Pediatric Experience Research Articles

Interviewing Teen Parents: Simulated Patient Experience for Clinical Education and Outreach.

Many medical students' initial experience obtaining a history from a pediatric patient happens in their clerkship years. There is a shift in medical education to provide early clinical experiences to train physicians. To increase the exposure to pediatric history in the pre-clinical years, we developed this simulation-based session involving students in their second year of medical school. They are tasked with eliciting a history from a babyprovided by a teenager who functions both as a standardized patient (SP)and the parent of the infant. Our goal was to have second-year medical students learn and practice interviewing an adolescent while obtaining history about an infant to assist in the transition to Year three Pediatric clerkship. Collaborating with the Office of Diversity at our medical school, we recruited students registered in medical academies in public middle and high schools in our county and asked them to be part of this simulation-based activity. A majority of these medical academy students are underrepresented in medicine (URiM). The students functioned as SPs for pre-clerkship medical studentswhile gaining exposure to a career in medicine and the medical school environment. The medical students obtained a history, with faculty providing formative feedback, followed by documentation of the encounter. Medical students felt they gained skills to communicate with caregivers of pediatric patients. They also practiced the skill of eliciting a pediatric history from an infant whose parent is a teenager. The middle and high school students that functioned as SPs gained a better appreciation for the medical education systemand felt that the experience was valuable for all parties involved. This session exposed pre-clerkship medical students to the nuances of eliciting a pediatric history from pediatric caregiverswhile also engaging URiM from middle and high school in the medical education process. This session could be used at other institutions to expand diversity in the medical fieldwhile also providing pre-clerkship medical students with pediatric experiences. This article was previously presented as an oral presentation at the AAMC Group on Education Affairs (GEA) Virtual Regional Spring Meeting on April 21, 2021.

Outcomes of temporary ventricular assist device: A pediatric institutional experience over 25 years

BackgroundThere are scarce data describing outcomes of pediatric temporary ventricular assist device support. MethodsA retrospective single-center study was conducted to review clinical outcomes of all consecutive patients with temporary ventricular assist device between 1996 and 2021. Given the complex clinical course in some patients requiring multiple temporary ventricular assist device runs, outcome analysis was based on “encounters” (hospitalizations with temporary ventricular assist device, regardless of the number of devices used). ResultsIn total, 126 temporary ventricular assist devices were implanted in 108 patients, resulting in a total of 114 encounters: 70 (61%) extracorporeal centrifugal pumps and 44 (39%) catheter-based axial pumps. The median (range) age and weight at temporary ventricular assist device implant were 10.1 years (1 day to 42.8 years) and 33.6 (2.5-128) kg, respectively. Underlying etiologies of cardiac dysfunction were cardiomyopathy (34, 30%), cardiac transplant graft dysfunction (29, 25%), congenital heart disease (23, 20%; 9 single ventricle), myocarditis (22, 19%), and other (6, 5%). Interagency Registry for Mechanically Assisted Circulatory Support Profile was 1 in 75 (66%) and 2 in 39 (34%). Support configuration was left ventricular assist device (104, including 9 systemic ventricular assist devices), right ventricular assist device (5), and biventricular assist device (5). The median (range) support duration was 6 (1-61) days. Overall, 97 (85%) encounters reached a positive primary end point: bridge-to-recovery (55), bridge-to-bridge (31), and bridge-to-transplant directly with temporary ventricular assist device (11). Seventeen (15%) encounters resulted in death during temporary ventricular assist device support: multiorgan failure (12), stroke (4), and cardiac arrest (1). The 6-month survivals with catheter-based axial pumps and extracorporeal centrifugal pumps were 84% (95% confidence interval, 74-96) and 67% (95% confidence interval, 57-79), respectively (P = .08). The 1- and 5-year survivals of 82 hospital survivors were 90% and 84%, respectively. ConclusionsThis study suggests temporary ventricular assist device support is feasible in children with favorable outcomes.

