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Journal of Paediatrics and Child Health Jan 2022Monogenic rare disorders contribute significantly to paediatric morbidity and mortality, and elucidation of the underlying genetic cause may have benefits for patients,...
Monogenic rare disorders contribute significantly to paediatric morbidity and mortality, and elucidation of the underlying genetic cause may have benefits for patients, families and clinicians. Advances in genomic technology have enabled diagnostic yields of up to 50% in some paediatric cohorts. This has led to an increase in the uptake of genetic testing across paediatric disciplines. This can place an increased burden on paediatricians, who may now be responsible for interpreting and explaining test results to patients. However, genomic results can be complex, and sometimes inconclusive for the ordering paediatrician. Results may also cause uncertainty and anxiety for patients and their families. The paediatrician's genetic literacy and knowledge of genetic principles are therefore critical to inform discussions with families and guide ongoing patient care. Here, we present four hypothetical case vignettes where genomic testing is undertaken, and discuss possible results and their implications for paediatricians and families. We also provide a list of key terms for paediatricians.
Topics: Child; Genetic Testing; Genomics; Humans; Pediatricians
PubMed: 34427008
DOI: 10.1111/jpc.15703 -
Current Problems in Pediatric and... Feb 2019Implicit bias has entered modern discourse as a result of our current sociopolitical climate. It is an area that has been largely explored in the social sciences, and... (Review)
Review
Implicit bias has entered modern discourse as a result of our current sociopolitical climate. It is an area that has been largely explored in the social sciences, and was highlighted in the landmark 2003 IOM report, Unequal Treatment, as a contributor to racial/ethnic health disparities. Implicit bias is the process of unconscious societal attitudes affecting our individual understanding, actions and decisions, thus leading to assumptions about groups. Immigrant populations are particularly at risk in our present-day environment, and as a result experience limited healthcare access and higher levels of psychological distress. There are many measures of implicit bias, but the most highly regarded tool is the Implicit Association Test (IAT), as it is valid and reliable. Some level of pro-White/anti-Black bias has been found in most systematic reviews and studies, although there are less studies on bias towards Latinx populations. Limited evidence exists about the association between implicit bias and health outcomes. However, existing publications have demonstrated clear associations between bias and treatment recommendations, nonverbal communication, adverse birth outcomes and provider communication styles. Implicit biases can be unlearned via debiasing strategies, but these have not been examined extensively amongst health care providers. Future research must rely on more than pre- and post-IAT measurements to examine the effect of these strategies on improving patient outcomes. Additionally, healthcare system leadership must prioritize implicit bias trainings for students and medical staff and make greater tangible efforts to improve workforce diversity as a debiasing strategy.
Topics: Attitude of Health Personnel; Child; Child Health Services; Emigrants and Immigrants; Healthcare Disparities; Humans; Pediatricians; Physician-Patient Relations; Racism; Unconscious, Psychology
PubMed: 30738896
DOI: 10.1016/j.cppeds.2019.01.003 -
BMC Ophthalmology Feb 2023Pediatricians play an important role in the early detection and prompt treatment of ocular disorders in children, including red eye disease. Our aim was to examine the...
BACKGROUND
Pediatricians play an important role in the early detection and prompt treatment of ocular disorders in children, including red eye disease. Our aim was to examine the knowledge level of pediatricians regarding treating children with red eye disease, as well as the factors that affect the knowledge level, and the potential implications of a low level of knowledge.
METHODS
In this correlational quantitative study, 152 expert pediatricians completed a questionnaire that included questions on knowledge, attitudes, and experience in treating red eye disease.
RESULTS
Respondents' mean level of knowledge was moderate. Most of the respondents (89.5%) knew that the most likely diagnosis for a child with red eyes and a discharge is viral conjunctivitis and that pain, blurred vision, and a clouded cornea, are symptoms indicative of a more complex systemic problem. In contrast, 78.3% of the pediatricians claimed that the treatment of choice for viral conjunctivitis is a conservative treatment that includes eye flushing and strict hygiene. However, 14.5% (n = 22) of the pediatricians were found to prescribe antibiotics. A negative association was found between the pediatrician's age and years of experience, and level of knowledge concerning treatment of children with red eye. A strong positive association was found between pediatricians' level of knowledge and their attitudes to performing eye tests. Moreover, a negative association was found between the level of knowledge and the number of cases in which pediatricians prescribed antibiotics for children with red eye.
