Paediatricians' perspectives in treating lower urinary tract symptoms: a qualitative exploratory needs assessment study.

BACKGROUND: Paediatric lower urinary tract symptoms (LUTS) are common experiences among school-aged children, with prevalence rates reaching as high as 20%. Paediatricians are often first-line stakeholders in providing treatment for these bothersome symptoms, yet there is no formal resource to support them with the treatment of LUTS. Evaluating paediatricians' experiences is an important step in informing health promotion efforts to improve health outcomes in children. This study aims to explore paediatricians' knowledge, beliefs, practice patterns, and perceived barriers and facilitators in providing LUTS care. METHODS: In this qualitative study, we conducted semistructured focus groups of paediatricians within California. Focus groups were conducted via Zoom, and participants were enrolled until thematic saturation was reached. Participants were asked about their current practices, knowledge and beliefs, barriers and facilitators to care, training and education, and responsibility for behaviour and action. Thematic analysis was performed using deductive and inductive approaches; themes were mapped through an iterative, team-based process. RESULTS: 15 paediatricians, aged 30-69 years, with 13 (86.7%) women, were interviewed. Most (11, 73.3%) practised in general outpatient settings. Interviewed paediatricians recognised paediatric LUTS as a common problem that can significantly impact children's well-being. In practice, paediatricians did not actively screen for LUTS beyond the potty-training milestone due to short visit duration and competing healthcare demands. Lack of guidelines, parental mistrust and inadequate clinical education were barriers identified by paediatricians. CONCLUSIONS: Paediatricians expressed a willingness to help patients but indicated several limitations to providing adequate LUTS care. Future professional development work can emphasise guideline development, early screening strategies to support timely intervention and better education for clinicians.

Prevalence of pediatric lower urinary tract symptoms in a national claims database of privately insured patients, 2003-2014.

BACKGROUND: We conducted this study to estimate the prevalence of pediatric lower urinary tract symptoms (pLUTS) in a US privately insured pediatric population who are 6-20 years old by age, sex, race/ethnicity from 2003-2014. This has not been previously described in the literature. METHODS: We retrospectively reviewed Optum's de-identified Clinformatics® Data Mart Database between 2003-2014. A pLUTS patient was defined by the presence of ≥ 1 pLUTS-related ICD-9 diagnosis code between the age of 6-20 years. Neurogenic bladder, renal transplant and structural urologic disease diagnoses were excluded. Prevalence by year was calculated as a proportion of pLUTS patients among the total population at risk. Variables reviewed included age, sex, race, geographic region, household factors and clinical comorbidities including attention-deficit/hyperactivity disorder (ADHD), constipation, and sleep apnea. Point of service (POS) was calculated as a proportion of pLUTS-related claims associated with a POS compared to the total claims at all POS in the time period. RESULTS: We identified 282,427 unique patients with ≥ 1 claim for pLUTS between the ages of 6-20 years from 2003 to 2014. Average prevalence during this period was 0.92%, increasing from 0.63% in 2003 to 1.13% in 2014. The median age group of patients was 6-10 years. More patients were female (59.80%), white (65.97%), between 6 and 10 years old (52.18%) and resided in the Southern US (44.97%). Within a single household, 81.71% reported ≤ 2 children, and 65.53% reported ≥ 3 adults. 16.88% had a diagnosis of ADHD, 19.49% had a diagnosis of constipation and 3.04% had a diagnosis of sleep apnea. 75% of pLUTS-related claims were recorded in an outpatient setting. CONCLUSIONS: Families consistently seek medical care in the outpatient setting for pLUTS. The demographic and clinical characteristics of our cohort reflect prior literature. Future studies can help define temporal relationships between household factors and onset of disease as well as characterize pLUTS-related healthcare resource utilization. Additional work is required in publicly insured populations.

Discerning animal-sourced food in diet using isotope analysis of human scalp hair and fingernails.

PURPOSE: Diet-related diseases are advancing as the leading cause of death globally. As self-reporting of diet by patients can be associated with errors, stable isotopes of human tissues can be used to diagnose diseases, understand physiology, and detect change in diet. This study investigates the effect of type and amount of food on the nitrogen and carbon concentration (Nconc and Cconc) and isotopic composition (δ15N and δ13C) in human scalp hair and fingernails. METHODS: A total of 100 residents participated in the study whereas only 74 individuals provided complete diet history. Sixty-six food items majorly available to them were also collected. The Nconc, Cconc, δ15N and δ13C values of human hair, nails and food items were determined. RESULTS: The Nconc, Cconc, δ15N and δ13C values between plant-sourced and animal-sourced food items, as well as human hair and nail tissue were significantly different (p < 0.05). The δ15N value of human tissues was distinct between lacto-vegetarians and omnivores by 0.9‰. The δ15N and δ13C values of human tissues increased by 0.4-0.5‰ with every 5% increase in the consumption of animal protein. CONCLUSIONS: The study helps to demarcate lacto-vegetarians from omnivores, and estimate the percentage of animal protein in diet based on the dual isotope values of human tissues. It also acts as a reference to determine isotopic composition of hair tissue provided the isotope value of nail tissue is known and vice versa.

