Pediatric Specialists Research Articles

P-1169. Disseminated Pediatric Coccidioidomycosis at an Academic Center in Southern Arizona (2013 - 2023)

Abstract Background There have been few reviews of pediatric disseminated coccidioidomycosis, particularly regarding presentation. A better understanding of this may enable more timely diagnosis and improve management in children. Methods We identified 157 children with coccidioidomycosis seen in the pediatric infectious diseases practice at University of Arizona – Banner University Medical Center in Tucson, AZ, between 2013 – 2023. Criteria included: age under 18, seen by a pediatric infectious diseases specialist, with a diagnosis of coccidioidomycosis in the consultation note. This study includes the subset of children with a diagnosis of disseminated coccidioidomycosis. Cases were excluded if the electronic medical record did not document at least one of the following supporting diagnostics: positive coccidioidal IgM or IgG by EIA, culture positive for Coccidioides, or histopathological findings characteristic of coccidioidomycosis. Demographic, laboratory, and radiologic data as well as clinical characteristics were collected from review of the electronic medical record. Results Among 157 patients, 28 (17.8%) had disseminated disease. Median age at diagnosis was 11.7 years (range 7 months to 17 years of age). 64% were male. Musculoskeletal disease was the most common extrapulmonary organ system involved (15 patients), followed by skin (11), central nervous system (4), abdominal organs and viscera (2), pericardium (1) and bloodstream (1). Sixteen (57%) had no comorbidities. The chest radiograph was normal in 10 of 26 (38%) where it was performed. Seventeen (61%) had a negative coccidioidal EIA IgG serology, and 3 patients (11%) had negative IgM and IgG serologies on presentation. Only 3 (11%) had an elevated absolute eosinophil count (above 600/µL). Conclusion Disseminated coccidioidomycosis affects children of all ages and can involve many different organ systems, particularly musculoskeletal, skin, and central nervous system. It should be considered in the appropriate clinical setting even in patients with negative coccidioidal serologies, normal chest x-rays, normal eosinophil counts, or no underlying illness. Disclosures All Authors: No reported disclosures

P-993. Increased Reporting of RPR Seronegative Infants with Congenital Syphilis to the Chicago Department of Public Health, A Quality Improvement Project

Abstract Background We are in the midst of an epidemic of congenital syphilis (CS). Nationwide CS diagnosis and treatment recommendations provided by the Centers for Disease Control are dependent on the timing of maternal treatment, and laboratory and procedural results of the mother and infants. There are specific circumstances where infants with a non-reactive rapid plasma reagin (RPR-) should receive a 10-day course of treatment in the context of inadequate maternal treatment. Depending on the institutional reporting practices of CS to departments of public health, there may be scenarios where RPR-based reporting protocols will leave out this specific cohort. Methods Baseline data of Infants stratified by RPR status was collected through electronic medical record (EMR) review for those born at the University of Chicago Comer Children’s Hospital in Chicago, IL between January 2011 and December 2022, using billing codes & penicillin administration data. From September 1st, 2023, through March 31st, 2024, a quality improvement intervention was implemented that involved communicating with the hospital’s Pediatric Infectious Diseases specialists, Pediatric & Newborn Hospitalists, Neonatologists, Infection Prevention & Control, and Chicago Department of Public Health (CDPH). The intervention components included 1) formalize expectation to page Pediatric ID on-call team all infants with concern for maternal syphilis exposure, 2) create an Epic Smart Phrase to standardize data presentation for clinical and reporting purposes, 3) standardize ICD-10 diagnosis coding practices, and 4)email reminders monthly to teams involved. Results 154 infants were identified who had a CDC case definition of CS and received penicillin administration therapy. Infants with CS from 2011-2022 showed 107/154 (69.4%) were RPR- and 41/154 (26.6%) were RPR- and received > 1 day of penicillin. At the end of the first PDSA cycle, a total of 22 infants were reported to CDPH with 36% (n=8) being RPR-. Conclusion Our Quality Improvement project identified a large percentage of infants diagnosed and treated with CS who were not reported to the CDPH with our previous RPR-positive – based reporting strategy. We implemented an intervention that successfully improved reporting of this specific type of patient. Disclosures Allison H. Bartlett, MD, MS, CVS/Caremark: Advisor/Consultant

