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Enhancing Pediatric Long COVID Care Through Telementoring: Insights From an ECHO Program.
IF 1 4区 医学 Q3 PEDIATRICS Pub Date : 2025-03-12 DOI: 10.1177/00099228251323396
Cindy Villatoro, Ellen Henning, Rowena Ng, Marianna Kogut, Janna Steinberg, Belinda Chen, Calliope Holingue, Mary Leppert, Laura A Malone

Long COVID affects a significant number of children, yet clinician knowledge gaps and limited access to specialized care hinder effective management. With fewer than 20 pediatric long COVID clinics in the United States, many families must travel long distances for care. To address these challenges, a pediatric long COVID ECHO (Extension for Community Healthcare Outcomes) program was developed to educate health care professionals on evidence-based care. The program engaged 94 participants from the United States and Canada via weekly tele-education sessions, recruited through word of mouth and professional listservs. Pre-surveys (41% response rate) and post-surveys (29% response rate) were sent to attendees. Participants reported statistically significant improvements in knowledge, confidence, competence, and self-efficacy (P < 0.001). This program represents a valuable initiative to facilitate timely interventions and empower primary care and community providers in diagnosing, treating, and managing long COVID in pediatric populations.

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引用次数: 0
Case Report and Literature Review of 10 Pediatric Cases of Knee Pigmented Villonodular Synovitis.
IF 1 4区 医学 Q3 PEDIATRICS Pub Date : 2025-03-12 DOI: 10.1177/00099228251316428
Yanan Ma, Kun Zhang, Sainan Fan, Shun Liu, Jinping Zhang

Objective: This study was aimed to analyze 10 pediatric cases of pigmented villonodular synovitis (PVNS) of the knee to elucidate their clinical features, diagnosis, treatments, and prognosis for providing reference regarding its clinical management in children.

Methods: A retrospective analysis was made pertaining to the clinical manifestations, magnetic resonance imaging (MRI) findings, pathology, immunohistochemical results, treatment methods, and follow-up outcomes of 10 pediatric PVNS patients of the knee treated from January 2022 to January 2024 at our hospital. They were compared and analyzed with existing literature.

Results: (1) All 10 patients had joint swelling with restricted movement, mainly in older female children with male-to-female ratio of 3:7 and average age of 14.1 ± 3.6 years; (2) diagnostic positive rate of MRI was 80%; (3) significant features of PVNS were the appearance of villous and nodular hyperplasia on synovial surface and deposition of brownish-yellow granular hemosiderin. Immunohistochemical staining results were clusterin (synovial cells+), D2-40 (synovial cells+), CD163 (histiocytes+), KP-1 (histiocytes+), CD31 (vascular+), P63 (-), and Ki67 (+, 1%-10%); and (4) all patients underwent arthroscopic surgery with 20% recurrence rate.

Conclusion: Pediatric knee PVNS is more prevalent in older female children. The PVNS diagnosis is carried out by MRI, pathology, and immunohistochemistry. Arthroscopic surgery is effective for treating this condition in children.

研究目的本研究旨在分析10例小儿膝关节色素性绒毛膜滑膜炎(PVNS)病例,以阐明其临床特征、诊断、治疗和预后,为儿童临床治疗提供参考:方法:对本院自2022年1月至2024年1月收治的10例小儿膝关节PVNS患者的临床表现、磁共振成像(MRI)结果、病理、免疫组化结果、治疗方法和随访结果进行回顾性分析。结果:(1)10 例患者均出现关节肿胀,活动受限,以年龄较大的女性儿童为主,男女比例为 3:7,平均年龄为(14.1±3.6)岁;(2)MRI 诊断阳性率为 80%;(3)PVNS 的显著特征是滑膜表面出现绒毛状和结节状增生,棕黄色颗粒状血色素沉积。免疫组化染色结果为群集素(滑膜细胞+)、D2-40(滑膜细胞+)、CD163(组织细胞+)、KP-1(组织细胞+)、CD31(血管+)、P63(-)和Ki67(+,1%-10%);(4)所有患者均接受了关节镜手术,复发率为20%:结论:小儿膝关节PVNS多发于年龄较大的女性儿童。结论:小儿膝关节 PVNS 多发于年龄较大的女性儿童。关节镜手术能有效治疗儿童的这种疾病。
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引用次数: 0
Electronic Health Record Clinical Decision Support to Close the Human Papillomavirus Vaccination Gender Disparity in Children Aged 9 and 10 Years.
IF 1 4区 医学 Q3 PEDIATRICS Pub Date : 2025-03-12 DOI: 10.1177/00099228251324017
Carole H Stipelman, Erica Ulibarri, Natalie Wilson, Alexis Olivas, Andie Sanders, Elly Trepman, Kensaku Kawamoto

