Prevalence of COVID-19 and Risk Factors for Infection Among Pediatric Anesthesia Patients: A Report From the PEACOC Research Network.

BACKGROUND: The Pediatric Anesthesia COVID-19 Collaborative (PEACOC) is a research network to advance the care of children during the pandemic. Here we calculate the prevalence of coronavirus disease 2019 (COVID-19) among children undergoing anesthesia, look at prevalence in the population data from the Centers for Disease Control and Prevention (CDC), and assess independent risk factors for infection. METHODS: This was a multicenter, retrospective, observational study. Children aged 28 days to 18 years scheduled for anesthesia services at 12 centers requiring universal COVID-19 testing from March 29, 2020 to June 30, 2020 were included. COVID-19 positivity rates among those tested were plotted and trends were assessed using the Cochran Armitage test of trend. Independent risk factors were explored using multivariable logistic regression. RESULTS: Data were collected and analyzed on 33,320 anesthesia encounters including 265 children with COVID-19. Over the study period, the rates of infections in the pediatric anesthesia population did not demonstrate a significant trend. In the general population, there was a significant downward trend in infection rates ( P < .001). In exploratory analysis, multivariable risk factors for a COVID-19 positive test were Black/African American race, Hispanic ethnicity, American Society of Anesthesiologists (ASA) physical status III or above, overweight and obese body mass index (BMI), orthopedic cases, abdominal cases, emergency cases, absence of injury and trauma, and West region (all P < .05). CONCLUSIONS: Rates of COVID-19 in pediatric anesthesia patients were consistently lower than in the general population. Independent risk factors of a positive test for children were identified. This is the first time universal testing for a single infectious disease was undertaken on a wide scale. As such, the association of infection with surgical case type or emergency case status is unprecedented.

Bronchoscopy for removal of foreign body: What's the big deal?

Foreign bodies of the airway are common occurrences in the pediatric population. Children requiring anesthesia for removal of airway foreign bodies can present many challenges. In this case, the patient required urgent removal of a foreign body while symptomatic with upper and lower respiratory symptoms. Circumstances such as these can result in higher intraoperative and postoperative complications. This presentation describes the clinical decision-making process and the discussion of common modalities for diagnosis, treatment, and anesthetic management.

Minimizing Post-Intensive Care Syndrome to Improve Outcomes for Intensive Care Unit Survivors.

TOPIC: Post-intensive care syndrome is a collection of symptoms that more than half of patients who survive a critical illness, and their family caregivers, experience after the illness. Those symptoms include weakness/ fatigue, sleep disturbances/insomnia, cognitive dysfunction, posttraumatic stress disorder, other mental health conditions, and a lack of effective coping strategies. CLINICAL RELEVANCE: To minimize the risk of a patient developing post-intensive care syndrome, intensive care unit nurses must adopt practices that reduce the severity of disability and optimize patient outcomes. They must also advocate for patients who need additional expert care. PURPOSE: To describe interventions that critical care nurses can implement to minimize a patient's risk for post-intensive care syndrome. CONTENT COVERED: This article describes patients who have a high risk of developing post-intensive care syndrome and interventions that are within nurses' purview.

Social work education and training in mental health, addictions and suicide: a scoping review protocol.

INTRODUCTION: Social workers are among the largest group of professionals in the mental health workforce and play a key role in the assessment of mental health, addictions and suicide. Most social workers provide services to individuals with mental health concerns, yet there are gaps in research on social work education and training programmes. The objective of this scoping review is to examine literature on social work education and training in mental health, addictions and suicide. METHODS AND ANALYSIS: Using a scoping review framework developed by Arksey and O'Malley, we will search for literature through seven academic databases: PsycINFO, Sociological Abstracts, CINAHL Plus, Social Sciences Abstracts, Education Source, ERIC and Social Work Abstracts. Two independent reviewers will screen articles utilising a two-stage process. Titles and abstracts will be reviewed in the first stage and full texts will be reviewed in the second stage. Selected articles that meet inclusion criteria will be charted to extract key themes and they will be analysed using a qualitative thematic analysis approach. ETHICS AND DISSEMINATION: This review will fill a knowledge gap in social work education and training in mental health, addictions and suicide. Ethics approval is not required for this scoping review. Through dissemination in publications and relevant conferences, the results may guide future research and education in social work.