Children’s experiences of hospitalization over time: An evaluation of using poetry and creative writing by children to assess their experiences of hospitalization

This article explores children’s experiences of hospital admissions through their poetry and creative writing and assesses the validity of this medium compared to other methods of evaluation. Pediatric patient experiences of hospital and their effects on children have been studied in various ways and there have been stepwise changes throughout the past century, matching the overall changes of medical care from paternalistic to patient centered. 17 poems were analyzed from children aged 6-13 years old (median 10) for recurrent themes whilst admitted to a large tertiary hospital in the north of England. Children frequently wrote about attacks on their senses, missing friends and family as well as their interactions with hospital staff. Other aspects described by the children included invasive procedures, difficulty with sleep, and their opinions of hospital food. Not all things were described in a negative way, with positivity surrounding play areas, meeting new peers and the availability of play therapists. Children’s voices are often lost in the hospital setting and it is of vital importance that they are heard so that their care can be optimized and lessen any damaging effects that traumatic experiences have on them. The results of this article match those of previous investigations and show creative writing can be used as a patient experience analysis tool.

Adolescent paediatric transplant patients' experiences of transition to adult services.

Transition of adolescents from paediatric to adult health services is an important aspect of caring for young people with chronic diseases. Successful transition of adolescents living with a transplant is critical for long-term survival into adulthood. This qualitative study explored the lived experience of adolescents in a South African setting following their planned and supported transition process. To explore the lived experience of transition for adolescents who had received a renal or liver transplant as a child, from paediatric to adult transplant services in the public health sector. Cape Town, South Africa. Six purposively sampled adolescents, who had participated in a planned transition from a tertiary level children's hospital to the affiliated adult hospital, were interviewed in the setting and language of their choice. The transcribed interviews were analysed using an interpretative phenomenological analysis (IPA) approach. Five themes emerged: living with uncertainty in a changing world; being known, not knowing, and knowing; ambivalent relationships; the journey of loss; and being heard. Pre-transition planning, support groups, and consistency of clinicians within an accepting environment facilitated the adolescents' individuation and acceptance of self-care responsibility. Carefully planned, collaborative preparation and implementation of a facilitated psycho-supportive intervention for transition can facilitate adolescent cooperation and adherence, minimise the risk of psychological and medical sequelae, and support the adolescent in adapting to living with a transplant as an adult. This study offers insight into the importance of planned and supported transitional care of adolescents living with an organ transplant.

Type 2 diabetes mellitus in children and young people; Single UK paediatric diabetes centre experience

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

A Qualitative Study of Resident Experiences With Clinical Event Debriefing.

The facilitated discussion of events through clinical event debriefing (CED) can promote learning and wellbeing, but resident involvement is often limited. Although the graduate medical education field supports CED, interventions to promote resident involvement are limited by poor insight into how residents experience CED. The objective of this study was to characterize pediatric resident experiences with CED, with a specific focus on practice barriers and facilitators. We conducted this qualitative study between November and December 2020 at a large, free-standing children's hospital. We recruited pediatric residents from postgraduate years 1 to 4 to participate in virtual focus groups. Focus groups were digitally recorded, deidentified, and transcribed. Transcripts were entered into coding software for analysis. We analyzed the data using a modified grounded theory approach to identify major themes. We conducted 4 mixed-level focus groups with 26 residents. Our analysis identified multiple barriers and facilitators of resident involvement in CED. Several barriers were logistical in nature, but the most salient barriers were derived from unique features of the resident role. For example, residents described the transience of their role as a barrier to both participating and engaging in CED. However, they described advancing professional experience and the desire for reflective learning as facilitators. Residents in this study highlighted many factors affecting their participation and engagement in CED, including barriers related to the unique features of their role. On the basis of resident experiences, we propose several recommendations for CED practice that graduate medical education programs and hospitals should consider for supporting resident involvement in CED.

