4%; RR 0.58, 95% CI 0.36-0.93, p = 0.018), but not significantly different from esketamine alone (20.6%; RR 1.38, 95% CI 0.74-2.58, p = 0.326). The combination also provided significantly superior sedation, improved ease of separation from parents, better acceptance of the mask for induction, shorter emergence time, and higher parental satisfaction than both monotherapies. In children undergoing tonsillectomy and/or adenoidectomy with sevoflurane anesthesia, intranasal dexmedetomidine-esketamine premedication more effectively reduces emergence delirium compared to esketamine alone and PNBC compared to dexmedetomidine alone. This combination also improves sedation, shortens emergence times, and enhances parental satisfaction compared to monotherapy without significant adverse effects. The Chinese Clinical Trial Registry, ChiCTR2300076709.

Assessment of transitional care in pediatric neurosurgery: a single-center analysis and survey of patients and parents.

Transitional care in pediatric neurosurgery is challenging for patients and their parents. The specific needs of neurologically affected patients and the unique characteristics of the pathologies affecting pediatric neurosurgical patients compared with adults make a comprehensive, well-organized transition process essential for patient well-being and ensuring continuity of care. Little is known about patients' preferences and opinions on this topic. This study aimed to assess the patients' and parents' expectations and perceptions of the transition process. The authors retrospectively identified patients aged 16 to 30 years who underwent surgery in their pediatric neurosurgical department. The patients were divided into two groups: those about to transition and those who had already transitioned. Transition models were identified within the latter group. Parents of eligible patients were contacted for a telephone survey, and the patients themselves were included when possible. A modified version of the established Got Transition questionnaire from the National Alliance to Advance Adolescent Health was used. Thirty-four patients were included, and 44 telephone surveys were conducted with the patients and their parents. Three transition models were applied, with 7 patients (41.2%) transitioned using the continued caregiver model, 9 patients (52.9%) using the shared caregiver model, and 1 patient (5.9%) using the specialized clinic model. Patient and parent satisfaction was highest among the patients transitioned using the continued caregiver and specialized clinic models. Neurosurgical conditions in children differ significantly from those in adults, creating unique transitional care challenges. The continuing caregiver model has been shown to provide continuity of care and high patient and parent satisfaction. However, there are differences in the perspectives of parents and patients regarding transitional care, with parents typically expressing greater concern and need for detailed information. Implementing a well-structured and individualized transition process is essential to reduce the caregiving burden on families and healthcare institutions.

Exploring parental thoughts and clinical experiences on blended food in a paediatric population, a qualitative study.

There's a growing interest in blended food (BF) as an alternative to commercial food (CF) for tube-fed children. Thus, we investigated parental and medical experiences with BF as an option for tube feeding in children. In this cross-sectional study, all patients were already using BF, chosen by parents. In March 2022, all patients using BF provided consent and completed a questionnaire assessing their experiences. Medical data were collected retrospectively from patient charts, including biometric changes, dietary adjustments, and nutritional status. A non-validated parent satisfaction score was computed from 17 questions, rated on a scale from one to five. A score of ≥ 51 points, indicating an average score of > 3 per question, was deemed indicative of a positive parental experience with BF. Nine children receiving BF were identified (median age: 4.7 years; weight: 14.9 kg; 66% male). All parents were satisfied with BF, reflected in the parent satisfaction score. Parents cited reduced feeding-related discomforts as the main reason for switching to BF. Weight (+0.3 SD) and length (+0.5 SD) showed positive changes. None discontinued BF, though modifications were made for five patients by the dietician. Nutritional deficiencies, mainly iron with or without zinc deficiency, were observed in four patients, with uncertain onset due to lack of pre-BF laboratory testing. In this small BF cohort overseen by an experienced multidisciplinary team, BF was well tolerated, resulting in high parental satisfaction and maintaining good nutritional status.

A Service‐Led Pragmatic Evaluation of Family Foundations Targeting the Reduction of Perinatal Parent Mental Health Difficulties and Family Conflict in Australia

ABSTRACTA service‐led evaluation of home‐based Family Foundations (FF), a perinatal intervention targeting interparental conflict and mental health difficulties, was conducted in Melbourne, Australia. The aims were to assess (a) pre–post intervention changes, (b) parent satisfaction and (c) intervention fidelity. Participants included 288 families who completed self‐report surveys, and FF clinicians who completed fidelity checklists. Approximately 78% of families who commenced FF completed all 10 sessions. High parent satisfaction and intervention fidelity were reported. For Parent 1s (primarily mothers), there were reductions in symptoms of depression, anxiety and stress, interparental conflict and parenting hostility and increases in co‐parenting support, parenting warmth and parenting self‐efficacy—all associated with small effect sizes. For Parent 2s (primarily fathers), there were reductions in interparental conflict and parenting hostility and an increase in parenting self‐efficacy—also associated with small effect sizes. These findings provide a platform for comprehensive and robust long‐term evaluations of home‐based FF in the future.

