Pediatric Training Research Articles

Validity evidence for a novel multiple-choice question bank in the field of child abuse pediatrics

BackgroundThough child abuse pediatrics has been a board-certified subspecialty for 15 years, there are few formalized board preparation resources available. ObjectiveThe purpose of this project was to establish a multiple-choice question bank with sufficient validity evidence for use in preparation for the child abuse pediatrics board examination. Participants and settingThe question bank was distributed via an electronic child abuse pediatrics mailing list. Participants completing the entire question bank included 27 board-certified child abuse pediatricians (CAPs), 19 board-eligible CAPs, and 18 CAP fellows. MethodsWe used Messick's framework to conduct the validity investigation, which includes five components: content evidence, response process, internal structure, relation to other variables, and consequences. Item analyses included difficulty index, discrimination index, and distractor analysis. We used Cronbach's alpha to estimate internal consistency reliability. We conducted linear regressions of scores on the question bank compared to in-training exam scores and career stage. ResultsEighty-four participants completed part of the question bank, and 64 completed the entire question bank. Of the original 117 questions (“items”), 94 met inclusion criteria. The mean score among board-certified CAPs was 80 %, and among participants reporting passing third-year ITE scores was 81 %. Correlation coefficient of scores on this question bank by career stage was r = 0.94, and by year of fellowship was r = 0.99. Cronbach's alpha for internal consistency reliability was 0.83. ConclusionsThis multiple-choice question bank is the first question bank with a robust validity investigation for use by child abuse pediatrics trainees.

Meeting the need for effective and standardized neonatology training: a pan-European Master’s Curriculum

Neonatology is a pediatric sub-discipline focused on providing care for newborn infants, including healthy newborns, those born prematurely, and those who present with illnesses or malformations requiring medical care. The European Training Requirements (ETR) in Neonatology provide a framework for standardized quality and recognition of equality of training throughout Europe. The latest ETR version was approved by the Union of European Medical Specialists (UEMS) in April 2021. Here, we present the curriculum of the European School of Neonatology Master of Advanced Studies (ESN MAS), which is based on the ETR in Neonatology and aims to provide a model for effective and standardized training and education in neonatal medicine. We review the history and theory that form the foundation of contemporary medical education and training, provide a literature review on best practices for medical training, pediatric training, and neonatology training specifically, including educational frameworks and evidence-based systems of evaluation. The ESN MAS Curriculum is then evaluated in light of these best practices to define its role in meeting the need for a standardized empirically supported neonatology training curriculum for physicians, and in the future for nurses, to improve the quality of neonatal care for all infants.Impact statementA review of the neonatology training literature was conducted, which concluded that there is a need for standardized neonatology training across international contexts to keep pace with growth in the field and rapidly advancing technology. This article presents the European School of Neonatology Master of Advanced Studies in Neonatology, which is intended to provide a standardized training curriculum for pediatricians and nurses seeking sub-specialization in neonatology. The curriculum is evaluated in light of best practices in medical education, neonatology training, and adult learning theory.

Confidence in adolescent contraceptive counseling among residents and fellows training at the University of Texas Southwestern in Dallas, Texas

ObjectivesEvaluate trainees’ perceptions of past training and confidence in counseling about five contraceptive methods. Study DesignTrainees completed an online survey in 2020. Logistic regressions evaluated the relationship between participant characteristics and confidence. ResultsAmong 227 respondents (63% response rate), pediatric trainees reported the least confidence in counseling across each contraceptive method. Past training and confidence were associated. ConclusionsGaps in training should be addressed to improve confidence in contraceptive counseling among pediatricians in reproductively restricted states.

