Pediatric Health Care Providers Research Articles

“I’d like more options!”: Interviews to explore young people and family decision-making needs for pain management in juvenile idiopathic arthritis

BackgroundJuvenile idiopathic arthritis (JIA) is a common pediatric rheumatic condition and is associated with symptoms such as joint pain that can negatively impact health-related quality of life. To effectively manage pain in JIA, young people, their families, and health care providers (HCPs) should be supported to discuss pain management options and make a shared decision. However, pain is often under-recognized, and pain management discussions are not optimal. No studies have explored decision-making needs for pain management in JIA using a shared decision making (SDM) model. We sought to explore families’ decision-making needs with respect to pain management among young people with JIA, parents/caregivers, and HCPs.MethodsWe conducted semi-structured virtual or face-to-face individual interviews with young people with JIA 8–18 years of age, parents/caregivers and HCPs using a qualitative descriptive study design. We recruited participants online across Canada and the United States, from a hospital and from a quality improvement network. We used interview guides based on the Ottawa Decision Support Framework to assess decision-making needs. We audiotaped, transcribed verbatim and analyzed interviews using thematic analysis.ResultsA total of 12 young people (n = 6 children and n = 6 adolescents), 13 parents/caregivers and 11 HCPs participated in interviews. Pediatric HCPs were comprised of rheumatologists (n = 4), physical therapists (n = 3), rheumatology nurses (n = 2) and occupational therapists (n = 2). The following themes were identified: (1) need to assess pain in an accurate manner; (2) need to address pain in pediatric rheumatology consultations; (3) need for information on pain management options, especially nonpharmacological approaches; (4) importance of effectiveness, safety and ease of use of treatments; (5) need to discuss young people/families’ values and preferences for pain management options; and the (6) need for decision support. Themes were similar for young people, parents/caregivers and HCPs, although their respective importance varied.ConclusionsFindings suggest a need for evidence-based information and communication about pain management options, which would be addressed by decision support interventions and HCP training in pain and SDM. Work is underway to develop such interventions and implement them into practice to improve pain management in JIA and in turn lead to better health outcomes.

Interprofessional reflective practice to improve pediatric healthcare outcomes

ABSTRACT There is limited research on the combined concepts of interprofessional reflective practice on healthcare outcomes. This research sought to better understand the concepts of interprofessional and reflective practice when utilized together to assess provider perception of improved healthcare outcomes in a pediatric setting. This article explores these concepts while also contributing to the body of knowledge for pediatric healthcare providers and quality improvement (QI) practices. After completion of a reflective QI project, 50 pediatric providers including nurse practitioners, physician assistants, and physicians were surveyed utilizing the reflective practice questionnaire (RPQ) along with other QI relevant healthcare data points. The results of this research demonstrated that interprofessional providers perceived the reflective project beneficial to improve their care to the pediatric population. These perceptions were consistent with the sister QI project that revealed significant improvements in care, thus validating the perceptions of the providers. Furthermore, provider participants demonstrated statistically significant overall satisfaction with an interprofessional reflective process. Many strides have been made utilizing both concepts in the educational preparation of healthcare providers with intentions to improve healthcare outcomes. This research supports the concept that pediatric healthcare outcomes may be improved through interprofessional reflective practice.

Predicting pediatric healthcare provider use of virtual reality using a technology acceptance model.

The primary aim of this study was to apply a novel technology acceptance model (TAM) for virtual reality (VR) in healthcare. The secondary aim was to assess reliability of this model to evaluate factors that predict the intentions of pediatric health providers' use of VR as an anxiolytic for hospitalized pediatric patients. Healthcare providers that interacted with pediatric patients participated in a VR experience available as anxiolysis for minor procedures and then completed a survey evaluating attitudes, behaviors, and technology factors that influence adoption of new technologies. Reliability for all domain measurements were good, and all confirmatory factor analysis models demonstrated good fit. Usefulness, ease of use, curiosity, and enjoyment of the VR experience all strongly predict intention to use and purchase VR technologies. Age of providers, past use, and cost of technology did not influence future purchase or use, suggesting that VR technologies may be broadly adopted in the pediatric healthcare setting. Previous VR-TAM models in non-healthcare consumers formulated that age, past use, price willing to pay, and curiosity impacted perceived ease of use. This study established that age, past use, and cost may not influence use in healthcare. Future studies should be directed at evaluating the social influences and facilitating conditions within healthcare that play a larger influence on technology adoption. The VR-TAM model demonstrated validity and reliability for predicting intent to use VR in a pediatric hospital.