Utilization and safety of telemedicine for pediatric lower urinary tract symptoms before and during the COVID-19 pandemic.

OBJECTIVES: Telemedicine for pediatric lower urinary tract symptoms (pLUTS) is a relatively new mode of delivering bladder health education with scant evidence supporting current practice. We aim to examine the safety of pLUTS-related telemedicine visits surrounding the COVID-19 pandemic. METHODS: We conducted a retrospective cohort study of new pLUTS referral diagnoses to our institution's pediatric urology clinics. Demographics, wait times, and referral diagnoses were captured and compared before and after March 2020 using χ2 /Fisher exact tests and t-tests. A retrospective chart review was performed for an initial telemedicine visit followed by an in-person visit to identify missed radiology, lab, or physical exam findings. RESULTS: Six hundred twelve patients were included from September 2018 to August 2021. Most were 5-10 years old (62.3%), female (56.2%), English speaking (86.5%), White (39.4%), and had private insurance (67.2%). Wait times were shorter for telemedicine versus in-person visits (t190 = -3.56, p < .001). After March 2020, patients with a urinary tract infection (UTI) and females utilized in-person visits more often (p < .001). After chart review (11 patients, mean = 10.4 years), 9 (81.8%) had comorbid conditions and/or family history of lower urinary tract symptoms. None had missed clinical findings that changed management. CONCLUSIONS: pLUTS care can be delivered via telemedicine without a significant change in patient volume and population, though additional investigations will clarify the needs of patients with specific referral diagnoses and comorbid conditions. The in-person exam can be omitted safely with proper clinical history taking, supporting future virtual programs that address delays in care within local communities.

Prevalence of pediatric lower urinary tract symptoms in a US population seeking medical care, 2003- 2014.

Background: We conducted this study to estimate the prevalence of pediatric lower urinary tract symptoms (pLUTS) in a US privately-insured pediatric population who are 18 years of age or older by age, sex, race/ethnicity from 2003-2014. This has not been previously described in the literature. Methods: We retrospectively reviewed Optum's de-identifed Clinformatics® Data Mart Database database between 2003-2014. A pLUTS patient was defined by the presence of ≥ 1 pLUTS-related ICD-9 diagnosis code between the age of 6-20 years. Neurogenic bladder, renal transplant and structural urologic disease diagnoses were excluded. Prevalence by year was calculated as a proportion of pLUTS patients among the total population at risk. Variables reviewed included age, sex, race, geographic region, household factors and clinical comorbidities including attention-deficit/hyperactivity disorder (ADHD), constipation, and sleep apnea. Point of service (POS) was calculated as a proportion of pLUTS-related claims associated with a POS compared to the total claims at all POS in the time period. Results: We identified 282,427 unique patients with ≥ 1 claim for pLUTS between the ages of 6-20 years from 2003-2014. Average prevalence during this period was 0.92%, increasing from 0.63% in 2003 to 1.13% in 2014. Mean age was 12.15 years. More patients were female (59.80%), white (65.97%), between 6-10 years old (52.18%) and resided in the Southern US (44.97%). Within a single household, 81.71% reported ≤ 2 children, and 65.53% reported ≥ 3 adults. 16.88% had a diagnosis of ADHD, 19.49% had a diagnosis of constipation and 3.04% had a diagnosis of sleep apnea. 75% of pLUTS-related claims were recorded in an outpatient setting. Conclusions: Families consistently seek medical care in the outpatient setting for pLUTS. The demographic and clinical characteristics of our cohort reflect prior literature. Future studies can help define temporal relationships between household factors and onset of disease as well as characterize pLUTS-related healthcare resource utilization. Additional work is required in publicly-insured populations.

Assessment of readability and quality of patient education materials specific to nocturnal enuresis.

