Pediatrics and Neonatal Nursing – Open Journal (e-ISSN 2377-1569) is a peer-reviewed open access journal that includes all problems related to pediatrics & neonates.
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Background Human tails are rare congenital anomalies protruding from midline of the lumbosacral r... more Background Human tails are rare congenital anomalies protruding from midline of the lumbosacral region covered by skin. Human tails are classified as true tail and pseudo tail. True tails, also known as vestigial tails are caudal, midline protrusion capable of spontaneous or reflex motion, consisting of skin covering with a combination of striated muscle, adipose and connective tissue, normal blood vessels and nerves. Case Presentation A 47-days-old-female infant born from 28-years old prime parous women present with cutaneous appendage arising from the sacrococcygeal region, in the midline, above the intergluteal cleft. The tail-like structure was 9 cm in length, with a diameter between 3 cm and 2 cm in all its length, cylindrical, and pointy towards the end. The structure was soft, covered in skin, it shows spontaneous movement. The magnetic resonance imaging (MRI) report shows S1-S2 level spinal bifida. Conclusion This is a rare case of vestigial human tail with spinal bifida on 47-days old female infant born from prime parous mother through spontaneous vaginal delivery diagnosed by histopathologic examination.
There is increasing concern regarding the impact of social media on adolescent mental health, yet... more There is increasing concern regarding the impact of social media on adolescent mental health, yet medical providers have limited guidance on how to effectively screen their adolescent patients. Research has suggested a negative association between excessive time on digital media, more than 2-hours per day, and emotional health. Perhaps more importantly, adolescent vulnerabilities, such as existing anxiety or depression, when exposed to certain social media experiences can cause further decline of mental health. The goal of this review is to help providers effectively evaluate social media use in adolescent patients and provide guidance on its use to help preserve or improve their emotional well-being.
Background Parenteral diarrhea is non-infectious diarrhea associated with extraintestinal infecti... more Background Parenteral diarrhea is non-infectious diarrhea associated with extraintestinal infections such as urinary tract infection (UTI), but evidence supporting this association is limited. We performed a systematic literature review to determine the reported frequency of UTI in pediatric patients who had diarrhea. Methods We searched electronic databases (PubMed, Scopus, Google Scholar, and CINAHL) to identify articles about diarrhea and UTI. We included English-language articles about studies of children (age, ≤5-years) who presented with diarrhea in which the frequency of culture-positive UTI was reported. We excluded studies that examined particular diets or specific pediatric patient populations presenting with diarrhea. Patient and study characteristics were extracted manually. Results The database search identified 32 articles. After excluding 25 articles and adding 3 articles identified during manual review of article references, there were 10 articles in the final review including 8 cohort and 2 case control studies. In all 10 studies combined, UTIs were observed in 172 of 1086 children who presented with diarrhea (15.8%), but the frequency of UTI varied between studies (range, 5 to 32%). Escherichia coli was the most common bacterial isolate from urine in all 9 studies that reported microbiology results. The stool and urine culture results (E. coli) were similar in 4 of the 6 studies that reported stool culture results. Conclusion In infants and children up to age 5-years, diarrhea may be associated with an UTI. In patients who have diarrhea of unknown cause, it may be prudent to consider an evaluation for a coexisting UTI.
Developmental disabilities are a set of disorders which occur during the child's developmental st... more Developmental disabilities are a set of disorders which occur during the child's developmental stages affecting his or her language, physical and mental abilities or behavior. These include autism and other related disorders which all negatively influence the way the child achieves normal developmental milestones. Nurses are expected to work in collaboration with parents and other health care professionals to monitor each child's growth and development during each well-child visit or Infant Welfare Clinics (IWC) as well as during illness episodes. Generally, parents' concerns regarding developmental delays are discussed and the child is followedup accordingly through developmental screening. A brief test is conducted on the child while the parent/caregiver completes a questionnaire or checklist regarding the child's developmental history. The American Academy of Pediatrics (AAP) recommends that developmental and behavioral screening be conducted for all children during regular IWC or well-child visits at nine, 18 and 30-months. Early diagnosis together with early treatment can make a major difference in a child's life and also decrease the possibility for costly interventions in future. Several programs have been designed to deal with the variety of social and behavioral difficulties associated with autism, focusing on reducing problem behaviors in children with autism. Once an individual is given a confirmed autism diagnosis by a qualified professional, the parents need to seek further information immediately on how to support their child. Early intervention treatment services have been shown to greatly improve a child's development. Thus, diagnosing autism early and instituting treatment and support promptly is mandatory for better prognosis.
Objective
This study evaluates patient responsiveness to an automated text messaging system for p... more Objective This study evaluates patient responsiveness to an automated text messaging system for pelvic inflammatory disease (PID) self-care support, and measures the reliability of text-reported adherence. Design Patients aged 13-25-years with mild to moderate PID were recruited from urban, academic outpatient settings. Enrolled patients received antibiotics and were randomized into a standard of care or intervention group. During a 14-day treatment period, participants in the intervention arm received a community-based nursing visit and daily text message medication reminders with evening prompts to report the number of doses taken. Result Of the 97 participants randomized into the intervention arm, 91 (94%) were eligible for analysis. Most were African American and low income, with a mean age of 18.3 (SD=2.2) years. Participants responded to ~53% (SD=34%) of all dosage inquiry messages. Responsiveness attenuated at approximately 2.2% per day over the treatment period. Ninety-three percent (n=85) of the analyzed intervention arm returned for the two-week follow-up. Despite overall adherence and general responsiveness, text-reported and self-reported medication adherence were not well correlated (r=0.37, p<0.001). Conclusion Our findings show that text messaging is a feasible strategy for reaching urban adolescents being managed for complicated sexually transmitted infections in outpatient settings. However, patient responsiveness to self-care text messages do vary, limiting the adherence monitoring capacity of this technology. Given the number of unanswered text messages and incomplete text-reported adherence data, additional measures to assess adolescents’ adherence to PID medications are needed in clinical trials.
Developmental disabilities (DDs) refer to a group of conditions that influence the early developm... more Developmental disabilities (DDs) refer to a group of conditions that influence the early development of children and cause changes in their normal developmental pattern affecting their physical, language and mental abilities or behavior. Children with DDs just like normally developing children have health issues that need to be addressed. This special group of children especially those having autism frequently suffer from associated conditions such as gastrointestinal disorders, eating and feeding challenges, seizures, sleep disturbances, attention deficit and hyperactivity disorder, and anxiety among others. These health problems affect the health of these children in different ways and extent. Thus, children with DDs need to access healthcare services and receive quality medical care just like their normally developing peers. However, the health needs of children with DDs particularly autism are not being met as required even though this special population are more likely to seek medical care due to their disabilities and associated conditions. Children with autism and other DDs experience disparities in health and healthcare service utilization. Autism is linked to many health conditions such as epilepsy, gastrointestinal problems and other mental disorders. These health problems affect each individual with autism in a unique way negatively affecting his/her existing social interaction and communication impairments. Again, health facilities and medical equipment are not disability-friendly making it difficult for this special group to effectively have access to quality care. In addition, most healthcare providers do not possess adequate knowledge and skills required to make critical decisions regarding this very special group of persons. Furthermore, due to cultural differences certain diagnosis and treatment regarding autism and other developmental disabilities may not be welcomed. The public health sector of all nations has the duty to promote health and prevent diseases for all including persons with disabilities.
