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Williams C, Pease A, Goodenough T, Breheny K, Shirkey B, Watanabe R, Sinai P, Rai M, Cuthill IC, Mumme M, Boyd AW, Wye C, Metcalfe C, Gaunt D, Barnes K, Rattigan S, West S, Ferris J, Self J. A school-based intervention to improve mental health outcomes for children with cerebral visual impairment (CVI): feasibility cluster randomised trial. Pilot Feasibility Stud 2025; 11:24. [PMID: 40033436 DOI: 10.1186/s40814-025-01603-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 02/03/2025] [Indexed: 03/05/2025] Open
Abstract
BACKGROUND Cerebral visual impairment (CVI) refers to brain-related vision difficulties, which are often undiagnosed and may lead to poor mental health outcomes. We have developed an intervention to improve mental health outcomes for affected children, and it requires evaluation. The aim of this study was to assess the feasibility of methods proposed for a future definitive cluster randomised trial. METHODS This 18-month study took place in South West England, UK, between 2019 and 2021 including a 6-month pause due to the COVID pandemic. Participants were children aged 7-10 years in mainstream primary schools and their teachers and parents. We recruited head teachers on behalf of their school. The intervention was a resource pack for teachers explaining about CVI, providing universal and targeted strategies to help children with CVI and the offer of CVI assessments at the local eye clinic. The control schools continued with usual practice. Our objectives were to evaluate the feasibility of recruitment and data collection, attrition, acceptability of the study methods and implementation of the intervention. We conducted a process evaluation including interviews and questionnaires. RESULTS We sent invitation letters to 297 schools, received responses to 6% and recruited 40% of these (7 schools, 1015 children). Parents of 36/1015 (3.5%) children opted out. Baseline data were collected from teachers for 94% children, and 91% children completed self-report questionnaires; parent-report questionnaires were returned for 19% of children. During the exceptional circumstance of the COVID pandemic, two schools left the study, and many children were not attending school, meaning follow-up data were received from 32% of children, 16% of teachers and 14% of parents. Interview data indicated that the intervention was acceptable, and teachers would have preferred on-site eye tests to the offer of a clinic appointment and a clear timetable for study events. Teachers in intervention schools reported expected changes in the children's and their own behaviour. There was some contamination between study arms. CONCLUSIONS A full-scale trial would be feasible, enhanced by insights from this feasibility trial, in non-pandemic times. Sharing these data with teachers, education policymakers and parents is planned to refine the design. TRIAL REGISTRATION ISRCTN13762177.
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Affiliation(s)
- Cathy Williams
- Bristol Medical School, University of Bristol, Bristol, UK.
| | - Anna Pease
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Katie Breheny
- Department of Health Economics, University of Bristol, Bristol, UK
| | | | - Rose Watanabe
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Parisa Sinai
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Manmita Rai
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Innes C Cuthill
- School of Biological Sciences, University of Bristol, Bristol, UK
| | - Mark Mumme
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Andrew W Boyd
- UK Longitudinal Linkage Collaboration, University of Bristol, Bristol, UK
| | | | - Chris Metcalfe
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Daisy Gaunt
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | | | | | - Stephanie West
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - John Ferris
- Cheltenham and Gloucester NHS Foundation Trust, Cheltenham, UK
| | - Jay Self
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Güney Yılmaz G, Tanrıverdi M, Şahin S, Çakır FB. Cross-cultural adaptation, reliability, and validity of the Turkish Pediatric Quality of Life Inventory-Cognitive Functioning Scale (PedsQL TM-CFS) in children with cancer. Child Neuropsychol 2025; 31:278-292. [PMID: 38832834 DOI: 10.1080/09297049.2024.2364205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/27/2024] [Indexed: 06/06/2024]
Abstract
The Pediatric Quality of Life Inventory-Cognitive Functioning Scale (PedsQLTM-CFS) was developed as a brief, general, symptom-specific tool to measure cognitive function. The 6-item PedsQL™ Cognitive Functioning Scale and PedsQL 3.0 Cancer Module answered 369 parents and 330 children with 5-18 years. Parents also completed Behavior Rating Inventory of Executive Function (BRIEF). The PedsQL™ Cognitive Functioning Scale evidenced excellent reliability (parent proxy-report α = 0.980/Fleiss Kappa: 0.794; children self-report α = 0.963/Fleiss Kappa: 0.790). Both child self-report and parent proxy-report PedsQL™ Cognitive Functioning Scale scores exhibited significant correlations with all parent-report BRIEF summary and subscale scores (p < .05). Both child self-report and parent proxy-report PedsQL™ Cognitive Functioning Scale scores exhibited significant correlations with PedsQL 3.0 Cancer Module total score and subscale scores (p < .05). The PedsQLTM-CFS can be used in high-risk populations with substantial to perfect reliability, both in regards to total/subcategory scores as well as in children with cancer.
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Affiliation(s)
- Güleser Güney Yılmaz
- Faculty of Health Sciences, Department of Occupational Therapy, Hacettepe University, Ankara, Türkiye
| | - Müberra Tanrıverdi
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Bezmialem Vakıf University, İstanbul, Türkiye
| | - Sedef Şahin
- Faculty of Health Sciences, Department of Occupational Therapy, Hacettepe University, Ankara, Türkiye
| | - Fatma Betül Çakır
- Faculty of Medicine, Department of Pediatric Hematology and Oncology, Bezmialem Vakıf University, İstanbul, Türkiye
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3
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Vogel C, Hinkle C, Cassedy A, Alden C, Colla E, Cowan K, Follmer R, Johnson S, Lacci C, Natarus M, Patrick C, O'Connor A, Parikh P, Ruiz C, Wolfe B, deRegnier RA, Marino BS, Allen K. Motor proficiency in school-aged children with CHD. Cardiol Young 2025; 35:117-125. [PMID: 39560311 DOI: 10.1017/s1047951124026763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2024]
Abstract
OBJECTIVES To evaluate the motor proficiency, identify risk factors for abnormal motor scores, and examine the relationship between motor proficiency and health-related quality of life in school-aged patients with CHD. STUDY DESIGN Patients ≥ 4 years old referred to the cardiac neurodevelopmental program between June 2017 and April 2020 were included. Motor skills were evaluated by therapist-administered Bruininks-Oseretsky Test of Motor Proficiency Second-Edition Short Form and parent-reported Adaptive Behavior Assessment System and Patient-Reported Outcomes Measurement Inventory System Physical Functioning questionnaires. Neuropsychological status and health-related quality of life were assessed using a battery of validated questionnaires. Demographic, clinical, and educational variables were collected from electronic medical records. General linear modelling was used for multivariable analysis. RESULTS The median motor proficiency score was the 10th percentile, and the cohort (n = 272; mean age: 9.1 years) scored well below normative values on all administered neuropsychological questionnaires. In the final multivariable model, worse motor proficiency score was associated with family income, presence of a genetic syndrome, developmental delay recognised in infancy, abnormal neuroimaging, history of heart transplant, and executive dysfunction, and presence of an individualised education plan (p < 0.03 for all predictors). Worse motor proficiency correlated with reduced health-related quality of life. Parent-reported adaptive behaviour (p < 0.001) and physical functioning (p < 0.001) had a strong association with motor proficiency scores. CONCLUSION This study highlights the need for continued motor screening for school-aged patients with CHD. Clinical factors, neuropsychological screening results, and health-related quality of life were associated with worse motor proficiency.
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Affiliation(s)
- Casey Vogel
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Clayton Hinkle
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Amy Cassedy
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Carrie Alden
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Elizabeth Colla
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Kaitlyn Cowan
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Rachel Follmer
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Sarah Johnson
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Christina Lacci
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Michael Natarus
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Cheryl Patrick
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Amy O'Connor
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Pooja Parikh
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Crystal Ruiz
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Brian Wolfe
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | - Bradley S Marino
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Kiona Allen
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
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4
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Curley MAQ, Watson RS, Killien EY, Kalvas LB, Perry-Eaddy MA, Cassidy AM, Miller EB, Talukder M, Manning JC, Pinto NP, Rennick JE, Colville G, Asaro LA, Wypij D. Design and rationale of the Post-Intensive Care Syndrome - paediatrics (PICS-p) Longitudinal Cohort Study. BMJ Open 2024; 14:e084445. [PMID: 38401903 PMCID: PMC10895227 DOI: 10.1136/bmjopen-2024-084445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 01/31/2024] [Indexed: 02/26/2024] Open
Abstract
INTRODUCTION As paediatric intensive care unit (PICU) mortality declines, there is growing recognition of the morbidity experienced by children surviving critical illness and their families. A comprehensive understanding of the adverse physical, cognitive, emotional and social sequelae common to PICU survivors is limited, however, and the trajectory of recovery and risk factors for morbidity remain unknown. METHODS AND ANALYSIS The Post-Intensive Care Syndrome - paediatrics Longitudinal Cohort Study will evaluate child and family outcomes over 2 years following PICU discharge and identify child and clinical factors associated with impaired outcomes. We will enrol 750 children from 30 US PICUs during their first PICU hospitalisation, including 500 case participants experiencing ≥3 days of intensive care that include critical care therapies (eg, mechanical ventilation, vasoactive infusions) and 250 age-matched, sex-matched and medical complexity-matched control participants experiencing a single night in the PICU with no intensive care therapies. Children, parents and siblings will complete surveys about health-related quality of life, physical function, cognitive status, emotional health and peer and family relationships at multiple time points from baseline recall through 2 years post-PICU discharge. We will compare outcomes and recovery trajectories of case participants to control participants, identify risk factors associated with poor outcomes and determine the emotional and social health consequences of paediatric critical illness on parents and siblings. ETHICS AND DISSEMINATION This study has received ethical approval from the University of Pennsylvania Institutional Review Board (protocol #843844). Our overall objective is to characterise the ongoing impact of paediatric critical illness to guide development of interventions that optimise outcomes among children surviving critical illness and their families. Findings will be presented at key disciplinary meetings and in peer-reviewed publications at fixed data points. Published manuscripts will be added to our public study website to ensure findings are available to families, clinicians and researchers. TRIALS REGISTRATION NUMBER NCT04967365.
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Affiliation(s)
- Martha A Q Curley
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - R Scott Watson
- University of Washington School of Medicine, Seattle, Washington, USA
- Seattle Children's Research Institute, Seattle, Washington, USA
| | - Elizabeth Y Killien
- University of Washington School of Medicine, Seattle, Washington, USA
- Seattle Children's Research Institute, Seattle, Washington, USA
| | - Laura Beth Kalvas
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mallory A Perry-Eaddy
- School of Nursing, University of Connecticut, Storrs, Connecticut, USA
- School of Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Amy M Cassidy
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Erica B Miller
- Seattle Children's Research Institute, Seattle, Washington, USA
| | - Mritika Talukder
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joseph C Manning
- School of Healthcare, University of Leicester, Leicester, UK
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Neethi P Pinto
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Janet E Rennick
- McGill University Health Centre, Montreal Children's Hospital, Montreal, Québec, Canada
- Ingram School of Nursing, McGill University, Montreal, Québec, Canada
| | | | - Lisa A Asaro
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - David Wypij
- Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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5
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Patterson C, So S, Shipley K, Shivgulam ME, Avitzur Y, Ng VL. Physical function in children and adolescents pre- and 1-year post-liver transplant. Pediatr Transplant 2023; 27:e14573. [PMID: 37492021 DOI: 10.1111/petr.14573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/25/2023] [Accepted: 07/03/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Several studies describe poorer motor developmental motor outcomes post-liver transplant (LT) in younger children. Limited studies examine physical function in older children and adolescents pre- and post-LT. METHODS Retrospective review of standard of care physical function outcome measures pre- and 1-year post-LT in children ≥6 years at LT. Measures include: 6-minute walk test (6MWT), grip strength, Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2) components, Physical Activity Questionnaire (PAQ), and Paediatric Quality of Life Multidimensional Fatigue Scale. Association of medical variables with outcomes was explored. RESULTS The study cohort included 23 (8 male, median (interquartile range) age 11.67 (8.25, 13.92) years at LT) participants. Top two primary diagnoses included biliary atresia (30.4%) and fulminant hepatic failure (21.7%). At 1-year post-LT, over one-third (36%) were overweight or obese. Compared with healthy norms, children had significantly lower pre-LT PAQ scores (p = .002), pre- and post-6MWT scores (p < .001) and post-LT BOT-2 strength and agility scores (p < .001). Pre-LT, lower balance scores were associated with abdominal distention/ascites (p = .009) and splenomegaly (p = .017). Lower pre-LT platelet count correlated with poorer balance (r = .532, p = .017) and lower strength and agility scores (r = .446, p = .043). Significant moderate inverse correlations were found between weight/body mass index z-scores and BOT-2 components. Post-LT children continue to demonstrate decreased levels of motor proficiency and functional capacity but report less fatigue and increased physical activity. CONCLUSIONS Older children and adolescents undergoing LT are at risk of decreased physical function, highlighting the need for pre- and post-LT rehabilitation to optimize long term outcomes.
