A Shared Decision-Making Process Utilizing a Decision Coach in Pediatric Epilepsy Surgery

Experience of post-traumatic growth among parents of children with biliary atresia undergoing living-related liver transplantation: a descriptive phenomenological study

Objectives: To explore the experience of post-traumatic growth among parents of children with biliary atresia undergoing living-related liver transplantation.Methods: Participants were recruited within 2 weeks of their child's transplant surgery using purposive sampling. Transcripts were analyzed using Colaizzi's descriptive analysis framework, with collaborative analysis conducted using NVivo 12 software and a post-traumatic growth model.Results: Five themes were identified: (a) experiencing a devastating blow, (b) cognitive reconstruction under overwhelming pain, (c) an arduous journey of decision-making, (d) rebirth in adversity and (e) post-traumatic growth. Parents undergo significant post-traumatic responses to their child's diagnosis of biliary atresia and liver transplantation, marking two major traumatic events. During the diagnostic stage, parents experience intense post-traumatic reactions characterized by emotional fluctuations and intrusive thoughts. The early treatment phase represents a crucial time for parents to transition from `denial of reality' to `accepting diseases'. The process of liver transplantation is also a significant traumatic event, accompanied by a final hope. Parents in the stable period after liver transplantation feel fortunate, hopeful and grateful, and their post-traumatic growth manifests gradually.Conclusions: Parents' experience of post-traumatic growth involves dynamic changes. Tailored intervention strategies should be developed for different stages to enhance their post-traumatic growth and psychological well-being. During the early treatment stage, mental health professionals could provide cognitive interventions to encourage parents to express their negative emotions and guide them to develop positive cognition toward traumatic events. The coping strategies and increasing personal growth are also important. In the postoperative stage, mental health professionals need to fully evaluate the coping styles of parents, and encourage them to establish effective internal coping strategies, while classic gratitude interventions could be given during the post-traumatic growth stage. Future research could involve a longitudinal qualitative study to explore parents' post-traumatic growth experiences at different stages of their children's transplantation process.

Social and economic impacts of pediatric neurovascular surgery: Part 1 a qualitative study of parent experiences

INTRODUCTION

Pediatric neurovascular disease can have lasting impacts on quality of life. High direct healthcare costs have been noted, yet indirect costs have not been explored. This qualitative study was part 1 of a series designed to explore the family experience with neurosurgical treatment of neurovascular conditions.

METHODS

Parents of children who had neurovascular surgery at our institution (2022-2023) underwent semi-structured interviews. Concepts explored included: access to treatment, financial and emotional impacts, and recovery.

RESULTS

5 of 8 (62.5 %) had emergency surgery, median time from symptoms to diagnosis was 7 (range 1-1095) days and diagnosis to treatment was 1.5 (0.1-365) days. Median distance traveled for treatment was 45 (15-95) miles. Median time taken off work during treatment was 24.5 (0-180) days for mothers and 5 (0-105) days for fathers. 37.5 % reported changes in employment status during or after treatment. Four themes (subthemes) were identified: (1) Decision Making (communication is crucial, cost is not a deterrent, pressure stems from emergency, time is positive), (2) Cost (high impact, income loss, transportation), (3) Emotional Impact (distress, gratitude, trust the process), and (4) Quality of Life After Surgery (difficulty with acceptance, routine adjustment, challenging healthcare coordination, frequent rehab appointments, vision deficiencies and school disruptions were common).

DISCUSSION

Neurovascular surgery is associated with social, economic, and emotional impacts on patients and their families. The presurgical period and early recovery period emerged as potential timepoints for intervention such as anticipatory guidance, navigation, and support. Future studies are warranted for quantifying burden and assessing interventions for mitigation.

Feasibility of and patient satisfaction with Readiness Brain Operation Optimization Training, a manualized cognitive prehabilitation program for epilepsy surgery

OBJECTIVE

Readiness Brain Operation Optimization Training (ReBOOT) is a manualized cognitive prehabilitation program for patients considering epilepsy surgery designed to improve presurgical preparedness through education and reduce the impact of postsurgical cognitive changes with preemptive cognitive compensatory training. The purpose of this study was to understand the feasibility of cognitive prehabilitation, examine patient satisfaction with ReBOOT, and assess changes in compensatory strategy use following ReBOOT.

METHODS

Seventeen participants (65% female, mean age = 41 years) considering epilepsy surgery were enrolled in ReBOOT, which includes two one-on-one psychoeducation sessions, four group sessions on cognitive compensatory strategies, and weekly goal setting to facilitate implementation of strategies. Patient retention, attendance, and goal completion were tracked. Participants also completed the Everyday Compensation Questionnaire pre- and postintervention along with a satisfaction survey postintervention. Aggregate ratings were examined, and paired samples t-test was used to assess change in compensatory strategy use postintervention.

RESULTS

Five participants withdrew shortly after consent, prior to starting ReBOOT, because of a change in surgical status/date or lack of desire to complete relevant study activities. Of the 12 remaining participants, only two missed one session. Participants indicated that they found ReBOOT to be quite beneficial, reported satisfaction with the information and support provided by ReBOOT, and felt that ReBOOT was effective at preparing them for epilepsy surgery and potential postsurgical cognitive changes. Most participants made some (i.e., little to moderate) progress on their goals each week and demonstrated increased compensatory strategy use by the end of ReBOOT.