Helicobacter pylori Infection Does Not Protect Against Allergic Diseases: Evidence From a Pediatric Cohort From Northern Sardinia, Italy

ABSTRACTBackgroundThe “hygiene hypothesis” states that reduced exposure to microbial antigens due to an excessively hygienic environment can increase the risk of developing autoimmune diseases, including atopic disorders and asthma. In recent decades, there has been a progressive decline in the prevalence of numerous microorganisms following improved hygienic‐sanitary conditions. More specifically, several studies reported an inverse association between the reduction in Helicobacter pylori infection and the rise of asthma and allergic disorders.AimTo evaluate the prevalence of atopic disorders in a pediatric population in relation to seropositivity against H. pylori.MethodsChildren from Northern Sardinia, Italy, referred to the local Children's Hospital for any reason, were investigated to identify risk factors, especially H. pylori infection, associated with atopic disorders. A validated questionnaire, including demographics, house size, history of breastfeeding, residence, school or daycare center attendance, exposure to animals, and a defined diagnosis of atopy—including asthma—was filled out by a trained pediatrician according to parents' answers and child records. A blood sample was collected from each participant and immunoglobulin G against H. pylori was assessed by a locally validated ELISA test.ResultsThe seroprevalence of H. pylori infection was 11.7% among 492 children (240 females). Thirty‐two children had a confirmed diagnosis of asthma and 12 of allergy. No one child showed both conditions. Statistically significant differences in H. pylori seropositivity were not detected between children with or without atopy (8.4% vs. 12.6; p = 0.233). Although atopic disorders were more frequent in children exposed to traditional atopic risk factors, none of them showed to be significant after adjusting for all covariates.ConclusionsSerologically assessed H. pylori infection was not significantly associated with a reduced risk of atopic diseases in children.

Enhancing neonatal thoracoscopic surgical training with rabbit model

BackgroundThoracoscopy, which has an increasing role in the treatment of indexed neonatal surgical conditions, requires adequate training. To support this, the current study aimed to evaluate the feasibility and effectiveness of using live rabbit models in neonatal thoracoscopic skills training among paediatric surgeons. MethodsFollowing didactic lectures and demonstrations, the participants were given hands-on opportunities to perform thoracoscopic procedures. The feasibility and effectiveness of using live rabbit models in neonatal thoracoscopic skills training among paediatric surgeons were evaluated with pre-/post-course procedural confidence scores and a questionnaire. ResultsThis study included 13 paediatric surgeons—2 (15 %) males and 11 (85 %) females—who were evenly distributed. There were four basic surgical trainees, five higher surgical trainees and four fellows in paediatric surgery (mean surgical practice experience: 4.5 ± 3.7 years). Most had experience assisting paediatric (70 %) and neonatal (62 %) thoracoscopic surgery. Only 30 % had experience as the chief surgeon of paediatric thoracoscopic surgery, with none on neonates. Significant improvement was seen in procedural confidence as the assistant and chief surgeon of all procedures post-workshop. The surgeons rated the model positively. ConclusionThe procedural confidence level of paediatric surgeons improved significantly after workshop participation. This realistic and easily reproducible model can help perfect thoracoscopic skills. Therefore, its integration into paediatric surgical training would promote surgical skill proficiency and could improve surgeons’ confidence in neonate operations.

Health Care for Unaccompanied Immigrant Children in US Communities: A Guide for Pediatric Practitioners.

Children who arrived at the United States border without a parent or legal guardian (ie, unaccompanied children) are present in communities throughout the country in growing numbers. For them to receive the highest-quality medical and mental services available, pediatric practitioners should have a foundational understanding of their unique set of circumstances and experiences. However, formal education on how to care for this specific immigrant subpopulation is not routinely incorporated into pediatric training programs, and limited clinical guidance is available in the published literature. This article provides best-practice recommendations for pediatric practitioners caring for unaccompanied children after their release from government custody, incorporating guidance for clinical encounters as well as suggestions of processes to meet their health-related social needs and advocacy actions to improve their well-being. [Pediatr Ann. 2024;53(5):e178-e182.].