We performed a quality improvement project (31 clinics; July 2021 to October 2023) to increase human papillomavirus vaccination initiation frequency and decrease gender disparity in children aged 9 and 10 years. The 11 process changes included electronic health record clinical decision support (CDS) tools for providers, staff, and parents and medical assistant participation. In phase 1 (preparation), initiation frequency was lower in boys (250 of 1688 visits, 15%) than girls (289 of 1549 visits, 19%; P = .003). In phase 2 (CDS alerts; recommended initiation age lowered from 11 to 9 years), initiation frequency was increased and similar between boys (906 of 1847 visits, 49%) and girls (867 of 1740 visits, 50%; P = .64). In phase 3 (patient portal outreach), initiation frequency was increased further for boys and girls. The multifaceted intervention, including CDS tools and lowering the initiation age, was associated with increased initiation frequency and decreased gender disparity.

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引用次数: 0
Hyperglycemic Emergencies in Minority Children and Adolescents With Diabetes.
IF 1 4区 医学 Q3 PEDIATRICS Pub Date : 2025-03-12 DOI: 10.1177/00099228251321899
Ahmed Badran, Amruta Thakkar, Despoina Galetaki, Assia Miller, Vatcharapan Umpaichitra, Renee Bargman, Vivian L Chin

Mixed presentation of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) has been reported in up to 27% of hyperglycemic emergencies. This 15-year retrospective chart review describes clinical features, risk factors, and outcomes among children presenting with hyperglycemic emergencies at our center. Out of 322 patients, 92% were Afro-Caribbean or Black with a mean age of 13.6 years, comprising 266 (83%) with DKA, 52 (16%) mixed DKA-HHS, and rarely with HHS (1%, n = 4). Most (98%) of DKA and DKA-HHS groups had type 1 diabetes mellitus (T1DM). All 4 patients with HHS had type 2 diabetes mellitus (T2DM). Compared with the DKA group, the mixed DKA-HHS group had higher IV fluid rates (P < .0001), 4.3-fold greater odds of acute kidney injury (AKI), and 3.3-fold greater odds of altered mental status (AMS). In the HHS group, 50% presented had AMS and AKI and required higher IV fluids rates (≥2× maintenance). Clinicians should recognize mixed cases of DKA-HHS to minimize complications.

糖尿病酮症酸中毒(DKA)和高渗性高血糖状态(HHS)的混合表现在多达 27% 的高血糖急症中均有报道。这篇 15 年的回顾性病历回顾描述了本中心高血糖急症患儿的临床特征、风险因素和预后。在322名患者中,92%为非洲裔加勒比海人或黑人,平均年龄为13.6岁,其中266人(83%)患有DKA,52人(16%)患有DKA-HHS混合型,极少数患有HHS(1%,n = 4)。大多数(98%)DKA 和 DKA-HHS 组患者患有 1 型糖尿病(T1DM)。所有 4 名 HHS 患者均为 2 型糖尿病 (T2DM)。与 DKA 组相比,DKA-HHS 混合组的静脉输液率更高(P < .0001),发生急性肾损伤 (AKI) 的几率高出 4.3 倍,发生精神状态改变 (AMS) 的几率高出 3.3 倍。在 HHS 组中,50% 的患者出现 AMS 和 AKI,需要更高的静脉输液率(≥2 倍维持量)。临床医生应识别 DKA-HHS 混合病例,以尽量减少并发症。
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引用次数: 0
Erythematous Neck Folds in Infant.
IF 1 4区 医学 Q3 PEDIATRICS Pub Date : 2025-03-11 DOI: 10.1177/00099228251321319
Margaret Hofstedt, Yucong Zhang, Meg G Keeley, Shakun Gupta
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引用次数: 0
Burnout Profiles Among French Pediatric Health Care Professionals: A Cluster Analysis. 法国儿科医护人员的职业倦怠概况:聚类分析
IF 1 4区 医学 Q3 PEDIATRICS Pub Date : 2025-03-01 Epub Date: 2024-07-26 DOI: 10.1177/00099228241265172
Damien Ridremont, Emilie Boujut

The aim of our study was to identify burnout profiles among pediatric nurses and physicians, and their specificities concerning sociodemographic characteristics, occupational stress, stress specific to pediatric caregivers, and coping. Conducted on a sample of 195 French pediatric health care professionals, a cluster analysis showed 2 endpoint profiles (Engagement, Burnout) and 3 intermediate profiles (Overextended, Disengaged, Ineffective). The Burnout profile showed the highest median scores on hours worked per week, occupational stress, stress related to working conditions, and relationships with colleagues and superiors. The Overextended profile reported more stress related to working conditions than did other intermediate profiles. The Disengaged profile showed the second lowest median score on stress related to relationships with colleagues and superiors and less social support-seeking than other profiles. The Ineffective profile used less problem-focused coping than the Engagement and intermediate profiles. Intervention for the well-being of these professionals should focus primarily on improving their working conditions.

