Do pediatric gastroenterology doctors address pediatric obesity?
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ABSTRACT:
SUBMITTER: Batra S
PROVIDER: S-EPMC5533254 | biostudies-other | 2017
REPOSITORIES: biostudies-other
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Project description:This document serves as an update of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) 2009 clinical guidelines for the diagnosis and management of gastroesophageal reflux disease (GERD) in infants and children and is intended to be applied in daily practice and as a basis for clinical trials. Eight clinical questions addressing diagnostic, therapeutic and prognostic topics were formulated. A systematic literature search was performed from October 1, 2008 (if the question was addressed by 2009 guidelines) or from inception to June 1, 2015 using Embase, MEDLINE, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Clinical Trials. The approach of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) was applied to define and prioritize outcomes. For therapeutic questions, the quality of evidence was also assessed using GRADE. Grading the quality of evidence for other questions was performed according to the Quality Assessment of Studies of Diagnostic Accuracy (QUADAS) and Quality in Prognostic Studies (QUIPS) tools. During a 3-day consensus meeting, all recommendations were discussed and finalized. In cases where no randomized controlled trials (RCT; therapeutic questions) or diagnostic accuracy studies were available to support the recommendations, expert opinion was used. The group members voted on each recommendation, using the nominal voting technique. With this approach, recommendations regarding evaluation and management of infants and children with GERD to standardize and improve quality of care were formulated. Additionally, 2 algorithms were developed, 1 for infants <12 months of age and the other for older infants and children.
| S-EPMC5958910 | biostudies-literature
Project description: Not available
| S-EPMC10249014 | biostudies-literature
Project description:Background and Aims: Non-anesthesiologist-administered propofol (NAAP) has been found to have an acceptable safety profile in adult endoscopy, but its use remains controversial and pediatric data is limited. Our aim was to examine the safety and efficacy of NAAP provided by pediatric hospitalists in pediatric endoscopy. Methods: We retrospectively reviewed 929 esophagogastroduodenoscopy (EGD), colonoscopy, and combined EGD/colonoscopy cases in children aged 5-20 years between April 2015 and December 2016 at a large children's hospital. We analyzed the data for adverse events in relation to demographics and anthropometrics, American Society of Anesthesiologists physical classification score, presence of a trainee, comorbid conditions, and procedure time. Results: A total of 929 cases were included of which 496 (53%) were completed with NAAP. Seventeen (3.4%) of NAAP cases had an adverse event including the following: 12 cases of hypoxia, 2 cardiac, and 3 gastrointestinal adverse events. General anesthesia cases had 62 (14.3%) adverse events including the following: 54 cases of hypoxia, 1 cardiac, 7 gastrointestinal, and 1 urologic adverse event. No adverse events in either group required major resuscitation. NAAP vs. general anesthesia had a lower overall adverse event rate (3.4 vs. 14.3%, p < 0.0004) and respiratory adverse event rate (2.4% vs. 12.5%, p < 0.0004). Overall, cardiac and gastrointestinal adverse event rates between the two groups were comparable. When accounting for all captured factors via logistic regression, both younger age (P < 0.001) and general anesthesia (P < 0.0001) remained risk factors for an adverse event. Conclusion: The overall adverse event rate of NAAP was low (3.4%) with none requiring major resuscitation or hospitalization. This is comparable to studies of NAAP in adult endoscopy and suggests that NAAP provided by pediatric hospitalists has an acceptable safety profile.
| S-EPMC7885908 | biostudies-literature
Project description:BackgroundThe COVID-19 pandemic has drastically changed healthcare systems and training around the world. The Training Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition sought to understand how COVID-19 has affected pediatric gastroenterology fellowship training.MethodsA 21 question survey was distributed to all 77 pediatric gastroenterology fellowship program directors (PDs) in the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition program director database via email on April 7. Responses collected through April 19, 2020 were analyzed using descriptive statistics.ResultsFifty-one of 77 (66%) PDs from the United States, Canada, and Mexico responded to the survey. Forty-six of 51 (90%) PDs reported that they were under a "stay-at-home" order for a median of 4 weeks at the time of the survey. Two of the 51 (4%) programs had fellows participating in outpatient telehealth before COVID-19 and 39 of 51 (76%) at the time of the survey. Fellows stopped participating in outpatient clinics in 22 of 51 (43%) programs and endoscopy in 26 of 51 (52%) programs. Changes to inpatient care included reduced fellow staffing, limiting who entered patient rooms, and rounding remotely. Fellows in 3 New York programs were deployed to adult medicine units. Didactics were moved to virtual conferences in 47 of 51 (94%) programs, and fellows used various online resources. Clinical research and, disproportionately, bench research were restricted.ConclusionsThis report provides early information of the impact of COVID-19 on pediatric fellowship training. Rapid adoption of telehealth and reduced clinical and research experiences were important changes. Survey information may spur communication and innovation to help educators adapt.
