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Journal of Graduate Medical Education Jun 2024
Topics: Humans; Mentors; Internship and Residency; Faculty, Medical; Education, Medical, Graduate
PubMed: 38882402
DOI: 10.4300/JGME-D-23-00806.1 -
Frontiers in Psychiatry 2024The escalating prevalence of personification abuse in language disorders among students poses a substantial challenge for autistic students in the domain of language...
INTRODUCTION
The escalating prevalence of personification abuse in language disorders among students poses a substantial challenge for autistic students in the domain of language disorders. While prior research has mainly focused on the cognitive hurdles faced by autistic students, ongoing debates persist about the onset, severity, and roots of these challenges in their classroom behavior, with limited exploration of how preconceived notions impact personification abuse. This study aims to delve into emotional treatments for language disorders, specifically targeting personification abuse, to facilitate the shift from distorted perceptions to normative expression. It seeks to pinpoint the primary emotional interventions linked to instances of personification abuse and scrutinize the emotional factors influencing therapeutic approaches for language disorders.
METHODS
The research encompassed a cohort of 110 autistic students, aged 2 to 5 years, diagnosed with language disorders, all clinically determined to have autism by developmental pediatricians at a prestigious medical facility. Among these children, 95 were attending specialized schools, while 15 were situated in community settings.
RESULTS
The outcomes disclosed that children across all developmental phases displayed instances of personification abuse in language disorders, showcasing noteworthy enhancements in personification abuse following emotional treatment. Significantly, the discernible disparity in personification abuse performance and emotional treatment can be linked to the simultaneous cognitive advancement of autistic students across four grade levels, with variations noted based on normative expressions.
DISCUSSION
These findings underscore the insufficiency of solely relying on intrinsic trends to comprehend personification abuse within an emotional treatment context. The study accentuates the potential pitfalls associated with emotional treatment for language disorders and stresses the imperative need for additional research and psychiatric intervention strategies.
PubMed: 38881550
DOI: 10.3389/fpsyt.2024.1283006 -
Pediatrics Jul 2024The death of someone close to a child often has a profound and lifelong effect on the child and results in a range of both short- and long-term reactions. Pediatricians,...
The death of someone close to a child often has a profound and lifelong effect on the child and results in a range of both short- and long-term reactions. Pediatricians, within a patient-centered medical home, are in an excellent position to provide guidance to caregivers and to offer assistance and support to grieving children of all ages and their families. This clinical report offers practical suggestions on how to talk with grieving children to help them better understand what has happened and its implications. An understanding of guilt, shame, and other common reactions as well as an appreciation of the role of secondary losses and the unique challenges facing children in communities characterized by chronic trauma and cumulative loss will help the pediatrician to address factors that may impair children's adjustment and to identify complicated mourning and situations when professional counseling is indicated. Advice on how to support children's participation in funerals and other memorial services and to anticipate and address grief triggers and anniversary reactions is provided so that pediatricians are in a better position to advise caregivers and to offer consultation to and collaborate with professionals in schools, early education and child care facilities, and other child congregate care sites. Pediatricians often enter their profession out of a profound desire to minimize the suffering of children and may find it personally challenging to bear witness to the distress of children who are acutely grieving. The importance of professional preparation and self-care is, therefore, emphasized, and resources are recommended.
Topics: Humans; Grief; Child; Family; Social Support
PubMed: 38881360
DOI: 10.1542/peds.2024-067212 -
Nursing Children and Young People Jun 2024Medical procedure-induced anxiety in children can have short- and long-term negative effects. Research shows that children's anxiety can be affected by...
Medical procedure-induced anxiety in children can have short- and long-term negative effects. Research shows that children's anxiety can be affected by non-pharmacological interventions and adults' behaviours in a complex manner. This article presents a scoping review of the literature on non-pharmacological interventions to manage medical procedure-induced anxiety in children. Based on this review, the authors propose a framework comprising six strategies for effective non-pharmacological management of medical procedure-induced anxiety in children. A real-life, and anonymised, example is used to illustrate this framework in practice.
PubMed: 38881235
DOI: 10.7748/ncyp.2024.e1499 -
Pediatric Obesity Jun 2024Recent pediatric guidelines recommend clinicians offer anti-obesity medication (AOM) as an adjunct to intensive lifestyle intervention.
BACKGROUND
Recent pediatric guidelines recommend clinicians offer anti-obesity medication (AOM) as an adjunct to intensive lifestyle intervention.
OBJECTIVE
To investigate pediatricians' perspectives about prescribing AOM, including barriers and facilitators.