我们的研究旨在确定儿科护士和医生的职业倦怠特征,以及他们在社会人口特征、职业压力、儿科护理人员特有的压力和应对方法方面的特殊性。这项研究以 195 名法国儿科医护人员为样本,通过聚类分析得出了 2 个终点特征(参与、倦怠)和 3 个中间特征(过度、脱离、无效)。在每周工作时间、职业压力、与工作条件相关的压力以及与同事和上司的关系方面,倦怠特征的中位数得分最高。与其他中间类型相比,过度扩展类型报告了更多与工作条件相关的压力。在与同事和上司的关系相关的压力方面,"脱离群众型 "的中位数得分仅次于其他类型,而且与其他类型相比,"脱离群众型 "寻求社会支持的程度较低。与 "投入型 "和 "中间型 "相比,"低效型 "采用的以问题为中心的应对方法较少。对这些专业人员福祉的干预应主要侧重于改善他们的工作条件。
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引用次数: 0
Multisystemic Inflammatory Syndrome in Children (MIS-C) With COVID-19 and Kidney Involvement: Poor Outcomes in a Case Series. 伴有 COVID-19 和肾脏受累的儿童多系统炎症综合征(MIS-C):一个病例系列的不良结果。
IF 1 4区 医学 Q3 PEDIATRICS Pub Date : 2025-03-01 Epub Date: 2024-08-09 DOI: 10.1177/00099228241272008
Nora S Alghamdi, Lujain Aletani, Ibrahim Sandokji, Hasan Aljefri, Khalid Alhasan, Mohammad A Shalaby, Jameela A Kari

Multisystemic inflammatory syndrome (Mis-C) has emerged in May 2020 as a serious complication of coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). A total of 6 children presented to tertiary care hospitals with Mis-C, of which 5 (83%) have died during hospitalization. All included patients presented with respiratory symptoms (ranged from mild to severe acute respiratory distress syndrome) and gastrointestinal symptoms. Most of the patients are known to have medical illnesses. Pediatric Risk of Mortality (PRISM) IV score ranged from 3 to 87. All patients developed acidosis and varying stages of acute kidney injury and electrolyte disturbances. All were treated for coagulopathy, thrombocytopenia, bacterial infections as well as antiviral medications (either ritonavir or lopinavir). Most patients had chest X-ray changes either unilateral or bilateral lung changes. Multisystemic inflammatory syndrome is a rare, yet serious complication of SARS-CoV2 infection in children. Multisystem involvement should be anticipated and promptly treated.

多系统炎症综合征(Mis-C)是由严重急性呼吸系统综合征冠状病毒2(SARS-CoV2)引起的冠状病毒病(COVID-19)的一种严重并发症,于2020年5月出现。共有6名儿童在三级医院就诊时感染了Mis-C,其中5人(83%)在住院期间死亡。所有患者均出现呼吸道症状(从轻微到严重的急性呼吸窘迫综合征)和胃肠道症状。大多数患者已知患有内科疾病。所有患者均出现酸中毒、不同程度的急性肾损伤和电解质紊乱。所有患者都接受了凝血病、血小板减少、细菌感染以及抗病毒药物(利托那韦或洛匹那韦)治疗。大多数患者都有胸部 X 光检查结果,要么是单侧肺部病变,要么是双侧肺部病变。多系统炎症综合征是儿童感染 SARS-CoV2 后一种罕见但严重的并发症。应预见到多系统受累并及时治疗。
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引用次数: 0
Traffic Proximity and Recurrent Wheeze Development by Severe Bronchiolitis Status. 按严重支气管炎状态划分的交通距离和反复喘息的发展。
IF 1 4区 医学 Q3 PEDIATRICS Pub Date : 2025-03-01 Epub Date: 2024-07-26 DOI: 10.1177/00099228241264359
Ying Shelly Qi, Janice A Espinola, Rebecca E Cash, Ashley F Sullivan, Kohei Hasegawa, Carlos A Camargo
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引用次数: 0
A Comparison of Sequelae After a Practice Change From Vancomycin to Ampicillin Containing Antibiotic Regimens for Necrotizing Enterocolitis. 治疗坏死性小肠结肠炎的抗生素方案从万古霉素改为氨苄西林后的后遗症比较。
IF 1 4区 医学 Q3 PEDIATRICS Pub Date : 2025-03-01 Epub Date: 2024-08-14 DOI: 10.1177/00099228241271938
James Hunter Fly, Kelley R Lee, Sandra R Arnold, Bindiya Bagga, Ajay J Talati, Jeremy S Stultz

