Pediatrics最新文献_第3页

Implementing a Clinical-Community Program to Address Menstrual Poverty: An Advocacy Case Study. 实施临床-社区方案解决经期贫困：倡导案例研究。

IF 8 2区医学

Pediatrics Pub Date : 2025-05-14 DOI: 10.1542/peds.2024-068710

Natalie Wichelt,Kimberly Montez,Reyna Osorio,Riley Roberts,Ivy Greene,Gabriela de la Vega,Callie L Brown

{"title":"Implementing a Clinical-Community Program to Address Menstrual Poverty: An Advocacy Case Study.","authors":"Natalie Wichelt,Kimberly Montez,Reyna Osorio,Riley Roberts,Ivy Greene,Gabriela de la Vega,Callie L Brown","doi":"10.1542/peds.2024-068710","DOIUrl":"https://doi.org/10.1542/peds.2024-068710","url":null,"abstract":"Menstrual poverty occurs when inadequate access to menstrual hygiene education or financial hardship creates difficulties in sufficiently accessing menstrual hygiene products, which results in adverse outcomes for emotional well-being, school attendance, and health autonomy. The American Academy of Pediatrics recently endorsed a position statement to eliminate menstrual poverty in adolescents and young adults (AYAs). However, few community-clinical collaborations exist in the literature that addresses menstrual poverty. We introduced a novel menstrual poverty screening tool in April 2022 at 1 academic pediatric clinic at all female AYA well visits. We partnered with a local advocacy organization, the Triad of North Carolina chapter of The Period Project, to create packets containing menstrual hygiene supplies. Those with positive screens were given the option of receiving a menstrual supply packet at the time of visit. Narrative feedback was obtained to evaluate for project feasibility and acceptability from AYA participants who screened positive for menstrual poverty and from clinic staff participating in screening or providing menstrual supply packets. Themes included (1) menstrual poverty as a problem in the community, (2) necessity of addressing and normalizing menstrual poverty at every AYA well visit, (3) medical and mental health consequences of menstrual poverty, and (4) suggestions to improve the clinical-community program. We found that a clinical program addressing menstrual poverty through partnership with a community-based advocacy organization was acceptable among patients and providers. Additional research is needed to determine effectiveness of a clinical-community program addressing menstrual poverty.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"35 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Consensus Recommendations for Sustainable and Equitable Neonatology Staffing: A Delphi Approach. 可持续和公平的新生儿人员配置的共识建议：德尔菲方法。

IF 8 2区医学

Pediatrics Pub Date : 2025-05-14 DOI: 10.1542/peds.2024-069943

Milenka Cuevas Guaman,Christine E Bishop,Emily R Miller,Christiane E L Dammann,Kaashif A Ahmad,Eric Horowitz,Mark Hudak,Satyan Lakshminrusimha,Patrick J McNamara,Mark R Mercurio,Marielle Nguyen,De-Ann M Pillers,Robin H Steinhorn,Annemarie Stroustrup,Kerri Z Machut