Happiness When the Body Hurts: Achieving Well-Being in Chronic Health Conditions.

This article provides a framework for understanding the application of positive psychology, in particular, Seligman's PERMA, in the context of chronic childhood illness. In particular, inflammatory bowel disease is a chronic illness that is often associated with social and emotional challenges for youth diagnosed with this lifelong condition. Specific disease factors that seemingly work against happiness are explained, and traditional notions of happiness are discussed and redefined. With PERMA as a guide, adult caregivers (eg, psychiatrists, psychologists, parents, gastroenterologists) can help youth living with chronic illness practice acceptance, adjust expectations, and find meaning, fulfillment, and psychological well-being.

Participation and attrition in a coping skills intervention for adolescent girls with inflammatory bowel disease.

The current study examined factors associated with adolescent and parent participation in a coping skills intervention for adolescent girls with inflammatory bowel disease (IBD) and examined factors associated with attrition related to intermittent missing data. Thirty-one adolescent girls with IBD and their parents enrolled in the intervention. Psychosocial and disease factors related to participation in the 6-week web component of the coping skills intervention were examined as were baseline group differences between those who provided post-treatment data and those who did not. Adolescents experiencing more difficulties related to their disease and psychosocial functioning participated less in the web component of the treatment intervention. Families who attrited had higher baseline levels of parental catastrophic thoughts, parenting stress, and adolescent depression. Families experiencing greater levels of psychological and disease-related difficulties may be at risk for low participation and eventual dropout from pediatric IBD psychological treatment interventions.

Coping skills for reducing pain and somatic symptoms in adolescents with IBD.

BACKGROUND: The current study involved the development and evaluation of a skills-based, psychological intervention for adolescent females with inflammatory bowel disease (IBD) and their parents. Psychological interventions were used to improve coping with pain and other somatic physical symptoms, as well as improve parental responses to children and adolescents who experience such symptomatology. METHODS: Thirteen and 11 adolescent females and one of their parents made up the treatment and wait-list control groups, respectively, for a total of 24 parent-child dyads. Adolescents and parents attended a 1-day intervention that taught disease-related coping skills, pain management, relaxation techniques, communication, and limit setting (parents only). The treatment day was followed by 6 weeks of Web-based skill review including homework assignments and weekly group chat sessions. RESULTS: Following treatment, significant improvements were found in adolescents' somatic symptoms and adaptive coping strategies. Further, parents reported reductions in irrational thoughts and improved behavioral reactions related to their daughter's physical symptoms. Implications of these findings, as well as limitations and future directions, are discussed. CONCLUSION: Overall, preliminary support suggests that programmatic psychosocial interventions for reducing physical symptoms and improving coping may be beneficial for adolescents with IBD and their families.

Medication barriers predict adolescent transplant recipients' adherence and clinical outcomes at 18-month follow-up.

OBJECTIVE: To prospectively validate the Parent and Adolescent Medication Barriers Scales (PMBS and AMBS) for assessing perceived barriers to medication adherence in adolescent transplant recipients by examining the relations of perceived barriers to medication adherence and clinical outcomes at 18-month follow-up. METHODS: Of the 82 adolescent recipients enrolled in the initial cohort, 66 families participated in the follow-up. Relations among barriers, adherence, and clinical outcomes were examined. RESULTS: Reported barriers demonstrated temporal stability over an extended span of time. Adolescent-perceived barriers of Disease Frustration/Adolescent Issues and parent-perceived barriers of Regimen Adaptation/Cognitive Issues were associated with poorer adherence to medication taking at follow-up. Interestingly, medical complications and mortality were significantly associated with both parent and adolescent-perceived ingestion issues barriers. CONCLUSIONS: Barriers to adherence are essential to address in an effort to ameliorate adherence difficulties and potentially reduce the incidence of medical complications.