METHODS
An investigator-developed survey was emailed to primary care pediatric physicians (n = 187) and advanced practice providers (n = 190) within an academic-affiliated network. The survey evaluated how willing clinicians were to prescribe AOM and their agreement with 25 statements about barriers and facilitators. Three vignettes explored AOM decision-making. Multinomial logistic regression was used to determine relative risk ratios for willingness to prescribe by agreement with each statement.
RESULTS
Among 74 respondents (20% response rate), 24% were willing, 42% uncertain and 34% unwilling to prescribe. Most (64%) agreed that AOM should be managed only by specialists. Willingness to prescribe was associated with clinician motivation and belief in guideline practicality and applicability. Unwillingness was associated with beliefs that patients would not continue AOM long enough for benefit and that there was insufficient time or resources to implement. In vignettes, 52% were willing to prescribe AOM for a patient with severe obesity and metabolic complications, versus 11% for a patient with obesity and possible disordered eating.
CONCLUSIONS
Willingness to prescribe AOM was low and was associated with perceived practicality and appropriateness for patients.
PubMed: 38880989
DOI: 10.1111/ijpo.13146 -
Academic Pediatrics Jun 2024Intrauterine opioid exposure (IOE) has increased over the last 2 decades and is associated with additional needs after birth. To date, no clinical guidelines address the...
OBJECTIVE
Intrauterine opioid exposure (IOE) has increased over the last 2 decades and is associated with additional needs after birth. To date, no clinical guidelines address the primary care of children with IOE. We aimed to characterize clinician-reported screening and referral practices, barriers to effective primary care for children with IOE, and clinician- and practice-level characteristics associated with perceived barriers.
METHODS
We conducted a cross-sectional survey of pediatric residents, pediatricians, and advanced practitioners at 28 primary care clinics affiliated with 7 pediatric residency programs (April-June 2022). We assessed screening and other clinical practices related to IOE and perceived barriers to addressing parental opioid use disorder (OUD). We used descriptive statistics to analyze survey responses, assessed the distribution of reported barriers, and applied a 2-stage cluster analysis to assess response patterns.
RESULTS
Of 1004 invited clinicians, 329 (32.8%) responses were returned, and 325 pediatric residents and pediatricians were included in the final analytic sample. Almost all (99.3%) reported parental substance use screening as important, but only 11.6% screened routinely. Half of the respondents routinely refer children with IOE to early intervention services and social work. Lack of standard screening for substance use was the most frequently selected barrier to addressing parental OUD. Participants reporting fewer barriers to addressing parental OUD identified having greater access to OUD treatment programs and home visiting programs.
CONCLUSIONS
Pediatricians report variations in primary care screenings and referrals for children with IOE. Access to parental OUD treatment programs may mitigate perceived barriers to addressing parental OUD in the pediatric office.
PubMed: 38880392
DOI: 10.1016/j.acap.2024.06.007 -
Journal of Pediatric Health Care :... Jun 2024This study explores referral patterns in pediatric dermatology and assesses the diagnostic concordance between referring and dermatology providers.
IMPORTANCE
This study explores referral patterns in pediatric dermatology and assesses the diagnostic concordance between referring and dermatology providers.
METHOD
This retrospective cross-sectional study utilized referrals to an outpatient pediatric dermatology clinic. The review included patients referred between July 1, 2018 and June 30, 2019. Only patients who completed a clinic visit were included in the diagnostic concordance. Referral and first visit diagnoses were compared to determine concordance.
RESULTS
A total of 8,682 charts were reviewed, and 3,738 completed a clinic visit. The most common referral diagnoses included atopic dermatitis, rash, lesion, melanocytic nevus, and warts. Physicians (78.5%) and APRNs (18.1%) most frequently referred patients. The diagnostic concordance of physicians was 67.1% vs 66.3% for APRNs.
CONCLUSION
Physicians and APRNs showed similar rates of diagnostic concordance, yet a large proportion of diagnoses were discordant. Primary care providers may benefit from focused education around the most commonly referred and missed diagnoses.
PubMed: 38878039
DOI: 10.1016/j.pedhc.2024.02.001 -
Translational Oncology Aug 2024For pediatric patients with solid abdominal tumors, early diagnosis can guide clinical treatment decisions, and comprehensive preoperative evaluation is essential to...
BACKGROUND
For pediatric patients with solid abdominal tumors, early diagnosis can guide clinical treatment decisions, and comprehensive preoperative evaluation is essential to reduce surgical risk. The aim of this study was to explore the feasibility of multiphase enhanced CT-based transformer in the early diagnosis of tumors and prediction of surgical risk events (SRE).
METHODS
A total of 496 pediatric patients with solid abdominal tumors were enrolled in the study. With Swin transformer, we constructed and trained two Swin-T models based on preoperative multiphase enhanced CT for personalized prediction of tumor type and SRE status. Subsequently, we comprehensively evaluated the performance of each model and constructed four benchmark models for performance comparison.