Convulsion is an event that can emotionally traumatise most parents. Inadequate knowledge regardi... more Convulsion is an event that can emotionally traumatise most parents. Inadequate knowledge regarding convulsion can cause parental anxiety. Aim This research sought to investigate the knowledge, attitudes, concerns and practices of parents regarding convulsion in children under five-years. Methods The study employed a community based cross-sectional survey design. Purposive, convenient and snowball samplings were used to select the study site and enroll participants to the study. The study was conducted in Muea Community, Buea Health District in Fako Division, South West Region of Cameroon. The study participants were made up of parents of children under 5-years of age and who had witnessed convulsion in a child. Respondents who met the inclusion criteria and gave their consent to participate in the study were selected. Data was collected using a semi-structured questionnaire made up of both open and closed-ended questions. Data was collected on the knowledge, attitudes, concerns and practices of parents regarding convulsions in children. Data collected was entered using a pre-designed EpiData version 3.1 and data from open-ended questions were analysed using systematic process of thematic analysis. Results A total of 100 respondents participated in the study. The study revealed that more than half of the respondents 53.7% had good knowledge on convulsion, 61.9% of the respondents had positive attitudes towards convulsion and 51.4% of parents had good practices regarding convulsion. This study also revealed that knowledge of convulsion had an association (p=0.05) with gender and marital status but was not dependent (p>0.05) on age and level of school attained. Conclusion The study concluded that even though more than half of the respondents were knowledgeable on convulsion, there is still need for proper parental education as inappropriate attitudes and practices like putting the child's head in the toilet pit, which can lead to complications are still being practiced.
Introduction
Congenital oesophageal atresia (COA) refers to a congenitally interrupted oesophagus... more Introduction Congenital oesophageal atresia (COA) refers to a congenitally interrupted oesophagus. It is commonly referred to in the literature as oesophageal atresia (OA) with or without tracheo oesophageal fistula (TOF) but acquired TOF is a different entity. Case Report We present a case of OA with TOF which was not suspected antenatally despite the presence of polyhydramnios. The baby presented with respiratory distress and excessive oral secretions at the age of 3-hours following initiation of breastfeeding. Thorascopic repair was performed on the second day of life. The pre-, intra- and post-operative course was smooth with no major challenges. There was no associated anomalies in our case following thorough systemic evaluation including brain ultrasound, abdominal ultrasound, skeletal survey, ophthalmic assessment and echocardiography. Conclusion This case demonstrates the importance of maintaining a high index of suspicion for OA when faced with a combination of respiratory distress and persistent frothy oral secretions in a newborn. The antenatal and postnatal diagnostic approaches are discussed with highlights of associated anomalies and pre-operative assessment and management. Keywords Congenital oesophageal atresia (COA); Tracheo oesophageal fistula (TOF); Oesophageal atresia (OA); Vertebral defects, anal atresia, cardiac defects, renal anomalies and limb abnormalities (VACTERL); Choanal atresia, retardation of growth, genital abnormalities, and ear abnormalities (CHARGE).
Esophageal replacement (ER) is indicated in patients with long gap esophageal atresia (LGEA) or f... more Esophageal replacement (ER) is indicated in patients with long gap esophageal atresia (LGEA) or failure of the primary anastomosis. Also, severe caustic or peptic strictures, resistant to conservative treatment with medication and dilations, may require an ER. Numerous techniques with different organs and routes have been described, all with satisfactory results. Objective Our objective is to describe the experience obtained with partial gastric pull-up according to the Schärli principles (SGPA).
Amongst the challenges faced by advanced training programs
in pediatric dentistry is adequate pre... more Amongst the challenges faced by advanced training programs in pediatric dentistry is adequate preparation of its students or residents to make use of the most effective and safe sedative agents and combinations for managing the diverse range of noncoping behaviors of pre-cooperative and non-cooperative pediatric patients. The dilemma is complicated by a number of factors. Foremost is a constricted interval of time in which to acquire sufficient exposure and expertise in both didactic and clinical applications. Having sufficient patient populations reflecting various levels of patient apprehension, resistance, and dental pathology has potential to limit student and resident experience is another complication. Faculty variability with respect to expertise, comfort level, and firsthand experience making use of a less than diverse arsenal of agents no doubt has potential impact on resident experience. This is particularly disconcerting where programs have elected to reduce their armamentariums to the extent that experience is gained exclusively with use of a single medication.
Over the past two decades, the American Board of Pediatric Dentistry (ABPD) has admirably and con... more Over the past two decades, the American Board of Pediatric Dentistry (ABPD) has admirably and conscientiously grappled with the dilemma of how to maintain the bar of clinical competency while vastly enhancing its membership numbers to pursue board certification. This editorial seeks to discuss the changes which have occurred historically that has impacted on the nature and quality of the examination process that is used to determine what constitutes a level of competency for pediatric dentists in the U.S. For matters of practicality and consistency throughout various disciplines within medicine and dentistry, perceptions have increasingly moved in the direction that a degree of competency be defined for which the vast majority of providers potentially qualify. While it would be optimal to set the bar for achievement at the level of excellence, doing such excludes the bulk of practitioners as previously existed in health care during the previous half-century. The need to redefine what sufficiently constitutes merely an acceptable level of comprehension has become the rule rather than the exception by today’s standards. Recognition of the achievement of excellence, while beyond the purview of certifying boards, might still best be re-examined, re-designed and awarded to the benefit of the practitioners and public these boards are intended to endorse and serve. The fact of the matter is that satisfactory completion of current board certification does not carry the weight or prestige it once represented. Certification boards might do well to reassess or reframe the reward of Diplomate status on the basis of the achievement of excellence vs. adequacy that is measured.
Assessment of nutritional status and ensuring adequate nutrient
intake are essential components o... more Assessment of nutritional status and ensuring adequate nutrient intake are essential components of health care for infants and children who are ill. Pediatric malnutrition is defined as “an imbalance between nutrient requirement and intake, resulting in cumulative deficits of energy, protein, or micronutrients that may negatively affect growth, development, and other relevant outcomes.” It is either illness-related or caused by social/environmental factors that result in decreased nutrient intake. It is classified as acute (less than 3 months) or chronic (greater than 3 months) in duration.