Increasing parent-pediatrician communication about children's psychosocial problems.

OBJECTIVE: To examine the differential effects of two scoring procedures for a parent-completed measure, the Pediatric Symptom Checklist (PSC), designed to assess children's behavioral and emotional functioning, on parent-pediatrician communication concerning psychosocial issues. METHODS: Prior to their medical appointment, 174 parents of children aged 4-16 were assigned to one of three experimental conditions: (1) typical medical care control, (2) Staff-Scored PSC administration, or (3) Parent-Scored PSC administration. Following the appointment, parent perception of parent-pediatrician communication was assessed. RESULTS: For children with more emotional and behavioral problems, participants in the Parent-Scored group and the Staff-Scored group had better parent-pediatrician communication scores than those in the control group. CONCLUSIONS: Both the Staff-Scored and Parent-Scored administrations of the PSC improved parent-pediatrician communication on psychosocial issues. The Parent-Scored PSC removed the scoring burden on the medical personnel.

Carbonic anhydrase-inhibiting medications and the intracarotid amobarbital procedure in children.

The intracarotid amobarbital procedure (IAP) is routinely conducted as part of the presurgical evaluation of pediatric patients with epilepsy. The aim of the present study was to investigate the possibility that anesthetization failures are the result of interactions of carbonic anhydrase-inhibiting (CAI) medications with sodium amobarbital. An archival review of 81 cases conducted between 1999 and 2008 was performed across two pediatric epilepsy centers. chi(2) analysis was used to assess whether CAI medications interfered with the outcome of these procedures. Of 81 patients, 85.2% had conclusive findings. All of the remaining 14.8% with anesthetization failures were taking CAI medications at the time of the procedure. However, 53.8% of patients taking CAI medications had conclusive results. This suggests that these medications may interact with sodium amobarbital, raising the possibility of anesthetization failures in children prescribed CAI medications.

Regionally specific cortical thinning in children with sickle cell disease.

Sickle cell disease (SCD) is a chronic disease with a significant rate of neurological complications in the first decade of life. In this retrospective study, cortical thickness was examined in children with SCD who had no detectable abnormalities on conventional magnetic resonance imaging/magnetic resonance angiography. Regional differences in cortical thickness from SCD were explored using age-matched healthy controls as comparison. A comparison analysis was done for SCD (n = 28) and controls (n = 29) based on age (5-11; 12-21 years), due to the age-dependent variation in cortex maturation. Distinct regions of thinning were found in SCD patients in both age groups. The number, spatial extent, and significance (P < 0.001) of these areas of thinning were increased in the older SCD group. Regions of interest (ROIs) were defined on the areas of highly significant thinning in the older group and then mapped onto the younger cohort; a multiparametric linear regression analysis of the ROI data demonstrated significant (P < 0.001) cortical thinning in SCD subjects, with the largest regions of thinning in the precuneus and the posterior cingulate. The regionally specific differences suggest that cortical thickness may serve as a marker for silent insults in SCD and hence may be a useful tool for identifying SCD patients at risk for neurological sequelae.

Parent and patient perspectives on barriers to medication adherence in adolescent transplant recipients.

The aim of this study was to identify barriers to medication adherence in adolescent transplant recipients. Eighty adolescent transplant recipient families reported in an open-ended manner about barriers to medication adherence. These responses were then coded to reflect potentially important themes associated with medication adherence. The themes derived included: forgot/distracted, poor planning/scheduling issues, physical barriers/medication issues, and voluntary resistance/attempts to be normal. Inter-rater reliability for barrier coding was very high (k = 0.91). Patients who were classified as non-adherent reported significantly more overall barriers, more forgot/distracted barriers, and more voluntary resistance/attempts to be normal barriers than those classified as adherent. Non-adherence was also found to be more likely when adolescents, as opposed to parents, were responsible for administering the medication. Further, non-adherence was more likely when taking morning rather than evening doses. These findings are explained with an emphasis on potential remedies that directly address the stated barriers.