Pediatric Community Research Articles

Experience in establishing Community Paediatric services at Teaching Hospital Batticaloa in Batticaloa District

Experience in establishing Community Paediatric services at Teaching Hospital Batticaloa in Batticaloa District

Kindy Moves: the feasibility of an intensive interdisciplinary programme on goal and motor outcomes for preschool-aged children with neurodisabilities requiring daily equipment and physical assistance

ObjectivesTo determine the feasibility of an intensive interdisciplinary programme in improving goal and motor outcomes for preschool-aged children with non-progressive neurodisabilities. The primary hypothesis was that the intervention would be...

Improving health outcomes for patients and families with preferred language other than English or French (PLOEF).

Equitable care considers the unique needs of an individual-including social determinants of health such as language, race, and gender. Health equity and providing equitable care are considered fundamental to medicine, however, in practice there continues to be significant gaps to providing equitable care. There is a growing body of research on health care disparities, such as research on patients and families who have a preferred language other than English or French (PLOEF), who have worse health outcomes. Language barriers have been associated with increased risk of hospital admission, increased risks of misdiagnosis, poorer patient understanding of and adherence to prescribed treatment, lower patient satisfaction, and increased risk of experiencing adverse events. This commentary aims to examine issues faced by patients and families with PLOEF, particularly among hospitalized children and youth, and propose how the paediatric community can work to improve their care and health outcomes.

Characterizing inter- and intra-individual differences in migraine-related cognitive symptoms and impairment across the migraine cycle: An analysis of the MiCOAS qualitative project (P7-12.007)

Characterizing inter- and intra-individual differences in migraine-related cognitive symptoms and impairment across the migraine cycle: An analysis of the MiCOAS qualitative project (P7-12.007)

Exploring within-person differences in migraine-associated symptoms across phases of the migraine cycle: Results of the MiCOAS Qualitative Study (P7-12.006)

Exploring within-person differences in migraine-associated symptoms across phases of the migraine cycle: Results of the MiCOAS Qualitative Study (P7-12.006)

Community pediatrics

Community pediatrics

“I’m 'just' a community pediatrician” views and challenges of pediatricians working in the community in Israel

BackgroundThere are ongoing changes around the world in the training and practice of pediatricians who work in the community. These changes are driven by the understanding that pediatricians are required to provide not only acute primary care but also to address more comprehensive concerns, particularly the ‘new morbidities’. The present study examines the professional identity of Israeli pediatricians in the community in light of these changes, the barriers and challenges to their work and professional adaptations in the field.MethodsWe used a mixed-methods approach, collecting the perspectives of 137 pediatricians who work in the community through an anonymous online survey, followed by in-depth semi-structured interviews with 11 community pediatricians.ResultsThe survey results show that community pediatricians in Israel have limited knowledge on a variety of developmental, behavioral and emotional issues; that they lack working relationships with medical or other professionals; and are rarely engaged with other community services. Three main themes arose from the interviews that support and deepen the survey results: perceptions of the profession (pediatrics in the community vs. community pediatrics), the stature of pediatricians in the community (during residency, the choice to work in the community, their daily work) and barriers and change in community pediatrics (isolation, limited resources and challenges arising from the nature of community work).ConclusionsThe present study sheds light on the professional identity and the day-to-day challenges and successes of pediatricians working in the community. Continuing medical education, providing a supportive framework and professional community, better resources, more time with patients, and tools and opportunities for professional development would help pediatricians who work in the community to overcome some of these challenges. The research findings reinforce the need for policy change in the field of community pediatrics with a specific community training curriculum, provision of more resources and ongoing support for pediatricians. This requires partnership between the HMOs, the Ministry of Health, the Scientific Council (Israel Medical Association, professional organizations) and NGOs in order to turn individual-level solutions into system-level and policy-changing solutions.