Amongst the many controversial topics in the field of dentistry for children is the relative appr... more Amongst the many controversial topics in the field of dentistry for children is the relative appropriateness (or lack thereof) of the application of physical restraints for the management of challenging and interfering child behavior. Believers in its appropriateness prefer the euphemistic 1 term "protective immobilization or stabilization" in contrast to the negative connotation implied by simply describing physical restraint. This manuscript provides a critical look from the perspective of a child-oriented behavioral researcher and private practitioner of forty years who shares a most unenthusiastic bias towards a reliance on restraint techniques to overcome interfering and undesirable child behavior. This bias is stipulated; from this author's perspective there are but a few indications under which application of immobilization devices are safe and in the best interest of children and their developing psyche with respect to safe delivery of treatment and the development of future attitudes toward care. In fairness, however, it would be remiss to not indicate the viability of these techniques for specific and isolated ultra-short and short-term interactions where the interception of potentially harmful child movements plays a role in the management of obstreperous responses of some children. Analysis of appropriateness or its lack begins where differentiation is made between neurological normality versus abnormality and patient's cooperative potential. Those lacking behavioral control by virtue of incapacity to refrain from injurious impulses and re-fractory movement can necessitate greater vigilance from the dental team. Those capable of working within a framework of coping potential responsive to verbal communications and conventional mainstream interventions might best approach challenging if not resistive behaviors slowly if not exhaustively to avoid resorting to the application of physical restraints to permit efficiency and productivity. Of the challenges facing clinical pediatric practice are economic pressures to accomplish treatment intervention and generation of revenues in a timely fashion. While there are some practitioners making use of a broad range of behavioral management strategies, there are others who make use of a limited arsenal of techniques to manage difficult and challenging behaviors. Those with authoritarian demeanors and high expectations for cooperation of challenging children may be hypothesized to have a heavier reliance on restraint techniques and possess a limited arsenal of management strategies to accomplish invasive treatment. Nevertheless it might similarly be hypothesized that while productivity is a reality of private practice, the obligation to comfort patient anxiety and its sequelae in the least stressful manner possible is ultimately the most expedient and optimal way to create a patient accepting of care while protecting the child's self-esteem. As Mark Twain has offered, "when you only have a hammer, all problems tend to look like a nail," addresses the subject of how imaginative and complete one's behavioral management arsenal might, or might not be. From the perspective of parents and clinicians alike, the climate of behavioral management has gradually changed over the past half century, with several abrupt alterations over the past two decades. 2
Adolescence is one of the fundamental processes of life, where transformation in composition of t... more Adolescence is one of the fundamental processes of life, where transformation in composition of the body along with behavioral and physiological take place making the adolescents one of the most vulnerable group of population in the community and it is extremely important to take care of their nutritional as well as health status. Present study was carried out to find the prevalence of obesity in adolescents of Islamabad, so that; their health and well-being can be improved. A total of 315 adolescents studying in different schools both male and female within the age range of 15-19 were selected after proper sample size calculation. For data collection a pre-tested self-report questionnaire was used in order to find out the level of obesity and factors leading to overweight and obesity. Results reveal that 74% of the adolescents living in Islamabad had a normal body mass index (BMI)-forage , 17.4% are overweight while 8.5% are obese. It was found that with increase in age and grade, level of overweight and obesity was higher.
Background: Urban adolescent and young adult women often require adult support throughout their t... more Background: Urban adolescent and young adult women often require adult support throughout their transition to adulthood particularly regarding seeking healthcare. While confidentiality is crucial feature of care delivery, successful adherence to treatment can be multi-factorial. The purpose of this study is to determine factors associated with parental notification and engagement in self-care of young women diagnosed with pelvic inflammatory disease (PID). Methods: This study utilizes data from 187 participants in the Technology Enhanced Community Health Nursing (TECH-N) study, a randomized controlled trial (RCT) of an intervention to prevent recurrent sexually transmitted infections (STIs) after a diagnosis of mild-moderate PID. Participants were recruited from pediatric ambulatory settings provided baseline demographic, reproductive history, and perceived social support using an audio computerized self-interview at baseline and parental notification collected during a two-week follow-up interview, served as the primary outcome. Results: Sixty-five percent of participants informed a parent of their PID diagnosis, 74% of whom reported receiving supportive care. Participants who reported a higher sense of responsibility to others were 17% less likely to inform a parent of their diagnosis. Conclusion: Most urban young women with PID notify parents of their diagnosis and obtain support for self-management in the outpatient setting. While autonomy is a critical milestone for transition to young adulthood, these data suggest that proactive youth-managed parental engagement may be an underutilized resource for young women diagnosed with PID.
Background: Planning the number of registered nurses (RN) per shift in the neonatal intensive car... more Background: Planning the number of registered nurses (RN) per shift in the neonatal intensive care unit (NICU) is a constant stressor and overtime is often used to assure adequate nurse to patient ratios at high costs. Aim: To identify the factors associated with shift-to-shift variations in the use of RN overtime in the NICU and assess the economic impacts of reducing overtime. Methods: We developed a two-year retrospective study in a NICU (CHU de Québec, Level 3 unit, capacity of 51 beds). Detailed administrative data for each shift of the day (night, day, evening) was collected. Non-modifiable organizational factors included patient volume, patient acuity, number of admissions, season, days of the week and work shift. The modifiable factors included the paid hours not at the bedside and the implementation of a bundle to reduce RN overtime (increase in full-time nurse positions and conversion of 10% of RN to regular 12-hour shifts). Multivariate linear regression models were used to assess the association between organizational factors and RN overtime per shift. Results: A total of 2184 shifts were included. Mean RN overtime per shift was 9.5±10.4 h corresponding to 4.7±5.2% of total hours worked per shift. RN overtime use was influenced by non-modifiable factors including unit occupancy, season and the number of acute patients. Paid hours not at the bedside were associated with overtime. Also, the implementation of a bundle to reduce RN overtime brought the mean RN overtime from 11.7±11.2 h to 6.5±8.5 h (p<0.001). This was associated with a reduction in nursing costs per patient day [386±10 $ vs. 381±7 $ (p<0.001)]. That corresponded to a yearly 102,948$ cost reduction. Conclusion: Reducing RN overtime in the NICU is associated with cost reduction.
A unique, progressive multidisciplinary simulation was developed for a pediatric end-of life expe... more A unique, progressive multidisciplinary simulation was developed for a pediatric end-of life experience. In order to prepare all participants, regardless of discipline, extensive pre-briefing and reflective debriefing was developed. The project included seven evolving pediatric simulations, each one with multiple disciplines participating, over a four-week period. Key components of the pre-briefing stages included learning about the topic of end-of-life, understanding the different inter-professional roles, teamwork, and feeling comfortable with the simulation environment. Reflective debriefing was carried out in small groups immediately after the simulation with objective feedback and affirmation of interdisciplinary teamwork, skills, and communication. A second culminating debriefing also occurred which offered the students the ability to pull their experiences together and reflect and compare their perceptions to those of an actual survivor of the same disease. This project revealed to faculty the importance of using multi-staged pre-briefing and debriefing in a progressive multidisciplinary pediatric simulation.
Background: Recently the use of antibacterial agents to clean and dry the stump of the newborns' ... more Background: Recently the use of antibacterial agents to clean and dry the stump of the newborns' umbilical cord (UC) after birth has been abandoned by many neonatal units. Aim of this study was to compare the occurrence of adverse events (AEs), time to UC separation and caregivers' satisfaction among newborns treated with dry cord care versus 70% alcohol after one day from birth in an Italian Hospital. Methods: From June 2014 to September 2014, 100 infants were enrolled for the study. Soon after birth, all the newborns were treated in the same way: their UC was cleansed with 70% alcohol, using a sterile gauze. One day after the birth, in the control group the UC was regularly cleansed with 70% alcohol twice a day, while in the case group, from the first nappy change, dry cord care was performed cleansing the UC with sterile saline solution (NaCl 90%), using a sterile gauze twice a day. In all cases UC was left without any dressing upon it as well. The time to UC separation and any AEs (local and systemic infections, haemorrhage, granuloma formation) were reported by mothers. Carers' perception regarding the two procedures were collected by a questionnaire between 6 and 24 hours after birth, and 1 month later. Results: We found a significant difference in the mean cord separation time between the two groups [dry cord care: 9.1 days (standard deviation (SD)=3.1] versus 70% alcohol: 11.3 days (SD=4.6); p<0.01], while no significant AEs and carers' satisfaction on the procedures resulted. Instead, change of treatment at home was more frequent in dry cord care group (23.9% versus 6.1%; p<0.01). Conclusions: This study confirms that dry cord care is an easy, accepted and safe method of handling the UC in healthy newborn infants born in a high-income hospital setting.