| S-EPMC7273936 | biostudies-literature
Project description:BackgroundObesity threatens to undo the improvements that have been made in life expectancy over the last two centuries. It disproportionately affects lower socioeconomic and ethnic minority groups and has become one of the most important global health challenges of the 21stcentury. Whilst obesity is not confined to city populations, cities are home to more than half of the world's population with concentrated groups at high risk of obesity. Cities have also long been the forefront of social and technological change that has led to our current obesogenic environment. The aim of this study was to systematically identify city-wide interventions to address obesity, from which recommendations for policy makers, health system leaders and political leaders in cities could be made.MethodsSystematic review, conducted according to PRISMA guidelines, examining Embase, Ovid Medline, Central, Scopus, Campbell Library, CINALH, Health Business Elite; Health Management Information Consortium (HMIC), PyschINFO and Prospero. No restrictions on article type, date range or geographic location were applied. Along with classic academic sources, books and policy white papers were sought and reviewed. Studies that described a city-wide intervention to reduce obesity were included, irrespective of study design or perceived methodological quality. Only studies in English language were included. The primary outcome indicators that were sought and extracted were: reduction in obesity, reduction in weight and/or reduction in BMI. Where a primary outcome indicator was not stated, any other secondary impact measure was identified and recorded. This manuscript represents thematic analysis of a sub-set of data from the Prospero study, registration number: CRD42020166210.FindingsOur search yielded 42,137 original citations of which 1614 met the inclusion criteria and 96 were coded as relating to obesity. The 96 citations, ranging in year of publication 1997 to 2019, were conducted in 36 cities, with 13 citations either not stating a city or covering multiple cities, across 5 continents. The highest proportion of publications were from North America (59 / 96) and in particular the USA (56/96) and New York City (23/96). Primary outcome indicators were only stated in one quarter of the identified studies (24/96). Overall, there was heterogeneity of study design, descriptive methodologies and publication types, with a majority being descriptive texts using qualitative instruments of assessment.InterpretationMulti-level and multi-component interventions, at the individual, community and city level, done in concert, are needed to address obesity. A composite of interventions that cities can utilise to address obesity is provided. These interventions will also be beneficial to the environment and make the case that personal health and planetary health are inextricably linked and should be considered as one.FundingNone.
| S-EPMC7910670 | biostudies-literature
Project description:ObjectiveThere is wide variation in the number and types of obesity policies enacted across states, and prior studies suggest that partisan factors may not fully explain this variation. In this exploratory analysis, we examined the association of a broad array of state-level factors with the number and types of obesity policies across states.DesignWe analyzed 32 predictor variables across 7 categories of state-level characteristics. We abstracted data from 1652 state obesity policies introduced during 2009-2014. We used multilevel regression models and principal component analysis to examine the association between state-level characteristics and policy outcomes.Main outcome measuresOur outcome measures included whether bills involved topics that were public health-oriented or business interest-oriented, whether bills were enacted into law, and the number of introduced bills and enacted laws per state.ResultsNumerous state-level characteristics were associated with obesity-related bill introduction and law enactment, and different state characteristics were associated with public health-oriented versus business interest-oriented policies. For example, state-level demographics, economic factors, policy environment, public programs, and the prevalence of obesity's downstream consequences were associated with the number of public health laws whereas obesity prevalence and policy environment were associated with the number of business interest laws.ConclusionsOur results support the hypothesis that a variety of factors contribute to a complex state obesity policymaking environment, highlighting the need for future research to disentangle these key predictors.
| S-EPMC7012724 | biostudies-literature
Project description:As a result of the 21st Century Cures Act, Pediatric Gastroenterology (Peds GI) patients and caregivers are receiving pathology reports directly on their online patient portal. This quality improvement project attempted to validate an educational handout about Peds GI pathology reports and identify areas for caregiver education.MethodsCaregivers (n = 59) of patients undergoing Peds GI procedures were surveyed about their knowledge of pathology reports. Caregivers' responses to each of 4 questions were assessed before and after reading an educational handout. These 4 questions questioned the contents and creators of pathology reports, the role of pathologists, and caregiver confidence in interpreting pathology reports.ResultsNearly one-third of caregivers did not know the role of pathologists before education, and one-fifth of caregivers did not know the contents of a pathology report. Caregivers with less than a college degree (n = 21, P = 0.0089), and caregivers of patients undergoing their first procedure (n = 27, P = 0.0022) showed a significant improvement in responses after the educational handout.ConclusionsEducational handouts can increase caregiver understanding of pathology reports, especially for those with lower education levels or those with children undergoing their first procedure.