Cardiac Disease in Childhood Cancer Survivors Treated With Radiation Therapy: A PENTEC Comprehensive Review

Radiation therapy (RT) is an essential component in the treatment of many pediatric malignancies. Thoracic RT may expose the heart to radiation dose and thereby increase the risk of late cardiac disease. This comprehensive review from the Pediatric Normal Tissue Effects in the Clinic (PENTEC) initiative focused on late cardiac disease in survivors of childhood cancer treated with RT. This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. We identified 1496 articles; 4 were included for dose-response modeling between mean cardiac radiation dose and risk of late coronary artery disease, heart failure (HF), valvular disease, and any cardiac disease. For each 10-Gy increase in corrected mean cardiac radiation dose in 1.8- to 2.0-Gy fractions, we estimated a hazard ratio of 2.01 (95% confidence interval [CI], 1.79-2.25) for coronary artery disease, of 1.87 (95% CI, 1.70-2.06) for HF, of 1.87 (95% CI, 1.78-1.96) for valvular disease, and of 1.88 (95% CI, 1.75-2.03) for any cardiac disease. From the same model, for each 100-mg/m2 increase in cumulative anthracycline dose, the hazard ratio for the development of HF was 1.93 (95% CI, 1.58-2.36), equivalent to an increase in mean heart dose of approximately 10.5 Gy. Other nontreatment factors were inconsistently reported in the analyzed articles. Radiation dose to the heart increases the risk of late cardiac disease, but survivors of childhood cancer who receive a mean dose <10 Gy at standard fractionation are at low absolute risk (<∼2% approximately 30 years after exposure) of late cardiac disease in the absence of anthracycline exposure. Minimizing cardiac radiation dose is especially relevant in children receiving anthracyclines. When cardiac sparing is not possible, we recommend prioritizing target coverage. It is likely that individual cardiac substructure doses will be a better predictor of specific cardiac diseases than mean dose, and we urge the pediatric oncology community to further study these relationships.

Impact of COVID‐19 in relation to the outpatient pediatric feeding therapy experience: A speech‐language pathologist's review of literature and professional experience

It is well known in the medical and pediatric feeding community how parental stress affects outcomes of pediatric nutrition and feeding behaviors. There is growing literature suggesting the impact of the COVID-19 pandemic in relation to caregiver and child stress. It could be suggested that this increase in stress contributed to or exacerbated pediatric feeding difficulties. In addition, the COVID-19 pandemic resulted in pediatric rehabilitation therapists quickly transitioning from in-person to virtual evaluation and treatment models. The purpose of this article is to review current literature regarding the definition and prevalence of pediatric feeding disorder, the impact of the COVID-19 pandemic on parent/child stress and relationships surrounding feeding, and this speech-language pathologist's perception of both the positive and negative aspects of providing ongoing outpatient feeding evaluations and treatments in the context of the COVID-19 pandemic, as well as clinical considerations for ongoing feeding therapy after the COVID-19 pandemic.

THE GENIUS BEHIND GUIDELINES

Medical guidelines are documents containing recommendations which can be used in clinical practice. They are intended to help physicians make informed decisions on diagnostic or treatment dilemmas and help achieve the best outcomes for patients. Medical guidelines are not made overnight. Members of the guidelines development committee, composed of a multidisciplinary panel of experts from key groups, are carefully chosen to produce a high qualityscientificdocument. Thisisachievedthrough atransparent,evidence-baseddecision-makingprocess that is labor intensive and rigorous. This ensures that guidelines are sound, credible and at par with international standards. The process starts by defining the topic and scope for guideline development. Key issues and questions regarding the topic are drafted. Review of questions, literature search, evidence reviews, and committee discussions are done. Available medical evidence are summarized, and grading of evidence is made, until a draft recommendation is developed. Draft guidelines are then reviewed by stakeholders until a final guideline is produced and published. In this special issue, we bring you outputs from this guideline development process - four relevant documents on COVID-19, Pediatric Community Acquired Pneumonia (in collaboration with the Philippine Academy of Pediatric Pulmonologists), Leptospirosis, and Pediatric Immunization (prepared by the National Institutes of Health-Institute of Clinical Epidemiology and funded by the Department of Health ). The guideline development process is imperfect. Some shortcomings include paucity of evidence on certain questions, presence of potential conflicts of interest among members of the committee, limitations in funding, and even time. The major advantage is access to a summarized wealth of evidence on a specific topic to enhance physician expertise, improve healthcare quality, and reduce healthcare cost. Guidelines can also influence health policies so that underrecognized health concerns and services can be made available to the majority. Guidelines should be used with the best interest of the individual patient in mind. They help to improve patient care quality. The complex medical decision making process done by the physician however, should not be limited by simplistic algorithms suggested by guidelines.