Implementation of a Global Pediatric Trauma Course in an Upper Middle–Income Country: A Pilot Study

IntroductionOver 90% of pediatric trauma deaths occur in low- and middle-income countries (LMICs), yet pediatric trauma-focused training remains unstandardized and inaccessible, especially in LMICs. In Brazil, where trauma is the leading cause of death for children over age 1, we piloted the first global adaptation of the Trauma Resuscitation in Kids (TRIK) course and assessed its feasibility. MethodsA 2-day simulation-based global TRIK course was hosted in Belo Horizonte in October 2022, led by one Brazilian and four Canadian instructors. The enrollment fee was $200 USD, and course registration sold out in 4 d. We administered a knowledge test before and after the course and a postcourse self-evaluation. We recorded each simulation to assess participants’ performance, reflected in a team performance score. Groups received numerical scores for these three areas, which were equally weighted to calculate a final performance score. The scores given by the two evaluators were then averaged. As groups performed the specific simulations in varying orders, the simulations were grouped into four time blocks for analysis of performance over time. Statistical analysis utilized a combination of descriptive analysis, Wilcoxon signed-rank tests, Kruskal–Wallis tests, and Wilcoxon rank-sum tests. ResultsTwenty-one surgeons (19 pediatric, one trauma, one general) representing four of five regions in Brazil consented to study participation. Women comprised 76% (16/21) of participants. Overall, participants scored higher on the knowledge assessment after the course (68% versus 76%; z = 3.046, P < 0.001). Participants reported improved knowledge for all tested components of trauma management (P < 0.001). The average simulation performance score increased from 66% on day 1% to 73% on day 2, although this increase was not statistically significant. All participants reported they were more confident managing pediatric trauma after the course and would recommend the course to others. ConclusionsCompletion of global TRIK improved surgeons’ confidence, knowledge, and clinical decision-making skills in managing pediatric trauma, suggesting a standardized course may improve pediatric trauma care and outcomes in LMICs. We plan to more closely address cost, language, and resource barriers to implementing protocolized trauma training in LMICs with the aim to improve patient outcomes and equity in trauma care globally.

HPV Vaccination Practices Among Medical Trainees in Pediatrics, Obstetrics and Gynecology, and Family Medicine.

The human papillomavirus (HPV) vaccine has been proven effective in preventing HPV-related cancer. However, vaccination uptake in the United States remains unacceptably low. The aim of this study is to determine whether residents' HPV vaccination status, demographics, or residency training setting are predictive of vaccination prescribing practices. This was an anonymous, IRB-approved, opt-in survey of OBGYN, Family Medicine, and Pediatric residents. Using the National Residency Match Program Web site, surveys were sent to program directors requesting their residents' participation. Demographics, practice settings, HPV vaccination status, reasons for being inappropriately vaccinated, and resident vaccination-prescribing practices were analyzed. A total of 853 residents participated. A total of 56.7% of respondents were fully vaccinated against HPV. The most common reasons for being unvaccinated were as follows: age (51.7%, n = 122), monogamous (30.9%, n = 73), do not believe it works (22.5%, n = 53), and affordability/insurance did not cover (14.4%, n = 34). Residents working in an urban setting were more likely to be vaccinated than those in suburban (odds ratio [OR] = 1.93, 95% confidence interval [CI], 1.364-3.229, p < .001) or rural (OR = 2.08, 95% CI 1.461-3.359, p 0.01) settings. Males were less likely than females (OR = 0.90, 95% CI 0.702-0.997, p < .001) to be vaccinated. Single residents were more likely to be vaccinated than married (OR = 2.56, 95% CI 2.444-2.704, p < .001) or divorced (OR = 2.15, 95% CI 1.822-3.264, p 0.21) residents. Vaccinated residents were more likely to recommend HPV vaccination to their patients than those who were unvaccinated (OR = 1.83, 95% CI 1.321-2.548, p .004). A significant portion of Family Medicine, Pediatrics, and OBGYN residents have not received appropriate vaccination against HPV. Vaccination is highest among residents who identify as female, single, or working in urban settings. Vaccinated residents were also found to be almost 2 times as likely to recommend vaccination to their patients. As such, our data suggest that targeted provider education is needed to increase vaccination rates for both trainees and their patients.