P-1882. Answering the Call: Volume and Characteristics of External Phone Consultations to Pediatric Infectious Diseases Specialists at a Large Academic Children's Hospital

Abstract Background Due to the limited supply and geographic distribution of pediatric infectious diseases (Peds ID) specialists, providing unremunerated telephone advice to outside clinicians has become a significant component of day-to-day practice for many academic Peds ID clinicians. This time-consuming service is not classified as direct patient care or adequately captured by traditional billing and productivity metrics. The objective of this study was to quantify and characterize external phone consults to Peds ID specialists at Children’s Hospital Colorado (CHCO), and compare the burden of these phone consults to other pediatric subspecialists. Methods External phone consults to pediatric subspecialists at CHCO from April 2019-March 2024 were obtained from the electronic medical record (EMR). Patient and call characteristics for Peds ID were summarized with descriptive statistics. Results From 2021-2023, Peds ID received the second most external phone consults (n=6376) of any pediatric subspecialty. From 2019 to 2024, average calls to Peds ID increased 21% from 38 to 46 calls/week. One-quarter of calls were about patients registered in the EMR only for the phone encounter and never for direct patient care. Most calls concerned children < 5 years and 9% were for children 0-7 days old. Eighty-five percent of calls occurred between 8AM-5PM and 23% requested immediate callback. Fridays had the most calls (mean 7.6 calls/day), and Sundays had the least (2.1). Based on dummy time-based RVU codes, the median call time was 11-20 minutes; 36% of calls required at least one follow-up call. Only 11% of calls were expected to lead to direct patient care at CHCO based on clinician recommendation. Peds ID specialists spent over 2000 unbilled hours on external phone consults over the study period and an average of > 10 hours/week in the most recent year of data. Conclusion External phone consults to Peds ID at CHCO are increasing and time-consuming, yet do not directly generate revenue and do not reliably lead to direct patient care in our health system. Given limited supply, increased demand, and reimbursement challenges for Peds ID clinicians, different economic models for external phone consults should be explored. Chart review to describe callers, reasons for calls, and patient outcomes may inform these efforts. Disclosures Juri Boguniewicz, MD, AstraZeneca: Grant/Research Support

Communication Preferences in Pediatric Palliative Care: Insights From Caregivers and Specialists-A Central-Eastern European Perspective.

Effective communication is crucial in pediatric palliative care and is essential to facilitate shared decision making between families and the health care team. This study explored the communication preferences of caregivers and health care specialists in Central-Eastern Europe, a region with unique cultural and health care dynamics. Through qualitative interviews, key communication style preferences and barriers were identified. The results affirm that caregivers need thorough information about their child's illness, symptoms, therapeutic options, and care plans. Pediatric palliative care specialists must deliver this information competently and compassionately. Both caregivers and specialists showed common preferences for clear, timely, and empathetic communication. However, specialists faced challenges in finding time within institutional frameworks to meet these communication needs effectively. These findings highlight the need for pediatric palliative care policies and practices that enable specialists to engage in meaningful, culturally sensitive communication, aligning with caregiver preferences while navigating health care system constraints to enhance caregiver satisfaction and improve patient outcomes.

Developing Assessments for Key Stakeholders in Pediatric Congenital Heart Disease: Qualitative Pilot Study to Inform Designing of a Medical Education Toy.

Congenital heart disease (CHD) is a birth defect of the heart that requires long-term care and often leads to additional health complications. Effective educational strategies are essential for improving health literacy and care outcomes. Despite affecting around 40,000 children annually in the United States, there is a gap in understanding children's health literacy, parental educational burdens, and the efficiency of health care providers in delivering education. This qualitative pilot study aims to develop tailored assessment tools to evaluate educational needs and burdens among children with CHD, their parents, and health care providers. These assessments will inform the design of medical education toys to enhance health management and outcomes for pediatric patients with CHD and key stakeholders. Through stakeholder feedback from pediatric patients with CHD, parents, and health care providers, we developed three tailored assessments in two phases: (1) iterative development of the assessment tools and (2) pilot testing. In the first phase, we defined key concepts, conducted a literature review, and created initial drafts of the assessments. During the pilot-testing phase, 12 participants were recruited at the M Health Fairview Pediatric Specialty Clinic for Cardiology-Explorer in Minneapolis, Minnesota, United States. We gathered feedback using qualitative methods, including cognitive interviews such as think-aloud techniques, verbal probing, and observations of nonverbal cues. The data were analyzed to identify the strengths and weaknesses of each assessment item and areas for improvement. The 12 participants included children with CHD (n=5), parents (n=4), and health care providers (n=3). The results showed the feasibility and effectiveness of the tailored assessments. Participants showed high levels of engagement and found the assessment items relevant to their education needs. Iterative revisions based on participant feedback improved the assessments' clarity, relevance, and engagement for all stakeholders, including children with CHD. This pilot study emphasizes the importance of iterative assessment development, focusing on multistakeholder engagement. The insights gained from the development process will guide the creation of tailored assessments and inform the development of child-led educational interventions for pediatric populations with CHD.

