Supporting the transition to senior pediatric resident: an interactive online resource.

Transitions to roles with increasing clinical responsibility and independence can be anxiety provoking for many trainees. To support our pediatric residents preparing to transition from the role of junior to senior resident, we developed a novel asynchronous online interactive case-based resource. Our experience suggests that this resource was voluntarily utilized and can effectively increase trainee confidence and reduce anxiety about this key transitional stage. We suggest that interactive case-based resources can be utilized as supplemental support for residents preparing for residency transitions in other programs and settings.

La transition vers des rôles comportant des responsabilités cliniques et une autonomie plus importante peut provoquer de l'anxiété pour de nombreux stagiaires. Pour soutenir nos résidents en pédiatrie qui se préparent à passer du rôle de résident junior à celui de résident senior, nous avons créé une nouvelle ressource interactive en ligne, asynchrone, qui est basée sur une étude de cas. Notre expérience suggère que cette ressource a été utilisée sur une base volontaire et qu'elle peut effectivement accroître la confiance des stagiaires et réduire l'anxiété liée à cette étape clé de leur parcours. Nous estimons que les ressources interactives basées sur des cas peuvent être utilisées à titre complémentaire pour aider les résidents à préparer leurs transitions dans d'autres programmes et contextes de résidence.

Residency training experiences of residents with children: A phenomenological study.

Parenthood during postgraduate medical training has become an increasingly relevant topic in recent years. While previous research has attempted to explore the experiences of residents in a parenting role through surveys and limited qualitative studies, an in depth understanding of the postgraduate training experience of these parent residents has not been clearly described. The optimal means of supporting trainees completing residency while parenting remains unclear. The study aim was to develop a rich understanding of the residency training experience of residents in a parenting role. We conducted 15 semi-structured telephone interviews. Our study population included postgraduate trainees from 9 different programs from a large research-intensive university who were parents upon entry to residency or who became parents during residency training. Transcendental phenomenology was used as a qualitative research methodology, guided by life course theory. Thematic analysis of residents' training experiences revealed the following themes: 1) challenges of being a parent with residency responsibilities; 2) work-life balance; 3) support systems; 4) impact on patient interactions; 5) impact on other interactions; and 6) unspoken expectations. Participants suggested actionable solutions to improve the training experience for residents in a parenting role, which included: 1) family-inclusive events; 2) scheduling flexibility; 3) support for fathers; and 4) optimizing support for breastfeeding mothers. Residents in a parenting role represent a unique postgraduate trainee population. Despite focus on resident wellness, challenges remain for individuals trying to navigate parenthood and residency. This data may be utilized to inform support and strategies to optimize the training experiences of these residents.

Duodenal Bulb Histology in Paediatric Celiac Disease: A Case-Control Study.

BACKGROUND: Controversy exists about optimal methods for duodenal biopsy in diagnosis of celiac disease (CD), in terms of both number of samples and anatomic location. The reliability of duodenal bulb biopsy has been questioned given that normal bulb architecture may mimic disease. However, multiple studies have reported patients with CD have histopathological lesions limited to proximal changes in the duodenal bulb alone. METHODS: We retrospectively compared duodenal and duodenal bulb histology in a population of paediatric patients with CD and compared with a population of nonceliac controls at Stollery Children's Hospital, 2010 to 2012. RESULTS: Fifty-seven paediatric patients diagnosed with CD and 16 nonceliac controls were included in the study. Fifty-three celiac patients (93.0%) had histopathology consistent with CD (modified Marsh score of 3A, 3B or 3C) in the duodenal bulb. The modified Marsh classification differed significantly between duodenum and duodenal bulb in nine celiac patients (15.8%). Of these, five (8.8%) had Marsh 3 in the bulb and Marsh 0 in the distal duodenum. Among controls, no patients had villous atrophy in either the distal duodenum or duodenal bulb, and all patients had a modified Marsh score of 0 at both sites. CONCLUSIONS: The results of this study reinforce that duodenal bulb samples are critically important for diagnosing CD in paediatric patients. We suggest that duodenal bulb samples be submitted in separate containers from distal duodenal samples to facilitate accurate interpretation. In contrast to prior reports, we found villous blunting and intraepithelial lymphocytosis are actually uncommon findings in paediatric patients with nonceliac gastrointestinal disorders.

Prediction of esophageal and gastric histology by macroscopic diagnosis during upper endoscopy in pediatric celiac disease.

AIM: To determine the sensitivity of macroscopic appearance for predicting histological diagnosis at sites other than duodenum in pediatric celiac disease (CD). METHODS: Endoscopic and histologic findings in pediatric patients undergoing upper endoscopy for first-time diagnosis of CD at Stollery Children's Hospital from 2010-2012 were retrospectively reviewed. RESULTS: Clinical charts from 140 patients were reviewed. Esophageal and gastric biopsies were taken in 54.3% and 77.9% of patients, respectively. Endoscopic appearance was normal in the esophagus and stomach in 75% and 86.2%. Endoscopic esophageal diagnoses were eosinophilic esophagitis (EE) (11.8%), esophagitis (7.9%), glycogenic acanthosis (1.3%) and non-specific abnormalities (3.9%). Endoscopic gastric diagnoses were gastritis (8.3%), pancreatic rest (0.9%), and non-specific abnormalities (4.6%). Histology was normal in 76.3% of esophageal and 87.2% of gastric specimens. Abnormal esophageal histology was EE (10.5%), esophagitis (10.5%), glycogenic acanthosis (1.3%) and non-specific (1.3%). Gastritis was reported in 12.8% of specimens. Sensitivity and specificity of normal endoscopy for predicting normal esophageal histology was 86.2% and 61.1%, and for normal gastric histology was 87.4% and 21.4%. CONCLUSION: In the absence of macroscopic abnormalities, routine esophageal and gastric biopsy during endoscopy for pediatric CD does not identify major pathologies. These findings have cost and time saving implications for clinical practice.

Indications and outcomes in children receiving renal replacement therapy in pediatric intensive care.

PURPOSE: We aimed to describe patient characteristics, indications for renal replacement therapy (RRT), and outcomes in children requiring RRT. We hypothesized that fluid overload, not classic blood chemistry indications, would be the most frequent reason for RRT initiation. MATERIALS AND METHODS: A retrospective cohort study of all patients receiving RRT at a single-center quaternary pediatric intensive care unit between January 2004 and December 2008 was conducted. RESULTS: Ninety children received RRT. The median age was 7 months (interquartile range, 1-83). Forty-six percent of patients received peritoneal dialysis, and 54% received continuous renal replacement therapy. The median (interquartile range) PRISM-III score was 14 (8-19). Fifty-seven percent had congenital heart disease, and 32% were on extracorporeal life support. The most common clinical condition associated with acute kidney injury was hemodynamic instability (57%; 95% confidence interval [CI], 46-67), followed by multiorgan dysfunction syndrome (17%; 95% CI, 10-26). The most common indication for RRT initiation was fluid overload (77%; 95% CI, 66-86). Seventy-three percent (95% CI, 62-82) of patients survived to hospital discharge. CONCLUSIONS: Hemodynamic instability and multiorgan dysfunction syndrome are the most common clinical conditions associated with acute kidney injury in our population. In the population studied, the mortality was lower than previously reported in children and much lower than in the adult population.