Parental Satisfaction with Health Care During Child Hospitalization at Tertiary Care Hospital Karachi

Pediatric care in hospital settings necessitates a comprehensive approach that considers not only the medical needs of the child but also the satisfaction and involvement of their parents or guardians. Parental satisfaction with healthcare services during their child's hospitalization is crucial for shaping their overall experience and ensuring quality care. Objective: To assess the level of satisfaction among parents of pediatric patients receiving care at a tertiary care hospital in Karachi, Pakistan. Methods: A cross-sectional study was conducted at the National Institute of Child Health Hospital in Karachi from October to December 2023. A total of 50 parents or blood-related guardians actively caring for pediatric patients were included in the study. Data were collected using a structured questionnaire comprising socio-demographic information and a 20-item Likert scale to measure parental satisfaction. Statistical analysis was performed using SPSS version 26.0. Results: The statistical results indicate that 26% had low satisfaction 28% moderate and 46% had high parental satisfaction with health care during child hospitalization at a tertiary care hospital in Karachi. Conclusions: The stats show mixed feelings among parents about the healthcare during their child's hospital stay in a Karachi tertiary care hospital. While 46% were happy with the services, indicating a good experience, 26% weren't satisfied. Another 28% felt okay. This means improvements are needed to address the concerns of the dissatisfied group and enhance overall satisfaction levels.

Is Intravenous Access Necessary in Pediatric Patients Undergoing Ophthalmologic Examinations Under Anesthesia? A Prospective Observational Study.

Ophthalmologic examinations under anesthesia (EUA) were employed in pediatric patients due to lower cooperation levels and associated discomfort during comprehensive eye examinations. There remains uncertainty regarding the necessity of intravenous (IV) placement during general anesthesia. The primary aim of the study is to investigate the impact of general anesthesia, with and without IV access, on operation time in pediatric patients undergoing EUA. Secondary objectives include assessing cardiovascular and respiratory complications and measuring parental satisfaction in both the IV and No IV groups. This prospective observational analytic study, conducted as a cross-sectional study, took place between October 2019 and October 2020, in Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Thailand. We included healthy pediatric patients aged 2 to 7 years undergoing elective ambulatory EUA. Eighty-two patients, with 41 in the IV group and 41 in the No IV group, were enrolled and included for analysis. The No IV group showed a significantly shorter median operation time (7.99 (6.63, 9.36) minutes) compared to the IV group (10.9 (9.05, 12.28) minutes), with a median difference of -2.74minutes (95% CI -3.76, -1.69, p < 0.001). In both groups, no cardiovascular or respiratory complications occurred, and there was no need for emergency IV access or drug administration. Children without IV access had higher parental satisfaction in extreme satisfaction (100% vs 48.78%; p < 0.001). Providing general anesthesia for EUA without IV access in healthy pediatric patients, leading to shorter operation times and heightened parental satisfaction, can be conducted safely. The trial registration number is TCTR20191021001 from the Thai Clinical Trials Registry.

Posterior quadratus lumborum versus caudal epidural block for perioperative analgesia in pediatric patients undergoing upper abdominal surgeries: Arandomized, double-blind trial