Suggested Dosing of Select Beta-lactam Agents for the Treatment of Antimicrobial-Resistant Gram-Negative Infections in Children.

The Infectious Diseases Society of America (IDSA) publishes annual guidance on the treatment of antimicrobial-resistant (AMR) gram-negative infections. Within the AMR guidance, suggested dosages of antibiotics for adults infected with AMR pathogens are provided. This document serves as a companion document to the IDSA guidance to assist pediatric specialists with dosing β-lactam agents for the treatment of AMR infections in children. A panel of 13 pediatric infectious diseases specialists, including 11 pharmacists and two physicians, reviewed existing pharmacokinetic/pharmacodynamic, animal, and clinical data for newer β-lactam agents that are available in the United States and suggested for the treatment of AMR infections (i.e., cefiderocol, ceftazidime-avibactam, ceftazidime-avibactam & aztreonam, ceftolozane-tazobactam, imipenem-cilastatin-relebactam, meropenem-vaborbactam, sulbactam-durlobactam). Suggested dosing for ampicillin-sulbactam is also provided given complexities in appropriate dosing for carbapenem-resistant Acinetobacter baumannii infections. Consensus-based suggested dosing for β-lactam agents used to treat AMR infections in neonates, infants, children, and adolescents and relevant supporting evidence are provided. Content is up to date as of December 1st, 2024. Gaps and limitations to existing data are discussed. Optimizing antibiotic dosing is critical to improving the outcomes of children with AMR infections.

Association Between Specialty-Specific Physician Salaries and Percentage of Women in the Workforce.

Several studies have demonstrated that female physicians within specific specialties are compensated less than their male counterparts. Academic institutions seek to address this using Association of American Medical Colleges (AAMC) data for benchmarking and starting salary standardization. However, few studies address whether there is an association between percentage of women across specialties and mean salary for each specialty. The purpose of this study was to examine whether there is an association between mean salary and percentage of women in various specialties. This cross-sectional study used AAMC Faculty Salary Report data for fiscal year 2022. Surveys were sent to 155 U.S. accredited medical schools, of which 153 schools participated (99% response rate). Univariable and multivariable analyses were performed to assess the association between mean specialty salary, calculated as the weighted mean of male and female salaries for each specialty, and the percentage of women in each specialty using a generalized linear gamma mixed model. Analysis using data from 124,480 full-time faculty at 153 accredited U.S. medical schools indicated that as the percentage of women in a specialty increases, mean salary decreases. This finding was true for all specialties (r = -0.65), medical specialties (r = -0.83), pediatric specialties (r = -0.80), and surgical specialties (r = -0.73). Multivariable analysis accounting for rank, pediatric vs nonpediatric specialties, procedural vs nonprocedural vs mixed specialties, and years of training showed that every 10% increase in percentage of women in a specialty was associated with a 7% decrease in salary independent of other factors. An inverse correlation between percentage of women in a specialty and mean salary for that specialty was observed even when controlling for confounding factors. This trend is worth noting because AAMC data are often used as a benchmark to establish physician starting salaries.

