Use In Pediatric Setting Research Articles

Formulation and Evaluation of Polyherbal Hematinic Capsule for Pediatrics

Hematinic deficiencies in children, including those related to iron, folic acid, and vitamin B12, are a serious health issue that impact a child's growth, development, and general wellbeing. Administration of dose, taste, and compliance are common problems with conventional therapies. To address these issues, the production and testing of polyherbal hematinic capsules intended for pediatric usage is the main focus of this work. Strong hematinic properties in plant extracts are selected with care, and the right processing methods are used for young users. The capsule size is adjusted for ease of swallowing, and the polyherbal mixture is improved to increase compliance. To ascertain the effectiveness, safety, and suitability for use in pediatric settings, testing is done. The created polyherbal hematinic capsules exhibit outstanding disintegration time, flow characteristics, and an hourly cumulative drug release of 97.7%. The results imply that hematinic polyherbal capsules have potential as a safe and efficient option for treating paediatric hematinic deficits, addressing compliance concerns and providing an appealing dose form.

Reliability of the EasyAngle® for Assessing Hip Range of Motion in Healthy Children.

The use of digital goniometry has emerged as a viable alternative to universal goniometry for assessing hip range of motion (ROM). However, few studies have assessed the use of digital goniometry in pediatric populations and there are a limited number of studies that investigate any one device. The EasyAngle® is a digital goniometer that may be beneficial for use in pediatric settings as it requires only one hand to operate the device. The purposes of this study were 1) to establish the intrarater and interrater reliability of the EasyAngle® digital goniometer in measuring hip joint ROM in healthy elementary school-aged children, and 2) to establish preliminary normative reference values for each year of age using the EasyAngle® for hip joint ROM in healthy elementary school-aged children. Descriptive Laboratory Study. Passive hip ROM (flexion, abduction, extension, internal rotation, external rotation) was measured on each leg of healthy participants using the EasyAngle®. A total of 40 hip joints were measured. Two blinded raters conducted three trials of each hip motion on both legs. Intrarater and interrater reliability of the recorded hip range of motion were calculated using intra-class correlation coefficients (ICC) (3,1). Twenty healthy children were measured (age 5-10, mean = 7.40 years old, SD = 1.37, 9 males, 11 females). Mean hip ROM was reported by age. Intrarater and interrater reliability were good to excellent for all hip ROM measurements (0.81-0.97 intra rater; 0.77- 0.91 interrater). Hip flexion had the strongest intrarater (0.96, 0.97) and interrater reliability (0.91). Intrarater reliability was lowest for hip abduction for Rater 1 and hip extension for Rater 2. Interrater reliability was lowest for hip external rotation (0.78). The EasyAngle® is a reliable tool for assessing hip range of motion in healthy children ages 5-10. Normative hip ROM values using the EasyAngle® are available to clinicians. Level 3- Reliability study.

Innovations in Pediatric Therapeutics Development: Principles for the Use of Bridging Biomarkers in Pediatric Extrapolation

Even with recent substantive improvements in health care in pediatric populations, considerable need remains for additional safe and effective interventions for the prevention and treatment of diseases in children. The approval of prescription drugs and biological products for use in pediatric settings, as in adults, requires demonstration of substantial evidence of effectiveness and favorable benefit-to-risk. For diseases primarily affecting children, such evidence predominantly would be obtained in the pediatric setting. However, for conditions affecting both adults and children, pediatric extrapolation uses scientific evidence in adults to enable more efficiently obtaining a reliable evaluation of an intervention’s effects in pediatric populations. Bridging biomarkers potentially have an integral role in pediatric extrapolation. In a setting where an intervention reliably has been established to be safe and effective in adults, and where there is substantive evidence that disease processes in pediatric and adult settings are biologically similar, a ‘bridging biomarker’ should satisfy three additional criteria: effects on the bridging biomarker should capture effects on the principal causal pathway through which the disease process meaningfully influences ‘feels, functions, survives’ measures; secondly, the experimental intervention should not have important unintended effects on ‘feels, functions, survives’ measures not captured by the bridging biomarker; and thirdly, in statistical analyses in adults, the intervention’s net effect on ‘feels, functions, survives’ measures should be consistent with what would be predicted by its level of effect on the bridging biomarker. A validated bridging biomarker has considerable potential utility, since an intervention’s efficacy could be extrapolated from adult to pediatric populations if evidence in children establishes the intervention not only to be safe but also to have substantive effects on that bridging biomarker. Proper use of bridging biomarkers could increase availability of reliably evaluated therapies approved for use in pediatric settings, enabling children and their caregivers to make informed choices about health care.

