[Non-pharmacological pain management methods in pediatrics and their application at the Bethesda Children's Hospital of the Hungarian Reformed Church]

Abstract: Over recent decades, non-pharmacological pain management approaches have gained increasing importance in pediatric care, as they can be applied with low cost and minimal time investment while significantly contributing to the improvement of care quality. The aim of this review article is to provide an overview of non-pharmacological options for procedural pain management based on the literature, and to present the dissemination of this approach in Hungary through the support of a child-centered, trust-based healthcare model. This paper presents a narrative review of the key findings of international literature on non-pharmacological management of procedural pain. In addition, it describes the practical implementation of an interdisciplinary non-pharmacological pain management program based on the principles of the Comfort Promise, which has been operating since 2021 at the Bethesda Children's Hospital of the Hungarian Reformed Church. The article outlines the steps of implementation, the tools and techniques applied, and summarizes clinical experiences. Methods shown to be effective in the literature - such as distraction, breathing exercises, comfort positioning, breastfeeding, and the use of various sensory tools - are, in line with international evidence, also supported by clinical experience as contributing to the reduction of children's anxiety, increasing parental satisfaction, and improving the quality of care. Experience suggests that integrating non-pharmacological methods into everyday clinical practice does not require significant additional resources; however, it does necessitate a shift in mindset and a structured implementation process. Interdisciplinary collaboration, staff training, the establishment of a volunteer network, and the active involvement of parents and children are key factors for sustainable implementation. Based on current experience, the combined application of this approach and its methods has proven to be effective. According to international literature, anxiety-reducing interventions - including parental presence, appropriate information provision, distraction, and relaxation techniques - contribute to the alleviation of procedural pain through neural mechanisms influencing pain perception, which is also supported by the institutional experience presented. Orv Hetil. 2026; 167(31): 1215-1223.

Vargay A
Bencsik AS
Szabó V
Székely IZ
Károlyi L
Forgács-Kristóf K
Perczel K
Gyimesi-Szikszai A
Major J

Humans
Hungary
Pain Management
Child
Hospitals, Pediatric
Procedural Pain
Pediatrics
Anxiety


When newborns die: walking the extra mile. Surgeon grief in pediatric neurosurgery: qualitative synthesis and framework development

Abstract: The aim of this study was to develop a conceptual framework for understanding surgeon grief in pediatric neurosurgery, examine its intersection with moral distress and professional burnout, and review evidence for institutional interventions supporting physician well-being after patient death. The author conducted a narrative review of English-language literature on physician grief, moral distress, and burnout in surgical specialties, with attention to pediatric practice. PubMed, PsycINFO, and CINAHL were searched for publications from January 2000 to December 2024. The initial search yielded 847 articles; after screening, 67 met inclusion criteria for narrative synthesis. An illustrative case of a neonate with an unresectable brain tumor contextualizes the framework. Five dimensions of surgeon grief specific to therapeutic futility were identified: grief of unexpressed mastery (inability to deploy technical expertise), grief of identity disruption (challenge to action-oriented surgical identity), grief of anticipatory knowledge (burden of prognostic awareness), grief of perceived failure (internalization of patient death as personal defeat), and disenfranchised grief (grief not socially recognized within surgical culture). These dimensions interact bidirectionally with moral distress to produce cumulative emotional burden contributing to burnout and career attrition. Evidence supports institutional interventions that include structured debriefing, peer support programs, Schwartz Rounds, and early palliative care integration. Surgeon grief represents a significant but understudied occupational hazard in pediatric neurosurgery. The proposed 5-dimension framework provides a conceptual foundation for research, instrument development, and targeted interventions. Recognizing that providing a good death is a form of surgical success and that surgeon grief reflects preserved humanity is essential for workforce sustainability.

Humans
Grief
Infant, Newborn
Neurosurgeons
Burnout, Professional
Neurosurgery
Pediatrics


Beyond burnout: professional grief and moral distress in pediatric neuro-oncological neurosurgery

Abstract: Pediatric neuro-oncology exposes healthcare professionals to high technical complexity, ethical uncertainty, and sustained emotional stress. Professional grief, moral distress, and second victim experiences are increasingly recognized in pediatric oncology, yet they remain insufficiently characterized in pediatric neuro-oncological neurosurgery. The authors conducted a cross-sectional, anonymous survey among healthcare professionals involved in pediatric neuro-oncology at a tertiary children's hospital. A 27-item questionnaire assessed 5 domains: professional grief, moral distress, second victim/emotional impact, neuro-oncology-specific emotional burden, and organizational support. The Pediatric Neuro-Oncology Professional Grief Score (PNOP-GS; range 27-135) was calculated as the sum of all items. Descriptive statistics, internal consistency analyses, and exploratory comparisons by training and exposure were performed. Forty-one complete responses were analyzed. Participants included nurses (46.3%), physicians (41.5%), and psychologists (9.8%), with 87.8% reporting exposure to children with advanced or terminal brain tumors in the preceding 12 months. The mean PNOP-GS was 91.2 ± 18.2, corresponding to a mean item score of 3.38 ± 0.67. Neuro-oncology-specific emotional burden (3.57 ± 0.96) and professional grief (3.42 ± 0.88) were the highest-scoring domains, while perceived organizational support was low (1.83 ± 0.78). Prior training in pediatric palliative care, communication of poor prognosis, or grief management was associated with significantly lower emotional burden (p = 0.002). Greater exposure to terminal cases correlated with higher PNOP-GSs (p = 0.049). Emotional burden did not differ significantly across professional roles. Internal consistency of the overall instrument was good (Cronbach's α = 0.82). Healthcare professionals in pediatric neuro-oncology experience substantial professional grief and emotional burden extending beyond patient death to ethical complexity and neurological morbidity. Training and organizational support represent modifiable protective factors and should be systematically integrated into pediatric neuro-oncological practice.

Vitulli F
Micucci M
Spennato P
Ferrara R
Dolcini A
Monorchio P
Cinalli G
Quaglietta L

Humans
Grief
Cross-Sectional Studies
Male
Ethical Dilemmas
Female
Burnout, Professional
Surveys and Questionnaires
Adult
Neurosurgery
Child
Psychologists
Brain Neoplasms
Pediatrics


Telemedicine in pediatrics: a critical narrative review of innovations, limitations, and future priorities

Abstract: This narrative review synthesizes recent technological and organizational developments in pediatric telemedicine, maps their principal clinical applications, and critically discusses implementation, safety, equity, and future priorities. This narrative review used a transparent, non-systematic literature-search approach in PubMed/MEDLINE, Scopus, and Google Scholar, considering publications available through April 2026. Searches were intended to identify and contextualize relevant literature across pediatric settings rather than to provide an exhaustive, reproducible systematic evidence synthesis. No formal risk-of-bias assessment, meta-analysis, or certainty-of-evidence grading was undertaken; therefore, findings are interpreted cautiously and according to the maturity and consistency of the available evidence. Evidence suggests that telemedicine can support follow-up, access to specialist care, and family engagement in several pediatric chronic-care pathways, particularly diabetes and asthma. However, the evidence base is heterogeneous across specialties, frequently relies on observational or implementation studies, and is less mature for acute assessment, neonatal and rehabilitation uses, wearables, and AI-enabled tools. Telemedicine should be considered a complementary component of pediatric healthcare rather than a replacement for in-person assessment. Hybrid models may support accessibility, continuity, and sustainability when embedded in structured, patient-centered, equitable, and clinically appropriate pathways. • Telemedicine expanded rapidly in pediatrics during the COVID-19 pandemic and is now used across many specialties. • It can improve access, continuity of care, remote monitoring, and family engagement, especially in chronic and complex conditions. • This review summarizes recent technological and organizational innovations, including wearables, mHealth, EHR integration, AI, and hybrid care models. • It highlights current limits and future requirements for safe, equitable, and sustainable integration into routine pediatric care.

Zuccotti G
Scavone IAM
Cordaro E
Rossi V
Calcaterra V

Humans
Telemedicine
Pediatrics
Child
Digital Health


Evaluating a Global Clinical Nutrition Program for Pediatric Oncology in Resource-Limited Settings

Abstract: Background: Children with cancer in low- and middle-income countries (LMICs) experience disproportionately high mortality. Nutritional care improves treatment tolerance and survival, yet access to trained nutrition professionals remains limited. The International Initiative for Pediatrics and Nutrition (IIPAN) was established to strengthen hospital-based clinical nutrition services through capacity-building, education, and mentorship. Objectives: To evaluate the IIPAN global clinical nutrition capacity-building program across hospitals in LMICs. Methods: A monitoring and evaluation framework was implemented across 16 hospitals in 11 countries (February 2024-June 2025). Monthly indicators captured patient characteristics, nutritional status, delivery of nutrition interventions, and dietary diversity. Nutritional status was classified using body mass index (BMI)-for-age, mid-upper arm circumference (MUAC), and height-for-age z-scores based on World Health Organization standards. Findings: Across all sites, 29,295 clinical visits were reported. Most consultations occurred in inpatient settings (79.9%) and were follow-up assessments (85.1%). Among patients, 52.5% had solid tumors and 39.6% had hematologic malignancies. Based on BMI-for-age, 10.3% were classified with severe acute malnutrition (SAM) and 13.5% with moderate acute malnutrition (MAM). Height-for-age analysis indicated that 27.2% were stunted. Nearly all hospitalized patients (95.8%) received a nutrition assessment within 24 hours of admission, and 96.0% received individualized or group nutrition education. Therapeutic foods or formulas were provided in 42.8% of consultations, while advanced nutrition therapy was administered in 3.5%. The prevalence of acute malnutrition decreased significantly between initial and follow-up assessments (38.9% to 25.2%; P < 0.001). In sites with food kitchens, provision of therapeutic nutrition was substantially higher than program-wide for both children consuming ≤50% of estimated needs (87.4% vs 55%) and for children with SAM (99.1% vs 86%). Conclusions: The IIPAN model demonstrates that integrated, hospital-based nutrition care led by trained nutritionists can reduce acute malnutrition and improve access to essential nutrition services in LMICs.