Alternative Clinical Learning Experiences for Nursing Education Using Virtual Individual Patients.

Acute care pediatric clinical experiences for undergraduate nursing students can present a challenge given the limited availability of clinical sites, increased restrictions, and variations in direct patient care experiences. Unfolding virtual individual patient pediatric simulations were developed using complex pediatric disorders with multiple physiological, psychosocial, and developmental components. Ten unfolding simulations were implemented to standardize clinical experiences and replace clinical hours. Students were evaluated using the Quint Leveled Clinical Competency Tool, demonstrating overall progressing ability to use clinical reasoning skills. Unfolding virtual individual patients allow for deliberate, coordinated, and consistent exposure to clinical experiences and are a valuable substitution for traditional clinicals.

The Evaluation of Troponin I Levels and Myocarditis in Children with COVID-19: A Pediatric Single-Center Experience.

Children with COVID-19 usually show milder symptoms than adults; however, a minority of them may have cardiac involvement. We aimed to identify the role of troponin I levels that may predict early cardiac involvement in children with COVID-19. A single-center retrospective study was conducted to evaluate hospitalized children diagnosed with COVID-19 between March 11, 2020, and December 31, 2021. Patients with available troponin I levels and with no known cardiac disease were included. During the study period, 412 children with COVID-19 who had troponin I levels on admission were identified. Troponin levels were elevated in 7 (1.7%) patients and were normal in 395 (98.3%) patients. The median age of patients with elevated troponin levels was 4 (min. 2–max. 144) months, which was statistically lower than the age of patients with normal troponin levels (P = 0.035). All the patients with elevated troponin levels had tachycardia. Out of 7 patients with high troponin levels, 3 (42.9%) of them were admitted to the pediatric intensive care unit (PICU), 2 (28.6%) required oxygen support, and 1 (14.3%) required a mechanical ventilator. Patients with elevated troponin levels had a statistically longer hospital stay (P < 0.001). Neutropenia, tachycardia, PICU admission, oxygen support, and mechanical ventilation were statistically more common in patients with elevated troponin levels (P values were 0.033, 0.020, < 0.001, 0.050, and < 0.001, respectively). Electrocardiography (ECG) and echocardiography (ECHO) were performed on all patients with elevated troponin levels, and 6 (85.8%) patients were diagnosed with myocarditis. The ECG and ECHO have been performed in 58 (14.3%) out of 405 patients with normal troponin levels. Two (3.5%) patients had negative T waves on ECG, and all ECHOs were normal. Our results suggest that elevated troponin I levels in children with COVID-19 can be used to evaluate cardiac involvement and decide the need for further pediatric cardiologist evaluation.

Trends in the treatment of undescended testes: a pediatric tertiary care center experience from Croatia

ObjectiveUndescended testes (UDT) is the most common anomaly of the male genitourinary tract. The guidelines suggest that orchidopexy in congenitally UDT should be performed between 6 months and 18 months...

“I would watch her with awe as she swallowed the first handful”: A qualitative study of pediatric multidrug-resistant tuberculosis experiences in Durban, South Africa

