ChemInform Research Articles

EMS Agency Characteristics and Adverse Events in Pediatric Out-of-Hospital Cardiac Arrest Among 49 U.S. EMS Agencies.

Pediatric out-of-hospital cardiac arrest (OHCA) impacts 15,000-25,000 children annually in the U.S. The objective of this study was to determine if specific Emergency Medical Services (EMS) agency factors such as pediatric volume and preparedness factors, including hours of required pediatric training, pediatric emergency care coordinator (PECC), or pediatric informational resources are associated with improved quality of care or adverse events for pediatric OHCA. We conducted a retrospective chart review of EMS clinical records and EMS agency survey among 5 agencies in the Portland OR, Pittsburgh PA, Milwaukee WI, San Bernardino CA, Atlanta GA, and Dallas TX regions. We reviewed medical records of children who experienced an EMS-treated OHCA between 2013-2019 using a validated structured chart review tool to identify adverse safety events (ASEs). Agencies who contributed medical records completed a survey that described elements of pediatric preparedness and organizational structure relevant to pediatric care. We first conducted a descriptive analysis of agency and patient characteristics, followed by an evaluation of the association of agency factors that we hypothesized could improve pediatric care and reduce the occurrence of ASEs. Twenty-two agencies with a total of 659 OHCA patient encounters completed the survey. The Broselow system was used by 81% of agencies, local protocol guides were used in 86% of agencies. Forty-five percent of agencies had a designated pediatric emergency care coordinator (PECC). Agencies reported a similar number of hours for pediatric and neonatal simulation (1.3 hrs, 1.5 hrs respectively) and skills training (2.0 hrs, 2.5 hrs, respectively) annually. We found that younger patient age significantly increased the risk of an ASE. In both univariate and multivariate analyses, several hypothesized variables were not associated with decreased risk of an ASE, including pediatric and neonatal skills/simulation training hours, conducting pediatric-specific quality reviews, and having an identified PECC. In this large medical record review of EMS-treated pediatric OHCA cases, pediatric training, pediatric care coordination, and conducting pediatric quality reviews were not associated with reduced ASEs. Additional research is needed to understand how EMS agencies can improve the quality of care for pediatric OHCA, especially for infants.

The Use of Local Flora in Treating Diarrheal Diseases in Children

Diarrheal diseases remain a significant cause of morbidity and mortality among children under five, particularly in resource-limited settings. Traditional medicine, utilizing local flora, offers a cost-effective and accessible alternative for managing diarrhea. This paper examines the role of indigenous plants in treating diarrheal diseases, emphasizing their antimicrobial, anti-inflammatory, and antioxidant properties. Case studies from Uganda illustrate the potential of these plants in pediatric care. Despite challenges like limited safety data and integration into modern healthcare systems, the inclusion of local flora presents opportunities for sustainable, community-based solutions. Future directions include rigorous research on bioactive compounds, dosage optimization, and synergistic effects, fostering a bridge between traditional and evidence-based medicine. Keywords: Diarrheal diseases, children’s health, local flora, traditional medicine, ethnobotany, pediatric care.

Microbial contamination of percutaneous endoscopic gastrostomy tube and nasogastric tube with drug-resistant bacteria.