ABSTRACT Background Ultrasound-guided Quadratus Lumborum block (QLB) has become an established modality for perioperative analgesia in lower abdominal surgeries. However, its efficacy in upper abdominal surgeries is still understudied. Objectives The study aimed to determine QLB2 efficacy as a perioperative analgesic modality in upper abdominal surgeries, compared to caudal epidural block (CEB), regarding FLACC score, the time to the first rescue analgesia, the amount of fentanyl consumed intraoperatively, amount of rescue analgesia administered, parents’ satisfaction, as well as the incidence of complications. Study design A randomized, prospective, double-blind, and single-center study. Setting Ain Shams University Hospitals Methods/patients/interventions/measurements Fifty-two pediatric patients scheduled for upper abdominal surgeries under general anesthesia were assigned randomly to undergo CEB or ultrasound guided QLB 2. As assessed by FLACC, postoperative pain scores were the primary outcome. The secondary outcomes included the amount of fentanyl consumed intraoperatively, the time to first rescue analgesia, the amount of rescue analgesia given, parents’ satisfaction, and the incidence of complications. Results The QLB cohort demonstrated decreased FLACC scores than the CEB group. Total fentanyl consumption was significantly lower (33.4 ± 14.9 µg vs. 56.5 ± 17.0 µg, p-value of 0.003), time to first rescue analgesia was more prolonged (14.4 ± 1.3hrs vs. 1.8 ± 1.2 hr, p-value <0.001), and parents’ satisfaction was significantly higher. Postoperative nausea incidence was significantly alleviated (11 (42.3%) vs. 22 (84.6%), p-value 0.002), whereas vomiting was substantially decreased (0 (0.0%) vs. 15 (57.7%), p-value <0.001). Conclusion Perioperative analgesia in pediatric patients can be effectively achieved using QLB type 2. Compared to CEB, it provides more stable hemodynamics, lower FLACC scores, less need for rescue analgesia, and higher parent satisfaction.

How safe and effective are paediatric virtual fracture clinics? A systematic review.

Virtual fracture clinics (VFC) involve a consultant-led multidisciplinary team meeting where cases are reviewed before a telephone consultation with the patient. VFCs have the advantages of reducing waiting times, outpatient appointments and time off school compared to face-to-face (F2F) fracture clinics. There has been a surge in VFC use since the COVID-19 pandemic but there are still concerns over safety in the paediatric population. Fractures make up a large burden of paediatric injuries, therefore research is required on the safety and efficacy of paediatric VFCs. This systematic review will look at the safety and effectiveness of paediatric VFCs, as well as determine the cost-effectiveness and parent preferences. As per the PRISMA guidelines two independent reviewers searched the following databases: Medline, Embase and Web of Science. Studies were included if children under 18 years old presented to A&E with a suspected or confirmed simple un-displaced fracture and were referred to a VFC. The primary outcomes assessed were effectiveness and safety, with the secondary outcomes of cost-effectiveness and parent satisfaction. Six studies met the inclusion criteria for this systematic review. There was a high rate of direct discharge from the VFC leading to reduced outpatient appointments. All patients were seen within 72 h of presentation. There were limited incidences of missed fractures and the rates of re-presentation were similar to that of F2F orthopaedic clinics. There were significant cost savings for the hospitals and high parent satisfaction. VFCs have shown to be safe and effective at managing most stable, low operative risk paediatric fractures. Safety must be ensured with a telephone helpline and an open return to fracture clinic policy. More research is needed into specific paediatric fracture types to be managed in the VFC. https://www.crd.york.ac.uk/PROSPERO/#searchadvanced, identifier: CRD42023423795.

The impact of enhanced recovery after surgery on inflammatory indicators and prognosis related to complex appendicitis in children

ObjectiveTo explore the application effect of enhanced recovery after surgery (ERAS) perioperative plan in the treatment of complex appendicitis in children, and further enrich the implementation plan of ERAS in the field of pediatric surgery.MethodThis study selected 122 children who underwent laparoscopic complex appendectomy at Inner Mongolia Maternal and Child Health Hospital and Baotou Fourth Hospital from August 2018 to July 2022, and randomly divided them into a traditional surgery group (TS) and an enhanced recovery surgery group (ERAS). The changes of white blood cell (WBC), hypersensitive C-reactive protein (CRP), pro Calcitonin (PCT) and interleukin 6 (IL-6) before and after surgery were compared. The degree of pain, recovery time of intestinal function, length of hospital stay, hospital costs, postoperative complications and parental satisfaction were compared between the two groups.ResultThe WBC and CRP levels in the ERAS group at 6 h after surgery, as well as the IL-6 levels on the 3rd day after surgery, were lower than those in the TS group. Meanwhile, the analgesic effect of ERAS group at 3 h and 6 h after surgery was better than that of TS group. And the ERAS group had a shorter postoperative first exhaust time, fewer overall hospital stays, and lower hospitalization costs. In addition, the ERAS group had high parental satisfaction during hospitalization. There was no statistically significant difference in postoperative complications between the two groups of children.ConclusionERAS can promote postoperative recovery of children, reduce surgical stress, save family medical expenses, alleviate the pain of children, and improve parental satisfaction. It is a safe and effective method for treating complex appendicitis in children.