Pediatric Health Care Provider Awareness, Perceptions, and Utility of Sport Specialization Recommendations.

Sport specialization, or focused participation in a single sport, is associated with an increased rate of overuse injury and burnout. Medical associations and sport organizations have published recommendations for sport specialization aimed at reducing its negative consequences. Health care providers (HCPs) are often identified as individuals who can educate athletes and parents about these important recommendations. To compare knowledge, perceptions, awareness, confidence in knowledge, and use of sport specialization recommendations among HCPs who work with pediatric athletes. Cross-sectional study. An online web-based survey was developed to assess HCPs' knowledge, perceptions, awareness, confidence in knowledge, and clinical use of sport specialization recommendations. Participants were recruited from the research survey services of 4 professional organizations. Dependent variables were responses for awareness, perceptions, confidence in knowledge, use, and barriers sections of the survey. Data were analyzed with descriptive statistics; comparisons among HCPs were made through χ2 and Kruskal-Wallis tests. The survey was completed by 770 HCPs (completion rate = 95.1%). Respondents lacked awareness specific to recommendations surrounding the maximum number of sport participation months per year (39.5%), maximum hours per week (40.7%), and maximum number of teams on which youth athletes should participate concurrently (43.9%). Physicians were the most aware of medical organization recommendations generally (48%-68.8%) and confident in their knowledge (41.5%-75.1%). All HCPs were less aware and confident in their knowledge of sport organization recommendations, with no differences among HCPs. Physicians did not perceive many barriers to the use of the recommendations, whereas athletic trainers felt that patient (39.9%) and parent (45.3%) behaviors were the greatest barriers to usage. Awareness, perceptions, and use of sport specialization recommendations varied by discipline, but most respondents believed they were associated with a decreased risk of injury. Future researchers should focus on improved education and implementation of recommendations across all roles.

Pre and Probiotics In Paediatrics

Microbes are all around us and play a significant role in both our overall health and the health of the planet. The interest in adding probiotics and prebiotics to nutritional goods has developed as a result of efforts to improve the internal microbial environment. Probiotic and prebiotic use and effectiveness should be supported by evidence-based medicine, just like with antibiotics. This clinical report's goal is to evaluate the medical applications of probiotics and prebiotics and to provide a summary of what is currently known regarding the health advantages of including them as dietary supplements in foods marketed to children, such as infant formula. The guidance in this report will help paediatric health care providers to make appropriate decisions regarding the usefulness and benefit of probiotics and prebiotics for their patients.

Reply by Authors.

No AccessJournal of UrologyPediatric Article22 Jun 2023Reply by Authors James T. Rague, Josephine Hirsch, Theresa Meyer, Courtney Streur, Ilina Rosoklija, Stephanie Kielb, Earl Y. Cheng, Diana K. Bowen, Elizabeth B. Yerkes, and David I. Chu James T. RagueJames T. Rague *Correspondence: Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave Box 24, Chicago, IL 60611 telephone: 312-227-6340; E-mail Address: [email protected] https://orcid.org/0000-0002-8089-5865 Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois More articles by this author , Josephine HirschJosephine Hirsch Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois More articles by this author , Theresa MeyerTheresa Meyer Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois More articles by this author , Courtney StreurCourtney Streur Division of Urology, CS Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan More articles by this author , Ilina RosoklijaIlina Rosoklija Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois More articles by this author , Stephanie KielbStephanie Kielb Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois More articles by this author , Earl Y. ChengEarl Y. Cheng Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois More articles by this author , Diana K. BowenDiana K. Bowen Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois More articles by this author , Elizabeth B. YerkesElizabeth B. Yerkes Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois More articles by this author , and David I. ChuDavid I. Chu Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003556.02AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Reply by Authors." The Journal of Urology, Publish Ahead of Print, pp. REFERENCES 1. “I just haven't done any of that”: applicability of the International Index of Erectile Function in young men with spina bifida. J Urol. 2023; 210(3):000-000. Google Scholar 2. . Sexual health communication between healthcare professionals and adolescents with chronic conditions in Western countries: an integrative review. Sex Disabil. 2020; 38(2):191-216. Crossref, Google Scholar 3. . Sexual and reproductive health in young people with spina bifida. Dev Med Child Neurol. 1999; 41(10):671-675. Crossref, Medline, Google Scholar 4. . “They assume that you’re not having sex”: a qualitative exploration of how paediatric healthcare providers can have positive sexuality-related conversations with youth with disabilities. Sex Disabil. 2021; 39(3):579-594. Crossref, Google Scholar © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information James T. Rague Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois *Correspondence: Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave Box 24, Chicago, IL 60611 telephone: 312-227-6340; E-mail Address: [email protected] More articles by this author Josephine Hirsch Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois More articles by this author Theresa Meyer Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois More articles by this author Courtney Streur Division of Urology, CS Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan More articles by this author Ilina Rosoklija Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois More articles by this author Stephanie Kielb Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois More articles by this author Earl Y. Cheng Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois More articles by this author Diana K. Bowen Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois More articles by this author Elizabeth B. Yerkes Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois More articles by this author David I. Chu Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois More articles by this author Expand All Advertisement PDF downloadLoading ...

