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European Journal of Pediatrics Dec 2022Evidence-based practice (EBP) significantly improves the quality of healthcare, but its use in community pediatrics has not yet been proven. We aimed to assess how Dutch...
UNLABELLED
Evidence-based practice (EBP) significantly improves the quality of healthcare, but its use in community pediatrics has not yet been proven. We aimed to assess how Dutch community pediatricians use scientific findings and apply evidence-based practice in everyday well-child care. We interviewed a purposive sample of 14 community pediatricians in the Netherlands regarding their professional activities in daily practice, focusing on instances in which their professional knowledge was insufficient to address the issue at hand. We transcribed the interviews verbatim, and coded them using ATLAS.ti software. We structured the information using template analysis. Community pediatricians relied largely on guidelines of their own profession. If these were not sufficient, they first consulted other medical specialists or colleagues, or used different sources that they considered reliable. They only rarely performed an EBP search, and if so, only for somatic problems. For psychosocial problems, they used a strategy of extensive interaction with clients and members of multidisciplinary teams. We identified five barriers to performing an EBP search: (1) a conviction that not every community pediatrician needs to be able to perform an EBP search; (2) a conviction that an EBP search is not suitable for psychosocial problems; (3) lack of confidence in one's own abilities to perform an EBP search; (4) limited access to literature; (5) lack of time.
CONCLUSIONS
Community pediatricians rely on professional guidelines; this indicates a need to keep these up-to-date and user-friendly. Furthermore, pediatricians should be better trained in performing EBP searches, and in working in multidisciplinary teams, especially for psychosocial problems.
WHAT IS KNOWN
• Conducting an evidence-based practice search is considered indispensable to determine the best management of the patient's problem. • Conducting such a search is still considered challenging in many medical disciplines, including pediatrics.
WHAT IS NEW
• There is a need to strengthen skills of community pediatricians to find evidence on psychosocial problems and to present this effectively in multidisciplinary teams. • The pediatricians' broad use of other sources of evidence, like experts and online sources, shows the importance of critical evaluation skills.
Topics: Child; Humans; Child Care; Netherlands; Pediatricians; Referral and Consultation; Evidence-Based Practice
PubMed: 36169713
DOI: 10.1007/s00431-022-04624-3 -
Allergologia Et Immunopathologia 2021Syndromic immunodeficiencies are a genetically and pathophysiologically heterogeneous group of inborn errors of immunity. These are characterized by multiple extra... (Review)
Review
BACKGROUND
Syndromic immunodeficiencies are a genetically and pathophysiologically heterogeneous group of inborn errors of immunity. These are characterized by multiple extra immune clinical symptoms and a wide range of immunological phenotypes with increased susceptibility to infections, autoimmune phenomena, immune dysregulation, organ-specific pathology, and malignancy.
OBJECTIVE
To increase the pediatricians' awareness of this multifaceted group of primary immunodeficiencies in children.
METHODS
A comprehensive review of genetic background and clinical symptomatology of syndromic immunodeficiencies as well as current diagnostic approach and treatment modalities.
RESULTS
From the pediatrician's perspective, an early-life diagnosis of syndromic immunodeficiencies, which is frequently indispensable for successful life-saving immunocorrection, poses a diagnostic challenge. Increased pediatricians' awareness to recognize signs and symptoms of these diseases in affected children is of paramount importance. Current advances in molecular biotechnology and immunogenetics, resulting in the implementation of newborn screening and new-generation sequencing, provide informative tools for definitive diagnosis and, in many new disease entities, for their definition and genotype-phenotype delineation and correlation.
CONCLUSIONS
A broad spectrum of clinical phenotypes in children with syndromic primary immunodeficiencies requires pediatrician's special attention, that is, individualized multidisciplinary approach under the supervision of a clinical immunologist.
Topics: Humans; Immunologic Deficiency Syndromes; Neoplasms; Pediatricians; Phenotype
PubMed: 34224226
DOI: 10.15586/aei.v49i4.200 -
Academic Pediatrics Aug 2020
Topics: Attitude to Death; Humans; Parent-Child Relations; Pediatricians; Physician-Patient Relations
PubMed: 31669754
DOI: 10.1016/j.acap.2019.10.012 -
JAMA Pediatrics Oct 2022
Topics: Humans; Pediatricians
PubMed: 35969386
DOI: 10.1001/jamapediatrics.2022.2868 -
Journal of Paediatrics and Child Health Nov 2017
Topics: General Surgery; Health Knowledge, Attitudes, Practice; Pediatricians
PubMed: 29148197
DOI: 10.1111/jpc.13764 -
Indian Pediatrics Aug 2021Exome sequencing is gaining popularity as a genomic test for the diagnosis of Mendelian disorders in children. It is essential for pediatricians to familiarize... (Review)
Review
Exome sequencing is gaining popularity as a genomic test for the diagnosis of Mendelian disorders in children. It is essential for pediatricians to familiarize themselves with this technique and its interpretation. This brief review discusses some of the key components of a clinical or research report on exome sequencing for a practicing pediatrician, so as to enable them to utilize this test well and provide timely referrals to a clinical geneticist.