Brief Report: Telehealth Music-Enhanced Reciprocal Imitation Training in Autism: A Single-Subject Feasibility Study of a Virtual Parent Coaching Intervention.

Telehealth delivery increases accessibility of parent-mediated interventions that teach parents skills and support autistic children's social communication. Reciprocal Imitation Training (RIT), an evidence-based Naturalistic Developmental Behavioral Intervention (NDBI) focused on imitation skills, a common difficulty in autism, holds promise for telehealth-based parent training. Imitation is also a core component of musical play during childhood and the affordances of musical play/song naturally shape parent-child interactions. We evaluate the feasibility of a music-based, telehealth adaptation of RIT-music-enhanced RIT (tele-meRIT)-as a novel format for coaching parents in NDBI strategies. This single-subject, multiple baseline design study included 4 autistic children (32-53months old) and their mothers. Parent-child dyads were recorded during 10-min free play probes at baseline, weekly tele-meRIT sessions, and one-week and one-month follow-up. Probes were coded for parents' RIT implementation fidelity, parent vocal musicality, and children's rate of spontaneous imitation. No parent demonstrated implementation fidelity during baseline. All parents increased their use of RIT strategies, met fidelity by the end of treatment, and maintained fidelity at follow-up. Parent vocal musicality also increased from baseline. Intervention did not consistently increase children's imitation skills. A post-intervention evaluation survey indicated high parent satisfaction with tele-meRIT and perceived benefits to their children's social and play skills more broadly. Implementing tele-meRIT is feasible. Although tele-meRIT additionally involved coaching in incorporating rhythmicity and song into play interactions, parents achieved fidelity in the RIT principles, suggesting one avenue by which music can be integrated within evidence-based parent-mediated NDBIs.

Possibility of Avoiding Anesthesia in the Reduction of Greenstick and Angulated Forearm and Distal-End Radius Fractures in Children: A Comparative Study.

Introduction Greenstick and angulated forearm bone fractures are the most common fractures in children and invariably require closed reduction under anesthesia. However, pediatric anesthesia is somewhat risky and not always available in developing countries like India. Therefore, this study aimed to evaluate the standard (quality) of closed reduction without anesthesia in children and to determine satisfaction among parents. Materials and methods The present study included 163 children with closedangulated fractures of the distal radius andfracture shafts of both forearm bones, who were treated by closed reduction. One hundred and thirteen were treated without any anesthesia (study group) on an outpatient department (OPD) basis, whereas50 children of similar age and fracture type underwent reduction with anesthesia (control group). After reduction by both methods check X-ray was done to evaluate the quality of the reduction. Results The average age of the 113 children in the present study was 9.5 years (range: 3.5-16.2 years), of which 82 children had radius or ulna fractures, and 31 had isolated distal radius fractures. In 96.8% of children, ≤10° of residual angulation was achieved. Furthermore, 11 children (12.4%) used paracetamol or ibuprofen for pain control in the study group. Moreover, 97.3% of parents stated that they would like their children to be treated without anesthesia if any fracture occurred again. Conclusions Closed reduction of greenstick angulated forearm and distal-end radius fracture in children in the OPD without anesthesia achieved satisfactory reduction and high parent satisfaction while reducing the risks of pediatric anesthesia and its associated complications.

A tailored COVID-19 vaccination pathway for children 5-11years in Victoria, Australia.

Procedural anxiety was anticipated in children 5-11years during the COVID-19 vaccine rollout in Victoria, Australia, as children in this age group receive few routine vaccines. Therefore, the Victorian state government designed a tailored, child-friendly vaccine program. This study aimed to assess parental satisfaction with elements of the bespoke vaccination pathway. The Victorian government and state-run vaccination hubs in Victoria facilitated an online immunisation plan to help parents identify their child's support needs, and utilised experienced paediatric staff and additional supports for children with severe needle distress and/or disability. All parents/guardians of children 5-11years who received a COVID-19 vaccine in a vaccination hub were sent a 16-item feedback survey via text message. Between 9 February and 31 May 2022 there were 9203 responses; 865 children (9.4%) had a first language other than English, 499 (5.4%) had a disability or special needs, and 142 (1.5%) were Aboriginal or Torres Strait Islander. Most parents (94.4%; 8687/9203) rated their satisfaction with the program as very good or excellent. The immunisation plan was used by 13.5% (1244/9203) of respondents, with usage more common for Aboriginal or Torres Strait Islander children (26.1%; 23/88) or families with a first language other than English (23.5%; 42/179). The child-friendly staff (88.5%, 255/288) and themed environment (66.3%, 191/288) were the most valued measures for vaccination. Additional support measures were required by 1.6% (150/9203) of children in the general population and 7.9%, (17/261) of children with a disability and/or special needs. A tailored COVID-19 vaccination program for children 5-11years, with additional support for children with severe needle distress and/or disability, had high parental satisfaction. This model could be utilised for COVID-19 vaccination in pre-school children and for routine childhood vaccination programs to provide optimal support to children and their families.