Point-of-care ultrasound (POCUS) pediatric resident training course: a cross-sectional survey

BackgroundPoint-of-care ultrasound (POCUS) is becoming increasingly crucial in the Pediatric Emergency Department for objective patient examination. However, despite its growing interest and wide-ranging applications, POCUS remains relatively unexplored in general pediatric training and education. Many physicians still find it challenging to comprehend and implement.MethodsA theoretical-practical POCUS course for pediatric residents was conducted at the University of Catania, Italy. The course’s effectiveness and practical impact on residents was assessed through a pre-post training survey. The first part of the questionnaire focused on the self-perceived time needed to learn how to recognize the following conditions using POCUS: (i) Pleural effusion (ii) Lung consolidation (iii) Pneumothorax (PNX) (iv) Cardiac contractility (v) Pericardial effusion (vi) Perisplenic effusion (vii) Morison’s pouch effusion (viii) Douglas’ pouch effusion (ix) Filling and collapsibility of the inferior vena cava. In the second part, we compared the potential role of POCUS in (i) Reducing the use of ionizing radiation in children (ii) Increasing the sense of security in diagnosis and treatment decisions making and (iii) Increasing the residents’ confidence level with POCUS after the course on a 1-to-10 rating scale.ResultsSeventy-two residents participated in the study. The statistical analysis showed significant pre-post differences in almost all the items considered, except for “cardiac contractility” and “PNX”. Furthermore, the perceived potential role of POCUS in reducing ionizing radiation usage and the sense of security in diagnosis and treatment decisions showed statistically significant differences (p < 0.05) before and after the course. Data analysis also revealed a consistently high confidence level with POCUS after the course.ConclusionsThe results highlight the importance of including a POCUS track course in pediatric post-graduate programs due to its simplicity, rapid learning time, and clinical usefulness. Based on these findings, it would be recommended to increase the teaching hours dedicated to the recognition of pneumothorax and cardiology POCUS examination. Emphasizing POCUS training in pediatric education can enhance patient care and diagnostic accuracy while minimizing radiation exposure.

A comprehensive study of modified three-month pediatrics training curriculum at Shahid Beheshti University of Medical Sciences and its impact on student satisfaction

ObjectivesContinuous curriculum improvements reveal the dedication of policy-makers to raising the quality of education and student learning. This study aims to report the impact of curriculum changes to the three-month pediatric course curriculum at Shahid Beheshti University of Medical Sciences (SBMU) on the satisfaction levels of medical students.MethodsOne hundred eighteen 4th-5th years medical students, who had completed their pediatric clinical rotation in SBMU-affiliated teaching hospitals including Mofid Children Hospital, Loghman Hakim Hospital, Shohada-e-Tajrish Hospital, and Imam Hossein Hospital from January to December 2022 were included in this cross-sectional study. After obtaining informed consent, a questionnaire was sent out to all participants, that included 27 statements about the impact of the modified curriculum on their satisfaction with their learning and performance. SPSS version 22 was used to analyze the data.ResultsThe level of satisfaction of trainees from attending clinics was 82-56%, prior introduction to the course was about 82%, and attending general hospitals (all hospitals except Mofid Children hospital, which is the only children hospital affiliated to SBMU) was 82-97%. The quality of patients-based learning was reported in terms of attendance at morning report sessions which was 92.3%, attendance at ward rounds, which was 71.8%, and attendance at clinics, which was 62.4%. The satisfaction rate from the senior attending mentor was 96.5%. The satisfaction rate of the pathology course was 67.2%, and the radiology was 82.4%. The satisfaction level of medical students from the infectious disease department was 70% and the gastroenterology department was 83.8%. The level of satisfaction with the implementation of the twelve-week program was 68.7%, with the expressiveness and usability of the presentation of materials was 53.9%, with the compatibility of the exams with the presented materials was 92%, and withholding weekly exams was 86.8%. The satisfaction rate of using the materials presented in the final exam in the digestive department and the infectious department was 85% and 68%, respectively. The overall satisfaction rate of the training course was 76.66%.ConclusionThe results provide vital insights for improving medical education. According to this study, medical student satisfaction with the pediatric curriculum after its recent revisions was in a satisfactory range. Attendance at clinics, information sharing, patient-based learning, practical training, attending mentorship, curriculum clarity, and alignment with student expectations all contributed to participants' high levels of satisfaction.