Leonardo S
Antillón F
Ayalew M
de Los Angeles Carrillo M
Espinoza DM
Chapagain RH
Damasco-Avila E
Dawit T
Domínguez TA
Dhungana J
Ecleo SY
Ferman S
Fu L
Gassant P
Hailu D
Hailu T
Henry A
Kambugu J
Kouya F
Majaliwa E
Muliro B
Murra M
Nkya E
Nzamu I
Oliveira W
Pedro M
Sapkota S
Scanlan T
Semujju JM
de Macedo Soares CF
Sui TH
Viani K
Walters M
Yemane E
Yitbarek T
Sagastizado SZ
Ladas EJ

Humans
Neoplasms
Resource-Limited Settings
Child
Child, Preschool
Nutritional Status
Developing Countries
Female
Infant
Male
Malnutrition
Program Evaluation
Capacity Building
Adolescent
Pediatrics
Child Nutrition Disorders


A Pediatric Resident Physician Coaching Program With Faculty Retreat Developed in Partnership With a Master Certified Coach

Abstract: In recent years, the Association of Pediatric Program Directors and American College of Graduate Medical Education surveys have highlighted challenges in pediatric residency, including burnout and suboptimal faculty-trainee relationships. Coaching has emerged as a promising strategy to support learner-centered professional development, but most medical faculty lack formal training in coaching. We developed a faculty coaching retreat to train a select set of faculty members who would then participate in a longitudinal pediatric residency coaching program. The retreat consisted of a 1-day (7.5-hour) training event including introductions to program structure, a keynote presentation on coaching mindset, and interactive small-group role-plays. We collected qualitative and quantitative data from faculty coaches before and after the retreat, measuring their ability to differentiate coaching versus advising interactions and to describe attributes of an effective coach. Quantitative data were compared using a Wilcoxon rank-sum test, and qualitative data were organized into themes. Eighteen faculty coaches participated in the coaching retreat. Faculty demonstrated improvements in their ability to distinguish between coaching and advising, with a median score of 90% (interquartile range 70-92.5) to 100% (interquartile range 90-100) (P = .003) on the knowledge assessment. Comparing pre- to postretreat qualitative data, new themes emerged, including curiosity and a resident-driven approach, both key concepts emphasized during the retreat. This faculty coaching retreat increased participants' knowledge and understanding about what it means to be an effective pediatric residency coach, effectively setting the stage for initiation of a longitudinal residency coaching program.

MedEdPORTAL : the journal of teaching and learning resources

Fashina O
Thorvilson M
Mavis S
Thorn PM
Pittock S
Munger K
McKone J
Raevsky E
Johnson KL

Mentoring
Humans
Internship and Residency
Faculty, Medical
Pediatrics
Surveys and Questionnaires
Education, Medical, Graduate


Needs and Concerns Regarding a Pediatric Palliative Telehealth App for Use in Palliative Home Care for Adults Among Providers in Germany: Embedded Mixed Methods Study

Abstract: Specialized outpatient palliative care (SOPC) provides home-based care for terminally ill patients and is associated with improved quality of life and prolonged survival. Due to its decentralized structure and growing demand, SOPC is a key target for digital transformation. Telehealth, mobile health, and AI offer considerable potential benefits but also present challenges, particularly with regard to user acceptance. Although both children and adults receive SOPC under the German statutory health insurance system, services differ in terms of patient characteristics, duration of care, and geographic coverage. Moreover, there is limited knowledge regarding the extent to which digital health applications are transferable across different areas of palliative care. This study assesses the extent to which needs and concerns regarding digitalization in SOPC for children are transferable to adult SOPC, using the PalliDoc Mobile app as a case example. Two adult SOPC teams using the PalliDoc Mobile app (a pediatric-origin mobile app) were surveyed between March 2022 and March 2025 using an embedded mixed methods design to assess digitalization needs and concerns. Therefore, a focus group study took place in the respective offices of the included teams. Twenty-five members from both teams, who were recruited via the personal network of the authors, participated, representing urban and rural care areas in Germany. Using an open-ended interview guide, the needs and concerns were first discussed with all participating members of each team. In a second step, the participants were allocated to profession-specific subgroups to further explore and prioritize the identified needs using a quantitative voting format. The focus group discussions were analyzed using qualitative content analysis, while the analysis of the prioritization votes was performed using descriptive statistics. The triangulation of qualitative and quantitative findings revealed a total of 13 needs within the examined care teams for adults, with functions focusing on voice control being the highest priority (n=8 positive votes and no negative votes for voice input; n=6 positive votes and no negative votes for voice output). Additionally, functions relating to digitization and organizational tasks were viewed as predominantly helpful. Unlike in pediatrics, telehealth functions like video contacts, telemetry, and electronic patient-reported outcome measures are neither used here now nor intended to be used in the future. The identified concerns predominantly addressed the potential risk of AI-assisted documentation (n=2 positive votes and n=7 negative votes) altering or distorting health care professionals' perception of information related to patients. Cross-setting telehealth applications may work, but they are no "plug-and-play solution." Needs and concerns in each setting should be addressed to guarantee customized services.

Hocher R
Weyandt S
Zimmermann J
Fischer S
Seibel K
Becker G
Nathrath M
Voelker T
Deckers M

Humans
Germany
Palliative Care
Telemedicine
Home Care Services
Adult
Male
Focus Groups
Female
Mobile Applications
Pediatrics
Middle Aged
Child
Qualitative Research
Health Personnel
Digital Health
Needs Assessment
Surveys and Questionnaires


Artificial intelligence as a clinical tutor in telemedicine: Opportunities and challenges in medical education

Abstract: Aim: To analyze key aspects of the application of AI as a clinical mentor in telemedicine-based medical education, and to assess the related opportunities, challenges, and attitudes of pediatric students. Materials and Methods: A cross-sectional study was conducted to assess the level of digital competence of future pediatricians regarding telemedicine and AI. A total of 251 students from the Faculty of Pediatrics at Bogomolets National Medical University (BNMU) participated in the survey. Participants were aged 17 to 26 years, of whom 17.9% were male and 82.1% were female. The questionnaire included items on demographic characteristics, knowledge and use of telemedicine and AI tools, self-assessment of digital competence, and attitudes toward the integration of AI in healthcare. Data were analyzed using descriptive statistics and presented as relative frequencies (%). Results: The study assessed digital competence and the use of AI among 251 future pediatricians regarding telemedicine-based medical education. Survey results indicated active engagement with AI tools in educational and professional tasks (63.7% positive responses), moderate confidence in integrated digital devices (55.0%), and cautious self-assessment of clinical decision support systems (53.4%). These findings informed the development and revision of courses at BNMU, enhancing students' practical skills and digital competence. Conclusions: Future pediatricians actively engage with digital tools and AI, although confidence is higher in AI tasks than in integrated devices or clinical decision systems. The findings guided the development of updated courses to strengthen digital competence, practical skills, and critical evaluation of AI. Successful telemedicine implementation requires addressing data security, regulation, human-centred care, and digital inclusion to ensure safe, effective, and equitable healthcare.

Wiadomosci lekarskie (Warsaw, Poland : 1960)

Kucherenko II
Vygovska OV
Terentyuk VG
Nataliia KS
Shadrin VO
Nizhehorodtsev VO
Matukova DG

Humans
Male
Female
Cross-Sectional Studies
Telemedicine
Adult
Adolescent
Young Adult
Artificial Intelligence
Education, Medical
Surveys and Questionnaires
Students, Medical
Pediatrics
Clinical Competence
Digital Health


Evaluation of an AI-Based Constraint-Optimization Scheduler to Optimize On-Call Schedule Equity and Reduce Administrative Burden in a Pediatric Residency: Retrospective Comparative Study

Abstract: Resident scheduling is a high-dimensional optimization problem with implications for workload, fatigue risk, and equity. Real-world evaluations of AI-based constraint-optimization in health care are limited. This study aimed to evaluate an AI-based constraint-optimization scheduler versus a legacy rule-based scheduler for pediatric residency night calls. This is a single-center retrospective before-after study at a 235-bed tertiary pediatric center. Twenty-four consecutive months of night-call rosters were analyzed: preimplementation (January to December 2024, legacy rule-based autoscheduler) and postimplementation (January to December 2025, AI-based constraint-programming scheduler combining a local-search metaheuristic solver with human-in-the-loop review). The analytic unit was the resident-month. Outcomes were workload distribution, threshold exceedances (>6 total and >2 weekend calls/month), undesirable sequences (consecutive weekend calls; call-rest-call; call-rest-call-rest-call), equity (mean absolute error from equal share [MAE-ES], root mean square error from equal share), publication lead time, as well as pre- and postsurvey experience. We analyzed 6519 shifts across 1530 resident-months (legacy: 803 resident-months/107 physicians; AI: 727/87; weekend share 28.8% [934/3246] vs 28.6% [935/3273]; service mix P=.99). Mean calls/resident-month did not decline (4.04 vs 4.50; P<.001), but within-period SD was approximately halved. Threshold exceedances fell from 133/803 (16.6%) to 28/727 (3.9%) for >6 calls per month (risk ratio [RR] 0.24, 95% CI 0.15-0.34) and 89/803 (11.1%) to 21/727 (2.9%) for >2 weekend calls (RR 0.27, 95% CI 0.16-0.40; both P<.001). Undesirable sequences declined: consecutive weekends 24.4→18.7/100 resident-months (RR 0.77; P=.02); call-rest-call 51.2→23.4 (RR 0.46); call-rest-call-rest-call 5.6→1.0 (RR 0.18; both P<.001). Equity improved overall and within every qualification stratum: MAE-ES -0.26 shifts (95% CI -0.28 to -0.23) and RMSE-ES -0.29 (95% CI -0.32 to -0.26); Senior, Advanced, and Novice strata were all P<.001 after Holm correction. Publication lead time more than doubled (10.7→21.2 d; Δ+10.5, Cohen d=4.78; Cliff δ=1.00; P<.001). Interrupted time-series confirmed immediate level shifts for >6-call exceedances (β=-8.88; P=.004), MAE-ES (β=-0.18; P<.001), call-rest-call (β=-13.17; P=.002), call-rest-call-rest-call (β=-2.35; P=.03), and >2 weekend exceedances (β=-7.32; P<.001), with stable postimplementation fairness slopes. Among survey respondents (n=47 pre; n=38 post), software satisfaction rose 6.77→8.71/10, perceived timeliness 3.28→4.61/5, perceived consecutive-night frequency 3.15→4.24, and perceived equity 2.98→3.61 (all P≤.006). An AI-based constraint-optimization scheduler was associated with significantly more equitable on-call workload across all qualification strata, large reductions in high-risk shift sequences and threshold exceedances, and a doubling of publication lead time, despite no reduction in mean per-physician burden once all physicians were retained. Multisite prospective replication is warranted before generalization.