Growth mindset in young people awaiting treatment in a paediatric mental health service: A mixed methods pilot of a digital single-session intervention.

Wait times are significant in child mental health services but may offer opportunity to promote growth mindsets in young people with physical and mental health needs. A digital growth mindset single-session intervention is effective in young people, but its use in paediatric settings has not been examined. This mixed methods pilot aimed to assess the intervention's feasibility, acceptability, and impact in this population. Patients aged 8-18 on waiting lists in a paediatric hospital's specialist mental health service were offered the intervention remotely. Treatment completion and retention rates, symptoms of depression and anxiety, perceived control, and personality mindset were assessed at baseline, post-treatment, and follow-ups. Semi-structured interviews to explore the intervention's acceptability were conducted post-treatment. Twenty-five patients completed the intervention and 17 patients and three carers/parents were interviewed. Outcomes showed small to large improvements across time-points. Most patients reported finding the intervention enjoyable, accessible, and instilled a hope for change. They valued elements of the intervention but made suggestions for improvement. The digital growth mindset single-session intervention is feasible, acceptable, and potentially beneficial for young people with physical and mental health needs on waiting lists. Further research is warranted to examine its effectiveness and mechanism of change.

24234 Development of a computerized neurocognitive test of interhemispheric transfer for use in pediatric settings

ABSTRACT IMPACT: As newborn screening is now available for X-linked adrenoleukodystrophy, there is a need to establish meaningful disease markers to detect the onset of the severe demyelinating cerebral form of this disease at the earliest possible stage, and to quantify early disease progression to evaluate the relative efficacy of therapies. OBJECTIVES/GOALS: Longitudinal testing of neurocognitive and motor function using smartphone and tablet-based applications holds promise for early detection and quantification of brain white matter changes in patients with adrenoleukodystrophy (ALD) and other rare demyelinating diseases, but this methodology requires validation in pediatric populations. METHODS/STUDY POPULATION: We developed an iPad application with a game-like interface to assess interhemispheric transfer across the corpus callosum, the brain structure where cerebral demyelinating disease typically begins in patients with ALD. Feasibility data from remote test administrations with healthy children were collected to analyze and speed and timing of finger tapping movements requiring bimanual coordination on a touchscreen. RESULTS/ANTICIPATED RESULTS: Among our pilot sample of healthy school-aged children, age-related improvements in finger tapping speed were observed in both single-hand and alternating-hand conditions. Results indicate that remote testing using iPad applications is a viable way to collect psychometric testing data rapidly in pediatric populations and is feasible during a pandemic. Next steps in this research project will be: (1) evaluating the stability of repeated test administrations (test-retest reliability), (2) assessing agreement between performance on our iPad application and validated measures of interhemispheric transfer and fine motor function, and (3) comparing performance of children with known corpus callosum white matter abnormality to performance of healthy children. DISCUSSION/SIGNIFICANCE OF FINDINGS: Brief neurocognitive tests that can be frequently administered may have the ability to capture subtle brain changes in developing children. Approaches enabling remote (virtual) testing will facilitate research during the covid-19 pandemic and are especially well-suited for data collection in rare disease populations.

Barriers to Delivery of Enteral Nutrition in Pediatric Intensive Care: A World Survey.

