Academic Pediatrics最新文献

{"title":"Proactive Approaches for a Wheelchair User in Pediatric Residency: A Case Study for Disability Inclusion.","authors":"Nalinda Charnsangavej, Uyen Truong, Lisa Meeks","doi":"10.1016/j.acap.2024.102619","DOIUrl":"https://doi.org/10.1016/j.acap.2024.102619","url":null,"abstract":"<p><strong>Objective: </strong>Despite encountering many barriers to inclusion, people with disabilities are entering residency training in increasing numbers. However, the increase in representation among people with physical disabilities remains low and published case studies and accommodations processes for wheelchair users in pediatric residency are absent in the literature. To support the inclusion of residents with physical disabilities in residency, we outline a proactive approach to the accommodations process and inclusion of a resident with a physical disability in pediatric residency.</p><p><strong>Methods: </strong>A multidisciplinary team including residency program leadership, disability professionals, the hospital system, and the resident, developed and implemented reasonable accommodations for a resident wheelchair user entering pediatric residency utilizing an iterative and interactive process.</p><p><strong>Results: </strong>A pediatric resident wheelchair user completed residency training and specialty requirements utilizing reasonable accommodations.</p><p><strong>Conclusions: </strong>Early planning and communication regarding necessary accommodations and the presence of an inclusive and supportive learning environment are key components for the successful inclusion of residents with physical disabilities in residency programs.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102619"},"PeriodicalIF":3.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual Psychosocial Screening of the Adolescent Patient by Implementing the SEEK Teen Questionnaire.","authors":"Ryan L Spotts, Jennifer Shook, Benjamin N Fogel, Chelsea Emrick, Eric Schaefer, Howard Dubowitz","doi":"10.1016/j.acap.2024.102622","DOIUrl":"https://doi.org/10.1016/j.acap.2024.102622","url":null,"abstract":"<p><strong>Objective: </strong>This study introduces the SEEK Teen Questionnaire, expanding the Safe Environment for Every Kid (SEEK) approach to include adolescent perspectives alongside caregiver responses for dual psychosocial screening. The objective of this study aims to triangulate adolescent responses with those of their caregivers to demonstrate the benefits of dual psychosocial screening.</p><p><strong>Methods: </strong>The SEEK Teen Questionnaire was developed by integrating input from primary care and adolescent medicine professionals, national experts, and adolescent stakeholders. The resulting 32-item psychosocial screening tool was administered to adolescent patients aged 11-18 during well visits simultaneously with caregiver completion of the SEEK Parent Questionnaire from August to October, 2022 with interventions offered for identified problems. Responses were compared using McNemar's and Fisher's exact tests.</p><p><strong>Results: </strong>Four hundred and eighty caregivers and adolescents consented to the study. Participants were generally white (64%), non-Hispanic (81%), and privately insured (62%). Adolescents had a high completion rate (97%) with concordant responses among matched caregivers between 83-96%. Among discordant dyads, adolescents disclosed concerns for their caregivers more commonly than caregivers expressed for themselves: discipline (83% vs. 17%, P<0.001), food insecurity (71% vs. 29%, p=0.09), intimate partner violence (78% vs. 22%, p<0.018), stress (81% vs. 19%, p<0.001), depression (64% vs. 36%, p=0.12), and substance misuse (91% vs. 9%, p<0.001).</p><p><strong>Conclusion: </strong>This study demonstrates adolescents' willingness to provide insights into their caregivers' well-being and their high awareness of stressors affecting them. Incorporating adolescent perspectives enhances the identification of issues that may otherwise go unnoticed, underscoring the importance of dual psychosocial screening during adolescence.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102622"},"PeriodicalIF":3.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric to Adult Care Transition in the Hospital Context (PATCH) Tool: A Novel Tool to Assess Pediatric Institutional Guidelines for Inpatient Care of Adults.","authors":"Ann-Marie Tantoco, Rachel Peterson, Bethany Corbin, Francis Coyne, Brian Herbst, Susan Hunt, Emily Levoy, Harrison Luttrell, Susan Shanske, Shuvani Sunyal, Keely Dwyer-Matzky, Ashley M Jenkins","doi":"10.1016/j.acap.2024.102625","DOIUrl":"https://doi.org/10.1016/j.acap.2024.102625","url":null,"abstract":"<p><strong>Objective: </strong>The growing number of adults with childhood onset chronic conditions (COCC) is reflected in the increase of adult-aged admissions to pediatric institutions. Despite national bodies advising pediatric institutions to have a pediatric to adult healthcare transition (HCT) policy, little guidance is available on if or how to include inpatient care. We sought to create a framework-based Pediatric to Adult Transitional Care in the Hospital Context (PATCH) tool to assess how inpatient care of adults is addressed in pediatric institutional guidelines or policies (hereafter guidelines) as a first step towards informing future PATCH guideline development.