Screening and management of bladder and bowel dysfunction in general pediatric outpatient clinic: a prospective observational study.

BACKGROUND: Bladder and bowel dysfunction (BBD) is a common disorder in children that is often associated with psychosocial and behavioral problems. Data specific to BBD in Asian children are comparatively scarce. Accordingly, this study aimed to investigate the prevalence of BBD and the response to standard urotherapy among Thai children attending the general pediatric outpatient clinic of Siriraj Hospital - Thailand's largest national tertiary referral center.  METHODS: Children aged 4-12 years were recruited to complete the Dysfunctional Voiding Symptom Score (DVSS) questionnaire to screen for BBD during 2018 to 2020. Standard urotherapy, which consists of education and behavior management, was prescribed to those with a DVSS score that suggests the presence of BBD. Enrolled children and their caregivers were followed-up at 3 and 6 months. The Strengths and Difficulties Questionnaire (SDQ) was completed at baseline. DVSS scores at baseline, and at 3 months and 6 months after standard urotherapy were compared using repeated measures analysis of variance (ANOVA). RESULTS: A total of 1,042 children completed the DVSS during the study period, and 90 (8.6%) were deemed to have BBD. The mean age of BBD children was 6.9 ± 2.2 years, and the female to male ratio was 2.9:1. The most common symptoms were defecation frequency (80.0%), difficult defecation (80.0%), curtsying (74.4%), urgency (68.9%), infrequent voiding (43.3%), and daytime incontinence (32.2%). Forty-one BBD children completed the SDQ, and 32.5% had scores suggestive of hyperactivity problems. Among the 24 BBD patients who were followed-up after 3 and 6 months of standard urotherapy, there was a significant improvement in DVSS results (9.5 ± 3.1 at baseline vs. 6.9 ± 3.4 at 3 months vs. 4.4 ± 3.9 at 6 months; p < 0.01). Nine of 12 patients with urinary incontinence showed complete response at 6 months. The overall Bristol stool score significantly improved from 2.6 ± 0.7 at baseline to 3.2 ± 1.0 at 6 months (p = 0.03). CONCLUSIONS: BBD is a prevalent condition among Thai children that is often associated with emotional and behavioral problems. Standard urotherapy prescribed in a general pediatric outpatient clinic setting yielded favorable outcomes in Thai children with BBD.

Disproportionate reduction in respiratory vs. non-respiratory outpatient clinic visits and antibiotic use in children during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic led to improved hygiene and reduced social encounters. Near elimination of the activity of respiratory syncytial virus and influenza viruses were observed, worldwide. Therefore, we assessed the rates of pediatric outpatient clinic visits and medications prescribed at those visits during the coronavirus disease 2019 (COVID-19) pandemic and pre-COVID-19 period (2016-2019). METHODS: Monthly and annual incidence rates for respiratory and non-respiratory diagnoses and dispensed prescription rates were calculated. Acute gastroenteritis (AGE) visits were analyzed separately since the mode of transmission is influenced by hygiene and social distancing. RESULTS: Overall, 5,588,702 visits were recorded. Respiratory and AGE visits declined by 49.9% and 47.3% comparing the COVID-19 and pre-COVID-19 periods. The respective rate reductions for urinary tract infections, trauma, and skin and soft tissue infections were 18.2%, 19.9%, and 21.8%. Epilepsy visits increased by 8.2%. Overall visits rates declined by 21.6%. Dispensed prescription rates of antibiotics and non-antibiotics respiratory medications declined by 49.3% and 44.4%, respectively. The respective declines for non-respiratory antibiotics and non-antibiotics were 15.1% and 0.2%. Clinic visits and prescription rates reductions were highest in April-May, following the first lockdown in Israel. CONCLUSIONS: COVID-19 pandemic resulted in a substantial reduction in respiratory outpatient clinic visits and dispensed respiratory drugs, with only a mild reduction seen for non-respiratory visits. These trends were probably driven by COVID-19 mitigation measures and by the profound disruption to non-SARS COV-2 respiratory virus activity.

National study of continuity clinic satisfaction in pediatric fellowship training.

BACKGROUND: A national online survey was conducted to evaluate pediatric subspecialty fellow satisfaction regarding continuity clinic experience. METHODS: An anonymous online survey (SurveyMonkey™) was developed to evaluate demographics of the program, clinic organization, and patient and preceptor characteristics, and to compare fellow satisfaction when fellows were the primary providers with faculty supervision versus attending-run clinics assisted by fellows or a combination of the two models. Pediatric subspecialty fellows in a 3-year Accreditation Council for Graduate Medical Education accredited program in the United States (excluding emergency medicine, neonatology, and critical care) were invited to participate. RESULTS: There were 644 respondents and nearly half (54%) of these had fellow-run clinics. Eighty-six percent of fellows responded that they would prefer to have their own continuity clinics. Higher satisfaction ratings on maintaining continuity of care, being perceived as the primary provider, and feeling that they had greater autonomy in patient management were associated with being part of a fellow-run clinic experience (all P < 0.001). Additionally, fellow-run clinics were associated with a feeling of increased involvement in designing a treatment plan based on their differential diagnosis (P < 0.001). There were no significant associations with patient or preceptor characteristics. CONCLUSION: Fellow-run continuity clinics provide fellows with a greater sense of satisfaction and independence in management plans.