Perspectives of Pediatric Patients, Parents, and Healthcare Providers on the Disclosure of a Leukemia Diagnosis and the Investigation of Internalizing Symptoms in Children with Leukemia

Background: The purpose of this study was to examine study participants’ knowledge, attitudes, anxiety, and coping strategies following a leukemia diagnosis. Study Design: The 350 participants included 100 pediatric patients, 100 parents, and 150 healthcare providers. The survey was filled out by all participants. Patients’ and Parents’ perceptions of their children’s anxiety levels were also evaluated using the Revised Child Anxiety and Depression Scale. Results: In total, 84 pediatric patients were aware of their leukemia diagnosis, but the remaining 16 were not at the time of the survey. Thirteen (82%) of the 16 patients were under the age of seven at the time of diagnosis. Parents and health care providers strongly agreed that leukemia diagnosis should be disclosed directly to children. Compared with healthcare providers, parents were significantly more likely to opt for disclosure after starting chemotherapy by the parents in the doctor’s office (p<0.05). Parent’s perceptions of their children’s anxiety levels were significantly higher than patients’ (p<0.05). Healthcare providers responded to the survey that 32% of the pediatrician, 16% of nurses, and 86% of interns received training on delivering bad news. Conclusions: Our research shows that there is no agreement among healthcare providers and patients’ parents about who, when, and where to inform children of a leukemia diagnosis. The findings also highlight the importance of reinforming children diagnosed at less than 7 years when they are older. Additionally, delivering bad news training to healthcare providers and providing psychological support to parents and adolescents have a positive impact.

CARD15: Parent Perceptions of Ex-Situ Heart Perfusion

Introduction: Pediatric heart transplant (HTx) candidates continue to have high waitlist mortality due to donor availability. Ex-situ heart perfusion (ESHP) has the potential to increase the donor pool, yet has been used sparingly in pediatrics due to size restrictions of the current technology. Previous work has shown that for ESHP to be accepted by pediatric healthcare providers (HCP), the risks to the donor heart and the costs need to be better understood and that rigorous research and implementation oversight is essential. Perspectives from caregivers about ESHP has not been assessed and forms the basis of this qualitative study. Methods: Virtual, semi-structured interviews were conducted with caregivers of children who are awaiting or received HTx. Data were analyzed using qualitative content analysis. Results: Twelve participants from 2 countries participated in this study. Awareness about and understanding of ESHP varied among participants from complete unawareness to understanding specifics. Independent of their awareness, all purported that it was an excellent and innovative technology, and supported ESHP implementation in pediatrics. No ethical issues or concerns about the use were identified that differed from other medical technologies, although participants did state that understanding the length of time the heart can be mounted and risks to donor and recipient were important. Participants expressed various views on how to approach parents regarding ESHP. Overall, most participants stated that the consent processes should be like other medical procedure and some commented that deferred or waived consent would be acceptable, especially if ESHP became part of routine clinical practice. Even if consent was waived, participants agreed that the use of ESHP should be disclosed just like other information is disclosed about the donor heart and that introduction of ESHP should come early in the HTx journey. Conclusion: Families are supportive of the use of ESHP. Like HCPs, they endorse the need to understand the potential risks and that information should be presented early in the transplant process.

