Evaluating the use of laparoscopic-assisted gastrostomy tube feeding in children with epidermolysis bullosa: A single-center retrospective study.

BACKGROUND: Nutritional management of children with epidermolysis bullosa (EB) presents multiple challenges including reduced oral intake compounded by mucosal fragility. Gastrostomy tube feeding is effective in improving nutritional status however there is limited data on the safety and tolerance of this technique in EB children. We aim to review the effectiveness and morbidity of our minimally invasive two-port laparoscopic-assisted gastrostomy (LAG) approach using Seldinger techniques with serial dilatations in children with EB. METHODS: A retrospective, observational cohort study was conducted on all consecutive EB patients who underwent LAG tube insertion between 2009 and 2019. Patient demographics, admission details and 12-month clinical outcomes were reported. RESULTS: 32 EB patients underwent LAG placement. Median age at insertion was 7.3 (IQR ± 6.3) years, with 8 (25.0%) and 3 (9.4%) of patients also undergoing oesophageal dilatation and fundoplication, respectively. Minor complications arose in 58.1% of patients including: peri-stomal overgranulation (25.8%), gastrostomy infection (22.6%), pain (22.6%), mild gastrostomy leakage (16.1%), blockage (9.7%) and device failure (3.2%). 2 patients (6.5%) developed major complications with extensive gastrostomy site leakage. Improvements in growth were reflected in mean height Z-scores (-1.99 to -1.71). Mean weight Z-scores improved in patients aged 0-10 years (-2.30 to -1.61) and mean BMI Z-scores increased in patients more than 10 years (-2.71 to -1.46). No cases of gastrostomy-related mortality were reported. CONCLUSION: LAG is well-tolerated in EB patients with improvements in growth and minimal morbidity 12-months post-gastrostomy insertion. An extended follow-up period is required to ascertain the long-term implications of gastrostomy feeding.

Supporting choices about HIV disclosure in the workplace: A cross-Canada survey of strategies.

BACKGROUND: People living with human immunodeficiency virus (HIV) often make highly personal decisions about whether or not to disclose their HIV status in the workplace. OBJECTIVE: We aimed to determine current practices that support people living with HIV to make workplace disclosure decisions and to understand factors that affect disclosure decision-making. METHODS: Ninety-four people who provide health, social and peer-based services responded to an on-line survey about their experiences supporting workplace disclosure decisions of employees living with HIV. RESULTS: Respondents identified a range of strategies to support workplace disclosure decision-making. One-third of respondents were only a little or not confident in their abilities to support people in making disclosure decisions and 32% expressed little or no confidence in the resources available. Respondents working at HIV-specific organizations, as compared to respondents not working at those organizations, were more confident supporting people with disclosure decisions and in available resources, p < .05. Perceived barriers to disclosure decisions included stigma, lack of knowledge, and personal factors. Supports for decision-making resided within personal, workplace and societal contexts. CONCLUSIONS: The study provides important understanding about the complexity of disclosure decision-making and strategies that people living with HIV can use to address this complex issue.

Modified Ride-on Cars as Early Mobility for Children with Mobility Limitations: A Scoping Review.

Aim: This study aims to systematically examine and map current available evidence describing the benefits of modified ride-on car use for young children with mobility limitations and identify potential applications to occupational and physical therapy practice while illuminating gaps in knowledge to be explored in future research. Methods: An electronic database search, manual search of bibliographies, contact with existing networks and organizations were used to identify all relevant literature. Studies addressing modified ride-on toy use by children ≤6 years old with identified mobility delays were included. Data were extracted and analyzed independently by the investigators using a standardized process. Results: Thirteen case studies and one case controlled study involving children ≤6 years old with a variety of diagnoses were included in the review. Studies were at the activities and participation levels and focused on mobility, interpersonal interactions and relationships, communication, and Community, Social, and Civic Life. Conclusion: Findings support the use of modified ride-on cars as a form of early mobility to encourage the development of social-emotional and mobility skills in young children with mobility limitations. Future research with valid, reliable outcome measures that address changes in developmental levels across domains is indicated.

Use of Living Strategies among Adults Aging with HIV in Canada: Comparison by Age-Group Using Data from the HIV, Health and Rehabilitation Survey.

OBJECTIVE: To examine the type and frequency of living strategies used by adults living with HIV. METHODS: We conducted a cross-sectional web-based survey that included 51 living strategies: maintaining sense of control, attitudes and beliefs, blocking HIV out of the mind, and social interaction. We examined the frequency of use and compared the proportion of respondents who engaged in strategies across 3 age-groups (<40 years, 40-49 years, and ≥50 years). RESULTS: Of the 935 participants, the majority were men (79%) and most (≥60%) engaged "most" or "all of the time" in healthy lifestyle strategies and maintained a positive outlook living with HIV. Compared to younger participants, a higher proportion of older adults (≥50 years) engaged "most" or "all the time" in strategies that involved maintaining control over health and adopting positive attitudes and outlook living with HIV. CONCLUSIONS: Findings can help to inform the role of self-management to enhance successful aging with HIV.