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Affiliation(s)
- Catherine Patterson
- Rehabilitation Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Stephanie So
- Rehabilitation Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | | | - Madeline E Shivgulam
- Division of Kinesiology, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Yaron Avitzur
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vicky Lee Ng
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
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6
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The current pediatric perspective on type B and C hepatic encephalopathy. Anal Biochem 2022; 643:114576. [DOI: 10.1016/j.ab.2022.114576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 01/23/2022] [Indexed: 11/20/2022]
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7
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Gmuca S, Sonagra M, Xiao R, Mendoza E, Miller KS, Thomas NH, Young JF, Weiss PF, Sherry DD, Gerber JS. Characterizing Neurocognitive Impairment in Juvenile Fibromyalgia Syndrome: Subjective and Objective Measures of Dyscognition. Front Pediatr 2022; 10:848009. [PMID: 35281242 PMCID: PMC8908005 DOI: 10.3389/fped.2022.848009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Our understanding of brain fog, or dyscognition, among youth with juvenile fibromyalgia syndrome is limited. We aimed to determine the prevalence of subjective (self-reported) and objective dyscognition, as well as factors associated with subjective dyscognition in juvenile fibromyalgia syndrome. METHODS A cross-sectional cohort study of patients (n = 31) 12-17 years old diagnosed with primary juvenile fibromyalgia syndrome and one of their parents from 2017 to 2019. Subjects completed a series of survey measures and patients completed a brief neurocognitive battery. Subjective dyscognition was determined based on scores on the Pediatric Quality of Life Inventory (PedsQL) Cognitive Functioning Scale and Behavior Rating Inventory of Executive Function (BRIEF-2) global executive composite (GEC). Objective dyscognition was defined as impairment of more than two standard deviations in any of the neurocognitive domains. We used Fisher's exact test or Wilcoxon rank-sum test, as appropriate, to compare clinical patients based on the presence of dyscognition. Multivariable logistic regression modeling was performed to determine factors associated with subjective dyscognition. RESULTS Of the 31 subjects, 65% reported subjective dyscognition and 39% had objective dyscognition, primarily in the domains of psychomotor speed (23%), executive function (23%), and attention (3%). Subjective dyscognition was not indicative of objective dyscognition. Subjective dyscognition was independently associated with functional disability (OR: 1.19 [95% CI: 1.02-1.40]) and anxiety (OR: 1.12 [95% CI: 1.02-1.24]). DISCUSSION Adolescents with fibromyalgia predominantly experience subjective dyscognition but more than 1/3 also experience objective dyscognition. Future research should explore the impact of interdisciplinary rehabilitation programs on the treatment of dyscognition in youth with JFMS.
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Affiliation(s)
- Sabrina Gmuca
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Maitry Sonagra
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Seattle Children's Hospital, University of Washington, Seattle, WA, United States
| | - Rui Xiao
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, United States
| | - Elizabeth Mendoza
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Kimberly S Miller
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Nina H Thomas
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Center for Human Phenomic Science Behavioral Neuroscience Core, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Child and Adolescent Psychiatry and Behavioral Services, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Jami F Young
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Department of Child and Adolescent Psychiatry and Behavioral Services, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Pamela F Weiss
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - David D Sherry
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jeffrey S Gerber
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, United States
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8
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Sun KP, Xie WP, Liu JF, Chen Q, Cao H. Quality of life analysis of children with patent ductus arteriosus after closure treatment: A single-centre study. J Paediatr Child Health 2021; 57:1936-1941. [PMID: 34142752 DOI: 10.1111/jpc.15617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/26/2021] [Accepted: 06/07/2021] [Indexed: 01/22/2023]
Abstract
AIM To explore the changes in quality of life (QoL) in children who underwent patent ductus arteriosus (PDA) closure and the difference in the QoL between the post-operative patients and healthy children. METHODS The Pediatric Quality of Life Inventory 4.0 scale was used to assess the QoL of 48 children before and after receiving PDA closure and 50 healthy children who underwent physical examination in our hospital. Relevant clinical data were collected and analysed. RESULTS In this study, a total of 45 patients completed the follow-up, and all the children in the control group completed the follow-up. The results showed that the patients' QoL had been improved after PDA closure, and the scores of emotional functioning and social functioning had been significantly improved compared with those in the pre-operative status. In comparing the QoL between the patient group and the control group, the results before treatment were worse than those of the control group. After treatment, the gap between the score of QoL of the patients and the healthy control group was reduced to some extent. However, in terms of social functioning, the patients' feedback was not as positive as healthy children. CONCLUSION For children with PDA, closure treatment can significantly improve their clinical symptoms and QoL. However, there is still a gap compared with healthy children, so health education and further intervention after treatment are still necessary.
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Affiliation(s)
- Kai-Peng Sun
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Wen-Peng Xie
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Jian-Feng Liu
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
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9
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Gaudioso C, Oo S, Mar S, Hendricks-Ferguson VL, Newland P, Varni JW. PedsQL Multiple Sclerosis Module Domain and Item Development: Qualitative Methods. J Child Neurol 2021; 36:901-910. [PMID: 34048290 DOI: 10.1177/08830738211015016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The objective of this qualitative methods study was to develop the domains and items to support the content validity for the Pediatric Quality of Life Inventory (PedsQL) Multiple Sclerosis Module for youth with pediatric-onset multiple sclerosis. METHODS A literature review of multiple sclerosis-specific questionnaires and clinical research was conducted to generate domains. An expert panel composed of 12 neurologists who were pediatric-onset multiple sclerosis specialists provided feedback on the conceptual framework. Focus interviews with 9 youth with pediatric-onset multiple sclerosis and 6 parents were conducted to develop the relevant domains and item content from the patient and parent perspective. In the cognitive interviews phase, 9 youth with pediatric-onset multiple sclerosis and 6 parents provided feedback on item content, relevance, importance, and understandability of the pediatric-onset multiple sclerosis-specific domains and items. The final interview phase with 5 youth with pediatric-onset multiple sclerosis and 5 parents comprised a pilot testing of the new PedsQL MS Module. RESULTS Eighteen domains were derived from the qualitative methods with item content saturation achieved at 100 items based on 40 interviews with 23 youth with pediatric-onset multiple sclerosis aged 10-21 years and 17 parents. The domains derived include general fatigue, sleep/rest fatigue, cognitive functioning, tingling sensations, numbness sensations, physical weakness, pain, speech, balance, fine motor, vision, urination, constipation, bowel incontinence, worry, communication, treatment, and medicines. CONCLUSIONS Qualitative methods involving 23 youth with pediatric-onset multiple sclerosis and 17 parents in the domain and item development process support the content validity for the new PedsQL MS Module. Future plans include a national field test of the PedsQL MS Module scales and items.
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Affiliation(s)
- Cristina Gaudioso
- Department of Neurology, Division of Pediatric Neurology, 12275Washington University School of Medicine, St Louis, MO, USA
| | - Samuel Oo
- Department of Neurology, Division of Pediatric Neurology, 12275Washington University School of Medicine, St Louis, MO, USA
| | - Soe Mar
- Department of Neurology, Division of Pediatric Neurology, 12275Washington University School of Medicine, St Louis, MO, USA
| | | | - Pamela Newland
- 499763Goldfarb School of Nursing, Barnes Jewish College, St Louis, MO, USA
| | - James W Varni
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, 14736Texas A&M University, College Station, TX, USA
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10
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Benchetrit L, Stenerson M, Ronner EA, Leonard HJ, Aungst H, Stiles DJ, Levesque PA, Kenna MA, Anne S, Cohen MS. Hearing Aid Use in Children With Unilateral Hearing Loss: A Randomized Crossover Clinical Trial. Laryngoscope 2021; 132:881-888. [PMID: 34415079 DOI: 10.1002/lary.29829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/21/2021] [Accepted: 08/09/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS In children with mild to moderately severe unilateral hearing loss (UHL), assess whether subject-reported quality of life (QOL) and teacher- and parent-reported perception of listening difficulty are affected by use of a hearing aid (HA) with baseline accommodations, compared to children receiving only baseline accommodations. STUDY DESIGN Randomized crossover clinical trial. METHODS Thirty-seven children 6-12 years of age with mild to moderately severe UHL and ≥80% word recognition scores in the poorer hearing ear were randomized into arm 1, using baseline accommodations (frequency-modulated system and strategic seating) for 12 weeks, followed by addition of a HA for 12 weeks. The other participants were randomized into the reverse methodology: arm 2, using a HA in addition to baseline accommodations for 12 weeks, followed by baseline accommodations alone. Surveys of QOL (Hearing Environments and Reflection on Quality of Life) and listening difficulties or challenges with hearing amplification (CHILD and LIFE-R questionnaires) were administered at 6-week intervals. Differences in mean survey scores, percent change, and improvement over time were computed between the two arms and inter-arm intervals. Per-protocol analysis was used. RESULTS Of the 37 children enrolled, 34 children underwent the study interventions and were included in the analysis, (arm 1 = 20, arm 2 = 14) (mean [standard deviation] age = 8 [1.5] years; 21 boys [61.8%]). Survey scores averaged across both arms during the HA interval (77.79 [15.13]) were significantly higher than during the baseline-only interval (69.67 [14.69], P = .036). There was no significant difference between trial arms in mean scores between the two HA intervals (P = .450) and two baseline-only intervals (P = .539). CONCLUSIONS Hearing-related QOL and listening ability improved in children who met eligibility criteria with mild to moderately severe UHL with HA use compared with baseline accommodations alone. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02269124. LEVEL OF EVIDENCE 1 Laryngoscope, 2021.
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Affiliation(s)
- Liliya Benchetrit
- Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, Boston University Medical Center, Boston, Massachusetts, U.S.A
| | - Matthew Stenerson
- Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Evette A Ronner
- Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, U.S.A
| | - Heidi J Leonard
- Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Holle Aungst
- Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, U.S.A
| | - Derek J Stiles
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Patricia A Levesque
- Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Margaret A Kenna
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Samantha Anne
- Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, U.S.A
| | - Michael S Cohen
- Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
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11
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Varni JW, Shulman RJ, Self MM, Febo-Rodriguez L, Charron H, Williams K, Nurko S, Chumpitazi BP, Gastroparesis Research Consortium (GpCRC). PedsQL™ Gastroparesis Symptoms Module Domain and Item Development: Qualitative Methods. J Pediatr Gastroenterol Nutr 2021; 73:192-196. [PMID: 33853112 PMCID: PMC8373654 DOI: 10.1097/mpg.0000000000003146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Like adults, children suffer from gastroparesis; however, there are currently no validated instruments to determine the impact of gastroparesis in pediatric patients. The objective of this study was to develop the items and domains to support the content validity of the new Pediatric Quality of Life Inventory (PedsQL™) Gastroparesis Symptoms Module. METHODS Patients were recruited from the National Institute of Diabetes and Digestive and Kidney Diseases Pediatric Gastroparesis Registry. The qualitative methods involved an iterative process comprising a literature review of existing questionnaires and gastroparesis clinical research, an expert review panel of pediatric gastroenterologists who provided feedback on the conceptual framework in developing the semi-structured interview, and in-depth focus interviews with six pediatric patients with gastroparesis and five of their parents (one did not participate) in developing relevant domains and item content. In the subsequent cognitive interviews phase, five additional patients with gastroparesis and their parents provided detailed feedback on item content, relevance, importance, and understandability of the domains and items. RESULTS Ten domains/scales were derived from the qualitative methods, with item content saturation achieved at 67 items, with no further themes or content identified during the final cognitive interviews. The Module is comprised of 10 individual scales measuring nausea, stomach fullness when eating, vomiting, dry heaves, heartburn and reflux, stomach pain and hurt, food and drink limits, bloating, appetite, and worry. CONCLUSIONS Our study supports the content validity of the new PedsQL Gastroparesis Symptoms Module. The Module field test study will be conducted in a multisite national study.
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Affiliation(s)
- James W. Varni
- Department of Pediatrics, College of Medicine, Department
of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M
University, College Station, TX
| | - Robert J. Shulman
- Department of Pediatrics, Baylor College of Medicine,
Children’s Nutrition Research Center, Texas Children’s Hospital,
Houston, TX
| | - Mariella M. Self
- Departments of Psychiatry and Pediatrics, Baylor College of
Medicine, Texas Children’s Hospital, Houston, TX
| | | | - Heather Charron
- Department of Pediatrics, Baylor College of Medicine,
Children’s Nutrition Research Center, Texas Children’s Hospital,
Houston, TX
| | - Kent Williams
- Department of Pediatrics, Nationwide Children’s
Hospital, Columbus, OH
| | - Sam Nurko
- Department of Pediatrics, Boston Children’s
Hospital, Boston, MA
| | - Bruno P. Chumpitazi
- Department of Pediatrics, Baylor College of Medicine,
Children’s Nutrition Research Center, Texas Children’s Hospital,
Houston, TX
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12
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De Bie F, Swaminathan V, Johnson G, Monos S, Adzick NS, Laje P. Long-term core outcomes of patients with simple gastroschisis. J Pediatr Surg 2021; 56:1365-1369. [PMID: 33012557 DOI: 10.1016/j.jpedsurg.2020.09.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To report the long-term core outcome set of patients with simple gastroschisis. METHODS This was a retrospective chart review of all patients with simple gastroschisis managed at our hospital between August 2008 and July 2016. We collected all data included in the core outcome set developed for the standardization of gastroschisis outcomes reporting. We conducted a phone survey of the patients' parents using the PedsQL™ Pediatric Quality of Life Inventory, Cognitive Functioning Scale, and Gastrointestinal Symptoms Scale (GSS). Additionally, parents reported their subjective evaluation of the patients' cosmetic result and overall quality of life. RESULTS There were 124 patients included in the study. The majority (76.5%) was born prematurely at a median gestational age of 36 (range 27.6-38) weeks. At neonatal discharge (median 36 days [18-150] days) most patients were below the 10th percentile for height (81.4%) and weight (87%). Their growth, however, normalized during early childhood. Seven patients (5.6%) required at some point an operation for acute abdominal complications. One-third of patients required long-term treatment for constipation and one-third of patients required long-term treatment for gastroesophageal reflux disease (GERD). Thirty-five parents participated in the phone survey. Mean parent-reported quality of life score was better than healthy controls (87.5% vs. 82.3%, p = 0.049). Cognitive functions and gastrointestinal symptoms scores were similar to healthy controls. All patients are alive. CONCLUSION Growth restriction in patients with simple gastroschisis is common at birth and during the neonatal period, but it improves during the first three years of life. Abdominal operations are rarely needed in patients with simple gastroschisis. GERD and constipation, on the other hand, are common and often require long-term medical management. The overall parent-reported quality of life of patients with simple gastroschisis is excellent. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Felix De Bie
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia
| | - Vishal Swaminathan
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia
| | - Gabrielle Johnson
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia
| | - Stylianos Monos
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia
| | - N Scott Adzick
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia
| | - Pablo Laje
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia.
