Michael Joseph, Michelle M. Corrado, Eunice Odiase, Joel A. Friedlander, Clint Smith, Nathalie Nguyen
Patients with esophageal atresia and tracheoesophageal fistula (EA‐TEF) are at increased risk of conditions including gastroesophageal reflux, peptic esophagitis, gastric metaplasia, anastomotic strictures, eosinophilic esophagitis, and dysphagia. Patients with TEF‐EA may need serial endoscopy in their lifetime given the known short‐ and long‐term GI complications. There has been increased interest in pediatric unsedated transnasal endoscopy (TNE) as an endoscopic alternative as it is lower cost, has shorter recovery time, and eliminates potential risks associated with anesthesia. We report on the use of TNE with EA‐TEF in four patients: One patient had gastroesophageal reflux disease, one patient had eosinophilic esophagitis and TNE was used for surveillance in two patients. Use of TNE allowed for close endoscopic monitoring and changes in medication management. The third and fourth patients underwent TNE as part of routine EA‐TEF screening which is recommended by societal guidelines (Krishnan et al, J Pediatr Gastroenterol Nutr. 2016;63(5):550‐570). Unsedated TNE is an alternative endoscopic approach in the management of patients with EA‐TEF.
{"title":"Sedation‐free transnasal esophagoscopy to evaluate and monitor esophageal diseases in children with esophageal atresia‐tracheoesophageal fistula","authors":"Michael Joseph, Michelle M. Corrado, Eunice Odiase, Joel A. Friedlander, Clint Smith, Nathalie Nguyen","doi":"10.1002/jpr3.12063","DOIUrl":"https://doi.org/10.1002/jpr3.12063","url":null,"abstract":"Patients with esophageal atresia and tracheoesophageal fistula (EA‐TEF) are at increased risk of conditions including gastroesophageal reflux, peptic esophagitis, gastric metaplasia, anastomotic strictures, eosinophilic esophagitis, and dysphagia. Patients with TEF‐EA may need serial endoscopy in their lifetime given the known short‐ and long‐term GI complications. There has been increased interest in pediatric unsedated transnasal endoscopy (TNE) as an endoscopic alternative as it is lower cost, has shorter recovery time, and eliminates potential risks associated with anesthesia. We report on the use of TNE with EA‐TEF in four patients: One patient had gastroesophageal reflux disease, one patient had eosinophilic esophagitis and TNE was used for surveillance in two patients. Use of TNE allowed for close endoscopic monitoring and changes in medication management. The third and fourth patients underwent TNE as part of routine EA‐TEF screening which is recommended by societal guidelines (Krishnan et al, J Pediatr Gastroenterol Nutr. 2016;63(5):550‐570). Unsedated TNE is an alternative endoscopic approach in the management of patients with EA‐TEF.","PeriodicalId":17618,"journal":{"name":"JPGN Reports","volume":"1994 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140246447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Odelya Kaufman, Colleen Donnelly, Emalyn E. Cork, Maria I. Fiel, Jaime Chu, Jaya Ganesh
Shwachman–Diamond syndrome (SDS) is a genetic disorder caused by mutations in the Shwachman–Bodian–Diamond syndrome (SBDS) gene. The syndrome is characterized by multiorgan dysfunction primarily involving the bone marrow and exocrine pancreas. Frequently overlooked is the hepatic dysfunction seen in early childhood which tends to improve by adulthood. Here, we report a child who initially presented with failure to thrive and elevated transaminases, and was ultimately diagnosed with SDS. A liver biopsy electron micrograph revealed hepatocytes crowded with numerous small mitochondria, resembling the hepatic architecture from patients with inborn errors of metabolism, including mitochondrial diseases. To our knowledge, this is the first report of the mitochondrial phenotype in an SDS patient. These findings are compelling given the recent cellular and molecular research studies which have identified SBDS as an essential regulator of mitochondrial function and have also implicated SBDS in the maintenance of mitochondrial DNA.