Examining the experiences of pediatric mental health care providers during the early stage of the COVID-19 pandemic

BackgroundThe COVID-19 pandemic fundamentally impacted the way that mental health services were provided. In order to prevent the spread of infection, many new public health precautions, including mandated use of masks, quarantine and isolation, and closures of many in-person activities, were implemented. Public health mandates made it necessary for mental health services to immediately shift their mode of delivery, creating increased confusion and stress for mental health providers. The objective of this study is to understand the impact of pandemics on the clinical and personal lives of mental health providers working with children during the early months of the COVID-19 pandemic, March -June 2020.MethodsMental health providers (n = 98) were recruited using purposive sampling from a public health service in Canada. Using qualitative methods, semi-structured focus groups were conducted to understand the experiences of mental health service providers during the beginning of the COVID-19 pandemic.ResultsData from the focus groups were analysed and three main themes emerged: (1) shift to virtual delivery and working from home; (2) concerns about working in person; (3) exhaustion and stress from working through the pandemic.DiscussionThis study gave voice to mental health providers as they provided continuity of care throughout the uncertain early months of the pandemic. The results provide insight into the impact times of crisis have on mental health providers, as well as provide practical considerations for the future in terms of supervision and feedback mechanisms to validate experiences.

An Overview of Adolescent Psychostimulant Use.

Adolescence marks a period of significant neural maturation and development of lifelong habits, including the potential use of recreational psychostimulant drugs. Increased prevalence of drug adulteration and fatalities related to drug overdose pose new challenges for individuals who use drugs recreationally. As the prevalence of recreational psychostimulant use drastically increases during young adulthood, pediatric and adolescent health care providers can play a crucial role in the lifelong well-being of their patients by identifying those with risk factors for consequences associated with substance use at an early age. This article discusses the epidemiology, pharmacology, clinical manifestations, complications, and common methods of use for three types of psychostimulant drugs-amphetamines, methamphetamine, and 3,4-Methylenedioxymethamphetamine. This article aims to provide pediatric and adolescent health care providers with practical knowledge to effectively perform substance use screening, brief intervention, and referral to treatment with the goal of reducing drug-related morbidity and mortality among the adolescent age group. [Pediatr Ann. 2023;52(5):170-e177.].

Parental reports of vaccine information statement usage in Utah.

Since the implementation in 1986, there is little research focused on vaccine information statements (VISs) use for vaccine education and parental perception. To explore parental reports of dissemination and use of VISs. Data for this pilot, cross-sectional, descriptive study were collected through an online survey in both English and Spanish. Responses from 130 parents in one school district were analyzed. Most participants (67.7%) reported getting vaccine information from a pediatric health care provider. A majority (71.5%) said that VISs were included in the vaccination process. Approximately one third of participants (37.7%) reported reading some or all the VIS before their child was vaccinated, and more than half (59.3%) read some or all the VIS after their child was vaccinated. While promising that many parents reported receiving a VIS, more than one quarter of parents reported they did not. Inadequate time to read and understand VIS information before an immunization may lead to limited parental understanding. Although some participants reported struggling to understand VISs, more than half said that VISs were helpful and would read another in the future. Without appropriate use of vaccine education material, providers miss the opportunity to educate parents on the risks and benefits of vaccinating their children. Providers must be aware of literacy levels and vaccine attitudes and create appropriate opportunities for parents to read and learn about vaccines. VISs are valuable educational tools for patients and parents. Improvements are needed to improve both VIS clarity and dissemination.

Asia-Pacific Consensus Recommendations on X-Linked Hypophosphatemia: Diagnosis, Multidisciplinary Management, and Transition From Pediatric to Adult Care.