Fetal Alcohol Spectrum Disorder and Neuropsychology: Exploring the implications of new NICE quality standards (2022) for neuropsychologists through a pilot assessment service

Recently released NICE Quality Standards for the assessment and diagnosis of Fetal Alcohol Spectrum Disorder (FASD) in children and young people emphasise neuropsychological assessment as an important part of the process. However, for many areas of England &amp; Wales this may not be in line with current service provision. We conducted a scoping study of services within Oxfordshire to understand the current support available for children with possible FASD. In addition, we offered a pilot neuropsychology assessment service for seven children referred by a Community Paediatrician. We found that many services across Oxfordshire work with children who they suspect to have FASD, but no service offers FASD assessment or specific intervention. A trial neuropsychology service confirmed evidence for significant heterogeneity within this population, and therefore the need for careful, hypothesis driven assessment, to which neuropsychologists are well-placed to contribute.

Quality improvement dissemination in pediatric surgery: The APSA quality and safety toolkit

Shared experiential learning is critical in the field of pediatric surgery to support the translation of evidence into practice. Surgeons who develop QI interventions in their own institutions based on the best available evidence create work products that can accelerate similar projects in other institutions, rather than continuously reinventing the wheel. The American Pediatric Surgical Association (APSA) Quality and Safety Committee (QSC) toolkit was created to facilitate knowledge-sharing and thereby hasten the development and implementation of QI. The toolkit is an expanding open-access web-based repository of curated QI projects that includes evidence-based pathways and protocols, stakeholder presentations, parent/patient educational materials, clinical decision support (CDS) tools, and other components of successful QI interventions in addition to contact information for the surgeons who developed and implemented them. This resource catalyzes local QI endeavors by showcasing a range of projects that can be adapted to fit the needs of a given institution, and it also serves as a network to connect interested surgeons with successful implementers. As healthcare shifts towards value-based care models, quality improvement becomes increasingly important, and the APSA QSC toolkit will continue to adapt to the evolving needs of the pediatric surgery community.

Arresting microbiome development limits immune system maturation and resistance to infection in mice

Disruptions to the intestinal microbiome during weaning lead to negative effects on host immune function. However, the critical host-microbe interactions during weaning that are required for immune system development remain poorly understood. We find that restricting microbiome maturation during weaning stunts immune system development and increases susceptibility to enteric infection. We developed a gnotobiotic mouse model of the early-life microbiome Pediatric Community (PedsCom). These mice develop fewer peripheral regulatory Tcells and less IgA, hallmarks of microbiota-driven immune system development. Furthermore, adult PedsCom mice retain high susceptibility to Salmonella infection, which is characteristic of young mice and children. Altogether, our work illustrates how the post-weaning transition in microbiome composition contributes to normal immune maturation and protection from infection. Accurate modeling of the pre-weaning microbiome provides a window into the microbial requirements for healthy development and suggests an opportunity to design microbial interventions at weaning to improve immune development in human infants.

