Pediatric Clinical Settings Research Articles

Patient Safety Culture among Nurses in Pediatric Clinical Settings

Patient Safety Culture among Nurses in Pediatric Clinical Settings

Systematic review and meta-analyses on the accuracy of diagnostic tests for IgE-mediated food allergy.

The European Academy of Allergy and Clinical Immunology (EAACI) is updating the Guidelines on Food Allergy Diagnosis. We aimed to undertake a systematic review of the literature with meta-analyses to assess the accuracy of diagnostic tests for IgE-mediated food allergy. We searched three databases (Cochrane CENTRAL (Trials), MEDLINE (OVID) and Embase (OVID)) for diagnostic test accuracy studies published between 1 October 2012 and 30 June 2021 according to a previously published protocol (CRD42021259186). We independently screened abstracts, extracted data from full texts and assessed risk of bias with QUADRAS 2 tool in duplicate. Meta-analyses were undertaken for food-test combinations for which three or more studies were available. A total of 149 studies comprising 24,489 patients met the inclusion criteria and they were generally heterogeneous. 60.4% of studies were in children ≤12 years of age, 54.3% were undertaken in Europe, ≥95% were conducted in a specialized paediatric or allergy clinical setting and all included oral food challenge in at least a percentage of enrolled patients, in 21.5% double-blind placebo-controlled food challenges. Skin prick test (SPT) with fresh cow's milk and raw egg had high sensitivity (90% and 94%) for milk and cooked egg allergies. Specific IgE (sIgE) to individual components had high specificity: Ara h 2-sIgE had 92%, Cor a 14-sIgE 95%, Ana o 3-sIgE 94%, casein-sIgE 93%, ovomucoid-sIgE 92/91% for the diagnosis of peanut, hazelnut, cashew, cow's milk and raw/cooked egg allergies, respectively. The basophil activation test (BAT) was highly specific for the diagnosis of peanut (90%) and sesame (93%) allergies. In conclusion, SPT and specific IgE to extracts had high sensitivity whereas specific IgE to components and BAT had high specificity to support the diagnosis of individual food allergies.

Intercorporeal Formations in Pediatric Dental Encounters With Patients Showing Distress: The Intertwine of Controlling and Comforting Touch.

Dental fear and anxiety are highly prevalent among children and have been shown to lead to irregular use of dental services. Previous research has suggested that while touch can alleviate the patient's stress and help in accomplishing dental procedures, it can also be a source of stress or used to restrain the patient. In this study, we explore the emergence and intertwine of controlling and comforting touch in pediatric dental clinic settings in which patients show signs of resistance, distress, or fear. We use microanalysis of video-recorded interactions to unveil how the adults in the room-any combination of the dentist, dental assistant, hygienist, and caregiver(s)-deploy various types of touch on the child patient to perform the dental procedure while simultaneously comforting the child. Our data set covers video-recordings of naturally occurring dental clinic visits of 3- to 12-year-old child patients from four cultural contexts: Finland, China, Iraq, and the United States. Drawing on Merleau-Ponty's writings on intercorporeality and the interaffectivity of bodies, the study proposes that touch in pediatric dentistry unfolds as complex intercorporeal formations where the interaffectivity emerges not only through touch but also via vocal resonance. In contrast to clear boundaries between comforting and controlling touch, our analysis indicates that the line between comforting and controlling touch can be blurred. We suggest that touching a pediatric patient showing resistance toward a dental procedure requires careful affective attention to the patient's subtle and moment-by-moment bodily expressions and reactions to the touch.

Design and protocol of a clinic-based comparative effectiveness randomized controlled trial to determine the feasibility and effectiveness of food prescription program strategies in at-risk pediatric populations