The aim of this study was to compare sequelae and acute kidney injury (AKI) occurrence among patients with necrotizing enterocolitis (NEC) after changing institutional guidelines replacing vancomycin with ampicillin for gram-positive coverage. This was a retrospective, single-center cohort analysis of patients from 2016-2020 (n = 73) with NEC at a surgical neonatal intensive care unit with a high community prevalence of methicillin-resistant Staphylococcus aureus (MRSA). Multivariate logistic regression was utilized to assess associations. Twenty-five (34%) patients had at least 1 sequela related to NEC. Ampicillin containing regimens were not associated with any sequelae type or AKI. Postmenstrual age < 29 weeks at diagnosis ([OR] 5.8 [1.2-28.8], P = .03; and receipt of vasopressors [OR] 3.3 [1.1-10.2], P = .04) were independently associated with sequalae. Stage III NEC was independently associated with AKI, OR 10.6 (2-55.6), P = .005. In conclusion, ampicillin-containing regimens are effective for NEC management at our institution despite a high prevalence of MRSA.

本研究的目的是比较在改变机构指南,用氨苄西林取代万古霉素治疗革兰阳性覆盖物后,坏死性小肠结肠炎(NEC)患者的后遗症和急性肾损伤(AKI)发生率。这是一项回顾性、单中心队列分析,研究对象是在耐甲氧西林金黄色葡萄球菌(MRSA)社区流行率较高的外科新生儿重症监护病房就诊的 2016-2020 年 NEC 患者(n = 73)。多变量逻辑回归用于评估相关性。25例(34%)患者至少出现了一次与NEC相关的后遗症。含氨苄西林的治疗方案与任何后遗症类型或 AKI 均无关联。诊断时月经后年龄小于 29 周([OR] 5.8 [1.2-28.8],P = .03;接受血管加压[OR] 3.3 [1.1-10.2],P = .04)与后遗症有独立关联。NEC III 期与 AKI 独立相关,OR 为 10.6 (2-55.6),P = .005。总之,尽管 MRSA 的发病率很高,但在我们医院,含氨苄西林的治疗方案对 NEC 的治疗是有效的。
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引用次数: 0
Reasons for Unmet Health Care Needs Among Black, Hispanic, and White Children in the United States With or at Risk for Physical and Mental Health Conditions. 美国黑人、西班牙裔和白人中患有或可能患有身心健康疾病的儿童的医疗保健需求未得到满足的原因。
IF 1 4区 医学 Q3 PEDIATRICS Pub Date : 2025-03-01 Epub Date: 2024-06-24 DOI: 10.1177/00099228241263042
Anna K Ault, DeLawnia Comer-HaGans, Sarah J Faubert, Bakari A Wallace, Bridget E Weller

Children with special health care needs (CSHCN)-ie, children who are at increased risk for, or currently manage, persistent physical and mental health conditions-require more health care resources than children without special health care needs. Furthermore, CSHCN who identify as racial/ethnic minorities disproportionately encounter unmet needs, according to reports from their caregivers. However, the reasons for their unmet needs are relatively unknown. This study estimated and compared the US national prevalence of caregiver-reported reasons for unmet health care needs for Hispanic, non-Hispanic black, and non-Hispanic white CSHCN. The most common reasons were problems getting an appointment for black CSHCN and cost for Hispanic and white CSHCN. Issues related to transportation were significantly less likely for black than for white and Hispanic CSHCN. Cost-related issues were significantly less likely for black than Hispanic CSHCN. To address reasons for unmet needs for CSHCN, effective structural changes are needed.

与没有特殊健康护理需求的儿童相比,有特殊健康护理需求的儿童(CSHCN)需要更多的健康护理资源。此外,根据照顾者的报告,少数种族/少数族裔的 CSHCN 有更多的需求未得到满足。然而,他们的需求未得到满足的原因却相对不明。本研究估算并比较了美国全国西语裔、非西语裔黑人和非西语裔白人 CSHCN 的照顾者报告的医疗保健需求未得到满足的原因。最常见的原因是黑人 CSHCN 难以获得预约,西班牙裔和白人 CSHCN 难以获得费用。与交通有关的问题在黑人 CSHCN 中的发生率明显低于在白人和西班牙裔 CSHCN 中的发生率。与费用相关的问题,黑人 CSHCN 明显少于西班牙裔 CSHCN。为了解决 CSHCN 需求得不到满足的原因,需要进行有效的结构改革。
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引用次数: 0
期刊
Clinical Pediatrics
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