"Every breath you take": evaluating sound levels and acoustic characteristics of various neonatal respiratory support and ventilation modalities.

Early sensory experiences have a significant impact on the later life of preterm infants. The NICU soundscape is profoundly influenced by various modalities of respiratory support or ventilation, which are often mandatory early in the care. The incubator, believed to shield from external noise, is less effective against noise originating inside. The objective of this study was to evaluate the sound levels and characteristics of frequently used respiratory support and ventilation modalities, taking into consideration the developing auditory system of premature infants. To evaluate sound dynamics inside and outside an incubator during respiratory support/ventilation, experimental recordings were conducted at the Center for Pediatric Simulation Training of the Medical University Vienna. The ventilator used was a FABIAN HFOI®. Jet CPAP (Continuous positive airway pressure), whether administered via mask or prongs, generates significantly higher sound levels compared to High-flow nasal cannula (HFNC) and to High-frequency oscillatory ventilation (HFOV) delivered through an endotracheal tube. Upon evaluating the sound spectrum of jet CPAP support, a spectral peak is observed within the frequency range of 4 to 8 kHz. Notably, this frequency band aligns with the range where the hearing threshold of preterm infants is at its most sensitive. Non-invasive HFNC and invasive HFOV generate lower sound levels compared to those produced by jet CPAP systems delivered via masks or prongs. Moreover, HFNC and HFOV show a reduced acoustic presence within the frequency range where the preterm infant's hearing is highly sensitive. Therefore, it is reasonable to speculate that the potential for auditory impairment might be more pronounced in preterm infants who require prolonged use of jet CPAP therapy during their time in the incubator.

Pediatric anesthesiology in Brazil, Chile, and Mexico.

Latin America comprises an extensive and diverse territory composed of 33 countries in the Caribbean, Central, and South America where Romance languages-languages derived from Latin are predominantly spoken. Economic disparities exist, with inequitable access to pediatric surgical care. The Latin American Surgical Outcomes Study in Pediatrics (LASOS-Peds), a multi-national collaboration, will determine safety of pediatric anesthesia and perioperative care. Below, we provide a descriptive initiative to share how pediatric anesthesia in Brazil, Chile, and Mexico operate. Theses descriptions do not represent all of Latin America. Brazil an upper middle-income country, population 203 million, has a public system insufficiently resourced and a private system, resulting in inequitable safety and accessibility. Surgical complications constitute the third leading cause of mortality. Anesthesiology residency is 3 years, with required rotations in pediatric anesthesia; five hospitals offer pediatric anesthesia fellowships. Anesthesiology is a physician-only practice. A Pediatric Anesthesia Committee within the Brazilian Society of Anesthesiology offers education through seasonal courses and workshops including pediatric advanced life support. Chile is a high-income country, population 19.5 million, the majority cared for in the public system, the remainder in university, private, or military systems. Government efforts have gradually corrected the long-standing anesthesiology shortage: twenty 3-year residency programs prepare graduates for routine pediatric cases. The Chilean Society of Anesthesiology runs a 1-month program for general anesthesiologists to enhance pediatric anesthesia skills. Pediatric anesthesia fellowship training occurs in Europe, USA, and Australia, or in two 2-year Chilean university programs. Public health policies have increased the medical and surgical pediatric specialists and general anesthesiologists, but not pediatric anesthesiologists, which creates safety concerns for neonates, infants, and medically complex. Chile needs more pediatric anesthesia fellowship programs. Mexico, an upper middle-income country, with a population of about 126 million, has a five-sector healthcare system: public, social security for union workers, state for public employees, armed forces for the military, and a private "self-pay." There are inequities in safety and accessibility for children. Pediatric Anesthesiology fellowship is 2 years, after 3 years residency. A shortage of pediatric anesthesiologists limits accessibility and safety for surgical care, driven by added training at low salary and hospital under appreciation. The Mexican Society of Pediatric Anesthesiology conducts refresher courses, workshops, and case conferences. Insufficient resources and culture limits research.