Use Situation of Supplement and Health Food for Pediatrics Patients in Teikyo University Hospital Pediatrics Outpatient Clinic / 医薬品情報学

  We require our students in the 4th grade to take an on-site pediatric outpatient clinic course at the Teikyo University Hospital as part of a 4-week on-site training program.  This year, 64 trainees divided into groups of 3 or 4 students took the course between June and August.  In the morning, trainees were asked to conduct clinical interviews with 287 patients’ guardians in the presence of trainers.  This was followed by the observation of consultation and treatment services provided to patients.  In the afternoon, students reported the findings obtained in medical interviews, participated in group discussions, and received supplementary lectures from trainers.  After completing the course, students were asked to fill in a questionnaire.  When asked whether they were satisfied with the course, 62.5% and 37.5% of students said “very satisfied” and “satisfied,” respectively, while 64.1%, 29.7%, and 6.2% of students said the observation of consultation and treatment services was “very good,” “good,” and “cannot say which,” respectively.  About the medical interviews, 64.1% and 34.4% said that it is “very good” and “good” to conduct them, while 1.5% said “cannot say which.”  All students said they could determine the problems faced by guardians regarding drugs in the medical interview.  The on-site pediatric outpatient care course was found to be “very useful” and “useful” by 62.5% and 35.9% of patients, respectively, while 1.6% said “cannot say which.”  In conclusion, most students were greatly satisfied with the medical interview with guardians using a questionnaire and said that it made it possible for them to closely communicate with guardians.  This result was thought to be attributable to the use of the techniques of the medical interview OSCE which the students learned prior to conducing medical interviews with guardians.

Validación de un cuestionario autoadministrado para la evaluación del desarrollo psicomotor / Validation of a parent completed developmenal screening questiommaire

Introduction: Psychomotor Development (PMD) is an essential component of health care. Several authors have attempted to facilitate this evaluation through quick and inexpensive tools that do not prolong the time of consult. The "Ages and Stages Questionnaire" (ASQ) is a well-known and validated parent-directed survey. Objective: To evaluate the psychometric validity of ASQ, through comparison with Bayley's Scale of Infant Development (BSID), a universally accepted tool which measures similar parameters, and is administered by an expert. Patients and Methods: Children seen at an upper-middle class Private Clinic in Santiago, Chile were admitted to this study, with the exception of pre-term newborns, or children with known neurological, genetic or metabolic disease. Groups were formed at 8, 18 and 30 months of age. A sample of nearly 40 children per age Group was formed. After parents responded to the ASQ, an expert, blind to the results of the ASQ, evaluated each patient within two weeks. Results: Total number of children enrolled was 119. PMD deficit was scored in 19.3 percent of children according to ASQ, 14.3 percent according to BSID (not significant). While the results obtained with both tests were found to be correlated (r = 0.52), scores obtained through BSID were lower among children with deficit, compared to those rated through ASQ (p < 0.001). The sensitivity of ASQ was 58.8 percent and the specificity was 87.2 percent. Conclusions: Both tests are correlated. ASQ was found to be highly specific, suggesting its use as a screening tool in outpatient clinics, at least in a similar a population. These results should be reevaluated after national validation, to determine cutting points and test potency in all populations.

Introducción: La evaluación del desarrollo psicomotor (DSM) es un componente esencial en la supervisión de salud. Distintos investigadores han buscado formas de facilitar esta evaluación en forma rápida y económica, sin prolongar el tiempo destinado a la consulta pediátrica. El Ages and Stages Questionnaires (ASQ) es un cuestionario de auto-reporte de los padres, validado ampliamente para este fin. Objetivo: Evaluar las propiedades psicométricas del ASQ. Para eso se compara con la Escala de Bayley III de Desarrollo Infantil (BSID), el cual es universalmente aceptado, mide parámetros similares, y es administrado por un experto. Pacientes y Métodos: Estudio transversal analítico. En forma secuencial se enrolaron niños de 8, 18 y 30 meses, de nivel socio económico medio alto, que acudieron a control sano en una Clínica privada de Santiago de Chile. Se excluyeron los nacidos de pretérmino o con enfermedad neurológica, genética o metabólica conocida. Se obtuvo una muestra cercana a 40 niños por grupo etáreo. Tras responder el ASQ, los niños fueron evaluados con la BSID III, por un experto, ciego a los resultados ASQ. La latencia entre ambas evaluaciones no superó las dos semanas. Resultados: Participaron 119 niños. La frecuencia global de déficit de DSM fue de 19,3 por ciento de acuerdo al ASQ y 14,3 por ciento según el BSID (no significativo). El rendimiento promedio del BSID fue inferior en el grupo de niños con déficit según el ASQ comparado con el grupo con ASQ normal (p < 0,001). Se demostró correlación entre ambos test (r 0,52). La sensibilidad del ASQ fue 58,8 por ciento y la especificidad fue 87,2 por ciento. Conclusiones: Se demostró una adecuada correlación entre el ASQ y el BSID. El ASQ resultó altamente específico, por lo que odría ser usado como método de screening del DSM en la consulta pediátrica. Estos resultados deberían ser reevaluados luego de completar la validación nacional, para establecer los puntos de corte y real potencia del teste.