Academic Pediatrics最新文献

Objectives: (1) Improve resident skills in delivering difficult news (DDN) by educating pediatrics residents using a communication framework with validity evidence, the m-SPIKES framework. (2) Determine whether small group practice with peer role-play or Rapid Cycle Deliberate Practice (RCDP) simulation is a more effective practice modality for improving DDN.

Methods: IRB-exempt single-institution pilot randomized controlled trial involving twenty-eight pediatrics residents. Residents attended an educational intervention that consisted of a large-group didactic session to learn the m-SPIKES framework followed by randomization into either peer role-play or RCDP groups for small group practice. The residents completed pre- and post-surveys regarding self-efficacy in DDN using a Likert scale and were evaluated for fundamental communication skills and mastery of m-SPIKES by trained faculty during a simulation with a standardized patient before and after the educational intervention. Data was analyzed using bivariate inferential statistical analysis with t-tests.

Results: After the educational intervention, residents in both cohorts were found to have significantly increased self-efficacy in DDN, fundamental communication skills, and overall mastery of the use of m-SPIKES (p=<0.001). The two cohorts had similar improvements in self-efficacy (p=0.223) and fundamental communication skills (p=0.306), however the peer role play showed a significant improvement in mastery of m-SPIKES when compared to the RCDP group (p=0.046).

Conclusions: While this educational intervention demonstrated a significant improvement in DDN skills for all residents in both the peer role-play and RCDP groups, more studies are needed to determine whether the use of RCDP is advantageous in communication education.

Academic Pediatrics has been the official journal of the Association of Pediatric Program Directors (APPD) since 2009. The View from the APPD section of the journal provides an important venue to highlight APPD members' scholarship regarding issues impacting residency and fellowship training. Since 2020, the annual commentary (Re)View from the APPD summarizes articles published in View over the past year including their alignment with overall APPD mission, values, and organizational priorities.^1-4 The APPD's mission is to ensure the health and well-being of all children and serve pediatric programs by leading: 1) the advancement of medical education; 2) the development of a diverse workforce; 3) the cultivation of an inclusive clinical learning environment; and 4) the promotion of educational innovation and research.⁵ This year's annual commentary falls during the APPD's 40th Anniversary, an occasion to look back (hindsight is 20/20) and sum up (20+20=40) this year's outstanding APPD mission-aligned work published in the View!

Objective: The objective of this study was to determine the population-based incidence of influenza-associated serious neurologic events in children < 5 years of age.

Methods: We conducted a retrospective cohort of children < 5 years of age enrolled in a Medicaid program during the 2016-2017 through 2019-2020 influenza seasons. Serious influenza-associated neurologic events were defined as a neurologic event resulting in hospitalization. Population-based incidence of serious influenza-associated neurologic events was calculated by dividing the number of events by the total accrued follow-up time and expressed per 100,000 influenza person-weeks. Incidence estimates were stratified by neurologic event category, age, sex, neurologic comorbidity, influenza season, and antiviral use.

Results: A total of 79,727 influenza cases among 70,258 unique children were included. The overall incidence of serious influenza-associated neurologic events was 38.0 (95% CI 27.5-51.2) per 100,000 person-weeks of influenza. The most common serious neurologic event was seizure (34.5 per 100,000 influenza person-weeks of influenza, 95% CI 24.5-47.1) whereas encephalitis and ataxia/movement disorders were least common (0.9 per 100,000 influenza person-weeks of influenza, 95% CI 0.02-4.9). Incidence rates were generally higher in children <2 years and significantly more common in children with neurologic conditions compared to those without neurologic conditions. Incidence rates were similar among those with and without influenza antiviral use.

Conclusions: Our findings reveal that serious neurologic complications are uncommon in young children with influenza but markedly higher in those with underlying neurologic conditions. These data emphasize the importance of preventing, identifying, and treating influenza in this vulnerable population.

Objective: To quantify the annual direct healthcare cost of intentional overdose and other types of self-harm resulting in emergency department (ED) and/or inpatient encounters among youth in the United States (U.S.).

Methods: Using the 2021 Nationwide Emergency Department Sample (NEDS) and National Inpatient Sample (NIS) datasets, produced by the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP), we determined nationally representative cross-sectional frequencies and costs for specific types of self-harm encounters among 8- to 21-year-old pediatric and young adult patients.

Results: The total combined one-year cost of all self-harm encounters was $869 million (95% CI $841M-$897M). The majority of this cost was due to intentional overdose-related encounters, which totaled $530 million (95% CI $512M-$547M). Of this total, $232 million (95% CI $223M-$241M) was paid by public insurers and $296 million (95% CI $281M-$312M) was paid by private insurers. Encounters by females accounted for 79% of the intentional overdose costs ($420 million, 95% CI $404M-$435M).