| S-EPMC10158402 | biostudies-literature
Project description:ObjectivesPediatric gastroenterology is a clinical and research discipline principally developed over the past 50 years. Bibliometric methods provide quantitative analysis and identify research trends. Study aims were to characterize the growth and trends in pediatric gastroenterology clinical and translational research using citation analysis.MethodsUsing citations analysis software, a search strategy specific for pediatric gastroenterology was implemented for the years 1970 to 2017. The 50 most-cited research articles per decade were identified. These 250 articles were coded for topic and study attribute. Analysis included authors, affiliations, journals, countries, and funding sources.ResultsOverall average annual growth rate for pediatric gastroenterology publications was significantly higher than that for general pediatrics (51.7% vs 6.2%; P < 0.05). Among the top 250 cited articles, the distribution of study focus was epidemiology (43%), pathophysiology (18%), treatment (16%), diagnosis (8%), prevention (8%), and comorbidities of gastrointestinal diseases (7%).There were 38 different topics represented and there was a notable shift in topic focus over time. Cholestasis, biliary atresia, and total parenteral nutrition were common topics from 1970 to 1989 and obesity, nonalcoholic fatty liver disease, and eosinophilic esophagitis were common topics after 1990. Notably, 2.3% of the authors accounted for 30% of the top 250 articles.ConclusionsPediatric gastroenterology research has undergone rapid growth yielding advancements in the management of gastrointestinal conditions in children. The emergence of new diseases in need of better diagnostics and therapeutics led to a temporal shift in research focus. Further advancements will require multidisciplinary collaborations and continued funding for pediatric gastroenterology research.
| S-EPMC6203653 | biostudies-literature
Project description:The delivery of endoscopic care is changing rapidly in the era of Coronavirus Disease 2019 (COVID-19). The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) Endoscopy and Procedures Committee has formulated this statement to offer practical guidance to help standardize endoscopy services for pediatric patients with the aim of minimizing COVID-19 transmission to staff, patients, and caregivers and to conserve personal protective equipment (PPE) during this critical time. Appropriate use of PPE is essential to minimize transmission and preserve supply. Pediatric endoscopic procedures are considered at high risk for COVID-19 transmission. We recommend that all pediatric endoscopic procedures are done in a negative pressure room with all staff using proper airborne, contact, and droplet precautions regardless of patient risk stratification. This includes appropriate use of a filtering face-piece respirator (N95, N99, FFP2/3, or PAPR), double gloves, facial protection (full visor and/or face shield), full body water-resistant disposable gown, shoe covers and a hairnet. In deciding which endoscopic procedures should proceed, it is important to weigh the risks and benefits to optimize healthcare delivery and minimize risk. To inform these decisions, we propose a framework for stratifying procedures as emergent (procedures that need to PROCEEED), urgent (PAUSE, weigh the benefits and risks in deciding whether to proceed) and elective (POSTPONE procedures). This statement was based on emerging evidence and is meant as a guide. It is important that all endoscopy facilities where pediatric procedures are performed follow current recommendations from public health agencies within their jurisdiction regarding infection prevention and control of COVID-19.
| S-EPMC7273958 | biostudies-literature
Project description:Medical graduates' early career is known to be disorienting, and career decision-making is influenced by a complex set of factors. There is a strong association between rural background and rural undergraduate training and rural practice, and personal and family factors have been shown to influence workplace location, but the interaction between interest, training availability, and other work-relevant factors has not yet been fully explored. A qualitative study conducted by the Rural Clinical School of Western Australia (RCSWA) and WA Country Health Service (WACHS) explored factors influencing the decision to pursue rural work among junior doctors. Data collection and analysis was iterative. In total, 21 junior doctors were recruited to participate in semi-structured telephone interviews. Two main themes relating to the systems of influence on career decision-making emerged: (1) The importance of place and people, and (2) the broader context. We found that career decision-making among junior doctors is influenced by a complex web of factors operating at different levels. As Australia faces the challenge of developing a sustainable rural health workforce, developing innovative, flexible strategies that are responsive to the individual aspirations of its workforce whilst still meeting its healthcare service delivery needs will provide a way forward.
| S-EPMC7013936 | biostudies-literature