There are limited data on the experiences of children being treated for drug-resistant tuberculosis (DR-TB), and most work in the area has been done with older children and adolescents. Comprehensive explorations of the caregiver experiences in this area are also lacking. To describe the experiences of being treated for drug-resistant tuberculosis of children and their caregivers. This was a qualitative study done using focus group discussions (FGDs) among three different groups of participants: 1) health care providers involved in the care of children being treated for DR-TB (including physicians, nurses, and pharmacists)-herein referred to as providers; 2) household caregivers of children being treated for DR-TB-herein referred to as caregivers; and 3) children who were being treated for DR-TB-herein referred to as children. The population was a convenience sample and included children hospitalized between January 1, 2018, and June 30, 2020, ages 0-14 years old, as well as their caregivers and providers. Focus group transcripts and notes were analysed using a thematic network analysis based in grounded theory The analysis was iterative and the coding system developed focused on "stressful experiences" as well as ways to address them along the diagnostic and treatment journey. This paper follows the COREQ guidelines. 16 children between the ages 7 and 14 years participated in 5 FGDs, 30 caregivers participated in 7 FGDs, and 12 providers participated in 3 FDGs. Data from the children and the caregivers were the focus of this analysis, although some themes were informed by the discussions with the providers as well. In general, it was reported that for a child diagnosed with DR-TB, there is a lived experience of stress that impacts their physical, mental, and social well-being. These pediatric patients and their families therefore develop strategies for coping with these disruptions to their lives. In general, there were major disruptive experiences that resulted from the process around receiving a diagnosis of DR-TB and second distinct set of stressful experiences that occurred during the treatment of DR-TB once the diagnosis had been made. These stresses occur in the physical, mental, and social realms, and families develop multiple strategies to cope with them, demonstrating resilience in the face of this disease. Addressing the stresses experienced by children and their caregivers through child-friendly DR-TB testing, treatment, and counseling is not only essential for ending TB but also for enacting a human-rights based approach to child health in general. Children with DR-TB are a vulnerable population, and they have often been the last to benefit from advances in general pediatric care and in DR-TB care more specifically.

Parental Perceptions of the Efficacy of Methylphenidate on Health-Related Quality of Life in Survivors of Paediatric Brain Tumour

Purpose: Survivors of pediatric brain tumor experience substantial post-treatment challenges, facing greater cognitive impairment and lower Health-Related Quality of Life (HRQoL) compared to survivors of other childhood cancers. Early studies report methylphenidate to benefit cognition and HRQoL in paediatric survivors of cancer via improved processing speed and attention. Parental opinion is an important element of treatment decision making, however parents’ views on methylphenidate treatment have not been reported. This study explored parental perceptions of their child’s treatment with methylphenidate. Materials and methods: An evaluation of 10 parents of children with previous brain tumour receiving methylphenidate was performed. Data were gathered by qualitative parental-report HRQoL questionnaire (PedsQL parent form) and by a questionnaire developed for use in this population. Results: Preliminary data suggest that parents are positive about the use of methylphenidate as an interventional measure, and believed this to have a beneficial impact on their child’s HRQoL. Conclusion: Early data from a small sample of parents suggest that methylphenidate may be effective in supporting HRQoL within this population. Parental information supports an increasing evidence base for the benefits of methylphenidate as an intervention for the management of long-term difficulties associated with paediatric cancer.

The Pediatric Pharmacy Association and Members Threaded Through a Career and the Impact on Pediatric Drug Development.

The Pediatric Pharmacy Association and Members Threaded Through a Career and the Impact on Pediatric Drug Development.

Reliability and Validity of the Dental Anxiety Question Used With Children.

Dental fear screening is an important part of providing a positive pediatric dental experience. To improve efficiency, the development of a single-item dental fear assessment tool for children has been desired. In this psychometric analysis, the reliability and validity of the Dental Anxiety Question (DAQ) is studied when used in children aged 7 to 18 years. Participants completed the DAQ (pre-tx-DAQ), the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), and a demographic information questionnaire before treatment. Participants repeated the DAQ after treatment (post-tx-DAQ) and once more at least 2 weeks later (follow-up-DAQ). Stability reliability within the DAQ scores and criterion validity with the CFSS-DS were evaluated. Stability reliability analyses between pre-tx-DAQ/post-tx-DAQ and post-tx-DAQ/follow-up-DAQ demonstrated significant positive correlations: Spearman rank correlation coefficient (rs) = 0.420, rs2 = 0.18, P &lt; .001, and rs = 0.563, rs2 = 0.32, P &lt; .001, respectively. Criterion validity analysis between the pre-tx-DAQ and CFSS-DS also demonstrated a significant correlation: Pearson correlation coefficient (r) = 0.584, r2 = 0.34, P &lt; .001. The stability reliability and criterion validity of the DAQ was proved among children.