Enteral nutrition is used in patients with stroke, head-and-neck or esophageal cancer surgery, or repeated aspiration pneumonia. Japanese enteral nutrition guidelines recommend percutaneous endoscopic gastrostomy tube (PEG) for long-term use of >4 weeks and nasogastric tube (NGT) for short-term use of <4 weeks. Catheters may be contaminated with microorganisms because enteral feeding products passed through them daily, but there are few reports on catheter contamination in Japan and no reports on the duration of catheter use. There are also reports that enteral feeding is a risk factor for the appearance of drug-resistant bacteria. Therefore, this study aimed to determine whether microorganisms could be isolated from enteral feeding catheters and determine the percentage of drug-resistant bacteria. Forty-six PEGs and 59 NGTs were collected at Showa University Hospital and Showa University Fujigaoka Rehabilitation Hospital from May 2019 to March 2020. Microorganisms were cultured by incubating 20 mL pass/wash solution of sterile purified water on BHI agar medium (37°C) for 24-72 h. The strains were isolated and cultured, then frozen (80°C) and stored. Antimicrobial susceptibility was determined by broth microdilution method. Microorganisms were detected in 37 PEGs and 57 NGTs (p = 0.007). Bacteria were detected in 27 PEGs and 53 NGTs (p < 0.001), and yeasts were detected in 29 PEGs and 28 NGTs (p = 0.112). Drug-resistant bacteria were isolated from 19.6% (9 of 46) in PEGs and 23.7% (14 of 59) in NGTs. PEGs and NGTs were contaminated with microorganisms, and drug-resistant bacteria were isolated. This study provides a rationale for future appropriate use in enteral feeding catheters.

Evidence-Based Medicine Within Surgical Practice and Training: A Scoping Review.

Evidence-based medicine (EBM) is a fundamental element of modern surgical practice. However, its integration into surgical training remains challenging. Through a scoping review, this study mapped existing evidence on the practice of EBM in surgery, focusing on knowledge, attitudes, barriers, and curricula. The literature was systematically searched through 3 databases and 2 registers. Fifty articles published over a 22-year period (2001-2023) were identified based on predefined eligibility criteria. These were reviewed using Arksey and O'Malley's methodological framework. The review was checked against the PRISMA 2018 checklist for scoping reviews. There is evidence of awareness and appreciation of EBM principles among surgeons and surgical trainees. However, the understanding of EBM terminology is varied. Attitudes toward EBM were predominantly positive yet reliance on clinical experience over evidence-based guidelines was noted. Key barriers to EBM practice included time constraints, lack of structured training, and methodological challenges in surgical research. The review highlighted the lack of validated competency assessment tools and the need for structured EBM curricula. Various educational strategies, such as journal clubs and courses, were found to improve EBM knowledge, albeit with limited evidence on long-term practice change. This scoping review underscores the need for a more detailed understanding of stakeholder views of EBM in surgical practice, the development, implementation, and assessment of educational interventions in this field, and tailored strategies to assess EBM competency in surgery.

Interoperable Models for Identifying Critically Ill Children at Risk of Neurologic Morbidity.

Decreasing mortality in the field of pediatric critical care medicine has shifted practicing clinicians' attention to preserving patients' neurodevelopmental potential as a main objective. Earlier identification of critically ill children at risk for incurring neurologic morbidity would facilitate heightened surveillance that could lead to timelier clinical detection, earlier interventions, and preserved neurodevelopmental trajectory. To develop machine-learning models for identifying acquired neurologic morbidity in hospitalized pediatric patients with critical illness and assess correlation with contemporary serum-based, brain injury-derived biomarkers. This prognostic study used data from all children admitted to a quaternary pediatric intensive care unit in a large, freestanding children's hospital in Western Pennsylvania between January 1, 2010, and December 31, 2022. External model validation used data from children admitted between January 1, 2018, and December 31, 2023, to a quaternary pediatric intensive care unit in a large, freestanding children's hospital that serves as a referral center for the 5-state region of Washington, Wyoming, Alaska, Montana, and Idaho. Critical illness. The outcome was neurologic morbidity, defined according to a computable, composite definition at the development site or an order for neurocritical care consultation at the validation site. Models were developed using varying time windows for temporal feature engineering and varying censored time horizons between the last feature and the identified neurologic morbidity. A generalizable model created at the development site was optimized and assessed at an external validation site. Correlation was assessed between development site model predictions and measurements of brain biomarkers from a convenience cohort. After exclusions, there were 18 568 encounters from 2010 to 2022 in the development site generalizable model cohort (median age, 70 [IQR, 18-161] months; 8325 [45%] female). There were 6825 encounters from 2018 to 2021 at the external validation site (median age, 96 [IQR 18-171] months; 3159 [46%] female). A generalizable extreme gradient boosted model with a 24-hour time horizon and 48-hour feature engineering window demonstrated an F1 score of 0.37 (95% CI, 0.33-0.40), area under the receiver operating characteristics curve of 0.81 (95% CI, 0.78-0.83), and number needed to alert of 4 at the validation site. After recalibration at the validation site, the Brier score was 0.04. Serum levels of the brain injury biomarker glial fibrillary acidic protein significantly correlated with model output (rs = 0.34; P = .007). This prognostic study of prediction models for detecting neurologic morbidity in critically ill children demonstrated a well-performing ensemble of models with biomolecular corroboration. Prospective assessment and refinement of biomarker-coupled risk models in pediatric critical illness are warranted.