Pediatric Bowel Management Options and Organizational Aspects

A bowel management program (BMP) to treat fecal incontinence and severe constipation is utilized for patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and functional constipation, decreasing the rate of emergency department visits, and hospital admissions. This review is part of a manuscript series and focuses on updates in the use of antegrade flushes for bowel management, as well as organizational aspects, collaborative approach, telemedicine, the importance of family education, and one-year outcomes of the bowel management program. Implementation of a multidisciplinary program involving physicians, nurses, advanced practice providers, coordinators, psychologists, and social workers leads to rapid center growth and enhances surgical referrals. Education of the families is crucial for postoperative outcomes, prevention, and early detection of complications, especially Hirschsprung-associated enterocolitis. Telemedicine can be proposed to patients with a defined anatomy and is associated with high parent satisfaction and decreased patient stress in comparison to in-person visits. The BMP has proved to be effective in all groups of colorectal patients at a 1- and 2-year follow-up with social continence achieved in 70-72% and 78% of patients, respectively, and an improvement in the patients' quality of life. A transitional care to adult program is essential to maintain the same quality of care, and continuity of care and to achieve desired long-term outcomes as the patient reaches adult age.

ADHDCoach-a virtual clinic for parents of children with ADHD: Development and usability study.

Attention-deficit/ hyperactivity disorder (ADHD) is one of the most common mental health problems in childhood. Despite the fact that evidence-based treatments exist, behavioral parent training programs are the gold standard in the care of children with ADHD, a significant percentage of parents of children with ADHD do not access such interventions. Internet-delivered interventions are effective for a range of mental health problems, however, there is limited research conducted on the efficacy of such interventions in the treatment of ADHD. Objective: The aim of this study is to present the development and feasibility of an Internet-delivered intervention for parents of children with ADHD. Methods: The intervention was based on Behavioral Parent Training and Rational Emotive Behavior Therapy. Participants were mental health specialists (N = 16) and parents of children diagnosed with ADHD (N = 24). Results: Our results indicated high usability and parental satisfaction with the intervention. Conclusion: In conclusion, an Internet-delivered intervention addressed to parents of children diagnosed with ADHD is a promising approach. Future research should investigate the efficacy of this Internet-delivered intervention in a randomized controlled trial.

High Flow Nasal Cannula Therapy in the Pediatric Home Setting.

High flow nasal cannula (HFNC) therapy may be better tolerated than traditional non-invasive ventilation (NIV) and is rapidly gaining acceptance in pediatric acute care. In Israel, HFNC is approved for domestic use. We aim to describe its indications, efficacy, parental satisfaction and safety. Retrospective study of children treated with home HFNC therapy in three pediatric centers. Data included demographic parameters, indication of use, weight and days of hospitalization before and after initiation. Safety, tolerability and parental satisfaction were assessed via standardized telephone questionnaire. Median (IQR) age of initiating home HFNC in 75 children was 8.3 (2.2, 29.6) months. Indications were obstructive sleep apnea (33; 44%), airway malacia (19; 25%), chronic lung disease (15; 20%), neuromuscular disease (4; 5%) and post-extubation support (4; 5%). Weight standard deviation score rose from -2.3 pre HFNC to -1.7 at 6.7 months post HFNC initiation, p<0.001. Hospital admission days during the two months pre vs post HFNC initiation were 22 (5.5, 60) and 5 (0, 14.7) respectively, p<0.008. Median (IQR) parental satisfaction score was 5/5 (4, 5). Fifty of 60 (83%) respondents would recommend home HFNC to other families in a similar situation. There were no serious adverse events. In our population, domestic HFNC appeared safe and well tolerated for a variety of indications. Its introduction was associated with improved weight gain, fewer hospitalization days and high parental satisfaction. Further work is required to characterize groups of children most likely to benefit from HFNC, as opposed to traditional modes of NIV. This article is protected by copyright. All rights reserved.

Implementation and Evaluation of a Wraparound Virtual Care Program for Children with Medical Complexity.

