Pediatric Assessment Research Articles

Improving quality of pediatric onco-critical care: A 2-year experience using PROACTIVE at a cancer center in Jordan.

PROACTIVE (PediatRic Oncology cApaCity Assessment Tool for IntensiVe CarE) is a consensus-derived tool that evaluates pediatric onco-critical care (POCC) services and identifies gaps amenable to improvement. King Hussein Cancer Center (KHCC), an oncology hospital in Jordan, completed PROACTIVE in 2021 and 2022. We evaluated PROACTIVE's ability to identify gaps and improve POCC services at KHCC by analyzing score changes and interviewing site leaders to understand mechanisms of improvement. Results identified three types of outcomes: direct (e.g., improved multidisciplinary communication), indirect (e.g., guidelines implementation), and other outcomes unrelated to PROACTIVE (e.g., funding mechanisms). PROACTIVE can assist institutions strengthen and monitor POCC services over time.

Commentary: Pediatric Pain Measurement, Assessment, and Evaluation

Renee C.B. Manworren, Jennifer Stinson Seminars in Pediatric Neurology Volume 23, Issue 3, August 2016, Pages 189-200 Assessment provides the foundation for diagnosis, selection of treatments, and evaluation of treatment effectiveness for pediatric patients with acute, recurrent, and chronic pain. Extensive research has resulted in the availability of a number of valid, reliable, and recommended tools for assessing children's pain. Yet, evidence suggests children's pain is still not optimally measured or treated. In this article, we provide an overview of pain evaluation for premature neonates to adolescents. The difference between pain assessment and measurement is highlighted; and the key steps to follow are identified. Information about self report and behavioral pain assessment tools appropriate for children are provided; and fac tors to be considered when choosing a specific 1 are outlined. Finally, we preview future approaches to personalized pain medicine in pediatrics that include harnessing the use of potential digital health technologies and genomics.

Nurses' knowledge and attitudes regarding children's pain assessment and management in Nepal.

Pain is frequently experienced by children in hospital, and international guidelines for appropriate pain assessment and management are available. Optimal management of paediatric pain has important long-term health, psychosocial, and economic benefits. However, evidence indicates that globally there are deficits in nurses' understanding of paediatric pain assessment and management. This study explored knowledge and attitudes regarding paediatric pain assessment and management among nurses at a tertiary children's hospital in Nepal. In this cross-sectional study all 140 nurses at a tertiary children's hospital in Nepal, were invited to complete the validated Paediatric Nurses Knowledge and Attitudes Survey. Findings revealed substantial deficits in nurse's knowledge and erroneous attitudes towards pain assessment and management in children. Test scores ranged from 14% to 56%, with mean scores of 38%, with no nurses achieving a recommended pass score of 80% regarding knowledge and attitudes in paediatric pain management. Consistent with previous research, nurses had insufficient knowledge and attitudes that did not reflect best practice regarding pain assessment and management in children. Education programmes targeting both trainees and registered nurses are essential to enable nurses to deliver evidence-based care and improve outcomes for children and their families.

Unveiling The Spectrum: A Comprehensive Review Of Mental Health Assessment And Support In Pediatrics

Unveiling The Spectrum: A Comprehensive Review Of Mental Health Assessment And Support In Pediatrics

Using Web-based Training and Low-fidelity Simulation to Provide Education and Support to Emergency Nurses Undertaking Non-Urgent Paediatric Inter-Hospital Transfers

BackgroundPaediatric interhospital transfers have been associated with significant clinical risk and one of the causative factors identified is insufficient educational preparation for nursing staff involved with non-urgent interfacility transfers. MethodsA single group pretest-posttest design was used to evaluate knowledge acquisition and participant perceptions of an education package (PEANUT: Paediatric Education and Assessment for Non-urgent Transfers) using the Kirkpatrick evaluation model. ResultsSimulation targeting non-urgent interhospital transfer increased participant’s knowledge of transfer processes and confidence when required to undertake a transfer. A comparison of pre- to post-education learning scores detected a significant difference (p<.001), the average total score increased by 3.49 (95% CI:3.04, 3.93) points after training. ConclusionsSimulation education in paediatric non-urgent inter-hospital transfer, demonstrated an improvement in the confidence and knowledge of staff transferring children between facilities.