Neuropathological comorbidity, genetics and cognition in a Chinese community-based autopsy cohort.

Neurodegenerative comorbidities are common and critical, yet data specific to the Chinese population remains limited. The study aims to investigate the prevalence and associations of neuropathologic changes and comorbidities, and their correlation with genetics and cognition in a community-dwelling autopsy cohort in China. Datasets of 610 participants were obtained from the National Human Brain Bank for Development and Function at the Chinese Academy of Medical Sciences/Peking Union Medical College. Neuropathological changes analysed included Alzheimer's disease neuropathological change (ADNC) (n = 331); α-synucleinopathies (n = 124) with 120 Lewy body disease (LBD) and 4 multiple system atrophy; limbic-predominant age-related TDP-43 encephalopathy neuropathologic changes (LATE-NC) (n = 341); primary age-related tauopathy (PART) (n = 231); argyrophilic grain disease (AGD) (n = 107); age-related tau astrogliopathy (ARTAG) (n = 144); cerebral amyloid angiopathy (CAA) (n = 183); hippocampus sclerosis (HS) (n = 46). Frontotemporal lobar degeneration, amyotrophic lateral sclerosis, and amygdala-predominant LBD are rare. Descriptive statistics and logistic regression models were used to assess the neuropathological associations. Increased age at death was correlated with increased severity in ADNC, LBD, and LATE-NC, as well as with a higher number of comorbidities. APOE ε4 allele frequency in the present autopsy cohort was 13.63%. The presence of the APOE ε4 allele was linked to an advanced ADNC stage and increased comorbidities. The co-pathology prevalence varied by pathologies, with notable increases in specific subgroups: within the ADNC subgroups, LBD, LATE-NC, CAA, and HS were more frequent in advanced stages; in the LATE-NC subgroups, ADNC, CAA, and ARTAG increased, while PART decreased in higher LATE-NC stages. PART cases presented the highest proportion of pure pathology (37.2%) compared to other groups. Advanced ADNC stages were significantly associated with higher LATE-NC stages, and vice versa. Neocortical LBD was correlated with elevated ADNC levels, and higher LATE-NC stages were associated with worsening LBD pathology. High level ADNC, neocortical LBD, and stage 3 of LATE-NC were identified as independent predictors of severe cognition status. Our study suggests that older age at death and APOE ε4 presence are the risk factors for neuropathologic comorbidities in Chinese people. The findings underscore the importance of considering comorbid neurologic diagnoses and therapies in clinical practice.

Stepping into adulthood: pediatric cancer survivors and their parents' perspectives on the transition from pediatric to adult care.