To explore the perceived barriers by pediatric intensive care healthcare professionals (nurses, dieticians, and physicians) in delivering enteral nutrition to critically ill children across the world. Cross-sectional international online survey adapted for use in pediatric settings. PICUs across the world. PICU nurses, physicians, and dietitians. The 20-item adult intensive care "Barriers to delivery of enteral nutrition" survey was modified for pediatric settings, tested, and translated into 10 languages. The survey was distributed online to pediatric intensive care nurses, physicians, and dieticians via professional networks in March 2019 to June 2019. Professionals were asked to rate each item indicating the degree to which they perceived it hinders the provision of enteral nutrition in their PICUs with a 7-point Likert scale from 0 "not at all a barrier" to 6 "an extreme amount." Nine-hundred twenty pediatric intensive care professionals responded from 57 countries; 477 of 920 nurses (52%), 407 of 920 physicians (44%), and 36 of 920 dieticians (4%). Sixty-two percent had more than 5 years PICU experience and 49% worked in general PICUs, with 35% working in combined cardiac and general PICUs. The top three perceived barriers across all professional groups were as follows: 1) enteral feeds being withheld in advance of procedures or operating department visits, 2) none or not enough dietitian coverage on weekends or evenings, and 3) not enough time dedicated to education and training on how to optimally feed patients. This is the largest survey that has explored perceived barriers to the delivery of enteral nutrition across the world by physicians, nurses, and dietitians. There were some similarities with adult intensive care barriers. In all professional groups, the perception of barriers reduced with years PICU experience. This survey highlights implications for PICU practice around more focused nutrition education for all PICU professional groups.

Paediatric Rational Prescribing: A Systematic Review of Assessment Tools.

Rational prescribing criteria have been well established in adult medicine for both research and quality improvement in the appropriate use of medicines. Paediatric rational prescribing has not been as widely investigated. The aims of this review were to identify and provide an overview of all paediatric rational prescribing tools that have been developed for use in paediatric settings. A systematic literature search was made of MEDLINE, Embase, CINAHL and IPA from their earliest records until July 2019 for all published paediatric rational prescribing tools. The characteristics of the tools were recorded including method of development, types of criteria, aspects of rational prescribing assessed, and intended practice setting. The search identified three paediatric rational prescribing tools: the POPI (Pediatrics: Omissions of Prescriptions and Inappropriate Prescriptions) tool, the modified POPI (UK) tool, and indicators of potentially inappropriate prescribing in children (PIPc). PIPc comprises explicit criteria, whereas POPI and the modified POPI (UK) use a mixed approach. PIPc is designed for use in primary care in the UK and Ireland, POPI is designed for use in all paediatric practice settings and is based on French practice standards, and the modified POPI (UK) is based on UK practice standards and is designed for use in all paediatric practice settings. This review describes three paediatric rational prescribing tools and details their characteristics. This will provide readers with information for the use of the tools in quality improvement or research and support further work in the field of paediatric rational prescribing.

Smartphone Use in Pediatric Settings

Communication errors are attributed to 70% of adverse events in health care (Guttman et al., 2018). Within the past decade, health care providers have made impressive efforts to improve communication and have implemented communication tools in an effort to minimize adverse effects.

Validity of brief screening instrument for adolescent tobacco, alcohol, and drug use.

The National Institute on Alcohol Abuse and Alcoholism developed an alcohol screening instrument for youth based on epidemiologic data. This study examines the concurrent validity of this instrument, expanded to include tobacco and drugs, among pediatric patients, as well as the acceptability of its self-administration on an iPad. Five hundred and twenty-five patients (54.5% female; 92.8% African American) aged 12 to 17 completed the Brief Screener for Tobacco, Alcohol, and other Drugs (BSTAD) via interviewer-administration or self-administration using an iPad. Diagnostic and Statistical Manual, Fifth Edition substance use disorders (SUDs) were identified using a modified Composite International Diagnostic Interview-2 Substance Abuse Module. Receiver operating characteristic curves, sensitivities, and specificities were obtained to determine optimal cut points on the BSTAD in relation to SUDs. One hundred fifty-nine (30.3%) adolescents reported past-year use of ≥1 substances on the BSTAD: 113 (21.5%) used alcohol, 84 (16.0%) used marijuana, and 50 (9.5%) used tobacco. Optimal cut points for past-year frequency of use items on the BSTAD to identify SUDs were ≥6 days of tobacco use (sensitivity = 0.95; specificity = 0.97); ≥2 days of alcohol use (sensitivity = 0.96; specificity = 0.85); and ≥2 days of marijuana use (sensitivity = 0.80; specificity = 0.93). iPad self-administration was preferred over interviewer administration (z = 5.8; P < .001). The BSTAD is a promising screening tool for identifying problematic tobacco, alcohol, and marijuana use in pediatric settings. Even low frequency of substance use among adolescents may indicate need for intervention.