Outcomes of a Population-Based Congenital Cytomegalovirus Screening Program

Detection of congenital cytomegalovirus (cCMV) infection has previously relied on targeted screening programs or clinical recognition; however, these approaches miss most cCMV-infected newborns and fail to identify those infants who are asymptomatic at birth but at risk for late-onset sensorineural hearing loss. To determine the feasibility of using routinely collected newborn dried blood spots (DBS) in a population-based cCMV screen to identify infants at risk for hearing loss and describe outcomes of infants screened. This diagnostic study of a population-based screening program in Ontario, Canada, took place from July 29, 2019, to July 31, 2023. All newborns with a DBS sample collected as part of routine care were screened using polymerase chain reaction (PCR) analysis for cCMV as a risk factor for hearing loss. Infants with positive DBS PCR results for cCMV were referred for confirmation of infection by urine PCR (the gold standard), as well as complete medical and audiologic assessments for sequelae of cCMV infection. Infants with possible or confirmed symptomatic cCMV were referred to pediatric infectious disease specialists for evaluation for potential treatment with valganciclovir. Detection of cCMV by polymerase chain reaction assay on a newborn DBS. Number of infants with positive screening results successfully retrieved and confirmed to have cCMV and the timeliness of retrieval and symptomatic evaluation. Of 565 987 infants born in the screening period, 551 034 (97.4%) received cCMV screening on the DBS (45.7% female, 54.3% male). Of these infants, 689 (0.13%) screened positive for cCMV; 601 (87.2%) had cCMV infection confirmed and a complete assessment of sequelae of their congenital infection. Ninety-six infants with completed assessments (16.0%) were deemed to have cCMV symptoms, and 63 of these (65.6%) began valganciclovir treatment. Sensorineural hearing loss was confirmed in 34 of 96 infants (35.4%). This program found acceptable and feasible implementation of a population-based screening program using routinely collected DBS samples, suggesting that it may serve as a template for jurisdictions considering universal cCMV screening. The program had a much lower than expected prevalence of cCMV-positive screens but still identified many children who would otherwise not have been diagnosed and who would benefit from ongoing audiologic surveillance.

Consensus evidence-based clinical practice guide for the diagnosis and management of osteoporosis in childhood and adolescence

BackgroundThe incidence of osteoporosis in children has increased dramatically during the last decade. This has been attributed to better survival rates of children living with chronic disorders, the increased use of medications known to have a negative impact on the children’s bones, and the increased preference for indoor activities and sedentary life in healthy children. Recent advances in pediatric osteoporosis definition, along with a lack of management recommendations or national consensus on its diagnosis and treatment, have led to a wide range of approaches being implemented to manage this illness. The aim of this work was to develop an optimal evidence-based consensus, target-oriented, on-steered therapeutic approach for children with osteoporosis. Based on 15 key clinical questions, a qualitative literature evaluation was conducted to provide evidence-based recommendations for the treatment of pediatric osteoporosis. An expert panel of 14 pediatric osteoporosis specialists conducted a Delphi survey. The level of evidence for each element was assessed using the Oxford Centre for Evidence-based Medicine (CEBM) System, when available, and/or based on the expert panel’s personal experience. All recommendations with an agreement rate of 75% or higher were included.ResultsThirty-six recommendations, categorized into 13 domains, had evidence 4 or 5 and consequently were included in the Delphi survey. This was assessed online and a response rate of 82.4% was achieved. Delphi 2 round revealed that all the recommendations achieved 75% or more level of agreement and therefore have been accepted and included in this management recommendations. Based on that an algorithm showing an approach to pediatric osteoporosis management and maintenance of therapy has been developed.ConclusionFor the management of children with osteoporosis, consulting a pediatric bone specialist is strongly advised, either by referral or by advice. This is extremely relevant because children are uniquely capable of recovering spontaneously or with the assistance of medication. This includes also vertebral fractures reshaping. Consequently, there is a huge opportunity to improve bone mass accretion and thus musculoskeletal health in children with osteoporosis.

Perancangan UI/UX Aplikasi Stunting Your Buddy dengan Metode User-Centered Design

The aim of this study is to design a mobile application that can assist in handling stunting in Panjer Village, Bali. Stunting is a condition where a child cannot grow to their optimal height according to the height of a child of their age. In this digital era, education can be conducted through various platforms, such as applications that are now commonly used. Based on a field survey that has been conducted by researching the needs of users one and two, Your Buddy will be designed to help provide education for young women about stunting prevention. Furthermore, this application will serve as an intermediary for pediatric specialists to provide education regarding stunting. This research focuses on an application that will function for stunting prevention education, requiring improvements in terms of appearance (UI) and usability (UX) to make it more appealing and user-friendly. To achieve this goal, this study will utilize the User Centered Design (UCD) method. The UCD method consists of four stages: specify the context of use, specify user and organizational requirements, produce design solutions, and evaluate design against user requirements. After testing several potential users, a final SUS score of 87.5 was obtained, which falls into point B with an Excellent category. The design of the Your Buddy application is proven to have quality that meets user expectations, but in the future, it is recommended to add AI features and increase the number of respondents to expand this research.