P11.25: Why Do Not All Living Kidney Donor Candidates Are Accepted For Donation? A Pediatric Center Experience

P11.25: Why Do Not All Living Kidney Donor Candidates Are Accepted For Donation? A Pediatric Center Experience

Assessment of Nurses' Knowledge and Confidence Regarding Tracheostomy Care in a Pediatric Long Term Care Hospital in Saudi Arabia.

BackgroundThe incidence of tracheostomy insertion in pediatric patients has increased over the last few decades. Tracheostomized pediatric patients need daily, meticulous care by qualified nurses to minimize severe, avoidable complications. Adequately trained nurses facilitate patients’ stability, accelerate weaning from the ventilator, and reduce potential tracheostomy dislodgement.MethodsA cross-sectional, retrospective cohort survey was conducted in September 2021, using an electronic version of a self-questionnaire, to assess nurses’ knowledge and comfort level regarding tracheostomy care of pediatric patients at the International Extended Care Center in Jeddah, Saudi Arabia. Statistical analysis of the accrued data was performed using the SPSS 21.0 software package and a P-value <0.05 calculated by t-Test, was considered significant.ResultsAmong 43 nurses included in the study, 14 (32.6%) were very comfortable taking care of tracheostomized patients, 13 (30.2%) were comfortable, and 16 (37.2%) were uncomfortable. Regarding knowledge, three main aspects of tracheostomy care were correctly answered (%) by all the nurses: knowledge of routine tracheal care (55%), tracheal care skills (11.6%), and tracheal emergency care (2.3%). The study showed a significant positive correlation between nurses’ comfort level with tracheal care and academic degree, duration of pediatric experience, completion of more than one life support course, and attendance at the annual local tracheostomy care competency learning program (TCCLP; all P <0.05).ConclusionDeficits exist in nurses’ knowledge of tracheostomy care. Improved knowledge garnered through repetitive participation in tracheostomy competency programs and life support courses correlate with greater comfort and more than 5 years of pediatric experience. Nurses’ deficits in emergency care knowledge and skills should be addressed through a structured educational program and a simulation, hands-on based TCCLP course, irrespective of comfort level with tracheostomy care.

Adult Head and Neck Rhabdomyosarcoma: Management, Outcomes, and the Effect of Intensity Modulated Radiation Therapy on Locoregional Control

PurposeOnly 9% of adult rhabdomyosarcomas (RMS) present with primary disease in the head and neck (HNRMS). Management is often extrapolated from the pediatric experience in which prognosis is better but treatment imperatives differ. We report management and outcomes of adult HNRMS treated over 3 decades. Methods and MaterialsAdult HNRMS treated from 1984 to 2017 were reviewed. HNRMS were categorized as embryonal/alveolar (E/A) or pleomorphic (P). Standard management was as follows: E/A-HNRMS were treated with neoadjuvant chemotherapy, definitive chemoradiotherapy (CRT), and then maintenance chemotherapy. P-HNRMS were generally treated with surgery +/– radiation. Intensity modulated radiation therapy (IMRT) was adopted from 2005 onward. ResultsFifty-eight patients were eligible; the median age was 32 years. Seventy-six percent of tumors (n = 45) were parameningeal and 45% (n = 26) were >5 cm. Of 45 patients with M0 HNRMS treated with curative intent, 33 (73%) were E/A-HNRMS and 12 (27%) P-HNRMS. Patients with E/A-HNRMS received definitive RT with 66 to 70 Gy in 2 Gy per fraction. Elective nodal RT was routinely delivered. In the pre-IMRT era (before 2005), 12 of 23 (52%) patients with M0 E/A-HNRMS experienced locoregional recurrences. In the IMRT era (2005 and onward), 1 of 10 patients (10%) with M0 disease recurred locally; this patient achieved a complete clinical response despite a 3-week interruption after 48 Gy because of local toxicity but experienced an in-field local recurrence 45 months later that resulted in death. Locoregional control was superior in the IMRT era vs pre-IMRT era (P = .049). Distant metastasis among patients with E/A-HNRMS was the predominant mode of treatment failure (n = 17 of 33, 52%). ConclusionsOur study shows a high rate of locoregional control for adult E/A-HNRMS following definitive CRT using IMRT, and CRT should be considered for the majority of patients in this population. In contrast, P-HNRMS is distinct and requires surgery +/– RT.