Objectives: Children and adolescents with medical complexity benefit from care coordination and specialized pediatric care, but many access barriers exist. We implemented a virtual wraparound model to support patients with medical complexity and their families and used an economic framework to measure outcomes. Methods: Children with medical complexity were identified and enrolled in a virtual complex care program with a dedicated multidisciplinary team, which provided care coordination, education, parental support, acute care triage, and virtual visits. A retrospective pre- and postanalysis of data obtained from the Hospital Industry Data Institute (HIDI) database measured inpatient, outpatient, and emergency department (ED) utilization and charges before implementation and during the 2-year program. Results: Eighty (n = 80) children were included in the economic evaluation, and 75 had sufficient data for analysis. Compared to the 12 months before enrollment, patients had a 35.3% reduction in hospitalizations (p = 0.0268), a 43.9% reduction in emergency visits (p = 0.0005), and a 16.9% reduction in overall charges (p = 0.1449). Parents expressed a high degree of satisfaction, with a 70% response rate and 90% satisfaction rate. Conclusions: We implemented a virtual care model to provide in-home support and care coordination for medically complex children and adolescents and used an economic framework to assess changes in utilization and cost. The program had high engagement rates and parent satisfaction, and a pre/postanalysis demonstrated statistically significant reduction in hospitalizations and ED visits for this high-cost population. Further economic evaluation is needed to determine sustainability of this model in a value-based payment system.

Short Term Clinical, Functional and Radiological of Fixation of Paediatric Femoral Shaft Fracture by Titanium Elastic Nail in Paediatric Patients

Introduction: Femoral shaft fracture is the most common major paediatric orthopaedic. For generations traction and casting was the standard treatment for all femoral shaft fractures in children. Elastic stable intramedullary nailing is one for treating these fractures and has a reliable methodology. Over the past two decades the advantages of fixation and rapid mobilisation have been increasingly recognised. Objective: To evaluate the short term clinical, functional and radiological outcome of intramedullary fixation of displaced femoral shaft fractures in skeletally immature children using titanium elastic nails. Methods: A prospective study was conducted in the Department of Ortho Surgery, National Institute of traumatology and orthopedic rehabilitation (NITOR), Dhaka, Bangladesh from July to December 2020. 52 femoral shaft fractures in child aged 6-14 years were fixed with titanium intramedullary elastic nail in the department of Orthopaedics, NITOR, Bangladesh. Two nails of proper and equal diameter were used for fracture fixation. No external splint was used after surgery. Outcomes assessed on the basis of Flynn et al., scoring criterion. Results: The results of the 52 included in our study. All patients achieved complete healing at a mean of 9.1 (Range 8- 10) weeks. 44 fractures were reduced by closed means but 8 needed open reduction. No major complication was recorded. Most common minor complication was entry site skin irritation recorded in 8 patients. 84.61% had excellent result and 15.38% had satisfactory. Conclusion: The treatment of paediatric shaft femur fracture has been drastically changed over the last two decades to internal fixation by elastically stable intra- medullary nail (ESIN). It allows early ambulation and shorter hospital stay and higher parent satisfaction. It also provides flexural, translational and rotational stability as well.

Nonsurgical Correction of Congenital Ear Deformities: The Relationship Between Age of Presentation and Regression.

After 3 weeks of age, studies show ear molding to be unsuccessful due to increased regression rates. Studies have not differentiated success rates based on regression severity; partial regressions may be deemed successful and satisfactory by parents. We examined successful ear molding at different ages of presentation by measuring regression severity and parental satisfaction. Patients who presented to [blinded for review] for ear molding from January 2017 to October 2018 were eligible for inclusion. Molds were applied on the initial visit and monitored biweekly. Treatment length was based on age, deformity type, and severity. One month after treatment completion, parents completed a satisfaction survey where they assessed regression on a 3-point severity scale. A total of 165 patients were included in this study. Sixty-seven were younger than 3 weeks of age and had an overall correction rate of 95%. The complete correction rate was 80% and only 5% saw complete regression. In the remaining 98, the overall correction rate was 94%, with a 63% complete correction rate. Only 6% saw complete regression. There was no statistical significance in parental satisfaction, perceived improvement, or likelihood to recommend ear molding between age groups. Regression rates are higher in children older than 3 weeks although not statistically significant. Most regressions were partial and ear molding still significantly corrected most deformities. We suggest that ear molding be offered past 3 weeks of age, with maximum age being dependent on deformity type, as it still leads to high parental satisfaction.