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13
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Goldschmidt I, van Dick R, Jacobi C, Pfister ED, Baumann U. Identification of Impaired Executive Functioning after Pediatric Liver Transplantation Using Two Short and Easily Applicable Tests: Cognitive Functioning Module PedsQL and Children's Color Trail Test. CHILDREN-BASEL 2021; 8:children8070571. [PMID: 34356549 PMCID: PMC8303617 DOI: 10.3390/children8070571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 11/28/2022]
Abstract
We aimed to assess executive functioning in children after liver transplantation compared with healthy controls and in relation to real-life school performance using the PedsQLTM Cognitive Functioning Scale (CogPedsQL) and the Childrens’ Color Trail Test (CCTT). One hundred and fifty five children (78f, median age 10.4 (1.2–18.3) years) underwent testing with CogPedsQL and/or CCTT 4.9 (0.1–17.0) years after transplantation. Results were compared to those of 296 healthy children (165f, median age 10.0 (2.0–18.0) years). Liver transplanted children displayed significantly reduced scores for cogPedsQL and CCTT1&2 compared to healthy controls. Overall, school performance was lower in patients compared to controls. In both patients and controls, results of CCTT2 and CogPedsQL correlated strongly with school performance. In contrast to controls, school performance in patients correlated with the level of maternal but not paternal primary education degree (r = −0.21, p = 0.03). None of the patient CCTT or CogPedsQL test results correlated with parental school education. Conclusion: CogPedsQL and CCTT 1&2 were easily applicable in children after OLT and revealed reduced executive functioning compared to controls. Results reflect real life school performance. The association of parental education with school performance is reduced in transplanted children, which possibly indicates the overriding impact of transplant-associated morbidity on cognitive outcomes.
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Affiliation(s)
- Imeke Goldschmidt
- Division of Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany; (E.D.P.); (U.B.)
- Correspondence: ; Tel.: +49-511-532-3233
| | - Rolf van Dick
- Institute of Social Psychology, Goethe University Frankfurt, 60323 Frankfurt, Germany;
| | - Christoph Jacobi
- Pediatric Pulmonology and Neonatology, Hannover Medical School, 30625 Hannover, Germany;
| | - Eva Doreen Pfister
- Division of Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany; (E.D.P.); (U.B.)
| | - Ulrich Baumann
- Division of Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany; (E.D.P.); (U.B.)
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14
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Poh PF, Lee JH, Manning JC, Carey MC, Sultana R, Latour JM. Singapore's health outcomes after critical illness in kids: A study protocol exploring health outcomes of families 6 months after critical illness. J Adv Nurs 2021; 77:3531-3541. [PMID: 34081353 DOI: 10.1111/jan.14911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/08/2021] [Indexed: 01/18/2023]
Abstract
AIM To explore and understand the impact of paediatric intensive care unit (PICU) admission on longitudinal health outcomes, experiences and support needs of children and their parents in the first 6 months after PICU discharge and to examine the role of ethnicity. DESIGN This study uses a prospective, longitudinal design. METHODS The sample will include children (N = 110) and at least one parent (N = 110) admitted to the PICU (KKH-AM start-up fund, October 2020). Quantitative study: Participants will be recruited at PICU admission. Data will be collected at five time points: during PICU admission (T0), at PICU discharge (T1), 1 month (T2), 3 months (T3) and 6 months (T4) after PICU discharge. Questionnaires will assess physical and cognitive outcomes of the child survivor. Emotional and social health outcomes will be assessed for both the child and the parents. Qualitative study: At least 12 parents will take part in a semi-structured interview conducted at both 1 and 6 months after PICU to explore their experiences and support needs after PICU discharge. All interviews will be audio-recorded with verbatim transcription. We will use framework analysis for qualitative data analysis. DISCUSSION Understanding of Singapore health outcomes after critical illness in kids (SHACK) and their families is limited. There is an urgent need to comprehensively understand the health trajectory and consequences of the PICU child survivors and their families. This research will be the first to explore the health outcomes, needs and experiences after paediatric critical illness in Asia. IMPACT This study will provide an understanding of the health outcomes and trajectory of children and parents in the first 6 months after PICU discharge and examine the association between race and outcomes after PICU discharge. Identification of modifiable pre-disposing risk factors during the PICU admission will inform future interventions to improve long-term outcomes of children and parents following paediatric critical illness. TRIAL REGISTRATION Clinicaltrial.gov: ClinicalTrials.gov Identifier: NCT04637113.
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Affiliation(s)
- Pei-Fen Poh
- University of Plymouth, Plymouth, UK.,Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore
| | - Jan Hau Lee
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore
| | - Joseph C Manning
- School of Health Sciences, University of Nottingham, Nottingham, UK.,Paediatric Critical Care Outreach, Nottingham Children's Hospital, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Matthew C Carey
- Faculty of Health, School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
| | | | - Jos M Latour
- University of Plymouth, Plymouth, UK.,Curtin University, Perth, Western Australia, Australia
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15
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Williams C, Pease A, Goodenough T, Breheny K, Gaunt D, Sinai P, Watanabe R. Improving outcomes for primary school children at risk of cerebral visual impairment (the CVI project): protocol of a feasibility study for a cluster-randomised controlled trial and health economic evaluation. BMJ Open 2021; 11:e044830. [PMID: 33952548 PMCID: PMC8103402 DOI: 10.1136/bmjopen-2020-044830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/20/2021] [Accepted: 03/23/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Cerebral visual impairment (CVI) refers to a spectrum of brain-related vision problems. CVI is associated with poor educational and mental health outcomes. An intervention has been developed to help children with CVI, involving input from clinicians, teachers and parents. The effectiveness of this intervention needs to be evaluated. This study aims to guide any refinements to the intervention or the design of a future cluster-randomised trial that may be needed. METHODS AND ANALYSIS This study will include all methods anticipated for a future cluster-randomised controlled trial. Eight primary schools will be recruited and randomised to receive the intervention or carry on with usual practice. The intervention will comprise an information pack for schools and access to a local paediatric ophthalmology clinic (who are prepared to assess them for CVI), for up to 5% of participating children. Outcome assessments will be carried out at baseline (before randomisation) and after 4-5 months of intervention period. Assessments will include children's self-reported quality of life, their learning ability and behaviour as reported by teachers, and family functioning reported by parents. Cost data will include service use, family expenditure on additional support (eg, private appointments and administration) and school spending and resource used in helping children with special educational needs or disability. A process evaluation (PE) will collect additional data relating to the implementation of the intervention and the trial processes, in the school and clinic settings. The protocol for the PE will be reported separately. ETHICS AND DISSEMINATION Ethical permission was obtained from the University of Bristol Faculty of Health Sciences Ethical Committee. The results will inform the design of a future trial to assess the effectiveness and cost-effectiveness of the intervention and will be shared with participants, CVI-support groups and peer-viewed journals. TRIAL REGISTRATION NUMBER ISRCTN13762177; Pre-results.
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Affiliation(s)
- Cathy Williams
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Anna Pease
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Katie Breheny
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Daisy Gaunt
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Parisa Sinai
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Rose Watanabe
- Bristol Medical School, University of Bristol, Bristol, UK
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16
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Topjian AA, Scholefield BR, Pinto NP, Fink EL, Buysse CMP, Haywood K, Maconochie I, Nadkarni VM, de Caen A, Escalante-Kanashiro R, Ng KC, Nuthall G, Reis AG, Van de Voorde P, Suskauer SJ, Schexnayder SM, Hazinski MF, Slomine BS. P-COSCA (Pediatric Core Outcome Set for Cardiac Arrest) in Children: An Advisory Statement From the International Liaison Committee on Resuscitation. Resuscitation 2021; 162:351-364. [PMID: 33515637 DOI: 10.1016/j.resuscitation.2021.01.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Studies of pediatric cardiac arrest use inconsistent outcomes, including return of spontaneous circulation and short-term survival, and basic assessments of functional and neurological status. In 2018, the International Liaison Committee on Resuscitation sponsored the COSCA initiative (Core Outcome Set After Cardiac Arrest) to improve consistency in reported outcomes of clinical trials of adult cardiac arrest survivors and supported this P-COSCA initiative (Pediatric COSCA). The P-COSCA Steering Committee generated a list of potential survival, life impact, and economic impact outcomes and assessment time points that were prioritized by a multidisciplinary group of healthcare providers, researchers, and parents/caregivers of children who survived cardiac arrest. Then expert panel discussions achieved consensus on the core outcomes, the methods to measure those core outcomes, and the timing of the measurements. The P-COSCA includes assessment of survival, brain function, cognitive function, physical function, and basic daily life skills. Survival and brain function are assessed at discharge or 30 days (or both if possible) and between 6 and 12 months after arrest. Cognitive function, physical function, and basic daily life skills are assessed between 6 and 12 months after cardiac arrest. Because many children have prearrest comorbidities, the P-COSCA also includes documentation of baseline (ie, prearrest) brain function and calculation of changes after cardiac arrest. Supplementary outcomes of survival, brain function, cognitive function, physical function, and basic daily life skills are assessed at 3 months and beyond 1 year after cardiac arrest if resources are available.
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17
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Suicidal risk and resilience in juvenile fibromyalgia syndrome: a cross-sectional cohort study. Pediatr Rheumatol Online J 2021; 19:3. [PMID: 33407630 PMCID: PMC7789563 DOI: 10.1186/s12969-020-00487-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/09/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND To characterize suicidality among youth with juvenile fibromyalgia syndrome (JFMS) receiving treatment from pediatric rheumatologists at a tertiary care center in order to determine the prevalence of suicidality in JFMS and to explore risk factors for persistent suicidal ideation. METHODS We performed a cross-sectional cohort study of children 12-17 years old with JFMS seen in a specialty pediatric rheumatology pain clinic from 7/2017-9/2019. All subjects completed patient-reported outcomes measures, complemented by retrospective chart review. Subjects who endorsed item 8 on the Children's Depression Inventory, 2nd Edition (CDI-2) were categorized as endorsing suicidal ideation. We assessed for differences between the suicidal and non-suicidal patients using Wilcoxon-rank sum test. Logistic regression modeling was performed to identify psychosocial factors associated with suicidality. RESULTS Of the 31 subjects, more than one-quarter endorsed suicidality. Nearly 90% of teens with suicidal ideation were established in outpatient counseling. In bivariate analyses, suicidality was associated with lower resilience and greater depression and anxiety (all p < 0.05). Pain intensity trended towards a statistically significant positive association (OR: 1.16 [0.99-1.37]; p = 0.06). Lower resilience was independently associated with suicidality (OR: 0.90 [95% CI: 0.82-0.98]; p < 0.02). CONCLUSIONS Suicidality was prevalent among youth with JFMS and persistent despite concurrent receipt of mental health services. Higher patient-level resilience was independently associated with a reduced odds of suicidality. Future work should examine the role of resilience training on reducing psychological distress and mitigating the risk of suicidality in JFMS.
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18
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Varni JW, Panepinto JA. Cognitive functioning, patient health communication, and worry mediate pain predictive effects on health-related quality of life in youth with sickle cell disease. Pediatr Blood Cancer 2020; 67:e28680. [PMID: 32860648 DOI: 10.1002/pbc.28680] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/25/2020] [Accepted: 08/19/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The objective was to investigate the serial mediating effects of perceived cognitive functioning, patient health communication, and disease-specific worry in the relationship between pain and overall generic health-related quality of life (HRQOL) in youth with sickle cell disease (SCD) from the patient perspective. METHODS The pain, cognitive functioning, communication and worry scales from the Pediatric Quality of Life Inventory (PedsQL) Sickle Cell Disease Module and the PedsQL Multidimensional Fatigue Scale, and the PedsQL 4.0 Generic Core Scales were completed in a multisite national study by 233 youth with SCD of ages 5-18. Hierarchical multiple regression and serial multiple mediator model analyses were conducted to test the mediating effects of perceived cognitive functioning, health communication, and disease-specific worry as intervening variables in the association between the pain predictor variable and overall generic HRQOL. RESULTS Pain predictive effects on overall generic HRQOL were serially mediated by cognitive functioning, health communication, and disease-specific worry. In predictive analytics models utilizing hierarchical multiple regression analyses with age and gender demographic covariates, pain, cognitive functioning, health communication, and worry accounted for 65% of the variance in patient-reported overall generic HRQOL (P < .001), representing a large effect size. CONCLUSIONS Perceived cognitive functioning, patient health communication, and disease-specific worry explain in part the mechanism of pain predictive effects on overall generic HRQOL in youth with SCD. Identifying SCD-specific pain, perceived cognitive functioning, health communication, and disease-specific worry as predictor variables of overall generic HRQOL from the patient perspective may inform clinical interventions and future patient-centered clinical research.