BACKGROUND: Bedwetting, or nocturnal enuresis (NE), is a common childhood disease. Families increasingly turn to free online resources for health education in order to navigate treatment options. OBJECTIVE: We aim to determine the readability and quality of online health information that families may encounter when searching for information on pediatric NE. STUDY DESIGN: The search term 'bedwetting' was queried in commonly used search engines. Included articles were further categorized as institutional/reference, commercial, non-profit/charitable, or personal. An online readability platform calculated 3 commonly used readability assessments as well as a consensus score. Quality was assessed by two independent pediatric urologists using a validated DISCERN instrument. Differences in readability were further assessed by article category type. RESULTS: 36 websites were reviewed, 3 did not include treatment options and were not included in quality assessment. 55.6% of the articles were categorized as institutional/reference, 27.8% as non-profit/charitable, 11.1% as personal, and 5.6% as commercial. The average, standard deviation, and range of readability level were as follows: overall consensus score = 9.56 ± 2.09, FK Grade Level Formula score = 9.38 ± 2.17 (range 5.8-14.1), SMOG Index score = 8.89 ± 1.79 (range 6.4-12.9), and the GF Index score = 11.86 ± 2.34 (range 8.4-16.9). The overall consensus score, 9.56, correlates to a 9th-grade reading level. 16 articles were considered to be of 'good' quality, 12 of 'fair' quality, and 5 of 'poor' quality; according to the DISCERN scoring. There was no statistically significant difference in readability scores across website categories. Two articles included the outdated treatment option of intranasal DDAVP. DISCUSSION: These findings are concordant with the increasing body of literature demonstrating that patient education materials are too difficult to read. Pediatric urologists should be aware of the readability and quality of available online content for common clinical presentations. They can ensure that institutional articles online are useful to patients by participating in the development and design of these materials. CONCLUSION: We demonstrated that online articles that families encounter via a search engine query for bedwetting are written at a higher level than recommended and the majority are of 'fair' quality. There is much room for improvement for institutions to provide high quality, readable content that supports the needs of families seeking information on NE.

Surgical Experience in Pediatric Patients with Chiari-I Malformations Aged ≤18 Years.

OBJECTIVE: The objective of this study was to retrospectively study Chiari I malformation patients (<18 years) treated surgically. MATERIALS AND METHODS: Chiari I malformation patients (<18 years) treated surgically at our institute were retrospectively studied. RESULTS: During the study period between January 1999 and June 2011, fifty patients, aged ≤18 years with Chiari malformation, were treated surgically and formed the basis for this series. There were 21 female children (42%) and 29 male children (58%), with a female-to-male ratio of 1:1. At the last follow-up, oropharyngeal symptoms were improved in 33% (n = 3/9). Headache/neck/back pain improved in 69.56% of children (n = 16/23). Upper-extremity pain/weakness/numbness improved in 73.91% of children (n = 17/23). Ataxia improved in 66.66% of children (n = 4/6). Lower-limb weakness/hyperreflexia improved in 83.33% of children (n = 5/6). At follow-up, magnetic resonance imaging for patients with syrinx was available for 75% of patients (n = 30/50) and not available for 25% of patients (n = 10/40). Syrinx was diminished in size or resolved in 66.33% of patients (n = 19/30) and the remaining was same for 36.66% of patients (n = 11/30). CONCLUSIONS: The main goal of surgery is to arrest the progression of neurological deficits. Foramen magnum decompression with a lax duroplasty is the surgical procedure of choice.

Medial Sural Artery Perforator Flap for Head and Neck Reconstruction.

AIM: The aim is to study the assessment of feasibility of medial sural artery perforator (MSAP) free flap for head and neck reconstruction at our center. MATERIALS AND METHODS: Oral cancer patients with squamous cell carcinoma of the tongue, buccal mucosa, and floor of mouth cancer attending our center were reconstructed using MSAP flap after oncologic resection. Handheld 8 MHz Doppler was used to identify the perforator preoperatively. RESULTS: We reconstructed 10 patients using MSAP flap. The flap was designed according to defect and donor site was primarily closed in all cases. Excellent results were seen in nine patients reconstructed with MSAP flap without any postoperative complication. Flap failure occurred in one patient due to venous thrombosis. The thickness of flap ranged from 4 to 8 mm. The vascular pedicle length ranged from 9 to 13 cm. CONCLUSION: The MSAP flap is appropriate for medium-sized oral defect reconstruction, with a long pedicle of matching caliber, adequate tissue volume, and minimal donor-site morbidity which makes it comparable to other microvascular free flaps such as radial artery free flap (RAFF) and anterolateral thigh flap.

A Rare Presentation of Synovial Sarcoma as Cervical Lymphadenopathy in a Pediatric Patient-a Case Report.

Synovial sarcoma is the uncommon malignant tumor of children and adolescents. It usually involves the soft tissues of the upper and lower joints and most commonly affects adults in their fourth decade of life. We report a rare case of synovial sarcoma of the head and neck region in a five-year-old child who has presented with right side cervical lymphadenopathy associated with dysphagia and hoarseness of voice. Patient was managed by modified radical neck dissection followed by chemotherapy.

Surgical management of masseteric hypertrophy and mandibular retrognathism.

Masseter hypertrophy is a rare condition. It is mostly idiopathic with no known cause. It is recognized as an enlargement of one or both masseter muscles. Most patients complain of facial asymmetry; however, symptoms such as trismus, protrusion, and bruxism may also occur. This article reports a case of bilateral masseter hypertrophy with retrognathic mandible in which comprehensive treatment was rendered to the patient by using a combination approach.