Gilad D
Farbstein-Aljanati T
Kassif Lerner R
Ashkenazi M
Pessach IM

Retrospective Studies
Internship and Residency
Humans
Pediatrics
Workload
Personnel Staffing and Scheduling
Artificial Intelligence


Pediatric Oncology Clinical Trial Participation Among Families From Historically Marginalized Groups

Abstract: Perspectives of families from historically marginalized groups regarding pediatric oncology clinical trial participation are not well-represented in the literature. To describe clinician- and parent-perceived facilitators and barriers to clinical trial participation. This single-center cross-sectional study with an explanatory sequential mixed-methods design enrolled parents of Black and Hispanic children with cancer as well as pediatric oncology clinicians from a large pediatric cancer center in Boston, Massachusetts. Parent participants completed single-time point surveys, and a subset, purposively sampled based on self-identified race and ethnicity, language, and household material hardship (HMH; ie, food, housing, transportation, or utility insecurity), completed semistructured interviews from September to December 2021. Clinicians completed semistructured interviews from February to March 2022. Data were analyzed from April 2022 to October 2025. Key factors influencing clinical trial participation in pediatric oncology among parents from historically marginalized groups. Quantitative data were summarized descriptively. Interview transcripts were analyzed using thematic analysis and integrated along key domains. A total of 60 parents completed the questionnaire; self-identified race and ethnicity included 5 Hispanic Black (8%), 10 Hispanic White (17%), 21 Hispanic other (35%), 21 non-Hispanic Black (35%), and 3 non-Hispanic White (5%) parents; most were mothers (51 [85%]). Twenty parents participated in interviews. Fifteen clinicians (10 [67%] female participants; 10 [67%] with ≥10 years caring for children with cancer) were interviewed, including 12 (80%) attendings and 3 (20%) advanced practice practitioners; most identified as non-Hispanic White (14 [93%]). Most families experienced HMH (44 [73%]) and reported high trust in their oncology team (mean [SD] score, 4.63 [0.65] of 5.00). Qualitatively, parents and clinicians aligned in identifying altruism and trustworthiness as facilitators to trial participation, while the informed consent discussion, non-English language preference, trial materials, and study requirements were participation barriers. Unlike clinicians, parents did not identify HMH or the experimental nature of trials as significant barriers to participation. Parents identified the desire for representation as a facilitator to participation, and clinicians identified gatekeeping as a barrier. In this cross-sectional study of pediatric oncology families from historically marginalized groups and clinicians, clinician- and parent-perceived barriers identified opportunities to increase equitable trial participation. Next steps include standardization of trial eligibility screening and systematic HMH screening and support to reduce gatekeeping.

Umaretiya PJ
Paul MA
Valenzuela A
Hawkins A
Revette AC
Nava-Coulter B
Eche-Ugwu IJ
Snaman JM
Aziz-Bose R
Kelly CA
Nguyen G
Pruitt SL
Wolfe J
Bona K

Humans
Cross-Sectional Studies
Female
Male
Child
Clinical Trials as Topic
Hispanic or Latino
Neoplasms
Parents
Black or African American
Boston
Medical Oncology
Adult
Surveys and Questionnaires
Pediatrics
Patient Participation
Adolescent
Child, Preschool


What works in educational interventions for teams caring for children and young people admitted to general acute paediatric wards for mental health? A systematic review

Abstract: To systematically review educational interventions for staff working on acute paediatric wards aimed at improving the care of children and young people (CYP) admitted for mental health support. We conducted a systematic search of PubMed, The Education Resources Information Centre, PsychInfo and Web of Science from 2000 to March 2026 using terms related to healthcare professionals, training/education, mental health and children/young people. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Interventions were classified using the Kirkpatrick model and the Behavioural Change Technique Taxonomy (BCT V.1) to identify mechanisms underpinning effective change. We found nine studies meeting inclusion criteria, across a range of teaching methodologies and settings. Most interventions were designed and applied for nurses. Overall quality of evidence was poor. Although no single intervention could be recommended, analysis identified potentially useful components tailored to different learner needs, mapped through the Kirkpatrick and BCT frameworks. A notable gap was a lack of codesign with CYP and carers with lived experience and the absence of strategies to engage ambivalent or reluctant learners who might not attend educational interventions voluntarily. Existing educational interventions contain elements that may support behavioural and practice change among staff caring for CYP with mental health needs. However, future research should prioritise high-quality, framework-based evaluations developed through codesign with CYP and carers. Interventions should also address how to engage learners who may be reluctant to participate in training for this area of clinical practice.

Sanwo O
Rich A
Pomfret I
Downs J
Davis S
Dearden J
Buchanan M
Omer L
Griffin A
Hudson LD

Humans
Child
Adolescent
Patient Care Team
Health Personnel
Mental Health
Mental Disorders
Pediatrics


Leveraging multicenter databases to improve care in pediatric vascular surgery

Abstract: Pediatric vascular surgical problems are rare and variable in presentation, thus making them challenging to characterize and treat. The diversity of patient conditions and size combined with variability in pediatric vascular surgical training leads to an ad hoc approach to these patients. With few published guidelines as well as a lack of robust research to support evidence-based assertions, pediatric vascular practices have been largely driven by anecdotal evidence and limited retrospective single-institution reviews. Collaborative data collection in vascular surgery is necessary to generate more robust data, improve understanding of nuances in pediatric vascular surgery, and establish standardized practices in the pediatric patient population. The aim of this review is to assess multicenter surgical registries and identify opportunities for similar entities in pediatric vascular surgery. LEVEL OF EVIDENCE: n/a.

Koh EY
Wang SK
DuBose JJ
Lally P
Harting MT
Cox CS Jr
Drucker NA

Humans
Vascular Surgical Procedures
Registries
Pediatrics
Quality Improvement
Databases, Factual
Child


Association between organisational patient safety practices, safety culture and adverse event reporting in paediatric emergency departments in Spain: a multicentre cross-sectional survey study

Abstract: To analyse the association between organisational patient safety practices, including training in patient safety and clinical simulation, and safety culture and adverse event (AE) reporting in paediatric emergency departments. Observational analytical multicentre cross-sectional study. 19 paediatric emergency departments at different levels of healthcare. Healthcare professionals working in paediatric emergency departments. Not applicable PRIMARY AND SECONDARY OUTCOMES: Safety culture was analysed using the Hospital Survey on Patient Safety Culture, following the Agency for Healthcare Research and Quality methodology. Logistic regression analyses were performed. Organisational patient safety practices included the presence of patient safety specialists, leadership walkarounds, additional reporting systems and training in patient safety and clinical simulation. A total of 1176 professionals participated (response rate 63.8%). The presence of patient safety specialists was associated with more favourable scores in 'supervisor/manager expectations and actions', 'organisational learning' and 'teamwork' (p<0.001). Additional reporting systems were associated with higher scores in 'frequency of events reported' and 'feedback' (p<0.001). Leadership walkarounds were associated with higher response rates in 'supervisor/manager expectations and actions' (p=0.013) and 'organisational learning' (p=0.048). Training in patient safety and clinical simulation were associated with higher positive response rates across most questionnaire dimensions. Higher AE reporting was observed in centres with clinical simulation training, presence of patient safety specialists, leadership walkarounds and additional reporting systems in bivariate analyses. However, in the multivariable model, only other reporting systems (OR 2.690; 95% CI 1.565 to 4.662) and annual emergency department visit volume (OR 1.023; 95% CI 1.1013 to 1.033) were independently associated with AE reporting. The presence of more than two patient safety specialists was associated with lower reporting (OR 0.553; 95% CI 0.306 to 0.998). Paediatricians were more likely to report AEs. Organisational patient safety practices were associated with favourable safety culture dimensions. However, after the adjustment, AE reporting was primarily associated with reporting infrastructure and organisational characteristics. The implementation of these practices varied across centres, highlighting differences in the availability of organisational safety practices. Further research is needed to better understand these associations in paediatric emergency departments.

Paediatric Emergency Safety Culture Group

Humans
Cross-Sectional Studies
Emergency Service, Hospital
Patient Safety
Spain
Organizational Culture
Safety Management
Logistic Models
Surveys and Questionnaires
Pediatrics
Female
Male

Journal Article
Multicenter Study
Observational Study


"Reading level is just one component": best practices for cognitive debriefing patient-reported outcome instruments with pediatric populations

Abstract: The purpose of this study was to develop best practices for conducting cognitive debriefing interviews with pediatric populations by drawing on the currently available literature and insights from experts in the health-related quality of life research community. A scoping review of the literature was conducted to identify existing recommendations, considerations, and methods for conducting cognitive debriefing interviews with pediatric populations. Findings from the review informed the development of a draft set of best practices, which were subsequently reviewed and refined through a two‑round modified Delphi process. The Delphi panel was composed of experts (i.e., researchers) in patient-reported outcome instrument development and evaluation with experience conducting interviews with pediatric populations. Thirty-five articles or guidance documents were included in the final scoping review, contributing insights that were used to develop a draft set of 17 best practices. Following the two rounds of review by the Delphi panel, the final set of 17 best practices, which reflects panel consensus, addresses: developing the interview guide, evaluating the characteristics of the instrument to be debriefed, and interview conduct. The best practices described in this article provide evidence‑based guidance that can help to standardize and strengthen the rigor of cognitive debriefing interviews with pediatric populations while potentially also improving the experience for participants. Broader implementation across drug development programs may enhance the reliability of measurement, improve the quality of pediatric participant input, and promote more patient‑centered decision‑making.

Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation

Broderick L
O'Connor M
Brennan E
Bayliss M

Humans
Patient Reported Outcome Measures
Delphi Technique
Child
Quality of Life
Pediatrics
Cognition
Interviews as Topic
Psychometrics
Surveys and Questionnaires


Three-dimensional printing as a transformative platform for patient-centric pediatric drug delivery: technologies, formulation strategies and clinical translation

Abstract: Pediatric patients require age-appropriate dosage forms because developmental differences in physiology, pharmacokinetics and swallowing ability can significantly affect therapeutic outcomes. Conventional dosage forms are often unsuitable for children and practices such as tablet splitting, crushing or extemporaneous preparation may lead to dose inaccuracy, altered stability, poor palatability and reduced adherence. These limitations highlight the need for innovative formulation strategies that provide precise dosing while improving acceptability and therapeutic effectiveness. In this context, three-dimensional (3D) printing has emerged as a promising platform for personalized pediatric drug delivery. This review critically examines recent advances in 3D printing technologies for pediatric drug delivery and provides a formulation-focused and translational perspective by integrating pediatric therapeutic needs with technology selection, polymer considerations and dosage form design flexibility. A comprehensive literature review was conducted to evaluate recent developments in pediatric pharmaceutical applications of 3D printing. Major technologies including fused deposition modeling, semi-solid extrusion, binder jet printing and inkjet printing were assessed with respect to formulation design, polymer selection, drug-polymer compatibility and pediatric suitability. Particular emphasis was placed on taste-masking approaches, personalized dosing capability and dosage adaptability for different pediatric age groups. Three-dimensional printing enables fabrication of diverse pediatric-friendly dosage forms including chewable gummies, mini-tablets, orodispersible films and confectionery-like formulations. Published studies demonstrated improved dose precision, effective taste masking, customizable drug release profiles and enhanced patient acceptability. Regulatory approval of Spritam further supports the clinical feasibility of this technology. However, challenges remain regarding printer calibration, reproducibility, limited pharmaceutical-grade printable materials, long-term stability and regulatory harmonization. Three-dimensional printing represents an important advancement in patient-centric pediatric pharmacotherapy by enabling precise control over dose, geometry, release kinetics and sensory attributes. This review highlights its practical potential and translational readiness for pediatric healthcare.

Daru : journal of Faculty of Pharmacy, Tehran University of Medical Sciences

Phadte P
Jeedigunta MK
Rao G
Chellampillai B

Printing, Three-Dimensional
Humans
Drug Delivery Systems
Child
Chemistry, Pharmaceutical
Polymers
Pediatrics
Pharmaceutical Preparations
Technology, Pharmaceutical
Taste
Dosage Forms


Core Competencies for Pediatric Disaster Medicine: An International Modified Delphi Study

Abstract: Children are disproportionately affected by disasters and represent a vulnerable population in such settings. However, no internationally recognized core competencies exist to guide health care providers in caring for children impacted by disasters (particularly non-pediatricians). This study aimed to establish consensus-based core competencies for pediatric disaster response through international expert agreement across disciplines. A three-round modified Delphi study was conducted following CREDES criteria, using competency statements generated via a comprehensive scoping review of pediatric disaster literature. International disaster medicine experts rated competency statements on a 7-point linear scale (1 = disagree, 7 = agree). Consensus was defined a priori as standard deviation (SD) ≤ 1.0. Data were collected and analyzed using the STAT59 online platform. 57 competencies met consensus criteria across three Delphi rounds, with mean scores ranging from 5.4 to 6.6. The highest-ranked competencies (mean = 6.6) were pediatric vulnerabilities recognition, pediatric transport management, child identification and tracking, and child-parent reunification. Decontamination initiation was also highly ranked (mean = 6.5). The 57 consensus-based core competencies for pediatric disaster medicine response, spanning 16 practice domains, provide a foundation to further develop standardized curricula, guide preparedness and response efforts, and define minimum training expectations for health care providers caring for children impacted by disasters.

Disaster medicine and public health preparedness

Grodman SZ
Hertelendy AJ
Issa F
Hart A
Woodward CA
Sarin R
Franc JM
Voskanyan A
Issa Y
Hertelendy A
Weiner D
Ciottone G

Humans
Delphi Technique
Pediatrics
Disaster Medicine
Clinical Competence
Child
Consensus
Female


Development of a Joint-Specialty Simulation-Based Workshop to Optimize Counseling at Extreme Prematurity

Abstract: Educational interventions addressing counseling at extreme prematurity to date have focused on single-specialty clinicians, overlooking the important communication and collaboration required by maternal-fetal medicine and neonatology for optimal counseling. This simulation-based workshop aimed to unite maternal-fetal and neonatology clinicians to enhance interspecialty-personalized and family-focused counseling at extreme prematurity. We developed and conducted 3 half-day virtual workshops with neonatology and maternal-fetal medicine attendings and fellows utilizing a combination of didactics, scenarios with simulated participants, and facilitated debriefs, including a cofacilitator with lived patient-family neonatal intensive care unit experience. A total of 26 clinicians participated in the 3 workshops. After the workshop, 92% of participants felt "more prepared" or "much more prepared" to have difficult conversations with families. Qualitative analysis of open-ended responses found key themes among participants, including increased adoption of parent-driven and personalized counseling approaches, enhanced interspecialty collaboration between maternal-fetal medicine and neonatology, and greater awareness of and efforts to mitigate bias in antenatal counseling. This novel workshop facilitated interspecialty collaboration between maternal-fetal medicine and neonatology when counseling at extreme prematurity and emphasized relational skills, personalized counseling, and bias mitigation techniques.

Sullivan A
Brown SD
Ward E
Williams D
Luff D
Duffy CR
Sage YH
Spiel M
Cummings C

Humans
Infant, Newborn
Neonatology
Counseling
Female
Education
Simulation Training
Infant, Extremely Premature
Qualitative Research


[Expert consensus on the clinical application and management of pediatric fecal microbiota transplantation (2026)]

Zhonghua er ke za zhi = Chinese journal of pediatrics

Subspecialty Group of Infectious Diseases, the Society of Pediatrics, Chinese Medical Association

Gut Microbiota Collaborative Group of the Chinese Society for Parenteral and Enteral Nutrition

Collaborative Group for Pediatric Gut Microbiota and Fecal Microbiota Transplantation of the Precision Medicine Committee, China Maternal and Child Health Association

Humans
Fecal Microbiota Transplantation
Child
Gastrointestinal Microbiome
China
Pediatrics


Clinical Research Capacity Building in Pediatric Oncology in Resource-Limited Settings: Application and Early Results of Regional Educational Workshops

Abstract: The global need for training in clinical research is substantial, particularly in resource-limited settings. We describe an international collaboration to build capacity in clinical research skills through a semi-personalized curriculum. Five sequential workshops (2020-2025) combined online modules with on-site, project-based learning. The curriculum across workshops included research project planning, proposal writing, and manuscript publishing. Topics included fundamentals of clinical study design, data registries, statistical considerations, research ethics, and scientific writing. At registration, applicants submitted an abstract for further development. An average of 35 applicants per workshop were selected. Participants' experiences were evaluated through postworkshop surveys. Participants across the workshops presented from 17 countries and seven disciplines, with the majority being physicians (66%) and nurses (16%). During each 2.5-day workshop, participants refined their abstracts with structured guidance and shared their work in a 10-minute presentation. Workshop 1 used a group-based model where each group developed one common abstract. Workshop 2 focused on quality improvement research; each group worked on preselected mock concepts through a structured learning exercise. Workshops 3 and 4 involved individualized learning, with each participant developing their own abstract into a study proposal. Workshop 5 focused on scientific writing, guiding participants to develop their abstracts into a manuscript outline. Surveys after each workshop consistently demonstrated a high level of satisfaction and perceived gain in knowledge and skill. These workshops effectively engaged trainees with various levels of clinical research training and imparted skills for research planning and manuscript writing. Future iterations will include thematic workshops including advanced statistical methods. Combining asynchronous learning modules with on-site, project-based training can be implemented across other regions and specialties in context-relevant settings.

Saab R
Nasr R
Sidhom I
Belgaumi A
Devidas M
Naidu P
Saha V
Sultan I
Friedrich P
Fanous M
Ghamloush F
Gulten G
Rodriguez-Galindo C
Jeha S
Santana VM

Humans
Capacity Building
Resource-Limited Settings
Biomedical Research
Medical Oncology
Pediatrics
Education
Curriculum


Partnering With Caregivers and Clinicians to Determine Research Priorities in Pediatric Migrant Health

Abstract: Pediatric migrant health has been identified by the World Health Organization as a critical area for interdisciplinary research to improve care for children and adolescents with migration experience. Nevertheless, research agendas have rarely been shaped systematically by individuals with lived and professional experience, limiting relevance and impact. To identify and prioritize the most important unanswered research questions in pediatric migrant health in Europe through a structured, participatory priority-setting process. This multiphase survey study (April 2024 to June 2025), led by migrants and clinicians using the James Lind Alliance participatory priority-setting methodology, comprised 2 online consultations informed by Delphi procedures and a final in-person consensus workshop using a modified nominal group technique. Participants residing in multiple European countries included migrant caregivers, former migrant children and adolescents, health care workers in pediatric migrant health, and double experts with combined lived and professional experience. They were recruited via professional networks, community organizations, and open calls. The final in-person consensus workshop convened in Basel, Switzerland, in June 2025. The primary outcome was a ranked list of the top 10 unanswered research priorities in pediatric migrant health based on participant-generated questions and consensus methods. In consultation 1, 256 participants (156 [61.0%] with lived migration experience; 25 countries of residence, 41 countries of origin; 115 aged <35 years [44.9%], 138 aged ≥35 years [53.9%]; 158 female [61.7%]) submitted 1589 questions and comments, which were consolidated into 53 unanswered summary questions after qualitative content analysis and evidence checking. In consultation 2, rankings from 576 participants (214 [37.2%] with lived migration experience; 31 countries of residence, 50 countries of origin; 193 aged ≤35 years [33.5%], 364 aged ≥35 years [63.2%]; 412 female [71.5%]) yielded a short list of 25 questions. During the final consensus workshop, participants selected the top 10 research priorities. The 3 highest ranked priorities focused on universal access to health care, the health impact of racism and discrimination, and barriers to accessing care. Remaining priorities addressed health effects of migration, social determinants of health, needs of at-risk groups (including unaccompanied or undocumented minors and children with medical complexities), professional language support, training of health care workers, and family involvement in care. The research priorities identified in this survey study could provide a roadmap for future multidisciplinary and participatory research to improve health equity for pediatric migrants in Europe.

Refugees and Migrants in Europe–Adolescent and Child Health (REACH) Network

Humans
Transients and Migrants
Female
Child
Male
Adolescent
Europe
Caregivers
Health Priorities
Adult
Research
Surveys and Questionnaires
Pediatrics


Prev-Sepse Pediátrica: content validation of a digital serious game on pediatric sepsis

Abstract: to validate the content of a digital serious game on pediatric sepsis. methodological content validation study conducted in two rounds with expert judges (nurses and physicians). In the first round, the expert panel evaluated all screens of the initial prototype. After adjustments, the second version of the game underwent content validation using the Health Educational Content Validation Instrument (IVCES), and the agreement rate and Content Validity Index (CVI) were calculated. in the first round, 11 judges evaluated the game and made suggestions, all of which were incorporated. The second round involved nine judges. The overall agreement rate for the prototype items was 100%, and the overall CVI was 0.99. the game was modified according to the judges' feedback, and its content was validated for use as a tool for teaching and learning about pediatric sepsis.