</p><p><strong>Methods: </strong>We used convenience and snowball sampling to obtain 11 pediatric institutional guidelines. Combining the GotTransition® core elements with Coller et al's inpatient transition conceptual model through iterative consensus building, we developed the PATCH tool. Interrater reliability was assessed by using mean percent agreement amongst raters. A three-phase content validity process utilizing existing guidelines refined the finalized tool.</p><p><strong>Results: </strong>The PATCH tool included 42 items within nine domains. There was a high degree of agreeability amongst reviewers, and qualitative analysis revealed no missing items. Twenty-five (59%) of our 42 PATCH tool items were present in at least one of the reviewed guidelines, with age being present in all.</p><p><strong>Conclusion: </strong>We developed the PATCH tool as a guide for pediatric institutions regarding the care of adolescent and adult patients. The PATCH tool, embedded in multidisciplinary stakeholder discussion and patient- and system-specific knowledge, may help institutions incorporate HCT into processes for adolescent and adult patients with COCCs.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102625"},"PeriodicalIF":3.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Universal suicide risk screening in pediatric neurologic, developmental, and behavioral clinics.","authors":"Suzanne Rybczynski, Allison Gornik, Benjamin Joffe Schindel, Mwuese Ngur, Teresa Matte-Ramsdell, Carmen Lopez-Arvizu, Paul H Lipkin, T Andrew Zabel","doi":"10.1016/j.acap.2024.102623","DOIUrl":"https://doi.org/10.1016/j.acap.2024.102623","url":null,"abstract":"<p><strong>Background and objectives: </strong>Suicidal thoughts and behaviors in youth have been increasing over the last thirty years, resulting in recommendations to screen for suicide risk. Our aim was to evaluate suicide risk screenings in children during outpatient care at a specialty care facility for those with neurologic, developmental, and behavioral disorders (NDBD).</p><p><strong>Methods: </strong>This cross-sectional, retrospective study utilized suicide screening data from the Ask Suicide-Screening Questions tool administered to children attending initial outpatient visits at medical, mental health, or autism specialty clinics serving individuals with NDBD. Primary outcomes included whether screening occurred or was declined, and if it yielded elevated risk for suicide. Predictive factors were examined.</p><p><strong>Results: </strong>15,462 children aged 8-17 (38.4% female; 47.7% White, 26.0% Black; 21.0% Medicaid) were offered screening as part of routine care. Overall, 10,970 children underwent screening; 4,492 (29.1%) declined. Probability of declined screenings was greater if children were younger, male, attended a medical clinic appointment, and were offered the screening prior to the COVID-19 pandemic. The overall rate of positive screening was 10.3%. Children as young as age 8 screened positive in all settings. Positive screening rates in medical, mental health, and autism specialty clinics were 7.9%, 12.2%, and 12.7%, respectively. Screenings were more likely to be positive for children who were older, female, self-reported rather than caregiver-reported, and occurring within a behavioral health or autism specialty clinic.</p><p><strong>Conclusions: </strong>Suicide risk was identified in children across all pediatric programs, indicating strong support for universal suicide screening of children and youth in pediatric settings.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102623"},"PeriodicalIF":3.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cyberbullying Victimization among Transgender and Gender-Questioning Early Adolescents.","authors":"Jason M Nagata, Priyadharshini Balasubramanian, Thang Diep, Kyle T Ganson, Alexander Testa, Jinbo He, Fiona C Baker","doi":"10.1016/j.acap.2024.102624","DOIUrl":"https://doi.org/10.1016/j.acap.2024.102624","url":null,"abstract":"<p><strong>Objective: </strong>To determine the association between transgender or gender-questioning identity and cyberbullying victimization in a diverse national sample of early adolescents in the US.</p><p><strong>Methods: </strong>We analyzed cross-sectional data from the Adolescent Brain Cognitive Development (ABCD) Study (N=9,989, Year 3, 2019-2021, 11-14 years old, 48.8% female, 47.6% racial/ethnic minority). Logistic regression analyses were conducted to estimate the associations between transgender or gender-questioning identity and lifetime cyberbullying victimization, adjusting for sociodemographic confounders.