Topics: Child; Exome; Humans; Pediatricians; Referral and Consultation
PubMed: 33634792
DOI: No ID Found -
Pediatric Annals Mar 2021Paroxysmal supraventricular tachycardia (SVT) is the most common clinical arrhythmia in young patients. With an estimated prevalence of roughly 1 in 500 children, a... (Review)
Review
Paroxysmal supraventricular tachycardia (SVT) is the most common clinical arrhythmia in young patients. With an estimated prevalence of roughly 1 in 500 children, a pediatrician may knowingly or unknowingly see several patients who are affected each year. SVT symptoms can sometimes be vague or conflated with common pediatric complaints. Different forms of SVT are predominant at different ages, sometimes complicating timely recognition and referral. Differing pathophysiology and age distribution impact risk of complications such as heart failure, or rarely, sudden death. Treatment choices continue to evolve as new medications, monitoring devices, and ablation technologies continue to mature. This review focuses on the most common types of paroxysmal SVT: atrioventricular nodal reentrant tachycardia, atrioventricular reciprocating tachycardia, and Wolff-Parkinson White syndrome. Atrial arrhythmia mechanisms are also briefly outlined. It is meant to provide practical guidelines for the diagnosis and management of patients with SVT from infancy through adolescence. .
Topics: Adolescent; Child; Electrocardiography; Humans; Pediatricians; Tachycardia, Paroxysmal; Tachycardia, Supraventricular; Tachycardia, Ventricular
PubMed: 34038647
DOI: 10.3928/19382359-20210217-01 -
Pediatric Annals Dec 2023
Topics: Humans; Adolescent; Transgender Persons; Gender Identity; Transsexualism; Pediatricians
PubMed: 38049187
DOI: 10.3928/19382359-20231016-01 -
Academic Pediatrics Apr 2019Utilize the unique capabilities of a longitudinal design to 1) examine whether burnout is increasing over time among 2 cohorts of pediatricians, and 2) identify factors...
OBJECTIVE
Utilize the unique capabilities of a longitudinal design to 1) examine whether burnout is increasing over time among 2 cohorts of pediatricians, and 2) identify factors associated with decreased burnout.
METHODS
Data from a national longitudinal study, the American Academy of Pediatrics Pediatrician Life and Career Experience Study, were used to examine self-reported burnout over a 5-year period (2012 to 2016) among 2002 to 2004 and 2009 to 2011 residency graduates (N = 1804). Study participation rates ranged from 94% in 2012 to 85% in 2016. Mixed-effects logistic regression for longitudinal analysis was used to examine burnout over time.
RESULTS
In any given year, between 20% and 35% of study pediatricians reported that they were currently experiencing burnout. Significant increases in burnout over time were found for all participants combined and for each subgroup examined. Several factors were associated with reduced burnout. The largest associations with reduced burnout were found for increased flexibility in work schedule (adjusted odds ratio [aOR], 0.28; 95% confidence interval [CI], 0.22-0.35), decreased work busyness (aOR, 0.28; 95% CI, 0.22-0.36), or a job change (aOR, 0.48; 95% CI, 0.36-0.65).
CONCLUSIONS
Following 5 years of participation in a longitudinal study, more than 1 in 3 early- to mid-career pediatricians reported experiencing burnout. This represents a 75% relative increase in burnout from the start of the study. Specific characteristics of pediatricians' jobs, such as flexible work schedules and busyness of work settings, were most strongly associated with reduced burnout.
Topics: Burnout, Professional; Female; Humans; Logistic Models; Longitudinal Studies; Male; Odds Ratio; Pediatricians; Personnel Staffing and Scheduling; Protective Factors; United States; Workload
PubMed: 30412766
DOI: 10.1016/j.acap.2018.11.006 -
Pediatric Emergency Care Feb 2022The relationship between pediatrician availability and emergency department (ED) attendance is uncertain. We determined whether children in counties with more...
OBJECTIVES
The relationship between pediatrician availability and emergency department (ED) attendance is uncertain. We determined whether children in counties with more pediatricians had fewer ED visits.
METHODS
We conducted a cross-sectional study of all ED visits among children younger than 18 years from 6 states. We obtained ED visit incidences by county and assessed the relationship to pediatrician density (pediatricians per 1000 children). Possible confounders included state, presence of an urgent care facility in the county, urban-rural status, and quartile of county-level characteristics: English-speaking, Internet access, White race, socioeconomic status, and public insurance. We estimated county-level changes in incidence by pediatrician density adjusting for state and separately for all possible confounders.
RESULTS
Each additional pediatrician per 1000 children was associated with a 13.7% (95% confidence interval, -19.6% to -7.5%) decrease in ED visits in the state-adjusted model. In the full model, there was no association (-1.4%, 95% confidence interval, -7.2% to 4.8%). The presence of an urgent care, higher socioeconomic status score, urban status, and higher proportions of White race and nonpublic insurance were each associated with decreased ED visit rates.
CONCLUSIONS
Pediatrician density is not associated with decreased ED visits after adjusting for other county demographic factors. Increasing an area's availability of pediatricians may not affect ED attendance.
Topics: Ambulatory Care; Child; Cross-Sectional Studies; Emergency Service, Hospital; Humans; Pediatricians; Rural Population
PubMed: 34282091
DOI: 10.1097/PEC.0000000000002502