Pediatric Program Research Articles

How does the number of training years in pediatric surgery affect appendectomy outcomes?

Appendectomy has traditionally been considered as a training operation for junior pediatric surgeons during their training period. However, with the increase of laparoscopic appendectomy, there has been a growing concern about the performance of this procedure by junior trainees. Our aim is to analyze intra-/postoperative appendectomy outcomes according to the number of training years during Pediatric Surgical residency training program. A retrospective study was performed in patients who underwent appendectomy between 2018 and 2021 in our institution, who were divided into 5 groups according to the number of training years of the junior surgeon who performed the intervention (Y1-Y5). Demographics, complicated appendicitis rate, operation time, and postoperative complications were compared. A stratified analysis according to the technique performed (open/laparoscopic) was performed. A total of 1274 appendectomized patients were analyzed, of which 1257 (98.7%) were operated on by junior trainees (81 in Y1; 407 in Y2; 337 in Y3; 261 in Y4; and 171 in Y5) without demographic differences between groups. As the year of training increased, an elevation in complicated appendicitis rate was observed, although without statistically significant differences. However, laparoscopic/open appendectomies ratio increased with increasing year of training (p < 0.001). Operative time decreased significantly with increasing year of training (p < 0.001), both in open and laparoscopic appendectomies. There were no significant differences in postoperative complications, nor in the stratified analysis according to surgical technique. Appendectomy performed by junior pediatric surgery trainees can be considered a safe procedure from the first year of training, regardless of the technique used.

Assessing Strengths, Challenges, and Equity Via Pragmatic Evaluation of a Social Care Program

ObjectiveModels of pragmatic social care program evaluations are needed as many are clinical services programs and are not focused on research, limiting the ability to address key evidence gaps. We describe the use of the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to conduct a pragmatic evaluation of a pediatric ambulatory social care program. MethodsOur evaluation was based on automated electronic health record data on clinics, community partners, social care program processes, and social needs screen data linked to patient sociodemographic characteristics from February 2020 to September 2021. Two Reach outcomes were assessed: 1) the proportion of eligible patients that completed social needs screening and 2) the proportion of positive screens that receive social care program follow-up. The Effectiveness outcome was meeting families’ resource need(s). ResultsReach among eligible patients who completed screening was 79.2%. Reach for positive screens receiving social care program referrals demonstrated a higher proportion of referrals among patients with a preferred healthcare language (PHL) of Spanish (45.1%) compared to English (31.2%, P < .001). Effectiveness analyses demonstrated that overall, 75.1% of social care program referrals had all social resource needs met, 17.5% had some needs met, and 7.4% had no needs met. The percent of patients with all resource needs met was higher for patients with PHL of Spanish or Non-English, Non-Spanish (79% for each respectively) compared to English (73%, P = .023). ConclusionsMaximizing automated data collection is likely the most feasible way for social care programs to complete evaluation activities outside of the research context.

Abstract 6576: Gabriella Miller Kids First Data Resource Center (KFDRC): Empowering discovery across germline and somatic variation in pediatric cancer

Abstract The Gabriella Miller Kids First Pediatric Research Program (Kids First) has enabled genomic and transcriptomic characterization across a multitude of pediatric diseases at an unprecedented scale. This includes both pediatric cancer cohorts and structure birth defect cohorts, as co-occurrences of these suggest a shared context of developmental biology alterations. Making this quantity of data findable, accessible, interoperable and reusable (FAIR) to researchers around the world has been enabled via the Gabriella Miller Kids First Data Resource Center (KFDRC). Twenty-six Kids First studies are released on the Kids First Data Resource Portal, representing more than 21,000 participants and more than 1.25 PB of data, with additional datasets being released yearly. Additionally, via a partnership between NCI Childhood Cancer Data Initiative and Kids First, large studies currently undergoing sequencing on childhood sarcomas and brain tumors will also be made available via the KFDRC. The KFDRC Portal (https://portal.kidsfirstdrc.org/) provides an interactive cohort building interface as well as powerful search capabilities across 61 billion germline variants in real-time. The somatic variants are made available on the open-access PedcBioPortal (https://pedcbioportal.kidsfirstdrc.org/). Search features include leveraging ontologies to enable different granularity across studies to be cross-querable. The use of these ontologies enable semantic interoperability, while also leveraging FHIR as an interoperable standard for exchange of clinical and other relevant metadata. GA4GH DRS and Passport services via Gen3 and NIH’s Researcher Authentication Service (RAS) enable streamlined access to controlled access data within researchers’ cloud platform of choice, including CAVATICA (https://cavatica.org) which is directly integrated with the KFDRC Portal. The KFDRC is part of the NIH Cloud-Based Platform Interoperability efforts, which includes the NCI Cancer Research Data Commons. This enables discovery and analysis across combined cancer datasets and data modalities and further potential for the cross analysis between cancers and structural birth defects to accelerate the discovery process to ultimately lead to improved knowledge and outcomes for childhood cancer and more generally pediatric disease from genetic causes. Citation Format: David Higgins, Jean-Philippe Thibert, Michele Mattioni, Jack DiGiovanna, Robert L. Grossman, Bailey K. Farrow, Eric Wenger, Samuel Volchenboum, Robert J. Carroll, Melissa A. Haendel, Deanne M. Taylor, Yuankun Zhu, Vincent Ferretti, Adam C. Resnick, Allison P. Heath. Gabriella Miller Kids First Data Resource Center (KFDRC): Empowering discovery across germline and somatic variation in pediatric cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6576.