舒瓦赫曼-博迪恩-钻石综合征（SDS）是一种由舒瓦赫曼-博迪恩-钻石综合征（SBDS）基因突变引起的遗传性疾病。该综合征的特征是多器官功能障碍，主要涉及骨髓和胰腺外分泌。经常被忽视的是儿童早期出现的肝功能障碍，这种情况在成年后往往会得到改善。在此，我们报告了一名最初表现为发育不良和转氨酶升高的患儿，他最终被诊断为 SDS。肝脏活检电子显微照片显示，肝细胞内密集分布着许多小线粒体，与先天性代谢异常（包括线粒体疾病）患者的肝脏结构相似。据我们所知，这是第一份关于 SDS 患者线粒体表型的报告。最近的细胞和分子研究发现，SBDS 是线粒体功能的重要调节因子，而且 SBDS 与线粒体 DNA 的维护也有关联，因此这些发现令人信服。
{"title":"Shwachman–Diamond syndrome mimicking mitochondrial hepatopathy","authors":"Odelya Kaufman, Colleen Donnelly, Emalyn E. Cork, Maria I. Fiel, Jaime Chu, Jaya Ganesh","doi":"10.1002/jpr3.12064","DOIUrl":"https://doi.org/10.1002/jpr3.12064","url":null,"abstract":"Shwachman–Diamond syndrome (SDS) is a genetic disorder caused by mutations in the Shwachman–Bodian–Diamond syndrome (SBDS) gene. The syndrome is characterized by multiorgan dysfunction primarily involving the bone marrow and exocrine pancreas. Frequently overlooked is the hepatic dysfunction seen in early childhood which tends to improve by adulthood. Here, we report a child who initially presented with failure to thrive and elevated transaminases, and was ultimately diagnosed with SDS. A liver biopsy electron micrograph revealed hepatocytes crowded with numerous small mitochondria, resembling the hepatic architecture from patients with inborn errors of metabolism, including mitochondrial diseases. To our knowledge, this is the first report of the mitochondrial phenotype in an SDS patient. These findings are compelling given the recent cellular and molecular research studies which have identified SBDS as an essential regulator of mitochondrial function and have also implicated SBDS in the maintenance of mitochondrial DNA.","PeriodicalId":17618,"journal":{"name":"JPGN Reports","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140245705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ryan Shargo, Morgan Ekblad, Jessica V Baran, Jerry M. Brown, Wilfredo Chamizo, Sara Karjoo, Michael J Wilsey
We report the case of a 14‐year‐old patient with a known history of Crohn's disease who was incidentally diagnosed with an asymptomatic cecal lipoma. A routine surveillance colonoscopy as part of the management of the patient's Crohn's Disease revealed a well‐defined, submucosal, yellowish mass in the patient's cecum. Histopathological examination of a biopsy specimen revealed submucosal adipose tissue, consistent with the endoscopic images showing the characteristic appearance of the lipoma. A computed tomography examination further confirmed the diagnosis. While colonic lipomas are infrequent and typically manifest later in life, few cases report the coexistence of a cecal lipoma with Crohn's disease, particularly in the pediatric population. In this case, managing this dual condition posed a notable challenge. Here, we present the conservative approach to managing a pediatric patient with cecal lipoma and Crohn's disease. The decision to leave the lipoma in situ was based on the absence of symptoms and potential risks associated with surgical removal.