Pain management in pediatric age. An update.

Differently from the adult patients, in paediatric age it is more difficult to assess and treat efficaciously the pain and often this symptom is undertreated or not treated. In children, a selection of appropriate pain assessment tools should consider the age, the cognitive level, the presence of eventual disability, the type of pain and the situation in which it is occurring. Improved understanding of developmental neurobiology and paediatric analgesic drug pharmacokinetics should facilitate a better management of childhood pain. The objective of this update is to discuss the current practice and the recent advances in pediatric pain management. Using PubMed and the Cochrane Library we conducted an extensive literature analysis on pediatric pain assessment and commonly used analgesic agents in this kind of patients. According to our results, a multimodal analgesic regimen provides a better pain control and a functional outcome in children. Cooperation and communication among the anaesthesiologist, the surgeon and the paediatrician remains essential for successful anaesthesia and pain management in childhood.

Paediatric vestibular assessment in French cochlear implant centres: Challenges and improvement areas.

Survey of paediatric vestibular activity in all 30 French paediatric cochlear implant (CI) centres to identify challenges and areas of improvement. All 30 French CI centres answered a 29-question questionnaire about their paediatric vestibular activity, equipment, and management in different clinical situations (e.g. vestibular assessment before a cochlear implantation or in cases of vertigo) at different ages. Eighteen CI centres had dedicated paediatric vestibular clinics and 12 did not. Minimum age required for vestibular testing was 3 years in eight centres. Four vestibular tests stood out: caloric tests, video Head Impulse Test (vHIT), rotating chair, vestibular evoked myogenic potentials (VEMP). Depending on the centre's experience, the use of vestibular tests in clinical routine was very heterogeneous. Expert centres mostly used vHIT and cervical VEMP (in bone conduction) for assessments before the first cochlear implantation in 1-year-old children. Dizziness assessment in 4-year children was based on the use of vHIT, cervical VEMP on bone conduction, rotatory test, and caloric test. Ocular VEMP was rarely used. Paediatric vestibular assessment requires specific expertise compared to adults. Due to a lack of specialised human resources, some centres may be unable to follow French paediatric CI guidelines. International recommendations could help standardise paediatric vestibular management and public health policies should be discussed to improve training and access for children.

Characteristics and management of patients with SARS-CoV2 infection admitted to pediatric intensive care units: Data analysis of the Spanish national multicenter registry.

The purpose of this study is to describe the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) disease characteristics and management in children admitted to the pediatric intensive care units (PICU). The present study was based on a national multicentric prospective registry including PICU patients with SARS-CoV2 infection or symptoms of multisystem inflammatory syndrome in children (MIS-C). A total of 298 patients were admitted to 41 different Spanish PICUs. A total of 76% of them were previously healthy. The most frequent manifestation was MIS-C (69.8%). On admission, 59.4% of patients did not have respiratory distress, and only 17.4% needed conventional mechanical ventilation (MV). The need for MV was associated with age (incidence rate ratios[IRR] 1.21, p < .012), pediatric sequential organ failure assessment score(p-SOFA) Score (IRR 1.12, p = .001), and need for transfusion (IRR 4.5, p < .004) in MIS-C patients, and with vasoactive drug use (IRR 2.73, p = .022) and the diagnosis of acute respiratory distress syndrome (IRR 2.83, p = .018) in patients admitted for other reasons. During the first day of admission, 56% of patients met shock criteria and 50.7% needed vasoactive drugs. In MIS-C patients, their use was associated with higher p-SOFA score (IRR 1.06, p < .001) and with the diagnosis of shock (IRR 5.78, p < .001). In patients without MIS-C, it was associated with higher p-SOFA score (IRR 1.05, p = .022). The mortality rate was 3%, being lower in MIS-C patients compared to patients admitted for other reasons (0.5% vs. 9.4%, p < .001). It was also lower in previously healthy patients compared to patients with previous comorbidities (0.9% vs. 9.7%, p < .001). Severe SARS-CoV2 infection is uncommon in the pediatric population. In our series, respiratory distress was rare, being MIS-C the most frequent cause of PICU admission related to SARS-CoV2. In most cases, the course of the disease was mild except in children with previous diseases.