Impact of COVID-19 on the Sense of Job Security Among Community Pediatric Hospitalists.

The coronavirus disease 2019 (COVID-19) pandemic offers a prime opportunity to examine the ability of community pediatric hospital medicine programs to respond to external stressors. This study aims to characterize the impact of the COVID-19 pandemic on compensation and furlough among community pediatric hospitalists, as well as self-reported sense of job security. This study was part of a larger quantitative project investigating community pediatric hospitalists' career motivators. The survey was drafted through an iterative process by the authors. It was disseminated via e-mail to a convenience sample of community pediatric hospitalists obtained through direct contact with community pediatric hospital medicine programs. Data were collected on changes in compensation and furlough because of COVID-19, as well as worry about job security measured as self-reported worry about one's job being permanently terminated on a 5-point Likert scale. Data were collected from 31 hospitals across the United States with 126 completed surveys. Because of COVID-19, many community pediatric hospitalists experienced reduced base pay and benefits and a minority experienced furlough. Nearly two-thirds (64%) reported some worry about job security. Initial base pay reduction, working in suburban areas compared with rural areas, and affiliation with a university-based center or free-standing children's hospital were significantly associated with greater worry about job security. The initial response to the COVID-19 pandemic resulted in changes in compensation and furlough for some community pediatric hospitalists and many expressed concerns about job security. Future studies should identify protective factors for community pediatric hospitalists' job security.

A Qualitative Analysis of Assessment and Evaluation Practices Within the Individualized Curriculum.

The Accreditation Council of Graduate Medical Education requires an "individualized curriculum" (IC) in pediatric residency. A shared understanding across programs of methods to evaluate the IC is lacking. We explored pediatric program leaders' perceptions of assessment and evaluation within the IC to further understand and inform most useful practices. We conducted a phenomenology study using semi-structured interviews to 1) determine what IC assessment and evaluation strategies are utilized in pediatric residency programs, and 2) explore program leaders' perceptions of the feasibility and value of assessment and evaluation in the IC. We recruited a purposive sample of leaders from 15 pediatric residency programs of various sizes and regions. Interviews were recorded and transcribed. Data were analyzed to produce themes. Three themes arose from our analysis: 1) Systematic assessment of the IC, though desired, is not robust in pediatric residency training; 2) Program differences present unique barriers and facilitators that impact the feasibility of assessment within the IC; and 3) Meaningfulness of assessment in the IC varies by stakeholder. Themes reflected perspectives on individual learner assessment and program evaluation. While systematic assessment and evaluation of the IC in pediatric residency training is lacking, program leaders desire feasible strategies that are meaningful to the resident, the program, and its leadership team. Leveraging current assessment and evaluation tools and aligning new assessment strategies could promote the integration of IC assessment with other assessments, minimizing burden. More structured IC assessment and evaluation could inform how to best achieve curricular goals of the IC.