Purpose: The high-risk parental experience in the neonatal intensive care environment is a major ... more Purpose: The high-risk parental experience in the neonatal intensive care environment is a major stress event that is not necessarily resolved with discharge. Many parents report "walking on eggshells" with worry and stress for up to a year beyond the birth of their infant. Because stressors can induce behavioral, physiological, and biochemical changes to such a degree that family adaptation is challenged, attempting to resolve stressors before the discharge should be a goal. The ethical concept of beneficence (doing good) provides the Neonatal Intensive Care Unit (NICU) nurse with a framework for wanting to lower stressors as much as possible prior to discharge. The purpose of this study was to examine the relationship between high-risk experiences including high-risk pregnancies, deliveries, and NICU admissions and unresolved parental stress up to a year after delivery. Method: Women in a day care center with infants under a year old were tested for their emotional status and pregnancy related demographics. Principal Results: Findings show a positive correlation between two factors, both NICU admission of a newborn and parental stress (r=.88) and a high risk primiparous births without NICU admissions and parental stress (r=.72). Major Conclusion: While this is a pilot study, the findings illustrate unresolved parental stress well beyond the birth of the baby, providing ethical support for early identification of stressed parents and interventions to normalize that stress before discharge. When parents report significant stress after their deliveries or infants' NICU admissions, and there is no specific intervention to identify and reduce this stress, high levels of stress may last and be measurable even a year later.
Fetus develops in a relatively hypoxemic environment in utero, however they need supplemental oxy... more Fetus develops in a relatively hypoxemic environment in utero, however they need supplemental oxygen at birth when born prematurely ≤32 weeks' gestation. Reduced antioxidant defenses from lack of induction of antioxidant enzymes at birth, predispose premature infant susceptible to toxic effects of oxygen such as bronchopulmonary dysplasia and brain injury. Studies have demonstrated that even short exposures to 100% oxygen at birth could have long term implications. Guidelines and nomograms were published in 2010 regarding oxygen concentrations to be administered along with the oxygen saturations (SpO 2) to be targeted in the first ten minutes after birth in both term and premature infants. We review the impact of differing oxygen concentrations in the first 10 minutes soon after birth on oxygen saturations, the biochemical effects of oxidative stress and on clinical outcomes in premature infants. Initiating resuscitation with an oxygen concentration of 21% O 2 to 30% O 2 as recommended by resuscitation guidelines is a good starting point, despite the lack of evidence of well-defined SpO 2 targets in premature neonates, which necessitate large clinical trials. Starting low oxygen concentration at resuscitation, facilitates lower oxidative stress which is desirable in premature infants with immature anti-oxidant defenses at birth. However, there is insufficient evidence to indicate that resuscitation with lower oxygen concentration (≤30% O 2) at birth will decrease BPD or other clinical outcomes in premature neonates.
Background Human tails are rare congenital anomalies protruding from midline of the lumbosacral r... more Background Human tails are rare congenital anomalies protruding from midline of the lumbosacral region covered by skin. Human tails are classified as true tail and pseudo tail. True tails, also known as vestigial tails are caudal, midline protrusion capable of spontaneous or reflex motion, consisting of skin covering with a combination of striated muscle, adipose and connective tissue, normal blood vessels and nerves. Case Presentation A 47-days-old-female infant born from 28-years old prime parous women present with cutaneous appendage arising from the sacrococcygeal region, in the midline, above the intergluteal cleft. The tail-like structure was 9 cm in length, with a diameter between 3 cm and 2 cm in all its length, cylindrical, and pointy towards the end. The structure was soft, covered in skin, it shows spontaneous movement. The magnetic resonance imaging (MRI) report shows S1-S2 level spinal bifida. Conclusion This is a rare case of vestigial human tail with spinal bifida on 47-days old female infant born from prime parous mother through spontaneous vaginal delivery diagnosed by histopathologic examination.
There is increasing concern regarding the impact of social media on adolescent mental health, yet... more There is increasing concern regarding the impact of social media on adolescent mental health, yet medical providers have limited guidance on how to effectively screen their adolescent patients. Research has suggested a negative association between excessive time on digital media, more than 2-hours per day, and emotional health. Perhaps more importantly, adolescent vulnerabilities, such as existing anxiety or depression, when exposed to certain social media experiences can cause further decline of mental health. The goal of this review is to help providers effectively evaluate social media use in adolescent patients and provide guidance on its use to help preserve or improve their emotional well-being.
Background Parenteral diarrhea is non-infectious diarrhea associated with extraintestinal infecti... more Background Parenteral diarrhea is non-infectious diarrhea associated with extraintestinal infections such as urinary tract infection (UTI), but evidence supporting this association is limited. We performed a systematic literature review to determine the reported frequency of UTI in pediatric patients who had diarrhea. Methods We searched electronic databases (PubMed, Scopus, Google Scholar, and CINAHL) to identify articles about diarrhea and UTI. We included English-language articles about studies of children (age, ≤5-years) who presented with diarrhea in which the frequency of culture-positive UTI was reported. We excluded studies that examined particular diets or specific pediatric patient populations presenting with diarrhea. Patient and study characteristics were extracted manually. Results The database search identified 32 articles. After excluding 25 articles and adding 3 articles identified during manual review of article references, there were 10 articles in the final review including 8 cohort and 2 case control studies. In all 10 studies combined, UTIs were observed in 172 of 1086 children who presented with diarrhea (15.8%), but the frequency of UTI varied between studies (range, 5 to 32%). Escherichia coli was the most common bacterial isolate from urine in all 9 studies that reported microbiology results. The stool and urine culture results (E. coli) were similar in 4 of the 6 studies that reported stool culture results. Conclusion In infants and children up to age 5-years, diarrhea may be associated with an UTI. In patients who have diarrhea of unknown cause, it may be prudent to consider an evaluation for a coexisting UTI.
Developmental disabilities are a set of disorders which occur during the child's developmental st... more Developmental disabilities are a set of disorders which occur during the child's developmental stages affecting his or her language, physical and mental abilities or behavior. These include autism and other related disorders which all negatively influence the way the child achieves normal developmental milestones. Nurses are expected to work in collaboration with parents and other health care professionals to monitor each child's growth and development during each well-child visit or Infant Welfare Clinics (IWC) as well as during illness episodes. Generally, parents' concerns regarding developmental delays are discussed and the child is followedup accordingly through developmental screening. A brief test is conducted on the child while the parent/caregiver completes a questionnaire or checklist regarding the child's developmental history. The American Academy of Pediatrics (AAP) recommends that developmental and behavioral screening be conducted for all children during regular IWC or well-child visits at nine, 18 and 30-months. Early diagnosis together with early treatment can make a major difference in a child's life and also decrease the possibility for costly interventions in future. Several programs have been designed to deal with the variety of social and behavioral difficulties associated with autism, focusing on reducing problem behaviors in children with autism. Once an individual is given a confirmed autism diagnosis by a qualified professional, the parents need to seek further information immediately on how to support their child. Early intervention treatment services have been shown to greatly improve a child's development. Thus, diagnosing autism early and instituting treatment and support promptly is mandatory for better prognosis.