Humans
Sepsis
Pediatrics
Video Games
Child
Reproducibility of Results


Assessment of Pediatric Residents in the United States by Sex, Ethnoracial and Intersectional Group

Abstract: Inequitable assessments in medical education disproportionately affect historically marginalized trainees and undermine development of a diverse physician workforce. With programs around the world incorporating competency-based medical education (CBME), understanding whether assessment disparities exist in specialty-specific competency frameworks is critical. This study examined disparities in program-reported performance assessments of pediatric residents across demographic groups in two pediatric-specific competency frameworks: the General Pediatrics Entrustable Professional Activities (EPAs) and Accreditation Council for Graduate Medical Education (ACGME) pediatric milestones. This prospective cohort study was conducted at 15 pediatric residency programs in the U.S. across the 2021-22, 2022-23, and 2023-24 academic years. Clinical Competency Committee-assigned entrustment-supervision levels for 5 EPAs and all milestone levels were collected twice yearly. Residents self-reported ethnoracial group and sex, analyzed as exposure to systems of racism and sexism. Time-to-event analysis and growth curve modeling with intersectional analytic approaches examined disparities across demographic groups. 475 of 803 (59%) residents completed demographic surveys, including 17.3% underrepresented in medicine (URiM), 22.9% Asian, 56.4% white, 70.7% female, and 27.8% male. Time-to-event analyses revealed significant differences for Asian and Asian female residents in reaching the highest EPA supervision level across all EPAs. Growth curve analyses showed Asian males had significantly flatter growth trajectories for EPA 15 (Lead an Interprofessional Team), resulting in lower estimated scores at graduation. URiM female residents had significantly lower scores on EPA 16 (Facilitate Handovers) at graduation. URiM residents showed lower Milestone growth curves for interpersonal communication, and Asian residents for systems-based practice. Subtle but meaningful disparities exist in program-reported assessments of pediatric residents, with distinct patterns affecting Asian and URiM residents across both frameworks. These findings highlight the need for proactive attention to equity in competency-based medical education assessment systems.

Anderson HLK
West DC
Schwartz AJ
Lockwood L
Rassbach CE
Winn AS
Michelson CD
Kinnear B
Chen JG
Martini A
Turner DA
Schumacher DJ

Humans
Internship and Residency
United States
Pediatrics
Prospective Studies
Female
Male
Clinical Competence
Educational Measurement
Sex Factors
Surveys and Questionnaires
Adult


Randomized single-blind study to examine the implementation and effectiveness of integrating evidence-based early relational health programs in pediatrics for families with low incomes: A clinical trial protocol

Abstract: Disparities in early childhood development due to poverty are linked to lifelong gaps in health and well-being. To address such disparities, interventions must not only include the prevention of toxic stress, but also the promotion of early relational health-that is the presence of safe, stable, nurturing relationships between young children and their caregivers. Moreover, a public health approach that integrates multiple programs in order to meet the unique needs and build on the varied resources of individual families is needed to effect population-level change. This randomized controlled trial seeks to examine the implementation and effectiveness of combining two evidence-based interventions, HealthySteps and PlayReadVIP. A total of 355 parent-child dyads, 35 in the implementation phase and 320 in the effectiveness phase, will be randomly assigned to receive HealthySteps+PlayReadVIP or traditional HealthySteps, as an active Control. Families will receive the intervention at each pediatric well-child visit from birth to age 2 and will complete assessments at enrollment and child age 12 and 24 months. In addition, up to ten HealthySteps Specialists and other care providers will be enrolled and will complete surveys at each assessment point. The primary outcomes include positive parent-child relationship, parent cognitive stimulation, and child socioemotional development.

Humans
Poverty
Infant
Child, Preschool
Single-Blind Method
Female
Child Development
Male
Infant, Newborn
Parent-Child Relations
Pediatrics

Journal Article
Randomized Controlled Trial


"From Exhaustion to Invigoration": a mixed-methods study exploring the role of a community in supporting resilience of pediatric education leaders

Abstract: It is critical to identify factors in the work environment that contribute to physician burnout to foster a professional culture that nurtures wellness. This study examined the prevalence of burnout symptoms among a group of Canadian pediatric undergraduate education leaders and explored how membership in a national community (Paediatric Undergraduate Program Directors of Canada, PUPDOC) may serve as a potential mitigating factor. This mixed-methods study involved a survey and subsequent focus groups of PUPDOC members. Survey comprised questions from the Maslach burnout index (MBI) adapted for the educational context. Data were analyzed using descriptive statistics. A qualitative descriptive approach was selected and focus group transcripts were analyzed using content analysis. Themes were generated that relate to PUPDOC's role in shaping members' educational and academic work. Sixteen members completed the survey (16/23, 70%). On the traditional MBI screen, three of 16 participants scored high-risk for burnout, but none reported high levels of symptoms on the adapted questions. Eighteen members participated in focus groups. Themes were interrelated, and included the significance of a sense of community, strengths and stressors of the job, finding meaning in one's work, opportunities, and legitimacy associated with belonging to a group. Our small group of pediatric undergraduate education leaders demonstrated a relatively low burnout rate compared to published rates in physician colleagues. We propose a sense of community that transcends institutions may help to mitigate burnout. By encouraging membership in such organizations, academic institutional leadership can support resilience and invest in the wellbeing of their education leaders.

Punnett AS
Forbes KL
Bannister SL
Weiler G
Mickleborough T

Humans
Burnout, Professional
Resilience, Psychological
Focus Groups
Leadership
Canada
Pediatrics
Female
Male
Academia
Surveys and Questionnaires
Education, Medical, Undergraduate


Accelerating Pediatric Oncology Drug Development: Advances in Clinical Pharmacology, Trial Design, Non-Clinical Evidence, and Regulatory Science

Abstract: Pediatric oncology drug development remains uniquely challenging due to the rarity and biological heterogeneity of childhood cancers, ethical considerations in trial conduct, and the limited feasibility of large, randomized studies. Despite these barriers, recent years have seen a notable acceleration in the approval of oncology therapies for pediatric populations, driven by advances in molecularly targeted treatments, evolving regulatory requirements, and innovation in trial design. Reducing nonclinical data requirements and increasing the adaptation of model‑informed drug development approaches are also contributing to advances in pediatric oncology treatment by supporting dose selection, optimizing study design, and reducing unnecessary patient burden. In this review, recent regulatory requirements from the United States, the EU, and other key regions on pediatric oncology drug development are discussed. Thirty-three drugs with oncology indications in pediatric populations approved by the US FDA between 2018 and 2025 are reviewed. These approvals provide examples of how nonclinical and clinical data were generated with a focus on strategies for dose-finding and justification. Common challenges and considerations related to clinical operations and formulation development in pediatric populations and the emerging use of real-world data, external controls, and artificial intelligence/machine learning are also discussed.

Wen YF
Wang X
Boyanapalli S
Anderson L
Dang T
Xing G
Calvet M
Hart T
Kasichayanula S
Zhao X

United States Food and Drug Administration


Global trends and career development of human resources for paediatrics: a systematic review

Abstract: The paediatric workforce plays a central role in health systems worldwide. National reports and studies have described its size and structure, as well as the retention of staff within the paediatric workforce. However, there have been few syntheses of empirical evidence examining workforce trends across career stages, and none have focused specifically on paediatric staff. We aimed to systematically synthesise evidence on the global trends of the availability, distribution, career progression, and differences across career stages among the paediatric workforce. We searched CENTRAL, Embase, MEDLINE, and Scopus between 1 and 20 November 2025 for primary studies reporting on the above-mentioned trends within the paediatric workforce. We extracted and narratively synthesised the related data, and assessed the risk of bias of included studies using Joanna Briggs Institute tools. We included 35 studies from high-income and upper-middle-income countries, with no low- or lower-middle-income countries being eligible. Workforce supply increased steadily over time in high-income countries, driven largely by subspecialty growth. However, geographic imbalances persisted, with low representation of paediatric staff in rural areas. In terms of career stage, early-career paediatricians reported higher workload burden, dissatisfaction, and career uncertainty compared with their senior counterparts. Women progressively came to account for most of the workforce, although men continued to predominate in leadership positions. Evidence from upper-middle-income countries focused primarily on training preparedness and early-career experiences. Despite growth in the size of the paediatric workforce in high-income countries, challenges related to distribution, retention, and equity persist, particularly during early career stages. Importantly, the evidence base on this topic heavily underrepresents low- and lower-income countries. Future research should prioritise career-stage specific data to support equitable global workforce planning. PROSPERO: CRD420261283831.

Humans
Pediatrics
Health Workforce
Career Mobility
Developing Countries
Developed Countries
Global Health
Staff Development


Enhancing organizational health literacy through pediatric clinical training: Mini-CEX-based formative assessment in case-based learning for pediatric pneumonia-a perspective

Abstract: Organizational health literacy (OHL) remains a critical yet underexplored dimension of health equity, particularly at the interface between clinical training and patient care. This article proposes a conceptual reframing of the Mini-Clinical Evaluation Exercise (Mini-CEX) as an OHL-oriented formative assessment tool within case-based learning for pediatric pneumonia. The OHL-Mini-CEX model integrates three assessment domains-teach-back evaluation, de-jargonization capacity, and empowering guidance-to systematically evaluate residents' communicative competence in addressing health literacy barriers. We delineate the mechanisms through which this instrument operates: embedding equity-conflict scenarios into teaching cases, generating bidirectional formative feedback for both clinicians and organizations, and constructing a closed loop from micro-level training to macro-level health equity outcomes. Implementation challenges, including faculty preparedness gaps and psychometric rigor, are examined alongside integrated strategies drawing on public health collaboration. This perspective advances a theoretically grounded and practically actionable pathway for transforming clinical education into an institutional driver of health equity.