Editorial introduction

Editorial introduction

Burden of influenza in Spanish pediatric population and the benefit of vaccination

IntroductionThe burden of influenza in the paediatric population is often underestimated by healthcare professionals and the general population, mainly due to poor perception of its clinical importance at the individual level and its health impact at the healthcare level. The aim of this review was to collect data on the burden of paediatric influenza in Spain and to compare them with data of countries where vaccination strategies for healthy paediatric populations have been implemented. MethodsWe collected data on the burden of paediatric influenza in Spain through a systematic search of literature published between 2016–2021 (PRISMA methodology). We conducted a review of reports from the Spanish Influenza Surveillance System (SVGE) (2010–2011 to 2019–2020) and of international reports (from Canada, Finland, USA, and UK) through a systematic (2016–2021) and pragmatic search. Results1366 articles were obtained from the systematic searches by country; 26 met the inclusion criteria. According to the SVGE (Spain's Influenza Surveillance System), those <15 years have the highest incidence of influenza per 100,000 population (cumulative-mean rate: 9457.9) compared to those ≥15 years (2285.6), and percentage of admission to the Paediatric Intensive Care Unit (PICU) greater than those >65 years (mean: 29.1% vs. 17.5%). Hospitalisation of severe cases per 100,000 population in children aged 0–4 years and those >65 years is similar (median: 20.2 vs. 28.4). Those aged <15 years have a higher incidence rate per 100,000 population (213.3), in contrast to those aged 15–64 years (21.9) and those aged ≥65 years (65.2). In countries with paediatric vaccination programmes (USA, Finland, and UK) the burden of influenza in children is reduced by 40%–74%, whereas 50%-93.5-% of cases presenting to the ED, hospitalised, admitted to PICU, or dying from influenza are unvaccinated. ConclusionsThe burden of paediatric influenza in Spain includes a significant number of hospitalisations and PICU admissions and justifies the vaccination strategy recommended by the WHO since 2012. In countries with this recommendation, the vaccinated paediatric population is better protected against severe forms of influenza and potential benefits for reducing the burden of paediatric influenza in Spain can be extracted from their data.

MP70-06 MATCHED ANALYSIS OF URINARY TRACT INFECTIONS AND READMISSIONS AFTER OPEN URETERONEOCYSTOSTOMY: DOES AGE MATTER?

You have accessJournal of UrologyCME1 Apr 2023MP70-06 MATCHED ANALYSIS OF URINARY TRACT INFECTIONS AND READMISSIONS AFTER OPEN URETERONEOCYSTOSTOMY: DOES AGE MATTER? Abraham Almatari, Khaled Aldabek, Gerald Jerkins, Dana Giel, Amr Mahran, and Mary Killian Abraham AlmatariAbraham Almatari More articles by this author , Khaled AldabekKhaled Aldabek More articles by this author , Gerald JerkinsGerald Jerkins More articles by this author , Dana GielDana Giel More articles by this author , Amr MahranAmr Mahran More articles by this author , and Mary KillianMary Killian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003338.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The effect of age on the outcomes of Vesicoureteral Reflux (VUR) surgery is not well studied. Our hypothesis is that older children are at higher risk of complications and readmissions following open ureteroneocystostomy (UNC) as they are more prone to voiding dysfunction. Our objective is to study the rates and predictors of the 30-day post-operative urinary tract infection (poUTI) and readmissions after UNC among children younger and older than the age of 3. METHODS: The ACS pediatric National Surgical Quality Improvement Program (NSQIP-P) between 2012–2020 was queried for open UNC CPT codes 50780 and 50782. Only vesicoureteral reflux patients were included. Patients with severe comorbities and unknown ASA class/prematurity were excluded. Propensity score matching (PSM) was performed in a 1:1 ratio to nearest matching (> 3 years “older group” versus≤3 years “younger group”). Multivariable regression analyses were performed on the matched set for poUTI and procedure-related readmission. Database limitations included the lack of information regarding the degree of VUR, prior VUR procedures, and preoperative urine culture results. All analyses were performed utilizing R 4.1.2. RESULTS: 6552 patients were identified including 2749 and 3803 patients in the younger and the older groups; respectively. After PSM, 2383 patients were included in each group. There were no statistical differences among the baseline characteristics and the operative time across the matched groups. The rate of poUTI and procedure-related readmissions were significantly higher in the younger patients as compared to the older group either before or after PSM as seen in Table 1 (all; p<0.001). On multivariable analysis, younger patients had higher odds of poUTI (adjusted odds ratio (aOR): 1.92, 95% confidence interval (CI): 1.35-2.72, p<0.001) as well as higher odds of procedure-related readmissions (aOR: 2.42, 95% CI: 1.72-3.40, p<0.001) CONCLUSIONS: Three-year old children or younger were at increased risk of UTI and procedure-related readmissions after open UNC for VUR when compared to older patients. Study results should be interpreted with caution given the database limitations. Further validation of the current study findings is warranted. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1005 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Abraham Almatari More articles by this author Khaled Aldabek More articles by this author Gerald Jerkins More articles by this author Dana Giel More articles by this author Amr Mahran More articles by this author Mary Killian More articles by this author Expand All Advertisement PDF downloadLoading ...