</p><p><strong>Results: </strong>In a sample of 9,989 adolescents (1.0% transgender, 1.1% gender-questioning), both transgender (OR 2.24, 95% CI 1.22-4.10) and gender-questioning (OR 1.91, 95% CI 1.05-3.47) adolescents had greater odds of cyberbullying victimization compared to their cisgender peers. There was no evidence of significant effect modification of the association between transgender identity and cyberbullying victimization by sex assigned at birth.</p><p><strong>Conclusions: </strong>Transgender and gender-questioning early adolescents experience higher rates of cyberbullying victimization than their cisgender peers. Future research could investigate the risk and protective factors for cyberbullying in gender minority adolescents.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102624"},"PeriodicalIF":3.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inaccuracy of temporal thermometer measurement by age and race.","authors":"Rama A Salhi, Melissa A Meeker, Carey Williams, Theodore J Iwashyna, Margaret E Samuels-Kalow","doi":"10.1016/j.acap.2024.102620","DOIUrl":"https://doi.org/10.1016/j.acap.2024.102620","url":null,"abstract":"<p><strong>Objective: </strong>Rapid vital sign assessment, including temperature measurement, is critical among pediatric patients presenting to the emergency department (ED). While error rates in temporal thermometry are well documented, the potential for differential error rates by demographics are not well established. Our objective was to evaluate error rates of temporal thermometers by demographic variables, specifically race and age, among pediatric patients in the ED.</p><p><strong>Methods: </strong>Pediatric patients (≤18 years old) identified as either Black or White in the medical record presenting to the ED between January 2020 and December 2022 who received at least one paired temperature measurement (temporal and oral/rectal temperature within 30 minutes) were included. Rates of discordance by demographic characteristics were then evaluated. Secondarily, we explored characteristics of patients who received temporal thermometry only.</p><p><strong>Results: </strong>The final population included 1,526 paired temperatures (1,412 patients). Among all paired measurements, 26% had discordant measurements (25% in Black patients vs. 26% in White patients). In the final adjusted model, children age ≤12 years old were found to have 2-3 times higher odds of discordance than children >12 years old. Black patients were statistically significantly more likely to receive a temporal thermometer measurement only (aOR 1.27, 95%CI: 1.22, 1.33), even when controlling for fever-related chief complaints.</p><p><strong>Conclusions: </strong>Age ≤12 years old was associated with increased odds of missed fever by temporal thermometry. In our secondary analysis, Black patients were found to be more likely to receive temporal thermometry only. These findings highlight the need for consistent, accurate measurement protocols among pediatric patients.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102620"},"PeriodicalIF":3.0,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caregiver Experiences with Prescribed Antibiotic Access After a Pediatric Emergency Department Visit: A Qualitative Study.","authors":"Hanae Fujii-Rios, Tara Ketterer, Ashlee Murray, Whitney V Cabey, Cynthia Mollen","doi":"10.1016/j.acap.2024.102621","DOIUrl":"https://doi.org/10.1016/j.acap.2024.102621","url":null,"abstract":"<p><strong>Objective: </strong>Approximately one third of caregivers do not obtain a prescribed medication after their child's pediatric emergency department visit. We sought to explore the facilitators and barriers that caregivers experience in accessing prescribed antibiotics after their child's pediatric emergency department visit.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with caregivers of children who presented to a quaternary academic pediatric emergency department and were discharged with prescribed antibiotics. An interview guide was developed by the study team based on literature review and expert opinion. Interviews were coded, and thematic analysis was performed. Descriptive statistical analysis was used for demographic characteristics and medication pick up rates.</p><p><strong>Results: </strong>Twenty-two interviews were completed. Caregivers unanimously felt that antibiotics were important. Themes pertaining to medication access included (i) pharmacy location and convenience, (ii) pharmacy efficiency, responsiveness, and medication availability, (iii) impact of receiving first dose of antibiotics in the ED, and (iv) clear verbal and written communication by healthcare providers regarding diagnoses, medication indication and discharge instructions.</p><p><strong>Conclusions: </strong>Factors contributing to medication access have an underlying theme surrounding convenience and emphasis on the impact of first antibiotic dose administration during ED course. As such, consideration of systems changes that allows caregivers to leave the hospital with the entire course of antibiotics in hand may improve caregiver access to prescribed medications.