{"title":"Concurrent cecal lipoma and Crohn's disease in a pediatric patient: A conservative approach","authors":"Ryan Shargo, Morgan Ekblad, Jessica V Baran, Jerry M. Brown, Wilfredo Chamizo, Sara Karjoo, Michael J Wilsey","doi":"10.1002/jpr3.12061","DOIUrl":"https://doi.org/10.1002/jpr3.12061","url":null,"abstract":"We report the case of a 14‐year‐old patient with a known history of Crohn's disease who was incidentally diagnosed with an asymptomatic cecal lipoma. A routine surveillance colonoscopy as part of the management of the patient's Crohn's Disease revealed a well‐defined, submucosal, yellowish mass in the patient's cecum. Histopathological examination of a biopsy specimen revealed submucosal adipose tissue, consistent with the endoscopic images showing the characteristic appearance of the lipoma. A computed tomography examination further confirmed the diagnosis. While colonic lipomas are infrequent and typically manifest later in life, few cases report the coexistence of a cecal lipoma with Crohn's disease, particularly in the pediatric population. In this case, managing this dual condition posed a notable challenge. Here, we present the conservative approach to managing a pediatric patient with cecal lipoma and Crohn's disease. The decision to leave the lipoma in situ was based on the absence of symptoms and potential risks associated with surgical removal.","PeriodicalId":17618,"journal":{"name":"JPGN Reports","volume":"12 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140247903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Khalid Noli, N. Aleysae, Ismail Alzahrani, Ahmed Al‐Ghamdi, Mohammed Alkazmi, Ahmed Almasoudi
Johanson–Blizzard syndrome (JBS) is a rare genetic disorder caused by Ubiquitin Protein Ligase E3 Component N‐Recognin1 (UBR1) gene mutations. It is characterized by exocrine pancreatic insufficiency, craniofacial deformities, sensorineural hearing loss, and a broad variety of intellectual disabilities. The aim of our study is to report four pediatric cases (three of which are siblings, and the fourth patient is unrelated) that presented some features of JBS. The cases have been confirmed by genetic testing to have mutations in the UBR1 gene. This case series study was conducted retrospectively, giving a detailed description of the demographic and clinical information of these four cases, and reflecting our experience with this subset of patients. All these cases have been treated at the King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia, and were identified by their clinical and laboratory markers that favor JBS. A novel homozygous missense mutation c.2075 T > C (p. lle692Thr) in exon 18 (UBR1: NM_174916.3) was identified and confirmed by Sanger sequencing in all our cases outlined in this paper. These presented cases illustrate the phenotypic variability and complexity of JBS and the importance of physical examination to reach a diagnosis. The identified novel mutation in this study broadens the spectrum of UBR1 mutations that contribute to JBS.
{"title":"Johanson–Blizzard syndrome caused by novel UBR1 mutation in four Saudi patients","authors":"Khalid Noli, N. Aleysae, Ismail Alzahrani, Ahmed Al‐Ghamdi, Mohammed Alkazmi, Ahmed Almasoudi","doi":"10.1002/jpr3.12057","DOIUrl":"https://doi.org/10.1002/jpr3.12057","url":null,"abstract":"Johanson–Blizzard syndrome (JBS) is a rare genetic disorder caused by Ubiquitin Protein Ligase E3 Component N‐Recognin1 (UBR1) gene mutations. It is characterized by exocrine pancreatic insufficiency, craniofacial deformities, sensorineural hearing loss, and a broad variety of intellectual disabilities. The aim of our study is to report four pediatric cases (three of which are siblings, and the fourth patient is unrelated) that presented some features of JBS. The cases have been confirmed by genetic testing to have mutations in the UBR1 gene. This case series study was conducted retrospectively, giving a detailed description of the demographic and clinical information of these four cases, and reflecting our experience with this subset of patients. All these cases have been treated at the King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia, and were identified by their clinical and laboratory markers that favor JBS. A novel homozygous missense mutation c.2075 T > C (p. lle692Thr) in exon 18 (UBR1: NM_174916.3) was identified and confirmed by Sanger sequencing in all our cases outlined in this paper. These presented cases illustrate the phenotypic variability and complexity of JBS and the importance of physical examination to reach a diagnosis. The identified novel mutation in this study broadens the spectrum of UBR1 mutations that contribute to JBS.","PeriodicalId":17618,"journal":{"name":"JPGN Reports","volume":"125 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140090135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Olivier Leclercq, Laurie Lecomte, X. Stephenne, I. Scheers
Duodenal obstruction (DO) is an uncommon complication of pancreatitis. It has been described in groove and severe acute and chronic pancreatitis in adults but, to the best of our knowledge, it has not yet been reported in pediatric acute pancreatitis. Current guidelines comment on management of several early and late‐onset complications, but DO is not mentioned. We describe two patients with acute necrotizing pancreatitis who presented with several complications including walled‐off necrosis and DO. In adults, DO is generally managed with adapted nutrition but may require surgical bypass, such as gastroenterostomy. Our patients were managed conservatively and fully recovered 2 months after DO diagnosis. DO may require lengthy hospitalizations and markedly restrict patients' quality of life; however, prolonged conservative treatment was effective in our patients and should be considered even in severe pediatric cases.