Nurse vs physician decision-making in the ED for short acting β2-agonist administration in pediatric asthma.

To evaluate triage nurses' clinical judgment in determining short acting β2-agonist bronchodilator therapy need for children with shortness of breath in the pediatric emergency department, without prior physician assessment. This prospective study compared decision-making between triage nurses and physicians regarding bronchodilator inhalation therapy necessity. Trained nurses assessed children aged 2-18 with shortness of breath, including history-taking, vital signs, and lung auscultation. Nurses made short acting β2-agonist therapy decisions based on predefined criteria. Pediatric specialists independently evaluated patients and recorded their decision. Analysis of 62 assessments from 31 patients showed no statistically significant difference between nurses and doctors in administering inhaled bronchodilators (nurses: 87.1%, doctors: 83.9%). Clinical sign detection was similar, except for tachypnea (nurses: 48.4%, doctors: 71%, P=0.07). McNemar's test and Cohen's kappa coefficient demonstrated strong nurse-doctor correlation per patient (accuracy: 83.9%, P=0.1; kappa: 0.351). Nurses excelled in recognizing certain clinical signs but showed lower compatibility in others. For severe cases, nurses consistently identified patients needing additional treatments.

Clinical Case Report: Secondary syphilis in a child with no history of sexual abuse

This pediatric case report details the diagnostic and therapeutic challenges of secondary syphilis in a six-year-old child presenting with oral lesions and perianal condyloma lata. The diagnosis was confirmed through the Venereal Disease Research Laboratory (VDRL) test, and successful treatment was achieved with benzathine penicillin. The case presented significant diagnostic complexities, necessitating the evaluation of three potential transmission routes: late congenital syphilis, sexual abuse, and non-sexual transmission. Late congenital syphilis was excluded based on the absence of typical symptoms such as bone and dental abnormalities and neurosensorial deafness. Sexual abuse was thoroughly investigated and ruled out following an extensive four-month evaluation by a multidisciplinary team comprising a psychologist, nurse, social worker, and pediatric infectious disease specialist. Ultimately, non-sexual transmission, likely from an untreated family member, emerged as the most plausible cause, supported by the observation of overcrowded living conditions and inadequate hygiene practices in the child's environment. This case underscores the necessity of comprehensive diagnostic evaluations, including consideration of all possible transmission routes, in managing pediatric syphilis. Public health interventions focusing on improving living conditions and hygiene practices are essential to prevent similar cases.

Management of ankyloglossia in 2 years old male patient with epilepsy and global developmental delay

Introduction: Ankyloglossia is defined as a developmental anomaly of the tongue characterized by an abnormally short, thick lingual frenulum resulting in limitation of tongue movement. Ankyloglossia or tongue-tie affects speech, feeding, oral hygiene as well as social environment also. Case History: A 2 years old male patient was brought by his parent by referral of pediatrician to the pediatric dentist policlinic at Dr. Saiful Anwar Regional General Hospital Malang, East Java with the chief complaint difficulties to speech, choked when eating, and excessive drooling. The patient also has epilepsy and global developmental delay and under the control of his pediatrician. According to the clinical examination, the patient had a tongue tie with a thick frenum, limited tongue movements. Discussion: Tongue is an important organ that plays a big role in influencing speech, tooth position, periodontal tissue, swallowing function, as well as nutritional function. The key principle of management of children with developmental concerns is early intervention. In this case the children got reffered by his pediatrician to pediatric dentist specialist to give the intervention to the tongue so the child could improve the ability to drink, eating, and also the speech. Several studies have shown tongue-tie release as a safe and successful procedure with little to no complications. The purpose of post operative exercise after surgery is to develop new muscle movements particularly those involving tongue tip elevation and protrusion, inside and outside of the mouth, improved speech and mastication. Conclusion: frenotomy to treat ankyloglosia in 2 years old male patient with epilepsy and global developmental delay shows no post operative complication