RESULTS
There was no significant difference in SRE status between tumor types. In the diagnostic task, areas under the receiver operating characteristic curves (AUC) of the Swin-T model were 0.987 (95 % CI, 0.973-0.997) and 0.844 (95 % CI, 0.730-0.940) in the training and validation cohorts, respectively. In predicting SRE, AUCs of the Swin-T model were 0.920 (95 % CI, 0.885-0.948) and 0.741 (95 % CI, 0.632-0.838) in the training and test cohorts, respectively. The Swin-T model achieved the best performance in both classification tasks compared to benchmark models.
CONCLUSION
The Swin-T model is a promising tool to assist pediatricians in the differential diagnosis of abdominal tumors and in comprehensive preoperative evaluation.
PubMed: 38875936
DOI: 10.1016/j.tranon.2024.102034 -
JMIR AI May 2024The integration of artificial intelligence (AI), particularly deep learning models, has transformed the landscape of medical technology, especially in the field of...
BACKGROUND
The integration of artificial intelligence (AI), particularly deep learning models, has transformed the landscape of medical technology, especially in the field of diagnosis using imaging and physiological data. In otolaryngology, AI has shown promise in image classification for middle ear diseases. However, existing models often lack patient-specific data and clinical context, limiting their universal applicability. The emergence of GPT-4 Vision (GPT-4V) has enabled a multimodal diagnostic approach, integrating language processing with image analysis.
OBJECTIVE
In this study, we investigated the effectiveness of GPT-4V in diagnosing middle ear diseases by integrating patient-specific data with otoscopic images of the tympanic membrane.
METHODS
The design of this study was divided into two phases: (1) establishing a model with appropriate prompts and (2) validating the ability of the optimal prompt model to classify images. In total, 305 otoscopic images of 4 middle ear diseases (acute otitis media, middle ear cholesteatoma, chronic otitis media, and otitis media with effusion) were obtained from patients who visited Shinshu University or Jichi Medical University between April 2010 and December 2023. The optimized GPT-4V settings were established using prompts and patients' data, and the model created with the optimal prompt was used to verify the diagnostic accuracy of GPT-4V on 190 images. To compare the diagnostic accuracy of GPT-4V with that of physicians, 30 clinicians completed a web-based questionnaire consisting of 190 images.
RESULTS
The multimodal AI approach achieved an accuracy of 82.1%, which is superior to that of certified pediatricians at 70.6%, but trailing behind that of otolaryngologists at more than 95%. The model's disease-specific accuracy rates were 89.2% for acute otitis media, 76.5% for chronic otitis media, 79.3% for middle ear cholesteatoma, and 85.7% for otitis media with effusion, which highlights the need for disease-specific optimization. Comparisons with physicians revealed promising results, suggesting the potential of GPT-4V to augment clinical decision-making.
CONCLUSIONS
Despite its advantages, challenges such as data privacy and ethical considerations must be addressed. Overall, this study underscores the potential of multimodal AI for enhancing diagnostic accuracy and improving patient care in otolaryngology. Further research is warranted to optimize and validate this approach in diverse clinical settings.
PubMed: 38875669
DOI: 10.2196/58342 -
Quality of Life Research : An... Jun 2024The Measure Yourself Medical Outcome Profile (MYMOP) is an individualised tool designed for adults but used with children without any evidence of validation in this...
BACKGROUND
The Measure Yourself Medical Outcome Profile (MYMOP) is an individualised tool designed for adults but used with children without any evidence of validation in this population. Individualised instruments are patient-specific rather than disease-specific and therefore can be applied across various health conditions. This study sought to adapt, and content validate the MYMOP for application in 7-11 year old children.
METHODS
There were two main phases of the four iterations: expert consultation (three rounds) and interviews with child-parent pairs at the Outpatient clinics of a Children's Hospital. Thematic analysis was undertaken using an inductive, interpretative approach.
RESULTS
Four paediatricians completed the first survey, five paediatricians participated in the focus group, and four paediatric health-related quality of life (HRQOL) research experts completed the second survey. Several changes were recommended to the MYMOP by the expert groups. Twenty-five children (17 general medicine, and 8 diabetes/endocrine clinic) aged 7-11 years completed the draft paediatric MYMOP (P-MYMOP) and were interviewed. Results demonstrated that the majority of participants were able to identify their own problems and activity limitations, and all participants understood the 7-point faces scale. Most parents and children perceived that the P-MYMOP would be useful to complete before clinic appointments.
CONCLUSIONS
The P-MYMOP is the first content-validated generic individualised HRQOL measure for children 7-11 years old. Given that validation is an iterative process, further research to assess its feasibility, reliability, and construct validity is required.
PubMed: 38874698
DOI: 10.1007/s11136-024-03702-3