十二指肠梗阻（DO）是胰腺炎的一种不常见并发症。成人的槽沟和重症急慢性胰腺炎中都曾出现过这种并发症，但据我们所知，小儿急性胰腺炎中还没有出现过这种并发症。目前的指南对几种早期和晚期并发症的处理进行了评论，但并未提及 DO。我们描述了两名急性坏死性胰腺炎患者，他们出现了多种并发症，包括贴壁坏死和 DO。在成人中，DO 一般通过调整营养来控制，但可能需要外科旁路，如胃肠造口术。我们的患者接受了保守治疗，并在确诊 DO 两个月后完全康复。DO 可能需要长时间住院治疗，并明显限制患者的生活质量；但是，长期保守治疗对我们的患者很有效，即使是严重的儿科病例也应考虑长期保守治疗。
{"title":"Duodenal obstruction: A rare complication of severe acute pancreatitis in children","authors":"Olivier Leclercq, Laurie Lecomte, X. Stephenne, I. Scheers","doi":"10.1002/jpr3.12034","DOIUrl":"https://doi.org/10.1002/jpr3.12034","url":null,"abstract":"Duodenal obstruction (DO) is an uncommon complication of pancreatitis. It has been described in groove and severe acute and chronic pancreatitis in adults but, to the best of our knowledge, it has not yet been reported in pediatric acute pancreatitis. Current guidelines comment on management of several early and late‐onset complications, but DO is not mentioned. We describe two patients with acute necrotizing pancreatitis who presented with several complications including walled‐off necrosis and DO. In adults, DO is generally managed with adapted nutrition but may require surgical bypass, such as gastroenterostomy. Our patients were managed conservatively and fully recovered 2 months after DO diagnosis. DO may require lengthy hospitalizations and markedly restrict patients' quality of life; however, prolonged conservative treatment was effective in our patients and should be considered even in severe pediatric cases.","PeriodicalId":17618,"journal":{"name":"JPGN Reports","volume":"65 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139150296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Isaline Chabbey, C. Cudalbu, Eugénie Barras, Sylviane Hanquinet, Bénédicte Maréchal, A. Rougemont, Julie Wacker, Florence Zangas‐Gheri, V. McLin
Chronic hepatic encephalopathy (CHE) has been reported both in patients with congenital porto‐systemic shunts (CPSS) and chronic liver disease. CHE is difficult to recognize in children as there is no clear definition and its manifestations are highly variable. CHE is associated with variations in brain volumes and metabolites that have already been demonstrated using 1.5‐3T MRI systems. However, the in‐depth study of brain metabolism requires the high spectral resolution of high magnetic fields.We analyzed the neurometabolic profile, brain volumes and T1 relaxation times of a child with a CPSS using high field proton magnetic resonance spectroscopy (1H MRS, 7T) combined with MRI and compared it to an age‐matched control group. We also evaluated the impact of shunt closure on neurocognitive symptoms using adapted neuropsychological tests.7T MRS revealed a significant increase in glutamine compared to controls, a decrease in brain osmolytes, and a slight elevation in NAA concentrations. 7T MRI scans showed morphological abnormalities but no changes in the signal intensity of the globus pallidus. Neurocognitive testing revealed attention deficit disorder, language difficulties, and mild intellectual disability. Most of these areas improved after shunt closure.In this paediatric case of type B HE with normal fasting ammonia, neurometabolic profile was compatible with what has been previously shown in chronic liver disease, while also demonstrating an isolated glutamine peak. In addition, neurocognitive function partially improved after shunt closure, arguing strongly for shunt closure in both presymptomatic and symptomatic patients.