CONCLUSIONS
The research findings indicate that lack of knowledge was more conspicuous among pediatricians with more experience. Knowledge appears to be critical both for readiness to treat red eye and for proper treatment. It is necessary to provide pediatricians with tools for treating eye disorders in children and to refresh their knowledge on red eye, particularly among pediatricians with more years of experience.
Topics: Humans; Child; Health Knowledge, Attitudes, Practice; Surveys and Questionnaires; Vision Disorders; Pediatricians; Anti-Bacterial Agents; Attitude of Health Personnel
PubMed: 36782135
DOI: 10.1186/s12886-022-02755-7 -
Andes Pediatrica : Revista Chilena de... Feb 2021Neonatal care has undergone important advances involving the technology for treatment and mo nitoring, the design of care spaces, the incorporation of support...
Neonatal care has undergone important advances involving the technology for treatment and mo nitoring, the design of care spaces, the incorporation of support professionals, and, especially, the strengthening of an organizational model in networks with centers of different levels of care. Neona tal units should be located in centers with maternity services and, ideally, with pediatric ones of an equivalent level of care. This document defines the admission and transfer criteria according to the level of care and among the different levels, respectively. The evidence recommends an individual room design due to the associated benefits such as decreased occurrence and better control of health care-associated infections, improved breastfeeding, and better interaction with parents. The sugges ted room sizes favor the implementation of the family-centered care model. These recommendations establish the possibility of performing emergency surgical procedures in the neonatal unit and define the safety criteria of the physical plant. In addition, they define the human resources according to the level of care, recognizing the time dedicated to non-direct patient care activities, , and the re quirements of non-medical professionals such as psychologists, physical and respiratory therapists, occupational therapists, speech therapists, pharmacists, dietitians, and social workers. Neonatal care should be led by the neonatologist allowing the participation of general pediatricians with training and demonstrated experience in neonatal care. Midwives and neonatal nurses should have accredited formation in such area. The purpose of this document is to update the "Recommendations on the Organization, Characteristics and Operation of Neonatology Services or Units" to serve as an orien tation and guide for the design and management of neonatal care in public and private health care centers in the country.
Topics: Emergencies; Family; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Neonatal Nursing; Neonatologists; Neonatology; Nurseries, Hospital; Patient Care Team; Pediatricians; Surgical Procedures, Operative
PubMed: 34106195
DOI: 10.32641/andespediatr.v92i1.3553 -
Clinical Pediatrics Sep 2023The Development and Behavior Access Clinic (DBAC) deploys a general pediatrician with brief/intensive training and proctoring by developmental-behavioral pediatricians...
The Development and Behavior Access Clinic (DBAC) deploys a general pediatrician with brief/intensive training and proctoring by developmental-behavioral pediatricians (DBP) to provide developmental-behavioral (DB) care to children referred with mild/moderate complexity needs as determined by a team of clinical psychologists. This pilot study utilizes visit data, chart review, and surveys to assess wait times, need for subspecialty care, and referring clinician satisfaction. In its first 18 months, DBAC decreased the need for subspecialty DB care, providing initial services for 44% of patients referred for DB pediatric care from the study site; 89% did not require subsequent subspecialty evaluation. Among DBAC participants, average wait times for DB care decreased from a baseline of 218 to 41 calendar days. This pilot study provides a model for building DB clinical skills among interested general pediatricians, decreasing wait times, and building the capacity of primary care settings to address mild-to-moderate complexity DB concerns.
Topics: Humans; Child; Capacity Building; Pediatricians; Primary Health Care; Psychology, Clinical; Ambulatory Care Facilities; Health Workforce; Pilot Projects; Adult; Middle Aged
PubMed: 36609195
DOI: 10.1177/00099228221147753 -
Revista Chilena de Pediatria 2016
Topics: Chile; Depression, Postpartum; Female; Humans; Pediatricians; Physician's Role; Pregnancy
PubMed: 26971830
DOI: 10.1016/j.rchipe.2016.01.003 -
Orphanet Journal of Rare Diseases Apr 2022Epidermolysis bullosa (EB) is a severe hereditary disease characterized by defective epithelial adhesion causing mucocutaneous fragility. The major types are EB simplex...