X-linked hypophosphatemia (XLH) is a rare, inherited, multisystem disorder characterized by hypophosphatemia that occurs secondary to renal phosphate wasting. Mutations in PHEX gene (located at Xp22.1) in XLH alter bone mineral metabolism, resulting in diverse skeletal, dental, and other extraskeletal abnormalities that become evident in early childhood and persist into adolescence and adult life. XLH impacts physical function, mobility, and quality of life, and is associated with substantial socioeconomic burden and health care resource utilization. As the burden of illness varies with age, an appropriate transition of care from childhood and adolescence to adulthood is necessary to meet growth-related changes and minimize long-term sequelae of the condition. Previous XLH guidelines that encompassed transition of care have focused on Western experience. Regional differences in resource availability warrant tailoring of recommendations to the Asia-Pacific (APAC) context. Hence, a core expert panel of 15 pediatric and adult endocrinologists from nine countries/regions across APAC convened to formulate evidence-based recommendations for optimizing XLH care. A comprehensive literature search on PubMed using MeSH and free-text terms relevant to predetermined clinical questions on diagnosis, multidisciplinary management, and transition of care of XLH revealed 2171 abstracts. The abstracts were reviewed independently by two authors to shortlist a final of 164 articles. A total of 92 full-text articles were finally selected for data extraction and drafting the consensus statements. Sixteen guiding statements were developed based on review of evidence and real-world clinical experience. The GRADE criteria were used to appraise the quality of evidence supporting the statements. Subsequently, a Delphi technique was utilized to rate the agreement on statements; 38 XLH experts (15 core, 20 additional, 3 international) from 15 countries/regions (12 APAC, 3 EU) participated in the Delphi voting to further refine the statements. Statements 1-3 cover the screening and diagnosis of pediatric and adult XLH; we have defined the clinical, imaging, biochemical, and genetic criteria and raised red flags for the presumptive and confirmatory diagnosis of XLH. Statements 4-12 tackle elements of multidisciplinary management in XLH such as therapeutic goals and options, composition of the multidisciplinary team, follow-up assessments, required monitoring schedules, and the role of telemedicine. Treatment with active vitamin D, oral phosphate, and burosumab is discussed in terms of applicability to APAC settings. We also expound on multidisciplinary care for different age groups (children, adolescents, adults) and pregnant or lactating women. Statements 13-15 address facets of the transition from pediatric to adult care: targets and timelines, roles and responsibilities of stakeholders, and process flow. We explain the use of validated questionnaires, desirable characteristics of a transition care clinic, and important components of a transfer letter. Lastly, strategies to improve XLH education to the medical community are also elaborated in statement 16. Overall, optimized care for XLH patients requires prompt diagnosis, timely multidisciplinary care, and a seamless transfer of care through the coordinated effort of pediatric and adult health care providers, nurse practitioners, parents or caregivers, and patients. To achieve this end, we provide specific guidance for clinical practice in APAC settings. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Interim Federal Health Program: Survey of use of supplemental benefits by paediatric health care providers.

The Interim Federal Health Program (IFHP) provides temporary healthcare coverage to refugees and refugee claimants. Previous research demonstrates that paediatric healthcare providers poorly utilize the IFHP, with low registration rates and limited understanding of the program. The objective of this study was to examine paediatric provider use of IFHP-covered supplemental benefits, and their experience with trying to access these benefits. A one-time survey was administered via the Canadian Paediatric Surveillance Program in February 2020. Of those who had provided care to IFHP-eligible patients, descriptive tables and statistics were created looking at provider demographics, and experience using the IFHP supplemental benefits. A multinomial logistic regression was built to look at provider characteristics associated with trying to access supplemental benefits. Of the 2,753 physicians surveyed, there were 1,006 respondents (general paediatricians and subspecialists). Of the respondents, 526 had recently provided care to IFHP-eligible patients. Just over 30% of those who had recently provided care did not access supplemental benefits as they did not know they were covered by the IFHP. Of those who had tried to access supplemental benefits, over 80% described their experience as difficult, or very difficult. Paediatric providers have a poor understanding of IFHP-covered supplemental benefits, which is cited as a reason for not trying to access supplemental benefits. Of those who do try to access these benefits, they describe the process as difficult. Efforts should be made to improve provider knowledge and streamline the process to improve access to healthcare for refugee children and youth.