{"title":"Neurometabolism and brain morphometry in an adolescent female with an extra‐hepatic congenital portosystemic shunt","authors":"Isaline Chabbey, C. Cudalbu, Eugénie Barras, Sylviane Hanquinet, Bénédicte Maréchal, A. Rougemont, Julie Wacker, Florence Zangas‐Gheri, V. McLin","doi":"10.1002/jpr3.12035","DOIUrl":"https://doi.org/10.1002/jpr3.12035","url":null,"abstract":"Chronic hepatic encephalopathy (CHE) has been reported both in patients with congenital porto‐systemic shunts (CPSS) and chronic liver disease. CHE is difficult to recognize in children as there is no clear definition and its manifestations are highly variable. CHE is associated with variations in brain volumes and metabolites that have already been demonstrated using 1.5‐3T MRI systems. However, the in‐depth study of brain metabolism requires the high spectral resolution of high magnetic fields.We analyzed the neurometabolic profile, brain volumes and T1 relaxation times of a child with a CPSS using high field proton magnetic resonance spectroscopy (1H MRS, 7T) combined with MRI and compared it to an age‐matched control group. We also evaluated the impact of shunt closure on neurocognitive symptoms using adapted neuropsychological tests.7T MRS revealed a significant increase in glutamine compared to controls, a decrease in brain osmolytes, and a slight elevation in NAA concentrations. 7T MRI scans showed morphological abnormalities but no changes in the signal intensity of the globus pallidus. Neurocognitive testing revealed attention deficit disorder, language difficulties, and mild intellectual disability. Most of these areas improved after shunt closure.In this paediatric case of type B HE with normal fasting ammonia, neurometabolic profile was compatible with what has been previously shown in chronic liver disease, while also demonstrating an isolated glutamine peak. In addition, neurocognitive function partially improved after shunt closure, arguing strongly for shunt closure in both presymptomatic and symptomatic patients.","PeriodicalId":17618,"journal":{"name":"JPGN Reports","volume":"17 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139148425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Whitney C. Gulledge, Brittany M. Gerald, Kathryn M. Sumpter, Nathaniel G. Rogers
A 4‐month‐old previously healthy female presented with persistent nonbloody, nonbilious emesis, decreased urine output, weight loss, fussiness, and lethargy. Serum levels of calcium were increased at 14.1 mg/dL, serum phosphate decreased at 1.6 mg/dL, and serum parathyroid hormone decreased at <4 pg/mL. The patient had been consuming unsweetened almond milk due to inability to find infant formula during a national infant formula shortage. Milk alternatives including almond milk are calorie‐poor, low fat, low protein, and too high in free water and calcium to safely be the primary nutrition source for infants.