BackgroundProduce prescription programs are gaining traction in the U.S.; however, data on the impact of such approaches in pediatric populations are limited. The purpose of our clinic-based comparative effectiveness randomized controlled trial (CE RCT) is to evaluate the preliminary effectiveness of two produce prescription strategies (at-home delivery and grocery store vouchers) implemented by the Brighter Bites non-profit organization in improving obesity-related health outcomes and dietary behaviors among low-income 5–12-year-olds in Houston, Texas. This paper presents the study design, intervention components, and the study measures. MethodsParticipants (n = 150) are being recruited from two pediatric clinics in Houston, Texas. Child eligibility criteria are aged 5–12 years, Medicaid recipients, body-mass index (BMI) percentile ≥85 and living within 10 miles of a Brighter Bites distribution site. Following consent and baseline measures, children are randomized into one of three arms: (1) Bi-weekly $25 vouchers redeemable for produce at stores (n = 50), (2) Bi-weekly produce delivery to participants' homes through DoorDash (n = 50), and (3) wait-list usual care controls (n = 50). Intervention participants also receive Brighter Bites nutrition education materials. Main child outcome measures are BMI z-scores, blood pressure, hemoglobin A1c, liver panels, and lipid panels. Other outcomes including household food insecurity, child diet quality, and home nutrition environment will be collected through parent surveys. Outcome measures are collected at baseline and post-intervention. Process evaluation will measure program dosage, reach, acceptability, and feasibility. ConclusionsOur paper presents the design and next steps to ensure the successful implementation of a produce prescription program in a pediatric clinic setting.

Accommodative-vergence disorders in a paediatric ophthalmology clinical setting in Argentina.

To determine the frequency of potential non-strabismic accommodative-vergence anomalies (NSAVA) and investigate associations between NSAVA, refractive errors and age among children attending a paediatric ophthalmology clinic. This study included children and adolescents aged 5-19 years attending an ophthalmology clinic with at least two follow-up visits. At their first visit, children had a comprehensive ophthalmic examination, including refractive error measurement by cycloplegic autorefraction and spectacles were prescribed if necessary. At the second visit, children had an examination of best-corrected visual acuity, convergence and accommodation to identify potential NSAVA. The relationship between age, sex, heterophoria and refractive error and potential NSAVA was assessed by a multivariable logistic regression model. A total of 384 children and adolescents were evaluated. Their mean age was 10.97 ± 3.07 years and 58.9% were females. Forty-two per cent of children failed the NSAVA tests and 34.1% had myopia (≤-0.50 D). Children who failed NSAVA tests self-reported a higher proportion of reading problems (73.7%) compared to those who passed the tests (26.3%; p < 0.001). Children with self-reported reading problems were more likely to have accommodative infacility (57.9%) compared with children without (42.1%; p < 0.001). Refractive error and age were not associated with failure in NSAVA tests (p > 0.05). NSAVA was a frequent cause of vision problems found in a sample of children from an ophthalmology paediatric clinic. Thus, further research is necessary to understand the potential of public health policies to prevent, refer, diagnose and treat those conditions.

Disrupted identities, invisibility and precarious support: a mixed methods study of LGBTQI adolescents and young adults with cancer

BackgroundLesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) adolescents and young adults (AYAs) with cancer report higher levels of depression and anxiety and lower health related quality of life than non-LGBTQI AYAs with cancer, and LGBTQI adults with cancer. This mixed methods study examined LGBTQI AYAs' experiences of cancer and cancer care, to understand these health disparities.MethodsOnline surveys were completed by 95 LGBTQI AYAs with cancer (age 16–39 years); 19 AYAs took part in a one-to-one semi structured interview. Reflexive thematic analysis of interviews and open-ended survey responses facilitated in-depth examination of subjective experiences; descriptive statistics performed on individual closed-ended survey items identified the percentage of AYAs reporting experiences identified in the qualitative analysis.Results63% of AYAs reported high or very high distress on the K10. Three themes were identified in the qualitative analysis: 1) “Identities in flux”, included subthemes “Cancer disrupts developing identities, and involvement with LGBTQI communities”; “Internalized prejudice impacts identities”; and “Cancer facilitates identities and embodiment”. 2) “Invisibility in cancer care”, included subthemes “Navigating disclosure amongst cis-heteronormative assumptions”, “Discrimination and paternalistic cancer care” and “ Cis-heteronormativity within cancer information”. 3) “Precarious social support for LGBTQI AYAs with cancer”, included subthemes “ Social support during cancer is helpful for LGBTQI AYAs”, “LGBTQI AYAs navigate limited support”, and“ Finding cancer peer support networks is difficult for LGBTQI AYAs”.ConclusionsLGBTQI AYAs with cancer experience psychosocial vulnerabilities related to identity development, experiences of care, and social support networks. These factors likely contribute to their previously evidenced elevated risk of distress, relative to both non-LGBTQI AYAs and LGBTQI older adults. AYAs affected by cancer may require additional, tailored supportive care, including targeted information resources, LGBTQI AYA specific cancer support groups, or partnerships and referrals to LGBTQI community organisations. Additionally, it is evident that health care professionals and cancer services have much work to do in ensuring LGBTQI AYAs receive affirming and appropriate care across paediatric and adult clinical settings. They must move beyond assuming all patients are cisgender, heterosexual and do not have intersex variations unless otherwise stated; work to signal inclusivity and facilitate disclosure; and be able to respond appropriately with tailored information and care, which is inclusive of LGBTQI partners, chosen family, and support systems.