Epidermolysis bullosa (EB) is a severe hereditary disease characterized by defective epithelial adhesion causing mucocutaneous fragility. The major types are EB simplex (EBS), junctional EB (JEB), dystrophic EB (DEB) and more than 35 EB subtypes. Another very rare type of EB is Kindler EB (KEB). Clinically, it is a very heterogeneous disease which ranges from localized to extensive skin lesions with frequent multisystem extra cutaneous involvement. The role of a pediatrician-dermatologist cooperation within a multidisciplinary team is fundamental for both the diagnosis and management contributing to these patients' better life expectancy. Aim of this study is to describe clinical and laboratory characteristics of the main EB subtypes focusing on nutritional and gastrointestinal aspects, providing information to aid the paediatric management of children with EB. This retrospective study reviewed the cases of 160 pediatric EB patients (76 male and 84 female): 31 patients affected by EBS (mean age ± SD: 4.37 ± 7.14), 21 patients affected by JEB (mean age ± SD: 9.26± 17.30) and 108 with DEB (mean age ± SD: 11.61 ± 13.48). All patients were admitted at the Bambino Gesù Children's Hospital in Rome, between June 2005 to June 2020. The reduced gastrointestinal absorption, chronic losses, esophageal stenosis and chronic inflammatory state, represent the basis of nutritional problems of EB patients. In particular, anemia represents one of the most important complications of DEB patients which could require transfusion-dependent patterns. Malnutrition, vitamin deficiencies and anemia have been related to growth delay in EB patients. A specific diet with a balance of all macronutrients is required and improving caloric intake with sugar limitations is fundamental to prevent dental caries and tooth decay typical of EB patients. While sepsis proved to be the major cause of morbidity and mortality in younger patients, squamous cell carcinoma was mostly observed in older patients, especially those affected by DEB. Patients with EB require regular monitoring for complications and sequelae with a frequency of evaluations which varies based on age and EB subtypes. Cooperation among medical teams involving paediatricians, dermatologists, specialist clinicians including nutritionists such as families and patient's association is fundamental to approach the disease and improve the quality of life of these patients.
Topics: Aged; Child; Dental Caries; Epidermolysis Bullosa; Female; Humans; Male; Pediatricians; Quality of Life; Retrospective Studies
PubMed: 35379269
DOI: 10.1186/s13023-021-02144-1 -
Israel Journal of Health Policy Research Oct 2020Facing the global health crisis of COVID-19, health systems are increasingly supporting the use of telemedicine in ambulatory care settings. It is not clear whether the...
BACKGROUND
Facing the global health crisis of COVID-19, health systems are increasingly supporting the use of telemedicine in ambulatory care settings. It is not clear whether the increased use of telemedicine will persist after the pandemic has resolved. The aims of this study were to assess the use of telemedicine by Israeli pediatricians before and during the first lockdown phase of the pandemic, and to elucidate how they foresee telemedicine as a medium of medical practice in the post-pandemic era.
METHODS
A web-based survey was distributed among Israeli pediatricians in May 2020, soon after the end of first lockdown was announced. The survey assessed the frequency of telemedicine use as well as its influence on clinical decision making before and during the first COVID-19 lockdown, using two hypothetical clinical scenarios. The same scenarios were also used to assess how the pediatricians foresaw telemedicine in the post-pandemic period. In addition, administrative data from Maccabi on telemedicine use before, during and after the first lockdown were retrieved and analyzed.
RESULTS
One hundred and sixty-nine pediatricians responded to the survey (response rate = 40%). The percentage of respondents who reported daily use of text messages, pictures and videoconferencing increased from 24, 15 and 1% before COVID-19 to 40, 40 and 12% during the lockdown, respectively (p < 0.05). After the pandemic, projected use of text messages and pictures/videoclips was expected to decrease to 27 and 26% of respondents, respectively (p < 0.05), but pictures/videoclips were expected to increase from 15% of respondents before to 26% of respondents after (p < 0.05). The reported high likelihood of treating suspected pneumonia or prescribing antibiotics for suspected otitis media via telemedicine was expected to decrease from 20% of respondents during the COVID-19 lockdown to 6%% of respondents after (p < 0.05), and from 14% of respondents during the lockdown to 3% of respondents after, respectively. (p < 0.05). Maccabi administrative data indicated that during the lockdown, there was an increase in phone visits and a decrease in in-person visits compared to the pre-lockdown levels of use. One month after the end of the first lock-down there was a partial return to baseline levels of in-person visits and a sustained increase in phone visits. Phone visits accounted for 0% of pediatrician visits before the first lockdown, 17% of them during the lockdown, and 19% of them 1 month after the lockdown relaxation.