{"title":"Symptomatic hypercalcemia in an infant secondary to excessive consumption of almond milk as a formula alternative","authors":"Whitney C. Gulledge, Brittany M. Gerald, Kathryn M. Sumpter, Nathaniel G. Rogers","doi":"10.1002/jpr3.12028","DOIUrl":"https://doi.org/10.1002/jpr3.12028","url":null,"abstract":"A 4‐month‐old previously healthy female presented with persistent nonbloody, nonbilious emesis, decreased urine output, weight loss, fussiness, and lethargy. Serum levels of calcium were increased at 14.1 mg/dL, serum phosphate decreased at 1.6 mg/dL, and serum parathyroid hormone decreased at <4 pg/mL. The patient had been consuming unsweetened almond milk due to inability to find infant formula during a national infant formula shortage. Milk alternatives including almond milk are calorie‐poor, low fat, low protein, and too high in free water and calcium to safely be the primary nutrition source for infants.","PeriodicalId":17618,"journal":{"name":"JPGN Reports","volume":"24 41","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139148520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Autoimmune enteropathy is a rare cause of chronic intractable diarrhea and is present in <1 in 100,000 infants. We report the case of a 9‐month‐old boy who presented with intractable diarrhea and vomiting. Genetic panel testing revealed a STAT3 heterozygous mutation in exon 6, suggesting infantile‐onset multisystem autoimmune disease‐1. The patient was initially treated with steroids and sulfasalazine. However, on tapering steroids, he had another episode of diarrhea and was subsequently put on baricitinib to which he responded.
{"title":"Intractable diarrhea in an infant—autoimmune enteropathy: A case report","authors":"Shivangi Tetarbe, Kasvi Shah, Ira Shah","doi":"10.1002/jpr3.12038","DOIUrl":"https://doi.org/10.1002/jpr3.12038","url":null,"abstract":"Autoimmune enteropathy is a rare cause of chronic intractable diarrhea and is present in <1 in 100,000 infants. We report the case of a 9‐month‐old boy who presented with intractable diarrhea and vomiting. Genetic panel testing revealed a STAT3 heterozygous mutation in exon 6, suggesting infantile‐onset multisystem autoimmune disease‐1. The patient was initially treated with steroids and sulfasalazine. However, on tapering steroids, he had another episode of diarrhea and was subsequently put on baricitinib to which he responded.","PeriodicalId":17618,"journal":{"name":"JPGN Reports","volume":"19 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139153858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1097/pg9.0000000000000384
Cory Wyatt Jones, Andrew A.M. Singer
Currently, there exists a scarcity of suitable nutrition training resources for the primary care physician (PCP) and a paucity of educational materials for pediatric residency programs. Barriers to nutritional education include: a lack of well-defined competencies, a dearth of centralized resources for nutritional education, and a reliance on didactic teaching methodology. Because PCPs often cite a lack of confidence as a primary reason for not providing nutritional counseling, we created an interactive 3-pronged nutritional curriculum for pediatric residents with the aim of increasing their confidence to provide nutritional counseling to patients. This curriculum included an in-person visit to a local supermarket, an online, interactive case during the resident’s continuity clinic, and an interactive lecture. There was a statistically significant change in pediatric residents’ confidence to manage issues of outpatient nutrition management. We find this particularly relevant as increasing physician confidence is key to increasing nutritional counseling in a clinical setting.