The transition from pediatric to adult healthcare is crucial for adolescent cancer survivors due to the potential lifelong late effects of their treatment. Despite the importance of ongoing follow-up care, attendance often declines after transitioning to adult services. This study explores the perspectives of adolescent and adult pediatric cancer survivors and their families on this transition process. Using the Theory of Planned Behaviour, we developed interview guidelines and conducted 36 episodic narrative interviews with survivors and their parents. Our analysis focuses on their transition experiences and expectations, as part of the broader VersKiK-Study aimed at improving (long-term) follow-up care for pediatric cancer survivors in Germany. Findings show that although transitioning is viewed as a significant step toward adulthood, a lack of preparedness and anxiety can hinder a shift between healthcare systems. Survivors expressed the need to initiate the transition process while still under pediatric care. Clear and effective communication was identified as key to ensuring a smooth transition. Adult survivors acknowledged the transition's importance in fostering self-reliance and independence. To facilitate better outcomes, transition planning should include early introductions to adult care providers and strong communication strategies to address the emotional and psychosocial challenges faced by adolescent cancer survivors. Aligning transition practices with the needs and concerns of survivors could enhance follow-up care engagement, ultimately improving long-term outcomes for pediatric cancer survivors.

Effective and safe surgery for keratinocyte skin cancer in the elderly over 80 years of age: a single-institution retrospective study of 345 patients over one year

Objectives As life expectancy rises and the population continues to age, physicians will be faced with an increasing number of elderly patients with keratinocyte cancer (KC). This study aims to better characterize KC surgery in patients over 80 years of age, with a particular focus on the incidence of postoperative complications. Methods A retrospective study was conducted on all patients aged 80 years and older who underwent surgery for KC at the University Hospital of Zurich in 2022. Data were collected from operative and postoperative notes within six months after surgery. Results A total of 565 tumors were removed from 345 patients, consisting mainly of basal cell carcinoma (46.5%) and squamous cell carcinoma (45.8%), including 24.2% clinically large tumors (>2 cm in diameter). A total of 26 complications were recorded, resulting in an overall complication rate of4.6%. Only one patient with a hematoma required surgical revision under local anaesthesia. Four cases of hemorrhage were solved by bed side ligations under local anaesthesia. Of the 26 recorded complications, 15 (58%) concerned wound dehiscence, requiring no further measures. The use of novel oral anticoagulants, lower extremity location, surgical specimen size >2 cm2, and flap repair were found to be independent risk factors associated with a statistically higher incidence of complications. Conclusions This study demonstrated that dermatologic surgery adapted to the geriatric population is relatively safe and effective, even for larger KC of several centimeters in diameter.

Development and prospects of natural orifice specimen extraction surgery for colorectal cancer: a review article.

The natural orifice specimen extraction surgery (NOSES) procedure is an innovative approach to treating colorectal cancer that offers several advantages. First, the NOSES technique is minimally invasive, reducing the incidence of postoperative complications such as wound infection and fat liquefaction. Second, it provides excellent pain relief and improves cosmetic outcomes by requiring fewer abdominal incisions, thereby increasing patient satisfaction. Additionally, NOSES provides all of the advantages of minimally invasive surgery and enables patients to recover quickly, helping patients return to their normal lives faster. This approach aligns with the concept of patient-centered care and significantly improves patient quality of life. The positive results noted at both short- and long-term postoperative follow-up indicate that NOSES is a valuable option in cancer care. Despite its many benefits, NOSES has also been challenged by bacteriology, oncology, and ethics. This paper presents a review of recent research progress regarding NOSES in the treatment of colorectal cancer. In this article, we examined the advantages and disadvantages of NOSES in clinical practice and discussed potential issues and solutions.

Robot-Assisted Thoracoscopic Surgery Can Be Safely Performed in Patients With Obesity from the Early Stages of Implementation.

This study aimed to compare the perioperative outcomes of robot-assisted thoracoscopic surgery (RATS) and conventional video-assisted thoracoscopic surgery (VATS) for lung cancer in patients with obesity. Anatomical pulmonary lobectomy or segmentectomy performed at a single institution from April 2018 to September 2023 in patients with obesity (body mass index ≥25 kg/m2) were statistically compared in terms of perioperative clinical factors including operative time, blood loss, chest tube duration, pain score, intraoperative events, and early postoperative complications between RATS and VATS. In all, 89 patients were evaluated; 43 underwent RATS and 46 underwent VATS. All RATS procedures were performed using the da Vinci Xi system. Patient characteristics were comparable between the 2 groups. The operative time, blood loss, number of dissected lymph nodes, intraoperative events, and conversion rate to open thoracotomy were similar between the 2 groups. The frequencies of postoperative complications and chest tube placement duration between the groups were also similar. The median pain scores were slightly higher in the RATS group on postoperative day 1 but were equivalent between the 2 groups on postoperative day 7. The RATS group had a shorter postoperative hospital stay than the VATS group (P < 0.01). A surgical team proficient in conventional VATS can safely introduce RATS in patients with obesity and lung cancer with equivalent perioperative outcomes.