{"title":"Consensus Recommendations for Sustainable and Equitable Neonatology Staffing: A Delphi Approach.","authors":"Milenka Cuevas Guaman,Christine E Bishop,Emily R Miller,Christiane E L Dammann,Kaashif A Ahmad,Eric Horowitz,Mark Hudak,Satyan Lakshminrusimha,Patrick J McNamara,Mark R Mercurio,Marielle Nguyen,De-Ann M Pillers,Robin H Steinhorn,Annemarie Stroustrup,Kerri Z Machut","doi":"10.1542/peds.2024-069943","DOIUrl":"https://doi.org/10.1542/peds.2024-069943","url":null,"abstract":"BACKGROUND AND OBJECTIVEThe specialty of neonatology faces significant and growing challenges related to patient safety, physician well-being, and workforce sustainability that highlight the necessity for innovative work models. Our objective was to develop consensus recommendations to improve neonatologist staffing practices in the United States.METHODSWe used a modified Delphi process with 32 diverse subject-matter expert stakeholders to reach consensus. We derived 60 initial potential recommendations for improved staffing from the literature and our 2 previous studies of physician leaders. We defined consensus as 80% or higher agreement and strong consensus as 90% or higher agreement. We ultimately eliminated statements that achieved less than 80% consensus from the recommendations.RESULTSFifty-one individual statements reached consensus and were grouped into 24 final recommendations to improve neonatology staffing. Topics of focus included clinical allocations (eg, clinic work is counted in hours/year), shift characteristics (eg, clinical work after 24 hours is minimized), allocation of nonclinical work (eg, nonclinical work is accounted for in full-time equivalent), and staffing flexibility (eg, options to restructure clinical work are provided for specific circumstances such as aging and pregnancy). Significant discussion on many statements focused on ensuring that recommendations were both feasible and not overly prescriptive for individual institutions.CONCLUSIONSWe reached consensus on a set of neonatologist staffing recommendations that emphasize the critical issues related to patient safety and physician well-being. Future work will focus on advocating for widespread implementation of these recommendations and evaluating their effect on patient safety, physician well-being, and sustainability of the neonatal workforce.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"132 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pediatrician Characteristics Associated With Rural Practice and Retention: 2012-2023. 与农村实践和保留相关的儿科医生特征：2012-2023。

IF 8 2区医学

Pediatrics Pub Date : 2025-05-13 DOI: 10.1542/peds.2025-070705

Elizabeth A Gottschlich,Mary Pat Frintner,Kristin N Ray,Laurel K Leslie,Lynn M Olson

引用次数: 0

Safe Enough: Subjective Determinations in Hospital Discharge for Patients With Medical Complexity. 足够安全：医疗复杂性患者出院时的主观判断。

IF 8 2区医学

Pediatrics Pub Date : 2025-05-13 DOI: 10.1542/peds.2024-067585

Holly Hòa Võ,Rebecca R Seltzer,Maya Scott,Chris Feudtner,Carolyn Foster

{"title":"Safe Enough: Subjective Determinations in Hospital Discharge for Patients With Medical Complexity.","authors":"Holly Hòa Võ,Rebecca R Seltzer,Maya Scott,Chris Feudtner,Carolyn Foster","doi":"10.1542/peds.2024-067585","DOIUrl":"https://doi.org/10.1542/peds.2024-067585","url":null,"abstract":"Determining whether a discharge plan is safe relies on both objective and subjective evaluations. These safety determinations are often made with the goal of having children reintegrated into their community. In the case of pediatric mechanical ventilation via tracheostomy, the stakes for discharge home are high given potential morbidity and mortality risk if there are insufficient services in place. Clinical practice guidelines recommend that these children have continuous monitoring from a nurse or trained caregiver. However, this monitoring recommendation has led to unintended delays in discharges due to nursing shortages and limited caregiver availability. Conflicts can then arise about whether patients should remain hospitalized indefinitely until nursing is secured, be discharged home without adequate nursing support, or be placed in a long-term care facility until criteria are met. Important ethical considerations when addressing this conflict include the legal obligation to ensure children are properly integrated into their communities, the biases and racism that may impact which families are deemed as being unable to provide a safe environment, and the harm associated with the clinical team overriding a parent's decision about their child's care and recommending state intervention. To balance the medical goal of maximizing safety with the ethical standard of respecting autonomy and the civil rights that children with disabilities have to receive care at home, we must reconsider how safety is evaluated by seeking an integrated approach that provides a shared understanding of best practices and values between the clinical team and family in defining \"safe.\"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"17 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Stimulant Medication Use and Risk of Psychotic Experiences. 兴奋剂药物的使用和精神病经历的风险。

IF 8 2区医学

Pediatrics Pub Date : 2025-05-12 DOI: 10.1542/peds.2024-069142

Kirstie O'Hare,Jonah F Byrne,Hugh Ramsay,Liana Romaniuk,Jane McGrath,Dolores Keating,Maria Migone,Karen O'Connor,Nicola Coss,Mary Cannon,David Cotter,Colm Healy,Ian Kelleher