Pedi-R-MAPP | the development, testing, validation, and refinement of a digital nutrition awareness tool

The Remote Malnutrition Application (R-MAPP) was developed during the COVID-19 pandemic to provide support for health care professionals (HCPs) working in the community to complete remote nutritional assessments and provide practical guidance for nutritional care. R-MAPP was adapted into Pediatric Remote Malnutrition Application (Pedi-R-MAPP) using a modified Delphi consensus, with the goal of providing a structured approach to completing a nutrition focused assessment as part of a technology enabled care service (TECS) consultation. The aim of this study was to develop and validate a digital version of Pedi-R-MAPP using the IDEAS framework (Integrate, Design, Assess and Share). A ten-step process was completed using the IDEAS framework. This involved the four concept processes; Stage-1, Integrate (Step 1-3) identify the problem, specify the goal, and use an evidence-based approach. Stage-2, (Step 4-7) design iteratively and rapidly with user feedback. Stage 3, (Step 8-9) Assess rigorously, and Stage 4 (Step 9-10) publish and launch of the tool. Stage 1:Evidence-based development, Pedi-R-MAPP was developed using Delphi consensus methodology. Stage 2:Iteration & design, HCPs (n=22) from UK, Europe, South Africa, and North America were involved four workshops to further develop a paper prototype of the tool and complete small-scale testing of a beta version of the tool which resulted in eight iterations. Stage 3:Assess rigorously, Small scale retrospective testing of the tool on children with congenital heart disease (n=80) was completed by a single researcher, with iterative changes made to improve agreement with summary advice. Large scale testing amongst (n=745) children in different settings was completed by specialist paediatric dietitians (n=15) advice who recorded agreement with the summary advice compared with their own clinical assessment. Paediatric dietitians were in overall agreement with the summary advice in the tool 86% (n=640), compared to their own clinical practice. The main reasons for disagreement were i) frequency of planned review 57.1% (n=60/105), ii) need for ongoing dietetic review due to chronic condition 20.0% (n=21/105), iii) disagreement with recommendation for discharge 16.2% (n=17/105) and iv) concerns with faltering growth and/or need for condition specific growth charts 6.7% (7/105). Iterative changes were made to the algorithm, leading to an improvement in agreement of the summary advice on re-evaluation to 98% (p=<0.0001). A digital version of the Pedi-R-MAPP nutrition awareness tool was developed using the IDEAS framework. The summary advice provided by the tool achieved a high level of agreement when compared to paediatric dietetic assessment, by providing a structured approach to completing a remote nutrition focused assessment, along with identifying the frequency of follow-up or an in-person assessment.

Staphylococcus aureus Bacteremia in the Pediatric Emergency Department and Predictors of Poor Outcome.