Humans
Health Literacy
Pneumonia
Pediatrics
Problem-Based Learning
Educational Measurement
Child


Formative perception of 4th and 5th year Pediatric Surgery residents in Spain

Abstract: To evaluate the perception of autonomy and the main formative strengths and weaknesses of fourth-year (R4) and fifth-year (R5) Pediatric Surgery residents (MIR) in Spain, in order to identify areas for improvement in their surgical and clinical training. A descriptive cross-sectional study was conducted using an anonymous survey distributed via Google Forms during the last quarter of 2023. The questionnaire included 8 questions on demographic data, surgical activity, outpatient clinics, and training suggestions. The results underwent a descriptive statistical analysis. Eighteen residents participated (11 women and 7 men), with a mean age of 29.6 years; 61% were MIR-5 and 39% MIR-4. R4s perceived greater autonomy in frequent procedures (open orchidopexy, inguinal herniorrhaphy, appendectomy, and upper gastrointestinal endoscopy) and less in neonatal surgery and urological pathology. R5s reported greater independence in common general surgery and less in esophageal atresia, diaphragmatic hernia, pyeloplasty, and nephrectomy. In outpatient clinics, autonomy was greater in abdominal and skin pathology, and lower in urology and head and neck pathology. Among the main limitations noted were the low volume of neonatal surgery, the high number of residents, and the scarce offer of structured training activities. The lower perceived autonomy is concentrated in neonatal surgery and complex urological pathology. Coordinated training strategies are required at the national level, including surgical simulation, structured online training, and rotations in reference centers, to optimize the acquisition of competencies and ensure that training is as complete as possible.

Cirugia pediatrica : organo oficial de la Sociedad Espanola de Cirugia Pediatrica

Comajuncosas Pérez E
Moreno-Alfonso JC
Molina Caballero AY
Pérez Martínez A

Humans
Cross-Sectional Studies
Spain
Female
Internship and Residency
Male
Pediatrics
Surveys and Questionnaires
Adult
Clinical Competence
Professional Autonomy


Knowledge and level of implementation of "Do Not Do" recommendations in Spanish pediatric surgery departments

Abstract: In recent decades, initiatives have been developed to promote the de-implementation of low-value practices through "do not do" recommendations (RNH). This study aimed to estimate the level of awareness and the state of implementation of representative RNH in Pediatric Surgery Departments within the Spanish National Health System (SNS), as the initial phase of the NOCIPE project, endorsed by the Spanish Society of Pediatric Surgery (SECP). Observational, descriptive, cross-sectional study using a self-administered survey addressed to the heads of Pediatric Surgery departments within the SNS. Descriptive analysis and non-parametric comparisons for independent samples were performed. A total of 16/37 (43%) responses were obtained. Among respondent centers, 9 (56.2%) reported having a clinical practice appropriateness entity, and 5 (31.2%) included RNH in management agreements. The median number of RNH assessed per center was 6.5/8 known (81%; IQR 3), 5/8 implemented (62%; IQR 4), and 1/8 measured (12%; IQR 1). No significant differences were observed in the number of implemented RNH according to the presence of an appropriateness entity or inclusion in management agreements. Nine additional RNH were collected and used as a complementary source in subsequent phases of the project. The findings reveal a significant gap between awareness, implementation, and particularly the measurement of RNH, highlighting the need to strengthen dissemination strategies, facilitate implementation, and standardize indicators and tools to assess their impact and guide comparable improvements across centers.

Cross-Sectional Studies
Spain
Humans
Pediatrics
Surgery Department, Hospital
Guideline Adherence
Low-Value Care
Surveys and Questionnaires
Health Knowledge, Attitudes, Practice


Applications of nuclear magnetic resonance spectroscopy in pediatric clinical metabolomics: From research to future perspectives

Abstract: Metabolomics studies small-molecule metabolites to provide insights into health and disease, supporting early diagnosis and personalized medicine. Advances in mass spectrometry and nuclear magnetic resonance (NMR) have expanded its use in metabolic, cancer, and cardiovascular diseases. In pediatrics, high-resolution NMR metabolomics has been instrumental in identifying age-related metabolic changes during early childhood and their associations with growth, nutrition, and disease risk. However, a comprehensive review of its clinical applications and future potential remains limited. This review highlights how utilizing specific NMR pulse sequences, such as CPMG and NOESY, allows for precise and non-destructive metabolic profiling of diverse biofluids, supported by minimal sample preparation and high-throughput automated analysis. Data processing tools like NMRProcFlow and MetaboAnalyst facilitate spectral preprocessing, statistical analysis, and biological interpretation, streamlining metabolomics workflows. Clinically, NMR-based metabolomics has elucidated metabolic alterations in pediatric growth, prematurity, nutrition-related sensitizations, allergic diseases, lipid metabolism, infectious conditions, and neurobehavioral disorders. In particular, metabolomics has been applied to identify specific metabolic signatures underlying the molecular mechanisms of childhood allergic asthma. Despite limitations in detecting low-abundance metabolites, NMR's ability to preserve sample integrity and integrate multi-omics data, especially gut microbiota-derived metabolites, shows great promise in advancing precision pediatric medicine, early disease screening, and personalized therapeutic strategies.

Kuo CN
Chiang MH
Lee HJ
Yu YY
Shen EY
Chiu CY

Humans
Metabolomics
Magnetic Resonance Spectroscopy
Child
Pediatrics


Climate Stewardship in the Clinical Setting

Abstract: Pediatric clinicians have the potential to exert a large influence on health care sustainability for children and families as part of broader system transformation to promote sustainable practices. As a significant contributor to global greenhouse gas emissions, health care systems and providers have a responsibility to reduce emissions that negatively affect children's health. All pediatric clinicians should understand ways that we can mitigate health care impacts on our environment and should actively contribute to solutions in everyday practice through conversations with patients, trainees, and colleagues; and advocacy for institution-level, system-level, community-level, and global-level change.

Humans
Climate Change
Child
Environmental Health
Pediatrics


A Centralized Text Message Recall for Pediatric Influenza Vaccination, New York City, 2017

Abstract: Influenza vaccination coverage is suboptimal nationwide. To evaluate the effectiveness of centralized text message recall for influenza vaccination among children conducted by the New York City Department of Health and Mental Hygiene. A randomized assignment of 149 860 children, split between the intervention and control groups. Pediatric patients drawn from the Citywide Immunization Registry in New York City. Children aged 15 months to 18 years who did not receive an influenza vaccine in the 2016-2017 season and as of the study date in the 2017-2018 season. The Citywide Immunization Registry sent a generic Short Message Service (SMS) text message to the parents or guardians of the children: "The Health Department recommends that your child/children receive an annual flu shot. Call your doctor today!" Risk ratios of the proportions of children who received an influenza vaccine in the intervention and control groups within 28 days after the text message was sent. On October 25-26, 2017, 74 553 parents or guardians were sent a text message and 74 526 served as the control group. Of text messages sent, 73% were delivered successfully. Within 28 days of the intervention, 4.7% of children aged 15 months to 4 years in the text message group received an influenza vaccine compared with 4.3% in the control group, a statistically significant 9.5% relative increase in vaccination uptake (RR: 1.095, 95% CI: 1.001-1.199). Centralized text messages had a small positive effect on influenza vaccination among younger children. This approach may contribute to improving influenza vaccination in the pediatric population.

Journal of public health management and practice : JPHMP

Cheng I
Papadouka V
Ternier A
Langdon-Embry M
Daskalakis DC
Zucker JR

Humans
Text Messaging
New York City
Child, Preschool
Influenza Vaccines
Infant
Child
Influenza, Human
Female
Reminder Systems
Vaccination
Male
Adolescent
Pediatrics


Development and Usability Evaluation of an E-Learning Tool for Blended Learning in Pediatric Endocrinology: Formative Pilot Study

Abstract: Residents in pediatric endocrinology subspecialty units encounter diverse educational scenarios spanning theory, skills, and attitudes; yet, brief residencies frequently limit their exposure to certain clinical cases. Research in medical education demonstrates that e-learning can address such challenges efficiently. We implemented a blended learning model grounded in the Kolb learning cycle that uses structured, case-based e-learning. We aimed to evaluate the utility and usability of blended learning using a novel e-learning tool. We used a problem-solving approach and used the physical separation of case-based e-learning (interactive, patient scenario-based online modules) and theoretical content delivery as the educational model for residents in a pediatric endocrinology and diabetology unit. Residents worked asynchronously (on their own time, not simultaneously with others) on clinical scenarios and completed formative assessments (practice tests designed to provide feedback for learning rather than grades) with immediate feedback using a flipped classroom teaching method, in which students review material before group instruction. In addition, all cases could be discussed with specialists during face-to-face learning opportunities through a blended learning approach that combines online and in-person elements. We evaluated Kirkpatrick level 1 (reaction, how participants respond to training) and level 2 (learning, measured as an increase in knowledge or capability) outcomes using the postgraduate Medical E-learning Evaluation Survey (MEES) and the User Experience Questionnaire (UEQ), which assesses users' perceptions of e-learning platforms. Questionnaires from 12 pediatric residents and 1 questionnaire from a fourth-year medical student were evaluated. The main strengths identified were the tool's support for applying content to daily clinical work (12/13, 92% users), provision of timely summaries (n=9, 69% users), access to reliable information sources (n=9, 69% users), and immediate feedback on responses (n=8, 62% users). Key weaknesses included device compatibility for e-learning (n=5, 38% users), limited content personalization (n=4, 31% users), and a lack of a navigation aid (n=4, 31% users). No significant functional issues were reported. The UEQ evaluation showed that dependability received the lowest rating, while attractiveness and stimulation received the highest rating. Our e-learning proposal provides a practical way to apply theoretical knowledge through interactive clinical cases. Evaluations show that users are highly motivated to engage with e-learning, highlighting our tool's adaptability and effectiveness for postgraduate medical education in pediatric endocrinology. Identifying strengths and weaknesses will guide future improvements. Evaluating various aspects of e-learning remains crucial, as these aspects can affect learning outcomes. However, more longitudinal evaluations of e-learning are necessary to achieve a comprehensive understanding of its effectiveness.