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Affiliation(s)
- James W Varni
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, Texas
| | - Julie A Panepinto
- Department of Pediatrics, Hematology/Oncology/Bone Marrow Transplantation, Children's Hospital of Wisconsin of the Children's Research Institute/Medical College of Wisconsin, Milwaukee, Wisconsin
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19
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Topjian AA, Scholefield BR, Pinto NP, Fink EL, Buysse CM, Haywood K, Maconochie I, Nadkarni VM, de Caen A, Escalante-Kanashiro R, Ng KC, Nuthall G, Reis AG, Van de Voorde P, Suskauer SJ, Schexnayder SM, Hazinski MF, Slomine BS. P-COSCA (Pediatric Core Outcome Set for Cardiac Arrest) in Children: An Advisory Statement From the International Liaison Committee on Resuscitation. Circulation 2020; 142:e246-e261. [DOI: 10.1161/cir.0000000000000911] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Studies of pediatric cardiac arrest use inconsistent outcomes, including return of spontaneous circulation and short-term survival, and basic assessments of functional and neurological status. In 2018, the International Liaison Committee on Resuscitation sponsored the COSCA initiative (Core Outcome Set After Cardiac Arrest) to improve consistency in reported outcomes of clinical trials of adult cardiac arrest survivors and supported this P-COSCA initiative (Pediatric COSCA). The P-COSCA Steering Committee generated a list of potential survival, life impact, and economic impact outcomes and assessment time points that were prioritized by a multidisciplinary group of healthcare providers, researchers, and parents/caregivers of children who survived cardiac arrest. Then expert panel discussions achieved consensus on the core outcomes, the methods to measure those core outcomes, and the timing of the measurements. The P-COSCA includes assessment of survival, brain function, cognitive function, physical function, and basic daily life skills. Survival and brain function are assessed at discharge or 30 days (or both if possible) and between 6 and 12 months after arrest. Cognitive function, physical function, and basic daily life skills are assessed between 6 and 12 months after cardiac arrest. Because many children have prearrest comorbidities, the P-COSCA also includes documentation of baseline (ie, prearrest) brain function and calculation of changes after cardiac arrest. Supplementary outcomes of survival, brain function, cognitive function, physical function, and basic daily life skills are assessed at 3 months and beyond 1 year after cardiac arrest if resources are available.
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20
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Varni JW, Junger KF, Kellermann T, Grossman LB, Wagner J, Mucci GA, Guilfoyle SM, Smith G, Zupanc ML, Modi AC. PedsQL™ Cognitive Functioning Scale in youth with epilepsy: Reliability and validity. Epilepsy Behav 2020; 103:106850. [PMID: 31899165 DOI: 10.1016/j.yebeh.2019.106850] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/06/2019] [Accepted: 12/07/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The objective of the study was to report on the internal consistency reliability and discriminant, concurrent and construct validity of the Pediatric Quality of Life Inventory™ (PedsQL™) Cognitive Functioning Scale as a brief generic cognitive functioning measure in youth with epilepsy. METHODS The 6-item PedsQL™ Cognitive Functioning Scale and 23-item PedsQL™ 4.0 Generic Core Scales were completed by 221 pediatric patients ages 5-18 years with epilepsy and 336 parents of patients ages 2-18 years in a national field test study for the PedsQL™ Epilepsy Module. Parents also completed the 86-item Behavior Rating Inventory of Executive Function (BRIEF), a widely validated measure of executive functioning. RESULTS The PedsQL™ Cognitive Functioning Scale evidenced excellent reliability (patient self-report α = 0.88; parent proxy-report α = 0.96), distinguished between youth with epilepsy and an age, gender, and race/ethnicity-matched healthy sample supporting discriminant validity with large effect sizes (~20-30 point score differences, P < 0.001), and demonstrated concurrent and construct validity, respectively, through large effect size intercorrelations with the BRIEF (Behavioral Regulation Index, Metacognition Index, Global Executive Composite Summary Scores rs = 0.43-0.67, P < 0.001) and the PedsQL™ Generic Core Scales (Total Scale Scores rs = 0.67-0.74, P < 0.001). Minimal clinically important difference (MCID) scores ranged from 5.92 to 8.80. CONCLUSIONS The PedsQL™ Cognitive Functioning Scale demonstrated excellent internal consistency reliability, discriminant, concurrent, and construct validity in youth with epilepsy and may be suitable as a brief generic patient-reported outcome (PRO) measure for clinical research, clinical trials, and routine clinical practice in pediatric epilepsy.
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Affiliation(s)
- James W Varni
- Department of Pediatrics, College of Medicine, Texas A&M University, College Station, TX, USA; Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, TX, USA.
| | - Katherine F Junger
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Tanja Kellermann
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | | | - Janelle Wagner
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Grace A Mucci
- Division of Neurology, Children's Hospital of Orange County, Orange, CA, USA
| | - Shanna M Guilfoyle
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Gigi Smith
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Mary L Zupanc
- Division of Neurology, Children's Hospital of Orange County, Orange, CA, USA
| | - Avani C Modi
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Effects of a Fundamental Motor Skill-Based Afterschool Program on Children's Physical and Cognitive Health Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030733. [PMID: 31979255 PMCID: PMC7036962 DOI: 10.3390/ijerph17030733] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 12/27/2022]
Abstract
Globally, more than half of school-aged children do not engage in the recommended 60 minutes of daily moderate to vigorous physical activity (MVPA). Given that developing sufficient fundamental motor skills (FMS) competence during early elementary school years is important for a child’s physical and cognitive development, the purpose of this study was to examine the effects of an 8-week FMS-based afterschool program on physical and cognitive health outcomes among elementary children. Participants were 31 K–2 students (19 girls, 12 boys; Mage = 6.65 ± 0.98) from three public elementary schools in the southwestern United States who were assigned to the intervention group (FMS-based afterschool program; n = 20) or the control group (traditional afterschool program; n = 11). A 2 × 2 repeated measures MANOVA showed significant changes in FMS competence and MVPA between the intervention and the control group over time. However, no significant changes were found in cognitive functioning. The 8-week FMS-based afterschool program showed significant improvements in FMS competence and MVPA, compared to a traditional afterschool program. This finding suggests that structured FMS-focused strategies (e.g., fun games and goal setting) can be a critical component when implementing a physical activity program to enhance children’s motor skills and physical activity behavior.
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Ohnemus D, Neighbors K, Rychlik K, Venick RS, Bucuvalas JC, Sundaram SS, Ng VL, Andrews WS, Turmelle Y, Mazariegos GV, Sorensen LG, Alonso EM. Health-Related Quality of Life and Cognitive Functioning in Pediatric Liver Transplant Recipients. Liver Transpl 2020; 26:45-56. [PMID: 31509650 DOI: 10.1002/lt.25634] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 08/08/2019] [Indexed: 12/24/2022]
Abstract
The goal of this work was to examine the change in health-related quality of life (HRQOL) and cognitive functioning from early childhood to adolescence in pediatric liver transplantation (LT) recipients. Patients were recruited from 8 North American centers through the Studies of Pediatric Liver Transplantation consortium. A total of 79 participants, ages 11-18 years, previously tested at age 5-6 years in the Functional Outcomes Group study were identified as surviving most recent LT by 2 years and in stable medical follow-up. The Pediatric Quality of Life 4.0 Generic Core Scale, Pediatric Quality of Life Cognitive Function Scale, and PROMIS Pediatric Cognitive Function tool were distributed to families electronically. Data were analyzed using repeated measures and paired t tests. Predictive variables were analyzed using univariate regression analysis. Of the 69 families contacted, 65 (94.2%) parents and 61 (88.4%) children completed surveys. Median age of participants was 16.1 years (range, 12.9-18.0 years), 55.4% were female, 33.8% were nonwhite, and 84.0% of primary caregivers had received at least some college education. Median age at LT was 1.1 years (range, 0.1-4.8 years). The majority of participants (86.2%) were not hospitalized in the last year. According to parents, adolescents had worse HRQOL and cognitive functioning compared with healthy children in all domains. Adolescents reported HRQOL similar to healthy children in all domains except psychosocial, school, and cognitive functioning (P = 0.02; P < 0.001; P = 0.04). Participants showed no improvement in HRQOL or cognitive functioning over time. For cognitive and school functioning, 60.0% and 50.8% of parents reported "poor" functioning, respectively (>1 standard deviation below the healthy mean). Deficits in HRQOL seem to persist in adolescence. Over half of adolescent LT recipients appear to be at risk for poor school and cognitive functioning, likely reflecting attention and executive function deficits.
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Affiliation(s)
- Daniella Ohnemus
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Katie Neighbors
- Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Karen Rychlik
- Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Robert S Venick
- Department of Pediatrics, Division of Gastroenterology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - John C Bucuvalas
- Jack and Lucy Clark Department of Pediatrics, Mount Sinai Kravis Children's Hospital Recanati/Miller Transplantation Institute, New York, NY
| | - Shikha S Sundaram
- Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics and the Digestive Health Institute, Children's Hospital of Colorado and University of Colorado School of Medicine, Aurora, CO
| | - Vicky L Ng
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Transplant and Regenerative Medicine Center, Toronto, Ontario, Canada
| | - Walter S Andrews
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Yumi Turmelle
- Section of Hepatology, Department of Pediatrics, Washington University, St. Louis, MO
| | - George V Mazariegos
- Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Lisa G Sorensen
- Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Estella M Alonso
- Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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Anthony SJ, Stinson H, Lazor T, Young K, Hundert A, Santana MJ, Stinson J, West L. Patient-reported outcome measures within pediatric solid organ transplantation: A systematic review. Pediatr Transplant 2019; 23:e13518. [PMID: 31210404 DOI: 10.1111/petr.13518] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 04/09/2019] [Accepted: 04/26/2019] [Indexed: 02/06/2023]
Abstract
Subjective evaluation of medical care and disease outcomes from patients' perspectives has become increasingly important. Patient-reported outcome measures (PROMs) play a prominent role in engaging patients, capturing their experiences and improving patient care. This systematic review sought to identify PROMs that are used in the field of pediatric solid organ transplantation, with the aim to inform the implementation of PROMs into clinical practice for this population. A systematic review of English language, peer-reviewed articles was performed on key health science databases to identify publications using PROMs in pediatric solid organ transplantation. The search yielded 3670 articles, with a final data set of 62 articles that included 47 different PROMs. The three most frequently used PROMs included the following: (a) PedsQL™ Generic Core Scales (n = 25); (b) Children's Depression Inventory (n = 6); and (c) Child Health Questionnaire (n = 6). Of the 47 PROMs, 42 were generic and five were disease-specific; only six PROMS had a documented psychometric evaluation within a pediatric solid organ transplant population. This review outlines the attributes of the instruments (eg, domains captured), as well as the psychometric properties of those evaluated. PROMs are increasingly used in the field of pediatric transplantation; however, there are limited details in the current literature about their conceptual underpinnings and psychometric properties. This review highlights the need for additional psychometric evaluation of identified measures to establish the necessary foundation to inform the implementation of PROMs into clinical care for pediatric solid organ transplant patients.
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Affiliation(s)
- Samantha J Anthony
- Hospital for Sick Children, Toronto, Ontario, Canada.,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | | | - Tanya Lazor
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Amos Hundert
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maria J Santana
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer Stinson
- Hospital for Sick Children, Toronto, Ontario, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Lori West
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada.,Cardiac Transplantation, Pediatrics, Surgery and Immunology, University of Alberta, Edmonton, Alberta, Canada
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24
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Ladak LA, Hasan BS, Gullick J, Awais K, Abdullah A, Gallagher R. Health-related quality of life in surgical children and adolescents with congenital heart disease compared with their age-matched healthy sibling: a cross-sectional study from a lower middle-income country, Pakistan. Arch Dis Child 2019; 104:419-425. [PMID: 30554150 DOI: 10.1136/archdischild-2018-315594] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 10/04/2018] [Accepted: 10/04/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Inconsistencies have been reported in health-related quality of life (HRQOL) in postoperative congenital heart disease (CHD). Despite the need for lifelong care due for residual symptoms, only a few studies have explored cardiac-related HRQOL but none in lower middle-income countries (LMIC). This study therefore addresses the gap by exploring HRQOL and its associated predictors in postoperative CHD in Pakistan. OUTCOME MEASURES General and cardiac-related HRQOL, associated predictors. METHODS This cross-sectional study recruited patients with CHD and age-matched healthy siblings as controls (n=129 each) at a single centre in Pakistan. Patients and their siblings completed HQROL surveys (PedsQL 4.0 Generic Core, PedsQL Cognitive Functioning). Patients only completed PedsQL 3.0 Cardiac module. Generalised linear models identified predictors. RESULTS The sample mean age was 8.84±3.87 years and 70% were below the poverty line for an LMIC. The majority (68%) had their first surgery after 1 year of age and were interviewed at a mean 4.08±1.91 years postoperatively.Patients with CHD had lower HRQOL in all domains compared with their age-matched siblings, with the biggest differences for total HRQOL (effect size, d=-1.35). Patients with complex CHD had lower HRQOL compared with simple to moderate CHDs in cardiac-related HRQOL. The lowest scores were for treatment problems (effect size, d=-0.91). HRQOL was worse for patients who were on cardiac medications, had complex CHD, longer cardiopulmonary bypass time, re-operations and were female. CONCLUSIONS HRQOL issues persist in postoperative patients with CHD in LMIC, Pakistan. Solutions are needed to address poor HRQOL and lifelong concerns of patients and their parents.