Reliability of renal point-of-care ultrasound (POCUS) performed by pediatric postgraduates to diagnose hydronephrosis in infants.

Point-of-care ultrasound (POCUS) has gained prominence in a variety of medical specialties due to advances in ultrasound technology. POCUS has not been fully integrated into pediatric residency training programs despite its widespread use and proven benefits. At our institution, renal POCUS is performed by pediatric residents for the evaluation of hydronephrosis, which is the main pathology for which ultrasound is used in the clinical practice of pediatric nephrology. This study was conducted to evaluate the quality of renal POCUS performed by pediatric residents in infants. Four pediatric residents, comprising two first-year and two second-year residents at Konyang University Hospital, participated in the study conducted from May 2021 to May 2022. All participants had completed our Point-of-Care Ultrasound (POCUS) training program. The study focused on infants admitted to the pediatric inpatient unit, identified by attending physicians as requiring renal ultrasound. All infants underwent their initial kidney ultrasound examination. Temporal alignment between renal Point-of-Care Ultrasound (POCUS) performed by pediatric residents and conventional ultrasound (USG) conducted by radiologists was asynchronous. Pediatric residents conducted POCUS sessions during scheduled radiologist appointments throughout the day, occurring either before or after the radiologist's examination. There was no mutual awareness of each other's results. Inter-observer agreement between radiologists and pediatric residents was compared for the presence or absence of hydronephrosis and its grade, which are primary considerations in pediatric renal ultrasound. Our study found that 53 infants (68.8%) were diagnosed with hydronephrosis using point-of-care ultrasound (POCUS), compared to 48 infants (62.3%) diagnosed with conventional ultrasound (USG). Among the POCUS examinations conducted by pediatric residents, hydronephrosis of SFU grades 1, 2, 3, and 4 were observed in 56.6%, 35.8%, 7.5%, and 0%, respectively. Inter-observer reliability between POCUS and conventional USG showed good agreement, with Cohen's kappa coefficients exceeding 0.8 for sensitivity and 0.6 for grading. Renal POCUS performed well in diagnosing and grading hydronephrosis in infants when performed by pediatric residents who had completed a two-phase training program.

Current progress in international pediatric emergency medicine.

Over the past four decades, pediatric emergency Medicine (PEM) has witnessed significant global development, with a notable increase in training programs and official recognition by regulatory bodies. However, disparities persist in the recognition of PEM as an independent subspecialty, availability of training programs on a global scale, academic recognition, and the ability to provide high-quality care to children worldwide. There is paucity of published literature regarding development of PEM globally. This review explores the current trends and challenges in international pediatric emergency medicine. Current trends in international pediatric emergency medicine encompass the provision of training in pediatric-focused emergency and acute care, increased propagation of evidence-based guidelines specific to the care of children, the growth of collaborative research networks and interest groups within national and international societies. Simultaneously, the field continues to face challenges such as the lack of recognition, inequities in access, and a lack of dissemination of global PEM initiatives. While recent advancements have significantly enhanced the state of international pediatric emergency medicine, including pediatric specific research networks and training programs, barriers still hinder its overall quality. Many of these obstacles are not unique to pediatric emergency medicine but are directly affected by financial disparities and lack of governmental and public recognition of the essential role of pediatric emergency care.

Health Literacy in Pediatric Consultations on Allergy Prevention.