Management of septic shock by pediatric residents: An area for quality improvement

BackgroundCompliance with sepsis guidelines has been shown to be linked to better outcomes in patients with septic shock; however, adherence to these guidelines is not consistent among pediatric healthcare providers. In Tunisia, the management of children with septic shock is initiated by the pediatric resident on call. MethodsThis study assessed the compliance of Tunisian pediatric residents with the 2020 “Surviving Sepsis Campaign” guidelines and identified factors that could improve compliance. We conducted a cross-sectional national study based on an online survey (SurveyMonkey) presenting a clinical pediatric case of septic shock. The survey was sent to the 200 residents registered in the Tunisian pediatric residency program. ResultsThe response rate was 72%, with 144 residents replying to the survey. Up to 72.9% of the residents had good compliance with the 1-h bundle: obtaining blood cultures prior to antibiotics, early administration of intravenous (IV) antibiotics, IV fluid expansion, and vasopressor for fluid-refractory septic shock. Factors independently associated with good compliance were a pediatric intensive care unit rotation (odds ratio [OR]: 5.17, 95% confidence interval [CI]: 1.44–18.58; p = 0.012), availability of a written protocol (OR: 9.09, 95% CI: 2.67–30.97; p<0.001), an on-call senior supervisor on site (OR: 6.76, 95% CI: 2.24–20.40; p = 0.001), and European Pediatric Advanced Life Support (EPALS) certification (OR: 13.47, 95% CI: 3.05–59.31; p = 0.001). ConclusionThese factors could be considered in the process of a quality improvement strategy that ultimately better promotes performance in pediatric sepsis management and may improve patient outcomes.

Pediatric subspecialty healthcare providers' views of recruitment during a randomized controlled trial of a mobile health intervention

BackgroundRandomized clinical trials (RCTs) enrolling pediatric populations often struggle with recruitment. Engaging healthcare providers in the recruitment process may increase patients' and caregivers' willingness to participate in research. The purpose of this study was to understand the perspectives of pediatric subspecialty healthcare providers considering recruiting patients to participate in an mobile health (mHealth) RCT. MethodsWe conducted 9 semi-structured interviews and 1 focus group with a total of N = 11 providers from various disciplines before the initiation of an mHealth RCT addressing medication nonadherence. Then, we conducted 5 follow-up interviews and 1 follow-up focus group with a total of 8 of these providers several months later. We used thematic analysis to generate themes describing providers' views of the RCT and patient recruitment. ResultsProviders indicated that they were willing to recruit for this study because they believed that the intervention sought to address a significant problem. They also thought it made sense to intervene using technology for this age group. However, many providers thought that certain patients (e.g., those with mild, shorter-lasting adherence difficulties) were the most appropriate to recruit. They described how keeping the trial front of mind facilitated recruitment, and they advised researchers to use strategies to promote their ongoing awareness of the study if conducting similar research in the future. ConclusionPediatric healthcare providers are important stakeholders in mHealth intervention research. Engaging them in participant recruitment is a complex endeavor that might promote patient enrollment, but their views of research and demanding clinical roles are important to understand when designing study procedures.

Anxiety in children and youth: Part 2-The management of anxiety disorders.

Anxiety disorders are the most common mental health concerns affecting Canadian children and adolescents. The Canadian Paediatric Society has developed two position statements that summarize current evidence regarding the diagnosis and management of anxiety disorders. Both statements offer evidence-informed guidance to support paediatric health care providers (HCPs) making decisions around the care of children and adolescents with these conditions. The objectives of Part 2, which focuses on management, are to: (1) review the evidence and context for a range of clinical approaches that combine behavioural and pharmacological interventions to effectively address impairment, (2) describe the roles of education and psychotherapy in the prevention and treatment of anxiety disorders, and (3) outline the use of pharmacotherapy, with side effects and risks. Recommendations for managing anxiety are based on current guidelines, review of the literature, and expert consensus. Note that when the word 'parent' (singular or plural) is used, it includes any primary caregiver and every configuration of family.

Anxiety in children and youth: Part 1-Diagnosis.

Anxiety disorders are the most common mental health concerns affecting Canadian children and adolescents. The Canadian Paediatric Society has developed two position statements that summarize current evidence regarding the diagnosis and management of anxiety disorders. Both statements offer evidence-informed guidance to support paediatric health care providers (HCPs) making decisions around the care of children and adolescents with these conditions. The objectives of Part 1, which focuses on assessment and diagnosis, are to: (1) review the epidemiology and clinical characteristics of anxiety disorders and (2) describe a process for assessment of anxiety disorders. Specific topics are reviewed, including prevalence, differential diagnosis, co-occurring conditions, and the process of assessment. Approaches are offered for standardized screening, history-taking, and observation. Associated features and indicators that distinguish anxiety disorders from developmentally appropriate fears, worries, and anxious feelings are considered. Note that when the word 'parent' (singular or plural) is used, it includes any primary caregiver and every configuration of family.