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Affiliation(s)
- Laila Akbar Ladak
- Charles Perkins Centre and Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, University of Sydney, Camperdown, New South Wales, Australia
| | - Babar S Hasan
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Janice Gullick
- Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, University of Sydney-Mallett Street Campus, Camperdown, New South Wales, Australia
| | - Khadija Awais
- Medical College, The Aga Khan University, Karachi, Pakistan
| | - Ahmed Abdullah
- Medical College, The Aga Khan University, Karachi, Pakistan
| | - Robyn Gallagher
- Charles Perkins Centre and Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, University of Sydney, Camperdown, New South Wales, Australia
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Russell K, Selci E, Black B, Ellis MJ. Health-related quality of life following adolescent sports-related concussion or fracture: a prospective cohort study. J Neurosurg Pediatr 2019; 23:455-464. [PMID: 30660131 DOI: 10.3171/2018.8.peds18356] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/15/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The longitudinal effects of sports-related concussion (SRC) in adolescents on health-related quality of life (HRQOL) remain poorly understood. Hence, the authors established two objectives of this study: 1) compare HRQOL outcomes among adolescents with an acute SRC or a sports-related extremity fracture (SREF) who were followed up until physician-documented clinical recovery; and 2) identify the clinical variables associated with worse HRQOL among adolescent SRC patients. METHODS The authors conducted a prospective cohort study of adolescents with acute SRC and those with acute SREF who underwent clinical assessment and follow-up at tertiary subspecialty clinics. Longitudinal patient-reported HRQOL was measured at the time of initial assessment and at each follow-up appointment by using the adolescent version (age 13-18 years) of the Pediatric Quality of Life Inventory (PedsQL) Generic Core Scale and Cognitive Functioning Scale. RESULTS A total of 135 patients with SRC (60.0% male; mean age 14.7 years; time from injury to initial assessment 6 days) and 96 patients with SREF (59.4% male; mean age 14.1 years; time from injury to initial assessment 8 days) participated in the study. At the initial assessment, the SRC patients demonstrated significantly worse cognitive HRQOL and clinically meaningful impairments in school and overall HRQOL compared to the SREF patients. Clinical variables associated with a worse HRQOL among SRC patients differed by domain but were significantly affected by the patients' initial symptom burden and the development of delayed physician-documented clinical recovery (> 28 days postinjury). No persistent impairments in HRQOL were observed among SRC patients who were followed up until physician-documented clinical recovery. CONCLUSIONS Adolescent SRC is associated with temporary impairments in HRQOL that have been shown to resolve in patients who are followed up until physician-documented clinical recovery. Future studies are needed to identify the clinicopathological features that are associated with impaired HRQOL and to assess whether the initiation of multidisciplinary, targeted rehabilitation strategies would lead to an improvement in HRQOL.
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Affiliation(s)
- Kelly Russell
- 1Department of Pediatrics and Child Health, and
- 5Children's Hospital Research Institute of Manitoba
- 6Canada North Concussion Network; and
| | - Erin Selci
- 1Department of Pediatrics and Child Health, and
- 5Children's Hospital Research Institute of Manitoba
| | - Brian Black
- 2Department of Surgery
- 4Orthopaedic Surgery, University of Manitoba
- 7Pan Am Concussion Program, Winnipeg, Manitoba, Canada
| | - Michael J Ellis
- 1Department of Pediatrics and Child Health, and
- 2Department of Surgery
- Sections of3Neurosurgery and
- 5Children's Hospital Research Institute of Manitoba
- 6Canada North Concussion Network; and
- 7Pan Am Concussion Program, Winnipeg, Manitoba, Canada
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Impact of Immunosuppression on Executive Functioning After Pediatric Liver Transplantation: An Observational Cohort Study. J Pediatr Gastroenterol Nutr 2019; 68:480-487. [PMID: 30664562 DOI: 10.1097/mpg.0000000000002274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Children after liver transplantation show increased rates of impaired cognitive functioning. We aimed to assess the potential effects of immunosuppressive therapy on executive functioning measured by the Children's Color Trail Test and the cognitive functioning module of the PedsQL (cogPedsQL) in liver transplanted children to explore potential targets for intervention to improve executive functioning. METHODS We performed a cross-sectional study in 155 children (78 girls) aged 10.4 (2-18) years at 5.0 (0.1-17) years after liver transplantation, with follow-up at 6 months in n = 114. Executive functioning was assessed by Children's Color Trail Test (ages 8-16) and by patients and parent-proxy cogPedsQL (ages 5-18/2-18, respectively). Results were correlated with clinical parameters. Stability of results over time was compared between n = 23 patients who for clinical reasons switched from twice daily calcineurin inhibitor (CNI) to once-daily slow-release tacrolimus (Tac) during the study period, and patients with unchanged CNI. RESULTS Worse executive functioning was associated with longer stay in the intensive care unit and longer time elapsed since transplantation. No difference was found between users of cyclosporine and Tac. Children on once-daily slow-release Tac performed better than children on twice-daily Tac. In children who switched from twice-daily CNI to once-daily Tac, parent-proxy cogPedsQL improved significantly compared to stable results in the nonswitch group. CONCLUSIONS In addition to a strong impact of disease burden around transplantation, executive functioning appears to deteriorate over time. Although there is no clear-cut advantage of any CNI, once-daily Tac appears to be advantageous compared to twice-daily Tac.
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Decreased health‐related quality of life in children and adolescents with autoimmune hepatitis. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bozzini AB, Neder L, Silva CA, Porta G. Decreased health-related quality of life in children and adolescents with autoimmune hepatitis. J Pediatr (Rio J) 2019; 95:87-93. [PMID: 29331407 DOI: 10.1016/j.jped.2017.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/16/2017] [Accepted: 10/30/2017] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the health-related quality of life in children and adolescents with autoimmune hepatitis. METHODS A cross-sectional assessment with the Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0) was completed for 80 patients with autoimmune hepatitis and 45 healthy controls. Demographic data, prednisone dose, disease remission state, disease severity, and abdominal pain were also evaluated. RESULTS Based on the child self-reports, physical, emotional, school, and total scores were significantly lower in autoimmune hepatitis patients when compared with controls (p<0.05). Based on the parental reports, only the physical and total scores were significantly lower in autoimmune hepatitis patients versus controls (p<0.05). Further analysis in autoimmune hepatitis patients with abdominal pain in the last month revealed significantly lower physical, social, and total median scores (p<0.05). No differences were observed based on disease remission state or disease severity (p>0.05). Autoimmune hepatitis patients who received a prednisone dose below 0.16mg/kg/day at the time of the interview showed significantly higher physical scores than those who received a dose similar to or above 0.16mg/kg/day (87.5 [50-100] vs. 75 [15.63-100], p=0.006). CONCLUSIONS Reduced scores in the physical, emotional, and school domains were observed in pediatric autoimmune hepatitis patients compared to control patients. Abdominal pain and corticosteroid dose negatively influenced the health-related quality of life in children and adolescents with autoimmune hepatitis.
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Affiliation(s)
- Ana Beatriz Bozzini
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Pediatria, São Paulo, SP, Brazil.
| | - Luciana Neder
- Universidade Federal do Mato Grosso (UFMT), Departamento de Clínicas, Cuiabá, MT, Brazil
| | - Clovis A Silva
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Pediatria, São Paulo, SP, Brazil
| | - Gilda Porta
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Programa de Pós-graduação Pediátrica, São Paulo, SP, Brazil
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Quality of Life in Patients With Progressive Familial Intrahepatic Cholestasis: No Difference Between Post-liver Transplantation and Post-partial External Biliary Diversion. J Pediatr Gastroenterol Nutr 2018; 67:643-648. [PMID: 30052569 DOI: 10.1097/mpg.0000000000002118] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES In patients with progressive familial intrahepatic cholestasis (PFIC), partial external biliary diversion (PEBD), which is associated with a permanent stoma, is recommended as first-line therapy, whereas primary liver transplantation (LTx) is restricted to those with cirrhosis. Our aim was to quantify the health-related quality of life (HRQOL) in patients with PFIC and to evaluate whether there is a difference in their HRQOL depending on the surgical approach. METHODS A prospective HRQOL study on a consecutive series of PFIC was conducted using Pediatric Quality of Life Inventory 4.0 child-self and parent-proxy reports. Patients with PFIC after PEBD who still lived with their native livers were compared to those after LTx. Both groups were compared to healthy children. RESULTS A total of 32 patients (53% girls) patients with a mean age of 17.7 ± 7.3 years were studied. Twenty-two had undergone LTx at a mean age of 7.8 ± 3.8 years and 10 had undergone PEBD at a mean age of 4.1 ± 3.9 years. At the time of HRQOL assessment, the mean age was 18.9 ± 7.5 years in the LTx group and 15.3 ± 6.5 years in the PEBD group. Child-self and parent-proxy reports showed no significant difference in HRQOL between patients with PFIC after LTx and those after PEBD except for marginal difference in physical functioning/health (P = 0.07). Except for a lower score in patient school functioning of patients after LTx (P = 0.01), HRQOL-results showed no difference from healthy children in any group. CONCLUSIONS The HRQOL of patients with PFIC after PEBD was similar to those after LTx. The HRQOL in both groups was also similar to that of healthy children. Thus, our data support the current policy of PEBD as primary surgical treatment for patients with PFIC without cirrhosis.
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Sorensen LG, Neighbors K, Hardison RM, Loomes KM, Varni JW, Ng VL, Squires RH, Alonso EM, for the Pediatric Acute Liver Failure Study Group. Health Related Quality of Life and Neurocognitive Outcomes in the First Year after Pediatric Acute Liver Failure. J Pediatr 2018; 196:129-138.e3. [PMID: 29551316 PMCID: PMC5933443 DOI: 10.1016/j.jpeds.2018.01.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 01/04/2018] [Accepted: 01/11/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine health-related quality of life (HRQoL) and neurocognitive impairment in survivors of pediatric acute liver failure (PALF). STUDY DESIGN A longitudinal prospective study was conducted. At 6 and 12 months after PALF presentation, surveys of HRQoL were completed for 2- to 19-year-olds and executive functioning for ages 2-16 years. At 12 months, patients 3-16 years of age completed neurocognitive testing. HRQoL scores were compared with a healthy, matched sample. Neurocognitive scores were compared with norms; executive functioning scores were examined categorically. RESULTS A total of 52 parent-report HRQoL surveys were completed at 6 months, 48 at 12 months; 25 patients completed neurocognitive testing. The median age at 6 months was 7.9 years (range 3.5-15.0), and final diagnosis was indeterminate for 46.2% (n = 24). Self and parent-report on Pediatric Quality of Life Inventory Generic and Multidimensional Fatigue scales fell below the healthy sample at 6 months and 12 months (almost all P < .001). Children reported lower mean scores on cognitive fatigue at 12 months (60.91 ± 22.99) compared with 6 months (73.61 ± 27.49, P = .006) . The distribution of Behavior Rating Inventory of Executive Function scores was shifted downward on parent-report (preschool) for all indices at 6 months (n = 14, P ≤ .003); Global Executive Composite and Emergent Metacognition at 12 months (n = 10, P = .03). Visual Motor Integration (VMI-6) Copying (mean = 90.3 ± 13.8, P = .0002) and VMI-6 Motor Coordination (mean = 85.1 ± 15.2 P = .0002) fell below norms, but full scale IQ (Wechsler Scales) and Attention (Conners' Continuous Performance Test) did not. CONCLUSIONS Survivors of PALF appear to show deficits in motor skills, executive functioning, HRQoL, and evidence for worsening cognitive fatigue from 6 to 12 months following PALF presentation.
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Affiliation(s)
- Lisa G. Sorensen
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA; Child & Adolescent Psychiatry
| | - Katie Neighbors
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA; Pediatrics
| | | | - Kathleen M. Loomes
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Division of Gastroenterology, Hepatology and Nutrition, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA; Pediatrics
| | - James W. Varni
- Texas A&M University, College Station, TX, USA; Pediatrics
| | - Vicky L. Ng
- Hospital for Sick Children, University of Toronto, ON, Canada; Division of Paediatric Gastroenterology, Hepatology and Nutrition
| | | | - Estella M. Alonso
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA; Pediatrics
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Ladak LA, Hasan BS, Gullick J, Awais K, Abdullah A, Gallagher R. Health-related quality of life in congenital heart disease surgery patients in Pakistan: protocol for a mixed-methods study. BMJ Open 2017; 7:e018046. [PMID: 29084799 PMCID: PMC5665301 DOI: 10.1136/bmjopen-2017-018046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Reduced health-related quality of life (HRQOL) has been reported in postoperative patients with congenital heart disease (CHD). However, there is a paucity of data from low-income and middle-income countries (LMIC). Differences in sociodemographics and sociocultural contexts may influence HRQOL. This protocol paper describes a study exploring HRQOL in surgical patients with CHD from a tertiary hospital in Pakistan. The study findings will assist development of strategies to improve HRQOL in a resource-constrained context. METHODS AND ANALYSIS This prospective, concurrent triangulation, mixed-methods study aims to compare HRQOL of postsurgery patients with CHD with age-matched healthy siblings and to identify HRQOL predictors. A qualitative component aims to further understand HRQOL data by exploring the experiences related to CHD surgery for patients and parents. Participants include patients with CHD (a minimum of n~95) with at least 1-year postsurgery follow-up and no chromosomal abnormality, their parents and age-matched, healthy siblings. PedsQL 4.0 Generic Core Scales, PedsQL Cognitive Functioning Scale and PedsQL 3.0 Cardiac Module will measure HRQOL. Clinical/surgical data will be retrieved from patients' medical files. Student's t-test will be used to compare the difference in the means of HRQOL between CHD and siblings. Multiple regression will identify HRQOL predictors. A subsample of enrolled patients (n~20) and parents (n~20) from the quantitative arm will be engaged in semistructured qualitative interviews, which will be analysed using directed content analysis. Anticipated challenges include patient recruitment due to irregular follow-up compliance. Translation of data collection tools to the Urdu language and back-translation of interviews increases the study complexity. ETHICS AND DISSEMINATION Ethics approval has been obtained from The Aga Khan University, Pakistan (3737-Ped-ERC-15). Study findings will be published in peer-reviewed journals and presented at national and international conferences.
