Pediatric Care (pediatric + care)

Distribution by Scientific Domains

Selected Abstracts

Pediatric Interventional Cardiology in the United States is Dependent on the Off-label Use of Medical Devices

Jamie S. Sutherell MD
ABSTRACT Objective., A substantial unmet medical device need exists in pediatric care. As a result, the off-label use of approved devices is routine in pediatric interventional cardiology, but the extent and nature of this practice has not been previously described. The purpose of this study, therefore, is to evaluate the prevalence and nature of off-label cardiac device use in an active pediatric interventional program in the United States. Study Design., This study is a retrospective review of all interventional cardiac procedures performed at our institution from July 1, 2005 to June 30, 2008. Diagnostic (noninterventional) catheterizations, myocardial biopsies, invasive electrophysiology studies, and studies involving investigational devices were excluded. Interventions performed were compared with the manufacturer's labeled indications for each device. Results., During this 3-year period, 473 patients (median age 4.1 years) underwent 595 transcatheter interventions. An approved device was utilized for an off-label application in 63% of patients, and in 50% of all interventions performed. The most frequent off-label procedures were stent implantations (99% off-label), balloon dilations (78% off-label), and coil embolizations (29% off-label). In contrast, the off-label use of septal and ductal occluders was relatively uncommon. Conclusions., In our routine (noninvestigational) practice of pediatric interventional cardiology, 63% of patients underwent procedures utilizing medical devices for off-label indications. These data underscore the need to enhance cardiac device review and approval processes in the United States to include pediatric applications. [source]

World SIVA: the pediatric initiative

Summary Total intravenous anesthesia and targeted controlled infusions are emerging and developing techniques that can have a broad range of important clinical applications in future pediatric care. [source]

A survey of language barriers from the perspective of pediatric oncologists, interpreters, and parents

Marisa Abbe MA
Abstract Background Oncologists in the US increasingly face the challenge of communicating with non-English speaking parents of children with cancer. This study explores this challenge from the perspectives of a sample of pediatric oncologists, interpreters, and Spanish-speaking parents of children with newly diagnosed leukemia. Procedure Thirty-seven oncologists and 17 professional language interpreters based at two non-profit pediatric hospitals in the US were surveyed on the topic of language barriers in pediatric care. Seventeen parents who communicated with their child's oncologist through an interpreter were also surveyed. Results All groups expressed considerable concern over the process of communicating across a language barrier. For oncologists, these concerns included the accuracy and completeness of interpretations, complexity of information, and loss of confidence and control over the communication process. For interpreters, they included complexity of information, information overload, and lack of clinician sensitivity toward the cultural and socioeconomic backgrounds of limited English proficiency (LEP) families. Parent concerns included difficulties comprehending information and anxiety over the possibility of missing out on important information. All groups provided multiple suggestions for improving communication across a language barrier. Conclusions Oncologists, interpreters, and parents expressed considerable concern over the process of communicating across a language barrier. Some of these concerns could be minimized through efforts to boost interpreter accuracy and completeness, including the use of more simple, easy to understand language. Other issues, such as differences in culture and socioeconomic background, warrant consideration of the intercultural knowledge and skills of interpreters. Pediatric Blood Cancer 2006;47:819,824. 2006 Wiley-Liss, Inc. [source]

Transition programs in cystic fibrosis centers: Perceptions of patients

Deborah L. Anderson PhD
Abstract There is a growing population of adults with cystic fibrosis (CF) and a need for development of adult CF programs. Recommendations for transfer of patients from pediatric care to an adult program include a transition program. The purpose of this study was to survey adult CF patients to assess their own concerns regarding this issue. A survey was sent to all 1,288 members of the International Association of Cystic Fibrosis Adults (IACFA), with a response rate of 25.9% (n,=,334). The majority of patients (81.2%) received care from a CF center; the major difference between those seen at a CF center and those seen at another facility was proximity to a CF center. Nearly one-fourth of patients seen at a CF center continued to receive care from a pediatrician even though a CF-trained internist was available; though these patients were younger, their mean age was still about 30 years. Patients seen by a pediatrician were more like to be students and to live with their parents. Those patients seen in an adult program described a variety of criteria for their transfer to the adult pro-gram, but there were no consistent findings to suggest a standard transition program. Indeed, many patients did not meet the adult team until the time of the transfer. Most importantly, the patients reported their level of concern about transfer as minimal, far less than what CF physicians had perceived. These differences may impede the successful transition of patients into an adult program. Pediatr Pulmonol. 2002; 33:327,331. 2002 Wiley-Liss, Inc. [source]

ADHD and transition to adult services , the experience of community paediatricians

H. Marcer
Abstract Background Attention Deficit Hyperactivity Disorder (ADHD) is now recognized as a disorder that can persist into adulthood, and therefore, there is a need for transitional care. Aim To find out about the experiences of community pediatricians across the UK when transferring patients with ADHD to adult care. Method A questionnaire was sent out to 100 consultant community pediatricians asking about their experiences. Results The majority of respondents thought a proportion of their patients would require referral to adult services and only 22% were aware of a dedicated clinic for adults in their area. Many had tried to address the issue locally often with little success. Conclusion There is a gap in provision of services for young people with ADHD when they leave pediatric care, with many pediatricians struggling to find appropriate ongoing care for their patients. Commissioners need to address the problem. [source]