Physicians' Shared Decision-Making Behaviors in Attention-Deficit/Hyperactivity Disorder Care

To describe the amount of shared decision-making (SDM) behavior exhibited during treatment-planning encounters for children newly diagnosed as having attention-deficit/hyperactivity disorder and to explore relationships between participant characteristics and the amount of SDM. Prospective cohort study. Seven community-based primary care pediatric practices in the Cincinnati, Ohio; northern Kentucky; and southeast Indiana regions from October 5, 2009, through August 9, 2010. Ten pediatricians and 26 families with a 6- to 10-year-old child newly diagnosed as having attention-deficit/hyperactivity disorder. The amount of SDM behavior exhibited during videorecorded encounters, as coded by 2 independent raters using the validated Observing Patient Involvement (OPTION) scale, which was adapted for use in pediatric settings and produces a score ranging from 0 (no parental involvement) to 100 (maximal parental involvement). Treatment decisions focused on initiation of medication treatment. The mean (SD) total OPTION score was 28.5 (11.7). More SDM was observed during encounters involving families with white vs nonwhite children (adjusted mean difference score, 14.9; 95% confidence interval [CI], 10.2-19.6; P < .001), private vs public health insurance coverage (adjusted mean difference score, 15.1; 11.2-19.0; P < .001), mothers with at least some college education vs high school graduate or less (adjusted mean difference score, 12.3; 7.2-17.4; P < .001), and parents who did not screen positive for serious mental illness vs those who did (adjusted mean difference score, 15.0; 11.9-18.1; P < .001). Low levels of SDM were observed. Exploratory analyses identified potential disparities and barriers. Interventions may be needed to foster SDM with all parents, especially those of nonwhite race, of lower socioeconomic status, of lower educational level, and with serious mental illness.

Asistencia ventilatoria no invasiva en pediatría

Non-invasive ventilatory assistance: Pediatrics considerations Non-invasive ventilation (NIV) has extended its use in pediatric setting. Besides acute respiratory conditions, it is also used in chronic diseases associated to ventilatory failure. In the acute setting, PICU constitutes the natural scenery. In chronic conditions, therapy is transferred home as a multidisciplinary program already available in our country. The objective of this review is an update applying respiratory physiology, technical and clinical issues necessary for choosing and using accurately NIV in both acute and chronic settings.

Lower Extremity Muscle Strength in 6- to 8-Year-Old Children Using Hand-Held Dynamometry

The purposes of the study were to establish isometric torque reference values for healthy 6- to 8-year-old children for 6 lower extremity muscles and determine the effects of gender, age, height, weight, and physical activity upon strength. A hand-held dynamometer was used to obtain force/torque values for 154 children. Age-referenced force/torque and cutoff values are provided for each muscle group. Torque increased with age and height for all muscles and with weight for all muscles except knee extensors. No gender differences were found. Children who participated in 3 or more hours per week in organized sports were stronger in 4 of 6 muscles; the number of hours spent in active play did not affect torque. This study provides hand-held dynamometer strength reference values to enable clinicians to determine if clients of the same age, height, and weight have muscle weakness.

Goal Attainment Scaling

Goal attainment scaling is becoming an increasingly popular technique for evaluating the functional goal attainment of children receiving pediatric therapy services. This article reports on the experiences of the authors in conducting formal program evaluations using this individualized measurement approach. Goal attainment scaling is described, its utility is assessed, and issues in its use are identified. The article considers the pros and cons of the technique, highlights the key decisions required to use goal attainment scaling effectively, and provides standard criteria and procedures for its use in pediatric settings.

Response: Developing Preparatory Interventions for Use in Pediatric Settings

Response: Developing Preparatory Interventions for Use in Pediatric Settings