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Affiliation(s)
- Laila Akbar Ladak
- Charles Perkins Centre, Faculty of Nursing, The University of Sydney, Camperdown, New South Wales, Australia
| | - Babar Sultan Hasan
- Department of Pediatrics and Child health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Janice Gullick
- Faculty of Nursing, The University of Sydney, Camperdown, New South Wales, Australia
| | - Khadija Awais
- Medical College, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Ahmed Abdullah
- Medical College, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Robyn Gallagher
- Charles Perkins Centre, Faculty of Nursing, The University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Health, University of Technology, Sydney, New South Wales, Australia
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Modi AC, Junger KF, Mara CA, Kellermann T, Barrett L, Wagner J, Mucci GA, Bailey L, Almane D, Guilfoyle SM, Urso L, Hater B, Hustzi H, Smith G, Herrmann B, Perry MS, Zupanc M, Varni JW. Validation of the PedsQL Epilepsy Module: A pediatric epilepsy-specific health-related quality of life measure. Epilepsia 2017; 58:1920-1930. [PMID: 28901536 DOI: 10.1111/epi.13875] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To validate a brief and reliable epilepsy-specific, health-related quality of life (HRQOL) measure in children with various seizure types, treatments, and demographic characteristics. METHODS This national validation study was conducted across five epilepsy centers in the United States. Youth 5-18 years and caregivers of youth 2-18 years diagnosed with epilepsy completed the PedsQL Epilepsy Module and additional questionnaires to establish reliability and validity of the epilepsy-specific HRQOL instrument. Demographic and medical data were collected through chart reviews. Factor analysis was conducted, and internal consistency (Cronbach's alphas), test-retest reliability, and construct validity were assessed. RESULTS Questionnaires were analyzed from 430 children with epilepsy (Mage = 9.9 years; range 2-18 years; 46% female; 62% white: non-Hispanic; 76% monotherapy, 54% active seizures) and their caregivers. The final PedsQL Epilepsy Module is a 29-item measure with five subscales (i.e., Impact, Cognitive, Sleep, Executive Functioning, and Mood/Behavior) with parallel child and caregiver reports. Internal consistency coefficients ranged from 0.70-0.94. Construct validity and convergence was demonstrated in several ways, including strong relationships with seizure outcomes, antiepileptic drug (AED) side effects, and well-established measures of executive, cognitive, and emotional/behavioral functioning. SIGNIFICANCE The PedsQL Epilepsy Module is a reliable measure of HRQOL with strong evidence of its validity across the epilepsy spectrum in both clinical and research settings.
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Affiliation(s)
- Avani C Modi
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | | | - Constance A Mara
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Tanja Kellermann
- Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Lauren Barrett
- Children's Hospital of Orange County, Orange, California, U.S.A
| | - Janelle Wagner
- Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Grace A Mucci
- Children's Hospital of Orange County, Orange, California, U.S.A
| | - Laurie Bailey
- Cook Children's Health Care System, Fort Worth, Texas, U.S.A
| | - Dace Almane
- University of Wisconsin, Madison, Wisconsin, U.S.A
| | | | - Lauryn Urso
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Brooke Hater
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Heather Hustzi
- Children's Hospital of Orange County, Orange, California, U.S.A
| | - Gigi Smith
- Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | | | - M Scott Perry
- Cook Children's Health Care System, Fort Worth, Texas, U.S.A
| | - Mary Zupanc
- Children's Hospital of Orange County, Orange, California, U.S.A
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Gu X, Keller MJ, Weiller-Abels KH, Zhang T. The roles of physical activity and sedentary behavior on Hispanic children's mental health: a motor skill perspective. Qual Life Res 2017; 27:185-193. [PMID: 28815374 DOI: 10.1007/s11136-017-1687-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Motor competence (MC) has been recognized as the foundation for life-time moderate-to-vigorous physical activity (MVPA) as well as an influential factor in reducing sedentary behavior during childhood. Guided by Blair et al.'s health model, the purpose of this study was to examine the behavioral mechanism of mental health including physical, psychosocial, and cognitive health among Hispanic children related to MC and MVPA. METHODS A prospective research design was used with two-wave assessments across one academic year. A total of 141 Hispanic kindergarteners (Meanage = 5.37, SD = 0.48) were recruited in Texas. Nearly all (94.3%) of the participants were from low-income families based on the Income Eligibility Guidelines. The study was approved by the University Research Review Board, and informed consent was obtained from parents/guardians prior to starting the study. RESULTS Multiple regressions indicated that manipulative skill was a significant predictor of physical and psychosocial health (β = 0.21, β = 0.26, p < 0.05, respectively) and locomotor skill served as a significant predictor for cognitive health (β = 0.22, p < 0.01), after controlling for BMI. Bootstrapping analyses supported the statistical significance of indirect effects of MC on mental health outcomes through MVPA (95% CI [0.031, 0.119]) and sedentary behavior (95% CI [0.054, 0.235]), respectively. CONCLUSION The results suggest that skill-based activities/games, with instructions, should be encouraged during school-based physical activity and health promotion programs in childhood education. Better understanding of the early effects of MC may contribute to designing strategies to promote Hispanic children's well-being.
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Affiliation(s)
- Xiangli Gu
- Department of Kinesiology, Health Promotion, and Recreation, University of North Texas, Denton, TX, 76203, USA.
| | | | | | - Tao Zhang
- University of North Texas, Denton, TX, 76203, USA
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Russell K, Selci E, Chu S, Fineblit S, Ritchie L, Ellis MJ. Longitudinal Assessment of Health-Related Quality of Life following Adolescent Sports-Related Concussion. J Neurotrauma 2017; 34:2147-2153. [PMID: 28077006 DOI: 10.1089/neu.2016.4704] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To examine initial and longitudinal health-related quality of life (HRQOL) in adolescent sports-related concussion (SRC) patients, a prospective observational case-series study was conducted among adolescent SRC patients who were evaluated at a multi-disciplinary pediatric concussion program. Health-related quality of life was measured using the child self-report Pediatric Quality of Life Inventory (PedsQL) generic score scale (age 13-18 version) and the PedsQL Cognitive Functioning scale. Initial and longitudinal HRQOL outcomes were compared between patients who did and did not develop post-concussion syndrome (PCS). A total of 63 patients met the inclusion criteria during the study period. The mean age of the cohort was 14.57 years (standard deviation, 1.17) and 61.9% were male. The median time from injury to initial consultation was 6.5 days (interquartile range, 5, 11). At initial consultation, impairments in physical and cognitive HRQOL but not social or emotional HRQOL were observed. Initial symptom burden and length of recovery were associated with greater impairment in physical and cognitive HRQOL. Patients who went on to develop PCS had significantly worse physical and cognitive HRQOL at initial consultation and demonstrated a slower rate of recovery in these domains, compared with those who recovered in less than 30 days. Adolescent SRC was associated with HRQOL impairments that correlated with clinical outcomes. No persistent impairments in HRQOL were detected among patients who achieved physician-documented clinical recovery. Future studies are needed to evaluate the clinical utility of HRQOL measurement in the longitudinal management of adolescent SRC and PCS patients.
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Affiliation(s)
- Kelly Russell
- 2 Canada North Concussion Network , Winnipeg, Manitoba, Canada .,5 Department of Pediatrics and Child Health, University of Manitoba , Winnipeg, Manitoba, Canada .,7 Children's Hospital Research Institute of Manitoba , Winnipeg, Manitoba, Canada
| | - Erin Selci
- 2 Canada North Concussion Network , Winnipeg, Manitoba, Canada .,5 Department of Pediatrics and Child Health, University of Manitoba , Winnipeg, Manitoba, Canada .,7 Children's Hospital Research Institute of Manitoba , Winnipeg, Manitoba, Canada
| | - Stephanie Chu
- 2 Canada North Concussion Network , Winnipeg, Manitoba, Canada .,5 Department of Pediatrics and Child Health, University of Manitoba , Winnipeg, Manitoba, Canada .,7 Children's Hospital Research Institute of Manitoba , Winnipeg, Manitoba, Canada
| | - Samuel Fineblit
- 2 Canada North Concussion Network , Winnipeg, Manitoba, Canada .,5 Department of Pediatrics and Child Health, University of Manitoba , Winnipeg, Manitoba, Canada .,7 Children's Hospital Research Institute of Manitoba , Winnipeg, Manitoba, Canada
| | - Lesley Ritchie
- 2 Canada North Concussion Network , Winnipeg, Manitoba, Canada .,3 Department of Clinical Health Psychology, University of Manitoba , Winnipeg, Manitoba, Canada
| | - Michael J Ellis
- 1 Pan Am Concussion Program , Winnipeg, Manitoba, Canada .,2 Canada North Concussion Network , Winnipeg, Manitoba, Canada .,4 Department of Surgery, University of Manitoba , Winnipeg, Manitoba, Canada .,6 Section of Neurosurgery, University of Manitoba , Winnipeg, Manitoba, Canada .,7 Children's Hospital Research Institute of Manitoba , Winnipeg, Manitoba, Canada
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Neuropsychological functioning and health-related quality of life in pediatric liver disease: the sum of our perspectives is greater than each alone. Curr Opin Pediatr 2016; 28:644-52. [PMID: 27471904 DOI: 10.1097/mop.0000000000000405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW The review will discuss current data on neuropsychological and health-related quality of life (HRQOL) outcomes in children with liver disease. Research has trickled in over the past 30 years, mostly in small, single-center studies with observational or retrospective design. As medical treatment has advanced, survival has improved dramatically, with the majority now living into adulthood. The focus is shifting toward more systematic exploration of functional outcomes. RECENT FINDINGS Contemporary cohorts provide evidence for increased prevalence of IQ deficits despite overall average means in children with end-stage liver disease and long after transplant. Recent studies explore specific neurocognitive domains and populations, such as pediatric acute liver failure and metabolic disorders. HRQOL is reduced in pediatric liver transplant recipients, even years later. Current research examines HRQOL in pediatric acute liver failure, infants with chronic liver disease, and specific diseases. A major psychosocial concern is the transition from pediatric to adult care, and the challenges in assessing transfer readiness. SUMMARY As research in functional outcomes becomes more sophisticated (more prospective, controlled, and multisite studies), richer data are available. The most comprehensive understanding of how children with liver disease fare is achieved by integrating perspectives into one picture painted by many.
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Follansbee-Junger KW, Mann KA, Guilfoyle SM, Morita DA, Varni JW, Modi AC. Development of the PedsQL™ Epilepsy Module: Focus group and cognitive interviews. Epilepsy Behav 2016; 62:115-20. [PMID: 27454331 DOI: 10.1016/j.yebeh.2016.06.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/07/2016] [Accepted: 06/13/2016] [Indexed: 11/28/2022]
Abstract
UNLABELLED Youth with epilepsy have impaired health-related quality of life (HRQOL). Existing epilepsy-specific HRQOL measures are limited by not having parallel self- and parent-proxy versions, having a restricted age range, not being inclusive of children with developmental disabilities, or being too lengthy for use in a clinical setting. Generic HRQOL measures do not adequately capture the idiosyncrasies of epilepsy. The purpose of the present study was to develop items and content validity for the PedsQL™ Epilepsy Module. METHODS An iterative qualitative process of conducting focus group interviews with families of children with epilepsy, obtaining expert input, and conducting cognitive interviews and debriefing was utilized to develop empirically derived content for the instrument. Eleven health providers with expertise in pediatric epilepsy from across the country provided feedback on the conceptual model and content, including epileptologists, nurse practitioners, social workers, and psychologists. Ten pediatric patients (age 4-16years) with a diagnosis of epilepsy and 11 parents participated in focus groups. Thirteen pediatric patients (age 5-17years) and 17 parents participated in cognitive interviews. RESULTS Focus groups, expert input, and cognitive debriefing resulted in 6 final domains including restrictions, seizure management, cognitive/executive functioning, social, sleep/fatigue, and mood/behavior. Patient self-report versions ranged from 30 to 33 items and parent proxy-report versions ranged from 26 to 33 items, with the toddler and young child versions having fewer items. CONCLUSIONS Standardized qualitative methodology was employed to develop the items and content for the novel PedsQL™ Epilepsy Module. The PedsQL™ Epilepsy Module has the potential to enhance clinical decision-making in pediatric epilepsy by capturing and monitoring important patient-identified contributors to HRQOL.
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Affiliation(s)
- Katherine W Follansbee-Junger
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA
| | - Krista A Mann
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA
| | - Shanna M Guilfoyle
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA
| | - Diego A Morita
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA
| | - James W Varni
- College of Architecture, Texas A&M University, 3137 TAMU, College Station, TX 77843-3137, USA
| | - Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA.