Exploring and detecting predictors associated with survival and mortality of cervical cancer patients: a 10-year retrospective study

Abstract Background Cervical cancer is the 4th most prevalent cancer among females globally. In India, approximately 123,907 women are diagnosed with cervical cancer every year, leading to 77,348 deaths annually. However, Indian healthcare system lacks the sufficient information regarding the factors influencing survival and mortality among cervical cancer patients at regional levels. Thus, we aimed to identify the predictors associated with survival outcomes and mortality rates among cervical cancer. Methods A retrospective cohort study was conducted over 8 months at a tertiary care hospital where 10-year (January 2013–December 2022) data of cervical cancer patients were analyzed from medical record department (MRD). Telephonic interviews were carried out with patients or patient parties to know the survival status of patients. The data was analyzed using descriptive statistics, Kaplan–Meier curve, log-rank test and Cox regression. Results Out of 330 cervical cancer patients, majority (64.24%) were &gt; 50 years of age followed by 35.76% were &lt; 50 years. Most of the patients had abnormal body mass index (BMI) (46.96%), postmenopausal stage (75.76%), stage II cancer (43.03%), histologically poorly differentiated grade (47.88%) and squamous cell carcinoma (87.88%), with radiation plus chemotherapy being popular treatment choice (48.79%) and with the overall mean age of 56 years. Age, BMI, menopause, stage of cancer, histological grades and types of treatment were found to be significant predictors (p &lt; 0.05) of survival among cervical cancer patients. Using cox regression analysis, advanced age (age &gt; 50 years: hazard ratio (HR): 1.82), underweight (BMI &lt; 18.5: HR:1), postmenopause (HR:1), advanced stage of cervical cancer (Stage I, Stage II, Stage III, Stage IV: HR:1, HR:2.78, HR:10.08, HR:20.81), poorly differentiated cervical cancer (HR:1.70), radiation therapy (HR:4.86), chemotherapy (HR:6.55) or chemoradiation therapy (HR:3.31) and surgery plus chemotherapy (HR: 4.55) were identified to be significant predictors of mortality among cervical cancer patients. Conclusion We conclude that the 5- and 10-year survival rates for cervical cancer patients were found to be 51.2% and 42.9%, respectively. Advanced age, underweight, postmenopausal status, advanced cancer stage, poor cancer cell differentiation and chemotherapy-based treatment were significant predictor of mortality and vice-versa for survival which might guide clinicians and policymakers in making informed clinical decisions to combat cervical cancer.

Implementation of the children and young people’s health partnership model of paediatric integrated care: a mixed-methods process evaluation

ObjectiveA process evaluation of the Children and Young People’s Health Partnership (CYPHP) model of integrated care for the interpretation of trial findings and building evidence on the implementation of integrated...

Pediatric Primary Care Physicians’ Perceptions of, and Processes for, Pediatric Blood Pressure Screening, Follow-Up, and Hypertension Management