The first 3 years of life offer an opportunity to prevent allergic diseases. Pediatricians are an important source of health information for parents. However, a certain degree of health literacy is necessary to understand, appraise, and apply preventive behavior, which can be supported by health literacy (HL) sensitive consultations and a HL friendly environment. In this study, we want to shed light on how pediatricians in outpatient care in Germany advise on early childhood allergy prevention (ECAP) and how they consider parental HL. We conducted 19 semi-standardized telephone interviews with pediatricians from North-Rhine-Westphalia and Bavaria. The interviews were audio-recorded, transcribed, pseudonymized, and subjected to content analysis. Current ECAP recommendations were well known among our sample. Despite the shift of evidence from avoidance of allergens toward early exposure, providing advice on ECAP was considered non-controversial and it was widely assumed that recommendations were easy to understand and apply for parents. However, ECAP was treated as an implicit topic resonating among others like infant nutrition and hygiene. Regarding HL, our interview partners were not aware of HL as a concept. However, they deemed it necessary to somehow assess parental information level and ability to understand provided information. Formal HL screening was not applied, but implicit strategies based on intuition and experience. Concerning effective HL-sensitive communication techniques, interviewees named the adaptation of language and visual support of explanations. More advanced techniques like Teach Back were considered too time-consuming. Medical assistants were considered important in providing an HL-sensitive environment. Time constraints and the high amount of information were considered major barriers regarding HL-sensitive ECAP counseling. It seems warranted to enhance professional education and training for pediatricians in HL and HL-sensitive communication, to reach all parents with HL-sensitive ECAP counseling. [HLRP: Health Literacy Research and Practice. 2024;8(2):e47-e61.].

Development of a Virtual Pediatric Telemedicine Training Program

Development of a Virtual Pediatric Telemedicine Training Program

FEATURES AND EMPHASIS OF TEACHING FORENSIC MEDICINE FOR STUDENTS OF THE PEP "PAEDIATRICS"

This article addresses current issues in teaching the academic discipline "Forensic Medicine and Medical Law" to students of the professional educational program (PEP) "Pediatrics." With a focus on violence against children, the authors emphasize the necessity of educating pediatric students on forensic principles and practical skills. The article highlights the harmonization with international standards, the importance of awareness among students, and the critical role forensic medicine plays in pediatric training. Forensic medicine, as a discipline encompassing diverse medical fields, plays a crucial role in pediatrics. This article explores the integration of forensic principles into the PEP "Pediatrics," emphasizing the increasing societal issue of violence against children. The importance of training pediatric students to recognize and respond to such incidents while maintaining a solid evidence base is paramount.&#x0D; The authors emphasize that teaching forensic medicine to pediatric students should prioritize the following directions:&#x0D; &#x0D; Expert Involvement in Forensic Medical Examinations: Focuses on the significance of forensic medical examinations related to medical errors and offenses. Article 69 of the Criminal Procedure Code allows pediatricians to act as experts, emphasizing equivalence in rights and responsibilities with forensic medical experts.&#x0D; Physician Participation in Urgent Investigative Actions: Emphasizes the importance of practical skills, such as examining a corpse at the scene. Article 238 of the Criminal Procedure Code permits pediatricians to participate in urgent investigative actions. This includes instructing students on organizational and legal aspects, as well as theoretical and practical principles of examining a corpse at the scene.&#x0D; Accurate Documentation of Physical Injuries: Stresses the essential skill of accurately describing physical injuries on a child's body. Acknowledges the role of pediatricians in initial injury documentation, considering the potential involvement in criminal investigations.&#x0D; Accuracy and Completeness of Medical Documentation: Underscores the critical nature of accurate and complete medical documentation, serving as evidence in criminal proceedings. The article discusses potential legal consequences for physicians due to improper maintenance.&#x0D; Recording Sexual Offenses Against Children: Introduces an elective course focusing on preventing sexual offenses against children and domestic violence. Aims to form theoretical and practical competencies in students, adhering to the "Istanbul Protocol" and emphasizing the role of pediatricians in recognizing and responding to sexual violence against children.&#x0D; &#x0D; Therefore, educating pediatric students on how to act in such cases, how to work with patients without compromising the evidence base, and simultaneously providing timely medical assistance becomes paramount. This ensures the preparation of a highly qualified specialist in pediatrics whose competencies align with their professional qualification characteristics.&#x0D; Conclusion.&#x0D; &#x0D; Harmonizing domestic legislation with EU norms and standards as part of Ukraine's integration into the EU creates priority directions in teaching the discipline "Forensic Medicine and Medical Law."&#x0D; Insufficient awareness among pediatric students and a casual attitude towards the consequences of unprofessional actions or inaction in future professional activities contribute to a lack of motivation for studying "Forensic Medicine and Medical Law."&#x0D; Teaching forensic medicine is a crucial part of pediatric training. By providing students with the knowledge and skills necessary to recognize and respond to cases of violence against children, we can help protect children and ensure they receive the necessary assistance.&#x0D;

