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Children, Volume 2, Issue 1 (March 2015) , Pages 1-145

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Open AccessArticle
Families’ Perspectives of Quality of Life in Pediatric Palliative Care Patients
Children 2015, 2(1), 131-145; https://doi.org/10.3390/children2010131 - 23 Mar 2015
Cited by 1 | Viewed by 2294
Abstract
Medical and academic institutions began prioritizing Pediatric Palliative Care (PPC) less than two decades ago. Although policies and institutions claim to improve the Quality of Life (QoL) of PPC patients and their families, family-defined QoL remains ambiguous. This research investigates the definitions of [...] Read more.
Medical and academic institutions began prioritizing Pediatric Palliative Care (PPC) less than two decades ago. Although policies and institutions claim to improve the Quality of Life (QoL) of PPC patients and their families, family-defined QoL remains ambiguous. This research investigates the definitions of QoL for PPC patients according to their primary caregivers. We conducted qualitative, semi-structured focus groups of the primary caregivers of PPC patients. The transcripts were analysed for themes using inductive thematic analysis. Participants included primary caregivers of children currently receiving PPC from a healthcare institution in California. We identified several factors that primary caregivers considered components of QoL for their children. The ability to communicate and adapt or be accepted underpinned the concept of QoL for families. QoL for PPC patients was defined by primary caregivers as being able to communicate in a respectful, controlled, physically- and socially-comfortable environment. Attempts to improve QoL should focus not only on pain and symptom control, but also on enhancing opportunities for children to communicate and maintain a sense of dignity. Full article
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Open AccessReview
Cystic Fibrosis Treatment: A Paradigm for New Pediatric Medicines, Globalization of Drug Development and the Role of the European Medicines Agency
Children 2015, 2(1), 108-130; https://doi.org/10.3390/children2010108 - 23 Mar 2015
Cited by 1 | Viewed by 2395
Abstract
The European Pediatric Pharmaceutical Legislation wants children to benefit more from pharmaceutical progress. In rare diseases, concerns have been raised that this legislation might damage research and stymie drug development. We discuss the role of the European Medicines Agency (EMA) and its Pediatric [...] Read more.
The European Pediatric Pharmaceutical Legislation wants children to benefit more from pharmaceutical progress. In rare diseases, concerns have been raised that this legislation might damage research and stymie drug development. We discuss the role of the European Medicines Agency (EMA) and its Pediatric Committee (PDCO) in the development of ivacaftor, first-in-class for cystic fibrosis (CF) patients with the G551D mutation (and eight other mutations later) and of lumacaftor and ataluren, two more potential break-through CF medications. Ivacaftor was USA-approved early 2012 and six months later in the EU. Registration was based on the same data. We analyzed these drugs’ EU pediatric investigation plans (PIPs) and compared the PIP-studies with the pediatric CF studies listed in www.clinicaltrials.gov. The ivacaftor PIP studies appear to reflect what the developer planned anyway, apart from a study in 1–23-month-olds, which has not yet started. The total negotiation time for the current PIP version was approximately 5.5 years. For companies that develop drugs in pediatric diseases, e.g., CF, PIPs represent considerable additional procedural workload with minimal or no additional benefit for the patients. New drugs for pediatric diseases should not be hampered by additional, unnecessary and costly bureaucracy, but be registered as rapidly as possible without compromising safety. Full article
(This article belongs to the collection Development of Medicines for Paediatric and Rare Diseases)
Open AccessArticle
Pediatric Integrative Medicine in Residency (PIMR): Description of a New Online Educational Curriculum
Children 2015, 2(1), 98-107; https://doi.org/10.3390/children2010098 - 17 Mar 2015
Cited by 16 | Viewed by 4400
Abstract
Use of integrative medicine (IM) is prevalent in children, yet availability of training opportunities is limited. The Pediatric Integrative Medicine in Residency (PIMR) program was designed to address this training gap. The PIMR program is a 100-hour online educational curriculum, modeled on the [...] Read more.
