Comparison of Resident and Faculty Screening for Social Determinants of Health in an Academic Pediatric Primary Care Practice.

BACKGROUND: Social determinants of health (SDH) have an important role in children's health and development and should be investigated in pediatric well child care. METHODS: A retrospective chart review of children aged 5-17 at well visits at an urban academic pediatric primary care practice was performed. Chi-square tests of independence and z-test for proportions were used to assess differences between residents and faculty SDH screening.  Results: Faculty screened for SDH more frequently than residents (P<0.05). Residents screened less frequently for food insecurity (P<0.05) and financial insecurity (P<0.05). Financial insecurity was endorsed less frequently by resident families (P<0.05), while school absence was endorsed more frequently by resident families (P<0.05). Referrals to the clinic's community resource desk did not differ between residents and faculty. CONCLUSIONS: Differences exist in screening and need between clinician groups. Despite these differences, there was no difference in community resource desk referrals.

Effects of a Poetry Intervention on Emotional Wellbeing in Hospitalized Pediatric Patients.

BACKGROUND AND OBJECTIVES: The hospital is often a challenging and unfamiliar environment for families. Hospitalization can increase stress and anxiety among children and caregivers. In this study, we are the first to explore the possible therapeutic effects of poetry on hospitalized pediatric patients' emotional wellbeing. PATIENTS AND METHODS: Patients aged 8 to 17 years old admitted to the inpatient pediatric ward and their parents or guardians were eligible for inclusion. With the validated Pediatric Quality of Life Present Functioning Visual Analogue Scales, 6 items were measured before and after the poetry intervention for each participant: fear, sadness, anger, worry, fatigue, and pain in the present moment. The intervention itself consisted of poetry-based reading and writing exercises. Participants and parents also completed an open-ended qualitative survey on their experience. RESULTS: Data from 44 participants were analyzed. Using the Wilcoxon signed rank test, we showed that the poetry intervention had a statistically significant reduction in 5 of the 6 Pediatric Quality of Life Present Functioning Visual Analogue Scales symptom measures: fear (P = .021), sadness (P = .004), anger (P = .039), worry (P = .041), and fatigue (P < .001). Reduction in pain was not statistically significant (P = .092). Six coded themes emerged from qualitative analysis: the poetry intervention facilitated (1) happiness and (2) family involvement, was viewed as a (3) good distraction and (4) screenless activity, and cultivated (5) creativity and (6) self-reflection. CONCLUSIONS: The poetry intervention led to statistically significant reductions in fear, sadness, anger, worry, and fatigue but not in pain. The study reveals promising results and serves as a starting point for future investigations on the therapeutic impact of poetry on hospitalized pediatric patients.

Evaluation of knowledge and comfort with opioid prescribing among pediatric hematology/oncology fellows.

BACKGROUND: Deficits in knowledge and comfort related to pain management have been demonstrated in adult hematology/oncology fellows. No such evaluation has been undertaken in pediatric hematology/oncology (PHO) trainees. PROCEDURE: An IRB-approved survey was administered to PHO fellows throughout the United States (US) to assess comfort with opioid dosing, attitudes related to the use of opioids, and knowledge of basic concepts including weight-based dosing, incomplete cross-tolerance, and management of side effects. RESULTS: Email addresses were obtained for 132 fellows from 37 programs. Seventy-eight (59%) fellows participated. No significant difference was demonstrated between training level and comfort with dosing opioids in an opioid-naive patient, though a smaller proportion of first-year fellows (65%) reported comfort compared to more senior fellows (85.2% of second-year fellows, 80.6% of third- and fourth-year fellows). First-year fellows correctly answered a mean of 5.05 ± 0.43 out of 10 objective knowledge questions; second-year fellows answered 5.74 ± 0.35 correctly, and third- and fourth-year fellows 5.58 ± 0.30. The majority of respondents chose an appropriate dose of intravenous morphine based on weight (92%), and identified a low-dose naloxone drip as an appropriate intervention for opioid-induced pruritis (91%). However, the remainder of the questions had a correct response rate of 15-68%. CONCLUSION: This study characterizes PHO fellows' knowledge and comfort with prescribing opioids. Despite high levels of reported comfort, PHO fellows in all levels of training demonstrated knowledge gaps. PHO fellows may benefit from further education in pain management.

Pupillometry measures of autonomic nervous system regulation with advancing age in a healthy pediatric cohort.

PURPOSE: To determine if variables of the pupillary light response mature with age and sex in a healthy pediatric cohort and the utility of pupillometry in assessment among pediatric participants. METHODS: After 1 min in a dark room to establish baseline, pupillometry was performed on 323 healthy, pediatric participants (646 eyes; 2-21 years; 175 females). Variables included initial pupil diameter, pupil diameter after light stimulus, percent pupillary constriction, latency to onset of constriction, average constriction velocity, maximum constriction velocity, average dilation velocity, and time from light stimulus to 75% of the initial pupil diameter. Data analyses employed ANOVAs and non-linear regressions. RESULTS: Analyses of age group differences revealed that participants 12-21 years old had a larger initial pupil diameter and pupil diameter after light stimulus, with males aged 12-18 years demonstrating a larger pupil diameter than all younger participants (ps < 0.05). Participants 12-18 years old had a slower maximum constriction velocity than participants 6-11 years old, with no sex differences (ps < 0.05). Furthermore, males aged 12-18 years old had a smaller percent constriction than males 6-11 years old (ps < 0.05). Regressions revealed that percent constriction and dilation velocity seemed to mature linearly, initial pupil diameter and ending pupil diameter matured quadratically, and the constriction velocity terms matured cubically. CONCLUSIONS: Results revealed maturation of the pupillary light response by age and sex in healthy pediatric participants. Given the value of the pupillary light response as a biomarker, the results provide normative benchmarks for comparison in health and disease, including opiate-exposed and concussion patients.