Objective
This study evaluates patient responsiveness to an automated text messaging system for p... more Objective This study evaluates patient responsiveness to an automated text messaging system for pelvic inflammatory disease (PID) self-care support, and measures the reliability of text-reported adherence. Design Patients aged 13-25-years with mild to moderate PID were recruited from urban, academic outpatient settings. Enrolled patients received antibiotics and were randomized into a standard of care or intervention group. During a 14-day treatment period, participants in the intervention arm received a community-based nursing visit and daily text message medication reminders with evening prompts to report the number of doses taken. Result Of the 97 participants randomized into the intervention arm, 91 (94%) were eligible for analysis. Most were African American and low income, with a mean age of 18.3 (SD=2.2) years. Participants responded to ~53% (SD=34%) of all dosage inquiry messages. Responsiveness attenuated at approximately 2.2% per day over the treatment period. Ninety-three percent (n=85) of the analyzed intervention arm returned for the two-week follow-up. Despite overall adherence and general responsiveness, text-reported and self-reported medication adherence were not well correlated (r=0.37, p<0.001). Conclusion Our findings show that text messaging is a feasible strategy for reaching urban adolescents being managed for complicated sexually transmitted infections in outpatient settings. However, patient responsiveness to self-care text messages do vary, limiting the adherence monitoring capacity of this technology. Given the number of unanswered text messages and incomplete text-reported adherence data, additional measures to assess adolescents’ adherence to PID medications are needed in clinical trials.
Developmental disabilities (DDs) refer to a group of conditions that influence the early developm... more Developmental disabilities (DDs) refer to a group of conditions that influence the early development of children and cause changes in their normal developmental pattern affecting their physical, language and mental abilities or behavior. Children with DDs just like normally developing children have health issues that need to be addressed. This special group of children especially those having autism frequently suffer from associated conditions such as gastrointestinal disorders, eating and feeding challenges, seizures, sleep disturbances, attention deficit and hyperactivity disorder, and anxiety among others. These health problems affect the health of these children in different ways and extent. Thus, children with DDs need to access healthcare services and receive quality medical care just like their normally developing peers. However, the health needs of children with DDs particularly autism are not being met as required even though this special population are more likely to seek medical care due to their disabilities and associated conditions. Children with autism and other DDs experience disparities in health and healthcare service utilization. Autism is linked to many health conditions such as epilepsy, gastrointestinal problems and other mental disorders. These health problems affect each individual with autism in a unique way negatively affecting his/her existing social interaction and communication impairments. Again, health facilities and medical equipment are not disability-friendly making it difficult for this special group to effectively have access to quality care. In addition, most healthcare providers do not possess adequate knowledge and skills required to make critical decisions regarding this very special group of persons. Furthermore, due to cultural differences certain diagnosis and treatment regarding autism and other developmental disabilities may not be welcomed. The public health sector of all nations has the duty to promote health and prevent diseases for all including persons with disabilities.
Convulsion is an event that can emotionally traumatise most parents. Inadequate knowledge regardi... more Convulsion is an event that can emotionally traumatise most parents. Inadequate knowledge regarding convulsion can cause parental anxiety. Aim This research sought to investigate the knowledge, attitudes, concerns and practices of parents regarding convulsion in children under five-years. Methods The study employed a community based cross-sectional survey design. Purposive, convenient and snowball samplings were used to select the study site and enroll participants to the study. The study was conducted in Muea Community, Buea Health District in Fako Division, South West Region of Cameroon. The study participants were made up of parents of children under 5-years of age and who had witnessed convulsion in a child. Respondents who met the inclusion criteria and gave their consent to participate in the study were selected. Data was collected using a semi-structured questionnaire made up of both open and closed-ended questions. Data was collected on the knowledge, attitudes, concerns and practices of parents regarding convulsions in children. Data collected was entered using a pre-designed EpiData version 3.1 and data from open-ended questions were analysed using systematic process of thematic analysis. Results A total of 100 respondents participated in the study. The study revealed that more than half of the respondents 53.7% had good knowledge on convulsion, 61.9% of the respondents had positive attitudes towards convulsion and 51.4% of parents had good practices regarding convulsion. This study also revealed that knowledge of convulsion had an association (p=0.05) with gender and marital status but was not dependent (p>0.05) on age and level of school attained. Conclusion The study concluded that even though more than half of the respondents were knowledgeable on convulsion, there is still need for proper parental education as inappropriate attitudes and practices like putting the child's head in the toilet pit, which can lead to complications are still being practiced.
Introduction
Congenital oesophageal atresia (COA) refers to a congenitally interrupted oesophagus... more Introduction Congenital oesophageal atresia (COA) refers to a congenitally interrupted oesophagus. It is commonly referred to in the literature as oesophageal atresia (OA) with or without tracheo oesophageal fistula (TOF) but acquired TOF is a different entity. Case Report We present a case of OA with TOF which was not suspected antenatally despite the presence of polyhydramnios. The baby presented with respiratory distress and excessive oral secretions at the age of 3-hours following initiation of breastfeeding. Thorascopic repair was performed on the second day of life. The pre-, intra- and post-operative course was smooth with no major challenges. There was no associated anomalies in our case following thorough systemic evaluation including brain ultrasound, abdominal ultrasound, skeletal survey, ophthalmic assessment and echocardiography. Conclusion This case demonstrates the importance of maintaining a high index of suspicion for OA when faced with a combination of respiratory distress and persistent frothy oral secretions in a newborn. The antenatal and postnatal diagnostic approaches are discussed with highlights of associated anomalies and pre-operative assessment and management. Keywords Congenital oesophageal atresia (COA); Tracheo oesophageal fistula (TOF); Oesophageal atresia (OA); Vertebral defects, anal atresia, cardiac defects, renal anomalies and limb abnormalities (VACTERL); Choanal atresia, retardation of growth, genital abnormalities, and ear abnormalities (CHARGE).
Esophageal replacement (ER) is indicated in patients with long gap esophageal atresia (LGEA) or f... more Esophageal replacement (ER) is indicated in patients with long gap esophageal atresia (LGEA) or failure of the primary anastomosis. Also, severe caustic or peptic strictures, resistant to conservative treatment with medication and dilations, may require an ER. Numerous techniques with different organs and routes have been described, all with satisfactory results. Objective Our objective is to describe the experience obtained with partial gastric pull-up according to the Schärli principles (SGPA).
Amongst the challenges faced by advanced training programs
in pediatric dentistry is adequate pre... more Amongst the challenges faced by advanced training programs in pediatric dentistry is adequate preparation of its students or residents to make use of the most effective and safe sedative agents and combinations for managing the diverse range of noncoping behaviors of pre-cooperative and non-cooperative pediatric patients. The dilemma is complicated by a number of factors. Foremost is a constricted interval of time in which to acquire sufficient exposure and expertise in both didactic and clinical applications. Having sufficient patient populations reflecting various levels of patient apprehension, resistance, and dental pathology has potential to limit student and resident experience is another complication. Faculty variability with respect to expertise, comfort level, and firsthand experience making use of a less than diverse arsenal of agents no doubt has potential impact on resident experience. This is particularly disconcerting where programs have elected to reduce their armamentariums to the extent that experience is gained exclusively with use of a single medication.
Over the past two decades, the American Board of Pediatric Dentistry (ABPD) has admirably and con... more Over the past two decades, the American Board of Pediatric Dentistry (ABPD) has admirably and conscientiously grappled with the dilemma of how to maintain the bar of clinical competency while vastly enhancing its membership numbers to pursue board certification. This editorial seeks to discuss the changes which have occurred historically that has impacted on the nature and quality of the examination process that is used to determine what constitutes a level of competency for pediatric dentists in the U.S. For matters of practicality and consistency throughout various disciplines within medicine and dentistry, perceptions have increasingly moved in the direction that a degree of competency be defined for which the vast majority of providers potentially qualify. While it would be optimal to set the bar for achievement at the level of excellence, doing such excludes the bulk of practitioners as previously existed in health care during the previous half-century. The need to redefine what sufficiently constitutes merely an acceptable level of comprehension has become the rule rather than the exception by today’s standards. Recognition of the achievement of excellence, while beyond the purview of certifying boards, might still best be re-examined, re-designed and awarded to the benefit of the practitioners and public these boards are intended to endorse and serve. The fact of the matter is that satisfactory completion of current board certification does not carry the weight or prestige it once represented. Certification boards might do well to reassess or reframe the reward of Diplomate status on the basis of the achievement of excellence vs. adequacy that is measured.