Pediatric Headache Experience During the COVID-19 Pandemic.

ObjectiveHeadache disorders are exceedingly common in children and adolescents. The association between headaches, emotional stress, and disruptions in daily routines are well established. The goal of this study is to compare the experiences of patients with a preexisting diagnosis of a primary headache disorder in terms of headache frequency and severity, lifestyle techniques for headache prevention, screen use, and mood from before and after the onset of the COVID-19 pandemic.MethodsPatients evaluated by the Headache Clinic at Children’s National Hospital between Summer 2020 and Winter 2021 were enrolled in a patient registry. Patients completed a questionnaire examining changes in headache characteristics and lifestyle factors since the onset of the COVID-19 pandemic.ResultsA total of 107 patients completed the survey. Since the pandemic’s onset, patients reported decreased physical activity (n = 59, 55%), increased frequency of chronic headaches from 40% (N = 42) to 50% (N = 54), and increased constant daily headaches from 22% (n = 24) to 36% (n = 38). Patients reported worsened anxiety (n = 58, 54%), mood (n = 50, 47%), and workload (n = 49, 46%). Sixty-one percent (n = 65) of patients reported using screens for school for more than 6 hours per day. The majority (n = 67, 63%) of patients indicated that they would prefer attending in-person school, with 14% (n = 15) responding that they preferred online school.ConclusionSince the COVID-19 pandemic’s onset, pediatric headache patients have experienced increasing headache frequency, worsening anxiety and mood, decreased physical activity, and increased screen usage. Although this study is limited by sample size and observational design, future population-based studies will further elucidate the impact of this pandemic on pediatric headache.

Photodynamic therapy in pediatric age: Current applications and future trends.

Photodynamic therapy (PDT) is a photochemotherapy based on local application of a photosensitive compound and subsequent exposure to a light source of adequate wavelength. It is a non-invasive therapeutic procedure widely used in oncodermatology for treatment of numerous skin cancers, but in the last years its use has been gradually extended to an increasing list of skin diseases of both infectious and inflammatory nature. Although PDT is proven as a safe and effective therapeutic option in adults, its use is not well standardized in the pediatric population. In this review, we will focus on clinical applications, mechanisms of action, protocols, and adverse events in children and adolescents. Most of pediatric experiences concerned treatment of skin cancers in Gorlin syndrome and xeroderma pigmentosum, acne vulgaris, and viral warts, but other applications emerged, such as cutaneous lymphoma and pseudo-lymphomas, necrobiosis lipoidica, hidradenitis suppurativa, dissecting cellulitis, leishmaniasis, angiofibromas, verrucous epidermal nevus, and linear porokeratosis. In these pediatric diseases, PDT appeared as an effective therapeutic alternative. The results on vitiligo were limited and not fully encouraging. Although highly versatile, PDT is not a therapy for all skin diseases, and a deeper knowledge of its mechanisms of action is required to better define its spectrum of action and safety in pediatric patients.

Boarding for Youth Mental Health Conditions: How Can Hospitalists Be Part of the Solution?

Boarding for Youth Mental Health Conditions: How Can Hospitalists Be Part of the Solution?

In ongoing efforts to vaccinate communities against COVID-19, pharmacists must address fear and misinformation

In ongoing efforts to vaccinate communities against COVID-19, pharmacists must address fear and misinformation