Background/Objectives: Pediatric hypertension is an important and impactful condition. The 2017 American Academy of Pediatrics clinical practice guidelines provide recommendations for identifying and managing this condition within primary care. However, the perspectives and self-described practices of physicians are largely absent in the current evidence base. We aim to fill this gap through our qualitative investigation of physicians’ perceptions and practices related to the screening, follow-up, and management of primary pediatric hypertension. Methods: We conducted semi-structured interviews with pediatric and family medicine physicians from the largest healthcare system in central Massachusetts. The interviews explored physicians’ perceptions, and practices related specifically to pediatric blood pressure screening, follow-up for high blood pressures, and management of primary hypertension. We used rapid qualitative analysis to synthesize data into the resulting themes. Results: Eleven interviews were conducted. Resulting themes included: (1) physicians are generally concerned about pediatric hypertension and familiar with guidelines, but other concerns often take precedence, (2) blood pressure screening occurs mainly during yearly well visits, (3) physicians do not trust high blood pressure readings, (4) follow-up after high blood pressure readings varies, and (5) primary care physicians typically refer to specialists for hypertension management. Conclusions: This study expands current literature by providing salient context to the state of pediatric blood pressure screening, follow-up, and primary hypertension management after the 2017 guidelines among primary care physicians affiliated with an academic medical center. Our findings related to physicians’ trust in electronic health record flags and the utility of follow-up by school nurses warrant further investigation.

Prospective analysis of 246 fires of da Vinci SureForm SmartFire stapler in colorectal cancer: First Indian study.

One of the critical steps involved is the distal transection of the rectum in rectal cancer surgeries. Multiple staple firings have been proven to increase the rate of anastomotic leakage. In this study, we intended to learn the effectiveness of the robotic SureForm SmartFire (SS) stapling system and its application in robotic sigmoid colon and rectal procedures performed at our institution. Prospective study of patients who underwent surgeries for sigmoid/rectal cancer at our centre was considered. During the surgery, SS staplers were used, and its internal data log with regard to reload selection by the colour, reloads, clamp attempts and staple fires was considered along with intra- and post-operative outcomes. 246 firings were done in 147 cases with mean body mass index of 26.3 ± 4.3 kg/m2; mean blood loss was 53.6 ± 21.8 ml. None of our patients had stapler-related complications, and the mean length of stay was 7.18 ± 1.5 days. Average reloads used in robotic-low anterior resection (LAR) were 1.73 with the fire attempts beyond lap angle occurring only in robotic-assisted LAR (RA-LAR)/abdominoperineal resection in 87 fires (41%) with 120 instances of controlled and sequential pauses occurred in 246 fires once fire pedal was activated. Apart from oncological nodal and margin clearance in the carcinoma rectum surgery, obtaining adequate distal margin, sphincter preserving approach and distal transection of the rectum forms one of the key steps in the low anterior resection. Robotic SS staplers have 120° angulation in both axes with EndoWrist technology that has better manoeuvrability within the confines of the pelvis.

Alert design in the real world: a cross-sectional analysis of interruptive alerting at 9 academic pediatric health systems.

To assess the prevalence of recommended design elements in implemented electronic health record (EHR) interruptive alerts across pediatric care settings. We conducted a 3-phase mixed-methods cross-sectional study. Phase 1 involved developing a codebook for alert content classification. Phase 2 identified the most frequently interruptive alerts at participating sites. Phase 3 applied the codebook to classify alerts. Inter-rater reliability (IRR) for the codebook and descriptive statistics for alert design contents were reported. We classified alert content on design elements such as the rationale for the alert's appearance, the hazard of ignoring it, directive versus informational content, administrative purpose, and whether it aligned with one of the Institute of Medicine's (IOM) domains of healthcare quality. Most design elements achieved an IRR above 0.7, with the exceptions for identifying directive content outside of an alert (IRR 0.58) and whether an alert was for administrative purposes only (IRR 0.36). IRR was poor for all IOM domains except equity. Institutions varied widely in the number of unique alerts and their designs. 78% of alerts stated their purpose, over half were directive, and 13% were informational. Only 2%-20% of alerts explained the consequences of inaction. This study raises important questions about the optimal balance of alert functions and desirable features of alert representation. Our study provides the first multi-center analysis of EHR alert design elements in pediatric care settings, revealing substantial variation in content and design. These findings underline the need for future research to experimentally explore EHR alert design best practices to improve efficiency and effectiveness.