Hrasnica F
Pitteloud S
Jacot J
Antoniou MC
Ruiz-Arana IL
Bouthors T
Busiah K
Stoppa-Vaucher S
Hauschild M

Humans
Pilot Projects
Endocrinology
Pediatrics
Internship and Residency
Computer-Assisted Instruction
Education, Distance
Male
Educational Measurement
Female


Building the Foundations for Trustworthy AI in Pediatrics

Abstract: Artificial intelligence (AI) adoption in health care is rapidly accelerating, with pediatrics positioned to benefit from improvements in quality, efficiency, and access to care. Recent frameworks have articulated ethical commitments for trustworthy AI in pediatrics, but less attention has been paid to the foundational infrastructure required to achieve them. In this article, we examine the challenges that emerge at the intersection of AI and pediatrics: unique challenges that AI poses for pediatric care, including nonintuitive errors, impacts on clinician cognition, and new infrastructure requirements; and unique challenges that pediatrics poses for AI, including adequate training data, accommodation of developmental heterogeneity, and navigation of evolving patient autonomy. We then outline the data systems, governance structures, validation frameworks, and public trust infrastructure that must be established before the field can meet these challenges. We conclude with concrete recommendations for clinicians, caregivers, health care systems, government, technologists, and academic institutions seeking to lay the foundation for trustworthy and beneficial AI in pediatrics.

Finlayson SG
Wightman A
Weiss EM
Gallo V
Rabbani N
Diekema DS
Sarabu C
Võ HH
MacDuffie KE
Mazwi ML
Lin YC
Opel DJ

Humans
Pediatrics
Artificial Intelligence
Child
Trust


Medical Child Abuse Module in the Child Abuse Pediatrics Curriculum for Physicians (CAP-CuP)

Abstract: Medical child abuse is an underrecognized and undertaught condition with potentially fatal consequences. Clinicians must learn to recognize and manage harmful overmedicalization of children. We developed a 2-part interactive workshop on medical child abuse for pediatric clinicians. We evaluated part 1, an interactive high-yield lecture, using a pre- and postmodule assessment of self-rated confidence and knowledge in 1 resident conference and 3 multidisciplinary grand rounds settings across 2 institutions. We evaluated part 2, a popcorn-style role-play, with an additional postmodule confidence assessment at 2 resident conferences. We excluded duplicate participants. Part 1 duration was 45 minutes and part 2 was 60 minutes. We summarized results using descriptive statistics and analyzed paired data using paired t tests for knowledge (mean ± SD), and Wilcoxon signed-rank tests for confidence (median and interquartile range [IQR]). A total of 203 and 36 unique participants participated in part 1 and part 2, respectively. Participant confidence in recognizing and managing medical child abuse increased from a median of 5 (IQR 4-6; n = 124) to 7 (IQR 6-8) after part 1 (P < .001). Among participants completing part 2 (n = 20), confidence increased further to 8 (IQR 8-9; P <.001). Knowledge scores increased from 66% (SD = 29%) premodule to 88% (SD = 20%) postmodule (n = 119; P < .001). This interactive 2-part workshop was adaptable across clinical audiences and settings and improved confidence and knowledge in recognition and management of medical child abuse.

Humans
Child Abuse
Curriculum
Pediatrics
Child
Clinical Competence
Physicians
Internship and Residency


Pediatric disaster preparedness and health disparities: Gaps, future goals, and recommendations

Abstract: The healthcare disparity focus group within the Western Regional Alliance for Pediatric Emergency Management aimed to identify barriers to optimal care for children affected by disasters and potential opportunities for improvement. The study was conducted in six focus groups during the summer of 2023. A survey was distributed to individuals in emergency management and disaster medicine to collect demographic data. The survey also assessed the total number of trainings that participants attended. The focus group discussions were led by experienced qualitative researchers. Participants could also respond to the questions during the meetings on a digital note-taking platform. These discussions were then transcribed and analyzed using ATLAS.ti. The data from the survey were analyzed using SPSS, Windows Version 29.0. The survey included 49 people. The focus group meetings revealed multiple themes and subthemes that reflected the challenges that emergency management and disaster medicine professionals face when combating health disparities and raising awareness for pediatric populations. The challenges that these professionals face include funding, communication, gaps in knowledge, gaps in technology, and a lack of emergency preparedness plans. The focus groups also highlighted facilitators to preparedness, team cohesion, engagement, and the presence of certain grants to help with funding as ways to combat health disparities and raise awareness for pediatric populations during emergencies. The results of the focus groups can effectively be utilized to assess the challenges emergency management and disaster medicine professionals experience. The results highlight the need to prioritize funding, communication, and addressing gaps in knowledge, gaps in technology, and a lack of emergency preparedness plans. The results can be used to explore different approaches to improve health disparities through awareness initiatives as a forefront priority for pediatric populations.

Hicks CD
Hasson C
Bhatt S
Chiari-Keith L
Newton C
Burke RV

Humans
Focus Groups
Disaster Planning
Pediatrics
Healthcare Disparities
Child
Female
Surveys and Questionnaires
Male


Reducing Low Value Care Through Implementation of a Clinical Decision Support Tool Addressing Urine Culture in a Paediatric Emergency Department

Abstract: An interruptive alert as a clinical decision support tool has been implemented to reduce the ordering of unnecessary urine cultures in a tertiary paediatric emergency department. Following its introduction, there was an immediate and sustained reduction in urine culture ordering rates of 25%, with a small increase in cultures with pure growth over a twelve-month period.

Studies in health technology and informatics

Decision Support Systems, Clinical
Humans
Emergency Service, Hospital
Urinalysis
Unnecessary Procedures
Child
Pediatrics


Factors influencing workplace satisfaction and retention of paediatric and child health clinical officers in Malawi's public health sector: a mixed-methods study

Abstract: Malawi's paediatric and child health workforce faces a critical shortage. In response, the Kamuzu University of Health Sciences has been training clinical officers (29 to date) in a Bachelor of Science in Paediatric and Child Health (BSc PCH) program since 2012 to serve as paediatric and child health district leaders in mostly rural areas. However, little is known about their workplace reality, and how it affects their fulfilment professionally, and such information may have policy implications. Therefore, we aimed to investigate Malawian BSc PCH clinical officers' workplace satisfaction, retention and influencing factors. In a mixed-methods, sequential, explanatory design study, we used a quantitative workplace satisfaction survey (five-point Likert scale) covering 11 dimensions, and qualitative in-depth interviews. Analysis included paired t-tests applied to Herzberg's two-factor theory of individual needs dimensions contributing to workplace satisfaction. During data collection in 2022, a total of 27 (93%) clinical officers participated in the survey, and 15 clinical officers and 14 key informants participated in in-depth interviews. BSc PCH clinical officers worked at public district hospitals (n=13), public central hospitals (n=8), and at non-governmental organisations (NGOs) (n=6). Moral satisfaction and workplace/team harmony dimensions scored highest with means of 3.94±0.50 and 3.85±0.69, respectively. In contrast, career advancement and salary and benefits scored lowest with 2.01±0.99 and 2.46±0.80, respectively. Differences existed between clinical officers at public district hospitals compared to public central hospitals for the dimensions of tasks (eg variety, job description clarity) (p=0.034), work environment (p=0.006), and salary and benefits (p=0.032). Similarly, clinical officers at public district hospitals vs NGOs differed for the work environment (p=0.016), management style (p=0.003), and salary and benefits (p=0.002). Seventeen clinical officers considered leaving their current position, with salary being a significant reason (p=0.048). Moreover, delayed recognition and promotion, non-specific job descriptions, limited professional development opportunities, a lack of supervision, and career advancement barriers obstructed workplace satisfaction, according to the in-depth interviews. BSc PCH clinical officers program graduates' workplace satisfaction differs according to the workplace. Graduates working in public hospitals at district level, located mostly in rural areas, appear to be most critically affected and may leave government services. Changes in their specific work environment, career and professional development and remuneration may offer stakeholders opportunities to improve BSc PCH clinical officers' workplace satisfaction and retain them where they are needed most.

Yasmin F
Moons P
Phiri A
Appelbaum S
Nserebo-Banda L
Krüger C
Weigel R
Chimalizeni YF

Humans
Job Satisfaction
Malawi
Male
Female
Workplace
Adult
Personnel Turnover
Working Conditions
Pediatrics
Attitude of Health Personnel
Salaries and Fringe Benefits
Surveys and Questionnaires


Pediatric Oncology Knowledge Mobilization in Canada: A Environmental Scan

Abstract: IntroductionNon-profit organizations play a key role in supporting knowledge dissemination activities. However, their contribution to these activities in-person and online in the pediatric oncology field remains unclear. Our study aims to provide an overview of the pediatric oncology charitable organizational landscape and describe their knowledge mobilization efforts related to dissemination, highlighting existing strengths, gaps, and opportunities to strengthen and unite efforts.MethodsA bilingual environmental scan was conducted using an internet-based search strategy to identify Canadian pediatric oncology non-profit organizations. Eligible organizations were screened, and data on their characteristics and knowledge dissemination strategies were extracted. Extracted data were analyzed descriptively and presented in tables, spatially, and narratively with figures.ResultsThe scan identified 906 results, and 25 organizations were eligible for inclusion in the study. Eleven organizations (44%) are based in Ontario. The decade where the highest number of organizations were founded is 2000-2009 (n = 9, 36%), offering primarily English-only content (n = 18, 72%). Only six (26.1%) provided bilingual resources. Among the knowledge dissemination strategies, digital knowledge dissemination activities were utilized often, with all organizations using websites and social media (particularly Facebook, n=25 (100%), and Instagram, n =24 (96%)).ConclusionThis study identified the current list and knowledge dissemination efforts of non-profit organizations in the pediatric oncology community in Canada but reveals gaps in bilingual content and in other major languages spoken in the country, geographic physical location, and centralized resources.

Inquiry : a journal of medical care organization, provision and financing

Foulem C
Drake EK
Lui A
Dias S
Damoulianos E
Reid S
Cossette P
Duval M
Efremov K
Foster J
Haas K
Tsimicalis A

Humans
Canada
Organizations, Nonprofit
Information Dissemination
Pediatrics
Medical Oncology
Child
Internet


Ambient AI scribe in pediatric outpatient visits: documentation burden, quality, and scale-up limits

Abstract: Artificial intelligence (AI) medical scribes are an emerging technology intended to reduce the documentation burden. In pediatrics, evidence on implementation in the Spanish context is very limited. To evaluate the implementation of an AI medical scribe in pediatric outpatient clinics, examining its effects on clinician-patient interaction, documentation quality, and barriers to adoption. Prospective observational proof-of-concept study (February-October 2025) conducted at a tertiary pediatric hospital. Forty physicians from three subspecialties participated, and 197 visits were documented. The evaluation combined direct observations (n = 30), surveys of clinicians (n = 18) and patients (n = 20), and a quality assessment using a rubric based on the mPDQI-9. With the AI scribe, eye contact increased (median 95.7% vs. 78.6%; p < 0.001), with no significant change in visit duration (25.7 vs. 21.9 min; p = 0.262). Documentation quality improved in accuracy/completeness (p = 0.008), organization/structure (p < 0.001), and overall score (median 23 vs. 17; p = 0.008). Documentation of information provided to the patient was more frequent (80% vs. 20%; p = 0.003). Post-visit review time accounted for 33%-38% of total time. Fifty-five percent of users reported being satisfied or very satisfied, although 67% reported technical issues and 33% reported requiring extensive corrections. Adoption was concentrated in fewer than one-third of trained clinicians. The AI medical scribe was associated with improvements in interaction and selected domains of documentation quality. However, technical barriers and limited adoption persisted and should be addressed before wider deployment.