Assessment and Management of Attention-Deficit/Hyperactivity Disorder: Pediatric Resident Perspectives on Training and Practice.

Attention-deficit/hyperactivity disorder (ADHD) is a common presenting concern in primary care. This study examined the relationship between pediatric residency training program characteristics and residents' ADHD knowledge, attitudes, and comfort in providing ADHD services. Given the familiarity that pediatric chief residents have with the training and experiences within their residency programs, a 30-item survey was mailed to pediatric chief residents. A total of 100 residents returned their surveys (response rate 49.5%) and were included in the descriptive quantitative and thematic qualitative analyses. The majority of participants rated their ADHD knowledge as at least average. However, approximately half of the participants were comfortable with screening, and less than half were comfortable with managing stimulant medication or behavioral treatments. Participants emphasized the importance of interprofessional collaboration, clinical experiences, and integrated ADHD education throughout training. These results emphasize the importance of improved training in screening, diagnosing, and managing ADHD to increase resident comfort regarding these practices.

Contextual Vulnerability Should Guide Fair Subject Selection in Xenotransplantation Clinical Trials

Contextual Vulnerability Should Guide Fair Subject Selection in Xenotransplantation Clinical Trials

Global neurology: It's time to take notice.

Global neurology: It's time to take notice.

Building effective public dental care programs: The critical role of implementation evaluation.

There are significant income-related inequities in oral health and access to oral health care. Public dental programs generally aim to increase access to oral health care for individuals with financial barriers through government payments for appointments. Low engagement from both oral health care providers and intended patients are common challenges in delivery of public dental programs, and are impediments to program impact and outcomes. Still, these programs rarely address the systemic issues that affect the experiences of intended users. This accentuates the importance of monitoring of program delivery to refine or adapt programs to better meet needs of service providers and users. As such, specifying program goals and developing a related monitoring strategy are critical as Canada begins to implement a national public dental program. Drawing on an example of a pediatric public dental program for children from low-income families or with severe disabilities in Ontario, Canada, this article illustrates how an implementation and evaluation framework could be applied to measure implementation and impact of the national program. The RE-AIM framework measures performance across five domains: (1) Reach, (2) Effectiveness (patient level), (3) Adoption, (4) Implementation (provider, setting, and policy levels), and (5) Maintenance (all levels). Given the disparities in oral disease and access to oral health care, the results can be used most effectively to adapt programs if relevant stakeholders participate in reviewing data, investigating quality gaps, and developing improvement strategies.

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

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

Association of a primary care-based mobile food pantry with child body mass index: A propensity score matched cohort study.

To test the hypothesis that children in Food FARMacia-a six-month food insecurity intervention from May 2019 to January 2020-would have smaller age-adjusted, sex-specific body mass index (BMIz) gains than matched counterparts. In this proof-of-concept study, we performed a difference-in-differences (DiD) analysis of a propensity-score matched cohort among paediatric primary care patients aged <6 years with household food insecurity. Children with anthropometric measures prior to and after intervention started were included. The main outcome was child BMIz from standardized clinical anthropometric measurements. We examined differences in child BMIz change between Food FARMacia participants and matched non-participants. Among 454 children with household food insecurity, 265 were included, 44 of whom were in Food FARMacia. Mean child age was 1.48 (SD 1.46) years and most reported Hispanic/Latino ethnicity (84.5%). After propensity score matching, children in Food FARMacia had smaller increases in BMIz (unadjusted DiD -0.28 [-0.52, -0.04]) compared to non-participants in the follow-up period. After adjusting for potential confounders, findings remained statistically significant [adjusted DiD, -0.31 units (95% CI: -0.54, -0.08)]. In this proof-of-concept cohort study of children in households with food insecurity, a paediatric primary care-based mobile food pantry program was associated with improvement in child BMIz over 6months.