Assessment of nutritional status and ensuring adequate nutrient
intake are essential components o... more Assessment of nutritional status and ensuring adequate nutrient intake are essential components of health care for infants and children who are ill. Pediatric malnutrition is defined as “an imbalance between nutrient requirement and intake, resulting in cumulative deficits of energy, protein, or micronutrients that may negatively affect growth, development, and other relevant outcomes.” It is either illness-related or caused by social/environmental factors that result in decreased nutrient intake. It is classified as acute (less than 3 months) or chronic (greater than 3 months) in duration.
Amongst the many controversial topics in the field of dentistry for children is the relative appr... more Amongst the many controversial topics in the field of dentistry for children is the relative appropriateness (or lack thereof) of the application of physical restraints for the management of challenging and interfering child behavior. Believers in its appropriateness prefer the euphemistic 1 term "protective immobilization or stabilization" in contrast to the negative connotation implied by simply describing physical restraint. This manuscript provides a critical look from the perspective of a child-oriented behavioral researcher and private practitioner of forty years who shares a most unenthusiastic bias towards a reliance on restraint techniques to overcome interfering and undesirable child behavior. This bias is stipulated; from this author's perspective there are but a few indications under which application of immobilization devices are safe and in the best interest of children and their developing psyche with respect to safe delivery of treatment and the development of future attitudes toward care. In fairness, however, it would be remiss to not indicate the viability of these techniques for specific and isolated ultra-short and short-term interactions where the interception of potentially harmful child movements plays a role in the management of obstreperous responses of some children. Analysis of appropriateness or its lack begins where differentiation is made between neurological normality versus abnormality and patient's cooperative potential. Those lacking behavioral control by virtue of incapacity to refrain from injurious impulses and re-fractory movement can necessitate greater vigilance from the dental team. Those capable of working within a framework of coping potential responsive to verbal communications and conventional mainstream interventions might best approach challenging if not resistive behaviors slowly if not exhaustively to avoid resorting to the application of physical restraints to permit efficiency and productivity. Of the challenges facing clinical pediatric practice are economic pressures to accomplish treatment intervention and generation of revenues in a timely fashion. While there are some practitioners making use of a broad range of behavioral management strategies, there are others who make use of a limited arsenal of techniques to manage difficult and challenging behaviors. Those with authoritarian demeanors and high expectations for cooperation of challenging children may be hypothesized to have a heavier reliance on restraint techniques and possess a limited arsenal of management strategies to accomplish invasive treatment. Nevertheless it might similarly be hypothesized that while productivity is a reality of private practice, the obligation to comfort patient anxiety and its sequelae in the least stressful manner possible is ultimately the most expedient and optimal way to create a patient accepting of care while protecting the child's self-esteem. As Mark Twain has offered, "when you only have a hammer, all problems tend to look like a nail," addresses the subject of how imaginative and complete one's behavioral management arsenal might, or might not be. From the perspective of parents and clinicians alike, the climate of behavioral management has gradually changed over the past half century, with several abrupt alterations over the past two decades. 2
Adolescence is one of the fundamental processes of life, where transformation in composition of t... more Adolescence is one of the fundamental processes of life, where transformation in composition of the body along with behavioral and physiological take place making the adolescents one of the most vulnerable group of population in the community and it is extremely important to take care of their nutritional as well as health status. Present study was carried out to find the prevalence of obesity in adolescents of Islamabad, so that; their health and well-being can be improved. A total of 315 adolescents studying in different schools both male and female within the age range of 15-19 were selected after proper sample size calculation. For data collection a pre-tested self-report questionnaire was used in order to find out the level of obesity and factors leading to overweight and obesity. Results reveal that 74% of the adolescents living in Islamabad had a normal body mass index (BMI)-forage , 17.4% are overweight while 8.5% are obese. It was found that with increase in age and grade, level of overweight and obesity was higher.
Background: Urban adolescent and young adult women often require adult support throughout their t... more Background: Urban adolescent and young adult women often require adult support throughout their transition to adulthood particularly regarding seeking healthcare. While confidentiality is crucial feature of care delivery, successful adherence to treatment can be multi-factorial. The purpose of this study is to determine factors associated with parental notification and engagement in self-care of young women diagnosed with pelvic inflammatory disease (PID). Methods: This study utilizes data from 187 participants in the Technology Enhanced Community Health Nursing (TECH-N) study, a randomized controlled trial (RCT) of an intervention to prevent recurrent sexually transmitted infections (STIs) after a diagnosis of mild-moderate PID. Participants were recruited from pediatric ambulatory settings provided baseline demographic, reproductive history, and perceived social support using an audio computerized self-interview at baseline and parental notification collected during a two-week follow-up interview, served as the primary outcome. Results: Sixty-five percent of participants informed a parent of their PID diagnosis, 74% of whom reported receiving supportive care. Participants who reported a higher sense of responsibility to others were 17% less likely to inform a parent of their diagnosis. Conclusion: Most urban young women with PID notify parents of their diagnosis and obtain support for self-management in the outpatient setting. While autonomy is a critical milestone for transition to young adulthood, these data suggest that proactive youth-managed parental engagement may be an underutilized resource for young women diagnosed with PID.
Background: Planning the number of registered nurses (RN) per shift in the neonatal intensive car... more Background: Planning the number of registered nurses (RN) per shift in the neonatal intensive care unit (NICU) is a constant stressor and overtime is often used to assure adequate nurse to patient ratios at high costs. Aim: To identify the factors associated with shift-to-shift variations in the use of RN overtime in the NICU and assess the economic impacts of reducing overtime. Methods: We developed a two-year retrospective study in a NICU (CHU de Québec, Level 3 unit, capacity of 51 beds). Detailed administrative data for each shift of the day (night, day, evening) was collected. Non-modifiable organizational factors included patient volume, patient acuity, number of admissions, season, days of the week and work shift. The modifiable factors included the paid hours not at the bedside and the implementation of a bundle to reduce RN overtime (increase in full-time nurse positions and conversion of 10% of RN to regular 12-hour shifts). Multivariate linear regression models were used to assess the association between organizational factors and RN overtime per shift. Results: A total of 2184 shifts were included. Mean RN overtime per shift was 9.5±10.4 h corresponding to 4.7±5.2% of total hours worked per shift. RN overtime use was influenced by non-modifiable factors including unit occupancy, season and the number of acute patients. Paid hours not at the bedside were associated with overtime. Also, the implementation of a bundle to reduce RN overtime brought the mean RN overtime from 11.7±11.2 h to 6.5±8.5 h (p<0.001). This was associated with a reduction in nursing costs per patient day [386±10 $ vs. 381±7 $ (p<0.001)]. That corresponded to a yearly 102,948$ cost reduction. Conclusion: Reducing RN overtime in the NICU is associated with cost reduction.