Anterior open bite treatment using Balters class II bionator: a case report

There are several reasons for the onset of malocclusion, which promotes disharmonious development of the craniofacial structure and may involve various factors such as incorrect positioning of teeth, maxilla, mandible, lips, tongue, and/or cheeks, possibly accompanied by deleterious oral habits. Malocclusion is a common finding that affects facial aesthetics, smile, as well as masticatory and respiratory functions, occurring in a large portion of the world’s population. Hence, a correct and early diagnosis is necessary for malocclusion treatment. There are various available treatments aiming for early correction of malocclusions. This clinical case report will describe a possible treatment for correcting an anterior open bite during the mixed dentition associated with a deleterious oral habit. The Balters’ Bionator is a functional orthopedic dento-muco-supported appliance that harmonizes the muscles of the tongue, lips, and cheeks, and treats skeletal discrepancies. At the end of this orthopedic treatment stage, the patient achieved the objectives of this work and will continue her care in a pediatric dental clinical setting at the Federal University of Amazonas-UFAM for further analysis and additional dentomuco-skeletal corrections.

Intraprofessional learning: Dentistry and oral health students' readiness and experience.

Intraprofessional learning is a promising approach to enhance teamwork and patient care. This mixed-method study aimed to assess the readiness and experience of dental and oral health students toward intraprofessional learning. Dental and oral health students were paired alternatively in a clinician and assistant role in a pediatric clinical setting. The Readiness for Interprofessional Learning Scale was adapted for a pre- and post-survey. Focus groups were conducted to elicit the students' shared learning experience. Approximately 50% of dental and oral health students participated in the pre- and post-survey. Pre-test findings revealed similar attitudes toward intraprofessional practice for both groups. However, a statistically significant lower score (p<0.022) for the oral health students in the post-test suggested a less positive attitude toward their experience. Qualitative results indicated that dental students acquired a better understanding of the clinical scope of oral health students, and they learned clinical skills and behavior management from their counterparts. Conversely, oral health students experienced a hierarchical lack of collegiality and reciprocity from dental students, which may have contributed to their lower post-test score. Despite this, some oral health students gained more confidence in their roles and abilities within the intraprofessional team. Overall, dental students valued this learning experience more and desired more intraprofessional opportunities. Both groups of dental and oral health students had similar readiness levels to enter intraprofessional practice, appreciated the intraprofessional experience, and gained an increased appreciation for the collaborative approach to patient care. Intraprofessional learning during training may assist with developing collegiality across the dental professions in practice.

Adaptation and Formative Evaluation of Online Decision Support to Implement Evidence-Based Strategies to Increase HPV Vaccination Rates in Pediatric Clinics.

Human papilloma virus (HPV) vaccination rates remain below national goals in the United States despite the availability of evidence-based strategies to increase rates. The Adolescent Vaccination Program (AVP) is a multi-component intervention demonstrated to increase HPV vaccination rates in pediatric clinics through the implementation of six evidence-based strategies. The purpose of this study, conducted in Houston, Texas, from 2019-2021, was to adapt the AVP into an online decision support implementation tool for standalone use and to evaluate its feasibility for use in community clinics. Phase 1 (Adaptation) comprised clinic interviews (n = 23), literature review, Adolescent Vaccination Program Implementation Tool (AVP-IT) design documentation, and AVP-IT development. Phase 2 (Evaluation) comprised usability testing with healthcare providers (HCPs) (n = 5) and feasibility testing in community-based clinics (n = 2). AVP-IT decision support provides an Action Plan with tailored guidance on implementing six evidence-based strategies (immunization champions, assessment and feedback, continuing education, provider prompts, parent reminders, and parent education). HCPs rated the AVP-IT as acceptable, credible, easy, helpful, impactful, and appealing (≥80% agreement). They rated AVP-IT supported implementation as easier and more effective compared to usual practice (p ≤ 0.05). The clinic-based AVP-IT uses facilitated strategy implementation by 3-month follow-up. The AVP-IT promises accessible, utilitarian, and scalable decision support on strategies to increase HPV vaccination rates in pediatric clinic settings. Further feasibility and efficacy testing is indicated.