Geographic distribution of the major clone of extended-spectrum beta-lactamase-producing Escherichia coli infection in a pediatric community in southern Taiwan

BackgroundThe geographic distribution of the major clone of sequence type 131 (ST131) in extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) infections is not known. We analyzed the clinical features, resistance mechanisms, and geographic distribution of ESBL-producing E. coli clones in 120 children. MethodsWe studied the 120 ESBL-producing E. coli strains from children younger than 18 years. A VITEK 2 automated system was used to determine bacterial identification and ESBL production. Sequence type was determined by multi-locus sequence typing (MLST). The genetic relationship of the ESBL-producing strains was studied using pulsed-field gel electrophoresis (PFGE). Phylogenetic group and blaCTX-M group was performed using polymerase chain reaction (PCR). Multiplex PCR for detecting the common group 9 variant, CTX-M-14, and group 1 variant, CTX-M-15, was also performed. The addresses of the 120 children were collected, and plotted on the Taiwan map. ResultsThe groups in the center of Kaohsiung City lived mainly in urban areas with a population density of over 10,000 people per square kilometer, and the majority of the Kaohsiung groups on the outskirts of the city center lived in suburban areas with a population density of under 6000 people per square kilometer. There was no statistically significant difference between the city center and outskirt groups in terms of clinical presentation, laboratory, and imaging data. However, more ST131 clones, major pulsotype groups, and phylogenetic group B2 strains were found in the center of Kaohsiung than on the outskirts. ConclusionESBL-producing E. coli clones may be more challenging to treat clinically. Most infections were community-acquired, and there appeared to be major pulsotype clones, mainly in urban areas. This reinforces the necessity of environmental surveillance and sanitary procedures for ESBL-producing E. coli.

Health Outcomes of Children Living in Out-of-Home Care in Metropolitan Western Australia: A Sequential Mixed-Methods Study—A Protocol Paper

The research protocol described aims to examine and establish the health outcomes of children and young people living in Out-of-Home Care (OOHC) in Perth, Western Australia (WA) from the perspective of the care recipients and service providers. A Study Advisory Panel (SAP) will be established comprised of Aboriginal Elders (because of the over-representation of Aboriginal children in OOHC), health professionals and other relevant stakeholders to help co-design all phases of the study. Mixed methods will be used in data collection and analysis. In the quantitative phase, it is proposed to collect retrospective data from three WA Department of Communities (DOC) districts. The data proposed to be collected includes: the number of children who received initial and annual health assessments, the health needs identified, and interventions put in place to address these needs. The qualitative phase will consist of interviews with service recipients (young people who have exited OOHC and Carers), health service providers (Community Health Nurses, School Nurses, General Practitioners and Paediatricians) and OOHC Case Workers. The research will provide an overview of the current health needs of children and young people in OOHC in WA and the perspectives of these young people, their Carers and service providers on current processes for accessing healthcare. It is anticipated that the study will provide valuable evidence for quality improvement in health service delivery to better meet the health needs of children and young people in OOHC.

Management of a very rare case of polyorchidism: a case report

BackgroundPolyorchidism is a rare genetic anomaly characterized by the patient having more than two testicles. In the literature, only around two hundred cases have been reported. We present an unusual new case which does not conform to the traditional classifications of polyorchidism or previously reported cases. We discuss our diagnostic techniques as well as management decisions for this case and aim to raise awareness about the management choices available.Case reportA 3-year-old male presented to the clinic by his parents due to concern of a painless swelling in the left inguinal region. Physical examination revealed features of a left indirect inguinal hernia. Furthermore, scrotal examination revealed a firm, non-compressible painless mass in the left scrotum which was inferior to the left testis. Ultrasonography suggested the mass as an extra testis, and MRI was followed which showed no signs of malignancy. Due to the reassuring nature of these findings, a conservative approach was taken, with the patient referred for regular follow-up.ConclusionWhen facing cases of polyorchidism, physicians should move away from considering surgical excision and biopsy as exclusive first-line management. Instead, we place emphasize and raise awareness about the option of conservative management if imaging shows no abnormalities. Ultimately, the aim of this paper is to raise awareness among the paediatric surgeon community that while excision may be a valid option, it is not the only treatment.