Staphylococcus aureus has become the leading cause of bacteremia among previously healthy children older than 5 years. We aimed to describe the infants presenting to pediatric emergency departments and diagnosed with S. aureus bacteremia (SAB) and identify predictors (clinical and laboratory variables) of poor outcome (complications, sequelae or death). We performed an observational study and subanalysis of a multicenter prospective registry, including every patient under the age of 18 years with a positive blood culture obtained at any of the 22 participating Spanish pediatric emergency departments between 2011 and 2016. We considered chronic diseases, immunosuppressive treatment and the presence of mechanical devices as risk factors for SAB. Of the 229 patients with SAB, 176 (76.9%) were previously healthy, 192 (83.8%) had a normal pediatric assessment triangle and 158 (69.0%) had an associated focal infection (mainly osteoarticular infection, skin and soft tissue infection and pneumonia). Fifty-three patients (23.1%) had 1 or more risk factors for SAB. Thirty-one (13.5%) presented a poor outcome, including 4 deaths (1.7%). A poor outcome was more common in patients with SAB risk factors [odds ratio (OR): 7.0; 95% CI: 3.2-15.4], abnormal PAT (OR: 5.9; 95% CI: 2.6-13.3), elevated procalcitonin (OR: 1.2; 95% CI: 1.05-1.3) and C-reactive protein, the latter being the only independent predictor of poor outcome (OR: 1.01; 95% CI: 1.01-1.02). Overall, children with SAB are previously healthy, appear well, and have an associated focal infection. One out of 7 had a poor outcome, with C-reactive protein being the only predictor identified.

Pediatric infectious emergencies-from febrile seizure to purpura fulminans

Febrile seizures, which are relatively common in young children, are often triggered by an infection and resolve quickly. Prompt presentation to a pediatric department is mandatory after any first seizure and every time for children ≤ 12months. Central nervous system (CNS) diseases in childhood are able to cause seizures or other neurological disorders. Even the slightest suspicion of aseizure with CNS involvement must be promptly treated. In case of doubt, both an antiviral and an antibacterial treatment are started in parallel, which can be stopped after detecting the pathogen. Lumbar puncture is strictly indicated unless there are contraindications. Meningococcal sepsis is asevere clinical feature comprising high fever, chills and disorders of consciousness. The first skin symptoms are petechiae as ared flag sign. With progression, potentially lethal purpura fulminans may develop. Waterhouse-Friderichsen syndrome is asevere complication of acute bacterial meningitis. Lethality rate is 35%. The pediatric assessment triangle and the ABCDE algorithm help to identify critically ill children in a standardized, structured, and rapid manner.

Application of Quantitative Systems Pharmacology to Pediatric Drug Safety Assessment.

Application of Quantitative Systems Pharmacology to Pediatric Drug Safety Assessment.

The impact of the COVID-19 pandemic era on children with primary headache: a questionnaire survey study and literature review.

The coronavirus disease (COVID-19) pandemic has resulted in individual isolation and secondary problems, especially in children. Research on the effect of the social isolation on children with primary headache is limited. This study aimed at exploring the effects of environmental changes caused by COVID-19 on headache in children. This cross-sectional survey study enrolled school-aged children (age, 8-16 years) with headache who were able to complete the questionnaire from a Pediatric Headache Clinic between January 2021 and December 2022. Headache diaries for all patients were in their medical records and two questionnaire responses were requested at a 3-month interval. The questionnaires included headache type, frequency, previous medical conditions, family history, Pediatric Migraine Disability Assessment scores (PedMIDAS) scores, changes in daily life after COVID-19, and factors that aggravated headaches associated with social distancing. We identified 35 patients who were diagnosed with primary headache and continued to visit our outpatient clinic for at least 3 months. Among them, 33 (15 males and 18 females) patients responded to the first survey. The average age (±SD) of patients was 12.5 ± 1.9 years. PedMIDAS scores were not affected by the COVID-19 infection history. Prolonged use of masks and increased use of digital devices were reported as the most common factors that aggravated headache during the pandemic era. COVID-19 did not affect in worsening primary headache in children. However, the pandemic can introduce various changes in daily life, which in turn can affect the management of headache. By gathering feedback regarding the thoughts of the patients on the impact of the current pandemic environment, patient counseling on the precautions and management can be conducted in advance in the case of repeated lockdown in the future.

Relationship between Sensory Processing Skills and Feeding Behaviors in Children Aged 3-6 Years with Cerebral Palsy with Cerebral Visual Impairment.