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Evaluation of Exercise Performance, Cardiac Function, and Quality of Life in Children After Liver Transplantation. Transplantation 2016; 100:1525-31. [DOI: 10.1097/tp.0000000000001167] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hooper SR, Laney N, Radcliffe J, Moodalbail D, Hartung EA, Ruebner RL, Jawad AF, Furth SL. Executive Functioning in Children, Adolescents, and Young Adults with Chronic Kidney Disease. J Dev Behav Pediatr 2015; 36:734-42. [PMID: 26468938 DOI: 10.1097/dbp.0000000000000221] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare behavior ratings of executive functioning in individuals with chronic kidney disease (CKD), using the Behavior Rating Inventory for Executive Functions (BRIEF), with a typically developing comparison group and to examine the correlation between disease severity and ratings of executive functioning. METHODS Participants included 92 individuals with CKD (eGFR < 90 mL/min per 1.73 m), aged 8 to 25 years, recruited from nephrology clinics in both hospital and community settings. The disease severity ranged from CKD Stage II to V. The BRIEF was completed by parents for individuals younger than 18 years of age and the BRIEF-Adult was completed by individuals who were older than 18. RESULTS For individuals with CKD younger than 18 years of age, the parent-reported BRIEF revealed significant group differences when compared with controls on the Metacognition Index and the individual scales of Initiate, Working Memory, and Plan/Organize. A large proportion of individuals with CKD were rated as being at-risk for executive dysfunction. For the individuals of 18 years of age and older, there were no significant group differences. The relationship between BRIEF ratings and disease severity was limited to a few scales across both versions of the BRIEF. CONCLUSION This study supported the presence of executive dysfunction through a parent report, although the level of impairment was mild and its association with disease severity was related to select executive functions. Few difficulties were reported by older adolescents and young adults with CKD. It will be important for developmental-behavioral pediatricians to be cognizant of the level and pattern of executive function capabilities in their patients with CKD, and possible discrepancies with parent reports, so as to facilitate their management and transition planning.
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Affiliation(s)
- Stephen R Hooper
- *University of North Carolina School of Medicine, Chapel Hill, NC; †The Children's Hospital of Philadelphia, Philadelphia, PA; ‡The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; §Nemours/A.I. DuPont Hospital for Children, Wilmington, DE
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Varni JW, Bendo CB, Shulman RJ, Self MM, Nurko S, Franciosi JP, Saps M, Saeed S, Zacur GM, Vaughan Dark C, Pohl JF. Interpretability of the PedsQL™ Gastrointestinal Symptoms Scales and Gastrointestinal Worry Scales in Pediatric Patients With Functional and Organic Gastrointestinal Diseases. J Pediatr Psychol 2015; 40:591-601. [PMID: 25682210 PMCID: PMC4469917 DOI: 10.1093/jpepsy/jsv005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 01/07/2015] [Accepted: 01/09/2015] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE The present study investigates the clinical interpretability of the Pediatric Quality of Life Inventory™ (PedsQL™) Gastrointestinal Symptoms Scales and Worry Scales in pediatric patients with functional gastrointestinal disorders or organic gastrointestinal diseases in comparison with healthy controls. METHODS The PedsQL™ Gastrointestinal Scales were completed by 587 patients with gastrointestinal disorders/diseases and 685 parents, and 513 healthy children and 337 parents. Minimal important difference (MID) scores were derived from the standard error of measurement (SEM). Cut-points were derived based on one and two standard deviations (SDs) from the healthy reference means. RESULTS The percentages of patients below the scales' cut-points were significantly greater than the healthy controls (most p values ≤ .001). Scale scores 2 SDs from the healthy reference means were within the range of scores for pediatric patients with a gastrointestinal disorder. MID values were generated using the SEM. CONCLUSIONS The findings support the clinical interpretability of the new PedsQL™ Gastrointestinal Symptoms Scales and Worry Scales.
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Affiliation(s)
- James W Varni
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, Department of Pediatric Dentistry and Orthodontics, Federal University of Minas Gerais, Department of Pediatrics, Baylor College of Medicine, Children's Nutrition Research Center, Texas Children's Hospital, Department of Psychiatry and Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Harvard Medical School, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Division of Gastroenterology, Hepatology and Nutrition, Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Department of Psychology, Texas A&M University, and Department of Pediatric Gastroenterology, Primary Children's Hospital, University of Utah Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, Department of Pediatric Dentistry and Orthodontics, Federal University of Minas Gerais, Department of Pediatrics, Baylor College of Medicine, Children's Nutrition Research Center, Texas Children's Hospital, Department of Psychiatry and Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Harvard Medical School, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Division of Gastroenterology, Hepatology and Nutrition, Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Department of Psychology, Texas A&M University, and Department of Pediatric Gastroenterology, Primary Children's Hospital, University of Utah
| | - Cristiane B Bendo
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, Department of Pediatric Dentistry and Orthodontics, Federal University of Minas Gerais, Department of Pediatrics, Baylor College of Medicine, Children's Nutrition Research Center, Texas Children's Hospital, Department of Psychiatry and Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Harvard Medical School, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Division of Gastroenterology, Hepatology and Nutrition, Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Department of Psychology, Texas A&M University, and Department of Pediatric Gastroenterology, Primary Children's Hospital, University of Utah
| | - Robert J Shulman
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, Department of Pediatric Dentistry and Orthodontics, Federal University of Minas Gerais, Department of Pediatrics, Baylor College of Medicine, Children's Nutrition Research Center, Texas Children's Hospital, Department of Psychiatry and Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Harvard Medical School, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Division of Gastroenterology, Hepatology and Nutrition, Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Department of Psychology, Texas A&M University, and Department of Pediatric Gastroenterology, Primary Children's Hospital, University of Utah
| | - Mariella M Self
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, Department of Pediatric Dentistry and Orthodontics, Federal University of Minas Gerais, Department of Pediatrics, Baylor College of Medicine, Children's Nutrition Research Center, Texas Children's Hospital, Department of Psychiatry and Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Harvard Medical School, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Division of Gastroenterology, Hepatology and Nutrition, Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Department of Psychology, Texas A&M University, and Department of Pediatric Gastroenterology, Primary Children's Hospital, University of Utah Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, Department of Pediatric Dentistry and Orthodontics, Federal University of Minas Gerais, Department of Pediatrics, Baylor College of Medicine, Children's Nutrition Research Center, Texas Children's Hospital, Department of Psychiatry and Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Harvard Medical School, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Division of Gastroenterology, Hepatology and Nutrition, Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Department of Psychology, Texas A&M University, and Department of Pediatric Gastroenterology, Primary Children's Hospital, University of Utah
| | - Samuel Nurko
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, Department of Pediatric Dentistry and Orthodontics, Federal University of Minas Gerais, Department of Pediatrics, Baylor College of Medicine, Children's Nutrition Research Center, Texas Children's Hospital, Department of Psychiatry and Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Harvard Medical School, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Division of Gastroenterology, Hepatology and Nutrition, Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Department of Psychology, Texas A&M University, and Department of Pediatric Gastroenterology, Primary Children's Hospital, University of Utah
| | - James P Franciosi
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, Department of Pediatric Dentistry and Orthodontics, Federal University of Minas Gerais, Department of Pediatrics, Baylor College of Medicine, Children's Nutrition Research Center, Texas Children's Hospital, Department of Psychiatry and Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Harvard Medical School, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Division of Gastroenterology, Hepatology and Nutrition, Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Department of Psychology, Texas A&M University, and Department of Pediatric Gastroenterology, Primary Children's Hospital, University of Utah
| | - Miguel Saps
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, Department of Pediatric Dentistry and Orthodontics, Federal University of Minas Gerais, Department of Pediatrics, Baylor College of Medicine, Children's Nutrition Research Center, Texas Children's Hospital, Department of Psychiatry and Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Harvard Medical School, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Division of Gastroenterology, Hepatology and Nutrition, Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Department of Psychology, Texas A&M University, and Department of Pediatric Gastroenterology, Primary Children's Hospital, University of Utah
| | - Shehzad Saeed
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, Department of Pediatric Dentistry and Orthodontics, Federal University of Minas Gerais, Department of Pediatrics, Baylor College of Medicine, Children's Nutrition Research Center, Texas Children's Hospital, Department of Psychiatry and Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Harvard Medical School, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Division of Gastroenterology, Hepatology and Nutrition, Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Department of Psychology, Texas A&M University, and Department of Pediatric Gastroenterology, Primary Children's Hospital, University of Utah
| | - George M Zacur
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, Department of Pediatric Dentistry and Orthodontics, Federal University of Minas Gerais, Department of Pediatrics, Baylor College of Medicine, Children's Nutrition Research Center, Texas Children's Hospital, Department of Psychiatry and Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Harvard Medical School, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Division of Gastroenterology, Hepatology and Nutrition, Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Department of Psychology, Texas A&M University, and Department of Pediatric Gastroenterology, Primary Children's Hospital, University of Utah
| | - Chelsea Vaughan Dark
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, Department of Pediatric Dentistry and Orthodontics, Federal University of Minas Gerais, Department of Pediatrics, Baylor College of Medicine, Children's Nutrition Research Center, Texas Children's Hospital, Department of Psychiatry and Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Harvard Medical School, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Division of Gastroenterology, Hepatology and Nutrition, Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Department of Psychology, Texas A&M University, and Department of Pediatric Gastroenterology, Primary Children's Hospital, University of Utah
| | - John F Pohl
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, Department of Pediatric Dentistry and Orthodontics, Federal University of Minas Gerais, Department of Pediatrics, Baylor College of Medicine, Children's Nutrition Research Center, Texas Children's Hospital, Department of Psychiatry and Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Harvard Medical School, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Division of Gastroenterology, Hepatology and Nutrition, Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Department of Psychology, Texas A&M University, and Department of Pediatric Gastroenterology, Primary Children's Hospital, University of Utah
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Bugescu N, Alioto A, Segal S, Cordova M, Packman W. The neurocognitive impact of Fabry disease on pediatric patients. Am J Med Genet B Neuropsychiatr Genet 2015; 168B:204-10. [PMID: 25739920 DOI: 10.1002/ajmg.b.32297] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 12/31/2014] [Indexed: 11/06/2022]
Abstract
Fabry disease (FD) is an X-linked lysosomal storage disorder that results in progressive multisystemic organ complications. Several studies have examined neurocognitive impairments in adults; however, there is a paucity of research examining neurocognitive functioning in children with FD. This is the first exploratory study to examine the neurocognitive functioning of pediatric patients with FD and to evaluate the effects of enzyme replacement therapy (ERT) on neurocognitive functioning within this population. Families attending a national conference with at least one child with FD and one parent affected by FD comprised the sample (n = 48; 24 pediatric patients, 24 parents). Pediatric participants (10 males, 14 females) between the ages of 6 and 18 years and their parent(s) were involved in the study. Data from a demographic questionnaire and two neurocognitive self-report and parent-report measures were analyzed. Parent reports of neurocognitive functioning were also compared to a sample of children with and without head injury and to a sample of children who had undergone liver transplant (LT). Children with FD had poorer cognitive and executive functioning than healthy peers, and were comparable to children with head injury and LT. In addition, children using ERT had higher scores on measures of overall cognitive functioning, as well as fewer problems with attention/working memory and executive functioning. Results of this study suggest that children with FD may exhibit poorer cognitive and executive functioning relative to healthy peers. The use of ERT may mitigate the negative impact of FD on neurocognitive functioning in pediatric patients.
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Affiliation(s)
- Nicolle Bugescu
- Department of Psychology, Pacific Graduate School of Psychology, Palo Alto University, Palo Alto, California; Department of Psychiatry, University of California, San Francisco, California
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Neuropsychological functioning and health-related quality of life: pediatric acute liver failure study group results. J Pediatr Gastroenterol Nutr 2015; 60:75-83. [PMID: 25250681 PMCID: PMC4276462 DOI: 10.1097/mpg.0000000000000575] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Pediatric acute liver failure (PALF) is a rare but serious event, with poorly understood functional outcomes. The goal was to determine the prevalence of reduced neuropsychological functioning and health-related quality of life (HRQOL) following PALF. METHODS This multicenter study examined neuropsychological functioning and HRQOL 1 to 6 (median 3.8) years after PALF. Participants ages 6 to 16 (median 9.9) years were recruited from the PALF registry and administered measures of intelligence, visual spatial/visual motor coordination, attention, executive function, depression, and adaptive skills. HRQOL and fatigue were assessed using the Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL 4.0) and PedsQL Multidimensional Fatigue Scale. RESULTS A total of 36 patients participated; 50% were boys and 67% were white. Median age at PALF was 5.6 years. A history of grade 3 or 4 hepatic encephalopathy was reported in 5/36 (14%) participants and 23/36 (64%) received a liver transplant. Visual spatial ability was significantly better than norms (P = 0.009), but motor coordination was worse (P = 0.04). Teachers (P = 0.04 to P < 0.0001) and parents (P = 0.005) reported more executive deficits versus norms, and participants had worse attention (P = 0.02). Participants did not differ significantly from norms on IQ, depression, or adaptive functioning. All of the child self-report PedsQL Generic Core and fatigue scales were significantly lower than a matched healthy sample (P = 0.001 to P < 0.0001) and parent proxy report was lower on the fatigue scales (P = 0.001 to P < 0.0001). CONCLUSIONS Long-term PALF survivors demonstrate average IQ and visual spatial ability, but greater than expected impairments in motor skills, attention, executive function, HRQOL, and fatigue.
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Fredericks EM, Zelikovsky N, Aujoulat I, Hames A, Wray J. Post-transplant adjustment--the later years. Pediatr Transplant 2014; 18:675-88. [PMID: 25220845 PMCID: PMC4179879 DOI: 10.1111/petr.12366] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2014] [Indexed: 01/04/2023]
Abstract
As survival rates for pediatric solid organ transplantation have continued to improve, researchers and healthcare providers have increasingly focused on understanding and enhancing the HRQOL and psychosocial functioning of their patients. This manuscript reviews the psychosocial functioning of pediatric transplant recipients during the "later years," defined as more than three yr post-transplant, and focuses on the day-to-day impact of living with a transplant after the immediate period of adjustment and early years after surgery. Key topics reviewed include HRQOL, cognitive functioning, impact on the family, regimen adherence, and transition of responsibility for self-management tasks. Overall, pediatric transplant recipients evidence impairment in HRQOL, neuropsychological outcomes, and family functioning as compared to non-transplant recipients. However, the degree of impairment is influenced by a variety of factors including, disease severity, age, solid organ type, and study methodologies. Studies are limited by small samples, cross-sectional design, and the lack of universal assessment battery to allow for comparisons across solid organ populations. Areas for future research are discussed.
