Functional Constipation: A Case Report.

Constipation is one of the most common chronic disorders in childhood. Functional constipation (FC) is the most common form of constipation and can be defined as difficult or infrequent passage of stool. Current practice guidelines for FC are well defined; however, primary provider perception and treatment often differ from clinical practice guidelines. Early diagnosis and appropriate treatment are vital in improving overall outcomes. Primary care providers should be knowledgeable about the diagnosis, initial treatment, and when to refer a child to a gastroenterology specialist. This case report will highlight diagnostic guidelines and treatment of FC in the pediatric population.

Use of text messaging to improve patient experience and communication with pediatric tonsillectomy patients.

OBJECTIVES: The aims of this quality improvement project were to develop a text messaging service to deliver messages to pediatric tonsillectomy patients to improve communication and overall experience. METHOD: Text messages were developed to deliver important information and reminders both preoperatively and postoperatively to pediatric tonsillectomy patients. After success with a small pilot program of five patients, a sample of 85 patients who underwent tonsillectomy participated in the program. RESULTS: Similar to the pilot program, the larger sample size had no canceled procedures and no visits to the emergency department. Approximately 25% of the participants called the ENT clinic nurse line for a question or concern postoperatively. The majority of phone calls were for concerns with pain or pain medications. Parental survey results were positive with respect to the value and overall helpfulness of the text messages. Respondents found the information useful, easy to understand, and it also helped reduce anxiety or level of worry during and after the surgery. Respondents all felt that the number of messages was just right. CONCLUSION: With the explosion of technology and smartphone use, text messaging is an innovative way to provide patient/family education for surgical procedures such as tonsillectomy.

Diagnosis and management of pediatric sinusitis: A survey of primary care, otolaryngology and urgent care providers.

OBJECTIVES: The aims of this project were two-fold: 1) To assess pediatric primary care (PCP), pediatric otolaryngology (ENT) and pediatric urgent care (UC) providers' perception of their adherence to the 2013 American Academy of Pediatrics (AAP) established guidelines for the diagnosis and management of acute bacterial rhinosinusitis (ABRS) in children 1-18 years old and 2) to assess the same providers' practice patterns in the diagnosis and management of pediatric chronic rhinosinusitis (PCRS). METHOD: A 21-item questionnaire (CVI .9) was designed by th investigators using Survey Monkey®. The survey was emailed to pediatric providers (including physicians and advanced practice providers) in a Midwestern USA healthcare system (94 PCP, 25 UC, 19 ENT providers) from 20 pediatric primary care practices, 1 pediatric UC practice and 1 pediatric otolaryngology practice. RESULTS: Diagnosis: The following diagnostic criteria are utilized: persistent nasal congestion/cough lasting >10 days (95%), worsening of classic viral URI symptoms at days 5-7 (70%), severe onset and purulent nasal discharge for at least 3 consecutive days (45%). ENT will most commonly culture their patients. ENT providers (57%) approve of a nasal culture being obtained by PCPs. MANAGEMENT: Typically used antibiotics: amoxicillin (72%), Amoxicillin-clavulanic acid (98%), cefdinir (73%), azithromycin (15%). ENT providers will also use clarithromycin and Bactrim more often compared to PCPs. For PCN allergy patients, most providers choose cefdinir. Typical length of antibiotic therapy for providers is 10 days (70%) and 14 days (17%); ENT (21%) prescribes 7 days past any symptom compared to PCP (6%) and UC (5%). Use of adjuvant therapy is variable among the groups. CONCLUSION: This quality initiative project demonstrates that providers' diagnosis of ABRS is consistent with the 2013 AAP guidelines while variation in clinical management exists for both ABRS and PCRS. This survey demonstrates the need to educate all providers on the current 2013 AAP guidelines and define practice across all settings.

A Pilot Program: Using Text Messaging to Improve Timely Communication to Tonsillectomy Patients.

Approximately 1,500 tonsillectomies are performed annually at a large pediatric academic medical center each year. Families need to be educated on how to care for their child after this surgery. Most tonsillectomy patients are discharged home either the same day as surgery or after one night of observation, resulting in post-operative tonsillectomy recovery and care falling upon the patient's family. Multiple quality improvement efforts to improve family education post tonsillectomy surgery have been performed over the last several years at a large pediatric academic medical center. None of these efforts, however, have focused on the use of technology to provide innovative patient education. The purpose of this project is to provide information to parents via text messages and videos to improve patient experience and outcomes following tonsillectomy. Families provided positive feedback, including that the texts were helpful, easy to understand, and reduced pre-operative and recovery anxiety. Also, none of these families needed to call the ENT clinic for any other questions or concerns. The recovery from tonsillectomy is not easy and this pediatric otolaryngology practice is always searching for new ways to improve care and education. Use of technology is an innovative approach and likely one that will be used more often in the future.