Paper 06: Is There a Home-Field Advantage in Sports Medicine Clinic? Comparing Well-Being Outcomes of Two Staffing Models

Objectives: Learning objectives: Define differences between integrated versus rotating team-based models of care Identify tools to assess professional fulfillment, burnout, and clinical efficiency Understand the impact of integrated versus rotating team-based care models on care team members well-being Project objective/background: Team-based healthcare improves patient access, billable services, and recruitment/retention (1). The staff roles and tasks impacts working to top of license (2) which likely contribute to professional fulfillment and well-being at work. However, well-being measures comparing team-staffing models have not been described. We compare well-being measures of an Integrated Consistent Care-Team Model (ICCM) with Rotating Care-Team Model (RTM) in pediatric sports medicine clinics. Our hypothesis is that ICCM providers and staff would consistently demonstrate greater professional fulfillment, less burnout, greater clinical efficiency, and more advanced team development compared to RTM providers and staff. Methods: We identified an ICCM and RTM model within one healthcare system. The ICCM group includes one core team of pediatric sports medicine providers and staff (n=6), consistently located in the same outpatient practice setting. The RTM includes varying provider and staff team members at varying locations (n=7). All care team members from both models completed three assessments (at 0 and 7 months) of professional fulfillment, burnout, and perception of team development. Metrics used included the Professional Fulfillment Index (PFI), a 16-item survey measuring professional fulfillment and burnout, the Mini-Z_2.0, a 10-item survey measuring burnout via Supportive Work Environment and Practice Efficiency subscales, and the Team Development Measure (TDM), a 31-item survey measuring team development. EMR Data was also analyzed to determine trends in efficiency and practice across the RTM and ICCM groups. Results: PFI results taken at both time periods indicated higher rates of Professional Fulfillment in the ICCM group than the RTM Group. A cutoff point of 3.00 or greater is indicative of professional fulfillment and was demonstrated by the ICCM group at both time points (M=3.31, SD=0.33; M=3.37, SD=0.30). RTM team members scored significantly higher (unfavorable) than ICCM team members on PFI Overall Burnout Scale and showed higher scores in Work Exhaustion and Interpersonal Disengagement subscales. Mini-Z_2.0 results were favorable for ICCM team members on the Supportive Work Environment and Practice Efficiency subscales at both time periods. Overall scaled scores for the ICCM team were greater than the cutoff point of 40 at both time periods, indicating a joyful workplace, in contrast to RTM scores which were below the cutoff points on subscale scores and overall scores at both time periods. ICCM members also trended higher in team development scores on the TDM survey at both time periods. A Welch’s t-test was performed for the Mini-Z and PFI data collection and determined results were statistically significant across both samples and time periods. Furthermore, ICCM providers yielded better EMR efficiency metrics than their RTM colleagues, including less in basket management, PJ time, clinical review and EMR time on unscheduled days at both time periods. Both groups averaged a similar number of appointments per day at each time point (M=9.51 in January; M=11.61 in August). Conclusions: This study describes differences in well-being measures for providers and staff within a pediatric sports medicine ambulatory clinic setting when comparing two different care team models across a 7-month period, suggesting that consistent care-team with core providers and less variability has advantages to provider and staff well-being.

Noise exposure in pediatric otolaryngology clinic: A sound survey of a single-institution tertiary care facility