Use of integrative medicine (IM) is prevalent in children, yet availability of training opportunities is limited. The Pediatric Integrative Medicine in Residency (PIMR) program was designed to address this training gap. The PIMR program is a 100-hour online educational curriculum, modeled on the successful Integrative Medicine in Residency program in family medicine. Preliminary data on site characteristics, resident experience with and interest in IM, and residents’ self-assessments of perceived knowledge and skills in IM are presented. The embedded multimodal evaluation is described. Less than one-third of residents had IM coursework in medical school or personal experience with IM. Yet most (66%) were interested in learning IM, and 71% were interested in applying IM after graduation. Less than half of the residents endorsed pre-existing IM knowledge/skills. Average score on IM medical knowledge exam was 51%. Sites endorsed 1–8 of 11 site characteristics, with most (80%) indicating they had an IM practitioner onsite and IM trained faculty. Preliminary results indicate that the PIMR online curriculum targets identified knowledge gaps. Residents had minimal prior IM exposure, yet expressed strong interest in IM education. PIMR training site surveys identified both strengths and areas needing further development to support successful PIMR program implementation. Full article
Open AccessArticle
Impact of Pre-Procedure Interventions on No-Show Rate in Pediatric Endoscopy
Children 2015, 2(1), 89-97; https://doi.org/10.3390/children2010089 - 17 Mar 2015
Cited by 5 | Viewed by 2813
Abstract
Pediatric endoscopy has evolved into an indispensable tool in the diagnosis and management of gastrointestinal diseases in children. However, there is limited literature focusing on quality improvement initiatives in pediatric endoscopy. The primary goal of this project was to reduce the no-show rate [...] Read more.
Pediatric endoscopy has evolved into an indispensable tool in the diagnosis and management of gastrointestinal diseases in children. However, there is limited literature focusing on quality improvement initiatives in pediatric endoscopy. The primary goal of this project was to reduce the no-show rate in the pediatric endoscopy unit. Also, we aimed to improve patient and family satisfaction with the procedure by identifying opportunities for improvement. A checklist was designed based on the potential causes of no-show. The endoscopy nurse coordinator reviewed the checklist when scheduling the procedure to identify patients at high risk for non-compliance. Once a risk factor was identified, appropriate actions were taken. She also made a pre-procedure phone call as a reminder and to address any of these risks for non-compliance if present. A patient satisfaction survey was used to identify potential areas for improvement. The no-show rate decreased from an average of 7% in the pre-intervention phase to 2% in the post-intervention phase (p = 0.009). 91% of the patients/family recorded an overall satisfaction of 4 or 5 on a scale of 1–5 5 being best). Quality improvement strategies decreased the no-show rate in the pediatric endoscopy unit. A patient satisfaction survey helped in identifying areas for improvement. Full article
(This article belongs to the collection Advances in Pediatric Digestive Diseases)
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Open AccessReview
Sleep and Children with Cerebral Palsy: A Review of Current Evidence and Environmental Non-Pharmacological Interventions
Children 2015, 2(1), 78-88; https://doi.org/10.3390/children2010078 - 27 Feb 2015
Cited by 6 | Viewed by 3060
Abstract
Between 23%–46% of children with cerebral palsy experience sleep problems. Many of the sensory-motor and cognitive features of cerebral palsy (such as immobility, pain, and seizures) act as predisposing factors for sleep problems in this population. This paper presents the background related to [...] Read more.
Between 23%–46% of children with cerebral palsy experience sleep problems. Many of the sensory-motor and cognitive features of cerebral palsy (such as immobility, pain, and seizures) act as predisposing factors for sleep problems in this population. This paper presents the background related to the etiology and consequences of sleep problems in children with cerebral palsy. The relationship between pain and sleep is emphasized, as the risk of pain is highly prevalent in children with cerebral palsy. The review concludes with a discussion of the evidence-base for environmental non-pharmacological interventions based on light, temperature, sound and bedding to promote sleep for children with cerebral palsy. Full article
Open AccessReview
Pediatric Hospital: The Paradigms of Play in Brazil
Children 2015, 2(1), 66-77; https://doi.org/10.3390/children2010066 - 29 Jan 2015
Cited by 1 | Viewed by 2666
Abstract
The role of play in Brazilian children’s hospitals is highlighted, as well as the perspective of humanization in Brazil. Some aspects of our culture are crucial to understanding the importance of play considering our society. Sabara Children’s Hospital (“Hospital Infantil Sabará”) in Brazil [...] Read more.