The Risk of the Development of Secondary Post-Traumatic Stress Disorder among Pediatric Health Care Providers: A Systematic Review

Background: Secondary PTSD is defined as the natural, consequential behaviors and emotions that result from knowledge about a traumatic event experienced by a significant other deriving from working with suffering individuals. Pediatric health providers with symptoms of PTSD report problems with relationships and general life dissatisfaction as well as and anxiety, depression and burnout syndrome. Aim: The aim of this systematic review was to estimate the risk of developing secondary PTSD among pediatric health care providers as well as all additional contributing factors. In more detail, we investigated the PTSD symptomatology between pediatric health care providers and the extent to which parameters such as the job, gender, department and other factors had an impact on the mental health status of pediatric health care providers. Methodology: We searched all published English papers in PubMed, Google Scholar and the Cochrane Library from September to November 2022. We excluded reviews, systematic reviews and meta-analyses as well as letters to editors. From a total of 748 papers, we included only 12 research articles that met the admission criteria. Results: According to our results, the prevalence of secondary PTSD ranges from 13% to 94%. Burnout, nurses, the female gender, intensive care units, past traumatic life events and a psychiatric history identified as factors contributing to the development of secondary PTSD. Conclusions: Health policy-makers should take the specificity in the working environment of the pediatric sector seriously into consideration, especially emergency departments.

Canadian Pediatric & Perinatal HIV/AIDS Research Group consensus recommendations for infant feeding in the HIV context.

Providing comprehensive infant feeding guidance to families affected by HIV is complex and requires a multidisciplinary approach. While exclusive formula feeding remains the preferred recommendation for infants born to women living with HIV (WLWH) in high-income countries, a more nuanced approach that may include the option of breastfeeding under certain circumstances is emerging in many resource-rich countries. The Canadian Pediatric & Perinatal HIV/AIDS Research Group (CPARG) hosted a Canadian Institute of Health Research-funded meeting in 2016 to develop consensus among multidisciplinary providers around counselling and recommendations for infant feeding. After presentations by adult and paediatric health care providers, basic scientists, and community-based researchers, a subgroup drafted summary evidence-informed recommendations. Along with revisions among CPARG members, a community review was performed by a convenience sample of WLWH who had given birth in the past 5 years from Ontario and Quebec. A legal review was also conducted to ensure understanding of the criminalization potential and concern of HIV transmission and exposure. The Canadian consensus guidelines continue to support formula feeding as the preferred method of infant feeding as it eliminates any residual risk of postnatal vertical transmission. Formula should be made available for all infants born to mothers living with HIV for their first year of life. A comprehensive approach to counselling WLWH is outlined to assist providers to effectively counsel on current evidence to ensure WLWH are fully informed in their decision making. For women meeting criteria to and elect to breastfeed, frequent maternal virologic monitoring and follow-up is required of both mother and infant. Antiretroviral prophylaxis and monitoring are recommended for breastfed infants. The community review highlighted the importance of other supports and counselling needed for implementing effective formula feeding, aside from access to formula. The legal review provided clarifying language around child protection services involvement and the need to provide referral to legal resources or information upon request. Surveillance systems to monitor for cases of breastmilk transmission should be in place to improve gaps in care and develop further knowledge in this area. The Canadian infant feeding consensus guideline is designed to inform and enable better care for WLWH and their babies. Ongoing evaluation of these guidelines as new evidence emerges will be important.

Intimate Partner Violence and Children: Essentials for the Pediatric Nurse Practitioner

Intimate partner violence (IPV) is a public health problem of epidemic proportions. IPV often starts early in adolescence and continues throughout an individual's lifespan. IPV is defined as abuse or aggression occurring in the context of a romantic relationship that is perpetrated by a current or former partner. IPV victims often experience severe psychological trauma, physical injury, and even death. The direct recipient of the violence is often not the only individual impacted. Children are often peripheral victims of IPV. It is vital that pediatric health care providers, including pediatric nurse practitioners, recognize that IPV is indeed a pediatric health care crisis requiring strategies for both identification and intervention. This continuing education article will discuss IPV and its impact on children from conception to adolescence while exploring implications for practice.