BackgroundThe Occupational Safety and Health Administration (OSHA) considers acoustic exposure of 90 decibels (dB) an occupational risk for noise-induced hearing loss. Pediatric healthcare clinicians are exposed to considerable noise especially during invasive procedures, predisposing them to noise-induced hearing loss, increased work-related stress, and increased complications associated with intense noise exposure. While there has been extensive research in noise exposure in dentistry, to date there has been no research on noise exposure in the pediatric otolaryngology clinic setting. The objective of this study is to quantify the degree of noise exposure that pediatric otolaryngologists encounter in the clinical setting. MethodsA sound survey was performed of 420 pediatric otolaryngology clinic visits within a single-institution tertiary care facility from January 2022 to March 2022, with a total of 409 visits included. At each visit, noise was measured using a calibrated National Institute for Occupational Safety and Health (NIOSH) Sound Meter application, an iPad, and a microphone. The Equivalent Continuous Sound Pressure Level (LAeq), peak sound pressure level (SPL), C-weighted peak noise level (LCpeak), and the 8-hour time-weighted average (TWA) sound level were recorded. ResultsThe average LAeq was 61.1 dB, the median LAeq was 60.3 dB, and the average peak SPL was 80.5 dB. Only 0.5 % of visits reached an LAeq above 80 dB, however, 51 % were above 60 dB and 99 % were above 45 dB. No clinicians were exposed to noise exceeding established limits of safety. Patients younger than ten years old (p < 0.001) and those who underwent procedures such as cerumen removal (p < 0.001) elicited higher ranges of elevated noise. Multivariate analysis confirmed that increased age decreased acoustic exposure while procedures increased acoustic exposure. ConclusionsThe results of this study suggest that pediatric otolaryngology clinicians do not exceed hazardous noise limit exposure. However, they are exposed to levels above those which have been linked to stress, poor productivity, and stress-related disorders. This analysis also reports that patients who are younger and those that undergo procedures, specifically cerumen removal, tend to expose their providers to the highest levels of noise. This is the first study examining noise exposure in pediatric otolaryngology, and further research should evaluate the risks of noise exposure in this environment.

Camera-based Prospective Motion Correction in Paediatric Epilepsy Patients Enables EEG-fMRI Localization Even in High-motion States

Background: EEG-fMRI is a useful additional test to localize the epileptogenic zone (EZ) particularly in MRI negative cases. However subject motion presents a particular challenge owing to its large effects on both MRI and EEG signal. Traditionally it is assumed that prospective motion correction (PMC) of fMRI precludes EEG artifact correction. Methods: Children undergoing presurgical assessment at Great Ormond Street Hospital were included into the study. PMC of fMRI was done using a commercial system with a Moiré Phase Tracking marker and MR-compatible camera. For retrospective EEG correction both a standard and a motion educated EEG artefact correction (REEGMAS) were compared to each other. Results: Ten children underwent simultaneous EEG-fMRI. Overall head movement was high (mean RMS velocity < 1.5 mm/s) and showed high inter- and intra-individual variability. Comparing motion measured by the PMC camera and the (uncorrected residual) motion detected by realignment of fMRI images, there was a five-fold reduction in motion from its prospective correction. Retrospective EEG correction using both standard approaches and REEGMAS allowed the visualization and identification of physiological noise and epileptiform discharges. Seven of 10 children had significant maps, which were concordant with the clinical EZ hypothesis in 6 of these 7. Conclusion: To our knowledge this is the first application of camera-based PMC for MRI in a pediatric clinical setting. Despite large amount of movement PMC in combination with retrospective EEG correction recovered data and obtained clinically meaningful results during high levels of subject motion. Practical limitations may currently limit the widespread use of this technology.

Comorbidity of Obsessive-Compulsive Symptomatology and Bowel and Bladder Dysfunction in a Tertiary Children's Hospital: A Case Series

ObjectiveTo improve understanding of co-occurring obsessive-compulsive disorder (OCD) and bowel and bladder dysfunction (BBD) in an outpatient pediatric urology clinic setting. To provide a series of clinical care recommendations to enhance the identification and integrated medical and behavioral health treatment of these disorders. MethodsAuthors participated in a series of discussions to define the patient population and specific aims for the study. Efforts were made to select index patients of diverse background despite limited sample availability. Three patients were ultimately selected for the study. ResultsThe case studies highlight the connection between urinary issues and underlying OCD symptoms. All patients were initially seen for medical treatment of urological symptoms, then referred for psychological evaluation, and were diagnosed with and received treatment for OCD. Similarities among the cases, including experience of phantom urinary incontinence, stressors present that contributed to symptoms, and obsessive fears of incontinence that led to compulsive behavior, were discussed. Differences between the cases, including patient age, sex, and compulsive behavior demonstrated (ie, urinary frequency, excessive wiping) were also reviewed. ConclusionAccess to a behavioral health provider can enhance the identification of comorbid psychological disorders and can reduce duration of symptoms through appropriate psychological treatment. Authors provide recommendations for screening measures and reinforce importance of including basic education on psychiatric diagnoses and impact on urological symptoms in urology and pediatric fellowship training programs. Future research exploring prevalence of comorbid psychiatric conditions and efficacy of treatment interventions in a pediatric urology population would be beneficial.