The role of play in Brazilian children’s hospitals is highlighted, as well as the perspective of humanization in Brazil. Some aspects of our culture are crucial to understanding the importance of play considering our society. Sabara Children’s Hospital (“Hospital Infantil Sabará”) in Brazil is used particularly to discuss humanization. To understand the issue of play in Brazil, it is important to discuss hospitals in their social context, their history, current roles in children’s care, humanization history and child development, according to the approaches of Piaget and Winnicott that are used in our culture. Full article
Open AccessEditorial
Integrative Pediatrics: Looking Forward
Children 2015, 2(1), 63-65; https://doi.org/10.3390/children2010063 - 28 Jan 2015
Cited by 3 | Viewed by 2352
Abstract
Increase in the prevalence of disease and illness has dramatically altered the landscape of pediatrics. As a result, there is a demand for pediatricians with new skills and a sharper focus on preventative health. Patient demand and shifting pediatric illness patterns have accelerated [...] Read more.
Increase in the prevalence of disease and illness has dramatically altered the landscape of pediatrics. As a result, there is a demand for pediatricians with new skills and a sharper focus on preventative health. Patient demand and shifting pediatric illness patterns have accelerated research in the field of pediatric integrative medicine. This emerging field can be defined as healing-oriented medicine that considers the whole child, including all elements of lifestyle and family health. It is informed by evidence and carefully weighs all appropriate treatment options. This Special Issue of Children, containing a collection of articles written by expert clinicians, represents an important educational contribution to the field. The goal of the edition is to raise awareness about integrative topics with robust supporting evidence, and to identify areas where more research is needed. Full article
Open AccessArticle
Children’s Play Environment after a Disaster: The Great East Japan Earthquake
Children 2015, 2(1), 39-62; https://doi.org/10.3390/children2010039 - 28 Jan 2015
Cited by 3 | Viewed by 3470
Abstract
The Great East Japan Earthquake of March 11, 2011, together with the subsequent tsunami and nuclear power station accident, damaged a wide area of land. Children who experienced these terrible disasters and the post-disaster situation are still suffering in mental, physical and social [...] Read more.
The Great East Japan Earthquake of March 11, 2011, together with the subsequent tsunami and nuclear power station accident, damaged a wide area of land. Children who experienced these terrible disasters and the post-disaster situation are still suffering in mental, physical and social ways. Children’s play is an activity that they undertake naturally and which can help them recover from such disasters. This paper addresses the role of play, adventure playgrounds and other play interventions, including play buses, for the health triangle, which addresses mental, physical and social issues of children after the disasters. These interventions were shown to be effective because children could express their stress. This included play for their mental health, different body movements for their physical health and communication with playworkers and new friends for restructuring their social health. These three aspects relate to and support each other within the health triangle. An increase in childhood obesity and lack of exercise is an additional health issue in Fukushima. For a balanced recovery within the health triangle, more play environments should be provided and some improved. A child’s right to play should be implemented in the recovery stage after a disaster. Full article
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Open AccessEditorial
Acknowledgement to Reviewers of Children in 2014
Children 2015, 2(1), 37-38; https://doi.org/10.3390/children2010037 - 12 Jan 2015
Viewed by 1806
Abstract
The editors of Children would like to express their sincere gratitude to the following reviewers for assessing manuscripts in 2014:[...] Full article
Open AccessReview
Impairments that Influence Physical Function among Survivors of Childhood Cancer
Children 2015, 2(1), 1-36; https://doi.org/10.3390/children2010001 - 08 Jan 2015
Cited by 11 | Viewed by 2463
Abstract
Children treated for cancer are at increased risk of developing chronic health conditions, some of which may manifest during or soon after treatment while others emerge many years after therapy. These health problems may limit physical performance and functional capacity, interfering with participation [...] Read more.
Children treated for cancer are at increased risk of developing chronic health conditions, some of which may manifest during or soon after treatment while others emerge many years after therapy. These health problems may limit physical performance and functional capacity, interfering with participation in work, social, and recreational activities. In this review, we discuss treatment-induced impairments in the endocrine, musculoskeletal, neurological, and cardiopulmonary systems and their influence on mobility and physical function. We found that cranial radiation at a young age was associated with a broad range of chronic conditions including obesity, short stature, low bone mineral density and neuromotor impairments. Anthracyclines and chest radiation are associated with both short and long-term cardiotoxicity. Although numerous chronic conditions are documented among individuals treated for childhood cancer, the impact of these conditions on mobility and function are not well characterized, with most studies limited to survivors of acute lymphoblastic leukemia and brain tumors. Moving forward, further research assessing the impact of chronic conditions on participation in work and social activities is required. Moreover, interventions to prevent or ameliorate the loss of physical function among children treated for cancer are likely to become an important area of survivorship research. Full article
(This article belongs to the Special Issue Acute and Long-Term Sequelae of Childhood Cancer Therapy)
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