{"title":"Stimulant Medication Use and Risk of Psychotic Experiences.","authors":"Kirstie O'Hare,Jonah F Byrne,Hugh Ramsay,Liana Romaniuk,Jane McGrath,Dolores Keating,Maria Migone,Karen O'Connor,Nicola Coss,Mary Cannon,David Cotter,Colm Healy,Ian Kelleher","doi":"10.1542/peds.2024-069142","DOIUrl":"https://doi.org/10.1542/peds.2024-069142","url":null,"abstract":"BACKGROUND AND OBJECTIVESThe prescription of stimulant medications for young people with attention-deficit/hyperactivity disorder is common and increasing. Concerns have been raised about potentially psychotogenic effects of stimulants, and previous observational research has documented an increased risk of psychotic experiences in young people prescribed stimulants. Our aim was to estimate the causal effect of stimulants on psychotic experiences.METHODSThe trial was emulated using Adolescent Brain Cognitive Development Study data. Eligible participants were aged between 9 and 14 years. Treatment (stimulant prescription) propensities were derived using covariates indexing demographic factors and mental illness severity. The average causal effect of first stimulant prescription on psychotic experiences by 1-year follow-up was derived using inverse probability of treatment weighting followed by standardization (doubly robust estimation).RESULTSOf 8391 participants included in the analytical sample, 460 (5.5%) reported 1 or more stimulant prescriptions. In unweighted analyses, stimulant prescription was associated with subsequent psychotic experiences (odds ratio [OR]: 1.46; 95% CI: 1.15-1.84). The reverse, however, was also true, in that baseline psychotic experiences predicted subsequent stimulant treatment (OR: 1.93; 95% CI: 1.57-2.37). When applying doubly robust estimation, there was no evidence of a causal effect of stimulant prescription on the subsequent occurrence of psychotic experiences (OR: 1.09; 95% CI: 0.71-1.56).CONCLUSIONSOur findings do not support a causal relationship between stimulant prescription and psychotic experiences. Rather, the association appears to be confounded by factors that both increase probability of stimulant prescription and lead to psychotic experiences.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"2 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Inflammatory Markers and Invasive Bacterial Infection in Febrile Infants With Positive Urinalyses. 尿检阳性发热婴儿的炎症标志物和侵袭性细菌感染。

IF 8 2区医学

Pediatrics Pub Date : 2025-05-09 DOI: 10.1542/peds.2025-071109

Beatriz A Ruiz,Lyubina C Yankova,Corrie E McDaniel,Ellen Kerns,Paul L Aronson

引用次数: 0

Understanding Complex Care Through Narrative Medicine: A Qualitative Study. 通过叙事医学理解复杂护理：一项定性研究。

IF 8 2区医学

Pediatrics Pub Date : 2025-05-09 DOI: 10.1542/peds.2024-069776

Cara L Coleman,Lucas Bruton,Stephanie J Adler Yuan,Kathleen Huth

{"title":"Understanding Complex Care Through Narrative Medicine: A Qualitative Study.","authors":"Cara L Coleman,Lucas Bruton,Stephanie J Adler Yuan,Kathleen Huth","doi":"10.1542/peds.2024-069776","DOIUrl":"https://doi.org/10.1542/peds.2024-069776","url":null,"abstract":"BACKGROUND AND OBJECTIVESCurrent training models do not adequately prepare pediatricians to care for children with medical complexity (CMC) as part of a team. Narrative medicine may foster mutual understanding between clinicians and families with colearning as a foundation for collaborative care. In this study, we implemented family-led interprofessional narrative medicine training and explored participants' perspectives in complex care.METHODSWe performed a qualitative study of narrative medicine training grounded in entrustable professional activities (EPAs) in complex care. We recruited clinicians and families who care for CMC to participate in a series of 6 workshops. Each workshop involved close reading of a text and discussion related to a clinical activity in complex care. Participants defined the EPA before and after each workshop. We performed thematic analysis of EPA definitions and workshop transcripts and synthesized findings into a conceptual model.RESULTSWe recruited 3 interprofessional cohorts (35 total participants) with a mean participation rate of 80%. Each cohort included at least 2 family partners. We analyzed EPA definitions and transcripts from 18 workshops across all cohorts. Four themes emerged involving shifts in perspective about complex care: fragmented to holistic care, intractable to navigable complexity, transactional to relational connection, and caring in isolation to caring in community. Findings aligned with elements of patient- and family-centered care.CONCLUSIONSClinician and family participants in narrative medicine training described changes in their perspectives on key clinical activities in complex care. Further research should explore colearning models for pediatricians and families that foster team-based patient- and family-centered care.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"229 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Key Infrastructure Elements for Conducting Pediatric Medical Device Clinical Trials. 开展儿科医疗器械临床试验的关键基础设施要素。