Safety of Multifood Oral Immunotherapy in Children Aged 1 to 18 Years at an Academic Pediatric Clinic

Oral immunotherapy (OIT) aims to increase the reaction threshold to a food allergen and decrease the risk of a potentially life-threatening allergic reaction in the event of an accidental ingestion. Whereas single-food OIT is the most extensively studied, data on multifood OIT are limited. Our study aimed to examine the safety and feasibility of single-food and multifood immunotherapy in a large cohort in an outpatient pediatric allergy clinic setting. A retrospective review of patients enrolled in single-food and multifood OIT between September 1, 2019, and September 30, 2020, and data collection of those patients until November 19, 2021, were performed. There were 151 patients who underwent either an initial dose escalation (IDE) or a standard oral food challenge. Seventy-eight patients were receiving single-food OIT with 67.9% reaching maintenance. Fifty patients were undergoing multifood OIT with 86% reaching maintenance to at least 1 OIT food and 68% reaching maintenance for all their foods. Of the 229 IDEs, there were low frequencies of failed IDEs (10.9%), epinephrine administration (8.7%), emergency department referrals (0.4%), and hospital admission (0.4%). Cashew accounted for one-third of failed IDEs. Epinephrine administration during home dosing occurred in 8.6% of patients. Eleven patients discontinued OIT owing to symptoms during up-dosing. No patients discontinued once reaching maintenance. Desensitization to 1 food or multiple foods simultaneously through OIT appears to be safe and feasible using the OIT protocol that has been established. The most common adverse reaction causing discontinuation of OIT was gastrointestinal symptoms.

Interdisciplinary feeding clinic during the coronavirus disease 2019 pandemic: Implementing telehealth and social determinants of health screening.

Interdisciplinary feeding clinic during the coronavirus disease 2019 pandemic: Implementing telehealth and social determinants of health screening.

"I Felt Like I Had Something I Could Do About It": Pediatric Clinician Experiences With a Food Insecurity-Focused Produce Prescription Program.

Efforts to address food insecurity (FI) in pediatric clinics have increased over the last decade, particularly after a groundbreaking 2015 American Academy of Pediatrics policy statement supporting universal routine screening and intervening. Produce prescription programs are a novel strategy addressing FI. Limited data exist on effectiveness and feasibility in pediatric clinical settings. This study explored clinician experiences after enrolling patients who completed a produce prescription program in an urban primary-care clinic in Washington, DC. One year after program completion, the experiences of 11 clinicians were explored through qualitative interviews and coded using thematic content analysis. Identified themes explored changes in clinician knowledge, attitudes, and behaviors. Clinicians expressed that the program offered a tangible resource to address FI, building trust and strengthening their sense of self-efficacy in addressing families' concerns. Incorporation of a produce prescription intervention to address FI was feasible and well accepted by pediatric primary-care clinicians.

Old Dog, New Tricks: A Review of Identifying and Addressing Youth Cannabis Vaping in the Pediatric Clinical Setting

Cannabis vaping has emerged as a predominant mode of cannabis use among United States (US) adolescents and young adults (AYA) primarily due to the popularity of modifiable designs of vaping devices coupled with changes in cannabis policies and increased availability of cannabinoid products. New methods for cannabis vaping by e-liquid/oil vaping, dry plant vaping, and cannabis concentrate vaping (ie, dabbing) have had high uptake among American youth with unclear long-term health implications. Issues with contamination, mislabeling, and expansion of the vaped cannabis market to include not only delta-9-tetrahydrocannabinol (delta-9-THC) and cannabidiol (CBD) but also delta-9-THC analogs (eg, delta-8 and delta-10) sold as hemp-derived "legal highs" further complicated this healthcare space. Recent research suggests that cannabis/THC vaping carries distinct and overlapping risks when compared to cannabis smoking and may be associated with greater risk for acute lung injuries, seizures, and acute psychiatric symptoms. Primary care clinicians providing care for AYA are in an ideal position to identify cannabis misuse and intervene early to address cannabis vaping. To improve public health outcomes, a need exists for pediatric clinicians to be educated about different ways/methods that youth are vaping cannabinoid products and associated risks related to cannabinoid vaping. Further, pediatric clinicians need to be trained how to effectively screen for and discuss cannabis vaping with their youth patients. In the current article, we present a clinically focused review of cannabis vaping among young people with 3 main aims to: (1) identify and describe the cannabis vaping products commonly used by American youth; (2) review the health correlates of youth cannabis vaping; and (3) discuss clinical considerations related to identifying and treating youth who vape cannabis.