{"title":"Application of an Interactive, Hands-On Nutritional Curriculum for Pediatric Residents","authors":"Cory Wyatt Jones, Andrew A.M. Singer","doi":"10.1097/pg9.0000000000000384","DOIUrl":"https://doi.org/10.1097/pg9.0000000000000384","url":null,"abstract":"Currently, there exists a scarcity of suitable nutrition training resources for the primary care physician (PCP) and a paucity of educational materials for pediatric residency programs. Barriers to nutritional education include: a lack of well-defined competencies, a dearth of centralized resources for nutritional education, and a reliance on didactic teaching methodology. Because PCPs often cite a lack of confidence as a primary reason for not providing nutritional counseling, we created an interactive 3-pronged nutritional curriculum for pediatric residents with the aim of increasing their confidence to provide nutritional counseling to patients. This curriculum included an in-person visit to a local supermarket, an online, interactive case during the resident’s continuity clinic, and an interactive lecture. There was a statistically significant change in pediatric residents’ confidence to manage issues of outpatient nutrition management. We find this particularly relevant as increasing physician confidence is key to increasing nutritional counseling in a clinical setting.","PeriodicalId":17618,"journal":{"name":"JPGN Reports","volume":"120 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135714301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1097/pg9.0000000000000386
Jennifer L. Dotson, Josh Bricker, Deena J. Chisolm, Laura M. Mackner
Objectives: Children with inflammatory bowel disease (IBD) have a significant life-long burden as a result of disease, impacted by environmental and individual barriers. Successful health system interventions require a comprehensive approach, informed by various stakeholders. The main objective was to identify health system barriers and potential solutions from existing patients, families, and providers via focus groups. Methods: Participants for the focus groups were existing English-speaking patients (ages 9–18) with IBD, their caregiver(s), and providers including multiple professions (eg, physician, nurse, pediatrician, social worker, care coordinator, scheduler, and psychologist). Separate focus groups were led by experienced personnel for parents, children, and providers, using a standardized interview guide. Sessions were recorded, transcribed, and verified. Using content analysis, we systematically classified data through coding and identified themes. Results: Focus groups comprised (a) 3 patient groups (n = 20, 50% female, including 2 younger; mean age = 11.4 ± 1.5 years) and 1 older group (mean age = 15.6 ± 1.3 years), (b) 3 parent groups (n = 24, 83% female), and (c) 2 multidisciplinary provider groups (n = 19). Families shared several common concerns with providers (eg, school, care delay, psychosocial, and financial) but varied on specifics. Some barriers may be addressable through family or staff education, improved communication (eg, care delay/ access, transition), or training (eg, labs and diet), while others may require change at an institutional or policy level (eg, insurance). Conclusions: This qualitative analysis identified several barriers to IBD care, some shared, some unique to patients, parents, and providers, highlighting the importance of obtaining multiple stakeholder perspectives when exploring barriers to care.
{"title":"Patient, Parent, and Provider Perceptions of Barriers to Pediatric Inflammatory Bowel Disease Care","authors":"Jennifer L. Dotson, Josh Bricker, Deena J. Chisolm, Laura M. Mackner","doi":"10.1097/pg9.0000000000000386","DOIUrl":"https://doi.org/10.1097/pg9.0000000000000386","url":null,"abstract":"Objectives: Children with inflammatory bowel disease (IBD) have a significant life-long burden as a result of disease, impacted by environmental and individual barriers. Successful health system interventions require a comprehensive approach, informed by various stakeholders. The main objective was to identify health system barriers and potential solutions from existing patients, families, and providers via focus groups. Methods: Participants for the focus groups were existing English-speaking patients (ages 9–18) with IBD, their caregiver(s), and providers including multiple professions (eg, physician, nurse, pediatrician, social worker, care coordinator, scheduler, and psychologist). Separate focus groups were led by experienced personnel for parents, children, and providers, using a standardized interview guide. Sessions were recorded, transcribed, and verified. Using content analysis, we systematically classified data through coding and identified themes. Results: Focus groups comprised (a) 3 patient groups (n = 20, 50% female, including 2 younger; mean age = 11.4 ± 1.5 years) and 1 older group (mean age = 15.6 ± 1.3 years), (b) 3 parent groups (n = 24, 83% female), and (c) 2 multidisciplinary provider groups (n = 19). Families shared several common concerns with providers (eg, school, care delay, psychosocial, and financial) but varied on specifics. Some barriers may be addressable through family or staff education, improved communication (eg, care delay/ access, transition), or training (eg, labs and diet), while others may require change at an institutional or policy level (eg, insurance). Conclusions: This qualitative analysis identified several barriers to IBD care, some shared, some unique to patients, parents, and providers, highlighting the importance of obtaining multiple stakeholder perspectives when exploring barriers to care.","PeriodicalId":17618,"journal":{"name":"JPGN Reports","volume":"36 12","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135564280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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