SIGNIFICANCE

Findings indicate that cognitive prehabilitation is feasible. Participants reported high satisfaction with ReBOOT, reporting multiple benefits, and demonstrated increased compensatory strategy use following program completion. These results highlight cognitive prehabilitation for epilepsy surgery as a worthwhile pursuit and demonstrate that ReBOOT may serve as a useful clinical resource in the future following further validation of its efficacy.

Navigating Transition to Adulthood in Epilepsy Patients: A Multidisciplinary Approach

The transition from pediatric to adult healthcare systems is a critical yet complex process for individuals with epilepsy, requiring careful attention to both medical and psychosocial aspects. This review highlights best practices and strategies to facilitate effective transitions, focusing on the roles of multidisciplinary teams, communication strategies, shared decision-making, and transition readiness assessment. Key topics include early and ongoing communication, promoting patient autonomy, addressing mental health comorbidities, and implementing transition readiness assessments such as the Epilepsy Transition Readiness Assessment Questionnaire (EpiTRAQ). Additionally, the review evaluates models for transition clinics, emphasizing the importance of sustainability, collaboration, and tailored interventions. By leveraging these insights, healthcare professionals can support young adults with epilepsy in achieving independence and optimal health outcomes as they navigate the challenges of transitioning to adult care.

Heterogeneous knowledge of childhood seizures and epilepsy care in Canadian healthcare Providers: Identifying the gaps

Epilepsy is the most common chronic neurological condition in children. Many barriers exist in early recognition which cause delay in care and impact quality of life. Some of these children require advanced treatments which are underutilized due to lack of education, awareness and referrals. Overall, childhood epilepsy is underdiagnosed and poorly understood by non-expert providers. We investigated awareness and knowledge about epilepsy from primary care providers via the quality of their referrals. We prospectively collected and examined all epilepsy related referrals to the Paediatric Neurology Division at Children's Hospital in London, Ontario, Canada during a six-month period. We developed a modified "epilepsy focused" scoring tool to evaluate the referrals and scored them as basic or advanced. During the study time frame 175 (82 %) referrals met the inclusion criteria. Out of these, 152 (87 %) were identified as basic and 23 (13 %) were advanced (p < 0.001). Amongst the referrals that scored basic vs advanced: Family Doctors n = 49 with 40 basic (81 %) vs 9 advanced (18.3 %), Paediatric ER physicians n = 37, all 37 were basic (100 %) and Paediatricians n = 41 with 36 (87 %) basic and 5 (12 %) advanced. Our results showed significant lack of critical information in the content of epilepsy referrals coming from non-epileptologist providers, largely from the cohort of paediatric ED doctors. This reveals that knowledge and awareness of epilepsy in children remains scarce. Identifying these barriers can provide insights to develop strategies to facilitate accurate identification and rapid triage for children presenting with new onset epilepsy.

Overdiagnosis of dental caries in South Korea: a pseudo-patient study

BACKGROUND

To evaluates the tendency of South Korean dentists to over-diagnose clinically healthy teeth in pseudo-patients.

METHODS

We conducted a pseudo-patient, cross-sectional study in 196 private dental clinics with 58 pseudo-patients in South Korea between August and December 2018. Trained pseudo-patients with no previous oral diseases, including dental caries, diagnosed by two experienced dentists, were sent to each dental clinic. Before visiting each private dental clinic, participants were instructed to state, "I have no symptoms, but I would like to have a dental caries examination". The oral examination was performed using visual and tactile inspection methods only. The interactions between the dental clinic staff and the pseudo-patient were documented on a data collection form shortly after each visit.

RESULTS

In 33.2% (65/196) of these interactions, the pseudo-patients were diagnosed as having no dental caries. 11.7% (23/196), 12.8% (25/196), 10.7% (21/196), and 10.7% (21/196) of the sample were diagnosed with dental caries in one, two, three, and four teeth, respectively. Dentists diagnosed five or more dental caries in 20.9% (41/196) of the sample. 196 dental clinics diagnosed a total of 503 dental caries. Of these, 392 were in molars. Small solo practice dentists diagnosed 3.54 dental caries and large group practice dentists 1.57, but the difference was not significant (p = 0.07). The recommendation rate for dental caries treatment was highest among 43 (55.1%) large solo practices, and lowest in 7 (33.3%) large group practices. However, small solo practices had the lowest rate of preventive care recommendations at 12 (30.8%) and 10 (47.6%) in large group practices. The data shows that preventive care recommendations increased as the practice size increased.

CONCLUSION

The study findings indicate that Korean dentists tend to over-diagnose dental caries, which could pose a threat to public health both in Korea and worldwide. Therefore, it is important to carefully consider strategies to improve the correct diagnosis and standard of care for dental caries by private dentists.

The role of psychology and neuropsychology in pediatric epilepsy surgery evaluation

Epilepsy is one of the most common neurological problems affecting 470,000 children in the United States. While most youth will achieve seizure freedom using medication, up to a third will continue to have seizures and are therefore considered to have drug-resistant epilepsy (DRE). Children and adolescents with epilepsy are at higher risk of behavioral, cognitive, and emotional disorders. Youth with DRE are at even greater risk of behavioral and emotional problems impacting quality of life and may need to pursue surgical interventions, including resective surgery or device implantation. Due to advances in the evaluation of candidates and surgical options, epilepsy surgery is more effective and has become second-line treatment for youth with DRE. This paper highlights the importance of exploring, assessing, and treating psychological and neuropsychological factors throughout the three phases of the epilepsy surgery process and ways pediatricians can support youth and families.