A unique, progressive multidisciplinary simulation was developed for a pediatric end-of life expe... more A unique, progressive multidisciplinary simulation was developed for a pediatric end-of life experience. In order to prepare all participants, regardless of discipline, extensive pre-briefing and reflective debriefing was developed. The project included seven evolving pediatric simulations, each one with multiple disciplines participating, over a four-week period. Key components of the pre-briefing stages included learning about the topic of end-of-life, understanding the different inter-professional roles, teamwork, and feeling comfortable with the simulation environment. Reflective debriefing was carried out in small groups immediately after the simulation with objective feedback and affirmation of interdisciplinary teamwork, skills, and communication. A second culminating debriefing also occurred which offered the students the ability to pull their experiences together and reflect and compare their perceptions to those of an actual survivor of the same disease. This project revealed to faculty the importance of using multi-staged pre-briefing and debriefing in a progressive multidisciplinary pediatric simulation.
Background: Recently the use of antibacterial agents to clean and dry the stump of the newborns' ... more Background: Recently the use of antibacterial agents to clean and dry the stump of the newborns' umbilical cord (UC) after birth has been abandoned by many neonatal units. Aim of this study was to compare the occurrence of adverse events (AEs), time to UC separation and caregivers' satisfaction among newborns treated with dry cord care versus 70% alcohol after one day from birth in an Italian Hospital. Methods: From June 2014 to September 2014, 100 infants were enrolled for the study. Soon after birth, all the newborns were treated in the same way: their UC was cleansed with 70% alcohol, using a sterile gauze. One day after the birth, in the control group the UC was regularly cleansed with 70% alcohol twice a day, while in the case group, from the first nappy change, dry cord care was performed cleansing the UC with sterile saline solution (NaCl 90%), using a sterile gauze twice a day. In all cases UC was left without any dressing upon it as well. The time to UC separation and any AEs (local and systemic infections, haemorrhage, granuloma formation) were reported by mothers. Carers' perception regarding the two procedures were collected by a questionnaire between 6 and 24 hours after birth, and 1 month later. Results: We found a significant difference in the mean cord separation time between the two groups [dry cord care: 9.1 days (standard deviation (SD)=3.1] versus 70% alcohol: 11.3 days (SD=4.6); p<0.01], while no significant AEs and carers' satisfaction on the procedures resulted. Instead, change of treatment at home was more frequent in dry cord care group (23.9% versus 6.1%; p<0.01). Conclusions: This study confirms that dry cord care is an easy, accepted and safe method of handling the UC in healthy newborn infants born in a high-income hospital setting.
Purpose: The high-risk parental experience in the neonatal intensive care environment is a major ... more Purpose: The high-risk parental experience in the neonatal intensive care environment is a major stress event that is not necessarily resolved with discharge. Many parents report "walking on eggshells" with worry and stress for up to a year beyond the birth of their infant. Because stressors can induce behavioral, physiological, and biochemical changes to such a degree that family adaptation is challenged, attempting to resolve stressors before the discharge should be a goal. The ethical concept of beneficence (doing good) provides the Neonatal Intensive Care Unit (NICU) nurse with a framework for wanting to lower stressors as much as possible prior to discharge. The purpose of this study was to examine the relationship between high-risk experiences including high-risk pregnancies, deliveries, and NICU admissions and unresolved parental stress up to a year after delivery. Method: Women in a day care center with infants under a year old were tested for their emotional status and pregnancy related demographics. Principal Results: Findings show a positive correlation between two factors, both NICU admission of a newborn and parental stress (r=.88) and a high risk primiparous births without NICU admissions and parental stress (r=.72). Major Conclusion: While this is a pilot study, the findings illustrate unresolved parental stress well beyond the birth of the baby, providing ethical support for early identification of stressed parents and interventions to normalize that stress before discharge. When parents report significant stress after their deliveries or infants' NICU admissions, and there is no specific intervention to identify and reduce this stress, high levels of stress may last and be measurable even a year later.
Fetus develops in a relatively hypoxemic environment in utero, however they need supplemental oxy... more Fetus develops in a relatively hypoxemic environment in utero, however they need supplemental oxygen at birth when born prematurely ≤32 weeks' gestation. Reduced antioxidant defenses from lack of induction of antioxidant enzymes at birth, predispose premature infant susceptible to toxic effects of oxygen such as bronchopulmonary dysplasia and brain injury. Studies have demonstrated that even short exposures to 100% oxygen at birth could have long term implications. Guidelines and nomograms were published in 2010 regarding oxygen concentrations to be administered along with the oxygen saturations (SpO 2) to be targeted in the first ten minutes after birth in both term and premature infants. We review the impact of differing oxygen concentrations in the first 10 minutes soon after birth on oxygen saturations, the biochemical effects of oxidative stress and on clinical outcomes in premature infants. Initiating resuscitation with an oxygen concentration of 21% O 2 to 30% O 2 as recommended by resuscitation guidelines is a good starting point, despite the lack of evidence of well-defined SpO 2 targets in premature neonates, which necessitate large clinical trials. Starting low oxygen concentration at resuscitation, facilitates lower oxidative stress which is desirable in premature infants with immature anti-oxidant defenses at birth. However, there is insufficient evidence to indicate that resuscitation with lower oxygen concentration (≤30% O 2) at birth will decrease BPD or other clinical outcomes in premature neonates.
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Papers by Pediatrics and Neonatal Nursing – Open Journal
This study evaluates patient responsiveness to an automated text messaging system for pelvic inflammatory disease (PID) self-care
support, and measures the reliability of text-reported adherence.
Design
Patients aged 13-25-years with mild to moderate PID were recruited from urban, academic outpatient settings. Enrolled patients
received antibiotics and were randomized into a standard of care or intervention group. During a 14-day treatment period, participants in the intervention arm received a community-based nursing visit and daily text message medication reminders with evening
prompts to report the number of doses taken.
Result
Of the 97 participants randomized into the intervention arm, 91 (94%) were eligible for analysis. Most were African American and
low income, with a mean age of 18.3 (SD=2.2) years. Participants responded to ~53% (SD=34%) of all dosage inquiry messages.
Responsiveness attenuated at approximately 2.2% per day over the treatment period. Ninety-three percent (n=85) of the analyzed
intervention arm returned for the two-week follow-up. Despite overall adherence and general responsiveness, text-reported and
self-reported medication adherence were not well correlated (r=0.37, p<0.001).
Conclusion
Our findings show that text messaging is a feasible strategy for reaching urban adolescents being managed for complicated sexually transmitted infections in outpatient settings. However, patient responsiveness to self-care text messages do vary, limiting the
adherence monitoring capacity of this technology. Given the number of unanswered text messages and incomplete text-reported
adherence data, additional measures to assess adolescents’ adherence to PID medications are needed in clinical trials.
Congenital oesophageal atresia (COA) refers to a congenitally interrupted oesophagus. It is commonly referred to in the literature
as oesophageal atresia (OA) with or without tracheo oesophageal fistula (TOF) but acquired TOF is a different entity.
Case Report
We present a case of OA with TOF which was not suspected antenatally despite the presence of polyhydramnios. The baby presented with respiratory distress and excessive oral secretions at the age of 3-hours following initiation of breastfeeding. Thorascopic repair was performed on the second day of life. The pre-, intra- and post-operative course was smooth with no major challenges.
There was no associated anomalies in our case following thorough systemic evaluation including brain ultrasound, abdominal
ultrasound, skeletal survey, ophthalmic assessment and echocardiography.
Conclusion
This case demonstrates the importance of maintaining a high index of suspicion for OA when faced with a combination of respiratory distress and persistent frothy oral secretions in a newborn. The antenatal and postnatal diagnostic approaches are discussed
with highlights of associated anomalies and pre-operative assessment and management.