High-performance pediatric surgical risk calculator: A novel algorithm based on machine learning and pediatric NSQIP data

BackgroundsNew methods such as machine learning could provide accurate predictions with little statistical assumptions. We seek to develop prediction model of pediatric surgical complications based on pediatric National Surgical Quality Improvement Program(NSQIP). MethodsAll 2012–2018 pediatric-NSQIP procedures were reviewed. Primary outcome was defined as 30-day post-operative morbidity/mortality. Morbidity was further classified as any, major and minor. Models were developed using 2012–2017 data. 2018 data was used as independent performance evaluation. Results431,148 patients were included in the 2012–2017 training and 108,604 were included in the 2018 testing set. Our prediction models had high performance in mortality prediction at 0.94 AUC in testing set. Our models outperformed ACS-NSQIP Calculator in all categories for morbidity (0.90 AUC for major, 0.86 AUC for any, 0.69 AUC in minor complications). ConclusionsWe developed a high-performing pediatric surgical risk prediction model. This powerful tool could potentially be used to improve the surgical care quality.

Clinical Unmet Needs and Treatment Patterns of Paediatric Psoriasis Patients: A Real-World Evidence Study in Spain

Background and objectiveReal-world evidence of paediatric psoriasis (PsO) is lacking in Spain. The purpose of this study was to identify physician-reported disease burden and current treatment patterns in a real-world paediatric PsO patient cohort in Spain. This will enhance our understanding of the disease and contribute to the development of regional guidelines. Material and methodThis retrospective analysis of a cross-sectional market research survey assessed the clinical unmet needs and treatment patterns in patients with paediatric PsO in Spain, as reported by their primary care and specialist physicians, using data collected as part of the Adelphi Real World Paediatric PsO Disease-Specific Program (DSP™) between February and October 2020. ResultsSurvey data from 57 treating physicians were included (71.9% [N=41] dermatologists, 17.6% [N=10] general practitioners/primary care physicians, and 10.5% [N=6] paediatricians); the final analysis included 378 patients. At sampling, 84.1% (318/378) of patients had mild disease, 15.3% (58/378) had moderate disease and 0.5% (2/378) had severe disease. Retrospectively reported physician-judged severity at the time of PsO diagnosis recorded 41.8% (158/378) of patients with mild disease, 51.3% (194/378) with moderate disease and 6.9% (26/378) with severe disease. Overall, 89.3% (335/375) of patients were currently receiving topical PsO therapy, while 8.8% (33/375), 10.4% (39/375) and 14.9% (56/375) of patients were currently receiving phototherapy, conventional systemics and biologics, respectively. ConclusionsThese real-world data reflect the current burden and treatment landscape of paediatric PsO in Spain. The management of patients with paediatric PsO could be improved by further educating healthcare professionals and developing regional guidelines.

How to become a pediatric neurosurgeon in Latin America: training opportunities, current status, and future challenges.

To provide an analysis of pediatric neurosurgery educational opportunities in Latin America in order to characterize and evaluate the strengths, weaknesses, and limitations to assume a career in pediatric neurosurgery. An online survey was distributed to pediatric neurosurgeons in Latin America to assess aspects of pediatric neurosurgical education, working conditions, and training opportunities. The survey was open to neurosurgeons that treat pediatric patients, whether or not they had completed fellowship training in pediatrics. A descriptive analysis was done with a subgroup analysis stratified the results among certified pediatric neurosurgeons and non-certified pediatric neurosurgeons. In total, 106 pediatric neurosurgeons completed the survey, of whose the vast majority completed their training in a Latin American pediatric neurosurgery program. A total of 19 accredited academic programs in pediatric neurosurgery were found in Latin America distributed in 6 different countries. On average, the pediatric neurosurgical training in America Latina has a duration of 278years, ranging from 1 to > 6years. This study is the first of its kind to review pediatric neurosurgical training in Latin America, in which both pediatric and general neurosurgeons provide neurosurgical care to children in the continent; however, we found that in the majority of the cases, children are treated by certified pediatric neurosurgeons, of whose the vast majority were trained in Latin American programs. On the other hand, we found areas of improvement in the specialty in the continent, including regulation of training opportunities, increased support for funding, and more opportunities for education among all countries.

Donor specific antibody surveillance among pediatric kidney transplant programs: A report from the improving renal outcome collaborative.