Conclusion: Based on 2021 data, preventing youth intentional overdose could save the U.S. health system up to $530 million, annually. As we collectively work to prevent suicide deaths among young people, it is important to recognize the needs of the larger group of youth who are engaging in serious self-harm and non-fatal suicidal acts, the majority of whom are young females. Prevention of intentional overdose in this population should be a priority, both in terms of upstream public health efforts and promotion of evidence-based methods of safer storage.

Objective: Children and youth with special healthcare needs (CYSHCN) are those who have one or more chronic conditions necessitating medical, educational, and/or social services use. Of the 15 million CYSHCN, a quarter report accessing emergency care annually, some of whom have physical injuries. This study examines the perspectives, challenges, and opportunities identified by prehospital and hospital clinicians delivering injury care to CYSHCN.

Methods: Qualitative interviews were conducted with 23 hospital and 13 prehospital clinicians in one geographic region. All interviews were recorded and transcribed; interviews were analyzed using multiple coders and rapid analysis procedures to identify themes.

Results: One intrapersonal theme pertaining to clinicians' prior experiences and six interpersonal themes capture the factors characterized by the participating EMS- and hospital-level clinicians. Identified interpersonal themes include: 1) how prior experiences of injured CYSHCN shape future encounters with emergency care, 2) communication challenges specific to CYSHCN, 3) parental expertise and guidance during care, 4) emotional support, 5) trust-building, and 6) the need to balance accommodations pertaining to the child's special healthcare need in the emergent care context.

Conclusions: In prehospital and hospital settings, injured CYSHCN may need care for both their physical injury and their special healthcare need. Prehospital and hospital clinicians, who likely have not previously provided care for the child, are mindful of the opportunities and challenges this situation presents. These results inform an understanding of how clinicians approach care of injured CYSHCN in the emergency setting and indicate opportunities for future exploration, such as how to effectively leverage family strengths in this context.

Background: A departmental educational leadership role, Director of Fellowships (DF), has emerged in academic pediatric departments to aid in subspecialty programmatic support. Demographics, job responsibilities and challenges are not fully described and thus may be underappreciated.

Methods: An electronic survey was distributed to DFs through the Association of Pediatric Program Directors listserv. Descriptive statistics and thematic analysis of free text were performed.

Results: Response rate was 36/54 (67%). Most DFs were female (75%) and were in clinical practice for a median of 15 (IQR 12.5-20) years with 10 (IQR 7-13) years in fellowship program leadership and 39% with advanced training in education. The main responsibilities included oversight of fellowship core curriculum, faculty development of fellowship program directors, assistance with performance issues, and coordination of common fellowship events. Challenges were limited community understanding of DF role; insufficient time/ resources; and disparate fellowship needs. Perceived outcomes included centralization of and advocacy for resources, educational innovation, greater visibility/enhanced community among FPDs, fellows and coordinators.

Conclusion: DFs are increasingly widespread, filling important gaps in graduate medical education. Individuals in this role provide necessary expertise and management of central resources, which can break down fellowship silos. However, support is variable and institutional impact understudied.

Background: Identification of suicide risk among individuals with autism and other intellectual/developmental disabilities (IDD) is increasingly required by developmental-behavioral pediatric (DBP), psychology and psychiatry practices that frequently serve these populations. Improved understanding of current practice for risk identification is needed.

Objective: To identify variations in practices, facilitators of and barriers to universal suicide screening of children and adolescents with IDDs in pediatric developmental and behavioral health settings.

Methods: Centers from the Developmental Behavioral Pediatrics Research Network (DBPNet) were invited to describe suicide-screening practices in their developmental-behavioral pediatrics, psychology, and/or psychiatry clinics. A representative per site/specialty was asked to complete surveys (summarized with descriptive statistics) and semi-structured interviews (summarized using thematic analysis) to explore sites' current practices, and barriers/facilitators to screening.

Results: Participants included 34 survey respondents and 21 interviewees.Surveys revealed variation in suicide screening practices across sites; 44.1% of respondents reported that their practice conducts universal screening, but the screening processes varied widely. Interviews identified some facilitators to screening youth with IDD, such as standardizing procedures, training, and having staff available to respond to positive screens. Barriers to universal screening include factors at the patient, family, provider, and system levels. Insufficient mental health care systems, as well as a lack of IDD-specific supports, are significant challenges.

Conclusions: Despite Joint Commission requirements and specific expertise in behavioral health, sites serving patients with IDD vary widely in how suicide screening is implemented and how positive screens are addressed. Findings offer opportunities to standardize procedures to increase suicide risk identification and response.