CONCLUSIONS
The study indicates that use of telemedicine technologies by primary care pediatricians increased substantially during the first COVID-19 lockdown. The study also found that pediatricians expected that use levels will recede after the pandemic. As the pandemic continues and evolves, it will be important to continue to monitor the level of telemedicine use as well as expectations regarding post-pandemic use levels.
Topics: Adult; Aged; Attitude of Health Personnel; COVID-19; Child; Coronavirus Infections; Female; Forecasting; Humans; Israel; Male; Middle Aged; Pandemics; Pediatricians; Pneumonia, Viral; Primary Health Care; Public Policy; Quarantine; Telemedicine
PubMed: 33081834
DOI: 10.1186/s13584-020-00414-0 -
Revista Chilena de Pediatria 2019Anaphylaxis is an emergency condition. According to the latest international guide lines, early recognition and treatment with intramuscular epinephrine are associated...
INTRODUCTION
Anaphylaxis is an emergency condition. According to the latest international guide lines, early recognition and treatment with intramuscular epinephrine are associated with increased survival.
OBJECTIVE
To determine the level of knowledge of pediatricians in a tertiary Pediatric Hos pital about the diagnostic criteria and treatment of anaphylaxis.
MATERIAL AND METHOD
A cross-sec tional descriptive study was conducted, designing, applying, and validating an anonymous survey to physicians with complete residency in pediatrics who are on call at a third level hospital. The statisti cal analysis was made using the SPSS v.21 software, presenting measures of central tendency (median, range, and frequency table) and Chi-square test for comparison. A value of p < 0.05 was considered significant.
RESULTS
71 physicians completed the survey with a median of three years after the end of residency.35% of them identified all clinical criteria, 99% (70) indicated epinephrine, 73% chose the intramuscular route, and 55% indicated the correct dose. Only 48% of responders chose the dose and administration route correctly. In general, 21% recognized anaphylaxis and used epinephrine correctly. Physicians with less than five years of experience performed better in the intramuscular administration of epinephrine (83% vs 52% p = 0.005) and in the detection of gastrointestinal symp toms (60% vs 35% p = 0.043).
CONCLUSIONS
There are difficulties in the identification and proper management of anaphylaxis by pediatricians of a tertiary Pediatric Hospital in a theoretical clinical setting. Although most of pediatricians chose epinephrine as a first-line drug, half of them did not indicate it correctly, and only one-third recognized anaphylaxis in all scenarios.
Topics: Anaphylaxis; Argentina; Child; Clinical Competence; Cross-Sectional Studies; Emergencies; Epinephrine; Guideline Adherence; Health Care Surveys; Hospitals, Pediatric; Humans; Injections, Intramuscular; Pediatricians; Practice Guidelines as Topic; Practice Patterns, Physicians'; Sympathomimetics
PubMed: 31095218
DOI: 10.32641/rchped.v90i1.839 -
Annals of Allergy, Asthma & Immunology... Mar 2021Anaphylaxis remains difficult to diagnose and epinephrine underused.
BACKGROUND
Anaphylaxis remains difficult to diagnose and epinephrine underused.
OBJECTIVE
To better understand the thoughts of pediatricians regarding when acute allergic reactions constitute anaphylaxis and when epinephrine should be given by conducting an anonymous online survey.
METHODS
The survey consisted of 8 case-based scenarios of allergic reactions with the following 2 questions on each case: (1) does this case represent anaphylaxis? and (2) if this patient immediately presented to you, would you treat the patient with epinephrine during the reaction?
RESULTS
A total of 1001 responses were analyzed. When assessing all cases combined, there was discordance in whether a case represented anaphylaxis and administration of epinephrine was warranted in 8% of the cases. An average of 5% of all the respondents suggested that the case represented anaphylaxis but would not warrant epinephrine, whereas an average of 3% suggested that the case did not represent anaphylaxis but that epinephrine was warranted.
CONCLUSION
The results of this survey reveal that there is discordance among pediatricians on when an allergic reaction is considered anaphylaxis and when epinephrine is warranted. These data highlight the need for continued improvement of the definition of anaphylaxis and continued need for education regarding the diagnosis and management of anaphylaxis.
Topics: Adult; Anaphylaxis; Epinephrine; Female; Health Care Surveys; Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; Pediatricians; Practice Patterns, Physicians'; United States
PubMed: 33232828
DOI: 10.1016/j.anai.2020.11.010