Kidney transplantation (KT) is the preferred treatment for children with end-stage kidney disease. Recent advances in immunosuppression and advances in donor specific antibody (DSA) testing have resulted in prolonged allograft survival; however, standardized approaches for surveillance DSA monitoring and management of de novo (dn) DSA are widely variable among pediatric KT programs. Pediatric transplant nephrologists in the multi-center Improving Renal Outcomes Collaborative (IROC) participated in a voluntary, web-based survey between 2019 and 2020. Centers provided information pertaining to frequency and timing of routine DSA surveillance and theoretical management of dnDSA development in the setting of stable graft function. 29/30 IROC centers responded to the survey. Among the participating centers, screening for DSA occurs, on average, every 3 months for the first 12months post-transplant. Antibody mean fluorescent intensity and trend most frequently directed changes in patient management. Increased creatinine above baseline was reported by all centers as an indication for DSA assessment outside of routine surveillance testing. 24/29 centers would continue to monitor DSA and/or intensify immunosuppression after detection of antibodies in the setting of stable graft function. In addition to enhanced monitoring, 10/29 centers reported performing an allograft biopsy upon detection of dnDSA, even in the setting of stable graft function. This descriptive report is the largest reported survey of pediatric transplant nephrologist practice patterns on this topic and provides a reference for monitoring dnDSA in the pediatric kidney transplant population.

Outcomes of Menstrual Management Use in Transgender and Gender-Diverse Adolescents.

To describe and compare the outcomes of various menstrual-management methods, including method choice, continuation, bleeding patterns, amenorrhea rates, effect on moods and dysphoria, and side effects, in transgender and gender-diverse adolescents. This was a retrospective chart review of all patients seen in a multidisciplinary pediatric gender program from March 2015 to December 2020 who were assigned female at birth, had achieved menarche, and used a menstrual-management method during the study period. Data were abstracted on patient demographics and menstrual-management method continuation, bleeding patterns, side effects, and satisfaction at 3 months (T1) and 1 year (T2). Outcomes were compared between method subgroups. Among the 101 included patients, 90% chose either oral norethindrone acetate or a 52-mg levonorgestrel (LNG) intrauterine device (IUD). There were no differences in continuation rates for these methods at either follow-up time. Almost all patients had improved bleeding at T2 (96% for norethindrone acetate and 100% for IUD users), with no difference between subgroups. Amenorrhea rates were 84% for norethindrone acetate and 67% for IUD at T1 and 97% and 89%, respectively, at T2, with no differences at either point. The majority of patients had improved pain, menstrually related moods, and menstrually related dysphoria at both follow-up points. There were no differences in side effects between subgroups. There were no differences in method satisfaction between the groups at T2. Most patients chose norethindrone acetate or an LNG IUD for menstrual management. Continuation, amenorrhea, and improved bleeding, pain, and menstrually related moods and dysphoria were high for all patients, indicating that menstrual management is a viable intervention for gender-diverse patients who experience increased dysphoria related to menses.

"Working Together": Perspectives of Healthcare Professionals in Providing Virtual Care to Youth with Chronic Pain during the COVID-19 Pandemic.

The onset of the coronavirus disease in 2019 necessitated a rapid transition to virtual care for chronic pain treatment. A mixed methods design was implemented using qualitative interviews and quantitative satisfaction surveys. Interviews were conducted in February 2021 with a sample of healthcare professionals (HCPs; n = 6) who had provided multidisciplinary treatment (MDT) through an outpatient hospital pediatric chronic pain program. Satisfaction surveys were distributed to all MDT professionals employed by the clinic in April 2021 (n = 13 of 20 eligible; 65% response rate). Participants represented medicine, rehabilitation, and mental health professionals. Analysis of interviews generated five themes: (1) adaptation to virtual care, (2) benefits of virtual care, (3) limitations of virtual care, (4) shifting stance on virtual care over time, and (5) considerations for implementing virtual care. The satisfaction survey data revealed that respondents were able to effectively provide appropriate diagnoses, recommendations, and/or care plans for pediatric chronic pain via virtual care (n = 12, 92.3%). Detailed survey responses are presented by discipline. This study provides a rich exploration of HCPs' experiences in providing MDT for pediatric chronic pain within a virtual care model. The current results may contribute to the future development of guidelines for virtual care delivery with pediatric chronic pain populations.