Management of Acute Liver Failure in Children

Introduction: Pediatric Acute Liver Failure (PALF) incidence has been increasing in recent times. It is an emergency and needs appropriate management in a specialized center with availability for liver transplant. Methods: In this article, we shall provide an overview of etiologies and approach to the management of PALF. Conclusions: Various known etiologies for pediatric acute liver failure involve infections, immunologic disorders, and metabolic and drug/toxin-mediated illnesses. However, a known etiology for liver failure may be lacking in approximately 30–50% of cases. In developing countries like India, infections still dominate as the leading cause of pediatric ALF, with the hepatitis A virus (HAV) being the most identified etiology. Metabolic disorders account for approximately 23–30 percent of the PALF in infancy or early childhood (less than 5 years). Around 9–52% of children with PALF have indeterminate etiology. Management requires a multidisciplinary approach involving hepatologists, pediatric intensive care specialists, nephrologists, and a liver transplant surgery team. Cerebral edema is the most frightful complication of acute liver failure, which may progress rapidly, leading to irreversible brain damage, so every possible measure should be taken to identify as well as prevent the progression of cerebral edema and raised intracranial pressure. Elective intubation and mechanical ventilation should be started in patients with significant encephalopathy (Grade II). Identification of the need for liver transplantation and early referral for the same before irreversible brain damage sets in. Extracorporeal liver assist devices have shown promising results in bridging these children to native liver survival or liver transplantation, but continuous careful monitoring should be done to assess for treatment failure and the need for liver transplantation. Liver transplantation is the only definite treatment that improves survival in PALF, and with several advances in surgical techniques and good intensive care, the overall survival after LT for ALF has improved significantly.

Transition Readiness in Pediatric Chronic Digestive Diseases: A Regional Perspective from North-Eastern Romania.

Background: The transition from the pediatric to the adult healthcare system is a challenging process involving adolescents, parents, and pediatric and adult specialists. For a successful approach for an organized transition program, we must assess the level of training of adolescents facing transition. Methods: We applied a clinic-based questionnaire measuring perceived self-management skills, adherence to health-related tasks, medication knowledge, and social adjustment to pediatric patients with chronic digestive diseases from North-East Romanian medical units, including a tertiary center and private practice offices. Results: There were 124 participants; 73.38% from rural areas, 26.62% from urban areas; 59.67% were females, and 40.33% were males; 91.93% attended school and 73.4% declared wanting to pursue university classes after turning 18. Adolescents from urban areas showed better medication managerial (p < 0.01) and tracking healthcare change skills. Significant correlations were found between medication and appointment making, tracking health dynamics, and communication skills. Other correlations were found between communication skills and medication knowledge, appointments management, and tracking healthcare dynamics. All the investigated domains were positively correlated with the overall scores, highlighting the potential impact of active targeted interventions during transition. Conclusions: We identified significant areas to address and potentially influence during an organized transition program such as communication skills and knowledge regarding the chronic disease and the followed medication.

Choosing a pediatric surgery career: affecting factors and status assessment.

This study aims to investigate the factors influencing career choices in pediatric surgery with a focus on gender and generational differences in Türkiye. A cross-sectional survey study was conducted. A questionnaire, consisting of 42 questions was developed and distributed to pediatric surgeons via email and other digital platforms. The study included 121 participants (72 males, 49 females). During clinical internships, the recognition score for pediatric surgery specialty was significantly higher among those who volunteered in clinics or participated in surgical procedures (p < 0.05). Females had higher operating room participation compared to males (51.4% vs. 69.4%, p < 0.05). For career choice reasons, Baby Boomers (1943-1960) cited "affinity towards a specific clinic" (53.6%), while Millennials (1982-2004) prioritized the "TUS score effect" (50%) and "program's geographic location" (42.5%). Job satisfaction averaged 6.8/10, with dissatisfaction related to "harsh working conditions" and "low income." Regarding marital status, 87.5% of men and 59.2% of women were married (p < 0.05). Additionally, 23.6% of men and 55.1% of women had no children (p < 0.05). Pediatric surgery faces persistent challenges across generations. mproving training conditions, creating a supportive work environment, and increasing student involvement in pediatric surgery practices are critical. Adjustments are needed for future Generation Z residents.

Usefulness of Generative Artificial Intelligence (AI) Tools in Pediatric Dentistry.