The association between cirrhosis and outcomes among female patients undergoing surgery for breast cancer in Ontario: a population-based study.

The association between cirrhosis and post-operative breast cancer outcomes has not been explored. We evaluated the association between cirrhosis and surgical outcomes in female patients with breast cancer. We performed a retrospective population-based cohort study of female patients undergoing surgery for breast cancer between 2007 and 2018 using health administrative data from Ontario, Canada. Patients were stratified by cirrhosis status. Overall survival (OS) was described using the Kaplan-Meier method and the association between cirrhosis and long-term cancer-specific mortality (CSM) was evaluated using adjusted competing risks regression and subdistribution hazard ratios (sHR). A total of 902 patients with breast cancer and cirrhosis were compared to 81,514 patients with breast cancer without cirrhosis. The median age at diagnosis was 65years vs 61years in patients with and without cirrhosis, respectively (p < .001). The most common etiologies of cirrhosis were metabolic dysfunction-associated steatotic liver disease (n = 595, 66%) and alcohol-associated (n = 143, 16%) liver disease. The median model for end-stage liver disease sodium score was 8 (IQR 6-11, n = 215). Furthermore, cirrhosis was associated with a twofold higher 90-day rate of post-operative mortality (RR 2.82; 95% CI 1.49-5.33). OS was lower in patients with cirrhosis (HR 1.41, 95% CI 1.26-1.58); however, there was no association with CSM (sHR 1.11, 95% CI 0.93-1.32). This large population-based study demonstrates that patients with cirrhosis have lower OS compared to those without cirrhosis; however, there is no difference in CSM. Their outcomes remain favorable, and they should be considered for curative-intent therapies.

Screening Cognition, Sleep, and Physical Activity in Pediatric Oncology Long-Term Follow-Up Care.

Children treated for pediatric cancer are at risk for cognitive late effects, as well as impairments in sleep and physical activity. The aim of the present study was to examine the psychometric properties of clinical screening of child- and caregiver-reported cognitive functioning, sleep, and physical activity and the relationship between cognitive functioning and health behaviors within a pediatric oncology long-term follow-up clinic. The study included a retrospective chart review of 99 caregivers and 80 children (8-17years old) who completed the Conners Short Form (parent only) and PROMIS cognitive functioning, sleep-related impairment, sleep disturbance, and physical activity scales at the child's annual long-term follow-up visit. Test statistics and T-tests were used to assess psychometrics of the PROMIS scales. Bivariate correlations were used to examine the relationship between cognitive function and health behaviors. The child- and parent-report, short-version PROMIS cognitive functioning, sleep, and physical activity scales demonstrated high internal consistency and inter-rater reliability. High convergent validity was observed between PROMIS cognitive functioning and Conners Short Form. Caregiver- and child-reported cognitive functioning and health behaviors were significantly related (p ≤ 0.042). The PROMIS short-version scales are reliable and valid measures for screening cognitive function and health behaviors in pediatric oncology long-term follow-up care. Further research examining the predictive validity and longitudinal utility of the PROMIS scales in survivors is warranted. There was a positive association between cognitive functioning and health behaviors in survivors, warranting further investigation to inform potential targets of intervention in long-term follow-up care.

Pediatric Readiness and Trauma Center Access for Children.