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Affiliation(s)
- Emily M. Fredericks
- Department of Pediatrics, University of Michigan and C.S. Mott Children’s Hospital
| | - Nataliya Zelikovsky
- Department of Psychology, La Salle University and The Children’s Hospital of Philadelphia
| | - Isabelle Aujoulat
- Université Catholique de Louvain, Institute of Health & Society (IRSS), Brussels, Belgium
| | - Anna Hames
- Institute of Liver Studies, King’s College Hospital, London UK
| | - Jo Wray
- Critical Care and Cardiorespiratory Division, Great Ormond Street Hospital for Children, London UK
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Development and validation of the pediatric liver transplantation quality of life: a disease-specific quality of life measure for pediatric liver transplant recipients. J Pediatr 2014; 165:547-55.e7. [PMID: 24976329 DOI: 10.1016/j.jpeds.2014.05.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 03/03/2014] [Accepted: 05/12/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To develop and validate a Pediatric Liver Transplantation Quality of Life (PeLTQL) questionnaire via an international multicenter collaboration. STUDY DESIGN Item generation with 146 child and/or parent interviews (92 pediatric liver transplantation [LT] recipients) and 3 focus groups generated over 300 items. An item reduction questionnaire with 76 questions was completed by 320 participants (212 pediatric LT recipients). RESULTS Frequency-importance product ranking, questionnaire formatting, and pre-testing resulted in a 26-item PeLTQL questionnaire. Factor analysis identified 3 domains: future health, coping and adjustment, and social-emotional. The validation phase was completed by 133 (46% male) LT recipients (aged 8-18 years). Internal consistency (Cronbach α = 0.86) and test-retest reliability (intraclass correlation coefficient = 0.85) were excellent. Mean patient PeLTQL score was 69.54 ± 13.06. Construct validity with validated tools identified significant correlations between mean PeLTQL scores and (1) Pediatric Quality of Life Inventory generic (r = 0.64, P < .001); (2) Pediatric Quality of Life Inventory transplant (r = 0.73, P < .001); and (3) Screen for Child Anxiety Related Disorders (r = -0.57, P < .001) scores. Only 17/3458 (0.5%) questions were left blank. A Flesch-Kincaid grade level of 5.4 was calculated as a measure of the PeLTQL readability statistic. CONCLUSIONS The PeLTQL is a valid and reliable novel 26-item disease-specific health related quality of life instrument for LT recipients aged 8-18 years. Low PeLTQL scores can identify patients at risk for childhood anxiety and depression. The tool is now ready for broad use in both clinical practice and clinical interventional trials.
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Annunziato RA, Parbhakar M, Helcer J, Kapoor K, Henkel K, Arnon R. Strategies for Measuring Quality of Life among Pediatric Solid-Organ Transplant Recipients. Prog Transplant 2014; 24:247-56. [DOI: 10.7182/pit2014171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective Quality of life (QoL) has become a mainstay in the outcome assessment of pediatric solid-organ transplant recipients. Yet, how QoL is operationalized and measured varies drastically. It may be very difficult for clinicians and researchers to determine which methods of QoL assessment best meet the needs of their patients or study. The purpose of this literature review is to describe and evaluate the current status of QoL measurement in studies of pediatric solid-organ transplant recipients. Data Sources Searches of PubMed and PsycINFO from January 1985 to February 2012. Study Selection English peer-reviewed publications that described a method for measuring QoL whether it was a standardized questionnaire, qualitative approach, or another way of operationalizing the construct. Data Extraction QoL measurement strategies were extracted from 43 studies that met inclusion criteria. Data Synthesis Each article was reviewed and summarized by 2 study team members. Conclusions Many different strategies were used for measurement, and some were not consistent with established conceptualizations of QoL. Overall recommendations for best practices are offered. Detailed information about specific measures is included, and measures that seem to capture the construct well are recommended. Additionally, our review highlighted the importance of using a “battery approach,” including child and parent report as well as considering other variables, such as patient's age, when selecting a QoL measurement strategy.
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Affiliation(s)
- Rachel A. Annunziato
- Fordham University, Bronx, New York (RAA, MP, JH, KH), Icahn School of Medicine at Mount Sinai, New York (KK, RA)
| | - Meera Parbhakar
- Fordham University, Bronx, New York (RAA, MP, JH, KH), Icahn School of Medicine at Mount Sinai, New York (KK, RA)
| | - Jacqueline Helcer
- Fordham University, Bronx, New York (RAA, MP, JH, KH), Icahn School of Medicine at Mount Sinai, New York (KK, RA)
| | - Kathryn Kapoor
- Fordham University, Bronx, New York (RAA, MP, JH, KH), Icahn School of Medicine at Mount Sinai, New York (KK, RA)
| | - Kristen Henkel
- Fordham University, Bronx, New York (RAA, MP, JH, KH), Icahn School of Medicine at Mount Sinai, New York (KK, RA)
| | - Ronen Arnon
- Fordham University, Bronx, New York (RAA, MP, JH, KH), Icahn School of Medicine at Mount Sinai, New York (KK, RA)
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Sundaram SS, Alonso EM, Haber B, Magee JC, Fredericks E, Kamath B, Kerkar N, Rosenthal P, Shepherd R, Limbers C, Varni JW, Robuck P, Sokol RJ, Liver C, Disease Research and Education Network (ChiLDREN). Health related quality of life in patients with biliary atresia surviving with their native liver. J Pediatr 2013; 163:1052-7.e2. [PMID: 23746866 PMCID: PMC4014354 DOI: 10.1016/j.jpeds.2013.04.037] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 02/14/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To quantify health related quality of life (HRQOL) of patients with biliary atresia with their native livers and compare them with healthy children and patients with biliary atresia post-liver transplant (LT) and to examine the relationship between HRQOL and medical variables. STUDY DESIGN A cross-sectional HRQOL study of patients with biliary atresia with their native livers (ages 2-25 years) was conducted and compared with healthy and post-LT biliary atresia samples using Pediatric Quality of Life Inventory 4.0 child self and parent proxy reports, a validated measure of physical/psychosocial functioning. RESULTS 221 patients with biliary atresia with native livers (54% female, 67% white) were studied. Patient self and parent proxy reports showed significantly poorer HRQOL than healthy children across all domains (P < .001), particularly in emotional and psychosocial functioning. Child self and parent proxy HRQOL scores from patients with biliary atresia with their native livers and post-LT biliary atresia were similar across all domains (P = not significant). Child self and parent proxy reports showed moderate agreement across all scales, except social functioning (poor to fair agreement). On multivariate regression analysis, black race and elevated total bilirubin were associated with lower Total and Psychosocial HRQOL summary scores. CONCLUSIONS HRQOL in patients with biliary atresia with their native livers is significantly poorer than healthy children and similar to children with post-LT biliary atresia. These findings identify significant opportunities to optimize the overall health of patients with biliary atresia.
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Kelly DA, Bucuvalas JC, Alonso EM, Karpen SJ, Allen U, Green M, Farmer D, Shemesh E, McDonald RA. Long-term medical management of the pediatric patient after liver transplantation: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Liver Transpl 2013; 19:798-825. [PMID: 23836431 DOI: 10.1002/lt.23697] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 06/15/2013] [Indexed: 12/15/2022]
Affiliation(s)
- Deirdre A Kelly
- Liver Unit, Birmingham Children's Hospital, National Health Service Trust, Birmingham, United Kingdom.
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Ladner DP, Alonso EM, Butt Z, Caicedo JC, Cella D, Daud A, Friedewald JJ, Gordon EJ, Hazen GB, Ho BT, Hoke KR, Holl JL, Ison MG, Kang R, Mehrotra S, Preczewski LB, Ross OA, Sharaf PH, Skaro AI, Wang E, Wolf MS, Woods DM, Abecassis MM. NUTORC-a transdisciplinary health services and outcomes research team in transplantation. Transl Behav Med 2012; 2:446-458. [PMID: 23667403 PMCID: PMC3647618 DOI: 10.1007/s13142-012-0176-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The field of solid organ transplantation has historically concentrated research efforts on basic science and translational studies. However, there has been increasing interest in health services and outcomes research. The aim was to build an effective and sustainable, inter- and transdisciplinary health services and outcomes research team (NUTORC), that leveraged institutional strengths in social science, engineering, and management disciplines, coupled with an international recognized transplant program. In 2008, leading methodological experts across the university were identified and intramural funding was obtained for the NUTORC initiative. Inter- and transdisciplinary collaborative teams were created across departments and schools within the university. Within 3 years, NUTORC became fiscally sustainable, yielding more than tenfold return of the initial investment. Academic productivity included funding for 39 grants, publication of 60 manuscripts, and 166 national presentations. Sustainable educational opportunities for students were created. Inter- and transdisciplinary health services and outcomes research in transplant can be innovative and sustainable.
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Affiliation(s)
- Daniela P. Ladner
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
- />Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Estella M. Alonso
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Zeeshan Butt
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Juan Carlos Caicedo
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - David Cella
- />Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
| | - Amna Daud
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - John J. Friedewald
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Division of Nephrology, Department of Medicine, Northwestern University, Chicago, IL USA
| | - Elisa J. Gordon
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Gordon B. Hazen
- />Department of Industrial Engineering and Management Sciences, McCormick School of Engineering, Northwestern University, Chicago, IL USA
| | - Bing T. Ho
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Division of Nephrology, Department of Medicine, Northwestern University, Chicago, IL USA
| | - Kathleen R. Hoke
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Jane L. Holl
- />Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Michael G. Ison
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Division of Infectious Diseases, Department of Medicine, Northwestern University, Chicago, IL USA
| | - Raymond Kang
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Sanjay Mehrotra
- />Department of Industrial Engineering and Management Sciences, McCormick School of Engineering, Northwestern University, Chicago, IL USA
| | - Luke B. Preczewski
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
| | - Olivia A. Ross
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Pamela H. Sharaf
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Anton I. Skaro
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Edward Wang
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
| | - Michael S. Wolf
- />Division of General Internal Medicine, Department of Medicine, Northwestern University, Chicago, IL USA
| | - Donna M. Woods
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Michael M. Abecassis
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
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O'Connor SS, Zatzick DF, Wang J, Temkin N, Koepsell TD, Jaffe KM, Durbin D, Vavilala MS, Dorsch A, Rivara FP. Association between posttraumatic stress, depression, and functional impairments in adolescents 24 months after traumatic brain injury. J Trauma Stress 2012; 25:264-71. [PMID: 22729979 DOI: 10.1002/jts.21704] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The degree to which postinjury posttraumatic stress disorder (PTSD) and/or depressive symptoms in adolescents are associated with cognitive and functional impairments at 12 and 24 months after traumatic brain injury (TBI) is not yet known. The current study used a prospective cohort design, with baseline assessment and 3-, 12-, and 24-month followup, and recruited a cohort of 228 adolescents ages 14-17 years who sustained either a TBI (n = 189) or an isolated arm injury (n = 39). Linear mixed-effects regression was used to assess differences in depressive and PTSD symptoms between TBI and arm-injured patients and to assess the association between 3-month PTSD and depressive symptoms and cognitive and functional outcomes. Results indicated that patients who sustained a mild TBI without intracranial hemorrhage reported significantly worse PTSD (Hedges g = 0.49, p = .01; Model R(2) = .38) symptoms across time as compared to the arm injured control group. Greater levels of PTSD symptoms were associated with poorer school (η(2) = .07, p = .03; Model R(2) = .36) and physical (η(2) = .11, p = .01; Model R(2) = .23) functioning, whereas greater depressive symptoms were associated with poorer school (η(2) = .06, p = .05; Model R(2) = .39) functioning.
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Affiliation(s)
- Stephen S O'Connor
- Harborview Injury Prevention & Research Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
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Abstract
OBJECTIVES The objective of the present qualitative study was to develop the items and support the content validity for the Pediatric Quality of Life Inventory (PedsQL) Gastrointestinal Symptoms Module for pediatric patients with functional gastrointestinal (GI) disorders and organic GI diseases, hereafter referred to as GI disorders. METHODS The iterative process included multiphase qualitative methods. A literature review of GI disorders was conducted to generate domains for the focus interviews. Six pediatric gastroenterologists with extensive clinical experience in GI disorders provided expert opinion regarding the conceptual framework. A total of 98 participants, 46 pediatric patients ages 5 to 18, and 52 parents of patients ages 2 to 18 with physician-diagnosed GI disorders (chronic constipation, functional abdominal pain, irritable bowel syndrome, inflammatory bowel disease [Crohn disease, ulcerative colitis], gastroesophageal reflux disease), participated in the focus interviews and cognitive interviewing phases, including think-aloud and cognitive debriefing protocols. RESULTS Eleven domains were derived from the qualitative methods involving patient and parent interviews and expert opinion, with content saturation achieved, resulting in 76 items. The 11 domains consisted of items measuring stomach pain, stomach upset, food and drink limits, trouble swallowing, heartburn and reflux, gas and bloating, constipation, diarrhea, worry, medicines, and communication. CONCLUSIONS Qualitative methods involving pediatric patients and their parents in the item generation process support the content validity for the new PedsQL Gastrointestinal Symptoms Module. The PedsQL Gastrointestinal Symptoms Module is undergoing national multisite field testing as the next iterative phase.
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Effect of Aripiprazole 2 to 15 mg/d on Health-Related Quality of Life in the Treatment of Irritability Associated with Autistic Disorder in Children: A Post Hoc Analysis of Two Controlled Trials. Clin Ther 2012; 34:980-92. [DOI: 10.1016/j.clinthera.2012.02.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2012] [Indexed: 11/19/2022]
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