Keywords
Congenital oesophageal atresia (COA); Tracheo oesophageal fistula (TOF); Oesophageal atresia (OA);
Vertebral defects, anal atresia, cardiac defects, renal anomalies and limb abnormalities (VACTERL); Choanal atresia, retardation of
growth, genital abnormalities, and ear abnormalities (CHARGE).
in pediatric dentistry is adequate preparation of its students
or residents to make use of the most effective and safe sedative
agents and combinations for managing the diverse range of noncoping behaviors of pre-cooperative and non-cooperative pediatric patients. The dilemma is complicated by a number of factors.
Foremost is a constricted interval of time in which to acquire sufficient exposure and expertise in both didactic and clinical applications. Having sufficient patient populations reflecting various
levels of patient apprehension, resistance, and dental pathology
has potential to limit student and resident experience is another
complication. Faculty variability with respect to expertise, comfort
level, and firsthand experience making use of a less than diverse
arsenal of agents no doubt has potential impact on resident experience. This is particularly disconcerting where programs have
elected to reduce their armamentariums to the extent that experience is gained exclusively with use of a single medication.
the dilemma of how to maintain the bar of clinical competency while vastly enhancing its membership numbers to pursue board
certification. This editorial seeks to discuss the changes which have occurred historically that has impacted on the nature and
quality of the examination process that is used to determine what constitutes a level of competency for pediatric dentists in the
U.S. For matters of practicality and consistency throughout various disciplines within medicine and dentistry, perceptions have
increasingly moved in the direction that a degree of competency be defined for which the vast majority of providers potentially
qualify. While it would be optimal to set the bar for achievement at the level of excellence, doing such excludes the bulk of practitioners as previously existed in health care during the previous half-century. The need to redefine what sufficiently constitutes
merely an acceptable level of comprehension has become the rule rather than the exception by today’s standards. Recognition of
the achievement of excellence, while beyond the purview of certifying boards, might still best be re-examined, re-designed and
awarded to the benefit of the practitioners and public these boards are intended to endorse and serve. The fact of the matter is
that satisfactory completion of current board certification does not carry the weight or prestige it once represented. Certification
boards might do well to reassess or reframe the reward of Diplomate status on the basis of the achievement of excellence vs.
adequacy that is measured.
intake are essential components of health care for infants and
children who are ill. Pediatric malnutrition is defined as “an imbalance between nutrient requirement and intake, resulting in cumulative deficits of energy, protein, or micronutrients that may negatively affect growth, development, and other relevant outcomes.” It is either illness-related or caused by social/environmental factors that result in decreased nutrient intake. It is classified as acute (less than 3 months) or chronic (greater than 3 months) in duration.
This study evaluates patient responsiveness to an automated text messaging system for pelvic inflammatory disease (PID) self-care
support, and measures the reliability of text-reported adherence.
Design
Patients aged 13-25-years with mild to moderate PID were recruited from urban, academic outpatient settings. Enrolled patients
received antibiotics and were randomized into a standard of care or intervention group. During a 14-day treatment period, participants in the intervention arm received a community-based nursing visit and daily text message medication reminders with evening
prompts to report the number of doses taken.
Result
Of the 97 participants randomized into the intervention arm, 91 (94%) were eligible for analysis. Most were African American and
low income, with a mean age of 18.3 (SD=2.2) years. Participants responded to ~53% (SD=34%) of all dosage inquiry messages.
Responsiveness attenuated at approximately 2.2% per day over the treatment period. Ninety-three percent (n=85) of the analyzed
intervention arm returned for the two-week follow-up. Despite overall adherence and general responsiveness, text-reported and
self-reported medication adherence were not well correlated (r=0.37, p<0.001).
Conclusion
Our findings show that text messaging is a feasible strategy for reaching urban adolescents being managed for complicated sexually transmitted infections in outpatient settings. However, patient responsiveness to self-care text messages do vary, limiting the
adherence monitoring capacity of this technology. Given the number of unanswered text messages and incomplete text-reported
adherence data, additional measures to assess adolescents’ adherence to PID medications are needed in clinical trials.
Congenital oesophageal atresia (COA) refers to a congenitally interrupted oesophagus. It is commonly referred to in the literature
as oesophageal atresia (OA) with or without tracheo oesophageal fistula (TOF) but acquired TOF is a different entity.
Case Report
We present a case of OA with TOF which was not suspected antenatally despite the presence of polyhydramnios. The baby presented with respiratory distress and excessive oral secretions at the age of 3-hours following initiation of breastfeeding. Thorascopic repair was performed on the second day of life. The pre-, intra- and post-operative course was smooth with no major challenges.
There was no associated anomalies in our case following thorough systemic evaluation including brain ultrasound, abdominal
ultrasound, skeletal survey, ophthalmic assessment and echocardiography.
Conclusion
This case demonstrates the importance of maintaining a high index of suspicion for OA when faced with a combination of respiratory distress and persistent frothy oral secretions in a newborn. The antenatal and postnatal diagnostic approaches are discussed
with highlights of associated anomalies and pre-operative assessment and management.
Keywords
Congenital oesophageal atresia (COA); Tracheo oesophageal fistula (TOF); Oesophageal atresia (OA);
Vertebral defects, anal atresia, cardiac defects, renal anomalies and limb abnormalities (VACTERL); Choanal atresia, retardation of
growth, genital abnormalities, and ear abnormalities (CHARGE).
in pediatric dentistry is adequate preparation of its students
or residents to make use of the most effective and safe sedative
agents and combinations for managing the diverse range of noncoping behaviors of pre-cooperative and non-cooperative pediatric patients. The dilemma is complicated by a number of factors.
Foremost is a constricted interval of time in which to acquire sufficient exposure and expertise in both didactic and clinical applications. Having sufficient patient populations reflecting various
levels of patient apprehension, resistance, and dental pathology
has potential to limit student and resident experience is another
complication. Faculty variability with respect to expertise, comfort
level, and firsthand experience making use of a less than diverse
arsenal of agents no doubt has potential impact on resident experience. This is particularly disconcerting where programs have
elected to reduce their armamentariums to the extent that experience is gained exclusively with use of a single medication.
the dilemma of how to maintain the bar of clinical competency while vastly enhancing its membership numbers to pursue board
certification. This editorial seeks to discuss the changes which have occurred historically that has impacted on the nature and
quality of the examination process that is used to determine what constitutes a level of competency for pediatric dentists in the
U.S. For matters of practicality and consistency throughout various disciplines within medicine and dentistry, perceptions have
increasingly moved in the direction that a degree of competency be defined for which the vast majority of providers potentially
qualify. While it would be optimal to set the bar for achievement at the level of excellence, doing such excludes the bulk of practitioners as previously existed in health care during the previous half-century. The need to redefine what sufficiently constitutes
merely an acceptable level of comprehension has become the rule rather than the exception by today’s standards. Recognition of
the achievement of excellence, while beyond the purview of certifying boards, might still best be re-examined, re-designed and
awarded to the benefit of the practitioners and public these boards are intended to endorse and serve. The fact of the matter is
that satisfactory completion of current board certification does not carry the weight or prestige it once represented. Certification
boards might do well to reassess or reframe the reward of Diplomate status on the basis of the achievement of excellence vs.
adequacy that is measured.
intake are essential components of health care for infants and
children who are ill. Pediatric malnutrition is defined as “an imbalance between nutrient requirement and intake, resulting in cumulative deficits of energy, protein, or micronutrients that may negatively affect growth, development, and other relevant outcomes.” It is either illness-related or caused by social/environmental factors that result in decreased nutrient intake. It is classified as acute (less than 3 months) or chronic (greater than 3 months) in duration.