Vallejo V
Farreras J
Valero L
González-Grado C
Peral I
Cano I
Launes C
Grupo de estudio LAIA-DOC

Humans
Prospective Studies
Documentation
Artificial Intelligence
Child
Pediatrics
Physician-Patient Relations
Male
Female
Electronic Health Records
Spain
Ambulatory Care


Caregiver and Care Recipient Perspectives on Paediatric ED Mental Health Presentations: A Qualitative Study

Abstract: To explore care recipients (patients' and their caregivers) and care providers (healthcare providers' and law enforcement officers') perspectives on paediatric mental health presentations to emergency departments, to identify challenges to care. Secondary qualitative analysis of free-text responses from a Delphi study conducted within the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network in 2022. The original Delphi process aimed to identify research themes and key data points for child and adolescent mental health ED presentations; however, a large number of additional free-text responses were received. The primary aim of this specific study was to identify major categories using the General Inductive Approach (GIA) of these free-text responses to explore the experiences, service delivery and perceived challenges of care recipients and care providers. Patients were recruited from 12 EDs across three Australian states, and pre-hospital services (two police and three ambulance departments) across four Australian states. A total of 184 participants provided responses (36 care recipients and 148 care providers). Three main categories are described: (1) care continuity and communication gaps, (2) challenges in the ED environment and (3) need for improved training and education and behavioural support. Care recipients and care providers identified challenges in service coordination, clinician readiness and the ED environment. Strengthening communication, expanding training, reducing sensory overload and improving privacy in physical EDs and improving links to community care could enhance patient experiences and outcomes.

Sufian M
Xu Y
John-White M
Muscara F
Babl FE
Anderson V
Wilson CL
Borland ML
Tonge BJ
Gray KM
Melvin GA
Kochar A
Borschmann R
Haslam R
Tavender E
Gordon MS
Dalziel S
Smith K
Craig S

Humans
Female
Qualitative Research
Caregivers
Child
Emergency Service, Hospital
Male
Australia
Adolescent
Delphi Technique
Mental Disorders
Pediatrics
Adult
Perception


System-Level Analysis of Japan's Pediatric-Perinatal Disaster Liaison Operations During the 2024 Noto Earthquake

Abstract: Children, neonates, and pregnant women are particularly vulnerable during disasters. Fragmentation between specialized pediatric-perinatal systems and general disaster response frameworks can hinder coordinated care. Following lessons from the 2011 Great East Japan Earthquake, Japan established the Disaster Liaison for Pediatric and Perinatal Medicine (DLPPM) to embed specialists within disaster command structures. However, large-scale activation under prolonged infrastructure disruption has not been systematically evaluated. We conducted a structured retrospective descriptive analysis of DLPPM operational records during the first month after the 2024 Noto Peninsula Earthquake. Activities were reviewed across five pre-specified domains to examine how the liaison framework functioned during the acute and subacute phases. DLPPM was integrated into the prefectural disaster headquarters and consolidated maternal-child health information, enabling centralized identification of 83 pregnant women, estimated to represent most pregnant women in the severely affected region. Twenty-one obstetric transfers were coordinated. Pediatric transfers and evacuation of medically dependent children were facilitated through established networks. During the subacute phase, DLPPM initiated maternal-child support measures, including a "Children's Conference" and a support website. These findings suggest that DLPPM functioned as a centralized coordination hub linking specialized clinical networks with disaster governance, although real-time identification of vulnerable families in shelters remained limited. Embedding pediatric and perinatal specialists within disaster headquarters can support structured medical coordination for vulnerable populations. Earlier and more systematic integration with public health and welfare systems is essential to extend this hub function beyond hospital-centered care.

Pediatrics international : official journal of the Japan Pediatric Society

Kagami K
Imai K
Ueno Y
Kitano H
Hirabuki S
Sasaki H
Sato H
Mitani Y
Iwasaki H
Wada T
Fujiwara H
Unno N

Humans
Earthquakes
Japan
Female
Retrospective Studies
Pregnancy
Infant, Newborn
Disaster Planning
Pediatrics
Perinatal Care
Child
Infant
Disasters


Physician Characteristics Associated With Choosing Pediatrics in Japan: A Nationwide Survey

Abstract: Identifying factors related to physicians' specialty choice is crucial to ensure a sustainable healthcare workforce. However, knowledge regarding the factors influencing the choice of pediatrics remains inadequate. This study aimed to clarify physicians' background characteristics associated with choosing pediatrics and factors associated with hospital-based practice among pediatricians in Japan. This cross-sectional study, comprising an online survey of eligible physicians (N = 6415), was conducted in June 2022 via the Nikkei Medical Online website. The primary outcome was the choice of pediatrics, whereas factors associated with hospital-based pediatricians were examined in a secondary analysis. Multivariate logistic regression analyses were used to assess the association between physician background characteristics and outcomes. Among 6415 physicians, 340 (5.3%) were pediatricians. Factors associated with choosing pediatrics included being female (adjusted odds ratio [aOR] 1.84, 95% CI 1.39-2.44), having children (aOR 1.71, 95% CI 1.27-2.29), and graduating from a public university (aOR 1.67, 95% CI 1.24-2.26). Analyses restricted to pediatricians demonstrated that willingness to work in rural areas (aOR 3.24, 95% CI 1.05-10.04) was positively associated with hospital-based practice, whereas age (per 1-year increase; aOR 0.93, 95% CI 0.90-0.95), an urban hometown (aOR 0.54, 95% CI 0.29-0.98), and having a physician father (aOR 0.40, 95% CI 0.19-0.83) were negatively associated. These findings indicate that pediatric healthcare workforces may be shaped by structural factors, such as educational environment, regional background, and family background, in addition to individual preferences.

Humans
Japan
Female
Cross-Sectional Studies
Career Choice
Pediatricians
Male
Pediatrics
Surveys and Questionnaires
Adult
Middle Aged


Caregiver-Reported Quality of Pediatric Primary Care Language Services

Abstract: Caregivers who use languages other than English (LOEs) experience health disparities. However, little is known about how spoken and written language services are experienced in pediatric primary care. The goal of this exploratory, cross-sectional study was to ask caregivers who use LOEs in health care about language services received during pediatric primary care visits. We conducted the study in 3 pediatric primary care clinics in Southwestern Pennsylvania. Caregivers labeled in the electronic health record as using an LOE were called within 2 weeks after a visit and completed an interpreter-assisted structured interview. Questions included receipt of spoken and written services during their most recent visit, satisfaction with language services, and recommendations to improve care. Interviews lasted 45 minutes, and interviewers captured answers via Qualtrics. Descriptive statistics and qualitative thematic analysis were used. One hundred twenty-four participants were interviewed; 13 who reported preferring English were excluded. The remaining 111 participants used 21 different languages for health care. Most participants reported receiving spoken language-concordant services (professional interpreter or bilingual clinicians) with the health care clinician (94/111, 85%), but fewer when scheduling (62/111, 56%), rooming (43/109, 39%), or with nursing needs (26/58, 45%). Less than one-fourth reported receiving language-concordant written materials such as questionnaires or pre-appointment reminders. Most reported "Excellent"-quality interpreters and bilingual health care clinicians. Participants reported high-quality communication with the health care clinician; however, fewer received language-concordant written materials or spoken services during other visit touchpoints. Future work should implement processes to ensure receipt of language services before, during, and after a visit.

Yu L
Migliori O
Schweiberger K
Kurs-Lasky M
Schoemer P
Heidenerich K
Lion KC
DeCamp LR
Ray K
Chaves-Gnecco D
Saladino J
Ragavan MI

Humans
Cross-Sectional Studies
Primary Health Care
Female
Male
Caregivers
Medical Interpreting
Communication Barriers
Child, Preschool
Child
Quality of Health Care
Pennsylvania
Pediatrics
Language
Infant


Evaluating the Scale-Up and Sustainability of the Paediatric ESCALATION System in Country Western Australia: A Multi-Methods Study

Abstract: To identify factors influencing implementation and integration of the paediatric ESCALATION system in country Western Australia. Health professionals (nurses and doctors) working in country Western Australia. A multi-methods study using an interpretive descriptive approach guided by the Practical Robust Implementation and Sustainability Model (PRISM) and Normalisation Process Theory (NPT). Data collection across six sites included patient chart audit, health professional survey and focus groups/interviews. Data were analysed descriptively (audit and survey) and thematically (focus groups/interviews). An audit of 94 patient charts showed 61.7% met escalation of care criteria, while 69.0% of cases were escalated per policy. Among 114 survey responses, findings indicated system integration, with 95.6% reporting ESCALATION was part of their role, 93.5% agreeing it supported early detection of clinical deterioration and 93.8% reporting ease of use. Fewer identified local champions (66.7%), had confidence in others' use of the system (61.1%), reported sufficient training (69.0%), or were aware of reports demonstrating system effectiveness (55.0%). Seventy-eight health professionals participated in focus groups/interviews. Three themes were interpreted through the PRISM and NPT frameworks: (i) Enhanced patient safety (intervention characteristics and participants' perspectives; coherence; cognitive participation), (ii) Strengthening clinical decision-making (implementation and sustainability infrastructure; cognitive participation; collective action), (iii) Monitoring and fidelity (implementation and sustainability infrastructure, external; collective action; reflexive monitoring). The paediatric ESCALATION system is embedded and valued, but sustaining fidelity through scale-up requires ongoing training, teamwork, confident communication and organisational support across regional, rural and remote WA health services.

Boyle E
Laird P
Leslie GD
Stokes S
Andrew J
Howard J
Robinson M
Harris T
Gill FJ

Humans
Western Australia
Focus Groups
Child
Pediatrics
Program Evaluation
Rural Health Services
Child Health Services