IF 8 2区医学

Pediatrics Pub Date : 2025-05-08 DOI: 10.1542/peds.2024-069842

Chris Feudtner,Douglas L Hill,Russell T Nye,Harvey S Borovetz,Ashley Magnavita,Lynn A Sleeper,Joshua Dienstman,Stanley J Stachelek,Robert J Levy

{"title":"Key Infrastructure Elements for Conducting Pediatric Medical Device Clinical Trials.","authors":"Chris Feudtner,Douglas L Hill,Russell T Nye,Harvey S Borovetz,Ashley Magnavita,Lynn A Sleeper,Joshua Dienstman,Stanley J Stachelek,Robert J Levy","doi":"10.1542/peds.2024-069842","DOIUrl":"https://doi.org/10.1542/peds.2024-069842","url":null,"abstract":"BACKGROUND AND OBJECTIVESPediatric medical device (PMD) development lags behind device development for adults. We sought to identify infrastructure elements that support the conduct of PMD clinical trials (PMD-CTs).METHODSWe conducted a multistage modified Delphi process with 25 panelists who were experts on different aspects of PMD-CTs to identify and rate the importance of infrastructure elements and supporting activities.RESULTSThe panelists identified and rated the importance of 24 activities and 130 infrastructure components for conducting PMD-CTs. The panelists gave the highest importance ratings to assuring compliance with US Food and Drug Administration regulations (mean score, 5.0; IQR, 5.0-5.0; range, 5.0-5.0) and data and safety monitoring (mean score, 4.9; IQR, 5.0-5.0; range, 4.0-5.0). The infrastructure components with the highest importance ratings were \"Principal investigator with clinical experience\" and \"Device training plan\" under the activity \"Implant and use device.\" Although some activities and infrastructure components received low importance ratings from individual panelists, all received high ratings from most panelists.CONCLUSIONSOur panelists showed areas of agreement on what activities and infrastructure elements are important for conducting a successful PMD-CT, but panelists did not start with a common mental model of the tasks required for a PMD-CT, with some activities dismissed by a subset of panelists as unimportant or irrelevant. Lack of a shared mental model, differences in preferred terminology, and variability regarding the importance of key activities and infrastructure supports pose challenges for institutions and organizations attempting to support the development of PMDs.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"9 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143921116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Partnering With Youth Researchers in a Dynamic Reproductive Health Policy Landscape. 在动态生殖健康政策格局中与青年研究人员合作。

IF 8 2区医学

Pediatrics Pub Date : 2025-05-08 DOI: 10.1542/peds.2024-068259

Andrea J Hoopes,Elena Padley,Kinsey Vear,Tammy Chang,Tamara Marzouk,Thang D Dao,Eleanor Esbrook,Renee M Odom,Julie Maslowsky,Bianca A Allison

引用次数: 0

Retropharyngeal Abscess as a Cause of Bilateral Brachial Palsy in a Neonate. 新生儿双侧臂臂麻痹的原因之一咽后脓肿。

IF 8 2区医学

Pediatrics Pub Date : 2025-05-08 DOI: 10.1542/peds.2025-070883

Isabel Miras Aguilar,Gemma Villar Villar,Araceli Corredera Sánchez,Ariadna Sánchez Suárez,Rocío Castillo Miguel,María Medina Muñoz,Manuel Gómez Serrano,Eva Arias Vivas

引用次数: 0