Background/Objectives: Generative artificial intelligence (AI) such as ChatGPT has developed rapidly in recent years, and in the medical field, its usefulness for diagnostic assistance has been reported. However, there are few reports of AI use in dental fields. Methods: We created 20 questions that we had encountered in clinical pediatric dentistry, and collected the responses to these questions from three types of generative AI. The responses were evaluated on a 5-point scale by six pediatric dental specialists using the Global Quality Scale. Results: The average scores were >3 for the three types of generated AI tools that we tested; the overall average was 3.34. Although the responses for questions related to "consultations from guardians" or "systemic diseases" had high scores (>3.5), the score for questions related to "dental abnormalities" was 2.99, which was the lowest among the four categories. Conclusions: Our results show the usefulness of generative AI tools in clinical pediatric dentistry, indicating that these tools will be useful assistants in the dental field.

Nursing and medical delegable measures for children and adolescents with cancer as outpatient outreach care - The pilot project KIK HomeCare

In the period from 2019 to 2022, pediatric hemato-oncological patients were cared for in a pilot project in North Rhine-Westphalia (NRW). The project delivered care at the homes of the patients as opposed to care at the clinics and included both general nursing as well as specific treatments that were delegated from physicians. Patients were admitted to this form of care upon referral by a physician. The project objective was to test the feasibility of such a method of care in the context of pediatric hemato-oncologic disease. For the evaluation, a documentation system was designed and applied, which made it possible to evaluate relevant health care data. The evaluation was carried out by means of descriptive statistics and content-analytical categorization. From 11/2019 to 12/2022, a total of N=475 hemato-oncological patients were enrolled in the care project and n=4005 home visits were performed in 242 different zip code areas in NRW. The majority of activities that could be delegated to physicians consisted of blood sampling (79.2%). Assessment of general condition (96.5%) represented the largest proportion of care services. Complications related to the method of care did not occur. The nurse-led outpatient care of pediatric, hemato-oncological patients was shown to be a patient- and team-oriented form of care and seems to be an alternative to purely clinic based care. Presumably, transfer to other pediatric specialties is possible. In the next step, a prospective multicenter randomized study is needed to draw relevant conclusions about the actual possibilities and limitations.

Learning Curve of First-Trimester Detailed Cardiovascular Ultrasound Screening by Moderately Experienced Obstetricians in 3509 Consecutive Unselected Pregnancies with Fetal Follow-Up.

Our primary objective was to assess the effectiveness of detailed cardiovascular ultrasound screening during the first trimester, which was performed by obstetricians with intermediate experience. We collected first-trimester fetal cardiac screening data from an unselected pregnant population at RMC-Fetal Medicine Center during a study period spanning from 1 January 2010, to 31 January 2015, in order to analyze our learning curve. A pediatric cardiologist performed a follow-up assessment in cases where the examining obstetrician determined that the fetal cardiac screening results were abnormal or high-risk. Overall, 42 (0.88%) congenital heart abnormalities were discovered prenatally out of 4769 fetuses from 4602 pregnant women who had at least one first-trimester cardiac ultrasonography screening. In total, 89.2% of the major congenital heart abnormalities (27 of 28) in the following fetuses were discovered (or at least highly suspected) at the first-trimester screening and subsequent fetal echocardiography by the pediatric cardiology specialist. Of these, 96.4% were diagnosed prenatally. According to our results, the effectiveness of first-trimester fetal cardiovascular ultrasound screening conducted by moderately experienced obstetricians in an unselected ('routine') pregnant population may reach as high as 90% in terms of major congenital heart defects, provided that equipment, quality assurance, and motivation are appropriate.

Implementation of Design Thinking Method in Pediatric Specialist Clinic Service Innovation: Case Study of SPC Pediatric Clinic

This research aims to evaluate the implementation of the Design Thinking method in service innovation at SPC Pediatric Clinic. This method is applied to improve service quality and efficiency through five stages: Empathize, Define, Ideate, Prototype, and Test. Data were collected through interviews, observation, documentation, and questionnaires, then analysed using the Miles and Huberman model. The results showed that innovations such as online registration, home care services, health education, service specialisation, and partnerships with schools successfully improved patient satisfaction. Technical, coordination, and adaptation constraints were also identified but were overcome with gradual improvements. The overall implementation of these innovations had a positive impact on patient comfort and trust.