The current study aimed to examine the relationship between sensory processing skills and feeding behavior in cerebral palsy (CP) children aged 3-6 years with cerebral visual impairment (CVI). A total of ninety mothers participated in the study in three groups: thirty mothers of children with CP with CVI, thirty mothers of children with CP without CVI, and thirty mothers of children with typical development (TD). The sensory processing skill of the children was evaluated with the Sensory Profile (SP), and feeding behavior was evaluated with the the Behavioral Pediatric Feeding Assessment Scale (BPFAS). In the triple comparison, a significant difference was found between the groups in all SP parameter and BPFAS scores (p < 0.001). Post hoc analysis revealed statistically significant differences between the groups in all parameters (p < 0.001). Feeding problems were detected in 65% of all groups. In the correlation analysis, a significant relationship was found between all parameters of the SP and the BPFAS (p < 0.05). In terms of sensory processing skills and feeding status, it was determined that children with CVI with CP had more problems than children with CP without CVI, and children with CP without CVI had more problems than children with TD. With these results, it was concluded that sensory processing problems affect feeding status, and visual impairment causes both sensory problems and feeding problems.

AlexNet-based deep convolutional neural network optimized with group teaching optimization algorithm (GTOA) for paediatric bone age assessment from hand X-ray images

ABSTRACT Bone age assessment is used to diagnose paediatric growth because some types of bone diseases occur in childhood. To overcome these issues, AlexNet-Based Deep Convolutional Neural Network Optimized with the Group Teaching Optimization Algorithm is proposed. First, input images are gathered via RSNA paediatric bone age dataset. These images are preprocessed using Wavelet Packet Transform Cochlear Filter Bank. Then input hand X-ray images’ ROI is segmented using Bayesian fuzzy clustering. Then segmented ROI region is fed to ADCNN that accurately predicts BAA. In general, ADCNN does not divulge any optimization techniques adopted for determining the optimal parameters and ensuring accurate classification. Therefore, the GTOA is used to optimize the ADCNN weight parameters. The proposed approach is done in MATLAB and various performance metrics such as accuracy, F-score, sensitivity, precision, specificity, CCC and CC. The BAA-ADCNN-GTOA method provides higher accuracy 23.75%, 17.97%, 31.65% compared with existing methods, like BAA-CNN-RRNN, BAA-RNN-AF-SFO, BAA-U-Net-CTO- WOA, respectively.

Comparison of current paediatric contrast sensitivity assessments using simulated reduced contrast thresholds

ABSTRACT Purpose There are limited tests of contrast sensitivity (CS) for use in children. The Hiding Heidi (HH) is suitable for all cognitive abilities, but has a ceiling effect. The Double Happy (DH) test has comparable thresholds to the Pelli Robson (PR), however the ability to detect changes in contrast has not been established. This study aims to compare contrast thresholds and agreement between HH and the DH, comparing to the PR chart in normal conditions and under reduced visual and lighting conditions. Methods Tests were repeated under different conditions to reduce the contrast. Room illumination was 20,900{plus minus}2% lux in bright conditions and 2,000{plus minus}2% lux in dim conditions, both conditions were repeated with the addition of simulation spectacles to reduce the clarity of vision. Participants’ CS was measured uniocularly using the PR, HH and DH tests. Results 50 participants, age 18–62 years (mean{plus minus}standard deviation: 24.5{plus minus}7.98), were assessed. On HH 94% (n = 47) reached the maximum score, with the DH it was 18% (n = 9). The difference in reduction between conditions was smaller with HH in comparison to PR and DH, but significantly different from baseline conditions. Under dim conditions the reduction in PR and DH was −0.21 logCS units, but only −0.04 logCS for HH. Conclusion The DH test has better agreement with PR than HH and is better at detecting CS changes, highlighting the advantages of use in clinical practice.

The pediatric provider communication skills assessment scale.