A POCUS-first pathway to streamline care for children with suspected ileocolic intussusception.

As point-of-care ultrasound (POCUS) has emerged as a valuable tool for intussusception screening, this quality improvement study aimed to implement a "POCUS-first" pathway in a Pediatric Emergency Department (ED) to streamline workflow and expedite care for children with suspected intussusception. This was a prospective analysis of children diagnosed with ileocolic intussusception in a Pediatric ED between June 2022 and June 2023. The study compared the "POCUS-first" cohort with the group receiving only radiology-performed ultrasound. Key outcomes included physician initial assessment to radiology-performed US time and physician initial assessment to reduction time. Continuous improvement efforts incorporated pediatric emergency medicine physician training, education, and pathway dissemination through plan-do-study-act cycles. The study included 29 patients in the "POCUS-first" pathway group and 70 patients in the non-POCUS group. The "POCUS-first" pathway demonstrated a significantly shorter physician initial assessment to reduction time compared to the non-POCUS group (170.7min vs. 240.6min, p = 0.02). Among non-transferred patients, the "POCUS-first" group also had a significantly shorter emergency department length of stay (386min vs. 544min, p = 0.047). Implementation of a "POCUS-first" pathway for managing ileocolic intussusception led to notable improvements in process efficiency. The shorter physician initial assessment to reduction time highlights the potential for expedited decision-making and intervention. These study findings support the potential of this pathway to optimize the management and outcomes of children with ileocolic intussusception.

Care of the Pediatric Patient for Ambulatory Tonsillectomy With or Without Adenoidectomy: The Society for Ambulatory Anesthesia Position Statement.

The landscape of ambulatory surgery is changing, and tonsillectomy with or without adenoidectomy is one of the most common pediatric surgical procedures performed nationally. The number of children undergoing tonsillectomy on an ambulatory basis continues to increase. The 2 most common indications for tonsillectomy are recurrent throat infections and obstructive sleep-disordered breathing. The most frequent early complications after tonsillectomy are hemorrhage and ventilatory compromise. In areas lacking a dedicated children's hospital, these cases are managed by a nonpediatric specialized anesthesiologist and general otolaryngology surgeon. In response to requests from our members without pediatric fellowship training and/or who care for pediatric patients infrequently, the Pediatric Committee of the Society for Ambulatory Anesthesia (SAMBA) developed a position statement with recommendations for the safe perioperative care of pediatric patients undergoing tonsillectomy with and without adenoidectomy in freestanding ambulatory surgical facilities. This statement identifies children that are more likely to experience complications and to require additional dedicated provider time that is not conducive to the rapid pace and staffing ratios of many freestanding ambulatory centers with mixed adult and pediatric practices. The aim is to provide health care professionals with practical criteria and suggestions based on the best available evidence. When high-quality evidence is unavailable, we relied on group consensus from pediatric ambulatory specialists in the SAMBA Pediatric Committee. Consensus recommendations were presented to the Pediatric Committee of SAMBA.

Looking at the impact of COVID-19 on pediatric allergic diseases: Effects on pediatric allergy care and training

Looking at the impact of COVID-19 on pediatric allergic diseases: Effects on pediatric allergy care and training