Virtual communication training to address COVID-19 vaccine hesitancy.

Medical EducationEarly View REALLY GOOD STUFF Virtual communication training to address COVID-19 vaccine hesitancy Francis J. Real, Corresponding Author Francis J. Real [email protected] orcid.org/0000-0002-7980-3185 Correspondence Francis J. Real, Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2011, Cincinnati, OH 45229, USA. Email: [email protected]Search for more papers by this authorAndrea Meisman, Andrea MeismanSearch for more papers by this authorBrittany L. Rosen, Brittany L. RosenSearch for more papers by this author Francis J. Real, Corresponding Author Francis J. Real [email protected] orcid.org/0000-0002-7980-3185 Correspondence Francis J. Real, Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2011, Cincinnati, OH 45229, USA. Email: [email protected]Search for more papers by this authorAndrea Meisman, Andrea MeismanSearch for more papers by this authorBrittany L. Rosen, Brittany L. RosenSearch for more papers by this author First published: 28 February 2023 https://doi.org/10.1111/medu.15061 Funding information: This work was supported through the Cincinnati Children's Hospital Medical Center Place Outcomes Research Award. Funders played no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data, and preparation, review or approval of the manuscript. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

A "global village": promoting research and careers in the pediatric radiology community through diversity.

There is a severe shortage of pediatric radiologists in the USA and across the globe due to multiple factors. These severe shortages, along with increased clinical demand, growing research costs and limited funding sources place pediatric radiologists, particularly those in academic departments, under increasing time pressure, affecting their ability to maintain research productivity. In this paper, we model a new concept that should help boost the research efforts within the pediatric radiology community, while diversifying the academic workforce through the involvement of international medical graduates (IMGs). We describe the mutual advantages this concept could have on academic pediatric radiology departments and IMGs alike, as well as pose some of the unique challenges that could impact this concept and effective strategies to ensure success.

Comparative Study between some Parameters in Ultrasonography and Renal Scintigraphy in the Evaluation of Hydronephrosis among Iraqi Paediatric patients

Hydronephrosis describes a urinary tract abnormality where hydrostatic dilatation of the renal pelvis and calyces exists and considered as a hallmark for obstruction to urine flow downstream. Detecting the pathologic hydronephrosis cases along with the cause using the least invasive techniques is a matter of interest since ages especially in pediatric community. In the Iraqi healthcare practice, many cases are referred for advanced urology imaging tests without clear rational. This study aims to evaluate the rational of referring hydronephrosis pediatric cases to renal scintigraphy studies by comparing the results with the ultrasonography using particular parameters. A cross-sectional observational study involved prospective measurement of a number of variables via two main radiology techniques; sonography and scintigraphy was carried on in Baghdad, Iraq. Classical US and dynamic renal MAG-3 were performed on the same day for each of 35 children aged between 1-5 years presumed or suspected to have obstructive type of hydronephrosis by earlier US work-up. Results revealed a clear statistical significance between normal differential renal function and the good quality of renal drainage of Mag-3 test with the undilated PCS category (p-value 0.028) when measured by our team using the sonography technique. Other results of the calyceal dimension (CD) and the parenchymal thickness (PT) have failed to obtain a statistical significant difference when compared with the categories of the three variables of MAG-3. This study supports the inference of assessing renal function based on sensitive parameters of evolutionary sonography. Each radiologist/nephrologist/urologist should evaluate the measurement of reliable parameters of sonography especially the anteroposterior diameter of the pelvicalyceal system (APD of PCS) at the hilum area and the parenchymal thickness (PT) in millimeters and set the pediatric patient for logical follow-up before recommending the dynamic scintigraphy tests.

Do we need more clinical trials?

Do we need more clinical trials?