Oral findings in pediatric patients with allergic rhinitis and asthma: a cohort study of an Italian setting.

Allergic rhinitis and asthma are two frequent respiratory clinical entities commonly encountered in pediatric clinical settings. Previous studies have evaluated the influence of these two conditions on oral health, but conflicting results have been obtained. The present cohort study aimed to record oral findings (i.e., caries, plaque, gingival inflammation and mouth breathing) in 50 pediatric patients diagnosed with allergic rhinitis and/or asthma in an Italian pediatric setting and to compare them to a control group of 50 healthy children. The following oral indexes were calculated: Periodontal Screening and Recording (PSR), Plaque Control Record (PCR), and Decayed Missing Filled Teeth (DMFT) Index. The absence or presence of mouth breathing was also recorded. Descriptive and inferential statistics were conducted. Statistically significant differences were found between cases and controls for PSR (p = 0.0051) and PCR scores (p < 0.0001), whereas no significant differences were detected for DMFT. Mouth breathing was found among 20 (40.00%) patients of the Case Group, while in the Control group only in 11 (22.00%) patients, and no significant differences were found between allergic rhinitis and asthma gradings for mouth breathers (p > 0.05). Finally, linear regressions showed a significant influence of PSR (p = 0.0051) and PCR (p < 0.0001) on the Case group. Mouth breathing also significantly influenced PCR scores of the Case group (p = 0.0206). Accordingly, allergic rhinitis and asthma can promote mouth breathing, plaque accumulation, and periodontal inflammation. Based on these considerations, pediatric dentists and physicians are expected to know the influence of respiratory conditions on oral health and consider this aspect when taking care of children.

Children's and adolescents' descriptors of asthma symptoms: An integrative review.

Accurate assessment of asthma symptoms is central to appropriate treatment and management; however effective communication about symptoms-how it is perceived and reported-remain challenging in pediatric clinical and research settings. To synthesize the existing pediatric literature on children's and adolescents' word descriptors of asthma symptoms. In this integrative review, we systematically searched Cumulative Index of Nursing and Allied Health Literature and PubMed databases to identify original research studies from 1980 to 2021 on children and adolescents' word descriptors of asthma symptoms. The search yielded 2,232 articles, of which 21 studies met the eligibility criteria. Scientific literature focused on children and adolescents' descriptions of asthma symptoms are limited. In addition to standard asthma symptom terminology (e.g. cough, wheeze, chest tightness, shortness of breath), pediatric populations used nonstandard word choices to describe the asthma symptom experience. Children and adolescents used a variety of affective (e.g. 'helpless', 'afraid of dying') and sensory words (e.g. 'pressure in chest', 'tightness, lungs feel shut') to describe the phenomena. Literature examining race differences in word descriptors in pediatrics is limited; thus it is unclear if word descriptors vary by race or ethnicity. Evidence of relationships between descriptors and gender and age are also lacking. Our review elucidates gaps in the literature regarding the full extent of the language common to racially and ethnically diverse samples of children and adolescents. Further research is warranted to help clinicians and researchers query children and adolescents' experience of asthma symptoms.

Exploring outcomes from an innovative, pediatric-focused intervention with undergraduate nursing students

BackgroundTo adapt to COVID-19 restrictions, a virtual pediatric skills day was developed to provide nursing students with practical experience prior to entering the pediatric clinical setting. Student assessment before and after participation indicate a virtual skills day is helpful in building student confidence prior to pediatric clinicals. MethodsThis mixed-method study involved a cross-sectional approach with a six-item survey administered before and immediately after the virtual pediatric skills day intervention to undergraduate junior nursing students. Outcome measures included comfort and preparation for pediatrics and families of pediatric patients. FindingsAfter exploring outcomes from 93 students complete pre and post intervention measures, we addressed comfort themes including excited, nervous, and readiness while preparedness themes highlighted concerns with parental interactions, upset children, and COVID-19 restrictions. DiscussionIt is beneficial for nursing students to have clinical experiences with children prior to visiting a pediatric clinical setting. Such experiences decrease student stress and anxiety and allow meaningful opportunities to occur.