Children initially treated in a timely fashion at trauma centers with high levels of pediatric readiness have been shown to have improved survival, but children historically have had geographically disparate access to pediatric trauma center care. Considerable effort has been invested in improving pediatric readiness nationally, including the implementation of new standards to improve emergency department pediatric readiness at all trauma centers. To assess current access to US pediatric-ready trauma center care and to estimate potential improvement in access if all high-level trauma centers had optimal pediatric readiness. This descriptive cross-sectional study collated trauma centers from national organizational lists, state government websites, and online searches. A geospatial analysis was performed of access by pediatric patients (aged ≤18 years) to trauma centers by ground or air ambulance within 60 minutes, stratified by trauma center type and pediatric readiness status. Population density was estimated using 2020 US census data. Weighted pediatric readiness scores (wPRS) were obtained from the 2021 National Pediatric Readiness Project assessment. The data analysis was performed between April 1 and June 30, 2023. Access times to trauma centers. The main outcome of interest was access to a pediatric-ready trauma center, defined as a high-level pediatric trauma center (level I-II) or high-level adult trauma center (level I-III) with a wPRS of at least 93 (out of 100). Access times were calculated using previously validated methods and service network model analysis for each trauma center to census block group centroid. The analysis included 148 pediatric and 1075 high-level adult trauma centers. A total of 273 adult centers (25%) were pediatric ready. Pediatric trauma center access within 60 minutes by ground or air ambulance was available for 65% of all 74 090 665 children; 73% of children had access to a pediatric-ready trauma center within 60 minutes, and 92% had access to any high-level trauma center within 60 minutes. These findings suggest that access to pediatric trauma center care is limited, even with air ambulance transport. Ensuring pediatric readiness at all high-level adult trauma centers may substantially improve access to early high-quality initial resuscitative trauma care for children.

Risk of hospital malnutrition, inflammatory markers, and medical nutrition therapy in digestive surgery patient: a retrospective cohort study from eastern indonesia.

Introduction: The prevalence of hospital malnutrition in Indonesian 23.9% - 60.5%. It is important to evaluate nutritional status of patients at admission to prevent malnutrition and to identify the need for nutritional therapy. Nutrition, immunity, and the gastrointestinal tract are closely interrelated. Malnutrition is widely reported in surgical patients, especially those who have undergone major surgery, and is a particular risk in patients undergoing surgery for upper gastrointestinal cancer or colorectal cancer. Studies show a high prevalence of malnutrition or high nutritional risk during hospital admission, but this is rarely assessed in the clinical setting, especially for patients undergoing elective surgery. There has been no study on digestive surgery patients receiving medical nutritional therapy (MNT). Method: Cohort retrospective study. This study used medical record data with a total sample of digestive surgery patients. This study identified the MUST modified scores of digestive surgery patients, with albumin, NLR, and TLC values. Assess length of stay , mortality rate, and medical nutritional therapy. Result: The most common diagnosis is rectal cancer. Moderate MUST score in 144 patients (40.7%), low MUST score in 140 patients (39.6%) and high MUST scores in 69 patients (19.5%). 96 patients (27%) received medical nutrition therapy, 71% with severe protein energy malnutrition diagnosis, 29% with moderate protein energy malnutrition diagnosis.

Shared Priorities for Sibling Psychosocial Support in Pediatric Cancer Care: A Value-Weighting Study.

Although psychosocial support for siblings of youth with cancer is a standard of care, what sibling supportive services should entail remains unclear. Given limited resources for sibling care, establishing clinical and research priorities may guide resource allocation toward supports perceived as holding the greatest potential benefit. The current study used a two-round, value-weighting approach to identify priorities for sibling support services. Participants were recruited from a group of sibling experts (clinicians, researchers, community program leaders, and adults who had a sibling with childhood cancer) invited to attend an international sibling summit. In Round 1, 27 participants provided feedback on a list of potential priorities for sibling psychosocial support. In Round 2, 30 participants completed a web-based value-weighting questionnaire indicating how they would allocate 100 units of hypothetical funding among various priorities and qualitatively described the rationale for their decisions. Funding allocations generally averaged out across participants, highlighting the need for investments across all domains of sibling support. Participants allocated the greatest proportion of hypothetical funding to community-based sibling supports, which they perceived as more accessible to siblings than hospital-based supports. Participants allocated a particularly high level of funding to sibling supports in local schools. Within sibling subpopulations, bereaved siblings, siblings during active cancer treatment, and siblings with more adverse social determinants of health were allocated the largest proportion of funds. Sibling-focused researchers, clinicians, program leaders, and adult siblings endorse broad investments in sibling support. Investments in community-based supports particularly may improve access to sibling support services.