Building rapport and trust between healthcare professional and patient/parents would improve satisfaction of patient/parents. The purpose of this study was to develop "The Pediatric Provider Communication Skills Assessment Scale" in this study. A trial form, with linguistic and psychometric validation and consisting of 44 statements, was administered to a sample of 325 individuals. Data were collected between January 20 and October 22, 2021. The validity of the scale was concluded after examining its construct validity and internal validity. "Exploratory factor analysis" was used for determining construct validity, and "comparison of lower-upper groups" for internal validity. "Cronbach's α reliability coefficient" and "split half test consistency coefficient" were calculated for testing the reliability of the scale. The Pediatric Provider Communication Skills Assessment Scale that we developed consists of one dimension and 20 items, and the variance it can explain was calculated as 62.3%. The Cronbach α reliability coefficient of the scale was calculated as 0.90, indicating high reliability. According to the findings, "The Pediatric Provider Communication Skills Assessment Scale" is a scale with features that can measure in a valid and reliable way, with high variance and a low number of items. The study aims to develop the "The Pediatric Provider Communication Skills Assessment Scale," and present it to the literature as a validated and reliable new objective measurement tool. This study will enable us to understand more about the complex communication processes involved in pediatric care and how these may influence care delivery.

Multi-characteristic reinforcement of horizontally integrated TENet based on wrist bone development criteria for pediatric bone age assessment

Multi-characteristic reinforcement of horizontally integrated TENet based on wrist bone development criteria for pediatric bone age assessment

Association between feeding/mealtime behavior problems and internalizing/externalizing problems in autism spectrum disorder, other neurodevelopmental disorders and typically developing children.

The aim of current study was to examine the nature and prevalence of feeding problems and mealtime behavior problems in children with autism spectrum disorder (ASD) comparing to children with other neurodevelopmental disorders (NNDs) and TD children. We also investigated the impact of intelligence quotient (IQ) and/or emotional and behavioral problems on feeding and mealtime behavior problems. Participants completed the following tests: Social Communication Questionnaire (SCQ), Child Behavior Checklist (CBCL), Brief Autism Mealtime Behavior Inventory (BAMBI) and Behavioral Pediatric Feeding Assessment Scale (BPFAS). Children with ASD showed more feeding and mealtime behavior problems including food refusal (P<0.001, P<0.001) and limited variety of foods (P=0.014; P=0.018) compared with NDDs and TD children. ASD group showed more problems in mealtime behavior (P=0.034) and parent behaviors (P=0.028) compared to TD group. Internalizing (P=0.003) and externalizing (P=0.008) problems were positively related to parent frustration during mealtime in ASD group. These results suggest that routine screening for feeding and mealtime behavior problems among children with ASD is necessary to prevent dietary inadequacies that may be associated with eating habits.

Measurement properties of the Arabic version of the pediatric functional assessment of chronic illness therapy-fatigue in children with cancer.

The pediatric Functional Assessment of Chronic Illness Therapy-Fatigue (PedsFACIT-F) measures fatigue in various clinical settings. To verify the measurement properties of the Arabic version (PedsFACIT-F-Ar) in patients with cancer. In this cross-sectional validation study, the PedsFACIT-F and the Pediatric Quality of Life Multidimensional Fatigue Scale (PedsQL-MFS) were administered to 114 participants (74 boys and 40 girls) aged 8-18. Exploratory factor analysis was used to test the structural validity of PedsFACIT-F-Ar. Its construct validity was investigated using the hypothesis testing method to predict a moderate correlation (rho ⩾ 0.4) with the PedsQL-MFS domains and the total score. Its reliability was also tested. The PedsFACIT-F-Ar is a two-factor model that explains 67.38% of the total variance. It is significantly correlated with PedsQL-MFS (rho > 0.84). It displayed excellent internal consistency (Cronbach's α= 0.93) and test-retest reliability (ICC2.1= 0.99; 95% CI: 0.96-0.99). Bland-Altman's analysis revealed the absence of a systematic error between the two test sessions. The standard error of measurement, minimal detectable change (MDC95), and MDC% were 0.92, 2.56 points, and 2.88%, respectively, with no floor or ceiling effects. The PedsFACIT-F-Ar demonstrated excellent psychometric properties. The findings suggest the clinical usefulness of this scale.