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102621"},"PeriodicalIF":3.0,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal stability and predictive value of socio/emotional/behavioral screening in an Outpatient Pediatric Network.","authors":"R Christopher Sheldrick, Justin Birudavol, Dina R Hirshfeld-Becker, Alice S Carter, Ellen C Perrin, Anamika Dutta, Talia S Benheim, Juliana M Holcomb, Alexy Arauz Boudreau, Michael S Jellinek, J Michael Murphy","doi":"10.1016/j.acap.2024.102618","DOIUrl":"https://doi.org/10.1016/j.acap.2024.102618","url":null,"abstract":"<p><strong>Background: </strong>In 2022, the American Academy of Pediatrics recommended annual social/emotional/behavioral (SEB) screening at preventive pediatric visits. Numerous SEB screeners have considerable empirical support for children of all ages. However, few studies inform the longitudinal use of SEB screeners in pediatrics.</p><p><strong>Methods: </strong>Using electronic health records (EHR) from seven pediatric clinics in a large hospital system, we analyze the longitudinal stability of three SEB screeners among 9,153 children and adolescents who were screened multiple times over a 3-year period, and we evaluate associations with International Classification of Disease (ICD) codes for SEB diagnoses.</p><p><strong>Results: </strong>Moderate stability was documented for the Baby Pediatric Symptom Checklist (ICC =.57), Preschool Pediatric Symptom Checklist (ICC =.60), and Pediatric Symptom Checklist-17 (ICC =.69). Stability of positive/negative results was sensitive to each screener's threshold. Across a range of thresholds that classify 7-20% of children as positive, all three screeners achieved positive predictive values (PPVs) of approximately 40-65% and diagnostic odds ratios ranging from 8 to 15. These findings compare favorably to published results for longer measures and structured interviews. Recommended thresholds varied markedly across screeners, and associations with ICD codes demonstrate that higher thresholds yield higher specificity but lower sensitivity (i.e., a majority of ICD codes are not anticipated by positive screens).</p><p><strong>Conclusions: </strong>Three common SEB screeners display longitudinal stability similar to longer, more established measures. Results demonstrate that recommended thresholds vary markedly across measures and that choice of threshold strongly influences sensitivity and specificity, underscoring the need for greater attention to selection of thresholds. CLINICAL TRIAL REGISTRATION (IF ANY): none.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102618"},"PeriodicalIF":3.0,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Childhood Opportunity Index, Healthcare Systems, and the Potential to Improve Child Health Equity.","authors":"Molly K Krager, Jessica L Bettenhausen","doi":"10.1016/j.acap.2024.102617","DOIUrl":"https://doi.org/10.1016/j.acap.2024.102617","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102617"},"PeriodicalIF":3.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge and attitudes about perinatal marijuana use among U.S. postpartum mothers: A BORN network study.","authors":"Neera K Goyal, Pearl W Chang, Esther K Chung","doi":"10.1016/j.acap.2024.102616","DOIUrl":"https://doi.org/10.1016/j.acap.2024.102616","url":null,"abstract":"<p><strong>Objective: </strong>Perinatal marijuana use is common and may be perceived as safer than use of other substances. We evaluated the association between healthcare provider counseling and maternal marijuana knowledge.</p><p><strong>Methods: </strong>This multi-state, cross-sectional study was conducted June 2021 to August 2022 at 15 U.S. hospitals in the Better Outcomes through Research for Newborns (BORN) network. A 48-item investigator-developed survey was administered to a convenience sample of postpartum mothers ≥ 21 years giving birth to a newborn ≥ 34 weeks' gestational age and receiving routine mother-baby care. The survey assessed sociodemographics, marijuana use, attitudes and knowledge, and receipt of pre- or post-natal healthcare provider counseling about perinatal marijuana use. Descriptive statistics were tabulated, and key comparisons were tested using Chi-square analysis and multivariable logistic regression.</p><p><strong>Results: </strong>Of 484 postpartum mothers, 59.9% endorsed any lifetime marijuana use, while 9.3% reported use during the current pregnancy. Almost 40% reported that in their experience, marijuana use among mothers who are breastfeeding is common or somewhat common. One-third of participants reported receiving any healthcare provider counseling about marijuana either prenatally or postpartum. Adjusting for covariates, counseling was associated with greater maternal knowledge about risks of perinatal marijuana use to exposed children, including child learning problems (adjusted odds ratio 1.93 [95% confidence interval: 1.13, 3.29]).</p><p><strong>Conclusions: </strong>A strengthened and standardized approach to healthcare provider counseling may help to address maternal knowledge gaps about the risks of perinatal marijuana use on exposed newborns and children.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102616"},"PeriodicalIF":3.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}